Tag Archives: VA

Veterans Administration Has $1 Billion Unexpected Funding Shortfall

VA Budget Shortfall httpdelmarvapublicradio.net

Image: delmarvapublicradio.net


“Under repeated questioning, VA Secretary David Shulkin acknowledged the department may need emergency funds.

The Department of Veterans Affairs was scolded by both parties over its budget Wednesday as lawmakers scurried to find a fix to an unexpected shortfall of more than $1 billion that would threaten medical care for thousands of veterans in the coming months.

“We would like to work with you,” Shulkin told a Senate appropriations panel. “We need to do this quickly.”

At the hearing, lawmakers pressed Shulkin about the department’s financial management after it significantly underestimated costs for its Choice program, which offers veterans federally paid medical care outside the VA. Several questioned Shulkin’s claim that the VA can fill the budget gap simply by shifting funds — without an emergency infusion of new money — without hurting veterans’ care.

“The department’s stewardship of funds is the real issue at hand,” said Sen. Jerry Moran, R-Kan., chair of the Appropriations panel overseeing the VA. He faulted VA for a “precarious situation” requiring a congressional bailout.

Shulkin cited unexpectedly high demand for Choice and defended President Donald Trump’s 2018 budget request as adequate, but allowed that more money may be needed.

“On financial projections, we have to do better,” he said. “We do not want to see veterans impacted at all by our inability to manage budgets.”

Shulkin made the surprise revelation last week, urgently asking Congress for help. He said VA needed legal authority to shift money from other VA programs.

His disclosure came just weeks after lawmakers were still being assured that Choice was under budget, with $1.1 billion estimated to be left over on Aug. 7. Shulkin now says that money will dry up by mid-August. He cited excessive use of Choice beyond its original intent of using private doctors only when veterans must wait more than 30 days for a VA appointment or drive more than 40 miles to a facility.

Skeptical senators on Wednesday signaled they may need to move forward on a financial bailout.

In a letter Wednesday to the VA, Moran joined three other GOP senators, including John McCain, in demanding more detailed information from VA on what fix is needed.

“Unless Congress appropriates emergency funding to continue the Veterans Choice Program, hundreds of thousands of veterans who now rely on the Choice Card will be sent back to a VA that cannot effectively manage or coordinate their care,” the senators said. “We cannot send our veterans back to the pre-scandal days in which veterans were subjected to unacceptable wait-times.”

VA is already instructing its medical centers to limit the number of veterans sent to private doctors. Some veterans were being sent to Defense Department hospitals, VA facilities located farther away, or other alternative locations “when care is not offered in VA.” It also was asking field offices to hold off on spending for certain medical equipment to help cover costs.

Congressional Democrats on VA oversight committees have also sharply criticized the proposed 2018 budget. Shulkin, for instance, says he intends to tap other parts of the VA budget to cover the shortfall, including $620 million in carryover money that had been designated for use in the next fiscal year beginning Oct. 1.

The budget proposal also seeks to cover rising costs of Choice in part by reducing disability benefits for thousands of veterans once they reach retirement age, drawing an outcry from major veterans’ organizations who said veterans heavily rely on the payments.

Shulkin has since backed off the plan to reduce disability benefits but has not indicated what other areas may be cut.

Sen. Patty Murray, D-Wash., told Shulkin that it sure sounded like VA needed money.

“You’re defending this budget, but your job is to defend veterans,” she said. “It seems to me if the administration makes the request, it will be better served.”

The VA’s faulty budget estimates were a primary reason that Congress passed legislation in March to extend the Choice program beyond its Aug. 7 expiration date until the money ran out, which VA said would happen early next year. At the bill-signing ceremony with veterans’ groups, Trump said the legislation would ensure veterans will continue to be able to see “the doctor of their choice.”

The department is now more closely restricting use of Choice to its 30-day, 40-mile requirements.

The unexpectedly high Choice costs are also raising questions about the amount of money needed in future years as VA seeks to expand the program.

Earlier this month, Shulkin described the outlines of an overhaul, dubbed Veterans CARE, which would replace Choice and its 30-day, 40-mile restrictions to give veterans even wider access to private doctors. He is asking Congress to approve that plan by this fall.”




Military’s Health Records Maze



VA Records Maze


“More than $1 billion has been invested in medical record interoperability in recent years but with mixed results.

Veterans Affairs Secretary David Shulkin said he is open to adopting the new military electronic health record system for his department but stopped short of promising that will happen this summer.

“We’re exploring all options,” Shulkin told members of the House Appropriations Committee on Wednesday. “It’s a highly complex issue … if there was an easy solution here, it would have been made already.”

The comments came in response to criticism from lawmakers related to the ongoing health records saga, a point of tension for the departments for decades.

“We’ve been giving you all a lot of money, and it’s not fixed,” said Rep. Tom Rooney, R-Fla. “You could be the best VA secretary of all time if you solved this one problem.”

At issue is the seamless medical transition of active-duty troops and reservists to VA care. Veterans have long lamented missing records, repeated exams and frustrating inefficiencies with the dueling department systems.

Last year, defense and VA officials certified that their Joint Legacy Viewer now allows physicians in both departments to share and read those critical health records, eliminating many of those problems.

But the separate back-end systems still prevent VA doctors from editing or updating veterans’ old military records, and vice versa. Shulkin acknowledged that “it is not the complete interoperability we would hope for.”

Earlier this year, officials with the Military Health System announced plans to shift to the new GENESIS system for all personal military health records, allowing easier access for both patients and doctors.

Shulkin said he hopes to settle on a similar new system for VA this summer. He said a number of factors will go into that decision, including long-term viability of the new system, ease of transferability from old systems and interoperability with defense records.

But VA officials have long been resistant to simply adopting the same IT systems as the military because of specific agency needs. Lawmakers pushed Shulkin to break that trend, but he would not commit to any system at the hearing.

He did say that “VA needs to get out of the software development business” and will be looking for more private sector “off-the-shelf” options for health record systems, to minimize the workload of maintaining any future health records systems.

“It’s not an easy project in a single hospital, much less a whole system the size of VA,” he said.

Shulkin’ appearance before the committee was billed as a conversation about next year’s budget request, but so far only a few details of that plan have been released publicly. A full budget is expected to be released by White House officials later this month.

The department would see a 6 percent boost in programming funds under the “skinny budget” outlined by President Trump, one of only a few federal agencies looking at a funding boost under his plan.

Committee members told Shulkin to expect many more questions about the health records issue after the fiscal 2018 specifics are released”




VA Secretary Robert McDonald’s Advice To Vets


veterans-affairs-secretary-bob-mcdonaldcnn                                   Veterans Affairs Secretary Bob McDonald(CNN)


“In my mind, there is no single human endeavor that leads to greater transformation than education,” McDonald said.

The secretary also recommended that the student veterans look for careers that continue the service that they began in uniform.

“What more important blessing could there be than to be able to have a positive impact on the life of another person? What a positive impact you can have.”

McDonald said he became the VA secretary to do just that. But he expressed frustration with the politics inherent in the role.

“When I listen to the political dialogue, I sometimes get incensed,” he said. “Should we privatize the VA, you know, so the healthcare companies of America can make more money? Should we ask veterans to go to private sector doctors who may not know anything about post traumatic stress?”

McDonald dedicated a large section of his speech to giving veterans four pieces of advice:

  1. Consider your life’s purpose: “Please think about what your purpose is in life, and you will find that if you do that, it will animate the rest of your life,” McDonald said. He added that it’s OK to change your mind a few times. “But you’re living your life every single day, wouldn’t it be good to lead it in a certain direction, toward purpose?”
  2. Set big goals: “As you think about your purpose, think about your goal and make sure your goal is big enough to overcome all your fears,” he said. McDonald recalled how he was unable to become an Eagle Scout because he was afraid to swim. But he passed several much more difficult swimming tests while attending West Point. “Why? Because I had a goal that was bigger than my fear.”
  3. Work for an organization that shares your values and purpose: “Find a company that has a purpose congruent with your own,” McDonald said. “That’s where you’re going to be spending the majority of your waking hours, and you want to make sure you’re achieving your personal purpose, while also achieving the corporate purpose.”
  4. Never stop learning: “I’ll tell you a secret, but you’ve got to promise me you’ll keep it secret: What differentiates those who succeed in business … is maintaining that ability to learn. You’ve got to learn new things all the time,” McDonald said. The most important things students learn in school aren’t any particular facts or equations. It’s how to learn. And learning should not stop once you graduate, he added. “Things are going to change and you need to change too, and the only way to do that is to continue learning.”




Military Health Records System Launch Delayed




“The new MHS GENESIS system — a $4.3 billion upgrade to the military’s current records system — was scheduled to be launched at two military bases this December.

Defense officials are delaying the initial roll out until early 2017.

Program officials announced Tuesday that it will be launched at a single base — Fairchild Air Force Base in Washington — in February, with several other locations to follow next June. They blamed the delay on compatibility and technical issues that emerged during early testing.

“The time we are investing in the program now will help us ensure success in the future, providing the best possible user experience to our beneficiaries and health care providers from day one,” said Stacy Cummings, program executive officer for Defense Healthcare Management Systems.

She said that the multiyear deployment schedule for the new health record system allows some flexibility in individual site launches and benchmarks without jeopardizing the overall goal of militarywide use of the system in 2022. She also said the delay will not change the price tag of the new system.

Officials did not characterize the delay as a setback, but instead part of the expected process in putting a new system in place.

Whether Congress sees it that way remains to be seen. Lawmakers have been critical of the Defense Department and VA for past failures to develop a shared electronic health records system, leading to continuity of care problems for troops as they transition from active-duty to veteran status.

President Barack Obama in 2009 promised a better, more interoperable system for both departments, but results thus far have been slow.

Cummings said that officials from both departments certified earlier this year that they have met congressional requirements for shared systems and information mandated by the end of this year, and will be able to better coordinate health records in coming years as the new MHS GENESIS system is implemented”


New Veteran’s Prescription Drug Law



Vets and Addiction

Image: aforeverecovery.com


“A new law designed to curb opiate and heroin abuse.

It includes tougher prescription guidance for Veterans Affairs medical facilities nationwide.

Sought by the family of Marine veteran Jason Simcakoski, who died of an accidental overdose at the Tomah, Wisconsin, VA Medical Center in 2014, the changes are designed to strengthen VA pain management guidance and training, improve prescription oversight and promote alternative therapies.

Under the bill, VA must ensure that its prescribers are schooled in the latest practices and that all medical facilities stock overdose countermeasures such as naloxone and establish pain management teams to oversee opioid prescriptions for veterans with non-cancer-related pain.

“The bill recognizes that too often, these drugs have been used inappropriately and ineffectively, and because they are so powerful and so addictive, this inappropriate use is very dangerous,” said Sen. Tammy Baldwin, D-Wis., a sponsor of the veterans provisions.

The Comprehensive Addiction and Recovery Act, which passed the Senate on Wednesday by a vote of 92-2 and is expected to be signed by President Obama, authorizes $181 million in new funding for a range of measures designed to fight the national opiate abuse epidemic.

The bill requires the VA to ensure health care providers can access and provide information to state prescription databases. It also gives patient advocates more independence by providing an avenue for reporting patient concerns outside the hospital’s chain of command.

It promotes alternatives to incarceration for those with substance abuse issues, to include grants to expand veterans treatment courts, and it broadens the number of health care providers who can oversee patients prescribed medications for opioid addiction by allowing some nurse practitioners and physician assistants to facilitate treatment.

Simcakoski died Aug. 30, 2014, in the Tomah hospital’s short-stay mental health unit from “mixed drug toxicity,” having taken 13 prescribed medications, including several that cause respiratory depression, in a 24-hour period.

Staff psychiatrists had added new medications to Simcakoski’s lengthy list of prescriptions in the days preceding his death and according to Baldwin, both Simcakoski and his family members had questioned staff whether the treatment was appropriate.

Veterans also told a Center for Investigative Reporting journalist that distribution of narcotics was so rampant at Tomah, they nicknamed the place “Candy Land” and the center’s chief of staff Dr. David Houlihan the “Candy Man.”

According to Baldwin, the patient advocacy measures in the new legislation were most important to the Simcakoski family.

“In Jason’s case, he and his family questioned the treatment. But nevertheless, the patient advocate answered to the prescribing physician and the hospital chief of staff. That’s not independence,” she said.

According to a 2014 VA inspector general report, the Veterans Health Administration issued 1.68 million prescriptions for opioids to 440,000 outpatients, or 7.7 percent of all VA patients, in 2012.

The IG found that 13.1 percent of those prescribed opioids had an active substance use issue and 7.4 percent of patients taking opioids also had a prescription for benzodiazepine — a combination that can cause respiratory depression and death.

In 2012, the Center for Investigative Reporting published an analysis showing that VA prescriptions for opiates such as hydrocodone, oxycodone, methadone and morphine have increased 270 percent over the past 12 years.

The investigation also found that on average, VA has issued more than one opiate prescription per narcotic-prescribed patient for the past two years.

Baldwin said the Simcakoski family worked hard to make sure the VA provisions were included in the final bill, and she praised their efforts.

“This bill may have a real impact on the chances of [a veteran] becoming addicted,” Baldwin said. “My goal is to prevent Jason’s tragedy from happening to other veterans and their families.”


Heal the V.A. (But First, Do No Harm)


VA Hospital, Minneapolis, MN

VA Hospital Minneapolis

VA Hospital – Minneapolis, Minnesota


“For all its problems, the V.A. is not failing in the area that matters most.

It delivers excellent, integrated health care to a population with many challenging medical needs. The overall quality of its clinical care is high, as good as and often better than what the private sector can offer.

And for veterans with complex, combat-related wounds — spinal-cord injuries,traumatic brain injuries, severe burns, amputations, post-traumatic stress disorder, or the combination of grave injuries called polytrauma — there is no substitute for the breadth and specialized competence of the V.A.

Two years after a scandal engulfed the nation’s veterans hospitals, with reports of long waiting lists, cooked appointment books and patients dying while they waited for care, a commission created by Congress has delivered a plan to transform the Veterans Affairs Department over the next 20 years.

Its 300 pages, released on Wednesday, are a chronicle of failings at the Veterans Health Administration, the part of the V.A. that handles medical care. The debate over the report’s many judgments and prescriptions is just beginning. But the commission’s ambitious work brings two immediate thoughts to mind.

First is a fresh awareness of the danger of quick fixes. After the furor of 2014, which forced the V.A. secretary, Eric Shinseki, to resign, Congress swiftly passed a law and gave the V.A. 90 days to carry it out. It offered a seemingly straightforward solution to long-delayed appointments — allowing patients who have to wait more than 30 days or live more than 40 miles from a V.A. hospital or clinic to see private doctors.

But that hastily created program, whose management was outsourced to private contractors, with confused and conflicting rules, only made things worse. “In execution,” the commission wrote, “the program has aggravated wait times and frustrated veterans, private-sector health care providers participating in networks, and V.H.A. alike.”

That leads to the second thought: the danger of jumping to the wrong conclusions. The V.A. is troubled, no question. But the commission properly stops short of recommending a solution dear to ideologues on the right, which is to dismantle one of the largest bureaucracies in American government — one with a critically important mission — and hand the wreckage to the private sector.

For all its problems, the V.A. is not failing in the area that matters most: delivering excellent, integrated health care to a population with many challenging medical needs. The overall quality of its clinical care is high, as good as and often better than what the private sector can offer. And for veterans with complex, combat-related wounds — spinal-cord injuries,traumatic brain injuries, severe burns, amputations, post-traumatic stress disorder, or the combination of grave injuries called polytrauma — there is no substitute for the breadth and specialized competence of the V.A.

Those who delight in accounts of big-government ineptitude and inefficiency will find lots to savor in the commission report. The commission acknowledges that V.A. care can be inconsistent, with the lack of access to doctors being the agency’s worst management failure. It recommends overhauling the agency’s leadership structures, reforming eligibility requirements, investing in buildings and updating information technology, among other things.

But its primary recommendation is to greatly expand access by creating “integrated, community-based” health care networks that all veterans can use, bolstering the Veterans Health Administration with doctors and hospitals from the Defense Department, other federally funded providers, and local ones.

It’s unclear how that new public-private agglomeration is supposed to work, but getting those devilish details right is crucial. Veterans’ advocacy groups are right to be concerned that shedding patients and services to the private sector may ultimately weaken the V.H.A.

Given the egregious gap between the need for medical care and the supply of doctors and providers, there is clearly a role for qualified private health care providers to pitch in. But privatizing the V.A. — throwing wounded veterans upon the vagaries and mercies of corporations, co-pays and premiums — is no solution.”

Heal the VA

See Related Topic:

Why does the United States veterans administration have it’s own health care facilities and provide its own healthcare?

VA Regional Director Dismissed




“VA said preliminary results of two federal investigations at the Cincinnati VA Medical Center warranted the agency to remove Jack Hetrick from his job.

The Veterans Affairs regional network director, in charge of overseeing Indiana veterans while being investigated in Cincinnati, abruptly retired Thursday after the VA recommended he be removed from his position.

“We are committed to sustainable accountability,” Solan Gibson said in a statement, deputy secretary of Veterans Affairs. “We will continue to use VA’s statutory authority to hold employees accountable where warranted by the evidence. This is simply the right thing to do for Veterans and taxpayers.”

Indiana lawmakers had raised serious questions this week about why Hetrick continued to oversee VA facilities in Indiana during the ongoing investigation.

Rep. Jackie Walorski (R-Ind.), a member of the House Veterans’ Affairs Committee, isn’t satisfied with the decision.

“In classic VA fashion, instead of taking real action they’ve allowed a bad employee to take early retirement and continue to receive benefits for irreprehensible actions. There is no justification for forcing bad bureaucrats to retire instead of showing them the door. Once again, this just proves there is still a long way to go until we see true accountability at the VA.”

In a statement Thursday, Sen. Dan Coats (R-Ind.) said:

“I commend the VA for taking this important step to ensure our veterans remain the department’s top priority.”

Rep. Luke Messer (R-Ind.), whose office has received complaints about the Cincinnati medical center, was critical of the VA’s handling of Hetrick:

“Allowing Mr. Hetrick to retire—likely with full benefits and a pension— is not holding him accountable. It’s absurd that a VA investigation revealed Mr. Hetrick was involved in misconduct and possibly broke the law, yet he wasn’t fired. It’s past time for the Obama Administration to end this cycle of dysfunction at the VA. Our veterans and our taxpayers deserve better.”

Sen. Joe Donnelly (D-Ind.) said he has been personally in contact with VA Secretary Bob McDonald throughout the investigation.

“I’ve spoken with Secretary McDonald about the situation at the Cincinnati VA, and I expect the Department of Veterans Affairs to continue taking aggressive action to hold their leaders accountable.”

Reports of misconduct inside the Cincinnati VA medical center prompted the two federal investigations, addressing allegations of cost-cutting affecting quality of care and claims that drugs were improperly prescribed.

Tied into the investigation was Hetrick, who oversaw VA facilities in Indiana, including Fort Wayne, Marion, and Indianapolis, as part of a nationwide consolidation effort. As of October, Hetrick was in charge of overseeing the care of 500,000 veterans throughout the lower peninsula of Michigan, Ohio, Northern Kentucky and Indiana.

But in light of the federal investigations launched earlier this month, Hetrick’s oversight authorities had been removed only in Cincinnati.

An initial investigation by WCPO-TV in Cincinnati reported investigators were looking into Cincinnati’s Chief of Staff, Dr. Barbara Temeck, and accusations she prescribed highly-addictive pain medication to the wife of Hetrick.

The VA announced Thursday, officials removed Temeck from her current position as well, “pending appropriate administrative action.”

The VA said it found “substantiate misconduct” by both Hetrick and Temeck “related to Temeck’s provision of prescriptions and other medical care to members of Hetrick’s family.”

Rep. Jeff Miller (R-Fla.), chairman of the House Committee on Veterans’ Affairs, echoed Messer and Walorski’s concerns.

“A VA investigation has already substantiated that both employees committed serious misconduct in violation of multiple VA regulations and quite possibly the law, yet both of these individuals are still collecting taxpayer-funded paychecks.”

The VA said a potential criminal investigation could follow.”

VA regional director overseeing Hoosier veterans abruptly retires after officials find ‘substantive misconduct’

Military’s PTSD and Depression Care Falls Short




“The military’s health program falls significantly short in providing mental-health care to service members, according to a Rand study published last week.

The study focuses on depression and post-traumatic stress disorder, the two most common mental-health conditions experienced in the armed services.

It finds some good news: The Military Health System, which is operated by the Defense Department, is effective at contacting active-duty personnel diagnosed with one of the conditions. In addition, a vast majority of those diagnosed with PTSD or depression receive at least one session of talk therapy, the study finds. In that regard, the military system outperforms civilian health services.

But the system faces difficulties ensuring that patients continue with treatment, either by continuing to see a psychotherapist or following up with a doctor after being prescribed medication.

“It’s essential to provide excellent care for these service members because of how much we ask of them,” said Kimberly Hepner, the study’s lead author and a senior behavioral scientist at Rand.

The study examined medical records for service members diagnosed with one of the two conditions between January and June 2012. About 15,000 had PTSD, and about 30,000 had depression. About 6,000 had both.

About 1 in 3 patients newly diagnosed with PTSD got the appropriate follow-up care — typically, that’s at least four visits to a psychotherapist within two months. For those with depression, less than a quarter completed those four visits.

Only about 40 percent of patients who were prescribed medication followed up with a doctor afterward. Those visits are essential, Hepner said, because the physician can make sure patients take their medication and help them manage side effects. A physician’s involvement also ensures that medication doesn’t counteract other drugs being taken.

“Service members received a tremendous amount of medical treatment,” she said. “That’s why it’s even more critical to make sure that it’s a successful experience.”

Combat can contribute to mental health problems, according to the Department of Veterans Affairs. Meanwhile, research has found that suicide attempts seem to be more common in service members than in civilians, though it can be difficult to make such comparisons.

The study is the first part of an overarching project to assess mental-health care in the military. The research, which was commissioned by Defense, hasn’t yet delved into such questions as why patients stop their therapy and medication.

Potential explanations could include insufficient access to mental-health professionals, said Joe Davis, a spokesman for the Veterans of Foreign Wars. Many service members might also fear judgment from their peers for asking for help.

“It’s very easy for senior leaders to say there is no stigma, but far different on the ground at the small-unit level, where everyone relies on their buddy . . . and vice versa,” he said in an email.

Service members might also have been unhappy with the care they got, he added, and therefore chose not to return.

The shortage of providers is one of the biggest barriers to continuous mental-health care, said Elspeth Cameron Ritchie, a former military psychiatrist. As the number of service members deployed to Iraq and Afghanistan has increased, she added, the need for doctors has grown.

It may also be true that appointments are not available at convenient times, Hepner said. “We ask a lot of service members, and they have a lot of demands on their jobs.”

Because they travel a lot, it can be difficult for them to keep up good, continuous access to care, Ritchie said. That difficulty can compound reluctance to keep up with mental-health care. Many, she added, worry about others’ perception if they are seen regularly visiting a psychiatrist.

“If you need to go to the doctor all the time, people will think, ‘Oh, what’s wrong with that person?’ ” Ritchie said. “There’s a lot of talk about how we should treat this as a broken leg, and there shouldn’t be a stigma. But there is a stigma.”

The Defense Department’s commissioning of the study is encouraging, Hepner said, because it suggests an interest in trying to improve mental-health care and access to it. DOD could build on efforts to publicly measure how good its providers are, she said. The department has begun doing that, but Hepner said the public needs more information about quality of care.

The Rand findings may have understated the difficulty of obtaining mental-health care, Hepner added. The study focused on patients who had been diagnosed, but it probably missed some who either hadn’t seen a doctor at all or who had but hadn’t been diagnosed.

Even when they go to the best doctors, service members must ask for help, which can be difficult, Davis noted.

For instance, everyone in the Rand study had been identified as needing help. That makes it easier to connect them with care, which may have influenced the high proportion who had an initial visit, Hepner said.

“The real risk here is the people we are not addressing,” she added.”


VA Boosts Budget to Tackle Outstanding Healthcare Claims from Vets




“The Veterans Affairs Department is requesting a budget of $182 billion next year, a nearly $20 billion funding increase designed in part to tackle outstanding health care claims from veterans.

The proposed spending plan unveiled on Tuesday includes nearly $103.6 billion for mandatory programs such as disability compensation and pensions, and more than $78 billion in discretionary funding — mostly for health care.

VA Secretary Bob McDonald, who is scheduled to testify Wednesday before Congress on the budget request, said the agency now has “one of the greatest opportunities in its history to transform the way it cares for our veterans.”

McDonald says the funding will expand health care options to veterans across the country, continue efforts to end chronic veteran homelessness and further reduce the backlog on first-time claims and also on appeals.

Claims appeals, which have increased over the past six years as the VA put more resources and manpower into tackling the first-time claims backlog, is being targeted next year with more money and personnel.

The budget proposes $156.1 million and 922 full time employees for the Board of Appeals, up from about $110 million for a staff of 680 personnel in 2016.
The department’s spending plan marks the last one that President Barack Obama will submit as his second term ends next year and amounts to about double what it was in 2009 when he was sworn in.

After the White House released the budget details, Rep. Jeff Miller, R-Florida, a Republican from Florida and the chairman of the House Veterans Affairs Committee, released a rundown of recent and longstanding department problems, from cost overruns on construction projects to employees not being held accountable for poor performance and alleged wrongdoing.

“I will fight to ensure VA has the resources it needs, but given the complete lack of accountability for the department’s string of past financial failures, this budget request will receive every bit of the scrutiny it is due,” he said in a statement.

The department budgeted $68.6 billion for health care. Of that amount, more than $12 billion is slated to deliver health care to vets in their community.
Another $8.5 billion is for long-term care; $7.8 billion for mental health programs; $1.6 billion to reduce veteran homelessness; $1.5 billion to treat veterans ill with hepatitis C; $601 million for treating spinal cord injuries and $284 million for traumatic brain injuries, according to budget documents.

The VA expects to spend $725 million for caregivers.

To improve claims processing, the VA is continuing to invest in technology, earmarking $180 million to the Veterans Benefits Administration to enhance its electronic claims system and $143 million to the Veterans Claims Intake Program to continue converting older, paper records, including health records, into digital images and data.

The backlog in first-time claims — those not acted on within 125 days of filing — has been reduced from its 2013 peak of 611,000 to about 82,000, McDonald said last month.

Unlike other parts of the federal budget, Congress has authorized the VA to include funding requests one year in advance. As a result, the department included 2018 funding figures that totaled about $174 billion, including $104 billion in mandatory programs, a $1.5 billion increase from the 2017 request, and $470 billion in advance appropriations, an boost of about $300,000 from next year’s amount.”