<DOC>
[110th Congress House Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:33755.wais]
THE DEPARTMENT OF VETERANS AFFAIRS
FISCAL YEAR 2008 BUDGET PRIORITIES
=======================================================================
HEARING
before the
COMMITTEE ON THE BUDGET
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
HEARING HELD IN WASHINGTON, DC, MARCH 1, 2007
__________
Serial No. 110-11
__________
Printed for the use of the Committee on the Budget
Available on the Internet:
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COMMITTEE ON THE BUDGET
JOHN M. SPRATT, Jr., South Carolina, Chairman
ROSA L. DeLAURO, Connecticut, PAUL RYAN, Wisconsin,
CHET EDWARDS, Texas Ranking Minority Member
JIM COOPER, Tennessee J. GRESHAM BARRETT, South Carolina
THOMAS H. ALLEN, Maine JO BONNER, Alabama
ALLYSON Y. SCHWARTZ, Pennsylvania SCOTT GARRETT, New Jersey
MARCY KAPTUR, Ohio THADDEUS G. McCOTTER, Michigan
XAVIER BECERRA, California MARIO DIAZ-BALART, Florida
LLOYD DOGGETT, Texas JEB HENSARLING, Texas
EARL BLUMENAUER, Oregon DANIEL E. LUNGREN, California
MARION BERRY, Arkansas MICHAEL K. SIMPSON, Idaho
ALLEN BOYD, Florida PATRICK T. McHENRY, North Carolina
JAMES P. McGOVERN, Massachusetts CONNIE MACK, Florida
BETTY SUTTON, Ohio K. MICHAEL CONAWAY, Texas
ROBERT E. ANDREWS, New Jersey JOHN CAMPBELL, California
ROBERT C. ``BOBBY'' SCOTT, Virginia PATRICK J. TIBERI, Ohio
BOB ETHERIDGE, North Carolina JON C. PORTER, Nevada
DARLENE HOOLEY, Oregon RODNEY ALEXANDER, Louisiana
BRIAN BAIRD, Washington ADRIAN SMITH, Nebraska
DENNIS MOORE, Kansas
TIMOTHY H. BISHOP, New York
[Vacancy]
Professional Staff
Thomas S. Kahn, Staff Director and Chief Counsel
James T. Bates, Minority Chief of Staff
C O N T E N T S
Page
Hearing held in Washington, DC, March 1, 2007.................... 1
Statement of:
Hon. John M. Spratt, Jr., Chairman, House Committee on the
Budget..................................................... 1
Prepared statement of.................................... 4
Hon. Paul Ryan, a Representative in Congress from the State
of Wisconsin............................................... 6
Prepared statement of.................................... 8
Unanimous consent request................................ 33
Hon. R. James Nicholson, Secretary, U.S. Department of
Veterans Affairs........................................... 9
Prepared statement of.................................... 13
THE DEPARTMENT OF VETERANS AFFAIRS FISCAL YEAR 2008 BUDGET PRIORITIES
----------
THURSDAY, MARCH 1, 2007
House of Representatives,
Committee on the Budget,
Washington, DC.
The Committee met, pursuant to call, at 10:00 a.m., in Room
210, Cannon House Office Building, Hon. John M. Spratt
presiding.
Present: Representatives Spratt, Edwards, Cooper of
Tennessee, Boyd, McGovern, Scott, Hooley, Baird, Bishop,
Etheridge, Moore, Kaptur, Ryan, Garrett, Hensarling, and
Tiberi.
Chairman Spratt. I call the hearing to order, and Secretary
Nicholson, welcome. Welcome, and thank you for joining us to
discuss something of great importance to you and to us and to
all Americans: the budget for the Department of Veterans
Affairs. Our purpose today is to learn more about the
President's budget request for 2008 for the VA so that we can
determine whether it is adequate to meet our commitments to the
veterans who have served this country so well and so honorably.
Your testimony and answers to our questions will help inform us
as to how we will put together our budget resolution providing
for veterans benefits.
Today there are more than 23 million veterans. More and
more of these veterans are relying on VA healthcare each year.
If I could have chart number one just to show you graphically
what I am talking about.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
The number of VA healthcare patients continues to rise. As
you can see here, it is well above five million in that
particular case, a substantial number. According to the
Veterans Department, in 2008 the VA will provide healthcare to
more than five million veterans, as shown on this chart, and
500,000 non-veterans.
This Committee is interest in knowing how the VA developed
its estimates upon which this budget is based and the related
budget request. These questions are critical to making
decisions about the VA's budget. About half of that budget goes
to pay disability compensation, pensions, and other benefits
that operate under permanent law, so-called entitlements. We
may have some questions about those benefits in this hearing,
but today they are not our primary focus. Today our primary
focus is on the other half of the VA budget, the half which
Congress appropriates every year. Almost 90 percent of these
funds go to Veterans Healthcare Administration.
The President's budget for 2008 increases this appropriated
funding for veterans to $39.6 billion, a substantial increase.
That level is more than the appropriation for 2007 and more
than the Congressional Budget Office's baseline budget estimate
for 2008. The next chart, chart number two, will show you
graphically what I mean.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
So it is a substantial increase and that is good news. But
after 2008 the administration's budget fund veterans care at
billions of dollars below what CBO calls its baseline, that is
the amount of money necessary to keep pace with current
services so that there are no, at least no deletions or no
diminishment of coverage. If you put up chart number four you
will see further what I am saying.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
The President's budget increases fees as well as decreasing
the Veterans Healthcare allotment. In the out years fees would
be increased substantially. And one of the assumptions you make
is these fees will be available to pay for services and the
fact of the matter is these fees have been proposed repeatedly.
They have been around the track time after time and they have
never yet made it to the finish line. And I think it is
doubtful that they will survive this year, either.
Approximately 1.4 million men and women have served in the
various wars. Some of the veterans who have served have
sustained significant injuries, particularly in the current War
in Iraq, have sustained traumatic brain injuries and spinal
cord injuries. And VA healthcare will be critically, absolutely
critically, important to them for years to come. Others will
suffer now or in the future from Post Traumatic Stress
Syndrome. We want to better understand from your testimony and
the questions we put to you how your budget will meet this
critical need which is so emblematic of the situation in Iraq
and Afghanistan today, where multiple injuries like this are
being incurred.
The Department of Veterans Affairs has received accolades
for healthcare and medical research. Just last year, the VA was
recognized for innovative, computerized patient record system.
I have a daughter and a son-in-law at Duke and they both work
from time to time in the VA Hospital. They have told me it is a
good system. It is a system that is user friendly, but also
very comprehensive and we commend you for that. At the same
time, we remain aware that just a few years ago the VA's
original budget request significantly underestimated the
increased number of patients the VA would see and the amount of
funding that would be required to treat them. We can all agree
that we do not want to see that happen again.
Ultimately, we are here to do our best to determine the
budget necessary to fulfill our promises to the veterans of
this country. These are promises that rank high among those
that must be kept by the government. We want to see that the
promises that we have made to them, particularly in the area of
veterans healthcare, will be honored. Not only carried out and
fulfilled, but done in the best possible form so that they get
medical care at the VA medical care system that is equal to any
care received anywhere in the country.
Mr. Secretary, for all of these reasons we look forward to
your testimony. But before going to your testimony, I would
like to recognize Mr. Ryan, our Ranking Member, for a statement
of his own.
[The prepared statement of Chairman Spratt follows:]
Prepared Statement of Hon. John M. Spratt, Jr.,
Chairman, Committee on the Budget
Secretary Nicholson, welcome and thank you for joining us to
discuss the budget for the Department of Veterans Affairs (VA). Our
purpose today is to learn more about the President's budget for 2008
and later years so that we can determine whether it is adequate to meet
the Nation's commitments to the veterans who have served this country
so honorably. Your testimony and answers to our questions will help to
inform us as we prepare our own budget.
Today, there are more than 23 million veterans. More and more of
these veterans are relying on VA health care every year. According to
the Department of Veterans Affairs, in 2008, VA will provide health
care to more than 5 million veterans and 500,000 non-veterans. This
committee is interested in learning more about how VA developed its
estimates and the related budget request.
These questions are critical to making decisions about VA's budget.
About half of VA's budget goes to pay disability compensation,
pensions, and other benefits that operate under permanent law. We may
have some questions about these benefits in this hearing, but they are
not our primary focus today.
Rather, this hearing will focus on the other half of VA's budget,
which the Congress appropriates each year. Almost 90 percent of these
funds go to veterans' health care.
The President's budget for 2008 increases this appropriated funding
for veterans to $39.6 billion. That level is more than the
appropriations for 2007 and the Congressional Budget Office's baseline
budget estimate for 2008. After 2008, however, the Administration's
budget cuts funding for veterans and is billions of dollars below the
CBO baseline over the five year period. In addition, this budget again
proposes to increase fees on veterans for their health care by millions
of dollars.
It is also important for us to learn more about how VA is helping
the veterans of the wars in Iraq and Afghanistan. The number of these
veterans continues to rise significantly.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Approximately 1.4 million men and women have served in these wars.
According to VA, about 155,000 of them received VA health care
treatment in 2006. VA projects that this number will grow to 263,000 in
2008.
Some of these veterans have experienced severe injuries like
traumatic brain and spinal cord injuries, and VA health care will be
important to them for many years to come. Others of them will suffer
now, or in the future, from Post-Traumatic Stress Disorder. We want to
better understand how this budget meets their needs.
The Department of Veterans Affairs has received many accolades for
its health care and medical research. Just last year, VA was recognized
for its innovative computerized patient record system. These
acknowledgments are well-deserved, Mr. Secretary, and I know you would
agree that they are most important because they represent real
advancements for this Nation's veterans.
At the same time, we remain aware that just a few years ago, VA's
original budget requests significantly underestimated the increased
number of patients that VA would see and the amount of funding needed
to treat them. We can all agree that we do not want to repeat that
situation.
Ultimately, we are here to do our best to determine the budget
necessary to fulfill our commitments to the veterans who served this
country in the past and the future veterans who are serving it so ably
and honorably today.
Mr. Secretary, I look forward to your testimony.
Mr. Ryan. All right, thank you Chairman. Thank the Chairman
for yielding. And, you know, anybody that watches television or
reads the news, you might think that we Americans are always
arguing with one another and that is especially true here in
Congress. But in fact, there are many things that we Americans
agree on. And that is we place a high value on those who serve
our country and we are very proud of them. I, along with Mr.
Andrews who is on this Committee, went to Iraq last week to
meet with our soldiers and our troops to see just the valiant
efforts, just the incredible amount of heroism that is on
display today for our country. And so, this is an area where
Republicans and Democrats together agree and believe that we
owe a great debt of thanks and gratitude to our nation's men
and women who served in our armed forces.
That degree of honor has also been reflected in the budget
and policy actions Congress has taken in recent years, and I
want to just bring up a couple of examples just to show the
kind of level of commitment that has been displayed here. If
you could bring up slide six, please?
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Take a look at the total budget authority for hospitals and
medical care for veterans before and after 1995. If you take a
look at the dedication to veterans healthcare, since 1995 the
budget was $16.6 billion. This last year, in 2006, it was $31.2
billion, an almost near doubling of the VA medical care budget.
If you go to slide three, please.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Take a look at spending per veteran, which really goes to
the heart of the issue because as Mr. Spratt noted we have
increased those who have been consuming veterans healthcare.
Spending per veterans started at $1,366 in 1995 to today, this
year, $3,167 in 2007, a 132 percent increase over the last ten
years on spending per veterans healthcare. So clearly, Congress
has demonstrated its priorities in honoring our veterans and
meeting the needs of the VA healthcare.
We are going to disagree on how best to meet those needs.
But it is wrong to say that this area has been abjectly
neglected. A few years ago, Congress enacted the most sweeping
change in concurrent receipt policy in more than one hundred
years. For the first time, military retirees who were 50
percent or more disabled plus all purple heart disabled began
receiving concurrent receipt of their retired pay and
disability compensation. Over ten years the legislation
provides $22.1 billion for eligible persons. Over the past
decades VA medical care has improved to the point where VA care
is now some of the best medical care in the country.
This has happened under both Democrat and Republican
administrations, so the credit for it is bipartisan. My own
home state of Wisconsin, we have enacted CBOCs, Community Based
Outpatient Clinics. Three of them in my own congressional
district, a number of them throughout the State of Wisconsin,
to reduce the waiting lines at our VA hospitals and to get
veterans better outpatient care close to their homes and
relieve pressure on some of our hospitals. So we have made
substantial progress on getting the waiting lines down, on
getting the care our veterans need, and improving the quality
of its care.
So in the process we should constantly look for better ways
to achieve this goal and to improve on the success that we have
already achieved. There are clearly areas where we need to make
improvements. There are clear areas of deficiencies. We just
read some stories about Walter Reed Hospital. But it is
important to note that the dedication is here, that the honor
and commitment will be made, and that this is something that we
ought to be able to work on on a bipartisan basis. And I am
sure that this is the attitude that the Secretary and other
witnesses will bear and I appreciate, Secretary Nicholson, you
and the other panel witnesses coming and joining us today. And
I yield the balance of my time.
[The prepared statement of Mr. Ryan follows:]
Prepared Statement of Hon. Paul Ryan, a Representative in Congress From
the State of Wisconsin
To anyone who watches television or reads the news, you might think
we Americans are always arguing with one another--and that seems even
more pronounced here in Congress. But in fact there are many things we
Americans agree on, and one of them is this: we place a high value on
those who serve our country.
This was certainly true even before President Lincoln uttered those
famous words in his second inaugural--``to care for him who shall have
borne the battle and for his widow, and his orphan''--and it survives
right up to this day, when those who have fought in the front lines in
the war against terrorism have the respect of everyone in this country.
It is why we have long had a separate agency in the Federal Government
to serve veterans, and why President Reagan made that agency a cabinet-
level department in the early 1980s.
It is also reflected in the budget and policy actions Congress has
taken in recent years. Here are just a few examples:
<bullet> Under the past several Congresses, spending for veterans
medical care increased from $18.9 billion in fiscal year 2000 to $31
billion in 2006.
<bullet> Since 2000, spending per veteran has increased 85 percent
from $1,715 to $3,167.
<bullet> A few years ago, Congress enacted the most sweeping change
in concurrent receipt policy in more than a hundred years. For the
first time, military retirees who are 50 percent or more disabled, plus
all purple heart disabled, began receiving concurrent receipt of their
retired pay and disability compensation. Over ten years, the
legislation provides $22.1 billion to eligible persons.
<bullet> Over the past decade, veterans medical care has improved
to the point where VA care is now some of the best medical care in the
country. This has happened under both Democrat and Republican
administrations, so the credit for it is bipartisan--and it further
proves that our veterans are important to all of us.
So despite our various differences, I'm sure all of us on this
committee--and in this Congress, for that matter--agree that our
respect for America's veterans--and our enduring thanks--should always
be one of our highest priorities. It's because of their service that we
can peacefully hash out our differences in this committee room, or on
the House floor, or anywhere in the country. They have protected our
freedoms--often at great sacrifice--and we should always provide the
honor they deserve.
In the process, we should constantly look for better ways to
achieve this goal. So if we differ about how well the Department is
functioning--or how well it delivers its services, or how wisely it
makes use of the funds Congress provides--it's because we put a high
priority on those things. It's precisely because we honor our veterans
that we should always try to make their Department better.
I'm sure that's the attitude we will all bring today as we hear
from Secretary Nicholson.
Chairman Spratt. Mr. Secretary, you may submit your
statement for the record and we will have it printed in its
entirety and you can summarize when and where you see fit.
Thank you again for coming. The floor is yours.
STATEMENT OF R. JAMES NICHOLSON, SECRETARY, DEPARTMENT OF
VETERANS AFFAIRS; ACCOMPANIED BY ADM DANIEL L. COOPER, UNDER
SECRETARY FOR BENEFITS; WILLIAM F. TUERK, UNDER SECRETARY FOR
MEMORIAL AFFAIRS; DR. MICHAEL J. KUSSMAN, ACTING UNDER
SECRETARY FOR HEALTH; GEN ROBERT T. HOWARD, ASSISTANT SECRETARY
FOR INFORMATION AND TECHNOLOGY; AND ROBERT J. HENKE, ASSISTANT
SECRETARY FOR MANAGEMENT, CHIEF FINANCIAL OFFICER
Secretary Nicholson. Thank you very much, Mr. Chairman, Mr.
Ranking Member, members of the Committee. Good morning. I
appreciate the fact that you have invited us here. I look
forward to this discussion. I do have a written statement I
would like to submit for the record, Mr. Chairman. And I would
like to introduce my colleagues that are with me this morning.
My far left, your right, is Under Secretary Bill Tuerk, the
Under Secretary for Memorial Affairs. Next is Under Secretary
for Benefits, Admiral Dan Cooper. My immediate left is the
Acting Secretary for Health, Dr. Michael Kussman. My far right,
your left, is Assistant Secretary for Information and
Technology General Bob Howard. At my right is the Assistant
Secretary for Management, who is also the Chief Financial
Officer of the VA, Assistant Secretary Bob Henke.
Mr. Chairman, I would like to mention a few things from my
written submittal. First, a mention of the media reports that
have recently talked about the VA's care. And I would like to
say first that I welcome the light of media scrutiny because I
know the VA's 235,000 are dedicated to providing the best
possible healthcare, benefits, and memorial benefits to
America's veterans. The quality of VA care is widely
recognized, as you have generously mentioned. It is widely
recognized as the best integrated healthcare system in the
United States, maybe in the world. But the fact is there is
still, in spite of that, areas where improvement is needed. And
there is no question that what we have all seen in these recent
media reports is not what the VA or veterans, especially young
combat veterans or their families, should expect. It is
absolutely unacceptable for anyone of these young people and
their families to have to endure the circumstances that we saw.
That breaks my heart. And I want them to know that we are here
to serve them, and we will do better by those cases.
To that end, additional improvement measures will be
forthcoming from the VA over the next several days and weeks
ahead. And we will keep you apprised as we implement those
enhancements. I am committed to assuring and proving to
America's veterans that even in a system that now has over one
million patient visits a week that one failure is unacceptable
when it comes to honoring our promise to those veterans who
honored their promise to us.
So Mr. Chairman, I look forward to working with the 110th
Congress in a bipartisan, bicameral way in support of our
veterans. I believe that taking care of veterans is not a
bipartisan or partisan endeavor. It is a patriotic mandate. I
am here to discuss the President's 2008 budget proposal for the
Department of Veterans Affairs. The President is requesting a
landmark budget of nearly $87 billion to fund our commitment to
our veterans. This budget will allow us to expand the three
core missions of the VA, those being to continue to provide
world class healthcare; provide broad, fair and timely
benefits; and dignified burials in shrine-like settings. It
will also allow us to continue our progress toward becoming a
national leader in information technology and data security.
I believe that with the right resources in the hands of the
right people, anything and everything is possible when it comes
to caring for America's veterans. And at the VA we already have
the right dedicated people. With this proposed budget we will
have the right resources as well. The $87 billion requested a
77 percent increase in veterans spending since the President
took office on January 20, 2001. The medical care portion of
the budget is up 83 percent.
I would like to outline very briefly the major portions of
the proposed budget. In the Veterans Health Administration, as
has been stated, our total request is $36.6 billion in
authority. VA healthcare, overall, is the best anywhere. And
that is not just me saying that as the proud Secretary, Mr.
Chairman, medical journals, the national media, institutions as
respected as the Harvard Medical School recently stated that we
are leading this nation in healthcare delivery, safety, and
technology. As I said, though, we can do better and during 2008
we expect to treat 5.8 million patients and this is more than
134,000 above the 2007 estimates. Patients in priorities one
through six, that is veterans with service connected
conditions, lower incomes, special healthcare needs, and
service in Iraq and/or Afghanistan will comprise 68 percent of
the total patient population in 2008. They will account for 85
percent of the healthcare costs. The number of these patients
will grow by 3.3 percent over this fiscal year. In 2008 we
expect to treat 263,000 who served in Iraq and Afghanistan.
This is an increase of 54,000, or 26 percent above the number
in these campaigns for this year.
Access to care, with the resources requested, the
Department will be able to enhance access. 96 percent of
primary care appointments and 95 percent of specialty care
appointments are currently scheduled within thirty days of the
patient's desired date. We will minimize the number of new
enrollees waiting for their first appointment to be scheduled.
I am pleased to say that in the last eight months we reduced
this number by 94 percent and we will continue to place strong
emphasis on this effort.
Mental health services, this budget requests nearly $3
billion to continue our effort to improve access to mental
health services across the country. The VA is a respected
leader in mental health and PTSD research and care. About 80
percent of the funds for mental health go to treat seriously
mentally ill veterans, including those suffering from Post
Traumatic Stress Disorder.
The medical research budget includes $411 million to
support our unparalleled medical and prosthetic research
programs. This amount will fund nearly 2100 high priority
research projects to expand knowledge in areas most critical to
veterans particular healthcare needs. Most notably in the area
of mental health, mental illness, $49 million, aging $42
million, health services delivery improvement $36 million,
cancer $35 million, and heart disease $31 million. Nearly 60
percent of our research budget is devoted to OIF/OEF healthcare
issues.
Polytrauma care, I have traveled to three of our four
polytrauma centers and there is no doubt that these centers of
compassion and competency are where miracles are performed
every day. In response to the need for such specialized medical
services, the VA has expanded from these four traumatic brain
injury centers, which are in Minneapolis, Palo Alto, Richmond,
and Tampa, to a broader center of polytrauma care that will now
be twenty-one such centers and clinical support teams around
the country providing state of the art treatment that will be
closer to injured veterans' homes. Because of traumatic brain
injury, or TBI, can be present without any visible injuries
from explosions, this spring we will at the VA initiate a TBI
screening program for all recent combat veterans from Iraq and
Afghanistan. And this will take place in all of our 155 major
medical centers.
One of the most important features of the President's 2008
budget is to ensure that servicemembers transition from active
duty status to mobilized Guard and Reserve to civilian life
continues to be as smooth and as seamless as possible. And we
will not rest until every seriously injured or ill serviceman
or woman returning from combat receives the treatment they need
in a timely way.
Let me speak a minute about veterans benefits. The VA's
primary focus within the administration of benefits remains
unchanged: delivering timely and accurate benefits to veterans
and their families. Improving the delivery of compensation and
pension benefits has become increasingly challenging, however,
over the past few years. The volume of claims applications has
grown substantially and it is now the highest it has been in
fifteen years. We received more than 806,000 claims last year.
We expect this high volume of claims to continue as we are
projecting the receipt of about 800,000 this year and next year
each. However, through a combination of management and
productivity improvements, and our 2008 request which is to add
approximately 450 additional staff, we will improve our
performance while maintaining our high quality. With this
budget we expect to improve the timeliness of processing
claims. We will make better use of new technologies and have
more trained people to process and evaluate these claims. As I
said, we project that we can reduce our claims processing time
while maintaining our quality and are committed to do so.
Finally, the National Cemetery Administration, Mr.
Chairman. We expect to perform nearly 105,000 internments in
this fiscal year of 2008, which is an 8.4% increase higher than
the number of internments we performed last year. These are
primarily the result of the aging World War II and Korean War
population and the opening of new cemeteries. The President's
2008 budget requests include $167 million in operations and
maintenance funding to activate six new national cemeteries and
to meet the growing workload at existing cemeteries by
increasing staffing and funding for contract maintenance,
supplies, and equipment.
The capital programs in this budget request $1.1 billion in
new authority for capital programs, which include $727 million
for major construction, $233 million for minor construction,
$85 million in grants to states for extended care facilities,
and $32 million in grants to build state veterans cemeteries.
The 2008 request for construction funding for our healthcare
programs is $750 million. These resources will be devoted to
continuing the Capital Asset Realignment for Enhanced Services,
better known as CARES. Over the last five years, $3.7 billion
in total funding has been provided for CARES projects. Within
our request for 2008 are major construction resources to
continue six medical facilities now underway. They are in
Pittsburgh; Denver; Las Vegas, this will complete funding for
Las Vegas; Orlando; Lee County, Florida; and Syracuse, New
York. Funds are also included for six new national cemeteries
in Bakersfield, California; Birmingham; Columbia/Greenville,
South Carolina; Jacksonville, Florida; Southeastern
Pennsylvania; and Sarasota County, Florida.
The budget also requests $1.8 billion for information
technology, which includes the first phase of our major
comprehensive reorganization of the IT function in the
Department, and will help to establish the new management
system for IT in the VA. This transformation within the VA is
progressing very well and will bring our program in line with
the best practices in the IT industry. Greater centralization
will play a significant role in fulfilling our promise, our
commitment, to lead the pack in the government for data
security.
To that end, the budget also includes almost $70 million
for enhanced cybersecurity. And I know, Mr. Chairman, that the
Committee shares with me the concern about the VA's ability to
secure all veterans' personal information. There have been
security incidents that are simply unacceptable and have made
it a priority to assure that our veterans are getting the
protection of their privacy that they deserve. We are taking
unprecedented steps to implement the required national security
measures and to change the culture of the agency as to
protected data. And it is not that these incidents will never
occur, but when they do that the VA now has a process to
properly respond. We are encouraging all of our employees to
report, including self reporting, the thefts or other losses of
equipment, whether in the workplace, at home, or on travel, so
that we can strengthen our information security procedures
through lessons learned reviews, personal accountability, and,
when appropriate, disciplinary actions including terminations.
The most critical IT project for our medical care program
is the continued operation and improvement of the Department's
electronic medical records. I have made it a point for the past
year to praise our electronic records for their ability to
survive such things as Katrina and Hurricane Rita. Electronic
records are a presidential priority and the VA's electronic
record system has been nationally recognized for increasing the
productivity, quality, and safety of our system. Within this
initiative we are requesting $131.9 million for ongoing
development and implementation of our Healthy Vet Vista. This
is the program to modernize this electronic health record
system. It will make use of standards that will enhance the
sharing of data within VA, as well as without, or as with other
federal agencies and public and private sector organizations as
well.
In closing I want to let you know that I will soon be
naming members to a special advisory committee on OIF/OEF
veterans and their families. It is worth mentioning a new
initiative to assist returning veterans to connect with their
state and territorial veterans departments as well. First the
OIF/OEF panel, its membership will include veterans, spouses,
survivors, and parents of combat veterans and it will report
directly to me. Under its charter, the committee will focus on
ensuring that all men and women with active military service in
Iraq and Afghanistan are transitioned to the VA in a seamless,
hassle-free, informed manner. The committee will pay particular
attention to severely disabled veterans and their families.
Second, in order to help severely injured servicemembers
receive benefits from their states and territories when they
move from the military hospitals to the VA and eventually to
their home communities, I have recently announced the expansion
of a collaborative effort between the states and including the
District of Columbia, and it is called the States Benefits
Seamless Transition Program. We just completed a very
successful four-month pilot of this with the State of Florida
and have now expanded it nationwide. It is a promising
extension of the VA's own transition assistance for those
leaving the military service. It is also an opportunity to
partner with the states to make long term support possible for
our most deserving veterans throughout the country.
Over the last few weeks and months as I have traveled this
country I have met with commanders of several combatant
commands to talk to them about how the VA and the DOD can
better work together to care for our soldiers, sailors, airmen,
marines, and guardsmen when they return home from duty
overseas. In the coming weeks, and these meetings have now been
scheduled, I will be meeting with the senior enlisted advisors
of the respective services as well as the service chiefs. I
will be extending an invitation to each service secretary to
also meet with me so that we can keep our lines of
communication open, working for the benefit of our servicemen
and women.
Mr. Chairman, this concludes my remarks. Thank you.
[The prepared statement of R. James Nicholson follows:]
Prepared Statement of Hon. R. James Nicholson,
Secretary, U.S. Department of Veterans Affairs
Mr. Chairman and members of the Committee, good morning. I am
pleased to be here today to present the President's 2008 budget
proposal for the Department of Veterans Affairs (VA). The request
totals $86.75 billion--$44.98 billion for entitlement programs and
$41.77 billion for discretionary programs.
The total budget request is $37.80 billion, or 77 percent, above
the funding level in effect when the President took office. The 2008
request for discretionary funding is $18.74 billion (or 81.4 percent)
above the discretionary resource level available in 2001. The growth in
funding for entitlement programs from 2001 to 2008 is similar--$19.06
billion (or 73.5 percent). Nearly 90 percent of the increase in
entitlement costs is accounted for by compensation payments to veterans
with service-connected disabilities as well as their survivors.
The President's requested funding level will allow VA to continue
to improve the delivery of benefits and services to veterans and their
families in three primary areas that are critical to the achievement of
our mission:
<bullet> to provide timely, high-quality health care to a growing
number of patients who count on VA the most--veterans returning from
service in Operation Iraqi Freedom and Operation Enduring Freedom,
veterans with service-connected disabilities, those with lower incomes,
and veterans with special health care needs;
<bullet> to improve the delivery of benefits through the timeliness
and accuracy of claims processing; and
<bullet> to increase veterans' access to a burial option in a
national or state veterans' cemetery.
ensuring a seamless transition from active military service to civilian
life
The President's 2008 budget request provides the resources
necessary to ensure that service members' transition from active duty
military status to civilian life continues to be as smooth and seamless
as possible. We will continue to ensure that every seriously injured or
ill serviceman or woman returning from combat in Operation Iraqi
Freedom and Operation Enduring Freedom receives the treatment they need
in a timely way.
Recently I announced plans to create a special Advisory Committee
on Operation Iraqi Freedom/Operation Enduring Freedom Veterans and
Families. The panel, with membership including veterans, spouses, and
parents of the latest generation of combat veterans, will report
directly to me. Under its charter, the committee will focus on the
concerns of all men and women with active military service in Operation
Iraqi Freedom or Operation Enduring Freedom, but will pay particular
attention to severely disabled veterans and their families.
We will expand our ``Coming Home to Work'' initiative to help
disabled service members more easily make the transition from military
service to civilian life. This is a comprehensive intergovernmental and
public-private alliance that will provide separating service members
from Operation Iraqi Freedom and Operation Enduring Freedom with
employment opportunities when they return home from their military
service. This project focuses on making sure service members have
access to existing resources through local and regional job markets,
regardless of where they separate from their military service, where
they return, or the career or education they pursue.
VA launched an ambitious outreach initiative to ensure separating
combat veterans know about the benefits and services available to them.
During 2006 VA conducted over 8,500 briefings attended by more than
393,000 separating service members and returning reservists and
National Guard members. The number of attendees was 20 percent higher
in 2006 than it was in 2005 attesting to our improved outreach effort.
Additional pamphlet mailings following separation and briefings
conducted at town hall meetings are sources of important information
for returning National Guard members and reservists. VA has made a
special effort to work with National Guard and reserve units to reach
transitioning service members at demobilization sites and has trained
recently discharged veterans to serve as National Guard Bureau liaisons
in every state to assist their fellow combat veterans.
Each VA medical center and regional office has a designated point
of contact to coordinate activities locally and to ensure the health
care and benefits needs of returning service members and veterans are
fully met. VA has distributed specific guidance to field staff to make
sure the roles and functions of the points of contact and case managers
are fully understood and that proper coordination of benefits and
services occurs at the local level.
For combat veterans returning from Iraq and Afghanistan, their
contact with VA often begins with priority scheduling for health care,
and for the most seriously wounded, VA counselors visit their bedside
in military wards before separation to assist them with their
disability claims and ensure timely compensation payments when they
leave active duty.
In an effort to assist wounded military members and their families,
VA has placed workers at key military hospitals where severely injured
service members from Iraq and Afghanistan are frequently sent for care.
These include benefit counselors who help service members obtain VA
services as well as social workers who facilitate health care
coordination and discharge planning as service members transition from
military to VA health care. Under this program, VA staff provide
assistance at 10 military treatment facilities around the country,
including Walter Reed Army Medical Center, National Naval Medical
Center Bethesda, Naval Medical Center San Diego, and Womack Army
Medical Center at Ft. Bragg.
To further meet the need for specialized medical care for patients
with service in Operation Iraqi Freedom and Operation Enduring Freedom,
VA has expanded its four polytrauma centers in Minneapolis, Palo Alto,
Richmond, and Tampa to encompass additional specialties to treat
patients for multiple complex injuries. Our efforts are being expanded
to 21 polytrauma network sites and clinic support teams around the
country providing state-of-the-art treatment closer to injured
veterans' homes. We have made training mandatory for all physicians and
other key health care personnel on the most current approaches and
treatment protocols for effective care of patients afflicted with brain
injuries. Furthermore, we established a polytrauma call center in
February 2006 to assist the families of our most seriously injured
combat veterans and service members. This call center operates 24 hours
a day, 7 days a week to answer clinical, administrative, and benefit
inquiries from polytrauma patients and family members.
In addition, VA has significantly expanded its counseling and other
medical care services for recently discharged veterans suffering from
mental health disorders, including post-traumatic stress disorder. We
have launched new programs, including dozens of new mental health teams
based in VA medical facilities focused on early identification and
management of stress-related disorders, as well as the recruitment of
about 100 combat veterans as counselors to provide briefings to
transitioning service members regarding military-related readjustment
needs.
medical care
We are requesting $36.6 billion for medical care in 2008, a total
more than 83 percent higher than the funding available at the beginning
of the Bush Administration. Our total medical care request is comprised
of funding for medical services ($27.2 billion), medical administration
($3.4 billion), medical facilities ($3.6 billion), and resources from
medical care collections ($2.4 billion).
From 2001 to 2006, VA spent over $158 billion on the delivery of
veterans' health care. Two of the most significant components of the
total expenditures for veterans' health care during this period were
for payroll costs for physicians, nurses, and other health care
professionals and support staff ($83 billion) and for pharmaceuticals
($21.2 billion).
legislative proposals
The President's 2008 budget request identifies three legislative
proposals which ask veterans with comparatively greater means and no
compensable service-connected disabilities to assume a small share of
the cost of their health care.
The first proposal would assess Priority 7 and 8 veterans with an
annual enrollment fee based on their family income:
------------------------------------------------------------------------
Annual enrollment
Family income fee
------------------------------------------------------------------------
Under $50,000....................................... None
$50,000-$74,999..................................... $250
$75,000-$99,999..................................... $500
$100,000 and above.................................. $750
------------------------------------------------------------------------
The second legislative proposal would increase the pharmacy co-
payment for Priority 7 and 8 veterans from $8 to $15 for a 30-day
supply of drugs. And the last provision would eliminate the practice of
offsetting or reducing VA first-party co-payment debts with collection
recoveries from third-party health plans.
While our budget requests in recent years have included legislative
proposals similar to these, the provisions identified in the
President's 2008 budget are markedly different in that they have no
impact on the resources we are requesting for VA medical care. Our
budget request includes the total funding needed for the Department to
continue to provide veterans with timely, high-quality medical services
that set the national standard of excellence in the health care
industry. Unlike previous budgets, these legislative proposals do not
reduce our discretionary medical care appropriations. Instead, these
three provisions, if enacted, would generate an estimated $2.3 billion
in mandatory receipts to the Treasury from 2008 through 2012.
workload
During 2008, we expect to treat about 5,819,000 patients. This
total is more than 134,000 (or 2.4 percent) above the 2007 estimate,
and is 1,572,000 (or 37.0 percent) higher than the number of total
patients we treated in 2001. Patients in Priorities 1-6--veterans with
service-connected conditions, lower incomes, special health care needs,
and service in Iraq or Afghanistan--will comprise 68 percent of the
total patient population in 2008, but they will account for 85 percent
of our health care costs. The number of patients in Priorities 1-6 will
grow by 3.3 percent from 2007 to 2008.
We expect to treat about 263,000 veterans in 2008 who served in
Operation Iraqi Freedom and Operation Enduring Freedom. This is an
increase of 54,000 (or 26 percent) above the number of veterans from
these two campaigns that we anticipate will come to VA for health care
in 2007, and 108,000 (or 70 percent) more than the number we treated in
2006.
funding drivers
Our 2008 request for $36.6 billion in support of our medical care
program was largely determined by three key cost drivers in the
actuarial model we use to project veteran enrollment in VA's health
care system as well as the utilization of health care services of those
enrolled:
<bullet> inflation;
<bullet> trends in the overall health care industry; and
<bullet> trends in VA health care.
The impact of the composite rate of inflation of 4.45 percent
within the actuarial model will increase our resource requirements for
acute inpatient and outpatient care by nearly $2.1 billion. This
includes the effect of additional funds ($690 million) needed to meet
higher payroll costs as well as the influence of growing costs ($1.4
billion) for supplies, as measured in part by the Medical Consumer
Price Index. However, inflationary trends have slowed during the last
year.
There are several trends in the U.S. health care industry that
continue to increase the cost of providing medical services. These
trends expand VA's cost of doing business regardless of any changes in
enrollment, number of patients treated, or program initiatives. The two
most significant trends are the rising utilization and intensity of
health care services. In general, patients are using medical care
services more frequently and the intensity of the services they receive
continues to grow. For example, sophisticated diagnostic tests, such as
magnetic resonance imaging (MRI), are now more frequently used either
in place of, or in addition to, less costly diagnostic tools such as x-
rays. As another illustration, advances in cancer screening
technologies have led to earlier diagnosis and prolonged treatment
which may include increased use of costly pharmaceuticals to combat
this disease. These types of medical services have resulted in improved
patient outcomes and higher quality health care. However, they have
also increased the cost of providing care.
The cost of providing timely, high-quality health care to our
Nation's veterans is also growing as a result of several factors that
are unique to VA's health care system. We expect to see changes in the
demographic characteristics of our patient population. Our patients as
a group will be older, will seek care for more complex medical
conditions, and will be more heavily concentrated in the higher cost
priority groups. Furthermore, veterans are submitting disability
compensation claims for an increasing number of medical conditions,
which are also increasing in complexity. This results in the need for
disability compensation medical examinations, the majority of which are
conducted by our Veterans Health Administration, that are more complex,
costly, and time consuming. These projected changes in the case mix of
our patient population and the growing complexity of our disability
claims process will result in greater resource needs.
quality of care
The resources we are requesting for VA's medical care program will
allow us to strengthen our position as the Nation's leader in providing
high-quality health care. VA has received numerous accolades from
external organizations documenting the Department's leadership position
in providing world-class health care to veterans. For example, our
record of success in health care delivery is substantiated by the
results of the 2006 American Customer Satisfaction Index (ACSI) survey.
Conducted by the National Quality Research Center at the University of
Michigan Business School, the ACSI survey found that customer
satisfaction with VA's health care system increased last year and was
higher than the private sector for the seventh consecutive year. The
data revealed that inpatients at VA medical centers recorded a
satisfaction level of 84 out of a possible 100 points, or 10 points
higher than the rating for inpatient care provided by the private-
sector health care industry. VA's rating of 82 for outpatient care was
8 points better than the private sector.
Citing VA's leadership role in transforming health care in America,
Harvard University recognized the Department's computerized patient
records system by awarding VA the prestigious ``Innovations in American
Government Award'' in 2006. Our electronic health records have been an
important element in making VA health care the benchmark for 294
measures of disease prevention and treatment in the U.S.
These external acknowledgments of the superior quality of VA health
care reinforce the Department's own findings. We use two primary
measures of health care quality--clinical practice guidelines index and
prevention index. These measures focus on the degree to which VA
follows nationally recognized guidelines and standards of care that the
medical literature has proven to be directly linked to improved health
outcomes for patients. Our performance on the clinical practice
guidelines index, which focuses on high-prevalence and high-risk
diseases that have a significant impact on veterans' overall health
status, is expected to grow to 85 percent in 2008, or a 1 percentage
point rise over the level we expect to achieve this year. As an
indicator aimed at primary prevention and early detection
recommendations dealing with immunizations and screenings, the
prevention index will be maintained at our existing high level of
performance of 88 percent.
access to care
With the resources requested for medical care in 2008, the
Department will be able to continue our exceptional performance dealing
with access to health care--96 percent of primary care appointments
will be scheduled within 30 days of patients' desired date, and 95
percent of specialty care appointments will be scheduled within 30 days
of patients' desired date. We will minimize the number of new enrollees
waiting for their first appointment. We reduced this number by 94
percent from May 2006 to January 2007, to a little more than 1,400, and
we will continue to place strong emphasis on lowering, and then
holding, the waiting list to as low a level as possible.
An important component of our overall strategy to improve access
and timeliness of service is the implementation on a national scale of
Advanced Clinic Access, an initiative that promotes the efficient flow
of patients by predicting and anticipating patient needs at the time of
their appointment. This involves assuring that specific medical
equipment is available, arranging for tests that should be completed
either prior to, or at the time of, the patient's visit, and ensuring
all necessary health information is available. This program optimizes
clinical scheduling so that each appointment or inpatient service is
most productive. In addition, this reduces unnecessary appointments,
allowing for relatively greater workload and increased patient-directed
scheduling.
funding for major health care programs and initiatives
Our request includes $4.6 billion for extended care services, 90
percent of which will be devoted to institutional long-term care and 10
percent to non-institutional care. By continuing to enhance veterans'
access to non-institutional long-term care, the Department can provide
extended care services to veterans in a more clinically appropriate
setting, closer to where they live, and in the comfort and familiar
settings of their homes surrounded by their families. This includes
adult day health care, home-based primary care, purchased skilled home
health care, homemaker/home health aide services, home respite and
hospice care, and community residential care. During 2008 we will
increase the number of patients receiving non-institutional long-term
care, as measured by the average daily census, to over 44,000. This
represents a 19.1 percent increase above the level we expect to reach
in 2007 and a 50.3 percent rise over the 2006 average daily census.
The President's request includes nearly $3 billion to continue our
effort to improve access to mental health services across the country.
These funds will help ensure VA provides standardized and equitable
access throughout the Nation to a full continuum of care for veterans
with mental health disorders. The resources will support both inpatient
and outpatient psychiatric treatment programs as well as psychiatric
residential rehabilitation treatment services. We estimate that about
80 percent of the funding for mental health will be for the treatment
of seriously mentally ill veterans, including those suffering from
post-traumatic stress disorder (PTSD). An example of our firm
commitment to provide the best treatment available to help veterans
recover from these mental health conditions is our ongoing outreach to
veterans of Operation Iraqi Freedom and Operation Enduring Freedom, as
well as increased readjustment and PTSD services.
In 2008 we are requesting $752 million to meet the needs of the
263,000 veterans with service in Operation Iraqi Freedom and Operation
Enduring Freedom whom we expect will come to VA for medical care.
Veterans with service in Iraq and Afghanistan continue to account for a
rising proportion of our total veteran patient population. In 2008 they
will comprise 5 percent of all veterans receiving VA health care
compared to the 2006 figure of 3.1 percent. Veterans deployed to combat
zones are entitled to 2 years of eligibility for VA health care
services following their separation from active duty even if they are
not otherwise immediately eligible to enroll for our medical services.
medical collections
The Department expects to receive nearly $2.4 billion from medical
collections in 2008, which is $154 million, or 7.0 percent, above our
projected collections for 2007. As a result of increased workload and
process improvements in 2008, we will collect an additional $82 million
from third-party insurance payers and an extra $72 million resulting
from increased pharmacy workload.
We have several initiatives underway to strengthen our collections
processes:
<bullet> The Department has established a private-sector based
business model pilot tailored for our revenue operations to increase
collections and improve our operational performance. The pilot
Consolidated Patient Account Center (CPAC) is addressing all
operational areas contributing to the establishment and management of
patient accounts and related billing and collections processes. The
CPAC currently serves revenue operations for medical centers and
clinics in one of our Veterans Integrated Service Networks but this
program will be expanded to serve other networks.
<bullet> VA continues to work with the Centers for Medicare and
Medicaid Services contractors to provide a Medicare-equivalent
remittance advice for veterans who are covered by Medicare and are
using VA health care services. We are working to include additional
types of claims that will result in more accurate payments and better
accounting for receivables through use of more reliable data for claims
adjudication.
<bullet> We are conducting a phased implementation of electronic,
real-time outpatient pharmacy claims processing to facilitate faster
receipt of pharmacy payments from insurers.
<bullet> The Department has initiated a campaign that has resulted
in an increasing number of payers now accepting electronic coordination
of benefits claims. This is a major advancement toward a fully
integrated, interoperable electronic claims process.
medical research
The President's 2008 budget includes $411 million to support VA's
medical and prosthetic research program. This amount will fund nearly
2,100 high-priority research projects to expand knowledge in areas
critical to veterans' health care needs, most notably research in the
areas of mental illness ($49 million), aging ($42 million), health
services delivery improvement ($36 million), cancer ($35 million), and
heart disease ($31 million).
VA's medical research program has a long track record of success in
conducting research projects that lead to clinically useful
interventions that improve the health and quality of life for veterans
as well as the general population. Recent examples of VA research
results that are now being applied to clinical care include the
discovery that vaccination against varicella-zoster (the same virus
that causes chickenpox) decreases the incidence and/or severity of
shingles, development of a system that decodes brain waves and
translates them into computer commands that allow quadriplegics to
perform simple tasks like turning on lights and opening e-mail using
only their minds, improvements in the treatment of post-traumatic
stress disorder that significantly reduce trauma nightmares and other
sleep disturbances, and discovery of a drug that significantly improves
mental abilities and behavior of certain schizophrenics.
In addition to VA appropriations, the Department's researchers
compete for and receive funds from other federal and non-federal
sources. Funding from external sources is expected to continue to
increase in 2008. Through a combination of VA resources and funds from
outside sources, the total research budget in 2008 will be almost $1.4
billion.
general operating expenses
The Department's 2008 resource request for General Operating
Expenses (GOE) is $1.472 billion. This is $617 million, or 72.2
percent, above the funding level in place when the President took
office. Within this total GOE funding request, $1.198 billion is for
the administration of non-medical benefits by the Veterans Benefits
Administration (VBA) and $274 million will be used to support General
Administration activities.
compensation and pensions workload and performance management
VA's primary focus within the administration of non-medical
benefits remains unchanged--delivering timely and accurate benefits to
veterans and their families. Improving the delivery of compensation and
pension benefits has become increasingly challenging during the last
few years due to a steady and sizeable increase in workload. The volume
of claims applications has grown substantially during the last few
years and is now the highest it has been in the last 15 years. The
number of claims we received was more than 806,000 in 2006. We expect
this high volume of claims filed to continue, as we are projecting the
receipt of about 800,000 claims a year in both 2007 and 2008.
VA's processing of the increased claims volume has led to a
significant rise in the number of veterans and their survivors
receiving compensation or pension payments from VA. In 2008 this total
will exceed 3.7 million. This is about 513,000, or 16 percent, more
than the number of compensation and pension recipients in 2001.
The number of active duty service members as well as reservists and
National Guard members who have been called to active duty to support
Operation Enduring Freedom and Operation Iraqi Freedom is one of the
key drivers of new claims activity. This has contributed to an increase
in the number of new claims, and we expect this pattern to persist. An
additional reason that the number of compensation and pension claims is
climbing is the Department's commitment to increase outreach. We have
an obligation to extend our reach as far as possible and to spread the
word to veterans about the benefits and services VA stands ready to
provide.
Disability compensation claims from veterans who have previously
filed a claim comprise about 55 percent of the disability claims
received by the Department each year. Many veterans now receiving
compensation suffer from chronic and progressive conditions, such as
diabetes, mental illness, and cardiovascular disease. As these veterans
age and their conditions worsen, we experience additional claims for
increased benefits.
The growing complexity of the claims being filed also contributes
to our workload challenges. For example, the number of original
compensation cases with eight or more disabilities claimed nearly
doubled during the last 4 years, reaching more than 51,000 claims in
2006. Almost one in every four original compensation claims received
last year contained eight or more disability issues. In addition, we
expect to continue to receive a growing number of complex disability
claims resulting from PTSD, environmental and infectious risks,
traumatic brain injuries, complex combat-related injuries, and
complications resulting from diabetes. Each claim now takes more time
and more resources to adjudicate. Additionally, as VA receives and
adjudicates more claims, this results in a larger number of appeals
from veterans and survivors, which also increases workload in other
parts of the Department, including the Board of Veterans' Appeals.
The Veterans Claims Assistance Act of 2000 has significantly
increased both the length and complexity of claims development. VA's
notification and development duties have grown, adding more steps to
the claims process and lengthening the time it takes to develop and
decide a claim. Also, we are now required to review the claims at more
points in the adjudication process.
We will address our ever-growing workload challenges in several
ways. First, we will continue to improve our productivity as measured
by the number of claims processed per staff member, from 98 in 2006 to
101 in 2008. Second, we will continue to move work among regional
offices in order to maximize our resources and enhance our performance.
Third, we will further advance staff training and other efforts to
improve the consistency and quality of claims processing across
regional offices. And fourth, we will ensure our claims processing
staff has easy access to the manuals and other reference material they
need to process claims as efficiently and effectively as possible and
further simplify and clarify benefit regulations.
Through a combination of management/productivity improvements and
an increase in resources in 2008 to support 457 additional staff above
the 2007 level, we will improve our performance in the area most
critical to veterans--the timeliness of processing rating-related
compensation and pension claims. We expect to improve the timeliness of
processing these claims to 145 days in 2008. This level of performance
is 15 days better than our projected timeliness for 2007 and a 32-day
improvement from the average processing time we achieved last year. In
addition, we anticipate that our pending inventory of disability claims
will fall to about 330,000 by the end of 2008, a reduction of more than
40,000 (or 10.9 percent) from the level we project for the end of 2007,
and nearly 49,000 (or 12.9 percent) lower than the inventory at the
close of 2006. At the same time we are improving timeliness, we will
also increase the accuracy of our decisions on claims from 88 percent
in 2006 to 90 percent in 2008.
education and vocational rehabilitation and employment performance
In 2001, about 485,000 trainees took advantage of the readjustment
and vocational rehabilitation and employment services offered by the
Department. In 2006, that number swelled to over 614,000. From 2001
through 2006, nearly $15.6 billion was paid in support of these
programs. In 2006 alone, $3.2 billion was obligated for readjustment
programs, an increase of 82 percent from the 2001 level.
The largest readjustment program is the All Volunteer Force
Educational Assistance Program, or the Montgomery GI Bill. Effective
October 1, 2006, the monthly education benefit under this program rose
to $1,075. This monthly rate is 60 percent higher than it was 5 years
ago. This investment in education continues to produce clear and
substantial benefits for veterans. For example, the unemployment rate
among users of the Montgomery GI Bill is well below that of non-users,
while earnings among program participants are higher than for non-users
of the program.
With the resources we are requesting in 2008, key program
performance will improve in both the education and vocational
rehabilitation and employment programs. The timeliness of processing
original education claims will improve by 15 days during the next 2
years, falling from 40 days in 2006 to 25 days in 2008. During this
period, the average time it takes to process supplemental claims will
improve from 20 days to just 12 days. These performance improvements
will be achieved despite an increase in workload. The number of
education claims we expect to receive will reach about 1,432,000 in
2008, or 4.8 percent higher than last year. In addition, the
rehabilitation rate for the vocational rehabilitation and employment
program will climb to 75 percent in 2008, a gain of 2 percentage points
over the 2006 performance level. The number of program participants
will rise to about 94,500 in 2008, or 5.3 percent higher than the
number of participants in 2006.
Our 2008 request includes $6.3 million for a Contact Management
Support Center for our education program. These funds will be used
during peak enrollment periods for contract customer service
representatives who will handle all education calls placed through our
toll-free telephone line. We currently receive about 2.5 million phone
inquiries per year. This initiative will allow us to significantly
improve performance for both the blocked call rate and the abandoned
call rate.
The 2008 resource request for VBA includes about $4.3 million to
enhance our educational and vocational counseling provided to disabled
service members through the Disabled Transition Assistance Program.
Funds for this initiative will ensure that briefings are conducted by
experts in the field of vocational rehabilitation, including
contracting for these services in localities where VA professional
staff are not available. The contractors would be trained by VA staff
to ensure consistent, quality information is provided. Also in support
of the vocational rehabilitation and employment program, we are seeking
$1.5 million as part of an ongoing project to retire over 650,000
counseling, evaluation, and rehabilitation folders stored in regional
offices throughout the country. All of these folders pertain to cases
that have been inactive for at least 3 years and retention of these
files poses major space problems.
In addition, our 2008 request includes $2.4 million to continue a
major effort to centralize finance functions throughout VBA, an
initiative that will positively impact operations for all of our
benefits programs. The funds to support this effort will be used to
begin the consolidation and centralization of voucher audit, agent
cashier, purchase card, and payroll operations currently performed by
all regional offices.
national cemetery administration
The President's 2008 budget request includes $166.8 million in
operations and maintenance funding for the National Cemetery
Administration (NCA). These resources will allow us to meet the growing
workload at existing cemeteries by increasing staffing and funding for
contract maintenance, supplies, and equipment. We expect to perform
nearly 105,000 interments in 2008, or 8.4 percent higher than the
number of interments we performed in 2006. The number of developed
acres (over 7,800) that must be maintained in 2008 will be 7.3 percent
greater than last year.
The number of veteran deaths peaked in 2006 at about 687,600, or an
average of 1,884 deaths per day. Due primarily to the aging of the
Vietnam Era, Korean Conflict, and World War II populations, the number
of veteran deaths will remain above 600,000 a year for the next 10
years. The next decade will also see workload growth at our national
cemeteries.
Our budget request includes $3.7 million to prepare for the
activation of interment operations at six new national cemeteries--
Bakersfield, California; Birmingham, Alabama; Columbia-Greenville,
South Carolina; Jacksonville, Florida; southeastern Pennsylvania; and
Sarasota County, Florida. Establishment of these six new national
cemeteries is directed by the National Cemetery Expansion Act of 2003.
The 2008 budget has $9.1 million to address gravesite renovations
as well as headstone and marker realignment. These improvements in the
appearance of our national cemeteries will help us maintain the
cemeteries as shrines dedicated to preserving our Nation's history and
honoring veterans' service and sacrifice.
With the resources requested to support NCA activities, we will
expand access to our burial program by increasing the percent of
veterans served by a burial option within 75 miles of their residence
to 84.6 percent in 2008, which is 4.4 percentage points above our
performance level at the close of 2006. In addition, we will continue
to increase the percent of respondents who rate the quality of service
provided by national cemeteries as excellent to 98 percent in 2008, or
4 percentage points higher than the level of performance we reached
last year.
capital programs (construction and grants to states)
VA's 2008 request includes $1.078 billion in appropriated funding
for our capital programs. Our request includes $727.4 million for major
construction projects, $233.4 million for minor construction, $85
million in grants for the construction of state extended care
facilities, and $32 million in grants for the construction of state
veterans cemeteries.
The 2008 request for construction funding for our health care
programs is $750 million--$570 million for major construction and $180
million for minor construction. All of these resources will be devoted
to continuation of the Capital Asset Realignment for Enhanced Services
(CARES) program, total funding for which comes to $3.7 billion over the
last 5 years. CARES will renovate and modernize VA's health care
infrastructure, provide greater access to high-quality care for more
veterans, closer to where they live, and help resolve patient safety
issues. Within our request for major construction are resources to
continue six medical facility projects already underway:
<bullet> Denver, Colorado ($61.3 million)--parking structure and
energy development for this replacement hospital
<bullet> Las Vegas, Nevada ($341.4 million)--complete construction
of the hospital, nursing home, and outpatient facilities
<bullet> Lee County, Florida ($9.9 million)--design of an
outpatient clinic (land acquisition is complete)
<bullet> Orlando, Florida ($35.0 million)--land acquisition for
this replacement hospital
<bullet> Pittsburgh, Pennsylvania ($40.0 million)--continue
consolidation of a 3-division to a 2-division hospital
<bullet> Syracuse, New York ($23.8 million)--complete construction
of a spinal cord injury center.
Minor construction is an integral component of our overall capital
program. In support of the medical care and medical research programs,
minor construction funds permit VA to address space and functional
changes to efficiently shift treatment of patients from hospital-based
to outpatient care settings; realign critical services; improve
management of space, including vacant and underutilized space; improve
facility conditions; and undertake other actions critical to CARES
implementation. Our 2008 request for minor construction funds for
medical care and research will provide the resources necessary for us
to address critical needs in improving access to health care, enhancing
patient privacy, strengthening patient safety, enhancing research
capability, correcting seismic deficiencies, facilitating realignments,
increasing capacity for dental services, and improving treatment in
special emphasis programs.
We are requesting $191.8 million in construction funding to support
the Department's burial program--$167.4 million for major construction
and $24.4 million for minor construction. Within the funding we are
requesting for major construction are resources to establish six new
cemeteries mandated by the National Cemetery Expansion Act of 2003. As
previously mentioned, these will be in Bakersfield ($19.5 million),
Birmingham ($18.5 million), Columbia-Greenville ($19.2 million),
Jacksonville ($22.4 million), Sarasota ($27.8 million), and
southeastern Pennsylvania ($29.6 million). The major construction
request in support of our burial program also includes $29.4 million
for a gravesite development project at Fort Sam Houston National
Cemetery.
information technology
VA's 2008 budget request for information technology (IT) is $1.859
billion. This budget reflects the first phase of our reorganization of
IT functions in the Department which will establish a new IT management
structure in VA. The total funding for IT in 2008 includes $555 million
for more than 5,500 staff who have been moved to support operations and
maintenance activities. Prior to 2008, the funding and staff supporting
these IT activities were reflected in other accounts throughout the
Department.
Later in 2007 we will implement the second phase of our IT
reorganization strategy by moving funding and staff devoted to
development projects and activities. As a result of the second stage of
the IT reorganization, the Chief Information Officer will be
responsible for all operations and maintenance as well as development
activities, including oversight of, and accountability for, all IT
resources within VA. This reorganization will make the most efficient
use of our IT resources while improving operational effectiveness,
providing standardization, and eliminating duplication.
This major transformation of IT will bring our program under more
centralized control and will play a significant role in ensuring we
fulfill my promise to make VA the gold standard for data security
within the federal government. We have taken very aggressive steps
during the last several months to ensure the safety of veterans'
personal information, including training and educating our employees on
the critical responsibility they have to protect personal and health
information, launching an initiative to expeditiously upgrade all VA
computers with enhanced data security and encryption, entering into an
agreement with an outside firm to provide free data breach analysis
services, initiating any needed background investigations of employees
to ensure consistency with their level of authority and
responsibilities in the Department, and beginning a campaign at all of
our health care facilities to replace old veteran identification cards
with new cards that reduce veterans' vulnerability to identify theft.
These steps are part of our broader commitment to improve our IT and
cyber security policies and procedures.
Within our total IT request of $1.859 billion, $1.304 billion (70
percent) will be for non-payroll costs and $555 million (30 percent)
will be for payroll costs. Of the non-payroll funding, $461 million
will support projects for our medical care and medical research
programs, $66 million will be devoted to projects for our benefits
programs, and $446 million will be needed for IT infrastructure
projects. The remaining $331 million of our non-payroll IT resources in
2008 will fund centrally-managed projects, such as VA's cyber security
program, as well as management projects that support department-wide
initiatives and operations like the replacement of our aging financial
management system and the development and implementation of a new human
resources management system.
The most critical IT project for our medical care program is the
continued operation and improvement of the Department's electronic
health record system, a Presidential priority which has been recognized
nationally for increasing productivity, quality, and patient safety.
Within this overall initiative, we are requesting $131.9 million for
ongoing development and implementation of HealtheVet-VistA (Veterans
Health Information Systems and Technology Architecture). This
initiative will incorporate new technology, new or reengineered
applications, and data standardization to improve the sharing of, and
access to, health information, which in turn, will improve the status
of veterans' health through more informed clinical care. This system
will make use of standards accepted by the Secretary of Health and
Human Services that will enhance the sharing of data within VA as well
as with other federal agencies and public and private sector
organizations. Health data will be stored in a veteran-centric format
replacing the current facility-centric system. The standardized health
information can be easily shared between facilities, making patients'
electronic health records available to them and to all those authorized
to provide care to veterans.
Until HealtheVet-VistA is operational, we need to maintain the
VistA legacy system. This system will remain operational as new
applications are developed and implemented. This approach will mitigate
transition and migration risks associated with the move to the new
architecture. Our budget provides $129.4 million in 2008 for the VistA
legacy system. Funding for the legacy system will decline as we advance
our development and implementation of HealtheVet-VistA.
In veterans benefits programs, we are requesting $31.7 million in
2008 to support our IT systems that ensure compensation and pension
claims are properly processed and tracked, and that payments to
veterans and eligible family members are made on a timely basis. Our
2008 request includes $3.5 million to continue the development of The
Education Expert System. This will replace the existing benefit payment
system with one that will, when fully deployed, receive application and
enrollment information and process that information electronically,
reducing the need for human intervention.
VA is requesting $446 million in 2008 for IT infrastructure
projects to support our health care, benefits, and burial programs
through implementation and ongoing management of a wide array of
technical and administrative support systems. Our request for resources
in 2008 will support investment in five infrastructure projects now
centrally managed by the CIO--computing infrastructure and operations
($181.8 million); network infrastructure and operations ($31.7
million); voice infrastructure and operations ($71.9 million); data and
video infrastructure and operations ($130.8 million); and regional data
centers ($30.0 million).
VA's 2008 request provides $70.1 million for cyber security. This
ongoing initiative involves the development, deployment, and
maintenance of a set of enterprise-wide controls to better secure our
IT architecture in support of all of the Department's program
operations. Our request also includes $35.0 million for the Financial
and Logistics Integrated Technology Enterprise (FLITE) system. FLITE is
being developed to address a long-standing material weakness and will
effectively integrate and standardize financial and logistics data and
processes across all VA offices as well as provide management with
access to timely and accurate financial, logistics, budget, asset, and
related information on VA-wide operations. In addition, we are asking
for $34.1 million for a new state-of-the-art human resource management
system that will result in an electronic employee record and the
capability to produce critical management information in a fraction of
the time it now takes using our antiquated paper-based system.
summary
Our 2008 budget request of $86.75 billion will provide the
resources necessary for VA to:
<bullet> strengthen our position as the Nation's leader in
providing high-quality health care to a growing patient population,
with an emphasis on those who count on us the most--veterans returning
from service in Operation Iraqi Freedom and Operation Enduring Freedom,
veterans with service-connected disabilities, those with lower incomes,
and veterans with special health care needs;
<bullet> improve the delivery of benefits through the timeliness
and accuracy of claims processing; and
<bullet> increase veterans' access to a burial option by opening
new national and state veterans' cemeteries.
I look forward to working with the members of this committee to
continue the Department's tradition of providing timely, high-quality
benefits and services to those who have helped defend and preserve
freedom around the world.
Chairman Spratt. Mr. Secretary, thank you very much. And
before proceeding with questions let me state for the record
and ask unanimous consent that all members who were not able to
make an opening statement be allowed to submit one for the
record at this point if they would like.
Mr. Secretary, thank you for your testimony, thank you for
your service. We have a concern about veterans healthcare,
which is our principal concern. And there is a pattern that
your budgets have tended to follow the last five years that I
would like to show you by putting up once again chart number
two.
As you can see, this year you have made a substantial
request for an increase in veterans healthcare, $3.1 billion I
believe. That is $1.9 billion above what CBO calls current
services, basically the provision next year of the same thing
we are providing this year. That is a substantial increase,
too. However, in the out years the amount of money provided
increasingly falls short of current services. So if you look in
the fifth year, you will see that there is a shortfall of about
$2.5 billion in that year alone. And over the five year span of
those bar graphs there is a shortfall of about $3.4 billion
below current services.
Now, if I can show you chart number two.
As you can see you are treating more and more veterans from
Afghanistan and Iraq and I do not think that chart is likely to
cease rising anytime in the near future. But given the fact
that you have got this caseload, increasing caseload, of
patients from recent engagements who are going to demand a lot
of intensive care, do you not think your budget requests for
veterans healthcare are likely to be trending upward for the
next several years at least?
Secretary Nicholson. Mr. Chairman, as you would appreciate,
our focus at the Department has been on the 2008 budget. We do
work very closely with the administration and OMB on this
budget and they do out year projections. We base our requests
for the, each year that we come up here on very deliberative,
intensive modeling and projections on, you know, on the data
that we have. And I have looked at historically how that has
operated. And it appears that there is a pattern each time a
budget is submitted here for those out years to be included.
What I can tell you is that in 2004 they were projecting the
budget for this year, 2008, it had a number in there of $28
billion. We are here today requesting $35.3 billion. So what I
can say is, there will be a lot of intervening information that
will comprise the request for 2009 before it comes here to the
Congress, that I think this number is not reflecting at all.
Chairman Spratt. But do you not think that VA, you will be
needing the additional amount to at least track current
services in years to come?
Secretary Nicholson. Yes, sir. I do. I think that the
number will continue to go up.
Chairman Spratt. But your budget does not really reflect
that because it either flattens out or comes down in terms of
current services in particular.
Secretary Nicholson. Well, it does not reflect it because
it does not have the ingredients that we use to develop these
budget requests. It is a number, some call it a place holder,
it is a number that has been put in there.
Chairman Spratt. Let me ask you about specifically what is
the most typical and most tragic type of injury being sustained
in the Persian Gulf today in Iraq and Afghanistan both. That is
traumatic brain injuries and spinal cord injuries. They account
for more than 25 percent, according to our information, of
combat casualties. And typically, they involved more than just
brain injury. They involve a loss of limb, a loss of vision, a
loss of hearing, cognitive loss, paralysis, chronic pain, and
PTSD as well. How much is your budget providing for this
particular type of injury for 2008? And how much of an increase
is that over and above 2007?
Secretary Nicholson. First, maybe let me tell you Mr.
Chairman, in our polytrauma centers, which is where we have the
most serious cases. And as I said in my testimony we
established those so that we would have the aggregation of all
the medical disciplines in one place and that these people
could be treated for these at one time and not serially if they
have a burn problem, an amputation, traumatic brain injury. And
they are doing wonderful work. We have 342 people that we have
treated or are treating in those polytrauma centers. Our budget
number for 2008 is I am being told, it is an increase of 86
percent, from $405 million for these purposes to $752 million
in this budget.
Chairman Spratt. So how many patients is this for? Can you
tell us on a per patient basis what you are spending for a
typical brain trauma or spinal cord injury?
Secretary Nicholson. Well I can tell you, as I said, we
have 342 that we have treated or are currently being treated in
the polytrauma centers. But we have other less minor brain
injury patients in the system. And I think we have treated
about 1100 of those that we have diagnosed with some form of
brain injury. I have not done that math but we could do that.
Chairman Spratt. Over what period of time? Is that over the
last year, or the current?
Secretary Nicholson. No, sir. That is since we have opened
these centers to these combatants.
Chairman Spratt. Polytrauma centers?
Secretary Nicholson. Since the inception of the combat.
Chairman Spratt. I am sure you are aware that it has been
said that there are patients who are being sent to the VA
Hospital at their home communities. They are going back home.
They go to the Veterans Healthcare facilities nearest home only
to find that they do not have the kind of treatment expertise
that the polytrauma centers have. And some of them, before they
are able to get to a polytrauma system, are sustaining some
significant injuries that could otherwise maybe have been
abated if not avoided. Is this a problem? Do you acknowledge
this problem? And if so, what does the VA plan to do about it?
Secretary Nicholson. Well, there have been those cases,
there was one reported in a very recent ABC article on this.
What we are doing about it, and this has been underway, is that
we are enhancing the training of our clinical physician and
nurse staff with respect to traumatic brain injury. And thus in
all 155 of our major medical facilities, we will have embedded
people who are competent for the diagnosis and treatment of
that. And they will not be at the level of these polytrauma
centers, which are these very concentrated centers of
excellence for the advanced treatment. But many of these
patients----
Chairman Spratt. But is there a process by which these
conditions can be detected, diagnosed, and immediate transfer
to one of these polytrauma centers can be affected so that
people do not lose time and perhaps lose some hope for a better
recovery?
Secretary Nicholson. Yes, that is what is being done, is
that we have enhanced the training and thus the capability, the
competence, in those medical centers.
Chairman Spratt. What about the administrative process of a
patient, or his family, or a local physician who want to get
this particular veteran to a polytrauma center as fast as
possible. Is there some kind of fast track or expedited process
for approval?
Secretary Nicholson. Well, they are admitted, if they come
to our attention, and most of them that are seriously injured
would be handed off to us from the military and come right into
our polytrauma centers. And in fact many of them by the way are
in our polytrauma centers while they are still on active duty.
And the unfortunate case that was talked about the other night
was one of those. That person was still in the Army. But the
answer is yes. They are given just very focused, intensive
attention and expedition.
Chairman Spratt. Let me ask you this. I think you would
agree, I at least have the perception as a lot of people do,
that in certain areas the VA does excellent work, really fine
work, the best of any treatment anywhere. And that is
particularly true with prosthetics because of your experience
over the years. Can you say the same thing about your treatment
for spinal cord injuries and brain injuries? And in particular
the reporter we are talking about, Bob Woodruff, has said that
he got better treatment in the civilian sector than soldiers he
knew in the public sector were getting from the Veterans
Administration. Can we say that we are moving spinal cord
treatment and traumatic brain injury up to the level where it
is the best in the country? Because after all, this tends to be
an all too typical injury for our Iraqi veterans. And what are
we doing to get there? That is the basic question.
Secretary Nicholson. We can say that. I think we can say
that proudly. I think the VA is the expert in the world in
spinal cord injury, Post Traumatic Stress Disorder. It is a
recognized expert in traumatic brain injury. We have, in
concert with DOD, been operating a joint traumatic brain injury
facility since 1994. So we have the expertise. But I will tell
you, now with respect to traumatic brain injury, that that is
still a developing science. And there is still a lot that is
not known, or I guess I should say, we wish we knew more about
that. For example, I mean the basis of what we used to know
about this really came primarily from athletic injuries,
concussions. We still do not know what we want to know about
young people's proximities to blasts, to explosions, where they
do not lose consciousness. Or maybe they have a fluttered
series of blinking, or maybe a second of loss of consciousness.
What effect does that have or will that have on them? We know
of these things. And it is over and the squad leader says to
his guys, ``Is everybody okay?'' and they say, ``Yeah, Sarge,
okay.'' And they are up and at them. What effect does that
have? And that is very difficult, also, to detect.
Having said that, we now also, and I think I said that in
my testimony, we are going to screen every one of those people
that come to us for this at the time they come to us which is
upon their separation from active duty.
Chairman Spratt. Would you not agree you are stretched
pretty thin on PTSD psychiatrists who are truly qualified in
this area, to render the care that lots of veterans are
needing?
Secretary Nicholson. No, I think we are, we have got good
capacity for treating PTSD, Mr. Chairman.
Chairman Spratt. One final question with respect to spinal
cord injuries and traumatic brain injuries. As we look through
the budget we see there is about $333 million for research and
treatment on spinal cord injuries, barely an increase for 2008
over 2007. And we cannot break out what is provided for
traumatic brain injuries. Can you give that to us now or could
you provide it for the record if you cannot? Is there an
increase, a significant increase, so that the VA is leading the
way in developing new treatment modalities for traumatic brain
and spinal cord injuries?
Secretary Nicholson. We have that but I do not have it at
my fingertips. We will submit that to you, Mr. Chairman. Yes,
sir.
Chairman Spratt. Is it a significant increase, next year
over this year?
Secretary Nicholson. It is an increase. I do not know if
you would consider it significant. But it is an increase, I
know that.
Chairman Spratt. Okay. Thank you very much, Mr. Secretary.
I ask unanimous consent that the newest member of the
Committee, the gentle lady from Wisconsin, be allowed to sit in
and participate in this hearing. Hearing none, welcome to the
Committee. I now yield to Mr. Ryan.
Mr. Ryan. First, before I start questioning, I just want to
welcome my neighbor and my friend from Milwaukee to the
Committee. Welcome aboard. It is great to have you.
I want to just pick up where the Chairman left off. You
know, we went to Camp Arifjan where all our armored vehicles
that are hit by IEDs come to. And you saw basically a piece of
land the size of a county fairground full of Strikers, Humvees,
M1A1 Abrams, Bradleys, ripped apart by IEDs. And now we have
the newest version, the explosive foreign projectiles, which
really no armor can stop. And so our enemies are getting better
at hitting our troops. And so I simply want to add, what the
Chairman was saying, Secretary, is that, you know, we are going
to have more of the same thing with our newest veterans coming
into your system. We are going to have more PTSD. We are going
to have more brain and spinal cord injuries. And so I simply
want to, you know, with the strongest possible way encourage
the VA to recognize that this is coming, and to get ahead of
the curve and to do everything within your power to be prepared
for that, especially with Post Traumatic Stress. You know, I
have heard other stories from, from just vets, from
constituents on the lack of follow up after leaving. And that
to me is something that has to be addressed.
Let me ask you a couple questions about your actuarial
projections. A couple years ago or a year and a half ago, the
VA had a funding shortfall that had to be made through a
midyear supplemental, which is not the easiest thing to do here
in Congress. And that had to do with some actuarial projection
problems in areas. Could you just give me a sense of exactly
what happened? And what is the VA doing to make sure that we do
not have this kind of a problem again?
Secretary Nicholson. Yes, I can. You are referring to the
fiscal year 2005 budget.
Mr. Ryan. Yes.
Secretary Nicholson. And in the beginning of the third
quarter of that, roughly spring of 2005, it became apparent
that the VA was going to be short of money in the medical care
side of the endeavor. And one of the things that happened
there, or the main thing that happened, was that the projection
for demand for services was off. And it was a peculiar
circumstance that the same model was used to develop that
budget that has been used for a long time and is still used,
which is called the Milliman model which has historically
uncanny accuracy. In its projection of total patient load it
comes within five-tenths of one percent, and with unique
patients it is one-tenth of one percent accurate.
But what happened is, and how it works is, it models itself
based on real data. And as you know, the budgeting cycle, we
are sitting here working on the 2008 budget now in March of
2007. So back then they were using 2002 data in that model, the
numbers that were being----
Mr. Ryan. 2002 data for 2005?
Secretary Nicholson. Yes, sir.
Mr. Ryan. Okay.
Secretary Nicholson. And in 2002 there was not a War. And
so that model, and thus that budget projection that I got right
after I came into this job, entering into that, was off. And it
became very clear that it was off. We did come here and got a
supplemental.
Mr. Ryan. Are you confident that the base assumptions in
your model now are adjusted to reflect today's reality and
2008's reality? That that is going to be adjusted?
Secretary Nicholson. I have a good degree of confidence. We
have applied some judgment to it. It does not, for example,
does not model long term care. It does not model our expenses
for CHAMPVA, which are quite ascendant in recent years, if you
have noticed. And it does not model dental care. So we apply
those independently, plus, you know, a little bit of judgment
factor to it based on----
Mr. Ryan. Yeah, but any model you can add discretionary
assumptions into it and you have done so to reflect current
realities. Is that what you are saying?
Secretary Nicholson. That is correct.
Mr. Ryan. The data security, you touched on this a little
bit in your testimony. Can you give us kind of specifically
what the VA is doing to protect the identities and the
privacies of our vets? You know, what specific reforms are you
putting in place to make sure that this episode of, I cannot
even remember, 16 million veterans does not happen again. What
exactly are you guys doing to fix that, to prevent that from
happening?
Secretary Nicholson. Well, we have the Assistant Secretary
for IT here with us. But essentially we are going through a
major transformation of this huge agency that is disbursed
throughout the world, we really have facilities from Maine to
Manila, that has had a culture of decentralized sort of semi-
autonomous operation. These hospitals are major things,
employments centers, vendor centers in their communities, grown
up that way. We are centralizing all of the IT. It is long
overdue, but it is a real cultural shock and an imposition. And
it is necessary that we have the discipline and the uniformity
of systems and reporting in the entire system so that we do not
have all these independent operations. That is ongoing and that
is going quite well.
Mr. Ryan. When do you expect it to be completed?
Secretary Nicholson. Well, the entire, I think we project,
and I will ask Secretary Howard for that, for the end of that
we have an elaborate chart of steps there. Bob, do you want to
answer?
Mr. Howard. Yes, sir. Sir, we have a very comprehensive
program. We have laid down hundreds of actions that need to be
taken, beginning with the proper directives. Many of those have
already been written and published. In fact, the actions are
broken down into managerial type actions, like the directives.
Technical actions, enhancing the use of specific technology be
that encryption, the use of public key infrastructure in
encrypting emails, and things like that. And then we have
operational actions, enhancing procedures that need to take
place. You know, that do not involved technology, in a sense,
but involve the way you do business. And as I said, this
overarching plan, the actions number in the hundreds. And that
is already ongoing. It is considerable work, but a lot of work
to do.
Mr. Ryan. When do you feel like you will be confident that
you have the right technology and actions and processes in
place to prevent something from happening?
Mr. Howard. Sir, this fiscal year, in fact, is a very
critical one. We anticipate by the end of this fiscal year we
will have a number of those in place, but it will not be
complete. I would anticipate probably another year before we
are very comfortable with the protection of our infrastructure.
By that I mean the complete ability to control our networks and
eliminate the use of open transmissions and things like that,
controlling our ports on our computers, shutting those down
when necessary, monitoring devices that are plugged into
computers not only throughout VA but we also non-VA activities
that we have to control, like our affiliates, our contractors.
And in fact that particular population will be the most
difficult. It is very extensive. And the other aspect of all
this, sir, is that as we move forward we must be very careful
not to shut the operation down. We are flying the plane at the
same time that we are tightening controls.
Mr. Ryan. Right, but is it your opinion that you now have
in place specific controls that would prevent that kind of an
episode from occurring tomorrow? Meaning, I understand it is
going to take you a year and a half or a couple years to get
the whole procedure put into place. The culture changed, the
interoperability, the data security, all of that. But do you
have the right controls in place right now so a worker who
takes a laptop home and that gets stolen and the data can be
downloaded, do you have the right controls in place today to
stop that specific kind of a problem from happening tomorrow?
Mr. Howard. In other words, sir, to prevent the
downloading----
Mr. Ryan. Yes.
Mr. Howard [continuing]. From a remote area?
Mr. Ryan. Yes.
Mr. Howard. Not yet, sir. There is a technology that is in
use right now in region four, that is the northeast, that does
that. And that is being distributed throughout the country, but
it is not 100 percent yet.
Mr. Ryan. When would that technology you are talking about
in region four be distributed?
Mr. Howard. Sir, we anticipate by the end of this fiscal
year.
Mr. Ryan. Okay, thank you.
Mr. Howard. And the thing is, sir, to just comment one more
point about that. The awareness issue, the culture change, is
critical to what you just said. Because even with the
introduction of some of these technologies, where there is a
will, there is a way. In other words, if someone really wants
to do something incorrect they can do that. The awareness part
and the culture change and the responsibility of each employee
throughout the VA is absolutely critical to solving this
problem.
Mr. Ryan. But when I hear you say, ``the end of the fiscal
year,'' what you have in place in region four to protect
against this specific kind of a problem, that, you are talking
about the end of September this will all be in place?
Mr. Howard. For that particular, controlling the
downloading of critical information and eliminating devices
from being plugged into the VA network, inappropriate devices.
Mr. Ryan. Why does it take that long?
Mr. Howard. Sir, one reason is we are dealing with a very
highly decentralized organization. And although we just
recently centralized information and technology, it was as I
said very decentralized in the past. And as a result, there are
all kinds of devices that were purchased out there. For
example, just computers alone, there are all kinds of different
types of computers. And when introduce a fairly rigid
technology into that kind of an environment you do have to be
careful to make sure the computers will accept the technology,
that the network will accept the technology and not shut down
and not be overloaded. That is why we have got to be very
careful as we move forward. Because particularly in the health
arena we cannot afford to have a hiccup in any of that. We are
very careful, testing is going on. We are using region four in
the northeast as our test bed in fact. And there are a number
of these technologies. You know, we could share with you how we
are approaching some of that. But there is an extensive amount
of effort going on to introduce an array of activities. You
know, it is not just one particular thing. It is not just
encryption alone. It is control over the network, it is control
over the ports and the computers, a variety of activities that
need to be put in place.
Mr. Ryan. Well, I will just close with this. If you could
keep us in writing up to date on this. Let us know if you are
meeting benchmarks, let us know when this first round of
protections have been implemented. And I would sure like to
know if you are going to slip past the end of September
deadline.
Mr. Howard. Sir, we can share with you those near term
activities along with long term activities. For example, a lot
of what we are doing now, as I say this is this fiscal year.
But we have also got follow on activities that will take place
well beyond that, that will even improve things even more.
Mr. Ryan. And keep us posted as you are doing this.
Mr. Howard. Yes, sir.
Mr. Ryan. Thank you, I yield.
Chairman Spratt. Thank you, Mr. Ryan. Mr. Edwards of Texas.
Mr. Edwards. Thank you, Mr. Chairman. Secretary Nicholson
from my vantage point as the Chairman of the VA Appropriations
Subcommittee I want to thank you not only for your
distinguished combat service to our country in Vietnam but for
your lifetime of service which you are continuing in this
position. And I know over the last several years since you
attained this position you have been an aggressive voice for
veterans and initiated a lot of new positive programs for
medical care and other services for our vets, and I salute you
for that.
I want to get, for the record, some budget numbers. And I
want to make it clear that we all understand that these budgets
are not put together by the VA administration. The OMB bean
counters are the ones who eventually sign off on these and
force budgets that none of us would ever approve. But I want to
get down for the record a few points. As I understand it, you
are asking for $36.6 billion for VA medical care services for
fiscal year 2008, is that correct?
Secretary Nicholson. That is correct, sir.
Mr. Edwards. For 2009, what does the budget request for VA
medical care services?
Secretary Nicholson. It is not a request.
Mr. Edwards. But what is in the five-year budget? What is
the estimate for 2009 fiscal year for VA medical care services?
Secretary Nicholson. The estimate is $34.5 billion.
Mr. Edwards. $34.5 billion? So that would be a $2.1 billion
cut starting October 1, 2008 in VA medical care services. Now,
that does not take into account, well let me get for the
record. You assume this year a 4.45 percent medical care
inflation just to maintain present services, given the extra
costs for healthcare supplies, salaries, is that a correct
number?
Secretary Nicholson. Yes, sir. That is the inflation plus
payroll, 4.45 percent, yes.
Mr. Edwards. Okay. And you are projecting 2.4 percent
increase in workload, or in effect net number of new veterans
coming into VA healthcare system. So you need extra money just
to maintain present services for each veteran, given you have
an increase in population. Is that correct?
Secretary Nicholson. Yes, sir.
Mr. Edwards. Okay. So for the record, let me just say this
and I am not going to ask you to respond to it, Mr. Secretary.
But for the record, if the Congress were to follow the OMB
recommendation and to fulfill the President's budget request
for veterans it would require the most massive and
unprecedented cut in veterans healthcare services in American
history. It would be over $2.1 billion cut before you
considered the 4.45 percent increase inflation for maintaining
present services for healthcare and that would not take into
account increase in number of veterans going into the system.
And I want veterans in this country to know that is not going
to happen. Congress is not going to support it.
But I want to send a message to the bean counters at OMB,
when they brag that we can easily balance the budget by 2012,
protect every tax cut we passed, fund the War in Iraq and
Afghanistan, they should also have the integrity to say they
stand behind their recommendation that we would have the most
massive cut in veterans healthcare services in the history of
America. They cannot have it both ways. They cannot ask the
press to say we are going to balance the budget by 2012 in a
responsible way and then run from their own numbers, which
would require millions of veterans to have their healthcare
services cut, perhaps cause hundreds of thousands of other
veterans not to get their healthcare. And I am not going to ask
you to comment on that, Mr. Secretary, because I know how the
system works. And I know the recommendations for 2009 did not
come from the VA. But I am tired of letting the OMB counters
get a free ride, bragging about how they are going to balance
the budget responsibly, but there is nothing responsible about
having a $2 billion cut in fiscal year 2009 for medical care
services.
That also touches on a debate, Mr. Secretary, I will not
drag you in the middle of but it is a debate we have in this
Committee often, about when is a cut a cut. And there are some
who would say if you provide one additional dollar for 2009
compared to 2008 for VA healthcare you have increased funding
and therefore you have not cut veterans healthcare. I think
that is disingenuous because if you added one dollar from 2009
to the 2008 VA healthcare budget, you would be facing $2 to $3
billion in cuts in present services for veterans because of
healthcare inflation, increase in population of veterans. So,
to those of my colleagues that say, you know, we are being
disingenuous when we suggest a one dollar increase in the VA
healthcare budget in 2009 over 2008, I would say that a cut is
a cut when hundreds of thousands of veterans would not receive
the healthcare that our nation promised them and the healthcare
that the nation delivered to them in the year before.
Mr. Secretary, the one question I want to ask you is this.
I met with several veterans recently who have formed a new
Afghan/Iraqi War veterans organization. And they told me that
in the post-deployment questionnaires and surveys there have
been thousands of our servicemen and women who have requested
mental healthcare services. And the vast majority, well over 50
percent of those, have not received a call yet. I do not think
this was the fault of the VA because I assume this was still
within the Department of Defense healthcare system. But I know
you interact with them. And if that in fact is true, or those
numbers are even close to being true, I think it is shameful
that thousands of our Iraqi and Afghan War vets have asked for
mental healthcare and have not received any response, no
appointments with doctors, nurses, psychologists,
psychiatrists. Can I just ask you for the record, have you
heard about this concern? Or has the Department of Defense
mentioned this problem to you? Because if it is true then it
will eventually be a huge problem for the VA. But I would like
to see if we can address it in the supplemental bill if we can
get the facts on the table. Can you shed any light on this
situation?
Secretary Nicholson. I cannot confirm that proportion,
those percentages, Congressman Edwards. But I know the GAO
mentioned it in a report on the Army. And so we know that there
is a disconnect occurring there. I think I very recently
testified I had a meeting with the Deputy Secretary of Defense
to talk about better communications. And that has begun. We are
getting better information now on both the sessions and the
people they are getting ready to discharge, which is very
helpful to us in anticipation. This is another area that needs
to be improved upon. And that is underway.
Mr. Edwards. Okay. Thank you, Mr. Secretary. Thank you, Mr.
Chairman.
Chairman Spratt. Mr. Barrett of South Carolina.
Secretary Nicholson. Excuse me, Mr. Chairman? Could I just
make one more comment on something that we are finding out
about that, that for your information, Mr. Edwards, in
discussion with those people. And we do not have a solution to
this yet, either. But we find that a lot of these young people
who are experiencing these reactions to having been in that
dangerous condition, combat 360, are reticent to come forward
and to have it recorded in a medical record of some kind
because they feel that there is some stigma that attaches to
this. And we, in our outreach efforts when we do these post-
deployment screens and so forth, are trying to inform them and
their families and their community of people, including their
employers, that this is not uncommon. This is a common reaction
to a very uncommon experience. They are not losing their mind.
There is no fault. If we are allowed to treat them early enough
we can make most of them whole. And so we are really
encouraging them not to be inhibited by this stigma.
Mr. Edwards. Right. I thank you for that. And I would just
add a final footnote that because of that outreach if the
Department of Defense is not doing its job in following up and
providing appointments with physicians with these veterans who
have pleaded for it, with these actually active duty and Guard
and Reserve members, then the word is going to get out. You
overcome the fear of the stigma, you finally do fill out a
questionnaire honestly asking for help, and then you do not get
it. I am afraid it is going to discourage other veterans coming
back from the wars to ask for that help. But thank you for your
leadership, and I will look forward to following up with you on
this, see if we can work with DOD to do something, perhaps even
in the supplemental.
Chairman Spratt. Mr. Secretary with your indulgence, we
would like to pause for just a moment for a brief piece of
housekeeping business that needs to be done. And I yield to the
gentleman from Wisconsin, our Ranking Member Mr. Ryan, for a
unanimous consent request.
Mr. Ryan. Thank you, Mr. Chairman. Mr. Chairman, I ask
unanimous consent that the Committee approve Andrew Morton's
service in the capacity as independent consultant to the House
Budget Committee Republican Staff. He meets the requirements to
act as an independent consultant as set forth by the Committee
and House administration and applicable statutes.
Chairman Spratt. We have a letter here to the Committee on
behalf of Mr. Ryan, it is my understanding that you have
secured the approval of the House Administration Committee for
this employment, which will be for a course of one year unless
renewed. Without objection, unless there is objection, the
unanimous consent request is agreed to, as well as requesting
the consulting contract will be made a part of the record. This
will be a consultant to the Republican Staff for the Committee.
Hearing none, it is all approved by unanimous consent.
Mr. Ryan. Thank you.
[The attachment of Mr. Ryan follows:]
Unanimous Consent Request by Mr. Ryan for the House Budget Committee to
Approve an Independent Consultant
Mr. Chairman, I ask unanimous consent that the Committee approve
Andrew Morton's service in the capacity as independent consultant to
the House Budget Committee, Republican staff.
Chairman Spratt. Thank you very much. And now, Mr. Barrett
is not here. Mr. Garrett?
Mr. Garrett. Thank you, Mr. Chairman. Thank you, Mr.
Secretary. I appreciate the questions of the Ranking Member
earlier. I will not be redundant on those, they already covered
some of the points. I would like to thank the Secretary,
though, for your service to the vets of this nation. I would
like to also thank you personally for during your tenure
traveling up to my neck of the woods, the great state of New
Jersey, the fifth congressional district, and spending some
time up there. You may recall you had the opportunity to travel
up and visit the Paramus Veterans Home. And the men who were
there were sort of shocked to see you there, but very pleased
to see you, had the opportunity to engage in conversation with
you. So I appreciate that.
While there and through our discussion there, we were able
to point out some of the advances that are being made as far as
some safety improvements that are being made to that particular
facility to enhance the conditions from a safety point of view
for the men who are in that facility, and who will spend their
lives there now. One aspect that we were able to touch on a
little bit that was not able to, we are still working on, it is
something not from a safety point of view although you might
put it in that category in some definition is for the fact that
these people spend their entire day, twenty-four hour, twenty-
four seven there, and need recreation as well. And so we are
looking to have expansion of what we call a day room for
exercise, and done in a way that we are actually not just
looking to the VA but outside organizations are stepping up to
the plate to help as well, to help underwrite and fund these
programs which I think is a good joint effort. We just look to
you to see that the hope that the VA continues but a priority
in the construction and grants funding for programs that are
not specifically safety in nature, but are also life critical.
And that is in the area of the environment and the recreation
for the gentlemen there. And if you just want to, I will just
let you comment on that if you see the importance of those
aspects in addition to simply the safety aspects of these
facilities?
Secretary Nicholson. Well, we do consider that important.
We of course have to prioritize for, you know, life safety and
medical support needs. But we agree. In the long term care
environment we try to be as holistic as we can. We coordinate a
lot of volunteers into those centers and, you know, the things
that go with that: trips, outside stimulation, so forth. And
the recreation part of it is very important.
I might add parenthetically, I was visiting a long term
care facility here in the North Washington VA Center and a
little lady in a wheelchair with one leg said, ``Hey Secretary,
how old do you think I am?'' And I guessed. I said, ``Oh, I
think you are about seventy-five, ma'am.'' She says, ``I am
ninety-five and I want to go to Atlantic City.'' And it turned
out she was, she is now 100. She was ninety-five and we, I
organized a little thing and we got a van with some of the
other colleagues, and she went up and had her, what she said
was her final wish. She is still kicking and she still wants to
go back again. But she went to Atlantic City.
Mr. Garrett. Well, we appreciate New Jersey for Atlantic
City. The second question is, with regard to cemeteries. On
federal cemeteries, correct me if I am wrong, if a
servicemember or a spouse was to be buried in a federal
cemetery then there is no cost to that soldier or his spouse.
If he wants to be, if he or his spouse want to be buried in a
state cemetery there is a minimal cost, or some cost to the
individual, to the soldier, but there is no subsidy, if you
will, the spouse has to pay their total fee to go into a state
cemetery is my understanding. My question to you, if I
understand that correctly, would it not be a true cost savings
in long term, because a state cemetery pays for all the
additional costs of maintaining that cemetery down the road, if
the VA could just supplement just to the extent of a few
hundred dollars or whatever that they pay for the soldier for
the spouse to go into that? Because at that point the spouse
would never be, there would never be a cost to the VA in the
future for that spouse had that spouse decided to go into a
federal cemetery.
Secretary Nicholson. Well, I appreciate the question,
Congressman. As you know, the plots are there and they are
there without cost. Those details I am going to defer to Under
Secretary Tuerk to respond to.
Mr. Tuerk. Yes, thank you Mr. Garrett. I am glad to respond
to you to the extent that I can this morning.
Mr. Garrett. Okay.
Mr. Tuerk. And we can supply additional information. You
are correct, in a national cemetery there is no charge to
anyone who is eligible for burial there. In the state
cemeteries, however, we leave it to the states to determine
whether they are going to charge a fee for a spouse. I am not
personally aware that New Jersey charges a fee. Apparently that
is the case. As I said, we leave that to the states.
Mr. Garrett. Well, I would just encourage you to take a
look at this, whether there would be a cost savings overall.
Because now if a New Jersey resident who obviously is defending
not just New Jersey but is defending the entire nation when
they are a soldier is buried in a state cemetery, the spouse
has to pay upwards to $500 I believe or more for internment.
And then the state is picking up the cost, as I said before,
for the perpetual care of that site. Whereas if they had chosen
to go to a federal facility, the federal government would be
responsible for both ends of it, for the internment plus for
the perpetual care as well. We see this as a way to encourage
people to remain where they want to be, which is back at home
in their own state facilities, and decrease the overall cost.
And also decrease the need, as there is an apparent need now,
for additional federal cemeteries for our soldiers and their
spouses as well. So I encourage you to take a look at that and
I would be glad to discuss it with you.
Mr. Tuerk. I would be happy to. I will talk with your
staff, Mr. Garrett, and we will get back to you with
information on that question.
Mr. Garrett. Thank you so very much.
Mr. Tuerk. Happy to do that.
Chairman Spratt. Mr. Cooper?
Mr. Cooper of Tennessee. Thank you, Mr. Chairman, thank
you, Mr. Secretary. I would like to yield my five minutes to
the person I think is the only member of this Committee who has
actually worked in a VA hospital, Mr. Baird of Washington
State.
Mr. Baird. I thank Mr. Cooper. I would rarely ask for this,
but I have to go to another mark up. And having worked in the
VA and specializing in traumatic brain injury, I really wanted
to take the chance to ask you a few questions if I might.
And I want to respond to my good friend, the Ranking Member
from Wisconsin, who asked about the 2005 shortfall. A brief
story about that is in order. I, along with my colleague Ms.
Hooley from Oregon, in late 2004 began to ask our local
psychologists and other health professionals at our regional
VA, ``Do you have the resources you need currently to treat the
current veterans? And with reasonable anticipation of certain
incidence rates among the incoming returnees, have you plussed
up your budget and staffing levels to meet that?'' The answer
was deeply troubling. The first answer was, ``Congressman, if I
tell you the truth I will lose my job.'' That is a true story.
Federal employees telling an elected representative of the
people that if they told the truth they would lost their job.
Secondly, the answer was absolutely not. ``We do not have
enough to meet our current needs and we do not have any
projected increase proximal to what we are going to need.''
In response to that Ms. Hooley and I tried to offer an
amendment to the then emergency supplemental to add $1.5
billion, which we estimated and veterans groups estimated would
close the anticipated gap. We were not allowed to offer that
amendment when the supplemental came up, and the office
administration position is, ``You do not need to because we are
going to meet the needs.'' Six months later, sure enough, there
was the shortfall revealed, as the Secretary said.
So my first question, Mr. Secretary, and I know this may
not have been on your watch initially because you came on right
after that. Would you without any hesitation say that a staff
member of a VA who responds honestly to a request for
information from a member of Congress that does not violate
confidentiality restrictions will not be subject to dismissal
if they answer the question honestly?
Secretary Nicholson. I will unequivocally answer that and
say absolutely not. One, because that is the way it ought to
be. But two, it would not even be possible to dismiss them. I
mean, I have people that we were talking about these data
breaches, some of which are pretty flagrant, and I find my
hands very tied in taking discipline action against them for
that, let alone someone that decides to speak his or her
opinion.
That happens, by the way, all the time. I was just on this
television special and had several members of the VA
interviewed that had a view of some things different from I and
they were not a bit inhibited about saying it.
Mr. Baird. Well, I will tell you, Mr. Secretary, I spoke to
a half dozen Phds, MDs, nurses, and others, all of whom gave me
the same answer. So when your model falls short, because the
reason the model falls short in estimation is the people who
are on the line providing the service are not included in that
and they are intimidated. I will just put that out there.
Second question, that same issue arises, though, as we look
at the current budget. As we look at the projected incidence of
certain issues, like traumatic brain injury, Post Traumatic
Stress Disorder, etc., you said earlier we have good capacity
to meet Post Traumatic Stress Disorder. I do not hear that from
the people in the field. When you say good capacity, have you
done incidence calculations to determine what is the percentage
of normal incidence of returnees and what capacity do we have
to meet that? Because I am not seeing that. I certainly am not
seeing it on the ground.
Secretary Nicholson. I am going to ask Dr. Kussman to give
you more of a refined answer. But I will give you some numbers
of, you know, the returnees from the War, we see in the
vicinity of 210,000 of those that have come back and have been
separated. And of that number I think it is 73,000 that we have
screened have mental health issues. And continuing the
diagnosis that we do with those people we have concluded that
39,000 should be in treatment for Post Traumatic Stress
Disorder and are.
Mr. Baird. Well, let me, because I am going to run out of
time here, ask three things. Can you give me some more details
about what it means to be in treatment for Post Traumatic
Stress in terms of frequency of visits, waiting time to access
that? That would be question one. Question two would be when
you make your long term cost projections, and I think Mr.
Edwards was very articulate about this, having worked in TBI,
that was my specialty, was traumatic brain injury. Some of
these folks are going to need long term care and vocational
rehab. They are going to need emotional support for their
families. The data suggest people tend to have fairly positive
recoveries immediate post-injury, then four or five years out
is when things begin to fall apart for their families and
themselves as the recovery rate is plateaued. So I am
interested in long term costs for TBI. And then the final
question I would like, could you provide members of the
Committee some estimate of the additional cost to the VA system
resulting from the Iraq conflict? Just the Iraq conflict? You
know, I am not asking for that now. But I think when we hear
the cost of this War I am very interested in what the
additional cost of this system would be if we fully met the
needs of the veterans for the projected future. In other words,
the lifetime of the veterans, what is the full cost of this War
going to be for that?
And I thank the gentleman for yielding the time, and
obviously I care passionately about this having worked with our
soldiers in the VA.
Secretary Nicholson. We will attempt that. But I would like
to be able to get with you to get some more particularity about
what that would mean.
Mr. Baird. Sure. I would be happy to do that.
Secretary Nicholson. Thank you.
Chairman Spratt. Mr. Hensarling?
Mr. Hensarling. Thank you, Mr. Chairman. Welcome, Mr.
Secretary. It is good to see you again. We have known each
other for a number of years, and let me add my voice to those
who want to congratulate you for your continued service to our
nation.
I really want to start out with a statement, and hearken
back to something our Ranking Member, Mr. Ryan of Wisconsin,
said. And that is unfortunately that now we do not agree across
the aisle in this Committee. But I think if there is one thing
that we would agree on is that it would be more difficult to
find a greater moral obligation of this country in this
Congress than to ensure that our veterans have the best
healthcare in the world, period, paragraph. And we clearly want
accountability. We do not want waste. And we know it is not how
much money you spend that counts, it is how you spend the
money.
We will debate in this Committee and in this Congress where
that money ought to come from. Some will want to pass debt on
to future generations. Some will want to increase taxes. Others
will try to find it in lower priority spending. That is
personally my own preference, but I do not think anyone in this
Committee would offer a greater priority. And so clearly when
you see stories like you saw on the cover of Newsweek they are
disturbing. Simply because I see something in print does not
mean I accept it as gospel, but it does want me to ask some
serious questions.
So I think you said that in your opinion today, that the VA
is the world's leader in spinal cord injuries and Post
Traumatic Stress Disorder injury, but yet the traumatic brain
injury is an evolving area. What is it going to take to make
sure that the VA does become the world's leader in this area?
Secretary Nicholson. Well, that is also a goal for the
obvious reasons of the patient base that we have and we will
have to serve that affliction. So we are going to continue the
research that we have ongoing with it, both in concert with
DOD, as I said we have that research center. And we are going
to continue and be able to do all the research on the clinical
work that we are doing because we have patients that we are
treating for this. And we have an outstanding group of doctors
involved in it. There is a Dr. Scott in our Tampa Polytrauma
Center who is one of the leaders both as a clinician and as a
researcher and visionary in this area. There is a commitment to
this and we have, we are excellently positioned to do it.
Mr. Hensarling. Mr. Secretary, over the recent recess I had
the occasion to meet with veterans in Kaufman, Cherokee, and
Wood County Texas, mainly Korean, Vietnam era veterans. It is a
most unscientific survey. But I wanted to let you know that
with one or two exceptions they are very, very pleased with the
healthcare that they are receiving at various Va facilities in
east and north Texas. The same has not always been true from
the feedback I have received from those coming back from Iraq
and Afghanistan. I saw a statistic recently, and like a lot of
statistics that cross my desk, sometimes they are apocryphal in
nature so I do not know where I received this one. But I read
that in Vietnam the ratio of those who were wounded to those
who died was three to one, and now it is sixteen to one. Which
I suppose means we have a far greater number of wounded
veterans that we are dealing with, and better to deal with a
wounded veteran than a deceased veteran. Is that part of that
challenge to some extent? Are we victims of our success?
Secretary Nicholson. I think it is. It is clear that many
of the people that are coming back now alive from this conflict
would in all previous conflicts be coming back in a body bag.
And, you know, that is the good news. And then the challenge is
to take care of them and try to reconstitute them and their
life to the extent that we can. And I am also very proud of the
VA and I am proud of the DOD facilities and what they are doing
in taking care of these people and restoring, putting a lot of
ability back into, you know, what appears to be initially
mostly disability.
Mr. Hensarling. I see I am out of time. Thank you.
Chairman Spratt. We have a vote in ten minutes and fifteen
seconds. What we are going to try to do is to carry on to the
hearing down to about the five minutes point. We will then run
over, vote with your indulgence Mr. Secretary. I am sorry, but
this is the nature of this institution, and we will be back as
quickly as possible. We may have two votes, otherwise we would
go in shifts, but I think we may have two votes. In the
meantime let me recognize Mr. Boyd of Florida.
Mr. Boyd. Thank you, Mr. Chairman. And Mr. Secretary, let
me join the others who greatly admire and respect your service
to this country. Many of us know of the long history of your
service to your country, and we are grateful, and you have
heard me say that before.
I have got a couple of things I wanted to ask. First, I
think I will start with Dr. Kussman. Dr. Perlin, your
predecessor, came to North Florida. This really has to do with
the CBOCs and how we are coming with the long backlog list that
we have. He came last year down and visited North Florida to
visit some clinics that you have there, and also look at the
sites that we had picked out for another clinic. And at that
point in time we had been donated a building that only had to
have a little bit of rehab done on it, that would have cost the
Veterans Administration about $50,000. That now is no longer
available, and we are not sure what it will cost. But can you
give us an update on the CBOC list and how we are progressing
with that?
Secretary Nicholson. Well, I will take the 30,000 footer on
that, Congressman, and ask Dr. Kussman if he has something in
particular with your case. But at the end of fiscal year 2006
we had 717 CBOCs that were open, and that included eight that
were open or expanded in 2006. In this current fiscal year we
have twenty-four that have been approved for going into
operation. And in this budget that we are here presenting to
you today for 2008 we have twenty-nine in that plan.
Mr. Boyd. But that would be twenty-nine new ones?
Secretary Nicholson. Yes, sir.
Mr. Boyd. I am not talking about improved. I am talking
about new facilities.
Secretary Nicholson. Those would be new, yes sir.
Mr. Boyd. And none in 2007, is that correct?
Secretary Nicholson. No, in 2007 we have twenty-four.
Mr. Boyd. That were improved, you said?
Secretary Nicholson. That is approved.
Mr. Boyd. Oh, approved.
Secretary Nicholson. Approved.
Mr. Boyd. Oh, I am sorry. All right, thank you sir. Mr.
Secretary, let me also say that the Chairman asked early on
that the demands for health services would increase in out
years, and your quote was, ``We are focused on the 2008
budget.'' And then you went on to explain that the budget
numbers that we have before us for the out years are not really
reflective of what you think the demands will be. Is that a
paraphrase of what you said?
Secretary Nicholson. That is correct, yes sir.
Mr. Boyd. So I would assume that given that, that when the
administration officials, OMB officials come before us and tell
us they are going to balance the budget by 2012 with the
proposed budget that we see in front of us, that they are
really misleading us. Would that be accurate?
Secretary Nicholson. No, I would not characterize that way.
What I would say is that those out year numbers do not have the
benefit of our projected needs at the VA.
Mr. Boyd. Okay. Mr. Secretary, you have a great deal of
influence with the folks that run the administration. We all
know that. You have heard me say to you before that we have
some very difficult fiscal issues that this Committee is trying
to deal with in a very responsible way. And the thing that we
really need to do to be able to solve these long term problems
is to talk straight with the American people and the folks who
represent the American people. And I guess that is the biggest
problem I have with this budget. I personally think that under
your administration that the Veterans Administration services
have improved. I see it and hear it in the district and the
folks that I represent. But I think long term, if we are going
to be honest with each other about how we deal with the numbers
that have been reflected, been talked about by everybody here,
including Mr. Hensarling who said that the number of sixteen to
one wounded to killed when it was three to one when you and I
were in Vietnam. The numbers have changed that much, we have
got probably over 50,000 veterans, then, out there I assume
being in treatment in the VA system. So, you know, we cannot
solve these problems unless we can talk straight with each
other. And I know you do not want to comment on, or I do not
need you to comment on it, but I just wanted to make that
point.
Thank you, Mr. Chairman.
Chairman Spratt. Mr. Secretary, for about ten or fifteen
minutes now the Committee will stand in recess subject to the
call of the Chair. Thank you for your indulgence.
[Recess]
Chairman Spratt. The Committee will be called to order and
we will reconvene the hearing we just adjourned. And next in
line on the Republican side is Mr. Porter of Nevada, who is not
here yet. Mr. Alexander of Louisiana? Mr. Smith of Nebraska?
Mr. Tiberi, I beg your pardon. Mr. Tiberi of Ohio.
Mr. Tiberi. Thank you, Mr. Chairman. Mr. Secretary, thank
you for being here. Thank you for your service as well. It is
very much appreciated, as others have said. And I was here late
because I had another committee meeting and I apologize if my
questions are going to be duplicative. But on a personal note,
I want to thank you for coming out to central Ohio last year
and visiting with local veterans and coming to a new CBOC that
opened up last year in Newark, Ohio just east of Columbus. And
also visiting the construction site of what is going to be
fabulous facility for veterans in Columbus, the new ambulatory
care facility. And want to compliment you on your leadership on
both accounts. And also your continued leadership on working
with local hospitals to provide for veterans an opportunity to
have long term care there that the hospital will not provide
with local hospital so they do not have to go to Cleveland or
Cincinnati or Dayton. So thank you very much on behalf of the
veterans of central Ohio for your leadership.
Another issue that we talked about, I know was on your
radar screen, that I want to also encourage you to continue to
pursue is that as you are aware the claims office in Cleveland
has been one that has been very behind in its claims for
veterans. And we continue to work with your local office there
in central Ohio and in Cleveland, the delegation does, to try
to make sure that we can have a more timely process for
veterans. And especially as Senator Voinovich has pointed out
in the coming years when you have a number of people retiring
in that Cleveland office who have been of great value to the VA
will make a bad situation worse. So I appreciate you being
concerned about that.
Since I came to Congress in 2001 we have spent over 50
percent more in VA spending. I know spending alone is not going
to solve all the problems at the VA, Mr. Secretary. Can you
touch on other things that you all are trying to do? I know
when you came out to Columbus you pointed to a national
magazine article very proudly about the VA's medical care being
recognized for its top rate care. But what other things are you
doing, your leadership at the VA since you have been there, to
try to accomplish more for veterans?
Secretary Nicholson. Well, how much time do you have?
Mr. Tiberi. A couple minutes.
Secretary Nicholson. Because everything that, I mean, we
are doing is we are trying to do for veterans and do it better,
and I do not say that lightly at all. Let me just mention, in
terms of some things that are not real expensive that do not
get a lot of attention. But one of them is an initiative that I
have kicked off which is called MRSA initiative. MRSA stands
for methicillin-resistant staph aureus, which is infections in
hospitals. And we ran a pilot in our hospital in Pittsburgh and
discovered that we could make considerable improvement using
just common sense sanitation techniques. They seem so self
evident, but they do not do it. It is kind of like, you know,
these cultural things. We cut staph infections in that hospital
by 70 percent in one year. So that is conclusive to me so I
have instituted that throughout the entire system. The cost of
that is about $20.5 million. Most of that is to buy a culture
reader, it takes two days now to read a culture. What you do
is, you swab people when they come in in their nasal passages
to see whether they are positive or negative. If they are
positive then we treat them in a special way, which cuts down
exposure. That is now system wide.
Another is trying to retard the epidemic of diabetes that
we have in our veterans population. One out of five of our
veterans have diabetes. And most of it is Type 2, adult onset
diabetes, meaning most of it was preventable, is preventable.
And 70 percent of our veterans are obese. So I have instituted
a big movement. They just yesterday filed some pieces for this
that we are putting out. All they have to do is a modicum of
exercise and change in their diet, and it can make tremendous
effects on their health. Thirty minutes of aerobic exercise
three times a week, which is just walking. That is costing us
virtually nothing and can have great effects.
We have enhanced our performance standards in measurement
of our hospitals' performance, and we have added some new
criteria to that. This is a wonderful management tool, because
it not only gives you an assessment of how that hospital or
that medical facility is doing, but it is also a big barometer
that we use in exercising something I think the government was
very inspired to do, which is to give CEOs of organizations,
like I am, the right to give bonuses to these people. And that
is a very clear criteria that we have to measure, whether they
are worthy of a bonus or not. How are they performing out
there? Those are examples.
Mr. Tiberi. Thank you. Thank you, Mr. Chairman.
Chairman Spratt. Thank you. Mr. McGovern?
Mr. McGovern. Thank you, Mr. Chairman, and thank you Mr.
Secretary. I appreciate your testimony. I appreciate your
service. I also am grateful to your under and assistant
secretaries who are here and all your staff. I appreciate their
work. I appreciate the work of the many hardworking doctors and
nurses and healthcare providers. And the vet centers in our
communities, who are dedicated to helping our veterans. But I
am, you know, I want to add my voice to some others here today
who have expressed concern as to whether or not we are
adequately meeting the needs of our veterans. I appreciate your
testimony and the citations of the statistics of who we are
treating, and of who you are reaching out to and who you are
getting to. But what I am not clear on is: who we are not
getting to? And who are falling through the cracks?
A couple years ago I was at a town hall meeting in
Massachusetts and had a father stand up and tell me a story
about his son, who volunteered and went to Iraq because he was
moved by the speech that President Bush gave at the outset of
this War. And he came back and according to his father, he was
given inadequate care by our country. That notwithstanding
records that show where he told VA officials that he intended
to end his life, he was released. And then a short while later,
he committed suicide. And I did not know what to tell the
father. But the point is that there are people that are falling
through the cracks. That because of lack of expertise, or
because we are not getting to them properly, or because we are
not diagnosing what is wrong, we even have people losing their
lives when they come back to the United States.
You mention and the Chairman mentioned and others did the
Bob Woodruff ABC news report that was on the other night. And
there were a lot of telling moments in that documentary, and I
cannot go into all of them. But one in particular stood out for
me, and that is when it came to traumatic brain injuries, you
know, where it was reported that tens of thousands of our
veterans are suffering and remain undiagnosed and undetected,
which also means they are not being treated. And the estimate,
and it is just an estimate, put forward by the doctors in that
interview, is that about 10 percent of our troops returning
from Iraq and Afghanistan suffer from undetected brain
injuries. That is maybe roughly 150,000? Or whether it is that
or 50,000, that is still a huge amount. And, you know, this is
the result, as you mention, of constant exposure to multiple
shocks of explosions of combat even though there were not
outward signs of physical trauma. And when these men and women
complain to their doctors of headaches or forgetfulness or
feeling fuzzy headed, they are ignored. And they often are not
diagnosed because as the system is currently put together,
there is a lack of expertise in many areas. And so some people
go for two or three years until correctly diagnosed and
treated, and that is only if they do not get too discouraged to
give up.
So when we talk about adequate budgets, I wonder whether or
not what is put forward here is adequate enough? And I would
appreciate your response to that. And just one other thing, as
I am sitting here listening to the back and forth here, you
know, this [pointing to budget books] is what the
administration sent up to us. And the President told us that,
you know, this is our blueprint and this is going to balance
the budget and these are the numbers that we need to follow.
And as I am listening to the testimony here you are conceding
that with the exception of the upcoming fiscal year you know
that the numbers that are contained in this budget are not
real. They do not accurately reflect what we are going to need.
Yet, you know, when we get to this whole issue of we have
balanced the budget, it is these cuts in the out years that are
used to get to that figure of balance. Now the problem for us
is that in this Committee we do not have the luxury of, you
know, of kind of fuzzy math. What we have to do is come up with
a budget that actually is real. That will withstand scrutiny.
That really does accurately reflect what we are going to need
to spend on veterans, you know, not only in 2008 but 2009,
2010, and so on. And so I guess I just want to echo a little
bit of frustration here that, you know, while I appreciate your
candor and your forthrightness and the work that you have done
to improve the quality of care for our veterans, it leaves this
Committee in a little bit of a dilemma as we try to figure out
how to come up with our budget.
And so I guess my two issues are, you know, the adequacy of
what is on the table right now given the fact, and you heard it
here through anecdotal evidence, of people on the ground,
veterans who are falling through the cracks. The ABC new
special the other night about all those who are undiagnosed and
undetected with severe brain injuries. And also your comment on
how we are supposed to do our job when we do not know what the
real numbers are beyond this year.
Secretary Nicholson. Well, first Congressman McGovern, let
me clarify in response to your question about quoting me as
saying that these numbers are not real. What I said, and would
repeat, is that that budget, which has a lot of things in it
besides the VA, does not reflect the input of the VA for our
needs for 2009 or subsequent years.
Mr. McGovern. But that is a nice way of saying that these
numbers are not going to reflect what in fact the
administration is going to request next year, and the year
after. Well, there will be a new administration by then. But
the bottom line is that, I mean I guess we look at these
numbers. And when you can say we are going to balance the
budget, I mean, I am assuming that these are accurate
predictions of what in fact the Veterans Administration, or any
other agency, is going to need. And so it is a little
frustrating when on one hand we are told ``we are going to
balance the budget and here is how we are going to do it.'' And
I think we all know that the VA is going to need more than is
what is in these pages here.
Secretary Nicholson. I cannot speak for any of the other
agencies. But I can for the VA. And we are in a dynamic
situation with a War going on and common sense would tell you
that given the base of patients and the demand on this
organization that it will need more money. I will say that.
Mr. McGovern. Well, you and I are on the same wave length
on that. I guess the other question was about the report on ABC
news. I mean, those who are undetected. Those who are
undiagnosed, which again, if we are looking at that report, and
again it was just an estimate, that is a significant amount of
people that are right now undiagnosed or undetected. Who
hopefully we will get better at being able to get to, and I
know you are committed to that. But that is a significant
number of people that have served our country, and are coming
back, and not getting the treatment that they need.
Secretary Nicholson. It is. And I will tell you, I have
said before, I welcome the input, the oversight of you and the
Congress and of other people doing that, the veterans
organizations, the IG, the media. Because this is a vast
organization with a huge mission. And it is helpful to me to
get different inputs, including the criticism although very
painful when I become aware of these unacceptable and happily
exceptions to the rule of this great organization.
As a result already of what has developed, we are now going
to screen every patient, every veteran who comes to us, for
brain injury. We have 44,000 nurses and doctors and clinicians
out there that are now undergoing training to be able to be
capable of doing this. We have developed a drop down menu of a
checklist on their computer, because we are electronic as you
know, that not only reminds them to do this but details for
them the interrogation to make to try to detect this. What the
percentage of people who have this is latent or hidden or none,
I do not know that. I do not know anybody that knows that.
Mr. McGovern. Could you use more money?
Secretary Nicholson. Well, you know, I get asked that all
the time. And when you are running a big organization like this
I could always use more money, yes. For a lot of different
things, not least of capital construction.
Mr. McGovern. Thank you.
Chairman Spratt. Mr. Scott?
Mr. Scott. Thank you. Thank you, Mr. Secretary. Let me
first ask, did I understand your previous testimony to say that
people coming from Iraq have routine psychological screening?
You did not say that?
Secretary Nicholson. I am going to ask Dr. Kussman to
respond to that.
Dr. Kussman. Thank you, sir. When any veteran of OIF/OEF
comes to us regardless of what the symptom is, we have a drop
down menu related specifically to PTSD but other potential
mental health things. And the primary care person, whoever it
is, is required to ask those questions of someone so we can----
Mr. Scott. There is some screening of everybody that comes
in from Iraq?
Dr. Kussman. Yes, sir, when they come to us.
Mr. Scott. To the VA?
Dr. Kussman. Yes, sir.
Mr. Scott. Can I get chart number two please?
Mr. Secretary, just for the record, does this chart, I
think you have indicated that you agree with those numbers?
Those are accurate numbers? Do you have any problem with the
numbers on chart number two?
Secretary Nicholson. I can agree that they are in the
budget, displayed in the budget projections, yes.
Mr. Scott. Okay. And does the CBO baseline, would you
consider that conservative because it probably underestimates
the number of traumatic brain injuries and psychological
problems that returning veterans from Iraq will have?
Secretary Nicholson. That is not our estimate, Congressman.
Mr. Scott. Those are not your estimates?
Secretary Nicholson. No.
Mr. Scott. Are your estimates higher or lower than what is
on chart number two?
Secretary Nicholson. We do not have those estimates for
those out years yet.
Mr. Scott. Okay. On the appeals for disability, what is the
backlog on appeals and how long do veterans have to wait for
decisions?
Secretary Nicholson. Currently the waiting time is about
177 days. Which includes all claims. We had 806,000 new claims
last year.
Mr. Scott. I am not blaming you because I know how bad it
was before you got there, so you chipped away at it. What is it
down to now?
Secretary Nicholson. Well, it is down to 177. In this
budget, if approved at the level that we are asking, we think
we can take it down to 145 days.
Mr. Scott. Which would be about five months?
Secretary Nicholson. Yes, a little less.
Mr. Scott. Can you tell me what priority seven and eight
personnel, who are they and what effect the budget has? Is
there a lower priority than eight? Is there a priority?
Secretary Nicholson. Eight.
Mr. Scott. Seven and eight? Who are they and what effect
does the budget have on them?
Secretary Nicholson. First, who are they? They are people
who have served, are veterans who have no service connected
disability and they are making, they are working. They are
making money. And it is at different levels----
Mr. Scott. Seven and eight?
Secretary Nicholson. Yes, sir.
Mr. Scott. And what, they are usually eligible for
services. What does the budget do to them?
Secretary Nicholson. Well, currently we are not enrolling
eights as of 2003. And I cannot tell you that, they are in, the
ones that are in, and we are treating a considerable number of
sevens and eights because they were at open enrollment prior to
January, 2003.
Mr. Scott. And after 2003?
Secretary Nicholson. And your question is how much do they
cost us?
Mr. Scott. No. What happens if somebody is a category
eight, they used to be able to enroll, can they enroll now? Do
they have to pay extra? What does the budget do to their
ability to get healthcare at the VA?
Secretary Nicholson. Well, if they are enrolled they are in
the system and they are in this budget.
Mr. Scott. But if they are not enrolled they cannot get in?
Secretary Nicholson. That is correct.
Mr. Scott. Let me quickly, I just have a few seconds left.
Identity theft, have you ascertained whether or not anyone has
been adversely affected by the apparent breaches in
information?
Secretary Nicholson. Yes. Yes, we have contracted for a
service to monitor that. And they are doing that. And to date,
knock on wood, we have not any report of an exploitation of one
of these breaches.
Mr. Scott. Okay. And let me just make a statement. One of
the problems with identify theft is nothing ever happens. If
somebody steals your identity and runs something on the credit
card, the bank eats the loss and forgets about it. Nobody ever
pursues the person that did it. I would assume that you would
insist on prosecution to the full extent of the law if anybody
was found to have misused a veteran's identification?
Secretary Nicholson. Absolutely right.
Mr. Scott. And do you have an identity theft for medical,
not consumer type things? People coming in, using a veteran's
id to get medical treatment?
Secretary Nicholson. We have not, no. We have a few cases
of fraud. Not fraudulent identification, but fraudulent claims.
And the IG, I get a report on that every month and there are
periodically cases that they have discovered where they have
been fraudulent. And most of them have been prosecuted, and the
government has gotten restitution.
Chairman Spratt. Thank you, Mr. Scott. Ms. Hooley?
Ms. Hooley. Thank you, Mr. Chair. Mr. Secretary, thank you
for your time, thank you for your service. And I think things
have gotten better. I have a lot of questions to ask and I will
try to do them as quickly as possible.
That first chart we saw today, where it showed from 1984
the amount of money we are spending on each veteran versus what
we are spending today on each veteran. You know, it went up
three times the amount. The problem is with those numbers, at
the same time what has healthcare costs gone up? And how much
more costs have been added because of the aging population,
severity of the cases and more expensive? So how that figure in
with the numbers that we saw right at the beginning?
Secretary Nicholson. Well, since 2001, for healthcare alone
the increase has been 83 percent.
Ms. Hooley. Healthcare costs have gone up 83 percent?
Secretary Nicholson. Our requested amount for healthcare
delivery is up 83 percent, yes ma'am.
Ms. Hooley. And how much of that is healthcare inflation
and how much of that are new enrollees?
Secretary Nicholson. Since 2001?
Ms. Hooley. Yes.
Secretary Nicholson. I have to get you that since 2001.
Ms. Hooley. Okay.
Secretary Nicholson. I think I can answer that for 2008,
which is 4.5 percent of that is inflation and payroll. And 3.9
percent is for cost increases in products, pharmaceuticals.
Ms. Hooley. Right.
Secretary Nicholson. Services that we have to purchase.
Ms. Hooley. And new enrollees?
Secretary Nicholson. Well, the new enrollees are the
product of driving the total amount of money that we are
requesting, that we will need to serve the population. The
amount of new enrollees is 134,000.
Ms. Hooley. Okay. And your World War II vets and your
Korean vets, I am assuming are costing, because of the aging
population and the complexity of their cases, is also driving
the cost up.
Secretary Nicholson. You are correct.
Ms. Hooley. So, sometimes when we deal with numbers I think
it is important that we have all of those things in front of us
as opposed to, ``here is a set of numbers that went up this
much versus what we did, you know, five years ago or ten years
ago.'' Let me talk about appeals and how long it takes in the
Portland VA region. We have got over 7,000 pending rating
decisions. We have got almost 3400 pending appeals. We have 108
full time employees. So that means each person, no matter what
their job is, has 96 people pending cases, the second highest
rate to employees in the country. Washington Regional Office
has thirty-five per person pending cases, so ours is more than
double. And in the past, and I want to know if you have changed
this policy, we did not allocate staffing based on pending work
or of the ratio of pending work to staff. Instead we allocated
staff based on performance standards and timeliness. Well, when
you already have the second highest caseload in the United
States, it is very hard to deal with the timeliness because you
just keep getting further and further behind. And you know, I
have got people that have, I mean cannot wait that long for
their cases to be decided. I mean, they are waiting way too
long and, you know, they need that money to pay for their
everyday expenses. So are you changing that policy?
Secretary Nicholson. Congresswoman, I am going to ask Under
Secretary Cooper if he would respond to those questions.
Admiral Cooper. We are looking at Portland very carefully
and are making some changes in Portland. However, part of our
looking at allocation of people is how a given Regional Office
is doing and we have a brokering strategy where in fact offices
which cannot handle the workload they have we in fact get them
ready to rate and send them to other offices that have been
able to do fairly well and take care of that. So the fact that
the numbers themselves are high, or the number of people that
you have is not as high as it might be, we attempt to do that
through this brokering strategy.
In looking at Oregon, Oregon has improved over the last
couple of years. We are, as I say, making moves. But their
quality has come up in the last couple years. Their days are
still too long, but we are watching that very carefully. But
our strategy has essentially remained the same for about the
last four or five years. And we are trying to operate the
system in a totality, where everybody is able to improve some.
Ms. Hooley. Well, I still think you have a problem with
timeliness and being judged adding new staff when you have a
higher caseload than anybody else in the United States. So I
think, I mean, I would like you to look at what I see as a very
regressive policy.
Let me quickly add, because I do not have too much time,
the current Medcom policy is that all soldiers that, mobilized
or demobilized, had a base would go to that base for follow on
care. So I think, again, our state which has had a lot of
National Guard serve in both Afghanistan and Iraq, they, if
they are mobilized out of Georgia, out of Texas, that is where
they go for care. And what has happened is, and we do not have
any treatment facility in Oregon. So what happens as they
return, some of these soldiers and warriors have sort of
minimized that anything is wrong. Then they have gone to the
VA. But what they are finding at the VA, it is harder to get VA
support if they do not already have the documentation in their
military medical records. This policy seems unfair to guardsmen
and reservists, but it is also unfair to the VA in states where
there is a high percentage of National Guardsmen returning from
deployment. Those VA's are more heavily burdened than states
with an MTF that guardsmen can be treated at without delays in
seeing their families. I mean, these guys want to get home to
see their families. Can you tell me how much of an effect the
DOD policy has had on already overburdened VA facilities? What
are your suggestions for handling the problem for troops that
would allow them to return home quickly but still get treated
for the injuries at the expensive DOD rather than the VA?
Secretary Nicholson. Well Congresswoman, several things.
One, if any of those people are showing up at a VA hospital and
they are not being properly treated, that should not be the
case. And that is something over which I have authority and
responsibility, that they are eligible for care at a VA
hospital for twenty-four months from the time they are deployed
back.
Ms. Hooley. I know they are. But how much is this adding to
your costs? I mean, we have this, is it the responsibility of
DOD to pay for them? Or is the responsibility of VA? And how
much is that adding to our costs by this happening?
Secretary Nicholson. That is our responsibility. That is a
right in the law that they have been given. And we project
that, and that is in this budget. That I think about 250,000 we
project seeing in 2008, and that will be our cost. And we have
been seeing them----
Ms. Hooley. I mean I think the VA Portland does a great
job.
Secretary Nicholson. Thank you.
Ms. Hooley. I have no complaints other than the long
waiting periods, but they are seeing returning soldiers from
Afghanistan and Iraq very quickly. But you see, I mean part of
it is a DOD policy that is putting an extra burden on the VA.
Secretary Nicholson. Well, if you are talking about people
that are still on active duty, are you?
Ms. Hooley. No, I am talking when they are Guard or
Reserve.
Secretary Nicholson. Yeah.
Ms. Hooley. They come back. They do not want to go back to
the base where they were deployed because they want to come
home and see their family. So when they go to the VA they do
not always have the documentation they need from DOD.
Secretary Nicholson. Well, I know that is the case because
they have paper records, they get lost, or they are in another
location. That to me, though, is not an excuse for treating
them and treating them adequately. We can take steps to seek
their records. I am going to look on that one. But we are
working with DOD much more than we were on issues like this for
this transition. And making some progress. If they are more
remotely located, you know, they can get TRICARE if they are
still in an active Guard or Reserve status in a community. Or,
and we welcome them, we have a very robust outreach to these
people to come into our facilities both for healthcare and for
benefits. And we are keeping up with it pretty well.
Ms. Hooley. Well, I hope you would also work with DOD to
see if there is another way that you can do this. So in fact
they can get the paperwork taken care of at DOD and still get
the healthcare at the VA without sort of trying to skip that
step because they do not want to go back to the base where they
were deployed from because they are not going to see their
families.
Secretary Nicholson. I will look into that. I have not
heard.
Ms. Hooley. Okay. Thank you very much.
Chairman Spratt. Mr. Etheridge?
Mr. Etheridge. Thank you, Mr. Chairman. Mr. Secretary,
thank you. And I join my colleagues in thanking you for your
service, which is long and distinguished.
As you probably know, I have the distinction of
representing Fort Bragg and Pope Air Force Base, too. It is
kind of hard to say one without the other because of the
peculiar nature of it. And when the call goes, they respond.
And as a result of that, there is a large population of
veterans in my district. And really in adjacent districts. And
one of the criticisms and concerns I hear from constituents who
applied for VA benefits is in regard to mandatory examinations
at VA facilities by VA people.
Now, let me tell you what I am talking about. Because today
one of the real big issues we are bumping into is a lot of
Korean War veterans and World War II veterans, many of whom
have a well documented medical history. And their health gets
to the point where they cannot go a great distance to be
examined. My question to you is that many of them as they get
older and get weak and they are unable to go. Why is there no
avenue, and if there is one please tell me what it is, how we
can expedite it, for referrals from personal physicians? And
especially about those situations that wind up in emergency
situations, and dire situations, because as you know if a
person is deceased before their eligibility position may be
determined, their family are denied benefits. And in many cases
it is a widow without means of support in some cases.
Secretary Nicholson. I am going to first ask Dr. Kussman if
he would respond to your question as I understand it about
those people to whom it would be a hardship to come to a VA
facility for a physical.
Mr. Etheridge. And in many cases it is a very limited
number. We are not talking about a lot of folks, but for those
it is very important.
Dr. Kussman. Yes, sir. Both the VBA and VHA work very
closely together as part of the benefit package. One not only
has to document what the injury was but we do a physical
examination to determine whether compensation and pension
should be granted. Let me ask Admiral Cooper.
Admiral Cooper. Thank you. When we look at a person we are
determining what the disability is. And it is important,
particularly these older veterans, that we look at them because
as they get older and age whatever disability they have has
gotten worse. So it is important to them that we do that.
Secondly, if we ever find out, one of the high priorities we
have are those people who are extremely ill, those people who
are close to being terminal. And if we find out about it, I
guarantee we will do it just as fast as possible. And finally--
--
Mr. Etheridge. What is the expedited procedure, then? We
need to know that.
Admiral Cooper. I would say to you for them to get hold of
the Regional Office, which in your case is Winston-Salem.
Mr. Etheridge. I am telling you, it is not working the way
it is supposed to be then if it is supposed to be expedited. We
need to do some training.
Admiral Cooper. And we are doing training. But then I would
say to you, if someone on your staff gets hold of me I will
guarantee you that we will do it.
Mr. Etheridge. I will need your phone number before I
leave.
Admiral Cooper. Yes, sir. Secondly, I would say to you that
a law was passed three years ago or four years ago to address
the very thing you talked about. Namely that the dependents,
presumably we were not addressing some of these cases that were
terminal, and the dependents were not getting anything. And the
law was passed that if the claim is in a certain stage of being
adjudicated that in fact we continue adjudication and the money
will go to the estate.
Mr. Etheridge. But part of the problem is if you cannot get
the person there to get the determination you still do not get
the benefit.
Admiral Cooper. It is if we are in a certain state of
adjudication, you are right. And I would merely say that if
there are such things as that let me know and I will personally
assure you that we will take care of that. But it is a problem
and----
Mr. Etheridge. Let me follow this up. I am going to take
every bit of my time to do that.
Admiral Cooper. Yes, sir.
Mr. Etheridge. Let me have chart number four up there if I
could please.
Mr. Secretary, I just had one question on this because it
deals with the out years. And I noticed in the handout we have
it shows a substantial new enrollment fee. What is that
enrollment fee? It starts in 2009.
Secretary Nicholson. That is an enrollment fee for, it
would be category seven and eight veterans. Those are veterans
with no service disabilities and who are working, making money
but are in the system and being treated.
Mr. Etheridge. Are those ones who are presently in the
system? Or new enrollees?
Secretary Nicholson. No, they are in, in the system.
Mr. Etheridge. So we are not letting new ones in, but we
are charging those that are already in the system.
Secretary Nicholson. That is correct.
Mr. Etheridge. So that is not a new enrollment fee. It is a
fee to remain in the system.
Secretary Nicholson. Well, it is new in that they are not
paying it now. And if it were instituted they would. The sevens
and eights who are in the system being treated.
Mr. Etheridge. But we are not charging that fee to any
other veteran?
Secretary Nicholson. No. We are not charging that fee
period, now.
Mr. Etheridge. All right. What is that fee?
Secretary Nicholson. It is $250 starting for a veteran that
is making $50,000 a year. Under that there would be no
enrollment fee.
Mr. Etheridge. Okay.
Secretary Nicholson And then it is progressive. For
veterans making $100,000 it would be $750 a year.
Mr. Etheridge. For those making how much again, please?
Secretary Nicholson. $100,000.
Mr. Etheridge. Would be how much?
Secretary Nicholson. $750.
Mr. Etheridge. Per year?
Secretary Nicholson. Yes, sir.
Mr. Etheridge. And that is a flat fee just to be in the
system?
Secretary Nicholson. That is correct.
Mr. Etheridge. It is over and above any copay or anything
else?
Secretary Nicholson. That is correct. Copays for
pharmaceuticals would also apply, yes sir.
Mr. Etheridge. I yield back.
Secretary Nicholson. Thank you, Mr. Etheridge. Mr.
Chairman, could I ask----
Chairman Spratt. Sure.
Secretary Nicholson. I want to clarify one thing and ask
Admiral Cooper, would you comment on the fact, we have
established these Tiger Teams to take care of these claims
applicants that were 70 years old and older. Would you just
comment on that?
Admiral Cooper. Yes. We have established a Tiger Team in
Cleveland, as a matter of fact. And that Tiger Team, we have
been able to bring on retired annuitants and help them to help
us to adjudicate claims for people who are over 70 and whose
claim has been extant for over a year.
Mr. Etheridge. Mr. Chairman, may I have your indulgence to
follow it up? Would you be kind enough to share that with every
member of Congress?
Admiral Cooper. Yes, sir.
Mr. Etheridge. I think that would be helpful because I
guarantee you every member is having some of those challenges
in their offices. And if they could share it and get it to
their district office I think it would help a lot of veterans
across this country.
Admiral Cooper. Yes, sir.
Mr. Etheridge. Thank you, Mr. Chairman.
Chairman Spratt. Thank you, Mr. Etheridge. Ms. Kaptur?
Ms. Kaptur. Thank you, Mr. Chairman, Mr. Secretary, and all
of your associates there at the VA. Thank you for trying to do
a fine job, sometimes without enough resources and that is why
we are here to help.
I have several questions. One is a request. And that is, if
you could identify someone within your organization that could
work with our office to create an assisted medical housing
model in northern Ohio associated with our Sandusky Veterans
Home, which is a state home that receives about 40 percent of
its funding that is federal. Particularly to help with
supportive housing, because there are a number of units there
that are not occupied, for veterans who present with
neuropsychiatric issues and possibly brain injured veterans
that will be coming home to us. It is very hard to work with
the VA and connecting the floor that deals with housing and the
floor that deals with medicine, and certainly when we have a
state home involved. And I would like to really push that
prototype model with you, if we could. If you could just send
somebody I would sure appreciate it.
Secretary Nicholson. I will do that. And ask Dr. Kussman,
because that is in his domain, to follow up with that.
Ms. Kaptur. Thank you very much. Number two, we put a
little slide up, I do not know if they can get it up there on
the screen or not.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
But I represent the northwestern part of Ohio. And we have
one of two veterans clinics in America that are not in the
state of the mother hospital. So Toledo, Ohio sticks up in the
northwestern corner of what is called VISN 10, there. And what
I am going to ask you to do is to work with me to figure out
how we can change this so that we can be in the state in which
our veterans live. The reason this relationship with the Ann
Arbor Hospital has existed for years, it is an anachronism left
over since post-World War II when our region had no medical
hospital. We now have a medical hospital. Actually, it is a
graduate medical facility. Our veterans would prefer to go
there and to develop an association with our veterans clinic,
which is in the city of Toledo, rather than having to travel
all over the place. As I go east in my district, that is okay.
We take care of them at Brecksville and over in Cleveland. But
in the Toledo area we have got this strange bird. And our goal
is to treat our veterans close to home and to find a way to do
that. So I would very much appreciate if you could send
somebody over, work with us, tell me if I have got to have
legislation up here to stick us in an appropriate VISN.
We had another slide that shows the various communities,
now there is VISN 10.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
They have got Chillicothe, Cincinnati, Cleveland, Columbus,
Dayton, which is Ohio. And then if you go up to VISN 11 you
have got Ann Arbor, Battle Creek, Danville, Detroit, Fort
Wayne, you have got mainly Michigan cities up there. So I just
wanted to draw this to your attention and hopefully we can work
on that.
And finally, I wanted to move to the neuropsychiatric area,
which I know a number of other members have discussed. I have
not looked at your budget to know if there is funding in there
for the Homeless, Chronically, Mentally Ill Program anymore.
Those tend to be underfunded around the country. But I am
interested in your HCMI, whether it has been transmorphed or if
it exists. I am going to ask you some questions for the record
about the number of doctors you have on staff who are skilled
in neuropsychiatry as well as psychiatry for diagnosis and
treatment. How you organize this set of skills, do you have a
chief doc that is in charge of a division that deals with
neuropsychiatric issues? What about your peer review groups for
research that is done? Do you incorporate neuropsychiatrists on
those and what percent of those reviewing are
neuropsychiatrists and psychiatrists and psychologists? We know
one thing. We know that in our country, 95 percent of those who
are diagnosed with a neuropsychiatric condition, many time
complicated by substance abuse, are improperly diagnosed, even
by a psychiatrist. With a psychologist we know 98 percent are
misdiagnosed. So one of the reasons half the homeless in
America are veterans is because those diagnoses are wrong and
we have not figured out a way to really help to a greater
degree. So I am very interested in how you structure those
programs within the VA.
And I want to tell you a story. The commander of the Ohio
Military Order of the Purple Heart came into see us here in
Washington about a week ago. And he is a partially disabled vet
who has worked his whole life. He is a 59 year old Vietnam vet.
He said, ``Congresswoman,'' he said, ``here is what happened to
me.'' He said, ``I recently had a stroke.'' And he said, ``It
took the VA six months to pull all my paper together and give
me an appointment. Now they tell me it is going to take me
another six months to get another appointment. Can you help?''
He was so calm. One of his buddies committed suicide. He has
attempted it twice himself. And yet, it is going to take six
months to get an appointment at a VA facility? Something is
really wrong. And so I know the general answer of the VA is,
``Well, we will take care of that patient.'' But that patient,
even though it will make me happy to get him proper
appointments and everything, represents just the tip of a big
iceberg of problems down there at the local level, where we had
these extended appointment periods and so forth. So I would
like you to comment, if you could, as we get more cases now
coming back from Iraq who have neuropsychiatric damage, PTSD,
we are not even taking care of our Vietnam vets. How are you
structured within the VA to give this importance? Because over
half your population presents with neuropsychiatric and
substance abuse, do they not? In terms of on any given date in
the beds?
Secretary Nicholson. Well, I will ask Dr. Kussman to
address that specific technical demographic question, if he
can. Otherwise we will have to get back to you with that.
Dr. Kussman. I cannot give you a specific number, but, I
mean, you are saying 50 percent of the patients that we see
every day have neuropsychiatric----
Ms. Kaptur. That are in the beds. That have either
complications of substance abuse or neuropsychiatric as
comorbid.
Dr. Kussman. Which beds are you talking about,
Congresswoman?
Ms. Kaptur. VA hospitals.
Dr. Kussman. All of our patients?
Ms. Kaptur. Mm-hmm, that is my understanding. On any given
day.
Dr. Kussman. I would have to, that seems like an awfully
large number.
Ms. Kaptur. Well, let us pull those numbers, doctor. Yes,
the first time I heard it I was shocked, too. But let us take a
look at those numbers and see what they show.
Dr. Kussman. Okay.
Ms. Kaptur. And then if someone could get us the
organization chart. I do not want a thousand pages, I just want
one page, that shows me how you organize your approach to
neuropsychiatric and substance abuse issues within the VA. How
are you structured to deal with this at the central office and
then as you get down into the regions and at the local level?
Dr. Kussman. Yes, ma'am.
Chairman Spratt. Mr. Edwards would like to clarify
something for the record. Mr. Edwards?
Mr. Edwards. Mr. Secretary, this will be very brief because
you have been patient and thank you for you and all of the VA
leadership for being here today.
Obviously as we work together to try get an adequate budget
for VA healthcare for fiscal year 2008, one of the key
assumptions is what will be the projected growth of the number
of veterans in the system and the net increase in that number.
I know no one can predict that exactly during a time of war,
but I do want to ask you. I think I heard you say earlier that
for fiscal year 2007 we are on a path to a net increase of 3
percent. Is that an accurate recollection? Or could you give me
what we project the net increase in number of veterans in VA
healthcare system for fiscal year 2007 to be?
Secretary Nicholson. I am going to ask somebody to help me.
I know what it is for what we are asking for 2008.
Mr. Edwards. It is a 2.4 percent, I think you are
projecting for 2008, is that correct?
Secretary Nicholson. Yeah, it is 134,000 for 2008.
Mr. Edwards. Right. So 2.4 percent for 2008.
Secretary Nicholson. The total for 2007 is 5,685,000. But
that is not giving you the question you asked. You want the net
increase of 2007 over 2006?
Mr. Edwards. Yes.
Secretary Nicholson. If we could.
Mr. Edwards. And if you need to give follow up----
Secretary Nicholson. If you give us a minute I think we
have it.
Mr. Edwards. Okay.
Secretary Nicholson. It is 219,000.
Mr. Edwards. Can you give that to me in percentage numbers
in any of your----
Secretary Nicholson. Well, it is going to be about, it is 4
percent.
Mr. Edwards. About a 4 percent. All right. As I recall
looking at the independent budget, as you know, from several
veterans service organizations projections for 2008, I think
they had gone back and they had a chart that showed over the
last five years in the year of the smallest net increase number
of veterans going into VA healthcare it was a 4.6 percent
increase over the previous year. And the year during that five
year period where you had the largest increase it was 5.5
percent. So a low of 4.6 percent, the high of 5.5 percent. I do
not know if they use the same assumptions as you do. But they
generally have been pretty accurate, and I have been impressed
with the independent budget numbers.
And my question is, let us just assume those numbers were
correct. So that the history for the last half a decade has
been an approximately 5 percent increase in new veterans coming
into the system. If we are on a projection of 4 percent
increase for the present fiscal year, what in the model allows
us to suggest that it will only be a 2.4 percent increase in
net new veterans in the VA healthcare system for 2008? That is
approximately 50 percent below what the historical annual
increase has been over the last five years. And without getting
into all the complications of the sophisticated computer
models, sometimes recent history is a better prediction than
somebody's mathematical model, as good as that might be. And
there may be very understandable factors that would have us go
from 4 percent increase this year down to 2.4 percent increase
next year. But I do not want to just assume that is correct
because otherwise that gets us on a glad path toward
underfunding your needs for fiscal year 2008.
Secretary Nicholson. Well, again, that model has a very
good history of accuracy save for that exception for 2005. And
that is what it projected. And, again, the other 15 percent of
it was the inputs that we put in for long term care and dental
and for CHAMPVA. And with 134,000 projection of new additions
to it coming back and off of active duty from the War, we do
have a diminishing population of veterans overall in the
country.
Mr. Edwards. Right.
Secretary Nicholson. Because of their aging, on a net basis
we are losing veterans every year by several hundred thousand.
That is a factor in that model.
Mr. Edwards. Right. And I assume the aging of the World War
II, Korean, Vietnam veterans probably has counteracted that at
least at this point. We are not on a down slope, yet, not
seeing a reduced number.
Secretary Nicholson. Oh, we are on a down slope of those
numbers. Yes, sir.
Mr. Edwards. A down slope in the number of veterans, but
still there is a net increase in the number of veterans going
into the VA healthcare system.
Secretary Nicholson. That is correct.
Mr. Edwards. Okay, but a down slope in the number of
veterans.
Secretary Nicholson. Yes.
Mr. Edwards. One last question on this. Because this may
sound technical, but this is going to be key to Chairman Spratt
putting together a budget that reflects the real needs of the
VA healthcare system. You say we are on a glad path for 4
percent net increase for this present fiscal year, in 2007. Do
you know a year ago or when the administration put together its
budget request, what did the computer model project the net
increase to be for fiscal year 2007? So we can figure out how
accurate it was for the present fiscal year.
Secretary Nicholson. I do not know that I have that with
me, Congressman. We can get you that. I will say it is pretty
close to what we requested and what we got.
Mr. Edwards. I would not have expected you to have that in
the tip of your fingers today. But if you could provide for the
Committee the 2006, and 2005 was a rough year in projections.
But perhaps include 2004, 2005, 2006, 2007. Let us look at the
track record of what the assumption was when the administration
presented its budget versus what the actual reality was at the
end of the year. I think that would be helpful for us to judge
that.
Thank you. And thank you all for your tremendous service on
behalf of our nation's veterans.
Chairman Spratt. Mr. Secretary, we have had one more member
come, Mr. Bishop of New York. If you could respond to his
questions we would appreciate it. Mr. Bishop?
Mr. Bishop. Thank you, Mr. Chairman, and Mr. Secretary
thank you very much. I am sorry I have been running in and out.
I have been in a mark up of another committee that I am on.
I have just two questions, one of which you have dealt with
in one form or another but I want to go back to it and that is
the issue of the appropriate level of care and whether or not
we are appropriately geared up to deal with veterans with Post
Traumatic Stress Disorder. You indicated in response to a
question from Chairman Spratt that we had a ``good'' capacity
for treating PTSD. I know Mr. Baird pursued this, but I am
drawn to this tragic story of the young veteran in Minnesota
who went to the Regional Veterans Affairs Center in St. Cloud
and he was told that he was twenty-sixth on a waiting list for
one of the twelve beds in the PTSD section of that hospital.
And according to state VA officials that number of twelve has
been a static number in terms of beds available for PTSD
treatment for the last decade. And I am just wondering how that
happens. First off, is that accurate? And second, if it is
accurate is that an absence of funding? Is it an absence of
foresight? I mean, what is the truth there?
Secretary Nicholson. I have to be careful responding to
that specific case because we have not been given a waiver by
the family. It is a tragic case, very sad. I have testified,
though, what I can say and have is that young veteran was seen
forty-six times by our healthcare providers in Minnesota. And
that in Minnesota and throughout the system we have psychiatric
inpatient capability and capacity that exists everywhere. And
overall, at the time we looked at this systemwide we had 30
percent capacity unused. Meaning, that 70 percent of our beds
were taken and 30 percent were not. And we of course for him
had that capacity. So that was not the question if it were
considered to be an emergent situation. And I have the chief
health inspector and the inspector general, and they are both
investigating that situation at this time.
The facility in St. Cloud is, one of the programs they have
is an inpatient post-detoxification rehab facility for
substance abuse. And it is a serial set of classes with
inpatient participants. And that was full. And that is the
reason that he was put in that queue.
Mr. Bishop. If I may, I guess the thrust of my question is,
it would seem that now we are, you know, several hundred
thousand troops have returned home, have been discharged, and
the estimate is that at least close to one out of five of them
will have some form of Post Traumatic Stress Disorder. So the
thrust of my question is, are we about the process of
increasing our capacity to deal with those veterans? And if
that is the case, is it accurate that the number of beds
available in this particular hospital for PTSD has remained
static over a decade?
Secretary Nicholson. I am going to ask Dr. Kussman to
respond. I will tell you that we have, in the system we have
over 200 special PTSD programs throughout the system. We are
recognized for our expertise in it. We have numbers on those
that we are treating that have come back from OIF/OEF. And I
will let him give you more detail.
Dr. Kussman. Yes, sir. Thank you. Obviously PTSD is very
important to us. It is a spectrum of adjustment reactions, and
clearly someone who comes with any kind of acute urgent or
emergent they will get in right away. Otherwise they are put
into programs, they are through the primary care or directly
into mental health services. The treatment spectrum is all the
way from a very acute inpatient, if it is needed, to outpatient
services as well. So we put a lot of money and part of our
mental health strategic plan was to address this particular
issue. We targeted large amounts of money. We have increased
the number of psychiatrists and psychologists. There are
obviously challenges occasionally in hiring people in certain
geographic areas, but it is very important to us and we are
looking at that very closely.
Mr. Bishop. Thank you very much. Mr. Chairman, I did have
one additional question. I wonder if you would indulge me to
ask one additional question?
Chairman Spratt. Go ahead.
Mr. Bishop. I will be very quick. State approving agencies,
my understanding is that the current year budget is $19
million. The President's request for next year is $13 million
for state approving agencies. And I am just curious what level
of service will be, if it is a 30 percent cut or thereabouts,
how will we provide the service and maintain the quality
control in terms of post-secondary training that veterans
enroll for if we are cutting the evaluation agency by 30 to 33
percent?
Secretary Nicholson. Let me ask Under Secretary Cooper if
he would respond to that.
Admiral Cooper. Yes, sir. That is my program in the
education. My understanding is that five years ago it was
stated that they would increase it to $19 million, and now in
this particular time come back to $13 million. We have been
discussing this with various people. The SAAs were in here the
other day trying to figure it out. As it stands right now, my
group will absorb what has to be done and ensure that it is
done properly.
Mr. Bishop. So the level of service would remain constant?
Admiral Cooper. It should remain the same, yes.
Mr. Bishop. Thank you very much, and thank you Mr.
Secretary.
Chairman Spratt. Mr. Secretary, Ms. Moore would like to put
a few questions to you if we could and we will wrap it up after
that.
Ms. Moore of Wisconsin. Thank you so much, Mr. Chairman,
and thank you Mr. Secretary for your long suffering through all
of these questions. I am so delighted to be here. I am a new
member of this Committee, almost member of this Committee. But
I am absolutely delighted. Just by way of background, I was in
the state legislature for sixteen years before I came to
Congress. And my very, very, very first bill I ever passed as a
legislator was on behalf of veterans. And so it is a passion of
mine.
And during my very first term in Congress I worked very
hard to secure $32.5 million for urgently needed upgrades at
the Zablocki VA Medical Center Spinal Cord Injury Unit. And we
have discussed all morning how we are having more paraplegia
and quadriplegia return from Afghanistan and from Iraq. And
Zablocki has one of only twenty-three spinal cord injury units
in the country.
I can see that my time is waning, but I just want to point
out that it is such a pathetic institution. We have a spinal
cord injury unit on the tenth floor. Basically the plan for
evacuating the spinal cord injury veterans is to put them
between two mattresses and drag them down ten flights of
stairs. Just to give you the most dramatic part of the
inadequacy of those facilities.
We had this as one of the ``earmarks'' in the continuing
resolution. Now, the VA administration placed this as their
highest priority for new construction prior to the continuing
resolution being passed. So I just want to know, Mr. Secretary,
it is your discretion, I just want to know, the suspense is
killing me, is you is or is you ain't going to build this new
spinal cord injury unit at Zablocki?
Secretary Nicholson. We is.
Ms. Moore of Wisconsin. Yes. Yes! I will yield back.
Chairman Spratt. Thank you, ma'am. Mr. Secretary, you have
been forthright and forebearing, you and your colleagues both.
And we appreciate very much the testimony you have provided,
the information, your answers to our questions. I want to
assure you that our objective is common with yours, and that is
to deliver the best possible service that we can to our
veterans and to keep the promises we have made to them. To that
end we will work together, I can assure you. Thank you again so
much for your participation today.
Secretary Nicholson. Thank you, Mr. Chairman, members of
the Committee.
Chairman Spratt. Before adjourning, I ask unanimous consent
that all members who did not have the opportunity to ask
questions be given seven days to submit questions for the
record. So we are not through. We are indeed, though, the
meeting is adjourned. Thank you again.
[Whereupon, at 1:12 p.m., the Committee was adjourned.]
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