VIETNAM VETERANS OF AMERICA
2001 GOVERNMENT RELATIONS PRIORITIES
GEORGE C. DUGGINS
DIRECTOR, GOVERNMENT RELATIONS
HOUSE AND SENATE VETERANS’ AFFAIRS COMMITTEES
MARCH 22, 2001
Mr. Chairman, my name is George C. Duggins, and I serve as National President of Vietnam Veterans of America (VVA). We are grateful to both the Committee on Veterans Affairs of the House of Representatives and the Committee on Veterans’ Affairs of the United States Senate for the opportunity to present our most pressing concerns regarding the vital needs of veterans to you and your distinguished colleagues here today. Mr. Chairman, I would be grateful if you would enter our prepared statement into the record, and I will try to summarize some of our key points of our concerns.
One of VVA’s key concerns is that we have adequate resources for the U.S. Department of Veterans Affairs (VA) for Fiscal Year 2002. VVA strongly recommends that there be at least $1.7 billion provided above the level for FY2001 just to keep pace with inflation at the Veterans Health Administration (VHA), plus about $600 million specifically to restore organizational capacity, particularly in the specialized services, that has been lost since 1996. This diminishment in capacity means that the VA is out of compliance with a vital and explicit requirement of the Veterans Eligibility Law of 1996. This situation must be corrected at the earliest possible time.
VVA also urges that the Veterans Benefits Administration (VBA) be accorded additional FTEE and resources to be able to do their job of timely, accurate, and fair adjudication of veterans’ claims. If they concentrate on “getting it right the first time” then the system will not be clogged with endless remands and appeals, and the backlog will be reduced rapidly. Although we are certain that additional resources and FTEE are needed to clean up this growing mess, VVA is also certain that better training, a better attitude of adjudicators toward veteran claimants, and proper supervision that is held truly accountable is equally necessary.
VVA believes that at least an additional $200 million is required to ensure that the VBA, the National Cemetery Administration, and other functions are properly funded.
As you know, Vietnam Veterans of America has enthusiastically endorsed the Independent Budget of the Veterans Service Organizations (IBVSO).
Mr. Chairman, we are grateful to you, to Mr. Evans, and to all of the distinguished members of the House Veterans Affairs Committee for the Views and Estimates the Committee forwarded to the Subcommittee on VA, HUD, and related agencies of the Committee on Appropriations regarding the FY 2002 appropriation for the Department of Veterans Affairs. Your recommendations regarding discretionary spending comes much closer than the President’s submittal to the amount of resources that are vitally needed by veterans. We thank you and your colleagues for this.
Of equal concern to VVA is how the dollars are spent by VA, and not just the amount of dollars appropriated. VVA believes that the VA has a long way to go to be in compliance with both the letter and the spirit of the Government Performance & Results Act (GPRA). VVA believes that Congress needs to take steps to ensure that its will is carried out. The first three steps are:
One, there is a pressing need to centralize funding and control over each of the specialized services, in a manner similar to what has happened in prosthetics. Only since prosthetics has been re-centralized have the problems in this area abated. There is a pressing need to also to centralize other specialized services, such as Seriously & Chronically Mentally Ill (SCMI), PTSD treatment, spinal cord injury services, and blind and visually impaired.
Control and faith placed in the Veterans Integrated Services Network (VISN) Directors to do the right thing and stay in conformance with the 1996 Veterans Eligibility Reform Act simply has not worked. No matter what face VHA tries to put on this issue, the VHA has reduced the organizational capacity in all of the specialized services below the FY 1996 level.
Two, VVA urges you to work with the Secretary and give him statutory authority if necessary, so that he ensure that VISN Directors, VAMC Directors, managers, supervisors, and others are held much more accountable for performance. The same is true on the VBA side of the VA, in that VA Regional Office Directors, managers, and supervisors should be held accountable for the accuracy and fairness of claims decisions, and the proper actions of their Vocational Rehabilitation people in truly assisting disabled veterans.
Three, VVA urges both the House and Senate Veterans’ Affairs Committees to hold oversight hearings on what the VA said they were going to do in FY2000 in their narrative that accompanied their budget request. Since the Congress gave them a great deal more than they asked for, the problem cannot be lack of resources. Especially in regard to the specialized services, hepatitis C, homelessness, and other key areas, this oversight is key to moving the VA toward greater accountability on an ongoing basis. For example, it will greatly interest us to find out what happened to the $350 million appropriated last year for treatment of hepatitis C.
Frankly, Mr. Chairman, VVA believes that Congress and the veterans service organizations are much more passionate and angry about this lack of accountability than key folks at VA understand. You can help them understand that VA can and must do better, beginning this fiscal year, and at the same time support Secretary Principi in his efforts to bring greater accountability.
VVA is strongly committed to holistic care for veterans, with a concerted effort to keep a veteran as healthy, independent, and autonomous as possible. To do this, VA must do a much better job of examining veterans, particularly for all of the maladies and conditions that may be related to their military service.
Key to this is changing the corporate culture of VHA staff from being just a general health care system that happens to be for veterans instead of what their real mission is—a Veterans health care system that concentrates on the wounds of war and of military service. For this to happen, a complete military history needs to be taken of every veteran, and used to indicate follow-up tests that should be done on each veteran based on when, where, and what branch the veteran served.
VVA appreciates the sense of Congress regarding this issue passed last year, but we feel that Congress must take stronger action to insure that the Veterans’ Health Initiative is fully developed and uniformly implemented.
Part of VVA’s commitment to treating the “whole veteran” is that VVA strongly believes that virtually all VA programs should be measured by whether that program contributes toward helping veterans obtain and sustain meaningful employment at a living wage.
It can certainly be argued that we should spend more in many areas, but the fact of the matter is that VA spends billions on treatment and rehabilitation of one sort or another, but all of those prodigious efforts will come to nothing if we do not actually help the veteran obtain and sustain meaningful employment at a living wage.
The system for assisting veterans to find work is not working well, particularly in many of the most populous areas of the country, and there are no meaningful standards of performance and results, much less rewards for good performance or sanctions for poor results.
Mr. Chairman, Vietnam Veterans of America (VVA) urges Congress to pass legislation this year that makes meaningful reform in the Veterans Employment & Training Service (VETS) system at the United States Department of Labor (USDoL), and meaningful efforts to hold VA Vocational Education, Counseling, & Employment much more accountable at every level of the organization for assisting men and women to obtain and sustain meaningful employment at the highest level of the veteran’s potential, or to enter self-employment micro-business. VVA believes that this must be a top priority for this legislative year.
In regard to the vital needs of homeless veterans, VVA urges quick passage of the Heather French Henry Homeless Assistance Veterans Act, introduced recently by Congressman Lane Evans. VVA also urges numerous important changes in the VA Grant & Per Diem Program that would result in improving the access to funding for the highly cost-efficient community-based homeless veterans service providers. VVA also urges restoration and extension of effective alcohol and substance abuse program for homeless veterans and others.
In regard to Health Care issues of vital importance to veterans, VVA urges that work begin now on renewing the Agent Orange Act of 1991 (PL 102-4). In the renewed act we urge that the reviews by the National Academy of Sciences Institute of Medicine (IOM) continue, but that there also be specific funds authorized and appropriated to fund privately conducted, peer reviewed studies. The main problem with the IOM bi-annual reports is that it only can review research that is peer reviewed and published. There are no American studies now being conducted except for the Air Force’s Ranch Hand Study which has major shortcomings. The only studies being done are European or Asian countries.
The need is for at least $100 million in research dollars to fund universities and other research institutions to conduct numerous studies over the next few years, if we are to be able to adequately answer the legitimate questions of Vietnam veterans and their families. We look forward to working with the Committee staff in both Houses on a bipartisan basis to develop an adequate blueprint for the next ten years on Agent Orange. Frankly, VVA believes that the best way to do this is creation of a National Institute for Veterans Health as part of the National Institutes of Health.
In regard to Hepatitis C, VVA strongly favors early hearings and prompt passage of H.R. 639, the Veterans Hepatitis C Comprehensive Health Care Act, introduced by Congressman Freylinghuysen and co-sponsored by more than 60 members of both parties, to ensure that resources and quality assurance actually reach the service delivery level where needed. Additionally VVA strongly favors action to confirm hepatitis C as a presumptively service connected condition. While we understand that the Committees may be waiting for the new Secretary of Veterans Affairs to act on Vietnam Veterans of America’s petition of March 23, 1999 and May 5, 2000 regarding this issue (See Appendix I), we ask that you work with us on a bipartisan basis to develop proper legislation regarding service connected presumption for hepatitis C before the 107th Congress ends.
Vietnam Veterans of America asks that you take steps to ensure that the VA Readjustment Counseling Service, popularly known as the VA Vet Centers‘ are accorded at least 60 more FTEE, and at least another $3.9 million for FY 2002 as compared to FY 2001. The Vet Centers are perhaps the most studied program at VA over the last 20 years, and endure as a low cost, highly effective and cost efficient program that helps many veterans keep their current employment, others to overcome problems that get in the way of finding and keeping a job, and helps reunite and keep families together. Just as important, there are many veterans of all generations who will use one of the 206 Vet Centers but will not go near a Veterans Administration Medical Center.
Vietnam Veterans of America asks that you take steps to insure that both inpatient and residential care treatment for veterans with chronic, acute Post-Traumatic Stress Disorder (PTSD) is available in each of the 22 VISNs, and that overall resources in this area be restored at least to the levels of FY 1996. We also ask that you take all necessary steps to ensure that the same restoration is accomplished for substance abuse treatment programs.
In regard to military retirees, VVA strongly favors early passage of HR 303 and S171, the concurrent receipt bills that would restore equity of military personnel who retired because of longevity of service and later turn out to have service connected disabilities with federal civilian employees who retired because of longevity of service who are also later turn out to have service connected disabilities. There should be no reduction from earned military retiree pay for disability payments any more than there should be deductions from civilian retiree pay for disability payments.
VVA opposes forcing retirees to choose between their personal health care needs and securing health care coverage for their families by forcing them to choose either VA or Tri Care as their provider. VVA also strongly favors allowing military retirees to have the same access, at the same cost, to Retired Federal Employees Health Care Benefits (RFEHB) as is accorded to civilian Federal retirees. Not doing so for military retirees is blatant antimilitary service discrimination, in our view.
VVA strongly favors an increase in the Montgomery GI Bill to at least $1000 per month, indexed for inflation into the future. More than an earned benefit, the GI Bill is perhaps the best investment America can make in our future. VVA also urges increasing the appropriation for the State Veterans Education Approving Agencies to at least $18 million, given their expanded scope and responsibilities under recent legislation. They have been flat lined for more than five years now, and are in danger of not being able to meet their important duties.
VVA asks that you take steps to make permanent the authority for care for sexual trauma, and take steps to ensure that there are enough full time Women Veteran coordinators within each VISN to ensure that the needs of women veterans are being met in both the community-based outreach clinics, and the medical centers.
VVA also request that you take steps to ensure that Public Law 106-419, which provides for treatment services and certain benefits to children born to women who served in Vietnam, is implemented at an early date. Not much has happened thus far, and no regulations or proposed regulations implementing this law have been published thus far. VVA further asks that legislation be crafted that would extend the same treatment services and benefits to children with birth defects who were fathered by male Vietnam veterans, and that Congress exercise your important oversight function to the fullest to ensure that proper implementing regulations are promulgated, and that these vitally needed services are delivered in an effective and timely manner.
Vietnam Veterans of America asks that Congress begin work now on the extension and possible improvements on PL 102-4, the Agent Orange Act of 1991, which must be completed this Congress to extend the authority for the ongoing work with the National Academy of Science Institute of Medicine (IOM) to help determine overall validity of the science in regard to various conditions and maladies that may be due to exposure to Agent Orange and other possible toxins present on the battlefield in Vietnam. While this work continues in this Congress, VVA urges you to press for action on the outreach (as noted above), and the making of grants to reputable scientific institutions to perform research on the effects of Agent Orange and the many other environmental hazards that existed on the Vietnam battlefield, quite apart from enemy fire.
The IOM review is working well as far as it goes, but it is a passive process. By that we mean that the IOM panels of distinguished scientists can only review peer-reviewed studies that have been published. Since no U.S. Government entity is now funding research, except for the limited use Ranch Hand study being conducted by the Air Force, most of the scientific articles come from abroad. It is high time that Congress sees to it that funds are available to reputable academic and recognized scientific entities for legitimate studies, of a sufficiently large and robust sample size, into the possible health impact of Agent Orange and other toxic substances present in Vietnam.
In regard to benefits, VVA urges you to seek legislation that would eliminate the arbitrary 30-year limit on some service-connected presumptive conditions for those exposed to Agent Orange. There is no scientific evidence to back this 30 year limit, and it should be removed. Further we ask your help in ensuring that VA modernizes the so-called Agent Orange registry by fully automating this registry and making it accessible nationally, and not from just one locale, greatly improve the examination protocol so that it is in line with what is currently know about the effects of dioxin and the many other harmful toxic agents that were prevalent on the Vietnam battlefield, and start to really do outreach on Agent-Orange-related issues to the 85 percent of veterans who currently don’t use VA at all. As an example, VVA believes that the majority of Vietnam veterans who are suffering from, and possibly dying of, prostate cancer have no idea that it may be related to their service in Vietnam. VA simply must do a better job in outreach on Agent Orange, as well as outreach on the need for veterans to get tested for hepatitis C. We ask the Congress to assist in making sure that this outreach occurs, and that it is done in an effective manner.
Vietnam Veterans of America (VVA) also believes that it is time to recognize that adult onset diabetes mellitus as a presumptive service connected disability. While we hope and trust that the current Secretary of Veterans Affairs will complete the process of moving forward with regulations to accomplish this needed change, VVA asks that the Congress support the Secretary of Veterans Affairs in this regard, and take steps to ensure that this regulatory change is placed in statute at the appropriate time. This process began with a formal petition form VVA in the year 2000. (See Appendix II).
"As part of VVA's long-standing commitment that never again will one generation of veterans abandon another, we hope the Congress will act swiftly to pass and codify into statute H.R. 612 and S.409, The Persian Gulf War Illness Compensation Act of 2001. These measures are designed to address the very real problem of Gulf War veterans being denied undiagnosed illness compensation on the basis of incomplete or inappropriate diagnoses. The Congress original intent in passing Gulf War illness compensation legislation was that veterans would received compensation for ill-defined or poorly understood medical conditions developed in the wake of Desert Storm. Unfortunately, the VA General Counsel's office chose to narrowly interpret the intent of Congress, resulting in thousands of ailing Desert Storm veterans being denied compensation for their legitimate undiagnosed conditions. HR 612 and S.409 will eliminate this problem by specifically defining undiagnosed conditions in legislation, thus ensuring sick Gulf War veterans receive the compensation that is their due. We urge the committee to support H.R. 612."
VVA also urges significant expansion and better funding for the grants to the states for construction of state veteran homes and for state veteran cemeteries. In order to meet the demand for long-term care for veterans and for additionally needed proper burial sites for veterans, no matter where they live in America, these state grant programs are the key to meeting these genuine and pressing needs when these services are needed.
We have attached a list of issues, briefly stated, that outlines the full range of VVA’s current legislative and policy concerns (See Appendix III). Mr. Chairman, I again thank you for this opportunity to present some of the most pressing of those concerns of Vietnam Veterans of America to you and your distinguished colleagues here today. I will be happy to answer any questions you may have.
George C. Duggins
George Duggins, National President of Vietnam Veterans of America, is 56 years old and lives in Chesapeake, Virginia, Mr. Duggins served with the U.S. Army Security Agency (ASA) from July 1965-April 1969, attaining the rank of Specialist Five. Mr. Duggins served two tours in Vietnam: with the ASA in Phu Bai from January 1966 to December 1967, and in Pleiku from April 1968 to April 1969. After his second tour, Mr. Duggins was honorably discharged.
A graduate of Tidewater Community College with a degree in computer technology, Mr. Duggins has been a long-time veterans advocate and has received numerous awards for his service to veterans. He is a life member of Vietnam Veterans of America, holding membership in VVA’s Tidewater, Virginia, Chapter 48. Mr. Duggins has been on VVA’s National Board of Directors, has served as national chair of VVA’s membership, credential, convention, scholarship, and minority affairs committee, and in 1995, was elected national Vice President. In 1996, he was a member of an official U.S. delegation sent to Vietnam, Laos, and Cambodia by President Clinton to investigate the POW/MIA issue. Mr. Duggins became national president of Vietnam Veterans of America in January 1997.
Mr. Duggins is employed at ValueOptions, in Norfolk, Virginia, as a computer system engineer. He has played a role in forging and implementing the business expansion plans of the company in the past ten years. ValueOptions is today the second largest managed behavioral health company in the United States, offering “more choice for more people.”
Mr. Duggins is past chair of the City of Chesapeake’s Mayors Committee on Veterans Affairs and is the chairman of the Board of Trustees at Metropolitan A.M.E. Zion Church. He also served on the Citizens Advisory Board of Huntsman’s Chemical and the Aeolin Club. Mr. Duggins has also been appointed to the Board of the National Task Force on Veterans Entrepreneurship.
George is married to the former Blanche L. Neal, a middle school teacher. They have two daughters, Stacey Davida, who is a graduate of Virginia Tech University, and Shana Tenille, who is a senior at the College of William and Mary in Williamsburg, Virginia.
FRANCIS EDWARD CROUCHER
Ed Coucher, 53, the Executive Director of Vietnam Veterans of America (VVA), served for more than 29 years with the U.S. Marine Corps. He rose from the enlisted ranks, through the warrant officer ranks, to captain. Croucher served two tours in Vietnam as a helicopter aircrewman in I Corps, August 1965 to October 1967, and as an aviation ordnance technician in the Danang ammunition depot, December 1969 to August 1970. He was awarded the Purple Heart, the Meritorious Service Medal, 15 Air Medals, the Navy Commendation Medal, and the Navy Achievement Medal. Croucher retired from active service in October 1993.
A Graduate of Southern Illinois University with a degree in aviation management and a master’s degree in Management from Troy State, Croucher is a vocal advocate for veterans. He is a life member of VVA with membership in Eastern Montana Chapter 234, Glendive, Montana, the Veterans of Foreign Wars, The Retired Officers Association, The Disabled American Veterans and the Military Order of the Purple Heart of the USA, Inc. He has held numerous positions in VVA at the chapter, state, regional and national levels, most recently Region 8 director and chair of the Mike Nash Scholarship Committee.
Croucher sat on the Management Advisory Council and the Long Term Care Planning Group for the Department of Veterans Affairs, Rocky Mountain Network. He is founder and past president of Community Giving Assistance to Employment, a nonprofit organization providing supportive services to the unemployed. Croucher is past member of Montana’s Veterans Advisory Council. Prior to becoming VVA’s executive director, he was administrator of the Eastern Montana Veterans Home.
Croucher is married to the former Chris Brock, a public assistance coordinator. They have three sons. Don, a student at Montana State University, School of Technology, and Wesley and Scott who are both pursuing Navy careers.
THOMAS H. COREY
Tom Corey currently serves as Vice President of Vietnam Veterans of America, the nation’s only congressionally charted organization devoted to serving the needs of Vietnam-era veterans and their families.
A native of Detroit, Corey was drafted into the U.S. Army and sent to Vietnam in May 1967. He served as a squad leader with the 1st Air Cavalry Division. While engaged in an assault against enemy positions on January 31, 1968, he received an a enemy round in the neck which hit his spinal cord and left him paralyzed and a quadriplegic. He was medically retired in May 1968.
After an extended period of hospitalization, Corey returned to his family in Detroit where he spent much of his time in and out of the local VA hospital. He relocated to the West Palm Beach, Florida, in 1972, where he is involved in community affairs and serves on many advisory boards. He has received awards for speaking out on veterans and disabled persons rights.
Corey was the first recipient of the Vietnam Veterans of America’s Commendation Medal, VVA’s highest award for service to veterans, their families and the community.
He served as a member of the board of directors and President of the Paralyzed Veterans Associating of Florida. He also serves on advisory boards at the VA Medical Center in West Palm Beach, Florida, the VA Research Foundation of the Palm Beach, VISN 8 Management Assistance Council, and Vietnam Veterans Assistance Fund.
Corey was the founding President of VVA Palm Beach County Chapter 25, in 1981. In 1991 the chapter was named the Thomas H. Corey Chapter at its 10th Anniversary celebration. In 1985 he was elected to a two-year term as a VVA national board member. In 1987, he was elected as VVA’s national secretary and was re-elected in 1989, 1991, 1993 and 1995 to that position. In 1997, he was elected VVA’s national Vice President.
Tom Corey currently resides in West Palm Beach. He has an eighteen-year-old son, Brian.
Richard Weidman serves as Director of Government Relations on the National Staff of Vietnam Veterans of America. He served as a medic with Company C, 23rd Med, Americal Division, located in I Corps of Vietnam in 1969.
Mr. Weidman was part of the staff of VVA from 1979-1987, serving variously as Membership Service Director, Agency Liaison, and Director of Government Relations. He left VVA to serve in the Administration of Gov. Mario M. Cuomo (N.Y.) as Director of Veterans Employment & Training for the New York State Department of Labor.
He has served as Consultant on Legislative Affairs to the National Coalition for Homeless Veterans, and served at various times on the VA Readadjustment Advisory Committee, the Secretary of Labor’s Advisory Committee on Veterans Employment & Training, the President’s Committee on Employment of Persons with Disabilities on Disabled Veterans, Advisory Committee on veterans’ entrepreneurship on the Small Business Administration, and numerous other advocacy posts in veteran affairs.
Mr. Weidman was an instructor and administrator at Johnson State College (Vermont) in the 1970s, where he was also active in community and veteran affairs. He attended Colgate University B.A., (1967), and did graduate study at the University of Vermont.
He is married and has four children.
VIETNAM VETERANS OF AMERICA
March 22, 2001
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.
For Further Information, Contact:
Director of Government Relations
Vietnam Veterans of America.
(301) 585-4000 ext. 127
May 5, 2000
The Honorable Togo D. West, Jr. (00)
Secretary of Veterans Affairs
United States Department of Veterans Affairs
810 Vermont Avenue NW
Washington, D.C. 20420
Re: Hepatitis C Rulemaking
Dear Mr. Secretary:
Over thirteen months ago, on March 23, 1999, Vietnam Veterans of America (VVA) submitted a formal petition to you requesting that you promulgate an important regulation on Hepatitis C claims. Thirteen months is longer than the standard tour of duty in Vietnam, and should be enough time for the Department of Veterans Affairs to accomplish the necessary regulatory analysis needed to issue this desperately needed regulation. For your convenience, I have attached a copy of our petition.
As you are aware VVA has requested that you declare that Vietnam veterans who have been diagnosed with Hepatitis C and who were exposed to recognized risk factors in the course of serving our Nation in the Vietnam War receive service connection for such disease on a presumptive basis.
This past weekend marked the twenty-fifth anniversary of the last Americans leaving Vietnam, and May 7th will mark the official ending date of the Vietnam Era. While VVA hopes that you and the President will soon begin to work with us in regard to the petition on “in-country effect” that we filed with you on April 27, 2000, it would certainly be an interim measure of good faith in dealing with the wounds of war to immediately promulgate regulations that allow for presumptive service connection for Hepatitis C.
VVA has reason to believe that the necessary regulatory analysis has been sufficiently accomplished so that you can act at any time that the will becomes present. Since your representative stated at the recent hearings by the House Committee on Veterans Affairs that regulatory approach is more practical than waiting for Congress to pass legislation on this issue, we are puzzled as the need for additional time to publish regulations on this issue. These regulations are vitally needed by many veterans and their families. VVA urges you to take action now, and for you to announce your intent to do so as early as May 7, or at least prior to May 29th, (which is the twenty-fifth Memorial Day since the formal end of the Vietnam War).
If VVA can be of assistance to you in this matter, we stand ready to assist you in any way possible. As always, thank you for consideration of our views.
George C. Duggins
October 13, 2000
Honorable Hershel W. Gober
Acting Secretary of Veterans Affairs
U.S. Department of Veterans Affairs
810 Vermont Avenue, N.W.
Washington, D.C. 20420
Re: Presumptive Service-Connection for Adult-Onset Diabetes Mellitus (Type 2) as the Result of Exposure to Herbicidal Agents
Dear Mr. Acting Secretary,
I am writing once again to petition the U.S. Department of Veterans Affairs (VA) to immediately amend existing regulations to provide for presumptive service-connection for adult-onset diabetes mellitus (type 2) as the result of exposure to Agent Orange and other herbicidal agents. Veterans have been severely affected by this disease for years without both well-deserved compensatory relief and desperately needed health care. In an April 27, 2000, formal petition for rulemaking, Vietnam Veterans of America (VVA) requested former-Secretary West to add adult–onset diabetes to the list of diseases that are presumed to be related to herbicidal exposure during the Vietnam War. Previously, Secretary West deferred doing so pending the results of the Institute of Medicine (IOM) of the National Academies’ reevaluation of the relationship between such exposure and the subsequent development of that disease. In view of the IOM’s October 11, 2000, announced determination that there exists “new ‘limited or suggestive’ evidence” of an association in this respect, it is clear that the time has come for the VA to establish presumptive service connection for diabetes mellitus.
By way of background, Congress, almost a decade ago, passed Public Law 102-4, the “Agent Orange Act of 1991”. See 38 U.S.C. § 1116. The Act provided the Secretary of Veterans Affairs with the authority to establish presumptive service connection (i.e., entitlement to service connection for diseases without the necessity of medical evidence to establish an etiological nexus between military service and a current disease) for diseases that have been scientifically demonstrated to be associated with exposure to the chemical defoliant Agent Orange, dioxin and other herbicidal agents during military service in Vietnam. Whenever the Secretary determines, on the basis of sound medical and scientific evidence, that a “positive association” exists between such exposure and the subsequent occurrence of disease, the Secretary shall prescribe regulations providing that a presumption of service connection is warranted for such disease. See 38 U.S.C. 1116(b)(1). In making such a determination, the Secretary has been directed to take into account both reports received from the National Academy of Sciences (NAS) and “all other sound medical and scientific information and analyses available to the Secretary.” 38 U.S.C. 1116(b)(2). The association between disease and exposure is considered to be positive if “credible evidence for the association is equal to or outweighs the credible evidence against such association.” 38 U.S.C. § 1116(b)(3).
Currently, nine diseases are presumptively considered to be the result of exposure to herbicidal agents used in Vietnam during the war. They are as follows: chloracne or other acneform disease consistent with chloracne; Hodgkin’s disease; acute and subacute peripheral neuropathy; porphyria cutanea tarda; multiple myeloma; non-Hodgkin’s lymphoma; prostate cancer; respiratory cancers (i.e., cancer of the lung, bronchus, larynx or trachea); and certain specified soft-tissue sarcomas. See 38 C.F.R. § 3.309(e). Moreover, exposure to these agents has been shown to be so detrimental that VA healthcare, vocational training and a monetary allowance are available for children of Vietnam veterans who suffer from spina bifida. See Pub. L. 102-4, § 402.
Earlier this year, the U.S. Air Force released the results of its own Ranch Hand Study. In that study, scientists found strong evidence that exposure to Agent Orange is associated with adult-onset diabetes, as well as the disease’s known complications. In this respect, the study noted a 47 percent increase in diabetes in persons with high levels of dioxin in their tissues. Moreover, the study reflects significant decreases in the time to onset of such disease. This study, in combination with the IOM’s current findings, clearly constitutes sufficient medical and scientific evidence to establish a positive association and a biological mechanism between exposure to Agent Orange/dioxin and adult-onset diabetes mellitus. Consequently, this new evidence is, at minimum, equal to, or, in our opinion, outweighs, evidence against such association.
Since the requirements of the Agent Orange Act have therefore been satisfied, we maintain that the Acting Secretary has the authority, and the solemn responsibility, to immediately promulgate an interim final regulation that would establish presumptive service connection for adult-onset diabetes mellitus as the result of exposure to herbicidal agents while serving in Vietnam. Therefore, VVA, with the deepest conviction, respectfully urges that 38 C.F.R. § 3.309(e) be amended to reflect this presumption. We would also ask that such action be accomplished within the next 30 days.
Mr. Acting Secretary, there can be no doubt that veterans who served in Vietnam faced exceedingly more than the dangers associated with hostile action. The environment in which they lived, fought and died teemed with toxic chemicals and endemic diseases. Much has been accomplished in recognizing this basic truth, but there is a long way to go. Vietnam veterans incur diseases of old age many years sooner than those of similar age who did not serve there. Adult-onset diabetes mellitus, generally with no prodromal manifestations during service, is a prime example of this phenomenon. Vietnam veterans are dying of this disease. Often, they go without medical treatment because of financial difficulties. For these veterans, presumptive service connection not only means receiving disability compensation, but also entitlement to life-saving VA medical care. With the body of scientific evidence that currently exists, as well as the Secretary’s Congressional authority to take immediate action through administrative rulemaking, VVA believes that there is no factual or legal impediment to presumptive service connection for diabetes as described above. See, generally, 38 U.S.C. § 501.
Thank you very much for your prompt attention to this important matter.
George C. Duggins
VVA National President
2001 VVA LEGISLATIVE AGENDA AND POLICY INITATIVES
Adopted at the VVA National Board Meeting of January 27, 2001
I. HOMELESS VETERANS
Enactment of the Millennium Fair Share for Homeless Veterans Act or an Executive Order:
· Require that a fair share of resources from all federal programs be targeted to veteran- specific programs, especially to programs meeting the special needs of homeless veterans.
· Eliminate the “match” requirements for VA Grant & Per Diem Program.
· Require separate funding pools at VA for expansion and enhancement of existing programs.
Enactment of The Service Members’ & Veterans Self-Sufficiency Act of 2001,
A Holistic Approach To Assist Homeless Veterans:
· Ensure mental health and PTSD treatment is available in all VAMCs.
· Expansion of existing alcohol & substance abuse detoxification programs to every VAMC. Ensure adequate transitional housing and subsidized apartments.
· Extend Homeless Veteran Reintegration Program (HVRP) for 10 years.
- Revision of eligibility rules for VA per diem.
- Mandate that at-risk and homeless veterans be designated a “special needs” population by the VA.
- Mandate day-treatment and partial hospitalization/residential treatment program. participants be eligible for 100 percent service-disabled veteran compensation during treatment.
- Support the Heather French Homeless Veterans Assistance Act of 2001.
- Support legislation that would incorporate a fair-share dollar approach for the funding of programs and services that specifically target homeless veterans.
- Advocate to legislatively create veteran offices in major federal agencies to suggest policy and coordinate services.
- Establish a homeless veterans advisory committee consisting of (VSO’s) at the federal level for all agencies serving the homeless, beginning with HUD, DOL, HHS, and DVA.
- Support the introduction of legislation that would allow amendment of Title 38,Chapter I, Part 17, Section 17.700 that would permit existing homeless providers to access the VA Grant & Per Diem Program.
Enactment of The Comprehensive Agent Orange and Dioxin Act of 2001, that would authorize, mandate, and fund:
- Research in Vietnam funded at a level of $5 million per year over a 5 to 6 year period.
- Research in the United States at a level of at least $100 million in aggregate funding to do research that is independently performed but funded by the federal government would include truly national epidemiological study focused on Vietnam veterans and research adverse health impact of exposure to Agent Orange and other toxic substances; experiences in military service; and birth defects in progeny of male Vietnam veterans.
- Review of death certificates of veterans, children and their grandchildren.
- $3.2 million for a National Vietnam Veterans Readjustment Study to include hepatitis C.
- Veterans in Times Beach, Missouri and other dioxin-contaminated sites in the United States.
- Compile a database at Library of Congress or National Institutes of Health and National Institute of Environmental Health Study of all relevant toxic chemicals studies and surveys, to include state studies.
- Fund fully the National Institute of Veterans Health at National Institute of Health.
- To strengthen Scientific Advisory Group/civilian control of Ranch Hand Study.
- Additional birth defects studies and presumptive connections where indicated; study birth defects in second and third generations.
- Advocate for presumptive service-connection of all cancers diagnosed in Vietnam veterans.
Enactment of The Veterans’ Comprehensive Health Care Act of 2001:
- Mandate testing for theater/branch/era/M.O.S. specific conditions.
- Require Medicare subvention for non-service connected conditions at VAMC to keep revenue.
- End discrimination in allocation of resources against neuropsychiatric disciplines and readdress current imbalance of resources.
- Institute quality assurance system for each VAMC/VISN, for each discipline; report to Congress.
- Utilize rewards, sanctions, and competitive models to insure health care quality and real accountability for performance and results at VA.
- Holistic care approach, especially for PTSD/Mental Health/Sexual Trauma.
- Mandate permanent sexual trauma treatment at VHA.
- Create former-POW health registry, conduct health studies, and designate as a special population.
- Mandate OMBUDSPERSON at each VAMC with former POW responsibilities.
- Insure universal access to services for service-related maladies, irrespective of veterans’ location.
- Seek approximately $2 billion increase for inflation VHA in FY02 budget and average a increase of $1 billion for the next three years to restore organizational capacity lost since 1996.
- Due to the increase in Community-based Outpatient Clinics (CBOCs), VA needs to seek a full-time Women Veterans Coordinators within each VISN for oversight and coordination of programs to insure women veterans receive proper medical services at all VHA sites.
- Require a study regarding access to medical care and outcomes, comparing results for each ethnic and racial grouping, as well as differences by gender and age.
- Significant increase in capital and operating budget for State Veterans Homes.
- Insure PTSD and mental health treatment are available in all geographic areas (22 VISNS). The amount of care available should be related to the veterans population.
- Expand existing alcohol and substance abuse detox services to all VAMCs.
- Insure continuum of care for care of severely chronically mentally ill patients.
- Legislation that would mandate the monies for NIEHS that would be utilized exclusively for Agent Orange/dioxin research in Vietnam.
- Amend P.L. 102-4 and require that NAS consider all studies that are relevant to chemicals used in Vietnam.
- Amend P.L. 102-4 in relation to burden of proof on scientific studies.
- Mandate that NAS make a statement on diseases as to whether it is just as likely as not that Agent Orange/dioxin, etc., could have caused the illness.
- Increase Vet Center staff especially in larger vet centers to the national level of 1,000 FTEE, with increase in funds
· Mandate research regarding cancers in veterans and their families at Camp Lejeune, North Carolina.
- Mandate dual diagnoses for co-morbidity acute anxiety or severe depression.
- Seek GAO report on quality assurance at VAMC and Community-based Outpatient Clinics.
- Expand contracted services to benefit veterans health care.
- Give nurse practitioners and physician assistants the same range and scope of practice at VA as accorded at DOD, with commensurate increase in pay.
- Need follow-up aftercare program for veterans coming out of residential programs.
- Need longitudinal study on long-term illness and long-term care, and follow-up action to fully meet the long-term care needs of veterans.
Medical Care for Retirees - VVA is committed to legislation that would allow all military retirees and medically retired military persons and their families to obtain Federal Employee Health Benefits (FEHB) with no initiation fee, and at the same cost to the individual as for retired federal civilian employees.
Modify Veterans Equalization of Resource Allocation system (VERA) at VA to address and reflect acuity of illness, number of service-connected veterans, and low-income veterans in dollar distributions.
III . EMPLOYMENT, TRAINING, AND BUSINESS OPPORTUNITIES
- Secure enactment of more effective legislation to accord veterans’ preference in hiring, promotion, and retention by federal contractors; evidence non-discrimination in promotion; Federal Labor Relations Board and federal courts as adjudicator of claims; demand compliance to bid.
- Work with the Small Business Administration (SBA), Departments of Commerce and Labor to publish small business pamphlets for veterans who want to be entrepreneurs.
- Seek sole source authority for federal agencies to buy from disabled-veterans-owned businesses.
The Veteran Family Preservation Act of 2001 (veterans’ one- stop legislation)
- Competitive measures as a means of quality assurance in DVOP/LVER and other employment services programs; results oriented; and “fair share” accountability.
- Re-education and training of veterans for the new 2001 work force.
- Compensated Work Therapy program expanded and coordinated with all federal resources.
- Mandate full-time DVOP outstation at each Vet Center, VA Vocational Rehabilitation, and other sites. Measure and enforce Federal Contractor Compliance employer contacts (measured results, with rewards and sanctions) with mandate to hire, promote, and retain veterans and disabled veterans.
- Authority for VA to provide services to veterans’ family members and significant others where clinically indicated; creation of Veterans Family Service Coordinators in each VAMC and VARO.
- Expand and strengthen self-employment assistance programs.
- Seek a study on disparities among Compensated Work Therapy (CWT) programs operated by the VA, pursue legislation requiring minimum standards and quality assurance for each CWT site, with real accountability.
Seek and secure congressional oversight hearings that address:
- Disparity between Agent Orange claims filed versus claims granted and lack of Agent Orange research.
- Report on length of time in adjudication; remand rate (each by category of claim).
- Veteran access to claims file.
- Seek legislation that requires effective quality assurance procedures within the Veterans Benefits Administration (VBA) in performance ratings, and require other forms of rewards and sanctions for performance.
Seek enactment of The Equitable Hazardous Battlefield Compensation Act of 2001 that would include:
- Service connection for other appropriate conditions related to Agent Orange exposure and other exposures due to service in Vietnam (the “In-Country” effect).
- Service connection for secondary illnesses induced by or exacerbated by exposure to Agent Orange or other toxic substances in military service or by chronic acute PTSD.
- Address inadequacies of VA rating schedules for benefits.
Seek enactment of The Dates Bill that would:
· Modify IRS statute or IRS ruling to begin eligibility for 501(C)(19)B to begin in April 1, 1954, and extend to 1975 for in-country veterans.
· Adjust the dates of eligibility to receive the Vietnam Service Medal.
· Modify Vietnam-era beginning date as deemed appropriate by the VVA National Board.
Seek legislation that would:
- Increase Montgomery GI Bill stipends to a more reasonable rate.
- Secure enactment of successor legislation that would create an educational benefits program modeled on the World War II Era educational benefits.
- Significantly increase budget for State Approving Authorities (SAA) for education benefits and access to Federal Courts (not VA)
- Seek real judicial review for Court of Veterans Appeal (COVA).
- Secure GAO report and oversight hearing concerning homeless and seriously mental ill veterans who have conservators appointed to handle their finances.
- Upgrade VA compensation to reflect actual cost of surviving in today’s world. Rates have increased only because of COLA.
- Remove the 30 year deadline for service-connection for respiratory cancer due to Agent Orange exposure. Currently there is no time limit for other types of cancer.
- Review and revise the current rating schedule of service-connected mastectomies.
- Extend benefits to men and women of the Reserved and National Guard to include sexual trauma and assault, while on non-active duty training.
- Seek legislation or regulations to add men to P.L. 106-419 for birth defects. Current law only states women.
- Support Hepatitis C legislation for proper testing, treatment, and compensation.
· Support concurrent receipt legislation to allow military retirees to collect full retirement as well as VA compensation.
· Diabetes/Agent Orange legislation to codify approval of Secretary’s November 9th ruling that Type II Diabetes is an Agent Orange disability.
· Treating physician rule: establish the principle that the treating physician’s opinion hold more weight in determining a rating decision in the Veterans Benefits Administration proceedings.
· Change in the rating schedule of disabilities 38 CFR part 4 for PTSD as a separate diagnostic code to reflect the uniqueness of PTSD and reinstate 38 CFR 4.16C as part of the code.
· Veterans and widows receiving pension benefits are penalized dollar for dollar for virtually any income; eliminate penalty.
· Advocate Congress to protect money allocated for specific veteran programs and extend to three years time frame for the protected money of special need programs.
· Stipend for Gold Star Mothers.
· Seek to enforce law that all post offices fly the POW/MIA flag on the days they are required to do so
· Work to get the third Friday in September recognized as POW/MIA Remembrance Day in each and every state.
· Push for quicker and full declassification of all documents dealing with POW/MIAs.
VI. STATE LEGISLATION
Work with the State Councils to seek enactment of legislation to create:
· A VVA State Legislative agenda appropriate to each state that is actively pursued.
· State Veterans’ Preference laws modeled on Florida's recent law.
· Veterans' set-aside in state procurement based on California's law.
· POW/MIA Recognition Day to conform with federal date.
VII. INTEGRITY OF VETERAN RECORDS
- Seek legislation that would make it a felony under federal law for any person to fabricate, falsify, modify, or in any way alter a DD-214 or any other military personnel or medical records.
- Seek legislation that would make it a felony under Federal law for any private citizen to access another person’s confidential military, medical, or veterans records without that person’s explicit written permission. or to transmit, receive, publish, or disseminate such illegally garnered information; or to assist or enable such gathering, transmission, or dissemination in any manner.
- Eliminate memorandum of understanding (MOU) between the Veterans Benefits Administration and Federal Bureau of Investigation pursuant to the Brady Bill that would use veterans’ records to deny rights to own a hand gun.
- Eliminate states garnishment of 10 percent of incarcerated veterans disability compensation.
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