va officials? >> i certainly have, sir. i've had the opportunity to speak with numerous current va physicians and prosthetic chiefs, several candid off the record discussions and all of them had real concerns about this process, and about us moving forward in changing our procurement requirements and potentially tying the hands of our clinicians and hampering the delivery time for our veterans. >> i guess particularly the members here on the va subcommittee, which i've served for 24 years, i guess with a growing population of wounded veterans, do you feel confident that the transition that we're making will not encounter greater delays perhaps in our veterans receiving the care they need and the prosthetics they need? >> sir, i certainly feel that that is a real danger and that's why we've, we're asking the committee to stop the implementation of this until either we are assured there are safeguards in place that won't cause this to happen or just find another way to define savings. the ig report that was cited several times here today

and how many veterans are the va? >> we have found in looking at transition to care that there is a flow back and forth between dod and va for veterans. some veterans have dod disability that allows them to go to a dod facility or who are -- or they are retired and therefore, are able to use dod facilities. in our report, we show that the veterans transferred -- with prosthetic issues transferred to va fairly quickly, and in much larger numbers than the average veteran who left dod did. and i was actually, when we started this study, concerned that dod might hold on to or that those veterans might reside around the cities where these areas of the dod areas of expertise i've highlighted but i think we found that really, they've not stuck there. they've transitioned very quickly to va, which was somewhat of a surprise to me. i could get back with specific numbers at specific times but there's a nice chart that shows over four or five years they're almost all in the va. >> great. thank you very much. >> mr. reyes. >> than

with regard to the cost comparisons in our report, addressing va fabricating the prosthetic limbs, or processing these limbs via contract, our report concluded va lacked information to make the decisions it needs to make to know whether it should continue with the use of the labs or to rely on contracts to provide these limbs. in no way did we address cutting the quality of the requirements to purchase a limb. this was the focus was on the contract contracted administration piece and the piece is that va entered into contracts with vendors to provide limbs, at certain prices. what we looked at was that the invoices were coming in. they lacked an adequate review process prior to certification for payment, in which case resulted in overpayments. that's a contract administration issue and i want to be very clear, we did not say cut the quality of a prosthetic limb for any of these veterans, but clearly it is an opportunity to, if you can fix this control, you can then reprogram the funds saved to provide more prosthetics care for veterans. the overpayments for prosthetic limbs were a sys

the va supports the executive order, which directs va and other federal agencies to develop and implement these principles of excellence to ensure service members, veterans, spouses, and other family members using military and veterans education benefits have comprehensive educational and financial aid information so they can make informed choices in selecting educational programs which will best meet their educational and readjustment needs. further, the executive order will put in place enhanced oversight and enforcement mechanisms to ensure beneficiaries are protected from deceptive practices and have the means to resolve effectively their complaints. in fiscal year 2011, va provided educational benefits to nearly one million veterans, service members, and dependents under the post-9/11 gi bill and our legacy educational benefit programs. while we continue to focus on processing claims accurately and timely, the va has been working to expand our focus from benefit delivery to provide mortgage comprehensive information and support throughout a veteran's academic career. in 2011, we upda

nacubo committee that is having conversations with the va. and one of the things we have continually brought up is that if we could simply have a release that a veteran would sign that would allow people at the institution to talk to them, it's a pretty simple concept. we do have people at our institutions that can talk to them, but they're usually in margaret's role. it's not people in my area where we do the billing and the -- all of those types of processing. so we'll call up and we'll try to get some questions answered for the veteran, and we're immediately shut down. so we have been trying to work with them to have a very simple form that a veteran can form. we could fax it to them. we said you could create an online form. >> what was the feedback you got from them on that? because i can tell you, thing is a fundamental reform both in the processing of benefits claims, burial claims, and others. my county veterans service officers don't have the ability of what you're asking for. these are licensed, you know, basically licensed and bonded

the 600 contracted vendors are our community partners. so they're active within our own va facilities. they attend clinics, and they help in the prescription rationale of that item for that veteran. so they are involved extensively with us in the care. >> so they would not have independent contact with the vet raps themselves? >> yes, sir, they would, if the vendor was selected to provide that limb, the veteran then would typically go to their private facility and have that prog thesis designed for them independent of what's going on at the va medical center. >> okay. and do those vendors, are they just doing these prosthetics based to va specs or do they do them independent? >> whenever a prescription is written for that, it's done to what we refer to as the industry standards. so we contract with those providers that have accreditation and certification just like the va providers do. >> for a specific product? >> that's correct. >> the other thing is, on the surveys, part of -- part of what i think doesn't reflect the sentiments of the veteran base -- and i say this from

hide it is proud to partner with the va and the city -- hud is proud to partner with the va and the city of san francisco. to clarify how hard the works, hud was cleared to fund an additional 200 housing vouchers. the va identifies a homeless veteran, prefers them to the housing authority and provides them with case management services. these are all important elements of the program. hud is the federal agency that convenes the san francisco bureaus and guides the initiative. i want to make sure i acknowledge mark ruiz as the team lead for the home initiative here. also george, in the back of the broom, and toed cabrreras, whose work has been a central. we're working to find homes for chronically-homeless veterans who have a hud voucher. specifically the goal is to find housing for 50 veterans and 100 days. to accomplish this, we need owners and lamb motor -- and landlords to join our efforts. we know we have a long way to go before we can call this effort a success. it requires sustained engagement by the community. as for the housing choice voucher program, also called section 8, rent

so, they may not be able to participate in some of the va programs. that's why our relationship with samhsa and kathryn's group, the memorandum of understanding that we have between the national guard and samhsa is so important because it connects with the community. and the communities, through samhsa and our relationship, that's where the national guard is. it's the governor in the state and it's the militias, as kathryn mentioned, so a vast majority of folks that we're seeing in the psychological health program, they've never been deployed. so, it's very important for us to look at community resources, as kathryn mentioned. absolutely, and hector, you're in the thick of it in the community. take us through a cycle of some of the folks that you counsel and that you work with. the most important part, when we think about these veterans and when it comes to homelessness, for me, the key is how do we get the information to them? it's hard for them to get to a phone or seek, because the level of hopelessness, it is just completely eroded. so i try to get

point in case, i went on the va website last night. there are 22.7 as of 2010, there are 22.7 million vets in the united states. this is not dependents, this is vets. of them, 8.3 million or 37% are enrolled in the va health care system. of the ones who are enrolled in the va health care system, 47% avail themselves of outpatient care. if you combine those two numbers, that means it's 17.39% of veterans are seeking va care, 17%. that number does not even begin to address the dependents and families that aren't eligible for care. i'm not sure of the current regulations. it may have changed but i'm pretty sure the majority of people in that armory on that sunday morning in indianapolis were not allowed to use the best behavioral health care facility in the va five miles down the road. how do we solve that problem? their dependents couldn't use that facility. how do we solve that problem? i think it's incumbent upon the civilian community to stop simply putting yellow ribbons on their bumpers and actually stand up at the community level an

in the past, va has had some communication issues between these offices. i think the new leadership is working very hard to fix those and i can't comment to whether the veterans will experience delays. va has just put a pilot in place to look at this new model, but they have not shared that information with us, nor have i had an opportunity to see it in practice to really measure its effectiveness. i think the question should also go to va. >> okay. so can you comment on whether or not there's either going to be or there is a process of providing feedback? >> i can't comment on that. i think that's a question for va. >> okay. thank you. >> with that, if there's no more questions from the committee, we thank you very much for your testimony this morning and we will now invite the fourth and final panel to come to the witness table. joining us this morning in our fourth panel is dr. lucille beck. dr. beck is the acting chief consultant for the prosthetic and sensory aid service. she is accompanied by dr. joe webster, national director for the amputation syste

in recent months the va office at the inspector general released numerous reports on va prosthetics and sensory aids, inventory management, acquisition of prosthetic limbs and prosthetic limb care. pva believes that the audits and investigations have identified many areas in need of improvement within psas and pva generally supports the oig recommendations. these recommendations provide not only an opportunity to improve upon prosthetic services for veterans for amputations but for all veterans who utilize va prosthetic services. the oig's key evaluations and assessments are taking place at a key turning point. the organization is undergoing a structural reorganization that directly impacts the delivery of prosthetic services to veterans. today i'll limit my remarks to this reorganization. under the current changes, va prosthetics will no longer be solely responsible for managing the purchases of prosthetic items. rather the va is currently implementing a joint purchasing structure that includes making prosthetic purchases. while the va reports this change will result in increased overs

or are they through the va? is it sometimes happens that a patient will be contacted outside of the system and be convinced that maybe this product is something they ought to try? how do those 600 venders have contact with our wounded warriors? >> yes, sir. the 600 contracted venders are our community partners and so they are active within our own v.a. facilities. they attend clinics and they help in the prescription rational in the item for that veteran. they are involved extensively with us in the care. >> so they would not have independent contact with the veterans themselves? >> yes, sir, they would. if the vender was selected to provide that limb, the veteran then would typically go to their private facility and have that prosthesis fabricated and designed for them independent of what's going on at the v.a. medical center. >> okay. and do those venders -- are they just doing these prosthetics based to v.a. specks? or do they do them independent? >> so whenever a prescription is written for that, it's done to

the spot. we notify va of the problems we find and sometimes they have to do a compliance survey. just as a bit of background, i was with va for 23 years. i started doing compliance surveys in 1975, and i was on two that ended very badly for the schools. we closed one school completely. it was a private proprietary operation that was just not a good thing. and we came very close to closing a public community college and we cost a president his job through the state approving agency back then. this is not new stuff. it's complicated more by chapter 33, the post 9/11 gi bill and the many ways payments are made and so on. it's not that terribly new. but with va and the saas working together in the past, those problems have been dealt with for 65 years. now we're not -- we have not been in that kind of partnership recently. we want to be, we want to be able to help va. we want to be able to say that we're looking at educational quality, we're looking at all those things, looking at appropriateness of reporting, let va look at the appropriateness of their payments. we don't feel we shou

they're not connected to the va. d so a singular challenge but one that there are ways that communities are taking on very successfully through the 100,000 homes campaign is to actually identify who the homeless veterans are by name and prioritize people on the basis of their health risks. and that whole data connection process can actually drive a lot more effective housing resource allocation. so it's a surprising insight, but the fact that we just don't know who these individuals are is one of the big barriers to getting the remaining homeless veterans housed. >> yeah. if i could step in, i'd like to just add on that, first of all, we want to thank the national housing conference for inviting nchv to be a participant here. this is a critical moment, nan, i think you said that very eloquently, a critical moment in terms of helping bring veterans into the fold as it were. and it addresses your point. prior to 2011 communities were not required to report veteran data in their hmis systems. we had long said that would

dod has a significant lowered patient population than the va. our patients are significantly different than the vast majority of the va patients. they are young active service members frequently with severe trauma and multiple limb loss that desire and deserve to return to highest levels of function including returning to active duty. they are strong willed warriors who challenge us daily to improve how we care for them. we start would a small program and built it into a program recognized as a world leader in amputee care and meeting our patient's needs. va and d.o.d. have long worked together. in 1945 the army prosthetic research lab was established. in 1948, v.a. established the prosthetic research headquarters in new york city v.a. many of the devices were continuing to be used at the time the current conflict started. in 2004 congress provided $2.5 million for prosthetic device enhancement and clinical evaluation at walter reed added an additional $10 million in 2005. and the project for upper extremity prosthetic devices program was $30 mil

lastly, let me touch on the va. you've may have read it, witnessed it or heard it and i'll reconfirm for you firsthand the relationship between our armed forces and the veteran's administration has never been better. in addition, i mean i really see it only growing stronger. the va, its critical linkage or continuity, not just only from a medical benefits standpoint, sure, that's important, but you know, from acute to long-term care, but i think it's larger than that. you see the community of military life that, again, denise has touched on earlier, and the feeling of remaining attached, and a sense of continuing to belong shouldn't stop at separation or retirement, when a service member leaves its military service. it's a point in one's career where actual ownership of the service now transfers to the veteran's administration but having the va and its centers and outreach clinics in cities and towns play a significant role in this connection. remember the feeling of staying connected, not alienation nor cocooning. w

we believe that the va identify at least five but not more than ten relevant da the points with which veterans compare programs and engage with va on which are most beneficial over 90 days. third, the vfw must clarify that the anonymous complaint protects students information and the processes must be in place to verify the complaints from actual enrolled veterans and that the veteran exercises proper chains of authority before va intervention. we must also clarify that the new reporting mechanism is designed as a tool to collect relevant information. state approving agencies must still serve as the primary enforcers resolving complaints at the local level. finally, the vfw calls for additional hearing on resourcing for the vsaas. the vfw believes value resources are being diverted to cover down on unrelated tasks, preventing from conducting quality program evaluations. we must solve this confusion in the short term to remain it's effective. the post 9/11 g.i. bill stands to be a transformative benefit. we must protect the benefit at all costs. unfortunately, the vfw and our partners

i went on the va web site last night. there are 22.7 -- as of 2010, there are 22.7 million vets in the united states. this is not dependents, this is vets. of them 8.3 million or 37% are enrolled in the va health care system. of the ones who are rolled in the va health care system, 47% avail themselves of outpatient care. if you combine those two numbers, that means that 17.39% of veterans are seeking va care. 17%. that number does not even begin to address the dependents and families that aren't eligible for care. i'm not sure of the current regulations, it may have changed, but i'm pretty sure that the majority of people in that armory on that sunday morning in indianapolis were not allowed to use the best behavioral health care facility in the va five miles down the road. how do we solve that problem? their dependents couldn't use that facility. how do we solve that problem? i think it's incumbent upon the civilian community to stop simply putting yellow ribbons on their bumpers and actually stand up at the community le

change and what's happening. >> just if you would, before you start, so does that mean heretofore, the va was not compliant, if that's the basis of your change that compliance was an issue, maybe you could make that clear to us. >> yes, ma'am. thank you, dr. beck. ma'am, yes, the impetus was to include contracting to bring vha and all the other va contracting organizations in better alignment with the federal acquisition regulations. we also, it's my understanding the department recognized several years ago actually that they were weak in certain areas, in contract administration and awarding of contracts, and this was also to bring it in house to ensure proper stewardship of the government dollars. in reference your question did we talk with veteran service organizations, actually, i don't believe we did before we started the process. however, last week, and i'm happy to meet with any organization to discuss what we're doing, i heard the complaints of the veterans service organizations that they feel out of the loop, i met last week with dr. beck with the secretary's advisory committee o

the va needs assistance with compliance tasks now that the bill has become so complex. diverting resources to the rule has proven problematic and leaves no one to fulfill the saa's historic role of providing training to institutions on broader education issues there are varying roles within the arena and tasks should be distributed to the agencies best suited and situated to accomplish them. mr. chairman, this concludes navpa's statement. as a veteran, and on behalf of the members of navpa, i would like to thank you and the members of the subcommittee for your leadership on an issue of critical importance to america's veterans. >> mr. nasserian, you are recognized for five minutes. >> thank you, distinguished members of the committee. my name is barmak nassirian. i'm associate executive director with the american association of collegiate registrars and admissions officers, which we mercifully have reverted to aacrao. we are delighted to be able to participate in this discussion. i have submitted a written testimony for the record. but i'd like to take this opportunity

it must be at the va. the va is the face of veteran's services within the government. nowhere else does this make sense from a practical or business perspective. however, it is a good start and we have to work to continue to pass the legislation, like hr 0 4057 and 4052 which will make the changes permanent. these bills will help restore free market control and prevent veterans from being harassed. the post 9/11 gi bill is the most significant bill. we all have a shared responsibility to ensure that every student veteran is entitled to use their benefits wisely and build a better future. thank you for your time and attention and i look forward to answering your question. >> thank you for inviting student veterans of america to speak on the president's order and it's impact on institutions of higher learn iing. i served as a marine and i used tuition services and use d onlie learning while onboard a navy ship. i know support student veterans as executive director of student veterans of america. we have over 450 chapters assisting veterans on a daily basis. this gives pe

you talked about the va having the authority to prohibit the enrollment into poor-performing schools and how the va could join in agreement with ftc to do things here. have they done those things? >> no. that's my frustration. i spent 16 years promoting all of higher ed. i am a big fan and the private sector and everybody. there is so much out there today in terms of regulatory authority to go after the bad conduct that all we ask is use your present authority and go after that school and you will never hear me or my association here defending one bad apple engaged in misconduct of a veteran or any other student. let's not indict all of higher ed or even just the private sector colleges in universities for the misconduct of one school. >> several of the rest of you hit on this and i don't say this facetiously in any way. i am the staunchest supporter, but also the harsh est critic. the prescriptions for the better way of doing this is communication and getting data from the va. good luck with that. i say that as i said, not facetiously. they do a lot and a lot of things that we put o

the va needs assistance with tasks now that the bill is so complex. diverting state approving agency resources to that role proved problematic and leaves no one to fulfill the historic role of providing institutions on broader education issues. there varying roles and tasks should be those best suited to accomplish them. this concludes the statement. as a veteran ando half of nafta i would like to thank you for your leadership on issues of critical importance to veterans. >> thank you. you are recognized for five minutes. >> thank you, mr. chairman and ranking members of the committee. i am associate executive director with the collegieate registrars and we abbreviate it to acro. we are delighted to participate in this discussion. i committed a written testimony for the record. i would like to do in plain damage for issues for the subcommittee's attention. i shall do so dogmatically because of the shortness of time. we can certainly talk about the underlying reasons. the for profit sector in higher education has a significant and pervasive problem wit

i came to the va about 5 years ago and i had worked in the community for many years and had worked with cpsa a lot when i worked at some of the public agencies. so, i had already the relationships with a lot of the people there. and then, once i came over here, i think that partly that we were having sort of a surge in kind of more mental health funding coming into the va. there was just kind of more tension because of all the returning iraqi vets. we believe that a system like ours can be of tremendous benefit to organizations like tricare, the department of defense, in providing behavioral health benefits to enlisted military and their families. and, in fact, have developed the proposal and have been working very closely with tricare and samhsa to try and move that forward. the two issues that you really see are peer support and in-home care. it's peer support because you must build the network of veterans, how they felt like they were in the service. you must have your brothers in arms, you must have your fellow service members standing beside you to overcome stigma, to get through t

and it's called the va hod voucher program. remains the nuclear weapon in the arsenal it's flexible, responsive, it moves homeless veterans and families into permanent housing quickly. here's how it works. it provide hogging assistance vowfers they low -- privately owned housing at the same time we do is wrap around that individual now in a home the intensive clinical and support services that would actually keep them there. since 2008, hud has made 37,500 vouchers of available that were fully funded about 10,000 each year and annual cost of $75 million a pop. 5,000 veterans have vouchers and waiting to find the house. there's a little bit of delay. in the president's 2013 budget request, there's an additional 75 million for another block of 10,000 hod vouchers. -- hud vouchers. it'll bring the total to 48,000 and great news as we drive down the numbers of homeless veteranses by ramping up the powerful tool that we. we're grateful to hud in the capped environment when they're making that at the same statement they're taking the

we cannot sue the navy or the va. the bureaucrats at the v.a. are total tyrants and their words is the final answer. in 1950, a veteran at the wrong way it -- the wrong leg chopped off and the supreme court ruled they did not have jurisdiction. therefore, for the last 200 years from the beginning of the va when you had over 100 men, women, and children shot in front of the white house because they were complaining about their disability what they wanted compensation, their blood spurred on the veterans administration because of the public outrage they created. in 1996, congress passed a law setting the veterans administration has to help veterans. they have not done that yet. now, what you have is 40% of the homeless people are veterans. you have more veterans dying on the streets than in actual combat. you have veterans coming back that our pilots from the air force that were given pharmaceutical speed to keep them awake for the long runs because they were doing so many tours. you have all these disabilities and you have atrocities happening at