Text: S.Hrg. 114-242 — PENDING HEALTH CARE AND BENEFITS LEGISLATION
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[Senate Hearing 114-242]
[From the U.S. Government Publishing Office]
S. Hrg. 114-242
PENDING HEALTH CARE AND BENEFITS LEGISLATION
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED FOURTEENTH CONGRESS
OCTOBER 6, 2015
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COMMITTEE ON VETERANS' AFFAIRS
Johnny Isakson, Georgia, Chairman
Jerry Moran, Kansas Richard Blumenthal, Connecticut,
John Boozman, Arkansas Ranking Member
Dean Heller, Nevada Patty Murray, Washington
Bill Cassidy, Louisiana Bernard Sanders, (I) Vermont
Mike Rounds, South Dakota Sherrod Brown, Ohio
Thom Tillis, North Carolina Jon Tester, Montana
Dan Sullivan, Alaska Mazie K. Hirono, Hawaii
Joe Manchin III, West Virginia
Tom Bowman, Staff Director
John Kruse, Democratic Staff Director
C O N T E N T S
October 6, 2015
Isakson, Hon. Johnny, Chairman, U.S. Senator from Georgia........ 1
Blumenthal, Hon. Richard, Ranking Member, U.S. Senator from
Rounds, Hon. Mike, U.S. Senator from South Dakota................ 20
Tester, Hon. Jon, U.S. Senator from Montana...................... 22
Boozman, Hon. John, U.S. Senator from Arkansas................... 24
Moran, Hon. Jerry, U.S. Senator from Kansas...................... 25
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 27
Sullivan, Hon. Dan, U.S. Senator from Alaska..................... 27
Feinstein, Hon. Dianne, U.S. Senator from California............. 2
Letters for the record are included in the Appendix.......... 81
Donnelly, Hon. Joe, U.S. Senator from Indiana.................... 3
Shaheen, Hon. Jeanne, U.S. Senator from New Hampshire............ 5
Lynch, Thomas, M.D., Assistant Deputy Under Secretary for Health
Clinical Operations, Veterans Health Administration, U.S.
Department of Veterans Affairs; accompanied by Vincent Kane,
Special Assistant to the Secretary; and Jennifer Gray, Staff
Attorney, Office of General Counsel............................ 7
Prepared statement........................................... 8
Additional views............................................. 12
Response to posthearing questions submitted by Hon. Richard
Augustine, Lauren, Legislative Associate, Iraq and Afghanistan
Veterans of America............................................ 30
Prepared statement........................................... 32
Celli, Louis, Jr., Director, National Veterans Affairs and
Rehabilitation Division, The American Legion................... 34
Prepared statement........................................... 36
Harig-Blaine, Elisha, Principal Housing Associate, (Veterans and
Special Needs), National League of Cities...................... 39
Prepared statement........................................... 41
Appendix A-C............................................. 44
Norris, David B., National Legislative Vice-Chairman, Department
of California, Veterans of Foreign Wars of the United States... 48
Prepared statement........................................... 49
Hagel, Hon. Lawrence B., Chief Judge, U.S. Court of Appeals for
Veterans Claims; prepared statement............................ 57
Kirch, Darrell G., M.D., President and Chief Executive Officer,
The Association of American Medical Colleges (AAMC); letter.... 58
Atizado, Adrian M., Deputy National Legislative Director,
Disabled American Veterans (DAV); prepared statement........... 60
Scott, Gregory C., President & CEO, New Directions for Veterans;
Rauber, Diane Boyd, Esq., Director of Legislative and Regulatory
Affairs, National Organization of Veterans' Advocates, Inc.
(NOVA); prepared statement..................................... 67
Stichman, Barton F., Joint Executive Director, National Veterans
Legal Services Program (NVLSP); prepared statement............. 68
Paralyzed Veterans of America (PVA); prepared statement.......... 70
Morosky, Aleks, Deputy Director, National Legislative Service,
Veterans of Foreign Wars of the United States (VFW); prepared
Lieu, Rep. Ted W., U.S. Member of Congress from California;
Peck, Stephen, MWS, President & CEO, United States Veterans
Initiative (U.S.VETS); letter.................................. 77
Ward, Orlando, Executive Director of Public Affairs, Volunteers
of America--Greater Los Angeles; letter........................ 79
Letters Submitted by Senator Diane Feinstein
Blumenfield, Bob, Councilmember, Third District, City of Los
Angeles; letter................................................ 81
Cragg, Jim, Director, Green Vets LA; letter...................... 82
Napolitano, Janet, President, University of California; letter... 83
Toebben, Gary, President & CEO, Los Angeles Area Chamber of
Commerce; letter............................................... 85
Koretz, Paul, Councilmember, Fifth District, City of Los Angeles;
Bonin, Mike, Councilmember, Eleventh District, City of Los
Angeles; letter................................................ 87
Garcetti, Eric, Mayor, City of Los Angeles; letter............... 88
Roman, Nan, President and CEO, The National Alliance to End
Homelessness; letter........................................... 89
Block, Gene D., Chancellor, University of California, Los Angeles
(UCLA); prepared statement..................................... 90
Gideon, Melanie, MHSA, Director, UCLA Health--Operation Mend,
Executive Advisor, UCLA Health Sound Body Sound Mind; letter... 91
Allen, Ben, Senator, 26th District, California State Senate;
Blecker, Michael, Executive Director, Swords to Plowshares;
Guest, Joseph ``Nick'', Adjutant/Quartermaster, Veterans of
Foreign Wars, Department of California; letter................. 95
Members of the Board of Supervisors, County of Los Angeles;
PENDING HEALTH CARE AND BENEFITS LEGISLATION
TUESDAY, OCTOBER 6, 2015
Committee on Veterans' Affairs,
The Committee met, pursuant to notice, at 2:30 p.m., in
room 418, Russell Senate Office Building, Hon. Johnny Isakson,
Chairman of the Committee, presiding.
Present: Senators Isakson, Moran, Boozman, Heller, Rounds,
Tillis, Sullivan, Blumenthal, Brown, and Tester.
OPENING STATEMENT OF HON. JOHNNY ISAKSON,
CHAIRMAN, U.S. SENATOR FROM GEORGIA
Chairman Isakson. I call this Senate Committee to order. I
would like to give a little pre-announcement. In the interest
of everybody on the panel, all three distinguished Senators, as
well as our audience and our Committee, as soon as we have
eight members present, we are going to go into executive
session so we can act on the nomination of Michael Michaud. So,
if you do not mind, I will interrupt you for a brief time once
we get to eight--if we get to eight--during your testimony.
We are pleased today to have three Members of the Senate to
discuss legislation that they have proposed to the Senate. We
also have two distinguished panels who will comment on their
legislation as well as other legislation. We are delighted that
you are here, and as I said, we are going to use this meeting
also for a markup whenever we get to a quorum of eight, with at
least one minority member part of the eight. We will have our
vote on Mike Michaud and send that on to the floor. I
appreciate the Ranking Member's and all the members'
cooperation in moving as quickly as we can on Mike because it
is important that we get his nomination sent to the entire
The bills we have today are about: our land use in West Los
Angeles, our veterans' benefits in terms of mental health,
access to mental health, and many other provisions that are
important to our veterans. I look forward to the testimony of
all our Senators. I look forward to the testimony of our
I will now recognize Senator Blumenthal for any remarks he
STATEMENT OF HON. RICHARD BLUMENTHAL,
RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. In the interest of our colleagues'
time, I just want to thank you for being here. These measures
that you have proposed are very worthwhile, and we look forward
to your testimony.
Chairman Isakson. Each member will get 5 minutes. It is the
Committee's tradition not to ask questions, so as soon as you
have made your testimony, if you would like to be excused, you
are welcome to.
Senator Feinstein, we are delighted to have you. You will
STATEMENT OF HON. DIANNE FEINSTEIN,
U.S. SENATOR FROM CALIFORNIA
Senator Feinstein. Thank you very much, Mr. Chairman,
Ranking Member Blumenthal, and Members on both sides of the
aisle. I am going to speak today on the Los Angeles Homeless
Veterans Leasing Act, a bill I introduced with Senator Boxer. I
would like to thank David Norris from the California chapter of
the Veterans of Foreign Wars for traveling to Washington to
testify in support of our proposal.
This bill would allow a facility, which is a very large
facility--it is 388 acres on Wilshire and San Vicente. On the
north side of Wilshire is a veterans' cemetery, and on the
south side of Wilshire is a very large complex, including a
hospital, several buildings, a UCLA baseball diamond, and many
other things. It is rundown. It needs help.
Now, the majority of veterans, the largest number of
veterans in America, actually live in Los Angeles. There are
300,000 of them, and more than 4,000 have no place to go. They
are, in fact, homeless. Ten percent of the veterans in this
country live in Southern California. Simply put, we need to get
things right at the West L.A. VA.
I would like to briefly recap the history. Every VA
facility in the country has the leasing authority provided in
my bill except for the West L.A. VA. In 2007, Congress took
that authority away after it became clear that leases were
being granted to commercial entities that were not serving
veterans. This included everything from a movie lot to a
laundry facility. The problem led to a 2011 lawsuit, which was
settled earlier this year.
Now, thanks to the leadership of VA Secretary Bob McDonald,
we are back on the right track. Since he has taken over, we
have spoken many times about the issues L.A. veterans face. He
has put an excellent new team together. I met with them in Los
Angeles last month and was thoroughly briefed.
I believe we now have a path forward to make sure the
campus fulfills its obligation to serve the veterans, and here
is why: this land is a grant from a former Senator by the name
of Jones and the Bandini family in 1888. The grant said it has
to be used exclusively for veterans. So, at a certain time,
facilities were rented out like a Fox studio back lot to: UCLA
for a baseball stadium; a laundry; and a rental car business.
Well, that is not for veterans.
This enhanced lease would enable the VA to partner with and
thereby access about $600 million of the State of California's
money, which has been specifically earmarked for veterans, on
that facility. At present, that cannot be done.
So, it is an essential tool to implement the new Master
Plan, and it will allow the Department to build housing more
quickly and more affordably than it would be able to through
the traditional VA construction process.
I also want to thank this Committee. You authorized funds
for the first building for homeless vets. They now have 55
units. We have $35 million for the second building, and the
thrust here is to allow nonprofits to come in for the specific
purpose of building veterans housing.
So, I am hopeful that--let me just point a couple of things
out. New leases must be consistent with the Master Plan. The
Office of Inspector General will regularly report on any new
leases and land-use agreements. If the VA is not in compliance,
new leases will be prohibited. The VA must submit a report to
Congress 45 days before entering into any new lease agreement.
I truly believe--and I have worked on this for 10 years
now--that this plan will help turn the page and ensure that we
are doing everything we possibly can for veterans in Los
Angeles going forward.
Mr. Chairman, I would like to insert letters of support
from local officials, homeless advocacies, and veterans groups
into the hearing record.
Chairman Isakson. Without objection.
Senator Feinstein. Thank you very much for this courtesy.
[The letters are found in the Appendix.]
Chairman Isakson. Well, thank you, Senator Feinstein.
I want the Committee to know that Senator Feinstein has
worked with me diligently to try to bring this to a conclusion.
Today's testimony is very helpful in that. The VA, I
understand, will have the Master Plan completed by October 22.
We intend to move forward as quickly and expeditiously as
possible. We appreciate your input.
For the benefit of the other Members, we are going to go
into an executive session for just 2 minutes, if you do not
mind, so if everybody will stay put.
[Whereupon, at 2:37 p.m., the Committee proceeded to other
business and reconvened at 2:38 p.m.]
Chairman Isakson. Thank you for your patience.
Next we will hear from Senator Donnelly. Welcome to the
STATEMENT OF HON. JOE DONNELLY,
U.S. SENATOR FROM INDIANA
Senator Donnelly. Thank you, Mr. Chairman.
Chairman Isakson, Ranking Member Blumenthal, and Members of
the Committee, thank you for holding this hearing today. I
appreciate the opportunity to speak briefly with you about my
legislation, S. 717, the Community Provider Readiness
Mr. Chairman, as you know, the suicide rate among our
military servicemembers and veterans is not just a tragedy; it
is a crisis. Last year, we lost 443 servicemembers to suicide.
Last week, the Department of Defense reported we have seen more
than 200 military suicides in the first half of this year. We
are all painfully aware of the statistic that 22 veterans every
day take their own lives.
In Indiana, we have lost too many Hoosier veterans to this
scourge. I am sure each Member of this Committee can say the
same about your homestate.
Despite the time and effort we, DOD, and VA have put into
combating military and veteran suicide, these numbers and the
stories of each of these preventable deaths tell us how much
more work we have to do.
The key challenge we must overcome is tackling this problem
with a clear-eyed understanding of how stigma, provider
shortages, and budget constraints impact when and how veterans
and servicemembers seek care.
I have worked over the past 3 years to advance common-sense
bipartisan legislation to meet that challenge. We took an
important step forward last year with the Jacob Sexton Military
Suicide Prevention Act, which was part of the National Defense
Authorization last year.
This year, I am working with several Republican colleagues
to advance the Servicemember and Veteran Mental Health Care
Package; three bills aimed at improving the accessibility and
quality of mental health care for vets, servicemembers, and
I am here today to talk about one of those care package
bills that is on the agenda, S. 717. I have been working with
my colleague Senator Ernst whose experience and insight as a
veteran and as an officer in the Iowa Army National Guard has
been indispensable. This bill creates a special designation for
private sector community mental health providers who
demonstrate a strong knowledge of military culture and
evidence-based therapies for mental health issues common to
veterans and servicemembers. It creates a regularly updated
online registry so vets and servicemembers can search for these
Due to an increasing demand for mental health services,
combined with DOD and VA provider shortages, use of community
providers by servicemembers and veterans has increased
dramatically. If we know veterans and servicemembers are
accessing care through private community providers, we owe it
to them to do our best to improve the quality of care they
receive in those settings and to provide resources to help them
select providers who understand their unique challenges and how
best to treat them.
That is the goal of S. 717. Multiple, internal, and
independent reviews of DOD and VA purchase care networks have
identified the need to improve military cultural competency,
the use of DOD/VA clinical practice guidelines, and evidence-
based therapies to enhance the quality of care servicemembers
and vets receive from community providers.
I have a few examples with me here today: DOD's 2010
Suicide Prevention Task Force report; the Institute of
Medicine's 2014 Assessment of PTSD Treatment for Military and
Veteran Populations; and RAND's 2014 report entitled ``Ready to
We know more and more veterans each year are going to be
seeking care from non-VA providers. We need to be sure as many
of those providers as possible are trained to provide high-
quality care, and we need to give vets tools to help them make
decisions on where to seek care, whether or not they are using
their VA benefits. Both DOD and VA are working to push out
trainings in military culture and evidence-based therapies for
providers. But it will come as no surprise to hear the uptake
rates on those trainings needs to improve. We need to give
providers better incentives to participate. Many of the
trainings are already free. Many already grant continuing
medical education credit.
We could require the training. We could tell providers they
cannot be in DOD and VA purchase care networks unless they
complete it. But imposing those kinds of mandatory requirements
can backfire. At a time when our vets and servicemembers
desperately need more options, S. 717 gives providers an
incentive to voluntarily access military and veteran-specific
training and receive a military/veteran-friendly designation if
they fulfill the requirements.
The Star Program, which was begun in Indiana, has now
expanded to seven States, including the homestates of a number
of Members of this Committee. Mr. Chairman, as you know,
Georgia is one of those States, and it is an extraordinary
The DOD provisions of this legislation were included in the
fiscal year 2016 NDAA conference report under section 717, with
unanimous bipartisan support.
Can I have an additional 30 seconds? [Chairman nods.]
Senator Donnelly. Thank you, sir.
Assuming we keep intact our 53-year record of passing the
NDAA, this legislation will become law by year's end, but only
for military personnel and their families, not for veterans.
The NDAA deals only with this program as it would impact DOD,
servicemembers, and military families. It does not address
veterans or the Department of Veterans Affairs. That is why I
am here today asking to work with all of you to ensure the
services established through this legislation are available not
only to current military personnel but also the veterans that
we care so much for.
Mr. Chairman, thank you for your time.
Chairman Isakson. Thank you, Senator Donnelly. I appreciate
STATEMENT OF HON. JEANNE SHAHEEN,
U.S. SENATOR FROM NEW HAMPSHIRE
Senator Shaheen. Thank you, Mr. Chairman, Ranking Member
Blumenthal, and all of the Members of the Committee, for
holding this hearing today and for giving me the opportunity to
speak in support of my legislation to expand the number of
judges on the U.S. Court of Appeals for Veterans Claims.
As every Member of this Committee knows full well, one of
the most complex challenges facing this Committee and Congress
over the next several years will be the growing backlog of
veterans disability claim appeals. Veterans denied benefits by
the VA continue to face a complicated, frustrating, and
unacceptably prolonged process to receive additional
consideration of their disability claims.
The growth in the number of claims awaiting appeal over the
past several years is staggering. As you, the Board of Veteran
Appeals is the highest appellate level within the VA. Over the
past 4 years, the number of disability claims appeals received
by the Board has increased 65 percent, from 49,611 in 2012 to
81,640 in 2016. The Board is now receiving almost twice as many
claims per year as it has the capacity to decide. In 2014, it
began the year with 65,000 unresolved cases. Over the course of
the year, it received an additional 56,600 cases.
As a result of this growing workload, the average number of
days to resolve a case increased from 289 to 335 between 2014
and 2015, and I have personally spoken with veterans in New
Hampshire who have waited 3, 5, even one 9 years to resolve a
As a matter of basic fairness to our Nation's veterans, we
have got to do better. We have to take a serious look at every
level of the appeals process. The bill I am here to talk about
this afternoon is very simple. It would reauthorize the Court
of Appeals for Veterans Claims to employ nine judges instead of
seven. Since 2002, Congress has granted temporary
authorizations for the Court to increase to nine judges. Before
that, it was authorized at seven. That authority ended in 2013,
and as a result, the Court has been reduced to eight active
judges. It will return to seven if we do not act soon.
The Court noted in its 2014 annual report that, ``Given the
anticipated increase in the number of decisions to be rendered
by the Board, we perceive a need to reauthorize nine judges. As
we see unprecedented and unrelenting growth in the backlog of
appeals, now is not the time to reduce our capacity to pre-2002
I urge the Committee to support this simple measure which
will provide some immediate help to relieve the crisis. I look
forward to answering any questions or further discussion about
how we streamline the appeals process in the future.
Thank you very much, Mr. Chairman.
Chairman Isakson. Thank you, Senator Shaheen.
Senator Donnelly, thank you very much for your testimony.
We appreciate your being here for the meeting. Thank you.
We will go into our Committee hearing now.
Senator Donnelly. Thank you, Mr. Chair.
Chairman Isakson. We have two distinguished panels. The
first panel is Thomas Lynch, M.D., Assistant Deputy Under
Secretary for Health Clinical Operations, Veterans Health
Administration, U.S. Department of Veterans Affairs;
accompanied by Vince Kane, Special Assistant to the Secretary;
and Jennifer Gray, Staff Attorney, Office of the General
Counsel, U.S. Department of Veterans Affairs.
If our first panel would come forward? [Pause.]
We welcome all of you to the Committee today. Dr. Lynch,
you will be the one to testify. Is that correct?
Dr. Lynch. I am, sir.
Chairman Isakson. Welcome; you have the floor.
STATEMENT OF THOMAS LYNCH, M.D., ASSISTANT DEPUTY UNDER
SECRETARY FOR HEALTH CLINICAL OPERATIONS, VETERANS HEALTH
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS;
ACCOMPANIED BY VINCENT KANE, SPECIAL ASSISTANT TO THE
SECRETARY; AND JENNIFER GRAY, STAFF ATTORNEY, OFFICE OF GENERAL
Dr. Lynch. Thank you. Good afternoon, Mr. Chairman, Ranking
Member, and Members of the Committee. Thank you for the
invitation to present our views on several bills that would
affect VA benefits, programs, and services. Seated beside me to
my right is Vincent Kane and to my left is Jennifer Gray.
I would like to begin by thanking Senator Feinstein for
introducing S. 2013, the Los Angeles Homeless Veterans Leasing
Act of 2015, and for the support from other congressional
members, including Senator Barbara Boxer and Congressman Ted
The bill would authorize VA to enter into enhanced use
leases and other agreements for housing and services benefiting
veterans and their families. VA firmly supports this bill as it
will enhance our current efforts to revitalize the campus and
help end veteran homelessness in greater Los Angeles. This
legislation will help us in three ways:
First, it will allow VA to enter into agreements with
housing providers, local governments, community partners, and
nonprofits to provide housing and services for those veterans
and their families that are homeless or at risk for
Second, it will allow VA to revitalize the campus into a
rich and vibrant community that puts the needs of veterans
first in a manner consistent with VA's ongoing efforts to
complete a new Master Plan for the campus.
And, third, it will ensure the campus honors the underlying
deed that transferred the property to the Federal Government in
1888 to be a safe, welcoming, and healing environment for
We appreciate the Committee's support for this needed
legislation and look forward to working closely with each of
you and other veteran stakeholders on its passage and
VA also supports S. 2022, which would increase pensions for
Medal of Honor recipients. VA recognizes the extraordinary
bravery and unparalleled service that our Medal of Honor
recipients have provided on behalf of our Nation. An increase
in their pension is an important step in demonstrating our
commitment and our gratitude.
VA supports Sections 2, 6, and 7 of S. 1885, the Veteran
Housing Stability Act of 2015, a bill that seeks to improve the
benefits and services we provide to homeless veterans and their
families. VA does not have cleared views on Sections 5 and 8
yet; however, we will be working with the Committee to provide
views and costs at a later date.
There are several other provisions of the bill that we
believe are not needed or may benefit from some further
discussion with the Committee. These have been highlighted in
our written statement.
S. 717, the Community Provider Readiness Recognition Act of
2015, would establish a special designation through DOD and VA
for non-Department mental health care providers who demonstrate
a strong knowledge of military culture and evidence-based
medical treatments. The VA does not support the provisions of
this bill. A few years ago, DOD and VA did recognize the need
to ensure that our non-Department clinicians were equipped with
the necessary education and training to properly care for and
treat our Nation's veterans. Through joint collaboration and
investment of resources between DOD and VA, we created a
military cultural competence course and community provider
toolkit which accomplished the intent of this bill.
In addition, this bill would also require VA to create a
registry of non-Department providers. While we acknowledge this
would be helpful in identifying those providers that possess
military training and evidence-based treatment experience, we
have concerns about the way such a certification would be
developed and maintained given all the facets associated with
judging the quality of a provider.
With respect to S. 1754, the Veterans Court of Appeals
Support Act of 2015, VA would defer to the Veterans Court on
whether this bill should be enacted as it would primarily
affect the Court and not VA operations.
Last, S. 1676, the Delivering Opportunities for Care and
Services for Veterans Act of 2015, addresses many important
issues related to medical education and training as well as
recruitment and retention of VA leadership. We do not currently
have prepared views, but are eager to engage and work with the
Committee to provide this at a later date.
Mr. Chairman, thank you for the opportunity to provide VA's
views on several important bills before the Committee today. My
colleagues and I would be pleased to answer any questions that
you or other Members of the Committee may have at this time.
[The prepared statement of Dr. Lynch follows:]
Prepared Statement of Thomas Lynch, M.D., Assistant Deputy Under
Secretary for Health Clinical Operations, Veterans Health
Administration, U.S. Department of Veterans Affairs
Good afternoon Chairman Isakson, Ranking Member Blumenthal, and
Members of the Committee. Thank you for inviting us here today to
present our views on several bills that would affect VA benefits
programs and services. Joining me today are Vince Kane, Special
Assistant to the Secretary and Jennifer Gray, Staff Attorney in VA's
Office of General Counsel.
We do not have cleared views on sections 5 and 8 of S. 1885. We
also do not have cleared views on S. 1676, a bill to increase the
number of graduate medical education positions treating veterans, to
improve the compensation of health care providers, medical directors,
and directors of Veterans Integrated Service Networks, and for other
purposes. We will be glad to work with the Committee on prioritization
of those views and cost estimates not included in our statement.
s. 717--community provider readiness recognition act of 2015
VA does not support S. 717, which would require the Department of
Defense (DOD) and VA to jointly develop a system to provide a mental
health provider readiness designation to non-Department mental health
care providers who demonstrate knowledge of military culture and of
evidence-based medical treatments approved by DOD and VA for treating
the mental health issues of members of the Armed Forces and Veterans.
This bill would also require DOD and VA to jointly establish and update
a public registry with this information.
Requiring VA and DOD to give the mental health provider readiness
designation to non-Department providers would confuse Veterans and
Servicemembers; they might think that VA has certified or endorsed the
providers' competence and ability to provide quality care, which could
lead Veterans to assume a level of specialized competence that may not
be warranted. Moreover, VA and DOD would be required to put providers
on the list based only on their knowledge of military culture and
medical treatments without consideration for other factors that
Veterans and Servicemembers should be aware of before choosing a
provider of mental health care. These factors may include Veteran and
Servicemember preferences for provider type, location, and provider
acceptance of VA or Third Party Administration payment as paid in full,
or a host of many other factors that may create potential barriers or
incentives to care.
VA has invested in the development of multiple resources to assist
non-Department mental health care providers who may work with
Servicemembers and Veterans. Two key resources are the DOD/VA Military
Cultural Competence course and VA's Community Provider Toolkit.
However, VA does not use these resources to evaluate or certify outside
providers' competence or skills. For providers who complete the DOD/VA
Military Cultural Competence course, which is currently open to the
community, awarding free continuing education units if the learner
scores 80% on the post-test. However, there is no process in place to
determine if the knowledge transfers reliably and consistently or if it
leads to a demonstrable behavior change or improved competence in
clinical care. Assessment of providers' knowledge also would require
significant additional resources.
VA understands the appeal of such a registry and agrees that the
availability of information about providers with evidence of training
in military culture and knowledge of evidence-based treatment of mental
health conditions would make it more likely that beneficiaries could
identify more knowledgeable providers. However, VA's ability to create
and maintain such a registry would be constrained by the limitations
described above. A registry of this sort would be difficult to manage,
qualifications would be difficult to assess beyond course completion,
and maintaining accuracy would be very challenging.
The Veterans Health Administration extensively explored this idea
in collaboration with DOD as part of the Integrated Mental Health
Strategy. Specifically, a workgroup explored the possibility of VA/DOD
``certifying'' rural community mental health clinicians who VA and DOD
believed were adequately trained. The workgroup ultimately concluded
that the legal, credentialing, and privacy challenges would be too
difficult. The workgroup suggested a self-report registry as opposed to
VA and/or DOD developing a certification process.
We estimate that implementation of this provision would cost around
$1.7 million in FY 2016, $5.9 million over 5 years and $10.4 million
over ten years.
s. 1754--veterans court of appeals support act of 2015
S. 1754 would amend section 7253(a) of title 38, United States
Code, by permanently increasing the maximum number of judges presiding
over the United States Court of Appeals for Veterans Claims (Veterans
Court) from seven to nine. Because the bill would primarily affect the
Veterans Court and would not affect the operation of VA, we defer to
the Veterans Court as to whether S. 1754 should be enacted.
s. 1885--veteran housing stability act of 2015
Section 2 of S. 1885 would expand the definition of ``homeless
Veteran'' to include those Veterans fleeing domestic violence and
interpersonal violence (DV/IPV), aligning VA's definition with that of
the Department of Housing and Urban Development (HUD). VA supports
section 2. Since Veterans fleeing from DV/IPV are considered at high
risk for homelessness, they are already served in VA's homeless
programs when it is clinically appropriate.
Section 3 would require VA to create a new program to provide
intensive case management interventions to homeless Veterans in at
least six locations selected by VA based on criteria which is described
in the bill. VA would also be required to prepare a report for Congress
on the outcomes of the program. VA does not believe section 3 is
necessary, as VA is already authorized to provide intensive case
management through the HUD-VASH program. HUD-VASH is similarly already
authorized to provide flexible team-based care management and thus does
not require the proposed program to provide such services.
Section 4 would require VA to award grants for the provision of
case management services for Veterans who are transitioning to
permanent housing and those who are at risk for homelessness. This
would help address a current gap in case management service delivery.
The Homeless Providers Grant and Per Diem (GPD) program, for example,
lacks the authority to provide funding for case management services
once a Veteran exits a GPD-funded transitional housing program.
However, such services may be currently provided by grantees in VA's
Supportive Services for Veteran Families (SSVF) program.
Section 4 would also require the Secretary to prioritize for grant
funding those organizations that would voluntarily stop receiving per
diem payments under the GPD program (38 U.S.C. Section 2012) or Special
Need awards (38 U.S.C. Section 2061), and be willing to use their
transitional housing facility for permanent housing. VA supports this
section of the bill. Currently there are nearly 9,000 transitional
housing beds developed through VA investment of capital in partnership
with community organizations. As the number of homeless Veterans
decreases, the need for some of this transitional housing will
diminish, but there will be a continued need for permanent housing
interventions like rapid re-housing and permanent supportive housing.
This grant funding could enable VA to help fill this need for permanent
housing interventions, consistent with the VA's Housing First approach
to assisting homeless Veterans.
VA supports section 6, which would require VA and HUD to
collaboratively provide outreach to public housing authorities,
tribally designated housing entities, realtors, landlords, property
management companies, developers, and other relevant audiences to
educate them about the housing needs of Veterans and encourage them to
rent to Veterans. VA and HUD currently collaborate on such efforts.
VA supports section 7, which would codify the role of the VA
National Center on Homelessness Among Veterans as a center of research,
evaluation, and dissemination of best practices regarding services for
s. 2013--los angeles homeless veterans leasing act of 2015
S. 2013 would authorize the Secretary of Veterans Affairs to enter
into Enhanced-Use Leases and other agreements for housing and services
at VA's West Los Angeles Campus in Los Angeles, California. The leases
would principally benefit Veterans and their families, including
severely disabled, aging, and women Veterans.
VA strongly supports this legislation. It would enable VA to enter
into agreements with housing providers, local governments, community
partners, and non-profits to provide additional housing and services
for homeless and disadvantaged Veterans. Such leases would be squarely
Veteran focused, as the benefits resulting from them would be designed
to principally benefit Veterans and their families. The legislation
would also enable VA to work with state entities such as the University
of California, Los Angeles, to obtain improved services for Veterans,
over and above the range of benefits generated from the current VA-UCLA
medical affiliation arrangement. This effort is in line with VA's goal
to foster and improve its medical affiliations nationwide, to help
ensure that sufficient quality and quantity of doctors, nurses, and
research are available, to help ensure that Veterans will receive
improved care and services well into the 21st Century and beyond.
The legislation is important to VA's goal of revitalizing the
campus into a rich and vibrant community, which Veterans will be proud
to call home. It would dovetail with existing law contained in Section
224 of Public Law 110-161, and the Consolidated Appropriations Act of
2008, to prohibit VA from selling or disposing of any land interests in
the West Los Angeles Campus, to third parties. Additionally, the
legislation contains several significant protections, to ensure
fulfillment of the bill's objectives. The protections including the
All leases must be consistent with the new Master Plan
under development, with community input, that will detail how the
campus will be used to benefit all Veterans;
Office of Inspector General (OIG) audit reports on lease
and land-use management of the West Los Angeles Campus will be required
to be issued two years following enactment of this legislation, five
years following enactment, and then as necessary;
VA will be prohibited from entering into new leases during
any periods where it is found by the OIG to be out of compliance with
Federal policy or law pertaining to leases and land-use on the campus,
until the Department certifies it has corrected any non-compliance or
VA will be required to notify the Senate and House
Veterans' Affairs Committees and the congressional delegation for the
area encompassing the campus 45 days before entering into or renewing
any lease, and submit an annual report evaluating all leases and land-
sharing agreements on the campus.
These restrictions will help to ensure the campus is Veteran
focused going forward, in a manner consistent with the underlying 1888
deed of the property to the United States.
Along with supporting this legislation, VA is working intensely to
positively revitalize the West Los Angeles Campus, to make it more
Veteran focused. Such efforts include pursuing a new master plan for
the campus; providing additional funding to VA's homeless-related
programs; and working with several entities in the Greater Los Angeles
area, to help end Veteran homelessness in Greater Los Angeles. Such
entities include the California congressional delegation; the former
plaintiffs in the West Los Angeles litigation (Valentini v. McDonald)
that was settled in January 2015; Veterans Service Organizations;
Veterans; State and local authorities; non-profit entities; VA
contractors; the local community; and charitable organizations. Through
such efforts and hopeful enactment of this proposed legislation, VA is
confident that all homeless Veterans of Greater Los Angeles will be
able to obtain housing and wrap around supportive services, so that
they can have restored dignity and improve their lives and well-being.
The ongoing Master Planning process takes into account VA's clear
priority to prospectively operate the campus as a vibrant, welcoming,
and sustainable community where all Veterans--including homeless,
severely disabled, women, and elderly Veterans--will feel comfortable
accessing care, living, and interacting with one another, their
families, VA personnel, and visitors.
Since March of this year, almost 1,400 Los Angeles area Veterans
have been placed into permanent housing through the implementation of
housing first principles. Housing first is the proven method where
homeless Veterans are placed into housing with the needed supportive
services to keep them in housing and more effectively help them
reintegrate into their community. On average, almost 275 Veterans per
month are being placed into housing, largely through VA outreach,
coordination efforts, and funding commitments. VA has also increased
resources to expand capacity to care for homeless and at-risk of
homelessness Veterans. Specifically, in 2015 an additional $30 million
was provided for Supportive Services for Veteran Families homeless
prevention, and rapid rehousing programs. Approximately 800 HUD-VASH
vouchers were awarded for Greater Los Angeles. This increased the total
vouchers in Greater Los Angeles to nearly 6,000. An additional 325 new
beds have also been added at the West Los Angeles Campus, for bridge or
emergency housing for Veterans in need.
Despite these enhancements, there is more to do to care for our
Veterans. The legislation will address gaps in services and facilitate
the revitalization of the 388 acre campus to better serve Veterans. It
will also ensure we care for disadvantaged Veteran populations to
ensure they have needed healthcare and housing.
VA estimates that S. 2013 will be cost-neutral because it provides
for outleases of certain properties on the VA West Los Angeles Campus,
without additional cost to VA. The bill does not create an obligation
by VA to fund the housing or services contemplated by Section 2(b).
There is also no obligation for VA to use future appropriations to fund
capital or other costs related to the outleases authorized by this
s. 2022--special pension of medal of honor recipients
S. 2022 would amend section 1562(a) of title 38, United States
Code, by increasing the monthly rate for the Medal of Honor Pension to
$3,000. VA administers the Medal of Honor Pension, a special pension
benefit that is not based on income level, need, or disability, to
recipients of the Medal of Honor. For reference, the monthly Medal of
Honor Pension rate established pursuant to 38 U.S.C. Sec. 1562 is
The bill would be effective either (1) 180 days after the date of
enactment, or (2) if the date 180 days after the date of enactment does
not fall on the first day of a month, the first day of the first month
beginning after the date that is 180 days after the date of enactment.
If the increased rate for the Medal of Honor Pension is effective prior
to December 1, 2016, the monthly rate would not be increased by a cost
of living adjustment (COLA) for FY 2017. Annual COLA increases would
resume beginning on December 1, 2017.
VA supports S. 2022, subject to Congress identifying acceptable
offsets for the additional benefit costs. This legislation would be
consistent with Congress' original intent for the Medal of Honor
Pension, which was to serve as a ``recognition of superior claims on
the gratitude of the country'' and to ``reward * * * in a modest way
startling deeds of individual daring and audacious heroism in the face
of mortal danger when war is on.''
VA estimates that benefit costs to the appropriation for
compensation and pension would be $788,000 in FY 2016, $7.2 million
over five years, and $16.1 million over ten years.
Additional VA Views
The Secretary of Veterans Affairs,
Washington, DC, December 8, 2015.
Hon. Johnny Isakson,
Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: By this letter, we are providing the remaining
views and cost estimates for the following bills from the Committee's
October 6, 2015, legislative hearing: S. 1676 and sections 5 and 8 of
We appreciate this opportunity to comment on this legislation and
look forward to working with you and the other Committee Members on
these important legislative issues.
Robert A. McDonald.
s. 1676--delivering opportunities for care and services for veterans
act of 2015
Section 101 of S. 1676 would amend the Social Security Act to
direct the Secretary of Health and Human Services to not take into
account any resident within the field of allopathic or osteopathic
medicine who counts towards the obligation of the Secretary of Veterans
Affairs under section 301 (b)(2) of the Veterans Access, Choice, and
Accountability Act of 2014 (Public Law 113-146; 38 United States Code
(U.S.C.) 7302 note) (VACAA) when applying the limitations regarding the
total number of full-time equivalent residents in a hospital's approved
medical residency training program. The Secretary would disregard such
residents for cost reporting periods beginning on or after July 1,
VA appreciates this effort to increase V A's ability to expand
graduate medical education (GME), including expanding into underserved
communities by allowing other community partners to assist in GME
development. Since VA does not sponsor its own physician residency
programs, it relies on its academic affiliates to select and sponsor
residents who then receive a portion (typically around a quarter of
their time) of their clinical training in a VA facility. This
arrangement can help ensure that residents receive a well-rounded
educational experience. The current cap on residency positions funded
by the Centers for Medicare & Medicaid Services (CMS) limits the
ability of potential partners to sponsor new VACAA residency positions
in collaboration with VA.
This provision, however, would have a budget impact on CMS and VA
that could be significant, which makes support for this provision
contingent on the availability of resources for both CMS and VA for its
implementation. Still, however, VA believes that a partnership with CMS
on the VA GME Expansion could assist with addressing known inequities
in physician workforce, including the increasing specialization of
physicians and the geographic maldistribution. VA's GME Expansion
specifically targets Primary Care and Mental Health, and focuses on GME
development in smaller and rural communities. A partnership with CMS on
this initiative could create significant and beneficial change in the
physician workforce for the nation.
Section 102 would amend section 301 (b) of the VACAA to extend from
5 years to 10 years the time period provided for the Secretary of
Veterans Affairs to increase the number of GME residency positions to
1,500; and extend by 5 years the time period during which the Secretary
must file annual reports to Congress on residency positions at VA
medical facilities. VA supports section 102. This legislation would
provide additional time for VA to build the infrastructure needed to
successfully create the required new residency positions. VA estimates
that enactment of section 102 would be cost neutral.
Section 103(a) would require the Secretary of Veterans Affairs and
the Secretary of Health and Human Services to jointly conduct a 6-year
pilot program to establish not less than three GME residency programs
in behavioral medicine in underserved areas in the United States.
Section 103(b) would require each residency program to provide
participating residents the opportunity to work with diverse patient
populations through rotations between medical facilities of VA, the
Indian Health Service, and facilities participating under the Medicare
program; provide education in the field of behavioral medicine; be
carried out in a manner consistent with other residency programs
supported and funded by VA and the Department of Health and Human
Services; and be located in a community that is designated as a
medically under-served area under 42 U.S.C. 254b(b)(3)(A), in a state
with a per capita population of Veterans of more than 9 percent
according to the National Center for Veterans Analysis and Statistics
and the United States Census Bureau, and be within 100 miles of a
Reservation as defined in 25 U.S.C. 1452.
Section 103(c) would require the Secretary of Veterans Affairs and
Secretary of Human Health and Services to provide to Congress at least
annually a joint report containing certain specified elements regarding
implementation of the pilot program.
VA appreciates the goals behind section 103 but does not support
these provisions. The extremely narrow criteria for the location of the
three pilot sites would make the pilot program difficult to implement.
For example, large states such as California and New York would be
disqualified from consideration because of the per capita Veteran
population requirement. Also, the requirement that each pilot site be
located within 100 miles of a reservation would exclude many VA
facilities from participation. In addition, the extremely limited
residency training opportunities within the Indian Health Service would
create a challenge when seeking to provide residents rotations through
the Indian Health Service. Finally, the requirement for detailed annual
joint reports from the Secretary of Veterans Affairs and the Secretary
of Health and Human Services would be unduly burdensome given the
relatively small portion of the GME workload these pilot sites would
represent. VA estimates that the reporting requirement in section
103(c) would cost $260,000 annually and $1.56 million over the course
of the pilot program.
Section 104(a) would require the Secretary of Veterans Affairs to
include in the education and training program required under section
7302(a)(1) of title 38 U.S.C., education and training of marriage and
family therapists (MFT) and licensed professional mental health
counselors (LPMHC). VA supports the goal behind section 104(a) but does
not believe that section 104(a) is necessary as VA is presently
providing this training and will continue to do so.
Section 104(b) would require the Secretary to apportion funding
equally among the professions included in the education and training
program. VA does not support section 104 and has a technical concern.
It is unclear to which professions the requirement for equal
apportionment of funding would apply. If the intent is to require equal
funding among all professions, VA does not support such a requirement.
Presently, trainee funding is allocated in accordance with future
hiring needs and capacity to support training programs at VA
facilities. If the intent is to provide equal funding for LPMHC and MFT
training programs, this would be problematic as well. VA has attempted
to provide equal funding for these two professions. Nonetheless,
internships are conducted in partnership with academic affiliate
programs and under principles ensuring a quality educational experience
and in the context of state licensing laws governing the credentials of
supervisors. We have been able to rapidly expand LPMHC internships, but
for the MFT internships, the supervisory requirements do not allow
equally rapid expansion. A legislative requirement for equal funding
might actually result in curtailing training for one profession, so
that training for one profession does not exceed funding for another.
Section 105 would amend section 7402(b)(11)(A) of title 38 to
expand eligibility for appointment within VA as a LPMHC to specifically
include persons who hold a doctoral degree. VA supports section 105. VA
estimates that there would be no cost associated with implementation of
Section 201 would amend section 7451(a)(2) of title 38 to include
physician assistants as ``covered positions'' to which the competitive
pay provisions of that section apply. Presently, only registered nurses
and certain positions as the Secretary may determine upon
recommendation of the Under Secretary for Health are covered positions
under section 7451.
While VA supports the intent of Section 201, VA's support is
conditioned on Congress providing the additional funding necessary to
support these costs. VA also believes that the following health care
professionals should also be added as ``covered positions'' to this
section of the law to apply these same competitive pay provisions to
physical therapists, occupational therapists, physical therapy
assistants, and occupational therapy assistants.
Recruitment and retention of physical and occupational therapy
professionals has been a longstanding challenge for VA. A major
recruitment and retention barrier for these disciplines is the
significant pay disparity between private sector market pay and VA pay
schedules for these therapies. Although special pay rate authority
exists at the local medical center level to address these disparities,
such authority is not consistently utilized and is ineffective in many
cases because special salary rates are below the full performance level
VA estimates that the cost of enactment of section 201 for PAs
would be $33.2 million in FY 2016, $129 million over 5 years, and $241
million over 10 years. In addition, VA estimates that expansion of the
cost of applying the competitive pay provisions of section 7511 to
physical therapists, occupational therapists, physical therapy
assistants, and occupational therapy assistants would be $42.8 million
in FY 2016, $220 million over 5 years, and $458 million over 10 years.
Section 202 would amend section 7681 of title 38 to require that
not less than 30 percent of the amount of debt reduction payments paid
under the Education Debt Reduction Program (EDRP) each year be paid to
individuals who practice medicine in a rural area or highly rural area
or demonstrate a commitment to practice medicine in such an area.
Section 202 would define ``highly rural area'' to mean an area located
in a county or similar community that has less than seven individuals
residing in that county or community per square mile, ``rural area'' to
mean an area that is not an urbanized area or a highly rural area, and
``urbanized area'' to have the meaning given that term by the Director
of the Bureau of the Census. VA does not support section 202. VA
recognizes the intent of the legislation is to ensure use of EDRP for
recruitment and retention in rural and highly rural areas. However, the
proposed legislation would negatively impact the ability of local
facilities to effectively use EDRP by restricting the flexibility that
exists in the current process and seriously misaligning funding with
respect to relative representation of clinical staff and vacancies.
EDRP is designed for recruitment and retention of health care
providers who are in difficult to recruit/retain health care positions
and who are providing direct patient care services or services incident
to direct patient care. Local facilities prioritize hard-to-recruit-
and-retain occupations based on facility needs. Each VA medical
facility receives EDRP funding allocation to recruit and retain health
care providers. Many VA facilities, including both urban and rural
facilities, are in fierce competition with the private sector. In fact,
some of the hardest to recruit/retain facilities are in urban areas
where the cost of living is extremely high and where VA has a harder
time competing with the salaries offered by the private sector.
Currently, the percentage of EDRP funding is on par with the
percentage of rural and highly rural facilities and providers at those
facilities. Rural and highly rural facilities make up 12.6 percent of
VA facilities, and employ only 6 percent of VA's clinical providers and
support staff. In FY 2015, 11 percent of facilities receiving EDRP were
rural or highly rural, and employees at those facilities received 8
percent of the total EDRP funds distributed, commensurate with their
representation in the workforce. Furthermore, a review of current
recruitment activity rates indicates that only 5.4 percent of clinical
vacancies are in rural and highly rural facilities.
Requiring 30 percent of all EDRP funding be awarded to rural
facilities would create a significant disparity in overall program
funding for other sites, preventing facilities with critical provider
shortages from filling EDRP-eligible positions. Restricting usage of
nearly one-third of all EDRP funding for rural areas would negatively
impact the flexibility afforded to local facilities to determine their
specific health care provider needs. Finally, past efforts to set aside
EDRP funds for various hiring initiatives have indicated that funds set
aside for special uses, such as this, are frequently under-used because
the employees hired at those sites or for those positions simply do not
have eligible student loan debt. It is imperative that flexibility not
be restricted for use of these funds in a way that has unintended
consequences, and potentially limits the use of the funding all
together. VA estimates that there would be no cost associated with
implementation of section 202.
Section 203(a) would require the Secretary of Veterans Affairs to
submit to Congress a report on the medical workforce of the Department
not later than 120 days after the date of enactment of the Act. Section
203(b) would require the report to include specific elements.
Specifically, section 203(b)(1) would require the report to include how
many LPMHCs and MFTs are enrolled in the mental health professionals
trainee program of the Department; how many are expected to enroll in
the mental health professionals trainee program of the Department
during the 180-day period beginning on the date of submittal of the
report; a description of the eligibility criteria for such counselors
and therapists compared to other behavioral health professions in the
Department; a description of the objectives, goals, and timing of the
Department regarding increasing the representation of such counselors
and therapists in the behavioral health workforce of the Department;
and a description of the actions taken by the Secretary, in
consultation with the Director of the Office of Personnel Management
(OPM), to create an occupational series for such counselors and
therapists and a timeline for the creation of such an occupational
Section 203(b)(2) would require the report to include a specific
breakdown of spending by the Department in connection with EDRP, as
well as descriptions of how the Department prioritizes such spending
and the actions taken by the Secretary to increase the effectiveness of
such spending for the purposes of recruitment of health care providers.
Section 203(b)(3) would require the report to include a description of
any impediments to the delivery of telemedicine services to Veterans
and any actions taken by the Department to address such impediments,
including with respect to certain specified issues.
Section 203(b)(4) would require the report to include an update on
the efforts of the Secretary to offer training opportunities in
telemedicine to medical residents in medical facilities of the
Department that use telemedicine, consistent with medical residency
program requirements established by the Accreditation Council for
Graduate Medical Education, as required by the Honoring America's
Veterans and Caring for Camp Lejeune Families Act of 2012 (Public Law
112-154; 38 U.S.C. 7406 note). Section 203(b)(5) would require the
report to include an assessment of the development and implementation
by the Secretary of succession planning policies to address the
prevalence of vacancies in the Veterans Health Administration (VHA) of
more than 180 days, including development of an enterprise position
management system to more effectively identify, track, and resolve such
Section 203(b)(6) would require the report to include a description
of the actions taken by the Secretary, in consultation with the
Director of OPM, to address any impediments to the timely appointment
and determination of qualifications for Directors of Veterans
Integrated Service Networks (VISN) and Medical Directors of the
VA does not believe that the reporting requirements in section 203
are necessary and the actions and initiatives addressed by section 203
are already deployed or being pursued within VHA. VA estimates that the
costs associated with enactment of section 203 would not be
Section 301 would amend section 7306(a)(4) of title 38 to add VISN
Directors to the list of personnel who comprise the VA Office of the
Under Secretary for Health and remove the requirement that Medical
Directors be doctors of medicine, dental surgery, or dental medicine.
Section 302 would amend chapter 74 of title 38 to add a new
subchapter VII and section 7481 regarding compensation for Medical
Directors and VISN Directors. Section 302 would establish the elements
of pay for Directors appointed under section 7306(a)(4) of title 38 to
include basic pay as determined under section 7404(a) of title 38 and
market pay as determined under the new section 7481. Section 302 would
require the Secretary to evaluate the amount of market pay payable to a
Director not less frequently than once every 2 years and may adjust
market pay as a result of such evaluation. Section 302 require the
Secretary not less than once every 2 years to set forth a Department-
wide total annual pay minimum and maximum which must be published in
the Federal Register. Section 302 would prohibit the Secretary from
delegating the authority to determine the Department-wide minimum and
maximum total annual pay.
VA supports sections 301 and 302, and the latter provision matches
a proposal put forward in February 2015 in VA 's Fiscal Year 2016
budget submission. VA believes that there are three primary factors
that warrant a separate compensation system for Medical Directors and
VISN Directors. First, existing pay compression within the current
Senior Executive Service (SES) pay system and the closely proximate
rates of pay for direct reports to Medical Center Directors and VISN
Directors have resulted in declining Director applicant pools. Second,
a high number of existing (an estimated 84 percent by FY 2018)
Directors are or will soon be eligible for retirement. Third, private
sector pay for health care leadership positions is highly competitive.
In addition, there are limited pay incentives for experienced
Medical Center Directors and VISN Directors to voluntarily move to fill
more demanding positions. Due to the SES pay compression between
experienced Medical Center Directors and VISN Directors, the small pay
raise, if any, that VHA is able to offer in a reassignment may cause
the candidate to be disadvantaged financially. The most significant
cost disparities occur due to housing costs and in some cases, higher
tax rates (e.g., New York, California). With current executive pay
authorities, a move for the good of the organization most of the time
means a move to the financial detriment of the Director and their
family. On average, it has taken over 6 months to fill Medical Center
Director and VISN Director positions, with many being re-announced
multiple times for positions in both rural and major metropolitan
areas. The reluctance on the part of these senior leaders to relocate
is understandable. It is imperative that VHA have the ability to
implement pay to retain eligible leaders, reward mobility, and ensure
knowledge transfer to the next generation of Medical Center Directors
and VISN Directors. VA estimates that enactment of section 301 would
involve no cost and that enactment of section 302 would cost $8.8
million in FY 2016, $46 million over 5 years, and $93.2 million over 10
Section 401(a) would require the Secretary, not later than 1 year
after the date of enactment of the Act, to conduct a 2-year pilot
program to assess the feasibility and advisability of implementing in
rural areas and highly rural areas with a large percentage of Veterans
a nurse advice line to furnish to Veterans medical advice, appointment
and cancellation services, and information on the availability of
benefits from VA.
Section 401(b) would require the pilot program to establish a nurse
advice line that operates free of charge, is based on and improves upon
the Department of Defense TRICARE advice line, complies with call
center requirements set forth by URAC, uses a process for
determinations of caller eligibility, allows for information sharing
between VA and the nurse advise line, and maintains quality controls to
ensure calls are answered by a customer service representative within
30 seconds with an abandonment rate of less than 5 percent.
Section 401(c) would require the nurse advice line to provide an
array of services including: medical advice from licensed registered
nurses who assess the caller's symptoms using a proprietary clinical
algorithm meeting specified criteria, information to address basic
questions regarding eligibility for VA benefits, and use of an
appointment clerk to facilitate scheduling of appointments for health
care from the Department.
Section 401(d) would require, not later than 120 days after the
date of completion of the pilot program, the Secretary to submit to
Congress a report providing specified information regarding the pilot
VA does not support section 401 as VA already provides telephone
services for clinical care. Specifically, VHA Directive 2007-033,
Telephone Service for Clinical Care, requires telephone services for
clinical care to be made available to all Veterans receiving care at
VHA facilities to include 24/7 telephone access to clinical staff
trained to provide health care advice and information. Each facility is
responsible for providing access for Veteran clinical concerns
consistent with VHA Directive 2007-033. Veteran telephone access to
clinical care during business hours is facility based, managed, and
resourced. Veterans are able to call their local facility and speak
with clinical staff to address and manage their concerns. VA staff
members working with Veterans are responsible for following evidence-
based guidance including during in-person and telephone contact. VA
estimates that enactment of section 401 would cost $75 million in FY
2016, $385 million over 5 years, and $770 million over 10 years.
s. 1885--veterans housing stability act of 2015
Section 5 of S. 1885 would amend section 2041 of title 38 U.S.C. to
expand eligibility for the services provided under that section as well
as the scope of services provided. Under section 2041, VA may enter
into agreements to sell, lease, or donate real property acquired by the
Secretary as a result of a default on a loan made, insured, or
guaranteed by VA to qualified nonprofit organizations or state or local
governments that agree to use the properties to shelter homeless
Veterans and their families. Section 5 would permit such entities to
continue assisting homeless Veterans and their families, as under
current section 2041, but would also expand section 2041 to include
Veterans and their families who are at risk of becoming homeless and
very low-income Veteran families (as defined in section 2044(f) of
title 38). Rather than limiting the entities' assistance to shelter, as
is currently the case, the entities would also be able to assist such
Veterans and their families in acquiring and transitioning to permanent
housing, and in maintaining occupancy in permanent housing. Section 5
would also require the entity to expand the range of services it
provides to the Veterans that it houses by ensuring that such Veterans
receive referrals for the benefits and services to which the Veterans
may be entitled or eligible under title 38.
VA does not object to section 5 but has a technical concern.
Section 5(a)(2)(C) would amend subsection (a)(3)(B) of section 2041 to
strike ``solely as a shelter primarily for homeless Veterans and their
families'' and insert ``to provide permanent or transitional housing
for Veterans and families described in paragraph (1).'' By striking
``shelter,'' section 5(a)(2)(C) would require the entity to agree to
use the property in a manner more narrow than the overall purpose of
the bill as expressed in section 5(a)(2)(A), which includes assisting
eligible individuals ``in acquiring shelter.'' Therefore, VA recommends
that line 2 of page 12 of the draft bill be revised to include
``shelter or'' before ``permanent or transitional housing.'' VA
estimates that enactment of section 5 would result in new benefit loan
subsidy costs of $16.6 million for FY 2016. The provision would expire
at the end of 2016. VA estimates that enactment would not increase
general operating expenses costs.
Section 8 would amend section 2012 of title 38 to require VA to
annually review each Homeless Provider Grant and Per Diem (GPD) program
grant recipient and eligible entity that received a per diem payment
and evaluate each grantee's success in assisting Veterans to obtain,
transition into, and retain permanent housing and increasing Veteran
income through obtaining employment or income-related benefits. VA
would only be able to continue providing per diem to the grantee if VA
determines that the grantee's performance merits continuation of the
per diem. Section 8 would also require VA to establish uniform
performance targets for all GPD grantees in order to conduct its review
VA supports section 8 and has a minor technical concern. Currently,
the GPD program has in place an annual inspection protocol which
includes an evaluation of certain performance metrics established by
VA. When grantees fail to meet the annual inspection requirements the
GPD program begins corrective action process that can lead to stopping
per diem if corrections are not implemented. VA believes the current
annual inspections process could be changed to incorporate the criteria
specified in, and new uniform performance targets required by, section
8. These changes would further help VA to tie continued per diem
payment to grantee performance. VA's minor technical concern relates to
lines 5 and 6 of page 16 of the bill, which state that VA would
evaluate performance with respect to success ``in assisting Veterans
obtain, transition into, and retain permanent housing.'' VA recommends
inserting the word ``to'' before the word ``obtain.'' VA estimates that
the enactment of section 8 would be cost neutral.
Chairman Isakson. Thank you, Dr. Lynch.
Let me begin the questioning. When do you expect the
Committee to receive the Master Plan for the West L.A.
Dr. Lynch. My understanding, Senator, is that it should be
received by the Committee in mid-October.
Chairman Isakson. October 22 is the date I have been
Mr. Kane. Actually, the Master Plan is due--the draft
Master Plan is due to the Secretary on October 15th. We expect
to put it out to public comment shortly thereafter. Around the
21st we should be able to get something advanced to the
Chairman Isakson. How long is the comment period? Sixty
Mr. Kane. We are proposing--that is still being debated.
The talk is between 30 and 60 days for a public comment period.
Chairman Isakson. Does the Feinstein bill incorporate the
baseball stadium for UCLA and the school?
Mr. Kane. The Feinstein bill does not directly incorporate
the UCLA stadium. It notes the importance of a partnership
between the university and the VA, noting that that is our
academic affiliate. But it is very clear that the focus of this
is on housing for the veterans and services that directly
benefit the veterans.
The Secretary is working directly with all of us through
the Master Plan and other legal issues to address the stadium.
But the bill does not give any special provisions for the
continuation of that stadium.
Chairman Isakson. Well, is it not true that the stadium and
the school are the two controversial portions of this property?
Mr. Kane. They are two of the most controversial aspects of
the property, but our intent is to make the entire property
veteran-focused that puts the veteran first.
Chairman Isakson. Well, pardon me for putting you on the
hot seat, but I have to ask you this question. If you are going
to submit by the 22nd of October a Master Plan, do you intend
to deal with whether or not the VA is going to recommend the
baseball stadium or the school or whether they are not?
Mr. Kane. So, the Master Plan really looks at how the
campus can be revitalized to be a community. It will talk about
how different zones on that campus, the 388 acres, can be best
utilized. Decisions related to the continuation of the stadium
get addressed through that zone process but, more importantly,
are being addressed in separate discussions that look at what
UCLA has submitted in the Master Plan as well as the ongoing
discussions we have had with them about how they can provide
services that really truly are veteran-focused and how that
stadium can be repurposed to have a focus on veterans.
It will not be directly addressed in the Master Plan, but
it will be addressed as an outcome and a byproduct of our
discussions and the master planning process.
Chairman Isakson. When the property was conveyed to the VA
by Mr. Jones in 1888, I believe--is that the correct date?
Mr. Kane. Yes.
Chairman Isakson. Was that by covenant on the deed, or was
that by an agreement of some type?
Mr. Kane. It was the deed.
Chairman Isakson. It was on the deed?
Mr. Kane. Yes.
Chairman Isakson. So, the definition of benefiting veterans
is a broad one, not a narrow one.
Mr. Kane. Correct, although we have been very clear through
our process, through the master planning, and through the
activities that we have undertaken since the settlement back in
January that the intent is to revitalize that campus as the
home for our veterans and to make sure that the health care is
state-of-the-art, 21st century, as well as that all the
services that are on that campus are focused and prioritizing
Chairman Isakson. The reason I am spending so much time on
questions on the West L.A. property is because I am one that
believes there is potential revenue to the Government and to
the VA on surplus property around the country the Veterans
Administration owns, and this particular Master Plan may be a
template for what we might do in the future for other
properties that are vacant that could otherwise be leased to
generate revenue for the VA or for the benefit of veterans. I
think the Master Plan that you come up with and the ultimate
comments that we receive to that Master Plan are going to be
critically important in terms of what we do.
Mr. Kane. We agree. We think that this Master Plan can be a
template for creating what we want the new VA to be and to be
focused on, which is 21st century health care, with the other
services that really dignify and respect the men and women that
serve this country.
Chairman Isakson. Senator Blumenthal.
Senator Blumenthal. Thanks, Mr. Chairman.
I think this hearing is very important because it deals
with mental health, with equality of justice, and with
homelessness. I appreciate all my colleagues' efforts to
address a number of the issues that veterans and their families
face, ranging from those issues to the recruitment of VA health
care professionals and housing instability.
There is a real and pressing need to move forward on many
of these issues, and I want to offer my strong support for the
bills mentioned by my colleagues, as well as for Senator
Tester's DOCS for Veterans Act, which is the next step in
enhancing the VA's medical workforce. In particular, it seeks
to tackle the problem of vacancies at the network and facility
director level across the VA, and, of course, my own measure
which I have offered, the Veterans Housing Stability Act. I
want to ask you, Dr. Lynch, I notice that there are some
provisions that you do not support in this measure. Would you
tell me why?
Dr. Lynch. There is one provision that VA does not support,
which is Section 3, that would require VA to create a new
program to provide intensive case management interventions for
homeless veterans in at least six locations. VA feels that we
already have a very strong program tied to HUD-VASH, but we
feel, in addition to that, that there are other opportunities
for outreach to veterans and homeless veterans at this time.
The VA has an extensive network that has outreach to the
street, under bridges, soup kitchens, prisons, and courts.
There are gap analyses that are being done to assure there is a
focus on cities, the veterans population, and their needs.
Senator Blumenthal. Do you feel the outreach already is
Dr. Lynch. We do.
Senator Blumenthal. Well, I would respectfully disagree. I
think that there is a need for more outreach to the homeless,
from what I have seen at least in Connecticut. Although we are
on the verge of purportedly ending front-line homelessness in
Connecticut, there is a need for outreach every day that
apparently is lacking or inadequate. So, I would just urge that
perhaps you consider working with me on that issue.
Let me ask you about the Veterans Court, increasing the
number of judges in the Board of Appeals. I understand you do
not run the Veterans Court of Appeals, but wouldn't you agree
that the backlog and the increase in caseload warrant this
Dr. Lynch. The case sounds compelling. I just feel on
behalf of VA we are not in a position to decide for the Court.
I certainly acknowledge there is backlog, and there could be
value in additional judges.
Senator Blumenthal. Perhaps you could consult with others
at the VA and come back to us; submit in writing a further
position on this issue. I think it is within the purview of
your responsibility to make sure that disability claims for the
benefit of veterans are processed as expeditiously as possible.
Dr. Lynch. Yes, sir. We will do that.
Response to Request Arising During the Hearing by Hon. Richard
Blumenthal to Dr. Thomas Lynch, Assistant Deputy Under Secretary for
Health Clinical Operations, Veterans Health Administration, U.S.
Department of Veterans Affairs
VA of course would not substitute its judgment for that of the
Court of Appeals for Veterans Claims (CAVC) regarding their needs.
However, VA does share with them the common goal of reducing the
appeals backlog and securing final disposition of appeals faster. In
addition, the requested additional resources for the Board of Veterans'
Appeals (the Board) in the FY 2017 budget will almost certainly lead to
a proportional increase in the Court's workload as there has been a
relatively stable relationship between the Board's output and appeals
to the CAVC. We note in CAVC's testimony for the record for this
hearing they expressed support for S. 1754, including making permanent
the increase in the number of judges from seven to nine. We deferred to
the CAVC's views in our written statement, but believe it is safe to
say we join in that judgment.
Senator Blumenthal. Finally, let me ask you about the
Delivering Opportunities for Care and Services for Veterans Act
of 2015, which has been sponsored by Senator Tester and others.
I gather--maybe you could restate your position on this bill.
Dr. Lynch. VA has not developed formal positions, but I
think I can safely say, looking particularly at Sections 101
and 102, which deal with residency slots, the use of provisions
of VACA regulations, that we feel strongly that these would be
a positive aspect to allow us to develop more residency
programs in VA, to have the potential to recruit residents from
those programs to provide care for veterans.
I think also looking at Section 300, which deals with
additional provisions that put network directors and medical
center directors under Title 38 and allow us to be more
competitive as we recruit in localities and address complexity
challenges that are facing a number of our locations, these are
all going to be very positive actions that will help us, I
think, be competitive in the health care market today.
Senator Blumenthal. Well, I am going to join as a cosponsor
of this measure. I think it is absolutely vital, and I want to
thank Senator Tester for his leadership. Thank you.
Thanks, Mr. Chairman.
Chairman Isakson. Thank you, Senator Blumenthal.
Senator Rounds, followed by Senator Tester.
HON. MIKE ROUNDS, U.S. SENATOR FROM SOUTH DAKOTA
Senator Rounds. Thank you, Mr. Chairman. I just wanted to
follow up also on Senator Tester's proposed legislation,
S. 1676. It would appear that it does a lot to help deliver
health care long term to the rural parts of the country, and I
am just curious. Originally, you indicated that you did not
have a position, and yet you just gave some reasons why you
would support it.
I would like to go a little bit more in-depth on it. Would
you share with us the reasons why you were not interested in
Dr. Lynch. We are not in a position to say we are not
supporting this bill. We just have not developed our views yet
in a formal fashion at this point. But, looking at the
provisions and sections of the bill, I see that there are
opportunities particularly for rural health.
If you look back at the VACA legislation, it identified
residency positions that would be focused in rural and highly
rural areas. Over the last year, we were actually able to get
400 requests for residency positions; 204 of those met the VACA
requirements; 163 of those positions have been filled, and we
expect to fill the rest the coming academic year.
I think the value of this bill moving forward is to begin
to work with smaller medical centers apart from our major
academic medical centers and osteopathic schools. It is going
to require time to develop those residencies, probably a couple
of years to develop the residency, another couple of years to
get it accredited, and then probably 3 years to fill the
residency. So, there is an advantage to extending the
provisions of the VACA legislation from 5 years to 10 years.
Senator Rounds. It sounds like a bureaucratic mess to me.
Let me just go on and try another one: S. 717, which is the
Donnelly-Ernst proposal. You indicated it was not OK with the
VA, and this is the one that would designate certain non-
Department mental health care providers who treat members of
the Armed Forces and veterans as providers who have particular
knowledge relating to the provisions of mental health care to
members of the Armed Forces and veterans and for other
I am just curious. It looks like a lot of our veterans
leaving DOD, stepping in, and now coming under of the care of
the VA, I suspect that if they could go directly to a VA
facility and receive the care, they probably would look at
that. And yet what we are looking at with this particular
proposal is for those individuals who could not access the VA
facility, you have indicated that you have got some other
alternatives out there that would be comparable to this
It looks to me like if it is working right now, we would
not have the requests for the bill. Are you thinking that right
now the ability to provide for those services is already there
within the framework that you have laid out versus the
alternative that has been proposed by this legislation?
Dr. Lynch. VA's position is that we feel there is a need to
educate the community, and we think we have vehicles out there
to provide that education. VA is also embarking on another
provision of the Defense Authorization Act that requested that
VA begin to reach out to the community providers and engage
them in providing mental health services.
Our real concern is that we do not feel that we can
adequately develop a program that certifies or recognizes
somebody because, while they have taken the training, it is
very difficult to determine the competency for people who do
not work for us, and also to determine long range whether they
maintain that competency.
Senator Rounds. You know, a lot of the folks that work for
you right now, good, hardworking individuals that provide good
professional services, they do not start out with a program in
which you have trained them to begin with. They come from
outside in the civilian world. You provide them with training
courses right now that make them better at what they do. They
get experiences working with veterans today. It seems to me
that the same type of approach would be comparable in these
other non-VA-employed facilities.
I would hope that you might reconsider the position just in
terms of being able to provide services in those parts of the
country that do not have access to the VA expertise that we do
in some of our larger communities.
Dr. Lynch. Yes, sir.
Senator Rounds. Thank you.
Thank you, Mr. Chairman.
Chairman Isakson. Senator Tester.
HON. JON TESTER, U.S. SENATOR FROM MONTANA
Senator Tester. Thank you, Mr. Chairman and Ranking Member,
for including S. 1676 on today's agenda, and I appreciate your
support, Senator Blumenthal, on this bill. You know, this
legislation, simply put, was really to address the chronic
shortage of VA medical professionals and really allow you to
better compete for the skilled staffing that you need over the
next many years as VA continues to get pressure for services.
Just as background, it incorporates a number of great ideas
from folks, veterans, and medical communities. It has been
endorsed by 17 organizations representing everyone from medical
colleges to mental health counselors to physician assistants to
disabled vets, and I want to particularly thank the American
Association of Medical Colleges and the American Legion for
their early engagement and support of this bill.
In July, this Committee unanimously reported out four
provisions of this legislation, and I am hopeful we can advance
the remaining provisions. In particular, I want to highlight a
section that you have highlighted, Dr. Lynch, Section 101
regarding medical residencies, which I believe are the surest
way to get a pipeline of docs into rural America and into the
areas where we need them to address our veterans' needs.
Congress included a critical provision in the Choice Act to
increase the number of residents training--and you are familiar
with this, Dr. Lynch.
Dr. Lynch. Yes, sir.
Senator Tester [continuing]. At VA facilities by over 1,500
over the next 5 years. But, to date, it is my understanding
that the VA has only been able to fill about 163 of those
positions. Is that correct?
Dr. Lynch. Yes, Senator.
Senator Tester. OK. After speaking with a number of folks
in the VA, it is clear that filling all 1,500 authorized
residency positions, as Congress intended, simply cannot
happen. Is that a fair statement?
Dr. Lynch. That is a fair statement.
Senator Tester. Is that because the VA no longer runs its
own stand-alone residency program and must partner with non-VA
affiliates to establish----
Dr. Lynch. In most cases, to my knowledge, we need to
partner with academic affiliates or community hospitals, yes.
Senator Tester. The problem with that is that even though
VA is willing, non-VA affiliates are hamstrung by the current
cap on Medicare-funded residencies. Is that correct?
Dr. Lynch. Yes.
Senator Tester. OK. That cap was established in 1997, for
the Committee's information. It is woefully insufficient to
meet the needs that are out there, and that is why the Section
101 of this bill would establish those 1,500 residency
positions that were authorized by the Choice Act. Subsequently,
Centers for Medicare and Medicaid Services would be allowed to
make Medicare direct graduate medical education and direct
medical education payments for Choice students who are in the
teaching caps. I just think this is critically important if we
are going to be able to address the medical needs we have on
the ground. I think it applies not only to rural but also urban
VA centers. It absolutely has benefits to rural America, make
no mistake about it, and they are big ones. It would lead to
more VA and non-VA affiliate partnerships and more doctors
ultimately joining the VA workforce.
Dr. Lynch, does the DOCS for Veterans Act give the VA the
flexibility and the tools it needs to really fill those
Dr. Lynch. I think it gives us the extended timeframe to
work with organizations to develop residencies, particularly in
rural areas with osteopathic facilities, that we may not have
had relationships with before that will allow us to have
outreach into rural and highly rural areas.
Senator Tester. Do you see this as a strategy that would
work to help fill the doctors that you need?
Dr. Lynch. I think this is a good strategy, Senator.
Senator Tester. OK. I want to talk about the other section
you talked about, Section 300. Very quickly, it has to do with
filling positions, making sure folks are held accountable in
leadership positions because I think leadership does matter,
whether veterans integrated service network (VISN) directors or
whether they are medical directors of medical facilities.
Do you believe a major hindrance to filling these positions
has been the VA's inability to compete within the health care
Dr. Lynch. Yes, sir.
Senator Tester [continuing]. For executive leaders in the
Dr. Lynch. Yes.
Senator Tester. Do you think the gap is wide?
Dr. Lynch. Yes, I do.
Senator Tester. Can you give me an indication of what that
gap might be on average?
Dr. Lynch. I do not have any average numbers, but I can
tell you that the salary paid in the private sector is
significantly greater than what we are paying our VA medical
center directors and network directors.
Senator Tester. OK. What kind of vacancies do you have now,
focusing on just the medical directors?
Dr. Lynch. Medical center directors I think is in the range
of 25 to 30 percent.
Senator Tester. OK. So, 25 to 30 percent less salary or 25
to 30 percent of those medical facilities do not have
Dr. Lynch. Do not have directors.
Senator Tester. That is what I thought. You guys know this
is like having a hospital with no CEO, which is a huge, huge
problem. I would hope that we could kick out both Sections 101
and 300 out of this Committee and would love to have your help
getting that done as we move forward. I appreciate all of you
for being on the panel. Thank you for your hard work.
Dr. Lynch. Thank you.
Chairman Isakson. I want to underscore what Senator Tester
has said. There are far too many vacancies, far too many acting
directors, and far too many people who do not have permanent
responsibility at the VA. I have talked about that before, and
I appreciate that you brought it up. Just an editorial comment
to pass on to Secretary McDonald.
Dr. Lynch. Yes, sir.
Chairman Isakson. Senator Boozman.
HON. JOHN BOOZMAN, U.S. SENATOR FROM ARKANSAS
Senator Boozman. I would second that editorial comment; it
is just something that we simply have to fix. It is common
sense, and it is good business practices. Yet, I know it is
difficult in the situation you are in.
Dr. Lynch, in your testimony you noted that you are
supportive of Senator Graham's legislation, S. 2022, and the
idea of that, I think in your testimony and that we all
understand, was to provide our Medal of Honor winners with a
small pension as they go forward.
One of the real values of these are individuals that have
done such heroic things and I have had the opportunity to be
around them at different events. They are so good about coming
out. You see young people, all ages, that learn about the
military and things, which is just a very positive experience.
One of the problems, and the reason I support this, is that
many times they come at their own expense. They are very
willing to do things, but there is an expense incurred by
themselves, which, again, they are in situations where perhaps
it is difficult. So, I think that is another reason that the
legislation would be beneficial. Would you agree with that,
Dr. Lynch. Yes.
Senator Boozman [continuing]. Importance of them being--and
them adding so much to whatever the event is, helping us
highlight the sacrifice and the importance of our military.
Dr. Lynch. Senator, absolutely.
Senator Boozman. Very good. I understand that you all are
not supportive of Senators Donnelly and Ernst's legislation
concerning designating non-Department mental health care
providers who treat members of the armed services and veterans
as providers with specialized knowledge of providing mental
health care to veterans and servicemembers. Tell me a little
bit about that. You know, it is not uncommon at all in the
private sector for them to be credentialed through medical
societies and things like that. Why is it so difficult for VA
to be able to do that?
Dr. Lynch. I think, Senator, the VA and DOD looked at this
several years ago with respect to another program related to
mental health services in rural areas and found that there were
significant, what felt to be legal obstacles to this. There was
also a feeling that some potential conflicts exist with State
licensing and professional review boards. So, one aspect is
The other aspect is developing a process that would allow
us to assess their competency beyond a simple self-administered
educational program and to follow the progress of their
treatment over time. Right now we just do not feel we have the
resources to do that properly.
Senator Boozman. I would encourage us to perhaps visit with
the American Psychiatric Association and the American
Psychological Association and really see if we could figure
that out, the reason being is mental health care issues have
been a crisis in the past, but they really are reaching the
breaking point now, not only in VA but throughout our society.
So, we have to start thinking outside the box.
It is something that I would appreciate, and I think the
Committee would appreciate it if you would really look hard and
see how we can expand the services that we are providing, and
yet it is very difficult to provide the service without
ancillary help. That is why I think we see the medical
societies and things credentialing these type of people.
Dr. Lynch. Yes, sir.
Senator Boozman. Thank you very much.
Thank you, Mr. Chairman.
Chairman Isakson. Senator Moran.
HON. JERRY MORAN, U.S. SENATOR FROM KANSAS
Senator Moran. Thank you, Mr. Chairman. Dr .Lynch, thank
you very much for your presence today. I may be following up on
what Senator Boozman was talking about.
I want to explore the issue of the use of community mental
health providers within the VA, and my understanding is, under
the Choice Act, the VA is required to provide services to those
who cannot receive the service they need within 30 days or who
live more than 40 miles from a VA facility. The facility, I
guess, has now been redefined.
Dr. Lynch. Yes.
Senator Moran. One of the only places in Kansas that you
can access mental health services in rural parts of our State,
but generally across our State, are what we call community
mental health centers, and they provide the wide array of
mental health services. My impression is--and we have been
working on this long before Choice was ever enacted, but we
have been trying to convince the VA to enter into agreements
with those mental health centers to allow veterans to receive
care through there. It really has not developed, and my
question is: In today's circumstance where the VA is required
to provide those services, maybe the bottleneck--it still does
not seem to be happening--is how the VA or TriWest decides
which organizations to contract with to provide those services.
Can you explain to me how that process works?
Dr. Lynch. To my understanding, TriWest on behalf of the VA
reaches out to providers in the community to engage them in the
Choice program. There are some requirements. They do have to be
Medicare-eligible in order to participate. They do have to
provide a copy of their records within 30 days of the provision
of services. We can reimburse them at rates up to Medicare. So,
a lot of the challenges are related to working with the
providers and getting them to engage in Choice.
We have been working with TriWest to improve those
engagements. We have been working to try to make it easier
through some recent legislation which would actually let us
work within the 30-day interval and avoid 60-day
reauthorizations to make this process easier to implement.
There are some recommendations going forward as of November 1
that will help us, I think, more greatly integrate the VA care
in the community beyond what we are doing right now.
Senator Moran. Would there be, Dr. Lynch, any circumstances
in which the VA would decide we do not want to have an outside
provider provide this kind of service and, therefore, TriWest
would never enter into negotiations with the provider?
Dr. Lynch. Not to my knowledge, as long as they meet the
provisions of the Choice Act.
Senator Moran. There would not be an attitude or approach
within the VA that says we want to retain the ability, only the
ability--and in a sense, ``revenue'' is not the right word, but
the revenue that flows from that veteran, we want to maintain
that within the VA and not allow an outside provider to provide
Dr. Lynch. No, Senator. I think the Secretary has made it
clear that we are coming into a new era in VA, that we need to
collaborate with the community, that we need to partner with
them to provide care to veterans, and that we cannot do it all
Senator Moran. One of the community mental health centers
in Kansas told me that they were allowed to contract but only
to provide screening services but not the actual care of the
veteran. Does that make any sense? They were interested in
providing a wide array of services, but the VA says no, we are
only going to contract--or TriWest says they are only going to
allow you to do screening.
Dr. Lynch. I do not understand that, but I would be happy
to get more information and explore it with you.
Senator Moran. Do you have the sense that this
implementation of the Choice Act is pretty uniform across the
country VISN-to-VISN? Or is it different because Kansas happens
to be in a certain VISN?
Dr. Lynch. It varies across the country, depending upon our
ability to recruit community partners. We are working
aggressively, I can assure you, with both of our third-party
administrators to engage the community and to have Choice
Senator Moran. Under the Clay Hunt Act the VA is also
instructed to provide additional mental health community
services. Any development there, or does the Choice Act, if
fully and appropriately implemented, take care of that mandate?
Dr. Lynch. I would have to look at the provisions of the
Clay Hunt Act that you are referring to, but I think we have a
number of resources that we need through Choice. I think the
other thing that I mentioned earlier through the Defense
Authorization Act, our mental health services are actually
mandated to reach out to the community and involve community
providers in mental health care.
Senator Moran. Are family and medical professionals and
therapist, are they--does the law require you to hire them
within the VA?
Dr. Lynch. I do not know if the law requires us. I know
that we have been reaching out to involve them more in VA
services. I have had that discussion with our mental health
program office, and we are beginning to look for ways to engage
these individuals further.
Senator Moran. My final question, Mr. Chairman, is that I
was told that a community mental health center could not be
reimbursed for any services provided by a family and marriage
therapist, and that I think makes no sense, in part based upon
what you just said, but I know there is an effort to integrate
that profession into the VA. Yet the community mental health
center says they cannot use family and marriage therapists and
Dr. Lynch. I would have to look more specifically at that.
Senator Moran. Thank you very much.
Chairman Isakson. Senator Tillis.
HON. THOM TILLIS, U.S. SENATOR FROM NORTH CAROLINA
Senator Tillis. Thank you, Mr. Chair. I am sorry I was
running late. I am not going to talk long except to just lend
words of support for two bills: Senator Shaheen's bill,
S. 1754. I do not think you all have taken a position on it,
but I think it is a valuable resource in trying to draw down
the claims backlog and give some certainty to the veterans who
are going through an appeals process. Also, Senator Graham's
bill, S. 2022. I look forward to seeing them make their way
through the Committee.
The only thing I will not do, since I do not think any of
you all have anything to do with the Camp Lejeune toxic waste
issue, but I am looking forward to a future meeting where I can
get some resolution to questions that I posed in the last
Thank you, Mr. Chair.
Chairman Isakson. Thank you, Senator Tillis.
HON. DAN SULLIVAN, U.S. SENATOR FROM ALASKA
Senator Sullivan. Thank you, Mr. Chair. Dr. Lynch, it is
good to see you again.
Dr. Lynch. Yes, sir.
Senator Sullivan. I think you probably will not be
surprised when I talk about a topic that you and I have been
spending a lot of time on lately, and that is the issues in
Alaska. Again, I appreciate the Chairman and the Ranking
Member's support for our hearings out in the State in August
that I think were, hopefully, very helpful to you and your team
and certainly are helpful to me and my team.
At the latest hearing, we talked about Dr. Shulkin's six
points with regard to an Alaska plan, an Alaska pilot program
to fix what I think everybody recognizes has been a real
problem in terms of the implementation of the Choice Act. I
appreciate you following up, you and your team just recently
with my staff.
My understanding is that most of what Dr. Shulkin is going
to do--and I am sure you have those six points in front of you
this time--do you?
Dr. Lynch. Absolutely.
Senator Sullivan. Good, I do, too. I will not grill you on
them, though. That is, for most of that, we are not going to
need legislation. I do think that on the issue my
understanding, particularly from the call yesterday, on the
pilot project in the Matsu Valley in terms of the partnerships
that you might need some legislative authority there, and I
just want to get a commitment from you--I know I am going to
get it--that you will work with my team and the Committee here
that we can make sure we know what that is. So, whatever bills
are moving soon, that we can make sure we have that in hand
working with you. Can I get that commitment from you on that?
Dr. Lynch. Yes, sir.
Senator Sullivan. What I wanted to do, just because you saw
how passionate our veterans were on the issue, I just wanted to
work through first the timeline on the issues in Alaska. I
think you saw how urgent the issues are. In the last hearing, I
talked about the ability for you guys to move up a timeline.
Again, can I get a commitment as soon as possible so we can
work with you to announce what we are going to do there in
terms of an Alaska pilot plan, particularly in the areas where
you have authority, so we can get that out and start giving our
Dr. Lynch. Yes, sir. I think we talked yesterday about two
phases. One, we have already implemented a virtual integration
between TriWest and the integrated care service in Anchorage so
that there is a direct connection between those individuals at
VA Alaska who have worked for a long time with the community
providers. TriWest is going out and recruiting seven additional
individuals who will actually be physically present in the
Integrated Care Service Center.
I think what came across in the phone call yesterday is we
want to make sure we do this right, and we want to make sure we
get the right people. Right now we think they will be in place
by mid-November, including recruitment. But----
Senator Sullivan. OK. You do not think there is a way to
move that up at all?
Dr. Lynch. Sir, it is my understanding they are moving as
quickly as possible.
Senator Sullivan. OK.
Dr. Lynch. They want this almost as bad as you do, because
Senator Sullivan. I doubt it, but that is OK.
Dr. Lynch. Well, I can tell you----
Senator Sullivan. Or maybe they do, and that is great. We
are all trying to work together. That is the key.
Dr. Lynch. Having walked through and talked with the people
in that unit, they are very committed to the veterans.
Senator Sullivan. Oh, they are.
Dr. Lynch. They are very committed to the vendors that are
working with our veterans. Anything they can do to facilitate
the communication between veteran and vendor and make that work
is going to be something they are going to push as quickly as
they can do that to put in place a good service.
Remember, this is a pilot. It will probably be implemented
in other places across VA. We want to make sure it is
Senator Sullivan. Good. I appreciate that constructive
We are still getting a ton of veterans weighing in with my
office on this issue, and what I thought would be useful in the
remaining time I have is to have them speak directly to you and
see if you can answer a couple of their questions.
One, Ms. Cathy Blodgett of Anchorage, she wrote in to our
office and said she is a veteran, she works at the VA, and she
is an Air Force veteran. Alaska VA takes pride in service to
our veterans, but are spending dozens of hours on the phone
trying to fix the contractor shortcomings, and our employees
cannot do the jobs they are hired to do because they are
spending so much time on resolving the Choice Act issues.
Dr. Lynch. Can I just make----
Senator Sullivan. I will just throw one other out there,
because I am trying to get in under the buzzer. A board-
certified doctor in Anchorage, Saket Ambasht, he said that--and
he is a disabled vet. He wrote in to my office. He said he has
provided care to 1,036 patients out of 7,994 over the last
several years, but in the last several weeks has been only able
to see two VA patients out of close to 100, again, from Choice
Will the Alaska plan kind of address some of these issues
that are directly coming from our vets and people who have
worked with the VA or in the VA?
Dr. Lynch. I think you illustrated the point I just made,
that the people at the VA, the people in the Integrated Care
Service Center, care as much as you do about serving the
veteran and resolving those problems and working efficiently
and reestablishing what is important in Alaska, which are
relationships between the veteran and the VA, between the VA
and its vendors. So, I think you have made my point as well as
Senator Sullivan. Will the plan allow these kind of things
to be fixed?
Dr. Lynch. I think it will, sir.
Senator Sullivan. Thank you.
Thank you, Mr. Chairman.
Chairman Isakson. Thank you, Senator Sullivan.
I want to thank our panelists for their testimony. Thank
you for being here today, and we will recognize the second
panel to come forward at this time.
Chairman Isakson. Let me bring the Committee back to order.
Before I introduce our panelists, I want to say a thank you, if
I can, to The American Legion, the VFW, Iraq and Afghanistan
Veterans of America, and all the other VSOs. Over the past 7 or
8 months, we have had a difficult situation in Denver,
Colorado, with the Denver hospital, and I want to thank the
Ranking Member in this eulogy as well--not eulogy, but whatever
it is, anyway--testimony. Because of the support of the VSOs
and the cooperation of the Ranking Member in the waning hours
of last week, we pulled off something nobody thought we could
do by getting the VA hospital authorized in Denver, finding the
money to finish the hospital without going outside the VA to
find that money, and I think it showed what we can do when we
work together. But the VSOs were extremely helpful to back the
Senate position in the waning days of that debate, and I want
to publicly thank them. We hope you will tell your commanders
the same. I want to thank Senator Blumenthal for his last-
minute--not last-minute support, but in the waning minutes when
we were challenged, he stuck behind the Committee and stuck
behind what we did, and we appreciate it very much.
Senator Blumenthal. Thank you, Mr. Chairman.
I want to thank the Chairman for his leadership on this
issue and others, although I am not sure I am wholly in accord
with his eulogy.
Chairman Isakson. Trilogy.
Senator Blumenthal. Trilogy.
Chairman Isakson. Testimony.
Senator Blumenthal. But I do want to thank him very
seriously for his leadership and, second, emphasize how
important the veterans service organizations have been. I think
the most telling word in that title is ``service.'' You have
truly been of service to the veterans of America as well as to
all of us who have a responsibility to try to provide for them,
and the partnership that we have with the VSOs is enormously
beneficial to the work we do, trying as hard as we can, and
working as hard as you do to serve our common goals. I want to
join in thanking you and hope you will pass that message along
not only to your leadership but to your membership, because
they are the ones who truly deserve credit for helping us serve
the veterans of America and for their service to our country in
Chairman Isakson. I would like to introduce our second
First, Lauren Augustine, legislative associate, Iraq and
Afghanistan Veterans of America.
Second is Lou Celli, director of Veterans Affairs and
Rehabilitation Division of The American Legion.
Great name here, Elisha Harig-Blaine--what a great name--
who is a Principal Associate of Housing (Veterans and Special
Needs), National League of Cities.
And David Norris, national legislative committee, Vice-
Chairman, Veterans of Foreign Wars.
We appreciate your being here today. Please limit your
testimony to 5 minutes each, if at all possible, and we will
start with Ms. Augustine.
STATEMENT OF LAUREN AUGUSTINE, LEGISLATIVE ASSOCIATE, IRAQ AND
AFGHANISTAN VETERANS OF AMERICA
Ms. Augustine. Chairman Isakson, Ranking Member Blumenthal,
and distinguished Members of the Committee, on behalf of Iraq
and Afghanistan Veterans of America and our more than 425,000
members and supporters, we would like to thank you for your
kind welcome and the opportunity to share our views on these
pieces of legislation.
IAVA supports each of the bills before the Committee today.
Having established that, I would like to focus my testimony on
two areas our members have expressed the greatest concern: one,
increasing access to health care and mental health care; and,
two, eliminating veteran homelessness.
Combating suicide among troops and veterans remains a top
priority for IAVA and its members. According to IAVA's 2014
member survey, 40 percent of respondents knew at least one Iraq
or Afghanistan veteran who had died by suicide and 47 percent
of respondents knew at least one veteran who had attempted
suicide. While the work conducted by this Committee on the Clay
Hunt SAV Act is greatly appreciated, there is still much more
work to be done. First and foremost is the need to ensure that
the Clay Hunt SAV Act is being implemented appropriately, and
IAVA strongly urges the Committee to hold an oversight hearing
before the end of 2015 to this end.
IAVA recognizes that the VA provides a needed service by
staffing mental health care providers specifically trained to
understand military experiences and by using evidence-based
treatments proven most effective. There is no question that the
VA should remain the leading experts on veteran-specific care
and services. However, many veterans do choose to seek care
outside of the VA system. According to the 2014 IAVA member
survey, 58 percent of respondents used VA health care, which
leaves a sizable percentage potentially seeking non-VA care. In
light of that, IAVA supports the measures outlined in S. 717 to
identify non-VA mental health care providers that have
Fostering a greater awareness of military culture and best
practices of care among non-VA providers will strengthen the
overall community of care available to veterans. IAVA
encourages the Members of this Committee to recognize the
potential benefit of this program and work together to help
connect veterans to a valuable network of providers.
Tied to the mental health care needs of veterans, ensuring
greater access to VA health care must remain a top priority in
order to prevent a repeat of the egregious situation that came
to light out of Phoenix in 2014. While the Choice Act created a
foundation for change at the VA, there are additional areas of
concern that still need to be resolved. In understanding that,
IAVA supports the numerous provisions in the DOCS Act that will
build on those initiatives to ensure the VA is adequately
meeting the needs of veterans.
The Choice Act included a provision to add 1,500 medical
residencies at the VA, but these residences are currently
included in the cap for Medicare-funded residencies, and it is
impacting the VA's ability to fully utilize this provision.
Excluding those residencies from the Medicare-funded cap will
give the VA and its local partners the ability to utilize the
increase in the manner in which it was intended.
IAVA also supports the 5-year extension to this residency
program and, in fact, would like to see the program made
permanent. Additionally, IAVA highly supports the provision to
increase the number of behavioral health residencies through a
pilot program in rural areas and encourages the Committee to
use the pilot program as a model for increased behavioral
health residencies across the entire country.
Another area of concern highlighted by some of today's
legislation addresses the continued effort to end veteran
homelessness. There has been considerable progress made at
addressing this issue in recent years, but there is now a need
to address some of the concerns that can arise when a veteran
may no longer be homeless but is still in need of transitional
assistance, and what communities should do moving forward with
the housing and services created to address homelessness. In
light of this, IAVA supports the Veteran Housing Stability Act.
After chronic homelessness is ended, or dramatically
reduced, there is a new need in communities to ensure veterans
can sustain permanent housing and to ensure providers
responsibly use existing transitional housing. The provisions
included in this legislation that aim to accomplish those goals
will help the VA and its community partners establish support
services that will help prevent veterans from falling back into
homelessness. IAVA applauds the type of planning this
legislation focuses on to continue ending veteran homelessness
and to prevent future veterans facing similar issues.
Focusing on a specific regional homelessness concern, the
West L.A. Homeless Veterans Leasing Act will help reinforce the
effort to end veteran homelessness in an area greatly affected
by the issue.
As a strong supporter of VA accountability and oversight,
IAVA understands the original need to remove this authority but
believes, under the leadership of Secretary McDonald and the
oversight provided in this legislation, the West L.A. campus is
poised to create a strong community for veterans. It is time
the VA utilize this space and support from the community for
its original purpose.
That support being stated, we are in close contact with our
members and many key activists on the ground in L.A. Listening
to their concerns, we must express concern that there may be a
special status granted to the UCLA baseball stadium. It is
imperative that Congress and the VA work together to address
this issue and ensure there are no competing directives, and a
veteran-centric model of care and service remain the priority.
At IAVA, we believe our members, and all veterans, deserve
the very best our Nation can offer when it comes to fulfilling
the promises made to them upon entry into the military. There
is no doubt that every Member of this Committee has the best
interests of our veterans in mind when drafting legislation.
Thank you for your time and attention. I am happy to answer
any questions you may have.
[The prepared statement of Ms. Augustine follows:]
Prepared Statement of Lauren Augustine, Legislative Associate,
Iraq and Afghanistan Veterans of America
Bill # Bill Name or Subject Sponsor IAVA Position
S.717 Community Provider Sen. Donnelly/Ernst Support
Recognition Act of
S.1676 DOCs for Veterans Act Sen. Tester Support
S.1754 Amend title 38 to Sen. Shaheen Support
make permanent the
increase in number
of judges presiding
over the United
States Court of
Appeals for Veterans
S.1885 Veteran Housing Sen. Blumenthal Support
Stability Act of
S.2013 Los Angeles Homeless Sen. Feinstein/Boxer Support
Veterans Leasing Act
S.2022 Amend title 38 to Sen. Graham Support
increase the amount
of special pension
for Medal of Honor
Chairman Isakson, Ranking Member Blumenthal and Distinguished
Members of the Committee; On behalf of Iraq and Afghanistan Veterans of
America (IAVA) and our more than 425,000 members and supporters, we
would like to extend our gratitude for the opportunity to share our
views and recommendations regarding these pieces of legislation.
IAVA supports each of the bills before the Committee today. Having
established that, I would like to focus my testimony on two areas that
our members have expressed the greatest concern: (1) increasing access
to health care and mental health care; and (2) eliminating veteran
Combating suicide among troops and veterans remains a top priority
for IAVA and its members. According to IAVA's 2014 member survey, 40%
of respondents knew at least one Iraq or Afghanistan veteran who has
died by suicide and 47% of respondents knew at least one Iraq or
Afghanistan veteran who had attempted suicide. While the work conducted
by this Committee on the Clay Hunt Suicide Prevention for America Act
is greatly appreciated, there is still much more work to be done with
regard to providing mental health care and support to veterans and
their families. First and foremost is the need to ensure that the Clay
Hunt Act is being implemented appropriately, and IAVA strongly urges
the Committee to conduct an oversight hearing before the end of 2015 to
IAVA recognizes that the Department of Veterans Affairs (VA)
provides a unique, and needed, service by staffing mental health care
providers specifically trained to understand military culture and
experiences, and by using evidence-based treatments proven most
effective at treating the mental health concerns facing veterans. There
is no question that the VA should remain the leading experts on
veteran-specific care and services. However, many veterans do choose to
seek care outside of the VA system. According to the 2014 IAVA member
survey, 58% of respondents used VA health care, which leaves a sizable
percentage seeking non-VA care. In light of that, IAVA supports the
measures outlined in S. 717 to identify non-VA mental health care
providers that have military-specific competencies.
Fostering a greater awareness of military culture and best
practices of care among non-VA providers will increase access to care
and strengthen the overall community of care available to veterans,
which are two key components in decreasing veteran suicide.
Additionally, providing a mechanism for private providers to identify
themselves as having military competencies will encourage more
providers to gain that knowledge and provide evidence-based treatment
to veterans in their communities. There are already several mechanisms
in place to aid in a quick and efficient implementation of this program
while not increasing the workload of the VA. IAVA encourages the
Members of this Committee to recognize the potential benefit of this
program and work together to help connect veterans to a valuable
network of providers.
Tied to the mental health care needs of veterans, ensuring greater
access to VA health care must remain a priority for all in the veteran
community in order to prevent a repeat of the egregious situation that
came to light out of Phoenix in 2014. While the Choice Act created a
foundation for change at the VA, there are additional areas of concern
that still need to be resolved. In understanding that need, IAVA
supports the numerous provisions in the Delivering Opportunities for
Care and Services for Veterans (DOCS) Act that build on the initiatives
of the Choice Act to ensure the VA is adequately meeting the needs of
veterans seeking care.
The Choice Act included a provision to add 1500 Graduate Medical
Education slots, or medical residences, at the VA to help increase
awareness of the opportunities available at the VA. These residences
are currently included in the cap for Medicare-funded residences and it
is impacting the VA's ability to fully utilize the increase in
residencies. This legislation excludes those 1500 residences from the
Medicare-funded cap to give the VA and its local partners the
capability of utilizing the residency increase in the manner in which
it was intended. This legislation also extends the residency program
created by the Choice Act by five years to allow for realistic
maturation of the residency program. IAVA supports this extension and
in fact, would like to see the program made permanent. Additionally,
IAVA highly supports the provision to specifically increase the number
of behavioral health residencies through a pilot program in rural areas
and encourages the Committee to use the pilot program as a model for
increased behavioral health residences across the entire country.
Another area of concern highlighted by some of today's legislation
addresses the rate of veteran homelessness across the country. There
has been considerable progress made at addressing this issue in recent
years, but the fact that tens of thousands of veterans remain homeless
on a given night is a harsh reminder that there is need for additional
support and services.
Given the progress made to end chronic veteran homelessness, there
is now a need to address some of the concerns that can arise when a
veteran may no longer be homeless, but is still in need of transitional
assistance; and what communities should do moving forward with the
housing and services created to address homelessness. In light of this,
IAVA supports the Veteran Housing Stability Act, which builds on the
successes of existing homeless prevention programs while addressing
some of the shortfalls that need to be filled.
After chronic homelessness is ended, or dramatically reduced, there
is a new need in communities to ensure veterans can sustain permanent
housing and to ensure providers responsibly use existing transitional
housing. The provisions included in this legislation that aim to
accomplish those goals will help the VA and its community partners
establish support services for veterans that will help prevent veterans
from falling back into homelessness. IAVA applauds the progress the VA,
community partners and state agencies have made at eradicating veteran
homelessness, and encourages the type of long-term planning this
legislation focuses on to continue ending veteran homelessness and to
prevent future veterans facing the same problem.
Focusing on a specific regional homelessness concern, the West Los
Angeles (L.A.) Homeless Veterans Leasing Act of 2015 will restore the
ability of the West L.A. VA Campus to enter into enhanced use leases
with community and state partners, which will help reinforce and
support the effort to end veteran homelessness in an area greatly
affected by the issue.
As a strong supporter of VA accountability and oversight, IAVA
understands the original need to remove this authority, but believes
under the leadership of Secretary McDonald and the oversight provided
in this legislation, the West L.A. campus is poised to create a strong
community for veterans in need of support. It is time the VA utilize
this space and support from the community for its original purpose.
That support being stated, IAVA does encourage the Members of this
Committee to work closely with the VA to ensure this legislation is
supportive of and in congruence with the upcoming VA Master Plan set to
be released in the near future. It is imperative that Congress and the
VA work together to address this issue and ensure there are no
competing directives; a veteran-centric model of care and services must
continue to be the priority.
At IAVA, we believe our members, and all veterans, deserve the very
best our Nation can offer when it comes to fulfilling the promises made
to them upon entry into the military. There is no doubt every Member of
this Committee has the best interests of our veterans in mind when
drafting legislation. But we do hope you take into consideration and
implement what we, and our fellow veteran service organizations, have
had to say on these pieces of legislation today.
Thank you for your time and attention. IAVA is happy to answer any
questions you may have.
Chairman Isakson. Thank you.
STATEMENT OF LOUIS CELLI, JR., DIRECTOR, NATIONAL VETERANS
AFFAIRS AND REHABILITATION DIVISION, THE AMERICAN LEGION
Mr. Celli. Chairman Isakson, Ranking Member Blumenthal, and
distinguished Members of this Committee, on behalf of our
National Commander, Dale Barnett, and the over 2 million
members of The American Legion, we thank you for this
opportunity to testify regarding The American Legion's
positions on legislation pending before this Committee, and we
appreciate the Committee's focus on these critical issues that
will have a direct effect on veterans and their families.
It is a rare and gratifying experience for The American
Legion when we can testify that we stand behind and support
every bill being offered for consideration during a hearing,
and The American Legion would like to take this opportunity to
thank and congratulate this Committee and especially the
leadership here today for their excellent bipartisan efforts on
behalf of the Nation's veterans who have been numbed by the
constant and ongoing drone of negative press regarding their
Department of Veterans Affairs.
The most comprehensive bill being considered today is
S. 1676, which broadens the ability of VA to fill its ranks
with qualified medical staff while attempting to compensate for
income disparities suffered by certain geographical areas.
While The American Legion supports this proposed legislation,
we take a moment to recognize some of the non-monetary benefits
of serving our veteran community while employed by VA: set
schedules, defined hours, protection from malpractice claims, a
vast network of resources, cutting-edge research opportunities,
and the personal fulfillment of noble service, just to name a
No one at this witness table or sitting at that dais is
here because we were offered maximum earning potential. So,
while The American Legion certainly supports competitive pay
for all VA employees, we are also mindful of the need to make
VA employment a more attractive employment option through non-
monetary incentives. While money is going to be helpful, the
best people to serve veterans are the ones that are motivated
by an internal code and ethos. We cannot ignore financial
reward, but we should not make that our primary recruitment
S. 1745 addresses a critical need at the Court of Veterans
Appeals. The attempt to clear the claims backlog has grown to a
fever pitch, and the backlog of claims appeals has grown to
unprecedented levels. Ensuring that the Court remains fully
staffed with law judges could not be more important than it is
today, and with the transitioning administration set to
coincide with several projected retirements at the Court, the
time to ensure veterans are not suffering needlessly due to a
crippled court is now.
A little over a year from now, The American Legion,
together with our sister VSOs, will host an inaugural ball
honoring the 78 living recipients and the 3,500 heroes who are
no longer with us who have earned the Nation's highest military
award, the Medal of Honor. At that event, it will be an honor
for us to let them know that this Committee supported adjusting
their monthly compensation to a more realistic value, something
that has not been done in over 10 years. And while a handful of
them currently live in California, they will also be interested
to hear an update about the West Los Angeles campus.
I was particularly encouraged, Chairman, to hear your
comments regarding the template that you look forward to
hearing about to see if we can generate revenue in other VA
facilities across the Nation. The American Legion has been
protesting the misuse of the West Los Angeles Campus VA medical
center land use since 1983, and we applaud VA's efforts to work
with litigants to come to an agreement that benefits veterans
while honoring the original deed set forth by the Jones and
Baker families in 1888.
While we absolutely support moving forward on legislation
that establishes limited future leasing that only benefits Los
Angeles area veterans, we remain angered over the lack of
accountability of revenue that was lost and remains unaccounted
for over the last several years through the illegal leasing
practices employed by VA. Millions of dollars remain
unaccounted for, and the employees responsible continue to
retire and move on before answering for the missing money that
was supposed to support veterans in Los Angeles. When The
American Legion asked VA officials for an accounting of those
funds, we were repeatedly told, ``We will get back to you.'' We
need accountability, and we need it now.
Finally, The American Legion notices that there is no
advisory committee involved in this process that includes any
veterans service organizations. We ask you, How will the
veteran's voice be heard if not so much is being asked?
[The prepared statement of Mr. Celli follows:]
Prepared Statement of Louis Celli, Jr., Director, National Veterans
Affairs & Rehabilitation Division, The American Legion
Chairman Isakson, Ranking Member Blumenthal, and distinguished
Members of the Committee: On behalf of our National Commander, Dale
Barnett, and the over 2 million members of The American Legion, we
thank you for this opportunity to testify regarding The American
Legion's positions on pending legislation before this Committee. We
appreciate the Committee focusing on these critical issues that will
affect veterans and their families.
s. 717: community provider readiness recognition act of 2015
To designate certain non-Department mental health care providers who
treat members of the Armed Forces and veterans as providers who have
particular knowledge relating to the provision of mental health care to
members of the Armed Forces and veterans, and for other purposes.
This bill would designate certain non-Department mental health care
providers who treat members of the Armed Forces and veterans as
providers who have particular knowledge relating to the provision of
mental health care to members of the Armed Forces and veterans. The
American Legion believes by establishing a registry of Non-VA Mental
Health Care providers who have been designated by the Department of
Veterans Affairs (VA) or Department of Defense (DOD) to understand VA/
DOD culture is beneficial to the veteran and their family. This bill
would ensure there are designated non-VA/DOD mental health providers
that are readily available to treat veterans and help to reduce mental
health access wait times within the VA Healthcare system.
The American Legion supports S. 717.
s. 1676: delivering opportunities for care and services for veterans
act of 2015
To increase the number of graduate medical education positions treating
veterans, to improve the compensation of health care providers, medical
directors, and directors of Veterans Integrated Service Networks of the
Department of Veterans Affairs, and for other purposes.
This bill would give the VA increased tools and the flexibility to
effectively and efficiently recruit and retain qualified healthcare
professionals to practice and provide health care services to veterans
living in rural and highly rural areas across the country.
Section 101: Disregard of resident slots that include VA training
against the Medicare graduate medical education limitations
This section would ensure that up to 24 Graduate Medical Education
(GME) residency slots within VA would not count toward the current cap
under Section 301(b)(2) of the Veterans Access, Choice, and
Accountability Act of 2014.
Section 102: Extension of period for increase in graduate medical
education residency positions at medical facilities of the Department
of Veterans Affairs
Section 301 of the Veterans Access, Choice, and Accountability Act
of 2014 authorizes the VA to allocate 1,500 additional residency
positions over the next five years. This section would increase the
timeframe for residency positions within the VA healthcare system from
5 years to 10 years.
Section 103: Pilot program on graduate medical education residency
programs in behavioral medicine in underserved areas
This section authorizes VA, Indian Health Services (IHS), and the
Department of Health and Human Services (DHHS) to develop a six-year
pilot program to create no less than three behavioral health graduate
medical residency programs to be located in underserved, rural and/or
highly rural areas of the country.
Section 104: Inclusion of mental health professionals in education
and training program for health personnel of the Department of Veterans
This section in accordance with Title 38, United States Code
(U.S.C.) section 7302(a)(1) would include the education and training of
marriage and family therapists (MFTs) and licensed professional mental
health counselors (LPMHCs) as well as including these professions in
the VA's recruitment programs.
The American Legion supports the inclusion of licensed professional
mental health counselors (LPMHCs) and marriage and family therapists
(MFTs) as funded associated health trainees through the Department of
Veterans Affairs (VA) trainee support programs.\1\
\1\ American Legion Resolution No. 283: Licensed Professional
Mental Health Counselors and Marriage and Family Therapists: Aug 2014
Section 105: Expansion of qualifications for licensed mental health
counselors of the Department of Veterans Affairs to include doctoral
Title 38 U.S.C. section 7402(b)(11)(A) states that if a Licensed
Professional Mental Health Counselor is to eligible to be appointed to
a licensed professional mental health counselor position the individual
must have a masters degree in mental health counseling or a related
field from a college or university that is approved by the Secretary.
This section of the bill calls for individuals to have a doctoral
degree in the related mental health fields.
Section 201: Requirement that physician assistants employed by the
Department of Veterans Affairs receive competitive pay
This section would amend Title 38, U.S.C. section 7451(a) (2) by
inserting the name ``Physician Assistant'' in sections (b) and (c)
respectively. This part of the bill would allow Physicians Assistants
to be included into the Nurse Locality Pay System so that the Veterans
Health Administration (VHA) can stay competitive with the local
The American Legion supports legislation addressing the recruitment
and retention challenges that the VA has regarding pay disparities
among physicians and medical specialists who are providing direct
health care to our Nation's veterans.\2\
\2\ American Legion Resolution No. 101: Department of Veterans
Affairs Recruitment and Retention: Sept 2015
Section 202: Modification of education debt reduction program of
Department of Veterans Affairs to require a certain amount to be spent
in rural and highly rural areas.
This section would amend Title 38, U.S.C. section 7681 by inserting
a new subsection (c) to include that 30 percent of the debt reduction
allocated under the Education Debt Reduction Program each year shall be
paid to individuals who practice in a rural or highly area, where the
VA struggles to effectively recruit qualified mental health
Section 203: Report on medical workforce of the Department of
This section requires the Secretary of Veterans Affairs to submit a
medical workforce report to the Senate and House Veterans' Affairs
Committees. This report would provide the Committees an assessment of
how the VA is addressing medical workforce shortages to include the
The recruitment and integration of licensed professional
mental health counselors and marriage and family therapists;
To determine if VA is utilizing the education debt
To understand how VA is addressing barriers in delivering
For the Veterans Health Administration to provide an
assessment of succession plans regarding vacancies across the
Section 301: Establishment of positions of Directors of Veterans
Networks in Office of Under Secretary for Health of Department of
Veterans Affairs and modification of qualifications for Medical
This section would amend Title 38, U.S.C. section 7306(a)(4), by
inserting ``and Directors of Veterans Integrated Service Networks''
after ``Such Medical Directors;'' and by striking ``, who shall be
either a qualified doctor of dental surgery or dental medicine.''
Section 302: Pay for Medical Directors and Directors of Veterans
Integrated Service Networks
This section would provide the Secretary of Veterans Affairs the
flexibility within a new compensation system to provide VA Veterans
Integrated Service Network and Medical Center Directors the ability to
determine market pay and to address the pay disparities between VHA and
the private sector.
Section 401: Pilot program on providing nurse advice line for
veterans in rural and highly rural areas.
This section of the bill authorizes that the Secretary of Veterans
Affairs conduct a two-year pilot program to assess the feasibility of
implementing a nurse advice line to address questions veterans living
in rural and/or highly rural areas of the country have regarding their
health care, availability of benefits, and appointment and cancellation
services through an appointment clerk.
The American Legion urges the VA Office of Rural Health (ORH) to
ensure Rural Health Resource Centers provide services to rural veterans
from surveys, national hotlines and connecting veterans living in rural
communities with providers.\3\
\3\ American Legion Resolution No. 37: Department of Veterans
Affairs Rural Healthcare Program: Aug 2014
This legislation is broad in scope, with many helpful sections that
have the potential to improve the health care veterans receive from the
VHA. In particular, improvements to mental health counseling,
competitive salaries for medical professionals, and improvements to
rural health care options all address problem areas for VHA and will be
improved by the passage of this legislation.
The American Legion supports S. 1676
s. 1754: veterans court of appeals support act of 2015
To amend title 38, United States Code, to make permanent the temporary
increase in number of judges presiding over the United States Court of
Appeals for Veterans Claims, and for other purposes.
The Court is authorized seven permanent, active Judges, and two
additional Judges as part of a past temporary expansion provision. Over
the next two years a sequence of retirements risks resulting in the
Court falling to just five judges right when a new administration and
Congress have a thousand other nominations to worry about. Past history
tells us that it will take at least two years before anyone notices the
Court is drowning. With the Board growing and its output going up to
levels not seen since the Court was created, the CAVC will be in big
trouble if allowed to fall to five judges for multiple years.
Therefore, this needs to be addressed this year.
The American Legion has a long history of supporting the Court and
it would be a great disservice to veterans and the Court to not address
The American Legion supports S. 1754.
s. 1885: veterans housing stability act of 2015
To amend title 38, United States Code, to improve the provision of
assistance and benefits to veterans who are homeless, at risk of
becoming homeless, or occupying temporary housing, and for other
This bill would modernize and strengthen existing Department of
Veterans Affairs' housing programs for homeless and at-risk veterans.
Currently, VA reports there are approximately 50,000 homeless veterans,
representing 12% of America's adult homeless population. As these
numbers have declined and as progress is being made to end veterans'
homelessness, it has become clear that insufficient availability of
affordable permanent housing is an obstacle to fully achieving this
goal. This legislation aims to increase veteran access to permanent
housing options by encouraging landlords to rent to veterans, providing
grants for organizations that support formerly homeless veterans, and
modifying a VA program that sells homes from VA's foreclosure inventory
at a discount to nonprofit agencies.
This bill would also expand the definition of ``homeless veteran''
to provide additional benefits to veterans in need by including a
veteran or veteran's family fleeing domestic or dating violence, sexual
assault, stalking, or other dangerous or life-threatening conditions in
their current housing situation. Additionally, it would also codify the
VA's National Center on Homelessness to guarantee its continued role in
researching the most cost-effective approaches to ending veteran
homelessness and disseminating them to the field.
In conclusion, The American Legion believes that S. 1885 would
dramatically help end and prevent veteran homelessness. We strongly
believe that all programs to assist homeless veterans must focus on
helping them reach their highest level of self-management and this bill
helps in accomplishing that ultimate goal.
The American Legion supports S. 1885.
s. 2013: los angeles homeless veterans leasing act of 2015
To authorize the Secretary of Veterans Affairs to enter into certain
leases at the Department of Veterans Affairs West Los Angeles Campus in
Los Angeles, California, and for other purposes.
This bill would allow veterans who are currently living on the
streets to relocate to a more secure space on the campus of the West
Los Angeles Healthcare System for the purpose of receiving housing,
health care, education, family support, vocational training, and other
For nearly 80 years, the VA West Los Angeles Campus has been
providing disabled veterans a place to live and receive needed
services. For over 35 years, The American Legion has been actively
protesting the Department of Veterans Affairs misuse of the property.
Since that time the VA has been leasing the land to private businesses
in the area directly contrary to the explicitly stated original intent
when the land was donated by Senator John P. Jones and a prominent Los
Angeles family intending to serve the homeless veteran community in Los
\4\ HVAC O&I Hearing: An Examination of Waste and Abuse Associated
with VA's Management of Land-Use Agreements: Feb 2015
While The American Legion supports S. 2013, we want to ensure that
the revenues generated by these leases are benefiting the veteran
community, as well as enhancing the West Los Angeles VA facility
itself. We also want those revenues well documented and tracked and
continue to urge VA to report what had happened to the original funds
as The American Legion asked earlier this year. VA has continued to
fail to provide answers regarding accounting of funds collected from
commercial tenants of the West Los Angeles VA facility when the
organization violated land-use agreements. To date, the money collected
in exchange for use of campus assets has not been accounted for.
The American Legion opposes any Enhanced-Used-Lease that does not
specifically provide any obvious and permanent benefits, resources or
services to the veterans' community.\5\ This legislation can provide
tangible benefits to the veterans in the West Los Angeles area, but
there must be a complete and transparent accounting of the activities
on the property, past and present, to restore trust in the veterans'
\5\ Resolution No. 154: Department of Veterans Affairs Enhanced-
Used-Leasing: Aug 2014
The American Legion supports S. 2013.
To amend title 38, United States Code, to increase the amount of
special pension for Medal of Honor recipients, and for other purposes.
The American Legion enthusiastically supports an increase in the
special pension assigned to Medal of Honor recipients. For the 78
living recipients \6\ of this Nation's highest military honor, an
increase in the monthly pension based upon heroic acts in the face of
nearly insurmountable challenges is a small token of appreciation and
gratitude for their sacrifices. As the Nation's largest wartime
veterans service organization, The American Legion fully appreciates
the service of those awarded the Congressional Medal of Honor and
supports increasing their monthly pension to $3,000.
The American Legion supports S. 2022.
As always, The American Legion thanks this Committee for the
opportunity to explain the position of the over 2 million veteran
members of this organization. For additional information regarding this
testimony, please contact Mr. Warren J. Goldstein at The American
Legion's Legislative Division at (202) 861-2700 or
Chairman Isakson. Thank you, Mr. Celli.
STATEMENT OF ELISHA HARIG-BLAINE, PRINCIPAL HOUSING ASSOCIATE,
(VETERANS AND SPECIAL NEEDS), NATIONAL LEAGUE OF CITIES
Mr. Harig-Blaine. Thank you, Mr. Chairman. On behalf of the
more than 19,000 cities, villages, and towns represented by the
National League of Cities (NLC), I thank you and the Committee
for the opportunity to provide testimony this afternoon.
As required by law, I would like to disclose that I am
currently serving as a member of the VA's Advisory Committee on
NLC is dedicated to helping city leaders build better
communities. We serve as a resource for municipalities as well
as 49 State municipal leagues on a range of issues. Our work on
veterans' issues has been grounded in the areas of housing and
We are the lead partner with the Administration for the
Mayors Challenge to End Veteran Homelessness, and to date, more
than 800 leaders have accepted this challenge, including 628
mayors, 9 Governors, and 165 county and city officials. In
addition, our program work supports national technical
assistance initiatives that are accelerating local efforts to
end veteran homelessness.
Given our organizational focus on veteran housing and
homelessness, my testimony will remain concentrated on S. 1885
and S. 2013, but we welcome the opportunity to support the
Committee and its staff regarding all legislation under review.
S. 1885 makes many needed amendments that will improve how
VA can and should serve homeless veterans and their families,
but we believe there are several opportunities to further
enhance these proposals.
Sections 3 and 4 of the bill propose two new programs and
require VA to issue reports analyzing their effectiveness. For
the report analyzing the effectiveness of a program providing
intensive case management services to veterans, we encourage
the VA also to be required to include costs that are incurred
beyond the Department alone.
We encourage the collection of information regarding costs
that are incurred by other entities including cities, counties,
and States, as well as costs that are not related to the
provision of health care and benefits. For example, costs
associated by the interactions veterans have with the public
safety, judicial, and penal systems, while not incurred by the
VA, should be measured to allow for a more robust cost-benefit
analysis of the intensive case management intervention services
that the Department would provide as part of this program.
By documenting the costs incurred by entities outside of
VA, the report can support municipal leaders in their efforts
to ensure that limited local resources are used in the most
cost-effective manner to end veteran homelessness.
For the report analyzing the success of awarding grants to
transitional housing providers to incentivize the conversion of
facilities into permanent housing, we encourage the review and
analysis of this program to include the depersonalized
information regarding mental health diagnoses and histories of
substance abuse. The collection of this information can help
develop and/or further our understanding about the impact that
mental health and substance abuse plays in the retention of
In regards to the legislation's direction that HUD and VA
collaborate with outside partners to improve outreach to
landlords, we recommend that VA and HUD be required to
separately, but not independently, provide a report to both the
House Committee on Veterans' Affairs and this Committee on how
they would use this within their respective organizational
structures and with key national partners.
Finally, in regards to the establishment of the National
Center on Homelessness among Veterans, NLC has seen the
tremendous impact that the National Center has played in
advancing local efforts to end veteran homelessness. As cities
across the country begin to see what the end of veteran
homelessness looks like, they must be able to work with Federal
partners and ensure the proper resources are in place to keep
veteran homelessness rare, brief, and non-recurring. The
National Center's work allows this to happen, and we support
the bill's efforts to formally establish the center.
Furthermore, we urge that the center be permanently authorized
as quickly as possible.
In regards to S. 2013, NLC strongly urges the Committee to
advance this bill and work closely with your colleagues in the
House and senate to have the legislation passed as soon as
possible. As the Committee is aware, the support for this bill
has come from the L.A. County Board of Supervisors and Mayor
Eric Garcetti. In addition, L.A. Councilmembers Mike Bonin and
Bob Blumenfield have written letters of support, which we have
attached to our written testimony. Councilmember Bonin has also
filed a resolution in support of this bill for consideration
and approval by the full city council. A copy of the resolution
is attached with our testimony, and it is expected the
resolution will pass when voted upon tomorrow.
Mr. Chairman, I again express the National League's
appreciation for the opportunity to speak before the Committee
today, and I welcome the opportunity to answer any questions.
[The prepared statement of Mr. Harig-Blaine follows:]
Prepared Statement of Mr. Elisha Harig-Blaine, Principal Housing
Associate (Veterans & Special Needs), City Solutions & Applied
Research, National League of Cities
s. 1885, veteran housing stability act of 2015
In December 2013, Phoenix, AZ became the first city in the United
States to end chronic veteran homelessness. When announcing this
milestone, Phoenix Mayor Greg Stanton said, ``The strategies that we're
using to end chronic homelessness among veterans are the exact same
strategies that we're going to use to end chronic homelessness among
the broader population. This model--doing right by our veterans--is
exactly how we're going to do right by the larger population.''
Since then, cities such as New Orleans; Houston; Binghamton, NY;
Pocatello, ID; Las Cruces, NM; Mobile, AL; and Troy, NY have
illustrated what the end of veteran homelessness looks like.
While the progress on veteran homelessness is unprecedented,
improvements can still be made and S. 1885 is an acknowledgement of
this reality. As discussed by Senator Blumenthal during his remarks
while introducing this legislation, S. 1885 seeks to modernize housing
programs provided by the U.S. Department of Veterans Affairs (VA), to
ensure they are appropriately meeting the needs of homeless veterans
and their families.
S. 1885 makes many needed amendments that will improve how VA can
and should serve homeless veterans and their families, but we believe
there are several opportunities to further enhance these proposals.
In Section 3, ``Program on Provisions of Intensive Case Management
Interventions to Homeless Veterans Who Receive the Most Health Care
From the Department of Veterans Affairs,'' S. 1885 would require VA to
pilot intensive case management services in no less than six locations.
The proposed legislation requires VA to issue a report analyzing the
effectiveness of this program no later than December 1, 2018.
In delineating the content of this proposed report, S. 1885
requires VA to provide ``An estimate of the costs the Department would
have incurred for the provision of health care and associated services
to covered veterans (as described in subsection (b) of section 2067 of
such title, as added by subsection (a)(1)) but for the provision of
intensive case management interventions under the program,
disaggregated by provision of intensive case management interventions
in locations described in subparagraphs (A) and (B) of subsection (c)
of such section.''
NLC encourages the authors and co-sponsors of this proposed
legislation to expand the requirements of VA in this section of the
report to include costs beyond those incurred by the VA alone but for
the provision of intensive case management interventions.
NLC encourages the collection of information regarding the costs of
providing health care and associated services to veterans that are
incurred by other entities including cities, counties and states, as
well as costs that are not related to the provision of health care and
For example, costs associated by the interactions covered veterans
have with the public safety, judicial and penal systems, while not
incurred by the VA, should be measured to allow for a more robust cost-
benefit analysis of the intensive case management intervention services
that VA would provide as part of this program.
By documenting the costs incurred by entities outside of VA, the
report required by S. 1885 can support municipal leaders in their
efforts to ensure that limited local resources are used in the most
cost-effective manner to end veteran homelessness.
In Section 4, ``Program to Improve Retention of Housing by Formerly
Homeless Veterans and Veterans at Risk of Becoming Homeless,'' S. 1885
would give grants to providers who have successfully housed veterans in
transitional housing programs to incentivize these organizations to
convert facilities into locations that provide permanent housing.
To analyze the impact of this program, S. 1885 requires a report be
submitted to the Committee's on Veterans' Affairs in both the House and
Senate no later than June 1, 2019.
S. 1885 requires this report to review the proposed program using
four overall assessment areas. NLC encourages a broadening of the
information sought within each of these areas.
NLC encourages the review and analysis of this program to also
capture de-personalized information regarding any mental health
diagnoses of veterans, as well as any assessment regarding their
histories of substance use and/or abuse. In collecting this
information, it is hoped that a more accurate understanding can be
developed about the impact mental health and substance abuse plays in
the retention of housing.
In Section 6, ``Outreach Relating to Increasing the Amount of
Housing Available to Veterans,'' S. 1885 directs the Secretaries of VA
and the U.S. Department of Housing and Urban Development (HUD) to
collaborate with numerous entities in an effort to increase the number
of housing units identified and committed for housing homeless
The recruitment of landlords to join collaborative community
efforts to end veteran homelessness is both vital and challenging.
Thanks to the Mayors Challenge to End Veteran Homelessness, community
stakeholders are increasingly partnering with committed local leaders
to use their platforms in order to raise public awareness about the
need for landlords to be more actively involved in ending veteran
homelessness. Successful landlord recruitment events have occurred in
cities such as Los Angeles, Seattle, Chicago and Dallas. NLC is
currently working with elected officials and community partners in
Tucson, Charleston and Omaha to recruit landlords.
NLC recommends that S. 1885 require VA and HUD to separately, but
not independently, provide a report to both the House Committee on
Veterans' Affairs and the Senate Veterans' Affairs Committee on how
they would execute this within their respective organizational
structures and with key national partners.
In Section 7, ``Establishment of National Center on Homelessness
Among Veterans,'' S. 1885 directs the Secretary of VA to establish and
operate a center which carries out multiple functions, including the
integration of ``evidence-based and best practices, policies, and
programs into programs of the Department for homeless veterans and
veterans at risk of homelessness and to ensure that the staff of the
Department and community partners can implement such practices,
policies, and programs.''
NLC draws the Committee's attention to the latter portion of this
As cities across the country begin to see what the end of veteran
homelessness looks like, their ability to ensure this tragedy never
returns becomes paramount. For veteran homelessness to be kept rare,
brief and non-recurring, cities must be able to work with Federal
partners and ensure the proper resources are in place. The National
Center on Homelessness Among Veterans' work to aggregate data helps
Federal and local officials make decisions about resource allocations
allowing all stakeholders to know they can maintain their progress.
To allow the National Center to do this critical work, among its
other activities, NLC urges the Committee to work with Senate
colleagues and provide permanent authorization for the center as
quickly as possible.
s. 2013, los angeles homeless veterans leasing act of 2015
In January 2015, VA resolved a long-standing conflict with numerous
community partners in the Los Angeles area regarding the use of the
West Los Angeles Campus.
To ensure and support the execution of the agreement VA entered
into, Senators Feinstein and Boxer joined Representative Lieu in
sponsoring S. 2013 and filed a letter with the Committee in August.
Support for S. 2013 has come from the Los Angeles County Board of
Supervisors, Mayor Eric Garcetti, and Los Angeles Councilmembers Mike
Bonin and Bob Blumenfield have also written letters of support, which
NLC attaches to this testimony (see NLC testimony appendix A and B).
In addition, Councilmember Bonin has filed a resolution in support
of S. 2013 for consideration and approval by the full city council. A
copy of the resolution is attached with our testimony and it is
expected the resolution will pass when voted upon on October 7 (see NLC
testimony appendix C).
Given the high concentration of homeless veterans in Los Angeles
and the report from earlier this year that the number of homeless
veterans in the city has increased 6% since last year, NLC strongly
urges the Committee to advance this bill and work closely with
colleagues in the House and Senate to have this legislation passed as
soon as possible.
Attachments: Appendix A
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Chairman Isakson. Thank you very much.
STATEMENT OF DAVID B. NORRIS, NATIONAL LEGISLATIVE VICE-
CHAIRMAN, DEPARTMENT OF CALIFORNIA, VETERANS OF FOREIGN WARS OF
THE UNITED STATES
Mr. Norris. I would like to start off this afternoon by
thanking Committee Chairman Johnny Isakson and Ranking Member
Richard Blumenthal for allowing me the opportunity to testify
on S. 2013.
I would also like to thank Senator Diane Feinstein and
Senator Barbara Boxer for sponsoring this bill.
I am here today along with Nick Guest. He is our national
chaplain and the Veterans of Foreign Wars (VFW) State of
California adjutant/quartermaster. He was also a VSO in L.A.,
and he uses the L.A. VA facilities. We are here representing
the over 88,000 VFW members from the State of California who
are all in complete support of S. 2013, which lays the
groundwork to return the West L.A. campus to where it belongs--
While this bill specifically addresses the property located
in Los Angeles, the larger issue of VA doing the right thing is
important to all veterans.
I am also the Student Veterans of America Chairman for the
Veterans of Foreign Wars in California, and as I travel to the
different college campuses, I hear the same question from our
young veterans as I have for years from our older veterans:
What is VA doing to help those who really need help like our
homeless or our veterans with PTSD? I do not have the answer,
but I think this is a start.
California has one of the largest homeless veterans
populations in the country. A lot of these veterans are also
female veterans. Some have problems with drug and alcohol
addiction, while others are contemplating suicide.
If housing could be approved under the Master Plan or be
able to increase housing for these veterans and their families,
we may be able to bring some of our veterans back into becoming
productive citizens of our great country. They served for us.
Now let us help serve them.
We now have a new VA Director in Southern California, and
now is the perfect time to put this property back on track. I
am not here to throw anyone under the bus for things that
happened in the past. We cannot change the past or the things
that have happened in the past, and it is a waste of your time
to sit and listen to the old stories.
The West L.A. campus was deeded through a will to the
Federal Government with the explicit intent for the property to
be used to assist veterans. Over time, VA lost sight of that
intent and leased out parts of this property--which is over 300
acres--to private entities and has made little to no repairs or
improvements for the veterans it was intended for. This bill
returns this property to its veterans, and Congress should work
quickly to pass this into law now.
Along with us, the VFW, we are currently working with The
American Legion, Purple Heart Association, Disabled American
Veterans, and many other veterans service organizations to make
sure things are done correctly as we move forward.
Again, thank you for allowing me to testify for all the
veterans in California and around the world. Stand with us
today and help us move this important bill forward.
[The prepared statement of Mr. Norris follows:]
Prepared Statement of David B. Norris, VFW National Legislative Vice-
Chairman, Department of California, Veterans of Foreign Wars of the
I would like to start off this afternoon by thanking Committee
Chairman Johnny Isakson and Ranking Member Richard Blumenthal for
allowing me the opportunity to testify on S. 2013.
I would also like to take this time to thank Senator Diane
Feinstein and Senator Barbara Boxer for sponsoring this bill.
I am here today along with Nick Guest our National Chaplain and the
Veterans of Foreign Wars California State Adjutant/Quartermaster. We
are here representing the over 88,000 VFW members from the state of
California who are in complete support of S. 2013, which lays the
ground work to return the West LA campus to where it belongs--veterans.
While this bill specifically addresses the property located in Los
Angeles, the larger issue of VA doing the right thing is important to
I am also the Student Veterans of America Chairman for the VFW in
California and as I travel to the different college campuses I hear the
same question from our young veterans as I have for years from our
older veterans--What is VA doing to help those who really need help
like our homeless or our veterans with PTSD?
California has one of the largest homeless veterans' populations in
the country. A lot of these veterans are also female veterans. Some
have problems with drug and alcohol addiction, while others are
If housing could be approved under the Master Plan or be able to
increase housing for these veterans and their families, we may be able
to bring some of our veterans back into becoming productive citizens of
our great country. They served for us, now let's help serve them.
We now have a new VA Director in Southern California and now is the
perfect time to put this property back on track. I am not here to throw
anyone under the bus for things that have happened in the past. We
cannot change those things and it is a waste of your time to sit and
listen to old stories.
The West LA campus was deeded through a will to the Federal
Government with the explicit intent for the property to be used to
assist veterans. Over time, VA lost sight of that intent and leased out
parts of this property (which is over 300 acres) to private entities
and has made little to no repairs or improvements for the veterans it
was intended for. This bill returns this property to its veterans and
Congress should work quickly to pass it into law.
Along with us, the VFW, we are currently working with the American
Legion, Purple Heart Association, DAV and many other veteran service
organizations to make sure things are done correctly as we move
Again, thank you for allowing me to testify for all the veterans in
California and around the world. Stand with us today and help us move
this important bill forward.
Chairman Isakson. Thank you, Mr. Norris. I want to commend
all of you and your comments regarding West L.A. In particular,
Mr. Celli, I think you made a great comment when you talked
about being angry about how the funds and the proceeds of those
leases have been handled. We really do not know how they have
been handled, to tell you the truth. There has been a lack of
coordination. As a guy who did real estate development for 33
years, if you do not have a plan to execute or a goal to
execute, you do not have an understanding of what assets that
you have, you never can maximize your return. This is a very
valuable piece of real estate that has kind of been used here
and used there with no direct tracking of the money, so I
commend you for your testimony.
You, too, Mr. Norris. This is the time for us to get it
right. I hope when the VA puts out their Master Plan, a
proposed Master Plan, that both your organizations will
comment, all of you will comment on that use, because we do
need to get it right. It kind of reminds me of the Denver
hospital. The Denver hospital got kicked down the road for 13
years, the cost overruns, nobody ever had a plan. We finally
got a plan together. Now we are going to finish it, but it is
costing us a lot of money. I think it has cost and deprived
veterans of a lot of benefits over the years by not having a
Master Plan that we could follow.
I also agree on the question on homelessness. I think it is
an unbelievable opportunity to have some land that can be used
to help veterans' homelessness in West Los Angeles and Los
Angeles County, California, and I support that entirely. I
think Senator Feinstein has done a good job of raising to the
attention of the Senate this piece of legislation, and we will
move forward. But we want your input and support, so when the
VA publishes their recommended Master Plan, I hope each and
every one of you will get your organizations to quickly and
efficiently give us your feedback on those plans.
I am hoping as Chairman of this Committee that this will be
a template for how we deal with other surplus land the VA owns
around the country today. We are sitting on a ham sandwich
starving to death, in my opinion, by having a lot of vacant
property that could be benefiting us that is not because we do
not have a plan. It is time we had a plan to see that that
revenue went to the benefit of our veterans.
On the Court, going to nine judges, I understand we have
eight judges now? The ninth one would be a Presidential
The legislation proposes the authority to take it to nine.
My question, I guess I will start with Ms. Augustine. I happen
to understand the backlog, and I think it is an important need,
but at some point in time in the future, if that is not the
necessary number of judges that we need, should that be a
floating cap or should that be a permanent cap in terms of the
number of judges?
Ms. Augustine. Mr. Chairman, there is currently a great
need to address the significant backlog, and until that is
addressed and focused, I think it is smart to make that a
permanent increase and then reevaluate that need as it is no
longer needed down the road. There will be a significant
backlog for the foreseeable future, and that should be our
Chairman Isakson. I want to thank all of you for your
testimony regarding Senator Graham's proposal on the Medal of
Honor recipients. I happen to associate myself with the
comments that each and every one of you made.
One of the rules I have put in as Chairman of the Committee
is that we do not do anything that we cannot pay for. We talk
about billions of dollars and millions of dollars often. This
is, as I understand it, a $16 million price tag to see to it
that the Medal of Honor winners get enhanced compensation,
which I happen to support as well. But if each and every one of
you would give us any input on where you think we might take
that money to pay it and offset the cost of that benefit, we
would appreciate that very much.
With that said, we will go to the Ranking Member, Senator
Senator Blumenthal. Thanks, Mr. Chairman.
I think all this testimony has been enormously valuable,
and I appreciate particularly, Mr. Norris, your mention of both
homelessness and Post Traumatic Stress, PTS. In fact, the two
are linked; are they not?
Mr. Norris. Correct.
Senator Blumenthal. Because somebody who is suffering from
PTS is more likely to also suffer from addiction, homelessness,
lack of employment, or a combination of factors that in effect
result from the medical condition, often invisible, obviously,
that is the source of it. I appreciate your comments on that
Ms. Augustine, I also thank you for your support of all
those measures, the five--or six, I should say, that you
mention. On the numbers of veterans--well, the number of judges
on the U.S. Court of Appeals for Veterans Claims, you rightly
mention the likelihood of a continuing large caseload there. In
fact, the caseload has been rising, has it not?
Ms. Augustine. To my knowledge, yes, it has been rising.
Senator Blumenthal. That is in part the result of the VA
doing better on disability claims at the first level because
the more cases that are processed, the more likely there are to
be appeals in higher numbers. Is that correct?
Ms. Augustine. Yes, that is also what IAVA has supported in
Senator Blumenthal. The increase, in my view, really ought
to be a permanent one. It is always possible to contract the
Court, but that number should not be a temporary one, in my
Let me ask you about the Community Provider Readiness
Recognition Act, which would recognize providers in the
community for mental health care services. There is such a
desperate shortage. I support this measure. I have some
questions about possibly endorsing the use of certain community
mental health providers who may not have the same training as
VA providers. Do you have a suggestion as to how we can
possibly address that shortcoming?
Ms. Augustine. Yes, sir. I think the best case to do here
is to utilize the success of the Star Behavioral Health Program
in DOD and replicate those same successes in the VA. It has
been a successful program for veterans in rural areas and the
National Guard, and I think it is time that we open up those
same successes to veterans.
Senator Blumenthal. Great. Great answer. With respect to
the Veteran Housing Stability Act of 2015, I can see some
people saying, well, we have already done so much on
homelessness and housing. Do you have a response to them?
Ms. Augustine. Yes, sir. Having spoken with your staff
extensively about this bill, as I understand it, this bill is
actually looking at the next stage of addressing veteran
homelessness, not necessarily chronic homelessness or the
immediate need for stable housing, but what is the next step.
We applaud the long-term planning that this legislation focuses
on and think that it is the correct thinking in looking at what
needs to come next to prevent this same sort of epidemic from
happening in the future.
Senator Blumenthal. In fact, the goal here is to go beyond
meeting the immediate, as you say, the urgent apparent need
that may be on the streets right now, but to provide a more
permanent solution, and that is the goal here, an equally
difficult goal, but one that I think we have an obligation to
I thank every one of you for your testimony today. It has
been, as I mentioned earlier, enormously valuable, and, again,
thank you for your service to our country.
Thank you, Mr. Chairman.
Chairman Isakson. Senator Boozman.
Senator Boozman. Thank you, Mr. Chairman.
Mr. Celli, Ms. Augustine, the VA voiced opposition to
S. 717 with concerns of legal, credentialing, and privacy
issues. Tell me a little bit, have your organizations looked
into this as far as what it would take as far as credentialing
and this and that. Can you comment a little bit further about
that particular bill?
Mr. Celli. We have not specifically looked into the
credentialing issue because we understand that VA does have a
good credentialing program in place. However--and this bill is
very comprehensive, as we discussed earlier on in the
testimony. The American Legion knows that the current need is
not being met.
Senator Boozman. Right.
Mr. Celli. We support any legislation that seeks to
increase that need. We supported the Choice Act. We did support
the Choice Act as a template to see where the VA needed some
additional resources, and these are the types of pieces of
legislation that are starting to address that and what was
ferreted out by the Choice Act.
Senator Boozman. Ms. Augustine.
Ms. Augustine. I would reiterate that and include once
again utilizing the success of the Star Behavioral Health
Program as a model to implement this for veterans. It has been
proven to be effective, and I think that we can replicate those
successes easily for veterans.
Senator Boozman. Very good. Ms. Augustine, tell me about--
in your testimony, you mention the progress that we have made
in homelessness in the VA and that they have been working hard
to do that and that we are moving in the right direction. The
West L.A. plan of having a strong community for veterans'
needs, which seems to be something that is very beneficial.
Are there other areas of the country where you feel like
the same plan would be effective?
Ms. Augustine. I would be happy to provide your office with
specific locations that our members have expressed concern. I
do not have any in front of me today, but I would be happy to
take it up with your office about things that our members are
Senator Boozman. Thank you.
The rest of you guys?
Mr. Celli. If I may, Senator. Specifically in South Dakota,
we are looking at some really great land out there. South
Dakota is being downsized, and we think that there is an
opportunity to have a Center of Excellence out there
specifically for PTSD. I think that the VA needs to take a
serious look at that.
Senator Boozman. Very good. Well, thank you all so much for
being here. We really do appreciate your advocacy and your hard
work and all that you represent.
Thank you, Mr. Chairman.
Chairman Isakson. Thank you, Senator Boozman.
Senator Tillis. Thank you, Mr. Chair. Thank you all for
what you do.
I want to go back--well, first off, I should have mentioned
when I was talking about bills, I thank Ranking Member
Blumenthal for 1885. I think it is a great idea, a great
opportunity, the work on making sure that we have the
partnerships with the right NGO's to provide the service is
something I look forward to working with you on, and I
appreciate your efforts.
I wanted to go back to the judges and the backlog. Again, I
may have found a way to actually weave the Camp Lejeune toxic
substance subject into this hearing after all.
Chairman Isakson. Surprise, surprise.
Senator Tillis. I promised you. Part of what I think we
need to do, as long as we have the backlog that we do, then we
need the judicial capacity to clear the backlog. It does raise
a question about, to your knowledge, what kind of work has been
done to try to reduce--get to the root causes of some of these
For example, in the Lejeune instance right now, they have
about an 87-percent decline rate. We are guessing it should
probably be somewhere north of 50. I do not know the root
causes of all the appeals, but do you all know of any
particular areas where the experience rate that causes an
appeal may raise questions about the criteria to begin with? I
will go down the line and start with Ms. Augustine, if you have
Ms. Augustine. As was mentioned earlier, as there has been
an increase in the number of benefit claims submitted to the
VA, there is naturally going to be an increase in the number of
appeals submitted to the VA as well. I think Secretary McDonald
has done a considerable amount of work in the past year to
address some of the training, some of the dissemination of
information issues that were seen earlier. I think that
continuing on those education-minded fronts and continuing to
train VA employees well, we will begin to see a decrease in the
number of appeals. But until that time, the increase in appeals
is going--or increase in benefit claims is going to have an
increase in appeals.
Mr. Celli. As we all know, claims are a complicated
business and so are appeals. When the appeal--if the claim is
remanded to the Appeals Management Center (AMC) and the work is
not done that the law judge says needs to be done, it just goes
back to the Board, and it gets into this hamster wheel. There
has to be a much healthier relationship between the Board and
the AMC, and I know there is some legislation right now that
seeks to address that.
With regard to making those positions permanent, I guess on
the day where we see that there are nine law judges that do not
have enough to do, then maybe we can consider reducing it then.
Mr. Harig-Blaine. That has not been an issue area that we
have focused on.
Mr. Norris. I would like to refer this back to our
Washington office to work with you on that. We have a
representative here from our Washington office. Alex is back
there, and maybe he can get with your staff and----
Senator Tillis. Yes, I think--and this is not trying to
find fault. I think I have developed a reputation for doing
everything I can to work with the Department, so it is not
necessarily faulting--I mean, they are doing what they are
doing within the parameters that they have been given, but it
is a question about do you go back and rethink it and either
come up with an acceptable disposition that the veteran may
accept and not seek an appeal, or find other circumstances
where maybe they should have been granted their request for
disability to begin with. It is more a matter of just looking
at the processes and seeing if we are doing the best job we
I also wanted to talk briefly--a couple of Committee
hearings ago, we had the discussion about homelessness and the
VA's goal to end veterans' homelessness or at least provide the
capacity that we do not currently have.
In your opinion, though, there is a very aggressive goal
out there to end homelessness. Do you think current course and
speed with the programs already in place, that we actually have
the ability to meet the goal that the VA has set forth for
ending homelessness or providing the capacity to support any
homeless veteran in the United States?
I may have to just go off script here for a minute. I
cannot remember--Dr. Lynch, you may be able to help me remember
the date--there is a specific date out there with the goal for
being able to provide that capacity. Do you recall what that
Mr. Harig-Blaine. Senator, I could help you with that.
Senator Tillis. Thank you.
Mr. Harig-Blaine. The U.S. Interagency Council on
Homelessness, which is the lead entity, they have set out the
Opening Doors: Federal Strategic Plan for Ending Homelessness,
and they have identified the end of this year as the----
Senator Tillis. I find that unimaginable given the
discussion we are having about West L.A. I worked--and we were
fortunate to secure another homeless vets facility just north
of Raleigh. I think it is great to set stretch goals, but in
this particular case, when you look back at the population that
is not served today into the calendar, it does not seem to make
sense. It makes me wonder whether or not we are using our
resources wisely to attain that goal, and that could be a
subject of maybe a future Committee meeting.
The last thing I will say is just on crisis intervention.
It relates somewhat to Senator Blumenthal's bill. Over the
weekend I am working on a situation that is actually not in my
State. It just happened to stem out of a conversation I had
with a special operator 100-percent disabled vet who himself--
he has his own issues, but he spends most of his days helping
other vets, and he literally has someone living with him today
because he called the crisis line, was explaining that he was
in a very dangerous situation with his wife, he wanted to
remove himself from that situation, and the person on the
crisis line said that they could get back to him in 4 days.
Anybody who knows anything about domestic violence knows it is
in that moment, and we have to have the processes in place to
deal with it in that moment. I am spending time this week with
my staff to get to the bottom of it, but these sorts of
situations are critically important for the veteran's safety,
for the spouse's safety. It may just be an outlier, but I think
it is something that we have to really look at. We are
responding in a very timely basis, whether it is a suicide
threat, whether it is a domestic violence threat. I do not know
if we are using the wonderful resources we have at the VA in
these sort of crisis situations to the fullest extent of their
Thank you, Mr. Chair.
Mr. Celli. Mr. Chairman, I recognize that we are out of
time. Could I add one thing?
Chairman Isakson. Absolutely.
Mr. Celli. One of the things that The American Legion is
extremely concerned with is not only what is being called now
``functional homelessness,'' but also there is a category of
homeless veteran that is not being recognized at all, and that
is the veterans that do not qualify for VA services, those with
``bad paper.'' And the percentage of veterans that do not
qualify for VA services is increasing as we lower the backlog
or as we lower the homeless rate. So, we are looking at better
than 10 percent of veterans that fall through a crack that will
never be recognized until we step up and do something about
Chairman Isakson. On the subject of veterans' homelessness,
I want to commend the Committee, because in 7 days we took
Nominee Michaud and took him from a markup to approval today to
be Under Secretary of Labor for Veterans' Employment. Other
than opioids, drugs, and pharmaceutical problems that our
veterans have and PTSD and TBI, unemployment is a huge
contributor to homelessness. I am going to talk to Secretary
Perez, and Mr. Michaud has already assured both the Ranking
Member and myself that his focus is going to be like a laser
beam and immediate to see to it we get the employment programs
together so our veterans have more and more opportunities for
employment and jobs and less and less homelessness.
We appreciate all your comments today. I appreciate all the
members' comments today. We will leave the record open----
Senator Blumenthal. Mr. Chairman, may I just make one
comment in response to----
Chairman Isakson. Senator Blumenthal.
Senator Blumenthal. I am sorry to interrupt. I apologize.
I want to just follow up on the comment you made, Mr.
Celli, about veterans with ``bad paper.'' You may know that
there was a lawsuit brought by the Yale Law School legal clinic
on behalf of a Connecticut veteran who suffered from PTS,
received a less than honorable discharge, and for two decades
suffered that black mark. He became addicted, unemployed, and
homeless. His name is Conley Monk.
He brought a lawsuit against the Department of Defense. I
joined in the lawsuit. I supported it. And then I reached out
to then-Secretary of Defense Hagel, who, after some
consideration, responded positively and revised the internal
procedures to enable more veterans with less than honorable
discharges--or dishonorable discharges, in other words, ``bad
paper,''--to seek review by the Boards of Appeals within the
Department of Defense. The procedure is complicated. It is
needlessly fraught with red tape. It is part of that cycle that
often afflicts veterans. We are talking about veterans of past
wars--Vietnam. Conley Monk was a veteran of Vietnam. When he
was in Vietnam and for more than a decade later, ``Post
Traumatic Stress'' was not a term in our vocabulary, not a
diagnosis in medical circles. Only in the 1980s did it become
really recognized, long after Conley Monk was denied the very
medical services that he needed to overcome the PTS. He was
doubly a victim in the discharge that resulted from PTS, acting
up, and then from the denial of health care services that would
have helped him overcome that PTS.
I want to thank you for recognizing this very, very
important topic. Ms. Augustine has very correctly recognized
the need for us to conduct some oversight on the Clay Hunt
bill. I think there is a need for us to conduct some oversight
on the change in policy that I believe with the best of intents
Secretary Hagel implemented and his successors have committed
to follow. I would respectfully suggest to the Chairman--and we
will have a chance to talk about it--that both of these
oversight hearings and inquiries are very much appropriate. I
just want to commend the VSOs for their help and support in
recognizing this issue and problem.
Chairman Isakson. We will leave the record open for 7 days
for any revision, extension of remarks, or any additional
comments anybody wants to submit to the Committee.
There being no further business to come before the
Committee, we stand adjourned.
[Whereupon, at 4:14 p.m., the Committee was adjourned.]
A P P E N D I X
Prepared Statement of Hon. Lawrence B. Hagel, Chief Judge, U.S. Court
of Appeals for Veterans Claims
Mr. Chairman and Distinguished Members of the Committee: Thank you
for the opportunity to comment on S. 1754, a bill that would amend 38
U.S.C. Sec. 7253(a), to make permanent the authorization for an
increase in the number of judges on the U.S. Court of Appeals for
Veterans Claims (Court), from seven to nine. Succinctly stated, the
Court supports this legislation and urges its passage.
The decision by Congress several years ago to expand the Court
temporarily to nine judges came in response to a significant increase
in the Court's caseload, and a perception that the rise was not simply
a spike but in fact a trend. Effective December 31, 2009, authorization
permitted the Court to grow to nine active judges, and we reached that
full complement in December 2012. We were fortunate to operate with
nine judges for almost three years until the retirement of one of our
colleagues one month ago. With full staffing the Court has been able to
conduct effective, efficient, and expeditious judicial review. Your
support in providing the resources to handle our heavy caseload is very
Under current law we will operate with eight judges until the next
retirement, and then we revert to seven judges, our current permanent
authorization. The reality is that two judges' terms expire within days
of each other in December 2016, so absent legislation the Court will
dip to six judges at that time. With the unpredictability of the
judicial nomination and appointment process, and another retirement
likely in 2017, there is a very real possibility that the Court will
shrink to five judges just two years from now. Passage of S. 1754 would
permit a judicial appointment now to bring us back up to nine judges,
and would prevent the Court from dropping to a critically low number of
judges in the near future.
Since its creation in 1988, the Court has become one of the
Nation's busiest Federal courts based on the numbers of appeals filed
and decided per judge. Up until about ten years ago the Court received
roughly 2,200 appeals annually. That number began to rise significantly
starting in FY 2005, reaching over 4,700 appeals filed in FY 2009.
Since that time, annual appeals filed have not fallen below 3,500 and
although we are still tabulating FY 2015 numbers, we estimate that over
4,400 appeals were filed. This is double the number of appeals filed
annually during the Court's first 15 years from 1989 to 2004.
For cases decided, the Court terminated in the neighborhood of
4,400 appeals in FY 2015. That is in addition to acting on nearly 3,000
applications for attorney fees, hundreds of petitions for extraordinary
relief, and thousands of procedural motions. We continue to be one of
the busiest national courts, but we are efficiently handling this
formidable caseload. Generally speaking, appeals filed at the Court
come from veterans who are dissatisfied with a decision of the Board of
Veterans' Appeals (Board). Much emphasis and financial support has been
placed toward increasing the numbers of personnel at the Department of
Veterans Affairs, and toward improving claims processing times. Up from
41,910 decisions in FY 2013, the Board issued 55,532 decisions in FY
2014, and the Board estimates that it will decide at least the same
number in FY 2015. Although it is difficult to predict with certainty
what our caseload will be in the future, it seems likely, considering
the number of claims filed annually with VA and the increased
productivity by the Board, that the number of appeals filed at the
Court will also rise further and stay high.
Over the past several years the Court has striven to create
efficiencies in how we conduct judicial review of veterans' appeals. We
have adopted an electronic case filing and management system. We are
constantly improving our pre-briefing mediation program to resolve
cases earlier in the process, to hone the issues on appeal, and to
stretch our judicial resources to the greatest extent possible. We have
an active bar, and we engage frequently with our practitioners to
discuss ways to further improve our process. Everyone involved in
judicial review of veterans' appeals shares a common goal of wanting to
honor our veterans and provide full, fair, and prompt decisions on
their appeals. Authorization for nine active judges would be a
significant factor in furthering that goal.
In closing, on behalf of the Court, I express my appreciation for
your past and continued support, and for the opportunity to provide
Letter from Darrell G. Kirch, M.D., President and Chief Executive
Officer, The Association of American Medical Colleges
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Adrian M. Atizado, Deputy National Legislative
Chairman Isakson, Ranking Member Blumenthal, and Members of the
Committee: Thank you for inviting DAV (Disabled American Veterans) to
submit testimony for the record of this legislative hearing, and to
present our views on the bills under consideration. As you know, DAV is
a non-profit veterans service organization comprised of nearly 1.3
million wartime service-disabled veterans. DAV is dedicated to a single
purpose: empowering veterans to lead high-quality lives with respect
s. 717--the community provider readiness recognition act of 2015
If enacted this bill would require the Department of Defense (DOD)
and Department of Veterans Affairs (VA) to designate certain non-
department mental health care providers, presumably in the community--
but who are familiar with the needs of active duty servicemembers and
veterans--as providers who have particular knowledge relating to mental
health care of such individuals.
The bill would require the two departments to work together to
establish criteria to determine eligibility of private practitioners to
participate in treating these beneficiaries. The bill would specify the
necessary eligibility criteria in broad, general terms, including
familiarity with, and knowledge about, the military and veteran culture
and experience, and of evidence-based treatments for mental health
conditions prevalent in the active duty and veteran populations.
Qualified candidates would receive a mental health provider
``readiness'' designation from DOD and VA under the terms of this bill.
The bill would require both DOD and VA to establish and maintain a
registry available to the public of all providers who would be so
designated. The bill would specify certain mental health professions,
but would permit the two departments to broaden the groups of
professions that would be eligible to participate.
The bill is silent on whether either DOD or VA would engage these
readiness-designated practitioners in any out-referral of authorized
contract care, or whether designation of such providers would imply
these individuals would gain some level of government preference in
treating servicemembers and veterans in private facilities at DOD or VA
The prospect of a private network of mental health providers
operating outside either system and providing mental health services to
active duty servicemembers as well as to veterans presents the
potential for fragmenting these individuals' DOD and VA direct care.
Thus, the bill might be more effective if a new provision were added to
require the departments to consider out-referrals to members of this
designated group on a preferential basis in circumstances in which
servicemembers and veterans are being referred by the two departments
to outside mental health care. The sponsor may wish to consider the
potential implications for servicemembers and veterans who receive
direct, integrated care and services in DOD and VA facilities and make
adjustments to the bill accordingly.
DAV believes the best and latest expertise to provide military and
veteran mental health services resides in DOD and VA, respectively.
However, on the assumption that not every servicemember or veteran has
ready access to DOD and VA direct care services for mental health, that
some might be aided by the information the bill would require to be
made public, and on the assumption that some individuals may not want
to receive mental health services from direct DOD or VA sources, DAV
would offer no objection to enactment of this bill. Nevertheless, we
ask that our concerns be taken into consideration if the Committee
intends to advance this bill.
s. 1676--the delivering opportunities for care and services for
veterans act of 2015
This bill, in four titles, would increase the number of graduate
medical education positions treating veterans, improve the compensation
of health care providers, medical directors, and directors of Veterans
Integrated Service Networks of the Department of Veterans Affairs, and
establish new requirements to aid the care and services delivered to
veterans in rural and remote areas.
Section 101 of the bill would exempt VA from limiting additional
appointments of medical and osteopathic residents when fulfilling the
requirements of section 302(b) of Public Law 113-146. Existing law, in
title 42, United States Code, imposes a ceiling on hospital residency
positions for cost-reporting purposes in the Federal graduate medical
education program (which reimburses residency costs from Federal
funds). This bill would authorize hospitals to disregard and not take
into account these limitations when additional residency positions are
established in VA to fulfill the requirements of Public Law 113-146.
The section would make technical changes to effect this policy
Section 102 of this bill would extend for an additional five years
a mandate from Public Law 113-146 for VA to add 1,500 new medical
residency positions to its existing graduate medical education program,
and also would extend for the same period VA's requirement to report
periodic progress to Congress in increasing VA residency positions.
Section 103 would establish a six-year pilot program of not less
than three graduate medical education residency programs in behavioral
medicine in underserved areas in the United States. Participating
agencies would be VA, the Indian Health Service, and private and public
hospital facilities that participate in the Medicare program. The bill
would establish criteria for locating such residency programs, and
would require an annual report to Congress to measure the progress of
the pilot program, and any impediments encountered.
Section 104 of this bill would require VA to include marriage and
family therapists, and licensed professional mental health counselors,
in its existing health personnel education programs. In including these
two new categories of personnel, the bill would also require VA to
apportion funds equally for each of the health occupations included in
the existing program.
DAV has not received a resolution from our membership on the
specific purposes of this section; thus, DAV takes no formal position
on the bill. Nevertheless, we are concerned that the bill would parse
VA resources and require each occupation concerned in the personnel
training program to receive an equal share of the resources to be spent
overall. DAV believes the level of expenditures for each profession or
technical field concerned should be determined by VA, not through an
edict of law. A number of variables could come into play and
potentially waste valuable resources if they were required to be
obligated to one professional or technical field despite the
requirements of the others. We recommend VA be afforded the flexibility
to make these decisions to ensure resources are spent most effectively.
We would also remind the Committee of DAV's and VA's prior
testimonies dealing with the topic of marriage and family counselors
and licensed mental health counselors, and their potential employment
in VA. DAV has long agreed with VA's position that these individuals
from these professions could be employed in the Department's mental
health programs without further acts of Congress.
Section 105 of this bill would also expand VA's hiring authority to
include hiring mental health counselors who are educated at the
Title III of this bill would increase compensation levels of
certain health care executives in the Veterans Health Administration.
DAV takes no formal position on these provisions.
Title IV of the bill (section 401) would require VA to establish a
two-year pilot program to determine the feasibility and advisability of
implementing a ``nurse advice line'' in rural and highly rural areas
with significant veteran populations. The functions of the advice line
would include providing medical advice, appointment and cancellation
services, and information on the availability of benefits. This bill
would require a VA report on the results of the pilot program, with
DAV has received Resolution No. 226 from our members at the most
recent DAV National Convention, calling on Congress to improve VA
health care services to rural and remote veterans. Therefore, we
support Title IV of the bill.
s. 1754--the veterans court of appeals support act of 2015
This bill would permanently expand the number of judges authorized
to preside over the United States Court of Appeals for Veterans Claims
(CAVC) from seven judges to nine.
The CAVC's caseload averages roughly 4,600 cases per year. As a
result, the CAVC has had one of the highest, if not the highest,
caseloads per active judge of any Federal appellate court in the
country. In response, the CAVC was authorized in 2008, as part of the
Veterans Benefits Improvement Act, to expand temporarily from seven to
nine judges as of January 2010.
The authorization to increase the number of CAVC judges was set to
expire at the end of 2012 if the positions were not filled within that
timeframe. Fortunately for the CAVC, the two available vacancies were
filled prior to the authority's expiration date. Due to this temporary
authorization the CAVC now stands at nine judges, an increase justified
due the growing number of appeals.
If these two temporarily authorized appointments become vacant, the
CAVC is not authorized to replace them as restricted under title 38,
United Stated Code, Sec. 7253 (i) (2), which sets the limit of judges
to not more than seven. Allowing the number of judges to drop below
nine would adversely impact the CAVC's ability to make timely decisions
because the remaining judges would be left to absorb the ongoing
DAV has no resolution to support this bill; however, because
permanently expanding the number of judges would be in the best
interest of veterans who rely on the Court to resolve their claims, we
would not object to its favorable consideration.
s. 1885--the veteran housing stability act of 2015
This bill would amend title 38, United States Code, by expanding
service and assistance to include veterans who are homeless, at risk of
becoming homeless, and veterans with very low income. This expansion
would also include veterans transitioning to occupancy, and maintaining
permanent residential occupancy. In addition, this bill would also
expand the current definition of ``covered veteran'' to include a
veteran who is enrolled in the VA homeless registry.
This legislation would require the Secretary to implement case
management oversight for veterans enrolled in the homeless registry,
participating in programs falling under the homeless veteran category,
and those associated with it. It would establish reporting requirements
to Congress. The bill would also designate intense case management
sites in three locations with the highest homeless veteran populations
across the United States, and three in suburban or rural areas totaling
no fewer than six sites.
This bill also would require the Secretary to utilize resources
from within the community. It would require the Secretary to conduct
outreach, educating those with resources relative to housing about the
needs of veterans, and the benefits of having veterans as tenants, and
build upon community relationships. The Secretary would be required to
collaborate with other community service providers, particularly
housing and urban development, public housing, tribally designated
housing, realtors, landlords, property management companies, and
developers. This bill would establish criteria to use in determining
success or failure of the services provided.
This bill would establish a VA National Center of Homelessness
Among Veterans. The center would function as a clearinghouse and
resource center, wherein all factors affecting veterans' homelessness
can be researched. The center would also provide oversight on the
effectiveness of related programs, and provide a foundation for best
practices in reducing homelessness. The center would open no later than
September 1, 2016, with a report due to Congress no later than
December 1, 2018.
DAV is pleased to offer support of this bill. It is consistent with
DAV Resolution No. 118, which calls for sustained and sufficient
funding to improve services for homeless veterans.
s. 2013--the los angeles homeless veterans leasing act of 2015
This bill would authorize the Department of Veterans Affairs (VA)
to carry out certain leases at the VA's West Los Angeles Campus in Los
Angeles, California, for establishment of supportive housing; health,
education, and family support; vocational training, and other services
that principally benefit veterans and their families. The bill would
also authorize a lease of real property to a California institution
that has had a long-term medical affiliation with the VA at the Los
DAV has received no resolution from our membership; however, we
would not be opposed to enactment of this bill.
s. 2022--to increase the amount of special pension for
medal of honor recipients
The appropriate Secretary of the Army, Navy, Air Force, or Coast
Guard is required to pay a special pension on a monthly basis to each
living person whose name has been entered on the Medal of Honor (MOH)
Roll. The base rate for this special pension is currently $1,000 per
month. This payment increases based on changes in cost of living.
This bill would increase the base rate of this special pension from
$1,000 to $3,000. The bill also includes provisions that would govern
the annual periodic increase of this benefit.
The MOH pension is paid as a sole benefit or added to VA pension or
compensation rates for veterans who were awarded the MOH for their
distinguished military service. While DAV has no resolution to endorse
this particular legislation, we would not object to its enactment,
which would provide this increased benefit to these deserving members
of our Armed Forces who have gone above and beyond the call of duty for
Mr. Chairman and Members of the Committee, this concludes DAV's
testimony. We thank the Committee for inviting DAV to submit this
testimony for the record of this hearing. DAV is prepared to respond to
any further questions by Committee Members on the positions we have
taken with respect to the bills under consideration.
Letter from Gregory C. Scott, President & CEO, New Directions
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Prepared Statement of Diane Boyd Rauber, Esq., Director of Legislative
and Regulatory Affairs, National Organization of Veterans' Advocates,
On behalf of the National Organization of Veterans' Advocates, Inc.
(NOVA), I would like to thank Chairman Isakson and Ranking Member
Blumenthal for the opportunity to provide written testimony for the
record during a legislative hearing of the Senate Committee on
Veterans' Affairs on October 6, 2015.
Our written testimony will address Senate Bill 1754, the ``Veterans
Court of Appeals Support Act of 2015.''
veterans court of appeals support act of 2015
NOVA supports S. 1754, the ``Veterans Court of Appeals Support Act
of 2015,'' which makes permanent the temporary increase in the number
of judges presiding over the U.S. Court of Appeals for Veterans Claims
In 1988, Congress enacted the Veterans Judicial Review Act of 1988
(VJRA). The VJRA created an Article I court to provide judicial
oversight to a veterans' benefits adjudication process that had existed
in ``splendid isolation'' from our legal system. Brown v. Gardner, 513
U.S. 115, 122 (1994) (quoting H.R. REP. NO. 100-963, pt. 1, at 10
(1988), as reprinted in 1988 U.S.C.C.A.N. 5782). Veterans and their
dependents have exercised their right to judicial appeal in growing
numbers since the inception of the Veterans Court.
To assist the Veterans Court, Congress provided for the recall of
retired judges in 1999. The chief judge is authorized to recall a
retired judge when ``substantial service is expected to be performed.''
38 U.S.C. Sec. 7257(b)(1). As one commentator noted, by 2007, the
Veterans Court was frequently recalling retired judges. Michael P.
Allen, The United States Court of Appeals for Veterans Claims at
Twenty: A Proposal for a Legislative Commission to Consider Its Future,
58 CATH.U.L.REV. 361, 371 n.54 (2009). Review of Miscellaneous Orders
issued by the Veterans Court since 2007 indicates it often continues to
exercise this authority to meet its needs. See Miscellaneous Orders
2008-2015, United States Court of Appeals for Veterans Claims
(available at https://www.uscourts.cavc.gov/miscellaneous--orders.php).
In 2009, Congress further provided for assistance with a temporary
increase in the complement of judges serving on the Veterans Court from
seven to nine. Veterans Benefits Improvements Act of 2008, Pub. L. No.
110-389, Sec. 601, 122 Stat. 4145, 4176-77 (amending 38 U.S.C.
Sec. 7253). This authority expired on January 1, 2013, and without
further action, there will be no ability to appoint additional judges
when the next two terms expire.
There is ample support for making the temporary increase permanent.
In an effort to reduce the much-publicized claims backlog, the VA has
processed record numbers of claims in the past few years. According to
the VA, their overall claims inventory was reduced from 883,930 to
366,648 during the period between July 13, 2012 and September 26, 2015.
In addition, the VA reports their ``claims backlog,'' i.e., the subset
of the claims inventory representing claims ``awaiting a rating
decision for more than 125 days since receipt,'' was reduced from
611,073 to 75,444 between March 25, 2013 and September 26, 2015. See
Veterans Benefits Administration Status Reports (available at http://
benefits.va.gov/REPORTS/detailed--claims--data.asp; last reviewed
October 2, 2015). This action is resulting in an increasing numbers of
appeals to the Board of Veterans' Appeals (Board) and, in turn, to the
Specifically, from FY 2010 through FY 2013, the Board dispatched an
average of 45,981 decisions per year. U.S. Department of Veterans
Affairs, Board of Veterans' Appeals Annual Report (Fiscal Year 2014) 28
(July 2015) (available at http://www.bva.va.gov/docs/
Chairmans_Annual_Rpts/BVA2014AR.pdf); Board of Veterans' Appeals Annual
Report (Fiscal Year 2013) 25 (available at http://www.bva.va.gov/docs/
Chairmans_Annual_Rpts/BVA2013AR.pdf). In FY 2014, the number of
decisions dispatched jumped to 55,532. Board of Veterans' Appeals
Annual Report (Fiscal Year 2014) at 28. In its most recent Annual
Report, the Board estimated it would physically receive 74,072 cases
for consideration and potentially issue 57,600 decisions in FY 2015.
Id. at 21; 28. The number of decisions dispatched is expected to keep
rising, particularly as the Board has significantly increased the
number of staff attorneys in its employ and is authorized to expand the
number of Board members from 64 to 78.
In turn, the Veterans Court received an average of 3,988 appeals
and petitions between FY 2010 and FY 2013. United States Court of
Appeals for Veterans Claims, Annual Reports (Fiscal Year 2010-2013)
(available at http://www.uscourts.cavc.gov/report.php). In FY 2014, the
number of appeals and petitions rose to 4,057. United States Court of
Appeals for Veterans Claims, Annual Report (Fiscal Year 2014)
(available at http://www.uscourts.cavc.gov/documents/
FY2014AnnualReport06MAR 15FINAL.pdf). If the Board's projections are
any indication, the demand on the Veterans Court is likely to grow at
an accelerated rate.
Veterans who seek redress before the Veterans Court have endured
many years of agency processing and review while waiting for the
compensation earned through their service and sacrifice. These long
delays should not be increased due to judicial backlogs related to an
understaffed Veterans Court. The Veterans Court should be equipped to
handle the anticipated influx of cases with a suitable number of
qualified judges. Passage of the Veterans Court of Appeals Support Act
of 2015 is one essential way to tackle the avalanche of appeals just on
the horizon. Anything less would be an injustice.
For more information: NOVA staff would be happy to assist you with
any further inquiries you may have regarding our views on this
important legislation. For questions regarding this testimony or if you
would like to request additional information, please feel free to
contact NOVA Executive Director David Hobson by calling our D.C. office
at (202) 587-5708 or by emailing David directly at [email protected]
Prepared Statement of Barton F. Stichman, Joint Executive Director,
National Veterans Legal Services Program
Mr. Chairman and Members of the Committee: Thank you for the
opportunity to present the views of the National Veterans Legal
Services Program (NVLSP) on pending legislation. This testimony focuses
on S. 1754, which would make permanent the temporary increase in the
number of judges presiding over the U.S. Court of Appeals for Veterans
Claims. The temporary increase was to nine full-time judges and this
bill would make that number of judges a permanent fixture at the Court.
NVLSP is a nonprofit veterans service organization founded in 1980.
Since its founding, NVLSP has represented over 2,000 appellants before
the Court of Appeals for Veterans Claims. NVLSP is one of the four
veterans service organizations that comprise the Veterans Consortium
Pro Bono Program. In conjunction with the Consortium, NVLSP has, since
1992, recruited, trained, and mentored thousands of volunteer lawyers
to represent on a pro bono basis veterans who have appealed a Board of
Veterans' Appeals decision to the CAVC without a representative. In
addition, NVLSP publishes through Lexis Law Publishing the leading
treatise on veterans law--the 1900-page Veterans Benefits Manual--that
is regularly used by those who represent appellants before the CAVC.
NVLSP supports passage of S. 1754. In the past several years, the
caseload of the Court has increased significantly. In fiscal year 2013,
the Court received 3,724 case initiations (3,531 appeals and 193
petitions for a writ of mandamus). In calendar year 2014, the Court
received 4,438 case initiations. In the first nine months of calendar
year 2015, the rate of case initiations further increased to an annual
rate of 4,988. Over the last several years, the Court has had nine
full-time judges. Although the caseload has increased, the nine full-
time judges have been able to continue to issue decisions within a
reasonably short period of time after the briefs arrive in chambers for
a decision. Given the rising caseload and the fact that it is likely to
continue, allowing the number of full-time judges to fall below nine
would threaten the progress the Court has made in issuing decisions
within a short period of time.
An additional reason for NVLSP's support of S. 1754 involves the
Court's overuse of a shortcut in disposing of appeals--use of its
statutory authority under 38 U.S.C. Sec. 7254(b) to decide cases by a
single judge. Single-judge decisions are issued by the Court in the
form of a ``memorandum decision'' and are not precedential. Only
published opinions issued by a panel of three judges or more carry
precedential value. See Bethea v. Derwinski, 2 Vet. App. 252 (1992). No
other Federal court of appeals has authority to decide cases by single
judge; all of these other courts of appeal decide cases in panels of
three judges or more. Some of these three-judge decisions in the other
Federal court of appeals are designated as precedential, while others
are designated as non-precedential.
In recent years, single-judge dispositions by the CAVC have come to
dominate to a degree far greater than non-precedential decisions are
used in the other Federal courts of appeals. In fiscal years 2013 and
2014, the CAVC issued a precedential decision (i.e., an appeal decided
by a panel of three judges or more) in only 1.8% of the cases decided
by chambers (75 of 4,221). By comparison, in fiscal year 2014, the
Federal geographic courts of appeals handled 12% of judgments by a
precedential opinion.\1\ Although there was some variance, no Federal
court of appeals issued a precedential decision in less than 6% of its
\1\ See Statistics Div., Admin. Off. U.S. Cts., Judicial Business
of the United States Courts: 2014 Annual Report of the Director,
[hereinafter, U.S. Courts 2014 Report] tbl. B-12, available at http://
\2\ See id.
The relative lack of precedential decisionmaking by the CAVC is
inconsistent with its role as a national judicial interpreter of the
law. The Court's aversion to precedential decisionmaking has an adverse
impact on the claims adjudication process. The lack of precedential
decisions that interpret the meaning of statutes and regulations leaves
veterans, the VA regional offices, and the Board of Veterans' Appeals
without binding guidance on how these authorities should be
interpreted. When the VA decides claims in situations where the law is
not clear, it encourages veterans whose claims are denied to appeal to
a higher authority. Thus, the lack of binding precedent on the proper
construction of a statute or regulation exacerbates the existing
backlog of pending appeals within VA and leads to inconsistent outcomes
for similarly situated veterans.
Shortly after the Court was created by Congress, the CAVC took
reasonable steps to cabin its authority to dispose of an appeal by a
single judge. It announced in Frankel v. Derwinski, 1 Vet. App. 20, 25-
26 (1990) that a single-judge disposition was only appropriate if ``the
case on appeal is of relative simplicity'' and
1. does not establish a new rule of law;
2. does not alter, modify, criticize, or clarify an existing rule
3. does not apply an established rule of law to a novel fact
4. does not constitute the only recent, binding precedent on a
particular point of law within the power of the Court to decide;
5. does not involve a legal issue of continuing public interest;
6. the outcome is not reasonably debatable.
The CAVC continues to publicly embrace the Frankel criteria to this
But a survey of the single-judge decisions issued by the Court in
2013 and 2014 demonstrates that the Court is not faithful to these
reasonable criteria. As the Court's annual reports reflect, there are
three possible outcomes to an appeal over which the Court has
jurisdiction: the Board of Veterans' Appeal decision denying benefits
is either (1) affirmed, (2) reversed, or (3) vacated and remanded for
further administrative proceedings. In calendar year 2013, the variance
in the affirmance rates among the nine judges in a single-judge
decision was between a low of 26% for one judge to a high of 65% for
another judge. In other words, in 2013, the first judge was 2.5 times
more likely to affirm a challenge to a BVA decision denying a claim for
benefits than the second judge. In 2013, three of the nine full-time
judges were each over twice as likely to affirm a challenge to a BVA
decision denying a benefits claim as either of two other judges.
The variance in the results of single-judge memorandum decisions in
2014 was just as great as it was in 2013. The judge with the highest
affirmance rate (60%) in 2014 was the same judge who had the highest
affirmance rate in 2013. The judge with the lowest affirmance rate
(22%) in 2014 was the same judge who had the lowest affirmance rate in
2013. In 2014, as in 2013, the judge with the highest affirmance rate
was over 2.5 times more likely to affirm a challenge to a BVA decision
denying a claim for benefits than the judge with the lowest affirmance
rate. In 2014, four of the nine full-time judges as an aggregate were
over twice as likely to affirm a challenge to a BVA decision denying a
benefits claim as three of the other judges as an aggregate.
A statistical analysis of the large variance in 2013 and 2014 in
the affirmance rates among the nine CAVC judges is that the magnitude
of the variance cannot be explained by chance. That is, the large
variance shows that single judges in 2013 and 2014 reached outcomes in
some individual appeals that would result in a different outcome had
the appeal been adjudicated instead by one or more of the other judges.
This is compelling evidence that single judges issued a significant
number of memorandum decisions in 2013 and 2014 that were ``reasonably
debatable,'' in violation of the last Frankel criterion.
Members of the Court's Bar have communicated with the Court about
the problems with the Court's overuse of nonprecedential single-judge
decisionmaking. NVLSP is hopeful that the Court will respond to this
constructive criticism by adjusting its decisionmaking process so that,
at minimum, the percentage of cases decided by a panel of three CAVC
judges in a precedential opinion approximates the percentage of
precedential cases decided by the other Federal courts of appeal. NVLSP
believes that by providing the Court with a permanent roster of nine
full-time judges, S. 1754 will serve as a catalyst to encourage the
Court to make this adjustment. The Committee should, however, consider
amending S. 1754 by adding a requirement that the Court periodically
report to the Senate and House Committees of Veterans Affairs about the
steps it is taking to adjust its decisionmaking process so that the
percentage of cases decided by a panel of three CAVC judges in a
precedential opinion is equal to or exceeds the percentage of
precedential cases decided by the other Federal courts of appeal.
Prepared Statement of Paralyzed Veterans of America
Chairman Isakson, Ranking Member Blumenthal, and Members of the
Committee, Paralyzed Veterans of America (PVA) would like to thank you
for the opportunity to submit our views on legislation pending before
the Committee. We appreciate the Committee focusing on these issues
that will affect veterans and their families.
s. 717, the ``community provider readiness recognition act of 2015''
PVA supports S. 717, the ``Community Provider Readiness Recognition
Act of 2015.'' This legislation would allow the Department of Defense
(DOD) and the Department of Veterans Affairs (VA) to designate certain
non-department mental health care providers as knowledgeable,
comfortable, and understanding of the culture of members of the armed
services. It would make available a registry of those mental health
providers for servicemembers and veterans to use. Given the critical
shortage of mental health providers within the VA, community providers
are often the only option. Many may be ill-equipped to provide care
specific to one's military experience. By designating those culturally
competent providers, VA can lessen the likelihood servicemembers and
veterans will receive poorer quality care.
s. 1676, the ``delivering opportunities for care and services for
veterans act of 2015''
PVA supports S. 1676, the ``Delivering Opportunities for Care and
Services for Veterans Act of 2015.'' This legislation seeks to address
workforce issues inhibiting the Department of Veterans Affairs from
meeting the needs of veterans in rural areas. This bill would allow for
the training and hiring of desperately needed medical and behavioral
health providers at VA medical facilities. It would ensure that the
additional 1,500 medical residency slots authorized by the Veterans
Access, Choice, and Accountability Act of 2014 would not count toward
the current cap put in place by the Balanced Budget Act of 1997 on
Medicare-funded graduate medical education (GME) positions. Further, it
would establish mental health residency programs between VA and Indian
Health Services (IHS) and clarify that doctoral degrees be recognized
when determining eligibility for mental health counselor positions. The
veterans of Iraq and Afghanistan are the most rural veteran cohort
since World War I. These men and women will continue to rely on the VA
system for decades to come. This legislation will help to resource VA
with critically needed providers and leadership.
s. 1754, the ``veterans court of appeals support act of 2015''
PVA in accordance with past recommendations of The Independent
Budget supports S. 1754, the ``Veterans Court of Appeals Support Act of
2015.'' As pointed out in the current version of The Independent
Budget, the Court of Appeals for Veterans Claim's (CAVA) caseload
averages roughly 4,600 cases per year making it have one of the
highest, if not the highest, caseloads per active judge of any Federal
appellate court in the country. Recognizing this challenge, in 2008 the
CAVC was authorized to temporarily expand to nine judges.
We ask the Committee and Congress to enact S. 1754 to permit a
permanent increase in judge appointments to keep pace with an
increasing caseload that PVA believes will continue to grow as the VA
backlog is reduced.
s. 1885, the ``veteran housing stability act of 2015''
PVA fully supports S. 1885, the ``Veteran Housing Stability Act of
2015.'' PVA has continuously supported improving the housing options
for homeless veterans. Veterans have made this country strong and
protected our way of life. It is unfortunate that many veterans, often
faced with the challenges of mental illness and substance abuse, become
trapped in the ravages of homelessness.
The VA has had several successes in reducing homelessness among
veterans, but there is still more that can be done. The proposed
legislation will continue to improve on previous programs and also
provide for some of the most at risk veterans through the provisions of
Section 3's program of intensive management interventions for veterans
covered by the legislation. PVA's greatest concern is that as has
happened in the past, Congress dictates VA programs without an adequate
increase in funding. While funding provisions are not included in the
legislation, PVA welcomes the reporting requirements that would
identify both the cost of carrying out the program, as well as an
estimate of costs VA would have incurred for services had the program
In addition, PVA welcomes efforts to improve the retention of
housing by veterans that were formally homeless. Preventing veterans
from becoming homeless in the first place should be the overarching
goal of homeless programs. In the event a veteran becomes homeless and
is able to acquire new housing, it is even more critical to break the
cycle of homelessness to prevent them from becoming homeless again. PVA
applauds these efforts as well as the expansion of housing assistance
programs outlined in Section 5.
America's veterans are some of the most deserving citizens and it
is critical that the Nation demonstrate their continuing care for those
who have borne the battle, especially when they suffer from
s. 2013, the ``los angeles homeless veterans leasing act of 2015''
PVA supports S. 2013, the ``Los Angeles Homeless Veterans Leasing
Act of 2015.'' This legislation would authorize the Department of
Veterans Affairs (VA) to work with local governments and non-profits to
enter into long-term lease agreements for the sole purpose of providing
supportive housing to veterans. The services that must be furnished by
the lease-holders include nutrition, health care, vocational training,
child care and transportation. Similar leases have been used to develop
housing at VA properties across the country. Los Angeles County has
around 4,400 chronically homeless veterans, according to the Los
Angeles Homeless Services Authority. This is the largest population of
homeless veterans in the country. Given budget shortfalls for
construction, this bill will allow VA to create new housing faster than
the agency could on its own by partnering with local governments and
PVA supports the increase in the special pension for Medal of Honor
recipients. As our most honored heroes, those who have earned this
prestigious honor, deserve our greatest respect and support.
Once again, we thank you for the opportunity to submit for the
record. We look forward to working with the Committee to see these
proposals through to final passage. We would be happy to take any
questions you have for the record.
PVA would like to thank you again for the opportunity to testify on
the proposed legislation. We hope that the Committee will give these
bills swift consideration and move them forward for consideration in
the full Senate. We would be happy to answer any questions that you may
Prepared Statement of Aleks Morosky, Deputy Director, National
Legislative Service, Veterans of Foreign Wars of the United States
Chairman Isakson, Ranking Member Blumenthal and Members of the
Committee, on behalf of the men and women of the Veterans of Foreign
Wars of the United States (VFW) and our Auxiliaries, I would like to
thank you for the opportunity to testify on today's pending
s. 717, the community provider readiness recognition act of 2015
This legislation seeks to improve the private sector's ability to
provide culturally competent and evidence-based mental health care to
servicemembers and veterans by establishing a Department of Veterans
Affairs/Department of Defense (VA/DOD) mental health readiness program
for private sector providers. The VFW agrees with the intent of this
legislation, but cannot support the bill as written.
In a recent study entitled ``Ready to Serve'' the RAND Corporation
found that only 13 percent of private sector mental health providers
deliver culturally competent and evidence-based mental health care. The
VFW is also concerned by RANDs findings that less than 18 percent of
TRICARE affiliates and less than 50 percent of private sector providers
who work in a military or VA setting met RAND's readiness criteria. The
VFW acknowledges that VA and the military health care systems may never
have the resources or capacity to directly deliver timely mental health
care to all the servicemembers and veterans they serve. Thus, the two
systems have a vested interest to ensure the private sector is ready
and able to provide high quality mental health care when such care is
not readily available at military treatment facilities or VA medical
The VFW supports the intent of the readiness program, however, we
are concerned that a readiness designation would be interpreted by
servicemembers and veterans as VA and DOD deeming providers who are
listed in the readiness registry as participants in their respective
private sector provider networks. This may result in servicemembers and
veterans receiving care from providers on the registry, but not being
covered for such services by VA or DOD.
To ensure this does not occur, the VFW recommends that the
Committee amend the legislation to limited program eligibility to
private sector providers who have been approved to participate in the
VA Choice network or the TRICARE network. This would incentivize
providers to join VA and DOD networks and would increase readiness
among private sector mental health care providers who treat
servicemembers and veterans.
However, the VFW would oppose making the readiness program a
requirement for acceptance into VA's or DOD's private sector provider
networks. Approval to participate in VA's and DOD's networks must
continue to be based on a provider's accreditation and license to
s. 1676, the docs for veterans act of 2015
The VFW supports ten of the eleven sections included in this
legislation which would improve the quality of health care for rural
veterans. The VFW does not support section 202 as written, but would
like to offer a suggestion to improve it.
VA is the largest single provider of health professions education
in the United States and is second only to Medicare and Medicaid in
funding graduate medical education (GME). According to VA, more than
120,000 health professionals train in VA medical facilities annually
and almost all VA medical facilities have some health professions
trainees. To further increase VA's role in training America's health
care workforce, the Veterans Access, Choice and Accountability Act of
2014 authorized VA to add 1,500 additional GME residency slots over
five years. However, a Medicare imposed cap on GME slots has limited
VA's academic affiliates from accepting additional slots. We support
removing that barrier to ensure VA continues to train America's health
care providers. This legislation also includes other provisions that
would increase access to VA health care for rural veterans. With the
growing number of veterans living in rural areas, the VFW supports
efforts to ensure rural veterans have timely access to the health care
This legislation would also require that at least 30 percent of
VA's Education Debt Reduction Program beneficiaries practice medicine
in rural or highly rural areas. While the VFW supports expanding health
care access for rural veterans, we cannot support establishing a quota
for this important program. The Education Debt Reduction Program
enables VA to recruit and retain the best and brightest health care
professionals throughout the country. Requiring VA to have 30 percent
of program beneficiaries practice in rural areas may limit VA's ability
to recruit and retain health care professionals in areas or occupations
with the greatest need. The VFW recommends the Committee amend section
202 to ensure the Education Debt Reduction Program is appropriately
dispersed among health care providers in urban, rural and highly rural
areas without establishing quotas.
s. 1754, the veterans court of appeals support act of 2015
The VFW supports this legislation, which would permanently increase
the number of judges at the Court of Appeals for Veterans Claims (CAVC)
from seven to nine.
Under current law, the CAVC is authorized up to seven active
judges, but temporary expansions of two additional judges were
authorized in 2001 and again in 2008. These expansions came in an
effort to stagger the terms of the judges. The original members of the
CAVC all had terms that ended at the same time. The temporary expansion
allowed more judges to be appointed within a certain timeframe, with
the thought that there would then be some judges on the court who had
at least a few years of experience when the majority of the judges
retired. Unfortunately, since the current cohort also have terms that
end around the same time, the Court will soon be in a similar
The current situation is as follows: Judge Moorman recently
retired, bringing the Court down to eight members. The terms of Judge
Hagel, Kasold, Schoelen, Davis, and Lance all expire in 2018 and 2019.
Judges Greenberg, Pietsch and Bartley were all appointed in 2012 under
the last expansion.
While it is possible for judges to be reappointed, it is unlikely
that more than two of the five whose terms expire in the next few years
will seek or accept reappointment. The VFW believes that expanding the
Court is necessary to avoid a circumstance where judicial nomination,
which can be an intensive and politically fraught process, would reduce
the number of members of the court. If the Court is temporarily reduced
to five of the seven judges authorized while they wait for the
nomination and installation process, the backlog of cases at the Court
would almost certainly grow, along with veterans' wait times.
With over 318,000 total appeals pending at VA, the appeals to the
Board and the Court will only continue to grow in the foreseeable
future. The VFW believes that the CAVC must remain fully staffed in
order to handle the coming workload. With this in mind, we believe it
is both justified and prudent to permanently expand the number of
judges at the CAVC.
s. 1885, the veterans housing stability act of 2015
The VFW firmly believes that no veteran should ever be homeless. We
praise the great progress that has been made in reducing veterans'
homelessness in recent years as a direct result of coordinated efforts
across multiple government agencies to provide transitional housing,
rapid rehousing, and employment programs for veterans in need. This
legislation seeks to build on that progress by improving the benefits
afforded to homeless veterans. The VFW supports this legislation and
has a suggestion to improve it.
This legislation would clarify the definition of homeless, thereby
aligning it with the McKinney-Vento Act to include those displaced by
domestic violence. Expanding the definition of homeless to include
veterans who are fleeing situations of domestic abuse is the right
thing to do. This change would ensure veterans who have the courage to
leave their abusive and sometimes life-threatening situations receive
access to the benefits VA already provides thousands of homeless
veterans. The VFW believes this legislation will significantly improve
the lives of those who become homeless as a result of difficult
circumstances outside of their control, and help them begin a new
chapter in their lives.
This legislation would also provide case management services to
veterans who are at risk of becoming homeless to ensure they are able
to retain their housing. This legislation would expand other homeless
programs to at risk veterans. The VFW believes that the best way to
eliminate homelessness among veterans is through prevention. We fully
support such expansion and believe it will enable the Administration to
significantly reduce the number of homeless veterans.
The VFW generally supports section 7, which would require the
Secretary to establish a national center for homelessness among
veterans. While the VFW recognizes the need for a center of excellence
to collect and disseminate best practices, we are concerned the center
may not have the ability to ensure VA medical facilities and regional
offices utilize such best practices. For this reason, we suggest that
this section include an operations and compliance mechanism to ensure
the Department fully benefits from having a center of excellence that
improves the benefits VA provides homeless veterans.
s. 2013, the los angeles homeless veterans leasing act of 2015
The national VFW supports the position of the Department of
California VFW to quickly enact S. 2013. This legislation sets the
course to return the Veterans Affairs West Los Angeles Campus to a
campus that meets the intent of the land grant by providing services
directly to veterans in the community. We look forward to its quick
s. 2022, to amend title 38, united states code, to increase the amount
of special pension for medal of honor recipients, and for other
This legislation would increase the amount of special pension
granted to Medal of Honor recipients from $1,000 to $3,000 per month,
adjusted annually for inflation. Medal of Honor recipients are held in
the highest esteem by the veterans and military community. These men
have turned the tide of battle against overwhelming enemy forces, and
saved the lives of their comrades at great risk to themselves. With
only 78 Medal of Honor recipients alive today, increasing their pension
would not create a significant cost, but would represent a small but
meaningful token of our appreciation for their heroic actions.
Accordingly, the VFW supports this legislation.
Mr. Chairman, this concludes my testimony and I will be happy to
answer any questions you or the Committee Members may have.
Letter from Rep. Ted W. Lieu, U.S. Member of Congress
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Letter from Stephen Peck, MWS, President & CEO, United States
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Letter from Orlando Ward, Executive Director of Public Affairs,
Volunteers of America--Greater Los Angeles
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Letters Submitted by Senator Dianne Feinstein
Letter from Bob Blumenfield, Councilmember, Third District,
City of Los Angeles
Letter from Jim Cragg, Director, Green Vets LA
Letter from Janet Napolitano, President, University of California
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Letter from Gary Toebben, President & CEO, Los Angeles Area
Chamber of Commerce
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Letter from Paul Koretz, Councilmember, Fifth District,
City of Los Angeles
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Letter from Mike Bonin, Councilmember, Eleventh District,
City of Los Angeles
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Letter from Eric Garcetti, Mayor, City of Los Angeles
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Letter from Nan Roman, President and CEO, The National Alliance to
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Letter from Gene D. Block, Chancellor, University of California,
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Letter from Melanie Gideon, MHSA, Director, UCLA Health--Operation
Mend, Executive Advisor, UCLA Health Sound Body Sound Mind
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Letter from Ben Allen, Senator, 26th District, California State Senate
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Letter from Michael Blecker, Executive Director, Swords to Plowshares
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Letter from Joseph ``Nick'' Guest, Adjutant/Quartermaster, Veterans of
Foreign Wars, Department of California
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Letter from Members of the Board of Supervisors, County of Los Angeles
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