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Congressional Updates

The House of Representatives and Senate were both in session this week. Discussion of the debt ceiling-budget reduction took up much of Congress' agenda. Both chambers are still focused on recessing on August 5 for the summer work period in their home states or districts.

Examining the Lifetime Costs of Supporting the Newest Generation of Veterans

On July 27, the Senate Veterans' Affairs Committee held a hearing to receive testimony from OEF/OIF veterans, their caregivers and witnesses from government and the private sector which study these budgetary issues. The purpose was to garner their thoughts of the needs of these veterans, their families, and how to allocate federal dollars.

Committee Chairman Patty Murray (WA) presided. Other committee members in attendance were Sens. Sherrod Brown (OH), John Tester (MT), Mark Begich (AK), Johnny Isakson (GA), Mike Johanns (NE), and John Boozman (AR). Witnesses included:

• James Hosek, senior economist, RAND Corporation;• Paul Rieckhoff, executive director & founder, Iraq and Afghanistan Veterans of America;• Crystal Nicely, caregiver and spouse of an OEF veteran;• Heidi L.W. Golding, principal analyst of military and veterans compensation, Congressional Budget Office; and, • Lorelei St. James, director, physical infrastructure issues, Government Accountability Office.

Although invited, VA did not send a witness.

Chairman Murray gave her overview that she wanted to start the process of determining the present and future needs of this generation of veterans and the impact on VA and its funding. She said that the "costs of caring for our veterans and families must be [accounted for] long after the fighting is over." The advances of modern medicine have saved many veterans who would have perished in other conflicts; thus these surviving veterans will incur greater long-term costs. Specific areas of concern include: mental health costs; caregiver issues; more complex benefit claims and adjudications; the impact of multiple deployments on veterans and families; education and health benefits; and the acknowledgement that some long-term costs are not known at this time. She concluded by saying that government must make proper ‘investments' in veterans' care and benefits but tempered by [Congress] having to tighten our belts and reduce the nation's debt and deficit. But she also said regardless of the fiscal crisis that we can't balance our budget at the expense of the health care and benefits our veterans have earned.

Mr. Rieckhoff stated the long term costs will be expensive and complex. But that it will be less expensive for the nation if it invests in veterans now. He said now the nation is missing critical investments and is shortchanging benefits and services. Examples given were high unemployment, homelessness, suicide, lack of enrollment in VA healthcare, and poor transition assistance. He gave good marks for the Post-9/11 G.I. Bill and caregivers' assistance legislation.

Ms. Nicely is the spouse of a severely wounded Marine who survived an IED explosion but lost his arms and legs. She talked about the difficulties and the trouble with the Integrated Disability Evaluation System. She asked for help from Chairman Murray to resolve her situation and lamented that others in the system are not getting the help of a senator. She said one document sat for 70 days on one person's desk. Her husband is now on the list for retirement. However, she feels that they are having problems getting military benefits and is worried they will face similar problems with VA. She also discussed problems regarding the Warrior Transition Units frequent rotation of section leaders because the new leaders do not know what is required of spouses and these leaders lack certain skill sets to do their jobs. She said she had to rely on other resources for help because of this problem area.

Ms. St. James discussed the VA health delivery system challenges in the area of real property realignment efforts and VA's approach to its budget estimates for health care. The estimates were limited to the three medical accounts: Medical Services, Medical Support and Compliance, and Medical Facilities. With regard to the backlog of facility repairs there is over $13 billion in funding needed over the next 5 years. Problems in construction include legal and budgetary obstacles, competing stakeholder interests and inadequate capital planning processes that do not always address issues like excess and underutilized property.

She recommended that VA improve the transparency of its capital planning submission as it lacked transparency about the costs of future priorities and said VA concurred. In conclusion, VA and Congress will benefit from a more transparent view of potential projects and their estimated costs. To enhance this transparency for VA real property priorities the VA Secretary should provide more information on capital planning to Congress.

Ms. Golding testified that veterans returning from recent and ongoing overseas contingency operations (OCO) will place new demands on the health care system of VA. Her testimony was based primarily on CBO's October 2010 study Potential Costs of Veterans' Health Care.

CBO's analysis of VHA's costs indicated the following statistics: In 2010, VHA spent $1.9 billion to treat 400,000 OCO patients. VHA obligated $4,800 per OCO patient on average, compared with an average of $8,800 per patient for veterans from all eras who were being treated at VHA. OCO veterans are typically younger and healthier than the average VHA patient and are less expensive to treat; the funds devoted to the average OCO veteran is similar to that devoted to the average non-OCO veteran under the age of 45. Thus, although OCO patients made up 7 percent of the veterans VHA treated in 2010, they were responsible for only 4 percent of the total amount that VHA obligated for medical care and research.

The medical costs associated with VHA's treatment of OCO veterans could total between $40 billion and $55 billion over the 10-year period from 2011 through 2020, depending on the number of military personnel deployed to overseas operations in the future and the rate of growth of medical expenditures per person.

The number of OCO veterans using VHA in the future - and the potential costs for treating them - is affected by the number and types of medical conditions that service members develop while deployed to OCOs. CBO's analysis examined the number of veterans who already use VA's health care services and the number who may use them in the future. Of the 2.3 million active-duty military personnel and reservists who had deployed to combat operations in Iraq and Afghanistan by the end of March 2011, 1.3 million have become eligible for VA's health care services. Of those 1.3 million people, almost 685,000 (or 52 percent) have sought medical care from VHA since 2002. Through June of this year, close to 44,600 service members had been wounded in action during those operations.

Traumatic brain injury and mental health disorders - particularly PTSD - are conditions whose treatment could result in substantial future costs for VHA. However, a great deal of uncertainty surrounds the prevalence of PTSD and TBI within the OCO population and, hence, the number of veterans with those conditions whom DoD, VHA, and other health care providers may encounter in the future.

LEGISLATIVE FOCUS FOR THE WEEK: Update on American Legion Charter. H. R. 2369, the bill to amend the charter of The American Legion is now posted on THOMAS, the Library of Congress tracking website for Congressional legislation and can be found here:

The bill amends the charter of The American Legion to clarify statutorily the autonomous, independent nature of our posts and departments and to facilitate credit card processing of online membership renewal. The bill is in the Judiciary Committee of the House of Representatives. It currently has 195 cosponsors. Please write your representative and ask for swift passage of this legislation in the House.

Update on Flag Amendment Bills

Senator Orrin Hatch's (UT) office continues to solicit additional cosponsors for Senate Joint Resolution 19, a proposed constitutional amendment to protect the American flag from physical desecration. Its text states simply: "The Congress shall have power to prohibit the physical desecration of the flag of the United States." The cosponsor total for the Senate legislation now stands at twenty-four, with the addition this week of Sen. Pat Roberts (KS).

To date, H.J. Res. 13 - the House companion to the Senate measure - has accumulated 54 cosponsors, with the addition this week of Rep. Ralph Hall (TX). Please contact your representatives' and senators' offices, and ask them to become cosponsors of the flag amendment in their respective chambers. If they are already cosponsors, be sure to thank them for their support.

National Commander's Testimony

It is not too early to begin making your plans to attend the presentation of the new National Commander's testimony before the joint House and Senate Veterans' Affairs committees on September 21. More information on this will be forthcoming.