Mr. FISCHL. Yes, it is. [Laughter.]

I was going to ask the VFW to yield part of their time, butMr. CULLINAN. I had already declined, Mr. Chairman.

Mr. FISCHL. They have a history of being not cooperative. [Laughter.]

Chairman ROCKEFELLER. No, the VSO's have gotten closer, but not that close. [Laughter.]

I have questions, but what is embarrassing is I know exactly how you are going to respond to each one of them. So I could use that to get you to respond to each one of them, to put it on the record, but several of you have already addressed some of those questions. I do not see a need at this point to probe because we have your testimony. We know what you think. I think I would have guessed what you were going to say before we received the testimony, and you have come and made your pitch to help us now prepare for a markup.

So I do not feel the need. There are not other members here. I, personally, do not feel the need to grill you. I would if I felt the need to, but I do not. And so I think what I will just do is really thank you for coming here, for all of you having, in your various ways, worked to help support, to critique, to oppose certain legislation and, thus, to help us arrive at how we are going to act on this, when hopefully we have more members.

So I thank you very much. I thank all of you who attended, and this hearing stands in recess.

[Whereupon, at 10:51 a.m., the committee was adjourned.]

APPENDIX

PREPARED STATEMENT OF HON. MICHAEL B. ENZI, U.S. SENATOR FROM WYOMING

Thank you, Chairman Rockefeller and Ranking Member Specter, for holding this hearing on legislation pending before the Veterans' Affairs Committee. I particularly appreciate the opportunity to speak on behalf of the "Veterans Road to Health Care Act of 2001," which I introduced last June. This legislation would raise the travel reimbursement rate for veterans who must travel to hospitals operated by the U.S. Department for Veterans' Affairs for treatment. Veterans currently receive 11 cents per mile for reimbursement. This bill would raise that to 34.5 cents per mile, which is equivalent to the reimbursement level for Federal employees. My bill would also provide reimbursement at the Federal employee level for veterans who have been recommended to special care facilities by their VA physician for a non-service connected disability. This provision would provide veterans access to critical care that the VA recognizes but does not have the facilities to treat.

Given the fluctuating nature of gas prices and the many costs associated with automobile travel, 11 cents per mile rarely covers the expenses veterans face when they are forced to travel to distant places for health care. I have heard from numerous veterans in Wyoming who describe the difficulty in budgeting for travel between their hometown and the VA hospital, especially given the fact that many are on a fixed income. Health care access is vital for our nation's veterans, and they should not be forced to choose between paying for travel to a treatment center recommended by the VA or for other necessities needed for everyday life.

In Wyoming, we have two VA hospitals, one in Cheyenne and one in Sheridan. These hospitals provide many critical services, however many Wyoming veterans have to travel hundreds of miles to be treated at the facility and to be covered by their military health care plan. This poses a serious problem in terms of travel expense. Some of the largest towns in Wyoming are over 300 miles away from the nearest VA facility. For example, a veteran living in Evanston, Wyoming's eighth largest city, must travel 360 miles to reach a VA hospital, while a veteran from Rock Springs, Wyoming's fifth largest city has to travel almost 300 miles to Cheyenne or Sheridan. This is large population of veterans who must bear the out-ofpocket expense of promised health care.

This bill particularly addresses the health care needs of veterans who require special treatment. It would allow veterans who have been referred to a special care center by their VA physician to be reimbursed under the Travel Beneficiary Program for their travel to the specialized facility. This would apply to only those veterans who cannot receive adequate care at their VA facility and who have a non-service connected disability.

This legislation is important to all veterans, but it is particularly important for veterans in rural states like my home state of Wyoming. Because rural states are less populated, have greater distances between towns, and far fewer options for transportation, the cost of automobile travel is a significant barrier to quality medical care. Unlike urban areas, where alternative travel is readily available, rural veterans face a disparate cost in receiving comparable health care benefits. For this reason, I believe we must strengthen the VA's Beneficiary Travel Program.

Although the U.S. Department of Veterans' Affairs opposes this bill, it is important to note that their opposition is based on their current budgetary constraints. The VA will testify that this provision was not included in last year's appropriations process, and, therefore, the immediate enactment date would result in funds being pulled directly from the medical care budget. Yet, what the VA fails to mention is that veterans have little need for quality medical care if they cannot access it. Although I understand the VA's concerns, I would like to reiterate that the intent of this bill is to improve medical care for all veterans and equalize the disparate treatment of rural and urban veterans. As such, I strongly encourage the Veterans' Affairs Committee to consider this bill based on its merits, and then work with the

VA to address the problems with the enactment date and the additional appropriations needs.

Our veterans made unimaginable sacrifices in defending the freedoms of this country, and I believe the government should provide adequate and equal health care for all veterans regardless of their geographic location. It is our nation's responsibility to provide veterans the kind of access to health care they have earned through their service to our country. Travel expenses should not be THE deterring factor when deciding whether or not to seek treatment. This bill would help equalize access and I strongly urge you to consider it carefully.

Thank you Mr. Chairman.

Hon. JOHN D. ROCKEFELLER IV,

Chairman, Senate Veterans Affairs Committee,
U.S. Senate,

Washington, DC.

AIR FORCE ASSOCIATION, Arlington, Virginia, May 1, 2002.

DEAR MR. CHAIRMAN; The Air Force Association is pleased to offer our endorsement and comments on a number of legislative items to be considered by the Senate Veterans Affairs Committee in the coming days and weeks. On behalf of our membership of 146,000 airmen, veterans, retirees and their dependents, thank you for your hard work and leadership on issues affecting the United States Air Force and its veterans.

In your Committee's upcoming consideration and markup of legislation, I offer our endorsement of the following important bills:

• S. 1408: Increasing the income threshold for pharmacy co-payments addresses an important inequity in the current law. The Air Force Association does not support means testing for earned benefits under any circumstance; however, we do understand the need to offer a lower cost benefit to those veterans who are most in need of financial assistance. Prescription drug, coverage is one of the VA's most vital benefits, and low cost access should be brought in line with all other VA health care. • S. 1905, S. 2186 & S. 2229: Addressing primarily technical and administrative issues within the VA, these bills are important as they go a long way to offering Secretary Principi the latitude and authority he needs to ensure our nation's veterans are receiving the quality and efficiency of care they deserve.

• S. 2187: Events of the last year have tested our nation's resolve, and our ability to respond to domestic emergencies. This bill recognizes the important contribution that the VA makes to our nation's disaster response capability and is an important step in ensuring our ability to respond to future emergencies.

S. 2231: There is little doubt that the surviving dependents of those service members who make the ultimate sacrifice for their nation deserve all the support we can give them. This legislation to bring the Dependents Education Assistance program's benefit levels in line with the Montgomery GI Bill is a vital step in our support of these deserving individuals.

S. 1576: Increasing numbers of veterans of the Gulf War are falling ill to unknown ailments or diseases with unknown causes. Our efforts in both research of these illnesses and the care of those who are sick are vital to our nations own health. Extending priority of care and access to care is nothing short of the right thing to do.

As always, we appreciate the opportunity to voice our concern, and greatly appreciate your efforts on behalf of some of our nation's most deserving individuals. Sincerely,

THOMAS J. MCKEE, National Chairman of the Board.

PREPARED STATEMENT OF THOMAS H. MILLER, EXECUTIVE DIRECTOR, BLINDED

VETERANS ASSOCIATION

On behalf of the Blinded Veterans Association, thank you for this opportunity to submit our views on S.984, "Veterans Road to Health Care Act of 2001." BVA strongly supports this legislation. This is demonstrated by the BVA's adoption of Resolution 20-01 urging Congress to adopt S.984, which amends Title 38 USC section on Beneficiary Travel. BVA's resolution requests the Department of Veterans Affairs (VA) to pay travel for all veterans accepted for care in one of the VA Special

Disabilities Programs as well as increase the amount reimbursed for expenses incurred in travel for VA medical appointments.

BVA is grateful to Congressman Enzi for including the beneficiary travel section within this legislation. We are currently discussing some changes in language with Congressman Enzi's staff regarding the language of this section. BVA supports the provision in S.984 that allows for payment of beneficiary travel for veterans specifically to DEPARTMENTAL facilities.

BVA encourages this Committee to consider favorably this amendment to Title 38 governing beneficiary travel, and an exception for beneficiary travel associated with participation in one of the special disabilities programs. Exceptions should only be granted to veterans who have been accepted for care at the receiving facility. In the case of blind rehabilitation, there is a very formal and detailed application procedure for admission to a Blind Rehabilitation Center. An application must be completed at the veteran's home facility and then forwarded to the appropriate BRC. Clearly, therefore, these are veterans who are patients enrolled at one facility that is unable to provide the necessary care and who have been accepted by a distant VA facility capable of providing the needed services. The cost to expand the travel eligibility to these veterans would certainly be minimal for VA. If the responsibility continues to fall on the veteran, it will surely serve as a deterrent to blind rehabilitation or any other specialized program that requires veterans to travel great distances at their own expense.

When the beneficiary travel law was changed in part to reduce the VA costs, we believe the law and subsequent regulations were intended to address beneficiary travel applicable to veterans traveling to their local VA facilities for care. The special disability programs are only available at a few facilities around the system and require longer and more expensive travel. We strongly believe that if a veteran enrolled in VĂ health care must be referred to another VA facility other than the primary station to receive the care they need, VA should then be required to pay for those travel expenses. Although these veterans are normally outpatients when referred for blind rehabilitation, we believe for beneficiary travel purposes they should be treated as inter-facility transfers. This form of transfer is not bound by the general beneficiary travel regulations and relieves the veteran of the burden of paying for his or her own travel.

Despite all the potential benefits to be realized from participating in blind rehabilitation, many veterans are not highly motivated to leave home after losing their vision, particularly the elderly. There are several reasons for this reluctance. For one, veterans are anxious about leaving their home and families for a period of six to eight weeks because they remain unconvinced that the proposed rehabilitation would be beneficial. Depression, characterized by feelings of being overwhelmed and without hope, does not generate a high degree of motivation to reach out for help. The physical and emotional limitations inherent in sight loss are formidable deterrents for veterans seeking blind rehabilitation. Those limitations are severely exacerbated by the veteran's inability to travel to the appropriate BRC. Some blinded veterans are not eligible for Beneficiary Travel and are therefore expected to pay for their own travel to the BRC. These veterans are also required to pay the Social Security co-payment of $800 plus a $10 per diem. In most of these cases, air travel is required because of the long distances involved, and the price of airline tickets are cost prohibitive for these veterans. When motivation is marginal to begin with, the additional financial burden of transportation often proves to be the proverbial last straw causing the veteran to decline rehabilitation.

All blinded veterans, regardless of their service-connection status receive the complex care rate through VERA. According to the recent GAO study, VA Health Care: Allocation Changes Would Better Align Resources with Workload, "Table 3: Complex Care Workload Allocations Compared With Complex Care Expenditures, Fiscal Year 2000,"1 seven of the eight VISÑS that host BRCs indicated an excess in allocation for complex care patients. If VISNS have excess allocations for complex care patients, why not pay for the travel of all veterans who must travel to receive specialized VA services?

BVA is aware that VA costed this bill at $97 million. Further research reveals that this amount is only for the increase in mileage payment alone. VA did not cost the beneficiary travel proposal in this bill. Originally, VA informed BVA that the cost of the mileage increase would be estimated at $1 million per cent proposedfrom $.11 to $.34-an increase of $23 million dollars. We would like an explanation as to how this estimate increased so greatly within a matter of days. BVA supports the mileage increase. We understand there are budgetary concerns and suggest that

1U.S. General Accounting Office, VA Health Care: Allocation Changes Would Better Align Resources with Workload, GAO-02-338 (Washington, DC.: February 28, 2002) pp. 20–21.

the increase be incrementally implemented. This will decrease the effects on the health care budget, but more fairly compensate veterans who have to drive long distances to receive their promised health care. BVA is disappointed with the numbers games being played by VA regarding this bill. We suggest that VA cost the beneficiary travel amendments proposed in this legislation. In the future, BVA requests that VA be more explicit in its testimony when reporting the estimated cost of a bill.

Thank you, once again, for this opportunity to share the views of BVA on this important piece of legislation. VA should be proud of its special disabilities programs, especially blind rehabilitation. VA's blind rehabilitation program is recognized worldwide for its excellent services. These services should not be denied to blinded veterans for any reason. We hope that you will help remove this barrier of unfair travel regulations to ensure equal access to VA health care, especially special disability programs, for all of America's veterans.

PREPARED STATEMENT OF THE NATIONAL ASSOCIATION OF VETERANS' RESEARCH AND EDUCATION FOUNDATIONS (NAVREF)

The National Association of Veterans' Research and Education Foundations (NAVREF) thanks the Committee on Veterans Affairs for the opportunity to submit a statement for the record of the hearing on May 2, 2002, regarding Sections 2 and 3 of S. 2132. NAVREF is a membership organization of the eighty-five VA-affiliated nonprofit research and education corporations (NPCs) authorized by 38 U.S.C. §§ 7361-7368.

NAVREF strongly encourages the Committee to approve S. 2132, Sections 2 and 3 in order to:

1) Clarify that VA medical centers (VAMCs) and NPCs may enter into VA-approved contracts and other forms of agreements for the purpose of facilitating VA research and education; and

2) Provide Federal Tort Claims Act (FTCA) coverage for certain NPC employees. NAVREF thanks the Committee and its staff for the careful attention given to formulating Sections 2 and 3. Considerable care has been taken to modify the NPC authorizing statute to allow the NPCs to better fulfill their purpose of facilitating VA research and education while at the same time ensuring VA oversight.

S. 2132. SECTION 2. MODIFICATION OF AUTHORITIES ON RESEARCH CORPORATIONS— REGARDING CONTRACTS AND OTHER AGREEMENTS BETWEEN VAMCS AND NPCS The NPCs exist to facilitate VA's research and education missions, and each year they donate to their affiliated VAMCS research related personnel services, equipment, travel support, construction, and supplies as well as education related services. Last year, these contributions had an aggregate value of $141 million nationally. When it is cost effective and efficient, VAMC research and education programs would like to purchase additional services from NPCs over and above what they can afford to donate. However, to date, the VA Office of General Counsel (OGC) has considered a VA payment for a service provided by an NPC to be a prohibited transfer of VA-appropriated funds. As a result of this interpretation of §7361(a), the NPCs' ability to facilitate VA research and education has been curtailed.

Section 2 of S. 2132 has been carefully crafted to permit VAMCs to make payments to NPCs pursuant to VA-approved contracts, or other forms of agreements, for services provided by the NPCs to facilitate VA research and education. Please note that an integral feature of Section 2 is that all such agreements would be subject to VA review and approval. NAVREF and its members welcome this requirement to provide mutual assurance that the agreements will withstand rigorous scrutiny.

Agreements executed according to the provisions of Section 2 would allow the NPCs to better fulfill their purpose of facilitating VA research and education. Examples of situations in which VA-approved agreements would facilitate VA research or education include:

1. When a VAMC does not have a technician on staff with the highly technical skills necessary to conduct tests for a research project, the facility could contract with an NPC for the services. The NPC would hire someone to run the tests and would bill the VA project on a per test basis. This would allow VA to pay only for the services it needed.

2. VA cardiac researchers at a VISN 21 facility could contract with an NPC to obtain access to a $1.5 million Sonata Magnetic Resonance scanner. Because the facility and its research program have insufficient VA funds to purchase the scanner and to pay for staff to operate it, the NPC has offered to lease the Sonata, renovate