Legislative Issues

STATEMENT

VIETNAM VETERANS OF AMERICA

SUBMITTED BY

RICHARD WEIDMAN
DIRECTOR, GOVERNMENT RELATIONS

BEFORE THE

SENATE COMMITTEE ON VETERANS= AFFAIRS

REGARDING

DEPARTMENT OF VETERANS AFFAIRS BUDGET REQUEST FOR FISCAL YEAR 2002

MARCH 13, 2001

Mr. Chairman, on behalf of Vietnam Veterans of America (VVA), I thank you and your distinguished colleagues for the opportunity to express our views for the record in regard to the President’s proposed FY 2002 budget for the United States Department of Veterans Affairs (VA).

While we appreciate President Bush speaking with emphasis about the nation’s responsibility toward veterans in his recent address to Congress, a one billion dollar increase in discretionary spending at VA is not an acceptable increase. VVA is very concerned about the effects of this grossly inadequate proposal will have on vitally needed services for veterans. VVA is equally concerned about accountability; will the resources made available by Congress be utilized for maximum impact, and will VHA actually spend funds in the manner directed by Congress.

The rate of medical inflation in the United States varies from about 8-12 percent (+) per year. An $800 million dollar increase for the Veterans Health Administration (VHA) from FY 2001 to FY 2002 is represents a 4 percent increase. In other words, the administration’s proposal for VHA is less than half of the conservative estimate of what VHA simply to maintain its ability to serve veterans. Congress can and must do better than this.

Vietnam Veterans of America enthusiastically endorse the Independent Veteran Service Organization (IBVSO) budget. At least $1.7 billion in additional funds over the FY 2001 level is needed in the VHA just to keep up with inflation. This level of funding for VHA does not address the need to restore the organizational capacity to serve veterans that was lost because of flat-lined appropriations in FY 1996, FY 1997, and FY 1998.

Specialized care services at VHA (e.g., spinal cord injury treatment, blind & visually impaired services, Post-Traumatic Stress Disorder (PTSD) treatment programs and services have all been dramatically eroded in the past five years. When the Veterans Eligibility Reform Act was enacted in 1996, Congress mandated that the level of resources and capacity to deliver the specialized services, which is really the heart of the VHA mission, be maintained at least at the FY 1996 level of effort. That has not happened. Rather, such services have been diminished and truncated due to a lack of resources and a lack of emphasis on these programs by key managers at the VHA the local health care delivery level, the Veterans Integrated Services Network (VISN) level, and at the national level.

One example of this diminishment of services is to the Seriously & Chronically Mentally Ill (SCMI) patients, which includes Post-Traumatic Stress Disorder (PTSD) treatment and substance abuse treatment. The funding for SCMI has dropped dramatically below the funding provided in FY 1996. At least five VISNs have no inpatient or resident treatment for chronic, acute PTSD. Substance abuse treatment programs have disappeared or been dramatically cut. Yet VA maintains that they are in compliance with the capacity requirements of the 1996 law.

The General Accounting Office (GAO) has determined that the management information systems and documentation of where it spends resources (much less the outcomes and results for the veteran) are woefully inadequate or non existent. VVA believes that even without adequate systems it is clear that VA is not in compliance with the 1996 law and needs to move to restore needed capacity, particularly in the specialized services.

Therefore, VVA recommends that an average of $1 billion per year be dedicated to restoration of vitally needed organizational capacity in VHA. This would probably be $600 million the first year, $1 billion the second year, and $1.4 billion the third year. The overwhelming majority of these funds (75-90 percent) would go to specialized services, with the balance going to staffing needs in acute care areas such as hepatitis C.

It is the belief of Vietnam Veterans of America that centralized control of funding is required in the specialized services and in some other key areas. The decentralized allocation of funds to the VISNs for the past five years has resulted in dramatic reductions in specialized services. After the flood of complaints of denial of service from veterans who needed prosthetics to Congress, and the resulting seeming inability of VHA central management to win cooperation of the VISN Directors, it was determined that the only way to ensure that veterans could get proper prosthetics services, no matter where they lived in the United States, was to centralize the funding. That effort has been successful.

VVA believes that the same centralized control of funding is necessary for all specialized services and other key areas, such as services to homeless veterans, and outreach, testing, and treatment of hepatitis C. This requirement for centralized control can be removed once the VHA has actually developed a sensible and workable computerized management information system, and has proven that there is a working system for holding VISN directors and other managers truly accountable for results and performance of the right measures.

Although VHA has done a great deal to address hepatitis C in terms of national policy, there still has not been the kind of outreach, testing, treatment, and case management program, on a consistent facility to facility basis that is needed. Nor has there generally been proper moves to acquire new staff at the medical center level needed to deal with the more than 70,000 veterans who have tested positive for the hepatitis C virus, even with only sporadic testing and virtually no outreach. Congress appropriated $350 million to deal with this problem, but VHA cannot account for these funds. The same could be said about any of the specialized services.

The bottom line is that VVA recommends a minimum of at least $2.3 billion in discretionary funding be appropriated to VHA over the FY 2001 level, with special tight controls over at least $ 600 million of these funds to ensure that these funds are utilized as intended by Congress (for the restoration of vitally needed organizational capacity, mostly in specialized services and the VA Vet Centers).

Readjustment counseling is provided through a national system of 206 community-based Vet Centers. The Vet Centers are located outside of the larger medical facilities, in easily accessible, consumer-oriented facilities highly responsive to the needs of the local veterans. For many veterans who would not otherwise receive VA assistance, the Vet Centers are the community-access points for VA healthcare. Vet Centers also prioritize care to high-risk groups such as minorities, women, disabled, high combat exposed, rural and homeless veterans. Comprising a unique more-than-medical VHA program, Vet Centers report to the Chief Readjustment Counseling Officer at VA Headquarters. Locally, the Vet Centers function in full partnership with the medical facilities in each of the 22 VISNs to effect a coordinated spectrum of care for local veterans.

Vet Center counselors are well-trained clinicians operating close to the veterans in the community and tailoring the services provided to the needs of the local veterans. The Vet Center program service mission features a holistic mix of direct counseling and multiple community-access functions: psychological counseling for veterans exposed to psychological war trauma, or who were sexually assaulted during military service, family counseling, community outreach and education, and extensive case management and referral activities. The latter activities include the full range of social and psychological services designed to assist veterans improve their quality of life and their level of social and economic functioning.

However, the lack of consistent employment services at the Vet Centers needs to be addressed by the VA and the U.S. Department of Labor. Given that neither Labor or VHA is seemingly prone to address this need (otherwise they would have addressed it long ago), Congress must reform the Department of Labor’s Veterans Employment & Training Service grant programs to the states to make them much more accountable for results, and to ensure much collaboration with the Vet Centers as well as VA Vocational Rehabilitation & Education Service.

In the past two years, the Vet Centers have also acquired the additional function of providing education and counseling to veterans treated for HIV and hepatitis C at VA medical centers. The latter services also include assistance to veterans’ family members. In addition, Vet Center community access functions are used to facilitate provision of VA primary care closer to veterans’ communities through collocation and tele-health initiatives.

There has been no specific augmentation of Vet Center resources in over 10 years. Small annual incremental budget increases have enabled the program to meet inflationary increases and to maintain the same level of services over the years. With no increase in program resources, the Vet Centers have, nonetheless, systematically extended the scope of their mission to include new veteran populations from the Gulf War; the peace-keeping missions in Somalia; Bosnia and Kosovo; World War II; the Korean War; as well as taking on the largest component of VHA’s sexual-trauma counseling.

Through stringent cost saving approaches, the Vet Centers continue to be one of VA’s most cost-effective programs. The Vet Centers have managed to remain cost-effective without sacrificing services to veterans; they have the highest rate of consumer satisfaction for any VA program. Additional FTEE and associated salary dollars for the Vet Centers will ensure the program’s capacity to fully provide its unique service mission in those communities needing staff augmentation.

RCS currently has 206 Vet Centers and 941 FTEE. The operating budget for FY 2001 (minus field travel dollars and the contracts program budget) is $70.6 million. Vietnam Veterans of America urges that for FY 2002, the RCS Vet Centers be specifically authorized and appropriated an additional 60 FTEE, and be specifically accorded $3.8 million in additional funds, for a total of $74.4 million and 1,001 FTEE for FY 2002.

In regard to the Veterans Benefits Administration (VBA) we recommend at least $80 million increase, with the proviso that increased attention be paid to the hiring and proper training of new adjudicators, ensuring that these new personnel are attuned to knowledgeably, accurately, and equitably adjudicate veterans claims in a timely manner, with presumption in favor of approving a substantiated claim. To train new personnel and to look for reasons to deny a claim, as opposed to working with veteran to identify evidence that supports the claim, is not acceptable.

Furthermore, the VBA needs to take significant meaningful steps toward holding their staff in particularly the supervisors and managers, on more accountable for the accuracy and quality of their work. As of now, the predominant measurement emphasis is on volume of processed veteran claims, irrespective of how well or accurately the decisions were made. Because veterans know this, the number of appeals and remands by the Court of Veterans Appeals and the Board of Veterans Appeals back to the Regional Office of the Veterans Benefits is very high.

Veterans have lost confidence in the system and appeal everything. The number of remands and regional office decisions overturned indicate that veterans are correct to have little faith in the fairness and accuracy of decisions in many regional offices. Moreover, the high remand rate on appeal is directly responsible for increasing the pending claims backlog at the regional offices. Returned claims are afforded expedited consideration, pushing new claims that have been languishing in piles even further down the docket.

If we are ever going to eliminate the backlog of claims, the focus has to be on doing it right the first time. A few years ago the Ford Motor Company almost went out of business because the emphasis on the production line was solely on speed and volume, and not on quality. Once Ford focused on getting it right the first time, production costs went down Ford survived and earned the trust of the American people.

The same sort or improvement in performance and results can also happen at the VA if Congress moves to assist Secretary Principi in this task. While at least $80 million more is required for VBA, VVA is equally concerned about performance and results. Vietnam Veterans of America is very concerned that the money that is being spent toward accomplishing the objectives set by Congress and the Secretary.

The National Cemetery Administration needs a significant increase to keep pace with inflation (at least $10 to $12 million). The Office of the Inspector General appropriation should be significantly increased, at the same time that Congress help refocus their mission. Too much time is being spent on recurring reviews that result in few changes or improvements of services to veterans. VA management needs to be held accountable for following through with decisive action.

Mr. Chairman, Vietnam Veterans of America urges you and your distinguished colleagues to push hard for a significant increase in the administration’s request for the FY 2002 VA appropriation. VVA also urges that you push hard for safeguards to ensure accountability for actual performance and results in all areas of the VA.

VVA strenuously objects to the proposal to transfer $235 million from the Veterans Health Administration (VHA) to the Department of Defense (DoD) to help pay for the recently expanded Tri Care benefits. This is an outrageous suggestion, and we urge Congress to reject it out of hand. The Defense side of the budget has plenty of room under the cap to pay for these benefits that retirees have earned by virtue of longevity retirement. General Motors does not ask Medicare to pay part of the “retiree benefits”, nor should a resource-rich DoD ask an under- funded VA to pay their bills.

VVA also strongly urges you and your distinguished colleagues on this Committee to hold a series of oversight hearings this year focusing on what VA said they were going to do with both the money appropriated for FY 1999 and FY 2000. Since Congress gave significantly more funds than VA said they needed to accomplish the goals set forth in their submittal, the central question should be about results and performance.

Mr. Chairman, Vietnam Veterans of America thanks you for this opportunity to share our views on the budget for FY 2002 for the Veterans Administration. We stand ready to actively support you and your colleagues on this Committee in every way we can to achieve proper funding for vitally needed services and treatment of veterans, and to ensure that those funds are spent effectively to achieve the best performance.

The national organization Vietnam Veterans of America (VVA) is a non-profit veterans membership organization registered as a 501(c)(19) with the Internal Revenue Service. VVA is also appropriately registered with the Secretary of the Senate and the Clerk of the House of Representatives in compliance with the Lobbying Disclosure Act of 1995.

VVA is not currently in receipt of any federal grant or contract, other than the routine allocation of office space and associated resources in VA Regional Offices for outreach and direct services through its Veterans Benefits Program (Service Representatives). This is also true of the previous two fiscal years.