ADVOCACY AND LEGISLATION
This year, Jose Reynoso lead the charge at the 2018 Advocacy/Legislation Seminar from March 5 – March 8, 2018. Injured in October 2015, our Marine Corps Veteran will be our California Advocate. Below are the point papers we focused on:
PROTECTION OF SPECIALIZED SERVICES
Specialized services are part of the core mission and responsibility of the Veterans Health Administration (VHA). VHA’s specialized services, to include spinal cord injury/disease, blind rehabilitation, poly-trauma, and mental health, are of paramount importance due to the inability to replicate their comprehensive approach in the private sector. These specialized services must be strengthened and sustained within the VHA through allocation of appropriate resources, and not subject to defunding.
VHA has not maintained its capacity nor mission to provide for the unique health care needs of catastrophically disabled veterans. Reductions in both inpatient beds and staff in Spinal Cord Injury/Disease acute and extended care settings have been continuously reported throughout the system of care. Some political leaders advocate providing health care to veterans by contracting for services in the community. This would move veterans out of the “veteran-centric” care environment which is only found within VHA, lead to a diminution of existing services, and increase health care costs in the federal budget. In addition, for veterans who do receive care in the community, they are not protected under 38 U.S.C. § 1151. If medical malpractice occurs during outsourced care, the veteran must pursue standard legal remedies unlike similarly-situated veterans who are privy to VA’s non-adversarial process.
EXPAND ELIGIBILITY FOR THE VA COMPREHENSIVE FAMILY CAREGIVER PROGRAM
The current Veterans Affairs Caregiver Support Program is available only to veterans seriously injured as a result of their military service on or after September 11, 2001. Congress must eliminate the unfair date of injury requirement. Further, the program must make eligible those veterans with serious illnesses that are the result of their service.
OVERSIGHT OF REFORM OF THE VA CLAIMS APPEALS PROCESS
PVA has submitted comments on changes to VA’s claims and appeals system, including RAMP, which were directed by the Veterans Appeals and Modernization Act of 2017. PVA provided observations on the process to date, and comments on the information presented at a November meeting on proposed regulatory changes and on the draft proposed regulations released on November 20. PVA believes continued open and transparent communication from the VA is the best way to ensure veterans organizations are able to work within the new framework and best represent our members. While meetings and contact with staff are very helpful, 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 on the new appeals framework.
It is imperative that aggressive oversight be maintained to monitor this critical change to VA’s appeals process to ensure all veterans receive the compensation they are due and have earned.
IMPROVE BENEFITS FOR CATASTROPHICALLY DISABLED VETERANS
There is a well-established shortfall in the rates of Special Monthly Compensation (SMC) paid to the most severely disabled veterans that the VA serves. SMC represents payments for “quality of life” issues, such as the loss of an eye or limb, the inability to naturally control bowel and bladder function, the inability to achieve sexual satisfaction, or the need to rely on others for the activities of daily living like bathing or eating. PVA does not believe that a veteran can be totally compensated for the impact on quality of life; however, SMC does at least offset some of that loss. One of the most important SMC benefits is Aid and Attendance. PVA recommends that Aid and Attendance benefits be appropriately increased. Attendant care is very expensive and often the Aid and Attendance benefits provided to eligible veterans do not cover this cost. Ultimately, they are forced to progressively sacrifice their standard of living in order to meet the rising cost of necessary care. As the veteran is forced to dedicate more and more of their monthly compensation to supplement the shortfalls in the Aid and Attendance benefit, it slowly erodes the veteran’s overall quality of life.
AUTOMOBILE ADAPTIVE EQUIPMENT
The Automobile Adaptive Equipment (AAE) Handbook and Directives are outdated. The Handbook was written in 2000. The Reimbursable Amount for Automobile Adaptive Equipment Directive was written in 2011. Due to a lack of training, uncorrelated and conflicting information sent to the VA field offices by the Veterans Benefits Administration and the Veterans Health Administration, disabled veterans are not receiving reimbursement for standard AAE that they have received in the past. This has caused a hardship on those disabled veterans who are dependent on AAE for mobility.
PVA and other VSOs have met with VA three times in the last two years to provide recommendations as to how to improve the provision of AAE, including offering to provide guidance and help to rewrite the Directives and suggest methods to incorporate new technology into AAE. At this point, VA has refused to accept help and has refused to update the AAE documents.
AIR CARRIER ACCESS ACT
The Air Carrier Access Act (ACAA) prohibits discrimination based on disability in air travel. Despite progress, too many travelers with disabilities still encounter significant barriers, such as damaged assistive devices, delayed assistance, and lack of seating accommodations. Enforcement of ACAA protections is limited to administrative action and civil fines. Consequently, people with disabilities typically receive little, if any, redress to their specific grievances. To increase access to air travel, PVA supports the Air Carrier Access Amendments Act (S. 1318), which was introduced in 2017 by Senator Tammy Baldwin (D-WI). This legislation would strengthen ACAA enforcement, ensure increased access to aircraft, improve training for air carrier personnel and their contractors, require the Secretary of Transportation to work with stakeholders to develop an Airline Passengers with Disabilities Bill of Rights, and create a U.S. Department of Transportation Advisory Committee on the Air Travel Needs of Passengers with Disabilities. Some of the provisions in S. 1318 are included in the House and Senate versions of the Federal Aviation Administration (FAA) Reauthorization bills (H.R. 2997 and S. 1405), which are currently pending action.
In 2017, U.S. Representative Ted Poe (R-TX) introduced the ADA (Americans with Disabilities Act) Education and Reform Act of 2017 (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. This bill, which was approved on a party-line vote by the House Judiciary Committee in 2017, would remove all incentive for businesses, social service establishments, and other places of public accommodation to comply with the ADA’s accessibility requirements. Businesses could employ a “wait and see” approach, continuing to violate the law with impunity. Notification laws put the onus on the person with a disability to find ADA violations and notify a public accommodation of those violations. We believe that covered entities should continuously evaluate their businesses for appropriate access under the ADA and not wait to receive a notification before acting to make them fully accessible.
CONGRESS TARGETS SAFETY NET PROGRAMS
After passage of the Tax Cuts and Jobs Act, Congressional leaders announced plans to move on to making significant changes to Medicare and Medicaid in 2018. Since the tax bill will add between $500 million and $1.5 trillion to the deficit, many policymakers now contend that spending in federal benefit programs such as Medicare, Medicaid, and Social Security must be reined in. Specific proposals contained in Congressional budget plans for 2018 include raising the Medicare eligibility age from 65 to 67, raising Medicare premiums, and converting Medicare to a voucher program. Medicaid cuts of $1 trillion are assumed to come from turning Medicaid into a block grant program and ending the Medicaid expansion under the Affordable Care Act. The House and Senate budget resolutions also assume over $5 billion in cuts to Social Security. These programs provide a basic level of economic security and health care protection on which millions of veterans with disabilities and their families depend. There are numerous reforms that can be made to modernize, strengthen, and enhance Medicare, Medicaid, and Social Security without undermining vital safety net benefits.
Jose Reynoso Advocacy & Legislation
Jacqueline Baskett, National Director