Legislative Update

by Tom Zampieri

VCE Progress Report


Our recent focus has narrowed even further than ever before on the funding, staffing, and other critical tasks involved in institutionalizing the joint Department of Defense (DoD)/Department of Veterans Affairs (VA) Vision Center of Excellence (VCE). Because of past roadblocks that have hindered these efforts, we are pleased that $9.5 million in appropriations was provided for VCE once the final Continuing Resolution was passed by Congress in late April.

The additional funding was a first of sorts for VCE and its component Defense Veterans Eye Injury Vision Registry (DVEIVR), the latter of which was created so that DoD and VA would more effectively share medical records of the eye injured and provide for the "seamless transition" of those who have experienced Traumatic Brain Injury visual dysfunction.

VCE now has its own program funding for the first time since its establishment in Fiscal Year (FY) 2008. Until now, it has struggled with limited discretionary funds. We hope that this latest breakthrough is a sign of better things to come for service members and veterans who are listed in and tracked by DVEIVR.

VCE has now increased DoD staffing to four full-time staff and nine contractor staff. VA has funding for five full-time positions, still another sign of progress and evidence that our patience and perseverance have been worthwhile.

The new administrative headquarters for VCE will be at the National Naval Medical Center in Bethesda, Maryland. An area of the medical center is now under renovation to accommodate VCE. We understand that the work is actually ahead of schedule and that VCE staff will move into the new offices in August near the dates of our convention.

VCE Director Colonel Donald Gagliano will be attending some of our convention events this year in Las Vegas. At the same time, he will be conducting the first ever DoD-VA eye care conference at the same Golden Nugget Hotel and Casino. Some 80 military and VA optometrists and ophthalmologists will meet to discuss vision technology and research.

We are pleased that the eye care conference will be occurring simultaneously with our convention since the annual VA Blind Rehabilitation Service (BRS) meetings have become biennial events and will not be held in Las Vegas this year. Having the medical professionals near us in the same hotel will add a new dimension to this year's BVA convention.

VCE and Other Joint Centers of Excellence

We continue to request status reports on the implementation of Section 1623 of the FY 2008 National Defense Authorization Act (P.L. 110-181) and Sections 706, 721, and 723 of the FY 2009 National Defense Authorization Act (P.L. 110-417). These legislative actions authorized VCE and two other centers, the Hearing Center of Excellence (HCE) and the Extremity Amputation Center of Excellence (EACE), both of which we have mentioned in previous Updates and emailed Legislative Alerts.

HCE was established to improve the care of American military personnel and veterans affected by combat hearing trauma while EACE seeks to do the same for those with limb extremity trauma. Our interest in the other two Centers of Excellence has come about because those with vision trauma have often experienced additional injuries related to loss of limbs and/or hearing.

In addition, all three agencies have experienced many of the same funding and staffing challenges in moving forward with the registries, which should contain up-to-date information on the diagnosis, treatment, and monitoring of the injuries to our nation's military personnel. For example, HCE currently has just two Air Force physicians assigned to it.

We have included in our recent annual testimony and in other correspondence the need for Congressional oversight of HCE and adequate staffing from both DoD and VA.

Funding for Research

We continue to collaborate with the National Alliance for Eye and Vision Research, the American Optometric Association, and the American Academy of Ophthalmology in efforts to secure increased Congressional funding for programmatic research in the area of combat-related eye trauma.

This line item has been funded at just $4 million the past four years. We are aware of 56 requests for vision-related research grants in 2010 and only nine that were actually funded. Because our goal for FY 2012 is a much higher $10 million, we have met with House and Senate Committee members on Armed Services, Appropriations, and VA.

The demand for new research grows as statistics continue to reveal just how many service members are affected by vision loss. Some 16 percent of all of the evacuated wounded from Iraq and Afghanistan have experienced some type of eye injury. Approximately 5,000 have severe blast eye injuries. We know that 150 have now attended a residential Blind Rehabilitation Center (BRC) program.

Budgets and Funding For VA Health Care


Since March, hearings of the House Committee on Veterans Affairs of this, the 112th Congress under the chairmanship of Representative Jeff Miller (R-FL-1), have been dedicated almost exclusively to oversight-related matters. Congress is looking at many VA programs and attempting to come up with cost savings within such programs.

As a result, far fewer new bills relating to veterans have been introduced this year. Although we are not expecting this to change in the near future, we will continue to work with new Members on such issues as Seamless Transition, Special Adaptive Housing, and Beneficiary Travel.

We will also continue to monitor the FY 2012 and 2013 VA budgets. The White House proposed budget increases for those two years are close to the figure that the Veterans Service Organizations (VSOs) have recommended. The proposed increase for FY 2012 over FY 2011 appropriations is 6 percent.

VSOs are concerned about a floating suggestion that both Category 7 and 8 veterans be eliminated from the system. Although there is no major or official movement in this direction, we are aware from experience that anything is possible during the upcoming budget battles in July and August. Because BVA has worked so hard over the years to improve VA funding for a "Continuum of Care" for blinded veterans, we must do everything possible to ensure that such funding continues.

We also worry about trends toward privatization of care that are exemplified by programs such as HERO (Health Care Effectiveness through Resource Optimization), a pilot project in which veterans within four VA networks are outsourced to Humana providers. Such programs will most definitely decrease future advance appropriations.

Legislation Implementation And Status of Pending Bills

For a time, it appeared that combat blinded veterans would continue to be billed indefinitely for co-payments even after the legislation had passed. The problem was a technical one that required a software patch. We feel confident that the issue has been addressed and that veterans will avoid these co-payments as long as they make certain that their Visual Impairment Service Team (VIST) Coordinators enter them into the billing system as catastrophically disabled.

The Twenty-first Century Communications and Video Accessibility Act of 2010 went into effect last summer. The legislation established new safeguards for disability access to ensure that people with disabilities are not left behind as technology changes and the United States migrates to the next generation of Internet-based and digital communication technologies. It requires that electronic communication devices be fully accessible for blind individuals and that emergency alert television systems include both audio and visual warnings for natural disasters and emergencies.

As anticipated, enforcement of the legislation has many built-in complexities. Progress is being monitored by citizens and technical experts from the disabled community who have been appointed by the Federal Communications Commission. We will continue to provide periodic updates and Internet links to relevant information in the Bulletin and through our Legislative Alerts.

We have also referred several times in recent issues to our efforts to help deserving blinded veterans receive the housing benefits they have earned. Eligibility for the $13,860 Special Adaptive Housing grant currently requires that veterans meet the 5/200 criteria for blindness rather than the more commonly accepted visual acuity standard of 20/200 or 20 degrees of field loss. We mentioned in our last issue that Ranking Member Bob Filner (D-CA-51) had introduced H.R. 117 in January to correct this injustice. We are happy to report now that Senator Bernie Sanders (I-VT) sponsored a companion bill in the Senate in early May. We sincerely hope to report progress on this legislation in the future.

In May 2010, President Barack Obama signed into law the historic Caregivers and Veterans Omnibus Health Services Act. The landmark bill established a new program for VA which offers training, living stipends, and respite care for veterans' family members tasked with caring for their wounded loved ones. Included in the new law was the aforementioned elimination of co-payments charged to veterans with a catastrophic disability.

The implementation of the provisions of this legislation was slow until VSOs, working with key members of the Senate, raised the issue earlier this year in hearings with VA Secretary Eric K. Shinseki. On May 9, VA finally started accepting caregiver applications and during the first week more than 850 veterans applied. VA estimates that the program will eventually provide benefits for 3,000 severely injured war veterans.

Only the caregivers of the current generation of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom, Afghanistan (OEF) service-connected veterans were originally included in the group that would benefit from this statute. Once VA establishes a clearer regulatory policy concerning the program by the end of 2013, the caregivers from previous generations of severely war injured veterans will also receive support.

Applications can be processed by telephone through the Caregiver Support Line at 855-260-3274, in person at a VA Medical Center with a Caregiver Support Coordinator, by mail, or online at www.caregiver.va.gov with the new Caregiver Application (VA Form 1010-CG). The website application also features a chat option that provides the family caregiver with a live representative to assist in completing the form.

One of the issues raised during the hearings and subsequent meetings was that the support line was not open 24 hours a day seven days a week. Concerns were expressed that caregivers in distress might call during off-hours and receive an answering service. Although the normal hours of operation are still Monday through Friday from 8 a.m. to 11 p.m. Eastern Time and on Saturday from 10:30 a.m. until 6 p.m., the line is now being answered by staff from VA's Crisis Line when the support line is closed.

As of June 1, the clinical social workers who staff the line had responded to more than 6,000 calls since its inception.

Claims Backlog


The growing backlog of VA benefits claims is an additional problem for all veterans and especially those caught in long delays between the DoD medical boards and VA ratings.

The medical board process for a military disability rating now averages 267 days. The long process to become service connected for VA benefits now averages 168 days.

Frustration is growing in Congress over the 800,000 unresolved claims. BVA frequently attends hearings on this issue and remains similarly frustrated.

BRC Openings Now on Horizon

Two new BRCs will open by November 2011. Their locations are Biloxi, Mississippi, and Long Beach, California. By act of Congress (H.R. 4360) that was signed into law on May 7, 2010, the latter BRC will be named in honor of Major Charles R. Soltes, Jr., the first Army optometrist killed in action in Iraq in 2004. We strongly supported this legislation at the time, having become acquainted with Major Soltes' widow, Dr. Sally Dang.

Professional staff members at both new BRCs are now being hired. We are pleased to report that Sally has been appointed by VA as the low-vision optometrist at the Long Beach facility. As we reported in previous Updates, Sally volunteered to make a presentation and otherwise assist the Operation Peer Support program at the last two conventions. We hope she will be joining us again in Las Vegas.

We also anticipate that blinded veterans who receive training at the Long Beach BRC will come to appreciate the unusual connection between the name of the Center and the low-vision optometrist working at the facility.

Operation Peer Support Looks Ahead to Convention


Through the Association's Operation Peer Support initiative, Tom Miller and Tom Zampieri met blinded veteran A.J. Tong, right, at the 64th National Convention in 2009 in Portland, Oregon. A.J., a resident of Snoqualmie, Washington, paid a visit to BVA National Headquarters less than a year later.
Through the Association's Operation Peer Support initiative, Tom Miller and Tom Zampieri met blinded veteran A.J. Tong, right, at the 64th National Convention in 2009 in Portland, Oregon. A.J., a resident of Snoqualmie, Washington, paid a visit to BVA National Headquarters less than a year later.

We continue to visit OIF and OEF service members and their family members at Walter Reed Army Medical Center and the National Naval Medical Center. Although such visits are desirable in and of themselves, we consider them to be an integral part of our Operation Peer Support initiative begun back in early 2006.

Locating the eye injured and inviting them to attend the August conventions has been the mainstay of the program since its beginning. We are now seeing many of our past attendees come to the conventions at their own expense and as BVA members. While still small, Operation Peer Support alumni are a growing sector of the BVA membership. At press time, the number of Operation Peer Support alumni having joined BVA was 44.