Legislative Update

by Tom Zampieri

 

Annual Testimony, Mid-Winter Visits

 

From a government relations perspective, the final two weeks of winter here in Washington were filled with considerable activity. The busy schedule consisted mainly of preparations for our annual testimony before a Joint Session of the House and Senate Committees on Veterans Affairs, delivered on March 16 by Dr. Roy Kekahuna. We also arranged appointments with several senior VA staff members and Members of Congress.


The BVA Legislative Committee, made up of Roy, Sam Huhn, Mark Cornell, and Steve Beres, arrived at BVA National Headquarters on a Monday morning, giving us two full days to present our concerns on key issues at these meetings.

We visited first with Gale Watson, Blind Rehabilitation Service (BRS) Director, and Lucille Beck, Deputy Chief of the Veterans Health Administration's Rehabilitation Services and Acting Chief of VA Prosthetics. We then met with Secretary of Veterans Affairs (VA) Eric Shinseki, Deputy Under Secretary for Health Dr. Robert Jessie, and Chief of VA Adaptive Housing Brian Bixler.

With White House in background, BVA National Secretary Mark Cornell joined fellow members of the Legislative Committee in meeting with Secretary Shinseki at VA Central Office March 14.
With White House in background, BVA National Secretary Mark Cornell joined fellow members of the Legislative Committee in meeting with Secretary Shinseki at VA Central Office March 14.

On Tuesday we made rounds to the offices of several Members of the House and Senate VA Committees, reiterating the contents of our testimony and encouraging them to attend the hearing the next day. The opportunity allowed us to inform the Members of the Committees about our testimony in the event they had a conflict the next day and would not be able to attend.


Our issues of concern included the problems associated with implementation of the recently passed caregiver legislation providing special benefits to family members who care for disabled veterans. We also discussed the slow progress of the joint Department of Defense (DoD)-VA Vision Center of Excellence (VCE). We further emphasized the importance of VA vision research, accessibility (Section 508) issues for blinded veterans filing claims or gathering information electronically, beneficiary travel legislation, changes to special adaptive housing benefits, and the problems associated with recently passed legislation that eliminated co-payments for catastrophically disabled blinded veterans.


We asked Secretary Shinseki pointedly if he would speak directly with Secretary of Defense Robert Gates regarding the slow progress of VCE. As most of our regular readers will remember, the Center was authorized by the National Defense Authorization Act (NDAA) of 2008 (Public Law 110-181, Section 1623) for the prevention, diagnosis, mitigation, treatment, and rehabilitation of military eye injuries. Its establishment has been fraught with bureaucratic obstacles and resistance that have, at best, tried our patience.


Having become aware that the authorized DoD Hearing Center of Excellence and the VA Center of Excellence for Traumatic Extremity Wounds were experiencing many of the same problems as VCE, we brought up the topic of all three Centers with the Secretary. We pointed out that each was created to improve the care of American military personnel and veterans affected by combat eye, hearing, and limb extremity trauma, and to improve clinical coordination between DoD and VA. We discussed the fact that the Centers had also been tasked with developing registries containing up-to-date information on the diagnosis, treatment, and post-treatment analysis of such injuries.


We mentioned to Secretary Shinseki that Secretary Gates had listed these three Centers as a top priority in the February 2010 Quadrennial Defense Report but that lack of governance, limited budgets, and bureaucratic snags had all hindered significant progress toward their full implementation. While DoD and VA have appointed a Director, a Deputy Director, and other joint staff to support VCE, the other two Centers still lack this leadership. All three Centers in fact face major challenges in meeting their mandated objectives due to insufficient resources and inadequate funding.


Roy's oral testimony and the written statement we submitted for the Congressional Record mirrored the concerns we expressed in our earlier meetings. To access the complete written testimony, please visit http://www.veterans.senate.gov/hearings.cfm.

Secretary Shinseki Conducts Follow-Up


Our discussion with Secretary Shinseki brought a quick result on March 21, just five days subsequent to our testimony, when I was invited quite suddenly to meet at the Pentagon with John Campbell, Assistant Secretary of Defense for Wounded Warrior Care and Transition.


The purpose of the meeting was to go over the problems associated with the three DoD-VA Centers of Excellence.

We appreciate Secretary Shinseki's prompt action. He had met with Secretary Gates as promised and had requested of him an internal review of the status of the implementation plan for the Centers of Excellence. My meeting with Assistant Secretary Campbell was a positive sign of our influence and ability to get top officials to provide future oversight on this issue.

Budget Battles Behind and Ahead

 

Prior to submission of our testimony and the arrival of our Legislative Committee in the Nation's Capital, I also attended numerous Congressional hearings related to the VA budget requests for upcoming years. I listened to presentations on everything from VA health care to veterans' benefits, construction, national cemeteries, and research.


We are also in the midst of additional conflict, and its ensuing anxiety, over the federal budget issues. With Continuing Resolutions that lasted five months and threats of government shutdowns that did not end until April 8, we are more relieved than ever before that the Advance Appropriations legislation enacted two years ago protects the VA health care delivery system from at least some of these battles.


Even had a shutdown occurred within most other government agencies, the VA Medical Centers, clinics, and clinical providers would have all continued to provide health care services since the funds for FY 2011 were actually appropriated in FY 2010. Veterans can be certain that the health care funding they need for the current year will always be there.


We understand from a variety of sources that VA health care appropriations will not be cut in either FY 2012 or FY 2013. As Congress moves to pare the budgets of other agencies, however, we must be vigilant and on guard with respect to certain possibilities. Under the Paul Ryan (R-WI-1) plan, the House proposes that the federal budget be reduced across the board to FY 2006 levels, that it be frozen for five years, and that spending growth be limited to the rate of inflation. We are most concerned that portions of the VA budget dedicated to such items as medical center construction and renovation, clinic construction, research, information technology systems, veterans' benefits, and staff positions could be flat lined or even cut completely.


As is the case with other Veterans Service and Military Service Organizations, we at BVA are carefully monitoring and examining the statements of the leaders of the Committees in order to determine how such across-the-board cuts would affect veterans. Our position is that in a time of two wars, both of which have lasted longer than any previous wars in history, those who have repeatedly defended our freedoms should not at this point be asked to participate in making still another sacrifice—that of having their benefits or promised care reduced.

Invoices Still Issued Mistakenly

 

Last May, Public Law 111-163, the "Caregiver and Veterans Omnibus Health Services Act of 2010," was signed into law. The act exempted from co-payment all veterans with a catastrophic disability. It also addressed co-payments for medical services provided in an inpatient and outpatient setting.


Unfortunately, the VA information technology system has been slow to iron out the kinks in the area of billing. Catastrophically disabled veterans in Priority Group 4, as well as those enrolled in Priority Groups 2 and 3 who might also have a nonservice-connected catastrophic disability, are still being billed at some centers.


VA has been slow to come up with a software patch to repair the problem, thus resulting in hundreds of billing errors. We have asked that oversight hearings be held in which professionals are asked why the timetable to fix this problem is now July 2011 when Veterans Health Administration (VHA) representatives had promised that a fix would occur within a few months.


In July 2010, VA's General Counsel released an opinion addressing questions about the scope of P.L. 111-163. The opinion essentially concluded that the law prevents VA from collecting for any medical services. The current issue with mistaken billing most certainly contradicts this opinion. We will continue to keep abreast of this problem in order to ensure that blinded veterans are not unjustly billed and, if they are, to help them remedy their personal situations.

Beneficiary Travel

 

For veterans who are currently ineligible for travel benefits, P.L. 111-163 does not cover the cost of travel to a residential Blind Rehabilitation Center (BRC), thus adding to the financial burdens of those eligible and desirous of attending a Center.

Blinded veterans who must currently shoulder this hardship, which often involves airfare, can be discouraged by these expenses. The average age of a veteran who attends a BRC is 67. The figure is as high as it is because of the high prevalence of degenerative eye disease among those of this age group.


As we expressed in our recent testimony, BVA believes that such travel costs should be covered by the Veterans Integrated Service Network (VISN) in which a veteran lives. The expenses should not be an added burden when the veteran is on the verge of obtaining the crucial VA rehabilitation training needed to gain independence.


We requested in our testimony the introduction of legislation during the 112th Congress that would ensure that VHA cover such travel costs by changing Title 38, Section 111. The change would make VA responsible to cover public transportation costs for travel by air, train, or bus to a special rehabilitation program serving blinded veterans.


It makes little sense for VA to have developed, over several decades, world-class inpatient and outpatient rehabilitation programs and specialized services, only to inform individual catastrophically injured veterans who cannot drive that they must pay everything. This situation is especially challenging for rural veterans who have limited incomes and must travel a long distance.


In nearly every recent Capitol Hill and VA meeting attended by our Legislative Committee, we explained the issue in detail. We laid out the financial barriers that are placed before blinded veterans who are not able to purchase airline tickets or secure other public transportation for travel to a residential BRC.


Despite the uphill battle, we have seen some movement in the past and continue to be hopeful. In the caregiver legislation passed last May, then Chairman Daniel Akaka (D-HI) attempted to resolve the problem by inserting language stating that "VA should provide air travel if it is determined that a veteran needs it in order to obtain health care services." VA Legal Counsel ruled that Title 38, Section 111 still prohibits such an interpretation of beneficiary travel.


H.R. 117

 

Regular readers of our Updates and emailed Legislative Alerts are familiar with our concern for proposed legislation to change the eligibility requirements for Special Adaptive Housing (SAH) grants. The current SAH program has a very strict visual acuity standard of 5/200 for blinded veterans to be eligible. We believe that the 5/200 requirement should be modified to 20/200 or less.


Last June, the Veterans Benefits Administration (VBA) testified on behalf of this change, expressed in H.R. 5290, before the House VA Subcommittee on Economic Opportunity. The rationale for VBA's support in this case was simply that the 5/200 standard was not being used to determine eligibility for any other VBA benefits. In addition, VHA already uses 20/200 or less as its visual acuity standard for legal blindness.

We were pleased that H.R. 5290 passed the House Committee with full bi-partisan Member support. The bill was also approved on the House floor last September. Unfortunately, the bill was sent to the Senate just as Congress was recessing for the month of October. It was not even considered during the lame duck session. The bill died in the Senate VA Committee, requiring that the process start all over again in the new Congress.

Ranking Member Bob Filner (D-CA-51) has accordingly introduced H.R. 117, the Housing, Employment, and Living Programs (HELP) for Veterans Act of 2011. One of the most important arguments in favor of H.R. 117 is that if accessible housing grants are insufficient to allow disabled veterans to live independently at home, institutional care in nursing homes often becomes the alternative.


The cost of nursing home care, of course, is staggering. The average private room charge for this care is $212 daily ($77,380 annually), according to a MetLife 2008 survey. A semi-private room costs $191 daily ($69,715 annually). The same survey reported that assisted living centers averaged charges of $36,372 annually.


We believe that blinded veterans will not only be happier as they function independently in their own homes but that the Special Adaptive Housing grants represent a more economical alternative to nursing homes and assisted living arrangements. We are therefore focusing our advocacy efforts on making eligibility for the grants less stringent than it has been in the past.

BVA Recognizes Akaka, Kerry Support


One of our BVA Legislative Committee's many visits to Capitol Hill Senate offices on March 15 included one to Senator Akaka, where we presented him with BVA's 2011 National Legislative Achievement Award for his dedication and commitment to disabled veterans as he served as the Ranking Member on the Senate VA Committee during 2004-06 and as the Chairman during 2007-10.

Senator John Kerry accepts framed Braille flag from Tom Miller, left, and Tom Zampieri.
Senator John Kerry accepts framed Braille flag from Tom Miller, left, and Tom Zampieri.


The award consisted of a framed Braille American flag with an engraved tribute at the bottom.


It would be difficult to come up with any other past chairmen who were able to push through more than 54 major veterans bills in such a short period, or perhaps at all. The legislation under his influence will affect the lives of countless veterans, many of whom are blinded veterans. Some of the accomplishments include the New GI Bill for the 21st Century (education benefits), Advance Appropriations (protecting VA health care from at least some of the political battles), employment programs, and health care programs.


During our meeting, Senator Akaka repeated what he announced to the news media and his constituents back in February. After decades of public service, he said, it will be time next year at age 85 to retire from the Senate and return to his beloved Hawaii to spend time at home with family and friends.


On April 6, Tom Miller and I presented a similar award, BVA's 2011 National Legislative Leadership Award, to Senator John Kerry (D-MA) in his Washington office. Unfortunately, we were unable to schedule this presentation in March so that the Legislative Committee could participate.


The award recognizes Senator Kerry's "constant and persistent support of health care and benefits legislation that improves the lives of blinded veterans and their families."

More specifically, Senator Kerry took the lead in the legislation that created VCE. He has sponsored or co-sponsored many of our bills during the past six years. Last year, he introduced a bill in the Senate to stop the reduction of nonservice-connected pensions for blinded veterans receiving a state annuity in New York.


Senator Kerry also supported the scholarship bill that affects the recruiting and training of Blind Rehabilitation Outpatient Specialists (BROS). He further backed the expansion of outpatient low-vision programs and BRCs that has occurred the past three years.


He also worked with other key Senators in securing construction funding for renovations at the National Naval Medical Center in Bethesda, which directly affects the new headquarters facilities for VCE. The construction has now begun and will be completed this summer. We expect the grand opening of the new VCE facilities in early September, which will hopefully be held in conjunction with the new Walter Reed National Military Medical Center ribbon cutting ceremony on the precise tenth anniversary of the September 11, 2001 terrorist attacks.


Project Gemini

 

BVA will send four Operation Peer Support OIF and OEF war-blinded veterans to St Dunstan's in London this spring. St Dunstan's is the closest thing to a BVA equivalent in England but it is also a blind rehabilitation center of sorts.Project Gemini


This exchange with the British war blinded will occur May 22-28. Our friends from the United Kingdom have named this initiative "Project Gemini" for the transatlantic cable that links England and the United States. "Gemini" is the star sign known as "the twins." Roy Kekahuna and I will also join the entourage.

The wars in Iraq and Afghanistan have resulted in eye trauma to 16 percent of those who have been evacuated for injuries of any kind. We now know of 212 OIF and OEF war blinded who have attended VA BRCs at some point during the past nine years.


Project Gemini has at least some of its roots in Operation Peer Support with our invitations to Ben Shaw, Simon Brown, and Craig Lundberg to attend the 63rd National Convention in Phoenix in 2008. Aided by St Dunstan's Colin Williamson and Executive Director Ray Hazan, who spoke at last year's Father Carroll Luncheon, Simon is working hard to develop the plans to host us.


The British army sustained only seven cases of blindness during the first six years of the war in Iraq. There have now been 19 war-blinded Brits in Afghanistan alone the past 18 months. While at St Dunstan's, we hope to share our experiences and learn more about British rehabilitation programs and services. More importantly, we will meet our fellow war-blinded veterans on their home turf and strengthen the bonds we formulated from their visits with us here in the U.S. the past three years.


We will report on the trip in our next issue of the Bulletin.

Kardon, Choi Address TBI Visual Disorders


On February 22, the Association for Eye and Vision Research (AEVR) hosted a Capitol Hill briefing entitled "Vision Research Meeting Battlefield Needs: Diagnosing Vision Problems Resulting from Traumatic Brian Injury."

VCE Director Colonel Donald Gagliano introduced the two speakers, Dr. Stacy Choi of the New England College of Optometry and Dr. Randy Kardon of the University of Iowa, the latter of which also participated in our Friday Forum at last year's national convention.

Tom Zampieri greets Dr. Randy Kardon, left, following Capitol Hill briefing on Traumatic Brain Injury and vision loss.
Tom Zampieri greets Dr. Randy Kardon, left, following Capitol Hill briefing on Traumatic Brain Injury and vision loss.

The purpose of the briefing was to raise awareness among lawmakers and their staffs that traumatic eye injury from penetrating wounds and TBI-related visual disorders ranks second only to hearing loss as the most common injury among active military.


Many are unaware that VA now estimates that upwards of 75 percent of all TBI patients experience short- or long-term visual disorders, including double vision, sensitivity to light, inability to read print, and other cognitive impairments.

As ocular trauma rates rise and TBI continues to cause significant visual issues among U.S. service members, the funding of research into battlefield and post-conflict care becomes critical in the effective treatment of military eye injuries.