VCS Report for President-Elect Obama: Our VCS Vision for Vibrant VA in 2009

November 5, 2008 

The Honorable Barack Obama
Dear President-Elect Obama:
Congratulations on your election.  As our next President of the United States of America, you face a serious challenge in fixing a badly broken Department of Veterans Affairs (VA) and improving the delivery of health care and other services to our nation’s veterans and their families.  As a leading national veterans’ organization, Veterans for Common Sense respectfully submits to you our recommendations on how to fix VA and help our veterans and their families.  
Our vision is that whenever a veteran comes to any VA facility, his or her medical and benefit needs should be quickly and completely addressed, without red tape, delay, stigma, or discrimination.  For too many veterans this vision is a fantasy, however, because recent VA leadership has failed to put our veterans first and has inadequately funded vital services and programs.
VA needs an immediate overhaul to avert a perfect storm of problems threatening to overwhelm VA.  First, the economic recession is forcing more veterans who have lost their jobs and medical care into VA.  Second, VA faces a tsunami of up to one million Iraq and Afghanistan veterans flooding into VA.  And, third, VA faces a surge of hundreds of thousands of additional Vietnam War veterans seeking care for mental health conditions as well as medical conditions linked to Agent Orange poisoning.
VCS offers our recipe to overhaul VA that contains three critical ingredients: bold leadership, streamlined policies, and mandatory funding.  When all three elements are combined and enacted simultaneously, reform will be comprehensive for VA’s nearly $100 billion annual budget providing 5.5 million veterans with medical care and 3 million veterans and family members with disability benefits.  These reforms complement the passage of several new laws reforming VA passed by Congress during the past two years.

We look forward to working with you to assist our Nation’s veterans and their families.

Sincerely, Paul Sullivan, Executive Director

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Veterans for Common Sense: Our Vision for a Vibrant VA in 2009

Summary: VA requires significant and immediate reforms to meet our Nation’s obligation to provide prompt and high-quality healthcare and  benefits to our veterans and their families.

Introduction: A Vision for a Vibrant VA in 2009

Veterans for Common Sense (VCS) offers our recipe to overhaul the Department of Veterans Affairs (VA) that contains three critical ingredients: bold leadership, streamlined policies, and mandatory funding.  When all three elements are combined and enacted simultaneously, reform will be comprehensive for VA’s nearly $100 billion annual budget providing 5.5 million veterans with medical care and 3 million veterans and family members with disability benefits.  These reforms complement the passage of several new laws reforming VA passed by Congress during the past two years.

In 2009, VA’s new leaders will need streamlined policies designed to cut red tape and assure funding to handle the surge in patients and the backlog of claims.  The current system is overwhelmed.  VCS offers these recommendations for reforming VA in a spirit of recognition from two great Americans:

• President Abraham Lincoln said our government has an obligation “to care for him who shall have borne the battle and for his widow and his orphan.”
• General Omar Bradley, speaking about VA, said, “We are dealing with veterans, not procedures – with their problems, not ours.”

About Veterans for Common Sense: VCS is a non-profit formed in 2002 by Gulf War veterans.  Our mission, based on the ideals of American patriot Thomas Paine, raises the unique and powerful voices of veterans so our military, veterans, freedom, and national security are protected and enhanced.  VCS regularly testifies before Congress on issues involving veterans’ healthcare, disability benefits, legislation, and voting rights.  Visit our web site for more information:

Section One: Reforming VA’s Leadership

Poor leadership remains a core failure within VA.

VA currently suffers from poor leadership, and many systemic problems were not recognized or addressed during the last eight years.  To make the extensive policy, personnel and funding changes needed for institutional reform, new VA leaders should seek and embrace major improvements designed to put our veterans first.  VA’s new leaders should implement our suggested reforms in a joint and cooperative manner by both the Veterans Health Administration (VHA) and Veterans Benefits Administration (VBA).

Dozens of Congressional hearings clearly established there is need for better access to prompt and high-quality healthcare and benefits.  Here is a list of what VA’s new leaders can accomplish in the next 100 days to fix existing problems and prepare for the future.
1.1 Listen to Our Veterans

VA leaders should spend more quality time out of their office interacting with veterans and families in order to gain first-hand experience and understanding of their needs and concerns.  VA’s leaders should also spend time at the front desk of a VA hospital, clinic, or regional office and personally interact with veterans and families, some of whom are going to VA for the first time.  VA’s new leaders should regularly meet with advisory panels on subjects ranging from women veterans to Gulf War illnesses to Iraq and Afghanistan war veterans.  Directors of medical centers and community based outpatient clinics should work closely with VA’s new advocacy councils in an effort to improve the access and quality of mental healthcare.
1.2 Rally VA Staff

VA leaders need to recognize and honor the service of VA’s more than 250,000 dedicated, yet overworked, employees, many of whom are veterans.  This means top VA leaders should regularly meet with VA’s managers, VA’s rank and file employees, and VA’s unions to determine what they need to assist our veterans.  This specifically includes building strong relationships with VA employee unions that were nearly irreparably destroyed in the past Administration. 

1.3 Hire More VA Staff

VA currently suffers from a capacity crisis where the demand for healthcare and benefits outpaces VA’s supply of medical professionals and claims processors.  The capacity crisis has eased as Congress appropriated additional money to hire new healthcare and claims processing staff in the past two years.  However, an acute need for additional staff remains in mental health, where VA continues turning away suicidal patients because VA lacks the mental health professionals to assess and treat the psychological wounds of war.  The directors of VA’s more than 1,400 facilities should be asked to provide budget requests designed to meet this simple criterion: how many VA employees are needed so our veterans receive prompt medical care as well as disability benefits within 30 days?  Expanding VA is prudent as more veterans seek care due to a declining economy, more veterans returning home from war, and new scientific evidence linking military service with several serious medical conditions is published.  VA should also look beyond just the number of new employees by offering recruiting incentives for higher quality experienced healthcare providers.  VA leaders should also be monitoring VA mental health staff for signs of distress due to heavy workloads.

1.4 Remove Dead Wood

VA’s new leaders must not hesitate to remove or demote anyone who does not understand VA’s sacred mission or who does not perform to the full level of their job requirements.  There are four responsible steps to removing dead wood so new leaders may emerge.  First, form selection committees to review VA’s existing leadership.  Second, remove prior political appointees who created most of the mess at VA, including executives, Schedule C employees, and those who “burrowed” into civil service positions.  Third, identify potential VA leaders, both within and from outside VA, with demonstrated competence who put our veterans first, regardless of political party.  Fourth, hire these new leaders quickly so they can hire subordinates to assist with implementing much-needed reform.  The sooner the dead wood is cleared, the sooner VA’s new leaders can make significant improvements to VA’s policies and budgets.

1.5 Turn On Radar

New VA leaders must assess the damage done to VA by the out-going Administration and be prepared to respond to current and future VA crises.  VA leaders were caught off-guard by the flood of 350,000 new patients and 300,000 disability compensation claims from the Iraq and Afghanistan wars.  Even after seven years of war, VA leaders don’t know how many Iraq and Afghanistan war veterans have committed suicide.  VA still operates with unreliable and inconsistent data, and that should change immediately so that VA leaders can operate ahead of the curve instead of years behind it.  VA leaders, working closely with Congress and veterans’ groups, should develop and implement a comprehensive plan for our Iraq and Afghanistan war veterans as well as plans for other underserved groups, such as women and rural veterans. 

1.6 Share Facts and Reports

VA leaders must prepare and distribute clear and concise reports about VA quickly in a format easily understood by Congress, journalists, and veterans.  VA must respond to Congressional requests, Freedom of Information Act requests, and press requests in a complete, open, and direct manner.  VCS supports the efforts of the National Security Archives to streamline the FOIA process.  The more VA, Congress, veterans, and the public know about the needs and concerns of our veterans, then the better VA is positioned to respond quickly.

1.7 Stop Bonus Abuse

VA leaders should believe public service is an honor.  VA should stop paying millions in bonuses to top executives as more veterans wait longer for benefits.  In a related manner, VA should review existing salary formulas that pay one political appointee $328,000 per year.  Instead, VA’s new leaders should review and reward risk-taking that improves the quality and timeliness of healthcare and benefits delivered to our veterans.  VA should also end production quotas and unreliable performance standards, especially the work credits for processing disability compensation claims that may lead to the improper handling or destruction of veterans’ disability claim records.

1.8 Establish VA-Wide Ombudsman Office

VA should quickly establish the new Ombudsman office, authorized by Congress this year, to handle concerns about VA from veterans and family members.  All of VA’s “Seamless Transition” outreach and publicity efforts should be consolidated underneath this office so that VA’s assistance to both new and existing veterans becomes first-class and consistent. 

1.9 Expand Leadership Training

The various VA branches need to be taught the roles and responsibilities of their fellow branches at VA.  VA should resume mandatory “One VA” training so every employee knows they are empowered to provide simple referrals to veterans and family members.  Some VHA employees interacting with veterans have no concept of how VBA operates, and vice-versa.  Thus, VHA employees are at a loss to explain VBA disability benefit eligibility to veterans, causing confusion and frustration among veterans. 

Section Two: Reforming VA’s Policies
VA suffers from two major problems.  First, the claims process is adversarial.  Second, VA lacks the capacity to satisfactorily serve the large number of veterans entitled to its services.  To fix these problems, VA’s policies must be changed in order so VA becomes non-adversarial and so VA maintains sufficient capacity to provide both prompt and high-quality healthcare and benefits.
Over the past 70 years, VA’s regulations were written, and reasonably so, with a goal of preventing fraud, waste, and abuse.  Currently, VA applications for healthcare and disability benefits are lengthy and complex.  In order to obtain VA healthcare or benefits, veterans must confront an adversarial system so hostile it requires brain damaged and psychologically wounded veterans to complete a 23-page disability claim form plus stacks of healthcare enrollment forms before receiving assistance.
VA’s healthcare capacity crisis was not recognized or addressed completely during the past eight years – with the exception of significant legislative reform enacted earlier this year by Congress.  Four factors have created a perfect storm of increased demand for VA healthcare and benefits.  First, VA was overwhelmed by a massive influx of Iraq and Afghanistan war veterans, including 350,000 unexpected new patients and 300,000 unexpected new disability compensation claims.  Second, VA was unprepared to accommodate large numbers of veterans from prior wars seeking care and benefits for PTSD.  Third, when scientific evidence began linking more conditions, such as diabetes and prostate cancer, with Agent Orange poisoning from the Vietnam Wars, VA was unprepared for the influx of new Agent Orange claims.   Fourth, our economic recession is forcing hundreds of thousands of veterans into already overburdened VA healthcare and claims systems.
Many of the reforms listed here agree with similar proposals originally put forth by Joseph Stiglitz and Linda Bilmes in their groundbreaking book, The Three Trillion Dollar War published earlier this year.  Here is what VA should do to reform VA’s policies that interfere with the legitimate provision of prompt and high-quality medical care and benefits to veterans and families. 

Mental Health Reforms

2.1 Implement Mental Health Strategic Plan (MHSP)

VA must fully implement its MHSP for existing and new war veterans as well as a broader plan that considers the unique needs of younger veterans, including treatment for PTSD, TBI, and sexual assault among female and male veterans.  VA must name a top executive with broad authority and responsibility to oversee the full implementation of the MHSP with a goal of reducing stigma and stemming the tide of the suicide epidemic.  Implementing the MHSP also means making sure every Iraq and Afghanistan war veteran is examined for PTSD and TBI by experts in those fields, such as psychiatrists and neurologists.  VA should advertise for veterans to seek VA care and information about these conditions.  Directors of medical centers and community based outpatient clinics should work closely with VA’s new Recovery Coordinators and Suicide Prevention Coordinators in an effort to improve the access and quality of mental healthcare.

2.2 End Discrimination Against Mental Health Patients

VA must treat physical and mental conditions equally.  When a veteran arrives at a VA medical facility reporting mental health symptoms, VA must provide prompt and high-quality care.  Ending discrimination is very important because our newer veterans have overlapping symptoms related to Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorcer (PTSD).  Never again should VA turn away suicidal veterans.  VA should develop and implement a uniform national policy on handling emergency mental health conditions.  Ending discrimination also means making sure every facility has the capacity to provide physical and mental healthcare services to both female and male veterans.

2.3 Fight Stigma Against Mental Health Conditions

Studies confirm that some veterans remain reluctant to seek mental healthcare for fear of discrimination or retaliation.  In our July 2007 testimony to the House Veterans’ Affairs Committee, VCS asked Congress to implement an anti-stigma campaign aimed at both the public and veterans.  A recent Army study reported stigma remains the number one barrier to veterans seeking treatment.  VA should also implement an anti-stigma campaign that seeks to reduce job discrimination and other challenges for veterans and their families when dealing with employers, the police, and the public.  The Department of Labor’s new web site contains information for employers about the myths associated with TBI and PTSD.

Disability Claims Reform

2.4 Overhaul Disability Laws and Regulations

With the enactment of broad legislative reform written by Rep. John Hall earlier this year, now is the time to significantly streamline VA’s disability laws and regulations.  The root cause of the enormous claims backlog is the reliance upon a patch-work of laws and regulations, some nearly 70 years old.  Although many regulations were intended to expedite claims, the cumulative impact tied VBA into knots, sometimes by increasing demand for VA healthcare and benefits.  Several recent commissions, including the Veterans Disability Benefits Commission, reviewed VA laws, regulations, and manuals and found them complex and burdensome on VA employees.  VA must form a working task force that includes veterans groups and outside academics to begin implementing needed reform. The Government Accountability Office (GAO) transition web site contains investigations and recommendations on VA’s claims backlog.  VBA, Congress, and GAO should consider using the American Medical Association’s “Guide to the Evaluation of Permanent Impairment,” released in 2007.

2.5 End Use of “Fast Letters”

VA must end the use of extra-judicial “Fast Letters” and other end-runs around laws and regulations that deprive veterans of due process rights.  The most egregious recent “Fast Letter” created an entire new level of claims review by requiring all approved claims with retroactive benefits more than $250,000 to be re-adjudicated by VA central office without any rights provided to the veteran or surviving spouse.  Previous outrageous “Fast Letters” required two signatures to approve a PTSD claim, yet only one to reject a PTSD claim, a clear form of anti-PTSD discrimination that must end.

2.6 Create a New One-Page Application

As part of the claims reform process, VA’s new leaders should create a one-page uniform application for all VA services, including healthcare and disability benefits.  When a veteran applies for any VA benefit, VA must advise the veteran about all of the benefits they have earned.  A One-Page Application will be possible when VA demands and receives complete medical and military service records for service members.

2.7 Study Automatic Approval of Claims

VA should start a pilot program that automatically approves veterans’ disability claims.   Such a pilot program would then audit a percentage of the claims for fraud.  VA already has the authority to grant temporary disability status in some cases.  Automatic approval of claims should be reviewed closely as a method to expedite disability claims that currently take, on average, more than six months to process.  The review should determine if automatic approval should apply to most new claims since VA has approved nearly 94 percent of all Iraq and Afghanistan war veterans’ disability claims

2.8 Review Personality Disorder Discharges (PDD)

In our July 2007 testimony before the House Veterans’ Affairs Committee, VCS urged Congress to order the VA to review all denied healthcare and benefits claims involving PDD since September 2001.  As part of the claims reform process, VA should review these claims and assist the veterans involved because the DoD illegally discharged as many as 22,000 Iraq and Afghanistan war veterans with PDD, even though military regulations prohibit it.  Many of the veterans were actually diagnosed with TBI and/or PTSD.   This review is required because an October 31, 2008, Government Accountability Office report (GAO-09-31) confirmed the military continues to improperly discharge veterans with a personality disorder discharge.

2.9 Automatically Approve TBI Claims

According to the Defense and Veterans Brain Injury Center, and a recent RAND study, up to 20 percent of our Iraq and Afghanistan war veterans are at risk for TBI due to roadside bomb blasts.  For the 1.8 million deployed, that means as many as 360,000 recent war veterans may have TBI.  The military does not document all blast exposures.   Therefore, VA remains unable to process accurate and complete disability claims for TBI.  As part of the claims reform process, VA’s new Secretary, under existing rule-making authority, should expand VA’s new TBI regulations so a veteran deployed to Iraq or Afghanistan and diagnosed with TBI may be granted automatic VA disability compensation.

2.10 Automatically Approve PTSD Claims

According to RAND, 18 percent of our Iraq and Afghanistan war service members, or 324,000, are estimated to have PTSD.  In July 2007, VCS urged Congress to pass legislation to automatically approve disability claims for veterans diagnosed with PTSD.  As of late 2008, VA had diagnosed 75,850 veterans with PTSD, yet VA had granted only 38,448 veterans’ disability benefits for PTSD.  VA’s new Secretary can use VA rule-making to promulgate new regulations, similar to those proposed for TBI, to grant a presumption of service connection for Iraq and Afghanistan war veterans diagnosed with combat-related PTSD by VA or private psychiatrists or psychologists.  VA recently began automatically approving PTSD claims for new war veterans where DoD diagnosed PTSD.
Automatic Enrollment for VA Healthcare and Benefits

2.11 Demand Military Records

VA must demand that DoD provide both VA and service members a full electronic copy of their military and medical records at discharge.  The transition process from service member to veteran is now a mind-numbing maze of overlapping processes and stacks of bewildering applications and paperwork, resulting in an entrenched system that ultimately grinds veterans in an unrelenting sausage machine.  VA leaders currently meet with senior DoD leaders to discuss veterans’ transition from military medical and benefit programs to VA, yet they have failed to resolve this major problem except for a very small number of very seriously wounded Iraq and Afghanistan war casualties.  VA and DoD must immediately implement a plan that transfers DoD records to VA on all veterans in a format that VA can use to provide accurate and timely medical care and benefit decisions. 

2.12 Automatic Enrollment for VA Healthcare

Once the military has provided complete and current medical and service records to VA, then VA should automatically enroll every newly discharged veteran into VA’s healthcare system.  VA wastes time and money verifying veterans’ military service and medical conditions.  This proposal would also eliminate much of the application paperwork now required of newer veterans when enrolling in VA.  DoD and VA must also work together to define the Iraq and Afghanistan war zones so there is no confusion on who is eligible for the five years of free VA healthcare for deployed veterans. 

2.13 Expand VA’s Benefits Delivery at Discharge (BDD)

VA must expand BDD to every service member, especially those ordered to active duty from the Reserve or National Guard.  An expanded BDD should include a review of potential eligibility for Traumatic Servicemembers Group Life Insurance (TSGLI) and all other VA benefits.  The military should comply with the 1998 Force Health Protection law and provide service members with pre- and post-deployment medical exams.  Every new service member receives a complete medical exam when entering the service, yet not all receive an exit medical exam.  VA should insist that DoD conduct all required exams, especially in light of the military’s use of experimental drugs and service members’ known exposures to toxins, such as those from the Balad, Iraq base burn pit.   Full access to military records and an expanded BDD may reduce the enormous disparity in claims activity and outcomes among Iraq and Afghanistan war veterans.  According to June 2008 VA data, National Guard and Reserve veterans were half as likely as Active Duty to file a VA disability compensation claim.  However, National Guard and Reserve were twice as likely as Active Duty to be granted VA disability benefits.

2.14 Automatic Enrollment for Life Insurance

When entering the military, all new service members should be automatically enrolled for the maximum amount of life insurance available through Servicemembers Group Life Insurance (SGLI).  While on active duty, Reserve, or National Guard status, the military should pay the premium as an employee benefit.  The VA has denied SGLI benefits to at least one National Guard service member on the grounds that the service member did not pay monthly premiums while on inactive status shortly after serving in the Iraq War.  Upon discharge, VA should automatically enroll all new veterans in Veterans Group Life Insurance (VGLI), and the military should pay the first year of life insurance premiums as a transition benefit. New research shows an increase in deaths among returning veterans.

Other Important VA Reforms

2.15 Zero Tolerance for Homelessness

VA must seek to end homelessness among our veterans by increasing capacity and increasing per diem payments.  VA estimates there are 150,000 homeless veterans.  VA Grant per diem program funds just 8,500 beds, and the Department of Housing and Urban Development funds another 10,000 rental vouchers.  These numbers are unacceptable.  Further, VA must increase the $34.50 per diem payment to meet the realistic costs of housing, food, and assistance.  And VA should eliminate deductions for supportive services provided by others.  Stabilizing homeless veterans remains a key goal, as many are chronically homeless and have co-occurring mental health, substance abuse and physical challenges.  VA should be prepared to house additional homeless veterans due to the economic recession and the return of Iraq and Afghanistan war veterans with PTSD and TBI.

2.16 Expand Capacity for Women Veterans

VA should expand its healthcare capacity for women veterans.   Recent reports documenting fifteen percent or more of female service members were sexually assaulted while in the military.  This tragic epidemic of rape in our military is leading to more women seeking VA healthcare and disability benefits for physical and emotional trauma.   For the first time in history, a large number of female combat veterans are returning home from war.  According to July 2008 DoD data, nearly 200,000 women have deployed to the Iraq and Afghanistan war zones.  In addition to the trauma of rape by fellow service members, our women veterans also face the same level of combat stress that can lead to PTSD.  In addition, our women veterans may suffer different adverse health outcomes than men when exposed to battlefield toxins.

2.17 Expand Capacity for Priority 8 Veterans

VA’s new Secretary should work with Congress to grant access to VA for all eligible veterans, including the Priority Group 8 veterans excluded by the past Administration.  VA needs a detailed plan to implement this significant policy change.  VA must identify the number of existing and potential new veteran patients, the types of care the veterans would need, and the locations where veterans can be expected to seek care.  VA needs to determine if there are any economies of scale for treating more veterans for a wider array of conditions.  This recommendation may have the greatest impact on VA’s capacity because as many as two million veterans may utilize VA medical care if VA changes this policy.

2.18 Mandatory Voting Assistance

In recognition of their dedication to protect and defend our Constitution, veterans residing in VA medical facilities should be given voter registration and voting assistance.  In early 2008, VA issued an unconscionable ban on voter registration and voting assistance from election officials and non-partisan groups.  After a tremendous outcry from veterans, the public, and Congress, VA lifted the ban in September 2008.  In 2009 and into the future, VA must allow elections officials and non-partisan organizations into VA facilities for the purpose of registering voters and assisting with absentee voting, with reasonable restrictions on time, place, and manner.  VA should take pro-active steps so that all new nursing home residents are registered to vote when they move into a VA facility.

2.19 Phase Out Faith Based Programs

VA must cease violating our Constitution by funding religious groups, no matter how well intended some may believe these programs to be.  Faith Based organizations, under new rules recently pushed through by the exiting Administration, may now openly discriminate in their hiring, and that is wrong.  The discrimination in employment may eventually extend to discrimination in the provision of services to veterans and families.  No veteran should ever be placed in a position of wondering if the assistance provided to them may require participation in or conversion to a religion.  Faith Based programs should be reviewed, and then programs should be incorporated into existing non-religious programs or eliminated.
2.20 Follow the Law

VA must abide by the current laws and common sense.  VA should adhere to rulings made by the U.S. Court of Appeals for Veterans Claims.  Furthermore, veterans who believe they were denied or delayed healthcare should be given clear written guidance on how to file appeals.  Currently, there is no national policy, and most veterans are unaware they may appeal a denial or delay in care.

2.21 Enact a Veterans’ Bill of Rights

The late VA Secretary Jesse Brown got it right: he led the charge that VA should put our veterans first.  Expectations should be higher.  VA should quickly adopt a Veterans’ Bill of Rights so everyone knows VA puts our veterans first (the proposed text is located at the end of this report).

Section Three: Reforming VA’s Budget
VA’s budget and appropriations must be removed from the current system of discretionary spending resulting in unpredictable and incomplete funding.

VCS believes Veterans’ health care is an entitlement.  Full mandatory funding for the Veterans Health Administration is critical for the health of our veterans and for the long-term stability of VA.  With mandatory full funding, VA will then have the trained and dedicated staff to streamline policies and reduce the claims backlog and patient waiting lists.
How bad is VA’s funding problem?  In early 2005, VA leaders testified before Congress that it had adequate resources. A few months later, VA leaders came, hat in hand, to request billions of dollars in emergency funding due to incomplete budget projections caused in part from a surge in casualties from the Iraq and Afghanistan wars.  In 2007 and 2008, VA leaders testified before Congress that only five percent of veterans waited more than one month to see a VA doctor.  In sharp contrast, VA’s internal watchdog, the Office of the Inspector General, found that a quarter of VHA patients waited more than one month for an appointment.  Similarly, even after hiring thousands of more VBA claims processors, hundreds of thousands of our veterans still wait on average more than six months for an initial decision about a disability compensation claim.  If a veteran appeals a VA decision, three or four more years are added to the wait.

The best way to eliminate the healthcare and benefit delays is full mandatory funding.  The choice is clear: VA can treat and compensate emerging symptoms of brain damage and post traumatic stress now, when it is more effective and less expensive, or our veterans, VA, and our nation can face a significant social catastrophe among veterans and their families years down the road.

VA Budget Recommendations

3.1 Enact a Two-Year Budget

VA needs advanced planning. There should be a two-year budget cycle that allows VA to plan at least one year in advance.  In addition to reforms suggested by other veterans’ groups, VCS strongly urges VA to retain seasoned academic experts to advise VA on long-range economic and actuarial forecasts for healthcare and benefit use.  VA should also retain academic experts to implement the overhaul of VA’s broken disability compensation system, especially for benefits dealing with the diminished quality of life for disabled veterans.

3.2 Create a Veterans Benefit Trust Fund

Congress should set up a Veterans Benefit Trust Fund, as proposed by Harvard Professor Linda Bilmes.  The Fund should be set up and “locked,” so that veterans’ health and disability entitlements are fully funded as obligations occur.

3.3 Bottom-Up Budgeting

VA’s budget process must become bottom-up, where hospitals and clinics advise VA headquarters about their needs.  This would eliminate the top-down political interference from the White House and Office of Management & Budget (OMB) with VA’s budget.  As mentioned earlier, this means VA budgeting and appropriations should include a detailed plan to phase in care for all Priority Groups, including Priority Group 8 veterans excluded in the past Administration.  This also includes asking all VA facility directors to advise VA Central Office of their full staffing requirements to provide prompt healthcare and benefits. 

3.4 Training, Training, and Training

VA’s planned growth and overhaul require new thinking, and this means more funding for nationalized and standardized training for all employees.  For example, a primary goal at VBA would be to eliminate large differences in rating outcomes at offices processing disability compensation claims.  Similarly, all new political appointees need a broader understanding about all of VA’s healthcare services and benefits, and existing employees need training in the new streamlined policies that put our veterans first.  In a related manner, VA should prepare succession plans as employees retire.  VA should also offer incentives for VA employees to improve their skills, remain at VA, and seek promotions.  There should also be strong incentives for non-VA employees to enter the VA workforce at all levels.

Section Four: A Final Word – Transparency
Beyond the three key elements needed to reform and modernize VA – pro-active leaders, policy reform, and mandatory funding – our new VA leaders must be transparent in their on-going work as well as their plans. 
In early 2008, CBS Evening News revealed that top VA officials deliberately withheld information from reporters about the serious suicide epidemic among our veterans.  VA’s leading mental health official wrote an e-mail with the words, “Shh!,” suggesting that VA keep the enormous suicide epidemic under wraps.   VA had told reporters that less than 800 veterans under VA care attempted suicide each year.  However, the real number of attempted suicides each year was 12,000 – 15 times higher than what VA originally told reporters.  VA knew, but did not confirm to Congress or reporters, that more than 5,000 veterans complete a suicide each year.

Many other highly disturbing facts about VA were revealed during the trial in our lawsuit, Veterans for Common Sense v. Secretary James Peake.  VCS has incorporated many lessons learned from that lawsuit and our extensive Freedom of Information Act campaign into this report.

Transparency means that all VA employees, especially those at the top, follow ethics laws and do their utmost to provide all of the relevant accurate information requested by Congress, veterans, veterans’ groups, the press, and the public.
VA is now embroiled in a serious nationwide scandal over the improper shredding of up to 500 veterans’ claims files and supporting documents at dozens of VA regional offices.  The full extent of the crisis remains unknown, as top VA leaders have not held a press conference or released documents about the situation.  When serious problems emerge, top VA leaders should pro-actively address the problem with staff, Congress, and the public.

In conclusion, the transition period from November 5 through January 20 provides ample time for a new President to organize an expert team to implement the massive overhaul VA desperately needs so fewer veterans fall through the cracks.  Our bottom-line goal as a nation must be to honor the “Square Deal” President Teddy Roosevelt promised and that President Franklin Delano Roosevelt enacted with his “GI Bill” so our veterans receive prompt and high-quality medical care and benefits.

VA can and should evolve – VA can no longer do “business as usual” with only marginal changes.  When we pull together as a Nation, we can learn from the mistakes of the past and we can offer hope and recovery to our veterans and their families.

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A Veterans’ Bill of Rights
Preamble:  It is the intent of U.S. Government to honor the service and personal sacrifices of our veterans and their families by ensuring that they have fair and timely access to all the benefits to which they are entitled, including medical care, death and disability compensation, educational assistance, job training, housing, and pensions (“VA Benefits”).  To this end,
1.      Congress recognizes that all veterans and their families now have and always have had a Fifth Amendment property interest in the receipt of all VA Benefits.
2.      Veterans and their families shall have an unfettered access to retain attorneys at their own expense, and the Fee Prohibition, 38 U.S.C. § 5904(c)(l), shall be abolished.
3.      Veterans and their families should have full rights to judicial review in Article III courts, and the Court of Appeals for Veterans Claims should be abolished, with a transition plan for implementation.
4.      Veterans and their families shall have the right to full disclosure of all information affecting their claim for benefits.  This includes the right to subpoena documents or records from all federal agencies, and all federal agencies shall treat veterans’ document or record requests expeditiously and shall produce all responsive documents within 60 days.
5.      Veterans and their families shall have the right to call any VA employees as witnesses at any regional office hearings related to veterans’ benefits, including treating physicians or other medical personnel and anyone else who has made any determination in connection with a claim.
6.      Congress and the Courts shall take all necessary measures to insure that the VA delivers on its commitments to provide health care to veterans, and the VA’s practice of denying care to veterans based on Priority Group is abolished.
7.      The VA shall adopt remedies and procedures to timely address cases of alleged denial of or unreasonable delays in providing health care, including notice, an opportunity to call witnesses, and a hearing to any veteran contesting such denial, as well as an expedited procedure in cases of emergency.
8.      The VA shall award interest at the federal rate on all retroactive awards of any form of death or disability compensation or pension.
9.      Congress shall guarantee and appropriate all funds necessary to provide all veterans benefits in accordance with the VA’s budgets.

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