PREPARED STATEMENT OF HON. ALAN CRANSTON, RANKING MINORITY MEMBER OF THE SENATE COMMITTEE ON VETERANS' AFFAIRS Good morning. I am very pleased to welcome all of you to today's hearing of the Committee on Veterans' Affairs. The Committee is grateful to those of you who are testifying for your willingness to appear before us today and give us your views on the legislation pending before the Committee. I will be carefully reviewing your testimony. The maintenance of a strong, independent VA health-care system capable of providing quality care that is responsive to the particular needs of our Nation's veterans has been and is a matter of high priority for me. Thus, I am pleased that we have this opportunity to examine the question of what legislative actions this Committee should be taking in the near future to ensure that the VA system is capable of carrying out its vitally important mission most effectively. As the author of two of the measures before the Committee today, S. 2269, introduced on February 7, 1984, and Amendment No. 2850 to that bill, introduced on March 27, I will of course be very interested in the witnesses' views on those measures, as well as on Chairman Simpson's health bill, S. 2514, and other bills scheduled for this hearing. I described the provisions of S. 2269 and Amendment No. 2850 in detail in my floor statements at the time I introduced those measures and ask unanimous consent that, both those measures and my introductory remarks on them appear in the hearing record at an appropriate place. I'd like to highlight some of the provisions of the two measures I introduced with the cosponsorship of Senators Randolph, Matsunaga, and DeConcini. • First, a group of provisions that I'd like to highlight, in S. 2269 and Amendment No. 2850, are intended to enhance the VA's ability to assist Vietnam-era veterans and others who might be suffering continuing psychological problems related to their military service. Among these provisions is one, contained in Amendment No. 2850, that would require the VA to establish a national center for research into, and the training of health-care personnel in, the diagnosis and treatment of post-traumatic stress disorder -- PTSD and the dissemination of - relevant information about PTSD throughout the system. PTSD is a psychiatric disorder that is particularly prevalent among veterans who have seen combat, and most experts who have studied the issue believe that, because of the circumstances of the Vietnam war, including the reaction in our society to the war and its warriors, PTSD is especially prevalent among Vietnam combat veterans. Although the VA has made some strides in PTSD diagnosis and treatment programs, I am convinced that the agency could be and should be doing much more and doing so in a much more coordinated fashion. It is for this reason that I am advocating that the agency be mandated to establish a PTSD research, training, and information center. In this regard, I welcome the intent of the proposal recently made by the Chairman in S. 2514 to promote greater action on the VA's part on the PTSD issue, and I look forward to developing with him and other members of the Committee a consensual approach to meeting our shared concerns in this area. The other S. 2269 provisions, relating to the VA's efforts to assist Vietnam-era and other veterans who might be suffering continuing postservice psychological problems, deal directly with the VA's readjustment counseling program, the so-called "Vet Center" program, and more specifically with eligibility to receive readjustment counseling services. Specifically, I'm proposing that four new categories of individuals be made eligible for readjustment counseling: First, persons who served during the Vietnam era but who are still on active duty, and thus not "veterans" under the title 38 definition, would be made eligible for such services; second, by virtue of a proposed change to the starting date of the Vietnam era, individuals who served in Vietnam after July 8, 1959, but before August 5, 1964, the starting date for the Vietnam era in current law, would become eligible for readjustment counseling services; third, the Administrator would be authorized to extend eligibility for such services to individuals who, while serving in the Armed Forces after May 7, 1975, the ending date for the Vietnam era, were exposed to hostile fire in circumstances comparable to wartime conditions; and fourth, in a change that would affect the readjustment counseling program along with other VA mental health services, the VA would be authorized to continue to provide mental health counseling and other services to surviving family members of a veteran for up to six months after the veteran's death if, prior to the veteran's death, they were receiving such services in connection with the veteran's care and treatment by the VA. In addition to authorizing the VA to provide certain services through the readjustment counseling program, this last proposed change would allow the VA to continue to provide services to a veteran's family in situations, such as in the VA's experimental hospice activities, in which the VA is providing health care to eligible veterans suffering from a terminal illness. An appropriate, integral part of a program of hospice care is counseling for family members both prior to and after the veteran's death and this proposed amendment would provide a clear statutory basis for the VA to provide such counseling following the veteran's death. Again, I note that the Chairman has proposed a hospice report in his bill, and I look forward to integrating our efforts in this respect. - Second, both S. 2269 and Amendment No. 2850 contain provisions designed to improve the VA's ability to attract and retain personnel protective services officers who provide security at VA medical centers. As has been noted by many familiar with the VA particularly the various veterans' service organizations, such as The American Legion through its field service officers' visits to VA facilities -- the VA has had and continues to have significant difficulties in this regard, particularly at some larger VA medical centers located in urban areas. As a result, the level of security at many VA facilities has suffered as has the morale of VA protective services officers. In this regard, I note that The Legion has prepared a useful summary, based on their field service officers visits, of the security situation around the DM&S system, for which I am very grateful. I ask unanimous consent that this summary appear in the hearing record at an appropriate place. The provisions in the two measures that address this problem would give the Administrator new authority to modify rates of pay for these personnel; clarify the Administrator's authority to designate individuals to serve as VA protective services officers; require the Administrator to issue regulations relating to such employees' authority to make arrests, the content and duration of their training, limitations on the carrying and use of weapons, and other law enforcement matters; and authorize a special clothing allowance for VA protective services officers. Taken together, these provisions should help correct the problems the VA is facing in recruiting and retaining security personnel. Third, a further provision in S. 2269, like those I described earlier, also relates to the Vietnam conflict. It concerns not veterans of that conflict but, rather, those individuals who served in Vietnam as civilians, either as Government employees or as employees of organizations, such as the American Red Cross or the USO, that provided significant assistance to our Armed Forces. Under this provision, the Administrator of Veterans' Affairs, in conjunction with the Secretary of Defense and the Secretary of Health and Human Services, would be required to submit a report to the Congress on how the Federal Government might respond to the needs of these individuals for health problems related to their work in Vietnam, such as for disabilities that might be related to their exposure to dioxin in Agent Orange or to particularly stressful situations. This report should help provide guidance on how the Federal Government might provide assistance to the many individuals who made important contributions to the U.S. efforts in Vietnam but who, because of their non-military or non-federal status during that period, generally do not now have access to assistance from the Federal Government for problems that might be related to their work in Vietnam. A final provision that I wish to highlight, which is contained in Amendment No. 2850, would specify that any remuneration received by VA patients in a rehabilitation therapy program under section 618 of title 38, United States Code, shall not be counted as income for the purpose of VA pension programs. Under section 618, the VA is authorized to conduct programs of rehabilitation and therapy under which participants VA patients selected for such programs perform services for which they receive a small payment. Known commonly as incentive therapy and compensated work therapy, the primary emphasis of these programs is on the therapeutic benefit of the work performed and the fact that patients have an incentive to participate in this rehabilitative program because they receive some payment for it. - Earlier this year, a change was made in the program whereby the payments veterans are receiving for their work in these programs are being counted as income to the veterans for the purpose of determining their entitlement to VA pension. For many of these veterans who are in receipt of VA pension, this change has the effect of reducing their pension benefits by an amount equal to the amount they are receiving under incentive or compensated work therapy. This change has already had the entirely predictable result of discouraging participation in these therapy programs by those in receipt of VA pension. To avoid this result, the provision in Amendment No. 2850 would amend section 618 of title 38 to specify that payments to participants in programs carried out under that section are not to be counted as income for the purposes of VA pension. Again, I thank all the witnesses for their participation. I look forward to working with the Chairman and other members of the Committee as we develop legislation from the various bills before the Committee. Chairman SIMPSON. George Mitchell, please; Senator Mitchell of Maine. We are glad to have you here, George. Senator MITCHELL. Thank you, Mr. Chairman. I join with you and Senator Cranston in welcoming those who will present testimony this morning on the important issue of veterans' health-care services. I especially want to thank you, Mr. Chairman, for allowing me to have the topic of rural health-care services included among the topics to be addressed today. I am grateful to Senator Cranston for his support of my efforts regarding rural health-care services. As you know, the delivery of VĂ health-care services to veterans living in rural, geographically remote areas is an issue of great significance to many veterans in Maine and throughout the country. Of the 153,000 veterans now living in Maine, over half, or about 53 percent of them, live in rural areas. Last year I introduced legislation which would require the Administrator to establish an experimental program to determine the feasibility of furnishing diagnostic health-care services to veterans living in rural areas. My legislation was the subject of a hearing before this committee last July, which I feel clearly demonstrated the need for pilot program efforts on the part of the VA to upgrade health-care delivery to rural veterans living in Maine. At the same time, I believe the hearing demonstrated the lack of a centrally directed effort on the part of the VA to determine the extent of similar problems facing rural veterans nationwide, much less, any concerted efforts on the part of the VA to address any problems which might exist. Following that hearing, my colleague, Senator Cohen, and I agreed to work together to develop two-track legislation which would address the present shortcomings in the delivery of rural health-care services to veterans. The first track would set in motion efforts to gather statistics which would enable this committee to accurately assess the health-care needs of America's rural veterans. The second track would authorize a pilot program. In February, we made our intentions known to the leadership of this committee when I wrote to the chairman and ranking member. At this committee's hearing on the VA's fiscal 1985 budget, I again raised the issue of rural health care. In an attempt to facilitate the VA's compilation of evidence for presentation in today's written testimony, I wrote to Administrator Walters with a detailed list of issues I wished to be addressed. Unfortunately, the Administrator has since informed me, that because of the detail required in answering my questions, the VA would not be able to provide responses in its presentation today. I believe it is important that the record of today's hearing include what we have so far on the various issues that I asked the VA to address in its written statement. So if there is no objection, Mr. Chairman, I would ask that my complete opening statement, my February 3 letter to you and Senator Cranston, the March 13 letter from Šenator Cranston to you, my March 29 letter to Administrator Walters, and his April 6 response to me, be made a part of the record of this hearing. I will pursue it to the extent that I can with these witnesses in questions. Chairman SIMPSON. Without objection, so ordered. Senator MITCHELL. I do want to say, Mr. Chairman, I do have a very unfortunate schedule conflict. At this very moment, the Environment and Public Works Committee, on which you also serve, is holding a hearing on legislation which I have introduced. I will not be able to remain for this entire hearing, but I apologize in advance to those witnesses whose testimony I will not hear. I assure you that I will review their statements very carefully, along with all the record of this hearing. I thank you, Mr. Chairman. Chairman SIMPSON. Thank you. I appreciate your being here. [The prepared statement of Hon. George J. Mitchell, a U.S. Senator from the State of Maine, follows:] |