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Feb 1, 2010

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White House Seeks $125 Billion for Veterans in 2011

Homelessness, Claims Increases and Access - Priorities for VA Budget

WASHINGTON - To expand health care to a record-number of Veterans, reduce the number of homeless Veterans and process a dramatically increased number of new disability compensation claims, the White House has announced a proposed $125 billion budget next year for the Department of Veterans Affairs.

"Our budget proposal provides the resources necessary to continue our aggressive pursuit of President Obama's two over-arching goals for Veterans," said Secretary of Veterans Affairs Eric K. Shinseki. "First, the requested budget will help transform VA into a 21st century organization. And second, it will ensure that we approach Veterans'

care as a lifetime initiative, from the day they take their oaths until the day they are laid to rest."

The $125 billion budget request, which has to be approved by Congress, includes $60.3 billion for discretionary spending (mostly health care) and $64.7 billion in mandatory funding (mostly for disability compensation and pensions).

"VA's 2011 budget request covers many areas but focuses on three central issues that are of critical importance to our Veterans - easier access to benefits and services, faster disability claims decisions, and ending the downward spiral that results in Veterans' homelessness," Shinseki said.

Reducing Claims Backlog

The president's budget proposal includes an increase of $460 million and more than 4,000 additional claims processors for Veterans benefits.

This is a 27 percent funding increase over the 2010 level.

The 1,014,000 claims received in 2009 were a 75 percent increase over the 579,000 received in 2000. Shinseki said the Department expects a 30 percent increase in claims - to 1,319,000 - in 2011 from 2009 levels.

One reason for the increase is VA's expansion of the number of Agent Orange-related illnesses that automatically qualify for disability benefits. Veterans exposed to the Agent Orange herbicides during the Vietnam War are likely to file additional claims that will have a substantial impact upon the processing system for benefits, the secretary said.

"We project significantly increased claims inventories in the near term while we make fundamental improvements to the way we process disability compensation claims," Shinseki said.

Long-term reduction of the inventory will come from additional manpower, improved business practices, plus an infusion of $145 million in the proposed budget for development of a paperless claims processing system, which plays a significant role in the transformation of VA.

Automating the GI Bill

The budget proposal includes $44 million to complete by December 2010 an automated system for processing applications for the new Post-9/11 GI Bill. VA also plans to start development next year of electronic systems to process claims from other VA-administered educational programs.

The Post-9/11 GI Bill authorizes the most extensive educational assistance opportunity since the passage of the original GI Bill in 1944. Over $1.7 billion in regular Post-9/11 GI Bill benefit payments have been issued since the implementation of the program on Aug. 1, 2009. In 2011, VA expects the number of all education claims to grow by

32 percent over 2009, going from 1.7 million to 2.25 million.

"To meet this increasing workload and process education claims in a timely manner, VA has established a comprehensive strategy to develop industry-standard technologies to modernize the delivery of these important educational benefits," Shinseki said.

Eliminating Homelessness

The budget proposal includes $4.2 billion in 2011 to reduce and help prevent homelessness among Veterans. That breaks down into $3.4 billion for core medical services and $799 million for specific homeless programs and expanded medical care, which includes $294 million for expanded homeless initiatives. This increased investment for expanded homeless services is consistent with the VA secretary's established goal of ultimately eliminating homelessness among Veterans.

On a typical night, about 131,000 Veterans are homeless. They represent every war and generation, from the "Greatest Generation" to the latest generation of Veterans who served in Iraq and Afghanistan. To date, VA operates the largest system of homeless treatment and assistance programs in the nation.

Targeting Mental Health, Preventing Suicides

"The 2011 budget proposal continues the department's keen focus on improving the quality, access and value of mental health care provided to Veterans," Shinseki said.

The spending request seeks $5.2 billion for mental health, an increase of $410 million (or 8.5 percent) over current spending, enabling expansion of inpatient, residential and outpatient mental health services, with emphasis on making mental health services part of primary care and specialty care.

The secretary noted that one-fifth of the patients seen last year in VA's health care facilities had a mental health diagnosis, and that the department has added more than 6,000 new mental health professionals since 2005, bringing to 19,000 the number of employees dedicated to mental health care.

The budget request will enable the department to continue expanding its programs for post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), along with the diagnosis and treatment of depression, substance abuse and other mental health problems. Shinseki called PSTD treatment "central to VA's mission."

The proposed spending will continue VA's suicide prevention program.

Since July 2007, the department's suicide prevention hotline has received nearly 225,000 calls from Veterans, active-duty personnel and family members. The hotline is credited with saving the lives of nearly 7,000 people.

Reaching Rural Veterans

For 2011, VA is seeking $250 million to strengthen access to health care for 3.2 million Veterans enrolled in VA's medical system who live in rural areas. Rural outreach includes expanded use of home-based primary care and mental health.

A key portion of rural outreach - which shows promise for use with Veterans across the country - is VA's innovative "telehealth" program.

It links patients and health care providers by telephones and includes telephone-based data transmission, enabling daily monitoring of patients with chronic problems.

The budget provides an increase of $42 million for VA's home telehealth program. The effort already cares for 35,000 patients and is the largest program of its kind in the world.

Serving Women Veterans

The 2011 budget provides $217.6 million to meet the gender-specific health care needs of women Veterans, an increase of $18.6 million (or

9.4 percent) over the 2010 level. Enhanced primary care for women Veterans remains one of the Department's top priorities. The number of women Veterans is growing rapidly and women are increasingly using VA for their health care.

Shinseki said the expansion of health care programs for women Veterans will lead to higher quality care, increased coordination of care, enhanced privacy and dignity, and a greater sense of security among women patients.

Among the initiatives for women in the 2011 budget proposal are expanded health care services in Vet Centers, increased training for health care providers to advance their knowledge and understanding of women's health issues, and implementing a peer call center and social networking site for women combat Veterans. This call center will be open 24 hours a day, 7 days a week.

Delivering World-Class Health Care

During 2011, VA expects to treat 6.1 million patients, who will account for more than 800,000 hospitalizations and 83 million outpatient visits.

The total includes 439,000 Veterans who served in Iraq and Afghanistan, for whom $2.6 billion is included in the budget proposal. That's an increase of $597 million - or 30 percent - from the current budget.

The proposed budget for health care includes:

* $6.8 billion for long-term care, an increase of $859 million

(or 14 percent) over 2010. This amount includes $1.5 billion for non-institutional long-term care;

* Expanding access to VA health care system for more than 99,000

Veterans who were previously denied care because of their incomes;

* $590 million for medical and prosthetic research; and

* Continuing development of a "virtual lifetime electronic

record," a digital health record that will accompany Veterans throughout their lives.

VA is requesting $54.3 billion in advance appropriations for 2012 for health care, an increase of $2.8 billion over the 2011 enacted amount.

Planned initiatives in 2012 include better leveraging acquisitions and contracting, enhancing the use of referral agreements, strengthening VA's relationship with the Defense Department, and expanding the use of medical technology.

Preserving National Shrines

"VA remains steadfastly committed to providing access to a dignified and respectful burial for Veterans choosing to be buried in a VA national cemetery," Shinseki said. "This promise requires that we maintain national cemeteries as shrines dedicated to the memory of those who served this nation in uniform."

The requested $251 million for cemetery operations and maintenance will support more than 114,000 interments in 2011, a 3.8 percent increase over 2010. In 2011, the department will maintain 8,441 acres with 3.1 million gravesites. The budget request includes $37 million to clean and realign an estimated 668,000 headstones and repair 100,000 sunken graves.

Building for the Future

$1.15 billion requested for major construction for 2011 includes funding for medical facilities in New Orleans; Denver; Palo Alto, Calif.; Alameda, Calif.; and Omaha, Neb. Also budgeted for 2011 are major expansions and improvements to the national cemeteries in Indiantown Gap, Pa.; Los Angeles; and Tahoma, Wash., and new burial access policies that will provide a burial option to an additional 500,000 Veterans and enhance service in urban areas.

A requested budget of $468 million for minor construction in 2011 would fund a wide variety of improvements at VA facilities.

Feb 19th 2009

One of the biggest problems facing veterans today is their inability to get correct and timely decisions on their applications for benefits, particularly for disability compensation. As of February 13, 2010, there were 480,706 claims for disability compensation and pensions awaiting rating decisions by the Veterans Benefits Administration (VBA); 180,785 (37.6 percent) of the claims exceeded the 125-day strategic goal. In March of 2009, VAís Inspector General reported that almost a quarter (22 percent) of all veteransí applications for disability compensation were decided incorrectly in the 12-month period reviewed. In addition, benefit application folders for almost 300,000 veterans were misplaced and the files for 141,000 veterans are lost.

VBA continues to rely on a cumbersome paper-based system to review and evaluate applications for disability compensation and pension and has yet to develop a modern IT infrastructure. During a recent inspection at the VBA Regional Office in Roanoke, Virginia, the VA Inspector General found nearly 11,000 folders sitting on top of file cabinets already filled to capacity with paper claims and supporting evidence for tens of thousands of veterans. After consulting with the building engineer, they determined that the load on floors 10, 11 and 12 of the 14-story building was double what is considered safe and heavy enough to cause the entire building to collapse.

Simply put, too many disabled veterans and their survivors must wait too long for disability compensation and pension rating decisions that are too often wrong or inaccurate. If these problems are not addressed and the VA benefits approval process reformed, the entire system is in danger of collapsing on itself from the sheer weight of the workload.

Congress and the Administration must take whatever actions are necessary to reform the veterans benefits approval process so that disabled veterans and their survivors are be able to apply for benefits through a simple, uniform and modern IT-based system that enables VBA to make accurate decisions within acceptable time frames.

To accomplish these goals, Congress and the President must work with VBA to:

  1. Develop a work culture that emphasizes quality, not just quantity;
  2. Modernize its IT infrastructure and optimize its business processes; and
  3. Implement a simpler and more transparent application and approval process.

In the short term, there are several reforms that should be implemented, either by VBA directly or as a result of Congressional action, to reform the benefits approval system:

  1. Create standardized templates for physicians so that private medical evidence can be developed and delivered in a uniform manner that allows VBA rating specialists to make determinations without the need for redundant VA exams.
  1. Use existing authority to assign interim ratings when there is sufficient evidence to establish a compensable service-connected condition, thereby quickly providing service-disabled veterans with financial support and access to VA health care.
  1. Establish comprehensive and uniform systems to train and provide continuing education to VBA's workforce, and implement a new quality control regime that places emphasis on the quality of decisions made, rather than the quantity of work completed.


We applaud the Administrationís recently released budget request for fiscal year (FY) 2011. The budget request includes significant funding increases for Department of Veterans Affairs (VA) health care and benefits.

For VAís total budget, the Administration requested $125 billion for FY 2011, an increase of $12.2 billion over last year. Compared to the Presidentís request for VAís total discretionary budget of $60.3 billion, including medical collections, the Independent Budget (IB) recommends $61.5 billion, $1.2 billion more than the Presidentís request and an increase of $5.5 billion over last year.

Medical Care Budget: The Administrationís request of $51.5 billion includes $3.4 billion in collections. The IB recommends $52 billion, which is an increase of $4.4 billion over the FY 2010 level and is $424 million above the Administrationís requestó$375 million of the IBís recommendation includes a long-term care initiative.

Medical and Prosthetic Research: The Administrationís request of $590 million is only $9 million more than last yearís level. The IB recommends $700 million to allow VA to better understand and develop treatments for the unique injuries and diseases of veterans of the wars in Iraq and Afghanistan, as well as for diseases and injuries of older generations of disabled veterans.

Benefits Processing: The Administration recommends an increase of $2.1 billion for the Veterans Benefits Administration (VBA), an increase of $460 million over the FY 2010 appropriated level to reduce the out-of-control claims backlog, and improve timely, accurate education benefits to service members and veterans eligible for the Post-9/11 GI Bill.

The DAV has concerns, however, with the level of funding recommended for construction projects and grants, biomedical research, and information technology:

  1. With VA facing a massive backlog of important construction requirements and states becoming ever more reliant on VA to contribute to the funding for construction of state extended care facilities, now is not the time to reduce this critical funding.
  2. The VAís research program, funded only at the rate of inflation, is an important VA link with academic medicine and cutting-edge technologies, and will make major contributions to restoring the health of wounded veterans returning from service in Iraq and Afghanistan.
  3. There are a number of critical information technology initiatives for next generation VA health and benefits systems that need to be addressed. Nevertheless, with $3.3 billion requested, VA should still be able to maintain a steady information technology development program in 2011 that will enable a 21st century VA to fully automate its GI Bill benefits system, replace its aging VistA computerized patient care record, and create a seamless electronic record for military members entering the VA system.


For the first time, advance appropriation for VAís FY 2012 budget was part of the Administrationís request this year. The recommendation for VAís medical care budget of $54.3 billion in advance appropriations for FY 2012 includes $3.7 billion in collections. This is an increase of $2.8 billion over the Administrationís FY 2011 request.


With ongoing military operations in Afghanistan and Iraq increasing numbers of servicemembers continue to transition to veteran status. Unfortunately, thousands of our military personnel are returning from deployments with physical and mental wounds and permanent disabilities. Already, over 480,324, or 46 percent, of the more than one million discharged veterans from the wars in Iraq and Afghanistan have sought care at VA health care facilities.

As with previous generations of combat veteransóveterans from Operations Enduring and Iraqi Freedom are seeking care for a range of health care issues as a result of their wartime military service. Many need specialized treatment for traumatic brain injury, post-deployment mental health readjustment challenges, including depression, post traumatic stress disorder and substance-use disorders. Timely access to mental health services is essential to preventing the tragedy of suicide and the onset of chronic mental health problems.

Like past military conflicts, these wars have produced a number of veterans with catastrophic injuries in need of highly specialized polytrauma care and life-long services and support. Caregivers of the severely wounded also need comprehensive support services to facilitate the veteranís rehabilitation and recovery while maintaining their own health and well-being. Likewise, with greater numbers of women serving in the military, including in combat and support roles, there is a new generation of women veterans turning to VA with unique health care needs. Millions more veterans have also been disabled from their military service during prior wars and periods of service.

Veterans have fought to defend our nation and our freedoms; they should not need to fight to get the specialized medical services they need. Therefore, we urge Congress to enact legislation, S. 1963, the Caregiver and Veterans Omnibus Health Services Act of 2009, or the House companion bills with similar provisions, as expeditiously as possible to address these critical health issues.

S. 1963 combines the content of two prior measures (S. 252 and S. 801) into a single VA health care omnibus bill that would make significant enhancements in VA health care services. This legislation contains vital provisions to improve and enhance health care programs and services for women and to help assure equal access toóand quality ofómedical care for women veterans. S. 1963 would also provide desperately needed support for family caregivers of severely disabled veterans. Provisions contained in this bill have been approved by both House and Senate in various bills and are now in conference to reconcile any differences between the House and Senate measures. A specific concern to DAV during this conference period is to ensure inclusion of all eras of veterans for the purpose of caregiver support services, whether their needs are acute or chronic.

Please let your elected officials know that DAV supports legislation that would provide a comprehensive package of supportive services, including but not limited to financial support, health care and homemaker services, respite, education and training and other necessary relief, to caregivers of all veterans severely injured, wounded or chronically ill from military service.

Many of the important provisions in this bill have been pending from the 110th Congress. For these reasons, DAV urges immediate action for final approval and enactment of S. 1963, the Caregiver and Veterans Omnibus Health Services Act of 2009, or other measures containing essentially the same provisions.


Military retired pay is earned by virtue of a veteranís long service to the nation; disability compensation is for service-incurred disabilities. Yet some service members who retired from the armed forces after 20 or more years of service must forfeit a portion of the retirement pay they earned through that very faithful service to receive VA compensation for service-connected disabilities.

Most nondisabled military retirees go on to pursue second careers in order to supplement their income, thereby justly enjoying a full reward for completion of a military career, along with the added reward of full pay in civilian employment. To put service-connected disabled retirees on an equal footing with nondisabled retirees, disabled retirees rated 40 percent or lower should receive full military retired pay and compensation to account for diminution of their earning capacities.

Disabled veterans should not suffer financial penalties for choosing military service as a career rather than a civilian career, especially where in all likelihood a civilian career would have involved fewer sacrifices and greater rewards. If a veteran must forfeit a dollar of retired pay for every dollar of VA disability compensation otherwise payable, our government is, in effect, compensating the veteran with nothing for the service-connected disability he or she suffered.

H.R. 303, H.R. 333 and HR 811 have been introduced in the 111th Congress and would eliminate this longstanding inequity. The DAV supports these bills and asks for their immediate consideration.

Similarly, Survivor Benefit Plan (SBP) annuities are offset by the amount of any survivor benefits payable under the VA Dependency and Indemnity Compensation (DIC) program. Unlike many private sector retirement plans, survivors have no entitlement to any portion of the memberís retired pay after his or her death. Under SBP, a survivorís annuity is purchased through deductions from the memberís retirement pay. This is not a gratuitous benefit. Upon the veteranís death, the annuity is paid monthly to eligible beneficiaries under the plan.

DIC protects the survivors from the losses associated with the veteranís death from service-connected causes or after a period of time when the veteran was unable, because of total disability, to accumulate an estate for inheritance by survivors.

If a veteran is retired from the military and enrolled in SBP, the surviving spouse's SBP benefits are reduced by the amount of DIC (currently $1,154 per month). However, if the veteran died of other than service-connected causes or was not totally disabled by service-connected causes for the required time preceding his or her death, beneficiaries receive full SBP payments. There are approximately 61,000 military widows/widowers affected by the SBP offset of DIC benefits.

Where the monthly DIC rate is equal to, or greater than, the monthly SBP annuity, beneficiaries lose all entitlement to the SBP annuity. The offsets affecting military retirement pay and SBP payments are inequitable because no duplication of benefits is involved.

The DAV supports H.R. 775, the "Military Surviving Spouses Equity Act" and S. 535, a bill to amend title 10, United States Code, and repeal requirement for reduction of survivor annuities under the Survivor Benefit Plan by veterans' dependency and indemnity compensation. Both bills would finally end this disparity and would provide surviving spouses with the full spectrum of benefits they have earned and deserve.

The DAV strongly supports the repeal of these offsets, which penalize an already financially vulnerable population of survivors, dependents, and retirees. Urge your elected officials to support the removal of these offsets. Pass H.R. 303, H.R. 333, H.R. 775, H.R. 811 and S. 535