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.