Veterans Committee Goals
2021 TMC Veterans Committee Legislative Goals
The primary focus of these goals reflects recommendations to the Department of Veterans Affairs (VA) on disability compensation, health care, and other benefits administered through the VA Benefits Administration (VBA), the Veterans Health Administration (VHA) and the National Cemetery Administration (NCA) authorized under Title 38 of the U.S. Code.
GUIDING PRINCIPLES FOR VETERANS' HEALTH CARE AND BENEFITS
TOP AREAS OF FOCUS
Service-Connected Conditions and Toxic Exposure
Claims and Appeals Backlog
Issue: Due to the COVID-19 pandemic and the Veterans Benefit Administration’s (VBA) halting of Compensation and Pension (C&P) exams across the country, the implementation of PL-115-55, The Veterans Appeals Improvement and Modernization Act of 2017, has become ever more critical. While VBA was on track to lower its backlog of claims and appeals, COVID-19 has hampered those efforts. Currently, the claim and appeal backlogs are increasing, and the implementation of PL-115-55 has slowed.
TMC Position: Engage with VA in the implementation of the Veterans Appeals Improvement and Modernization Act of 2017 (P.L. 115-55) to improve the claims and appeals process. Support investment in software and hardware upgrades for claims management. Preclude 'unlicensed' individuals from taking fees for representing veterans' claims.
Service-Connected Occupational Health and Environmental Hazard Exposures
Issue: Toxic exposure-related illnesses are a growing health concern among the veteran and the military community. For the current generation, burn pits are the most common form of exposure to toxicants. GAO released a report regarding the effects of burn pits and other toxicants on the veteran and military communities on December 9, 2020. The GAO report highlighted areas that the VBA could focus on to better provide VA disability benefits related to exposure to burn pits and other hazardous materials for those serving in Southeast Asia.
TMC Position:
Issue: Currently, there are a few presumptive disabilities for toxic exposure and other illnesses related to service in Southeast Asia. Afghanistan is not included in the Southeast Asia region, but many of the diseases are similar.
TMC Position: Congress and VA consider the inclusion of Afghanistan service as Gulf War service for the application of all of the provisions contained in 38 C.F.R. § 3.317.
Caregivers and Aging Veterans
Issue: VA faces many challenges in providing care and services to the increasingly aging veteran population. The pandemic has further strained VA resources in both staffing and funding of services for older veterans. VA must take steps to maintain services as well as be innovative in meeting the additional challenges of the pandemic on older veterans. COVID-19 exposed the increased risks in nursing home or long-term care facilities and VA must apply lessons learned to meet the needs of these residents.
VA also issued regulations effective October 1, 2020, to implement the expansion of VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) to certain eligible veterans from World War II, Korea, and Vietnam. TMC is concerned that VA is restricting eligibility, removing current participants from the program and not being consistent criteria in determining eligibility.
TMC Position: Expand access to caregiving, palliative, geriatric, and extended care programs and services for veterans and wounded warriors and their caregivers.
Education, Training, Employment, and Protections
Education
Issue: As our economy and employment evolve, so do the education needs for transitioning service members, the GI Bill must continually be updated when necessary. Student veterans tend to be older, are more likely to have children, and have a disability. Since the inception of the GI Bill, it has been a vital tool for recruitment and retention by the uniformed services and essential for helping make the transition to civilian life. Research shows education benefits continue to be one of the top reasons for joining the military.
TMC Position:
Training
Issue: Service members who leave are not always looking to return to a standard education program. Providing for their unique needs and translating their skills to the civilian sector can support a quick assimilation with the right Veterans Readiness and Employment (VR&E) programs.
TMC Position:
Employment
Issue: Veteran unemployment spiked along with the rest of the nation, peaking at levels above the Great Recession. While this number has come down significantly, as it stands, veterans have lost over five years of progress at reducing unemployment. The current 6.4% unemployment is double that from a year ago.
TMC Position:
Protections
Issue: Veterans are often targeted by predatory corporations and institutions. Schools offer students valuable education options, but reforms are needed to prevent schools from aggressively targeting veterans, service members, families, and survivors for their earned educational benefits. Additionally, reports show veterans use high-cost loans at four times the rate of civilians. Protections need to be enacted and strengthened to ensure the veterans are supported after leaving service.
TMC Position:
Suicide Prevention and Mental Health
High Veteran Suicide Rates
Issue: Much has been reported about how much higher veteran suicide rates are compared to the non-veteran population – 150% higher overall for veterans, and 250% higher for female veterans. For younger veterans, the rates are even more disproportionate, and climbing even higher. For example, while the overall veteran suicide rate rose 30% from 2005 to 2017, the 18-34-year-old veteran suicide rate rose 77%. Further, while 18-34-year-old veterans make up only 10% of the veteran population, they represent 94% of the increase in veteran deaths.
TMC Position: Expand research into core causes, risk factors, and protective factors for veteran, caregiver, and service member suicide:
The VA Fiduciary Program and Veterans’ Constitutional Rights
Issue: The VA’s Fiduciary Program allows VA rating officials and health care providers, without any judicial oversight, to involuntarily refer a veteran to the fiduciary program. Once referred to the program, the veteran has 60 days to prove to the VA they are, in fact, competent to handle their VA benefits – the burden of proof falls to the veteran to prove they are competent. Once placed in the fiduciary program, the veteran is then reported by VA to the Department of Justice to be placed on the National Instant Criminal Background Check System (NICS) as a “mental defective”, after which the veteran is informed, they are no longer allowed to purchase or possess firearms.
By setting up such disincentives for veterans to seek mental health care from the VA, the VA is driving the very veterans who should be seeking mental health care away from the system. Because of the fear of losing their firearms, which 46% of veterans own, many veterans may not seek the mental health care they need. Over half the post-9/11 combat deployed veterans who need mental health care treatment do not use either VA or non-VA mental health care services.
TMC Position: Reform the VA Fiduciary Program so that:
Passage of S. 785, The Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (Public Law No: 116-171).
Issue: The legislation is a comprehensive law to address a wide variety of veteran suicide prevention measures, and will require extensive regulatory and policy action by the VA to fully implement, including:
TMC Position: Ensure the full implementation of S. 785, The Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019.
WOMEN AND MINORITY VETERANS
Issue: Women transitioning out of uniform face unique challenges because of their experiences in service. Women veterans are also the fastest growing population of veteran patients, according to the Department of Veterans Affairs (VA). VA expects women health care enrollees to grow from the current 10% to as high as 19% by 2025. VA has a comprehensive primary care strategy model it has successfully implemented; however, there remains several administrative, operational, governance, and organizational gaps preventing women from accessing the quality health care and services they need.
Additionally, according to GAO, VA has taken steps to reduce disparities in health care outcomes linked to race and ethnicity but lacks the mechanisms to measure progress and ensure accountability. VA funds research efforts that have identified disparities in health care outcomes involving minority veterans but rely on data that department officials and researchers noted have weaknesses in completeness and accuracy.
Despite recognizing weaknesses related to the quality of race and ethnicity data, VA has not implemented corrective actions to address them. COVID-19 has placed a spotlight on the barriers and disparities facing women and minority veterans when seeking access to health care and services through VA.
TMC Position
The primary focus of these goals reflects recommendations to the Department of Veterans Affairs (VA) on disability compensation, health care, and other benefits administered through the VA Benefits Administration (VBA), the Veterans Health Administration (VHA) and the National Cemetery Administration (NCA) authorized under Title 38 of the U.S. Code.
GUIDING PRINCIPLES FOR VETERANS' HEALTH CARE AND BENEFITS
- Promote national recognition and understanding of military service and how health care and benefits are earned through service in uniform in defense of the Nation and are qualitatively different from “entitlement” or “social welfare” programs.
- Oppose deficit-driven or political decisions that would erode foundational services and benefits delivered through the VA or decisions which would align earned veterans’ medical or other benefits with unrelated federal or civilian benefit programs.
- Oppose proposals that would eliminate or diminish veterans’ health care and other benefits to alleviate national economic or federal agency woes.
TOP AREAS OF FOCUS
- Service-Connected Conditions and Toxic Exposure
- Caregivers and Aging Veterans
- Education, Training, Employment, and Protections
- Suicide Prevention and Mental Health
- Women and Minority Veterans
Service-Connected Conditions and Toxic Exposure
Claims and Appeals Backlog
Issue: Due to the COVID-19 pandemic and the Veterans Benefit Administration’s (VBA) halting of Compensation and Pension (C&P) exams across the country, the implementation of PL-115-55, The Veterans Appeals Improvement and Modernization Act of 2017, has become ever more critical. While VBA was on track to lower its backlog of claims and appeals, COVID-19 has hampered those efforts. Currently, the claim and appeal backlogs are increasing, and the implementation of PL-115-55 has slowed.
TMC Position: Engage with VA in the implementation of the Veterans Appeals Improvement and Modernization Act of 2017 (P.L. 115-55) to improve the claims and appeals process. Support investment in software and hardware upgrades for claims management. Preclude 'unlicensed' individuals from taking fees for representing veterans' claims.
Service-Connected Occupational Health and Environmental Hazard Exposures
Issue: Toxic exposure-related illnesses are a growing health concern among the veteran and the military community. For the current generation, burn pits are the most common form of exposure to toxicants. GAO released a report regarding the effects of burn pits and other toxicants on the veteran and military communities on December 9, 2020. The GAO report highlighted areas that the VBA could focus on to better provide VA disability benefits related to exposure to burn pits and other hazardous materials for those serving in Southeast Asia.
TMC Position:
- Implement the September 2016 Government Accountability Office Report (GAO-16-781) recommendation for DoD and VA to examine the relationship between direct burn pit exposure and potential long-term health-related issues as well as the National Academies of Sciences, Engineering, and Medicine's Report of 2011, which suggested the need to evaluate the health status of service members from their time of deployment over many years.
- Advocate for presumptive process reforms to increase input from veterans organizations and regular studies of all toxic exposures
- Support the addition of illnesses as presumptives when the scientific burden has been met.
Issue: Currently, there are a few presumptive disabilities for toxic exposure and other illnesses related to service in Southeast Asia. Afghanistan is not included in the Southeast Asia region, but many of the diseases are similar.
TMC Position: Congress and VA consider the inclusion of Afghanistan service as Gulf War service for the application of all of the provisions contained in 38 C.F.R. § 3.317.
Caregivers and Aging Veterans
Issue: VA faces many challenges in providing care and services to the increasingly aging veteran population. The pandemic has further strained VA resources in both staffing and funding of services for older veterans. VA must take steps to maintain services as well as be innovative in meeting the additional challenges of the pandemic on older veterans. COVID-19 exposed the increased risks in nursing home or long-term care facilities and VA must apply lessons learned to meet the needs of these residents.
VA also issued regulations effective October 1, 2020, to implement the expansion of VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) to certain eligible veterans from World War II, Korea, and Vietnam. TMC is concerned that VA is restricting eligibility, removing current participants from the program and not being consistent criteria in determining eligibility.
TMC Position: Expand access to caregiving, palliative, geriatric, and extended care programs and services for veterans and wounded warriors and their caregivers.
- Increase telehealth services to offset the lack of in-person visits and care due to pandemic restrictions for older veterans needing care.
- Require VHA to develop measurable goals for its efforts to address key challenges in meeting the demand for long-term care such as workforce shortages, geographic alignment of care particularly for rural veterans, and limitations in providing specialty care.
- Expand long-term residential or home health care program options through community partnerships and assure community partners have capacity to meet need.
- Strengthen VHA’s engagement in monitoring and assessing State Veterans Homes through documentation of failures in meeting quality standards during facility inspections and reporting resolution of documented discrepancies.
- Assure VA uses consistent criteria in making eligibility decisions for the expanded caregiver program. Identify VA’s efforts to restrict eligibility and or remove existing participants from the program. Accomplish by monitoring and addressing legislative discrepancies during the implementation of VA’s Program of Comprehensive Assistance for Family Caregivers. Hold VA accountable to ensure programs meet congressional intent.
Education, Training, Employment, and Protections
Education
Issue: As our economy and employment evolve, so do the education needs for transitioning service members, the GI Bill must continually be updated when necessary. Student veterans tend to be older, are more likely to have children, and have a disability. Since the inception of the GI Bill, it has been a vital tool for recruitment and retention by the uniformed services and essential for helping make the transition to civilian life. Research shows education benefits continue to be one of the top reasons for joining the military.
TMC Position:
- Urge proportional upgrades to the Title 10 Montgomery GI Bill program to keep pace with the cost of education, and to transfer 10 USC 1606 into Title 38 as sub-chapter of Forever GI Bill to finalize sunsetting the Montgomery GI Bill.
- Ensure schools spend VA and DoD education program funds on serving veterans and service members.
- Ensure sufficient funding and oversight to modernize VA’s GI Bill information technology system.
Training
Issue: Service members who leave are not always looking to return to a standard education program. Providing for their unique needs and translating their skills to the civilian sector can support a quick assimilation with the right Veterans Readiness and Employment (VR&E) programs.
TMC Position:
- Strengthen the VR&E program to provide consistent and predictable benefits for veterans with disabilities.
- Establish a similar Monthly Housing Allowance (MHA) for VR&E students to that of the Post-9/11 GI Bill.
- Promote entrepreneurship within VR&E and outreach to other federal entities to advance training opportunities to increase success rates.
- Continue to improve and modernize the case management system. Increase staffing of and comprehensive training for VR&E counselors.
- Expand VET-TEC offerings and participation for in demand jobs to high quality providers.
Employment
Issue: Veteran unemployment spiked along with the rest of the nation, peaking at levels above the Great Recession. While this number has come down significantly, as it stands, veterans have lost over five years of progress at reducing unemployment. The current 6.4% unemployment is double that from a year ago.
TMC Position:
- Veterans’ Preference. Authorize veterans’ preference appeal rights for veterans employed by VA or other federal, state, and local government agencies. Oppose legislation restricting preference currently in law.
- Preserve and expand Public Service Loan Forgiveness which supports military recruitment and veteran hiring in public service.
- Veterans Hiring Incentives. Re-enact employer tax incentives under the VOW to Hire Heroes Act and pursue provision to increase the utilization rate.
Protections
Issue: Veterans are often targeted by predatory corporations and institutions. Schools offer students valuable education options, but reforms are needed to prevent schools from aggressively targeting veterans, service members, families, and survivors for their earned educational benefits. Additionally, reports show veterans use high-cost loans at four times the rate of civilians. Protections need to be enacted and strengthened to ensure the veterans are supported after leaving service.
TMC Position:
- Extend the “90-10” ratio of federal aid to include VA and DoD education benefits.
- Protect VA and DoD education program benefits from abuses and fraudulent practices targeting veterans and service members.
- VA Debt Collection. Eliminate inaccurate debt reporting and collection by the VA and improve the department’s practices to be in line with the Federal Debt Collection Practices Act.
- Financial and Legal Protections. Support continuous review and upgrades of the Servicemembers’ Civil Relief Act (SCRA), including elimination of “forced arbitration” clauses in contracts that nullify SCRA’s protections. Increase lending protections for uniformed service members, veterans, and family members while maintaining access to quality credit. Strengthen re-employment rights for operational reservists who support military missions on Title 10 orders.
- Exempt GI Bill from being considered income in any need-based federal student aid calculations.
Suicide Prevention and Mental Health
High Veteran Suicide Rates
Issue: Much has been reported about how much higher veteran suicide rates are compared to the non-veteran population – 150% higher overall for veterans, and 250% higher for female veterans. For younger veterans, the rates are even more disproportionate, and climbing even higher. For example, while the overall veteran suicide rate rose 30% from 2005 to 2017, the 18-34-year-old veteran suicide rate rose 77%. Further, while 18-34-year-old veterans make up only 10% of the veteran population, they represent 94% of the increase in veteran deaths.
TMC Position: Expand research into core causes, risk factors, and protective factors for veteran, caregiver, and service member suicide:
- Expand government and non-government funding around veteran, caregiver, and service member suicide rates, their possible causes, and the most significant risk and protective factors for each of these populations.
- Have the VA and DoD both release the underlying raw data surrounding their annual suicide reports (properly anonymized to protect individual victims’ identities).
- Have DoD resume reporting veteran combat deployment data to VA and for VA to resume reporting on combat deployment data for suicide victims.
The VA Fiduciary Program and Veterans’ Constitutional Rights
Issue: The VA’s Fiduciary Program allows VA rating officials and health care providers, without any judicial oversight, to involuntarily refer a veteran to the fiduciary program. Once referred to the program, the veteran has 60 days to prove to the VA they are, in fact, competent to handle their VA benefits – the burden of proof falls to the veteran to prove they are competent. Once placed in the fiduciary program, the veteran is then reported by VA to the Department of Justice to be placed on the National Instant Criminal Background Check System (NICS) as a “mental defective”, after which the veteran is informed, they are no longer allowed to purchase or possess firearms.
By setting up such disincentives for veterans to seek mental health care from the VA, the VA is driving the very veterans who should be seeking mental health care away from the system. Because of the fear of losing their firearms, which 46% of veterans own, many veterans may not seek the mental health care they need. Over half the post-9/11 combat deployed veterans who need mental health care treatment do not use either VA or non-VA mental health care services.
TMC Position: Reform the VA Fiduciary Program so that:
- The burden of proof for determining a veteran is incompetent to handle their own veteran’s benefits is placed upon the VA and not upon the veteran.
- De-link a fiduciary consideration or determination and reporting the veteran to the NICS database or any other law enforcement action.
Passage of S. 785, The Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019 (Public Law No: 116-171).
Issue: The legislation is a comprehensive law to address a wide variety of veteran suicide prevention measures, and will require extensive regulatory and policy action by the VA to fully implement, including:
- Improvements to military to civilian transition programs,
- A $175 million grant program for community veteran suicide prevention programs,
- Study on complementary and integrative health treatments,
- Analysis of the impact of opioids on veteran suicide risks,
- GAO reviews of both VA mental health staffing and VA efforts to manage particularly at-risk veteran suicide program,
- Develop a clinical provider treatment toolkit and revise its Clinical Practice Guidelines,
- Develop precision medicine initiatives for brain and mental health biomarkers,
- Expand VA funding of academic research,
- Broaden the review and execution of the VA’s Readjustment Counseling Service,
- Expand VA support services to women veterans,
- Award grants for expanding telehealth capabilities, and
- Review the expanded use of HBOT treatments.
TMC Position: Ensure the full implementation of S. 785, The Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019.
WOMEN AND MINORITY VETERANS
Issue: Women transitioning out of uniform face unique challenges because of their experiences in service. Women veterans are also the fastest growing population of veteran patients, according to the Department of Veterans Affairs (VA). VA expects women health care enrollees to grow from the current 10% to as high as 19% by 2025. VA has a comprehensive primary care strategy model it has successfully implemented; however, there remains several administrative, operational, governance, and organizational gaps preventing women from accessing the quality health care and services they need.
Additionally, according to GAO, VA has taken steps to reduce disparities in health care outcomes linked to race and ethnicity but lacks the mechanisms to measure progress and ensure accountability. VA funds research efforts that have identified disparities in health care outcomes involving minority veterans but rely on data that department officials and researchers noted have weaknesses in completeness and accuracy.
Despite recognizing weaknesses related to the quality of race and ethnicity data, VA has not implemented corrective actions to address them. COVID-19 has placed a spotlight on the barriers and disparities facing women and minority veterans when seeking access to health care and services through VA.
TMC Position
- Eliminate health disparities for women and minority veterans to ensure health equity in accessing timely, sensitive, and quality benefits through VA.
- Lessons learned during the COVID-19 national pandemic should be identified and applied to accelerate VA’s efforts to eliminate disparities and achieve health equity to meet the unique needs of high-risk veteran groups.
- Pursue joint VA-DoD research and health care studies to determine the impact of service on the health of women and minorities.
- Secure additional funding for research, treatment, data management, medical care, and staffing to provide gender-specific and culturally competent care.
- Redesign VHA delivery system and facilities to remove barriers to ensure privacy and a safe and inclusive environment for women and minority veterans accessing care, including veterans with special needs such as: those living in rural areas; homebound; aging; amputee; cognitively and physically impaired, and veterans with cultural and language differences.
- Expand VA sexual assault/harassment prevention efforts to eliminate problems enterprise wide.