VA Chiropractor Plan Hits Obstacles
December 7, 2001


The House has approved a plan to allow chiropractors to serve as primary-care physicians in the Department of Veterans Affairs, but some veterans groups have reservations. For example, although chiropractors might be needed to treat neuromuscular skeletal disorders, letting them serve as primary-care providers might force veterans with complex medical needs to make additional  appointments with other providers. Also, chiropractors would have to refer VA patients who need drugs to a doctor who can prescribe drugs. Furthermore, the move could place chiropractors in the position of making medical decisions involving the possibility of malpractice claims against the government, these groups suggest.

December 7, 2001

CONTACT: Peter Dickinson, (202) 225-3664

Smith Unveils Legislation To Reform Burial Rules at Arlington National Cemetery

Bill Would Ensure Access for Retired Reservists, Such as Captain Burlingame,
and Reservists Killed During Training (Washington, DC) - Congressman Chris Smith (NJ-4), Chairman of the House Committee on Veterans' Affairs has introduced legislation, H.R. 3423 to reform eligibility rules for burial of reservists at Arlington National Cemetery. The Smith bill would change existing law by eliminating the age requirement for retired reservists who would otherwise be eligible for in-ground burial. In addition, H.R. 3423 would allow in-ground burial of reservists who die in the line of duty while on training duty.

Smith's legislation would change the Army rule which is preventing Captain Charles Burlingame, the pilot of flight 77 which crashed into the Pentagon on September 11th, from receiving full burial rights at Arlington.

"Burial at Arlington National Cemetery is an honor that we bestow upon those members of our armed forces for service above and beyond the call of duty," said Smith. "While it is understandable that the Army would want to maintain strict eligibility rules because of the limited capacity at Arlington, people like Captain Burlingame should not be prevented from receiving the nation's highest tribute to the family of a deceased warrior," he said.

"Furthermore, H.R. 3423 will provide the families of reserve members who die while performing training duty, such as weekend or two-week reserve duty, with the right to have an in-ground burial for their loved ones at Arlington," said Smith. "Given the increased responsibilities assigned to our Reserve and National Guard forces, I believe that a compassionate government should treat these reserve component members whose death is in the line of duty in the same manner as those active duty members whose death occurs in the line of duty," he said.

Since 1967, burials rights at Arlington have been limited to veterans and the families of veterans who were wounded in combat, died on active duty, received one of the military services' highest awards for gallantry, were held as a prisoner of war, retired from military service or served in a high federal office. Last year, 3,727 veterans and family members were buried at Arlington National Cemetery, which is administered by the Department of the Army.

In addition, the Department of Veterans Affairs administers 133 national cemeteries throughout the United States, and since 1980 has provided $82 million in grants to states to establish or expand 42 state veterans cemeteries. Last year, over 82,000 veterans and family members were interred in VA cemeteries and more than 14,000 veterans and family members were buried in state veterans cemeteries.

Please visit, the House Committee on Veterans' Affairs web site, named 'One of the Best Web Sites in Congress' by the Congressional Management Foundation, May 3, 1999.

Metro and State 
Town rolls out the red carpet 
By Zeke MacCormack 
San Antonio Express-News 

Web Posted : 12/08/2001 12:00 AM 

FREDERICKSBURG A heroes' welcome greeted more than 300 survivors of Pearl Harbor who were honored Friday with speeches, a patriotic parade and special receptions.

"The respect the people have given us is heartwarming," said Robert Antell, 81, a Navy vet from Massachusetts. "You're almost glad you were there."

Others wouldn't go quite that far, but the veterans clearly were touched by the outpouring of adulation from 5,000 people at a memorial service, as well as from even larger crowd later at a parade.

The graying survivors' gratitude wasn't lost on Kimberly Meier and other spectators.

"The old guys are all happy," the 18-year-old Fredericksburg resident said as truck after truck loaded with flag-waving vets rolled by in the parade. "It's contagious. They're not forgotten."

Hawaiian shirts were the unofficial uniform of the day among the survivors, many of whom also sported canes, walkers, oxygen tanks and hearing aids.

"This is probably the last hurrah for a lot of people here," said Howard Schaeffer, 77, a visitor from Plano. 

John Podvin of Dallas was among those who wanted their children to get a firsthand look at history, while experiencing newfound patriotism that has followed the Sept. 11 attacks.

"It's important for our young boy to learn how to respect your country and appreciate the veterans who fought for it," said Podvin, 36, whose son Jack, 5, was sitting atop his shoulders.

The National Museum of the Pacific War went all out to make the event memorable. New exhibits opened Friday to high praise from veterans. Gov. Rick Perry and former President George Bush addressed the crowd between fly-overs by jets and vintage planes.

Ryan Abbott of Boerne was among those seeking survivors' autographs. 

"He's a hero because he was at Pearl Harbor," said Abbott, 8, while awaiting the signature of Alan Fouts, 81, of San Antonio.

"It's real nice," the Navy vet said. "All the hooting and shouting was over when my ship got back to San Diego in October of 1945."

The unabashed patriotism was clearly exhilarating to Les Bray of Fredericksburg.

"I often thought we wouldn't again show the unity we did in World War II, but we have since Sept. 11," said the 80-year-old local as the parade floats passed. "It's great. It's a feeling a lot of the younger generation never experienced."

After decades of silence about their war experiences, many vets now are opening up in the twilight of their lives, in part due to the recent terror attacks and the major movie on Pearl Harbor.

"I never said too much about my war stories until Sept. 11," said Melvin Schmidt, 77, an Army vet from North Dakota. "But things you have buried for a long time have resurfaced."

David Schmidt, 50, welcomed his father's newfound openness: "We had Japanese bayonets and stuff in the house and we'd ask him questions and he'd never say anything," he recalled.

And there was no shortage of interested listeners for the tales, many of which were recorded this week for the museum's archives.

Approaching survivors took a little extra tack for Reggie Yamanka, one of the few of Japanese descent on hand Friday.

"I understand the sensibilities of the veterans and I take the respectful approach," said Yamanka, 21, a fourth-generation Japanese American who is a petty officer at Lackland AFB. "They just want to tell their stories, and I want to listen."


Veterans gather at the Pacific War Museum to remember the attack and the friends they lost 
By Sig Christenson 
Express-News Military Writer 

Web Posted : 12/07/2001 12:00 AM 

FREDERICKSBURG Garth Sawyers walked alone in the museum, images of a scratchy black-and-white newsreel fresh in his mind, a World War II torpedo bomber on display nearby.

Editorial: America will never forget Pearl 
Rick Casey: Dec. 7, 2501: The power of rhetoric, the sadness of silence 
Gilberto Hinojosa: On Dec. 7, 1941, lives changed 
Sept. 11 opens Zero pilot's eyes 

An Army veteran of the Japanese attack on Pearl Harbor, Sawyers came from his home in St. George, Utah, to the Texas Hill Country knowing the journey would stir memories, but perhaps not quite prepared for the emotional impact.

"I think mostly about the people that were killed," Sawyers said of his visit Thursday to the National Museum of the Pacific War here. "It reminds you of the saddest day of your life."

Today is the 60th anniversary of the attack, but it might as well have been yesterday for 300 veterans who toured the museum along with Sawyers. Former President George Bush is to speak here today at 11:30 a.m. in observance of the 1941 attack. 

On Thursday, Sawyers and many other Pearl Harbor veterans walked the two blocks north of the museum to take the first tours of the new Pacific Combat Zone and the PT Boat Exhibition. Now 80, he identified the old Army half-track, jeep and cargo truck outside the entrance to the museum addition with the enthusiasm of a man greeting long-lost friends.

Sawyers' memories were sparked by museum footage from a 1943 newsreel. He and 23 other veterans and their families sat quietly, while on film, President Franklin D. Roosevelt predicted victory, telling a cheering crowd the Axis powers "have asked for it and they're going to get it."

America abruptly entered the war at 7:55 a.m. Dec. 7, 1941, when the first wave of Japanese planes swept low over Pearl Harbor, shattering a tranquil tropical morning in Hawaii.

In the moments that followed, the base was consumed by the cacophony of roaring planes, exploding bombs and acrid, black clouds of smoke billowing from the Navy's Battleship Row.

The sneak attack stunned the United States. In all, 19 ships were sunk or damaged, 2,408 Americans were killed and another 1,178 wounded. Japan lost 29 aircraft and five midget submarines and 64 were killed.

"I had a good view," said George Duke, 80, of Jackson, Miss. "I got the hell scared out of me."

He wasn't alone.

World War II veteran Howard Boney Sr. (left) and his cousin-in-law Larry Knight enjoy a moment with re-enactors Barry Faltesek, John Kier and Gill Eastland on Thursday in Fredericksburg.
Express-News/Billy Calzada

Pearl Harbor survivor Thomas Powell of the Texas community of West Point reads plaques Thursday at the Pacific War Memorial Wall at the National Museum of the Pacific War in Fredericksburg. Powell, 88, served on the USS Helena.
AP Photo/Eric Gay 
More coverage

Roy W. Gillette was a young second lieutenant whose soldiers downed a Japanese plane trying to strafe them as they headed to the Army's Hickam Field.

"I really think about the guys that were at Hickam there (who) got killed," Gillette, 82, of Fair Oaks Ranch said as he walked past shops and restaurants on Fredericksburg's Main Street with his wife, Eileen.

"After the second attack, my group and I went over and started taking wounded people to the hospital and the dead ones, of course and stacked them up at the hospital," he said. "But you know, you get to thinking about that and what they did to us. And no way in the world that I forgive them what they did."

Anger is a common emotion among Pearl Harbor veterans. So, too, is guilt.

Warren Miller, 77, of Omaha, Neb., saw the war from the first to the last, serving aboard the ill-fated USS Utah at Pearl Harbor. Four years later, he watched the Japanese surrender from the deck of the USS Detroit.

He refuses to buy Japanese cars and grows red-faced with frustration and resentment when other veterans of the war do, saying Tokyo "tried their best to do away with us and now we are supporting them."

Duke, a radioman assigned to a PBY flying boat, dived into a ditch to avoid the low-flying Japanese planes as they strafed Ford Island, where he was stationed. He then jumped into a plane and started firing at the enemy aircraft, an action that earned a commendation.

"I really kind of felt guilty being here because I'm alive and a lot of guys are out there 6 (feet) under a white cross," said Duke, a retired Shell Oil. Co. executive who recently marked his 59th wedding anniversary with his wife, Shirley.

"Why was I lucky enough to not get killed when a lot of my friends were?" he asked. "I have not come up with an answer. I don't think it's a celestial intervention by God. I don't know why. Why do things happen in this world? I don't know."

Ex-president lauds veterans from 1941 
By Sig Christenson 
Express-News Military Writer 

Web Posted : 12/08/2001 12:00 AM

FREDERICKSBURG Former President George Bush told Pearl Harbor survivors and other World War II veterans Friday they'll serve as a source of inspiration for a new generation of Americans facing the scourge of terrorism.

More coverage

Town rolls out the red carpet Cary Clack: Four reasons Louis McCabe will never forget Pearl Harbor Susan Yerkes: Chamber banquet waves school colors; Uncle Sam in business
"In America, we don't have kings or royalty, but in my view, that does not mean we lack nobility," Bush said. "Quite the contrary. Today we see a new band of heroes stepping forward to follow in the long line of Americans who answered the call of duty, fought for freedom and served their fellow man with honor and dignity."

Bush spoke to a crowd of 5,000 gathered here for the 60th anniversary of the Japanese attack on Pearl Harbor. During the ceremony, there was no escaping the similarities between the Sept. 11 terror strikes and 1941 attack on the Navy base in Hawaii.

Both attacks came out of the blue. Both saw horrific casualties. Both awakened an easily distracted nation, sparking a deep anger among Americans and a fierce determination to crush the enemy.

Standing in the shadow of the mainmast of the destroyer USS Foote outside the National Museum of the Pacific War, Bush tackled the parallels of the two days that stand among the grimmest on America's 2-century-old calendar.

In discussing them, he charted an upbeat course for the crowd, which included retired Brig. Gen. Chuck Yeager, a World War II ace who made history by breaking the sound barrier in a rocket plane in 1947.

Pearl Harbor veterans (from left) Ken Swedburg of Alamo; Wilbur Wright of Fairfax, Mo.; and Thomas J. Powell of West Point salute during the national  anthem at the 60th anniversary ceremony of the Pearl
Harbor attack at the National Museum of the Pacific  War in Fredericksburg on Friday.
Photo by Kin Man Hui/Express-News

Bush said his son and other U.S. leaders are "being tested by the forces of tyranny," just as President Franklin D. Roosevelt was challenged by Japan and Germany after Pearl Harbor.

But Americans, he predicted, are poised to pass this latest test.

"I say to each of you and them that your courage during the defining hour of the 20th century gives this country the same steadiness of purpose (and) the same resolution to meet this, the first great challenge of the 21st century," he said of World War II veterans living and dead.

"And today your selfless example of service offers our nation a deep, abiding reservoir of confidence from which we can draw forth the necessary will to once again turn back the tide of tyranny that crashed upon America's shores."

Before Bush sat 300 Pearl Harbor veterans, along with their wives and children. More than a few wore Hawaiian shirts, carried cameras and tapped their feet as the Air Force Band of the West from Lackland AFB performed.

A standing-room-only crowd behind those seats stretched from end to end of the street in front of the museum and the gallery named in honor of Bush, a naval aviator who bailed out of his crippled plane in September 1944 after a bombing run on the Japanese island of Chichi Jima.

The crowd watched four F-16 jets with their landing gear down fly slowly over the museum. The fighters later passed by a second time, one plane breaking away from the rest in a "missing man" formation traditionally flown on Pearl Harbor day.

Pearl Harbor was in ruins after the second wave of Japanese planes flew back to their carriers in 1941. In all, 19 ships were sunk or damaged, 2,408 Americans were killed and an additional 1,178 were wounded.

Japan lost 29 aircraft and five midget submarines and 64 were killed.

"Today we stand in the company of heroes men and women who know that freedom is not free, but requires a great cost," said Gov. Rick Perry. "America is free because you are brave. America's strong because of that day 60 years ago; you answered the call of duty."

Perry said terrorists picked a fight "with the wrong nation and the wrong leader."

The elder Bush told the crowd in his closing remarks that "our president has the courage to see this new crisis through just as Roosevelt did 60 years ago."

That message resonated with many veterans in the audience.

"I've got a real good feeling toward our president today, that he's going to stick with it," said USS Helena veteran Howard Luckham, 83, of Springfield, Ore.

Yeager, 78, and other veterans insisted after the ceremony that they aren't heroes.

"You had a job to do, you do it and don't ask questions," said 77-year-old Jack Edge of Grandy, N.C.

The ground-floor opportunity to take on the menacing Axis powers was, for Al DuBois, a matter of timing. 

"Most of us, we never went around telling people we were Pearl Harbor survivors," said the 80-year-old DuBois, a retired oil company manager from Ocala, Fla., who served on the battleship USS Pennsylvania. "Pennsy" received only minor damage in the attack.

"I mean, we had a job to do so we did it. I think we lived our life, and I'm hoping that the other generation coming up now will do the same thing."

April 23, 2002

Committee to Hold Field Hearing in NJ to Examine National Health Care Funding Formula for Veterans

Chairman Chris Smith Calls for Inclusion of ALL Veterans in Adjustments to VERA Formula, Cites GAO & IG Reports

WHEN: Tuesday, April 30, 2002 at 10:00 AM

WHERE: The War Memorial Building, Trenton, New   Jersey

WHO: House Veterans' Affairs Committee, Chairman Chris Smith (NJ-4)

WHAT: Public Hearing on Health Care Funding Formula for Veterans

(Washington, DC) - Congressman Chris Smith (NJ-4), Chairman of the House Committee on Veterans' Affairs today announced that he would hold a public hearing on Tuesday, April 30, 2002 in Trenton, NJ to examine the VA's health care funding formula that determines where federal health care dollars for veterans are spent.

The public field hearing will examine the Veterans Equitable Resource Allocation (VERA) formula that apportions federal funding for veterans' health care to each of the 21 Veterans Integrated Service Networks (VISN), and will focus on recent General Accounting Office (GAO) and VA Inspector General reports calling for changes to the VERA formula.

First developed in 1996, the VERA formula was implemented in April 1997 to better align VA's limited health care resources with the workload at VA facilities across the country, especially to account for population shifts. Recent reports by GAO and the VA Inspector General both recommended that all enrolled veterans be included in VERA's calculation of workload.  Currently, veterans in priority category 7 (those without service-connected disabilities and whose incomes are above defined poverty levels) are not included in VERA.

Chairman Smith has long argued that all veterans - including category 7 veterans - deserve access to timely and comprehensive VA health care.

Witnesses scheduled to testify at the Trenton field hearing include the Department of Veterans Affairs Under Secretary for Health, Dr. Robert H. Roswell, M.D., authors of the GAO and VA Inspector General reports, and representatives of veterans service organizations from New Jersey.

Please visit, the House Committee on Veterans' Affairs web site, named 'One of the Best Web Sites in Congress' by the Congressional Management Foundation, May 3, 1999.


Department of Veterans Affairs


Date: December 10, 2001

Subject: FY 2002 Network Budget Execution Policy Direction

To: Network directors (10N1-22)

  1. Recognizing that Fiscal Years 2002 and 2003 will be challenging budget cycles, the following policy direction is provided to facilitate network and local budget execution decisions.  My previous Outlook message on the restriction of all non-emergent expenditures remains in effect until the Deputy Secretary is briefed and accepts Network Expenditure Plans (briefing currently projected for January 22, 2002).  Discretion and good judgment should be used to distinguish between non-emergent and critical funding needs.  Network and facility Directors will adhere to the priorities expressed in the Secretary-s outline of general priorities in his recent Senior Leadership Retreat.  They are as follows:

        Preserve Quality Care

        Reduce Waiting Times

        Serve SC and Low Income NSC Veterans

        Maintain Specialized Disability Programs (SCI, Blind Rehab.,etc.)

        Research on Veteran Specific Health Care

        Emergency Response

  1. In addition, the following policy direction is provided:

        Central Program Managers and Network Directors much develop execution plans to support the Secretarys FY 2002 priorities within their budget allocations

        VHA will implement the Secretarys FY 2002 enrollment decision

        Prosthetic requirements above Specific Purpose allocations much be absorbed within Network General Purpose allocations

        VA Nursing Home capacity will be increased to 50 percent of the assigned FY 2003 target

        Assessment of Community Based Outpatient Clinics (CBOCs_ (addressed below in the Tier II initiatives_ per new VHA Policy Directive 2001-060

        Manage FTEE within budget allocation

  1. Certain initiatives have the potential of saving or generating significant dollars and are a high priority for initiation early this FY.  Each Network will be expected to implement those items listed below by April 1. A status report on these items will be requested early in the second quarter.  These mandatory initiatives are:
    1. Implement a Pharmacy Benefits Management Program and compliance with standardization in drug classes
    2. Prescribe Sensori-Neural (hearing aids and eyeglasses) aids to Priority 7 veterans as defined by CFR Part 17.149 (Information Letter is under development_
    3. Implement the recommendations from the September 2001 Revenue Cycle Improvement Plan to achieve increased MCCF collections:

 i.      Collection contract for bills over 90 days old

ii.      Consolidate billing function

iii.      Enforce national documentation policy

 iv.      Pre-registration of veterans

   v.      Provide Billing Activity with access to VistA ancillary packages

 vi.      Use of electronic medical records

vii.      Use of encoder software (3M or Quadramed)


    1. Reduce prosthetics inventories in excess of 30 days
    2. Review of fee basis bills and contract care for compliance with MEDICARE rates
    3. Consolidate procurement of supplies and services to achieve best price (includes Network-level BPAs , mandatory quantities on BPAs and may include organizational re-alignment of contracting staff Network-wide, etc.)
  1. Over and above the mandated actions, Attachment 1 outlines other mandated initiatives.  Other recommended actions are identified in Attachment 2.  Many of the administrative recommendations ave been demonstrated in several networks to reduce costs and should be evaluated by each network for implementation.  Some of the recommendations may be dependent on local situations and not all may be appropriate for every site.  These administrative recommendations are listed in alphabetic order.  Your status in these areas, as well as the mandated activities, will be requested early in the second quarter.
  2. For sites that have effectively addressed mandatory actions and other administrative recommendations but still anticipate budget shortfalls, the next level of initiatives identified as Clinical and Other Recommendations may be required.
  3. Because up to 70 percent of dollars spent locally are on employee salaries, it is recognized that Networks will not be able to execute the FY 2002 budget within available dollars unless FTEE is reduced.  A monitor has been established to measure FTEE against FY 2001 Pay Period 16.  Although it is hoped that most FTEE reductions will occur by attrition, networks anticipating the need for a RIF should initiate discussions with my office early in the year.
  4. In addition to initiatives to reduce or save dollars, networks should also address their capabilities to increase revenues such as ensuring clinicians are properly identifying billable medical conditions and services in general (specifically, billable conditions related to prescriptions issued), increasing the types and volume of existing sharing agreements and identifying additional excess capacity that may be utilized to generate additional revenue.
  5. Several actions should be avoided due to their impact on the direct provision of healthcare to veterans.  They include establishing patient waiting lists for clinic appointments or inpatient admission; termination of direct clinical staff (e.g., physicians, nurses, etc.) unless the recruitment was specifically for approved program restructuring or cyclic workload increases; and bed closures in NHC or Special Disability programs.  In addition, Title 38 staffing adjustments are still prohibited, pending the outcome of further legal actions.
  6. Previous guidance on stakeholders (labor, veterans service organizations, congressional, etc.) and employee communication regarding proposed changes should be adhered to.
  7. VHA and VA leadership recognize the significant challenges we face and also acknowledge that the leadership in each Network has been responsible for our significant achievements over the last several years.  The expectations outlined in this memorandum are designed to standardize and consolidate our achievements and to build the base for further difficult actions as they become necessary.


Laura J. Miller


v     Case management of high cost patients: Utilize DSS database to develop information abut high cost patients and develop mechanism to assign their care coordination.


v     Assure facilities do not pay more than the MEDICARE maximum amount for prosthetics devices


v     Utilize the Prosthetics Clinical Management Program at all facilities


v     Centralize the approval of management consultant contracts to minimize duplication and maximize utilization (Network-wide for consistency: Administration-wide for economies of scale, etc.)


v     Utilize Federal Suppy Schedule (FSS) for procurements where applicable

v     Consolidate laundry production services where cost beneficial


v     Consolidate reference laboratory functions, multi-VISN or contract where cost beneficial


v     Improve inventory management of medical/surgical and other supplies


v     Network-wide review of all recruitment actions to ensure Agency, Administration and Network goals and objectives are met


v     Consolidate engineering supplies and/or establish storeroom controls to minimize inventory levels, reduce redundant purchases, lost supplies, etc.


Note: One potential source of information on the implementing the actions identified above is the Lessons Learned database of the Virtual Learning Center Innovations located at:



                  Consoidate space and mothball buildings to minimize fixed overhead costs to maintain space.


      Consolidate selected Human Resource Management functions to maximize HR staff utilization (also recognized need for selected local HR staff requirements and HRLinks)


      Employ Network-wide benchmarking efforts to identify best practices and support financial and mission decisions


      Explore Enhanced-Use and enhanced sharing opportunities where feasible to maximize revenues

      Explore food factory concept/cook chill

      Improve CMOP utilization in collaboration with CMOP Director (National CMOP planning targets an 80% utilization level, this requires phasing with expanded CMOP capacity)

      Maximize energy conservation efforts and opportunities (e.g., ESPC)

      Institute oversight by Networks of position classification

      Review service contracts for potential consolidation and cost savings

Clinical and Other:

      Evaluate the utilization of CBOCs per VHA Directive 2001-060.   Requests to close CBOCs should be forwarded to your Heath System Specialist Liaison in my office.


      Review level of care for certain programs (i.e., determine if program could function as a domiciliary program, residential treatment or outpatient program rather than as an inpatient program: requires compliance with programmatic review to assure appropriate program plan and clinical care coordination)

      Utilize available nursing home care/long-term care funds to provide for allocated ADC nursing home requirements as first priority

      Consider tele-services (e.g., teleraiology, telepathology, etc.)

      Consider consolidation of certain high cost, high tech capabilities within a network such as cardiac surgery, neurosurgery, and radiation therapy


      Develop proposals for facility mission changes that include major bed closures (includes facility integrations and network-wide service consolidations)

Busy Seguin veterans clinic faces closure
By Roger Croteau
Express-News Staff Writer

Web Posted : 12/12/2001 12:00 AM

SEGUIN A popular veterans clinic at Guadalupe Valley Hospital will close at the end of this month unless a solution is found to an impasse between the hospital and the Veterans Administration.

The clinic serves about 400 veterans, twice as many as was expected when it was started a year ago, said Martin Boyle, an attorney for the Veterans Administration.

The biggest problem, according to Guadalupe Valley Hospital Administrator Don Richey, is that no local doctors are willing to review patient charts as the VA requires.

Patients at the clinic are seen by a nurse practitioner, who reviews their health status and gets low-cost prescriptions if needed. The charts from every patient's initial visit, plus a random 10 percent of charts from follow-up visits, must be reviewed by a doctor to meet the VA's standard of care, Boyle said. He said private insurers have the same requirement.

But the four local internists qualified to do that work are too busy and do not want to open themselves up to the potential liability of a malpractice lawsuit from a patient they've never even seen, Richey said.

About three dozen veterans attended Tuesday's Guadalupe County Commissioners Court meeting to urge the county to find a solution to the impasse.

"It would be a dismal failure for us to see this clinic close," said area veteran Don Larson. "There are many vets who can't afford to drive to San Antonio or can't afford the high cost of prescription drugs. All I am hearing right now are excuses about why this clinic has to fail. I'm not hearing anything positive about how to make it work."

Veteran Albert Kolbe told the commissioners, "Something is wrong with our form of government if our veterans are relinquishing their privilege to health care. I think it is your obligation to look into this program and do what you can to help us."

Guadalupe County Commissioner Jim Wolverton said, "I don't see why Guadalupe Valley Hospital and CA Associates (which holds the VA contract to run the clinic out of the hospital) can't sit down and iron this out and get the veterans the service they deserve."

December 13

TO: Action E-List

FROM: Joseph A. Violante, National Legislative Director


DATE: December 13, 2001

The fiscal year (FY) 2002 VA medical care budget falls $1.5 billion short of what is recommended by the Independent Budget. This will undoubtedly result in rationed health care and closed enrollment. The Administration recently agreed to provide additional funding to allow the VA to continue to enroll all veterans in its health care system for next year. Unfortunately, the FY 2002 VA budget shortfall and continued open enrollment have stretched the veterans' health care system to its limits, making it extremely difficult for VA to provide timely, quality health care services veterans deserve. At the very least, in order to continue enrollment of all veterans, Congress and the Administration must find the additional funds necessary to care for all enrolled veterans without compromising access to services. 

We continue to hear reports from across the country of increasingly long waiting lists for initial care once veterans are enrolled into the system and closed enrollments for new patients at several facilities. Additionally, there are reports of totally disabled veterans being put on waiting lists for health care and specialty care such as home health services. Clearly, VA facility directors are being forced to ration care as they struggle to meet the growing demand. This deplorable situation has had a profound impact on service-connected disabled veterans, the ones who rely most on the VA health care system, but are not given priority for treatment once they are enrolled. Without additional funding VA cannot adequately meet veterans' health care needs and provide the high quality care it is capable of delivering.

In a recent letter to the President, DAV National Commander George H. Steese, Jr., urged the Administration to fully fund veterans' medical care spending to $24.5 billion in FY 2003. It is imperative to impress upon the Office of Management and Budget (OMB) the importance of providing a sufficient VA medical care budget before the President's FY 2003 budget is finalized. 

We have updated the Legislative Advocacy section of our web site at to include a letter to the Office of Management and Budget (OMB) requesting the Administration to fully fund medical care spending for veterans. Please send your letter to OMB NOW! A copy of your letter will also go to the President.

We appreciate your prompt action on this important issue. 


December 14

VA Cuts Outpatient Copays

The Department of Veterans Affairs has lowered copayments for veterans receiving nonservice-connected outpatient care. A new VA regulation created a tiered system which replaced the former blanket copayment of $50.80. VA Secretary Anthony Principi asserted that the reduction in outpatient charges will be balanced by an increased copay for non-service connected prescriptions that begins February 4. (NSC medication copayments will jump from $2 to $7 for a 30-day supply, with total payments capped at n$840 for veterans in certain enrollment categories.) The new tiers for outpatient care: (1) preventive care visits, including flu shots, laboratory tests, certain radiology services, hepatitis C screenings and other preventive services - no copayment; (2) primary care visits - $15 copayment; (3) specialized outpatient treatments such as outpatient surgeries, audiology and optometric services - $50 copayment. Outpatient copayments apply primarily to veterans enrolled in Priority Group 7, said the VA.

December 19, 2001

CONTACT: Peter Dickinson, (202) 225-3664

House Veterans' Affairs Committee 2001 Accomplishments Fulfilling America's Promises to Our Veterans
H.R. 2716 - Homeless Veterans Comprehensive Assistance Act Authorizes $1 Billion to Aid Homeless Veterans and Prevent Veterans From Becoming Homeless

On the President's Desk, Awaiting His Signature for Enactment

Authorizes 2,000 Additional Section 8 HUD Low-Income Housing Vouchers for Homeless Veterans

Authorizes 10 New Domicilliaries for Homeless Veterans Programs

Authorizes $285 Million for the Homeless Grant and Per Diem Program

Authorizes $250 Million for the Department of Labor's Homeless Veterans Reintegration Program

Requires VA to Provide Technical Assistance to Nonprofit Community-Based Organizations Seeking Federal Funding for Homeless Programs

Requires the VA to Provide Mental Health Programs Wherever Primary Care is Provided

Earmarks $10 Million for Medical Care for Homeless Veterans With Special Needs, Including Older Veterans, Women and Substance Abusers

H.R. 1291 - Veterans Education and Benefits Expansion Act Authorizes More Than $3.1 Billion Over Five Years to Expand and Increase Educational, Housing, Burial and Disability Benefits.

On the President's Desk, Awaiting His Signature for Enactment

Boosts the MGIB College Education Benefit Amount by Record 46% over 2 Years

Restores Lost MGIB Benefits for Reservists and National Guard Members Called Up to Active Duty

Increases Home Loan Guaranty Program from $50,700 to $60,000

Increases Grants for Specially Adapted Housing for Severely Disabled Veterans from $43,000 to $48,000

Increases the Automobile and Adaptive Equipment Grant for Severely Disabled Veterans

Increases Burial and Funeral Expense Benefits by 25% and Doubles Burial Plot Allowances

Adds Diabetes Type II to List of Service-Connected Conditions for Vietnam Veterans Exposed to Agent Organge

Adds Undiagnosed Conditions, Such as Fybromyalgia, Chronic Fatigue Syndrome and Chronic Multi-Symptom Illnesses to List of Service-Connected Conditions for Gulf War Veterans

H.R. 2540 - Veterans Compensation Rate Amendments of 2001 Boosts Compensation Payments for Disabled Veterans by $2.5 Billion Over the Next Five Years.

On the President's Desk, Awaiting His Signature for Enactment

For 100% Disabled Veterans, the Average Increase Would Be $738 Per Year

H.R. 3447 - Department of Veterans Affairs Health Care Programs Enhancement Act Increases Spending on Health Programs for Veterans by $1.4 Billion

Passed the House, Senate Action Expected Any Day

Lowers Out-Of-Pocket Hospitalization Expenses for Lower Inco Veterans by 80% to Compensate for Regional Differences in the Cost-Of-Living

Requires the VA to Establish Chiropractic Care Programs Nationwide

Authorizes Service Dog Programs for Paralyzed and Other Severely Disabled Veterans

Requires the VA to Maintain Specialized Medical Programs - Such as for Mental Illness, Spinal Cord Injuries and Prosthetics - in Each of the 21 VA Regions

Creates New Incentive and Recruitment Programs to Attract and Retain
VA Nurses

H.R. 801 - Veterans Survivors' Benefits Improvements Act (P.L. 107-14) Adds $100 Million in New Health Care Benefits for Surviving Spouses of Veterans, and Extends Life Insurance Coverage to Spouses and Children of Servicemembers

Signed into Law on June 5, 2001

Expands CHAMPVA to Surviving Spouses of Veterans Who Die of A Service-Connected Disability

Expands Servicemembers' Group Life Insurance (SGLI) to Include Spouses and Children of Servicemembers; $100,000 for Spouses and $10,000 for Children

Makes Retroactive to October 1, 2000 Increases in the Maximum SGLI Benefit for Servicemembers Killed In The Line of Duty to $250,000

H.R. 811 - Veterans Hospitals Emergency Repair Act Authorizes $550 Million over Two Years to Repair, Renovate and Rebuild Dilapidated VA Medical Facilities

Passed the House Only

Provides the VA With Authority to Award Grants Up to $30 Per Selected Medical Facility

H.R. 3423 - Reforming Burial Rules at Arlington National Cemetery Reforms the Law on In-Ground Burials for Guardsmen and Reservists at Arlington National Cemetery

House Approval Expected Today (12/19/01)

Removes the Age Requirement for Retired Reserve Members

Makes Eligible All Guardsmen and Reservists Who Die in the Line of Duty.

Please visit, the House Committee on Veterans' Affairs web site, named 'One of the Best Web Sites in Congress' by the Congressional Management Foundation, May 3, 1999.

1700 Sidney Baker, Suite 100
Kerrville, Texas 78028
830.896.1157 -  Fax 830.896.1175

For Meeting With
Mr. Jose R. Coronado & Staff

19 December, 2001

This meeting was requested as a follow up to a meeting on 1 November 2001 with Dr. Dan Bacon and Robin Gutierrez and other Kerrville staff members.


  There are a lot of good things happening at the Kerrville and Audie Murphy VA Hospitals.  However, it seems we never hear about the great treatment and success stories from our Veterans only the bad things.

As you know this subject was discussed on November 1st with Dan and Robin.    It seems all such activity should come from the Audie Murphy PA staff.  Therefore, HCVC would like to know how to play a part in or assist in making known the good that is happening.


During our last luncheon visit with the VA staff we discussed the issue of providing the HCVC some form of liaison with the VA staff to share ideas, issues, Veterans complaints, etc.  Mr. Shea surfaced the possibility of participation in some existing committee at the hospital to take up these issues. 

Dan and Robin are not aware of any existing committee that would meet the needs as presented by the HCVC.  Therefore, we would like to advance this discussion to determine if there is such a format that would give the council the opportunity to pass on and discuss important issues.

We were introduced to Ms. Connie Smith, Patient Representative, as one that could provide assistance when a patient is having a problem.  This contact has already proven to be helpful in one case.


As the results of our meeting on 1 November we learned that the Kerrville VA does have somewhat of a Long Range Plan, perhaps two or three years out.  However, our discussion did not seem to address the issues the council has a direct interest in pursuing.  It seems, for a facility such a Kerrville, there should be a five, ten, twenty year Long Range Plan.  We know budget drives everything and budget should be based on the Long Range Plan. 

Therefore, we would like to discuss the Long Range Plan for Kerrville as it is seen by Audie Murphy, VISN 17, and VA Central at this time.  Issues that are important to the Council are:

  1. Is there funding for the implementation of the RUDY PROGRAM for the long range?
  2. Now that the plan is in place to make full use of the main hospital building, is there a plan to keep in occupied?
  3. The need for a great deal of improvements in the following services: a) Urology, b) Orthopedic,

c) Ophthalmology, d) Audiology.  The infrequent visits of Audie Murphy staff to support these clinics are placing a true hardship on our area Veterans.  In some cases where the doctor will only visit Kerrville one or two times a month, is just not right. There needs to be a plan in place to fix this problem. 

  1. Additional Doctors are needed to replace those that have left or retired and those that are getting ready to retire.  We know there was a hiring freeze for a while, but with the 2001-2002 budget there should be some relief from that policy.
  2. Additional Team Clinics The waiting time in these clinics is just entirely too long.  We know this is a nation wide problem, but it still needs to be fixed.
  3. A Long Range Plan for all of the vacant buildings on the site needs to be developed?
  4. A Long Range Plan for the 76-acre property and how it can best be used?
  5. What impact will the recent CARE inspection have on the hospital?
  6. What is the Long Range Plan for the laundry?
  7. Several clinics in the surrounding area are being closed.  Is this part of the long-range plan?


Where is help needed budget, political issues, administrative issues, political contacts, community, etc?  Where do you need support in order to solve some of the HCVC concerns and issues?

December 21

VA Recognizes Gulf War ALS Claims
The Department of Veterans Affairs and the Department of Defense have found preliminary evidence that veterans who served in Desert Shield-Desert Storm are nearly twice as likely as their non-deployed counterparts to develop amyotrophic lateral sclerosis (ALS), commonly called Lou Gehrig's Disease. Because of this finding, the VA is now accepting claims from veterans who served in the Persian Gulf August 1, 1990, to July 31, 1991, and have subsequently developed ALS. For additional information call the VA toll- free at 1-800-827-1000.

December 21

NDAA Derails Retiree Forced Choice
The fiscal 2002 National Defense Authorization Act includes a provision that blocks the Administration's plan to force military retirees with VA disabilities to choose between military or VA health care. Retiree and veterans groups have objected to "forced choice" because: (1) VA care is earned by incurring disability due to military service while Tricare is earned through the hardships of a military career, and (2) selecting one over the other would force the beneficiary either to forego specialty care that other veterans rate, such as hearing aids and prosthetics, or to relinquish a choice of civilian providers that other military retirees rate.

December 21

Congress Waffles on Concurrent Receipt
Congress has voted in principle to end pay cuts for military retirees who are authorized VA disability compensation. However, the legislation would authorize concurrent receipt in a future year only if the president puts it in the budget and Congress legislates it. This looks like a show-stopper because the Administration has told Congress it opposes concurrent receipt. This failure by Congress means that disabled military retirees must continue to fund their own disability by a $1 reduction in their retired pay for each $1 of VA disability compensation they have earned. American Legion commander Richard J. Santos blasted this lip service, saying that it undermined the will of the majority in Congress. He said it sends a message to troops injured on active duty today that they should get out of the service to avoid being shortchanged in their retirement years. The legislation is awaiting the president's signature.

Special Compensation for Some Disabled Retirees
Although Congress has refused to authorize funding for concurrent receipt (previous item), it upped special compensation for some disabled retirees and added others to the compensation list. Retirees with VA disabilities of 70 percent or higher currently receive $100 to $300 monthly. This will increase by $25 a month beginning January 1, 2003 for retirees rated 80 percent or more, and $25 a month effective October 1, 2004 for those rated 70 percent or higher. Added to the list for special compensation of $50 a month beginning February 1, 2002 will be retirees who served at least 20 years on active duty and who were awarded VA disabilities of 60 percent within 4 years of retiring. All of these changes depend upon whether the president signs the fiscal 2002 National Defense Authorization Act, which is on his desk.



Long Range Plan (LRP)

It seems there is no LRP (five, ten, fifteen years) for the Kerrville Facility.  Any LRP should drive budget.  However, in the case of the VA the budget drives all the plans short range or long range.  Therefore, the issue is how do we get some sort of a LRP for Kerrville. 

In Kerrville, there is a 76-acre site with great facilities and a fairly modern laundry facility.  It seems the laundry is finally reaching a creditable workload, mostly as the results of a large fire in the single most productive commercial laundry in San Antonio.

Many renovations are taking place that will make the main building structure 100% occupied.

Several things have been discussed with VA officials that have long-range effect.  One of those discussions centered on having Kerrville as the show place for long-range care for geriatric and Alzheimer Veterans.  Many things are taking place in this direction. 

Another discussion has centered on the possibility of having Kerrville become a Regional Diagnostic Center.  This would be a center where Veterans could be sent into Kerrville for a complete medical diagnostic evaluation and then returned to their local VA Hospital for treatment.  This is being done in the private sector, so why not the VA. This would truly be a long-range plan.  This possibility has been discussed with Secretary Principi.  Discussion will continue at this level in the VA.


The imbalance in the daily workload by the doctors in Kerrville vs. San Antonio is reaching a melt down situation.  The doctors in Kerrville are working at over 120% of established workload where the doctors at Audie Murphy and Frank Tejeda Clinic are working at a 97% level.  The question then is why are Veterans being sent to Kerrville from San Antonio and other area.  Why not sent more Veterans to Frank Tejeda and Audie Murphy?

Following are the last reported workloads:





Audie Murphy 5572 5422 97%
Frank Tejeda 9243   6946 97%
Kerrville  5550 6714 121%


As the result of the workload on the doctors at Kerrville, patients are being given four, five, six months appointments as if this will solve the problem.  In fact this only makes the problem worse and at the same time creates a serious problem for the Veteran.

CARES (Capital Asset Realignment for Enhanced Service)

The CARES Committee will be evaluating the Kerrville facilities some time in mid 2002.  A pre-evaluation was made in Dec. 2001 with the poor condition of the roof being the most serious fault noted in the review.  There will be a period during the asset review when input by all those interested will be solicited by the Committee.