by Tom Zampieri
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.
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
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
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.
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.
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.
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
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
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
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
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
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
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.
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.
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
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.
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.
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
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
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
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.