by Glenn Minney
Oral Testimony Presented On May Snow Makeup Day
Unusual as it seemed for us, BVA’s annual oral testimony before a joint session of the House and Senate Veterans Affairs Committees occurred just five days prior to Memorial Day. The hearing was hosted this year on the Senate side of Capitol Hill.
Although National President Mark Cornell had remained in town five additional days following the midwinter Board meetings in late February to represent the Association at the originally scheduled hearing March 5, a debilitating ice storm followed by 6-8 inches of snow postponed the hearing for more than 2½ months.
Busy with some of his own rehab training at the Biloxi, Mississippi, Blind Rehabilitation Center (BRC), Mark was unable to return in May to present the testimony. I filled in for him at the hearing’s witness table on a Washington Day that could only be described as the polar opposite of March 5. There was not so much as a cloud in the sky in 75 degree temperatures as the BVA contingency reached the Senate Office Building.
With my time limit of five minutes to present our testimony, we decided to emphasize our Beneficiary Travel bills (H.R. 288 and S. 171), our petition that Department of Veterans Affairs (VA) websites become compliant with Section 508 of the Americans with Disabilities Act, and the need for VA to begin implementation of the already legislated scholarship program to employ additional blind rehabilitation specialists. I believe it was a productive presentation as I put forth our major concerns as succinctly as possible in the time I had available.
We presented BVA’s other priorities in a document submitted for the Congressional record. They include lack of progress with the Vision Center of Excellence, the need for Information Accessibility Officers to help blinded veterans access Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA) documents and websites, research funding in the area of battlefield eye injuries, and general funding for VA Blind Rehabilitation Service programs.
Both the written document and a video of the hearing can be accessed athttp://www.veterans.senate.gov/hearings/joint-hearing-multivso052013
Beneficiary Travel Co-Sponsor Update
Regular readers of our Updates
have probably followed, over the course of several years now, BVA’s uphill battle with House and Senate legislation that would provide our catastrophically disabled, nonservice-connected blinded veterans with financial assistance to attend a residential BRC. The legislation applies similarly to the Spinal Cord injured.
The intent of the bills, introduced in the current 114th Congress as H.R. 288 and S. 171, is for Congress to amend Title 38, Section 111 of the U.S. Code by removing the term “service connected” from the existing language.
Introduced in the House by Representative Julia Brownley (D-CA-26), H.R. 288 authorizes payment under the VA beneficiary travel program of transportation expenses in connection with medical examination, treatment or care of a veteran with vision impairment, a spinal cord injury or disorder, or double or multiple amputations. The travel must be done in connection with care provided through a VA special disabilities rehabilitation program, if such care is provided.
At press time, H.R. 288 had 16 co-sponsors, 12 Democrats and four Republicans. Six of the most recent additions signed on in early June two weeks after our testimony.
S.171, similarly introduced on January 13 by Jon Tester (D-MT), had four co-sponsors, three Republicans and one Democrat. Senator Dean Heller (R-NV) signed on to S. 171 on May 21, the day after the hearing.
Choice Program Implementation
The Veterans Access, Choice, and Accountability Act of 2014 created the Veterans Choice Program to allow veterans unable to obtain appointments at VA medical facilities within 30 days, or who reside more than 40 miles from the nearest VA medical facility, to receive care outside the VA system. It was created in the wake of the Department’s secret wait-list scandal.
Although the program has helped many veterans, the 40 miles are calculated using “as the crow flies” parameters, excluding many veterans who live far more than 40 driving miles from a VA care center. After pressure from Congress, VA appropriately revised the rule to designate driving distance as the form of measurement, allowing more veterans to be included in this boundary.
While this was a step in the right direction, veterans who live more than 40 miles from a VA Medical Center are still being forced to drive excessive distances to receive the care they need. This is because Community Based Outreach Clinics are included in these criteria even when they often do not provide the type of care a veteran may need.
Many veterans have also expressed frustration at the amount of time they must wait in order to be able to speak with someone at VA. We are hearing that in some cases they are not able to speak with anyone. In addition, it typically takes several months to process reimbursements for travel costs.
On May 13, the House VA Committee held a hearing to examine the success of VA’s implementation of the program. Chairman Jeff Miller (R-FL-1) complimented VA on its efforts to reform the system through the Choice program but cautioned that veterans are still waiting too long and traveling too far to receive the health care they need.
BVA’s sister organizations presenting oral testimony at the hearing, which included Iraq and Afghanistan Veterans of America, Veterans of Foreign Wars, and Concerned Veterans for America, agreed that the program is still too complicated. They pointed out that veterans must deal with different rules, depending on their situation and health conditions. In addition, there is still confusion as to who is eligible for private care programs such as Choice.
In submitted testimony, DAV called for VA to streamline its private care options into a single integrated care network.
BVA concurs most closely with DAV’s assessment. With five options for private care, our veterans are often confused as to what the programs are and which one best fits their individual situation.
Hill Reports on Claims Backlog
On May 6, a bipartisan group of nine Senators released a report noting continuing problems at VA facilities and proposing potential solutions for VA's Office of Inspector General (OIG) to consider amid ongoing issues with backlogs of disability and pension claims.
VA contends that 161,000 disability and compensation claims are currently backlogged, down from a peak of 611,000 in March 2013. Claims are considered backlogged if they are more than 125 days old. The Obama administration had set a goal to eliminate the backlog of VA disability claims by 2015.
The report was released by the Senate's VA backlog working group. The group noted that VA has taken steps to fix the backlog issues but that the steps have been insufficient. According to the report, the ten lowest performing VA Regional Offices in terms of wait times are in the following cities: Baltimore, Jackson (Mississippi), Reno, Philadelphia, Los Angeles, Chicago, Oakland, Indianapolis, Boston, and St. Petersburg (Florida).
As of April, VA’s OIG had found evidence of data manipulation or other problems at half of the ten offices.
The report also urged OIG to consider whether VA claims processors need to be held accountable to deadlines and called on VA to do each of the following:
•Enhance managerial training.
•Keep lawmakers updated about VA's shift to using electronic claims systems.
•Submit an updated assessment of VA budget and staffing needs within six months.
To help address the issue, Senators introduced a bill that would require the Government Accountability Office to audit all 56 VA regional offices.
Evaluating VA Care For Our Veterans
Last month marked one year since the problems at VA were exposed to a much greater extent than before, resulting in tragic outcomes for those who have made countless sacrifices to protect our nation’s freedoms.
The weaknesses that were manifested are a result of a broken system and, although the work is far from over, we have seen efforts in Congress and the Executive Branch to implement meaningful, structural reforms to ensure that our veterans receive the care they deserve.
The 114th Congress has passed several pieces of legislation to further improve the treatment our veterans receive. The Clay Hunt Suicide Prevention Act for American Veterans, which the President has signed into law, improves veterans’ access to mental health care resources. Another bill passed by the House allows the VA Secretary’s authority to rescind all or part of the amount of any award or bonus paid to a VA employee.
While these bills are vital steps to meaningfully and structurally reform the delivery of care to our veterans, they are not enough. Congressional oversight is essential to effectively implement these necessary reforms.
New Under Secretary For Health Nominated
David J. Shulkin, M.D. was nominated by President Barack Obama on March 18, 2015, to lead the Veterans Health Administration. If confirmed, the job would be the first government post for Shulkin, a nationally regarded internist and hospital executive. At press time, Shulkin’s appointment had not yet been confirmed.
Shulkin will fill a position that has been vacant since May of 2014 when Robert Petzel resigned before his scheduled retirement date following reports that extra-long wait times at the Phoenix VA Medical were covered up while veterans passed away as they waited for appointments. Secretary Eric Shinseki later resigned as well.
President Obama’s first choice for the Under Secretary post, Jeffrey Murawsky, oversaw health care in the VA’s Chicago office. He withdrew from consideration following reports that one of the hospitals he supervised also hid long wait times for patients.
Shulkin has been the President of Morristown Medical Center since 2010. He also served as a Vice President of its parent company, Atlantic Health. He was previously President and Chief Executive Officer of Beth Israel Medical Center in New York. He is board certified in internal medicine and a fellow of the American College of Physicians.
Before joining Beth Israel, Shulkin was Chief Medical Officer at Temple University School of Medicine, where he also served as Professor of Medicine. Prior to working at Temple, he was on the faculty at the University of Pennsylvania School of Medicine for ten years while acting as the Chief Medical Officer of the Pennsylvania system.
Other administrative positions of leadership for Shulkin include Chairman of the Department of Medicine at Drexel University School of Medicine, where he was Professor of Medicine. He was also Vice Dean of the Medical College of Pennsylvania.
Shulkin earned his medical degree from The Medical College of Pennsylvania and completed his internal medicine training at the University of Pittsburgh’s Presbyterian University Hospital. He was a fellow in general internal medicine at the University of Pittsburgh. He also trained as a Robert Wood Johnson Foundation clinical scholar and as a fellow in general medicine at the University of Pennsylvania’s School of Medicine.
Shulkin has a dedicated interest in general internal medicine, preventive health care, and executive health. He has written or contributed to hundreds of peer-reviewed articles, book chapters, editorials, and professional letters. He also serves on various editorial boards for leading health care journals.
Obama Taps New IT Assistant Secretary
Lavern H. Council, private sector Information Technology consultant and a former Fortune 500 Chief Information Officer, was nominated March 19 by President Obama to become Assistant VA Secretary for Information and Technology.
Council comes to VA following tenure as Vice President and Chief Information Officer at Johnson & Johnson. She has also held several executive positions at Dell Computer in addition to leading her own firm, Council Advisory Service, since 2012. Council has also worked at Accenture and Ernst & Young. She also served for a time with the Tennessee Valley Authority.
Council’s appointment comes as BVA works to bring VHA and VBA into compliance with Sections 508 and 504 of the Americans with Disabilities Act so that blinded veterans may have access to all of the relevant and vitally important VA documents and webpages relating to their individual situations.
In her Senate Committee confirmation hearing May 5, Council told lawmakers how she planned to manage VA’s technology team and its $4.2 billion in annual technology spending. Committee members were eager for details and a timeline on plans to guarantee a seamless transition of health data between the Department of Defense (DoD) and VA as service members near retirement.
At press time, Council’s confirmation had still not come up for a vote.