WASHINGTON—Just as newly confirmed Department of Veterans Affairs Secretary Eric Shinseki appeared before Congress to run down his and VA’s top priorities for the coming year, so did the veterans service organizations. At a hearing of the Senate VA Committee last month, concerns over funding, the backlog of disability claims and providing medical care and support services to certain veteran populations topped the list of VSO concerns.

Advance Funding

It was a clean sweep for VSOs supporting the concept of advance funding for VA healthcare. A recent bill submitted by Sen. Daniel Akaka, D-Hawaii, would secure funding for VA healthcare a year prior to its distribution. (See page 5.) The bill is intended to keep the medical side of VA from being impacted by yearly funding delays and political haggling. The legislation was crafted in consultation with the Partnership for Veterans Health Care Budget Reform, a coalition of VSOs.

“Historically, advance appropriations have been used to make a program function more effectively, better align with funding cycles of program recipients or provide insulation from annual partisan political maneuvering,” explained Carl Blake, legislative director for Disabled American Veterans. “By moving to advance appropriations, veterans’ healthcare programs would accrue all three of these benefits.”

“The best way to ensure timely funding of veterans’ healthcare is to fully fund the Department of Veterans Affairs healthcare budget one year in advance,” added Todd Bowers, director of the Iraqi and Afghanistan Veterans of America. “In addition, IAVA endorses the annual independent budget as a blueprint for the VA funding levels.”

The independent budget contains VA funding recommendations calculated by a partnership of VSOs. The recommendations for FY 2010 are available at www.independentbudget.org.

“This year’s (FY 2009) budget is a highly sufficient budget, and it arrived on time. That’s remarkable, not only in its effi ciency, but in its rarity,” remarked Dennis Cullinan, legislative director of Veterans of Foreign Wars. “We don’t believe VA funding is targeted for delay, it just gets caught up in the funding wrangling that takes place. [The bill] takes VA out of that annual struggle and allows the system to run more effectively and everyone benefits with that.”

Dealing with the Backlog

Secretary Shinseki has called the backlog of disability claims, which exceed half a million, one of his top priorities and an unacceptable situation. The VSO representatives concurred, adding that without renovation of the adjudication system, the backlog will never be solved.

“The backlog is one great challenge Congress has this year. The backlog is ever growing and is outrageous in our belief, and we don’t see relief in sight at this time,” said Dean Stoline, legislative representative from the American Legion. Stoline pointed at understaffing at VA benefi ts offices and inadequate training of those adjudicating veterans’ disability claims as two significant contributors to the backlog.

“We would like VA to be more concerned with the quality of the review at the first level of the claim rather than pass it on to the appeals level and put the veteran through the hamster wheel of appeals and remands and four or five wheels before they get resolution of their claim,” Stoline said.

Underserved Demographics

Of great concern to all of the VSOs are certain veteran populations that have historically been difficult to serve or have been underserved. The VSOs are particularly concerned with the influx of female veterans—a population that has been growing and is expected to grow exponentially in coming years.

“VA should improve its ability to treat women who have experienced combat or military sexual trauma and increase the use of gender-specific evidence-based treatments,” explained Stoline. “Also, we believe VA should receive the resources to have at least one provider with women veterans’ expertise at each VA medical center.”

Cullinan praised the introduction of S.2552, a bill introduced by Sen. Akaka that includes provisions on improving healthcare for women veterans, including an order to the VA Secretary to develop a plan to improve healthcare provisions for women at VA facilities.

“Women veterans are still grossly underrepresented in the system, and I’m sure there are a variety of reasons for that,” added Cullinan. “But this kind of legislation will not only provide better care, but we think increased utilization by women.”

Providing care to veterans in rural areas remains a perennial concern. Despite the creation of clinics in underserved areas, difficultly getting to VA facilities remains one of the most common complaints from veterans.

“The figures show that 1 in 5 veterans who receive VA healthcare come from rural areas and this figure is only going to grow,” said Stoline. “Consequently the American Legion would like to see an increase in the community-based outpatient clinics (CBOCs), particularly for veterans living in states like Nebraska, Nevada, Utah, South Dakota, Wyoming and Montana because the veterans living in those areas face extremely long drives, a shortage of healthcare providers and bad weather.”

VA announced plans recently to open 31 new CBOCs in the next two years, most of them in rural areas.

Severely disabled veterans are also high on the VSOs’ priority list. They requested further resources for traumatic brain injury research and post-traumatic stress disorder treatment and screening, as well as more polytrauma and spinal cord injury specialty sites.

Adrian Atizado, legislative director for Disabled American Veterans, pointed out that not only do severely disabled veterans need more attention, but so do their family members, who often serve as their primary caregivers.

“Just as severely disabled veterans face daunting and lifelong challenges, so do their family caregivers who help maintain a veterans’ quality of life and independence,” Atizado said. “While this role can exact a high cost on family caregivers, they often do not receive enough support or financial assistance. In addition to psychosocial services, VA should conduct individual need assessments on family caregivers of severely disabled veterans and conduct a national survey for policy planning purposes.”

In short, the VSO representatives agreed, VA needs to be more active in bringing veterans and their families under the umbrella of its healthcare system.

“The VA has traditionally been a passive, inward-looking system,” said Bowers. “Veterans must overcome tremendous bureaucratic obstacles to get the benefits and services that the VA provides. Many veterans do not even know what benefits they are eligible for. The VA must develop a national strategy to promote the use of its services, including advertising VA benefits.”