Senate Veterans’ Affairs Committee Issues Testimony From Paralyzed Veterans of America
"Chairman Isakson, Chairman Roe, and members of the Committees, I appreciate the opportunity to present
"Today, I come before you with our views on the current state of veterans' programs and services, particularly those that impact our members--veterans with spinal cord injury or disease (SCI/D). Our concerns and policy recommendations are particularly important in light of the continuing discussion about reforming the delivery of veterans' health care. As the Committees and the Administration advance reforms to the
"Additionally, we thought it would be appropriate to reflect on some of the important achievements in 2017. However, even in the case of some of those legislative accomplishments, significant work remains to ensure proper implementation of those new requirements.
BACKGROUND
"Our organization was founded in 1946 by a small group of returning World War II veterans, all of whom were treated at various military hospitals throughout the country as a result of their injuries. Realizing that neither the medical profession nor government had ever confronted the needs of such a population, these veterans decided to become their own advocates and to do so through a national organization.
"From the outset, PVA's founders recognized that other elements of society were neither willing nor prepared to address the full range of challenges facing individuals with a spinal cord injury, whether medical, social, or economic. They were determined to create an organization that would be governed by the members themselves and address their unique needs. Being told that their life expectancies could be measured in weeks or months, these individuals set as their primary goal to bring about change that would maximize the quality of life and opportunity for all veterans and individuals with spinal cord injury--it remains so today.
"Over the years, PVA has established ongoing programs in service representation to secure our members' and other veterans benefits;
"Today, PVA is the only congressionally chartered veterans service organization dedicated solely to the benefit and representation of veterans with spinal cord injury or disease.
PROTECT SPECIALIZED SERVICES
"Preserving and strengthening the
"Many advocates of greater access to care in the community also minimize, or ignore altogether, the devastating impact that pushing more veterans into the community would have on the larger
"With this in mind, we strongly advocate for
EXPAND ELIGIBILITY FOR VA CAREGIVER SUPPORT SERVICES
"The current Program of Comprehensive Assistance for Family Caregivers is only available to veterans seriously injured due to their military service on or after
"Caregivers are the most important component of rehabilitation and eventual recovery for veterans with catastrophic injuries. Their wellbeing directly impacts the quality of care veterans receive. The caregiver program is a clinical program intended to improve or retain a veteran's independence and wellbeing. The assistance provided to the caregivers is to enable them to provide high quality care for their disabled veteran. This is the only clinical program for service-connected disabled veterans that arbitrarily denies access by era served. For eight years,
"For decades, pre 9/11 caregivers have sacrificed in the shadows. Most have had to compromise their careers, financial security, and wellbeing. For aging veterans and their caregivers, the program supports (respite, monthly stipend, paid travel to veterans appointments) are urgently needed. Without these services the quality of care provided by the caregiver is compromised and the veteran is more likely to be placed in a long-term care facility that would be much more costly to the government. Both the exclusion of "serious illnesses and diseases," and the use of the "date of injury" as eligibility requirements for such an important clinical service are unjust and as a result, the veterans and their families suffer.
"
"We are pleased that the
FUNDING FOR THE DEPARTMENT OF VETERANS AFFAIRS
"The IBVSOs have serious concerns about the FY 2019 advance appropriations requested by the Administration and subsequently approved by
"We also believe it is necessary to consider the projected expenditures under the Choice program authority that the Administration planned in FY 2018 and how that impacts the baseline that will dictate the funding needs for FY 2019. The Administration revised the FY 2018 budget for Choice to
"For FY 2019, the IB recommends approximately
"Additionally, The Independent Budget recommends approximately
IMPLEMENTATION OF THE ANNUAL CAPACITY REPORTING MANDATE FOR SPECIALIZED SYSTEMS OF CARE
"As we have emphasized, repeatedly, the
"In addition to the inaction to hire the necessary nursing staff to meet the need in the SCI/D system of care there have been reports of reductions of both inpatient beds and staff in the acute and extended-care settings.
"Again, we call on the Committees to conduct real oversight to ensure that the
"In October of 2017, the VSO community became aware of
"
"We will continue to monitor this action as the consequences for some key programs in
TITLE 38 PROTECTIONS FOR COMMUNITY CARE
"PVA is deeply concerned about the exclusion of Title 38 protections in the conversations regarding expansion of community care. When veterans receive treatment at a
"This is simply unacceptable.
GREATER FOCUS NEEDED TO IMPROVE PROSTHETICS SERVICES
"The
"The
"The Automobile Adaptive Equipment (AAE) program is a prime example of all that is wrong with
"Automobile Adaptive Equipment is essential to the mobility and health of disabled veterans. Unfortunately, the actions of
"Meanwhile, the Clothing Allowance reimbursement program--a common benefit for veterans with catastrophic disabilities, particularly those who use mobility equipment--was rewritten with some input from VSOs. Unfortunately, it was finalized and distributed to the field without a review by VSOs. The document contains flaws that cause significant problems with implementation every year. The
"Prosthetics equipment will continue to increase in complexity and costs. The
"
"PVA requests language changes in two specific ways. While we understand that
"Given how long the current regulations have been in effect, the proposed changes will be difficult to implement. We urge
"Another potentially major problem the
THE VETERANS MOBILITY SAFETY ACT
"Directly related to our concerns about prosthetics is the ongoing work surrounding implementation of P.L. 114-256, the "Veterans Mobility Safety Act." PVA led the charge during the last
"Prior to this law's enactment,
"Attempting to satisfy the law's requirement to consult with VSO's and a host of industry and safety organizations,
IMPROVE BENEFITS FOR CATASTROPHICALLY DISABLED VETERANS
"PVA believes it is time to improve benefits for the most severely disabled veterans, particularly with regards to the rates of Special Monthly Compensation.
"There is a well-established shortfall in the rates of Special Monthly Compensation (SMC) paid to the most severely disabled veterans that the
"One of the most important SMC benefits is Aid and Attendance (A&A). PVA recommends that Aid and Attendance benefits be appropriately increased. Attendant care is very expensive and often the Aid and Attendance benefits provided to eligible veterans do not cover this cost. Many PVA members who pay for full-time attendant care incur costs that far exceed the amount they receive as SMC-Aid and Attendant beneficiaries at the R2 compensation level (the highest rate available). Ultimately, they are forced to progressively sacrifice their standard of living in order to meet the rising cost of the specialized services of a trained caregiver, expensive maintenance and certain repairs on adapted vehicles, such as accelerated wear and tear on brakes and batteries that are not covered by prosthetics, special dietary items and supplements, additional costs associated with "premium seating" during air travel, and higher-than-normal home heating/AC costs in order to accommodate a typical paralyzed veteran's inability to self-regulate body temperature. As these veterans are forced to dedicate more and more of their monthly compensation to supplement the shortfalls in the Aid and Attendance benefit, it slowly erodes their overall quality of life.
REFORMING THE BENEFITS CLAIMS AND APPEALS PROCESS
"In
"Layer upon layer of substantive and procedural rights have been added over time to this unique system of administrative law governing veterans' disability claims. But these developments also produced unintended inefficiencies and an inability to identify faults in the process. A long-term fix requires a comprehensive overhaul of the entire claims process, not just appeals. The legislation consolidates and streamlines redundant processes, provides veterans with more information to help make strategic decisions, and increases protection of the claim's effective date. Ultimately, the increased efficiency and information will produce faster decisions with a greater degree of accuracy, reducing mistakes that lead to avoidable delays. PVA has concerns this is not happening with implementation of the RAMP process. While designated a pilot program, we feel
"It is incumbent upon the Administration to request, and for
ACCOUNTABILITY AND DEALING WITH THE ADMINISTRATIVE BUREAUCRACY OF VA
"It is no secret that
"Additionally,
PROVIDE PROCREATIVE SERVICES FOR CATASTROPHICALLY DISABLED VETERANS
"In
"No group of veterans is more affected by the ban on IVF than PVA's members--veterans with spinal cord injury or disease. PVA has long sought an end to the
"From 2001 to 2013, over 2,000 service members suffered a genitourinary injury, resulting in the loss of, or compromised ability, to have a child. While the
"While we were very excited to see procreative services made available for catastrophically disabled veterans, and are thrilled to learn of several families that are now expecting, our work is not done. We strongly support, and encourage
INCREASE LONG-TERM CARE RESOURCES
"PVA continues to be concerned about the lack of
"The
"The demand for additional LTC facilities in SCI/D is ever-present. From 2009 to 2013, the
"Currently, the
"In anticipation of the need for additional LTC services among the SCI/D veteran population, PVA conducted a survey in 2013 and 2014 to examine the non-VA LTC landscape. More than 400
"While
ENSURE EFFECTIVE OUTREACH BY VA TO VETERANS WITH SPINAL CORD INJURY/DISEASE
"PVA members, as well as all veterans with spinal cord injury served by the
"Unfortunately, we still encounter too many cases where veterans do not know they are entitled to an annual examination or have not been encouraged by a
"PVA believes an adequately staffed system of care with statutorily mandated staffed beds, coupled with a proactive outreach and education program, will improve what is already regarded as the best spinal cord injury and disease system of care in the world while also guaranteeing the best health care option for catastrophically disabled veterans. Ultimately, while the VA Choice program may serve other segments of the veteran population well (an assertion that is clearly debatable), our members have overwhelmingly made their choice. That choice is the
"Chairmen Isakson and Roe, and members of the Committees, I would like to thank you once again for the opportunity to present the issues that impact PVA's membership directly. As the
"We look forward to continuing our work with you to ensure that veterans get timely access to high quality health care and all of the benefits that they have earned and deserve. I would be happy to answer any questions that you may have."
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