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Legislative Hearing on H.R. 1448, H.R. 1853, H.R. 1925, H.R. 2005, H.R. 2172, et al

Legislative Hearing on H.R. 1448, H.R. 1853, H.R. 1925, H.R. 2005, H.R. 2172, H.R. 2173, H.R. 2378, H.R. 2219, H.R. 2192, and H.R. 2623







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LEGISLATIVE HEARING ON H.R. 1448, H.R. 1853, H.R. 1925, H.R. 2005, H.R. 2172, H.R. 2173, H.R. 2192, H.R. 2219, H.R. 2378, AND H.R. 2623










JUNE 14, 2007

SERIAL No. 110-27

Printed for the use of the Committee on Veterans' Affairs





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BOB FILNER, California, Chairman


VIC SNYDER, Arkansas
JOHN J. HALL, New York
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
TIMOTHY J. WALZ, Minnesota

STEVE BUYER,  Indiana, Ranking
HENRY E. BROWN, JR., South Carolina
BRIAN P. BILBRAY, California




Malcom A. Shorter, Staff Director

MICHAEL H. MICHAUD, Maine, Chairman

VIC SNYDER, Arkansas
PHIL HARE, Illinois
MICHAEL F. DOYLE, Pennsylvania
JEFF MILLER, Florida, Ranking
HENRY E. BROWN, JR., South Carolina

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records of the Committee on Veterans' Affairs are also published in electronic form. The printed hearing record remains the official version. Because electronic submissions are used to prepare both printed and electronic versions of the hearing record, the process of converting between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process is further refined.



June 14, 2007

Legislative Hearing on H.R. 1448, H.R. 1853, H.R. 1925, H.R. 2005, H.R. 2172, H.R. 2173, H.R. 2192, H.R. 2219, H.R. 2378, and H.R. 2623


Chairman Michael Michaud
        Prepared statement of Chairman Michaud
Hon. Jeff Miller, Ranking Republican Member, prepared statement of


U.S. Department of Veterans Affairs, Hon. Michael J. Kussman, M.D., MS, MACP, Under Secretary for Health, Veterans Health Administration
        Prepared statement of Hon. Kussman

American Legion, Shannon Middleton, Deputy Director of Health, Veterans Affairs and Rehabilitation Commission
        Prepared statement of Ms. Middleton
American Veterans (AMVETS), Kimo S. Hollingsworth, National Legislative Director
        Prepared statement of Mr. Hollingsworth
Disabled American Veterans, Adrian M. Atizado, Assistant National Legislative Director
        Prepared statement of Mr. Atizado
Herseth Sandlin, Hon. Stephanie, a Representative in Congress from the State of South Dakota
        Prepared statement of Congresswoman Herseth Sandlin
Hodes, Hon. Paul W., a Representative in Congress from the State of New Hampshire
        Prepared statement of Congressman Hodes
Lowey, Hon. Nita M., a Representative in Congress from the State of New York
        Prepared statement of Congresswoman Lowey
Miller, Hon. Jeff, a Representative in Congress from the State of Florida
        Prepared statement of Congressman Miller
Moran, Hon. James P., a Representative in Congress from the State of Virginia
        Prepared statement of Congressman Moran
Paralyzed Veterans of America, Carl Blake, National Legislative Director
        Prepared statement of Mr. Blake
Rodriguez, Hon. Ciro D., a Representative in Congress from the State of Texas
        Prepared statement of Congressman Rodriguez
Salazar, Hon. John T., a Representative in Congress from the State of Colorado
        Prepared statement of Congressman Salazar
Veterans of Foreign Wars of the United States, Dennis M. Cullinan, Director, National Legislative Service
        Prepared statement of Mr. Cullinan
Vietnam Veterans of America, Barry Hagge, National Secretary
        Prepared statement of Mr. Hagge
Watson, Hon. Diane E., a Representative in Congress from the State of California
        Prepared statement of Congresswoman Watson


National Rural Health Association, Andy Behrman, Chair, Rural Health Policy Board, statement
Reyes, Hon. Silvestre, a Representative in Congress from the State of Texas, statement
United States Ombudsman Association, Ruth Cooperrider, President, and Deputy Ombudsman, State of Iowa - Office of Citizens' Aide/Ombudsman, letter


Hon. R. James Nicholson, Secretary, U.S. Department of Veterans Affairs, to Hon. Bob Filner, Chairman, Committee on Veterans' Affairs, letter dated August 19, 2007, views on H.R. 2623 and H.R. 2699

U.S. Department of Veterans Affairs, Veterans Health Administration, report entitled:  "Plan to Increase Access to Quality Long-Term Care and Mental Health Care for Enrolled Veterans Residing in Rural Areas," January 10,  2008

Job Description for Program Analysis Officer, Office of the Assistant Deputy Under Secretary for Health for Policy and Planning, Veterans Health Administration, U.S. Department of Veterans Affairs

LEGISLATIVE HEARING ON H.R. 1448, H.R. 1853, H.R. 1925, H.R. 2005, H.R. 2172, H.R. 2173, H.R. 2192, H.R. 2219, H.R. 2378, AND H.R. 2623

Thursday, June 14, 2007
U. S. House of Representatives,
Subcommittee on Health,
Committee on Veterans' Affairs,
Washington, DC.

The Committee met, pursuant to notice, at 10:00 a.m., in Room 340, Cannon House Office Building, Hon. Michael Michaud [Chairman of the Subcommittee] presiding.

Present:  Representatives Michaud, Brown of Florida, Snyder, Hare, Miller, Brown of South Carolina.


Mr. MICHAUD. This hearing will now come to order.  I’d like to thank everyone for coming today.  I ask unanimous consent that all written statements be made part of the record.  Without objection, so ordered. 

I also ask unanimous consent that all members be allowed five legislative days to revise and extend their remarks.  Without objection, so ordered.

Today’s legislative hearing will provide members of Congress, Veterans, the U.S. Department of Veterans Affairs (VA) and other interested parties the opportunity to discuss legislation within this subcommittee’s jurisdiction in a clear and orderly process.  While not necessarily in agreement or disagreement with the bills before us today, I do believe that this is an important process that will encourage frank discussion and new ideas.

We have ten bills before us that seek to improve healthcare for the Nation’s veterans and I look forward to hearing the views of our witnesses.  I also look forward to working with everyone here to continue to improve the quality of care available for our veterans.

There are two draft discussions that are not before us today.  There is a discussion draft on homelessness, and a discussion draft on mental health services.  Congressman Patrick Murphy of Pennsylvania has also introduced H.R. 2699.  I’d ask that the members of the third panel, the veterans service organizations (VSOs), and the fourth panel, VA, provide comments and views on these three items for the record once they are made available.  We’d like to have the written comments submitted to the Committee by June 21st of this year.

We may as well begin, starting off with Mr. Rodriguez.

[The statement of Chairman Michaud appears in the Appendix.]



Mr. RODRIGUEZ. Mr. Chairman, thank you very much.  And members of the Committee thank you for this opportunity to be here before you.  I have my bill, H.R. 2173, a bill introduced by myself and my colleague Congresswomen Grace Napolitano, provides for increase in the capacity for mental health services through contracts with qualified community health centers.

This is an opportunity for veterans in rural communities, especially to be able to get access to services, not to mention in those areas where we don’t have access to mental health services within our VA system.  It’s also a great opportunity to follow up on individuals that need the services.

Recent surveys show that one in eight returning Iraqi war veterans report symptoms of post traumatic stress disorder (PTSD).  The same studies also report high incidents of major depression and anxiety disorders among returning members of the Army and Marine combat unit.  As a member of this Committee, we have long identified mental health services as a major issue facing returning soldiers as well as the Department of Veterans Affairs.

Experts note that the manifestation of clinical symptoms of post traumatic stress disorder and other mental health disorders often occurs over several years.  With the increase of active duty, guardsman and reservists returning from combat, the necessary capacity to provide mental health services is relatively unknown.  It is difficult to know if our large number of returning veterans will need mental health services beyond what the VA is capable of providing.

My bill, H.R. 2173, authorizes the VA to contract with community mental health centers to increase the capability.  In my opinion the need has out paced the capacity of the VA to provide mental health services in out patient clinics.  Contracting out to the community mental health centers is already been done successfully in some States, and could serve as a model for the VA-wide implementation.

Mr. Chairman, in my previous career, I worked as a mental health field social worker.  I am fully aware of the great services provided by the community health centers.  And if there is any doubt of the quality of the care they can provide, I can tell you of the hundreds of families who’s lives have been changed by the treatment received during my professional career in the field, but you don’t have to take my word.

Each year community health centers have nearly six million children, adults, families and communities across this country the chance to recover and lead productive lives.  Our returning soldiers deserve nothing less and we hope that we can provide them with that opportunity.

As I mentioned before, it is clear that our soldiers returning with an increased need for mental health services, but after this long war, it is unclear what the VA capacity to fulfill this need will be.  It is my hope that H.R. 2173 can provide the VA with the tools to continue to provide top notch mental health services to our veterans in their own communities.

Mr. Chairman, once again I would like to thank you for allowing me this opportunity, and I urge your support, and just indicate that this piece of legislation, I think, will help enhance the quality of care for our veterans especially in rural communities and in those areas, urban areas, where there’s a large number of our veterans.

Thank you.

[The statement of Congressman Rodriguez appears in the Appendix.]

Mr. MICHAUD. Thank you very much.  As you know I am very concerned about access to healthcare benefits for veterans particularly in rural areas that need that access.

Mr. Moran?


Mr. MORAN. Thank you Mr. Chairman, and Mr. Miller, Mr. Salazar, Mr. Brown.  I want to thank you for holding this important hearing today and commend the Subcommittee for the work that it has already undertaken on behalf of our Nation’s veterans.

The problem of suicide among our veterans is one of the most serious issues that we have to address as we care for our older veterans and prepare for a new generation of returning soldiers.

The Centers for Disease Control recently released very troubling statistics.  Each year approximately 115,000 veterans attempt suicide.  This accounts for nearly 20 percent of all suicide attempts, and yet the veteran population only accounts for 11 percent of the entire population.  So in other words, veterans are much more likely to attempt suicide as other groups of our society.

This disproportionate prevalence of suicide among veterans suggest that in addition to our overall national strategy on suicide prevention, particular attention should be paid to preventing suicide among this special population.  Unfortunately, I expect this trend to continue as more of our brave men and women return from multiple deployments with the symptoms of post traumatic stress disorder.

As we have learned, the staggering 20 percent of soldiers returning from Iraq are experiencing depression, sleep depravation, anxiety, and other symptoms of PTSD.  I am proud that this Congress has already acknowledged the growing problem of PTSD and dedicated substantial resources to it.  Still, I believe as scientific evidence suggests, that as our returning soldiers are increasingly susceptible to PTSD, they are at an elevated risk for suicide attempts. 

My bill, the "Veterans Suicide Prevention Hotline Act of 2007," would create a 24-hour national toll-free hotline to assist our Nation’s veterans in crisis.  It would be staffed predominately by veterans trained to appropriately and responsibly answer calls from other veterans.  The hotline would follow the models of the national suicide, sexual assault, and domestic violence hotlines who have volunteers trained in active listening and crisis de-escalation respond to a variety of crisis calls.

I believe that this cultural competency, the ability to connect to another veteran who understands what the caller may be experiencing can make a real difference in crisis counseling.  It is difficult to connect on this level with anyone else, even trained doctors or other professionals. 

So to build this capacity nationwide, my bill calls for a three-year competitively awarded grant for two and a half million dollars in the next three fiscal years.   The funding will be made available to a qualified non-profit crisis center to establish, publicize, and operate the hotline including developing curricula to train and certify volunteers.

We have reached out to the Department of Veterans Affairs and are encouraged that the Veterans Health Administration (VHA) is undertaking new efforts to establish a suicide hotline and address mental health needs.  Their plan is to divert callers from the national suicide prevention hotline to a VA facility staffed by doctors, psychologists, and other certified counseling professionals.  On the surface, the VHA’s effort may appear duplicative of what I am proposing, but there are some very important differences that I feel need to be highlighted.

First, my legislation requires that the people answering the phones, those dealing directly with the veterans are veterans themselves.  There are times when speaking with someone who has the cultural competence and the empathy to really understand the experiences of veterans in crisis can help make the difference between successful integration to mental health treatment and failure to reach a veteran in dire need of services.

Second, the VHA has many responsibilities for providing the highest quality of healthcare for our veterans.  However, they have experienced stressed budgets and staffing shortages in recent years.  Because the demands placed on any veterans hotline may be much greater as our Nation redeploys from Iraq in the future, I have concern that the VHA may not have the capability and commitment to the hotline that a non-profit organization dedicated to suicide prevention as its sole purpose might be able to provide.

Third, there are times when a person in crisis doesn’t want to talk to a doctor.  They want to talk to a volunteer.  Mentally ill individuals all face societal stigmas associated with seeking care.  Research from the Air Force's suicide prevention effort suggest that this is perceived to be even more profound in the military and veteran communities.  Fear of the system, of an un-friendly mental health establishment or of potential job-related consequences keep many from seeking care.  One of the motivations behind the National Suicide Hotline and this bill is to give people in crisis another option, an anonymous hotline that can respond to their immediate crisis.

To conclude, our vets deserve as much support when they return from combat as they receive while in battle.  Too many of our veterans are struggling to make the difficult adjustment back to society and need someone they can talk to, someone who has walked a mile in their shoes.  This legislation will offer a caring voice at the end of the line when it feels that there is no where else to turn.

Thank you, Mr. Chairman.

[The statement of Congressman Moran appears in the Appendix.]

Mr. MICHAUD. Thank you very much.  Ms. Watson? 


Mr. WATSON. Thank you so much, Mr. Chairman, for holding today’s hearing and letting me speak on the bill H.R. 1853, the "Jose Medina Veterans Affairs Police Training Act of 2007."

I believe this legislation is vital to protect our heroes and who have sacrificed their minds and bodies to protect our freedoms.  And I feel the two previous bills presented will be complimented by this legislation.

Mr. Chairman, too many veterans are suffering from mental health problems after returning from combat, and they are not receiving the proper treatment they deserve.  Congress has a responsibility to provide quality healthcare for our veterans.  We must analyze every aspect of services associated with the treatment of post traumatic stress disorder or PTSD for our vets.

So I have introduced H.R. 1853, the "Jose Medina Veterans Affairs Police Training Act of 2007," a bill that will force the Department of Veterans Affairs to better prepare it’s police force to interact with patients and visitors at the VA medical facilities who suffer from mental illnesses.

Jose Medina is a constituent of mine.  He is a Vietnam vet who suffers from PTSD.  In January of 2006, Mr. Medina was assaulted by two west Los Angeles VA police officers who kicked him and forced him to the ground after he isolated himself and fell asleep in a hallway at a VA medical center in Los Angeles.

After a physical altercation ensued, this 56-year-old veteran was forced to lay first face down on the hospital floor.  The officers injured Mr. Medina, and after the altercation they did not allow him to use the hospital’s emergency room.  Instead, the officers handcuffed him and detained him for an hour before sending him home and gave him a loitering ticket.

This is not the way we should be treating veterans who have served and protected this country.  What bothers me the most is that when we see someone sitting on a hospital floor, one would think law enforcement would have hospital staff come and question the individual to see if that individual was all right or in need of assistance.  Instead, in this case, Mr. Medina was without medical treatment and was mistreated at the same time.

This is happening to too many of our brave veterans out of sheer ignorance.  As we look to the future, thousands of veterans will be entering the VA healthcare system.  We must ensure that the VA has the ability to administer quality healthcare services to veterans that suffer from mental illnesses.  With over 20 percent of the one and a half million veterans that served in Iraq or Afghanistan showing signs of PTSD, we do not want any of them to endure what Mr. Medina went through.  They simply deserve better.

So, Mr. Chairman, the Department of Veterans Affairs believes this legislation is unnecessary, but the story of Jose Medina and other veterans from around the country who have contacted my office with similar problems have confirmed that this training is indeed necessary.

As Congress debates funding strategies and time lines for our military missions, we must not overlook the fact that they not only—that we not only need for our vets to have the resources for results from the battlefield, but they must also be treated with dignity and respect once they resume their lives after combat.  We must ensure that this occurs.

So, Mr. Chairman, I thank you for this opportunity to explain what this bill would do, and I urge the members to support H.R. 1853.  Thank you.

[The statement of Congressman Watson appears in the Appendix.]

Mr. MICHAUD. Thank you very much.  Appreciate your testimony.  Ms. Herseth Sandlin?


Ms. HERSETH SANDLIN. Thank you, Chairman Michaud and Ranking Member Miller.  I appreciate the opportunity to discuss here today the Services to Prevent Homelessness Act, a bill which I introduced May 17, 2007, to provide supportive services to very low income veterans.

The U.S. Census Bureau estimates that 1.5 million of our Nation’s veterans live in poverty, including 702,000 veterans with disabilities and 404,000 veterans in households with children.  Six hundred and thirty-four thousand of the 1.5 million poor veterans live in extreme poverty.  These poor veterans face residential insecurity due to their low income levels or their past episodes of homelessness.  They also face health and vocational challenges and access barriers to supportive services, which limit their ability to sustain housing and maintain independence for more costly public institutional care and support.

These poor veterans may benefit from flexible and individualized support services provided at home based settings.  The services to prevent Veterans Homelessness Act would authorize the Secretary of Veterans Affairs to provide financial assistance to non-profit organizations and consumer cooperatives to provide and coordinate the provision of supportive services that addresses the needs of very low-income veterans occupying permanent housing.

The financial assistance shall consistent of per diem payments for each household provided supportive services.  Supportive services that may be offered include physical and mental health, case management, daily living, personal financial planning, transportation, vocational counseling, employment and training, education, assistance in obtaining veterans benefits and public benefits, child care, and housing counseling.

Veterans sub-populations expected to benefit from the program include veterans transitioning from homelessness to permanent housing, poor disabled and older veterans requiring supportive services in home-based settings, and poor veterans in rural areas with distance barriers to centrally located services. 

While Federal programs exist to help create veterans home ownership, there is no national housing assistance program targeted to low-income veterans.  Permanent housing opportunities for veterans ready for independent living are limited.

In addition, the VA currently is not permitted to provide grants to create affordable permanent housing and the resources that are available for providers are inadequate and highly sought by competing housing projects.

Thank you again for the opportunity to be here today.  I look forward to continuing to work with the Chairman and the Ranking Member to support efforts to meet the housing assistance needs of our Nation’s low income veterans through the establishment of a permanent housing assistance program for this population.

I am happy to take any questions that you may have.

[The statement of Congresswoman Herseth Sandlin appears in the Appendix.]

Mr. MICHAUD. Thank you very much.  I have a couple of questions on some of the bills.  The first one is to Ms. Watson.

You so eloquently explained the problem you had with one of your constituents at the VA facility.  Is this typical?  Is this the first case or is it really ongoing out there?  Have you heard from the different VSOs?

And my second question, what type of training do you think additional training they need?

 Mr. WATSON. Yes.  To address your first concern, it is one of our top calls that comes in to my office and I had my staffers in here who could supply the actual numbers.  But in Los Angeles, our homeless population on any given night is somewhere between 80,000 and 90,000.  Those people who are homeless, 33 percent of them, are vets in need of mental health services.

So it is a pervasive problem that we must address.  And I hope in Markup to put a provision in this bill that would say that the training must come from highly trained professionals.  And the kind of training that it will supplement what is already called for in prior legislation is the handling and the respect for dealing with mentally ill patients.

And so we get in to the actual behavior of law enforcement and other personnel that deal with the mentally ill.

Mr. MICHAUD. Great.  Thank you.  My next question is for Mr. Moran.  You had mentioned setting up this separate hotline.  Do you know if there is currently a national hotline for suicide prevention?  How many calls go in to that hotline that actually deal with veterans?  Do you have any idea of that?

Mr. MORAN. I don’t have the numbers, Mr. Chairman.  The way I came up with this idea was that I was talking with some people that are involved with a group called Crisis Link that provides suicide prevention throughout the Washington Metropolitan area.  And one gentleman I was asking what is going on and he said, “Well when veterans found out that we had a veteran volunteer that they could talk to, that veteran become overwhelmed with calls.”  He is spending overtime.  It is taking up much of his life, because the word spreads.  And there is a clear indication that most veterans would like to talk to another veteran that can empathize with them.  That is what is distinct.

And I think that the numbers don’t necessarily reflect that, but the fastest increasing number of calls with this group was because of the presence of that veteran on the other end of the line, but I don’t have any specific numbers as you have asked.

Mr. MICHAUD. Great.  Thank you.  My last question actually goes back to Ms. Watson.  Is the police force at VA facilities, is that a contracted service or are they regular VA employees?

 Mr. WATSON. They are employees that have come in under a contract and I don’t know whether they are paid from the contract or from the VA.  Would you know that information?  They are Federal officers.

Mr. MICHAUD. Okay.  Great.  And hopefully the VA officials here will be able to let us know of all facilities whether they are VA Federal officers or contracted positions.

Mr. Miller?

Mr. MILLER. Thank you, Mr. Chairman.  Mr. Moran, I think we agree that the end result of what you are trying to have done is what we are trying accomplish, though I do have a question.  We passed H.R. 327, the Joshua Omvig Veterans Suicide Prevention Act, earlier this year that required an in-house 24-hour hotline.  Can you expand a little bit on why we would need this hotline. H.R. 327's hotline is veterans, these are members of the VA Office, and they are specially trained, why we would need to go outside and do this independently?

Mr. MORAN. That is a very good question.  I think the difference, and I address this in my testimony, is that the VHA line is designed to get people into the VA system, it’s doctors and psychologists who are not necessarily veterans that are on the other end of the line.

What this is, what I am suggesting is a volunteer organization.  These organizations exist in many of our districts.  People who are not necessarily professionals, but get specific training.  And many people have found that they can relate better to the veteran.  They are not trying to get them in to necessarily a mental health establishment immediately and there is some stigma to calling the VA.  And while the VA does wonderful work, and the professionals associated with the VA do a great job, the veteran that may be attempting suicide is not necessarily wanting to get in to what they consider to be the establishment to talk to necessarily a professional who has an objective.  We find that in other situations.

And what we are going to try to do if this is established, if it is not then groups will try to do it on their own, is to find a great many veterans who are willing to volunteer to get the training to be there for other veterans on a volunteer basis.  So it is a different kind of thing.

One is professional.  It is an official arm of the Department of Veterans Affairs.  It is designed to get people in to the VA system.  Another is volunteer hotline for people that can perhaps empathize to a greater extent with who will be there for them if they are having difficulty coping.

And so it is different personnel.  It is a differently run organization.  The ultimate purpose, of course, is the same; to save people’s lives and to be there for people in crisis.

Mr. MILLER. Thank you, I had some other questions, but all of you did such a good job.  Ms. Watson?

 Mr. WATSON. Yes.  If I can extend the response.  I mention that we have 33 percent homeless vets on the streets, and so this service nationally will allow them an opportunity.  They are not necessarily in-house, but wherever they are and I was just thinking as Representative Moran was speaking, that we might want to locate these services in homeless shelters, on skid rows, and places that will be assessable.

What we find in Los Angeles is that many of our people who are homeless are committing suicide through overdoses of drugs.  And they really need someone to talk to.  They don’t know how to access that.  So I think the idea of having them locate it where homeless people or homeless vets would go on the streets is something that we need to fill in our chain of services.

Mr. MILLER. I think, if I am correct, Mr. Moran’s proposed legislation is a single provider, a single hotline.  That is why I was asking the questions in regards to the single hotline that is already provided or will be provided under the Omvig bill that we passed earlier this year.

There may be a desire to expand it, but then you are talking about other mental health providers.  Now we are really beginning to go far beyond what I think the original intent and scope, which is to provide a single call that that veteran can make to somebody when he or she is at their very darkest, lowest moment.

That was what my question was.  Again, I think we are all trying to get to the same place, and I salute everybody here.  My other questions you have already answered in your opening statements.  Thank you.

Mr. MICHAUD. Mr. Salazar?

Mr. SALAZAR. Thank you, Mr. Chairman.  I just have a question for, let’s see, Ms. Watson, Mr. Moran, and Mr. Rodriguez.  Most of your issues deal with mental health issues of veterans.  Is there a way to be able to coordinate your three bills into one bill, which might be a little more effective way of addressing the issue of veterans and mental health issues?

Mr. RODRIGUEZ. Let me just indicate that the need for us to provide especially in mental health settings to provide training for those officers to treat people and to recognize them is essential.  And that has got to happen.  That has to occur.  Those people that are law enforcement, first responders, need to be aware of that whether they are public sector or private sector.

Secondly, the area of mental health we just have one too many veterans that are committing suicide.  So we need to provide that access.  And you yourselves and your offices I have had veterans come in to my offices that threaten our office and they are mentally ill.  And they need services.  And that is why we really need to push forward, and because we are just having one too many of them committing suicide. 

The contracting out to the community mental health centers throughout this country, those are the ones that provide the most access to mental health than anyone else in this country.  Those were created in the 1960's.  It is a great opportunity to provide that access.  Major metropolitan areas have crisis intervention centers that have 1-800 numbers. 

But one of the ways to look at it is maybe in some of the rural communities, there is one thing to provide the access, but the other thing is the referral that are needed and the follow up that is required in order to respond to those needs.  And some how we have to fill those gaps. 

And I think a comprehensive program that allows that to occur, and especially in rural America where you don’t have as much and some of those mental health services are available where you don’t have VA services.  So I think a comprehensive program is needed and the sooner we can do that the better.

Mr. SALAZAR. Mr. Moran?

Mr. MORAN. Mr. Salazar, everything that we have recommended is complimentary and deliberately complimentary of everything that the Department of Veterans Affairs is doing.  Mine is pretty limited in scope.  It is simply to have one single national hotline number that is available any time that veterans can memorize and call and find another veteran at the other end of the phone to expand it to include these, which is fine.  The dollar amount that is being recommended over a three year period would have to be substantially greater to do it right.  That is why the amount of resources that I suggested is pretty limited.

So they are all fine things, it is just that as you expand them you would have to contribute provide more money to make them work properly.

 Mr. WATSON. And in response, we gave a name to our bill because we want to send a message out there.  So we are naming the Jose Medina.  And if it would fit in to other pieces of legislation that is to be considered as well.  But we wanted to tag this with his name to send the word out there like the Miranda Act, and so, it comes out of an event.  And we want to let the veterans know that these incidents are very important.  We are sensitive to them so we put his name on it.

And so I guess we could integrate this in to another piece of legislation and we can talk about that.

Mr. SALAZAR. Thank you.  Ms. Herseth Sandlin, your bill talks about housing and the transition from homelessness towards someone who can actually live in a home.  Does your bill address the issue of those who are almost at the transition point of becoming homeless?  They have a home, but because of their income they are almost there or are in danger of becoming homeless?

Ms. HERSETH SANDLIN. I think the bill is more focused on the transition of the veterans subpopulation that has had episodes of homelessness, has transitioned to temporary housing programs of which we may be familiar with in our districts, but then addresses really that next hurdle of moving to more permanent housing.

So your question is a good one.  I think that we could certainly as the Secretary would have the authority in establishing the criteria for the non-profit organizations or cooperatives, consumer cooperatives, that would be utilized to extend the service that certainly it could address those that might be at danger of homelessness, although I think we are catching them already to a degree, at least a significant percentage of them in the subpopulation that has previously had episodes of homelessness.

So I appreciate the question and it is something that we could pursue I think more if we were to get this enacted with the Secretaries.  We work with them to establish a formula and the criteria as it relates to contracting with the non-profits.

Mr. SALAZAR. Thank you.  I yield back, Mr. Chairman.

Mr. MICHAUD. Mr. Brown?

Mr. BROWN OF SOUTH CAROLINA. Thank you, Mr. Chairman and I thank the witnesses for coming and bringing testimony to solve a problem that we have been trying in this Committee for a long time to connect to the homeless veteran.  We recognize that there are many homeless veterans that do have a mental condition.

We have tried to provide resources, and I believe they are adequate resources out there if we could just match the homeless veteran to the resource.  I appreciate the effort that you are trying to do that.

 Mr. WATSON. If I might respond, Mr. Chairman?  One unique feature of our bill is that we address police brutality.  We have received complaints from not only the West Los Angeles Medical Center, which is just right next to my district it is coterminous, but from Michigan, San Antonio, Texas and so on and it is all referring to the police brutality.  So we address that issue uniquely in our bill.

Mr. BROWN OF SOUTH CAROLINA. I know, Mr. Moran, in your bill and I appreciate that for the trying to reach out to those veterans that need particularly care.  And I know in our region we have like the 2-1-1 number where they can call and talk to some counselor that is on line all the time.

Is part of your bill to require that there be some voice at the end of that line all the time?

Mr. MORAN.  Thank you, Mr. Brown, for asking that question.  The answer is yes.  Many of these suicide prevention hotlines are very good and they have very fine people, but I notice that the volunteers tend to be young, single people who have the time to provide.  They don’t necessarily tend to be veterans.  And what this would do is to put a special emphasis upon getting trained veterans on the other end of the line.

Now, they are not veterans who have the career choice or interest, ability, whatever, to become doctors or psychologists or specific mental health counselors.  They are trained simply to be there to listen and to try to get help, get somebody to get through a crisis.  So we would be going out to veterans organizations just trying to get recruits to volunteer to help them to be there and have one single line nationally that would be toll free that people could call.

That is why it is fairly limited in scope, but it is particularly designed to get a veteran on the other end of the phone.

Mr. BROWN OF SOUTH CAROLINA. Thank you.  Thank you, Mr. Chairman.

Mr. MICHAUD. Mr. Hare?

Mr. HARE. Thank you, Mr. Chairman.  Thank you for holding this hearing this morning, it is very important.  Let me thank my four colleagues for being here today and for proposing various legislation.  You know we have seen a lot and heard a lot about all wounds that people have aren’t necessarily wounds that people can see.  So I am really delighted that you have come together on this and I want to commend you all for that. 

I have a question, if I could, for Mr. Rodriguez as soon as I find it.  Sir, like you, I have a lot of rural area in my district.  I know your district is extremely large, probably one of the largest in the country.  And I wonder if you could tell me a little more about how the bill that you have would address the problems that your constituents face accessing mental healthcare particularly in a geographic area that is so incredibly large?

Mr. RODRIGUEZ. First of all, the one of the few organizations that is responsible for that and that provides some degree of access to healthcare to in mental health throughout this country is the community mental health centers.

And so to provide services, and this is one of the few areas that where we can provide that access and the follow up.  The purposes of the community mental health centers were basically were to try to get the mentally ill out of the institutions in the 1960s.  So they were created to reach out to the community throughout America and meet those needs.

And so these centers are trained to do that.  And I really believe that we have some figures that we have seen of three million veterans committing suicide every year directly are tied in to the VA and there is a larger number that are not tied to them.  And so we really need to you know, provide those services as quickly as possible.  And I really believe I would of preferred it under the VA System, but I really believe that they don’t have the capability at the present time to meet the massive need that is needed out there.

And so I really believe that this is one of the few ways of meeting that need and that is reaching out through the community mental health centers that exist throughout the country, even in rural communities.  And they can reach out and get some kind of professional treatment that is required.  There are some areas where we don’t.  I got one psychiatrist in one community and I think it was a contract that was out there in the private sector, but the community health center there is actually a little better equipped to handle that.

Now the urban areas have the crisis centers and have the for the homeless and others, but in those other areas you know we have got to do more to those individuals that are out there, especially the ones who have hit the bottom of the totem pole which is the homeless veterans that find themselves without anything and find themselves without access.  And you have got to have those outreach workers that do that.

And I think that that is one of the better ways.  Now we still have a problem in that in rural America in terms of how do we, you know, in those areas where you have to provide that.  I have that problem in terms of trying to provide offices.  I have five offices right now and I don’t have the manpower to provide the staffing throughout my office.  And so there is still a need to provide some mobile units to go out in to rural America.

Mr. HARE. Thank you.  And I just have a question for my colleague Ms. Herseth Sandlin.  And I apologize for coming in just a bit late, I was on the floor.  But you know we see the stand downs that we have throughout the country every year to help homeless veterans.  The problem is that is a weekend, excuse me, that is a weekend opportunity.  And I was amazed in my district that when Congressman Evans was hosting these and working on them, that the number of veterans that would use, you know, the stand down and be able to come in.

I am wondering could you just expand a little bit on what your bill would do to establish assistance program so that we can move homeless veterans into, to give them some decent housing that they clearly, “A,” need; and “B,” deserve?

Ms. HERSETH SANDLIN. Well thank you for the question.  And you are right.  With the weekend stand downs one of the wonderful things about that is that you have generally this a centralized location that offers a whole host of other services that are either important to veterans who are interested in what they can access to avoid homelessness, if they are very low income veterans, but certainly those that have had episodes of homelessness that have perhaps been in transitional housing but the eligibility is 24 months of transitional housing and then what more may be needed in terms of financial counseling, access to other benefits to which they are eligible to have a more holistic approach, comprehensive approach to what the needs of the veterans are on a more consistent basis than the weekend stand downs where they look forward to that opportunity and word gets around the veteran population of a particular community or particular region of a district or a State.

And so what the bill does is I think it addresses a gap that currently exists in what the VA can provide in setting up a grant program, establishing a formula and the criteria for non-profit organizations and consumer cooperatives to access the grant and provide these services, particularly targeted toward veterans and their families who are very low income who are in that transition period. 

But as Mr. Salazar asked earlier, I think that the availability of support services for very low income veterans and their families that may already be in housing but at great risk for homelessness can also be provided within the terms of this bill.

So I think it addresses a significant gap that exists and I think especially at this time in our country’s history when we have many veterans returning who have very young children, who are very young themselves, this is an important grant program that needs to be established.

Mr. HARE. Thank you very much.  And once again, Mr. Moran and Ms. Watson, thank you very much for your legislation.  I think they are wonderful pieces of legislation.  I yield back.

Mr. MICHAUD. Dr. Snyder, you have any questions?

Once again, I would like to thank our first group of panelists for your testimony today and look forward to working with you as we look at this legislation later on.  Thank you.

Mr. MORAN. Thank you.

Mr. RODRIGUEZ. Thank you.

Mr. MICHAUD. I would now like to welcome our second panel. 

The first individual I will ask to give his statement is Mr. Hodes.  I want to thank you, Mr. Hodes, for your interest in veterans issues.  I know you have been a strong advocate for veterans issues, we have dealt with your legislation earlier in the year as well.  So thank you very much for coming here today.  Mr. Hodes?



Mr. HODES. Thank you, Chairman Michaud, and Ranking Member Miller for holding this important hearing today.  I appreciate the opportunity to come before this Subcommittee to testify about H.R. 2192, the bipartisan bill I introduced establishing an Office of the Ombudsman in the Department of Veterans Affairs.  I also want to thank Chairman Filner, who is not here, for his support of the bill.

This bill grew out of the visits I made to Walter Reed Army Medical Center and the hearings held by the Oversight and Government Reform Committee on which I sit.  I talked with numerous soldiers about the problems they experienced transitioning out of active duty and into the VA.  I also talked with numbers of veterans organizations within my own State, New Hampshire, and numbers of veterans.

Veterans in my district have repeatedly told me their compelling stories of the great difficulties and challenges they have faced in understanding and receiving all the benefits and services to which they are entitled.  The ombudsman’s office, which as proposed in this bill, should serve as the outreach master office.  A coordinating and coordinated center for benefits and health information services available both within and outside of the VA.

I am not interested in creating another meaningless layer of bureaucracy.  Instead, I would like the Ombudsman Office to become a one stop shop for veterans.  A CENTCOM for veterans benefits information.  I applaud the VA for their hard work in providing information that veterans need.  The VA has numerous hotlines and support services available to veterans.  I have counted ten different 1-800 numbers on the VA’s website to help with different types of benefits.  One for disability pension, another for healthcare benefits, another for life insurance, etcetera.

And while the VA provides veterans benefits and services information, the veterans may not know where they put their informational pamphlets six months or one year down the road when they have a question or a problem.  Our veterans are falling through the cracks and do not know where to turn. 

It was very interesting to me, recently a number of both active duty wounded soldiers and veterans came to the floor of the House to talk with a number of Members of Congress.  There were seven or eight members of Congress there and we heard compelling stories there on the floor from veterans who described what they—described as their ordeal working through the bureaucratic maze and the red tape in the Veterans Administration.  And this office is designed to provide that one stop shop that would help them cut through the red tape.

It would provide a focal point of information within the VA.  The office should head up the advocacy and information campaigns that the VA already has in place and consolidate the information services with an 800 number to address all the veterans needs and complaints.  For a veteran who has just returned from active duty an Operation Iraqi Freedom (OIF) or Operation Enduring Freedom (OEF) with traumatic brain injury, it would be a whole lot simpler and easier to have only one office to call to receive the information he or she needs.

The VA has a patient advocacy program for healthcare but a lot of brave men and women need help with loans for their homes and schooling too.  They shouldn’t have to run around asking the same ten questions to ten different offices.  The Ombudsman’s Office can help the veteran figure out all the services in the benefit system not just the healthcare and not just about disability.

I have reviewed the testimony of the esteemed panelists, the VA and VSOs who have presented written testimony before this Subcommittee.  And just in the six testimonies that specifically discuss the Ombudsman’s Office, the panelists referred to 14 different programs both within and outside of the VA that veterans could turn to for help with benefits coordination.  That is good news and the bad news.

The good news is the services are available.  The bad news is there are so many of them which can be confusing.  These 14 programs are extremely important to our veterans in providing specialized services.  But as a healthy member of Congress and not a PTSD patient or an ailing elderly veteran, I am even confused to some degree about which programs to use and under which circumstances.

So, Mr. Chairman, I am not trying to make redundant services.  The VA provides advocacy and resources and many VSOs provide advocacy and resources.  I look forward to working with the Honorable Members of the Committee to mold the Office of the Ombudsman in to a viable helpful resource for veterans.  I believe that this consolidation of various information sources in to a coordinated center of information will help make sure the veterans receive the care they need and cut through the seemingly endless amounts of bureaucratic red tape.

I would like to point out to the Subcommittee that especially with respect to the duties section as it is currently set forth in the draft bill, I believe that through markup and working with the expertise of the Committee, that section probably didn’t come back as complete to me from legislative counsel as it ought to be and should be expanded so that the duties include coordination of services and benefits both within the VA and also that may be available through VSOs and or the communities in which the veterans are so that it is a comprehensive coordination effort.

Thank you again for giving me the opportunity to testify before this Subcommittee and I look forward to working with the Committee to help veterans understand and access the benefits they deserve.

[The statement of Congressman Hodes appears in the Appendix.]

Mr. MICHAUD. Thank you very much, Mr.  Hodes.  Mr. Salazar?


Mr. SALAZAR. Thank you Chairman Michaud and Ranking Member Miller and Members of the Subcommittee.  I want to first of all thank you for your interest in rural veterans healthcare and I know that you have both been major leaders in this fight. 

Mr. Chairman, today I am happy to bring H.R. 2005 to the Subcommittee.  I am looking forward to discussion of this important legislation.  This bill called the Rural Veterans Healthcare Improvement Act seeks to improve healthcare services to veterans in rural areas.

As many of you have heard over the last several years in this Committee that a study of more than 767,000 veterans by researchers working for the Department of Veterans Affairs shows vets in rural areas are in poorer health than vets living in the cities. 

The VA found that the health of rural veterans still persist even after researchers adjusted for social economic factors such as race, education, and employment status.  It was identified in this study that access is a care—to care is a key factor.  The study suggested that in addition to establishing more clinics in rural areas VA should consider coordinating services of Medicare and other healthcare services based in rural areas similar to what Mr. Rodriguez was talking about earlier in the earlier panel.

As a way to begin addressing some of these issues, the Veterans Benefits Health Care and Information Technology Act of 2006, which passed at the end of the 109th Congress created the office of Rural Health within the VA.  Dr. Kussman’s testimony will tell you that the VA is opposed to this legislation because the Office of Rural Health is charged with these tasks.

I would like to make the point that even though Congress directed VA to establish this office it has not yet been implemented.  This new office, when the VA decides to set it up, needs support, direction, and resources in order to fulfill its mission of coordinating care in this vital constituency.  The Rural Veterans Health Care Improvement Act of 2007 would task the director and the Office of Rural Health with developing demonstration projects, centers of excellence, and a transportation grant program.  And the bill would also more fairly reimburse veterans in rural areas for traveling expenses they incur when driving long distances to VA medical clinics.

Mr. Chairman, with both an ailing veteran population to care for and a new generation of veterans returning from service in Iraq and Afghanistan, we immediately need to address access to care issues in rural areas.  It is estimated that nearly 45 percent of all new recruits are coming from rural America and with a large percentage of this war burdened on our National Guard, the number is only going to increase.

Many vets must travel hundreds of miles to access medical care that we promised and they do so almost entirely at their very own expense.  Currently we reimburse veterans at the rate of 11 cents a mile.  The rate has not been increased since 1978.  In 1978 the average price of a gallon of gasoline was 63 cents a gallon.  Today in rural America, in rural Colorado, the average is right around $3.39 a gallon.

This legislation would increase the reimbursement rate to 48