by Glenn Minney
Scandals at Medical Centers
As our members and readers now know all too well, the Department of Veterans Affairs (VA) Health Care System has received unprecedented national attention. A VA Inspector General investigative report in May revealed that more than 100,000 veterans in need of VA health care were not being served but that the names and needs of these same veterans did not appear on any VA waiting list.
This revelation and others led to the resignations of both the former VA Secretary and the Under Secretary for Health. The system was under temporary leadership for a short period, during which time Congress hurriedly introduced new laws to address VA’s shortcomings. On its own VA is instituting other changes in practice that its leaders have identified as necessary to avert further crises in the future.
We have closely followed all of the details and nuances of the VA problems since the very first news reports and have offered Congress and the Administration our views regarding what should be done to address the problems.
At its foundation, this explosive issue is a consequence of decades of underfunding of VA health care, budget gimmicks, and false promises despite the pleas every year by BVA and numerous other national Veterans Service Organizations (VSOs). Our contention has been that VA health care funding, whether proposed or appropriated, was insufficient for the challenges at hand.
As far back as 2003, it was widely recognized that VA health care demand and VA health care funding were mismatched. In fact, a Presidential task force found that VA had a list of more than 236,000 veterans who were waiting six months or more for appointments. The conclusion at that time was that VA would eventually face a crisis without an infusion of new funding from some generous source.
New VA Secretary
On July 29, Robert A. McDonald was confirmed by the U.S. Senate to be the eighth Secretary of Veterans Affairs. Prior to joining VA, Secretary McDonald was the Chairman and Chief Executive Officer of the Procter & Gamble Company.
Newly confirmed Secretary Robert A. McDonald was keynote speaker at convention Opening Business Session.
An Army veteran, Secretary McDonald served with the 82nd Airborne Division. He completed Jungle, Arctic, and Desert Warfare training and earned the Ranger tab, the expert infantryman badge, and Senior Parachutist wings. Secretary McDonald graduated from the United States Military Academy at West Point in the top 2 percent of the class of 1975.
Secretary McDonald spoke at the BVA 69th National Convention on August 19. He stated in his remarks that there is no clearer or more inspiring mission than the caring of those who bore the battles of our great nation. He also mentioned that VA has strong institutional values, mission critical ideas, and an attitude that profoundly influences day-to-day behavior and performance.
BVA looks forward to working with Secretary McDonald to improve the lives of the blinded veteran community.
President Signs VA Reform Bill
Glenn Minney enjoys rare photo opportunity with President Barack Obama on Memorial Day.
In response, at least in part, to the aforementioned crisis within VA, tens of thousands of military veterans who have been enduring long waits for medical care should be able to turn to private doctors almost immediately under the Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014, signed August 7 by President Barack Obama.
Other changes will take longer under the $16.3 billion law, which is the government's most comprehensive response to the problems that have hit VA and led to Secretary Shinseki’s resignation.
Improved access to outside care is likely to be the most immediate effect. Veterans who have waited at least a month for a medical appointment, or who live at least 40 miles from a VA Medical Center or Outpatient Clinic, will be able to see private doctors at government expense.
Another key component of the law is the expansion of VA staff, resulting in the hiring of thousands of doctors, nurses, and mental health counselors. This will take much longer to complete, perhaps months and years, according to VA officials. The opening of 27 new clinics across the country will, alone, take at least two years to accomplish.
"Implementing this law will take time," Obama was quoted as saying as he signed the bill at Fort Belvoir, an Army base in Virginia 25 miles from BVA National Headquarters. Service members, veterans groups, and military leaders attended the ceremony, along with lawmakers from both parties. I had the privilege of being present myself and representing BVA at this historic signing.
The President called the legislation a rare example of Republicans and Democrats working together effectively. He also said more action was needed.
The measure was approved overwhelmingly in the House and Senate. It was in direct response to reports of veterans dying while waiting for appointments to see VA doctors and to a widespread practice of employees covering up months-long wait times for appointments. In some cases, employees received bonuses based on falsified records.
Under the new law, employment rules will be revised to make it easier to fire senior VA executives judged to be negligent or performing poorly.
The law allocates $10 billion in emergency spending over three years to pay private doctors and other health professionals to care for qualifying veterans. It includes $5 billion for hiring more VA doctors, nurses, and other medical staff and $1.3 billion to open the aforementioned 27 new VA clinics.
Two-Year Budget Agreement
Chairman Patty Murray (D-WA) and Chairman Paul Ryan (R-WI-1) of the Senate and House Budget Committees, respectively, forged an agreement December 10, 2013, on the federal budget for Fiscal Years 2014 and 2015. The budget saved $28 billion over ten years by requiring the President to sequester the same percentage of mandatory budgetary resources in 2022 and 2023 as will be sequestered in 2021 under current law.
One agreed-to element modified the annual Cost-Of-Living Adjustment (COLA) for working-age military retirees. Under that plan, beginning in 2015, these retirees would see their COLA reduced by inflation minus one percent until they reach the age of 62. The joint statement explaining the agreement, issued on December 10, 2013 by both Budget Committees, stated: “This [reduction in COLA] would not affect service members who retired because of disability or injury.”
Despite this statement, we later learned that disabled military retirees would indeed be affected by this new policy. BVA fought to repeal this unconscionable policy toward wounded and ill military heroes. Congress subsequently repealed this reduction and the President signed it.
The legislation did not impact veterans in any other way and did not touch any VA programs, including payments for disability compensation, disability pension, Death and Indemnity Compensation (DIC), education, or VA life insurance plans.
The House passed the budget plan with a bipartisan majority on December 12, 2013 in a late evening vote. The Senate passed the plan on December 18, 2013. The Appropriations Committees in both Congressional chambers allocated funds accordingly in an omnibus Fiscal Year 2014 Appropriations Act. Congress subsequently enacted and the President signed the repeal of this portion of the agreement into law on January 17, 2014, nearly four months late.
Fiscal Year 2015 Independent Budget
BVA and Independent Budget (IB) co-authors AMVETS, Paralyzed Veterans of America, and Veterans of Foreign Wars of the United States are calling for $61.1 billion in VA medical care funding for the upcoming fiscal year.
For medical and prosthetic research, the IB recommends a funding level of $611 million. The IB further recommends approximately $2.9 billion for VA’s general operating expenses. For total capital infrastructure programs and grants it recommends $3.9 billion, $2.8 billion of which would be for major medical facility construction projects, $831 million for minor construction projects, and $298 million for VA grants to state veterans homes and state veterans cemeteries.
BVA and the authors recommend a total discretionary funding level of $72.9 billion in FY 2015. Additional detail on our recommendations for both policy and budget matters can be found at www.independentbudget.org
Fiscal Year 2015 Administration Budget
The Administration’s proposed budget for next year calls for Congress to appropriate $56 billion for VA medical care, including an assumption that VA will collect $3.1 billion in first- and third-party payments from veterans, their health insurers, and others. The Administration proposes an advance appropriation for FY 2016 medical care of slightly less than $62 billion.
For VA’s biomedical research program, the Administration is proposing $589 million. In infrastructure, the Administration is proposing $562 million for major medical facility construction and $495 million in minor construction funding. The General Operating Expenses (GOE) account would receive $2.9 billion. The GOE appropriation supports all operations of the Veterans Benefits Administration as well as the Office of the Secretary and numerous other national VA staff offices.
The Administration’s request totals $68.4 billion across all discretionary accounts. The FY 2015 budget and appropriations process is stalled as Congress, predictably once again, debates endlessly the acceptable size and scope of the federal government for next year. At press time, it was doubtful that VA would receive its regular appropriation before October 1, 2014 (the first day of FY 2015).
H.R. 1284 and S. 633
Director of Government Relations Glenn Minney, left, and Assistant Director Michael O’Rourke visited on July 30 with Senator John Boozman (R-AR) regarding S. 633.
During the month of July 2014, our Beneficiary Travel legislation gained three additional co-sponsors in the House of Representatives: Pete Gallego (D-TX-23), Collin Peterson (D-MN-7), and Tim Walz (D-MN-1). Representative Mark Amodei (R-NV-2) signed on to the bill on September 18. This brought the total number of co-sponsors for H.R. 1284 to 14.
On the Senate side, Sherrod Brown (D-OH) had been the last member to sign onto S. 633 as a co-sponsor since February 12 until Senator Boozman did so on September 17. Numerous efforts have been made by BVA to collect and gain co-signers in both the House and Senate. I have reached out to BVA members to contact their respective Members of Congress and to speak with them specifically about our Beneficiary Travel bills.
On September 10, there was a full House Committee on Veterans Affairs mark-up hearing. Numerous emails, official letters, and tweets had been sent to members of Congress urging them to consider H.R. 1284 for mark-up. Unfortunately, the bill was not considered at that time.
Patrick Sheehan, Director of the VA 508 Compliance Office, addressed the national convention regarding VA’s efforts to become compliant with Section 508 of the Rehabilitation Act of 1973.
Mr. Sheehan informed the BVA membership that due to the May 29 hearing before the House Subcommittee on Oversight and Investigations, the 508 compliance staff at the VA Central Office has been increased from five to eight VA Full-Time Equivalent Employees (FTEEs). He indicated also that the number of subcontractors was increased from 14 to 35 contract employees.
Mr. Sheehan stated that this increase in the number of employees in both categories will be beneficial in speeding up VA’s efforts to become compliant with Section 508. Because BVA has been especially concerned about lack of progress in this area, Mr. Sheehan’s remarks were welcome news to us.
SAH Grants for Blinded Veterans
VA is issuing a final rule to amend its adjudication regulations regarding Special Adaptive Housing (SAH) grants for members of the Armed Forces and veterans with certain vision impairments. This regulatory amendment is necessary to conform to changes mandated in Section 203 of the Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012.
As many of our BVA members will remember, the expansion of eligibility for such grants was the focus of BVA’s advocacy efforts for quite some time leading up to the passage of the legislation two years ago. We are pleased by the full implementation of this change, which amended Title 38 of the United States Code (U.S.C.), Section 2101(b).
The final rule was effective on September 12.
Prior to the amendment, eligible individuals with vision impairments were entitled to receive special home adaptation grants if the disability was rated as permanent and total, and due to blindness in both eyes with 5/200 visual acuity or less. Section 203 redefines qualifying blindness as blindness in both eyes, having central visual acuity of 20/200 or less in the better eye with the use of a standard correcting lens.
Section 203 also states that, for the purposes of 38 U.S.C. 2101(b)(2), an eye with a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees shall be considered as having a central visual acuity of 20/200 or less.
Specifically, to now qualify for this benefit, a claimant's disability must be due to blindness in both eyes having either (1) central visual acuity of 20/200 or less in the better eye with the use of a standard correcting lens or (2) an eye with a limitation in the fields of vision such that the widest diameter of the visual field subtends an angle no greater than 20 degrees.
Congress also eliminated in Section 203 the requirement that qualifying blindness be permanently and totally disabling by clearly distinguishing it from conditions which still require a finding of permanent and total disability.