VA's Budget Request for Fiscal Years 2011 and 2012

VA's Budget Request for Fiscal Years 2011 and 2012

Chairman Filner and Ranking Member Buyer, thank you for the opportunity to testify on behalf of Iraq and Afghanistan Veterans of America (IAVA) regarding the “VA’s Budget Request for Fiscal Years 2011 and 2012.” IAVA is the nation’s first and largest non-partisan, nonprofit organization representing veterans of the wars in Iraq and Afghanistan, and we are honored to be invited here today.

We’ve come a long way since 2004, when my infantry platoon and I first got home from Iraq. The era of rationing health care for our nation’s veterans, due to late and insufficient funding, has finally ended. Nearly two decades ago veterans’ advocates began demanding “sufficient, timely and predictable” funding for the Department of Veterans Affairs. Last year, this Congress and Administration finally delivered. With record increases for the third year in a row, the VA budget was more than just “sufficient.” And although the budget was passed two months after the start of the new fiscal year, by providing funding for fiscal years 2010 and 2011 we finally had a “timely” and “predictable” VA budget. IAVA didn’t exist when this campaign began, but we were proud to be a part of the battle and advance appropriations was our top priority last year. We are sincerely grateful for the work that the members of this committee and the veterans groups seated here today did to make advance appropriations possible.

I’m sure the members of this committee agree that our work is far from over. Right now, thousands of veterans are unemployed, more than 100,000 are homeless, and hundreds of thousands are desperately waiting months, and sometimes years, for their well-earned VA benefits. Veterans, like former Army Specialist and IAVA member Casey Elder, who suffered a Traumatic Brain Injury when her Humvee struck a roadside bomb in Baghdad in 2004. After nearly a year of waiting, and despite clear evidence for a disability rating from the VA’s own neurologist, Casey’s initial claim has been denied. She has since appealed the decision, but it could take up to two years for Casey to receive compensation—if she receives it at all.

VA employees are highly-dedicated, and we’re extremely appreciative of their service to veterans. However, the Department of Veterans Affairs must do better. It must do better for Casey Elder, and for veterans of all generations. IAVA believes that this year’s VA budget request of $125 billion for fiscal year 2011 and $50 billion in advance appropriations for health care in 2012 signals the beginning of this new era. One might even be tempted to call this the “advance appropriations era,” but we will borrow a term from VA Secretary Shinseki, and call it the “Transformation Era.” Government budgets are the clearest expression of a nation’s priorities. IAVA believes that this VA budget and all future budgets, during this transformative era, should be evaluated on the following four principles:

• Guarantee the Best Care Anywhere • Modernize Benefits Delivery • Recruit Veterans and their Families into the VA system • Support Female Veterans

True VA transformation will mean building a VA capable of handling the care of veterans and their families recovering from multiple injuries. Transformation means satisfying the expectations of an internet generation who can track a package anywhere in the world, but have no idea what happens to their VA claims once they are mailed. Transformation means treating a rapidly increasing number of female veterans using VA facilities. Transformation means providing top quality care for the surge home of veterans of Iraq and Afghanistan. And transformation means realigning resources to accommodate a steadily declining national veterans population. Transformation will not be easy. But working together, we can make it a reality by focusing on the following areas:

I. Guarantee the Best Care Anywhere for Veterans

The VA Funding Levels Must Match the Independent Budget Recommendations

To continue to provide the best care anywhere for our veterans the VSO Independent Budget (IB) recommendations should be the standard for future VA budgets. The IB budget is a blueprint for constructing a VA budget that meets the needs of our nation’s veterans. IAVA fully endorses it. We are grateful that VA funding levels have matched and sometimes exceeded the IB recommendations over the past three years. And we are pleased that the President’s VA budget request for 2011 appears to have also met the IB’s recommendations. We hope to see this convention for years to come.

The VA Must Collaborate with All Stakeholders to Successfully Implement Advance Appropriations

In addition to sufficiently funding the VA we must ensure the responsible and successful implementation of advance appropriations for veterans’ health care. Successful implementation hinges on the VA’s ability to accurately project their financial needs two years in advance. Everyone here knows this is no small task. I know from personal experience running a dynamic organization that projecting needs one year in advance is difficult. Tackling the budget for the largest health care provider in the United States two years in advance will require a herculean collaborative effort involving the VA, Congress and the veterans’ community.

Successful collaboration on this scale requires complete transparency throughout the entire budgeting process. Previous Presidential VA budget submissions were developed using projection models based on proprietary data and political scrubbing at OMB that were not made public. The VA must eschew this closed door approach and embrace a fully transparent budgeting process where all stakeholders have access to the core budget data and the projection models being used. While it may not make for great ratings on C-Span, opening the budgeting process to review and critique will allow the VA to harness the full expertise of Congress and the veterans’ community.

VA’s implementation of the new GI Bill last year was another transformative program that required an extraordinary effort. Arguably, one of the most valuable lessons learned during that process is that when the VA reaches out and involves Congress and the veterans’ community in their decision-making process the overall implementation runs more smoothly. For example, The VA held three town hall meetings to develop their implementation regulations for the New GI Bill. After these meetings they issued rules that students, schools and veterans groups accepted and generally understood. This was a successful collaboration. Alternatively, when the VA did not collaborate, and acted unilaterally, the GI Bill veered off course. This resulted in unacceptable delays and widespread confusion. The message to the VA from IAVA and the VSO community is clear: we are here to help. But you have to answer the phone and listen to what we are hearing from our members.

II. Modernize Benefits Delivery

It’s long overdue to bring our benefits system into the 21st Century. Iraq and Afghanistan veterans, like Casey Elder, the wounded veteran I described earlier, are receiving benefits under a VA disability system that was outdated years before most of them were born. This antiquated system, which focuses on quantity over quality, leads to frequent errors, mountains of bureaucratic red tape, and a lengthy wait for benefits. With the VA benefits backlog nearing 1 million claims, the need for transformation has never been greater. We therefore join with the chorus of other veterans groups in recommending that the VA modernize their claims processing system by digitizing records, holding processors accountable for the accuracy of their work, and removing unnecessary steps in the evaluation process. This issue is of the utmost importance and urgency so IAVA has made disability reform our number one legislative priority for 2010. These issues are further described in IAVA’s groundbreaking issue report, “Red Tape: Veterans Fighting New Battles for Care and Benefits,” available outside the door today and at www.IAVA.org/reports [1].

The greatest obstacle to the VA’s modernization of benefits delivery is its archaic IT system, which cannot exchange electronic health records between DOD and VA and does not allow veterans to track the processing of their benefits claims. The DOD still relies on a paper-based system for military service records, and as troops transition from the DOD to the VA, medical records and military service records regularly get lost in the shuffle. Hundreds of thousands of wounded troops and veterans are forced to wait months, and sometimes years, for disability compensation because of these IT deficiencies. VA and DoD have been working on the ability to seamlessly share veterans health records for over a decade, but progress has been slow and transparency limited.

In April 2009, the Administration announced a bold initiative to create the Lifetime Verification Electronic Record (LVER), integrating health and service data into a format usable between DOD, VA and the private sector. If successful, benefits processing time will be cut by months and veterans will receive higher quality health care across the board. A project of this magnitude is something in our world akin to landing a man on the moon, and should be given all the resources and attention necessary to ensure success. Like advance appropriations and the GI Bill, this initiative will require a truly collaborative effort on all of our parts.

IAVA is pleased to see that the President’s budget submission contained $52 million for the development of the LVER. We look forward to seeing regular progress reports from the VA on the strategic goals to have the LVER up at 3 pilot sites by the end of the year and to have developed a working prototype by 2012. And we encourage VA to work with Congress and the veterans’ community to ensure that adequate resources are being provided to guarantee the success of this critical initiative.

Upgrading these systems better serves our veterans and also makes the system more efficient. Efficiency results in significant cost savings, low hanging fruit in a time of historic national deficits. We are glad to see the VA bringing in one of IAVA’s Board Members, Craig Newmark – the Craig in Craigslist. VA leadership will certainly benefit from his technological expertise and strategic vision. And we also hope that they will learn from his incredible focus on customer service. Craig’s business card famously reads “Customer Service Representative,” and Craig is not joking. He is committed to providing Craigslist’s users with the best possible experience, and he literally spends hours a day personally answering customer service emails. This commitment to customer service has made Craigslist a dynamic, responsive company that is in close touch with its customers. This has allowed Craigslist to build an extremely strong and trusted brand. Changing the culture and processing claims quickly and accurately will make VA that same kind of trusted brand for veterans.

III. Recruit Veterans and their Families into the VA system

Innovative and Aggressive Outreach is a Must

The Department of Veterans Affairs must shed its passive persona, by adopting a customer-centered approach, and by recruiting veterans and their families more aggressively into VA programs. This means developing a relationship with the servicemember, while they are still in the service. They can learn from successful college alumni associations who greet students at orientation and hold student programs throughout their time in college. And once a veteran leaves the military, the VA should create a regular means of communicating with veterans about events, new programs and opportunities. If I got half as many letters and emails from the VA as I do from my College Alumni Association, we would be in great shape. The VA must also reach out to those veterans who have yet to access their VA benefits and aggressively promote VA programs.

In order to accomplish this phase of transformation, IAVA believes that the VA must prioritize outreach efforts and include a distinct line item for outreach within each VA appropriation account. These line item should help fund successful outreach programs such as the OEF/OIF Outreach Coordinators, Mobile Vet Centers and the VA’s new social media presence on Facebook and Twitter. Right now, these outreach programs are still too small and under-resourced to make a transformative difference. IAVA was disappointed that there were only a few brief mentions of outreach activities throughout the President’s VA budget submission. Not one of these mentions described a dedicated outreach campaign.

Based on experience with our own historic Public Service Announcement (PSA) campaign with the Ad Council, we have learned a thing or two about veteran outreach campaigns. Hopefully by now you’ve seen our iconic PSAs, like the one featuring two young veterans shaking hands in an empty New York City street. I know Chairman Filner has seen the ad, because he encouraged us to reenact that scene with the actual vets on the steps of the Capitol last year.

These TV ads are just one component of this groundbreaking campaign. That famous ad is complimented by billboards, radio commercials, and web banners that have blanketed the country and touched millions of Americans. In just the first year of the campaign, IAVA has already received $50 million dollars in donated media, and reached millions of veterans.

This entire campaign directs veterans to an exclusive online community that strongly demonstrates to our nation’s new veterans that “We’ve Got Your Back.” It also directs them to a wide range of mental health, employment and educational resources—operated by both private non-profits AND the VA. This campaign is an example of the type of innovation coming out of the VSO and non-profit community that can help guide the VA. Innovative, aggressive outreach programs like this should become part of the new VA culture, and can fuel-inject desperately needed outreach efforts. We are learning what works, and we are happy to share our knowledge with anyone.

We Must End the Suicide Epidemic

IAVA’s outreach efforts are also designed to make a dent in the suicide epidemic ripping through the military and veterans’ community. During the first eight days of this new year, eight servicemembers have already taken their own lives. And in 2009, a record 334 servicemembers committed suicide. Last year, more servicemembers died due to suicide than combat in Iraq. These numbers do not even include the veterans who commit suicide after their service is complete--whose fatalities are tragically insufficiently tracked. Untreated mental health problems can and do lead to substance abuse, homelessness, suicide, and difficulties at home.

In 2008 a RAND study reported that almost twenty percent of Iraq and Afghanistan veterans screened positive for Post Traumatic Stress Disorder (PTSD) or major depression. A recent study by Stanford University found that this number may be closer to 35 percent. Less than half of those suffering from mental health injuries are receiving sufficient treatment. Exacerbating the problem of inadequate treatment is the heavy stigma associated with receiving mental health care. More than half of the soldiers and Marines in Iraq who test positive for a psychological injury, report concerns that they will be seen as weak by their fellow servicemembers. One in three of these troops worry about the effect of a mental health diagnosis on their career. As a result, those most in need of treatment may never seek it out.

In order to end the suicide epidemic and forever eliminate combat stress stigma we believe that VA and DOD must declare war on this dangerous stigma by launching a nationwide campaign to combat stigma and to promote the use of DOD and VA services such as Vet Centers and the Suicide Prevention Hotline. This campaign must be well-funded, research-tested and able to integrate key stake-holders within Veterans Service Organizations and community-based non-profits like the members of the Coalition to Support Iraq and Afghanistan Veterans (CIAV). Furthermore, the VA should develop and aggressively disseminate combat stress injury training programs for civilian behavioral health professionals that treat veterans outside of the VA (e.g., college counselors, rural providers, behavioral health grad students and professional associations).

IAVA is pleased to see that the VA has allocated $5.2 billion toward the treatment of hidden injuries such as PTSD and TBI, a sizeable 8.5% increase over last year’s budget. However, the VA must allocate specific resources towards battling this dangerous stigma or we will never see the critical mass of veterans coming into the VA to seek help.

End Veterans’ Homelessness

The VA estimates there are 131,000 homeless veterans on any given night and nearly twice as many veterans experience homelessness at some point during the year. New veterans are especially at risk. At the height of the housing crisis, foreclosure rates in military towns were increasing at four times the national average, and already more than 3,700 Iraq and Afghanistan veterans have been seen in the Department of Veterans Affairs’ homeless outreach programs. Unlike previous generations of veterans, Iraq and Afghanistan veterans are often appearing in the nation’s homeless shelters within two years of separation from the military, and a significant percentage of the homeless are female veterans and their children.

In 2009, the VA laid out a bold vision to fully eradicate homelessness among veterans within the next 5 years. This ambitious plan will require a new model for serving veterans and extensive collaboration between government agencies, traditional Veterans Service Organizations (VSOs), and the new breed of grassroots and nontraditional nonprofit organizations. This partnership between the public and private sector must also be utilized to smooth the transition home for all veterans. IAVA believes the VA should be granted discretion to match the Grant and Per Diem (GPD) program payment rates to the actual cost of helping a homeless veteran. We must also expand the HUD-VA Supportive Housing (HUD-VASH) voucher program, to include the funding of 30,000 additional housing vouchers, will transform the lives of tens of thousands of homeless veterans.

IAVA applauds the VA’s goal to cut in half the number of veterans sleeping on our streets by the end of this year and we believe that the additional $294 million for joint VA-HUD programs in the President’s budget request will go along way towards accomplishing that goal.

IV. Support Female Veterans

While it has made strides in recent years, the VA is still underprepared to provide adequate care to the surge of female veterans coming to its hospitals and clinics. Women veterans are the fastest growing segment of the veteran population, and their enrollment in the VA is expected to more than double in the next 15 years. Women veterans make up 15% of IAVA’s membership, and still face several barriers when seeking care at the VA, including fragmentation of services, health care and service providers with poor understanding of women’s unique health issues, lack of knowledge regarding eligibility for benefits, an unwelcoming VA culture, inadequate privacy and safety practices at facilities, and no access to childcare. IAVA supports the President’s request to increase funding for female health by an additional 9.4%, bringing the total up to $217.6 million.

IAVA also believes that in addition to increased funding, Congress must establish a firm deadline for the VA to meet its own goal of providing comprehensive health care to women and require the VA to layout clear steps and benchmarks for all VA facilities. We also recommend increasing funding for Vet Centers and VA medical facilities to hire female practitioners, especially those who specialize in women’s physical and mental health. Lastly, the VA should provide health care services to a newborn child of a female veteran who is receiving maternity care furnished by the Department.

These issues are further described in IAVA’s groundbreaking issue report, “Women Warriors: Supporting ‘She Who Has Borne the Battle,’” available outside the door today and at www.IAVA.org/reports [1].

V. Conclusion

The President’s budget submission for 2011 and 2012 has all the right ingredients for transforming the VA. It is a message to veterans, like Casey Elder, that “We’ve got their back.”

IAVA strongly supports this budget request, and looks forward to collaborating with the VA, Congress and the rest of the veterans’ community to see this budget and the priorities listed above realized.

Next week, IAVA will be bringing dozens of our members, from across the country, to Capitol Hill for our annual “Storm the Hill” legislative trip. Our highly-motivated veterans already have over a hundred meetings scheduled to share their stories and our 2010 Legislative Agenda. We look forward to meeting with your offices to discuss these priorities in more detail.

Thank you.