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september/october 2007

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GOVERNMENT AFFAIRS

BY JOHN MITERKO, CHAIR, VVA GOVERNMENT AFFAIRS COMMITTEE,
WITH VVA GOVERNMENT AFFAIRS STAFF
When Rep. Chris Smith (R-N.J.) chaired the House Veterans’ Affairs Committee, he cultivated a reputation as an advocate for veterans. Deposed by House leadership two years ago in the 109th Congress because he fought so hard for funding for veterans’ health care at his own political peril, he left the committee. But he has not ceased serving veterans.

At a hearing of the Senate Veterans’ Affairs Committee on July 25, Smith was the lead witness to testify in favor of the need to overhaul the funding mechanism for veterans’ health care. “No one on earth has done more to protect and preserve freedom, democracy, and fundamental human rights than our veterans,” he intoned. “When the dust settles, it is the veteran and his or her family who bear the physical and emotional scars of war; for some it’s the ultimate price.”

Smith painted what he called a “sobering picture” of the current direction veterans’ health care funding is headed. “Notwithstanding a potentially huge
plus-up in the FY’08 VA Medical Appropriations, the funding mechanism remains broken,” he said.

“Unless we fix the funding process for VA health care, all efforts to improve its delivery will continue to be impeded, and worse, we risk new Walter Reed-like problems at VA facilities in the future,” he told the committee. Smith argued that the recent shortfalls in veterans’ health care funding could only be fixed by “sufficient, timely, and predictable funding. “It is astonishing to me that since 1990, 16 of the 18 VA appropriations were late—on two occasions five months late, once
seven months late. How can the Secretary, VISN directors, and medical directors plan and execute delivery of medical services under those adverse circumstances?”

Smith, who chaired the House Veterans’ Affairs Committee from 2001 to 2004, pointed to the proposal of a previous advisory board set up by President Bush to support his recommendation that the system must be reformed.

Smith, who has introduced legislation to create an independent, expert panel to determine the level of funding required to meet projected demand with accepted access standards, said that either of these suggestions or perhaps a hybrid of both “would be a dramatic improvement over the status quo.”

Smith noted that “no single issue garnered more of the committee’s attention than ensuring that the VA received the funds it required to provide services veterans needed” during his tenure as chairman. Despite the bipartisan nature of the committee, he said that the Congressional appropriations process for veterans’ funding is where the process becomes flawed as it “replaces sound data with other
agendas.

“With the devastating types of injuries being suffered in the war today and the long-term care needs of so many veterans on the rise, we must ensure that the VA continues to provide world-class medicine far into the future,” Smith said. “I urge you to move forward with recommendations for a systematic reform of VA’s health care funding system that provides sufficient, timely, and predictable funding.”

SEEING THE LIGHT AT THE PENTAGON
Meanwhile, top brass at the Pentagon have acknowledged what most of the rest of the veterans’ community have known for a while now, that the military is unable to provide adequate psychological care for troops, a situation made all the more dire by the nature and extent of the fighting in Afghanistan and Iraq. The problem is compounded because of insufficient funding and prejudices toward mental illness.

“The military health system lacks the fiscal resources and the fully trained personnel to fulfill its mission to support psychological health in peacetime or fulfill the enhanced requirements imposed during times of conflict,” according to “An Achievable Vision,” a report from the Pentagon’s Task Force on Mental Health.

Among the report’s findings:

  • A stigma attached to mental health problems among service members “remains pervasive and often prevents service members from seeking needed care.”
  • “Existing processes for psychological assessment are insufficient to overcome the stigma inherent in seeking mental health services.”
  • “Mental health professionals are not sufficiently accessible to service members.”
  • “Leaders, family members, and medical personnel are insufficiently trained in matters relating to psychological health.”
  • “Some Department of Defense policies, including those related to command notification or self-disclosure of psychological health issues, are overly conservative.”
  • “The number of active duty mental health professionals is insufficient and likely to decrease without substantial intervention.”

The task force calls for changing “policies to reflect current knowledge about psychological health, making “psychological assessment procedures an effective, efficient, and normal part of military life,” and ensuring that the military health network’s provisions “fulfill beneficiaries’ mental health needs.”

According to that report, soldiers who were deployed more than six months or multiple times were more likely to screen positive for a mental health issue.

ONE OF MANY
As a result of the media attention and public firestorm over conditions that erupted this spring at Walter Reed Army Medical Center, the President, acting decisively, appointed task forces and commissions to investigate what went wrong and what needs to be done to right the health care system.

Much of the media that jumped on the story after initial revelations by two reporters for The Washington Post managed to confuse military hospitals with VA medical centers. But all the attention and outrage helped crystallize the gaps in service that undermine health care at both VA and military facilities.

The findings and recommendations of the task forces and commissions, particularly the commission headed by former Senator Bob Dole, a veteran of World War II, and former Health and Human Services Secretary Donna Shalala, now the president of the University of Miami, generated much interest in the public and the press. Many of the recommendations are sensible and can be implemented at no cost or minimum cost.

But to really assist veterans, and particularly combat-wounded veterans and active-duty troops, the military services and the VA have got to forego their turf wars. The bottom line, that caring for our war-wounded is part of the continuing cost of the national defense, is basic: If the soldier or sailor or Marine or airman or Coast Guardsman is not afforded all the assistance (s)he needs to transition from active duty to veteran status, if the continuum of non-clinical case management breaks down somewhere along the chain, then all of the recommendations and new ways of doing business, all of the good will and sincere offers of assistance will be for naught. Both DoD and VA officials need to be held strictly accountable for implementing these recommendations, and bonuses withheld until all are actually accomplished. That will certainly focus the attention of all concerned on the tasks at hand that are most pressing.

AID FOR WOUNDED WARRIORS
H.R. 1538, the Dignified Treatment of Wounded Warriors Act, which passed the Senate on July 25, addresses veterans’ issues and concerns in a variety of arenas. In regard to mental heath, the bill authorizes $50 million to improve the diagnosis, treatment, and rehabilitation of service members with traumatic brain injury (TBI) and Post-traumatic Stress Disorder (PTSD). The legislation also establishes TBI and PTSD centers of excellence to conduct research and develop “best practices” for addressing these combat-related disorders.

The bill creates a new evaluation system for disability rating and increases severance pay for service members whose disability is rated 30 percent or less.
This legislation contains a provision that would allow the enrollment of Priority 8 veterans, e.g., veterans who do not have a disability related to their military service and whose annual incomes exceed $27,790. Passage of the bill by both the Senate and the House would rescind a January 2003 regulation that prohibited their enrollment.

Opposing this Democratic initiative, Larry Craig (R-Idaho), as of this writing still the Ranking Member of the SVAC, said, “If we open the door, the reality is that they will come.” He estimated that as many as 17 million additional veterans would be eligible to use VA medical services, although Sen. Daniel Akaka (D-Hawaii), the committee chairman, said that only 1.5 million veterans would likely enter the system as a result of the change. VVA continues to strongly advocate re-opening the VA health care system to all veterans, each of whom earned that right by virtue of military service.

A suicide-prevention bill (S. 479), also approved by the committee, would require the VA secretary to conduct an outreach effort aimed at Iraq and Afghanistan veterans and their families, and to mount a campaign to discuss mental-health problems among veterans. It would require the VA to make mental-health care available around the clock. Perhaps anticipating Congressional action, the VA announced a 24/7 suicide hotline. The House passed a similar bill (H.R. 327) in March.

The omnibus benefits bill (S.1315) would also provide expanded life insurance benefits for veterans and treat Filipino World War II veterans as U.S. veterans by paying them service-connected compensation benefits at the full rate for veterans living outside the United States.

This last provision sparked charges by the Ranking Member of the House Veterans’ Affairs Committee, Steve Buyer (R-Ind.), that, to pay for this “pork,” the VA would have to take monies that would otherwise be dedicated to the care of indigent and disabled veterans. Although spurious, this charge sparked confusion and concern in the veterans’ community. In fact, the poor interpretation of the law passed several years ago would mean that veterans who are 60 percent disabled at age 60 would receive larger payments from VA than 100 percent disabled veterans, which is simply not equitable.

MORE $$ FOR HEALTH CARE
As this issue of The VVA Veteran was going to press, the Senate was still debating the $109.2 billion Military Construction/Veterans Affairs spending bill, which would add $3.6 billion for veterans’ health care over and above the Administration’s budget request for FY ‘08.

(Ever the good and loyal acolyte of the President, VA Secretary Nicholson, who had announced his resignation during the VVA convention in July, effective no later than the first of October, argued that the President’s budget request would give the VA all the funding it needed. In fact, VVA believes that the additional $3.6 billion above the President’s requested amount is very much needed, and is too conservative, if anything.)

Despite early threats of a presidential veto because the spending measure passed in the House (H.R. 2642) would provide almost $4 billion more than the President requested, the White House Office of Management and Budget (OMB) stopped short of threatening to veto the bill. According to Congressional Quarterly, the OMB did state strong opposition to a provision pushed by Sen. Dianne Feinstein (D-Calif.) that would prohibit the commercial use of land at the 388-acre VA medical center site in Los Angeles.

“The provision circumvents the VA’s Capital Asset Realignment for Enhanced Services [CARES] process, which the department uses to determine where and when to build VA facilities,” CQ wrote. “Feinstein’s concerns came after the VA leased some of the land for commercial use to private companies, including the Fox Entertainment Group and Enterprise Rental Car, and her provision would not allow similar developments to take place at the site in the future.”

That provision, according to the OMB statement, estimated that the provision “would eliminate more than $4 billion of revenue,” which OMB suggested “would be used to improve facilities around the country for our nation’s veterans.”
The VA has not officially determined how it plans to use the Los Angeles site. It issued a report in August outlining four possible plans for the tract, citing a “need to maximize the reuse potential of surplus buildings and land” as a main consideration for future planning. It planned a September 6 public hearing to discuss the proposed plans with Los Angeles residents.

VVA continues to strongly support Senator Feinstein’s position in this matter. Furthermore, VVA has repeatedly pointed out the deep and fundamental flaws of the formula used by the VA in CARES, but the VA continues to use this civilian formula instead of one that would be more appropriate to our nation’s military veterans, given all of the injuries and illnesses that afflict veterans by virtue of their military service, which far exceeds a middle class, non-veteran population formula.

I-T BREAKDOWN, AGAIN
How could this be, after soon-to-be-former VA Secretary Nicholson promised his department would set the “gold standard” for IT security?

More than a quarter of the computer equipment at the Veterans Affairs Medical Center in Washington could not be found by investigators, according to a recent report by the Government Accountability Office (GAO).

Three other VA facilities showed slightly better results but still could not locate between 6 and 11 percent of their equipment, including computers, hard drives, monitors, and other devices. In all, the four facilities audited by the GAO reported more than 2,400 missing items originally worth $6.4 million.

Aside from decrying potentially wasted tax dollars, lawmakers said the report raises fresh questions about the security of the agency’s information, including sensitive medical records and Social Security numbers.

For the audit, the GAO sampled equipment inventories at medical centers in Washington, San Diego, Indianapolis, and at VA headquarters offices.

Auditors said much of the equipment that could be found was not where inventory records said it should be. Equipment often was moved or set aside for discard without documentation. As a result, it was difficult or impossible to determine what had happened to the missing equipment, the report said.

Equipment slated for disposal—some containing sensitive records—often sat unprotected in storage rooms for months or years, the report said. “Essentially no one was accountable for IT equipment,” it concludes.

VA officials did not dispute the findings, but said they were making “progress.” Since the three-month audit was completed, officials said they had located much of the missing equipment or had verified that it was sent to surplus.

Robert Howard, VA’s Assistant Secretary for Information and Technology, said he did not believe the agency has enough manpower to keep up with the problem.
The VA has been under intense scrutiny in the past year over the quality of its care for veterans and a series of information technology blunders.

Last year, the VA lost data on 26.5 million veterans when computer equipment was reportedly stolen in Maryland. In January, a VA hospital in Birmingham, Ala., lost sensitive data on more than 1.5 million people when a hard drive went missing. A recent internal review of that incident found that the medical center repeatedly failed to follow policies and regulations to protect information, including storing the hard drive.

FEDERAL AGENCIES FAIL TO MEET CONTRACTING GOAL FOR VETERANS
According to an article in WashingtonBusiness.com, contracting data for the fiscal year that ended last September 30 show that agencies have sent more contracting dollars to service-disabled veteran-owned small businesses than in past years, but they’re still falling short of the mark, an SBA official told a House subcommittee at a hearing on July 12.

Agencies have a long way to go in spending 3 percent of their contracting dollars with service-disabled, veteran-owned small businesses. Last year, only two agencies—the Small Business Administration and the Department of Veterans Affairs—met the mark. Most agencies lag well behind, officials told the House Veterans’ Affairs Committee’s Economic Opportunity Subcommittee.

Rep. Stephanie Herseth Sandlin (D-S.D.), who chairs the subcommittee, requested a list of agencies with the lowest percentages. The SBA’s Bill Elmore said a soon-to-come electronic scorecard rating agencies may be effective in urging them to meet the 3 percent goal. The scorecard will list the details of contracting dollars in real time.

Veteran small-business owners—and the Veterans’ Entrepreneurship Task Force, which VVA’s Al Gibson and Rick Weidman were instrumental in founding—are eagerly awaiting the scorecard. It is inexcusable that the SBA is still sitting on this and other key data pertaining to veteran-owned and service-disabled veteran-owned small businesses. The bright promise a year ago of SBA getting a new leader in Administrator Steve Preston dims as the SBA continues to fail to meet its responsibilities to veteran small-business owners under the law and as directed by Executive Order 13-360.

Paul Dennett, administrator of Office of Federal Procurement Policy, said contracts to small businesses owned and controlled by service-disabled veterans increased to $1.9 billion, up from $1.2 billion in 2004. However, that is far short of 3 percent the law and President Bush’s executive order call for, by about $10 billion in FY 2006.

WE REGRET THE OUTBURST, SECRETARY MANSFIELD
The only sour note at the smooth-running national convention in Springfield, Illinois, was sounded by a New York VVA member who interrupted the remarks of VA Deputy Secretary Gordon Mansfield.

The comments, writes Robert Parsons of VVA Chapter 295 in Indianapolis, “were disrespectful, embarrassing, and totally inappropriate.”

“The delegate’s views and the belligerent manner in which they were presented did not represent the opinions of myself or any other veterans that I spoke with, and certainly did not reflect the standards of civilized behavior that the vast majority of delegates tried to maintain throughout the convention.

“We as a body owe this official, who is a Vietnam veteran himself and took the time and effort to come and speak to us, a sincere and official apology. This will hopefully communicate that we are not all disrespectful, boorish, and crude, and that we do not condone this type of conduct.

“This official apology should appear prominently in The VVA Veteran.”

So here it is. Deputy Secretary Mansfield, please accept our sincere apology for this rude behavior that is so out of character as to how VVA does business, and not characteristic of how our leaders and staff at every level conduct ourselves. We are strong advocates on the keys issues for veterans and their families, but we are respectful of all persons whom we encounter.

 

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