VetsFirst believes that by focusing on the needs of homeless veterans, many of whom have disabilities, more veterans with service-connected disabilities will receive the benefits and services needed to allow them to successfully reintegrate into their communities.

Access to VA disability compensation can provide critical financial resources for veterans with disabilities that are connected to their service. As a result, the VA must provide information about programs available to help veterans who are homeless to all community-based organizations that work with people who are homeless. Many community-based organizations are stretched to near breaking in their efforts to provide services. The resources available from the VA must be accessible to those who are on the front lines of this battle. The VA must also develop a variety of materials to educate providers about the special needs of homeless veterans.

Furthermore, the VA must ensure that veterans who contact the VA are made aware of community programs that can be of assistance. Programs available through other federal, state and local agencies may provide additional, immediate resources that could further assist veterans. These types of resources, including emergency services, are also important to preventing veterans from becoming homeless.

Ending homelessness among veterans will be a continuing battle to ensure that those who are able to receive needed supports are able to reintegrate into their communities and that robust interventions are in place to prevent additional veterans from becoming homeless. The VA must also continue to evolve to meet the changing face of homelessness and the unique needs of today’s veterans, including the increasing number of women who are serving and the prevalence of traumatic brain injuries among returning servicemembers. Unless homelessness remains at the forefront of program efforts for the foreseeable future, budget cuts and societal indifference could result in a return to homelessness for many veterans.

Just the facts: VetsFirst supports legislation that will provide the resources and tools needed to eliminate homelessness for veterans, including the Homeless Veterans and Other Health Care Authorities Act of 2010 (S. 1237), which includes provisions of the Zero Tolerance for Veterans Homelessness Act of 2009 (S. 1547), and the End Veteran Homelessness Act of 2010 (H.R. 4810), which includes provisions from H.R. 2504; Help Our Homeless Veterans Act (H.R. 2559), as amended; H.R. 2735, as amended; and H.R. 3906.

“VetsFirst finds it intolerable that veterans who are perhaps the most deserving and in need of VA benefits and health care are denied their legal rights because of an overly rigid interpretation of a legal technicality,” said Paul J. Tobin, VetsFirst’s President and CEO.

The Supreme Court appeal centers around David L. enderson, a Korean War veteran who was discharged from the military because of severe mental illness. Almost 50 years later, still suffering from that condition, his claim for VA disability benefits was denied at the administrative and appellate levels. Upon receiving the VA’s complicated and confusing instructions for appealing to the U.S. Court of Appeals for Veterans Claims, Mr. Henderson missed the 120-day filing deadline by 15 days. The veterans court subsequently granted the VA’s request to dismiss the appeal because of the missed filing deadline.

Mr. Henderson appealed once more, this time to the U.S. Court of Appeals for the Federal Circuit. The Federal Circuit ruled that the 120-day filing deadline is absolute because a timely filed notice of appeal is the only way to confer jurisdiction over the appeal to the veteran’s court. The court based its decision on a Supreme Court case that made a similar finding – except that the appeal involved a convicted murderer who was appealing a procedural matter under criminal law.

Several judges in Mr. Henderson’s Federal Circuit decision vigorously dissented to the strict application of the 120-day veterans court deadline, finding it both “ironic and inhumane”.

Mr. Henderson has appealed the Federal Circuit’s decision to the Supreme Court. The first step in that process is to petition the Court to agree to review the appeal. If the Court agrees to do so, it will then decide the appeal on the merits. VetsFirst has filed a legal brief in support Mr. Henderson’s petition and argues that the principle of “equitable tolling” – a widely-applied legal doctrine that allows appeal deadlines to be extended because of the fundamental unfairness of strictly enforcing them in an individual case – should be applied to the veterans court appeals deadline.

“Since the Federal Circuit’s decision, the veterans court has been dismissing approximately two appeals per week because the veterans’ notice of appeal was not filed on time. Veterans who are not represented by a service organization or an attorney when they appeal a VA denial of benefits are at a distinct disadvantage. Even veterans with less than severe disabilities may find it difficult to understand and follow the complex appeals instructions that the VA sends them,” explained Tobin. “It is patently unfair to treat disabled veterans the same as murderers and other criminals when it comes to appealing denied VA benefits. Why must disabled veterans with meritorious appeals be held to strict deadlines when the VA is allowed to take years or even decades to adjudicate a veteran’s benefits claim?”, Tobin added.

It is likely that the Supreme Court will make a decision on Mr. Henderson’s petition for review before it recesses for the summer.

Recent federal court decisions have made it clear that Section 504 of the Rehabilitation Act of 1973 requires that individuals with disabilities may not be excluded from, denied access to, or be discriminated against when seeking benefits under any federal executive agency program on the basis of their disabilities. 

The courts have ruled that federal agencies with benefits programs like the VA that rely on standard print written correspondence sent by regular mail do not satisfy their section 504 obligation to provide adequate notice and other important information to claimants for agency benefits.  Rather, these agencies are required to provide “adequate alternative modes of communication” to ensure that claimants understand the significance of the notice. 

In response to VetFirst’s demand, the VA, in a letter from its General Counsel, advised that the VA is committed to complying with the requirements of section 504 and the federal courts.  In order to do this, the VA stated that it intends to partner with the American Council of the Blind to determine the best ways of addressing the issues raised in VetsFirst’s letter and that it will study other federal agencies’ best practices concerning crafting adequate alternative notices and other communications.

“We are gratified by the VA’s recognition of our concern that a large segment of claimants for VA benefits could have their benefits and health care jeopardized because they receive notices that are inaccessible to them because of the very disabilities that underlie their claims,” said Paul J. Tobin, VetsFirst’s President and CEO.  “We intend to work closely with the VA to ensure that it promptly develops and implements adequate alternative communications that allow veterans and their family members to receive vitally needed benefits and health care earned through military service.” Tobin said.

VetsFirst was joined by United Spinal Association, Vietnam Veterans of America and the Veterans Law Section of the Federal Bar Association in its letter to Secretary Shinseki.

VetsFirst’s submission builds on our commitment to proactive advocacy on key issues that impact veterans with disabilities, their families and survivors. The five main advocacy areas include reforms to the VA claims system to address the claims and appeals backlog, improved access to health care, expanded employment opportunities for veterans, increased access to housing, and better supports for veterans’ families and survivors.

One of VetsFirst’s top priorities is to reform the VA benefits claims process. VetsFirst believes that implementing systemic reforms to the claims process is the key to ending the backlog. VetsFirst supports changes to both the manner in which claims are processed and the rules that govern claims adjudication. Without this two pronged strategy, the current problems will likely continue.

VetsFirst believes that there are some critical reforms that must be implemented to change the manner in which claims are processed. One of these reforms includes reorganization of the claims decision-making system so that each claim is processed by a single team that specializes in claims related to a particular disability. VetsFirst also believes that staff must receive increased training and that supervisors must be held responsible for continued patterns of error. Lastly, when evaluating employee performance, the quantity of claims processed must not overtake quality in importance or focus.

Although changes to the manner in which claims are processed must be implemented, VetsFirst also supports changes to the rules that govern claims adjudication. Specifically, VetsFirst believes that innovative approaches must he employed to create greater efficiency in both the procedural and substantive aspects of claims adjudication. An example of an innovative approach that VetsFirst believes should be explored is revising the evidentiary burdens of establishing entitlement to service connection. For example, removing the need to establish a nexus between the onset or aggravation of a disease, disability, or injury during active military services and medical evidence of a current diagnosis would remove a substantial burden from the veteran and the VA in the development of the evidence process.

VetsFirst will continue to pursue policies that ensure that veterans with disabilities are able to experience a greater sense of self-sufficiency and have access to needed services and benefits.

Stay tuned for more posts in the coming weeks exploring VetsFirst’s other advocacy priorities.

For fiscal year 2011, which begins on October 1, 2010, the President is seeking $125 billion for the VA. Specifically, the President is requesting $60.3 billion for discretionary spending for the VA, which is nearly on par with the $61.5 billion called for by veterans service organizations in the Independent Budget (IB). Discretionary funding is mainly used for health care for veterans. The President’s budget request also includes $64.7 billion in mandatory funding, which is spending mainly for disability compensation and pensions for veterans.

One of VetsFirst’s top public policy priorities is to reform the VA’s benefit claims process to reduce the backlog. The President’s budget requests $2.149 billion for the Veterans Benefits Administration’s (VBA) operating budget, which is one of the few categories for which more was requested than was suggested by the IB. The 27 percent increase over the last fiscal year is intended to help reduce the claims backlog. In 2011, the VA estimates that veterans will submit 1,319,000 claims, which would be a 30 percent increase from 2009. The VA believes that hiring additional staff members and better business practices will help decrease claims processing times. The budget request also includes $145 million for the creation of a paperless claims processing system.

Unfortunately, increases in funding and staffing levels for the VBA have not yet been effective in reducing the backlog of claims and appeals. According to the Government Accountability Office, the VA has made only limited progress in recent years toward decreasing average claims processing times. Although VetsFirst believes that VBA must have the resources necessary to meet the current challenges, the VA claims process and substantive regulations and adjudicative principles must also be reformed.

As the budget process continues to move forward, VetsFirst will continue to advocate for the level of funding the VA needs and the strategies that must be adopted to efficiently and effectively address the challenges facing today’s VA. Both the Senate and House Budget Committees will create budget resolutions that must be voted on by their respective bodies. Once a concurrent resolution is agreed to that reconciles any differences between the House and Senate passed resolutions, each body will vote on the concurrent resolution. Although not law, the concurrent resolution provides broad spending guidelines for the appropriations process.

Click here for more information about the President’s fiscal year 2011 budget.

Heather Ansley
The VetsFirst Team

ALS is a progressive neurodegenerative disease that attacks nerve cells that control voluntary muscle movements and causes rapid degeneration throughout the brain and spinal cord. The disease often results in death within several years of its diagnosis.

A VA spokesperson announced that out of 2,500 veterans who received letters explaining about VA disability benefits and health care for their ALS, at least 1,200 of them were sent the letter by mistake. Once it discovered the error, the VA sent letters of apology to those veterans and confirmed that they had not been actually diagnosed with ALS. However, after receiving the first letter, many skeptical veterans underwent painful and expensive diagnostic tests at their own expense to determine whether they actually had the fatal illness. The VA has agreed to reimburse these veterans for related out-of-pocket medical expenses.

The VA does not know exactly how many of the erroneous letters have actually been sent to veterans without formal diagnoses of ALS. VA officials have blamed the mistake on a “coding” error that caused the computer-generated letters to include as recipients VA patients that have undiagnosed neurological symptoms, in addition to those who have confirmed ALS diagnoses.

Although it is understandable that clerical mistakes can happen, especially in computerized bureaucracies, VetsFirst strongly believes that the VA must be more vigilant to prevent these kinds of errors. Veterans in fragile states of physical and mental health can be seriously affected such shocking news. Some could even be driven to suicide, rather than face a prolonged battle with a deadly disease that they don’t actually have.

Earlier this year, VetsFirst reported that the VA discovered that it had exposed more than 10,000 veterans to HIV, Hepatitis C and other serious diseases as the result of cross-contaminated medical equipment used during endoscopic procedures, including routine colonoscopies. The equipment had been improperly sterilized after use between patients. The exposures went undiscovered for almost five years!

More recently, the VA Medical Center in Philadelphia revealed that it had given at least 98 veteran cancer patients incorrect dosages of radiation therapy over a six-year period!

VetsFirst considers these kinds of errors to be unacceptable. When the lives and health of our nation’s veterans are at stake the VA cannot simply say “we goofed and we’re sorry”. It must implement measures to detect such errors immediately, strategies to prevent them from occurring in the first place and meaningful improved quality control in both its claims administration and health care delivery systems.

If you have received a VA ALS notification letter, we urge you to contact us immediately for assistance or to answer any questions that you may have. Simply go to our website, www.vetsfirst.org, and use the “Ask VetsFIrst” feature. One of our national service officers will respond directly to you.

The question before the court is whether the strict time limit for veterans and other claimants to appeal a denial of U.S. Department of Veterans Affairs (VA) benefits to the U.S, Court of Appeals for Veterans Claims (CAVC) can be extended if the claimant has a physical or mental disability that prevents him or her from filing an appeal in a timely manner. The outcome of this lawsuit will have an impact on the thousands of veterans and their dependents and survivors who file appeals with the CAVC each year.

The lawsuit, Henderson v. Shinseki, involves the question of whether the legal doctrine of “equitable tolling” applies to the 120-day deadline for filing an appeal to the CAVC. Equitable tolling allows courts to suspend a jurisdictional deadline like this one if it would be fundamentally unfair or inequitable to enforce it.

Under the law, an appellant who receives an unfavorable VA Board of Veterans’ Appeals (BVA) decision has 120-days to file an appeal with the CAVC. Since the CAVC only has jurisdiction to decide timely filed appeals of unfavorable BVA decisions, CAVC appeals received after the 120-day deadline has expired must be dismissed for lack of jurisdiction before the appeal is even considered.

For almost 20 years, both the CAVC and the Federal Circuit have allowed equitable tolling of the 120-day deadline based on the uniquely informal and non-adversarial nature of the VA claims process. That changed when the CAVC dismissed Mr. Henderson’s appeal of denied VA benefits because his notice of appeal to the court was received after the 120-day deadline had passed. His appeal was late because the very disability that he was claiming VA benefits for prevented him from filing a timely appeal.

The CAVC based its decision in Henderson on a recent U.S. Supreme Court decision, Bowles v. Russell. In Bowles, the Supreme Court refused to apply the equitable tolling doctrine to an appeals deadline in a criminal matter.

Since its decision in Henderson¸ the CAVC has dismissed more than 130 veterans’ appeals for untimely filing. Most of these veterans either suffer from physical or mental disabilities that prevented them from filing their appeals before the deadline expired, or they filed on time, but misfiled the appeal with the VA instead of the court.

VetsFirst has joined Mr. Henderson’s appeal to the Federal Circuit as an amicus curiae (friend of the court). The essence of VetsFirst’s legal argument is that the Supreme Court’s decision in Bowles does not preclude equitable tolling of the CAVC appeals deadline because of the informal, non-adversarial nature of the veterans’ claims process and the special relationship between the U.S. and its military veterans.

The appeals deadline in Bowles involved the appeal of a criminal conviction. However, the criminal justice system is so compellingly different from the pro-claimant VA claims system that to treat America’s disabled veterans in the same manner as convicted criminals is fundamentally unfair and inequitable. In law after law, Congress has consistently expressed its intent that disabled veteran claimants should be entitled to special consideration when it comes to matters of fairness and equity.

If the Federal Circuit accepts this argument and overturns the CAVC’s decision, veterans who appeal denied VA claims will have greater access to review of denied benefits in federal court.

Oral argument in the Henderson appeal has been set for September 8, 2009.

Read VetsFirst’s brief.

Currently, the law and VA regulations require veterans whose military records do not reflect combat service, and who assert that their diagnosed PTSD is related to a combat experience, provide documentary proof that the alleged experience actually occurred (e.g., official military records or a statement from someone who shared the experience with the veteran). This kind of proof is often very difficult or impossible to obtain.

The COMBAT PTSD Act would change the law to include service in a combat theater of operations to trigger the VA’s obligation to accept the veteran’s assertion of the incident(s) that resulted in the onset or aggravation of any disease or injury (including PTSD) as proof of service connection, provided that the asserted stressor is consistent with the “circumstances, conditions, or hardships of such service”. Veterans without documented combat service would no longer have to provide proof of their combat-related experience if they served in a combat zone.

VetsFirst strongly supports the COMBAT PTSD Act, but we believe that the bill, as written, will not eliminate the barriers to VA benefits and health care that still exist for these veterans. Even with the expansion of the definition of “engaged in combat with the enemy”, veterans without documented combat service who served in a combat zone will still have to provide medical evidence that their PTSD is related to their military service. Given the delay that may occur between the occurrence of a stressor event and the onset of PTSD, as well as the subjective nature of the individual’s response to a stressor event, it is often very difficult to obtain this kind of evidence as well, since it must be provided by a health care professional usually years after the event.

Consequently, VetsFirst urged Congress to establish a legal presumption of service connection for PTSD where a veteran has a current diagnosis of PTSD and served in a theater of combat operations. Since the VA would be required to accept the veteran’s assertion of a combat experience, and a diagnosis of PTSD includes a medical finding that the stressor event triggered PTSD, it is logical for the VA to conclude that the combat experience is related to the veteran’s PTSD. A presumption of service connection would allow the VA to do that by eliminating the need for medical evidence of a connection between the veteran’s military service and his or her PTSD. Such a presumption could only be rebutted by clear and convincing evidence to the contrary (e.g., the VA provides credible evidence that the claimed combat-related event did not occur or medical evidence that the veteran’s PTSD was caused by an independent post-service stressor event).

A presumption of service connection for PTSD in these situations would save the veteran and the VA the time, effort and expense of trying to uncover proof that the veteran experienced a combat-related event and medical evidence that such an event caused the veteran’s PTSD. With the large number of veterans returning from the wars in Iraq and Afghanistan with diagnoses or symptoms of PTSD, the COMBAT PTSD Act and a presumption of service connection will allow these veterans to receive VA disability benefits and health care much more quickly than they would otherwise.

VetsFirst Letter

April 27, 2009

The Honorable Bob Filner
Chairman, U.S. House Committee on Veterans Affairs
335 Cannon House Office Building
Washington, D.C. 20515

Re: Support for H.R. 952, The COMBAT PTSD Act of 2009

Dear Chairman Filner:

As a national veterans service organization, United Spinal Association and its veterans service program, VetsFirst, we wish to express our strong support for the Compensation Owed for Mental Health Based on Activities in Theater Post-traumatic Stress Disorder Act of 2009 (the COMBAT PTSD Act, H.R. 952). The passage and implementation of this legislation will dramatically improve the lives of in-country veterans of all eras who suffer from mental disabilities incurred as the result of their military service, as well as those of their loved ones.

Currently, VA regulations make it unduly burdensome for veterans without documentary evidence of combat service to prevail in claims for service connection for PTSD. Even with a confirmed diagnosis of PTSD and medical nexus evidence that such PTSD is the result of a stressor during military service, if there is no official documentation to corroborate a veteran’s assertion that he or she was involved in a combat situation, service connection will be denied. Without an award of service connection, veterans with PTSD remain ineligible for VA mental health care, as well as disability compensation and ancillary VA benefits.

The Act would amend 38 U.S.C. § 1154(b), which currently provides that in the case of a veteran “who engaged in combat with the enemy” the VA must accept as proof of service connection the veteran’s assertion of the incident(s) that resulted in the incurrence or aggravation of any disease or injury, provided that the asserted stressor is consistent with the “circumstances, conditions, or hardships of such service”. In such cases, the absence of official records to corroborate the incident(s) will not preclude an award of service connection. The problem has been the VA’s narrow construction of “engaged in combat with the enemy”. Under this construction, the VA requires that in order for a veteran to receive the benefit of the application of § 1154(b), there must be documentary evidence that the veteran was involved in a confrontation with hostile forces. Such evidence is generally in the form of a military occupational specialty or other designation that necessarily implies combat (e.g., infantryman), an award or decoration that signifies combat service (e.g., Combat Infantryman Badge, Combat Action Ribbon, Purple Heart or Bronze/Silver Star), or the statement of a buddy who served alongside the veteran in direct combat. Where a veteran who alleges a combat-related stressor cannot produce this kind of evidence, the VA invariably denies the application of § 1154(b) and, ultimately, the veteran’s claim for service connection for PTSD.

H.R. 952 would expand the definition of “combat with the enemy” to include active duty service in a theater of combat operations during a period of war. This legislation will help to break down often insurmountable barriers facing veterans who experienced combat circumstances, but who do not have a combat designation, decoration or corroboration from a buddy. Nevertheless, we believe that the expansion envisioned by H.R. 952 will not necessarily eliminate these barriers. The legislation needs to go further.

Section 1154(b) does not provide a presumption that a veteran is entitled to service connection for a disease or injury (including PTSD), even if the VA is required to concede that he or she had engaged in combat with the enemy. Rather, the U.S. Court of Appeals for Veterans Claims has interpreted § 1154(b) as providing a presumption of service incurrence. This means that the veteran must still provide medical evidence that his or her PTSD is etiologically related to his or her military service. See, e.g., Dalton v. Nicholson, 21 Vet.App. 23 (2006). Given the delay that may occur between the occurrence of a stressor and the onset of PTSD and the subjective nature of a person’s response to an event, it is often difficult to provide such medical nexus evidence. We therefore recommend the following in addition to the expansion of the term “combat with the enemy” contemplated by Section 2(a)(2) of the COMBAT PTSD Act:

(3) In the case of a veteran who has been diagnosed
with PTSD subsequent to active military service and who has
engaged in combat with the enemy as defined in sub-section (2)
above, a connection between PTSD and the veteran’s active
military service shall be presumed and may be rebutted only
by clear and convincing evidence to the contrary.

A presumption of service connection for PTSD in these situations will clearly benefit both veterans and the VA. According to a recent study by the RAND Corporation, the nation’s largest independent health policy research program, nearly 20 percent of military service members who have returned from Iraq and Afghanistan report symptoms of PTSD and related disorders. Claims for disability compensation and health care have already begun to flood the VA. Historically, the extensive delays associated with the adjudication of PTSD claims have been caused by the VA’s stringent evidence requirements. A presumption of service connection of PTSD for veterans who have a confirmed diagnosis and who served in combat zones would eliminate the need for tortuous searches on the part of both the VA and the veteran for stressor and medical nexus evidence. The VA would be freed from its statutory duty to assist veterans by scheduling Compensation and Pension Service examinations for nexus opinions as well. Consequently, PTSD claims would be adjudicated much more quickly and backlogs of these claims would dramatically decrease.

We thank you for your outstanding leadership on behalf of our nation’s veterans. United Spinal Association and VetsFirst stand ready to assist the Committee and Congress in any way in furtherance of our shared mission.

Sincerely,

Paul J. Tobin
President and CEO

VetsFirst has identified serious shortcomings regarding inadequate coverage currently available under the VA’s Veterans Mortgage Life Insurance (VMLI) program.

Since the maximum amount of VMLI coverage falls well below the national average home sales price, veterans’ and service members’ families are at risk of losing their homes when an insured veteran or service member dies.

However, Congress can fix this problem with legislation. Accordingly, VetsFirst has appealed directly to Congressional leadership to require the VA to annually adjust the maximum amount of VMLI coverage according to the median national average home sales price.

In letters addressed to The Honorable Daniel K. Akaka, Chairman, U.S. Senate Committee on Veterans Affairs, The Honorable Richard Burr, Ranking Member, U.S. Senate Committee on Veterans Affairs, The Honorable Bob Filner, Chairman, U.S. House Committee on Veterans Affairs, and The Honorable Steven Buyer, Ranking Member, U.S. House Committee on Veterans Affairs, VetsFirst stated:

As a national veterans service organization, United Spinal Association and its veterans service program, VetsFirst, are deeply concerned about inadequate coverage currently available under the VA’s Veterans Mortgage Life Insurance (VMLI) program.

As you are aware, the VMLI program provides mortgage life insurance coverage to severely disabled veterans and active duty service members. This program is designed to pay off home mortgages of such veterans and service members in the event of their death. VMLI is, in essence, a guarantee that the insured’s family members will not become homeless if they cannot afford their mortgage payments following the insured veteran’s or service member’s demise.

VMLI is decreasing term insurance that reduces as the mortgage balance is reduced through regular mortgage payments. Coverage is available for a new mortgage, an existing mortgage, a refinanced mortgage or a second mortgage. Eligibility for VMLI is limited to those who have received a VA Specially-Adapted Housing (SAH) grant, and service members and veterans who have sustained severe burn injuries. The amount of coverage is equal to the amount of the outstanding mortgage balance still owed by the veteran or service member at the time of his or her death, or $90,000, whichever is the lesser amount.

The maximum amount of VMLI coverage has not been adjusted in approximately 16 years. In 1992, that amount more than doubled, from $40,000 to $90,000. We believe that given the current state of the economy, the job market, the mortgage/foreclosure crisis and the rising number of veterans and service members who will apply for home mortgages in the near future, the time has come to increase the maximum amount of VMLI coverage to more realistically protect veterans, service members and their families.

The National Association of Realtors (NAR) has published its 2008 median sales price report for existing single-family home sales (which can be found at http://www.realtor.org/ (PDF). According to the NAR, in 2008, the national median sales price for a single-family home was $197,100, which varied geographically from $150,500 in the mid-west to $271,500 in the northeast. Clearly, the current $90,000 maximum VMLI coverage amount is woefully inadequate to keep insured veterans’ and service members’ families off the streets if they pass on with unpaid mortgage balances.

We therefore propose that the VA should be required to annually adjust the maximum amount of VMLI coverage according to the median national sales price for single-family homes as established by a recognized housing authority, such as the U.S. Department of Housing and Urban Development or the NAR. While we are cognizant of regional variances in median sales prices and would welcome geographic adjustments to the VMLI maximum coverage amount, we are aware of the administrative burden that these adjustments would place on the VA. Consequently, we strongly urge Congress to pass legislation that would, at minimum, set the VMLI coverage limit according to the national average sales price for a single-family home.

We thank you both for your outstanding leadership on behalf of our nation’s veterans. United Spinal Association and VetsFirst stands ready to assist the Committee and Congress in any way in furtherance of our shared mission.

Congress should ensure that the VA maintains its critical medical facilities infrastructure. It appears that the VA has been attempting to back off from the capital infrastructure blueprint laid out by the Capital Asset Realignment for Enhanced Services (CARES) process concerning renovation and new construction. Further, the VA is planning to begin widespread leasing of inpatient services through the “Health Care Center Facilities” program which may not serve the best interests of veterans.

As the result of CARES project budget shortfalls, the VA is enacting the Health Care Center Facilities (HCCF) program which would replace facility construction with leasing facilities. Although leasing space can be accomplished more quickly than constructing new facilities, the HCCF leasing model deprives the VA of essential inpatient capacity. The leased VA facilities would provide extensive outpatient services, yet inpatient services would be provided by local contracts through agreements with an affiliate or a community hospital, which essentially privatizes many services that the should continue to provide on its own. If the leased facilities change ownership or the affiliated facilities close or downsize services, critical care to VA patients could be lost and additional expenses incurred (e.g., transporting patients to other VA facilities, VA paying for services from other private providers).

Congress should examine VA’s new HCCF plan to determine whether VA has the legal authority to proceed without specific Congressional authorization. In the interim, the VA should not be allowed to adopt a wide-scale leasing program that replaces critical inpatient capacity with contract or fee-basis care. Congress must exercise its oversight authority to ensure that VA is caring for veterans in the best possible way.

Overhaul of the VA Claims Process Required. Congress must focus on the claims process from beginning to end. The goal must be to reduce delays caused by superfluous procedures, poor training, and lack of accountability. Even though the VA has hired record numbers of new claims adjudicators, it is unable to keep pace with the flood of new disability claims, the complexity of such claims, and the time required for new employees to come up to speed. VA has achieved few noticeable improvements. The claims’ process is unduly burdensome, extremely complex, and often misunderstood by veterans and many VA employees. Enormous backlogs and delays abound and veterans whose access to VA health care depends on being awarded service-connected disability benefits are denied critical health care as a result. The subjectivity of the claims process results in large variances in decision making, unnecessary appeals and claims overdevelopment. Congress and the Administration should seek to simplify and provide structure to the VA claims process.

The US CAVC and the CAFC have run wild with statutory procedural and substantive due process requirements such as VA notice to claimants, the need for and evidentiary considerations relating to medical opinions. For example, Congress should amend 38 USC § 5103A(d)(1) to provide that when a claimant submits private medical evidence, including a private medical opinion, that is competent, credible, probative, and otherwise adequate for rating purposes, the VA shall not request such evidence from a VA physician. That claim is ready to rate.

Congress should also 38 US Code § 5125, which eliminated the former 38 CFR § 3.157(b)(2) requirement that a private physician’s examination report be verified by a VA examination report before the VA could award benefits. Congress enacted § 5125 with discretionary language which permits, but does not require, the VA to accept private medical opinions. Accordingly, Congress should amend § 5125 by requiring the VA to accept a private examination report if that report is provided by a competent health-care professional, probative to the issue being decided, credible and adequate for purposes adjudicating the claim.

The VA must invest more in training adjudicators and hold them meaningfully accountable for higher standards of accuracy. Congress should require the VA to implement comprehensive competency testing for adjudicators and their supervisors designed to hold both new trainees and long-time staff accountable. The VA must additionally refocus its adjudication goals from a production-based/quantity perspective to one based on the quality of decisions. Accordingly, Congress should require the VA to report on how it will establish a quality assurance and accountability program. Such a report should be developed in consultation with the veterans service organizations. The VA should continue its efforts to transition into a paperless, IT-driven process that promotes accuracy and uniformity in decision making. Congress should require the VA and the Department of Labor (DOL) to work on the issues of veterans employment, training and business opportunities in a more coordinated manner. These programs must be adequately funded. Congress must adequately fund the VA’s homeless veterans programs.   ]]> http://www.vetsfirst.org/vetsfirst-2009-public-policy-priorities/feed/ 1