April Washington Update

 

ACTING HEAD OF VA INSTALLED FOLLOWING THE DISMISSAL OF SECRETARY SHULKIN
On March 28th, President Trump announced the removal of Dr. David Shulkin as Secretary of Veterans Affairs. In his place, the President stated his intent to nominate Rear Admiral Ronny L. Jackson, MD. In the interim, he appointed Robert Wilkie, Under Secretary of Defense for Personnel and Readiness, to serve as Acting Secretary.
Following the announcement, PVA Executive Director Carl Blake released the following statement:
“We look forward to understanding more about the qualifications of Admiral Ronny L. Jackson, MD to helm the VA during this critical time. The VA has a broad mission and the Secretary must be someone who is eminently qualified to lead the nation’s second largest cabinet agency. In particular, reforming VA’s health care system to better serve the needs of veterans and their families is of great importance. We encourage the Senate Committee on Veterans’ Affairs to take these concerns very seriously as it considers Admiral Jackson’s nomination.”
Much has been made of Dr. Shulkin’s departure from VA and in particular what it means for the future of the VA’s health care system. The struggle to define the role of community care in serving the health care needs of veterans has torn open the debate on what some see as efforts by the Administration to privatize the provision of VA health care. Thus, we were pleased to see that Acting Secretary Wilkie has given his support to an existing bi-partisan, bi-cameral proposal with broad VSO support pending in Congress that would reform community care, expand eligibility for the program of comprehensive caregiver benefits, and launch a review of VA’s assets and infrastructure.
Rear Admiral Jackson’s confirmation hearing is currently scheduled for April 25th. In the meantime, PVA is anxious to learn more about him and hear his views on the issues that impact the services and benefits that PVA’s members depend on. During this time of change, VA needs a strong, capable leader who will focus on the needs of veterans in receiving the care they have earned.

OMNIBUS NEGOTIATIONS BREAKDOWN

In November 2017, the Senate VA Committee passed, 14-1, S. 2193, a bill that would reform the current VA Choice Program and all care in the community programs by consolidating them into one program. It also included the full expansion of the caregiver program to veterans injured in service in any era.

 

Amidst budget hearings in March 2018, there was speculation parts of S. 2193 would be included in the omnibus spending deal. Within a week, House and Senate committee leadership had crafted a deal, supported by the VSOs that included care in the community reform, asset review, and full expansion of the caregiver program.

Ultimately, these provisions were removed last minute in a round of political tradeoffs between House and Senate leadership. While a disappointing loss, we are pleased that members of Congress who were once opposed to expansion are now supportive. In the months to come, we hope to see such momentum push forward on behalf of caregivers.

FORTY-TWO SENATORS JOIN WITH SENATOR DUCKWORTH IN OPPOSITION TO THE ADA EDUCATION AND REFORM ACT
On March 29th, Senator Tammy Duckworth (D-IL) and 42 of her colleagues sent a letter to Majority Leader Mitch McConnell (R-KY) expressing opposition to the ADA Education and Reform Act (H.R. 620). Signatories to the letter include Minority Leader Chuck Schumer (D-NY) and Senate Judiciary Ranking Member Diane Feinstein (D-CA). In the letter, the Senators noted their strong opposition to not only H.R. 620, but also to “any legislation that would repeal or weaken rights under title III of the Americans with Disabilities Act.” The letter further requests that Leader McConnell join with them in ensuring that either H.R. 620 or any notification legislation “will never receive a vote in the United States Senate during the 115th Congress.”
PVA and other disability and civil rights organizations joined with Senator Duckworth to encourage Senators to sign on to the letter. In releasing the letter, Senator Duckworth specifically noted the opposition of PVA to H.R. 620. PVA Executive Director Carl Blake stated in a March 2nd letter to Senator Duckworth that, “Passing H.R. 620 would be devastating to the promise of the ADA to increase opportunities for people with disabilities.”
The formal opposition of 43 Senators means that any efforts to move ADA legislation that includes a notification requirement and cure period in the Senate would be up against very difficult odds. Nonetheless, to guard against the possibility of this or similar legislation moving this year, PVA staff recently participated in a briefing for Senate staff to educate them about the dangers of limiting the opportunity for people with disabilities to enforce their rights under the ADA. Moving forward, PVA will continue to strongly oppose the ADA Education and Reform Act, or any other legislation that rolls back the obligations of businesses under the ADA to accommodate people with disabilities.
For more information about Senator Duckworth’s efforts to stop ADA notification, please visit: https://www.duckworth.senate.gov/news/press-releases/duckworth-and-senate-democrats-vow-to-defeat-house-gop-led-effort-to-curtail-civil-rights-of-americans-with-disabilities.

FAA REAUTHORIZATION HAS TO MOVE
The Federal Aviation Administration Re-Authorization Act of 2017–S.1405, introduced by John Thune (R-SD) Chairman of the Senate Commerce, Science, and Transportation Committee and Ranking Member Bill Nelson (D-FL) along with Aviation Subcommittee Chair Roy Blunt (R-MO) and Ranking Member Maria Cantwell (D-WA) is must pass legislation in order to keep airports and general / commercial aviation in operation. The Senate is expected to take up debate in June after the House of Representatives finishes its business on H.R. 4–The FAA Reauthorization Act of 2018.
The House version is scheduled for debate at the end of April. Both versions of the legislation have amendments affecting passengers with disabilities as originally drafted in the Air Carrier Access Amendments Act (S.1318/H.R. 5004). Committee staff report that they would like to be through a conference committee by the end of July and have the legislation ready to go to the President, prior to September’s expiration of the current FAA authorization.

HOUSE ADDS COSPONSORS TO THE ACAAA
Representative Jim Langevin (D-RI-2) introduced the Air Carrier Access Amendments Act (H.R. 5004) in the House on February 13th. This is the companion piece to S.1318 introduced by Senator Tammy Baldwin (D-WI) last year. H.R. 5004 has been referred to the House Subcommittee on Aviation for further action. To date, the bill has added four cosponsors: Robert Brady (D-PA-1), Richard Neal (D-MA-1), Gwen Moore (D-WI-4), and David Young (R-IA-3), making the legislation bipartisan. This legislation would provide many improvements affecting passengers with disabilities including:
• Strengthening ACAA enforcement through referral of certain complaints to the U.S. Attorney General, increased civil penalties for damaged wheelchairs, and a private right of action.
• Ensuring airlines acquire airplanes that meet broad accessibility standards. Improved structural access includes safe and effective boarding and deplaning processes, procedures, and equipment along with better stowage options for assistive devices.
• Improving training for air carrier personnel and their contractors, including requiring heightened training for personnel who assist with the boarding and deplaning process.
• Requiring the Secretary of Transportation to work with stakeholders to develop an Airline Passengers with Disabilities Bill of Rights.
• Creating a U.S. Department of Transportation Advisory Committee on the Air Travel Needs of Passengers with Disabilities.

DOL VETS VSO MEETING
Advocacy staff attended the Department of Labor Veterans’ Employment and Training Service (DOL VETS) monthly briefing with veterans service organizations (VSOs) on March 30th. Senior Advisor for DOL, Matt Miller, gave an update on the omnibus appropriation that had just been enacted, noting the increases that were included for VETS.
The Jobs for Veterans State Grants program received an additional $5 million, as did the Transition Assistance Program (TAP) program and the Homeless Veterans Reintegration Program (HVRP).
HVRP is now funded at its authorized level. Miller also reported that 230 companies have signed up for the pilot run of the HIRE Vets Medallion program that seeks to recognize businesses that undertake special efforts to recruit and hire veterans.
The main focus of the meeting was a presentation by James Borbely with the Bureau of Labor Statistics (BLS) on the release of that agency’s annual report on the employment situation of veterans. The jobless rate for all veterans declined from 4.3 percent in 2016 to 3.7 percent in 2017. Veterans with a service-connected disability had an unemployment rate of 4.3 percent in 2017, which was little different from the rate for veterans with no disability. The unemployment rate measures those persons that are out of work but actively seeking employment.

 

Labor force participation rates are another measure and tell a somewhat different story when looking at the most recent cohort of veterans and their employment experiences.

The labor force participation rate of Gulf War-era II veterans with no service-connected disability is 85.5 percent. Among veterans with a service-connected disability, 75.8 percent are in the labor force. However, among veterans rated 60% or higher, only 61.7 percent are working. Detailed information from BLS on veteran employment can be found at: https://www.bls.gov/news.release/vet.toc.htm.

NEXT GENERATION AMTRAK CARS TO REPLACE ACELA

On April 3rd, Senior Associate Advocacy Director, Lee Page went to Wilmington, DE to view a “mockup” of the next generation high speed trainset business car. The new design by Alstom, a French manufacturer, has an extendable bridge plate that deploys from the train car to accommodate the gap. Upon entering the train car you will notice a wide open vestibule with a wider turning radius connecting two cars (business and café) with an accessible path to go between the cars. Immediately entering the business car, you will see the accessible restroom with a circular door operated by electronic push button. The restroom is large enough to accommodate a person in a power chair or 3 wheeled scooter. After the restroom, you pass through an automatic glass partition into the seating area where on your left is a cut out for wheelchair space adjacent to a table that is accessible for the passenger to use for work or eating. Across from the wheelchair cut out space is an accessible passenger seat that a passenger could transfer into and his wheelchair would be placed behind his seat in a designated space for wheelchair stowage on the car.

The train ordered by Amtrak is Avelia Liberty, the latest development of Alstom’s high-speed train range Avelia. The new trainset will be able to carry up to 33% more passengers than the current Acela trains. The trainset configuration includes an innovative compact power car and nine passenger cars, with the possibility of three more being added if demand grows. The train is capable of travelling at speeds up to 186 mph, but will initially operate at a maximum speed of 160 mph based on Northeast Corridor (NEC) track speed limits.
Alstom is contracted to design and build 28 new high-speed trains, which will run on the NEC between Boston and Washington D.C. eventually replacing the Acela.
Amtrak and Alstom also signed a long-term contract under which Alstom will provide Amtrak with long-term technical support and supply spare components and parts for the maintenance of the new trainsets. Together, these contracts are worth $2 billion.
LIMITED CAREGIVER EXPANSION DISCUSSED
On April 5th the Republican staff of the House Veterans’ Affairs Committee held a roundtable to further discuss their proposed legislation to both expand and limit the caregiver program to veterans of any era who require assistance with three Activities of Daily Living (ADLs). At the same time, this draft is being considered, PVA, along with other VSOs, are working to advance a deal negotiated last month that would expand the caregiver program to all eras with the current eligibility criteria of one ADL. As this approach is most ideal, and would serve most of PVA’s members, we continue to advocate the Congress pursue it without hesitation. We hope to see a vote before Memorial Day recess.

If the effort of full expansion does not succeed, PVA will continue to support any legislative measure that opens any access to the caregiver program.
PVA has been clear, incremental expansion is not success, only a first step. Our priority remains equal access to the caregiver program for all veterans regardless of era served.

MILITARY TO CIVILIAN TRANSITION SUMMIT

On April 10th, Associate Legislative Director Steven Henry attended the Military to Civilian transition summit that convened leaders from public and private sector organizations who are committed to the seamless transition of military service members, veterans, families, and caregivers.
During the summit, multiple presentations were conducted regarding transition of service members and personal stories were provided by the families of veterans who had committed suicide. During breakout sessions, it was determined that the greatest barriers to a seamless transition are: gender; lack of a support network, to include family support; financial difficulties; and a lack of job prospects. Everyone in attendance agreed that for a seamless transition, all of these factors must be addressed.

HOUSE AND SENATE VETERANS’ AFFAIRS COMMITTEE UPDATES

On April 11th, a markup of pending legislation was scheduled with the House Disability Assistance and Memorial Affairs subcommittee; however, that markup was cancelled.
That same day, the House Economic Opportunity subcommittee marked up the following bills that PVA currently supports:
• H.R. 1206, Reducing Barriers for Veterans Education Act of 2017: This bill makes an individual who is eligible for educational assistance under the Post 9/11 Educational Assistance program eligible for assistance with the fees for applying to Institutions of Higher Education (IHEs)

• H.R. 3023, To Amend Title 38, United States Code, to eliminate the Authority of the Secretary of Veterans Affairs to pay reporting fees to educational institutions: This bill eliminates the authority of the Department of Veterans Affairs to pay reporting fees to educational institutions.

• H.R. 3940, Veterans Education Disaster Assistance Act: This bill provides housing stipends and supply fee payments under the Post-9/11 Educational Assistance Program for individuals affected by extended school closures due to natural disasters.

• H.R. 4451, Homeless Veterans’ Reintegration Programs Reauthorization Act of 2017: This bill reauthorizes Department of Veterans Affairs (VA) homeless veterans’ reintegration programs through FY2022. The bill includes among those for whom job training, counseling, and placement services are to be provided to expedite their reintegration into the labor force:

(1) veterans participating in the VA supported housing program for which rental assistance is provided under the United States Housing Act of 1937, (2) Indians who are veterans receiving assistance under the Native American Housing Assistance and Self Determination Act of 1996, (3) veterans who are transitioning from being incarcerated, and (4) veterans participating in the VA’s rapid re-housing and homelessness prevention program.

 

• H.R. 4830, SIT-REP Act: This bill provides for the disapproval of any course of education for purposes of the educational assistance programs of the Department of Veterans Affairs unless the educational institution providing the course permits individuals to attend or participate in courses pending payment by Department, and for other purposes.

• H.R. 4835, Job TOOLS for Veterans Act: This bill extends the pilot program on off-base transition training for veterans and spouses.

• H.R. 5044, Service-Disabled Veterans Small Business Continuation Act: This bill clarifies the treatment of certain surviving spouses under the contracting goals and preferences of the Department of Veterans Affairs.

Additionally on April 11th, the Senate Veterans’ Affairs Committee held a hearing on the nominations of Paul R. Lawrence to be VA Undersecretary for Benefits; and Joseph L. Falvey Jr., to be a judge for the U.S. Court of Appeals for Veterans Claims (CAVC).
During the hearing, both gentleman were allowed five minutes to provide opening remarks where each gave a brief description of his background, experience, and veteran status.
Mr. Lawrence, a graduate of West Point, thanked his family and explained that one of his priorities is to address over payments within the Department of Veterans Affairs. He also stated that he had not been interviewed by the White House, has no intention of privatizing the Department of Veterans Affairs, and is committed to ensuring all veterans receive the benefits they have earned, timely and accurately.
Mr. Falvey is a 30-year veteran of the United States Marines who has vast experience as a Judge Advocate but very limited experience in veterans law. Mr. Falvey did state that in the past few months he has been reading up on precedential decisions made by the CAVC and that his lack of VA experience does not hamper his ability to be an effective judge; instead, he will effectively apply the law without allowing outside influences to affect his decisions.

 

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March Washington Update

March 20, 2018​​​​​​​​Volume 24, Number 3
***PRIORITY***
The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit http://www.AirAccess30.org and share your story.
PVA National President David Zurfluh Testifies Before Congress
On March 6, PVA National President David Zurfluh testified before a joint session of the Senate and House Veterans’ Affairs Committees regarding PVA’s public policy priorities. President Zurfluh’s testimony focused on protecting and strengthening VA’s specialized health care services and the expansion of VA’s Comprehensive Caregiver program. President Zurfluh also spoke about the difficulties faced by PVA members in Puerto Rico following last year’s devastating hurricane. In concluding his oral remarks, President Zurfluh told members of the committees that, “Our members and thousands of other veterans will hold you accountable if you fail to do what everyone in this room and people around this country know is right.”
To watch President Zurfluh’s testimony, please visit: https://www.veterans.senate.gov/hearings/legislative-presentation-of-multiple-vsos-03062018.

Air Carrier Access Amendments Act Introduced in the House
On February 13, Rep. Jim Langevin (D-RI) introduced the Air Carrier Access Amendments Act (ACAAA) (H.R. 5004). This legislation is a companion to legislation introduced in the Senate in June 2017 by Senator Tammy Baldwin (D-WI). The ACAAA would make needed improvements to the Air Carrier Access Act (ACAA) and provide increased opportunities for stakeholders to work with airlines and the U.S. Department of Transportation to improve the air travel experience for passengers with disabilities. One original co-sponsor, Rep. Robert Brady (D-PA), joined with Rep. Langevin in supporting the legislation. The bill currently has one additional co-sponsor.
Despite progress since the passage of the ACAA, too many travelers with disabilities still encounter significant barriers, such as damaged assistive devices, delayed assistance, and lack of seating accommodations. Access for people with disabilities in air travel must move into the 21st century.
Otherwise, people with disabilities will be left behind unable to compete in today’s job market or enjoy the opportunities available to other Americans.

The Air Carrier Access Amendments Act (H.R. 5004/S. 1318) will address these problems by:
• Strengthening ACAA enforcement by requiring referral of certain complaints to the U.S. Attorney General, increasing civil penalties for damaged wheelchairs, and establishing a private right of action.
• Ensuring airlines acquire airplanes that meet broad accessibility standards. Improved structural access includes safe and effective boarding and deplaning processes, procedures, and equipment, along with better stowage options for assistive devices.
• Improving training for air carrier personnel and their contractors, including those who assist with passenger boarding and deplaning.
• Requiring the Secretary of Transportation to work with stakeholders to develop an Airline Passengers with Disabilities Bill of Rights.
• Creating a U.S. Department of Transportation Advisory Committee on the Air Travel Needs of Passengers with Disabilities.
Some of the provisions in the ACAAA are included in the 21st Century Aviation Innovation, Reform, and Reauthorization Act (H.R. 2997) and the FAA Reauthorization Act of 2017 (S. 1405), the House and Senate versions of the FAA Reauthorization. Currently, these bills are pending floor action in the House and Senate. The FAA Authorization expires on March 31. It is likely that Congress will extend the current authorization with the hopes of completing a long-term reauthorization this summer.
We urge our members to contact their Senators and Representatives and ask them to co-sponsor this important legislation. We need to show widespread support for H.R. 5004/S. 1318 in the coming weeks and months.

ADA Notification Legislation Passes the House
On February 15, the ADA Education and Reform Act of 2017 (H.R. 620) passed the House by a vote of 225-192. Nineteen Republicans voted against it, while 12 Democrats, 6 from California, voted for its passage.
In a statement issued on February 16, Paralyzed Veterans expressed our strong opposition to this legislation. Executive Director Carl Blake stated that, “The message this vote sends to people with disabilities is that ADA compliance is no longer a priority in America.” Mr. Blake further stated that, “Instead of expecting that business owners will proactively seek to educate themselves about the legal requirements of the ADA, the burden would be shifted to people with disabilities who would be expected to tell businesses how to become compliant.”
Prior to passage by the House, several amendments were offered to amend the legislation. Rep. Jim Langevin (D-RI) and Rep. Greg Harper (R-MS) offered an amendment that would have removed the notice and cure provisions from the legislation. The PVA-supported amendment failed 188-226. In addition, three amendments directed at refining the notice and cure provisions were offered and accepted. The first was an amendment from Rep. Jackie Speier (D-CA) that would require a business to remove a barrier rather than just make “substantial progress” unless additional time is needed for barrier removal due to circumstances beyond the control of the business owner or operator.
The second amendment, from Rep. Ami Bera (D-CA), cut the amount of time that a business has to cure the ADA violation from 120 to 60 days. Finally, Rep. Cathy McMorris Rodgers (R-WA), who ultimately voted against the final bill, offered an amendment removing the requirement for a person with a disability to cite the specific section(s) of the ADA allegedly violated by the business in the notice.
Proponents of H.R. 620, and notice and cure requirements in general, assert that Congress must act to stop Title III lawsuits, whether frivolous or not. We oppose even the amended notice and cure requirements, because without the threat of a lawsuit, too many businesses may simply choose to employ a “wait and see” approach rather than become ADA compliant.
The lack of monetary damages under Title III would further remove any incentive for a business to meet ADA requirements. Consequently, there is no way to amend the notice and cure provisions of H.R. 620 to address the concerns of the disability community.
It’s now up to the Senate to stop this legislation from becoming law. Senator Tammy Duckworth (D-IL) is circulating a Dear Colleague letter seeking to solidify Senate opposition to the bill. We are working to educate members of the Senate about the dangers of this legislation and urging Senators who oppose ADA notification to sign the Duckworth letter.
At this time, we have no information about when or if this legislation might move in the Senate. In the meantime, please let your Senators know that you oppose H.R. 620, or any similar efforts to impose notification and cure requirements on the ADA.

House Veterans’ Affairs Committee holds Roundtable on Caregiver Program
On March 6, the House Veterans’ Affairs Committee held a roundtable with veterans service organizations to discuss their draft legislation to make certain improvements to the VA’s Comprehensive Family Caregiver Support Program. Department of Veterans Affairs Secretary David Shulkin proposed a limited expansion to certain pre-9/11 veterans to appease the cost concerns of some members of the House of Representatives and the White House. In a memo to Congress from January, the White House said it could not support expansion to pre-9/11 veterans because of “fiscal restraints.” Secretary Shulkin said he believes his proposal would allow for a restricted expansion with a more appealing cost.
The draft legislation articulated a limited expansion, proposed by Department of Veterans Affairs Secretary David Shulkin during a hearing last month. As drafted, the legislation would make eligible veterans injured prior to 9/11 who need a caregiver’s assistance with three or more Activities of Daily Living, rather than one as currently required for those injured post-9/11.
Veterans with severe PTSD and TBI would remain eligible. And the 26,000 caregivers already in the program would continue under the current eligibility requirements.
Chairman Roe continues to have concerns about the cost of a broader expansion, like the one in S. 2193, the “Caring for our Veterans Act,” currently awaiting a vote from the full senate. During the roundtable he again expressed his belief that expansion can only be done by tightening eligibility in order to allow pre-9/11 veterans to participate. PVA’s Associate Legislative Director, Sarah Dean, made it clear to the committee that while this draft could be a good first step, we will continue to advocate, along with our VSO partners to ensure the equitable treatment of all veterans in need of caregiver services.

We will continue to work to see that veterans who were made ill or injured in any era are able to receive the services they need.

VA Health Subcommittee Conducts Puerto Rico Field Hearing
The House Veterans’ Affairs Subcommittee on Health conducted a field hearing on Monday, March 12 in San Juan, Puerto Rico. The topic of the hearing was the overall operation of the health care system on the island in serving veterans as well as the performance of the VA during the 2017 hurricane season. Invited witnesses included Mr. Agustín Montañéz-Allman, Puerto Rico State Director of Veterans’ Affairs, Dr. Rafael Rodríguez-Mercado, MD, Puerto Rico Secretary of Health, Dr. Victor Ramos-Otero, MD, Puerto Rico College of Physicians and Surgeons, Dr. Miguel LaPuz, MD, Director, VA Sunshine Healthcare Network (VISN 8), VHA and Dr. Antonio Sanchez, MD, Acting Director, VA Caribbean Healthcare System, VHA. In addition to the hearing, the subcommittee held a roundtable with local veterans service organizations at which PVA was represented by its Puerto Rico chapter leadership. Written witness testimony, as well as a statement for the record submitted by the national office of PVA, can be found at http://docs.house.gov/Committee/Calendar/ByEvent.aspx?EventID=106923.

Independent Budget Testifies on FY 2019 Budget Request
On March 15, the House Committee on Veterans’ Affairs Subcommittee on Health held a hearing on the “FY 2019 Department of Veterans Affairs Budget Request for the Veterans Health Administration.” PVA Associate Legislative Director Sarah Dean testified along with Independent Budget (IB) partners, Disabled American Veterans (DAV) and Veterans of Foreign Wars (VFW). Overall, the IB commends the Administration’s budget submission as it includes several critically needed increases for FY 2019 for the Veterans Health Administration (VHA), construction, and information technology modernization. There remain looming questions over the adequacy of existing and now proposed funding as neither the House nor Senate has yet to pass legislation addressing the future of the Choice program and community care programs.
The IBVSOs conveyed to the members of the subcommittee our expectation of adequate resourcing and oversight of VA, particularly with regards to specialized services. In testimony, PVA expressed serious concerns with the lack of or altogether missing funding for several medical care programs. In 2016, Congress authorized appropriations through FY 2018 to provide the reproductive service, in-vitro fertilization (IVF), to those veterans whose catastrophic injuries preclude their ability to conceive children. As of January 2018, some 500 consults for IVF had been made. However, these procedures are not directly funded, and therefore, the IB recommends $20 million to cover the cost through FY 2020.
Additionally, PVA recommended the necessary funding to implement eligibility expansion of VA’s comprehensive caregiver support program to severely injured veterans of all eras. The funding level is based on CBO’s estimate for the expansion preparation costs under S. 2193. For the initial phase, we recommend $11 million for FY 2019 to increase staff and improve IT.
PVA’s formal written statement for the record on behalf of The Independent Budget—co-authored with DAV and VFW can be viewed at http://www.pva.org.
VA Proposes Rule Change Related to Consent for Sensitive Health Information for Community Partners
On January 19, the Department of Veterans Affairs (VA) proposed a change to the rules governing the consent to release confidential VA medical records. The proposed rule change would allow confidential VA information to be shared with a Health Information Exchange (HIE) community partner after a veteran provides consent to that partner.
The proposed rule would allow VA to amend current consent regulations so that partnering HIEs can obtain permission to share EHRs without a hardcopy of a patient’s written consent form. While a hardcopy form is still an acceptable way of obtaining consent, HIEs may also have the option to electronically attest that a patient has granted them legally sufficient consent.
With the proposed rule, VA intends to ensure more providers can access veteran EHRs at the point of care for better-informed clinical decision-making by having access to a patient’s comprehensive medical history.
According to VA, an estimated three out of every four veterans enrolled in VA’s healthcare system also visit non-VA facilities in their communities. However, community providers are frequently denied access to veteran EHRs because VA does not have a hardcopy of the patient’s consent form on file. And a lack of access to veteran’s EHRs may result in delays in care or poorly-informed treatment, which may have a negative impact on patient health outcomes.
PVA understands the rationale and the need behind the rule change making it easier for outside providers to view the records to provide the care needed to the veteran; however, PVA does have some concerns.
For example, information protected by 38 U.S.C. § 7332 is exceptionally sensitive information about a veteran. It can affect job prospects and other benefits or programs to which a veteran may be entitled. Furthermore, PVA is requesting more information regarding how the veteran’s information will be protected in the HIE. PVA is also requesting to receive copies and templates of the “opt-in” consent forms that veterans would be using.
The comment period closes on March 20. PVA appreciates VA’s continued communication with all VSOs and allowing us to provide input in regards to how perspective rule changes will affect our veterans.

PVA’s 2018 Advocacy and Legislation Seminar Includes Focus on Key Veterans and Disability Issues
On March 5-8, PVA Chapter representatives from across the nation descended on Washington, DC to educate their members of Congress about issues of importance to PVA, its members, and all veterans and people with disabilities. Approximately 100 attendees listened to presentations from PVA’s National Office staff, government officials, congressional staff, and other experts on issues of concern to veterans and people with disabilities.
Presentations focused on PVA’s top three policy priorities: protecting specialized health care services, expanding comprehensive caregiver benefits, and improving the air travel experience for people with

disabilities. Other topics discussed included oversight of VA’s implementation of appeals reform; improvement of benefits for catastrophically disabled veterans, including increasing Special Monthly Compensation and ensuring access to VA prosthetics; efforts to safeguard the Americans with Disabilities Act, and protection of Social Security, Medicare, and Medicaid.
Following two days of education and training, PVA members and Chapter representatives spent two days on Capitol Hill meeting with their legislators about PVA’s priorities. Early reports from the meetings indicated that members of Congress and their staff members were generally supportive of helping protect those who have given so much for this nation. Success was seen in the information presented and the approximately 300 meetings held during the event.
One of the highlights of the week was the presentation of the 2018 Gordon H. Mansfield Congressional Leadership Award to Senator Johnny Isakson (R-GA), Chairman of the Senate Veterans’ Affairs Committee. Senator Isakson received the award, in part, because he has championed the expansion of the VA’s Comprehensive Caregiver Program to pre-9/11 veterans.
To further move PVA’s policy priorities forward, please continue to speak with your elected officials about the needs of veterans and people with disabilities.

February Washington Update

February 14, 2018​​​​​​​​Volume 24, Number 2
***PRIORITY***
The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit http://www.AirAccess30.org and share your story.

ADA Notification Legislation Will be on the House Floor February 15

The ADA Education and Reform Act of 2017 (H.R. 620), is headed to a vote on the House floor. The House is scheduled to take up the legislation on Thursday, February 15th.

In a letter to House leadership on February 1, 2018, Paralyzed Veterans of America expressed its strong opposition to this legislation. If signed into law, it would require a person with a disability to send a letter with very specific information notifying a business, regardless of its size, that it is out of compliance with the ADA. The business would then have 60 days to respond and 120 days to make “substantial progress” toward fixing the problem. Only if the business failed to acknowledge the notification or make substantial progress in fixing the violation, could the business be sued.

Although proponents of notification insist that it is needed to stop lawsuits, whether frivolous or not, we believe that such a requirement would only serve to remove all incentive for businesses to comply with Title III ADA requirements. There are no monetary damages available under Title III of the ADA, only injunctive relief. If a notification and cure requirement, such as that laid out in H.R. 620, became law, a business could simply employ a “wait and see” approach and continue to violate the law without any real fear of consequences.

Now is the time to let your members of Congress know that you oppose this legislation. As action is imminent, it is important to call and express your opinion as opposed to emailing or sending letters. We will continue to advocate against the bill’s passage and will do so if it passes the House and heads to the Senate.

House Veterans Affairs Committee holds hearing on Caregiver Program

On February 6, 2018, the House Committee on Veterans Affairs held a hearing entitled “Correcting Course for Veteran Caregivers.” Chairman Roe’s goal for the hearing was to examine how to strengthen and modify the existing caregiver program. Sarah Dean, Associate Legislative Director, testified on behalf of PVA regarding the state of the program and current legislation that would authorize its expansion.

As is, the Program of Comprehensive Assistance for Family Caregivers provides monthly stipends, respite, CHAMPVA, and training to caregivers of veterans injured on or after 9/11. PVA, alongside DAV, and the Elizabeth Dole Foundation (EDF), used their opening statements to highlight the unconscionable inequity created by the date of injury requirement.

In November, 2017, S. 2193, passed out of the Senate VA Committee with a vote of 14-1. Included in that community care reform bill is the expansion of caregiver eligibility pre-9/11. The bill has not yet passed the Senate nor has it gained support from Chairman Roe because of his concerns of the cost of the expansion. During the hearing he expressed his belief that expansion can only be done by tightening eligibility in order to drive down costs.

Department of Veterans Affairs Secretary David Shulkin proposed a limited expansion to certain pre-9/11 veterans to appease the cost concerns of some members of the House of Representatives and the White House. In a memo to Congress sent last month, the White House said it could not support expansion to pre-9/11 veterans because of “fiscal restraints.” Secretary Shulkin said he believes his proposal would allow for a restricted expansion with a more appealing cost. It would restrict pre-9/11 eligibility to veterans who require assistance with three activities of daily living, rather than one as currently required for post-9/11 veterans. Veterans with severe PTSD and TBI would remain eligible.

The 26,000 caregivers already in the program would continue under the current eligibility. PVA, DAV, and EDF made it clear to the committee that while this proposal would not be opposed, our priority remains the equitable treatment of all veterans in need of caregiver services. We will continue to work to see that veterans who were made ill or injured in any era are able to receive the services they need.

PVA Testifies on Rapid Appeals modernization Program

On January 30, 2018, PVA Associate Legislative Director, Steve Henry testified before the House Veterans Affairs Committee (HVAC) on the Rapid Appeals Modernization Program (RAMP) and whether or not the program is effectively helping veterans. The testimony consisted of two panels; one panel was made up of VA and GAO staff and the other panel was Paralyzed Veterans of America (PVA), Disabled American Veterans (DAV) and the National Organization of Veteran Advocates.

The Rapid Appeals Modernization Program is a “test” program implemented by VA to test aspects of the Modernization law that will be fully implemented on February 2019. RAMP offers veterans an alternative to appealing their claims to the BVA by offering them two options: Veterans can choose between a higher level review and the supplemental claim process.

The higher level review is conducted by an experienced Decision Review Officer (DRO), who will review the veteran’s claim and provide a decision based on what was in the record. The supplemental claim option allows the veteran to submit additional evidence, have their claim reviewed by a DRO, who will then make a decision based on the entire record, including the newly submitted evidence.
Unlike DAV’s testimony that provided a positive outlook on the RAMP program, PVA’s testimony was quite the opposite. For veterans to “opt in” to RAMP, all of their appeals must be withdrawn from the Board of Veterans Appeals (BVA); consequently, they would lose their docket date and their place in line. Furthermore, if veterans receive an unfavorable decision, they would be unable to appeal their claims to the BVA until February 2019.

PVA reiterated to the HVAC that unlike DAV, claims filed by PVA members are more often than not extremely complex. It is difficult to believe that the same representatives who had previously denied and improperly adjudicated PVA’s initial claims would then re-review and provide a proper decision.

Furthermore, to force veterans to withdraw their claims and lose their docket date is unacceptable. The claims of our members must be adjudicated expeditiously. Our members require quick and accurate decisions. They should not have to navigate more layers only for a negative outcome. When asked by Committee Chairman Roe what PVA would change about the program, we stated that veterans should not be required to withdraw their appeal from the BVA resulting in losing their docket date.

PVA feels that RAMP is not good for our members.

Budget Agreement Includes Disaster Relief Funding

The budget bill signed into law by the President on February 9, 2018, after a brief government shutdown includes $89 billion in additional emergency funds for communities affected by the recent hurricanes and wildfires. The bill includes $28 billion in Community Development Block Grant Disaster Relief (CDBG-DR) funding, as well as resources to shore up the Medicaid program in Puerto Rico and the U.S. Virgin Islands.

While this bill contains significant disaster relief resources, housing advocates are concerned that it does not include the support necessary to ensure that disaster recovery reaches all households, including those with the lowest incomes. For example, the bill does not include the Disaster Housing Assistance Program (DHAP) that addresses longer term housing needs of low income disaster survivors, a requirement to collect and make public the data to ensure that the needs of low income people and communities are met, and housing-specific resources to ensure that the severe shortage of affordable rental homes in disaster-impacted communities is not worsened.

The following details of the CDBG-DR funds are provided courtesy of the Disaster Housing Recovery Coalition:

Community Development Block Grants

The bill provides $28 billion in CDBG-DR funding. Of this amount, up to $16 billion is slated to address unmet needs, including $11 billion that will be allocated to state and local governments impacted by Hurricane Maria, with $2 billion of that set aside for rebuilding the electrical grids in Puerto Rico and the U.S. Virgin Islands. The remaining $12 billion is set aside for mitigation projects. Up to $15 million of CDBG-DR funds can be used to provide capacity building and technical assistance.

The measure provides the HUD Secretary with a number of limitations and special authorities. For example, the bill:

​• Limits the determination of “duplication of benefits” to exclude those households that applied for, but did not accept, a Small Business Administration (SBA) loan.

​• Requires grantees to maintain a public website with common reporting criteria to allow the public to see how all grant funds are used, including copies of all relevant procurement documents, grantee administrative contracts, and details of ongoing procurement processes.

​• Allows the HUD Secretary to waive or specify alternative HUD requirements, except for requirements related to fair housing, nondiscrimination, labor standards, and the environment, if the HUD Secretary finds that good cause exists and that it is not inconsistent with the purpose of the CDBG program.

​• Allows the HUD Secretary to make temporary adjustments to the Housing Choice Voucher annual renewal funding allocations and administrative fee eligibility determinations for public housing agencies (PHAs) in disaster-impacted areas. This authority is provided to “avoid significant adverse funding impacts that would otherwise result from the disaster, or to facilitate leasing up to a PHA’s authorized level of units under contract.”

​• The bill also provides that any CDBG-DR funds that remain, after allocating funds for all necessary expenses, shall be used for additional mitigation activities in the most impacted and
distressed areas.

Rural Development

The disaster relief bill would provide a total of $18.7 million to offset the cost of modifying Section 502 homeownership loans and to rebuild Section 515 Rural Rental Housing properties in USDA’s portfolio that were damaged or destroyed by the recent hurricanes and wildfires. The bill, however, limits Section 515 funds to those property owners who were not required to carry flood insurance.

Nearly $166 million was provided to repair drinking water and wastewater systems that were damaged. Of this amount, $2 million is provided for technical assistance.

Legal Aid Services

A total of $15 million is provided for legal aid services, however, the bill limits the usage of these funds to “mobile resources, technology, and disaster coordinators to provide short-term services.”

Tax Provisions

The disaster package also extends favorable tax provisions that were provided to hurricane-impacted areas to communities affected by the California wildfires. This includes allowing tax-favored withdrawals from retirement funds, tax credits for employers impacted by the wildfires for retaining employees, and the temporary suspension of limits on charitable deductions, among other tax provisions.

Delta and United Announce Changes to Their Service Animal Policies

In recent weeks, Delta and United have issued revised policies for the transport of service animals and emotional support animals on their airlines. The new policies go into effect on March 1.

Delta’s revised service animal policy includes several key requirements that will impact all passengers with disabilities who use service animals. First, Delta’s revised policy requires all service animal users to submit a completed “Veterinary Health Form” 48 hours prior to travel. The form is available here: https://www.delta.com/content/dam/delta-www/pdfs/policy/TrainedServiceAnimal-RequiredForms.pdf. Second, Delta’s revised policy requires all psychiatric service animal and emotional support animal users to submit, in addition, a completed “Confirmation of Animal Training” form 48 hours prior to travel. On this form, available here: https://www.delta.com/content/dam/delta-www/pdfs/policy/EmotionalSupportAnimal-RequiredForms.pdf, the user of a psychiatric service animal or emotional support animal must confirm that the animal has been trained to behave in public and affirm that inappropriate behavior will lead to denied boarding of the animal or its removal from the aircraft.

United’s revised policy would also require emotional support animal users to provide confirmation of training and a health certificate, to include an affirmation from a veterinarian “that there is no reason to believe that the animal will pose a direct threat to the health and safety of others on the aircraft or cause a significant disruption in service,” 48 hours prior to travel. More information about United’s policy is available here: https://hub.united.com/united-emotional-suppport-animal-policy-2530539164.html.

Paralyzed Veterans and nine other disability organizations sent a letter to U.S. Department of Transportation Secretary Elaine Chao on February 6th, asking the Department to deem these revised policies to be in violation of the Air Carrier Access Act (ACAA) and advise Delta and United accordingly. On February 8th, disability organizations, including Paralyzed Veterans, also met with Delta to discuss their policy and express our concerns.

In the meantime, however, the policies are still slated to move forward. We will continue to follow their status. Also, the Department has stated that it will begin the process for revising the ACAA’s service animal regulations starting in July.

Disability Coalition Meets at PVA

The Consortium for Citizens with Disabilities (CCD) met for its annual meeting at PVA on January 29, 2018. CCD is the largest coalition of national organizations working together to advocate for federal public policy that ensures the self-determination, independence, empowerment, integration and inclusion of children and adults with disabilities in all aspects of society. Since 1973, CCD has advocated on behalf of people of all ages with physical and mental disabilities and their families. CCD has worked to achieve federal legislation and regulations that assure that the 54 million children and adults with disabilities are fully integrated into the mainstream of society.

In addition to organizational matters for 2018, the meeting featured an array of speakers from think tanks, Capitol Hill and federal agencies. Ellen Nissenbaum, from the Center on Budget and Policy Priorities,
offered an overview of the budget environment confronting Congress in the year ahead. There is strong interest among the majority in the House of Representatives to tackle changes and cuts to Medicare, Medicaid, Supplemental Security Income (SSI), food stamps and low income housing programs.

However, some of the changes would require the use of the so-called reconciliation process whereby only 51 votes are needed for passage in the Senate. Senate Majority Leader Mitch McConnell has expressed little inclination to use reconciliation this year but GOP members of that body are still particularly eager to pursue changes to Medicaid similar to those attempted in 2017.

A panel of administration officials featured representatives from the Department of Labor’s Office of Disability Employment Policy (ODEP) and Administration for Community Living (ACL). Jennifer Sheehy from ODEP reported that among DOL Secretary Alex Acosta’s priorities is increasing labor force participation, including among those injured on the job. She and her colleagues described numerous demonstrations and pilot projects underway that are aimed at promoting, staying at work or returning to work for those with job-related disabilities. Describing her office’s agenda in expanding employment opportunities for people with disabilities, Melissa Ortiz, from ACL, noted the President’s commitment to finding ways to encourage those “who are work capable.” She said she expects much of the administration’s work on welfare reform to target that issue.

Staffers with the Senate Health, Education, Labor and Pensions (HELP) Committee, the House Committee on Education and the Workforce, outlined a 2018 agenda heavily focused on education matters. Those committees also expect to monitor the evolution of Medicaid work requirements and implementation of the Workforce Innovation and Opportunity Act.

January Washington Update

PVA Outlines Policy Priorities for the 2nd Session of the 115th Congress

Prior to the Christmas holiday, the Government Relations Department finalized our primary policy priorities for 2018. A brief outline of those issues that will comprise our point papers for the 2018 Advocacy and Legislative Seminar in March is below:

  1. Protection of Specialized Services
  • The highest priority is to strengthen and sustain VA’s specialized services, such as spinal cord injury/disease care, blinded care, poly-trauma care, and mental health care, which are not duplicated in the private sector.
  • Provide sufficient funding for VA to hire additional clinicians, to include physician, nurses, psychologists, social workers, and rehabilitation therapists to meet demand for services in the SCI/D system of care.
  • Ensure veterans who receive care in the community retain current protections unique to VA health care under Title 38 U.S.C., including medical malpractice remedies governed by 38 U.S.C Section 1151, clinical appeal rights, no-cost accredited representation, and Congressional oversight and public accountability.
  1.      Expand Eligibility for VA’s Comprehensive Family Caregiver Program
  • Congress must expand eligibility for caregiver services provided through the VA’s Comprehensive Family Caregiver Program for veterans with service-connected injuries or illnesses incurred prior to September 11, 2001.
  1.     Oversight of Comprehensive Reform of the Claims Appeals Process Needed
  • Provide oversight of VA’s implementation of the comprehensive reform of the benefit claims and appeals process that was agreed to by stakeholders and subsequently signed into law.
  1.     Improve Benefits for Catastrophically Disabled Veterans
  • Increasing the rates of Special Monthly Compensation as well as Aid and Attendance benefits.
  • Maintaining appropriate Automotive Adaptive Equipment (AAE) reimbursement.
  • Ensuring access to Prosthetics as VA considers rule changes.
  1.    Air Carrier Access Act (ACAA) Problems for People with Disabilities
  • Improve access to air travel for people with disabilities by strengthening protections in the ACAA to ensure safe and efficient assistance and accommodations in air travel and increasing enforcement of these protections.
  1.    Americans with Disabilities Act (ADA) Notification
  • Protect the rights of people with disabilities to seek immediate redress of discriminatory barriers in public accommodations under the ADA by refusing to enact notification requirements under Title III.
  • Protect and Strengthen Social Security, Medicare, and Medicaid (Entitlement Reform)
  • American workers have earned these vital social insurance benefits. Because these programs represent an economic safety net for millions of Americans, Social Security and Medicare should be strengthened and efforts to undermine these programs through benefit cuts or privatization must be rejected. Access to Medicaid, including long-term services and supports, must also be protected.

Update – Tax Reform

Just before Christmas, Congress passed and the President signed into law the Tax Cuts and Jobs Act of 2017, the major tax initiative of the Trump Administration and Congress.  The vote in the House of Representatives was 227 in favor and 203 opposed with five Members not voting.  In the Senate, the party line vote was 51 to 48 with Senator McCain [who is undergoing treatment for brain cancer] not voting.  While taking no position on the overall issue of tax reform, PVA had expressed strong objections to several provisions in the House bill that would have adversely affected many veterans and people with disabilities.

The House bill would have eliminated the deduction for significant medical expenses, the Work Opportunity Tax Credit (WOTC) that offers incentives for companies to hire veterans, people with disabilities and others with barriers to employment and the Disabled Access Tax Credit (DAC) which assists small businesses in making their establishments accessible to people with disabilities.  The final version of the tax bill preserved these vital tax credits.  For those who itemize their taxes, the medical expense deduction was not only maintained but made more generous.  Starting next year, the deduction will kick in for expenses totaling 7.5percent of income instead of 10percent.

While the tax bill will provide significant cuts in corporate tax assessments and temporary reductions in tax rates for individuals, it will add an estimated amount to the deficit over ten years between $1.5 trillion and $600 billion (assuming economic growth offsets some of those costs).  PVA is concerned about the impact this may have on programs such as Medicare, Medicaid and Social Security because of the linkage between the tax measure and proposals outlined in the House and Senate 2018 budget plans.  Those Congressional budget resolutions call for $487 billion in savings over ten years from Medicare, $1 trillion in savings from Medicaid and $5.4 billion from Social Security.  Proposed changes for Medicare include a gradual increase in the eligibility age from 65 to 67, raising income related premiums for Parts B and D and converting this program to a premium support system of financing.  If enacted, Medicare beneficiaries would be given a flat payment or voucher with which to buy health insurance either under traditional Medicare or through the private market.

All plans competing in the program would have to match the benefits and services of traditional Medicare and insurers could not deny coverage to any beneficiary.

Although the impact on beneficiaries of this plan is unclear, previous analyses by the Congressional Budget Office have indicated that a premium support system would increase costs for those enrollees in traditional Medicare.

The $1 trillion in cuts to Medicaid are assumed to come from adoption of provisions that were included in previous House-passed health care reform bills such as turning Medicaid into a block grant to the states and ending the Medicaid expansion. Some two million veterans and their families are covered by traditional Medicaid or the expansion and reductions in spending on that program could strain capacity of other health systems such as the VA.  For Social Security, the 2018 budget resolution proposes reducing Social Security Disability Insurance (SSDI) benefits to those beneficiaries receiving Unemployment Insurance compensation.  Such a move could prove to be a work disincentive for SSDI recipients who attempt a return to work but lose their jobs through no fault of their own.

Although these changes proposed to Social Security, Medicare and Medicaid are only a road map for authorizing committees to turn into legislation, PVA remains concerned that pressure to address the deficit will drive calls to dramatically reduce benefits to beneficiaries of these programs.  PVA expects to be involved in efforts to combat threats to safety net programs that are vital to so many members and their families.

Analyses of the tax bill can be found at:  https://taxfoundation.org/final-tax-cuts-and-jobs-act-details-analysis and http://www.taxpolicycenter.org/feature/analysis-tax-cuts-and-jobs-act

House Committee on Veterans’ Affairs Subcommittee on Economic Development holds hearing on Veterans Home Loans

On Wednesday, January 10, 2018, the House Committee on Veterans’ Affairs Subcommittee on Economic Development held a hearing to address “Home Loan Churning Practices and How Veteran Homebuyers are Being Affected.”

Testifying on the panel were Mr. Jeffrey London, Director of the Loan Guaranty Service, Veterans Benefits Administration; Mr. John Bell, Deputy Director of the Loan Guaranty Service, Veterans Benefits Administration; Mr. Michael R. Bright, Executive Vice President and COO, Government National

Mortgage Association; Mr. J. David Motley, CMB, President, Colonial Savings F.A.; and Mr. Brock Cooper, General Counsel, Veterans United Home Loans.  The hearing opened with Mr. Jeffrey London providing testimony regarding the VA home loan program.

Over the past 70 years VA has guaranteed more than 23 million loans totaling in excess of $2 trillion dollars.  Last fiscal year alone, VA guaranteed an all-time record of over 740,000 loans totaling more than $189 billion.

The hearing focused on questionable practices by organizations who prey on veterans who used the VA home loan program and/or one of VA’s two refinance programs.  These organizations will provide erroneous information to the veterans that could have a detrimental effect on the loan to include ruining the equity of the loan.  It has been determined that these questionable practices, or “churning,” are not a systemic problem and VA has been addressing the problem.

Representative Mark Takano raised the question of whether or not the “churning” organization could be fined.  While the panel indicated the organization could be fined, it must be very specific and address whether the organization had intended to specifically fraud or mislead the veteran.

Representative O’Rourke asked the panel if there had been any progress ensuring the “churning” organizations have ceased their questionable practices.  The panel responded that as of that day, January 10th, organizations must disclose all loan information sent to the veteran including recoup time for refinance loans.

President Trump Signs Executive Order on Transitioning Veterans

With the statement that “We must ensure that our veterans are given the care and support they so richly deserve. That is our unwavering commitment to those who served under the flag of the United States,”  President Donald J. Trump signed a new Executive Order to ensure veterans have the resources they need as they transition back to civilian life.  He signed the Executive Order on “Supporting Our Veterans During Their Transition from Uniformed Service to Civilian Life.”  The Executive Order directs the Secretaries of Defense, Homeland Security, and Veterans Affairs to:

  • Within 60 days, develop and submit a Joint Action Plan to provide “seamless access to mental health treatment and suicide prevention resources for transitioning uniformed service members in the year” following military service; and
  • Within 180 days, update the President on the implementation of the Joint Action Plan and outline further reforms to increase veterans’ access to mental health services.

The status report will include the progress of reforms implemented through the Joint Action Plan and any additional reforms that could help further address problems that obstruct veterans’ access to mental health treatment resources.

There is significant concerns that veterans in their first year after service are particularly vulnerable to mental health risks but often do not receive adequate care.  Most veterans’ experience in uniform increases their resilience and broadens the skills they bring to the civilian workforce.  Unfortunately, in some cases within the first year following transition, some veterans can have difficulties reintegrating into normal life after their military experiences and some tragically take their own lives.  Only 50 percent of returning service members who need mental health treatment seek it, and only about half of those who receive treatment receive adequate care, according to the Substance Abuse and Mental Health Services Administration.

Perhaps more concerning, the suicide rate among veterans in the first year after their service is twice the average among veterans.  Veterans 3 to 12 months out of military service are 3 times more likely to commit suicide than their active duty compatriots, while those up to 3 months out of service were 2.5 times as likely, according to a study from the Naval Postgraduate School.  Approximately 18.5 percent of veterans returning from Iraq or Afghanistan suffer from post-traumatic stress disorder or depression

President Trump and Secretary Shulkin have announced four important initiatives to expand healthcare access for our veterans through technological innovation.

  • An expansion of the VA’s “Anywhere to Anywhere” healthcare, which allows VA providers to use tele-health technology to remotely treat veterans regardless of geographic location.
  • A greater adoption of VA Video Connect, an application for mobile phones and computers, which directly connects veterans and healthcare providers from anywhere in the country.
  • At over 100 VA sites across the nation, a rollout of the new Online Scheduling Tool, which enables veterans to schedule appointments from their mobile devices or computers.
  • A launch of the VA’s “Access and Quality Tool,” which allows veterans to view online both wait times at VA locations and important quality-of-care data.

President Trump has ensured continued access to care in the Veterans Choice Program by signing the VA Choice and Quality Employment Act, authorizing $2.1 billion in additional funds for the Veterans Choice Program (VCP).  The VCP gives eligible veterans their choice of private care if they live more than 40 miles from the closest eligible VA facility, experience wait times over 30 days from the clinically indicated date, or face an excessive burden in accessing VA care.  The President also announced that the Department of Veterans Affairs will adopt the same Electronic Health Record (EHR) as the Department of Defense (DOD).  VA’s adoption of the same EHR as DOD will ultimately result in all patient data residing in one common system, enabling the immediate availability of service member’s medical records and seamless care between the departments.  Secretary Shulkin has expanded access to urgent mental healthcare to former service members with other-than-honorable (OTH) discharges.

Access Board hosts meeting on Accessible Parking

On December 6, 2017, the Access Board hosted a stake holder’s forum on accessible parking and disabled placard abuses. The event was organized by the International Parking Institute and they shared the results of a survey they administered about accessible parking. The survey was online and distributed to the membership organizations of American Association of People with Disabilities (AAPD), National Council of Independent Living (NCIL), Paralyzed Veterans of America (PVA), United Spinal Association, and the United States ACCESS Board social media network.

There were 3,751 respondents who completed the survey.  Out of that number, 91 percent of the respondents said they had a permanent need for accessible parking and that 85 percent of the time they have trouble finding a space. The biggest obstacle is that there are not enough spaces or they are all full with fraudulent placards. In parking on the street, 82 percent of the disabled drivers said, when trying to leave the space other cars have parked to close. Forty percent of the time, respondents say they physically couldn’t pay for parking, or feed the meter because it was inaccessible.

Other presentations were made by the Texas Governors Committee on people with Disabilities, a survey that had over 7,500 participants. The KU Life Span Institute from the University of Kansas, did a presentation on the importance of accessible spaces designated for van parking. Demonstrated many violations and frustrations of drivers who cannot access their van because the access aisle has been blocked after they parked by another car or improper parking space design. They had an extensive study on signage and the message that discouraged violator’s from parking in the space.

Two study reports from Los Angeles and San Francisco Parking Management and Enforcement Divisions, San Francisco reported that at any time during the day in the central business district that 90 percent of the metered parking spaces had cars with handicapped placards allowing them to park for free. San Francisco has a dedicated parking enforcement members to seek out fraud in the handicapped placards.  Of the respondents surveyed 55 percent said, “If we had to pay for parking it still wouldn’t make a difference due to the amount of fraudulent placards in use.”

The participating groups in the meeting agreed to form a coalition to work on this issue which includes disability group, academics, state and local governments, the ACCESS Board and other interested parties

PVA Conducts Webinar for TSA Officers

On January 10, 2018, PVA recorded a webinar for the Transportation Security Administration (TSA) that will be available to TSA officers around the nation. The purpose of the webinar is to educate TSA personnel about PVA, spinal cord injuries, wheelchairs and accessories. Also included were important items for TSA officers to consider when screening someone with a spinal cord injury. TSA asked PVA to conduct the webinar as part of their series on disability awareness. Heather Ansley, Associate General Counsel for Corporate and Government Relations, and Lee Page, Senior Associate Advocacy Director, served as presenters for the webinar

PVA Expresses Concern to DOJ Regarding Withdrawal of Olmstead Employment Guidance

On December 21, 2017, the Department of Justice (DOJ) rescinded its “Statement on Application of the Integration Mandate of Title II of the Americans with Disabilities Act and Olmstead v. L.C. to State and Local Governments’ Employment Service Systems for Individuals with Disabilities.” The statement provided guidance to states on administering their employment services for people with disabilities in the most appropriate integrated setting. Although DOJ noted that their action “does not change the legal responsibilities of state and local governments under Title II of the ADA,” members of the disability community, including PVA, believe that DOJ’s withdrawal of the guidance sends the wrong signal to public entities and employment service providers about what is necessary to comply with the ADA’s integration mandate in employment services.

On January 8, 2018, the Consortium for Citizens with Disabilities (CCD) and the Collaboration to Promote Self-Determination sent a letter to John Gore, Acting Assistant Attorney General for Civil Rights at DOJ, expressing concern over the withdrawal of the guidance. PVA signed on in support of this letter. On January 9th, PVA and other members of the CCD Rights Task Force met with DOJ officials to further discuss our concerns. During our discussion, we also expressed concern regarding the lack of transparency in DOJ’s decision to withdrawal not only the Olmstead employment guidance but also nine other technical assistance documents. PVA will continue to work with the broader disability community to ensure that ADA protections for people with disabilities remain strong.

PVA Government Relations Welcomes Steven Henry to Legislative Team

The PVA Government Relations team welcomes our newest Associate Director Steven Henry.  Steve is replacing Gabe Stultz, who resigned from GVR in September of 2017.  Steve recently worked in PVA’s Veterans Benefits department.  Steve will be representing PVA to federal agencies, most notably the Department of Veterans Affairs (VA) on issues regarding veteran’s benefits.  Prior to joining PVA, Steve represented The American Legion at the Board of Veterans Appeals, he served as American Legion’s only service officer in Washington, DC, where he conducted site visits to VA Medical Centers across the United States to assess them for timeliness and quality of care.  Steve currently represents PVA on VA’s VSO Advisory Council on preventing veteran suicide.

Steve grew up in Severna Park, Maryland and enlisted into the Marines at the age of 17.  He started his career as a veterans advocate in 2010, with the American Legion. Steve currently resides in Bowie, Maryland with his wife Jennifer and his son Ethan.

 

December Washington Update

The Government Relations staff is still looking for stories about problems that our members have experienced during air travel.  Please visit www.AirAccess30.org and share your story.

December 18, 2017                                                         Volume 23, Number 12

Tax Cut Bill Moves Ahead But Preserves Disability Provisions

As the Washington Update went to press, Congress was preparing to vote on the Tax Cuts and Jobs Act of 2017, the major tax initiative of the Trump Administration and Congress.  While taking no position on the overall issue of tax reform, PVA had expressed strong objections to provisions in the House bill that would have eliminated the deduction for significant medical expenses, the Work Opportunity Tax Credit (WOTC) that offers incentives for companies to hire veterans, people with disabilities and others with barriers to employment and the Disabled Access Tax Credit (DAC) which assists small businesses in making their establishments accessible to people with disabilities.  PVA had also expressed concern about the impact on programs such as Medicare, Medicaid and Social Security of the tax bill’s $1.5 trillion addition to the federal deficit.  While the final conference agreement to be voted on does not eliminate the medical expense deduction, WOTC or DAC, it will still add at least $1.5 trillion to the deficit and debt which is likely to play out in 2018 in proposals to cut Medicare, Medicaid and Social Security.  PVA expects to be involved in efforts to combat any dramatic reductions in these safety net programs that are vital to so many members

Senate VA Committee Advances Reform Bil

On November 29, 2017 the Senate Committee on Veteran’s Affairs voted to advance the “Caring for our Veterans Act of 2017.”  This legislation would consolidate the Department of Veterans Affairs (VA) community care programs into a singular program and provide additional resources to enable VA to meet the ever-increasing healthcare needs of veterans.  Since the establishment of the Veterans Choice program in 2014, VA has struggled with ever-changing program requirements enacted by Congress.  The proposed legislation is the logical next step to finally solidify the ways in which VA provides care in the community and provide the necessary tools to keep pace with the needs of our nation’s heroes.

Of great significance to Paralyzed Veterans of America, and the major VSOs, is expansion of eligibility to VA’s Comprehensive Family Caregiver Program.  Currently, the program is restricted to veterans injured on or after September 11, 2001.  This legislation would make eligible those veterans severely injured during and prior to the Vietnam War.  Two years later the program would expand to include veterans of all eras.  This will correct a shameful inequity that has gone on for too long, and asked caregivers and veterans to endure far too much

Press Conference on Expansion of VA Caregiver Progra

On December 6, 2017, PVA, DAV (Disabled American Veterans), The American Legion, and Veterans of Foreign Wars (VFW) presented nearly 200,000 petition signatures to House and Senate leaders urging passage of the “Caring for our Veterans Act of 2017” to expand access to the caregiver program.  At a press conference highlighting the issue, longtime champion and architect of the bill, Senator Patty Murray, and Ranking Member Tester spoke of the bipartisan commitment among members of the Veterans Affairs Committee to see caregiver expansion is accomplished by the end of the 115th Congress.  A similar commitment was offered by House of Representatives members Ranking Member Walz, and Congressmen Langevin and Costello.  The bill now awaits passage in the full Senate and would then require passage in the House

PVA Submits Comments on VA Claim Appeals Program

In November, PVA submitted comments on VA’s changes to its claims and appeals system, including RAMP, directed in the Veterans Appeals and Modernization Act of 2017.  It was PVA’s intent to provide observations on the process to date, provide comments on the information presented at a November meeting on the proposed CFR changes, as well as comments on the draft proposed regulations released on November 20

Our general observations included that we believed continued open and transparent communication from the VA was the best way to ensure veterans organizations are able to work within the new framework and best represent our members.  The meetings and contact with staff are very helpful, but we urged VA to promptly make available any internal training materials the agency is using so that we can train our staff in both the transitional phases, including RAMP, and the new appeals framework.

We also indicated that to be successful in rolling out the new framework, we needed to see where RAMP was working and where it was not.  Throughout the discussions leading up to the passage of the Veterans Appeals and Modernization Act of 2017, VA emphasized the importance of creating a feedback loop to identify and correct RO-specific errors.  We expected that the RAMP analysis would begin to provide this information and looked forward to seeing what VA had to report.

There were several areas of concern such as the agency sometimes using the term “dissatisfied” to describe when veterans might make a choice within the new framework.  “Dissatisfied” is not a statutory term, so it should not appear in any regulations or other binding guidance.  We expressed concerns about what happens after a case is remanded by the Board because if the case is not returned to the Board following continued denial, and it is not tracked in some way, then there is no way to ensure compliance with the remand order. This puts a huge burden on veterans and NSO representatives.  PVA also had specific concerns with the RAMP draft Standard Operating Procedure and about notice being provided to representatives simultaneously with claimants, whether by letter, email, text, or phone.

PVA will continue to monitor this critical change to VA’s appeals process to ensure all veterans receive the compensation they are due and have earned.

PVA Raises Concerns on VA Automobile Adaptive Equipment Program

PVA is very concerned about VA will no longer reimburse qualifying veterans with disabilities for standard Automobile Adaptive Equipment (AAE).  VA argues that many items such as air-conditioning and power brakes or steering are now standard equipment and not eligible if the veteran does not have an invoice reflecting the specific cost.  Unfortunately, many manufacturers now include these components as “equipment packages” without an itemized listing.

Interim Executive Director Carl Blake has met with VA Under Secretary of Health Dr. Clancy to express PVA’s displeasure with the number of denials of reimbursement.  He has also informed her that there has been no action in rewriting the AAE Handbook, but that when VA does decide to take action, they must involve the PVA and other VSOs in the development and writing of the new Directives.  He has also told VA Secretary Shulkin that AAE is one of the top priorities for PVA.

PVA requested that the Veterans Health Administration (VHA) provide an AAE briefing to the Veteran Service Organization (VSO) Prosthetic Workgroup in November.  During the briefing PVA and other VSOs expressed their dissatisfaction with the AAE program’s failure to allow for changes in the automobile industry technological advances to provide reimbursement for new technology in addition to the continuing failure of VA to reimburse vets for standard AAE.

PVA has met with VHA three times in the last two years to provide recommendations to improve the new Directive whenever VA takes action to rewrite it.  PVA will consider to work on this issue and has included AAE as a policy priority for 2018

Senate Briefing on Employment of Veterans with Disabilities

Senators Bob Casey (D-PA), Tammy Duckworth (D-IL), and Jack Reed (D-RI) sponsored a briefing for Senate staff on December 7th about supports and strategies for increasing employment of veterans with disabilities.  Bill Metheny, Director of Field Operations, Veterans’ Employment and Training Service (DOL VETS), for the U.S. Department of Labor (DOL) described DOL VETS role in promoting veterans’ employment among the various workforce development programs at the agency.  Carol Glazer, Executive Director for the National Organization on Disability (NOD) outlined that organization’s employment programs for wounded warriors.  Susan Prokop, Senior Associate Director of Advocacy spoke about Paralyzed Veterans of America’s (PVA) successful vocational rehabilitation program, Paving Access to Veterans Employment (PAVE) that now operates in seven regional offices around the country offering services to veterans as well as their caregivers.  Information about PAVE can be found at http://www.pva.org/veterans-employment.

PVA Serves as Panelist for Congressional Briefing on the Dangers of ADA Notification Legislation

On November 29, 2017, PVA participated in a congressional briefing sponsored by the National Federation of the Blind in opposition to the ADA (Americans with Disabilities Act) Education and Reform Act (H.R. 620).  This PVA-opposed legislation would require a person with a disability to give notice to a public accommodation of an architectural barrier under the ADA and provide the business with an opportunity to “cure” the violation prior to filing a lawsuit.

The purpose of the briefing was to educate congressional staff about the ADA and why the notification requirements proposed by H.R. 620 would be devastating to public access for people with disabilities.

Heather Ansley, Associate General Counsel for Corporate and Government Relations, served as PVA’s representative to the panel.  Other participants in the briefing were Scott LaBarre, Chairman of the Disability Rights Bar Association Board of Directors and President of the National Association of Blind Lawyers; Andy Levy, Partner, Brown Goldstein and Levy; and Andraea LaVant, Self-Advocate, Girl Scouts of America.  Former Congressman Tony Coelho, principle author of the ADA, served as the moderator.

In her comments, Ms. Ansley noted that implementing a notice requirement would effectively remove all incentive for businesses to fully comply with the ADA prior to being notified by a person with a disability about a violation.  This is against the goal of Title III which is to prevent denials of access by ensuring that barriers are removed so that when a person with a disability arrives at a business it is accessible to them.  She also noted that compliance with the ADA is not burdensome as there are free resources available to help businesses comply with the law.  For example, the federally funded ADA National Network provides free technical assistance through 10 regional centers located around the country.  Businesses needing assistance can call 1-800-949-4232 to reach the center nearest them.

At this time, we still do not know when, or if, this legislation will move to the House floor.  It was passed on a party-line vote by the House Judiciary Committee in September.  In the meantime, please continue to contact your House Member to let him or her know that you oppose H.R. 620.

House Task Force Hosts Forum on Veterans Entrepreneurship

On November 30th, the House of Representatives Democratic Caucus’ Task Force on Reinvesting in our Returning Heroes held a Member briefing about challenges facing veterans in starting their own businesses.  Attending the forum were House Democratic Caucus Chairman Joseph Crowley (NY-14), Vice Chair Loretta Sánchez (CA-38), task force co-chairs Representatives Julia Brownley (CA-26), Ruben Gallego (AZ-7), Donald McEachin (VA-4) and Brad Schneider (IL-10) along with Representative Marcy Kaptur (OH-9).  Speakers included Sue Hoppin, President of the National Military Spouse Network,

LeRoy Acosta, Assistant National Service Director for Disabled American Veterans, Susan Prokop, Senior Associate Advocacy Director for Paralyzed Veterans of America, and Ed Vargas, veteran and owner of a small business in Maryland.  The panelists discussed many of the problems veterans and military spouses encounter in starting a business when they return home and seek to begin their post-military professional careers.  Prokop focused on the appeal of self-employment for veterans with disabilities and efforts in past sessions of Congress to overcome some of the unique barriers to entrepreneurship that these veterans often face.  Mr. Vargas, owner of a Mr. Appliance franchise, spoke about the difficulties that high franchise fees pose to many veterans who wish to establish a business, noting the introduction by Rep. Brownley of HR 4473, the Veteran Entrepreneurs Act of 2017 that would provide a tax credit worth up to 25 percent of initial franchise fees for eligible veterans.

PVA Leadership and Staff Visit Puerto Rico Chapter in Aftermath of Hurricane

PVA President David Zurfluh and Vice President Hack Albertson led a delegation of national staff to Puerto Rico on December 4 through 6 to meet with chapter leadership, check on PVA members and meet with federal officials for an update on recovery efforts in the wake of hurricanes Irma and Maria which devastated the island in September.  Meeting at the chapter office on the day of their arrival, the group heard a presentation about the Puerto Rico Recovery Fund (PRRF) recently established by the Center for a New Economy (CNE).  CNE is a non-partisan think-tank that advocates for the development of a new economy for Puerto Rico and created the PRRF to draw in nonprofit and corporate support for rebuilding the island.  Jose Oramas with UPS [a PVA corporate supporter], another CNE PRRF partner described some of the work UPS has been doing through PRRF to activate charter flights moving supplies to Puerto Rico.  PRRF has set up 11 distribution centers around the island for water, food, hygiene kits, and other material and have delivered 1.4 million pounds of supplies thus far.

December 5th the delegation visited several PVA members in the outskirts of San Juan and mountain areas in the middle of the island.  Most of the members with whom the group spoke had power to their homes supplied by generators, but getting water continued to be an issue for almost all with whom they met.  The VA Medical Center had established contact with some PVA members, but not others, and only one veteran reported contact with the Federal Emergency Management Administration (FEMA).  In the meeting the day before, several chapter members had expressed varying degrees of frustration in their encounters with the FEMA bureaucracy.

December 6th was devoted to meetings with VA and FEMA officials from the Joint Field Operations center, which is the main office for federal agencies coordinating in Puerto Rico.  Dr. Antonio Sanchez, the acting director of the VAMC outlined numerous challenges the hospital confronted in trying to contact and assist veterans after the storm because of the destruction of internet, phone and satellite capacity.  Lack of street addresses in the medical center’s patient registry made it difficult, if not impossible, to find many veterans in the more remote areas of the island.  Dr. Sanchez observed that the center needs to do better at identifying patients who live alone and include plans for these people in their emergency preparation plans.

Dr. Nadal, the acting chief of the spinal cord injury unit, reported on the efforts VA has undertaken to offer training to other agencies involved in emergency preparation and response.  One of the problems mentioned by several members in the visits the day before was difficulty in obtaining vital prescriptions in the immediate aftermath of the storms.  The VA had implemented a pharmacy emergency system whereby veterans in rural and hard to reach areas were authorized to obtain prescription drugs from local drug stores.   However, many local pharmacies were unfamiliar with this emergency program and were charging the veterans copays and other expenses.  Dr. Nadal acknowledged that the VA needed to be more proactive in advertising its resources such as this.

The VA hospital had an open door policy during the emergency to anyone with a spinal cord injury, but the patients they received were considerably sicker than they expected.  In addition, many of the 350 veterans with SCI on the VAMC registry were medically stable but most of the emergency shelters were a challenge for patients with spinal cord injury.  Dr. Nadal said they ended up sending 15 patients to the mainland because they couldn’t manage patients at all the shelters on the island and felt that more work is needed to develop better shelters for medically stable people with disabilities.

The meeting with FEMA representatives included Madeleine Goldfarb the FEMA Disability Integration Advisor in San Juan, Philip Shaw with the FEMA Volunteer Agencies Liaison (VAL) office and Josephine Carmona whose office is responsible for handling immediate needs of storm survivors.  In discussing the apparent lack of contact among PVA members by FEMA, Ms. Goldfarb noted that a FEMA survivor registration number is needed in order for them to send out disaster assistance teams and Ms. Carmona added that they have to depend on local governments to inform them of the locations of people with disabilities, but once that information is provided, FEMA will then send in aid.

The FEMA officials expressed a desire to work more closely with PVA’s chapter to resolve some of the problems that had been raised in the previous days and in the meetings.  There also seems to be a need for improvements in the integration of the VA with the overall emergency management system and in its communication with veterans and the community about the resources it has to offer in disasters.  At the same time, agencies like FEMA and voluntary organizations need to understand that the VA does not serve all of the needs of veterans with disabilities and, like other people with disabilities, their circumstances need to be taken into account in emergency preparation and response.  In the months ahead, PVA plans to map out a set of recommendations for improving emergency preparation and response for its membership as well as the broader community of people with disabilities.

 

November Washington Update

November 15, 2017​​​​​​​​            Volume 23, Number 11
***PRIORITY***
The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit http://www.AirAccess30.org and share your story.

House VA Committee Conducts Hearing to Review Choice Reform Legislation

On October 24, 2017, the House Committee on Veterans’ Affairs conducted a legislative hearing to examine a number of important proposals. The hearing included two very important draft bills that offered direction for the reform of the Choice program administered by the Department of Veterans Affairs (VA). Paralyzed Veterans of America submitted a statement for the record for the hearing.

The focus of our testimony was on the draft bill presented by the House VA Committee—a bill that would eventually become H.R. 4242, the “VA Care in the Community Act”—and on the draft bill presented by the VA—the “Veteran Coordinated Access & Rewarding Experiences (CARE) Act.’’ PVA did not explicitly oppose either draft bill as presented.

We also emphasized in our testimony that before the Committee takes steps to reform the delivery of veterans’ health care in the community, it is important to affirm that specialized services are part of the core mission and responsibility of VA. In recent months, VA has indicated that, along with improving the delivery of care in the community to veterans, it plans to concentrate on expanding and improving what it considers “foundational services.” The Secretary has indicated that it considers spinal cord injury and disease (SCI/D) care and blinded care foundational services. However, he must make that policy unequivocally clear to all networks and all facilities. Additionally, we do not believe foundational services end with just those areas; there are many areas of service within VA that inform the principle of veteran-centric care. We appreciate the fact that the Secretary has committed to expanding SCI/D nurse staffing by approximately 1,000 new positions. These concerns about foundational services cannot be dismissed simply in the interest of focusing attention on more community care.

Congress should examine more closely how VA will monitor the quality of care veterans are receiving in the community. This question goes beyond a plan for care coordination. If VA is unprepared to retain ownership of responsibility for care delivered in the private sector, Congress will be helpless in conducting adequate oversight. PVA believes that the Committee and VA need to seriously consider the consequences for veterans when they are injured during the course of their treatment in the community. When veterans receive treatment at a VA medical center, they are protected in the event that some additional disability or health problem is incurred. Under 38 U.S.C. § 1151, veterans can file claims for disability as a result of medical malpractice that occurs in a VA facility or as a result of care delivered by a VA provider.

When PVA questioned VA as to whether these protections are conferred to veterans being treated in the community, VA officials confirmed in writing that this protection, as a matter of law, does not attach to the veteran in such circumstances. We continue to advocate for the inclusion of this protection in any final bill considered by the Committee. Unfortunately, the bill being considered in the House does not include these provisions.

PVA strongly supports the concept of developing a high-performing integrated health care network that would seamlessly combine the capabilities of the VA health care system with both public and private health care providers in the community. We believe that the design and development of VA’s network must be locally driven using national guidance, and it must reflect the demographics and availability of resources within that area. VA has taken the first steps toward this goal by conducting its pilot market assessments using three individual VHA facilities and their surrounding health care markets.

PVA also supports the Secretary’s plan to move the Department away from the current 30-day/40-mile eligibility standards in favor of a case-by-case clinical determination. The Committee’s draft bill targets the same desired end goal. Access decisions dictated by arbitrary wait times and geographic distances have no comparable industry practices in the private sector. This change would shift the organizational mindset and focus of VA to clinical outcomes instead of catering to arbitrary metrics governing access to care in the community. We have consistently advocated for this proposition before Congress and the administration, stating that eligibility and access to care in the community should be a clinically-based decision made between a veteran and his or her doctor. Establishing appropriate eligibility standards will be an integral part of a sustainable network.

The hearing agenda also included several other bills. PVA supported H.R. 1133, the “Veterans Transplant Coverage Act;” H.R. 2123, the “Veterans E-Health and Telemedicine Support (VETS) Act of 2017;” and H.R. 2601, the “Veterans Increased Choice for Transplanted Organs and Recover Act of 2017.” While we also supported the intent of H.R. 3642, the “Military Sexual Assault Victims Empowerment (SAVE) Act,” we expressed reservations about some of the underlying assumptions of the bill. Similarly, we expressed concerns about a draft bill that would require the Veterans Crisis Line to collect certain data from veterans who contact the line in crisis.

Subsequent to the hearing, the Committee attempted to mark-up H.R. 4242; however, a recent cost estimate provided by the Congressional Budget Office forced the Committee to withdraw the bill from consideration at this time.

PVA’s full written statement can be viewed at http://www.pva.org.

House of Representatives Passes Veterans Legislation

During the week of Veterans’ Day, the House of Representatives passed a long list of bills targeted at improving various services in the Department of Veterans Affairs (VA). That list includes:

• H.R. 918, the “Veteran Urgent Access to Mental Healthcare Act.” This bill would require VA to provide an initial mental health assessment and any subsequent mental health services required to meet urgent mental health care needs to former service members who would otherwise be ineligible for
such services because they were discharged from military service under other than honorable (OTH) conditions.
• H.R. 1066, the “VA Management Alignment Act of 2017.” This bill would require VA to submit a report regarding the roles, responsibility, and accountability of elements and individuals of VA, using the findings of the Independent Assessment, the Commission on Care, and relevant GAO reports as resources.
• H.R. 1133, the “Veterans Transplant Coverage Act.” This bill would authorize VA to provide all care and services needed for a veteran to receive an organ transplant from a live donor, regardless of whether the donor is eligible for VA health care or whether the health care facility is part of the VA.
• H.R. 1900, the “National Veterans Memorial and Museum Act.” This bill would designate the Veterans Memorial and Museum in Columbus, Ohio, as the National Veterans Memorial and Museum.
• H.R. 2123, the “Veterans E-Health and Telemedicine Support Act (VETS) Act of 2017.” This bill would give the VA Secretary the legislative authority to allow VA providers to practice telemedicine across state lines.
• H.R. 2601, the “Veterans Increased Choice for Transplanted Organs and Recovery (VICTOR) Act.”
• H.R. 3122, the “Veterans Care Financial Protection Act of 2017.” This bill directs VA to work with federal agencies and states to develop and implement standards that protect individuals who are eligible for increased pension from dishonest, predatory or otherwise unlawful practices.
• H.R. 3562, a bill to authorize the Secretary of Veterans Affairs to furnish assistance for adaptations of residences of veterans in rehabilitation programs.
• H.R. 3634, “the Securing Electronic Records for Veterans Ease (SERVE) Act of 2017.” This bill would make BAH documentation available online to all veterans, which would help confirm a veteran’s monthly housing stipend and simplify their home or apartment rental process.
• H.R. 3656, a bill that would provide a headstone or marker for all eligible non-veterans who die on or after November 11, 1998.
• H.R. 3657, a bill that would authorize VA to provide headstones and markers to eligible spouses and dependents who are buried or interred at tribal veterans cemeteries.
• H.R. 3705, the “Veterans Fair Debt Notice Act.” This bill instructs VA to use plain language in its debt notices to provide a clear explanation of why VA is alleging that the veteran owes such a debt.
• H.R. 3949, the “Veteran Apprenticeship and Labor Opportunity Reform (VALOR) Act.” This bill would simplify an approval process by allowing companies to register their apprenticeship programs with one central approval agency.
• H.R. 4173, the “Veterans Crisis Line Study Act of 2017.” This bill would require VA to conduct a study on the outcomes and efficacy of the Veterans Crisis Line based on an analysis of national suicide data and data collected from the VCL.

PVA generally supported all of the bills that were considered and approved by the House. In testimony earlier this year, we did express concerns about the data collection process that would occur to support H.R. 4173, particularly what the impact might be of trying to obtain this type of information from veterans who are in crisis.

VA Considering Proposed Cuts to VA Special Purpose Funds

In October, PVA became aware of VA’s plan to move nearly $1 billion dedicated to programs such as Women’s Health, Mental Health, Research, and Suicide Prevention, to a general purpose fund for an unclear purpose. While the VA has claimed that it will be used to reinvest in “foundational services”—which includes spinal cord injury/disease care, there has been no guarantee that will actually occur at this point. It seems the real impact of this dramatic shift of funds from special purpose to general purpose is to provide more resources and flexibility to Veterans Integrated Service Networks (VISNs) and Medical Center Directors. PVA has long argued for the need for medical centers to be fully equipped to meet the needs of their patients. And while we understand the ultimate goal of this shift of resources we are deeply concerned by such a dramatic realignment of resources and the potential impact on veterans.

VA has not provided VSOs or Congress any detailed explanation for how the proposed cuts to critical programs will better serve veterans. Given the magnitude of the proposed repurposing and the potential to devastate critical programs, PVA and others in the VSO community have been diligently engaging with VA to pause the move until the extent of the impact is understood. Several members of Congress, including the Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies have reached out to Secretary Shulkin as well to get clarification.

We will continue to monitor this action as the consequences for some key programs in VA could be severe. While VA has promised that “foundational services” will benefit from this shift, we do not believe that it should be at the expense of other critical services within VA.

PVA Hosts Roundtable with Senate Commerce Leaders on Air Travel Accessibility

On November 8, 2017, PVA hosted a roundtable with the Senate Commerce, Science, and Transportation Committee on improving access to air travel for veterans with disabilities. The purpose of the roundtable discussion was to focus on how disability-related provisions in S. 1872, the “TSA Modernization Act,” and S. 1405, the “FAA Reauthorization Act of 2017,” would lay the ground work for ensuring safe and effective access to air travel for all people with disabilities. The roundtable provided an opportunity for PVA leaders to share their travel experiences and for Senators and staff to learn more about their concerns. Senators engaged leaders about the frequency of wheelchair damage, service animals, and the general accessibility of air travel.

PVA National President David L. Zurfluh, PVA National Secretary Larry Dodson, PVA National Vice President Charles Brown, and Interim Executive Director Carl Blake were joined at the event by Senate
Commerce Committee Chairman John Thune (R-SD), Ranking Member Bill Nelson (D-FL), and Senator Tammy Duckworth (D-IL). Heather Ansley, Associate General Counsel for Corporate and Government Relations and Lee Page, Senior Associate Advocacy Director, served as moderators for the event. Representatives for Wounded Warrior Project, the American Legion, and VetsFirst also participated.

PVA Hosts First Meeting of the RESNA Standards Committee on Air Travel

On November 7, 2017, PVA hosted the first meeting of the RESNA Standards Committee on Air Travel. The goal of the committee is to create air travel standards and guidelines for mobility devices, to include design, labeling, information cards, and airport personnel handling and training procedures. RESNA is a standards developing organization accredited by the American National Standards Institute (ANSI). The RESNA Assistive Technology Standards Board is the U.S. Technical Advisory Group to ANSI for the development of ISO (International Organization for Standardization) standards pertaining to assistive technology and other products for persons with disabilities.

PVA is an official member of the committee and works closely with the committee’s leadership. Moving forward, the committee plans to meet quarterly over the next year to work toward the goal of reducing damage to wheelchairs in air travel. PVA is joined by airlines, wheelchair manufactures, and other key stakeholders in these efforts.

Congress Prepares to Tackle Tax Reform by End of November

Efforts to make major changes in the tax code for the first time in 30 years recently moved forward in the House and Senate. As of press time for this newsletter, the House was preparing to vote on H.R. 1, the “Tax Cuts and Jobs Act,” while the Senate Finance Committee had begun working on its own version of the legislation with a vote expected in the full Senate after Thanksgiving. Proponents of these measures point to the anticipated economic growth that will ensue from reductions in corporate and individual tax rates and simplification of the tax code. Meanwhile, the nonpartisan Congressional Joint Committee on Taxation has produced analyses of the legislation showing almost 60 percent of U.S. households would see meaningful tax cuts in 2019. However, by 2027, because of changes to deductions and credits in the current tax code, less than half of Americans would experience a tax cut worth $100 or more, while about 1 in 5 would see their taxes go up compared with current law.

In a letter to the House Ways and Means Committee, PVA expressed strong opposition to provisions in the House bill that would eliminate several credits and deductions in the tax code of particular importance to veterans and people with disabilities. H.R. 1 would repeal the Work Opportunity Tax Credit that has helped companies hire almost 300,000 veterans with barriers to employment from 2013 to 2015.

The bill also would repeal the Disabled Access Tax Credit that was created in 1990 to help small businesses comply with the Americans with Disabilities Act. In addition, the House measure would eliminate the medical expense deduction which has softened the burden of over 9 million households facing high costs associated with long term disabilities and illnesses.

The initial Senate Finance Committee chairman’s mark of the tax measure did not include repeal of these credits and deductions. However, Congress must ensure that the final tax bill adds no more than $1.5 trillion to the deficit, which was the limit fixed in the House and Senate budget resolutions.

As a result, the conference committee that will be appointed to reconcile the House and Senate tax bills will be under considerable pressure to eliminate deductions and credits that add to the measure’s costs. Nevertheless, PVA will continue to press its support for these tax credits and deductions that advance the economic independence and community integration of veterans and people with disabilities.

FAIR Heroes Act Introduced

On November 9, 2017, Senator Bill Nelson (D-FL) and Senator Richard Blumenthal (D-CT) introduced S. 2117, the “FAIR Heroes Act,” that would make veterans who were medically retired from the military eligible for both Medicare Part B and TRICARE, a health care program for retired veterans and their families, and allow them to choose which health plan works best for them. Under current law, veterans who receive Social Security Disability Insurance (SSDI) benefits are required, by law, to purchase Medicare Part B coverage. In some cases, they must maintain that coverage even if they return to work. S. 2117 would give these veterans the choice to enroll in TRICARE instead of Medicare Part B. According to a press statement accompanying the bill’s introduction, this legislation could save many veterans up to $1,300 a year.

Currently, medically retired veterans who fail to purchase Medicare Part B coverage immediately upon becoming eligible, or who fail to maintain that coverage for at least eight years after returning to work, are forced to pay a late enrollment fee and higher premiums if they enroll in Medicare later in life. The late-enrollment penalty and higher premiums make Medicare coverage unaffordable for many of these veterans. The legislation seeks to change that, not only by giving these disabled veterans the option to enroll in TRICARE instead, but also by eliminating the eight-year Medicare requirement and late-enrollment penalties for those who were medically retired from the military.

PVA has endorsed this legislation because of many of our members are affected by this issue.

October Washington Update

October 17, 2017​​​​​​​​Volume 23, Number 10
***PRIORITY***
The Government Relations staff is still looking for stories about problems that our members have experienced during air travel. Please visit http://www.AirAccess30.org and share your story.

House VA Committee Holds Hearing on Asset Review Proposed Legislation
On October 12, 2017, the House Committee on Veterans’ Affairs conducted a legislative hearing to review a draft bill—the “Asset and Infrastructure Review (AIR) Act.” This legislation was originally discussed during a full Committee round table in September. Carl Blake, Associate Executive Director (AED) of Government Relations, testified on behalf of Paralyzed Veterans of America (PVA). PVA generally supports the intent of the legislation; however, we expressed some significant concerns with the proposal as presented.
The draft bill would require the Department of Veterans Affairs (VA) to undertake an asset review process that mirrors the BRAC process previously used in the Department of Defense (DOD). During the hearing, PVA expressed our support for the notion of rightsizing the VA’s infrastructure footprint. However, we emphasized that a BRAC-style process is not necessarily the optimal process to achieve that end. Representatives from the Government Accountability Office (GAO) and the Congressional Research Service (CRS) explained that the key to making the process work is spending all the time necessary to do advance planning, laying out the desired end goals and the processes needed to analyze the complete VA health care system. GAO explained that DOD had fully three years before a BRAC Commission was empaneled to consider the infrastructure alignment of DOD. Meanwhile, this bill establishes a process whereby the VA will complete all of its preparatory work within one year and the Commission will then submit its final recommendations to Congress within six months following that date (by May 2019), effectively giving VA and the Commission only 18 months to outline the complete realignment of the infrastructure footprint of the Veterans Health Administration (VHA). The draft legislation essentially ignores what GAO identified as the most critical point to ensure success of this process—time.
Moreover, this legislation appears to be putting the cart before the horse. We strongly believe that VA should have the opportunity develop and put into operation its integrated health care network before any decisions are made about what the footprint of VA should look like. It makes no sense for VA to make decisions about what its infrastructure alignment will be without first understanding what its capacity to deliver services currently is and how an integrated network must be designed to enhance that capability. Central to that effort is the completion of a thorough market assessment before the network can be fully established and implemented. With that in mind, the draft bill requires modification to its overall timeline in order to accommodate more time for market assessment.
We also have serious concerns that fitting a BRAC model to VA presumes that the nature of the VA health care system is not fundamentally different from the DOD base alignment that was considered during its own BRAC process. This proposal ignores the fact that the DOD BRAC addressed a static military population and simply consolidated and moved units to fit its planned infrastructure alignment. It was relatively easy, though not politically, to simply move military families to new locations to support the force realignment. This fact does not apply to the VA health care system and the population it serves. Decisions to close or downsize a VA medical facility will have a direct impact on the veteran population being actively served in that selected community.
Our last concern is the impact initiating a BRAC process will have on current major and minor construction activities at VA. When VA initiated its Capital Asset Realignment for Enhanced Services (CARES) process nearly 15 years ago, the most devastating result of this process was the moratorium placed on virtually all construction for a two-year period while the process was conducted. Congress has compounded that problem every year since that time by woefully underfunding the major and minor construction requirements of VA. Many facilities are now in serious decline simply because they were not upgraded or modernized, and because Congress continues to provide inadequate funding for VA’s infrastructure needs, and now many of those facilities face the possibility of closure because of that neglect.
With the establishment of an Asset and Infrastructure Review Account we believe that Congress will continue to ignore its responsibility to provide critically-needed funding for ongoing construction projects in an effort to wait for the outcome of the Commission. This is an unacceptable proposition for PVA.
The prospects for this legislation remain uncertain. The Senate Committee on Veterans’ Affairs is much less inclined to take up similar legislation. The bill may also be unnecessary as the Secretary has already laid out plans to deal with unused and underutilized facilities.
To read PVA’s full written statement, please visit http://www.pva.org.

House VA Committee Conducts Roundtable on Choice Reform Legislation
On October 3, 2017, the House Committee on Veterans’ Affairs conducted a round table to discuss a draft bill that would make the Veterans Choice program permanent. The bill presumably reflects bipartisan efforts of both Chairman Phil Roe (R-TN) and Ranking Minority Member Tim Walz (D-MN). Carl Blake, AED of Government Relations, represented PVA at the round table and was accompanied by Lana McKenzie, AED for Medical Services, who offered key insights into the ideas being considered by the Committee and how the provision of spinal cord injury (SCI) care will fit into this proposal.
PVA generally supports the draft bill that has been presented. The bill authorizes the development of an integrated health care network to support the VA health care system. Veterans would be assigned a primary care provider either within the VA or in the community dependent upon availability. Access to the community would then be governed by a determination of clinical need between the veteran and his or her primary care provider, the availability of services at the local VA medical center or in the community, and the performance of the local VA in providing those services in a timely, quality manner. Veterans needing specialty care must be referred into the community. Much of the structure of this proposal mirrors the concepts of an HMO.
Our emphasis during the round table was on ensuring proper coordination of care, particularly when veterans with catastrophic disabilities such as spinal cord injury are referred to providers in the community. We also recommended that the Committee revise the draft bill to allow more time for the completion of market assessments that will outline the capacity of VA to provide services. We do have concerns that those market assessments are focused too much on examining a way to allow for the community to provide more care when gaps are identified, rather than also outlining potential alternatives that will expand VA’s internal capacity.
The bill also lacks an urgent care benefit that many veterans’ service organizations and key stakeholders have recommended in the past. In fact, the VA’s draft community care plan presented earlier this year included an urgent care benefit. We have argued that urgent care options for veterans would potentially relieve significant pressure on the emergency care and primary care functions at the VA.
This legislation will be considered in a legislative hearing by the House VA Committee later in October. It remains unclear how the House and Senate VA Committees will resolve the significant differences that currently exist between the bills they are considering.
Of note, at the end of the round table, Chairman Roe emphasized that the notion of unfettered choice is a false choice. He explained that the only people who get unfettered choice in their health care in America are those who pay completely out of pocket. Otherwise, all other people seeking health care do so through a type of managed care. This is a critical point as some continue to advocate for unfettered choice within VA.

Amendment Addressing Passengers with Disabilities Added to TSA Modernization Bill
On October 4, 2017, the Senate Commerce, Science, and Transportation Committee marked up S. 1872, the “Transportation Security Administration (TSA) Modernization Act.” At the markup, the Committee accepted a PVA-supported amendment on improving the screening of passengers with disabilities. The amendment was sponsored by Chairman John Thune (R-SD), Ranking Member Bill Nelson (D-FL), Senator Roy Blunt (R-MO), and Senator Maria Cantwell (D-WA).
The amendment includes several provisions that would improve the travel experience for people with disabilities. One provision would require TSA to work with disability and veterans’ service organizations to develop specific training requirements for TSA personnel regarding the proper screening of passengers who use wheelchairs, indwelling medical devices, prosthetics, and service animals. As part of this process, TSA would be required to revise its current training to implement needed changes.
Another provision would require TSA to record each disability-related complaint, identify the most frequently concerns raised or accommodations requested, and determine the best practices for addressing the most frequent complaints and accommodation requests. The amendment would also require signage at security checkpoints informing passenger with disabilities of their right to request assistance with disability-related complaints. Importantly, it would also improve accountability by requiring TSA to report to Congress on an annual basis metrics related to the experiences of passengers with disabilities.
PVA will continue to work with Committee staff in the coming weeks to ensure additional protections for passengers with disabilities in transiting security are addressed before the bill heads to the Senate floor.

House and Senate Budget Resolutions Assume Cuts to Medicare, Medicaid and Social Security
On October 4, 2017, the House of Representatives approved its 2018 budget resolution that lays the groundwork for its tax reform plans through the process known as reconciliation. Adopting an overall $4.1 trillion spending plan for the federal government for fiscal year 2018, the budget resolution contains a set of instructions to Congressional committees to turn the budget resolution into implementing legislation.
Contained in the budget resolution are instructions to House committees to find $487 billion in savings over ten years from Medicare, $1 trillion in savings from Medicaid and $5.4 billion from Social Security. Proposed changes for Medicare include a gradual increase in the eligibility age from 65 to 67, raising income related premiums for Parts B and D (the physician services and prescription drug programs])of Medicare and converting this program for older Americans and people with disabilities to a premium support system of financing. If enacted, Medicare beneficiaries would be given a flat payment or voucher with which to buy health insurance either under traditional Medicare or through the private market. All plans competing in the program would have to match the benefits and services of traditional Medicare and insurers could not deny coverage to any beneficiary. Although the impact on beneficiaries of this plan is unclear, previous analyses by the Congressional Budget Office have indicated that a premium support system would increase costs for those enrollees in traditional Medicare. The $1 trillion in cuts to Medicaid are assumed to come from adoption of provisions that were included in previous House-passed health care reform bills such as turning Medicaid into a block grant to the states and ending the Medicaid expansion.
For Social Security, the budget resolution proposes reducing Social Security Disability Insurance (SSDI) benefits to those beneficiaries receiving Unemployment Insurance compensation. Such a move could prove to be a work disincentive for SSDI recipients who attempt a return to work but lose their jobs through no fault of their own. The vote in the House in favor of the FY 2018 budget resolution was on a nearly party-line voted of 219 to 206.
The Senate is expected to take up a similar budget resolution as soon as the week of October 16. Passing the budget resolution through both chambers sets in motion the process known as reconciliation by which changes to the tax code can be passed with a simple majority of 51 votes in the Senate. The changes proposed in the budget resolution to Social Security, Medicare and Medicaid are only a road map for authorizing committees to turn into legislation. However, PVA remains concerned over their potential harm to beneficiaries and will oppose measures that adversely affect the earned benefits of older Americans and people with disabilities.

Advocacy Staff Participate in Site Visit on Improving Air Travel Accessibility
In October, PVA Associate General Counsel Heather Ansley and Senior Associate Advocacy Director Lee Page travelled to Minden, NV, to meet with Peter Axelson of Beneficial Designs. The meeting was meant to educate our staff regarding Mr. Axelson’s research into accessible air travel. Specifically, Mr. Axleson and Beneficial Designs received a 2014 award from PVA’s Research Foundation to investigate assistive technology for non-ambulatory passengers in air travel. Staff had the opportunity to walk through the research protocol and learn more about the various boarding chairs and lift systems designed to help people with disabilities board and deplane an aircraft.

While in Nevada, staff also had the opportunity to meet with John McGuinness of HAYCOMP of Australia, a company that manufacturers lift devices for persons with disabilities including aviation lifters. Information about their product can be found at: http://www.haycomp.com.au/aviation-lifters/. The lift device is able to assist a person with complete immobility on an off an airplane as an alternative to the standard aisle chair. HAYCOMP is working with the PVA Florida Gulf Coast Chapter and the coordination committee for the 38th National Veteran Wheelchair Games that will be held in Orlando, FL, from July 29-August 4, 2018. The lift will be available in Orlando to assist veterans who need the assistance it provides to board and deplane in a safe and effective manner.

President Issues Executive Order to Expand Health Insurance Options
In the wake of Congressional inaction on repealing the Affordable Care Act (ACA), President Donald Trump signed an executive order (EO) on October 12 directing several federal agencies to issue regulations to broaden Americans’ access to lower cost health insurance options. The EO focuses on promoting greater use of three different types of health coverage plans: so-called association health plans (AHPs), short-term, limited-duration insurance (STLDI), and health reimbursement arrangements (HRAs).
The Labor Department (DOL) is given 60 days to develop proposed regulations to make it easier for small businesses and individuals to join together to purchase health insurance through nationwide association health plans. Association health plans already exist but DOL could amend rules so that these plans fall under similar regulations governing large-employer health insurance policies. Large employer health insurance plans are not required to abide by all of the ACA mandates such as coverage of prescription drugs, rehabilitation services or other essential health benefits. While this move could allow AHPs to restrict coverage based on medical history, the administration has said that employers participating in these plans would not be allowed to exclude employees or develop premiums based on health conditions.
DOL as well as the Departments of Treasury and Health and Human Services were assigned the two other tasks covered by the EO. Within 60 days, they are to devise proposed regulations to expand the availability of short-term health insurance policies, which also don’t have to comply with ACA protections, for those with pre-existing conditions. Typically used by persons who are between jobs, these STLDI plans are not required to offer the comprehensive set of benefits called for under the ACA and were limited by the ACA to no longer than 90 days. The order extends the term of these plans to a year. Within 120 days, these same three agencies are directed to propose regulations or revised guidance to increase the use of HRAs, to expand the ability of employers to offer HRAs to their workforces, and to allow HRAs to be used in conjunction with non-group coverage.
Critics of these proposals are concerned that allowing these health plans to sell more limited benefits and exclude persons with high cost health conditions may draw younger and healthier people to them, leaving older persons and those with disabilities or chronic conditions in the ACA health exchanges. That in turn would cause insurance premiums in ACA plans to spike, making insurance increasingly unaffordable and possibly leading to greater numbers of people without insurance.
All of the proposals contained in the executive order must go through the regulatory rule-making process so it may be at least six months before any changes are finalized by Labor, Treasury and HHS.