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House Appropriations Subcommittee Holds FY 2014 Budget Hearing

On April 15 the House Appropriations Defense Subcommittee conducted an oversight budget hearing regarding its official round of hearings on the Administration’s fiscal year (FY) 2014 budget request. The witnesses included:

The Honorable Charles "Chuck" Hagel, Secretary of Defense, DOD

General Martin Dempsey, Chairman, Joint Chiefs of Staff, DOD

The Honorable Robert Hale, Under Secretary (Comptroller), DOD

Subcommittee Chairman C. W. ‘Bill’ Young (FL) noted the lateness of the president’s delivery of the budget and the committee had only just received the Administration’s budget request, but he said the committee was deep into their analysis. He questioned the lack of submission of the Overseas Contingency Operations (OCO) portion within the budget submission.

Full Committee Chairman Harold Rogers (KY) derided the President’s budget proposal as "woefully late" and full of gimmicks. In general, he said, it is "unhelpful." He said sequestration is the "wrong approach to rein in spending." He noted all of the Armed Services have cancelled various training and operational activities as a result of the spending cuts.

Full Committee Ranking Member Nita Lowey (NY) noted that military spending is on a path to be at the lowest level of GDP in 40 years. She is dismayed the rest of the discretionary spending levels in the domestic part of the budget "have no chance" of being passed and what happens in that part of the budget absolutely impacts Defense spending. The Administration proposes funding the Department very close to the pre-sequester FY 2013 spending levels. She called that a "responsible" proposal. The government must invest in both sides of the budget for the nation’s security in all ways.

Subcommittee Ranking Member Peter Visclosky (IN) said this is "a difficult time" for DOD and the rest of the federal government, as they cope with sequestration. He called upon the Administration and Congress to work together to resolve those budgetary issues.

Secretary Hagel asked people not to jump to conclusions about the bombs at the Boston marathon. However, obviously, any event with multiple explosive devices is an act of terror, and will be treated as such. The government will find out who did it, and why. He thanked the members of the National Guard who responded to the event in Boston, and promised all possible ongoing support and assistance.

Turning to the FY 2014 budget request, Hagel said the Department is already operating under severe spending constraints. This is happening at a time when the world is not becoming any safer. At the same time, the need to re-examine how they are spending money is giving them a chance to restructure and determine if they are operating in the best manner possible. The budget proposal and the restructuring enables the department to not only operate more efficiently but also to provide for its people better. Going forward, DOD will need Congress’ help to manage through the uncertainty. Last month’s appropriations bill does help, somewhat, giving the Department more flexibility and additional spending authorities. However, they are still left with $41 billion in spending cuts over the next six months. As a result, they have a shortfall in Operations and Maintenance (O&M) accounts of $22 billion. This is happening despite hiring freezes, bans on travel, and other activities.

DOD will soon send Congress a large reprogramming request. He asked for fast Congressional approval. It is limited, so the Department will only be partially helped through the reprogramming. Training and other readiness activities will also have to cease. Secretary Hagel said, "We are consuming our readiness."

If sequestration is not de-triggered, the Department will have to absorb even steeper spending cuts in FY 2014. The President’s budget proposal includes enough cuts across the entire government to stop sequestration. Within DOD, most of those cuts are "back loaded," and scheduled to take effect towards the end of the ten-year budget planning cycle. Hagel stressed that this gives them time to plan and prepare to absorb the spending reductions.

As he has done in other hearings, Hagel made a special plea for Members to approve the base closing request. The Pentagon is examining its overseas infrastructure to determine what can be closed. At the same time, they also need to examine the possibility of reducing their domestic footprint.

Weapons and equipment programs are also being restructured. In some cases, the department will rely upon evolutionary technological gains, rather than "leap ahead" activities.

DOD is seeking changes in TRICARE, to bring beneficiaries’ cost share closer to the level "envisioned" when the program was first created. This is especially true for working age retirees. Families of the fallen and medical retirees will be exempt from these cost increases. He stressed these changes are made with the "strong support" of the Joint Chiefs and enlisted leadership, in order to sustain the TRICARE program in the long run.

The Secretary assured the Members the drawdown of forces out of Afghanistan is on target.

Another key area of focus within the budget is maintaining the all-volunteer force. The budget seeks to ensure the troops have the training, equipment, and support they need to continue to be the world-class force they are. This includes ongoing sexual assault and suicide prevention programs.

Changes to the department’s top-line spending would absolutely require major changes to the budget proposal. Thus, Hagel requested a management review across the department. The review is designed to re-examine management decisions across the board, regardless of budget requirements. "Everything will be on the table," he emphasized, including plans, policies, and how they measure readiness. The results will form the basis of the FY 2015 budget request. Achieving additional budget savings without risking national security will require significant changes to how the military operates. In the past, proposals have met fierce political resistance. The environment has changed, and he called upon the Members to make the hard decisions. The department needs flexibility, time, and spending certainty going into the future. He called upon the Members to bear in mind the "enduring national interest" when making budgetary decisions.

General Dempsey praised the work of those in the military. He talked about the impact of sequestration and other spending cuts, and the need for the Armed Services to cut back on training and readiness activities. He warned this will have impacts going into the future. The proposed budget focuses upon the department’s greatest priorities. It ensures the troops will continue to be the best equipped, trained, and led force in the world. It also ensures that they continue to have world class medical care. Dempsey stressed the importance of continuing to address suicide prevention. In addition, they must do everything possible to drive the crime of sexual assault from their ranks. He asked the Members to continue to support a responsible future for the national defense.

Subcommittee Chairman Young drew attention to the fact that the National Guard team that responded to yesterday’s bombing in Boston was the 24th Civil Support Team, and was scheduled to be disestablished. Last year, Congress disagreed with that decision and funded them. The Pentagon still wants to disestablish them. However, they are the ones who responded to yesterday’s bombing. Hagel replied that the budget request does include funding for them, as well as the other team scheduled for disestablishment.

Rep. Visclosky brought up the effort to implement the integrated electronic health records (iEHR) with VA. The new completion date is 2017. Hagel updated him on these efforts and promised the two departments continue to work closely on this. He claimed he met with VA Secretary Shinseki during his first week on the job. Interoperability is key to creating a seamless process of transferring records between the two departments. That is still the goal. A meeting took place just yesterday. Hagel admitted they are not where they should be, but promised they will get there. He promised DOD will be restructuring to create clearer lines of responsibility and activity in this area.

Committee Chairman Rogers asked about the security of sea lanes in the South China Sea. Hagel assured him the US continues to be a Pacific power, and is putting more of its attention and resources in that area. If China were to move to close those shipping lanes, the US is prepared to take action to keep them open. Rogers brought up cyber-security, and the allegations that "most" attacks in the US are state-sponsored and coming from China. He asked whether the US is prepared to defend itself in this area. Hagel said the budget proposes "considerable increases" in cyber, but the Department of Homeland Security has most of the domestic authority in this area. He agreed this is the biggest threat to national security on a number of levels. DOD is strengthening its capacity to deal with these problems. The US is also talking to China about these issues.

Rep. Lowey received a promise that DOD will continue to fund the civil support team that responded in Boston. She also elicited a promise from Hagel that DOD will continue to work with the VA to create a seamless electronic system in order to help VA eliminate its claims backlog. Lowey believes DOD should move to VISTA or some other system that works seamlessly with that system. Hagel replied he could not defend what has been done, and acknowledged "we are way behind." He also committed that someone in his office will be put in charge of making it happen. He deferred the Request for Proposal at the end of March because he did not think "we knew what the hell we were doing." He also promised that they will have something done in the next 30 days. Lowey expressed pleasure the President’s budget has additional resources for transition assistance programs.

Rep. Frelinghuysen (NJ) asked if there is a "red line" concerning China’s actions in developing a deep blue navy and trying to control shipping lanes. Hagel replied "every nation" agrees that freedom of navigation must rule. This is the basis of treaties and other international agreements governing the global economy. Freedom of the seas is indispensable to the global economy. The President has made very clear where his red lines in these areas lie. Hagel and Frelinghuysen talked about the US relationship with Israel.

Gen. Dempsey told Rep. Granger (TX) that the US must continue to maintain a strong relationship with Egypt. He has spoken with his counterpart there. The military has tried to stay out of the political turmoil in their country. His counterparts do express concern over their country’s future. Granger also expressed concern over the cancellation of the deployment of a second carrier group to the CENTCOM region. While she understands the sequestration constraints, she also questioned the strategic wisdom of that move. Hagel said the move was taken with the advice of the combatant commander there. Dempsey noted that over $300 million was saved by not deploying the carrier, which means more flying hours for its wings. The military can compensate for the loss of the carrier with land-based aircraft and in other ways in CENTCOM. He admitted the decision, made about a week before deployment, affected about 6,000 sailors and their families. The decision was not made lightly.

Rep. Moran (VA) praised Hagel for getting through the Senate confirmation process, despite how badly some there treated him. Moran chided the department for supporting Russia’s arms exporter Rosoboroexport. In last year’s authorization bill, the House overwhelmingly passed an amendment prohibiting the US government from doing business with them. However, DOD just announced that FY 2012 Afghan security funds will be used to buy more helicopters from there. Hagel explained the decisions behind the choice of the M-17 for the Afghan people was because it is such an easy vehicle to fly and maintain, the Afghans are used to it, and want it. Dempsey agreed this is the helicopter the Afghans want.

Rep. Crenshaw (FL) talked about strategic dispersal of the aircraft carriers. On the East Coast, there is only one home port. Despite repeated DOD reviews in favor of a second home port on the East Coast, no money was allotted in FY 2013 to continue the work in Florida. Hagel said the Navy is going to move the amphibious ships to Mayport, rather than the carriers. They need to balance where resources and assets are kept. Hagel and Crenshaw also discussed the importance of space. Hagel assured him that space continues to be a high priority.

Rep. McCollum (MN) asked about the ability of the industrial base to be maintained in these budgetary times. Hagel agreed with her about the importance of maintaining the industrial base and promised DOD is looking at doing everything possible. Gen. Dempsey said the industrial base is about future readiness and DOD is focused on these issues. Rep. McCollum said the military has a "disease" infecting it: sexual assault. An all-volunteer military that will be increasingly dependent upon women must address this. A problem of this magnitude works as a disincentive for women to join the military. McCollum praised Hagel for his attitude in this area so far and asked to work with him. To date, she is disappointed with the military’s response, finding it falls short. The witnesses promised to continue working to eliminate sexual assault.

Sec. Hagel told Rep. Calvert (CA) the department continues to work to reform its acquisitions and procurement process. Hagel also told Calvert DOD has not made any final decisions as to whether the civilian workforce will have to be furloughed. Congress was given notice, in order to give the department as much flexibility as possible. The good news is that, if it happens, a furlough has already been decreased from 21 days to 14 days. Secretary Hale assured the Member DOD is on track to reduce its civilian workforce by 5% by 2018. However, to achieve that, they will need another round of base closures.

Rep. Bonner (AL) talked about helicopters and ships. Hagel reminded the Member "we’ve got less money." Priorities must be set in determining what to procure, and how big to grow the Navy. However, a 600-ship Navy also means more maintenance and people to man those ships.

Rep. Ryan (OH) talked about a pilot program in his district to build mental resiliency in soldiers that is starting to see some benefit. He thanked the witnesses for their support for these programs.

Rep. Cole (OK) asked whether there are any plans to reduce the number of flag and general officers. Hagel replied former DOD Secretary Panetta had started an ongoing review of downsizing the size of the upper management ranks. In addition, the general review of DOD’s management ordered by Hagel will address this issue. Dempsey said Panetta’s review identified about 144 generals and admirals whose positions should disappear through attrition. That said, the size of the upper ranks occurred because there were requirements. As the situation has changed, DOD now looks at how they can operate with fewer at the top ranks, especially as the force is downsizing.

Rep. Owens (NY) received reassurances the New York civil support team that responded in Boston yesterday will not be dissolved. Dempsey and Hagel also talked to the Member about last year’s environmental assessment on creating a missile defense site on the East Coast. Dempsey said this does not mean one will be created. The military might decide to create a sea-based response instead of setting up a land-based site. Owens’ last question concerned BRAC. He believes that, during the last round, final decisions were made on political bases rather than on facts. Hagel assured him the BRAC process is as open, transparent, and fair as possible. However, he admitted it is an imperfect system. That does not mean they should not try to make it happen.

Rep. Womack (AR) returned to the "readiness shortfall" caused by sequestration. He agreed there will be recovery costs, as the military tries to recover from the loss of readiness. Dempsey agreed with Womack’s theory that some of those "recovery costs" will be lives lost on a future battlefield. The Member asked how he can assure today’s parents the military will continue to operate at its high levels of equipment, training, and support in light of sequestration. Hagel replied he has enduring confidence in the fiber and character of those who lead the country and the military. It is as much due to the people who serve in Congress as those who lead in the Pentagon.

Rep. Kaptur (OH) praised the work being done by Dr. Castro at MRMC in neurological research. She is heartened DARPA will be working with other parts of the federal government on the President’s brain initiative in the coming years. She wants to see Castro’s research linked with DARPA’s work on the Brain Initiative. As for the Guard and Reserves, Kaptur asked about their roles in the military’s future. She noted these forces cost far less to operate than active duty units. Kaptur is deeply concerned over whether DOD is moving towards achieving energy independence, given the high costs of moving fuel around on the front lines. She sees solar energy as critical to the US future. China is "dumping" solar panels globally. In addition, intellectual property in this area is also put at risk by China’s actions. Kaptur also expressed concern about the importance of maintaining the industrial base into the future.

Rep. Kingston (GA) submitted a question for the record about the purchase of the G-222 cargo planes in Italy for the Afghans. Now that the Afghans have rejected that plane in favor of the C-130, he questioned whether the initial purchase had been properly vetted. He asked for comparison information about the various cargo and transport planes being used by the military today. In addition, Kingston questioned the large number of civilian employees at the Pentagon. He believes DOD is disproportionately reducing the uniformed workforce in comparison with the civilian. Hagel confirmed for Kingston that, for those over 65, TRICARE copayment is zero today. For the under 65 retirees, family copayments are around $500. Kingston noted, in the civilian market, they would have to pay over $6000 for comparable coverage. Kingston pointed out TRICARE premiums have only increased since the 1990s and the reality is they do have to increase. Kingston does not think military retirees and their families actually realize these facts, and that the interest groups automatically fight any increase. Hagel replied that, in order to sustain military medicine for the long term, adjustments do have to be made. These proposals must be pushed through Congress. Hale said DOD has managed to slow the growth in TRICARE costs, but health care costs continue to grow and make up a very large part of the Defense budget.

In the interests of saving time, most of the last questions will be answered for the record.

House VA Subcommittee Holds Legislative Hearing

On Tuesday, April 16, the House Veterans’ Affairs Subcommittee on Disability Assistance and Memorial Affairs (DAMA) held a legislative hearing to receive testimony on a slate of bills being considered. On hand to offer testimony were members of Congress who sponsored the various pieces of legislation, representatives of Veterans’ Service Organizations, and representatives of the Veterans Administration (VA). The witnesses were:

Panel 1

• Representative Bill Johnson (OH),

• Rep. Chellie Pingree (ME), and

• Rep. Timothy Walz (MN).

Panel 2

• Mr. Jeffrey Hall, Assistant National Legislative Director, Disabled American Veterans

• Raymond Kelley, Director of National Legislative Service, Veterans of Foreign Wars

• Colonel Robert F. Norton, USA (Ret.), Deputy Director of Government Relations, Military Officers Association of America

• Heather Ansley, Esq., MSW, Vice President of Veterans Policy VetsFirst, a program of United Spinal Association

• Michael D. Murphy, Executive Director, National Association of County Veterans Service Officers

Panel 3

• David R. McLenachen, Director, Pension and Fiduciary Service, U.S. Department of Veterans Affairs (VA), accompanied by Mary Ann Flynn, Deputy Director, Policy and Procedures Compensation Service, VA, and

• Richard Hipolit, Assistant General Counsel, VA.

The American Legion, though not delivering oral testimony, submitted testimony for the record. In the testimony, The American Legion supported all bill except HR 569/HR 570, the Veterans’ Compensation Cost-of-Living Adjustment Act of 2013 and American Heroes COLA Act, respectively; and HR 1405, which would require the Secretary of Veterans Affairs to include an appeals form in any notice of decision issued for the denial of a benefit sought. In the case of HR 569 and HR 570, the reasoning given for The American Legion’s lack of support was given as "The American Legion supports an increased Cost-of-Living Adjustment for veterans, but is unable to support these bills at this time until they reflect assurances that veterans’ needs will be adequately reflected and not subject to whims of overzealous cost cutting measures." In the case of HR 1405, which would amend title 38, United States Code, to require the Secretary of Veterans Affairs to include an appeals form in any notice of decision issued for the denial of a benefit sought, The American Legion took no position, due to lack of resolution support.

Mr. McLenachen of VA took positions on several of the bills which were at odds with both those of the The American Legion, as well as with the other VSOs who testified. Specifically, VA took adversarial positions to HR 602, the Veterans 2nd Amendment Protection Act; HR 671, the Ruth Moore Act of 2013; HR 679, the Honor America’s Guard-Reserve Retirees Act; HR 733, the Access to Veterans Benefits Improvement Act; and HR 894, a bill which would improve the supervision of fiduciaries of veterans under laws administered by VA. The full statement of VA’s positions can be read at the following link:

House VA Subcommittee Discusses VHA Procurement

The Health Subcommittee of the House Committee on Veterans’ Affairs conducted a roundtable discussion on Thursday, April 19 to address concerns with the federal procurement procedures utilized by the Veterans’ Health Administration (VHA) of the Department of Veterans Affairs (VA). Chairman Dan Benishek (MI) described VA’s contracting system as "broken" and cited numerous examples of delays in obtaining vital equipment at VA hospitals in Michigan and other regions. Ranking Member Julia Brownley (CA) expressed concern that clinician’s decisions are being overridden by bureaucratic bean counters with no medical knowledge or experience.

Rep. Brownley’s concern was echoed in testimony from American Legion Deputy Director for Health Care Jacob Gadd. Gadd cited stories culled from many visits to VHA facilities conducted by the System Worth Saving Task Force including tales of prosthetics being denied because the option selected by the care provider was deemed more expensive than another option. "A veteran should never receive substandard care because of concern about the cost," Gadd cautioned.

For their part, VA was communicative and helpful to the committee. Phillip Matovsky, Associate Deputy Undersecretary for Health for Administrative Operations acknowledged the system was problematic, agreed that the delay times were far too long, and reiterated VA commitment to working through the procedure to make it more functional. In VA’s defense, Ms. Pat McKay, the Director of Government Contracts for Phillips Healthcare noted, "VA has to contend with the fact that there are 58 separate federal regulations governing contracting and contracts." Clearly there is a complex maze of bureaucracy to navigate to accomplish tasks such as ordering prostheses and high tech medical equipment for hospitals.

The makeup of the committee was in some ways unique. Four actual physicians sit on the committee, and all four doctors were present and engaged in the discussion. The Chairman himself, Mr. Benishek is a surgeon, as is Rep. Raul Ruiz (CA). Doctors Phil Roe (TN) and Brad Wenstrup (OH) also were very familiar with aspects of running a medical practice. The other members of the committee, Ranking Member Brownley (CA) and Representative Gloria Negrete McLeod (D-CA) were no less engaged. Negrete McLeod noted, "As the lay person here I can afford to ask the basic questions. If it takes 16 months to get a needed piece of equipment, what does the veteran do for that time?" Sadly, the round table agreed the answer to that question is often "The veteran waits."

Deputy Director Gadd, Pat McKay from Phillips Healthcare and testimony from Vietnam Veterans of America all raised the concern that decisions about contracting, order fulfillment and how VHA goes about their practices are being made without consultation or input from the key stakeholders involved. For their part, VA noted an upcoming summit on prosthetics and noted they are trying to increase communication with VSO stakeholders in their decision making process.

Senate VA Panel Examines VA’s FY 2014 Budget

On April 15 the Senate Veterans’ Affairs Committee to begin consideration of the President’s proposed Fiscal Year (FY) 2014 budget for the Department of Veterans Affairs (VA). The witnesses included:

• The Honorable Eric Shinseki, Secretary, Department of Veterans Affairs (VA)

• Accompanied by:

• The Honorable Robert Petzel, MD, Under Secretary for Health

• The Honorable Allison Hickey, Under Secretary for Benefits

• The Honorable Steve Muro, Under Secretary for Memorial Affairs

• Mr. Stephen Warren, Acting Assistant Secretary for the Office of Information and Technology

• Mr. Todd Grams, Executive in Charge for the Office of Management and Chief Financial Officer

Committee Chairman Bernie Sanders (VT) stressed the real cost of war is not the planes and tanks. It is caring for the people who fought in it. This includes physical wounds but also the invisible wounds, such as traumatic brain injuries (TBIs) and post-traumatic stress disorder (PTSD). The budget proposal comes down to how this country’s government treats those who have sacrificed so much in service to that country. The VA is recognized by many as providing an excellent quality of health care at a reasonable cost. There is certainly more room for improvement, but they have come a long way in the last 20 years. VA has also taken an aggressive effort to reduce the number of homeless veterans. Since 2009, the number of homeless veterans has gone down by 17 percent, but more remains to be done. VA also has a world class research program. Its findings benefit not only veterans but the entire American population. That work must continue. Sanders said he agrees with many of the concerns of the veterans’ service organizations (VSOs). This includes the obligation to address the tragic number of service member and veteran suicides. The claims system must be transformed to address and eliminate the unacceptably large backlog. VA must complete its move to a paperless claims system on time. Veterans must have a smooth transition between DOD and VA. Sanders opposes the use of the chained CPI to calculate VA benefits. The chairman called upon VA to step up its hiring pace in order to bring on 1600 new mental health providers on schedule. He reminded them not everyone responds to treatments the same way. He also asked them to provide complementary and alternative therapies in conjunction with more traditional therapies. VA must do a better job of ensuring they are available to all interested veterans.

Ranking Member Richard Burr (NC) questioned whether VA’s use of taxpayer money is leading to better outcomes. This is especially true in the information technology (IT) arena, where VA has rolled out numerous initiatives and spent a lot of money, without any clear advances. They still have a huge claims backlog. He also questioned the progress being made between DOD and VA in creating the integrated electronic health record (iEHR). Burr went through a list of IT projects and initiatives that have promised a great deal but delivered little so far. He stressed this is not a good way to serve the nation’s veterans.

Sen. Rockefeller (WV) praised the Secretary’s management of VA, given the size and complexity of VA’s mission and job. There are things that could be done better. However, VA is much better than it used to be. Rockefeller praised the President for the vote of confidence in Shinseki and VA posed in the proposed budget. He added he is "disturbed" the DOD-VA once-vibrant move towards the iEHR seems to have ended.

Sen. Johanns (NE) appreciates that a new VA cemetery is planned for the Omaha area. He expressed concern over facility maintenance. The Omaha VA dates from the 1950s. In fact, the operating suite was closed for "much-needed repairs". He wants to know how these kinds of facility needs are being addressed around the country.

Sen. Tester (MT) praised the work of the VA.

Sen. Isakson (GA) said VA spending is mandatory. Benefits to the veterans should never be shortchanged. Savings should be found in managing the Department more efficiently. His two main interests are the suicide rate and the claims backlog. VA must focus on these two issues in order to properly address the needs of the veterans.

Sen. Boozman (AR) stressed serving the veteran and resolving the difficult problems such as the suicide rate and the claims backlog is not a partisan issue. VA is doing a lot of things right. Ensuring this continues is a bipartisan effort.

Sen. Begich (AK) very much appreciated the new relationships between VA and tribal health care facilities, providing additional care opportunities for rural veterans. He also appreciates what is being done to help homeless veterans.

Secretary Shinseki said today’s veterans are enrolling in VA and using VA facilities and benefits at a higher rate than previous generations. VA’s programs and capabilities must be robust enough to answer that demand. Thus, the budget proposal includes modest funding increases in both the FY 2014 budget and the FY 2015 advance funding request. Increasing access is a success story at VA. They have sent more resources into more rural areas, and have used innovative ways, such as social media, to reach out to the veteran community. Shinseki readily admitted the claims backlog is unacceptable. More claims processors are being trained. Today’s employees process more claims per day than their predecessors. An express lane has been created for those claims predicted to be processed quickly, and a second process has been created to provide special treatment for very complicated claims. Most claims, about 60%, fall into the central "core" lane of processing.

Sanders reminded Shinseki of his desire to process all claims within 120 days at a 98 percent accuracy rate. The chairman recognized the "huge challenge" of moving from a paper-heavy system to a paperless one. Shinseki said, when he took office, there were Vietnam and Gulf War era veterans still waiting for action on their conditions. VA took on new decisions concerning Agent Orange and Gulf War conditions. When Congress made those decisions, VA testified that doing so would increase the claims volume at the Department. They are fielding a new processing system as quickly as possible. Secretary Hickey said, using the new automated system for education claims, VA has tripled its productivity, with an average processing time of 4.5 days. The VBMS for medical and benefits claims is being modeled after the education system. She assured the Senators VA is well along on the process of implementing the new system.

Burr took issue with the number of claims VA has predicted to complete in 2014 and 2015 in documents submitted to Congress in January, and the fact that they are different than the budget submission. Hickey said claims are being submitted at a slightly slower rate than expected. She also promised that VA raters are working every day to chip away at the backlog.

Rockefeller asked how people are prioritized to receive mental health care. Shinseki said no one should have to wait for mental health. VA has increased the number of providers they have. Shinseki also assured Rockefeller both DOD and VA are "still committed" to building an integrated, joint, common iEHR, with open architecture.

Johanns questioned why there is funding in the budget request for only one major medical facility, but many minor construction projects. He wondered how much of this money is being spent to keep aging, outdated facilities operating. The Secretary reviewed the makeup of the construction budget and assured him it is a stable, across-the–board program. It has an emphasis on medical leases and one-time maintenance projects.

Tester asked about the demonstration projects that allow VA to contract with community based clinics to provide mental health services to OEF/OIF veterans. None of the Montana clinics are contracted with VA. Secretary Petzel said there are 15 demonstration projects authorized and most of them are already providing care. The rest will be doing so in the next month or so. He was unaware that no clinics in Montana are under contract, and he will look into it. Tester asked about salaries and compensation for mental health providers within the VA system. Petzel explained that the local VA facilities have flexibility in setting salaries in order to attract new talent. There is a $60 thousand dollar cap in place in certain conditions, and Petzel and Tester will talk about this further off the record. Petzel assured Tester VA is aware of the need to ensure that existing staff morale does not suffer if people are hired at higher rates.

Isakson thanked Shinseki and the President for the new VA facility in his state. Then, the Senator engaged the Secretary in a discussion about what he is doing to address the claims backlog. Hickey added VA continues to engage in "process improvement even as they are implementing other process improvements."

Begich asked whether DOD will actually perform as they have promised in providing information electronically. Hickey said DOD is already pulling out health-related information and, for the first time, giving VA a full medical record (including from contract health professionals). DOD will be providing those records in electronic form by December.

Shinseki assured Sen. Blumenthal (CT) VA remains committed to creating the iEHR. As far as he knows, DOD is also still committed. Blumenthal and Shinseki talked about VA’s growing commitment to addressing the unemployment issue among veterans. Not only does the Department hire a lot of veterans, but they have also held a series of employment fairs. VA is active in helping veterans start small businesses.

Sen. Moran (KS) noted the committee will soon be holding a roundtable on unemployment among veterans. Kansas is a very rural state, and the CBOCs there have had a hard time attracting health care professionals. Some of the CBOCs simply do not have a physician at all. As for the provision of mental health, he said MFTs and LTCs are often used to provide mental health services. However, VA does not seem to pursuing these kinds of professionals. They represent 40% of the mental health workforce in the US, but only 1% of the VA workforce. Petzel explained MFTs and family counselors are new kinds of providers within VA, and admitted the Department is "behind the power curve" in hiring these kinds of professionals. Petzel agreed it makes sense to pursue this avenue in rural areas such as in Kansas. Petzel also assured Moran VA does employ chiropractors at almost all VA facilities and contracts with them in the private sector. He will respond for the record about the situation in Kansas. Moran asked for a status update about the planned joint DOD/VA facility at McConnell. Petzel said a major construction project was submitted but it did not rate high enough to score for the FY 2014 budget process. He expects this will be submitted again in a subsequent cycle. Moran wants to see this project move up as soon as possible.

Sen. Hirono (HI) brought up women veteran’s health. The budget does ask for money for more of these specific clinics. Shinseki said women make up 6% of the current VA population, but that is likely to grow. The budget request increases this spending by 134%. Petzel said the larger facilities have large comprehensive clinics for women’s care. In smaller facilities, there are primary care clinics dedicated to women’s health issues and needs. Even smaller facilities, such as CBOCs, provide specialized training in the needs of this population. Petzel believes all of the facilities with enough of a population to support one have already created a comprehensive clinic. The most important thing is to ensure VA is a safe environment for women to come to seek care. Too often, women do not see themselves as "veterans," and do not see VA as a place to serve them. The Department must take action to reverse these perceptions.

Sanders thinks people would be surprised to hear that the VA has been a leader in using complementary medicine to treat veterans, including things such as guided imagery, acupuncture, meditation, yoga, and so on. These kinds of things can help to control pain without a lot drugs, for example. Petzel said 80% of VA facilities have these kinds of programs in place. Sanders worries that, while VA Central Office strongly supports these kinds of programs, the excitement has not yet filtered down to the operational level. Petzel said additional research showing efficacy would help a great deal in those efforts. Right now, VA has a study underway on the impact of meditation on individuals with PTSD. Other work is being done using guided imagery to help victims of sexual assault.

As the hearing wound down, Burr again engaged the witnesses in a discussion on the costs involved in building the computerized system for handling the VA claims system or the VBMS. This includes licensure payments and maintenance, as well as straight operations.

American Legion Legislative Council

The Legislative Division continues the task of re-building the membership of the National Legislative Council for the 113th Congress. Council recommendation forms were emailed to Department leadership in December, asking for nominations for new congressional members. Completed forms were due in the Legislative Division offices in Washington, DC by January 18. To date, 46 Departments have returned their Council nomination forms. The Departments with the greatest congressional redistricting and turn over are still completing their assignments. The only Departments still working on their committee assignments are California, Connecticut, New York, and Ohio

The importance of the Legislative Council cannot be overstated. It is an especially important voice for The American Legion family, and the way in which members of Congress can be quickly contacted when legislative action is needed. Departments are urged to complete their nomination forms and return them to the Legislative Division offices as soon as possible.

Update on Flag Amendment Bill

On January 18, House Joint Resolution (H.J. Res.) 19 was introduced by Representative Jo Ann Emerson (MO). This legislation is 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 next task is finding cosponsors for this legislation. Please contact the offices of your representative and senators, and ask them to become cosponsors of the flag amendment in their respective chambers. [Res. 272-2012]