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[109 Senate Hearings]
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S. Hrg. 109-14
NOMINATION OF HON. R. JAMES NICHOLSON
TO BE SECRETARY, DEPARTMENT
OF VETERANS AFFAIRS
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
__________
JANUARY 24, 2005
__________
Printed for the use of the Committee on Veterans' Affairs
Available via the World Wide Web: http://www.access.gpo.gov/congress/
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COMMITTEE ON VETERANS' AFFAIRS
.........................................................
Larry E. Craig, Idaho, Chairman
Arlen Specter, Pennsylvania Daniel K. Akaka, Hawaii, Ranking
Kay Bailey Hutchison, Texas Member
Lindsey O. Graham, South Carolina John D. Rockefeller IV, West
Richard Burr, North Carolina Virginia
John Ensign, Nevada James M. Jeffords, (I), Vermont
John Thune, South Dakota Patty Murray, Washington
Johnny Isakson, Georgia Barack Obama, Illinois
Ken Salazar, Colorado
Lupe Wissel, Majority Staff Director
D. Noelani Kalipi, Minority Staff Director
C O N T E N T S
----------
JANUARY 24, 2005
SENATORS
Page
Craig, Hon. Larry E., U.S. Senator from Idaho.................... 1
Akaka, Hon. Daniel K., U.S. Senator from Hawaii.................. 3
Isakson, Hon. Johnny, U.S. Senator from Georgia.................. 4
Obama, Hon. Barak, U.S. Senator from Illinois.................... 5
Articles from the Chicago Sun-Times ......................... 30
Burr, Hon. Richard, U.S. Senator from North Carolina............. 6
Prepared statement........................................... 7
Rockefeller IV, Hon. John D., U.S. Senator from West Virginia.... 7
Thune, Hon. John, U.S. Senator from South Dakota................. 9
Jeffords, Hon. James M., U.S. Senator from Vermont............... 10
Prepared statement........................................... 11
Hutchison, Hon. Kay Bailey, U.S. Senator from Texas.............. 11
Allard, Hon. Wayne, U.S. Senator from Colorado................... 13
Salazar, Hon. Ken, U.S. Senator from Colorado.................... 15
Prepared statement........................................... 16
WITNESS
Nicholson, Hon. R. James, nominee to be Secretary, Department of
Veterans' Affairs.............................................. 17
Prepared statement........................................... 51
Questionaire for Presidential nominee........................ 54
Response to written questions submitted by:
Craig, Hon. Larry E...................................... 57
Akaka, Hon. Daniel K..................................... 64
Hutchison, Hon. Kay Bailey............................... 66
Specter, Hon. Arlen...................................... 69
Rockefeller IV, Hon. John D.............................. 69
Jeffords, Hon. James M................................... 72
Salazar, Hon. Ken........................................ 74
Thune, Hon. John......................................... 78
APPENDIX
King, James B., Executive Director, AMVETS, prepared statement... 81
Clements, R.E., Commander, Department of Colorado Veterans'
Affairs,
letter......................................................... 82
Howard, Gerald, Executive Vice President, National Association of
Home Builders, letter.......................................... 83
Mansell, Al, CRB, President, National Association of Realtors,
letter......................................................... 83
Maziarski, Frank T., President, and Carol M. Craig, President,
American Association of Nurse Anesthetists, letter............. 84
Molloy, John J. Jr., Chairman, National Vietnam & Gulf War
Veterans
Coalition, letter.............................................. 84
Muller, Sgt. Artie, Founder/National Executive Director, Rolling
Thunder, Inc., National Chapter 1, letter...................... 85
NOMINATION OF HON. R. JAMES NICHOLSON
TO BE SECRETARY, DEPARTMENT OF
VETERANS AFFAIRS
----------
MONDAY, JANUARY 24, 2005
United States Senate,
Committee on Veterans' Affairs,
Washington, DC.
The committee met, pursuant to notice, at 10:06 a.m., in
Room SR-418, Russell Senate Office Building, Hon. Larry Craig
presiding.
Present: Senators Craig, Hutchison, Burr, Thune, Isakson,
Akaka, Rockefeller, Jeffords, Obama, and Salazar.
OPENING STATEMENT OF HON. LARRY CRAIG,
U.S. SENATOR FROM IDAHO
Chairman Craig. Good morning, ladies and gentlemen. The
Committee will come to order. It is my pleasure to call this
hearing to order, the first hearing of the Senate Committee on
Veterans Affairs for the 109th Congress and the first hearing
of this Committee that I have the honor of chairing.
In a few moments, we will receive testimony from the
President's nominee to serve as Secretary of Veterans Affairs,
Ambassador Jim Nicholson, and I will offer him the opportunity
to introduce the family members who have accompanied him to the
hearing this morning. But if I may, I would like to offer a few
introductory remarks first.
Let me begin by thanking my Republican colleagues for
electing me Chairman of this Committee earlier this month. I
pledge to them--and to all of the Committee Members--that I
will work diligently to meet the needs of America's veterans
that we are honored to serve. I also would pledge to all of
you, as I have to our Ranking Member, Senator Akaka, that I
will maintain the Committee's long tradition of approaching
veterans' issues in a constructive, problem-solving and
bipartisan manner.
This approach has worked very well during the 10 years that
I have had the privilege of serving on this Committee, and that
will continue under my stewardship. I welcome back to the
Committee the returning Members, starting with our Committee's
newly-appointed Ranking Member, Senator Daniel Akaka of Hawaii.
I look forward to working with you, Senator, in putting
together and advancing this Committee's agenda. We have already
met to discuss a lot of issues and we will continue to meet
together and work together for the good of our veterans. We
share those same desires and goals.
I also want to welcome back Members to the Committee with
previous service: Senator Specter, who may not be with us this
morning--I think he is in transit--Senators Hutchison, Graham
and Ensign on the Republican side; Senator Rockefeller who is
with us, and Senators Jeffords and Murray on the Democratic
side.
Finally, but most particularly, I want to welcome our new
Senators who have been chosen to serve on this Committee:
Senator Burr, who is with us this morning; Senator Isakson, who
is also with us; Senator Thune, who I think will be joining us;
and Senator Obama, who is with us. Senator Salazar is sitting
down waiting to make introduction this morning. Again, thank
you all for being here. I look forward to working with you.
Now, to return to the business at hand. The President has
nominated Ambassador Jim Nicholson to serve as Secretary of
Veterans Affairs. Mr. Ambassador, I thank you for accepting
this charge. As you will soon find out, running VA is one of
the tougher jobs in Washington, one that will perhaps be made
more difficult by two realities that you will face. You will
succeed a man who will be a tough act to follow, and second, it
now appears clear that the fiscal environment that you will
inherit will be considerably less friendly than the relatively
flush times the VA has enjoyed over the past 4 years. But I
know, Mr. Nicholson, that you are up to the challenge.
When you are confirmed, you will find that this Chairman,
and I hope the Committee's Members, will be partners with you
in making sure that America's veterans are continually served
in the necessary and the appropriate fashion that we expect and
that I know you anticipate.
Before I proceed, let me offer to you a brief summary of
Ambassador Nicholson's extraordinary background. Jim Nicholson
was born on an Iowa farm in 1938. He left Iowa in 1957 to
attend the United States Military Academy at West Point. After
graduation in 1961, he served 8 years in active service in the
Army as a Ranger and paratrooper. Most notably, he served a
tour in Vietnam from 1965-1966, where he earned, among other
decorations, the Bronze Star, the Combat Infantry Badge, the
Air Medal and the Vietnamese Cross of Gallantry.
After returning from Vietnam, then-Captain Nicholson served
on active duty for 4 more years until 1970, followed by an
additional 21 years as a Reserve officer. He retired from the
Army Reserves in 1991 at the rank of colonel. Mr. Nicholson
holds a masters degree in public policy from Columbia
University and a J.D. from the University of Denver.
After practicing law for a relatively brief time in Denver
in the 1970s, he launched a successful real estate development
career in Denver. Among other positions, he served as Chairman
and President of Renaissance Homes of Colorado. His business
career was also marked by extensive community involvement and
charitable activities.
In 1986, Mr. Nicholson became a committeeman for the
Republican National Committee, and in 1993, he was elected
RNC's vice-chairman, and in 1997, he was elected for a 4-year
term as the RNC's Chairman. It was during that time that I grew
to know Jim a great deal better than I had in the past.
In August of 2001, President Bush appointed Mr. Nicholson
U.S. Ambassador to the Vatican. From that post, he has
advocated for religious reconciliation, religious freedom in
China and Russia, and against the international exploitation
and enslavement of defenseless persons, commonly referred to as
human trafficking.
If I may comment, that summarizes what I believe to be an
extraordinary career. Veterans are fortunate, I think, that you
have answered the President's call to service, Jim, and I hope
that this Committee can offer quick confirmation.
Now, if I may, let me recognize our Committee Members for
any comments they would like to make, and let me turn, of
course, to our Ranking Committee Member first, Senator Akaka.
Senator.
STATEMENT OF HON. DANIEL K. AKAKA,
U.S. SENATOR FROM HAWAII
Senator Akaka. Thank you very much, Mr. Chairman.
I am very pleased to be here with you. I look forward to
working with you. We have had a great beginning. We have sat
together and chatted about the future of this Committee, and
from that conversation I can tell you that we have some common
ideas, and of course, the common idea is to help our veterans
the best we can. And I am also pleased to be working with
Senator Craig, because we have had a long history of working
together in the House as well as here in the Senate, and we've
talked about things that make me feel excited about this
Committee and its future.
I am also very pleased to welcome Ambassador James
Nicholson to our hearing today. Mr. Ambassador, I also want to
welcome your wife, Suzanne, and your family and thank them for
their contributions to this process as well. And I want to
thank you for taking time to meet with me before today's
hearing.
We have some new Members in the Veterans' Affairs
Committee, and I am confident that, without question, they will
make important contributions as we work together to fulfill our
Nation's commitment to America's veterans.
Mr. Ambassador, I know I do not need to impress upon you
the importance of the leadership role you will soon assume as
VA Secretary. As a graduate of the United States Military
Academy, you have been provided with valuable lessons in
leadership that can be applied to VA. We expect you to hit the
ground running with the many challenges that you will face, and
of course, and I want to emphasize this, we will be here to
support you.
On the health care side of VA, I think you will find that
we are always open to new and cost-effective ways to care for
our current veterans and those who are returning from Iraq and
Afghanistan. However, it is a non-starter to cut back on
services or cut who is eligible for VA care. I want you to know
that we are proud of the work that this Committee and other
Members have done in the past and in 1996 to improve
eligibility for care.
Health care is now very often provided in different
settings that frequently are not hospitals. Outpatient clinics
dot the landscape and provide for ease of access. We are seeing
huge numbers of veterans seeking VA care for the first time. I,
for one, believe this is a good thing. Others rationalize that
as we are at war, we must cut back on VA care. I simply do not
understand that logic. We are at war, and therefore, we must do
everything we can to show our military that VA health care will
be there for all veterans who served.
On the benefits side, we are in crisis. VA has come under
fire for the lack of timeliness of its claims processing. As a
result, the Veterans Benefits Administration has turned its
attention to decreasing the amount of time it takes to process
a claim, to the detriment of the quality of its decision
making. We are looking to you for innovative approaches so that
the Veterans Benefits Administration can absorb changes in law
and new business processes without always going into a nose
dive. Our veterans deserve no less than quality workmanship
done in a timely manner.
Mr. Ambassador, because you did mention and quote from
George Washington, I want to do so as well and say that, I
quote: ``The willingness with which our young people are likely
to serve in any war, no matter how justified, shall be directly
proportional to how they perceive the veterans of earlier wars
were treated and appreciated by their Nation.''
Mr. Ambassador, our Nation and our veterans are depending
on you. Our servicemembers returning from Iraq and Afghanistan
have earned a seamless transition from the military to civilian
life. You must assure us that the Department of Veterans
Affairs will do its part in this endeavor.
Thank you very much. I welcome you, Mr. Ambassador, your
family, and thank you very much, Mr. Chairman.
Chairman Craig. Senator Akaka, thank you very much.
What I would like to do for those Members who have opening
statements is turn to you in the order in which you came into
the Committee room, and then, we will turn to our colleagues
who are here to introduce and endorse the Ambassador. We will
administer the oath of office--or the oath for the Committee to
the Ambassador and allow his testimony. We will not get to that
office yet.
[Laughter.]
Chairman Craig. That is anticipating a much more
accelerated process than we are going to go through today.
[Laughter.]
Chairman Craig. Senator Isakson, I believe you were the
first to enter the room. Do you have any opening statement?
STATEMENT OF HON. JOHNNY ISAKSON,
U.S. SENATOR FROM GEORGIA
Senator Isakson. Mr. Chairman, I will submit my full
statement for the record. I would like to make two or three
quick comments.
One, it is a privilege and an honor to serve on this
Committee, and to serve with you as Chairman and Ranking Member
Akaka; I look very much forward to doing that. I am delighted
to be here at this hearing for Ambassador Nicholson and
particularly delighted to be here in the best interests of the
veterans of the United States of America. I know that the
opening statement of the Ambassador is to follow, I have
already read it, and I want to acknowledge at the outset my
appreciation for his principles and commitments in terms of
veterans, their health care, and the honor of those who make
the ultimate sacrifice in our United States military, and I
look forward to the hearing and the opening statement of
Ambassador Nicholson.
Thank you, Mr. Chairman.
Chairman Craig. Thank you, Senator.
Senator Obama.
OPENING STATEMENT OF HON. BARAK OBAMA,
U.S. SENATOR FROM ILLINOIS
Senator Obama. Thank you very much, Mr. Chairman and
Ranking Member Akaka. Thank you so much for allowing me to join
this Committee. It is a great honor to be here.
I want to thank, first of all, Ambassador Nicholson, for
his service to this country. It is a great honor for you to not
only be willing to serve now in this current position, but also
your service as a veteran to the United States. And I am
looking forward to working with you. We have had occasion to
meet, and I have no doubt that you will do an outstanding job.
As you know, I do have a set of particular concerns with
regard to Illinois that I will be raising with you. Senator
Akaka mentioned this quote earlier from George Washington about
the importance of us serving our veterans so that we can
continue to ask our Nation's young men and women to serve on
our behalf. I think the Father of our Country understood what
every veteran in this great country knows today: that when we
send our troops to war, it is our solemn obligation to care for
them upon their return and to do so in a timely manner and to
treat them with the respect and dignity which they have earned
and which they deserve.
Now, a lot of my questioning is going to be focused on the
fact that in Illinois in particular, there seems to be some
concern that we are failing to live up to that obligation. Very
specifically, Illinois' disability pay compensation system
appears to be broken. There was a recent report by the Chicago
Sun-Times that found that Illinois veterans, when compared to
the compensation levels granted to veterans in other States,
rank 50th out of 52 States and territories, and I think, in
fact, we have a chart here that I just want to show very
briefly.
Apparently, there is as much as a $5,000 discrepancy
between Puerto Rico and Illinois with respect to compensation
levels for disabled veterans. Mr. Ambassador and Members of
this Committee, that is unacceptable by President Washington's
standard, and it should be unacceptable by our standards as
well.
Worse still, many of the veterans who finally receive
benefits only get them after long, stressful battles with the
VA. I believe we can and we must do better. Over the past
several days, I have met with more than 500 veterans throughout
Illinois to hear about what they believe, how they believe they
are being treated by the VA. Though I know that the Department
is doing some things very well, and that was acknowledged by a
number of the veterans' groups, nearly every veteran I talked
to was frustrated. Some have been fighting claims for decades;
some have yet to receive compensation they deserve, and worst
of all, some feel that the VA simply is not listening to them
or does not care about them.
So I recognize that some of these issues are going to have
to do with budget concerns. It was already referred to by our
Chairman that you are going to be inheriting a more difficult
fiscal situation than your predecessor. At the same time, I
also know that because we are at a time of war, this is
precisely the time when we are going to have to do better. We
know that the situations that contribute to post-traumatic
stress disorder are directly proportional to the type of
warfare fought. Urban combat in Iraq, mixed with an insurgency
that is not always identifiable, coupled with a prolonged
deployment create an even greater stress on today's brave
soldiers.
And I will just note in closing that a recent Army study
showed that 1-in-6 soldiers in Iraq reported symptoms of major
depression, and some think that figure could eventually reach
1-in-3, a figure equal to those veterans who served in Vietnam.
With hundreds of thousands of veterans from Iraq and
Afghanistan who are going to be coming back from the war, some
predict that the soldiers requiring mental health treatment
could exceed 100,000.
So I look forward very much to working with you, Mr.
Ambassador. I look forward to the answers that you're going to
be providing to this Committee. I am looking forward to your
actions to address the disparities that I have already alluded
to. Hopefully, if we learn where we failed our veterans in the
past, we can better serve them in the future.
I thank you for your attention.
Chairman Craig. Senator, thank you very much.
Senator Burr, any opening comment?
Senator Burr. Thank you, Mr. Chairman, and I would ask
unanimous consent that my full statement be in the record.
Chairman Craig. Without objection.
OPENING STATEMENT OF HON. RICHARD BURR,
U.S. SENATOR FROM NORTH CAROLINA
Senator Burr. Mr. Chairman, let me thank you for your
gracious welcome to us. Also, congratulations on your
chairmanship and to the Ranking Member. I look forward to this
year.
To the Ambassador, let me say welcome back. I know Rome is
a difficult place to leave, but it is my understanding that
from the top of the Capitol dome, you can see the Vatican. I am
told you can see everything from the top of the Capitol dome.
[Laughter.]
Senator Burr. The Veterans Administration will be a very
difficult challenge at a very challenging time. In 1988, Ronald
Reagan said of veterans: ``America's debt to those who would
fight for her defense does not end the day the uniform comes
off. For the security of our Nation, it must not end.''
In North Carolina, Mr. Ambassador, we now have over 800,000
military veterans. Honoring and working for those individuals
is something that I believe is a duty of a Member of the United
States Senate. We understand the importance of taking care of
those who have served so bravely and willingly to protect the
freedoms and the liberties that we have here in this country.
But in the last 16 years since the new department was
created, I do not think that we have perfected the operation of
what it does. My hope, my wish and my belief is that you come
with a level of commitment not to solve 100 percent, but to
solve something every day. I believe that is the most we can
ask of you. I believe that is the most we should expect, that
after your tenure and our tenure that, in fact, our veterans
are better off because of the contributions we have made.
I look forward to your confirmation. I urge my colleagues
to be as quick as the Chairman has tried to be by his
acclamation.
And I would yield back.
[Laughter.]
[The prepared statement of Senator Burr follows:]
Prepared Statement of Senator Richard Burr,
U.S. Senator from North Carolina
Thank you, Chairman Craig, and congratulations on your new
chairmanship and to Senator Akaka as Ranking Member. I know you will
serve our nation's Veterans well and I look forward to working with you
both.
Let me welcome you, Ambassador Nicholson, back from Rome and to the
United States Senate. I congratulate you on your selection by the
President to serve in the crucial position of Secretary of Veterans
Affairs and I appreciate your willingness to serve in this new
capacity.
My Dad, Dr. David Burr, served as a Frogman in the Navy during
World War II, and he sends along his regards as well.
When the legislation that created the Veterans Administration was
signed into law in 1988, President Ronald Reagan said that ``America's
debt to those who would fight for her defense doesn't end the day the
uniform comes off. For the security of our nation, it must not end.''
North Carolina has a growing population of Veterans, approaching
800,000 in recent reports. Honoring and working for these Veterans is
something I intend to work on as Senator from North Carolina.
We all understand the importance of taking care of those who have
served so bravely and willingly to protect the freedoms that America
offers. With troops on the ground defending those freedoms as we speak,
we are reminded to do our best for our Veterans.
In the past four years, the budget of the Department has increased
by just about 50%. Clearly, Congress and the Bush Administration have
committed to improving health care benefits and access, quality of life
programs, and pensions for Veterans.
But in the 16 years since the new Department was created, we have
certainly not perfected the operation. We still have inefficiencies and
waiting lines to see physicians. We continue to evolve and upgrade, but
work remains.
As a member of this Committee, I will commit myself to improving
the Department so that the care and services provided to Veterans will
improve.
I hope that you will join me in that commitment and I look forward
to working together to improve the Department of Veterans Affairs.
Chairman Craig. Thank you, Senator.
Now, let me turn to one of the more senior Members of the
Committee and one who I have had the privilege of working with
over the last good number of years on veterans' issues,
certainly an outspoken advocate for veterans. We always
appreciate your presence and service on this Committee, Senator
Rockefeller.
OPENING STATEMENT OF HON. JOHN D. ROCKEFELLER IV,
U.S. SENATOR FROM WEST VIRGINIA
Senator Rockefeller. Thank you, Chairman Craig, and I very
much am pleased that you are our Chairman. As I discussed with
the Ambassador, I think you are going to make an excellent
Chairman.
What this Committee, I think, needs is kind of the
methodical work, systematically going through issues not just
as they pop up in dramatic fashion, but on a systemic basis. I
think that is part of your makeup and part of your discipline,
and I have great respect for your fairness. And I equally honor
Senator Akaka, who has been on this Committee for a long time;
is a veteran and a splendid person.
Ambassador, you have already brought people together. There
are three people who I have never seen before, and they sit
across the table from me, and I must say that I am very pleased
to be working with you three gentlemen. The other lady, I
already know very well and have very high respect for.
Senator Obama, I think it is wonderful that you are on this
Committee. I think that you will bring a wonderful vigor to it
and intellectual analysis, and Senator Jeffords is just a piece
of art, a special person, and he is always good.
A couple of points: it was mentioned earlier that young
people are more likely to go into the service if they feel that
their Veterans Administration is going to take good care of
them afterwards. Actually, I do not agree with that statement,
and I think that is one of our problems. It is very hard to get
even those who are entering the service to think about more
than what it is they are going to be doing, which is certainly
understandable: the training and the pressure they are going to
be under.
But I think there is an enormous instinct in this country
to somehow assume that when veterans come home that they are
going to get the care that Abraham Lincoln promised them. And I
do not think that is the case, and yet, it is also one of the
best health care systems in the world and the only one over
which, in a sense, those of us who represent the American
people have full control, which makes your position
particularly important.
We had a very good talk. One of the things I liked about
you was not just your 30 years of service, your Ranger
training, a number of other things we discussed, but I think
you are doing this for the right reasons. You did not have to
do this. You did not have to accept this job, because you are
at a position and experience and et cetera where you do not
need to. You have served your country in many ways. But you
have chosen to do it, and I respect that. I think your soul is
good, and I think that is an awful good place to start.
A number of the problems have been raised. I worry, as
Senator Obama does, particularly about what is going to happen
with our returned veterans and the whole post-traumatic stress
disorder syndrome. I even have not given up yet on work to be
done on the Persian Gulf War Syndrome, and that may be, if I
get to it, part of my questioning.
But the work of this Committee, and I have been on it now
for 20 years, is extraordinarily important. Because it is a B
committee in the parlance of the Senate, it is not always given
the weight that some of the other committees, the Finance
Committee, the Commerce Committee, whatever, might be given.
I think that is a terrible mistake, particularly where we
are now in our Nation's history and where I think we are going
to be for several generations. We have to resolve as a
Committee, Mr. Chairman, and this is one of the reasons why I
am so glad that you are Chairman, we are going to have to
resolve as a Committee as well as a Veterans Administration to
sort of put a new intensity into our work. We cannot expand our
numbers. Your numbers are so large that only the Pentagon has
more people, and the question is how do you bring them the top
level, the middle level, you know, how do you close that gap
and shape people to your will, which I think is innate to your
character and to your experience and to what you want to do?
So I welcome you. You flat out have my vote for a lot of
reasons, and I think you are going to do a very good job, and I
think it is our job to work very closely together.
Thank you, Mr. Chairman.
Chairman Craig. Senator Rockefeller, thank you for those
comments.
This may be a B committee. When we are through with it in
the next few years, we will show the United States Senate that
it will have the intensity of a Super A.
All right; we thank you very much for that.
Now, let me turn to Senator Thune.
OPENING STATEMENT OF HON. JOHN THUNE,
U.S. SENATOR FROM SOUTH DAKOTA
Senator Thune. Thank you, Mr. Chairman and Senator Akaka.
It is a privilege to be on the Committee and to have the
opportunity to work with you and the other Members of this
Committee and also on behalf of America's veterans. This is
important business that we go about as we strive to serve the
needs of America's veterans, men and women who have served this
country and sacrificed for all of us when we were the ones in
need of their service. And it is particularly important now
because we are a country at war, and we will have men and women
who will be returning to civilian life trying to piece their
lives together after some of the most difficult and hazardous
tours of duty in recent history. Many will come back disabled,
and we owe all of these veterans our utmost care and devotion.
I also want to note that my State of South Dakota boasts an
exceptionally high ratio of veterans to its overall population
compared with other States. Because it is a largely rural State
with many remote communities, our veterans face a number of
peculiar issues. One of the problems I will be interested in
addressing while on this Committee is improved access to VA
health care facilities. Often, the nearest VA hospital is
hundreds of miles away, and to require a veteran to drive three
or four hours to the nearest VA hospital for a simple blood
test, especially for elderly vets, is simply not fulfilling
this country's obligation, and I look forward to working with
you toward finding a solution to this problem and many more. We
owe that to our veterans.
I also look forward to working with Ambassador Nicholson. I
cannot think of a more qualified nominee for this position. You
have got the character of an Iowa farm kid and have paid a lot
of dues in the time since, and I just think it is so important,
your commitment and dedication to serving the wellbeing of
veterans all across this country the same way that you were to
serving the needs of the servicemen under your command when you
were in uniform.
And the fact is that you have a tremendous record of
service to this country that did not end when you took the
uniform off, and for that, the country is already grateful, and
we are looking very much forward to working with you as we
again attempt to address the important challenges and problems
that are facing veterans across this country at a time when we
have some unique needs, the Nation being at war, and, as was
noted earlier, the budgetary constraints that we are all under,
but I cannot think of a priority that is higher in terms of
what we need to be doing to honor and respect and serve the
needs of America's veterans.
And so, I am delighted to be a part of this Committee and
look forward to working with you and am anxious to see you
quickly confirmed.
Thank you, Mr. Chairman.
Chairman Craig. Senator Thune, thank you.
Now, let me turn to Senator Jeffords from Vermont, where
the snow might be just a little deeper this morning.
[Laughter.]
OPENING STATEMENT OF HON. JAMES M. JEFFORDS,
U.S. SENATOR FROM VERMONT
Senator Jeffords. Mr. Chairman, congratulations on assuming
the chairmanship of this Committee.
Chairman Craig. Thank you.
Senator Jeffords. I am very pleased that you have
articulated your strong support for America's veterans, and I
look forward to working closely with you and Senator Akaka to
see that our veterans get the care and the benefits that they
need and deserve.
Mr. Ambassador, you are a graduate of West Point and a
distinguished veteran. You know the rigors of combat, and you
have seen the valor of America's finest. You have now accepted
one of the greatest challenges in American Government, that of
fulfilling our promise to our veterans. As a veteran myself and
an enrollee in my local VA, I know first hand the challenges
this system is facing.
Your predecessor, Secretary Principi, did a tremendous job
in improving the VA, even in the face of insufficient budgets,
but we can, and we must, do better. It is no longer a matter of
choice of relative priority. Hundreds of thousands of men and
women have gone into war, as required by their commander-in-
chief. They have suffered both visible and invisible wounds.
They require immediate care today, and many will require
extensive care for the rest of their lives.
We cannot equivocate in providing that care, nor is it
morally acceptable to provide that care at the expense of
veterans of previous eras. We are not meeting our national
obligation if we turn away any class of veterans. I ask you to
join me and join this Committee in ensuring that our Nation's
veterans receive the care and benefits that they deserve.
Mr. Chairman, I ask that my entire statement be made a part
of the record.
Chairman Craig. Without objection. Thank you, Jim.
[The prepared statement of Senator Jeffords follows:]
Prepared Statement of Hon. James M. Jeffords,
U.S. Senator from Vermont
Thank you, Mr. Chairman.
Let me first say that I appreciate the fact that you have moved
swift1y to schedule this hearing on this critical nomination. I am very
pleased that you have articulated your strong support for America's
veterans, and I look forward to working very closely with you and
Senator Akaka to see that our veterans get the care and benefits they
deserve.
Ambassador Nicholson, I appreciate your being willing to accept
this difficult assignment. Your appointment comes at a critical time
for our country and for the Department of Veterans Affairs. Under the
very strong and able leadership of your predecessor, Secretary
Principi, the VA was able to strengthen its health care system and
improve the delivery of veterans' benefits.
However, the entire VA system has been hampered by the
unwillingness of this Administration to provide the VA with the
resources that are necessary to fully meet the needs of veterans. VA
hospitals are forced to forego needed maintenance and capital
improvements in order to prevent a shortchanging of veterans health
care. Benefits that could have been provided in a more timely manner
are being delayed because sufficient resources have not been devoted to
processing of claims. Benefits that were widely endorsed by Congress,
such as concurrent receipt of full VA disability and military
retirement pay, are not being paid to veterans today because adequate
funding has not been included in the Administration's budget.
And on top of all this comes the Iraq war and the sharp increase in
demands on the VA system from returning servicemen and women.
As a veteran myself, I am determined that this Nation fulfill its
obligation to the men and women it has sent into battle. I am worried
that we do not have sufficient resources to care for all their wounds
and replace all their missing limbs. I am even more concerned that we
are not fully prepared to meet the challenge of the unseen wounds, the
psychological wounds that this war is inflicting on both the visibly
wounded and the physically unscathed veteran. While we may have
disagreed on the wisdom of starting this war, I don't believe there can
be any disagreement on the importance of properly caring for those who
are now suffering because of their military service.
The activation of unprecedented numbers of National Guard and
Reserve units is adding to the challenge facing the VA. Guard Members
and Reservists come from all over America. Upon their return home, they
do not have access to military base networks, where active duty
military personnel find support. In many instances, the VA is their
primary source of assistance. VA hospitals and clinics, many in remote
areas, will be faced with new and very urgent challenges, ones they
must meet!
Like many of my colleagues, I have been to Walter Reed Army
Hospital and have glimpsed the enormity of the task facing the VA.
Because you are a decorated soldier, I am sure you share my passion to
do right by our veterans. I hope you also share my determination to
demand that this be a top priority of this Administration.
Mr. Ambassador, let me just say in closing that we in Vermont are
very lucky. Our White River Junction VA medical center and regional
office is one of the very best in the country. Twice the recipient of
the prestigious Robert W. Carey Achievement Award, the White River
Junction VA was selected for the Trophy Award, the Carey Award's
highest honor, this fall. As an occasional patient at the White River
Junction VA, I can attest to both the quality of care and the
efficiency of their service. This center is truly a model for other VA
centers around the country. But even the White River Junction VA will
not be able to maintain this quality of care if adequate funding is not
secured in Washington. That must be our job. I am pledged to this task,
and I ask you to join me in this commitment.
Our men and women did not hesitate when our President ordered them
into battle. They continue to fulfill their duties with honor and
selflessness. It is now our turn to see that this Nation fulfills its
obligation to them. I am fearful that we are not meeting this
challenge. I beg you to help me reverse this course.
Thank you.
Chairman Craig. Now, let me turn to Senator Kay Bailey
Hutchison of Texas. Kay.
OPENING STATEMENT OF HON. KAY BAILEY HUTCHISON,
U.S. SENATOR FROM TEXAS
Senator Hutchison. Thank you, Mr. Chairman.
I do want to add to the Members who have said how pleased
they are that you are going to be Chairman and that you want to
make this an active and working Committee and also, your
Ranking Member, Senator Akaka, who has a wonderful record in
the service as well.
I am very pleased with the nomination of Jim Nicholson,
Ambassador Nicholson. I think that the previous Secretary of
Veterans Affairs, Secretary Principi, did a wonderful job of
reaching out to veterans to show how much he cared about the
health care and the services that they are being given. I found
him to be a straight shooter and someone on whom we could
always rely to do what he said he would do, and I have known
and worked with Ambassador Nicholson for many years and have
found exactly the same type of person: a straight shooter who
always does what he says he will do.
I am particularly pleased that the President has appointed
someone with such a great record in service. I think your
credibility with the veterans' community is absolutely
unsurpassed and essential, and I think you have done a great
service for our country the last 4 years, I think that you are
uniquely qualified to continue in service in this very
important way.
There are so many issues now facing our veterans, and I
think many of them have already been mentioned. I would just
add two more: one is the Gulf War Syndrome that was really
undetected for so many years, because it was felt in many of
the high echelons of government that the Gulf War Syndrome,
which affected one in every seven people who returned from the
original Gulf War was psychosomatic, that it was really stress
and had no actual damage to any body part.
And because of that, I think we lost a lot of time in
finding out what the source of these symptoms were, and I have
made it a cause of mine to assure that we get to the bottom of
it through research and then the treatment that will come from
the research that is being done, because now, there has been a
causal connection between brain damage and access or being
around chemicals, not necessarily chemical weapons, but just
exposure to chemicals and brain damage.
Secretary Principi made a commitment of $60 million over 4
years, $15 million per year, to continue this research, and I
think it is very important that we continue, and I hope to ask
you in the question period if you will continue this
commitment. Not only will it help treat the veterans of the
Gulf War, but will help us determine future problems that we
might face in battle and access and exposure to chemicals and
the type of people who might be able to get an antidote or some
kind of an enzyme that would keep them from being so afflicted
as those we have seen.
The second major thing that I think is particularly timely
is the effect that BRAC will have on veterans' health care
services at bases. I would hope that you would take an active
role in looking at bases that serve veterans where there is
little access around that base so that if that base were shut
down, veterans' health care concerns would be elevated, whether
you would weigh in on that to show a factor, at least; it is
not that you would not close the base, but that it would be
considered another one of the costs if you are going to have to
put a veterans facility in that area to compensate for the loss
of active duty and whether or not that is, in fact, efficient.
It may be; it may not, but I would hope that as we go into this
BRAC year that we look at veterans' health care services that
is now being done routinely on active duty bases.
You have a number of issues on the table, but I know you
are up to the job, and I will enthusiastically support your
nomination, and I hope that with the cooperation of the
Chairman and the Ranking Member and all of the Committee
Members that we can move your nomination quickly so that we
will not have any time wasted in beginning the next phase of
addressing issues.
The third area that I should mention as I close is the
CARES Commission that was put forward in the last 4 years, the
last 2 years, and its impact on veterans' facilities, and I
hope that you will continue to allow those communities that are
affected by the CARES Commission's recommendations to have full
access to you and the committees that would be making the final
decisions on how those facilities will be used.
So with that, I am looking forward to working with you
through these very important years, and I know that you will do
a wonderful job for our veterans. Thank you.
Thank you, Mr. Chairman.
Chairman Craig. Kay, thank you very much.
Now, before we turn to the Ambassador for his oath and also
his testimony, let me turn to our colleagues who are here today
to introduce him to the Committee: the senior Senator and the
freshman Senator from the great State of Colorado. First of
all, Senator Wayne Allard.
Senator.
STATEMENT OF HON. WAYNE ALLARD,
U.S. SENATOR FROM COLORADO
Senator Allard. Thank you, Mr. Chairman.
First of all, I would like to congratulate you on your
leadership as the Chairman of the Veterans' Affairs Committee
and also congratulate Senator Akaka for his position as Ranking
Member on the Committee. I extend my best wishes to the Members
of the Committee.
I am also very pleased today that my colleague, newly-
elected Senator Ken Salazar is joining me at the table in
support of Jim Nicholson to be Secretary of Veterans Affairs.
Both of us showing up reflects the fact that we have bipartisan
support from the State of Colorado, and we have a great deal of
respect for what Jim Nicholson has done for the State, what he
has done for the country, and what he will do, we think, on
behalf of veterans.
Before I get further on my comments, and it is a distinct
pleasure for me to be able to introduce Jim Nicholson to the
Veterans' Affairs Committee today, I just want to relate a
personal experience that I am having in the State of Colorado,
and that is that veterans are somewhat reluctant--or they are
just simply not signing up--when they come out of service in
Iraq and leaving the active military, getting their names on
the rolls of the Department of Veterans Affairs. If they would
do that now, that saves problems that many of us face in our
offices 20 or 30 years later trying to get them through the
paperwork, because you have already got them signed on the
rolls of the Department.
And in some cases, we run across situations where they do
not have a lot of confidence in the Department of Veterans
Affairs. I have all the confidence in the world that under the
leadership of Jim Nicholson, Ambassador now to the Vatican,
that he will help correct that problem, and I think that he
will help restore confidence in the Department of Veterans
Affairs.
Now, I have known and worked for years with Jim in the
State of Colorado, and I am proud that President Bush has
nominated him to be the next Secretary of Veterans Affairs. As
a West Point graduate, Army Ranger, highly-decorated combat
veteran and almost 4 years of service as the ambassador to the
Holy See, Mr. Nicholson is well-prepared and highly-qualified
for the duties as the head of the VA. He brings forward a
strong work ethic, and I think to be Secretary of Veterans
Affairs, you have got to have a strong work ethic.
Born during the Great Depression as the third child of
seven, Jim Nicholson grew up on a tenant farm in rural Iowa.
Both he and his older brother, Jack, earned appointments to
West Point while struggling as a farming family in the Midwest.
Prior to Jim's appointment, his brother returned home from
school to the summer, and his family could not find enough
money to send Jack back to New York for the start of his new
term.
In order to solve this problem, a 15-year-old Jim Nicholson
took it upon himself to find a job building railroads through
his home State of Iowa. By working as long as 19 hours some
days, Jim was able to not only earn enough money to send his
brother back to West Point, but also was eventually able to buy
his father a used car so that he could look for work.
These virtues that Jim displayed as a youth: work ethic,
self sacrifice, and determination, are the qualities that will
allow him to excel in the President's Cabinet. As a West Point
graduate and decorated veteran, this former Army Ranger also
has the personal experience in the armed forces that will serve
his new constituency well. During his service in the Army, Mr.
Nicholson fought in the Vietnam War and was a highly-decorated
soldier. He was awarded the Bronze Star, the Combat Infantry
Badge, the Meritorious Service Medal with oak leaf cluster, the
Vietnamese Cross for Gallantry and two Air Medals while
spending 8 years on active duty, 22 years in the Army Reserve
before retiring as colonel.
Clearly, Jim Nicholson's qualifications after his Army
career are just as impressive, including his advanced degrees,
starting a successful real estate business, numerous community
volunteer efforts throughout Colorado, and finally culminating
in his service as an ambassador to the Holy See.
This is a man who has been asked to serve his country in a
new capacity and who will answer that call with his own sense
of duty and honor, and it is indeed a great pleasure for me to
introduce Jim Nicholson to the Committee, and I also want to
thank in a public way the willingness of his wife Susan to
allow him to take on this job, because it means that he will
spend time away from the family and will mean a greater burden
on her, and I think a special thanks should be extended to her.
Thank you, Mr. Chairman.
Chairman Craig. Senator, thank you.
Now, let me turn to Senator Salazar. Senator Salazar is
also a Member of this Committee, and we welcome you to the
Committee and look forward to your statement.
Ken.
STATEMENT OF HON. KEN SALAZAR,
U.S. SENATOR FROM COLORADO
Senator Salazar. Thank you, Senator and Chairman Craig and
Senator Akaka, Ranking Member, and Members of the Committee.
I very much look forward to serving on this Committee. Like
all of you here, this is something that we do by choice, and I
made the choice to sit on this Committee, requested the
Committee assignment because of my respect for the veterans of
our country. My father passed away several years ago, a proud
veteran of World War II and insisted that he be buried in his
uniform from World War II because he wanted to make a statement
about how proud he was of this country and how proud he was of
the freedoms that we enjoy.
In that same vein, I have had uncles killed in World War II
and many members of my family who have served in many wars and
nephews who are currently in the military, and so, I very much
look forward to contributing to the efforts of this Committee
to make sure that we are honoring our commitments to our
Nation's veterans and in that regard very much look forward to
the activism that you will bring to this Committee, Mr.
Chairman and Mr. Ranking Member.
Let me also say, I didn't do my opening statement like the
rest of the Committee Members, but I do have an opening
statement, and if there is no objection, I would just submit
that for the record.
Chairman Craig. Without objection.
Senator Salazar. Thank you, Mr. Chairman.
Let me say that it is an honor for me as a fifth-generation
Coloradan today to be able to introduce a very fine and
distinguished member of our State, a favorite son from
Colorado, and that is Ambassador Jim Nicholson, to this
Committee.
Ambassador Nicholson and I have not always been on the same
team, if you will, on political issues in the State of Colorado
or the Nation, but I will tell you that you get to a point, as
we are today in our Nation, when the elections are now over,
that we need to move forward and get about the country's
business, and certainly the business of how we take care of our
veterans in my State and around this Nation is one of the most
important priorities of our country.
And so it is with that statement that I am very proud to be
able to introduce Ambassador Nicholson and also to urge my
colleagues, both Republicans and Democrats, to join in voting
for his confirmation. I look forward to working with him. We
have already started working together on a host of issues in
Colorado, including addressing the issue of a Veterans Affairs
Medical Center in Denver. He has sent clear signals that
notwithstanding the challenges that we face there that we are
hopeful that we will be able to resolve the issues and move
forward with the construction of a facility there that this
Committee has been involved in making possible over the last
several years.
I have met with Ambassador Nicholson and talked to him
about his life story and about his commitment to our Nation and
to our Nation's veterans. Ambassador Nicholson has proven with
his life story that nothing can stop him fighting for those
things that he believes in. He was born in Iowa in a tenant
house without plumbing. His family sometimes had to go without
food. His mother's faith and his dedication to family taught
him that he could succeed no matter how difficult the
challenge.
I know a little something about growing up on a poor farm
with a big family and trying to get by on a little, and I am
confident that his own life experiences have given him the
ability to lead the second-largest department of our Nation to
be the best that it can be.
Ambassador Nicholson's early life experience steeled him to
succeed as a cadet at West Point and then as an Army Ranger,
who won the multiple decorations that have already been
mentioned today. He took on those assignments as burdens of a
young man who had to fight for everything he and his family
got, and he took them on as a patriot who knew the best that
America had to offer.
I know that this hearing will go well and that the
nomination process will go quickly and that our country will
give Ambassador Nicholson another opportunity to serve our
great Nation as the Secretary of Veterans Affairs. The new
challenges that he will face are difficult. The basic question
for all of us in this room and in this country is how does the
United States honor its solemn obligations to our country's
heroes in a time of the huge and historic deficits that we face
today?
I do not know that any of us know the answer to that
question, but I do know that Ambassador Nicholson has the
ability and the tenacity to make sure that we prioritize the
needs of veterans around our country. And so, it is with that
statement that I pledge my support to Ambassador Nicholson. I
urge a positive and quick vote for his confirmation in the U.S.
Senate.
Thank you very much.
[The prepared statement of Senator Salazar follows:]
Prepared Statement of Hon. Ken Salazar,
U.S. Senator from Colorado
Good afternoon. Thank you Mr. Chairman. It is a privilege to serve
on this Committee with you and with Senator Akaka. I very much look
forward to working with you and all of my colleagues as we strive to
honor our obligation to those who so honorably served this country. I
know I will learn a great deal from all of you, as you share your
experiences and leadership on a wide range of issues affecting the
Nation's veterans. I am confident that my own experience as the son,
brother, and uncle of proud Salazar family veterans will be helpful to
this Committee.
And thank you, Ambassador Nicholson, for your long and
distinguished service to our country, and to the great State of
Colorado. Your experience as an Army Ranger in Vietnam and your 22
years of service in the Army Reserves will be very valuable, I expect,
as you consider ways to improve the lives of your fellow veterans. And
as I said in my introduction of you, your experience both as a soldier
and a diplomat will be invaluable as you fight within the President's
Cabinet for the funding our veterans have earned. It is long past time
for us to fully fund the VA, and I pledge to help you meet that goal.
Let me reiterate my appreciation to this committee for authorizing
the creation of a new VA medical facility in Colorado at the old
Fitzsimons Army Medical site. The development of this site presents a
unique opportunity for Colorado veterans to become a part of a world-
class medical campus.
The close proximity of the University of Colorado Hospital to the
VA's current hospital has served both communities well. The relocation
of these hospitals to Fitzsimons will strengthen this relationship,
resulting in what I'm sure will be continued cost savings and, most
importantly, excellent health care for our veterans.
I am hopeful that after some breakdowns in communication, the
hospital is back on track and that our veterans in Colorado will soon
have the world-class facility they have earned.
Colorado is blessed with values that encourage service to this
great Nation, including in the armed forces. The VA invested more than
$900 million in Colorado in 2003 to serve nearly 433,300 veterans who
live in Colorado. 56,904 patients received health care and 57,706
veterans and survivors received disability compensation or pension
payments from VA in Colorado. More than 9,401 veterans, reservist, or
survivors used GI Bill payments for their education, there were 68,461
owned homes with active VA home loan guarantees, and 3,339 veterans
were interred in Ft. Logan and Ft. Lyon national cemeteries.
Those are impressive numbers, but the fact of the matter is that
our veterans still have to wait too long for care, are forced to jump
through duplicative and cost-increasing hoops to get the prescription
drugs they need, are confronted with hospitals that are outdated, loan
guarantees better suited for real estate markets of two decades ago,
and in too many cases are forced to choose between the retirement they
have worked for and the disability pay they have earned.
One more thing that I find very disheartening, Mr. Chairman, is the
simple fact that in any given year, 500,000 veterans face at least one
night of homelessness. Imagine that: half a million men who laid
everything on the line for us spend the night on the street because
they cannot afford shelter. In Denver alone there are nearly 9,000
homeless veterans.
We can do better for our veterans--our national heroes. I
anticipate we will hear a lot over the coming weeks about the impact
the historic deficits we currently face will have on the priorities of
our country. That is as it should be--we cannot continue to heap debt
on our children and grandchildren at the rate we have done so for the
last 4 years.
I recently signed a letter, circulated by our Ranking Member,
Senator Akaka, calling on the President to fully fund the Veterans
Administration in his upcoming budget proposal. I also wonder, Mr.
Chairman, if we have not come to the point where we move to guaranteed
funding for the VA. It just is not fair to our veterans and their
families to have to hold their breath each year to see if they will be
able to get the care and support they were promised.
Ambassador Nicholson, after our discussion last week I am hopeful
that you will keep these principles in mind as you begin your
assignment. At our meeting, I shared my priorities with you, and I
reiterate my commitment to work with you to enact each of them. In
particular, I look forward to working with you and my colleagues on
this Committee to finalize the new VA facility at Fitzsimons.
Again, thank you, Mr. Chairman and Senator Akaka. And thank you,
Ambassador Nicholson.
Chairman Craig. Now, we turn to the gentleman that we are
here to take testimony from, and as we do that, Mr. Ambassador,
if you would stand, please; let me administer the oath.
[Witness sworn.]
Chairman Craig. Also, at your leisure, please introduce
anyone you would like to introduce, your family, who
accompanied you here today. We look forward to your testimony.
Please proceed.
STATEMENT OF HON. R. JAMES NICHOLSON, NOMINEE TO BE SECRETARY,
DEPARTMENT OF VETERANS AFFAIRS
Mr. Nicholson. Thank you, Mr. Chairman, Members of the
Committee.
I want to thank you for the opportunity to appear before
you so early in the new Congress and for the many other
courtesies that you and your staffs have extended to me. Your
words and actions underscore your commitment to the millions of
veterans who look to the Department of Veterans Affairs for the
benefits and services they earned, benefits and services that
our Nation has pledged to gratefully give them.
Let me add my congratulations to you, Senator Craig, and to
you, Senator Akaka, on your election to Chairman and Ranking
Member respectively of this Committee, which oversees the
department of our government with the largest civilian work
force and with one of our highest priorities: to deliver first
class, timely medical care and benefits to our veterans. Your
selections speak volumes about your colleagues' confidence in
your commitment to America's veterans.
I am joined here today by my wife of 37 years, Suzanne. She
has always been at my side, through thick and thin, and I am
very grateful to her for her support of me in accepting this
honor and this considerable challenge from President Bush to
lead this great Department if confirmed. I am also joined by my
son Nick and his wife, Charlotte, who live in the Washington
area. Our other two children could not be here.
I am also joined by a man who has been mentioned here
already this morning, my older brother, the pacesetter in our
family, Brigadier General Jack Nicholson and joined by my kid
brother, Patrick Nicholson, who is here.
Service to our country----
Chairman Craig. Jim, let me welcome all of your family to
the Committee. We appreciate your being here.
Mr. Nicholson. Service is a long tradition in my family. My
father was an enlisted man in the Navy during World War II. My
father-in-law served in both World War II and Korea. I have
mentioned my brother, Jack, who served 30 years in the Army and
was, until just very recently, the Under Secretary of the
Department of Veterans Affairs for Memorial Affairs, where he
did an outstanding job. One of my sons is a veteran; four of my
nephews are colonels in the Army and Air Force.
My 30 years of active and Reserve service in the Army,
coupled with my 4 years at West Point, have defined my life. I
love the armed forces of our country, their courage, their
integrity, their sense of duty. That is why I am so honored
that President Bush selected me to build upon his
Administration's great record of care and compassion for our
Nation's veterans of service in our armed forces, and if
confirmed, it would be a privilege for me to follow the
footsteps of Secretary Principi, a man who has provided
outstanding leadership and tireless dedication to the welfare
of this Nation's veterans.
I feel humbled that America's veterans, men and women who
served on the front lines for freedom, justice, and peace in
democracy's name might look to me as the faithful steward of
their trust and the leader of VA's 230,000 employees who work
so diligently around the clock to assure our veterans that we
are making good on the Nation's debt to her defenders.
Mr. Chairman, as has been said, I do come from the
heartland of this great country, Iowa, from a boyhood life that
is so far removed from this historic and stately temple of
liberty that we are in here today that it made Washington seem
barely a dream. It was a hardscrabble life, to be sure, but my
family of seven kids was filled by my mother with hope and
confidence, and she used to continually say to us, ``if you
will work hard, study hard,'' and she would always say, ``and
pray hard, you can be a success in America.'' You can have
legitimate dreams of a better life, in spite of sometimes the
extreme poverty that we were in, and you can make those dreams
come true, she would say.
As a teenager, I remember watching young men going off to
the Korean War, following in the wake of World War II, yet
another test of freedom's will to defeat an inhumane and evil
tyranny, yet another answered call by our countrymen to go off
to a frozen peninsula that we had never heard of prior to that.
They went off because their country asked them to go.
One of the brothers of a pal of mine never returned. One of
my best friends, who was slightly older than I, came back, but
he left a leg over there. He was also my introduction to the
VA, as they worked very hard to try to get his prosthesis to
work properly. Now, again, we are at war, and again, our
country is asking our men and women in uniform, all volunteers
now, to go to the sound of the bugle. Those friends and
neighbors who stood tall for freedom 50 years ago are now among
our most distinguished veterans, and today's heroes will soon
join them.
I will, if this Committee so entrusts me, be proud to lead
the Department dedicated exclusively to honoring their service
and sacrifices, to making good on our country's promises to
them. I have had the privilege of wearing the uniform of the
United States Army in combat, so I have seen both the horrors
of war and the heroes of America making the greatest sacrifices
of military service on behalf of their comrades and our Nation.
One cannot leave a battlefield without having profound
respect for the courage and cool of all who have served there.
One cannot appreciate all the blessings of our freedom without
thanking the men and women who serve in war to bring about
peace. Their example of unwavering commitment to their mission,
no matter how dangerous or uncomfortable, will always
reverberate with me and readies me for a mission of service to
those veterans.
I will do my utmost to see that they receive all they have
earned and that it is delivered with the dignity that they have
also earned. I do not underestimate the enormity of the
responsibilities of Secretary of Veterans Affairs. This
Committee knows well that the VA is the second-largest Cabinet
department, operates the Nation's largest integrated health
care system and is relied upon by millions of veterans, their
dependents and survivors not only for health care, but for
billions of dollars in monetary benefits, life insurance,
education, mortgage insurance and readjustment benefits.
The challenge of leading such an organization is daunting,
but I am prepared to accept it. If the Senate confirms my
nomination, I will commit without hesitation to upholding the
following principles: veterans should have access to the best
available health care in the most appropriate clinical
settings, delivered in a timely manner by caring, compassionate
clinicians, and veterans, their eligible dependents, and
survivors are entitled to prompt, accurate, equitable and
understandable decisions on their claims for benefits, and
veterans should be appropriately honored in death for their
service and sacrifices on behalf of a grateful Nation.
Mr. Chairman, the manner in which the VA supports the
transition of today's servicemembers into veterans, especially
those who are injured or because they became ill as a result of
their service in combat areas, will define the Department for
them. If confirmed, I will ensure that the VA and DoD continue
to work collaboratively to provide a seamless transition, so
that returning servicemembers are timely provided the benefits
and services that will enable them to reclaim their rightful
places as citizens in our society.
I am aware of recently-reported concerns of possible
regional variations in disability compensation awards.
Veterans' entitlements to Federal benefits is the same
regardless of where in this country they may reside, and if
confirmed, I will ensure that standardized training and sound
quality controls support a uniform approach to claims
adjudication. Further to that point, I will, if confirmed,
order a prompt study into this whole question of equity and
geographic differences in benefits adjudication. No one that I
have yet met knows exactly why these differences occur exactly
the way they do, but we need to understand this fully and then
take remedial action as appropriate.
Mr. Chairman, if the Senate will afford me the opportunity,
I pledge to work with this Committee and individual Members of
both houses for the betterment of veterans and their families.
I will keep you informed. I will listen to your concerns, and I
will respect your oversight responsibilities.
I understand that the success of the Department requires a
strong collaboration with the veterans' service organizations
who function both as our ears to the ground on matters of
service delivery and as our partners in devising solutions to
problems as they arise. If confirmed, I will work closely with
the VSOs so that I may both benefit from their counsel and draw
upon their willingness to serve their comrades.
I am also deeply committed to earning the respect, trust
and following of the men and women of the VA who have made
service to veterans their life's calling. The VA work force
represents an enormous reservoir of dedicated, committed talent
that must be put to its best possible use. I will hold myself
and my leadership team accountable for ensuring and harnessing
our employees' best efforts. It will be my job and my privilege
to lead and harness this awesome force of talented people so
that all of us have the same focus: our veterans.
It is critical that we honor America's debt to those who
have served us so faithfully. When President Bush announced my
nomination, I did quote America's first commander-in-chief,
President Washington, who said that it is, quote: ``our debt of
honor.'' And today, with so many American men and women in
uniform stationed around the globe, we give them heart when we
keep faith with those who have served before. They do have the
right to know that we will stand by them as well in their time
of need. This is also integral to our Nation's ability, I
believe, to be able to continue to attract an all-volunteer
force ready to defend us anywhere, any time.
The armed forces of our country are, in my opinion, the
model for what is good and great about America. They are a
paragon of integrity; they do not take; they give. They are
disciplined, highly trained, with a love for their country.
They are a unique force in the world, and we need to treat them
uniquely well. Our VA, under Secretary Principi, has made
terrific strides in serving our veterans. The VA provides
health care to 860,000 more veterans now than it did in 2001.
It has drastically reduced waiting times for health care
appointments and opened nearly 100 new community-based
outpatient clinics so that 87 percent of the veteran population
now lives within 30 minutes of a VA medical facility.
As a result of its focus on excellence in health care, the
VA is now the proven benchmark in preventive health care
quality and chronic disease management. Since 2001, the VA has
also drastically reduced its inventory of pending claims for
disability compensation, reduced average processing time for
those claims and at the same time substantially improved the
quality of claims decisions.
Moreover, in 2001, the VA embarked upon the largest
expansion of the national cemetery system since the Civil War.
When construction of all the new cemeteries is completed, the
VA will have expanded the national cemetery system by 85
percent, and according to the latest American Consumer
Satisfaction Index, the National Cemetery Association earned a
rating of 95 out of 100, the best rating ever earned by a
Federal agency. And I want to again here send a salute to my
big brother, because he was the head of that Administration
that got that wonderful affirmation from the people that have
used or benefited from that Administration, many of them at the
most sensitive, sad time of their life.
I will, if confirmed, strive to move the Department to
another level by building upon all that has been put in place
and improving upon those areas that remain a challenge. The VA
is a great American institution, created and founded by a
country that appreciates that freedom is not free, and our
veterans' lives and limbs are the price that is too often paid.
It falls on the Secretary of the VA and the men and women
he or she leads to keep faith with the expectations of all our
fallen citizens in uniform, past, present, and future,
expectations that they will be cared for as needed. This, too,
is the mandate of the grateful people of the United States. I
pledge to you if confirmed by you that I will do all in my
power to see that both the veterans and the citizens of our
great Nation are pleased by the service of their Veterans
Administration.
This concludes my remarks, Mr. Chairman.
Chairman Craig. Mr. Ambassador, thank you very much.
Let me talk to my colleagues about procedure here. We are
certainly going to ask you to engage in all of the questions
you want to ask of the nominee. It is important that we build a
record. I think the nominee knows as well as we do that that
record becomes increasingly valuable as time goes on as it
relates to his performance and promises made, and we believe
strongly that that is important.
But we also have another reality in front of us. Many of
you have already expressed your open support and willingness to
move the Ambassador's nomination forward to the Senate floor.
We also happen to have a quorum at this moment.
[Laughter.]
Chairman Craig. I am going to turn to my colleague, the
Ranking Member, to see if he might want to comment on this
before we address you as to what he and I might choose to do
here.
Senator Akaka. Mr. Chairman, I know some Members will be
leaving soon. As such, after our Committee Members and
Ambassador Nicholson make their statements, I would recommend
that we immediately mark up Ambassador Nicholson's nomination.
We have not seen the Ambassador's FBI report yet, but I
would ask that the Committee's approval be contingent upon its
approval of the FBI report and would therefore recommend that
we immediately take up this nomination.
Senator Hutchison. Mr. Chairman.
Chairman Craig. Senator Hutchison.
Senator Hutchison. I move that the Committee report the
nomination of R. James Nicholson to the Senate with the
recommendation that his nomination to serve as Secretary of
Veterans Affairs be confirmed, subject to Mr. Nicholson's
commitment to respond to requests to appear and testify before
any duly constituted committee of the Senate and further
allowing Senator Akaka and others who might wish to look at the
FBI file the time, obviously, to do that. But I think we should
move the confirmation forward.
Senator Rockefeller. Mr. Chairman.
Chairman Craig. Senator Rockefeller.
Senator Rockefeller. I will, in every way, cooperate with
the Chairman and Ranking Member on this, but I think it is
important to make a point here. In the case of Secretary
Principi and others, we have all been involved with the
confirmation process with a number of folks over the years, and
there is a psychological difference, and I think sort of a
procedural difference, between asking the questions which are
closest to us and not asking the questions that are closest to
us before we vote. There is a particular sort of emphasis and a
poignancy, a moral poignancy in a way, about the asking of
those questions.
I would just note that for the record that I hope this will
not become a common practice. I think it is the first example
of our Chairman having to deal with the fact that some Members
will be leaving, and that is another matter that we all need to
discuss to make our Committee rise to the A level that the
Chairman and all of us want. But I certainly will not stand
against what the Chairman is suggesting, because I strongly
favor the nominee, but I want to just put that on the record.
Chairman Craig. Let me dutifully note exactly what you have
said, Senator, and I do not disagree with that. That is why I
would assume that anyone having questions, and I have several,
remain so that we build an important record for the Committee
in moving with the new Secretary of the Veterans
Administration. But I do not disagree with your overall feeling
as to priority of action.
Is there a second to the----
Senator Burr. Second.
Chairman Craig. It has been seconded that this Committee
move forward the nomination of Jim Nicholson as Secretary of
Veterans Affairs with the caveat so expressed in the motion as
it relates to questions to be asked and answered. Senator Akaka
and I will spend time with the FBI report this morning and
background information to assure us that there are no
difficulties with that.
Senator Jeffords. Mr. Chairman, I do have questions that I
do wish to ask, which may make a difference on my decision how
to vote.
Chairman Craig. All right.
Senator Jeffords. That is why I raise it now, so I feel
that we perhaps should take the regular order, but I am not
going to object.
Chairman Craig. All right; does the Committee wish a roll
call vote?
Senator Jeffords. Aye.
Senator Rockefeller. I think it would be respectful to the
nominee to have that.
Chairman Craig. Then the Clerk shall call the roll.
The Clerk. Mr. Specter.
Mrs. Hutchison.
Senator Hutchison. Aye.
The Clerk. Mr. Graham.
Mr. Burr.
Senator Burr. Votes aye.
The Clerk. Mr. Ensign.
Mr. Thune.
Senator Thune. Aye.
The Clerk. Mr. Isakson.
Senator Isakson. Aye.
The Clerk. Mr. Akaka.
Senator Akaka. Aye.
The Clerk. Mr. Rockefeller.
Senator Rockefeller. Aye.
The Clerk. Mr. Jeffords.
Senator Jeffords. Present.
The Clerk. Mrs. Murray.
Senator Akaka. Aye by proxy, Mr. Chairman.
The Clerk. Mr. Obama.
Senator Obama. Aye.
The Clerk. Mr. Salazar.
Senator Salazar. Aye.
The Clerk. Mr. Chairman.
Chairman Craig. Aye.
The Clerk. Eleven ayes, zero nays.
Senator Hutchison. Mr. Chairman, I would just like to make
a parliamentary inquiry, and I would like to make a motion if
it is necessary, to allow Senator Jeffords to change his vote
if he wishes following his questioning so that if he decides he
would like to move one way or the other, he be allowed to do
that.
Chairman Craig. I have no objection as the Chairman to
that.
We will proceed with that caveat, that following
questioning, your vote can be changed as you wish.
Senator Jeffords. Thank you, Mr. Chairman. I did so because
I believe there are questions which are very pertinent to how I
will vote. I firmly believe that the VA must serve the needs of
all veterans. Because of budget shortages, your predecessor was
forced to create a new category of veterans known as Priority 8
veterans.
While Secretary Principi fought hard for adequate funding
for the VA, the Administration did not see fit to meet this
request to provide the VA with sufficient funds to treat these
veterans. All indications are that in order to reduce the
budget deficit, the Administration is going to cut funding for
the VA or at least freeze the funding at 2005 levels, which, of
course, amounts to a cut in actual services provided.
If that proves to be the case, are you willing to go to the
President and request that additional funds be provided to the
VA so services can be maintained for all veterans, or are you
willing to accept that we may have to write off whole
categories of veterans as now ineligible for VA services? In my
opinion, that would be a gross mistake.
Mr. Nicholson. Thank you, Senator. That is an important
question, and it, I think, aptly encapsulates, you know, some
of the tension that exists in trying to balance resources that
are available or will be available with the needs of our
veterans.
I will say I have not seen the 2006 budget. They have not
made that available, so I cannot comment on what that budget
has in it. But I am well aware of one of the important points
of your question as it relates to the so-called Category 8
benefits to veterans, and I am aware that that has been
curtailed. Those are veterans in that category who, on a means
test basis, have the ability where they are above that de
minimis level and thus not at this time entitled to benefits
strictly because of the finite amount of resources available to
serve the whole population, and the Veterans Administration has
a delineated set of priorities by law.
The first and foremost is to take care of those veterans
who have been disabled because of the service that they have
provided to our country or have incurred a chronic condition.
Another priority is those that have fallen down on their luck
and are indigent and are poor and then those that also have
spinal cord injury or diabetes or kidney disease.
And so, there is a balancing that has to go on. I will say
to you that my commitment in taking on this job if I am given
the privilege is to the veterans and their needs, because I
feel it, and they deserve it. And it will be a task for you and
your oversight responsibility for me in my leadership of the
Department if I am there to find that balance in a world of not
infinite, but finite resources.
Chairman Craig. Senator Jeffords, do you----
Senator Jeffords. Yes.
Mr. Ambassador, the war has produced many new challenges
for the VA. One of these challenges is meeting the increased
need for mental health services. Initial DoD data shows that 17
percent of the returnees from Iraq and Afghanistan suffer from
post-traumatic stress disorder, PTSD. Studies by the VA now
seem to indicate that as many as 25 percent of the returnees
who seek VA care have some form of PTSD.
In fact, this may only be the tip of the iceberg. This
presents two challenges to the VA: first and most immediately,
we must provide additional resources to existing VA health
programs all across the country, so that they can meet this
clinical demand. As a greater number of National Guard and
Reserve soldiers serve in combat, there will be an increasing
need for highly-skilled mental health professionals in the
widely-scattered VA hospitals and clinics all across the
country. We no longer have the luxury of concentrating mental
health services in a few centers around the country thinking we
can adequately serve all veterans.
Secondly and no less important, the VA must provide
additional resources to support research in the causes,
assessment and treatment of PTSD by the National Center for
PTSD. There is much and do not understand about the effects of
stress and trauma on our servicemembers and the implications on
their long-term health. I believe that significantly increased
funding for VA mental health programs must not only be a
priority, but must be viewed as an absolute necessity. I would
appreciate your comments.
Mr. Nicholson. First of all, I share your concern about
that, Senator, and I also agree that I think that those men and
women coming back have had a unique combat experience. I mean,
there is, in that urban environment with suicide terrorists,
there is no safe place. So that presents a new, I think, and
unprecedented challenge to us in the whole realm of trauma, and
I do not know what that number is or what that percent is or
will end up being, but that is something that commands our
priority attention, and we need to have early intervention and
screening with those people and begin a counseling regime when
we identify that it would be appropriate for that
servicemember.
We need to learn more about it, and I think there is some
very good research going on. I know there is some of it right
there in your State, as we have discussed before, at the Wind
River Junction, and there are three other centers throughout
the United States where this research is ongoing. And the
Department, I have also learned, as set up these polytrauma
centers for the treatment, not just the research, but the
treatment of these people.
So that really has the attention of the VA and needs it,
and I will pledge to work with you and others on that as a
priority.
Senator Jeffords. I appreciate that answer. Thank you.
Chairman Craig. Senator, thank you very much for that
questioning.
We will now proceed with a normal round of 5 minutes per
Senator in the order in which you came in, and I also
appreciate the cooperation of my colleagues to adjust the
scheduling and facilitate the situation so that we will not
have to return this afternoon for the actual motion and vote
for the disposition of this nominee from this Committee.
Does the Senator from Vermont wish to keep his vote as is
at this time?
Senator Jeffords. Yes, I do.
Chairman Craig. Let us now begin with questions, and again,
Jim, we appreciate your cooperation with the Committee, and as
I have stressed earlier, we certainly believe that the record
that is built here today--you have already heard some very
important concerns expressed by many of my colleagues--is an
important one as we work with you in the coming years to make
sure that the Veterans Administration is responsive not only to
current veterans' needs, but future veterans' needs.
You have talked about a variety of your priorities. You
have obviously, I trust, examined the record of Tony Principi,
who leaves us with a marvelous tenure, and so, let me ask you
this question: how do you see your first 100 days at the VA
unfolding, and what would be your immediate priorities?
Mr. Nicholson. I will answer the last part of your question
first, Senator Craig, and say that my immediate priorities are
perforce, I think, going to be on those people that are
returning from our combat zones in Iraq and Afghanistan and
some of the serious disabling cases that there are there to
make sure that we are doing everything in a timely way to make
a seamless transition from those people from their active duty
military status to that, into the Veterans Administration
status.
And I will say that this is not yet perfected as I
understand it. There is still work and emphasis needed for the
transference of their health information and that, you know, we
accept them into our system, our hospitals and our centers. And
we do it without uncertainty on their part and the part of
their families.
I met with some wounded members yesterday and family
members, and we talked about this, because some of these
people--I met yesterday with a young Army major and her
husband, and she was a Blackhawk pilot in Iraq and incurred an
RPG rocket that blew off her legs. And her copilot was almost
injured as seriously, but yet, she landed her helicopter and
saved the crew's life and then went unconscious and woke up two
weeks later at Walter Reed and now has this unbelievably
positive attitude, but is inquisitive about, you know, what's
next, and what's available to her. We have to take care of that
first and foremost.
The rest of the 100 days, I think, is to consolidate,
address the problems that are still out there, one of which I
know that Senator Obama is going to bring up which is a concern
of mine and organize and build on the great progress that has
been made in the last 4 years.
Chairman Craig. As my last question in this round, let me
offer you an easy one. All you have to do is say yes to this
one. Last year, at my insistence, the Committee and the
Congress approved legislation transferring title of a parking
lot adjacent to the Boise VA Medical Center from the General
Services Administration to the VA. My goal in pressing for the
land transfer was to allow VA to collocate its regional office,
now in rented space a substantial distance away in the downtown
area of Boise, near the VA Medical Center so that veterans
could secure all needed VA services at a single site.
Do you agree that the colocation of VA facilities at a
single site makes sense, and will you give priority attention
to the proposed colocation of the VA Boise Regional Office at
the Boise VA Medical Center?
Mr. Nicholson. Yes, I agree.
[Laughter.]
Mr. Nicholson. I think I have to be intellectually honest.
Yes, I believe in the proposition that co-location and
efficiency, primarily for those people that we are serving, the
veterans.
Chairman Craig. Exactly.
Mr. Nicholson. As to that specific situation, I am not
aware of it.
Chairman Craig. Sure.
Mr. Nicholson. But it sounds good, and I'll be happy to
take a look at it.
Chairman Craig. Thank you very much.
Let me turn to my colleague, Senator Isakson.
Senator, questions, and we are now and will stay with the
5-minute process.
Senator Isakson. Thank you, Mr. Chairman.
Ambassador Nicholson, I wanted really to ask one question
and let you kind of expand on it. Late last year, the 48th
National Guard Unit of the State of Georgia was activated. They
are being trained now. In May, they will be deployed in Iraq.
Our country is at a point in time where we have never been
more dependent on our Guard and our reservists, and obviously,
on volunteers. And we live in a world where we know, although
we hope it will not happen, that there will be another time and
another place and another occasion where we will call America's
young men and women in our reserves to fight on our behalf.
So, therefore, the attractiveness of that, continuing to
meet our recruiting requirements and the quality of life when
activated for those Guardsmen and reservists is critical. I
would like to hear your thoughts on that topic in particular
and if, in fact, you have looked into the future of your
administration, what you might want to do to accomplish that in
terms of the attractiveness of taking care of those Guardsmen
and reservists.
Mr. Nicholson. I tried to make that point in my opening
statement, Senator, because I do think there is a causal effect
between how we end up fulfilling the promise that we make and
the attitude of people as they look at that as one of their
options for a vocation or service to their country, however
they see it.
I think it is also very important the way we project it or
market it, and I am sensitive to Senator Rockefeller's comment
about that, because I think, and I can remember being this way
that, you know, as a young trooper, you feel a certain
immortality and that these things that they talk about, you
know, VA old folks homes or even VA hospitals are vagaries that
do not apply to me and in that way would have a diminished
recruiting or marketing appeal which bespeaks that we need, I
think, to really have a strong outreach about those benefits
and that concern of our country and, you know, we are spending
and trying very hard to provide a great service to our
veterans, and I think that education about that is a very
important point going forward in this all-volunteer force
context.
Senator Isakson. Well, I appreciate your commitment, and I
appreciate the fact that in your 30 years, 8 were active, and
22 were Reserve, so you've been on both sides of that service
to the country, and I am honored to have voted for your
confirmation. I look forward to working with you.
Mr. Nicholson. Thank you.
Senator Isakson. I yield back.
Chairman Craig. Thank you.
Freshman Chairmen are sometimes allowed a little margin of
error, and I erred a moment ago in failing to recognize my
colleague and Ranking Member Danny Akaka, so let me turn to him
now for his round of questioning, and I am going to even try to
soften that mistake a little bit by handing him the gavel for a
moment while I step out, so now, you are in full control,
Danny. And following your questions, would you please recognize
Senator Obama, and I will be back in just a moment? Thank you.
Senator Akaka. [Presiding]. Thank you very much, Mr.
Chairman. It is great working with you.
Mr. Ambassador, you spoke of this earlier. From your
experience with the military, I know you understand the value
of seamless transition. The transition from the Department of
Defense to the Department of Veterans Affairs needs to be, I
feel, hassle-free and as beneficial as possible for
servicemembers. I think we have some work to do in this arena,
and I am glad that VA is focusing some attention on it by
opening up a new office. What is your assessment of the
transition from active duty to veteran status and is anything
else missing besides the transfer of medical records?
Mr. Nicholson. Thank you for that question, Senator Akaka.
We are at war, and we do have people coming back from war,
and we have two different kinds of people. I mean, when they
are at war as warriors and our soldiers defending us are the
same. But when they return, the Guardsmen and the reservists
get into sort of a different queue than the people who are part
of the regular force. And we need to do better. The goal is
there, and we will achieve it, but I cannot sit here and tell
you that I think it is perfect or where it should be.
For Guardsmen and Reserve, what we are finding is that some
of them come back from their deployment, and they are not
captured for the kinds of debriefings and briefings of what is
available to them, and they are getting sort of scattered. They
are obviously so anxious to get home and get back in their
communities with their families that some of them are falling
through the cracks, and we know that now and are taking steps
to intervene early.
For example, I know that the VA put some people on a troop
transport and was able to sail with them and brief them on
their way coming home from Iraq. On the side of the regular
force, we need still to do better on the sharing of information
with the Department of Defense, medical information
particularly. I think the goal is there, that both agencies,
both departments want to get there, but we are not there yet,
but it is a high priority.
Senator Akaka. Thank you.
In your answers to my pre-hearing questions, which I
certainly appreciated from you, you indicated that you are, and
I am quoting: ``firmly committed to taking care of our core
constituency,'' which you define as ``those with service-
connected disabled conditions, low incomes, and veterans with
special health care needs.'' You went on to say that you will
work to ensure that sufficient resources are available to care
for these veterans who depend upon VA for care. Tell me more
about the attention that will be paid to the millions of other
veterans who depend upon VA care.
Senator Isakson. The priority are those that you have
stated for the Veterans Health Administration and Veterans
Benefit Administration. That is not meant to say or to be at
the exclusion of so many other veterans who do not fall into
those categories, but that is, and I think by law, Senator,
those priorities are a mandate of the law.
We just have to, I think, get the best value for the
dollars that you all authorize and appropriate to us to serve
as large a population of veterans as we can, because there are
a lot of needs there. They are not all the same, but my goal,
certainly, if I am made the Secretary of this Department is to
do our utmost and for me to do my utmost as an advocate for
veterans and to see that the maximum number of veterans that we
can take care of are taken care of.
Senator Akaka. Well, thank you for that. My time has
expired.
Chairman Craig. Senator Obama.
Senator Obama. Thank you very much, Senator Akaka.
The comment that I want to make is that with respect to
your brother. My grandfather is buried in Honolulu. He was a
World War II veteran, and it was an outstanding service. And
the division that your brother was operating does, in fact, do
an excellent job, and I am grateful for that.
Now, I am very appreciative, Ambassador, of the fact that
you took the time to meet with me ahead of this hearing. Part
of the reason that I agreed to gladly vote for your
confirmation, despite not having the opportunity to ask
questions formally in the Committee, was the fact that we had
met earlier, and you had addressed some of my concerns in your
opening statement.
But I do think it is important for purposes of getting it
in the record just to indicate the nature of the concerns that
we have. As I stated, there has been a series of Chicago Sun-
Times articles that I would ask unanimous consent to place into
the record that indicate that there are wide regional
disparities with respect to disability benefits paid to our
disabled veterans. Illinois is doing particularly poorly,
ranking 50th, although I would note that Colorado is not
better. It, I think, ranks 44th. And these are not modest
discrepancies; as I indicated from the chart earlier, these are
discrepancies that go into the thousands of dollars.
Chairman Craig. [Presiding]. Without objection.
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Senator Obama. I know that when we met, I stated that I
recognize this is something that you are just now getting
yourself familiar with, but I did want to just for purposes of
the record find out from you, based on what you know so far,
have you discerned any reason as to why Illinois veterans are
virtually last in the Nation in terms of average disability
benefits? Can you think of any reason why the disparities in
average disability benefits is so wide nationwide?
And finally, I would just ask whether--I know that
Secretary Principi, acting on a request from the Illinois
delegation, has ordered the Inspector General to look into this
problem. I am wondering whether there are any preliminary
findings. My staff tells me the study may take four months, and
I am just wondering whether there is some mechanism to speed
that up.
Mr. Nicholson. Thank you for that question and for the time
that we had together in your office, Senator.
This was a problem of first impression for me in my
learning curve, and it is beguiling. The answer to your
question about do I have any preliminary notions about why this
is occurring is that I do not. I have met with the Inspector
General to discuss this to see if he had any preliminary ideas,
and he said that he did not yet either. I have talked to
several members of the senior leadership of the VA about this,
and there are things that you can conjure about it. I mean,
there seems to be some correlations between median incomes and
even housing density, for some reason, and I do not know why,
but that does seem to correlate somewhat. Where people are
living in more spread out and sparse environments, those
benefits seem higher.
So I would only--I do not even have a good basis to
speculate. I know the concern, I share it, and we need to find
out why this is happening and then see what we can and should
do about it. And I look forward to working with you on that,
because it is a real issue.
Senator Obama. Mr. Chairman, I think my timer started all
over again, and I would love to have another 5 minutes, but I
want to be fair to the other Members of the Committee.
Chairman Craig. I am observant of the time. You do not have
another 5 in this round, but you do have time for another
question if you would like to ask one.
Senator Obama. Well, I do have another question.
Chairman Craig. Please proceed.
Senator Obama. And I may, you know, after this question
have one more.
Chairman Craig. Sure.
Senator Obama. Although I am happy to wait for a second
round, if that is possible.
Chairman Craig. Very fine.
Senator Obama. But one of the speculations in the articles
and discussions with veterans that I have had on this issue is
that the raters in Illinois, and there seems to be some
correlation with the Midwest having lower payments than in
other parts of the country, that the raters in some fashion are
either trained differently or incentivized differently in terms
of their evaluations of claims. And I recognize you are still
trying to figure out what causes this specific disparity.
I would ask a broader question, and that is how
standardized are the ratings procedures that are taking place
in these various regional offices, and what kinds of incentives
are we creating for raters? Are they being rewarded, which is
the suspicion, sadly, of some of the veterans that they are
being rewarded for turning down claims as opposed to being
rewarded for being accurate and just and hopefully generous in
terms of making decisions?
Mr. Nicholson. As to the training, that is something that I
am asking myself, is that, you know, how uniform and consistent
is the training, the preparation of these adjudicators? And I
think that there, also, is a fertile area for us to look at to
ensure that it is.
I also read the reports of your town hall meeting in
Illinois last week, Senator, and read where there was a
statement about incentives for people turning down claimants. I
am not aware that that exists, but that is something I also
will find out. This is a high priority for me, if confirmed, to
really get our arms around this. That is, to me, a surprisingly
big disparity in our country.
Chairman Craig. Thank you, Senator.
Now, let me turn to our colleague, Senator Burr.
Senator Burr. Ambassador, once again, welcome. I think that
every member of this institution probably has the health care
of veterans at the top of their list of concerns. It is of
mine, and I know it is of Senator Jeffords.
It is disturbing to see the long lines. It is disturbing to
see the amount, the length of the waits by individuals that are
following the process that the VA sets up. This is not a case
where we do not have a set of procedures that are in place. The
fact is that we do. In Charlotte, North Carolina today, for a
veteran to see a primary care physician, it is a two to three
month process. That is unacceptable. It would be in any realm
of health care, and I realize that health care is still
evolving, and thank goodness, it is, because of the advances
that take place.
My question specifically to you and if you cannot answer
it, if you would jot it down to check into as you take over is:
are the funds following the migration of veterans? In the
South, we have seen a growth in the veteran population. Are, in
fact, the dollars that are devoted to veterans' health care
following those individuals from region to region if they
relocate? Do we have the correct amount of dollars? I am sure
we all know the answer to that is we do not, and we will
continue to be challenged as it relates to health care dollars.
And how can the Department of Veterans Affairs more quickly
and efficiently adjust the VA funding formula to get funds
where they are most needed and where they can do the most good?
Mr. Nicholson. Senator, let me start by answering your
question in a general way: I think the VA has done a very
commendable job in recent years in transitioning from a
hospital-based medical care system to an outreach, to a
community-based outreach clinical system. There have been
several hundred new clinics brought on line to try to get
closer to where veterans are.
There is this whole comprehensive CARES process that has
been evolved, which is, you know, the Capital Asset Review for
Enhanced Services, and it takes into account the demographic
shifts of our country, where when most of the hospitals were
built, they were built where the people then lived after World
War II, and that is the vintage of the hospitals; they average
over 50 years old.
That has changed, and people now are moving south, and they
are moving west and southwest, and that CARES process took a
look at that to see what responses ought to be needed for the
delivery of care where the veterans are. That is ongoing. I
think that is something that, you know, will have my obvious
priority management attention.
But we are still in need of more primary care clinics so
that we can cut these waits and get out there where the
veterans are and be convenient to veterans. We have the same
goal, of course, for the cemetery system, so that people do
not--so that this system is accessible.
Is there enough money to do this? I cannot address that
with you this morning specifically, but that certainly is a
goal of the agency is to continue to push those community-based
clinics out there to be available, to cut waiting times, and
then, you know, be there if they need referrals for more
specialized medical care into a bigger, secondary, tertiary
facility.
Senator Burr. Let me say publicly that Secretary Principi
did a wonderful job during his leadership at the Veterans
Administration. My concern is that possibly, those dollars do
not shift as quickly as the population does, and certainly,
within this institution, we know how hard it is to move
dollars, but secondly that there may be a culture that accepts
two to three months as acceptable, and I hope you will very
quickly try to change that cultural problem if, in fact, it
exists within the Veterans Administration.
I thank you for your testimony today. Congratulations on
the vote, and Mr. Chairman, I yield back.
Chairman Craig. Senator Burr, thank you very much.
Senator Rockefeller and Senator Hutchison, Mr. Ambassador,
have had to leave us. They apologize through me to you. It does
not in any way reflect their intensity or their interest in
your tenure and in the activity of the Veterans Administration.
We will submit their questions for you so that you can respond
to them in writing, so they will become a part of the record.
You will have those to deal with, I would hope, in an expedited
fashion.
Now, let me turn to our colleague from Colorado, Senator
Salazar. Ken.
Senator Salazar. Thank you, Senator Craig.
Ambassador Nicholson, this question is a simple yes or no.
Over the weekend, Secretary Principi actually spent all of
Friday night getting to Denver for a very early morning meeting
to try to move forward with what I believe is going to be a
state-of-the-art medical facility for veterans that will help
us take care of veterans and also research the issues around
medical care for veterans. Will you be as supportive as
Secretary Principi has been of that project as we move forward?
Mr. Nicholson. Yes.
Senator Salazar. That is all I need.
Mr. Nicholson. Possibly more.
Senator Salazar. Good.
Mr. Nicholson. If that is possible.
Senator Salazar. Secondly, in Colorado as well as across
the country, I think one of the major problems that we all face
is the backlog in terms of claims processing. I think 4 years
ago, according to my information, there were approximately
400,000 claims that were awaiting processing for disability
compensation. Today, that number has grown to 470,000. I do not
know the reason why that number has grown, but do you have any
thoughts on it, and is it something you could look into for
this Committee?
Mr. Nicholson. Yes, sir, it is an important question. In
looking at that as I have done, actually, got those--the number
of those claimants to dip through a real mobilized effort, but
what has now happened is that they have gone back up, and one
of the reasons for that is it takes a certain amount of time to
process and adjudicate a claim.
What is now happening is that they are finding that a
claimant has an average, now, of eight different parts to his
or her claim. So the claims have gotten much more complex and
perforce takes much more time. And that is probably a reality,
which means that we are going to have to figure out how to
adjust to that resourcewise, adjudicators, in ways that we will
have to deal with so that we can once again try to cut that
backlog way down.
Senator Salazar. That is something that you will work on?
Mr. Nicholson. Yes, I will. I am well aware of that
problem. I have had a lot of discussions in the time that I
have, you know, been working with the Department to get up to
speed, and they share that commitment. You have my commitment
that we will work hard on that.
Senator Salazar. Ambassador, a question on prescription
drugs. A veteran who now has a prescription filled out by a
private doctor cannot use the VA prescription drug benefit
unless, as I understand it, he goes to a VA physician and gets
the prescription reviewed and then authorized. The Department
of Justice, as I understand, last year, in the last several
years issued an opinion to the Secretary of Veterans Affairs
saying that he did have the authority to go ahead and waive
that and to allow the prescription drug benefit to be used
whenever you have a private physician that has already issued
the prescription.
Is that something that you are aware of, and is it
something you would be willing to work on to try to implement
with this authority that the Department of Justice now has
found that you have as Secretary or will have as Secretary
soon?
Mr. Nicholson. Yes, Senator, it is. I am aware of that
problem, that issue, and I am also aware that the Secretary has
waived that at least once, maybe twice. Where the waiting was
so long, he exercised that discretion that he had. And what the
factual basis for that was, I could not comment on, but I know
the principle, and I share the concern about it.
I mean, there are a lot of important policy implications
around that, because, you know, doctors who are professionals
that we have in the VA, and I think we have some of the very
best in the world, like to not just have somebody come, you
know, and get the prescription, so to speak, but to have them
in their medical portfolio, so that they know exactly what
their condition is and can treat them comprehensively. And that
is part of the balance against just having them, you know, just
come to your pharmacy and get a prescription. And I plan to
look into that carefully.
Senator Salazar. Thank you, Ambassador.
Mr. Chairman, I have several other questions, but for the
sake of the Committee's time and Ambassador Nicholson's time,
what I would like to do is to have those questions submitted to
the record, and then, Ambassador Nicholson, if you would
respond to us in writing on down the road soon, I would
appreciate it.
Mr. Nicholson. I would be happy to.
Chairman Craig. Senator, thank you very much. There are a
number of Senators who are going to do, and have done, just
that, and all of the questions that you will ask of the nominee
will be submitted to him. We will ask for a prompt return so
that the nominee's answers can become part of the record. That
is a valuable part of that.
Let me turn to Senator Jeffords. Do you have any further
questions, Jim?
Senator Jeffords. I have about two.
Chairman Craig. Please proceed.
Senator Jeffords. Ambassador Nicholson, the VA has received
significant recognition for its outcome----
Chairman Craig. Jim, is your mike on? Thank you.
Senator Jeffords. The VA has received wide acclamation for
both its ability to monitor outcomes and for its performance.
Compared to the private sector and Medicare at the same time,
private sector and Medicare co-pays are increasing, and
prescription drug coverage remains generally poor.
Many veterans can choose between VA and non-VA care. This
is particularly true in Medicare-eligible veterans. Current
budgeting for VA health care costs is based primarily on past
use, but is the VA considering the possibility that VA usage
may increase from a less-likely sector, the veterans who have
recently relied solely on Medicare? Will you give special
attention to this factor in drawing up your budget
recommendations in the future?
Mr. Nicholson. Yes, Senator, we will. We must try to make
the best projections that we can to develop our budgets and
thus request the resources that we think are going to be
needed. There has been a large increase in requests for VA
Medical care, as you well know, since 2001. It has gone up by a
huge delta. And again, I think the agency's response to that
has been very laudatory. And as far as I know, and there is a
lot that I need to know more about this, that we could expect
that increase to continue, and we have to be prepared for that.
Senator Jeffords. As you know, the VA has been experiencing
difficulty hiring certain types of jobs, ranging from the most
specialized physicians all the way to cleaning and housekeeping
staff. Part of this difficulty comes from some unintended
consequences of locality pay. Locality pay is intended to
ensure that VA workers are paid a wage that represents roughly
an equal standard of living in different parts of the country.
However, locality pay has created real problems for the VA
in certain areas. For instance, experienced nurses at the VA
Hospital in White River Junction, Vermont are paid 20 percent
less than nurses just 8 miles away across the river in Hanover,
New Hampshire. Are you willing to examine the effects of the
Federal locality pay structure in the VA and consider
increasing VA pay where necessary to prevent shortchanging of
employees?
Mr. Nicholson. Yes, Senator, I am very willing to look into
that. I have not; that has not come to my attention yet in my
preparation for this job. I was unaware of what you just
stated. But I certainly will look into it and see what I think
should be done about it, because retention and recruitment are
very big issues.
I was reading a report yesterday, the Veterans
Administration has 47,000 people in its professional nursing
services, which is registered nurses and practical nurses and
nurse assistants, and we have, as we all know, a nursing
shortage in this country, and we need to be at our best to
recruit and retain nurses and all other people on this team.
Senator Jeffords. With that excellent answer, I will
retreat.
Chairman Craig. Senator, thank you very much.
Now, let me turn to Senator Akaka.
Senator Akaka. Thank you, Mr. Chairman.
Mr. Ambassador, as a follow up to my previous question on
seamless transition, I would like you to commit to working with
me and any other Members who are interested towards making sure
that our new veterans are able to receive the care and the
services they need and are made aware of the services and
benefits available to them.
You mentioned in our prior chat that you will be improving
the system by which servicemembers are made aware of services
and benefits available to them.
I want to make a statement prior to moving on to my next
question. I urge you to look strongly at the makeup of the VA
health care system. Nearly 2.5 million middle-income veterans
are coming to VA for care. They pay co-payments, and nearly 90
percent bring their health insurance coverage with them. The
cost of treating these veterans is the lowest of all patients
seen by VA, and I believe we can care for our core constituency
and still meet the health care needs of other veterans who have
earned VA care.
I want to comment to Senator Salazar that you will be
pleased to know that today, with Senator Reid, I will be
introducing legislation to allow veterans to bring their
outside prescriptions to VA. If you are interested, please talk
to me later.
Mr. Ambassador, VA's drug purchasing and negotiations have
yielded incredible savings for the Federal Government and also
for veterans. For example, VA uses the Federal supply schedule
to buy Zoloft, a medication for depression, at nearly half the
price of retail outlets, and I assume you will not be inclined
to reduce the vitality of negotiations. Given the incredible
success of the VA drug purchasing program, do you believe that
the Federal Government should do more in other areas?
Mr. Nicholson. First of all, I would say, Senator, that I
believe in the old management theorem of, you know, if it ain't
broke, don't fix it, and the VA's drug purchase program
certainly is not broke. So I would just like to salute those
who have gone before me, if I am able to follow, and what they
have done, because it is extraordinary.
The question of whether that could be replicated in the
rest of the Federal Government is a good question, and I, at
this moment, I do not feel qualified to give you a good answer.
I would be very happy to pursue it, work with you, stay in
touch to see what I end up thinking about that, but I do not
think I can give you a good answer.
Senator Akaka. Thank you. Certainly, we will be willing to
work with you on that.
Mr. Ambassador, VA's specialized services are one of the
jewels of the VA health care system. Yet, for years, we have
received complaints that VA managers are foregoing their
responsibility to maintain a high level of specialized
services. For example, maintaining the level of psychiatric
care has remained a problem.
In general, I am looking for a commitment that specialized
services, especially mental health care, will be different
under your administration. What assurances can you give that
this will be so?
Mr. Nicholson. The assurance that I can give you right now,
Senator Akaka, is that I will take a look at that right away,
because I am not aware of that problem that you have described.
I know the VA is working with, I think, 107 different academic
medical institutions to benefit from the cross-training that
both medical students, residents, get from that, and I am
unaware that the specialized care is suffering. I thought that
it, in fact, was benefiting from that academic collaboration
that is going on. But it is something that I will certainly
look at.
Senator Akaka. Thank you, Mr. Chairman. My time has
expired.
Chairman Craig. Thank you.
Mr. Ambassador, Senator Akaka talked about two areas that
are of concern to me. I had the privilege the week-before-last
of going to the Veterans Hospital in Spokane, Washington, a
facility that both Senator Murray and I share equally, and it
services both north Idaho, parts of Montana and the State of
Washington. And there, I saw this prescription drug process in
action. And what I found very unique is that while people
oftentimes arrive there to get their prescriptions filled, they
are sent out from a center in California, and they are at the
veteran's doorstep in 24 hours; tremendously automated; very,
very effective and cost-saving, and I agree that that part of
the Veterans Administration appears at this moment to be
tremendously efficient.
There is something about seamlessness that concerns me,
though, and it is a new phenomenon that we are engaged in in
this country that is something that I will address as Chairman
and something that I think concerns a good many of us. Idaho is
a perfect example of a lot of States today who are deploying
their Guard and their Reserves in unprecedented numbers into
active duty. The State of Idaho, at one point, 2 million
people, and I think Senator Thune referenced that in his
questioning as a percentage of total population, has about
2,500 in service now as Guard and Reserves that have just been
deployed to Iraq; the Army National Guard's 116th Cavalry
Brigade Combat Team.
Here is my concern: veterans' programs were designed for
the most part to facilitate the transition of active duty
troops out of service and back into civilian life and not to
facilitate the movement of Reserves and Guard personnel into
and out of active duty versus Reserve roles. Do you think
veterans' programs need to be reassessed in light of an
increasing movement of Reserves and Guard personnel into and
out of--and sometimes back into--active duty roles? Do VA
programs reflect the perhaps-dated view that persons are either
in or out of service, and once they have finished with active
duty, they are finished for good? Do we need to rethink
programs to account for the needs of Guard and Reserve
personnel who are asked to shift into and out of, and sometimes
back into and then oftentimes out of, active duty?
It is increasingly the case in the current situation we are
now in and one that I know the Defense Department is attempting
to address in a variety of ways, and it is something that I
believe that we may want to review pretty thoroughly. Your
reaction?
Mr. Nicholson. I think it is a very important subject area,
and I agree with you. I think that probably because of custom,
I mean, it is quite unusual what is going on now with the
deployment into war zones for, you know, long periods of time
for Guard and reservists.
Chairman Craig. This Guard unit will be expected to be
there for at least 18 months.
Mr. Nicholson. So, you know, we are looking at really kind
of a de novo situation over the last several decades at least
in our country, and we do need to adjust the systems to make
sure that these people who have gone there and have served are
treated exactly the same. And that is underway, I will tell
you. I mean, there is that shared commitment both at DoD and at
VA.
What needs to still be perfected is the system, so that
people do not get away from it, because many of these young
people cannot wait to get home and get back to their jobs and
their families, and they do not know about, or they do not
think about VA and the screening and the education that should
precede that, and that is underway and very important. And the
program, the benefits, I think, are good. You know, they are
working very hard giving the families Tri-Care while they are
away, making sure that the families know what they are entitled
to, and then, the VA gives any veteran returning from one of
those calls to duty 2 years of its services.
It is there; what is needed is to make sure that everybody
knows it and makes use of it.
Chairman Craig. We will follow up with you to make sure
that we work forward on that and that that process is completed
so that that knowledge is available, and services are
accessible.
Let me turn to my colleague, Senator Thune, questions of
the ambassador.
Senator Thune. Thank you, Mr. Chairman, and again, I
appreciate your testimony and your dedication to this important
mission. I know that there have been some questions asked in my
absence about some of the issues I was concerned with, one with
respect to the CARES Commission, and I also know that there
really are not any of these problems that probably cannot be
fixed with more money, and that is the challenge that we face
up here and that you will face in the job as well is most of
the issues, in many cases, at least, the issues that are
brought to me by the veteran community in my State of South
Dakota are funding issues. And that clearly is one of the
issues that we are going to have to grapple with, but I am also
interested in working with you on ways that we can make our
dollars go further and ways that we can become more efficient.
But I also have a specific interest, having said that and
talked about some of the challenges and problems that you face
that sometimes can only be solved by money; as I referred to
earlier, in access in rural areas, in your testimony, and I
believe this to be true, that with the community-based
outpatient clinics, which have been extremely successful in
rural areas like South Dakota, you said that 87 percent of
veterans now have access to a VA facility that is within 30
minutes.
And in South Dakota, they have to be driving awfully fast,
I think, to be able to get there in 30 minutes in a lot of
places, but I know there are places not unlike South Dakota,
other regions of the country that are very rural, very remote,
and where veterans still have to drive sometimes hundreds of
miles to get to a facility.
And there are some things that have been proposed to
address that. In some cases, veterans who have need for a
simple test that could be performed in a local clinic in their
own community, and I guess I am wondering if that is something
that you would consider establishing, and that is improved
access to a local clinic.
Congressman Osborne, a former colleague of mine on the
House side, introduced a bill that would have earmarked 5
percent of VA funding to contract with rural civilian health
facilities to provide services locally, and I understand that
the VA has opposed that sort of mandatory approach, but I guess
I am wondering if there is a less restrictive solution that you
might support that would allow veterans to have access to some
of these facilities, which are, in many cases, considerably
closer and more convenient than the distances they have to
travel in rural areas?
Mr. Nicholson. The answer is yes, Senator Thune. I believe
I am correct in saying that some of that is now happening, that
there are cases where they are engaging, on a contract basis,
local doctors to take care of veterans who are too distant from
a VA facility or a VA clinic or who cannot adequately be
serviced with telemedicine, which is really, now, coming into
its own, and the VA, I think, again, is on the forefront in the
innovations of the use of that.
And I have been learning examples of where they monitor
people's blood sugar and their heart rate and their temperature
electronically remotely every day, and we have equipped people,
we have allowed them to stay in their homes, and instead of
institutionalizing them in a long-term care facility, they stay
at home; there is a camera on both ends, and people talk to
each other, and that has got great potential to mitigate part
of that. And I will look into the use of local contractors
more, but I think some of that is happening.
Senator Thune. I appreciate that, and I do want to pick up
on one thing that you mentioned, because I really believe that,
and I have seen the examples of this in the State of South
Dakota, where telemedicine is doing some wonderful things, and
I hope that is something that can be further employed with the
VA. I worked as a Member of the House on some changes in the
Medicare program that will make it more possible for facilities
in rural areas to be able to have access to many of the
benefits of technology: teleradiology, a lot of diagnostic type
things can be done from a distance now. And with the technology
that exists and is available, we certainly want to employ that,
and particularly if it is a way that we can achieve cost-
savings, and I would suspect that there are a number of ways
where, if veterans had access to some of the technology that is
available in health care today and could be served in that
fashion, we might be able to achieve some cost-savings as well.
So I appreciate your interest in working with us on that.
As I said earlier, I am delighted that you are going to be in
the position. I think you are going to be a wonderful person
with tremendous experience and compassion for the veteran
community, and we look forward to working with you.
Thank you, Mr. Chairman.
Chairman Craig. Thank you, Senator.
Senator Obama, further questions?
Senator Obama. Thank you, Mr. Chairman.
Ambassador, I just want to revisit a couple of issues that
we discussed earlier. The first, I guess, is I was not clear
with respect to the investigation that you intend to be engaged
in that the Inspector General has already started on this
disabilities disparity, when, exactly, we can start getting
some sort of report, and I was wondering if you had some date
that when I go back to Illinois and talk to veterans, I can say
as of this time, I think we will at least have the initial
assessment in terms of what is going on.
Mr. Nicholson. I wish I could give you that, Senator Obama,
but I cannot. I asked that same question myself of the
Inspector General.
Senator Obama. Okay.
Mr. Nicholson. And he said he could not, would not project
that.
They are working on it with intensity, and we, if I am
confirmed and take over the VA, are going to review where his
work is and then see what, you know, if we should be doing
something independently of this, put a team together to look at
this.
I discussed this a great deal with our very able head of
the Veterans Benefits Administration, Admiral Cooper. He shares
the concern over this and sort of the puzzlement about why this
is happening to that degree, but we don't know. I can just tell
you that we will stay in close touch, and we will be working on
it.
Senator Obama. Let me say this: I have no doubt that you
are concerned about it, and I think that there are going to be
other people that are concerned about this. My concern is that
you have got a full plate coming into this thing. I mean, the
issues that were just raised, I thought the Chairman raised an
excellent point about Guardsmen and Reservists and how you have
to rethink the role there, because as I travel throughout the
State of Illinois, we get the same thing, that the lines are
now blurred between active duty and our citizen-soldiers. The
point that Senator Thune raised about travel times, you know,
believe it or not, in Illinois, we have got some folks who have
to drive a lot, too, and are experiencing the same issues.
So you are going to have a lot of things coming at you, and
I guess my concern is that without some timetable, this can get
lost. And I should note that even in the Sun-Times article, for
example, you have got quotes from senior analysts in
headquarters here in Washington that say things like the folks
who do the adjudication in Chicago are pretty tough; folks
there really look at everything with a jaundiced eye, and they
are rather stringent in their application.
So, I mean, there are people in your offices that have
opinions about why this is occurring, and if the Inspector
General cannot give us a date certain, then, I guess I would be
interested in whether there was some team that could be put
together, you know, so that I can provide some certainty to the
folks back home.
Mr. Nicholson. I understand exactly what you want and why,
and I am sympathetic to it. I can only say that we will get on
it, and I will make a decision about whether I think there is
some independent group that should come together to look at it
or wait for the IG, and as soon as I can give you some
projection of time, I will do so, Senator.
Senator Obama. Okay. Fair enough. Not to belabor the point,
because I only have a minute left on this round: one issue that
does seem to be coming up is the fact that there may be a
shortage of personnel in these offices. You know, it appears at
least that just to give an example, during the past 2 years,
the number of claims filed for service connection and the
numbers of issues per case have increased; you have already
noted that.
My understanding, at least, is that the Administration has
proposed decreasing the number of employees available to
adjudicate claims. As of December 31, 2004, there were 48 fewer
adjudication employees in the VA regional offices than there
were on September 30, 2004. So given what we expect to be a
significant influx of claims being made, partly as a
consequence of great medical care in the field, one of the
results of that is more disabled veterans making claims. I am
wondering whether, in fact, we are reducing or even just
maintaining, keeping constant, the number of people evaluating
claims and what you intend to do to make sure that these
numbers are sufficient to meet the demand.
Mr. Nicholson. The time that it is taking for these claims
to be filed and adjudicated bothers me. It seems to take a long
time, and so, I have a goal to see if we can shorten it. As to
the number of adjudicators, I think that they did go down, but
the agency was then able to transfer, I think, some fiscal 2004
money into this budget cycle so that we are now hiring some
more adjudicators, and the net result of that should be we
should have more. And I am not speaking specifically to your
case there, you know, in Chicago, Illinois----
Senator Obama. No problem.
Mr. Nicholson.----but across the system.
Chairman Craig. Senator, thank you.
Senator Jeffords, further questions?
Senator Jeffords. Mr. Chairman, I ask unanimous consent
that I may change my vote from nothing to yea.
Chairman Craig. I appreciate that. The Committee does, and
it will so dutifully be noted without objection.
Thank you.
Senator Akaka. Mr. Chairman.
Chairman Craig. Senator Akaka, further questions?
Senator Akaka. This is my final question, and I would ask
that my other questions be placed in the record.
Mr. Ambassador, each year, the Administration sends its
budget proposal to Congress with the expectation that Congress
will improve upon it. We have had some success in doing just
that, but I believe we can do better for our veterans. I would
like to start the process more rationally. What are your
thoughts on the current budget process for VA health care? Do
you agree there is room for improvement?
Mr. Nicholson. I am going to respond to that based on my
general awareness, Senator, of the budget process and say that
yes, I think we collectively could improve on the process by
seeing if we could get budgets done and not have to use
continuing resolutions so that we could get more certainty into
the Executive agencies, the departments of the Government, so
they know where they are, and they can project their work load,
know what their capacity is going to be. So that categorically,
I would say yes.
As to the specifics of the Veterans Administration and its
budget formulation, I do not feel qualified to give you an
answer on that at this point. I have not had that experience
yet.
Senator Akaka. Yes, well, another question, and it may fall
into the same category: I was going to ask you whether you have
had a chance to become familiar with the proposals to fully
fund VA health care by shifting at least some of the funding to
a mandatory account. If you have an idea about that, will you
please express it?
Mr. Nicholson. I have had an opportunity to have a
discussion with people about that, and what I believe at this
point is that given the mission of the VA and that where you
get these exigent conditions, like we have with a war, and the
load that comes from that and the intense and expensive care
that comes from having to do right by those people that are
injured and disabled, diseased as a result of that that having
the flexibility that the VA now has in the health care area is
a plus for them.
It allows them to meet some of these specific demands, and
thus, the present system which supports that seems good to me
categorically.
Senator Akaka. Well, I thank you, Ambassador, for your
responses. I want to wish you well in your administration.
Mr. Nicholson. Thank you.
Senator Akaka. And Mr. Chairman, I submit the rest of my
questions for the record.
Chairman Craig. Thank you, Senator, for doing that.
I will also submit the balance of my questions for the
record.
Do any of our colleagues have further questions?
Senator Thune.
Senator Thune. Mr. Chairman, I also would do that. I have
some questions I would like to have answered for the record.
Chairman Craig. All right. Without objection.
Senator Obama.
Senator Obama. Mr. Chairman, I do have a number of
questions I would like to submit.
Chairman Craig. Good.
Senator Obama. And I will follow suit, but there are just
three points I think that can be dispatched within 5 minutes
that I would like to complete here in the hearing if that is
all right.
Chairman Craig. Please proceed.
Senator Obama. One issue that has come up fairly
frequently, Ambassador, is the issue of back pay for
disabilities. I mean, it seems to be a particular problem where
you have a veteran who goes in, gets evaluated, the initial
evaluation says 10 percent disability. He continues to pursue
his claim. Perhaps two or three years later, there is an
evaluation that, in fact, he was deserving of 70 or 80 percent.
And one of the questions I guess I have is that--and I am not
sure whether you know the answer to this--where there is an
adjustment of that sort? Is that veteran then entitled to back
pay or retroactive benefits given the second opinion that was
rendered?
Mr. Nicholson. I am not sure I know the answer either,
Senator. Is your question that when they looked at the veteran
the second time, and they found him to be 70 percent that they
also found that he should have been adjudicated 70 percent when
it was 10?
Senator Obama. Right; this would not be a situation where
there would have been a deterioration of his condition, but
rather, simply, it turns out that there was a different
assessment that was made.
Mr. Nicholson. I do not know the answer. That is a good
question, and it also leads to what his appeal rights might be
about that.
Senator Obama. Right.
Mr. Nicholson. I will look into that and learn from the
answer and provide it to you.
Senator Obama. Okay; the second question I have really has
to do with the whole issue of mental health and post-traumatic
stress disorder that has already been discussed. Right now, are
there plans to expand the resources available for those
purposes, and if so at what point, would this Committee sort of
get a sense of how that is being structured?
Mr. Nicholson. There are plans to expand that in
anticipation of the needs of returnees from Operation Iraqi
Freedom and Operation Enduring Freedom. I would think that--I
guess the first time probably, I mean, we can always talk about
it soon, but the 2006 budget also will encompass that.
Senator Obama. Should reflect some of those.
Mr. Nicholson. Yes, and should have what the agency has in
their----
Senator Obama. Okay; and just the final point that I would
make, and this circles back to this broader concern that I have
expressed about disparities, regional disparities.
If it turns out that there does appear to be a problem with
the raters and how they are trained and the lack of
standardization, I guess part of what I would very much be
interested in would be to see some sort of third-party reviewer
to come in and assess these claims and to think about how we
create the same system across the board. I mean, I am new to
this Committee, but one thing that I am absolutely certain of
and that is that if a veteran has lost a leg and lives in
Illinois, they should get the same disability as a veteran who
lost his leg and lives in Puerto Rico. I mean, that seems to me
an unassailable statement.
And so, one of the commitments that I am going to have is
if it turns out that the raters need some sort of additional
training, it may also be necessary that we have some sort of
third-party reviewers or somebody from the Washington office
that starts overseeing some of this work until it gets smoothed
out.
Mr. Nicholson. I think that is a very insightful question,
Senator. I will tell you that the VA does send people around to
do an independent review of adjudications, and I have looked
into that with respect to Illinois, and for some reason, they
seem to have been found to have been pretty accurate and pretty
consistent.
Senator Obama. I am just curious: is it consistent
internally in the sense that they are uniformly stingy with all
of the--I mean, I do not mean to be sarcastic, but I guess----
Mr. Nicholson. That is not the meaning of the way I used
it. This person had this set of conditions, and they were
adjudicated thusly and that was being done consistently in the
findings of--because it is sort of an ombudsman function that
the VA does do, just to run a check on how these people are
doing. So that has not shed any light yet, but as I said in my
opening statement about this, there are two parts: we have got
to get to the bottom of it and then figure out what to do about
it. And you have my commitment on both of those.
Senator Obama. Right. Okay. I appreciate your commitment.
Mr. Chairman, I appreciate you devoting this time to an
issue that is very important to my folks.
And finally, I want to thank you, Ambassador. I know that
before this hearing, you had made a commitment that once we had
some answers, you would be willing to come to Illinois to
discuss them directly with veterans. I appreciate that
commitment, and I wish you all the best of luck in your
service.
Mr. Nicholson. Thank you.
Chairman Craig. Well, Senator Obama, let me thank you, and
obviously, this is an issue of great importance to you. It is
an issue of great importance to this Committee. As this issue
matures, and we are able to assess facts, it sounds like the
ideal kind of issue that would deserve some oversight of this
Committee, and I pledge to you we will do that in cooperation,
also, with the Secretary to make sure that happens.
Senator Obama. Thank you, Mr. Chairman.
[The prepared statement of Mr. Nicholson follows:]
Prepared Statement of R. James ``Jim'' Nicholson, Nominee for
Secretary, Department of Veterans Affairs
Good morning, Mr. Chairman, and Members of the Committee.
I want to thank you for the opportunity to appear before you so
early in the new Congress, and for the many other courtesies you and
your staffs have extended me. Your words and actions underscore your
commitment to the millions of veterans who look to the Department of
Veterans Affairs for the benefits and services they earned--benefits
and services that our Nation is pledged to gratefully give them.
Let me congratulate you, Senator Craig, and Senator Akaka on your,
election to Chairman and Ranking Member, respectively, of this
Committee, which oversees the department of our government with the
largest civilian workforce, and with one of our highest priorities, to
deliver first class, timely medical care and benefits for our veterans;
Your selections speak volumes about your colleagues' confidence in your
commitment to America's veterans.
I am joined here today by my wife of 37 years, Suzanne. She has
always been at my side through thick and thin and I am very grateful to
her for her support to accept this honor and challenge from President
Bush to lead this great Department, if confirmed. I am also joined by
my son, Nick and his wife Charlotte who live here in the DC area. Our
other two children could not be here.
Service to our country is a long tradition in my family. My father
was an enlisted man in the Navy during WWII. My father-in-law served in
both WWII and Korea. My brother, Brigadier General Jack Nicholson,
served 30 years in the Army and was, until now, the Under Secretary of
the VA for Memorial Affairs, where he did an outstanding job. One of my
sons is a veteran; four of my nephews are Colonels in the Army and Air
Force. My 30 years of active and Reserve service in the Army, coupled
with my four years at West Point, have defined my life. I love the
Armed Forces of our country-their courage, their integrity, their sense
of duty.
That is why I am so honored that President Bush selected me to
build upon his Administration's great record of care and compassion for
our Nation's veterans of our Armed Forces. And, if confirmed, it would
be a privilege for me to follow in the footsteps of Secretary Principi,
a man who has provided outstanding leadership and tireless dedication
to the welfare of this Nation's veterans.
I feel humbled that America's veterans--men and women who served on
the front lines for freedom, justice, and peace in democracy's name--
might look to me as the faithful steward of their trust, and the leader
of VA's 230,000 employees who work so diligently, around the clock, to
assure our veterans that we are making good on the Nation's debt to her
defenders.
Mr. Chairman, I come from the heartland of this great Nation--
Iowa--from a boyhood life so far removed from this historic and stately
temple of liberty that Washington was barely a dream. It was a
hardscrabble life, to be sure, but my family of seven kids was filled
by my mom with hope and confidence. She used to say to us, ``if you
will work hard, study hard and pray hard, you can be a success in
America, you can have legitimate dreams of a better life and make them
come true.''
As a teenager, I remember watching young men go of to the Korean
War, following in the wake of World War II--yet another test of
freedom's will to defeat an inhumane and evil tyranny. Yet another
answered call by our countrymen to go of to a frozen peninsula that we
had never heard of, because their country asked them to go. One of the
brothers of a pal of mine never returned. One of my best friends
slightly older than I left his leg over there. He also was my first
introduction to the VA as they wanted to get his prosthesis right. Now,
again, we are at war, and again our country is asking our men and women
in uniform, all volunteers, to go to the sound of the bugle.
Those friends and neighbors who stood tall for freedom 50 years ago
are now among our most distinguished veterans, and today's heroes will
soon join them. I will, if this Committee so entrusts me, be proud to
lead the Department dedicated exclusively to honoring their service and
sacrifices, to making good on our country's promises to them.
I have had the privilege of wearing the uniform of the United
States Army in combat, so I have seen both the horrors of war and the
heroes of America making the greatest sacrifices of military service on
behalf of their comrades and our Nation.
One cannot leave a battlefield without having profound respect for
the courage and cool of all who have served there. One cannot
appreciate all the blessings of our freedom without thanking the men
and women who serve in war to bring about peace. Their example of
unwavering commitment to their mission, no matter how dangerous and
uncomfortable, will always reverberate with me and readies me for a
mission of service to veterans. I will do my utmost to see that they
receive all they have earned, delivered with the dignity they also
deserve.
I do not underestimate the enormity of the responsibilities of
Secretary of Veterans Affairs. This Committee knows well that VA is the
second largest Cabinet department, operates the Nation's largest
integrated health-care system, and is relied upon by millions of
veterans, their dependents, and survivors, not only for health care,
but for billions of dollars in monetary benefits, life insurance,
education, mortgage insurance and readjustment benefits. The challenge
of leading such an organization is daunting, but I am prepared to
accept it.
If the Senate confirms my nomination, I will, without hesitation,
commit to upholding the following principles:
<bullet> Veterans should have access to the best-available health
care, in the ``most appropriate clinical settings, delivered in a
timely manner by caring, compassionate clinicians. And,
<bullet> Veterans, their eligible dependents and survivors are
entitled to prompt, accurate, equitable and understandable decisions on
their claims for benefits. And,
<bullet> Veterans should be appropriately honored in death for
their service and sacrifices on behalf of a grateful Nation.
Mr. Chairman, the manner in which VA supports the transition of
today's servicemembers into veterans, especially those who are injured
or become ill as a result of their service in combat areas, will define
the Department for them. If confirmed, I will ensure that VA and DoD
continue to work collaboratively to provide a seamless transition so
that returning servicemembers are timely provided the benefits and
services that will enable them to reclaim their rightful places as
citizens in our society.
I am aware of recently reported concerns of possible regional
variations in disability-compensation awards. Veterans' entitlement to
Federal benefits is the same regardless of where in this country they
may reside, and if confirmed, I will ensure that standardized training
and sound quality controls support a uniform approach to claims
adjudication. Further, to that point, I will, if confirmed, order a
prompt study into this whole question of equity and geographic
differences in benefits adjudication. No one that I have yet met knows
exactly why these differences occur the way they do, and we need to
understand this fully and then take remedial action, as appropriate.
Mr. Chairman, if the Senate will afford me the opportunity, I
pledge to work with this Committee and individual Members of both
houses for the betterment of veterans and their families. I will keep
you informed, I will listen to your concerns, and I will respect your
oversight responsibilities.
I understand that the success of the Department requires a strong
collaboration with the veterans' service organizations, who function
both as our ears to the ground on matters of service delivery and as
our partners in devising solutions to problems as they arise. If
confirmed, I will work closely with the VSOs so that I may both benefit
from their counsel and draw upon their willingness to serve their
comrades.
I am also deeply committed to earning the respect, trust, and
following of the men and women of VA who have made service to veterans
their life's calling. The VA workforce represents an enormous reservoir
of dedicated, committed talent that must be put to its best possible
use. I will hold myself and my leadership team accountable for ensuring
and harnessing our employees' best efforts. It will be my job and my
privilege to lead and harness this awesome force of talented people so
that all of us have the same focus--our veterans.
It is critical that we honor America's debt to those who have
served us so faithfully. When President Bush announced my nomination, I
quoted America's first Commander in Chief, George Washington, that
``[I]t is a debt of honor.''
And today, with so many American men and women in uniform stationed
around the globe, we give them heart when we keep faith with those who
have served before them. They have the right to know we will stand by
them as well in their time of need. This is also integral to our
Nation's ability to be able to continue to attract an all-volunteer
force willing to defend us anywhere, anytime.
The armed forces of our country are, in my opinion, the model for
what is good and great about America. They are a paragon of integrity;
they don't take, they give; they are disciplined, highly trained with a
love for their country. They are a unique force in the world and we
need to treat them uniquely well.
Our VA, under Secretary Principi, has made terrific strides in
serving our veterans. VA provides health care to 860,000 more veterans
than it did in 2001, has drastically reduced waiting times for health-
care appointments, and opened nearly a hundred new community-based
outpatient clinics so that 87 percent of the veteran population now
lives within 30 minutes of a VA medical facility. As a result of its
focus on excellence in health care, VA is now the proven benchmark in
preventive health-care quality and chronic disease management.
Since 2001, VA has also dramatically reduced its inventory of
pending claims for disability compensation, reduced average processing
time of those claims, and, at the same time, substantially improved the
quality of claims decisions. Moreover, in 2001, VA embarked upon the
largest expansion of the National Cemetery system since the Civil War.
When construction of all the new cemeteries is completed, VA will have
expanded the National Cemetery system by 85 percent. And, according to
the latest American Customers Satisfaction Index, the National Cemetery
Administration earned a rating of 98 out of 100--the best rating ever
earned by a federal agency.
I will, if confirmed, strive to move the Department to another
level by building on all that has been put in place and improving upon
those areas that remain a challenge. The VA is a great American
institution created and founded by a country that appreciates that
freedom isn't free, and our veterans' lives and limbs are the price
that is too often paid.
It falls on the Secretary of the VA, and the men and women he
leads, to keep faith with the expectations of all our fallen citizens
in uniform--past, present and future--expectations that they will be
cared for, as needed. This too is the mandate of the grateful people of
the U.S. I pledge to you, if confirmed by you, that I will do all in my
power to see that both the veterans and the citizens of our great
Nation are pleased by the service of their VA.
This concludes my remarks, Mr. Chairman.
______
Questionaire for Presidential Nominee
1. Name: Robert James Nicholson
2. Address: PSC 59, Box 66 APO AE 09624
3. Position to which nominated: Secretary of Department of Veterans
Affairs
4. Date of nomination: 1/05/05
5. Date of Birth: February 4, 1938
6. Place of Birth: Struble, Iowa
7. Marital Status: Married
8. Full name of spouse: Suzanne Marie Nicholson
9. Names and ages of children: Robert Jr., 35; Nicholas, 34;
Katherine, 27
10. Education: Institution, dates attended, degrees received, dates
of degrees; U.S. Military Academy, 1957-61, BS 1961; Columbia
University, 1966-69, MA 1969; University of Denver College of Law,
1970-72, JD 1972.
11. Honors and Awards: Imagio Dei Award, Archdiocese of Denver;
Nostra Aetate Award, The Center for Christian-Jewish Understanding at
Sacred Heart University; Honorary Doctorate in Civil Law, University of
Dallas; Honorary Doctorate of Public Service, John Cabot University;
Honorary Doctorate of Public Service, Regis University; Horatio Alger
Award Recipient; Man of the Year, Colorado Mortgage Lenders
Association; Investiture as Knight, Sovereign Military Order of Malta;
Home Builder of the Year, Homebuilders Association of Metropolitan
Denver; Distinguished Citizen of the Year, Colorado Association of
Homebuilders; Distinguished Citizen Award, Parker, Colorado; Who's Who
in American Politics; Pope John Paul II knighted Ambassador Nicholson
with the Grand Cross of the Order of Pius IX for his services as the
representative of the United States of America to the Holy See; Bronze
Star Medal; The Combat Infantry Badge; Meritorious Service Medal with
Oak Leaf Cluster; The Air Medal with Oak Leaf Cluster; The Vietnamese
Cross for Gallantry; Army Commendation Medal with Oak Leaf Cluster.
12. Memberships: 2002-Present: Member, Knights of the Constantinian
Military Order of St. George; 2001-Present, Member. Sovereign Military
Order of Malta; 1978-2001, Chairman of the Board and President,
Nicholson Enterprises, Inc.; 1991-2001, Chairman of the Board and
President, Rowley Downs Land Company; 1991-2001, Chairman of the Board
and President, The North Woodlands Company; 1991-2001, Managing
Partner, N-4 Associates Limited Partnership; 1991-2001, Chairman of the
Board and President, Renaissance Homes of Douglas County, Inc.; 1995-
1999, Chairman and President, Renaissance Homes of Colorado, Inc.;
1995-1999, Chairman and President, Renaissance Homes North, Inc.; 1995-
1999, Chairman and President, Renaissance Homes of Saddlebrook, Inc.;
1994-2001, Managing Partner, Parker Properties Joint Venture; 1986-
2001, Director, St. Mary's Land and Exploration Company (Board of
Directors); 1998-2001, Director, ITN Energy (Board of Directors); 1998-
2001, Director, Community Corrections Corporation (Board of Directors);
1986-2001, Partner, Casa Del Sol Partnership; 1996-2001, Limited
Member, Airport-Colfax, LLC; 1996-2001, Limited Member, GNMC Golf
Office; 1988-2001, Limited Member, Tubac Investors, LLC; 1973-2003,
Member, Colorado Bar Association; 1985-2001, Trustee, Nicholson
Enterprises, Inc. Foundation; 1996-2001, Development Manager, Matrix
Financial Services, Coyote Creek Development, Ft. Lupton, CO; 1989-
2001, Managing Partner, 20 Mile Associates; 1994-1999, Managing
Partner, Meridian Land Company; 1996-1997, Managing Partner, Phillips
Ranch Properties; 1976-1978, Partner, Calkins, Kramer, Grimishaw and
Harring Law Firm, Denver, CO; 1980-1996, Director, National Association
of Homebuilders for Metropolitan Denver; 1981-1985, Director, Colorado
Association of Homebuilders; 1995-1997, Director, Blue Cross/Blue
Shield of Colorado, Inc.; 1976-1999, Director, Lerch, Bates &
Associates, Inc.; 1990-1995, President, NTB Real Estate; 1997-2001,
Chairman, Republican National Committee; 1997-1998, Chairman,
Republican Task Force on Education (U.S. Senate, House, Governors and
RNC); 1997-2001, Vice Chairman, International Democratic Union; 1993-
1997, Vice Chairman, Republican National Committee; 1986-2001,
Republican National Committeeman for Colorado; 1993-1997, Chairman,
Republican National Committee Rules Committee; 1998, 1992 and 1996,
Delegate, Republican National Convention; 2000, Chairman, Republican
National Convention; 1996, Chairman, RNC Special Task Force on
Presidential Primary Reform; 1986-1990, Chairman, Chairman's Circle for
the Colorado Republican Party; 1987-1990, Director, The Center for
Democracy; 1987-1991, Chairman, Elephant's Club for the Colorado
Republican Party; 1996, Member, Committee on Arrangements, Republican
National Convention; 1996, Member, Host Committee Relations, Republican
National Convention; 1987-1992, Member, Republican National Committee
Budget Committee; 1996, Colorado Co-Chair, Gramm for President; 1996,
Surrogate Speaker, Dole for President; 1996, Surrogate Speaker and
Fundraiser, Allard for U.S. Senate; 1992, Chairman, Business Leaders
for Considine for U.S. Senate; 1988, Andrews for Governor Campaign;
1980, Strickland for Governor Campaign; 1984, Kramer for U.S. Senate
Campaign; 1984, Winn for Governor Campaign; 1976, Vanderhoef for
Governor Campaign; 1999-Present, Served as fundraiser, advisor,
campaign coordinator and grassroots organizer for scores of
legislative, county commissioner, mayoral and city council races in
Colorado for 25 years.
Director, Daniels' Fund (Board of Directors); Member and Director,
Horatio Alger Association (Board of Directors); Admitted to practice,
U.S. Court of Appeals for the Armed Forces; Admitted to practice, U.S.
Supreme Court; Colonel, U.S. Army Reserve (Retired); Trustee, U.S.
Military Academy Association of Graduates; Commissioner, Defense
Advisory Committee on Women in the Services (DACOWITS); Commissioner,
Colorado Air Quality Control Commission; Chairman of the Board,
Volunteers of America, Colorado; Chairman, Listen Foundation Annual
Campaign; Trustee, Kent Denver School; Member, President's Commission
on White House Fellows, Western Selection Panel; Trustee, Colorado
Youth Citizenship Foundation; Member, Platte River Greenway Foundation;
Member, Governor's Unified Housing Task Force; President, West Point
Society of Denver; Presidential Appointee, Board of Directors, New
Community Development Corporation (U.S. Department of Housing and Urban
Development); Member, Denver Bar Association; Trustee, Denver Chamber
of Commerce, Institute for Better Government; Director, Colorado
Association for Housing and Building; Selectee, Leadership Denver;
Director, Artreach Board of Directors; Member, Mayor's Manpower Area
Plan Council Member; Who's Who in American Politics.
13. Employment record: 6/1956 to 8/1956, U.S. Department of
Agriculture, Laborer, LeMars, Iowa; 7/1956 to 2/1970, United States
Army, Cadet and Officer, West Point, New York; Ft. Lewis, Washington;
Ft. Benning, Georgia; Ft. Bragg, North Carolina; Republic of Vietnam;
2/1970 to 9/1971, Lerch, Bates and Associates, Administrative
Assistant, Denver, Colorado; 9/1971 to 12/1972, Office of the Mayor,
Administrative Assistant, Denver, Colorado; 1973 to 1975, Calkins,
Kramer, Grimshaw and Harring, Lawyer, Denver, Colorado; 1/1975 to 1/
1976, Colorado Association for Housing and Building, Lawyer, Denver,
Colorado; 1/1976 to 4/1978, Calkins, Kramer, Grimshaw and Harring,
Lawyer, Denver, Colorado; 12/1999 to 8/2001, ITN Energy, Director,
Littleton, Colorado; 4/1991 to 8/2001, Rowley Downs Land Company,
Chairman/President Denver, Colorado; 12/1995 to 5/1999, Renaissance
Homes of Colorado, Chairman/President, Littleton, Colorado; 4/1970 to
9/1999, U.S. Army Reserve, Colonel, St. Louis, Missouri; 9/1998 to 8/
2001, Community Corrections Corporation, Director, Roseland, New
Jersey; 6/1986 to 8/2001, St. Mary Land and Exploration Company,
Director, Denver, Colorado; 1/1997 to 1/2001, Republican National
Committee, Chairman; 4/1978 to 8/2001, Nicholson Enterprises, Inc,
Chairman/President, Denver, Colorado; 8/2001 to Present, U.S.
Department of State, Ambassador to the Holy See (Vatican) Rome, Italy.
14. Military Service: 40Sth Military Intelligence Detachment-
Strategic; 1957-1961, Cadet, U.S. Military Academy, West Point, NY;
1961-1962, 2/Lt., Fort Benning, GA, Student Officer; 1962-1964, 1/Lt.,
4th Infantry Division, Fort Lewis, Washington (Platoon Leader Company
Commander); 1964-1965, 1/Lt., Ft. Holabird, MD/Ft. Bragg, NC, Student
Officer In Preparation for Vietnam Army Language School, Monterrey, CA;
1965-1966, Cpt., Republic of Vietnam, Senior Advisor to the 402nd
Infantry Scout Bn (ARUN); 1966, Cpt., Ft. Holabird, MD, Student
Officer; 1966-1970, Cpt./Major, U.S. Military Academy, Staff and
Faculty, Admissions Officer and Operations Officer; 1970-1991, Maj/Ltc/
Colonel, U.S. Army Reserves, Denver, CO (HQ at St. Louis, MI), USMA
Liaison Officer; 1991, Retired from U.S. Army Reserves as Colonel,
Honorable Discharge.
15. Government record: All Listed Above.
16. Published writings: Book: ``The United States and the Holy See-
The Long Road,'' published by Trenta Giorni Societa Cooperative, 2003;
Article: ``Biotech Food for the Hungry,'' International Herald Tribune,
October, 2004; Misc: Various articles and letters to the editor during
1997-2001 as Chairman of the RNC.
17. Political affiliations: (a) List all memberships and offices
held In and financial contributions and services rendered to any
political party or election committee during the last 10 years.
Chairman, Republican National Committee; Vice Chairman, Republican
National Committee; Republican National Committeeman, Colorado;
Chairman, Republican National Convention; 2000, Chairman, RNC Rules
Committee.
Contributions
------------------------------------------------------------------------
Value
------------------------------------------------------------------------
Republican National Committee................. $15,000 10/25/99
Value in Electing Women PAC................... 250 10/01/97
Ronald Gene Schmidt for Governor.............. 250 9/23/98
Republican National Committee................. 15,000 7/31/97
Republican National Committee................. 500 11/17/98
Republican National Committee................. 500 11/17/98
Colorado Republican Party..................... 1,000 11/19/96
Wayne Allard for Senate....................... 720 11/05/96
Colorado Republican Party..................... 1,000 3/21/96
Colorado Republican Party..................... 750 5/16/96
Colorado Republican Party..................... 1,000 11/19/96
Republican National Committee................. 15,000 1998
Tom Cole for Congress......................... 500 2004
Peter Coors for Senate........................ 1,000 2004
Bush-Cheney Committee......................... 4,000 2004
------------------------------------------------------------------------
(b) List all elective public offices for which you have been a
candidate and the month and year of each election involved in:
Republican Committeeman for Colorado, elected March 1986, re-elected
June 1988, June 1992, June 1996; Republican National Committee, Vice
Chairman, elected January, 1993; Republican National Committee
Chairman, elected January, 1997, re-elected January 1999.
18. Future Employment relationships: (a) State whether you will
sever all connections with your present employer, business, firm,
association, or organization if you are confirmed by the Senate.
(b) State whether you have any plans after completing Government
service to resume employment, affiliation, or practice with your
previous employer, business firm, association, or organization. No.
(c) What commitments, if any, have been made to you for employment
after you leave Federal service? None.
(d) (If appointed for a term of specified duration) Do you intend
to serve the full term for which you have been appointed? Yes.
(e) (If appointed for an indefinite period) do you intend to serve
until the next Presidential election? Yes.
19. Potential conflicts of interest: (a) Describe any financial
arrangements, deferred compensation agreements, or other continuing
financial, business, or professional dealings which you have with
business associates, clients, or customers who will be affected by
policies which you will influence in the position to which you have
been nominated. None to my knowledge.
(b) List any investments, obligations, liabilities, or other
financial relationships which constitute potential conflicts of
interest with the position to which you have been nominated. None to my
knowledge.
(c) Describe any business relationship, dealing, or financial
transaction which you have had during the last 5 years, whether for
yourself, on behalf of a client, or acting as an agent, that
constitutes a potential conflict of interest with the position to which
you have been nominated. None to my knowledge.
(d) Describe any lobbying activity during the past 10 years in
which you have engaged for the purpose of directly or indirectly
influencing the passage defeat or modification of any Federal
legislation or for the purpose of affecting the administration and
execution of Federal law or policy. None, other than in a general way
in support of the Republican Party agenda as the Chairman of the RNC.
(e) Explain how you will resolve any potential conflict of interest
that may be disclosed by your responses to the above items. (Please
provide a copy of any trust or other agreements involved.)
20. Testifying before the Congress: (a) Do you agree to appear and
testify before any duly constituted committee of the Congress upon the
request of such committee? Yes.
(b) Do you agree to provide such information as is requested by
such a committee? Yes.
______
Response to Post-Hearing Questions
QUESTIONS FOR THE RECORD, SENATOR LARRY E. CRAIG, CHAIRMAN, COMMITTEE
ON VETERANS' AFFAIRS; NOMINATION HEARING OF R. JAMES NICHOLSON TO BE
SECRETARY OF VETERANS AFFAIRS
Question 1: I have been given a very brief overview of your
military service. Please provide me with some details of that service,
particularly your combat experience in Vietnam. How has that service
equipped you to assume the post of Secretary of Veterans Affairs?
Response: Service to our country is a long tradition in my family.
My father was an enlisted man in the Navy during WWII. My father-in-law
served in both WWII and Korea. My brother, Brigadier General Jack
Nicholson, served 30 years in the Army and was, until now, the Under
Secretary of the VA for Memorial Affairs, where he did an outstanding
job. One of my sons is a veteran; four of my nephews are Colonels in
the Army and Air Force. My 30 years of active and Reserve service in
the Army, coupled with my 4 years at West Point, have defined my life.
I love the Armed Forces of our country--their courage, their integrity,
their sense of duty.
I have had the privilege of wearing the uniform of the United
States Army in combat, so I have seen both the horrors of war and the
heroes of America making the greatest sacrifices of military service on
behalf of their comrades and our Nation.
One cannot leave a battlefield without having profound respect for
the courage and cool of all who have served there. One cannot
appreciate all the blessings of our freedom without thanking the men
and women who serve in war to bring about peace. Their example of
unwavering commitment to their mission, no matter how dangerous and
uncomfortable, will always reverberate with me and readies me for a
mission of service to veterans. I will do my utmost to see that they
receive all they have earned, delivered with the dignity they also
deserve.
Question 2: Have you had an opportunity to assess Tony Principi's
tenure as Secretary? Do you yet see how your tenure will differ from
his in style or substance? Are there elements of his leadership you
will seek to emulate?
Response: I assess Secretary Principi's tenure as Secretary to have
been one of a superb performance. I believe that my tenure should build
upon his. To use a Navy metaphor, he began a sea change at the VA and I
see a major part of my responsibility to see that this continues and
that the VA is brought into the twenty-first century to serve twenty-
first century veterans. This implies that we must upgrade both physical
stock of the VA (the average age of a VA hospital is over 50 years),
and we must ensure that the quality of medicine given to our veterans
is on the cutting edge and both medical care and benefits are given in
a more timely way and that we are being consistent. So yes, there are
many elements of Secretary Principi's leadership that I would plan to
emulate, the principal one of which would be hands-on transparent and
accessible management and with a continuing emphasis to serve our
veterans with compassion, competency and dignity.
Question 3: I hope very much that this Committee will be able to
work cooperatively with you and the VA to solve problems that America's
veterans face. To do that, we will need you to appear personally before
this Committee to express the Administration's position on issues that
concern veterans. Can we count on you to make personal appearances at
Committee hearings when asked?
Response: Yes, you can count on me to make personal appearances at
committee hearings when asked.
Question 4: Access to health care for veterans who reside in rural
areas of Idaho is particularly difficult, and it is a problem that
calls for creative and innovative approaches. I recently learned that
Steele Memorial Hospital in Lemhi County, Idaho has donated space that
can be used by veterans to secure ``telemedicine'' services from the
Boise VA Medical Center. Such arrangements, it seems to me, improve the
care provided to rural veterans at no cost to VA.
A. Do you agree that VA and Congress must work together to improve
access to VA services for veterans who reside in rural areas? If so,
will you place a high priority on improving access to VA services for
veterans who reside in rural areas?
B. Will you monitor the progress--and hopefully, the success--of
the Lemhi County program and provided periodic updates to me?
Response: A. I agree that VA and Congress should continue to work
together to improve access to VA services. Growing up in rural Iowa has
given me an appreciation for veterans who reside in rural areas. I will
put a high priority on exploring approaches to improve access to VA
services in a cost-effective manner.
To assist in addressing the issue of improved access to health care
services, VA will continue to look at establishing additional Community
Based Outpatient Clinics (CBOCs). Since CBOCs are scheduled to be
opened in Fiscal Year (FY) 2005.
Response B. The Boise VA Medical Center (VAMC) has worked with
Steele Memorial Hospital in Salmon, Idaho to install two telehealth
devices that will give VA the capability to provide both primary care
and mental health care services to veterans in this area (a Viterion
500, and a video phone). The Viterion 500 provides the capability of
doing physiological monitoring remotely. The video phone will enable a
mental health provider to interact directly with a patient. The Boise
VAMC has already established services for two VA patients at the Steele
Memorial site and they plan to add additional veterans. In addition, VA
has placed monitors in the private residences of two other veterans in
the Salmon area who are not able to easily access the Steele Memorial
Hospital site.
The Boise VAMC will provide periodic updates about this program to
VA Central Office officials. In addition, they would be pleased to
provide your office with quarterly progress reports on the
implementation of telehealth services in the Salmon area and other
parts of rural Idaho. These reports will highlight the locations of
telehealth sites, the number of veterans served and the type of
services offered.
Question 5: Secretary Principi undertook an extensive review of VAs
hospital infrastructure-a review that is called the Capital Asset
Realignment for Enhanced Services, or ``CARES'', initiative. The
Secretary proposed that three VA Medical Centers be closed (in
Pittsburgh, Cleveland, and Gulfport, Mississippi ), that VA build
hospitals in two cities that have no VA medical centers (Las Vegas and
Orlando), and that decisions concerning the fates of 15 other VA
Medical Centers be deferred pending further study.
A. Have you yet had the opportunity to consider these decisions? Do
you think you ought to reconsider then, and get your own assessment of
VAs future medical infrastructure needs? Or do you think you ought to
trust in the validity and soundness of these decisions and simply
implement them?
Response: A. I have been briefed regarding former Secretary
Principi's decisions on CARES as well as the comprehensive process that
lead up to his decisions. At this time, I intend to move forward on
CARES implementation. I will be briefed on a regular basis regarding
the additional studies that are currently underway and regarding
implementation of all CARES initiatives through VHA's Strategic
Planning Process.
The CARES process was the most comprehensive assessment of VA
capital infrastructure and the demand for VA health care ever achieved.
The evaluation and review provided by the CARES commission insured that
the process was independent and objective. Their well-reasoned report
provides a road map for moving VA forward in planning for, investing
in, and locating our capital facilities. I believe that the CARES
report presents a carefully studied and strategically sound path for
the Department, and I will use it as a blueprint for VAs future.
B. One of the major criticisms of the CARES initiative was its
failure to address VAs needs for long-term care facilities. Secretary
Principi advised this Committee that a long-term care review would take
place later. Do you intend to carry out Secretary Principi's commitment
to assess VAs needs for long-term care facilities? Where does that
review now stand?
Response: B. I fully support the continuation of VA's assessment
regarding Long Term Care (LTC). VHA has recently completed new runs on
LTC workload projects by market and priority category. Strategic
Planning Guidance will be going out to the VISNs and facilities in the
next month requesting operational plans to include Strategic
Initiatives. Each VISN will prioritize its strategic initiatives by
year and within the year along with cost projects for inclusion in the
VISN and National Strategic Plan. Implementation of all CARES
initiatives, including LTC initiatives, is dependent on future funding.
Question 6: During the past few budget cycles, the Administration
has proposed, at various times, that so called ``low-priority'' VA
patients pay an annual deductible (of $1,500), an annual enrollment fee
(of $250), and that prescription drug co-payments be increased (from $7
per prescription per month to $15). These proposals were greeted with
some skepticism on the Hill.
A. What is your position on proposals to increase the costs borne
by ``low priority'' veterans seeking care at VA? Do you think some
cost-sharing approaches make more sense than others? Do you think that
this is a fair way of raising the level of funding available to VA?
B. Do you believe that it makes sense for VA to impose fees on some
classes of veterans and not on others? Does it make sense for VA to try
to tamp down demand for care by ``low-priority'' patients so that it
can devote more of its resources to the care of the service disabled
and the poor?
Response: A. Imposing cost sharing provisions, within reason, on
veterans who have a lower priority for care should help to focus
resources towards the care of those veterans who need us most.
Through eligibility reform legislation, Congress requires the VA
Secretary to decide annually whether VA has adequate resources to
provide timely, high quality care for all enrolled veterans. Each year,
VA reviews actuarial projections of the demand for VA health care in
light of available budgetary resources and develops policies
accordingly.
Response: B. VA has proposed cost-sharing policies for Priority 7
and 8 enrollees as a means of balancing veteran demand for VA health
care and the finite resources available, and ensuring that VA has the
capacity to serve those veterans who need us most--veterans with
service-connected medical conditions, special needs, and low incomes.
VA is committed to serving these veterans who depend upon VA for their
health care and represent our core constituency.
Thus, VA expects that those veterans now enrolled in priority
groups 7 and 8 who frequently use VA health care services will likely
pay the enrollment fee in order to continue to receive those services.
However, many other veterans in priority groups 7 and 8 do not
currently use the system, or use it very infrequently. Those veterans
will likely not pay the enrollment fee, but rather will leave the VA
system and use other health care options available to them.
In some cases, the savings and additional collections associated
with cost sharing proposals could help avoid more drastic enrollment
decisions such as disenrollment of current users.
Question 7: Do you believe that Operation Iraqi Freedom troops will
more likely be afflicted with Post-Traumatic Stress Disorder than their
predecessors in prior wars? Does this ``no rear echelon'' theory make
sense to you? Does your combat experience in Vietnam give you any
insight on this theory of extraordinary stress from Iraq combat?
Response: War related psychiatric disorders among veterans of our
Nation's wars for the past 60+ years have resulted in disorder rates
from 10-20% of troops (all services) with higher rates associated with
increased combat exposure and injury. The mental health problems of
veterans of the Vietnam war have been studied with the latest
psychological tools and scientific approaches and revealed that while
30% of male Vietnam theater veterans met diagnostic criteria for PTSD
at some point in their lives, only 15% met those criteria when they
were assessed at a point some 10 years after the war was over. Almost
everyone exposed to the horrors of war comes away from the experience
with some emotional distress, but our data suggests that 70-85% of
combatants may be expected to have no long term sequelae from the war.
Features of combat associated with stress related disorders include:
frequency of exposure to threat, including injuries sustained; number
of actual combat experiences, and repeated tours of duty in the war
zone. To the extent that these are features of the war in Iraq, one may
expect a rate of emotional problems including, but not limited to PTSD
(e.g. depression, substance use disorders) at least comparable to those
in Vietnam. Given current efforts at early identification of emotional
stress in theatre and post-deployment, by DoD and VA clinicians it may
be possible to lower the incidence of long term problems by a
concentrated effort at early detection and care.
The ``no rear echelon'' theory is reasonable given the nature of
the current war in Iraq. The insurgency is a form of guerilla warfare
in which attacks can occur at any place and time. Established bases and
supply convoys are subject to rocket, mortar and Improvised Explosive
Devices (IED) attack as well as more traditional forms of combat such
as combat patrols fighting in Fallujah. These experiences have been
confirmed by our troops and by the military healthcare providers who
have been in theatre and made presentations to VA staff.
It is reasonable to compare aspects of the war in Vietnam to the
current experience in Iraq. Urban combat, as in Fallujah, for example,
was experienced in Vietnam in Hue and other cities during the Tet
Offensive. Jungle warfare has similar stresses to urban warfare
including the enemy being hidden from sight either by jungle or
buildings. Guerilla warfare, in which one cannot tell friend from foe;
when the enemy attacks from amidst innocent civilians; when mines and
IEDs are used to attack without warning and with the enemy at distance
so they cannot be counterattacked, are all extremely anxiety provoking.
Modern body armor, and evolving combat doctrine and training of our
troops, and the superb in theater medical support received by troops in
combat, can strengthen our troops against these stresses.
Question 8: Some years back, VA reorganized its health care
bureaucracy into 22 ``Veterans Integrated Service Networks'' to
decentralize decision-making and to encourage innovation by managers
involved in the actual care of patients. More recently, authority for
critical decisions--for example, VAs recent review of its medical care
infrastructure needs--appears to be migrating back to VA headquarters.
A. As a matter of management philosophy, do you tend to delegate
decision-making authority? Or do you believe that--at least in
Government--authority has to be centralized in easily-identified senior
officials who are accountable to the President and to the oversight of
Congress?
Response A. There is always a tension between centralization and
decentralization. A system that is too centralized is grossly
ineffective and inefficient. On the other hand, a system that is too
decentralized loses the integration and cohesiveness that defines it as
a ``system.'' VA operates a large, integrated health care system that
functions both efficiently and effectively. Improvements in quality,
access, veteran satisfaction, and efficiency are measurable and have
been widely recognized. Health care policy is established centrally in
Washington and is expected to be executed uniformly throughout all 21
Veterans Integrated Service Networks (VISNs). I will expect the VISNs
to address the unique challenges of their respective environments, and
I will hold management at all levels accountable for implementing
national policy consistently. I intend to work with VHAs national and
Network leadership to assure that we address the local, regional, and
national needs of veterans effectively. I believe in performance
measurement, and I will be very aware of performance at all levels of
the organization.
Question 9: As you are undoubtedly aware, the veteran population is
aging rapidly--recent statistics show that nearly 60% of the veteran
population is over age 55. This trend suggests to me that VA will face
increasing demand for long-term care services. Yet VA is only required
to provide in-patient-based long-term care--that is, nursing home
care--to the most severely disabled of the ``service-connected''
veteran population.
A. Do you think VA can meet the demand of aging baby-boomers for
long-term nursing home care? Do you think VA ought to try to meet the
need? Do you have any sense of how much it would cost VA to take on
this mission?
Response A. VA can meet the Long Term Care needs of all veterans
for whom we are required to provide such care. VA policy is to provide
for the institutional needs of veterans in priorities 1-3, and those
with special needs. By reserving nursing home care for those situations
in which a veteran can no longer safely be maintained at home, and by
providing long-term care in the least restrictive setting that is
compatible with a veteran's medical condition and personal
circumstances, we can create a medical and extended care benefits
package that is available to veterans who need them most. Non-
institutional care is a basic part of the benefits package for all
enrolled veterans. VAs policy is to increase our capacity to provide
non-institutional home and community-based care by 18% annually, in
order to be able to meet the full need of enrolled veterans by 2011. A
detailed cost estimate, however, is unavailable at this time.
B. Do you think the current policy of mandating that long-term care
be provided only to those with the most severe of service-connected
disabilities strikes the proper balance of assuring that available
resources are directed to those having the best claim to VA-provided
care?
Response B.: Yes. The current law assures that the most severely
disabled service-connected veterans will be cared for if they need
nursing home care, while preserving flexibility for VA to provide care
for less severely disabled veterans, the indigent and those with
special needs as resources permit.
C. Where do outpatient-based long-term care services fit into the
equation? Does the requirement that VA provide such services to even
low-priority veterans divert resources away from the neediest
veterans--those who need in-patient care--to deal with service-
connected conditions?
Response C.: VA believes that long-term care should be provided in
the least restrictive setting that is compatible with the veteran's
medical condition and personal circumstances, and whenever possible in
non-institutional home- and community-based settings. Supporting
veterans in their local communities maintains their established ties
with spouse, family, friends and their spiritual community. These
contacts help provide the vital social, emotional, and spiritual
elements that complement the physical components of care that VA
traditionally provides in its hospitals and clinics. The availability
of a spectrum of home- and community-based services often prevents
unnecessary--and costly--institutionalization of veterans. It is as
essential that these services be available to enrolled veterans,
including lower priority veterans, as it is that acute care services be
available to them. The cost of non-institutional home- and community-
based services is very modest in comparison to nursing home costs, and
has relatively little impact on the availability of in-patient services
for the neediest veterans. A far greater impediment to the most
efficient allocation of resources is the requirement of the Millennium
Act (Public Law 106-117) that VA maintain an average daily census of
13,391 in its own Nursing Home Care Units. The President's budget for
fiscal year 2006 proposes repeal of that provision.
Question 10: One of the challenges you will confront as Secretary
is the backlog of compensation and pension claims awaiting VA
adjudication. When Secretary Principi appeared before this Committee
for his confirmation hearing in 2001, he committed to reduce the
backlog and improve the accuracy of decisions rendered.
A. Is this mission accomplished? Is there still more work to do to
speed claims processing and improve quality? Have you thought of a
strategy you will employ to finish the job?
Response A.: Improvement of benefits claims processing has been an
important goal of the President. Obviously, much progress has been made
both in reducing the backlog and timeliness--and especially in the
reduction of claims that had been pending from our oldest veterans who
had been waiting more than a year for decisions on their claims. I am
aware that quality levels have also significantly improved.
The changes made included making the regional offices--and the
claims processing procedures and supporting IT applications--more
consistent and efficient and improving the training and oversight of
the programs. These major changes have resulted in improvements in
production, timeliness, and quality.
While there has been significant success, there is much to be done.
VBA has seen large increases in incoming claims and appeals, both from
the returning servicemembers and from older veterans who had not
previously submitted claims. We will continue to emphasize the
improvements necessary to give our veterans the benefits they deserve
and which the Congress has so generously made available.
Question 11: The budget for the current fiscal year is relatively
tight compared to recent years and I expect the one which the
Administration will propose for fiscal year 2006 will be tighter still.
These realities have caused VA to prioritize eligibility for purposes
of healthcare eligibility.
A. Do you think VA ought to adopt similar systems of prioritizing
the processing of claims for benefits? For example, should claims filed
by veterans who have just returned from a combat deployment go to the
head of the line?
Should applications for benefits submitted by older veterans go
first? Or, should VA simply adopt a ``first-in, first-out'' approach to
prioritizing claims?
Response A. I have learned that VBA is giving top priority to the
benefit claims of all returning war veterans who are seriously injured,
and certainly providing the best possible service to these returning
heroes must remain our highest priority. VBA has also advised me that
claims from terminally ill veterans, homeless veterans, veterans with
severe financial hardship and former prisoners of war also receive
priority attention. I believe that priority processing for these
claimants is also most appropriate.
Our goal must be to provide quality, timely, and compassionate
service to all claimants. Reaching our goal will depend upon a well-
trained staff who properly develop the claims submitted and then act on
those claims as soon as they are ready to rate. I do not believe that
VBA should adopt a strict first-in, first-out process.
B. Three years ago, VA established a ``Tiger Team'' to speed the
processing of older claims submitted by World War II veterans. Should
similar specialized teams handle other high priority claims, e.g.,
claims filed by servicemembers returning from Iraq?
Response B. The Under Secretary for Benefits has made me aware of
the success of some of the specialized processing initiatives that VBA
has undertaken in recent years, including the Tiger Team, the Pension
Maintenance Centers, and the centralized processing of in-service death
claims. VBA is now centralizing the rating aspects of the Benefits
Delivery at Discharge program to two regional offices, Salt Lake and
Winston Salem. These initiatives have demonstrated that specialized
processing can provide better and more efficient service to veterans. I
will look for additional opportunities to improve the delivery of
benefits and services through specialization.
Question 12: VA spending from its compensation and pension account
has grown by approximately 50 percent in the past 5 years.
A. Do you have any sense of what is driving these increases?
Response A. A number of factors have been identified to me as
contributing to the increase in expenditures over the last 5 years.
Those are listed below.
<bullet> There has been a 6% increase in the total number of
beneficiaries receiving benefits from the VA from EOY1999 through
EOY2004, an increase of 196,000 beneficiaries.
<bullet> Diabetes Mellitus and Prostate Cancer were added as
presumptive conditions related to herbicide exposure, resulting in many
new beneficiaries and increased ratings. Because of the nature of the
two conditions, the disability evaluations for these conditions tend to
increase fairly rapidly. In June 2001, just prior to adding diabetes as
a presumptive condition, VA was paying about 38,000 veterans for this
condition. By December 2004, VA was paying 199,000 such claims.
Likewise, in June 2001, VA was paying approximately 18,000 prostate
cancer claims. By December 2004, VA was paying almost 30,000 claims.
<bullet> VAs efforts to reduce the backlog of claims increased the
number and amount of retroactive benefits paid.
<bullet> Vietnam Era veterans filed claims at rates higher than
World War II and Korean War veterans, and veterans of the Gulf Era have
higher application rates than Vietnam Era veterans. This may be due,
in, part, to VA's expanded outreach programs and the Benefits Delivery
at Discharge initiative.
Question 13: As long as I have been a Member of the Veterans
Affairs Committee, the problems confronting the compensation and
pension system have been the same: the backlog of claims and appeals is
too high; it takes too long for VA to process claims; and the accuracy
of decisions made on applications for benefits is not as good as it
ought to be. The Congress and VA have taken various approaches to
solving these problems-more staff has been hired, computer systems have
been bought, and VAs organizational structures have been repeatedly
``re-engineered''. Yet problems persist.
A. Do you believe it is time for Congress and the Administration to
take a closer look at the disability claims system to see if there are
structural flaws within the claims process that are outside VA's
control? Why do these problems seem to be resistant to management
reforms and money infusions?
Response A. I would welcome working with you regarding issues that,
while well intentioned, sometimes have adverse effects and merely clog
the system. I would point out that the Congress has already authorized
in the National Defense Authorization Act for 2003, a Veterans
Disability Benefits Commission to look at the whole range of disability
compensation benefits available to veterans from VA.
Question 14: On February 3, I will convene a hearing to examine the
adequacy of the benefits provided to the surviving spouses and children
of those who die in or as a result of service. From what I have seen so
far, survivors must navigate through a confusing maze of services
provided by at least three different Federal agencies to secure
benefits. Making matters even more confusing, cash benefits provided by
some agencies are offset from those provided by others--in plain
English, cash payments are allowed from two agencies, for example VA
and DoD, but not simultaneously. Will you commit to work with other
Department Secretaries to end this confusion?
Response: I wholeheartedly agree that we should strive to make the
benefits claims processes for surviving spouses and children of
servicemembers and veterans as simple and straightforward as possible.
I will be pleased to work with other Administration officials and with
the Congress to ensure coordination of both survivors' benefits and
survivors' benefits claims processes.
Question 15: Do you have any conflicts of interest which you have
not fully disclosed to the Committee? Do you know of any other matter
which, if known to the Committee, might affect the Committee's
recommendation to the Senate with respect to your nomination?
Response: No, I do not have any conflicts of interest that have not
fully been disclosed to the Committee or any matters that might affect
the Committee's recommendation.
Question 16: Have you fully and accurately provided financial and
other information requested by the Committee, and do you now affirm
that the information provided is complete, accurate, and provided in a
form not designed to evade or deceive?
Response: Yes.
Question 17: Do you agree to supply the Committee such non-
privileged information, materials, and documents as may be requested by
the Committee in its oversight and legislative capacities for so long
as you shall serve in the position for which you now seek confirmation?
Response: Yes.
Question 18: An organization named the Lung Cancer Alliance has
requested, by the attached White Paper, that I pose to you a question
relating to a potential establishment of a pilot program for the
screening, early detection and management of lung cancer. Would you
please review that attached White Paper and comment?
Response: Routine screening for lung cancer is not recommended at
this time, as there is currently no evidence of effectiveness. The
Federal Government has two large trials underway by the National Cancer
Institute, so there doesn't appear to be a need for a duplicative study
by VA and DoD. There is no evidence that the lung cancers that veterans
get by virtue of their smoking, exposure to combustion products, or any
other exposures would behave differently from lung cancers that non-
veterans get. Therefore, there is no compelling reason to duplicate in
the veteran or military population the studies already underway in the
general population.
Given that cigarette smoking is, by far, the most important risk
factor for lung cancer, the most effective method of preventing lung
cancer deaths is by keeping people from smoking in the first place and
helping those who do smoke to quit. The Veterans Health Administration
has a large-scale, effective program in place to assist those who smoke
and are interested in quitting. A clinical practice guideline on
tobacco use cessation, developed jointly by the VHA and the Department
of Defense, has recently been updated and is available at
www.oQP.med.va.Qov/cPQITUC3/tucbase.htm.
Lung cancer is a significant public health concern, with an
estimated burden of 172,570 new cases in 2005 (13% of all cancer
diagnoses). It is the leading cause of cancer-related deaths (29% of
all cancer deaths), estimated in 163,510 fatalities for both men and
women in 2005. Both incidence rates (new cases) and mortality rates
(deaths) in men have been declining for more than a decade, but they
have only recently started to decline for women. Since 1987, more women
have died each year of lung cancer than from breast cancer. Cigarette
smoking is by far the most important risk factor for lung cancer,
implicated in 90% of lung cancers in men and 78% in women. Cigar and
pipe smoking, environmental tobacco smoke exposure, and exposure to
other environmental agents, especially asbestos and radon, are also
risk factors for lung cancer.
Early detection of lung cancer through screening has not been shown
to be effective in reducing deaths from lung cancer. Screening for lung
cancer is not presently recommended by any major medical professional
organization. A recent review of the evidence about lung cancer
screening done by the U.S. Preventive Services Task Force, an
independent panel of experts in primary care and prevention that
systematically reviews the evidence of effectiveness and develops
recommendations for clinical preventive services, concluded that ``the
evidence is insufficient to recommend for or against screening
asymptomatic persons for lung cancer with either low dose computerized
tomography, chest x-ray, sputum cytology, or a combination of these
tests'' (Annals of Internal Medicine. 2004; 140:738-9).
The National Cancer Institute (NCI), part of the National
Institutes of Health, has two large studies underway to determine if
screening for lung cancer is effective. Both are randomized controlled
trials, the best type of study design for measuring the effectiveness
of screening tests. The first of these, the Prostate, Lung, Colorectal,
and Ovarian Cancer Screening Trial (PLCO), enrolled over 148,000 men
and women participants between the ages of 55 and 74. Enrollment took
place from 1992 to 2001 at ten centers around the country. Lung cancer
screening was done by chest x-ray upon entry and annually for 3 years
for smokers and for 2 years for never-smokers for those in the
intervention group. Participants in the control group received routine
health care from their physicians. All participants will be followed
for up to 16 years. Results of the PLCO study are not expected for
several years.
The second NCI-funded screening study is the National Lung
Screening Trial (NLST), launched in 2002. This study is comparing two
ways of detecting lung cancer: spiral computed tomography (CT) and
standard chest x-ray, and aims to show if one test is better at
reducing deaths from lung cancer than the other. Over 53,000 current or
former smokers aged 55 to 74 years have been enrolled in the trial at
more than 30 study sites across the country. Participants have been
randomly assigned to receive either chest x-ray or spiral CT every year
for 3 years and all will be followed by yearly surveys until 2009.
Results of the NLST will not be available until then.
Both studies will provide evidence about the benefits, if any, of
screening for lung cancer. They will also provide information about
harms of screening. All screening tests have the potential for both
benefits and harms. One common harm is false-positive tests results--
the finding of an abnormality that appears to be a cancer that, upon
further testing, turns out to be benign. In lung cancer screening,
suspicious areas on chest x-ray or spiral CT often require invasive
tests (lung biopsies done either through the chest wall with a needle
or through open chest surgery) to determine if they are malignant or
benign. Some screening tests may find many areas that appear to be
suspicious, but turn out to be benign, thus subjecting patients to the
risks of the invasive tests for no benefit.
Another potential harm is called ``over-diagnosis''--the finding of
a condition that would not have become clinically significant had it
not been detected by screening. Autopsy studies show that some people
die with lung cancer, rather than from it. If improved screening tests
find many small lung cancers that would not be likely to progress to
the point of causing clinical disease and death, then the detection and
subsequent treatment of these cancers might lead to more harm than
good. The randomized trials underway for lung cancer screening (PLCO
and NLST) will help to determine the extent to which these harms may
occur, if screening were recommended and applied to large numbers of
persons.
__________
Questions for the Record from Senator Daniel K. Akaka,
Ranking Member, Committee on Veterans' Affairs; Nomination Hearing of
R. James Nicholson to be Secretary of Veterans Affairs
Question 1: As you well know, Congress gave the Secretary the
responsibility for deciding which veterans can enroll for VA health
care. Using that authority, a decision was made in January of 2003 to
refuse enrollment to so-called ``middle-income veterans. Given that
waiting times for care have decreased--thanks to the incredible work of
your dedicated health staff--many of us here in Congress believe that
the ban on Priority 8 veterans should be rescinded. Because an
enrollment decision is typically made early in the year, I am curious
as to what your position will be on this year's enrollment decision.
Response: In addition to the incredible work of VA staff, the
suspension of Priority 8 enrollment contributed to the reduction in
waiting times. I will consult with VA staff to determine the need for
continuing this suspension and/or the need to exercise another
enrollment policy to balance demand with available resources for FY
2005. Equally important is the need to consider the out-year impact of
enrollment decisions in terms of expected resource availability,
expected demand for VA health care services and the potential for
growing waiting lists and waiting times.
Question 2: In the past, VA has come under fire for the lack of
timeliness of its claims processing. While VBA has made progress in
improving timeliness and accuracy of disability claims processing,
further improvement is needed. Notably, VBA has turned its attention to
decreasing the amount of time it takes to process a claim and taken its
focus off of appeals.
A. How can a more balanced approach be reached?
Response A.: I am aware of the need for a balanced approach to
managing our claims workload. A balanced approach must be taken in the
allocation of our personnel resources to ensure we are effectively
managing the full spectrum of our claims and appellate processing
responsibilities.
VBA has recently increased its emphasis on addressing appeals,
necessitated by an increase in the rate and number of appeals filed.
The increase is attributable to several factors, including the dramatic
increase in the output of claims decisions in the last few years.
VBA and the Board recently signed an agreement regarding additional
training that would be provided to field stations to ensure appeals are
ready to be certified to the Board of Veterans' Appeals. We need to
continue to track and analyze appellate cases to determine how we can
reduce the number of cases appealed to VBA as well as those remanded by
the Board for further development.
B. I am concerned that VBA does not have enough employees to
process claims timely and accurately. You noted in your pre-hearing
questions that additional hiring is anticipated this year. Will this be
reflected in the President's Budget? If not, where will the funding for
these employees come from?
Response B.: As a result of the Consolidated Appropriations Act,
2005 (Public Law 108-447), an additional $125 million will be made
available to VBA (through a transfer of funds from medical care) for
compensation claims processing. Of this total, $75 million will be used
in 2005 to fund additional staffing to address the increased volume of
disability claims. The remaining $50 million will be used in 2006.
C. VA officials have acknowledged that VBAs compensation and
pension claims processing needs to be more productive, that is, to
decide more claims without significant increases in staffing. How do
you plan to improve claims processing productivity without significant
staffing increases?
Response C.: Increased productivity does not depend solely on
increases in staffing. Better training, new technologies, and more
efficient organizational processes and structures can also contribute
significantly to higher levels of productivity. I believe we need to
continue to focus on all of these areas.
VA's recent decision to consolidate the rating aspects of the
Benefits Delivery at Discharge Program to two regional offices is an
example of the type of process and structural change that I believe
will allow VBA to be more productive. I will look for additional
opportunities to apply technology and make changes that will enhance
the delivery of benefits and services to veterans and their families.
Training is also key to improving productivity. I will focus our
efforts on improving VBAs training systems, both for new employees and
to raise the skill levels of the more experienced staff. Improvements
will be achieved through providing employees with more and better
training and with up-to date tools and IT systems to support their
decisions. As employees develop their skills, they will work faster and
with fewer errors.
Question 3: VA has become increasingly reliant on contractors. Do
you support contracting out VA functions? If yes, do you have any
concerns that it will erode VAs ability to meet its mission? And what
functions would you be comfortable contracting out services for?
Response: VAs primary goal is to provide the best possible service
to veterans within the current budget environment. As such, I will
continually challenge the Department to examine ways to more
effectively and efficiently use resources to better meet veterans'
needs. Contracting out certain functions may provide one avenue for
meeting this goal. However, the provision of services such as direct
medical care are a core capability for the Department, and contracting
out of these functions should only be pursued on an exception basis
where in-house resources are not available. In addition, a clear
business case must be made that justifies the rationale and provides
assurance that contracting will not erode VAs ability to meet its
mission. 38 U.S.C. 7409 affords the Department the flexibility to
contract out for ``scarce medical specialist services at Department
facilities'' in this case. However, VAs experience indicates that
contracting out for such positions generally is much more expensive
than direct hiring.
In addition, under 38 U.S.C. 8153, ``to secure healthcare resources
which otherwise might not be feasibly available, or to effectively
utilize certain other health-care resources, the Secretary may, when
the Secretary determines it in the best interest of the prevailing
standards of the Department's medical care program, make arrangements,
by contract or other form of agreement for the mutual use, or exchange
of use, of health-care resources between Department health-care
facilities and any health-care provider, or other entity or
individual.'' Contract services in this regard must also be supported
by a clear business case that ensures the quality of service provided
by another source is as good as or better than the existing service at
reduced costs.
There are other situations where contracting for non-core VA
functions may be appropriate. Our analysis of these opportunities
across the Veterans' Benefits Administration (VBA) and National
Cemetery Administration (NCA) indicate that contracting opportunities
are generally limited due to the nature of the functions performed, the
relatively small numbers of personnel involved, and the fact that they
tend to be highly geographically dispersed. Within VHA, we believe
there may be some opportunities to enhance the effectiveness and
efficiency of certain non-core, commercial, competitive functions,
e.g., grounds maintenance, through the President's Management Agenda
(PMA) competitive sourcing initiative. However, 38 U.S.C. 8110(a) (5)
prohibits VA from conducting certain cost comparisons with the private
sector unless funds are specifically appropriated for that purpose.
Since funds have not been specifically appropriated for the purpose of
conducting cost comparisons, VA's previously, OMB-approved competitive
sourcing program has been on-hold until such time as legislative relief
is obtained.
Question 4: GAO added VA's disability programs, along with other
federal disability programs, to its high risk list in 2003. VBA's
vocational rehabilitation and employment program has been criticized
for insufficient emphasis on helping disabled veterans return to work.
In what ways will you ensure that VBA strengthens its emphasis on
helping disabled veterans reintegrate into the workforce?
Response: Secretary Principi established the Task Force on the
Vocational Rehabilitation and Employment Program to conduct an
independent assessment of the program. The Task Force's report,
submitted in March 2004, contained many recommendations to produce a
more proactive, employment-driven program.
VA is now in the process of implementing the recommendations. The
most important of the recommendations is the Five-Track Employment
Model, which calls for VA to focus its efforts on:
<bullet> Reemployment of veterans with their previous employers.
<bullet> Access to rapid employment services with new employers.
<bullet> Self-employment for veterans whose disabilities preclude
more conventional channels of access to employment.
<bullet> Long-term vocational rehabilitation services for veterans
who need such services to obtain suitable employment.
<bullet> Independent living services, with the possibility of
employment when appropriate, for veterans whose disabilities are so
severe at present as to preclude them from working.
Along with developing this model, VA is testing a new field
position, Employment Coordinator. The Employment Coordinators will
perform duties recommended by the Task Force. It is anticipates that
they will enhance the delivery of quality and timely employment
services and increase the number of veterans obtaining suitable
employment.
I will ensure that the actions taken by VA to implement the Task
Force recommendations will give our disabled veterans the assistance
they need to successfully reenter the workforce.
Question 5: ``While you were at the RNC did you have dealings with
the VSOs and if so, what were the nature of those discussions?"
Response: Yes, I recall during my 4 years as Chairman of the
Republican National Committee, that I had occasional meetings with the
directors of several of the VSOs. I can specifically recall having one
meeting around a table in my office at the RNC, but I do not recall
what the substantive nature of the discussions addressed.
__________
Questions for the Record from Senator Kay Bailey Hutchinson, Committee
on Veterans' Affairs; Nomination Hearing of R. James Nicholson to be
Secretary of Veterans Affairs
Question 1: Currently, military retirees in many parts of the
country are not allowed to register with permanent military health care
providers due to the shortage of military physicians. Do you believe
that this situation can be corrected? How would you go about it?
Response: VA has an effective primary care system in place. When
veterans are enrolled into the system, they are assigned a primary care
physician. I would defer the questions on military health care to DoD.
Question 2: Many veterans are anxiously waiting the Base
Realignment and Closure (BRAC) results which should be released in May
of this year. A loss of a base or a post in a specific region of the
country could mean that a deserving veteran may have to travel many
additional miles to seek a treatment. Are you approaching the BRAC
process with similar concerns?
Response: VA plans to cooperate fully with DoD throughout Base
Realignment and Closure.
Question 3: Recently, the Walter Reed Amputee center here in
Washington, DC has seen an influx of wounded and amputated veterans to
its facility due to ongoing operations in Iraq and Afghanistan. What is
the process to allow these future veterans to transition from Walter
Reed back to their home of record or to their permanent duty station?
Are you confident of the VAs ability to serve these veterans?
Response: VA shares your concern that our Nation's newest veterans
get the healthcare and benefits they deserve, particularly those who
are ill or injured as a result of their service in Iraq or Afghanistan.
VA has worked hard over the past 18 months to implement numerous
programs to ensure these veterans receive timely and high quality
services and that their transition from DoD to VA is seamless and
efficient. For the first time, VA employees are stationed at many of
the major military treatment facilities (MTFs) receiving casualties
from Iraq and Afghanistan. VA staff brief servicemembers about VA
benefits, including healthcare, disability compensation, vocational
rehabilitation, and employment. VA enrolls these veterans into the VA
system and begins to complete the necessary paperwork for their
compensation claims prior to discharge from military service which
eliminates any gap in services or compensation. VA social workers
facilitate the transfer of veterans from Walter Reed and the other
major MTFs to the VA Medical Center closest to their home of record or
most appropriate for the specialized services their medical condition
requires. In addition, each VA Medical Center and Veterans' Benefit
Administration Regional Office has identified a point of contact to
ensure the seamless transition of these veterans into the VA system.
Vet Centers located throughout the country are providing mental health
services and counseling to returning veterans and their families, as
well as bereavement counseling to those who have lost a family member
in Iraq or Afghanistan. The Department has increased the number of
transitional assistance briefings given to active duty, Reserve and
National Guard servicemembers who are discharging from military
service. The purpose of the briefing is to educate servicemembers on
the VA benefits available to them. In total, the Department held nearly
12,000 briefings reaching nearly 500,000 servicemembers, including
those aboard some Navy ships returning to the U.S.
VA has made great strides in ensuring our veterans experience a
smooth transition between military and civilian life. VAs next
challenge is to ensure that those veterans and their families receive a
high level of customer service. VA is working to strengthen its support
system for the family to include Fisher Houses, hotels and meals. VAs
goal is to honor each new veteran and their family with compassion,
dignity, and coordination of every service and support that can help to
restore function.
Question 4: A November report found unsanitary conditions at the
Dallas Veterans Affairs Medical Center. I am concerned there is
currently not a framework for improving a facility so critical to the
veterans of North Texas. What will you do to remedy this shortcoming
and prevent similar issues at other facilities?
Response: The Department of Veterans Affairs Office of the
Inspector General (OIG) report that you referred to cited the status of
the VA North Texas Health Care System (VANTHCS), Dallas during its May
2004 OIG Combined Assessment Program (CAP) review. Subsequent to this
review, the OIG published report number 04-01878-34, on November 26,
2004 and tasked VISN 17 to draft a response to the findings that was
due on January 19, 2005: VISN 17 submitted its response to the findings
by the suspense date.
The CAP review focused on 14 areas. In two of the areas the
reviewers did not identify concerns. In the remaining 12 areas, the
reviewers noted a need for additional management attention.
VISN 17 and the VANTHCS began to immediately initiate action on the
recommendations as early as the period following the OIG team exit
briefing. An action plan along with a spreadsheet was developed by VISN
17 to monitor the VANTHCS progress in addressing the concerns noted by
the OIG reviewers. Specific milestones were established to monitor the
levels of improvement. The leadership of VISN 17 has been highly
involved in this process. Periodic meetings have been held to track
progress being made, and adjustments were made to ensure that
milestones were met. As a result of these improvement efforts, the
majority of the problems noted in the OIG CAP review were corrected by
early January 2005. The VISN Director has noted that the only reason
that the VANTHCC is not currently within 100% compliance is that some
needed construction work has not been completed.
Key leadership positions in the Dallas facility will be filled by
individuals tasked to facilitate the changes required to bring the
Dallas facility to a higher level of performance. The Acting Under
Secretary for Health has appointed a 5-member General Medical Review
Team, and tasked the VA Office of the Medical Inspector (OMI) to review
operations at the Dallas facility. The scope of the review includes
interviews of key staff at the facility, and the review of five key
operational areas. The results of the findings of the two teams will be
used to enhance the operations of the Dallas facility in particular,
and serve as a model to prevent similar situations in the future in
other VA facilities. These lessons learned will augment other programs
already in place that provide continuous monitoring of operations, and
quality improvement.
An example of programs already in place is the VHA System-wide
Ongoing Assessment Review Strategy (SOARS) program. During 2004, the
Veterans Health Administration (VHA) initiated the SOARS program. To
date, this initiative has visited 32 VA medical facilities. The purpose
of this initiative is to identify problems and areas for improvement in
50+ key areas within medical facilities that includes cleanliness,
infection control, safety, privacy, and security concerns. SOARS
utilizes multi-disciplinary employees from throughout the system as
Internal Consultants to identify issues as ``external observers''. This
also allows the sharing of strong practices and problem solutions from
other environments and the ability to take ``lessons learned'' back to
other VA facilities. After a successful pilot phase, this program is
now able to complete 4 facility site visits a month on a continuous
basis with more planned for the future. SOARS will allow for the
monitoring of past problems as well as the early identification and
correction of problematic areas in the future.
Question 5: On November 12, 2004, Secretary Principi announced that
VA would dedicate up to $60 million (up to $15 million annually over
the next 4 years) for research into Gulf War Illness. Secretary
Principi has been on the forefront of this issue, securing $14.6
million in federal funding over the past 5 years for research into Gulf
War related illness--much of it carried out at the University of Texas
(UT) Southwestern by Dr. Robert Haley.
Ambassador Nicholson, can we have your assurance that you will keep
this promise to Gulf War veterans?
Response: As Secretary Principi stated on November 12, 2004, VA
will commit up to $15 million in additional federal funding in FY 2005
to support continued research into the cause of and potential
treatments for Gulf War illnesses. This represents VA's single largest
set-aside of research funding for a specific area of investigation and
almost 20 percent of all new research grant awards for FY 2005.
In response to a reporter's question about commitments beyond FY
2005, Secretary Principi said, ``I'm not making any out-year
commitments. . . And we have taken an unprecedented step by earmarking
funds for this type of research. We certainly will look at it in 2006,
2007, 2008.''
While it essential to find answers to what is causing Gulf War
illness and to identify appropriate treatments, the specific financial
commitment will need to be reviewed each year.
To implement the commitment for FY 2005 funding, VA is in the
process of issuing a new request for proposals. The proposed studies
will undergo the same intensive evaluation and review for scientific
rigor as all projects sponsored by VA research.
Also, VA plans to establish a center dedicated to the investigation
of potentially effective treatments for veterans with Gulf War
illnesses. This center will use observational and epidemiologic methods
to identify promising therapies and will conduct pilot studies that may
serve as prelude for more definitive clinical trials. To ensure that
this center is designed successfully to meet the methodological
challenges of research in this difficult area of investigation, VA is
working closely with the Research Advisory Committee in forming a
committee of expert advisors to assist in the planning and design of
the center. The Committee will be meeting in early March.
VA has funded 111 projects on Gulf War veterans' illnesses since
1991. The direct research costs of these studies as of October 2004
total $56.4 million. Indirect costs associated with this research are
estimated at $16.9 million (historical data suggest indirect costs
equal 30% of direct costs).
In FY 2004, VA approved 18 new Gulf War projects. Total funding
over the life of these projects will exceed $9.5 million. VA is
currently funding 48 ongoing Gulf War studies in FY 2005. Areas of
focus include: brain and nervous system; depleted uranium; interaction
of multiple exposures; treatments; and epidemiology. Direct research
costs for these studies total $6 million.
Recent VA findings with impacts or potential for impacts in Gulf
War veterans' illnesses include:
<bullet> Identification of a superior mode of treatment for
veterans suffering from undiagnosed Gulf War symptoms.
<bullet> Finding that a statistically significant higher prevalence
of ALS in Gulf War veterans (led to presumptive service connection for
compensation).
<bullet> Confirmation of higher rates of PTSD and other
psychological disorders among Gulf War veterans.
<bullet> Substantiation that adverse reproductive outcomes have not
been more common among veterans deployed to the Gulf War than among
those who were not deployed.
Examples of ongoing VA studies include:
Neuroimaging: A team at the San Francisco VAMC has initiated the
largest effort to date to conduct research to detect any brain changes
associated with Gulf War veterans' illnesses and to determine possible
relationships with ALS. The team, under Dr. Michael Weiner, will use a
4-Tesla magnetic resonance imaging-magnetic resonance spectroscopy
system that the VAMC acquired through grants from the Department of
Defense (DoD) and the National Institutes of Health (NIH).
Epidemiology. Studies conducted to date have not shown an excess of
cancer-related deaths among Gulf War veterans. However, because many
cancers are not rapidly fatal, VA recently funded a cancer prevalence
study among Gulf War veterans.
Amyotrophic Lateral Sclerosis (ALS): VA has initiated a national
registry for veterans with ALS and an accompanying genetic tissue bank
(ALS-DNA) to build upon its earlier prevalence study. The goals of the
registry are to identify as completely as possible all veterans with
ALS, not just Gulf War era veterans, and to provide a mechanism for VA
to inform veterans with ALS about clinical drug trials and other
studies for which they may be eligible. The ALS-DNA bank will involve
collection of DNA and plasma from blood samples from consenting ALS
registry participants. It is the intent that these materials be made
available for future genetic research on ALS. The Veterans' ALS
Registry has generated great enthusiasm and praise among the national
community of ALS researchers.
While not specific to Gulf War veterans, VA investigators are also
conducting a clinical trial to determine the safety and efficacy of
sodium phenyl butyrate (NaPS) in subjects with ALS. While there is no
know treatment for ALS, NaPS is a pharmacological treatment that has
been shown to extend survival in mice with ALS. This study will also
seek to identify optimal doses for NaPS and riluzole (currently, the
only approved drug for ALS) and examine their combined effects in ALS
mice.
Depleted Uranium: VA continues to fund a clinical health
surveillance of Gulf War veterans who were exposed to depleted uranium
(DU) oxides as a result of friendly fire incidents. Some of these
veterans have retained DU fragments that cannot be removed due to
medical considerations, and the 39 surveillance participants, nine of
whom remain on active duty, had significantly higher exposures than
other servicemembers who served in the Kuwaiti Theater of Operations.
Testing to date has found no differences in the frequency of
musculoskeletal, cardiovascular, psychiatric, nervous system, or other
disorders. Although the kidney is the putative critical organ for
uranium toxicity under acute and chronic exposure conditions, no
evidence of renal dysfunction has been found. Of note, none of the
participants' offspring have had birth defects. This is far less than
would have been expected. Despite these favorable outcomes, VA will
continue to fund this surveillance to monitor for any potential DU-
related long-term health problems.
Question 6: Will you look carefully at the CARES Commission report
and where closure of a veterans' facility has been recommended, give
time and weight to the appointed community task forces so local leaders
may have a chance to maximize the efficiency and productivity of each
of these facilities?
Response: The Implementation Process for CARES includes the
requirement for stakeholder involvement by local VA facilities. For the
additional study sites listed in former Secretary Principi's Decision
Document, a formal process has been put in place to include leaders
from the community to provided advice to the Contractor completing the
studies. VISNs will be required to report on the progress of all CARES
initiatives to the CIS which I chair.
__________
Question for the Record from Senator Arlen Specter, Committee on
Veterans' Affairs; Nomination Hearing of R. James Nicholson to be
Secretary of Veterans Affairs
Question 1: The Veterans' Park Conservancy (VPC), a group of
concerned and civic-minded veterans and residents in Los Angeles, is
eager to create a 16-acre National Veterans' Park on the undeveloped
portion of land at the West Los Angeles VA facility. Over the past 15
years, this group has worked to preserve, protect and enhance the
historic West Los Angeles VA property, including the National Cemetery
and have made over $3 million of improvements in this property. Many
donors have made this work possible. The VPC intends to raise
substantial private funding for development of the Park and is looking
to have some assurance of permanence. Please review the January 21,
2005, letter addressed to me from Veterans' Park Conservancy regarding
this matter and respond to their concern for the record. Ambassador
Nicholson, will you work with Veterans' Park Conservancy toward a
mutually beneficial agreement regarding the creation of a National
Veterans' Park?
Response: The concerns addressed in this letter have been responded
to by Secretary Principi in a letter dated October 8, 2004 (attached
for the record). I will continue to work with Veterans' Park
Conservancy within the framework identified in the Secretary's
response. The Memorandum of Understanding signed in July of 2001 is our
commitment regarding the creation of a National Veterans' Park and
identifies the parameters of the partnership. The process described in
the Memorandum of Understanding was successful in a similar project VPC
performed for improvements to the West Los Angeles National Cemetery.
Although it is VAs intent to have this area remain as parkland and open
space, VA cannot consider preserving this designated area in perpetuity
in view of the ongoing Capital Asset Realignment for Enhanced Services
planning process. Included in that process will be a new Master Plan
for the VA West Los Angeles campus that will guide the future use of
the property.
__________
Questions for the Record from Senator John D. Rockefeller IV, Committee
on Veterans' Affairs; Nomination Hearing of R. James Nicholson to be
Secretary of Veterans Affairs
Question 1: Mr. Ambassador, as most people know, health care is my
passion, and I push for quality health care at every opportunity,
especially for our veterans who earned their benefits through
distinguished service. Your predecessor, Tony Principi, was a good
friend to me and to veterans. His candor and his voice about the true
needs for VA health were crucial. I urge you to be as candid and as
clear about the true need our veterans within the VA health system as
we all struggle under the pressures of our budget deficits.
Response: The Fiscal Year 2006 Budget will enable VA to continue
its mission of providing high-quality, timely, and compassionate health
care to all enrolled veterans who seek care. This budget enables VA to
place its greatest emphasis on our core population of veterans--those
with service connected disabilities including returning OIF/OEF
veterans; those with low income; and those who have specialized needs--
while asking veterans in Priority Groups 7 and 8 to make limited
contributions toward the cost of their care. We believe that these
contributions are modest in light of the comprehensive, high-value, and
high-quality care the Department provides. In addition, this budget
includes $700 million in construction to continue the Department's
commitment to the CARES initiative, $100 million for the Mental Health
Initiative, and $100 million for Prosthetics. In future years, I assure
you that I will be a firm advocate for budgets that allow the
Department to meet the needs of all enrolled veterans who choose to
come to VA for their health care.
Question 2: During the first Persian Gulf War, this committee asked
many questions about Persian Gulf War illnesses. I was pleased that
Secretary Principi did an advisory task force on the issue, and he
pledged $60 million in research to continue studies on the Persian Gulf
War illnesses. I think VA should aggressively pursue additional
research because we must have the facts, and I want to know if you are
committed to follow through on this issue.
Response: As Secretary Principi stated on November 12, 2004, VA
will commit up to $15 million in additional federal funding in FY 2005
to support continued research into the cause of and potential
treatments for Gulf War illnesses. This represents VA's single largest
set-aside of research funding for a specific area of investigation and
almost 20 percent of all new research grant awards for FY 2005.
In response to a reporter's question about commitments beyond FY
2005, Secretary Principi said, ``I'm not making any out-year
commitments . . . And we have taken an unprecedented step by earmarking
funds for this type of research. We certainly will look at it in 2006,
2007, 2008.''
While it essential to find answers to what is causing Gulf War
illness and to identify appropriate treatments, the specific financial
commitment will need to be reviewed each year.
To implement the commitment for FY 2005 funding, VA is in the
process of issuing a new request for proposals. The proposed studies
will undergo the same intensive evaluation and review for scientific
rigor as all projects sponsored by VA research.
Also, VA plans to establish a center dedicated to the investigation
of potentially effective treatments for veterans with Gulf War
illnesses. This center will use observational and epidemiologic methods
to identify promising therapies and will conduct pilot studies that may
serve as prelude for more definitive clinical trials. To ensure that
this center is designed successfully to meet the methodological
challenges of research in this difficult area of investigation, VA is
working closely with the Research Advisory Committee in forming a
committee of expert advisors to assist in the planning and design of
the center. The Committee will be meeting in early March.
VA has funded 111 projects on Gulf War veterans' illnesses since
1991. The direct research costs of these studies as of October 2004
total $56.4 million. Indirect costs associated with this research are
estimated at $16.9 million (historical data suggest indirect costs
equal 30% of direct costs).
In FY 2004, VA approved 18 new Gulf War projects. Total funding
over the life of these projects will exceed $9.5 million. VA is
currently funding 48 ongoing Gulf War studies in FY 2005. Areas of
focus include: brain and nervous system; depleted uranium; interaction
of multiple exposures; treatments; and epidemiology. Direct research
costs for these studies total $6 million.
Recent VA findings with impacts or potential for impacts in Gulf
War veterans' illnesses include:
<bullet> Identification of a superior mode of treatment for
veterans suffering from undiagnosed Gulf War symptoms.
<bullet> Finding that a statistically significant higher prevalence
of ALS in Gulf War veterans (led to presumptive service connection for
compensation).
<bullet> Confirmation of higher rates of PTSD and other
psychological disorders among Gulf War veterans.
<bullet> Substantiation that adverse reproductive outcomes have not
been more common among veterans deployed to the Gulf War than among
those who were not deployed.
Examples of ongoing VA studies include:
Neuroimaging: A team at the San Francisco VAMC has initiated the
largest effort to date to conduct research to detect any brain changes
associated with Gulf War veterans' illnesses and to determine possible
relationships with ALS. The team, under Dr. Michael Weiner, will use a
4-Tesla magnetic resonance imaging--magnetic resonance spectroscopy
system that the VAMC acquired through grants from the Department of
Defense (DoD) and the National Institutes of Health (NIH).
Epidemiology. Studies conducted to date have not shown an excess of
cancer-related deaths among Gulf War veterans. However, because many
cancers are not rapidly fatal, VA recently funded a cancer prevalence
study among Gulf War veterans.
Amyotrophic Lateral Sclerosis (ALS): VA has initiated a national
registry for veterans with ALS and an accompanying genetic tissue bank
(ALS-DNA) to build upon its earlier prevalence study. The goals of the
registry are to identify as completely as possible all veterans with
ALS, not just Gulf War era veterans, and to provide a mechanism for VA
to inform veterans with ALS about clinical drug trials and other
studies for which they may be eligible. The ALS-DNA bank will involve
collection of DNA and plasma from blood samples from consenting ALS
registry participants. It is the intent that these materials be made
available for future genetic research on ALS. The Veterans' ALS
Registry has generated great enthusiasm and praise among the national
community of ALS researchers.
While not specific to Gulf War veterans, VA investigators are also
conducting a clinical trial to determine the safety and efficacy of
sodium phenyl butyrate (NaPS) in subjects with ALS. While there is no
know treatment for ALS, NaPS is a pharmacological treatment that has
been shown to extend survival in mice with ALS. This study will also
seek to identify optimal doses for NaPS and riluzole (currently, the
only approved drug for ALS) and examine their combined effects in ALS
mice.
Depleted Uranium: VA continues to fund a clinical health
surveillance of Gulf War veterans who were exposed to depleted uranium
(DU) oxides as a result of friendly fire incidents. Some of these
veterans have retained DU fragments that cannot be removed due to
medical considerations, and the 39 surveillance participants, nine of
whom remain on active duty, had significantly higher exposures than
other servicemembers who served in the Kuwaiti Theater of Operations.
Testing to date has found no differences in the frequency of
musculoskeletal, cardiovascular, psychiatric, nervous system, or other
disorders. Although the kidney is the putative critical organ for
uranium toxicity under acute and chronic exposure conditions, no
evidence of renal dysfunction has been found. Of note, none of the
participants' offspring have had birth defects. This is far less than
would have been expected. Despite these favorable outcomes, VA will
continue to fund this surveillance to monitor for any potential DU-
related long-term health problems.
Question 3: In September 2004, the GAO issued a report noting that
VA needs better data to plan and prepare to serve veterans with Post-
Traumatic Stress Disorder (PTSD). GAO specifically calls on VA to do a
full assessment of current veterans receiving PTSD care. Then VA should
work with DoD to help identify how many servicemembers may need PTSD
care and where they will be located. Given that medical experts predict
that about 15% of military personnel serving in Iraq and Afghanistan
will develop PTSD, the need for planning and care is real.
What is VA doing to follow up on this GAO report, specifically,
what priority will VA make PTSD and care to our newest veterans, those
returning from Iraq and Afghanistan?
Response: In follow up to the GAO report of September 2004, VAs
Office of Environmental Epidemiology is identifying and tracking the
numbers and locations of Operation Enduring Freedom (OEF) and Operation
Iraqi Freedom (OIF) veterans being served by VA Medical Centers,
outpatient clinics and Readjustment Counseling Service (Vet) Centers.
To identify servicemembers who may need VA care, VA is working closely
with DoD to maintain accurate data on numbers of OEF/OIF returnees and
their use of VA services. For those veterans already in the system the
Northeast Program Evaluation Center publishes an annual national
analysis of all PTSD treatment programs. This provides Networks and
Facilities with demographic analysis of the veterans seen in their
programs.
Meeting the needs of our returning veterans and their families is
among VAs highest priorities. VAs approach toward the returning troops
and their families is guided by an emphasis on health promotion and
preventive care principles. It focuses on patient and family education
about good health care practices and behaviors to avoid. It avoids
``over pathologizing'' the veteran. For those who do have mental
disorders, the orientation involves the concepts of rehabilitation that
address a patient's strengths as well as deficits. It embodies a belief
in recovery of function to the greatest degree possible for each
patient. This approach is designed to identify and resolve problems in
readjustment to civilian life, before they progress to problems
requiring more intensive clinical interaction. Readjustment Counseling
Service takes the lead in providing this level of care through the 207
community-based Readjustment Counseling Centers (RCS) throughout the
United States. 50 additional Global War on Terrorism counselors have
been added to these centers to meet this need. In addition the
Secretary has expanded authority to RCS to deliver bereavement
counseling to those in need.
For those that require clinical interaction, VA provides state-of-
the-art psychotherapy and psychopharmacology treatments. The joint VA/
DoD Clinical Practice Guidelines direct evidence-based care for PTSD
and other disorders that may be associated with PTSD and the stress of
war such as Major Depression and Substance Use Disorders. VA provides
this care through 144 specialized PTSD programs in all States. These
consist of specialized in-patient PTSD units, Residential Treatment
units, and Outpatient PTSD clinical teams. All patients are currently
screened annually for PTSD. In addition an OIF/OEF clinical reminder
tool in the computerized medical record was developed for clinicians
which reminds them that they are seeing a veteran who has recently been
exposed in the War effort and needs to be screened for PTSD,
Depression, and Substance abuse.
Innovative clinical approaches are being pursued through the use of
Public Law 180-170 funding which authorizes $5 million for the
development of special outreach, health promotion, consultation, and
liaison programs for returning veterans in collaboration with Veterans'
Benefits Administration, DoD, and community resources. P.L. 108-170
also authorizes an additional $5 million each for the expansion of
existing PTSD and substance use disorder treatment programs. In
addition the National Center for PTSD coordinates state-of-the-art
research for the VA and provides training and guidance to our
clinicians. The National Center for PTSD produced an Iraqi clinician
guide that provides a tutorial for practitioners on what they might
look for in returning soldiers/veterans who have served in Iraq.
Question 4: The CARES Commission was intended to be a strategic
plan for VA health care, but it did not truly consider long-term care
issues and mental health issues. I believe each should be a priority of
VA given the needs of the veteran population. How are you going to deal
with long-term care and mental health?
Response: I fully support the continuation of VAs assessment of LTC
and Mental Health (MH). VHA has recently completed new runs on LTC and
MH workload projects by market and by priority category for LTC.
Strategic Planning Guidance will be going out to the VISNs and
facilities in the next month requesting operational plans to include
Strategic Initiatives. Each VISN will prioritize its strategic
initiatives by year and within the year along with cost projections for
inclusion in the VISN and National Strategic Plan. LTC and MH
initiatives are included in this process. Implementation of all CARES
initiatives, including LTC and MH initiatives, is dependent on future
funding.
__________
Questions for the Record from Senator James M. Jeffords, Committee on
Veterans' Affairs; Nomination Hearing of R. James Nicholson to be
Secretary of Veterans Affairs
Question: VA Physician Assistants--Mr. Ambassador, the Congress has
been pushing the VA for many years to provide an advisory position
within the VA for Physician Assistants. The VA currently employs over
1,500 physician assistants (PAs), who are a very important part of the
VA healthcare structure. However, they do not fall neatly into either
the doctor or nurse category. In 2000, Congress passed legislation
directing the VA to implement a PA advisor to the Under Secretary for
Health. The following year, a part time position was established, but
it was located outside of Washington and given very little travel
money. Congress has since reiterated that this position should be a
full time position and be either located in the Washington DC area, or
provided with a sufficient travel budget to fulfill the advisory
duties. As of yet, however, this has not happened.
The current PA Advisor's lack of access to the department's policy
deliberations hampers the department's ability to fully and
appropriately utilize this important resource. Have you examined the
issue of representation of the PAs in policy discussions, or the
position of the PA Advisor? I understand that you may not have had time
to reach this level of detail, but I would appreciate your attention to
this question at your earliest convenience and a response as to your
plans for the PA Advisor position.
Thank you.
Response: Prior to the enactment of P.L. 106-419, the Veterans'
Health Administration (VHA) had utilized a physician assistant (PA) in
a Lead PA function for advice, policy input, and guidance since October
1997. Since 2000, VA has established and filled the position of PA
Advisor on a permanent or acting basis. This position was and continues
to be filled by a field-based PA who advises the Under Secretary for
Health (USH) while also performing clinical duties.
In 2001, the Secretary explained to Senator Jeffords and two fellow
Senators the reasons that VHA believes that the responsibilities of the
position would be best fulfilled by a field-based PA position.
The PA Advisor and the PA Field Advisory Group are fully engaged in
policy deliberations and are consulted concerning a range of issues.
See attached Fact Sheet.
______
Response to Senator Jeffords Concerning The Physician Assistant Advisor
to the Under Secretary
The PA Advisor position has been filled with a field-based PA, with
financial support from headquarters for travel, training, and
miscellaneous expenses.
Until recently, the position was 50 percent for headquarters
duties; based on special projects, the amount of time has been
increased to 75 percent for the past several months.
The Veterans' Health Administration (VHA) has a long-standing
practice of obtaining clinical program leadership using field-based
clinicians. As VHA explained in its May 2001 response to a prior
Congressional inquiry concerning the PA Advisor position, this approach
is not unique to PAs. VHA's Office of Patient Care Services has a
number of clinical program managers working at VA medical facilities
across the country. These include VHA's Chief Consultant for Spinal
Cord Injury, located in Seattle, Washington; the Director, Podiatry
Service, located in Cleveland, Ohio; the Director, Radiology Service,
located in San Francisco, California; the Director, Optometry Service,
located in Baltimore, Maryland; and the Director, Infectious Diseases
Program Office, located in Cincinnati, Ohio, to name only a few. All of
these clinicians devote half-time to national duties and half-time to
local clinical responsibilities.
VHA believes that utilizing ``hands-on'' clinical providers as
national program leaders where possible and allowing them to stay in
the field provides several distinct advantages. First, clinical leaders
maintain active practice, thus maintaining their clinical skills and
current awareness of technology, patient, and treatment needs, demands,
and developments. Second, they are able to approach national policy
issues from the perspective of someone on the ``front lines'' taking
care of patients. And third, when recruiting, VHA increases the pool of
available candidates since many well-qualified candidates may not wish
to give up clinical work or move to Washington for exclusively
administrative assignments. We believe that these same advantages
accrue to a field-based PA Advisor with an active clinical practice.
Public Law 106-419, which added the Advisor on Physician Assistants
to the Under Secretary for Health's cadre of national clinical leaders,
did not specify a duty station or how much time the position would be
required to spend on PA Advisor duties. The legislative history of
Public Law 106-419 would appear to indicate that the intent of Congress
was to allow the position to be based in the field.
PL 106-419 amended 38 U.S.C Sec. 7306 to require that the Office of
the Under Secretary for Health include, among other specified
positions, ``[t]he Advisor on Physician Assistants, who shall be a
physician assistant with appropriate experience and who shall advise
the Under Secretary for Health on all matters relating to the
utilization and employment of physician assistants in the
Administration.'' This language is silent as to where the PA Assistant
should be stationed and whether his or her advisory duties may be
collateral to other assignments. However, there is specific legislative
history indicating that Congress intended that the PA Advisor would be
primarily assigned to a field facility and would simply travel to
Washington to advise the U.S.H on an as-needed basis.
Prior versions of the bill (set forth in HR 4759 and HR 5109)
provided that the Advisor on Physician Assistants ``may have a
permanent duty station at a Department medical care facility in
reasonable proximity to Washington, DC.'' The legislative history shows
that the version of the language enacted in PL 106-419 was approved as
a compromise between HR 5109 and a Senate Veterans' Affairs Committee
(SVAC) bill, S. 1810, which made no specific reference to the PA
Advisor's duty station. While the compromise language omitted the House
bill's reference to a permanent duty station other than VACO, Senator
Rockefeller--then the Ranking Member of the SVAC--discussed the PA
Advisor's duty station when he introduced the final bill on the Senate
floor. Sen. Rockefeller's comments (found at 416 Congo Rec. S 10500,
S10515) make it clear that the PA Advisor position was intended to be
filled by a field-based provider:
Another important provision in this legislation that I am very
proud of is the creation of a physician assistant advisory position
within the Veterans' Health Administration (VHA).
The VA Under Secretary for Health will designate a VHA physician
assistant to fill this position and charge that person with advising on
all matters regarding the employment and use of physician assistants
within the Veterans' Health Administration. The advisor may be assigned
out in the field with periodical visits as necessary to VHA
headquarters for reports, so that they are able to keep in touch both
with physician assistants working all over the country and the VA Under
Secretary for Health in VA Headquarters.
In the past several months, VHA has increased the percentage of
time that the PA Advisor spends on advisor duties to 75% in order to
meet the need to revise two critical VHA policy documents, one a VHA
Directive on the utilization of PAs and the other VAs PA qualification
standard. The Department will reconsider the PA Advisor position again
in the 3rd quarter of FY 2005, with a focus on the justifiable need for
the amount of time allotted to national issues and with due
consideration for reduced personnel ceilings, budgetary constraints and
other national priority issues.
VHA issued a national policy on the utilization of PAs, known as
VHA Directive 2004-029: Utilization of PAs, in July 2004. This policy
was developed with input from the PA Advisor, the PA-FAC, other PAs,
Primary Care physicians and nurses, policy decisionmakers in VA Central
Office, and other field staff.
VHA has undertaken a comprehensive revision of the qualification
standards for VA PAs, a process that again has involved input into the
utilization of PAs from the PA Advisor, the PA-FAC, and other
stakeholders throughout the VA system.
In addition, VHA has established a PA-Field Advisory Committee (PA-
FAC), which had its first face-to-face meeting in Washington, DC, on
May 17, 2004. Prior to that meeting, VHA's National Director for
Primary Care met with officials of the VA Physician Assistant
Association, and the PA-FAC held monthly conference calls during which
various PA issues were discussed at length to obtain input. A member of
the PA-FAC also serves on VHA's Primary Care-Field Advisory Committee
to represent PAs' interests, and VHA is currently developing PA
training which would assist in PAs in their re-certification process.
Regarding the question of funding support for the PA Advisor's
official travel, the level of funding has been equal to or greater than
that provided to other individuals for the performance of their
official duties. The level of support has consistently increased over
time to support PA professional activities.
__________
Questions for the Record from Senator Ken Salazar, Committee on
Veterans' Affairs; Nomination Hearing of R. James Nicholson to be
Secretary of Veterans Affairs
Question 1: Will you commit to use your best efforts to make the
new VA medical center at Fitzsimons a reality?
Response: VA continues to work on acquiring a site, preferably on
the Fitzsimons site, in close proximity to University of Colorado
Hospital and the affiliate to maintain the positive working
relationship that has been so successful for all.
Question 2: How will you advocate for sufficient health care
funding to meet increasing demand given the historic deficits we face?
Response: The Fiscal Year 2006 Budget will enable VA to continue
its mission of providing high-quality, timely, and compassionate health
care to all enrolled veterans who seek care. This budget enables VA to
place its greatest emphasis on our core population of veterans--those
with service connected disabilities including returning OIF/OEF
veterans; those with low income; and those who have specialized needs--
while asking veterans in Priority Groups 7 and 8 to make limited
contributions toward the cost of their care. We believe that these
contributions are modest in light of the comprehensive, high-value, and
high-quality care the Department provides. In addition, this budget
includes $700 million in construction to continue the Department's
commitment to the CARES initiative, $100 million for the Mental Health
Initiative, and $100 million for Prosthetics. In future years, I assure
you that I will be a firm advocate for budgets that allow the
Department to meet the needs of all enrolled veterans who choose to
come to VA for their health care.
Question 3: Will you work to lift the outdated and unfair income
cap for care of priority 8 veterans?
Response: I will consult with VA staff to determine the need for
continuing this suspension and/or the need to exercise another
enrollment policy to balance demand with available resources for FY
2005. Equally important is the need to consider the out-year impact of
enrollment decisions in terms of expected resource availability,
expected demand for VA health care services and the potential for
growing waiting lists and waiting times.
Question 4: Do you agree to exercise your authority to end co-pays
and duplicative physicals to permit access to prescription drugs?
Response: Historically, VA medical care has been defined by the
provision of comprehensive services for veterans, encompassing care
provided across the continuum of time and care setting. VAs
prescription benefit has been designed as an extension of the care
continuum, rather than an ``add-on'', non-integrated service. As
medications have become more costly and/or more difficult for patients
to obtain in the private sector, it is understandable that interest in
VA providing a prescription-only benefit has increased. I am hopeful
that the implementation of Medicare Part D next year will provide an
additional option for patients' medication needs and will improve
access to prescription drugs.
Providing prescriptions to veterans in the absence of comprehensive
medical care is problematic for two primary reasons. First, and most
importantly, I believe that coordination of care by one provider is the
cornerstone of high-quality health care. Without up-to-date information
such as a detailed medical history, a complete medication use summary,
and other pertinent clinical information as can only be provided by a
single Primary Care provider, there is risk that a course of treatment
for an individual patient which is based on incomplete or inaccurate
information could lead to significant negative outcomes. Specifically
from a quality of care perspective, providing medication therapy in a
fragmented, nonintegrated manner, as is the norm in much of the U.S.
health care system, is conducive to greater medication misadventures.
VA has considerable experience to demonstrate that providing
pharmaceuticals as an integrated portion of VAs health care benefit is
effective and efficient from both a qualitative and quantitative
perspective.
Second, from an economic perspective, dispensing prescriptions
prescribed by non-VA doctors would dramatically increase VAs per capita
expenditures for pharmaceuticals and has the potential to divert
resources from other medical care programs. VA has maintained
unprecedented control over its per prescription unit costs by using
sophisticated formulary management techniques and by assuring that
prescriptions written by VA staff are consistent with the goals of the
VA formulary management process. VAs per capita pharmaceutical
expenditures are well below those of most, if not all, managed care
organizations in the United States. This fact is most impressive
considering that VA cares for patients that are typically among the
oldest and sickest. Part of the reason for VAs success is the
infrastructure in place to develop and promulgate evidence-based drug
treatment guidelines and an effective National Formulary process. We
strongly believe that the quality of care provided by a comprehensive
Primary Care delivery approach, integrated with a well-managed National
Formulary process is vastly superior to the fragmented, medication
therapy model that many Americans access today.
I support VA's long-standing commitment to provide high quality,
cost-effective and safe healthcare to our Nation's veterans who choose
VA as their healthcare provider. However, based on the reasoning
described above, at this time I do not support providing prescriptions
to veterans outside of VA's comprehensive medical care program.
Question 5: How, specifically will you help reduce claims
processing backlog for disability and compensation claims? There are
currently 8,247 claims pending at the Denver Regional Office.
Response: Improvement of benefits claims processing has been an
important goal of the President. I am aware that much progress has been
made both in reducing the backlog and timeliness--and especially in the
reduction of claims that had been pending from our oldest veterans who
had been waiting more than a year for decisions on their claims.
Quality levels have also significantly improved.
The changes made included making the regional offices--and the
claims processing procedures and supporting IT applications--more
consistent and efficient and improving the training and oversight of
the programs. These major changes have resulted in improvements in
production, timeliness, and quality.
While there has been significant success, much remains to be done.
VBA has seen large increases in incoming claims and appeals, both from
the returning servicemembers and from older veterans who had not
previously submitted claims. We will continue to emphasize the
improvements necessary to timely provide our veterans with the benefits
they deserve and which the Congress has so generously made available.
I have been advised that the Denver Regional Office is working hard
to reduce its pending inventory and is making good progress. To assist
the office, over 1,000 cases were transferred to other regional offices
for processing during the first quarter of this fiscal year. The Denver
office also hired eight additional employees in 2004, which was the
largest single recruitment in the Veterans' Benefits Administration's
Western Area.
Question 6: Will you advocate to end concurrent receipt
regulations, the ``disabled veterans tax?''
Response: Under current statutory authority, concurrent receipt of
military retirement pay and veterans' disability compensation is being
phased in over a 10-year period for retirees disabled to a degree of
50-percent or more, at 10-percent increments each year through 2013. In
October, legislation was enacted by Congress and signed by the
President eliminating as of January 1, 2005, the phase-in period for
concurrent receipt for retirees receiving veterans' disability
compensation for a disability rated 100-percent disabling. It is my
understanding that the additional payments veterans receive as a result
of concurrent receipt are generally received in the form of increased
military retirement pay, which veterans had previously waived in order
to receive VA disability compensation. Amounts veterans receive from VA
as disability compensation are generally unaffected. Therefore, I would
defer to the views of the Department of Defense on this issue.
Question 7: Funeral costs routinely cost many thousands of dollars.
Those veterans who die from illness or injury directly related to their
service receive only $2,000 and the plot allowance for disabled or
indigent veterans is only $300. Will you agree to advocate to increase
burial benefits to $3,700 and $1,100 respectively?
Response: I understand that VA provides a full range of burial
benefits and services beyond the monetary benefits you mention. All of
these are designed to help defray the cost of burial. Included in these
benefits is burial in a national or State veterans' cemetery at no cost
to the veteran. Additionally, grave liners, headstones and markers, and
in some cases transportation fees to the nearest national cemetery are
available.
I also understand that in addition to these benefits many veterans
are entitled to burial assistance through other federal, State, and
local governments, their employers, or fraternal organizations as well
as through money they themselves have set aside for this purpose either
through pre-paid burial trusts or in insurance policies. I have learned
that the Government has responded to veterans' burial needs in recent
years by establishing several new national cemeteries and by
significantly enhancing the grant program under which State veterans'
cemeteries are established. The State Cemetery Grants Program now
provides up to 100 percent of the costs of improvements associated with
the establishment, expansion, or improvement of a State veterans'
cemetery, as well as the cost of equipment necessary to operate a new
cemetery.
While VA benefits may not cover every expense associated with a
burial, I believe they do represent a comprehensive list of benefits
and services available to honor America's veterans at the time of
death.
Question 8: Will you advocate to readjust mortgage assistance
levels to keep pace with real estate process and inflation?
Response: The amount of guaranty that VA provides on a loan
determines the amount of the loan that a lender will make to a veteran.
Lenders will generally make a no-down payment VA loan for up to four
times the amount of the VA guaranty. However, as your question rightly
recognizes, the guaranty amount has sometimes become insufficient to
permit all veterans to buy the homes of their choice with their VA home
loan benefit.
I am pleased that both the Administration and the Congress have
recognized the problem and recommended and passed legislation that will
go a long way toward alleviating it. As the result of the Veterans'
Benefits Improvement Act of 2004, the guaranty amount is indexed at 25%
of the ``conventional conforming loan limit,'' which is the limit on
loans that can be purchased by Fannie Mae and Freddie Mac. The
conforming loan limit is set annually by Freddie Mac to adjust for
inflation and market conditions. When this limit increases, the VA
guaranty will also increase to 25% of the new limit. In practical terms
this means that lenders will now make a VA no-down payment loan for up
to the conventional conforming limit, which is currently $359,650.
Question 9: Members of the National Guard and Reserve become
eligible for 2 years of health care through the VA after being deployed
for more than 180 consecutive days. Given the increased reliance on
Guard and Reserve in Iraq (where Guard and Reserve make up 40% of the
troops) and the global war on terrorism, thousands of soldiers are
becoming eligible for VA benefits--at the same time the President is
contemplating freezing funding for VA health care at last year's level.
What will you do to support this newest generation of VA clients, to
ensure a seamless transition from serving overseas to receiving care
through the VA, and to guarantee that these heroes will not return home
to waiting lists or doctor shortages?
Response: VA has recognized the importance of seamless transition
by opening a new VHA office dedicated to coordinating this critical
issue. VA has been and will continue to work with DoD to ensure that we
collect and share information on veterans serving in Operations
Enduring Freedom and Iraqi Freedom. VA is also working with its health
care actuary to assess the impact of these veterans on our health care
system and ensuring that we plan for and are prepared to deliver the
health care needed by this newest cohort of veterans. VHA is committed
to ensuring its core constituency receives the services they need and
is also closely monitoring access to health care in terms of waiting
lists.
Question 10: The New England Journal of Medicine recently found
that as many as 1-in-6 servicemembers returning from Iraq may suffer
from Post Traumatic Stress Syndrome, but that many servicemembers do
not receive mental health care. What can the VA do to improve mental
health care for veterans?
Response: The New England Journal of Medicine article by Dr.
Charles Hoge found that the percentage of study subjects whose
responses met the screening criteria for major depression, generalized
anxiety, or PTSD was 15.6-17.1% after duty in Iraq. Of those who
screened positive for a mental disorder only 23-40% sought mental
health care. The good news from this study is that 83% of the returning
troops did not meet the screening criteria for mental disorders. The
great majority of them will not suffer long-term consequences of their
war zone experience, although many will have some short-term reactions
to the horrors of war. Of those who do develop mental/emotional
problems, PTSD will not be the only problem to be addressed. Major
depression and substance abuse are two problems that can be recognized
with screening and successfully treated. VAs approach toward the
returning troops and their families is guided by an emphasis on health
promotion and preventive care principles. It focuses on patient and
family education about good health care practices, and behaviors to
avoid. It also avoids ``over pathologizing'' the veteran. For those who
do have mental disorders, the orientation involves the concepts of
rehabilitation that address a patient's strengths as well as deficits.
It embodies a belief in recovery of function to the greatest degree
possible for each patient. This approach is designed to identify and
resolve problems in readjustment to civilian life, before they progress
to problems requiring more intensive clinical interaction.
Program staff are contacting returned troops including members of
the National Guard & Reserves, and families in forums such as
preventive health/educational briefings that allow for informal sharing
of information about stress related disorders and coping mechanisms,
and availability of the range of VA psychosocial support services.
Other activities such as participation in Public Service Announcements,
presentations at community sites such as schools, faith-based and
professional organizations, liaison with (Veterans Service
Organizations, State Veterans' Affairs Departments, and Military Unit
Organizations), and other innovative approaches relevant to the local
community may also be employed. Collaboration with Readjustment
Counseling Service is a key element of these successful interventions.
VA provides comprehensive care for veterans with mental disorders
through a continuum of services designed to meet patients' changing
needs. The intensity of care ranges from acute in-patient settings, to
residential services for those who require structured support prior to
returning to the community, to a variety of outpatient services.
Outpatient care includes mental health clinics, ``partial
hospitalization'' programs such as day hospitals and day treatment
centers that offer care 3-5 days a week to avert the need for acute or
extended in-patient care, and intensive case management in the
community. Long term in-patient or nursing home care is available if
needed. VAs mental health programs include programs designed to meet
the needs of special populations of patients including those with
schizophrenia, major depression, PTSD, and addictive disorders.
VA mental health care is based on two core elements: state-of-the-
art psychopharmacology and evidence-based psychotherapy and
psychosocial rehabilitation. Evidence-based practices are outlined in
Clinical Practice Guidelines (CPGs), created jointly with DoD,
including CPGs on major depression, serious mental disorders, substance
use disorder, and PTSD.
Research in future practices is performed by Clinical research and
services delivery entities such as QUERI (Quality Enhancement Research
Initiative), ten Mental Illness Research, Educational and Clinical
Centers (MIRECCs), and VA's National Center for PTSD.
VA is known as a world leader in PTSD treatment and research, and
will continue to deliver state-of-the-art care to veterans with PTSD.
Question 11: According to the National Coalition on Homeless
Veterans, as many as 500,000 veterans spend at least one night a year
homeless. They also have circulated that 1-in-4 homeless people in this
country is a veteran. What can the VA do to improve the lot faced by
homeless veterans, who according to some estimates may number as high
as 500,000?
Response: VAs efforts to improve the, circumstances faced by
homeless veterans are aimed at enhancing the continuum of services for
homeless veterans. This includes: 1) outreach; 2) assistance in
securing access to medical and mental health treatment, including
substance abuse treatment; 3) case management; 4) transitional housing;
5) assistance in improving income support; and 6) assistance with
permanent housing.
To this end, VA intends to offer funding through capital grants to
increase the number of faith-based and community-based transitional
housing beds that will be available for homeless veterans across the
country. VAs goal is to provide support through per diem payments for
approximately 10,000 community-based beds by 2009.
VA will continue the 29 Special Needs Grants to allow existing
community-based grant and per diem recipients and their VA medical
center partners to enhance services for special segments of the
homeless population to include: (1) chronically mentally ill, (2) frail
elderly, (3) women, including women with children, and (4) terminally
ill homeless veterans. VA is committing approximately $30 million
across a 3-year period to support these partnership projects.
VA also intends to expand and augment the Domiciliary Residential
Rehabilitation and Treatment Program for Homeless Veterans by
activating 7 new programs and adding staffing to 10 existing programs
in FY 2005. With these program activations, VA will have more than
2,100 domiciliary residential rehabilitation beds dedicated to homeless
veterans.
VA will continue to work with the Departments of Housing and Urban
Development (HUD), Health and Human Services (HHS), and Labor (DOL) in
supporting collaborative initiatives that address the needs of
chronically homeless people, including homeless veterans, by providing
permanent housing, primary and mental health care and support services.
VA's contribution to these collaborative projects includes the
provision of case management services for homeless veterans who are
enrolled in these programs. In addition, VA's Northeast Program
Evaluation Center (NEPEC) is monitoring the programs and conducting a
long-term evaluation to determine the effectiveness of this innovative
approach.
VA is increasing its efforts of outreach to incarcerated veterans
who are at risk of becoming homeless upon release from jails and
prisons. These outreach efforts are aimed at providing veterans with
detailed information about VA services and benefits that are available
to them upon release and providing them with contact information for VA
staff, staff in other Federal, State, and local government agencies,
and staff in community-based programs so they can access services more
easily.
VA will continue to work toward implementation of at least 3
projects to develop long term transitional housing for homeless
veterans under the Loan Guarantee for Multifamily Transitional Housing
for Homeless Veterans Program. Conditional commitment letters issued to
date would guarantee loans totaling $9.57 million and would support
approximately 367 transitional housing beds for homeless veterans.
Finally, VA is incorporating performance measures into VA Network
Director's Performance Plans that focus on homeless veterans' access to
primary care and mental health treatment. By identifying benchmarks and
setting goals for improvement, VA expects to improve homeless veterans'
access to health care services.
__________
Questions for the Record From Senator John Thune, Senate Veterans'
Affairs Committee; Nomination Hearing of R. James Nicholson to be
Secretary of Veterans Affairs
Question: I understand the VA is considering a proposal to
standardize testing equipment made available to veterans suffering with
diabetes.
<bullet> What data do you have to indicate that quality of care
will not be compromised by switching veterans to different test
equipment?
<bullet> What will the direct and indirect costs be to transition
to a national program? How will these costs be measured?
<bullet> What are the VAs plans for obtaining public input into
this program? Has the VA considered an advisory committee to monitor
key aspects of the program including quality of care, access to testing
equipment, and overall implementation?
Last year Congress extended the authorization of long term care
(e.g. nursing home, geriatric day care, and home health care, etc.) to
veterans with service connected disabilities rated 70% or higher. This
is a 1-year extension of the 5 year authority originally provided for
in the Veterans' Millennium Health Care Act of 1999. Terminating this
program could have a negative impact on World War II and Korean
Veterans and chronically ill Vietnam Veterans. Will you seek a
permanent authorization for long-term health care?
Response: VA has two primary goals connected with standardization
of Self Monitoring Blood Glucose (SMBG) equipment. First, we must
ensure that veterans with diabetes receive the best care possible,
including using reliable, state-of-the-art SMBG equipment with which
they are comfortable; and second, we must pursue every opportunity to
leverage our volume purchasing power to achieve savings to support more
care for veterans.
Our initial efforts to implement standardization will be focused on
providing new devices to veterans newly diagnosed with diabetes, to
those whose existing equipment fails, as well as those patients who
choose to change equipment on their own accord. Local VA providers will
work with veterans who use the current standard SMBG equipment to offer
transition to the new device. As is true with all VHA standardization
efforts, individuals for whom the new device is not appropriate will be
offered alternate SMBG devices. No one will be forced to change
devices, and VA has made a commitment to various stakeholders to allow
patients to continue to use their existing devices after a national
award is made. Moreover, we would never prescribe a device that is not
clinically appropriate for the individual patient.
VAs experience with standardization of pharmaceuticals and other
medical supplies has shown that we can achieve significant savings to
support expanded care to veterans, while simultaneously maintaining and
in some cases, improving outcomes. The annual volume of SMBG strips has
increased 70% from 91 million strips in FY 1999 to 155 million strips
for FY 2004; however, the discounts offered by the vendors using this
contract strategy have not significantly changed. The cost per strip
has dropped by only a penny in the last 3 years even though utilization
has increased. Currently VA spends approximately $53 million dollars
annually on blood glucose strips dispensed in the outpatient setting.
Based on past standardization efforts however, a conservative estimate
of SMBG devices cost avoidance would be in the range of 15-25% off of
the current price. This would represent an $8M to $13M gross reduction
in VAs annual cost for SMBG device strips. If VA were to make an award
for 2 years, with 4 renewal options, the total gross reduction could
approach $64M to $104M.
In September 2003, VA convened a multidisciplinary advisory group
consisting of physicians, nurses, diabetic educators, medical
technologists, and pharmacists and charged the group to review the SMBG
medical literature and develop options for further SMBG
standardization. This advisory group is conducting market research and
clinical evaluations in this area, to include identifying direct and
indirect transitional costs, and measurement of the same. Once the
advisory group completes its evaluation and VA has had an opportunity
to reviews its findings and analyses, VA officials will be pleased to
brief the Committee on the results.
The Veterans' Health Care, Capital Asset, and Business Improvement
Act of 2003, Public Law 108-170, extended the long-term care provisions
of the Veterans' Millennium Health Care and Benefits Act of 1999 (the
``Millennium Act'', Public Law 106-117) for a 5-year period ending on
December 31, 2008. We believe that periodic review and reauthorization
of this authority by Congress is appropriate.
Section 1710B of title 38, United States Code, directs that the
Secretary operate and maintain a program to provide extended care
services to the extent and in the amount provided in advance in
appropriations acts for such purposes. The law specifies that such
services shall include geriatric evaluation, nursing home care,
domiciliary services, adult day health care, respite care, and such
other non-institutional alternatives to nursing home care as the
Secretary may furnish as medical services under section 1701 (10) of
title 38, United States Code.
Section 1710A of title 38, United States Code directs that the
Secretary shall provide nursing home care (1) to any veteran who is in
need of such care because of a service-connected disability, and (2) to
any veteran who is in need of such care and who has a service-connected
disability rated at 70% or more.
These categories of veterans are commonly termed ``mandatory
veterans'' under the provisions of the Millennium Act.
Chairman Craig. To all of my colleagues, again, let me
thank you for your cooperation and for allowing us to expedite
this process, as we have effectively done this morning. I will
leave the vote open for one full day. There are absent Members
who might wish to cast their vote on this most important topic,
and without objection of the Committee we will do so.
We will also ask the Ambassador--a variety of our
colleagues are submitting questions, and the timeliness of his
responses to those questions will be very, very important for
completing a full record.
Lastly and finally, Mr. Ambassador, let me again
congratulate you on being nominated by the President. We will
move as expeditiously as we have and can to get you in place.
It is obvious to me and to you, I think, that there are a good
many concerns to be addressed and that we have our colleagues
here who are certainly going to be active participants with you
in making sure they are effectively addressed and that you, the
Administration, and the Senate and the House combined can work
cooperatively together in a bipartisan way to make that
happens.
With that, the hearing will stand----
Senator Jeffords.
Senator Jeffords. How do I stand on the vote?
Chairman Craig. You have been recorded as having voted aye.
The vote remains open, and we have several of our
colleagues who were absent. We will seek them out to see if
they want to vote before it is closed.
With that, the hearing will stand adjourned.
[Whereupon, at 12:41 p.m., the hearing adjourned]
A P P E N D I X
----------
Prepared Statement of James B. King,
Executive Director, AMVETS
Chairman Craig, Ranking Member Akaka and Members of the Committee,
it is a pleasure to submit AMVETS testimony on President George W.
Bush's nomination of Ambassador R. James ``Jim'' Nicholson to be the
Secretary of the Department of Veterans Affairs. Thank you for this
opportunity and thank you, also, for scheduling this confirmation
hearing as early as you have in the new Congress.
As National Executive Director for AMVETS (American Veterans), I
would like to congratulate you, Senator Craig and Senator Akaka, on
being voted by your colleagues, respectively, as Chairman of the Senate
Veterans' Affairs Committee and Ranking Member. Your prior service on
the Committee has been superb. You have helped charter a course for
this Committee that has enabled the Nation to express its gratitude to
the brave men and women who have served in our military forces and
sacrificed so much to preserve our freedoms. I look forward to working
with you in the days ahead.
I would also like to briefly comment on the service of outgoing
Secretary Tony Principi, who has been an outstanding advocate for
veterans' issues, and successfully lead the VA with passion, commitment
and dedication.
Secretary Principi has been a true friend to America's veterans,
and we sincerely appreciate everything he has done on their behalf. He
set out to make a positive difference 4 years ago when he accepted the
position, and he has done exactly that. Secretary Principi has served
the veterans community with distinction, and we will miss him. We wish
him well in his future endeavors.
Mr. Chairman, we are certainly mindful of the importance of this
high national office. The Department of Veterans Affairs is the federal
government's second largest department, responsible for a nationwide
system of health-care services, benefits programs and national
cemeteries supporting more than twenty-four million veterans. Its role
is central to ensuring that our veterans receive critical medical care,
benefits to which they are legally entitled, and lasting remembrance
for their selfless sacrifices, patriotism, and unswerving dedication to
this Nation whenever America called.
Over the course of the last several years, AMVETS has witnessed VA
health care shift from an in-patient hospital base to a more
comprehensive outpatient care system. Frankly, change in VA health care
has been enormously successful and presented veterans with a day and
night difference in quality of care. In fact, when the prestigious New
England Journal of Medicine published a 2003 study on the quality of
care, the VA system received the highest rated measures and proved to
be ``significantly better'' than non-VA care.
Uncertainty about the future direction of VA health care, however,
is causing concern to rise. We are hopeful that the next Secretary can
improve overall delivery of veterans' health care. Despite growth in
the VA budget, we watch certain veterans being shut out of the system
designed for their care; we see curtailment of services at clinics and
care units across the Nation due to stringent resources; and we hear
some continue to propose budgetary restraint, new fees and higher
pharmaceutical co-payments to access the care veterans earned through
their military service.
The new nominee will immediately face these matters and many other
challenges, including health care funding shortfalls, access to care,
and timely care for veterans currently enrolled in the system. During
President Bush's first term, the number of veterans enrolled in VA's
health care network grew from 4 million to 7 million.
Conflicts in Iraq and Afghanistan have produced the highest number
of U.S. casualties in two generations and many American soldiers will
face a lifetime of injury from their military service. Given these
facts, it is critical that the new nominee show a willingness to work
with the members of this Committee, others in the Congress and in the
veterans community to ensure that resources keep pace with a system
struggling to care for sick and disabled veterans.
The members of AMVETS staunchly believe the Department of Veterans
Affairs should be led by an individual who understands that freedom is
not free; that the price is too frequently measured in terms of lives
lost and citizen soldiers either physically or psychologically injured
for life--men and women whose service to our Nation left them hurt and
too often unable to fully recover from the wounds of their military
service. This leader must be a veterans' advocate for he and the
department he leads must continue to advance the Nation's commitment to
provide effective, prompt attention to the well-being of our veterans.
In these terms, AMVETS will work hand-in-hand with President George
W. Bush's nominee to ensure VA's mission is met and the promises made
to America's veterans are kept. We are heartened by the fact Mr.
Nicholson is an outstanding veteran who has displayed a lifelong
commitment to and respect for our men and women in uniform. His prior
service as an Army Ranger, decorated Vietnam veteran, businessman, and
most recently, as Ambassador to the Vatican, has demonstrated a life of
service to his Nation and importantly to the community in which he
lives.
As a successful Colorado businessman, Army Ranger, and ambassador
who will now work, following confirmation, to coordinate policymaking
and administration of the second largest federal department, Jim
Nicholson will need to call on all his skills in the coming weeks when
the President's new budget hits the table.
Clearly in order to meet his pledge to halve the budget deficit,
the President will be looking to freeze some spending and cut
burgeoning federal programs. We anticipate a tight budget, but we
expect the administration and Congress to work together and recognize
the need for a strong defense at home and abroad and a strong
commitment to America's brave veterans who when called didn't tell
their country they had other priorities and simply couldn't answer the
call.
In summary, Mr. Chairman, AMVETS supports Jim Nicholson's
nomination as Secretary of the Department of Veterans Affairs. We
believe he is a committed individual who will do his very best to serve
America's veterans and lead a department of more than 230,000
employees. We urge you and your Committee to forward his nomination
favorably to the full Senate for confirmation.
Chairman Craig, thank you again for providing AMVETS the
opportunity to submit testimony concerning the nomination of Jim
Nicholson as Secretary of Veterans Affairs.
We look forward to working with you, Ambassador Nicholson, and
others in Congress to resolve the issues facing VA today. As we find
ourselves in times that threaten our very freedom, our Nation must
never forget those who ensure that our freedom endures.
__________
Department of Colorado Veterans of Foreign Wars
of the United States.
Arvada, CO, January 23, 2005.
Hon. Larry E. Craig, Chairman,
Committee on Veterans' Affairs, U.S. Senate.
Re: Jim Nicholson, Secretary of Veterans Affairs.
Dear Chairman Craig, This letter written on behalf of the nearly
30,000 members of the Department of Colorado Veterans of Foreign Wars
of the United States, and its' Ladles' Auxiliary, and the nearly
465,000 veterans in our State is in support of the confirmation of Jim
Nicholson to be the next Secretary of Veterans Affairs.
It is not only a great honor for Jim to be nominated by the
President, but by this nomination he has placed his faith in Jim for
this most important position.
We in Colorado know of Jim's long term interest and commitment for
veterans and their families. He will be an outstanding advocate for
this Nation's veterans, their families, and the armed forces of this
great country.
We fully support his nomination, and ask for your Committee's vote
in favor of his confirmation.
Very truly yours,
Department of Colorado, VFW
R.E. ``Bob'' Clements,
Commander.
cc: U.S. Senator Wayne Allard, U.S. Senator Ken Salazar, John J.
Senk, Jr., Adjutant General, Veterans of Foreign Wars of the United
States, Robert Wallace, Executive Director, Washington Office, Veterans
of Foreign Wars of the United States.
__________
National Association of Home Builders,
January 24, 2005.
Hon. Larry E. Craig, Chairman,
Senate Veterans' Affairs Committee.
Dear Chairman Craig: On behalf of the 220,000 members of the
National Association of Home Builders (NAHB), I would like to express
our enthusiastic support for Ambassador Jim Nicholson as the next
Secretary of the Department of Veterans Affairs. Ambassador Nicholson's
strong background and proven leadership capabilities make him an
outstanding choice for this cabinet position.
Ambassador Nicholson's commitment to his country, defined by his
service in our Nation's military, will give him the practical
experience needed to address the full range of concerns facing our
Nation's veteran community. Moreover, his leadership for the past 3
years in his role as the United States Ambassador to the Vatican will
serve him well while overseeing a department of more the 230,000
employees at the Department of Veterans Affairs.
From a housing perspective, as a former developer, I believe his
experience will guide him as we work together to ensure those who have
served our country have access to affordable housing.
We urge you to confirm Ambassador Nicholson's nomination as
Secretary of Veterans Affairs.
Sincerely,
Gerald Howard,
Executive Vice President
and Chief Executive Officer
__________
National Association of Realtors, Al Mansell, CRB,
President,
January 24, 2005.
Hon. Larry E. Craig, Chairman,
Committee on Veterans' Affairs, United States Senate.
Dear Mr. Chairman: On behalf of the more than one million members
of the National Association of Realtors, let me first congratulate you
upon your election as Chairman of the Senate Veterans' Affairs
Committee. The National Association of Realtors looks forward to
working with you on a range of housing issues affecting veterans under
the VA Home Loan Guaranty Program.
With this letter the National Association of Realtors is pleased to
support the nomination of Jim Nicholson as Secretary of the U.S.
Department of Veterans Affairs. For the past 3 years Mr. Nicholson has
served as the U.S. Ambassador to the Vatican. Prior to this he served
as Chairman of the Republican National Committee. Mr. Nicholson has a
distinguished career in the military, having served as an Army Ranger
in Vietnam and graduating from the U.S. Military Academy. He was a
practicing attorney and has an extensive background in residential real
estate development. His experience in real estate will serve him well
as the overseer of the VA Home Loan Guaranty Program which is an
important program to our membership.
The National Association of Realtors represents a wide variety of
housing industry professionals committed to the development and
preservation of the Nation's housing stock and making it available to
the widest range of potential homebuyers. The Association has a long
tradition of support for the VA Home Loan Guaranty Program and has
worked diligently with the Department of Veterans Affairs to fashion
housing policies that ensure the VA programs meet their mission
responsibly and efficiently.
The VA Home Loan Guaranty Program has made mortgage credit
available to many veterans whose loans otherwise would not have been
made. The program has helped many deserving veterans realize the
American dream of owning a home and the program has had a profound
impact on our Nation's economy and our mortgage markets. We stand ready
to work with Secretary-Nominee Nicholson to address veterans housing
issues encompassing his ideas, visions and innovations.
The National Association of Realtors welcomes the selection of Jim
Nicholson as Secretary of the Department of Veterans Affairs, and we
appreciate your grateful consideration of our endorsement.
Sincerely,
Al Mansell,
President.
__________
American Association of Nurse Anesthetists,
January 26, 2005.
Senator Larry E. Craig,
Washington, DC 20510.
Senator Daniel K. Akaka,
Washington, DC 20510.
Dear Mr. Chairman and Ranking Member: On behalf of the more than
33,000 Certified Registered Nurse Anesthetists (CRNAs) including the
530 full time CRNAs employed in the VA health system, we encourage
Members of the Senate to confirm the President's nominee for Secretary
of Veterans Affairs (VA), Jim Nicholson.
With an Army career that includes 8 years of active duty as an Army
Ranger, medals of distinction for combat in Vietnam, and 22 years in
the Reserves, Mr. Nicholson has been chosen by President Bush to lead
this Nation's Veterans' health system. The profession of nurse
anesthesia was begun treating America's soldiers in the battlefields of
the 19th Century, a tradition of care continually improved and extended
through the 21st Century as a substantial proportion of AANA members
have worked to ensure safe anesthesia care to our U.S. Armed Forces and
Veterans past and present. We look forward to working with Mr.
Nicholson to promote anesthesia patient safety within our VA
facilities, support educational funding for the VA-DoD nurse anesthesia
school in Ft. Sam Houston, Texas, and ensure quality healthcare to all
Veterans. The Administration has been more than gracious in extending
us the open door to address issues of concern to ensuring safe and
effective anesthesia care, so that we might together improve healthcare
for those men and women who have served this country honorably in the
military. I am sure that Mr. Nicholson will continue such a
relationship.
If we can ever be of service during this process, please feel to
contact Frank Purcell, Director of Federal Government Affairs in our
Washington, DC office at (202) 484-8400.
Sincerely,
Frank T. Maziarski, President,
CRNA, MS, LTC, ANC,
American Association of Nurse Anesthetists (AANA).
Carol M. Craig, President,
CRNA, Association of Veterans' Affairs,
Nurse Anesthetists (AVANA).
__________
National Vietnam & Gulf War Veterans Coalition
Hon. Larry E. Craig, Chairman,
Senate Committee on Veterans' Affairs,
Re: Hon. Jim Nicholson Secretary-designate, Department of Veterans
Affairs.
Dear Mr. Chairman: The National Vietnam & Gulf War Veterans'
Coalition is a federation of 98 veterans groups. One of our ten (10)
goals is to have qualified Vietnam and Gulf War veterans appointed to
high visibility government positions.
Colonel Jim Nicholson (USA-ret.) is a Vietnam Veteran, a graduate
of the United States Military Academy, and a former U.S. Army Ranger
who received the Combat Infantry Badge and the Bronze Star for service
to his country. He knows and understands veterans and the military. It
is with this in mind that we are pleased to strongly endorse and
support Jim Nicholson for the position of Secretary of Veterans
Affairs.
My organization and I have previously worked with Jim when he
served as Chairman of the National Republican Committee. We were
impressed with his availability to listen to our concerns, his fairness
with regard to all matters, and his interest in improving the
conditions of the men and women who have served in the Armed Forces of
the United States. Jim Nicholson is a man of integrity in whom we have
instilled our confidence and whom we feel will be an effective advocate
for both the Bush Administration and this country's veterans. We urge
you, the Senate Committee on Veterans' Affairs, and the United States
Senate to support Colonel Nicholson.
Respectfully,
John J. Molloy, Jr.,
Chairman.
__________
Rolling Thunder, Inc., National Chapter 1
Neshanic Station, NJ,
January 18, 2005.
Hon. Larry E. Craig, Chairman,
Senate Committee on Veterans' Affairs.
Dear Mr. Chairman: Rolling Thunder, Inc. National, a group of
veterans and citizens concerned with all veterans, current and future,
wholeheartedly endorse the Honorable Jim Nicholson for the position of
Secretary of Veterans Affairs.
Our organization feels that Colonel Jim Nicholson, a retired
Vietnam Veteran, truly knows and understands veterans and the military.
We feel he will listen to our concerns and will be fair in all matters
to improve the conditions of the men and women who have served and are
serving in the Armed Forces of the United States. We strongly urge you,
the Senate Committee on Veterans' Affairs, and the United States Senate
to support Colonel Nicholson as the next Secretary of Veterans Affairs.
Sincerely,
Sgt. Artie Muller,
Founder/National
Executive Director.
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