How can Congress expect the Departments of
Veterans Affairs and Defense to transition medical records and
other services for soldiers seamlessly when they become veterans
when the computer systems of various branches of the VA—
the Veterans Benefits Administration, the Veterans Health
Administration, the National Cemetery Administration—can’t even
seamlessly communicate with one another? The VA’s Information
Technology (IT) capabilities came under scrutiny at a Senate
Veterans’ Affairs hearing in late October. Senators offered praise
for the VA’s electronic medical records. Unlike paper records that
were destroyed in the flooding caused by Hurricane Katrina, VA
doctors have access to the records of displaced VA medical
patients.
A press release announcing the hearing
noted: “The VA’s record system has been so well thought of that
earlier this year officials at the Centers for Medicare and
Medicaid Services announced they would distribute to
non-government doctors and hospitals scaled-down versions of
software, developed for and used by, the VA for use in its
hospitals and clinics.”
The release went on
to say, however: “While the VA has had its successes with
information technology, it has also taken some hits. In the past
ten years the VA has spent approximately $600 million on a
yet-to-be-implemented compensation and pension claims-processing
system, and $342 million on a failed financial management system.”
Additionally, some $300 million was wasted on a failed automated
personnel system.
The House Committee on Veterans’ Affairs
voiced similar concerns. In a welcome display of bipartisanship,
Chairman Steve Buyer (R-Ind.) and Ranking Member Lane Evans
(D-Ill.) introduced H.R. 4061, the Department of Veterans Affairs
Information Management Improvement Act of 2005. This bill would
give the VA’s Chief Information Officer (CIO) authority over the
VA’s IT budget, which currently is balkanized in the VISNs. It
also would give the CIO control in the oversight of policies,
procedures, personnel, and assets.
The VA has an excellent CIO: Robert
McFarland, a Vietnam veteran, spent most of his career in the
private sector, most recently as vice president of government
relations for Dell Computer Corporation. We know him to be a man
of integrity and talent who, if given the authority, will help
make the VA’s IT system cost-effective and innovative.
The rest of the House, seeing the wisdom
in this bill, passed it, 408-0. The Senate is expected to do the
same.
Significant Disconnect
VVA and most other VSOs pointedly disagree with Rep. Buyer’s
stances on several issues. We do agree with him, however, that the
much-heralded “seamless transition” between DoD and the VA is more
fantasy than reality.
A hearing on the subject by Rep. Buyer’s
committee at the end of September focused on the “significant
disconnect” between what Congress expects and what VA and DoD
envision. Both departments have issued broad statements—the VA
even created an Office of Seamless Transition—and do very little.
Buyer noted that this is hardly an
innovative subject: The concept was, in fact, codified in 1982 in
what was known as the “Sharing Act.” Since 1996, both departments
have made surface attempts to show that they were doing something
to shape, focus, and clarify joint sharing plans. In reality very
little was accomplished in this arena.
The VA and DoD “are still operating in
separate worlds,” Buyer said. “What do we have to show,” he wanted
to know, “for 20 years of effort?”
This is unacceptable. Both departments need to cooperate and
coordinate their efforts, their systems, and their personnel if
they are to fulfill the ethical and legal mandate.
What Buyer found entirely unacceptable was
the non-appearance of two top DoD officials at his hearing. Both
David Chu, Under Secretary for Personnel and Readiness, and
William Winkenwerder, Assistant Secretary for Health Affairs,
declined Buyer’s invitation to testify at the hearing. The
chairman was so annoyed that he noted this on three separate
occasions.
David Chu, however, perhaps to deflect
some well-deserved criticism, issued a memorandum a few days
before the hearing that proclaimed that DoD and the VA “identified
an initiative to expedite data exchange … for ‘seriously injured’
members, and those members entering the Physical Evaluation Board
Process. The goal is to assist the VA in its efforts to better
insure members are aware of their benefits and that these benefits
start as soon as possible when the member is eligible.”
What should be obvious to all seems to be a major undertaking at
DoD.
For his part, Buyer has promised to hold
future hearings on the subject, in part to hold officials’ feet to
the fire. For this, he deserves kudos.
MORE BUDGET WOES
At press time, the VA budget for fiscal year 2006 had not been
passed by both houses and signed into law. While we are focusing
on the immediate, we also should be considering the future.
Back in May, the Democratic Caucus of the
House Budget Committee issued a letter that was sent to interested
parties. This letter noted that the Republican Budget Conference
report would cut veterans health care funding $13.5 billion below
what the Congressional Budget Office estimates will be needed just
to maintain services at their current levels.
It’s not too early to start agitating, yet
again, for a more effective way of insuring sufficient funding for
the VA’s medical operations. In this effort, we will need the
active support of VVA members and continued pressure from the
Partnership for Veterans Health Care Budget Reform. You’ll be
hearing a lot more about this in Legislative Alerts, as well as in
future issues of The VVA Veteran.
PTSD Claims No Longer Threatened
Testifying before the House Veterans’
Affairs Subcommittee on Disabilities and Memorial Affairs, Ronald
R. Aument, Deputy Under Secretary for Benefits at the VA, said
that the VBA had conducted its own review of the 2,100 cases
reviewed by the Inspector General (IG).
“Our preliminary findings are that we
generally agree with the IG that some of the decisions made were
premature. We did, however, find that a large percentage of cases
judged to have insufficient development were older cases in which
VA statutes prohibit a change in the rating decision. If a
condition has been determined to be service-connected for a period
of 10 years or more, service connection is protected and may not
be severed except for a finding of fraud on the part of the
veteran. In other cases, we found that evidence verifying a
stressor was of record, but the decision failed to adequately
address the evidence.
“Additionally, in a number of the claims
we reviewed, the benefit was granted by the Board of Veterans’
Appeals, and VBA is not authorized to review Board decisions. VBA
has agreed, because of the strong recommendation of the IG, to
conduct a review of PTSD claims in which the veteran was awarded a
100 percent disability rating or IU rating in the last five years.
In that review, we expect that the majority of the claims will be
found sufficient and will not require further development. We also
expect to find, based upon our review of the 2,100 IG cases, that
further consideration of entitlement in some cases is barred
because the benefit granted is now protected by statute.” The
complete testimony may be found at
www.veterans.house.gov
When asked at the hearing by Rep. Tom Udall (D-N.M.), what it
would take to stop this study, which is expected to begin in
January, Aument answered, simply, “the Administration.”
The Senate version of H.R. 2528, the VA FY06 funding bill,
incorporated language that would prohibit the VA from using
federal dollars to review these 72,000 PTSD claims. As The
Veteran went to press, however, this provision had not been
agreed upon by both houses.
Action by Congress is now moot. On the day
before Veterans Day, VA Secretary Nicholson put the kibosh on this
retrospective review. He, too, deserves kudos.