by Tom Zampieri
MILCON/VA and the 110th Congress
The turmoil of the 110th Congress stemming from its relationship with the Executive Branch has finally come to an end. Despite some of the disappointments, BVA and other Veterans Service Organizations (VSOs) can now attest to the passage of significant VA disability and health care legislation.
The legislation was preceded by an amazing 63 hearings held in the House and Senate Committees on Veterans Affairs during the second session of the 110th Congress (2008).
The most earth-shaking good news is that for only the second time in the past 15 years, Congress, the White House, and VA completed work on the appropriations bill in a timely manner. The FY 2009 Military Construction and Veterans Appropriations (MILCON/VA) bill was passed by Congress and signed during the first week of the new fiscal year beginning October 1. The legislation was part of the Continuing Resolution (CR) that funded all other federal agencies whose appropriations had not yet been passed.
This achievement did not come easily since Congressional leaders decided to attach Defense, Homeland Security, and VA appropriations to the CR funding for other federal agencies so that the President would not veto the bill.
While the tactic worked this time, the fact that it had to happen this way at all served to spotlight the growing need to reform the veterans health care budget process. Sufficient, timely, and dependable funding each year for VA health care is critical to ensuring the accessibility of quality health care delivery for all veterans.
Funding and Leadership for New Vision Centers
The aforementioned MILCON/VA appropriations bill includes $2 million for an eye trauma registry information technology program within the newly established Military Vision Centers of Excellence (VCE). The Centers will begin tracking all eye injuries that occur in combat operations.
BVA members who have kept up with events relating to VCE know that this has been an agonizing and painstaking process, but also a rewarding one. We are relieved that an improved system is now in place to help service members who have experienced eye casualties in Iraq and Afghanistan.
Between March 2003 and the end of July 2008, Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF, Afghanistan) have together produced approximately 1,500 moderate to severe combat eye wounds among those injured and evacuated from war zones. Of this number, some 80 blinded service members have already attended residential VA Blind Rehabilitation Centers (BRCs).
At press time, the Department of Defense had pledged just $3 million for FY 2009 toward the establishment of the Vision Centers of Excellence in four Military Treatment Facilities. BVA has been at the forefront of the drive to ensure that the Pentagon provide, in full, the $5 million necessary for these four sites to begin operating.
In addition to the $2 million information technology program, BVA successfully pushed for an additional $6.9 million to be included in MILCON/VA for VA’s participation in the establishment of VCE sites. As of yet, we do not know the specifics on how these funds will be used within the VA system to benefit VCE.
The Pentagon announced on November 6 that the first Director of the Vision Centers of Excellence would be Army Medical Corps Colonel Donald A. Gagliano, a medical doctor, retinal ophthalmologist, and a Fellow of the American College of Health Care Executives. He was named to the position by S. Ward Casscells, M.D., the Assistant Secretary of Defense for Health Affairs.
Dr. Gagliano has most recently served as Director of the Clinical Investigations Regulatory Office in the Army Medical Research and Materiel Command. He assumes the VCE directorship with a most impressive resume that includes distinguished military training and experience, management experience at multiple levels, and a career in military medicine, research, and academia.
Dr. Gagliano has led soldiers at every level of command, most noteworthy of which is his command of the 30th Medical Brigade in Iraq from February 2003 until February 2004. He simultaneously served as the CJTF-7 Surgeon with responsibility for planning, integrating, and executing coalition combat health support in Iraq during the first year of the war. The 30th Medical Brigade was awarded the Meritorious Unit Citation for exemplary performance during Dr. Gagliano’s command.
BVA and the American Academy of Ophthalmology (AAO) enthusiastically endorsed Dr. Gagliano’s candidacy. On November 5, several representatives from various VSOs met with him at AAO to express their concerns and suggestions regarding the Centers (see Cover Photo
Dr. Claude L. Cowan, Jr. has been selected as the VCE Deputy Director. He has most recently worked as an ophthalmologist at the VA Medical Center in Washington, DC, and is a Clinical Professor of Ophthalmology at both George Washington and Georgetown University Medical Centers.
Dr. Cowan received his Bachelor’s degree at Syracuse University and his medical degree at Howard University. He did his residency at Freedman’s Hospital, which converted to Howard University Hospital while he was in his residency. He then completed three fellowships at the Wilmer Institute of Johns Hopkins Hospital, studying Flourescein Angiography and Neuro Ophthalmology, External Ocular Diseases, and Anterior Segment Surgery.
Both Dr. Cowan and Dr. Gagliano will be in charge of a combined clinical, administrative, and information technological registry involving four VCE locations and several VA Medical Centers that provide specialized services to wounded OIF and OEF service members.
It bears repeating once again that the advent of the VCE is a dramatic and historic first, bringing together in cooperation the Department of Veterans Affairs and all branches of the Department of Defense. VCE will track serious eye injuries and eye diseases, updating clinical progress in a timely and accessible manner and jointly arranging and collaborating on vision research studies. Its mission is to prevent, diagnose, mitigate, treat, and rehabilitate military eye injuries.
The creation of the Centers is essential in providing the best possible surgical and rehabilitative eye care available to military personnel. We are confident that a system is now in place to track TBI cases as they relate to visual impairments, an issue that has been a source of great consternation to BVA since 2003.
We recognize the collective efforts of the entire vision community that strongly supported the Military Eye Trauma Treatment Act. We also express our thanks once again to Congressman John Boozman (R-AR-3) for sponsoring the legislation.
Partnering for Budget Reform
BVA continues its nine-year affiliation with the “Partnership for Veterans Health Care Budget Reform,” a group of nine Congressionally chartered VSOs with a common objective—adequate funding on time every year, not just once in a decade. Representatives of this partnership meet and strategize frequently to determine the most effective means for making this objective a reality.
The partnership recently developed, designed, and launched a new website highlighting our efforts and official actions together. The site, www.fundingforvets.org,
outlines the problem, possible solutions, and supporting documents relating to budget reform.
Delegates and other attendees at the BVA 63rd National Convention will recall our passage of Resolution 40-08 at the Saturday closing business session. This resolution affirms BVA’s support for the work of the partnership, calling for sufficient, timely, and predictable funding of VA health care. The terminology now being used by VSOs, VA, and in the halls of Congress is “Advanced Appropriations.”
The Chairmen of the House and Senate VA Committees, Bob Filner (D-CA-51) and Daniel Akaka (D-HI), respectively, introduced the “Veterans Health Care Budget Reform Acts of 2008” on September 22. The bills were numbered H.R. 6939 and S. 3527. The fact that the two chairmen took this action almost simultaneously is evidence of the progress that we have begun to see. Both chairmen have also pledged to reintroduce new bills early in the 111th Congress, perhaps as soon as January 2009.
Continuum of Care Progress and Updates
VA is reporting that more than 44 VA Medical Centers have already received or have been approved to receive centralized funding for a variety of basic, intermediate, and advanced blind or low vision programs.
Referred to as the Full Continuum of Care initiative in previous Bulletins
, Congress directed an additional $7 million for this plan in FY 2009. At press time, 11 additional full-time Visual Impairment Services Team (VIST) Coordinators had been hired, bringing the total number to 105. There are now 77 authorized Blind Rehabilitation Outpatient Specialist (BROS) positions, of which 45 are currently filled. The remaining 32 vacant positions, many of them new, are now being advertised in many locations.
In 2009, more VA Medical Centers than ever before will have VIST and BROS teams in place to provide outpatient services to blinded veterans. In addition, VA has hired several low-vision optometrists for new intermediate programs. VA is also in the process of establishing several advanced blind outpatient “hoptel” programs for 2009.
Admission to one of VA’s ten BRCs had a waiting time of 24 weeks back in 2004. That figure has now been reduced to nine weeks as of the end of 2008. The waiting time for Computer Access Training is presently at 18 weeks.
Every blinded veteran enrolled in VA in any network will benefit from this expansion of services, which began approximately one year ago. The progress demonstrates BVA’s influence in bringing about these positive changes.
Vets Welcome Mileage Reimbursement Raises
On November 17, VA announced that eligible veterans would see an increase in the mileage reimbursement they receive for travel to VA facilities for medical care. Secretary Peake indicated that the amount would increase from 28.5 cents per mile to 41.5 cents.
“We owe it to our veterans to give them the best care possible,” said Peake. “The increase will once again provide assistance to them, especially in these difficult times, to help offset gasoline costs and to assist veterans with access to VA’s world-class health system.”
“Eligible veterans” in this case means those who are service connected, those receiving VA pensions, and those with low incomes.
In 2007, Congressman Jerry Moran (R-KS-1) successfully offered an amendment during House consideration of the 2008 VA funding bill, which was signed into law in December of that year. The increase at that time, the first since 1978, was from 11 cents to 28.5 cents.
“It is good to see Congress and the President come together to make improvements in how our nation cares for veterans, especially those living in rural areas,” said Moran.
A Healthy COLA
The 2009 Cost-of-Living Adjustment (COLA) for VA disability benefits is the highest seen in more than 15 years at 5.8 percent. The increase, which affects 2.8 million veterans and more than 300,000 surviving spouses receiving Dependency and Indemnity Compensation, went into effect on December 1.
The Veterans Compensation Cost of Living Adjustment Act of 2008, S. 2617 introduced by Chairman Akaka, also contained a provision whereby veterans compensation rates will keep pace with inflation, making COLA bills unnecessary in future years.
Announcement of the larger-than-usual adjustment was certainly good news for our BVA membership. Social Security benefits for about 50 million retirees will increase by the same 5.8 percent.
Enhancement Act Dies in Committee
The House passed the Veterans Health Care Policy Enhancement Act of 2008, H.R. 6445, on July 30. The legislation prohibited VA from requiring co-payments for hospital or nursing home care of catastrophically disabled veterans.
Unfortunately, there was no equivalent Senate bill. For this and other reasons, this legislation was never included in any of the final VA Senate Committee packages, thereby dashing any hope that something could be passed on the final day of the 110th Congress.
Failure of this bill to get to the President is a major disappointment to many of our nonservice-connected blinded veterans who cannot afford to attend inpatient BRCs because of the high co-payments involved. BVA is already communicating with both Representatives and Senators in order to get the bill reintroduced in the early days of the 111th Congress.