Transcripts For CSPAN2 Veterans Administration Visually-Impaired Services 20140829

Starting at eight eastern on cspan. Cspan2, providing live coverage of the u. S. Senate floor proceedings and key Public Policy events. And every weekend, booktv. Now for 15 years the only Television Network devoted to nonfiction books and authors. Cspan2, created by the cable tv industry and brought to you as a Public Service by your local cable or satellite provider. Watch us in hd, like us on facebook and follow us on twitter. Iraq war veteran Travis Fugate says he may have gone p blind because his v. A. Center doctor didnt have the right information. Mr. Fugate says the v. A. s failure to fix issues was depressing. Veterans Affairs Department officials also testified at this hearing with members questioning why it was taking so long for the departments records to mirror the defense departments. This is just over two hours. [inaudible conversations] good morning. This hearing will come to order. I want to welcome everybody to todays hearing titled assessing inadequacies in v. A. Data usage for and Services Provided to visuallyimpaired veterans. My names mike coffman, and prior to hearing testimony and asking questions of our witnesses, i ask each member state his or her name to assist our witnesses in identifying who is speaking. Thank you for your cooperation. Now let us begin. This hearing focuses on continued problems within v. A. That have caused its contribution to the Vision Center of excellence to stagnate, allow ared v. A. Systems to continue to operate in noncompliance with section 508 of the americans with disabilities act and compromised other Services Provided to veterans with visual impairments. The creation of the Vision Center of excellence or vce as we will refer to it today, was mandated by the National Defense authorization act of fy2008. It stated that the department of defense was required to create the facility and to collaborate with the department of Veterans Affairs in doing so. One of the Main Responsibilities required in the 2008 ndaa for the operation of the vce was to, quote enable the secretary of Veterans Affairs to assess the registry and add information pertaining to additional treatments or surge call procedures surgical proceed juries and procedures and outcomes for veterans who were entered into the registry and subsequently received treatment through the Veterans Health administration. The reference to the registry is that the department of veterans eye injury and vision [inaudible] which we will also refer to as the registry today for convenience. The dod has done a commendable job of populating the rem industry with over 20,000 registry with over 20,000 unique patient entries. However, the most recent number v. A. Has provided the Committee Regarding the contribution of the vision registry is one entry. One compared to 20,000. Notably, in an october 2013 briefing v. A. Staff stated that the one entry was just a test case to insure that the transfer of information would work. So, essentially, v. A. Had not entered in any veterans information into the registry which precludes v. A. From meaningfully contributing to the very purpose the registry was created. Quote to collect the diagnosis, surgical intervention, operative procedures and related treatments and follow up on each significant eye injury incurred by members of the armed forces while serving on active duty can. We will hear from a veteran today who will articulate the importance hofstra fulfilling its obligation to contribute to the registry. Another major issue we will address today is v. A. s continued failure to bring its Information Systems into full compliance with section 508 of the americans with disabilities act. The two separate section 508 addresses access for people with physical, sensory or cognitive disabilities in various types of technologies. Two separate memoranda dated july 26th, 2012, issued by thenassistant secretary for information and technology roger baker, illustrated the ongoing problems with v. A. Regarding section 508 compliance. Both memoranda recommend how recent reference how recent audits conducted by v. A. Show that most of the content and information on v. A. Web sites was not section 508 compliant. Further, in a 2012 v. A. Dashboard summary analysis, every site review showed a status of less than 50 compliance with section 508. Some notable examples include v. A. Jobs, ebenefits and v. A. Forms. V. A. Jobs at 80 critical, ebenefits at 95 critical and v. A. Forms 100 critical. The rating of critical in the analysis staged that the listed percentage is the amount of that web site that is completely inoperable. We will hear today in v. A. s testimony that they are making Great Strides in bringing v. A. Systems into compliance with section 508. However, we will also hear from a blinded veteran who must actually navigate these pages himself. He may be inclined to disagree. With that, i now recognize Ranking Member kirkpatrick for her opening statement. Thank you, mr. Chairman. Im Ranking Member Ann Kirkpatrick from Congressional District 1 in arizona. The hearing topic today is an important one, and i look forward to an indepth discussion with our ps with our witnesses. Today we are examining the department of Veterans Affairs role in the Vision Centers of excellence and section 508 of rehabilitation act of 1973 compliance as they relate to proper access and services for blinded veterans. We will also a hear the testimony of mr. Glenn minney on a bill introduced by my colleagues on health. This bill will expand the v. A. s beneficiary travel Coverage Program for some veterans who are not currently eligible for beneficiary travel but who are in need of treatment at one of the v. A. s Blind Rehabilitation Centers or spike cord injury low spinal cord injury locations. Mr. Minney, i look forward to hearing your testimony, and as a result of being a cosponsor of h. R. 1284, i believe this bill will help remove another access to care obstacle within the v. A. Medical system for our veterans. Many of our visuallydisabled veterans would greatly benefit and become capable of living independently in their own homes if able to receive rehabilitation. However, some of these veterans are not able to receive these treatments because of high travel costs and ineligibility for beneficiary travel under the v. A. Programs. And this is a special problem in my district which has a very large rural district in arizona. And my veterans have to go to three different veterans hospitals depending on where they live and travel hundreds of mails. Miles. This bill will expand eligibility for beneficiary travel so that more veterans are able to receive rehabilitative treatments. I understand that in the current conflicts eye injuries have accounted for approximately 15 of all battlefield traumas. We also know that as many as 75 of traumatic brain injuries in patients, those patients also suffer visual dysfunctions that can affect their quality of life. When the Vision Center of excellence was envisioned and established through the 2008 National Defense authorization act, the department of defense in collaboration with the d. Of Veterans Affairs was tasked with prevention, diagnosis, mitigation, treatment and rehabilitation of eye injuries. While it took some time, i understand that the center is now functioning although problems such as staffing, funding and clear policy remain challenging. In addition to the center, the 2008 National Defense authorization act also required the establishment of a vision registry. I look forward to hearing from our Witnesses Today on the progress of that collaboration especially enrollment and seamless transfer hofstra vision care of v. A. Vision care data to the registry. Mr. Chairman, while the wars may be winding down, we know that the need for research, treatment and rehabilitation will remain for eye injury vet aarons veterans for decades to come. Today we are also looking at the department of Veterans Affairs compliance with section 508 of the 1973 rehabilitation act. Section 508 addresses access for the disabled to different types of technology. According to v. A. Testimony, v. A. Systems are still not compliant with the law. One of our Witnesses Today described the difficulty of navigating through the v. A. Web sites because they are not 508 compliant, causing him frustration and a lot of extra time to get the information he is looking for. Eyeinjured veterans are already challenges, and we should be working as fast as we can to insure that their next encounter on the v. A. Web site will not be so difficult. I would like to hear from our v. A. Panel what they are doing to become compliant, why is it taking so long, and what resources are needed, if any, to aid in becoming compliant. We need to get this right sooner rather than later. Thank you, mr. Chairman, and i yield back. Thank you, Ranking Member kirkpatrick. I ask that all members waive their opening remarks as per this committees custom. With that, i welcome the first panel. On the witness, at the witness table. On in this panel we will hear from many Travis Fugate, Kentucky National guard, retired. Mr. Terry kebbel, did i say that right . United states army, retired. And mr. Glenn minney, director of Government Relations for the blamedded Veterans Association. All of your blinded Veterans Association. Mr. Fugate, you are now recognized for five minutes. Thanks, chairman and Ranking Member, for inviting me here to speak again. It was over five years ago that i came here to speak about the vce. It had been the creation had been mandated the year prior to the time that i spoke before which was march of 2009. Only a week before the day before that i spoke id been told that my vision was totally gone and i wouldnt see again. Most people who reviewed the case agreed that the vision that i had lost let me explain something further. When i was injured, i had some remaining vision. And i had it for three years, and then i got an infection, went to the v. A. , and the doctors didnt have access to the proper medical data. So they failed to do preventive surgeries, and when i had an emergency situation, they didnt have access to the medical documentation which may have led to the vision loss that resulted. After the surgery. Since i was here before, ive went on, ive went to school, ive worked to improve myself, my life. Ive been active in the v. A. And the blinded Veterans Association trying to help other blinded veterans. I meet new, young blind men coming from the wars every year. Im interested in hearing you ask questions about how things have changed since the testimony in march 2009 in which i participated. If some young man went into the v. A. Tomorrow, as i did, would his doctors be able to have access to electronic data that allowed them to perform preventive surgeries and see all the surgeries he had in the past . Or she . Im open for questions. [inaudible] mr. Fugate. Mr. Kebbel, you are now recognized for five minutes. [inaudible] as a blinded veteran, ive had an opportunity to assist other blinded veterans on how to use web sites. Weve done a good job of describing what 508 is, compliance. Weve dope a good job of weve done a good job of stating that we need to do something about it. I want to talk about what we havent done yet, okay . As i i was asked to investigate ten web sites or ten web pages for this testimonial. I had the opportunity to design, with some help from some other blind veterans, a form that helped us to evaluate each of those web payments. In my web pages. In my opinion, each of those web pages failed. Each of those web pages failed in different areas, some very major and some very minor. When i get the opportunity to read a web page, i would like to be able to navigate properly, and i can do that with headings. And headings is a way for a nonvisual person like myself to to navigate a web page. One of the pages i evaluated had no heading level, heading on page which means that i have to navigate the whole web page to find out what the purpose of that web page is. A sighted person can visualize it and see what that purpose is right away. Another page that i had the opportunity to evaluate was one with link problems. And i was kind of interested when you said that the forms page failed 100 , well, im in total agreement with that one. I had the, you know, when i went to the web page, i listed the links on the page, and there was 217. And these are links to forms. Every one of those links were named by a numerical number, had no description on what that form us was. Another one was, another one i evaluated is where i went to it, the web page, first one i downloaded was a form to fill in, okay . The first thing i noticed was that it was an image file. Well, for those of us who use a Screen Reader and who are blind, we know that we cant look at pictures. And that is an image file. So i cannot read that image file. The second thing is, is that it was a form i was supposed to be able to fill out. Well, if its an image file and there are no formal edit boxes on that page, i cant till in the information fill in the information needed to fill out that form. So when i, when i hear that were making progress on it, its difficult for me believe. I would like the same opportunity to read a web page as a sighted perp, sighted person. And i can do that on web pages. I can go to a web site from Stanford University and access all their information. I can take courses there, i can do a lot of things on that particular web page. I can go to library of congress and do the same thing. I can go to the National Federation of the blind which is probably one of best web sites that i know of and read as if i was a sight ad perp. Sighted person. What concerns me the most is that were sitting here arguing about are we compliant or not. When i went to vietnam, i went to vietnam as a volunteer. I didnt go because it was the law, you know . I went because i thought it was the right thing to do. And as we sit here now, i think that, i think the right thing to do is to make it compliant. Whether its not the law or not. I just think its an issue of that you have the right to do it. As i look back, you know, in the 20th century the law became in effect, okay . Were now 13 into the 21st century, and as far as im concerned we have not made any progress. [laughter] i just, and im not going to be around for the 22nd century, so i dont think im really going to see anything happen. Thank you. [inaudible] care is really no different than a denial of care. Mr. Mi, this ney . Minney . You have five minutes for your remarks. Chairman coffman, Ranking Member kirkpatrick and other distinguished members of the house Veterans Affairs subcommittee on oversight and information, thank you for allowing the blind Veterans Association and its members to appear before you today. The blind Veterans Association is here to express our views and concerns regarding specific bva issues. The issue im going to discuss is h. R. 1284, the beneficiary travel. As a director of the Government Relations for bva, ive already spent many hours and days with members of the House Committee on Veterans Affairs regarding this bill. For veterans or who are currently ip eligible, which are nonserviceconnected veterans for beneficiary travel, title 38, us csection 111 does not cover travel to one of the 13 blind Rehab Centers. Or to any of the 28 spinal cord injury locations. If the law continues to stay as written, the nonserviceconnected veteran must purchase their own mode of travel to one of these Rehab Centers. The costs will certainly continue to discourage the nonserviceconnected veteran from traveling to a behind rehab or spinal cord injury center. At this time most of our nonserviceconnected veterans are of the age of 67 years old, and their blindness or Vision Impairment is due to agerelated conditions. They have to live on Social Security which is approximately 1450 a month. And with that, having that limited income and requiring them to pay for their own mode of travel to a rehab center, thats really going to pay dividends and be detrimental to their monthly income. The chief Business Office has scored this bill, h. R. 1284, as 3 million which, to be honest, i dont think that is true. Because as the language states in title 38, what we want changed is for it to say that it covers nonserviceconnected veterans. Were not wanting 3 million, we are just wanting the wording, the language to state that 1284 covered nonserviceconnected veterans as well as serviceconnected veterans so they can have the access to the Rehab Centers that the v. A. Has out there, the 13 blind Rehab Centers and the 29 spinal cord injury facilities. In a letter dated may 31, 2013, undersecretary of health, dr. Robert jesse, clearly stated v. A. Supports the intent of broadening travel e for those who could most benefit from the program. The v. A. Welcomes the opportunity to work with this committee to craft language so that those who are not Service Connected can have access to those rehab treatment facilities. One thing ive ran into with several of the members, speaking with them, is word the pay for or the pay go. Well, v. A. Travel budget continues to increase every year. How are we going to get this 3 million . Well, in 2013 the v. A. Collected 2. 931 billion through the medical care collection fund. Well, theres money that theyve collected. And i sat up last night listening to last nights hearing. 1. 1 billion returned two years ago, 1 billion returned last night and a half billion dollars returned just this year . Well, if theres that much money that can be turned back in from the v. A. To congress, well, theres our 3 million to send these nonserviceconnected veterans to the rehab that they so dearly deserve. So there is no pay for or pay go. The moneys there. It was clearly stated last night in the hearing that the v. A. Is giving the money back. So if you want to pay for it, theres your pay go. Also the v. A. Right now is currently, there are 147 state Veterans Homes. Ive been collecting data, and right now ive got 14 of those state Veterans Homes which is 10 . And of those, that 10 the state Veterans Home house 268 veterans who are there for blindness or visual impairment. Each one of those veterans the v. A. Pays a per diem of 100. 37 a day per vet, per day. You add that up. 266 vets, 365 days a year. Thats just 10 . Now lets make it 100 and, to be honest, that total is 97. 5 million annually were paying to house veterans in state Veterans Homes just because of blindness. If we can send them to a Blind Rehab Center, get them the rehab that they so dearly deserve, how many of them can we offer the opportunity to live independently . Not be housed in a state Veterans Home, but live independently, live on their own. The one thing i did want to mention here is just remember this there is no cure for blindness. There isnt. No matter how Much Research we do. But what there is is rehab for those who are blind and visually impaired. And getting that rehab will allow them to enrich their lives, become independent and be active members of their community. So lets not say, well, youre not Service Connected, so we wont send you to a rehab, you know . Blindness does not discriminate between serviceconnected and nonserviceconnected, and it doesnt know. Blindness is blindness. Lets eliminate serviceconnected, nonserviceconnected. Lets send the blind veteran to the rehab that the v. A. Is providing. And lastly, i want ill make this quote. George washington once stated the willingness to which our young people are likely to serve in any war shall be directly perpetual to how they perceive the veteran of earlier wars were treated and appreciated by their nation. This quote clearly begs the following question as generations pass, will this great nation continue to see young People Volunteer to join the armed forces knowing that their future Health Care Issues will not be covered by the v. A. . Are we willing, are we all a aware of the issues surrounding whats going on right now . Are we willing to enrich the lives of hundreds of nonserviceconnected veterans by housing them to go by allowing them to go to a Blind Rehab Center . Are you willing to see that its society toed on are you willing to see that its voted on . Thank you, ladies and gentlemen. This is mike cough match. Mr. Minney, thank you for your testimony. Again, this is mike coffman. Mr. Fugate, unfortunately, your story is not likely a unique one. Have you found that other blind veterans have gone through similar experiences with v. A. s failure to poppe p late the vision registry populate the vision registry . Its really, its really hard for me to say that i know individuals who have had situations that match my own, but im sure that they exist. Okay. Mr. Fugate, again, mike coffman. In your opinion, what would have been the benefits during your past surgeries had the v. A. Contributed to the vision registry . If my information was accessible to the v. A. Theres when i first met them doctors when i first met them, rather than asking me about the surgeries i had and thumbing true a twoinch stack of documents, they would have had access to, better access to the information. They would have seen that the dod doctors wanted me to have a preventive surgery within the year. I told the doctor that. The doctor, my word isnt as strong as the military doctors that had made the suggestion to me at watter reed. Okay walter reed. Okay. Also, im a number, im a statistic, and its meaningless. Theres no research being done on the numbers. If my information and all of the other blinded veterans information were in this data set, much more information could be discovered, and we could direct ourselves forward to help us all much better thank you. Again, this is mike coffman. Mr. Kebbel, thank you for providing a number of findings and observations for improving v. A. s compliance with section 508. Have you had an opportunity to share your findings with the v. A. . This is my first opportunity to do that. But i do share my findings with other veterans. I belong to a lot of virtual support groups in which us veterans talk about problems with with veterans web sites, you know, how to deal with the inconsistencies, how do to deal with the inaccuracies and how to deal with the problems of filling out forms. So i do that virtually. Okay. Mike coffman again. You stated earlier, mr. Kebbel, you stated earlier that there are many good examples of compliant web pages. Do you and your team keep a repository of best practices and Lessons Learned . Associated with that, do you have a list of performance metrics that agencies such as v. A. Can strive to achieve . Yes, we do. Its in various forms. It is not in one form that i would consider accessible yet, and were in the process of developing that. Thank you very much. Ranking member kirkpatrick. Thank you, mr. Chairman. Mr. Fugate, one of the things that our committee has been focused on is creating and making sure theres a seamless transfer of records from dod to v. A. So that theres no gap at all in the records that a doctor might see. The day that you transitioned out of the department of defense, im curious, did walter reed have the department of defense records but just not look through them . Can you just explain that to me . Walter reed had my medical records, and it was at the v. A. That i had the complications. It was the transfer between walter reed and v. A. So did the v. A. Have your department of defense records . My first meeting with my doctor at the v. A. Was surprising. My father drove me three hours to get to the facility. I lived, at the time, in the Appalachian Mountains of Eastern Kentucky. Once we got to the meeting, the doctor came and sat with me, and the nurse brought in my records which was a big, heavy stack of records. I couldnt see them. But i heard the thump. And he said there was something along the lines of he couldnt do anything with that. He would have to review it later and find the, you know, information. And i was sent back home, sent along my way. Even though, even though you told him that the doctors recommended that you have preventive surgery within a year. Absolutely. He said i told him, told him that numerous times. And after probably the third time, he said that it was better for us to wait until an issue occurred and address it then. And im not sure im pretty sure he must have been aware that i was commuting two and a half, three hours. Well, im so sorry that that treatment was not given to you in a timely manner, and i just want to say your positive attitude is really an inspiration. And i thank you for coming again. And i just wanted to take you up on what you said in your testimony and ask you what changes youve seen since your testimony before the committee in 2009. Ive been deeply involved in my education, but yearly i catch up with my blind veteran friends at the bva, and its every year it gets more discouraging. So for the last year or so i stopped asking about it because it just, it was just depressing to me. And this year when i go with them, they told me that for the past years the staffing was inadequate, and there were no finish the records werent being put into the registry, collaboration wasnt taking place as it was supposed to. I never, never got any positive information about the progress of the vce. If there were one thing that our committee could do to make a difference in that area, what would that be, in your estimation . To ask, to see what to ask the people responsible what they were asked to do and which of those tasks theyve completed. And how long it took them to complete that task. To just, just to hold the people responsible for creating this, this wonderful tool for us. Mr. Chairman, i think thats what our committee should do. Mr. Fugate, i understand that youre friends with our colleague, tim walton. Im not going to hold that against you [laughter] actually, i want to tell you that he is an ardent supporter, a passionate advocate for our veterans, and you couldnt have a better friend. Thank you very much for your courage and your testimony here today. I yield back. Thank you. Thank you, Ranking Member kirkpatrick. Mr. Huelskamp, you have five minutes. Thank you, mr. Chairman. Seems like i was just here a few minutes ago, and i do appreciate having more time to discuss these. Appreciate the testimony. My name is Tim Huelskamp and im here from the state of kansas. Mr. Fugate, i hope i pronounced your name correctly. Mine is off mispronounced as well. A little follow up on your situation and one thing ive seen lacking in just my few years in congress is accountability. Systems do fail. People do fail. Im particular im curious of your particular situation as you described in your testimony, written and oral. Is the v. A. Following up with you after this fact and termed, yes, this is where we failed in this system . I see a number of things that, obviously, Electronic Medical records didnt happen. And ill have a followup question for mr. Minney about other [inaudible] did v. A. Ever contact you after this or after your testimony saying, hey, this is where we failed, this is the doctor, this is where the system failed for you . No. No one ever from, that i can recall, explained to me where the failure occurred or held themselves accountable. Uhhuh. Or provided an apology. Ive stuck with the v. A. , and ive had great medical care and met and became friends with a lot of medical professionals within the v. A. But the system clearly, clearly failed in my case, and no one ever has explained to me what happened. Do you still travel two and a half hours to v. A. Certain for your current care with the v. A. , or have you found one closer they would let you, or did you move . Can you describe that a little bit more . I come from a rural district. Plenty of veterans have to drive 100, 200, 300 miles one way for care often times they could get almost next door, literally. And the v. A. Says, no, you have to drive. Im just curious of your particular situation. I moved out to california to go to school, california state monterey bay. Luckily, theres a v. A. In palo alto, a branch of the palo alto system right next to my campus. Be so that was very helpful for me. Ive came back home to Eastern Kentucky to spend some time with my family, and we now have a branch of sorts. Its an office and a medical facility. They dont i cant get my medication there. I have to travel or get them by mail. So ive seen improvements in trying to get centers, branches into rural areas. Yeah. Appreciate that and appreciate your testimony today. Mr. Minney, a followup question on the Electronic Medical records issue which has been plaguing the v. A. And the dod attempting to communicate. Its my understanding that it often actually happens in the private world, they actually do communicate, a fairly regular process, but the v. A. And dod cannot do that, its my understanding. Can you describe the situation that occurs with travis, given the current scenario would that likely occur again where a veteran walks in and says heres my medical records, and its just paper . Is that still the case . Yes, it is. Travis is a unique individual because he actually did have a copy of his Health Records. But ive spent 21 years in the navy as a corpsman in the medical field, and once i retired from there, then i actually went to work for the v. A. So i can tell you right now dod Health Records, theyre not even transferred into v. A. Health care system. If you take a young [inaudible] that gets injured and he gets surgery and [inaudible] when he gets back home and he goes into the v. A. Health care system, the doctor will ask him what surgeries did you have. Hes not going to know, you know, the names of these surgeries. So right there the v. A. Has to start from scratch and build a Health Profile on him. If there was a transfer of those Health Records or a joint Health Record, the v. A. Could access his dod Health Records and see exactly what surgeries hes had, what medications hes on and what therapies hes needed. Thats where the benefit would come into play. But, no, not everybody was as fortunate as travis to actually have a copy. Some, some of the injured show up at the v. A. With nothing, no documentation at all. Thank you, mr. Minney, mr. Fugate. I yield back, mr. Chairman. Mr. That can know . Thank you, mr. Chairman. Mr. Huelskamp, that last question brought up some very, very bitter memories. One of my First Committee hearings was about this issue of the Electronic Medical records not being able to be transferred from dod into vista, and i can barely contain the anger i feel about this situation and millions and millions of dollars that have been spent trying to solve this situation. And to hear in the interim months between my first hearing and now that there seems to be no way to bridge this gulf between the two departments. Its bad enough to see a casualty of war, but its even worse to see that casualty of war, you know, made even more tragic by this systemic failure between these two department cans. I dont know what to do about this. I mean, it is frustrating to be a member of congress and not with be able to say fix this thing ask have it fixed. That being said, i do want to say to mr. Fugate and, is it mr. Kebbel . Or can kibble . Mr. Kebbel. Im proud to have started the first deaf caucus in the congress. Im one of the cochairs, and it has put me in touch with the disabilities committee. One community. One of the useful things thats come out of it is weve made a commitment to have an intern from gal you debt university. Gal debt university. Its my belief that some of the disability communities are not well represented by advocates here on the hill compared to all the other very strongly represented interests here. And i want to ask mr. Fugate, youre a young man, and youre getting your education at cal state. Im crowd to call you a california im proud to call you a californian now. Have you given much thought to what direction your life might take at this point . I was really excited after having the opportunity to speak here back in 2009. It was, it felt great to be heard. But as the year went on and then a couple more years passed and things didnt happen, it was just, it was very discouraging. So i was really happy that i had picked a career in Computer Science where i could talk to computers instead of asking people for help. Computers are much easier to talk to. They gave gave me the answers i wanted. [laughter] so my path is in technology. Well, im wondering if there might be some individuals in your capacity in the same situation that might intern on the hill to be able to kind of be a constant reminder to members about just what are the challenges. Mr. Minney, if there might be a way for us to have a pipeline of veterans in this situation, it might facilitate that. This is going to take a long its been several, i dont know how much time its taken to get focused on dod and the veterans Affairs Department, the v. A. , on this records issue. The Health Records issue. It seems like its going to take us several more months if not years of focus. Might it not be helpful to have a way to get some of these Service Members to intern or each to have staff positions or even to have staff positions here on the hill . I think, i think it would be an absolute wonderful thing to have a few blind veterans here up on the hill for the simple fact as members of congress are walking the halls, their staff or even individuals from the outside coming in. If they see the blind veteran maneuvering the halls, getting around and seeing that, you know, that their disability isnt hindering them from being an active member of society or the community, then im all for having some blamed some blind veterans doing internship here on the hill, and i would advocate for that. Mr. Kebbel, do you think that we could understand, members might understand your struggles with web sites if we had to upgrade our systems to be able to accommodate blind interns, blind veteran interns here on the hill if our systems had to have the kind of software that would make it possible for them to work here and to advocate on behalf of their brothers and sisters in arms . Right now i think the va doesnt even have, i think their self audited as far as if a webpage is usable. The Automation Systems are fine, okay, ask and that make you an indication that its quoteunquote accessible. But into the of someone who sits down and uses a screen with the reader with it, i dont think youll have a very good result. Thank you. Mr. Chairman. Dr. Roe, tennessee. Thank the chairman. Up like to introduce someone before i start. Timothy dennis is 19, is here with us today. This is foster youth shadow day, and if you would stand up. He spent six years in foster care in tennessee and he is here, as many of his other friends are, with the hill today so lets give him a round of applause. [applause] travis, i would member your testimony very well and i remember you being here and it was powerful than to its powerful now and thank you for coming back. On your neighbor just south of you in east tennessee, so im just down. Were in kentucky are you from . Im from a small town in not county, kentucky. We border virginia. The closest city to me, people recognize is hazard, kentucky,. I knew exactly where you live them. First of all appreciate your testimony. One of the things that you brought up is extremely important, five years ago, last year we have the va and dod coming and they just burned a billion dollars. We are worried about 3 million . We burned a billion dollars trying to make dod and the Va Health Care records speak to each other, and they cant. They quit. So 3 million is nothing, and ive been to great lakes illinois twice to look at the system with a try to get it to interact. It hasnt worked. And i dont know, travis, whether you are finding that information out but it was certainly of been nice if they had found information. Whether it wouldve prevented what happened to you, god only knows but it wouldve been nice if the doctors at all the Information Available to be able to make those decisions. And by the way, just a commentary. When you go to california dont let them mess you up. You are just fine, okay . Out there in california. And also i think, mr. Kebbel, which he said, tomorrow i go back, im a veteran as you are, all of you are, and im going back to vietnam tomorrow on a codel. And what you just said we need major test that is the right thing to do is absolutely correct. Not because you have to do these things, because its the right thing to do. One of the things i do every year, we have about january or february we have our sight impaired folks come to the hill. I go to mike honda and i put a blindfold on for an hour and i try to walk around my condo, which is very small, and get around. Let me to you, it is an easy. We need to do everything we can for our veterans who are sight impaired. I agree with you, whether its serviceconnected or not. If there are veterans, and i completely agree with that. I have a question that may be better for the next battle but im going to have to miss it. Glaucoma and potentially blinding diseases that are highly prevalent in the aging veteran populations. What procedures or processes are in place as far as you know to ensure that veterans with advanced site threatening eye diseases have been seen by an apologist . Could you i had trouble hearing. I said, what procedures or processes are in place to ensure that veterans with advanced site threatening eye diseases have been seen by an ophthalmologist . Do you know that in the va Hospital System in . I do know that once they are first diagnosed with the first stages, that they are put on like a Screening Program where they monitor it, three months, six months, but then thats really all that they could do is monitor it. Because macular degeneration, there is medication to slow the progress but there is no cure. Glaucoma, medications, no cure. So the only thing they could is monitor it. It. Travis, one other thing before have to leave. Your comment here in your testimony, im disappointed after the past three years while on dod site they already have over 23,000 or hundred 50 i injured records in the division registry. But today va has one veterans record. The va has not set this up because instead of having a clinical electronic data records contractors at dod already do it and war, the va from what weve been told now is waiting for contractor bids to be settled before getting started. Thats now four years ago you were here. I recently had a chance to talk to my congressman Harold Rogers to ensure this isnt delayed any longer. Thank you for that information right there. We will find out from the next battle, and the three of you, all of you, sincerely, thank you for your service to our country. [inaudible] thank you very much, mr. Chairman, and thank you for holding this hearing. Great to have you all here again. Travis, i know my colleague gave a kind introduction and associate you and i together as friends. I think harry truman was right. I know you have a companion at your site. If you need a friend in washington, get a dog. Youve got that one. Im honored. Theres no one i would rather stand with. I say that because, its not often you get the opportunity were going to discuss the intent of congress, the spirit and letter of law. Today you got the folks in the room who broke who wrote the law. Advocated for funding and we worked together. Im reminded and i folded up, you would probably appreciate this, travis, he was a u. S. A. To destroy th the city military section devoted to finding a treatment for combat i increase has been delayed for your by an ongoing squabble between congress and the pentagon over who will pay the 5 million needed to get it started according to interviews. That was january 28, 2009. Mr. Takano asked how long this issue of electronic records has been going on, and seamless transition or i can just say from my perspective my entire adult life have we advocated for this both within the military and then after. Its an important point. I think its important to note because as mentioned, a federally 2013 new england medical attorneys and story make this clear. In the private sector 12. 2 of physicians use electronic records meaningfully. Dont try to pretend theres some type of magic bullet on the other side that is working. Thats nonsense. The issue on this is its not going to set up some paradigm here that the private sector is doing this and we are not. We are failing in getting this done. Our purpose is to get this right and i would ask, travis, on this. Is your gold of the Vision Center of excellence up and running and doing what it is posted to in getting this care, or is your gold to go to the private sector for your eyecare . My goal is to have i care deeply about the va and all the care they provided, recreational care, therapy, and Mental Health counseling. Ive recently came back to kentucky to help my parents, who are getting up there in their years, address some other medical issues. And they were unable to manage their care in the private sector. It was too complicated. And i couldnt imagine trying to go into the private sector to be honest with you. And one of the failings points when im telling young men and women about my military experience is that you can avoid the private sector when it comes to medical care. Its so freeing to know that i can just take the bus to the va and be around people who know me and care about me and understand my issues. This is important point because we need to really be careful, because fee for Service Issues are absolutely fair issues. There is a role for that and the gulf of that. But these core mission issues especially on issues of Vision Impairment and different things, youre not going to get off the hook by not fixing what is here. And im angry, too, this communicate is not working. I said in an interview back in 2009 demanding we get this right. I think collectively when theres a role and a mission and purpose and one that is working for people like travis or our other veterans, we need to get that right. So i agree with the doctor wrote on this. This is not a funding issue. Theyve got to get this figured out represent the mayo clinic and they tell me, the vista system in the is the best medical record in the world. We have that. Dod has a different one. I understand beauties roll is to fight wars. That intel this nation understands when we have our two biggest bureaucracies in government silent up in dod and va not communicate with one another, you cannot separate travis in these warriors and their entries from the war we fought. We got the problem of a turf battle fighting over who will institute and who put him. Tom gagliano was an absolute expert in this, and if one test, and if what has led to that in this article talk about i havent Eyecare Center of veterans by dont have computer at a cant get going. We have a responsibility to avoid easy flippant answers of what its going to do. Dig down and hold the the accountability which we heard, if you counted on this, get this thing up and running because thats travis came to me and told me, his goal is to get back and do the things you enjoy doing, get back into technology, get a little place sometime. And you did a tennessee. Ive got to give doctor wrote that at some point in time. But we can do that. I would appeal to my colleagues, lets let the data can lets let the oversight, lets try this and get this going. We chose to do the Vision Center of excellence fully knowing that it was the best chance to do all the things that mr. Minney, mr. Kebbel and mr. To get asked is to be. Now lets just make it work. I yield back. Thank you. Dr. Benishek . Thank you, mr. Chairman the gentlemen, thank you for being here. Im dan benishek from michigan. Im a physician as well as mr. Rove and i worked within the system for about 20 is as a consultant. I have a couple of questions for you all. Mr. Fugate, let me ask you this question. It sounds on the testimony that youre not quite happy with the care youre getting from the va right now. Is that correct . I mean, what could the va be doing quite it seems to be your checking in with them periodically and thats about all of you were doing, that correct . Its tough for me because im very satisfied and happy with a medical professionals and the community that i deal with, that i work with when they go to the va. Its failures in the system and, that are causing, you know, that bothered me. What could the va be doing for you now that they are not doing . What would you like is there something youd like them to do . To me it seems like youre not having a close of communication with the va over this tragedy of your loss of sight. It seems to me there should be some ongoing help to you to get your life in order as best they can be. Are you getting anything like that from the va no . Yes absolutely. They are serving i could to Mental Health meetings regularly. Ive been involved as i said before with the recreational departments. What we did you like them to do that they are not doing . Well, currently everything, they are doing fine by me. Its that they failed. I could see all of it. I had some vision, some very useful vision, and it was their failure in handling my need when i transferred from the dod to the va that led to me losing that remaining vision. And what my my care is fine now. What i hope to do is prevent other soldiers, veterans, from being hurt further by a failed transition between the dod and the va. Right, right. Mr. Minney, do you have any comments on that question . I mean, what could the va be doing, besides avoiding the issues like mr. Fugate talks about, and the whole reason we want this test for here is to the big the biggest challenge i see that prefix once again is communication across the board. The two agencies need to communicate better. It needs to be a more seamless transition so that no one gets lost in the system. When i was injured, i went my injuries required me to get surgery from a german hospital. I had five eye surgeries from a procurement hospital. Well, they had no idea they fit me better, but when my unit was looking for me, they still couldnt tell me where i was at. Once they discover where i was at, i had already left homburg, back, my unit and my family were looking in homburg. Tom bird finally got around to telling them i was at lunch still but by the time they met there i was back at bethesda naval hospital. The same thing with on a source by purple heart. My purple heart was delivered to me by the ups man. Because it went from homburg to bethesda. Everything was one month behind. Because no one was communicate and. Its detracting. They need better tracking. Thats where i would seek improvements being made. Mr. Kebbel, i was intrigued by your statement here about lack of car the difficulty for blind person to get through the va website. I guess enough by with the technology that involves dealing with a computer. I guess theres a big lack and the ability to communicate with a blind better. Could you just elaborate on that a little bit more than your testimony before . Yeah, ill be glad to do that. Let me just go back in history a little bit, and while downscale the situation a little bit instead of being at a government level. I will be at the city level and the city of las cruces. They were in the process of redesigning their website. So i had an opportunity to just sit there with her i. T. Departments, and discuss what that means to us. The next thing is once the i. T. Department had the concept of what to do, i sat down and performed training for the City Employees to give them a basic understanding on why we need accessibility, and why we need properly tagged elements. Okay, once i was able to do that, okay, the City Employees were 100 in. So i think right now what i see the problem is, is that we understand what needs to be done but nobody really understands why it should be done. All right. Well, i know why it should be done, mr. Kebbel, and i appreciate you being your details. Thank you all for your testimony. Im out of time. Mr. Orourke from the state of texas. Thank you, mr. Chairman. I want to thank the witnesses for being here, and i wanted to begin my comments and ask a question to mr. Fugate. You know, in the beginning of your comments you talked about being here five years ago in 2009, and implied in that was what difference did your testimony then make. What progress have been made since then, whats the value of your adventure today . And i want to just to you from my perspective as a member of this committee you have focused my attention on this problem. I have learned many things today that i did not know before todays hearing. I am a new member of congress. This is my first session in congress, my first session as a member of this committee your and i am now resolve as i know the rest of this committee is in ensuring that we correct the mistakes that were made in your individual case and a larger systemic problems that todays hearing has uncovered Innovation Centers of excellence and the problems for those who are sight impaired and are working with the va. So i first want to begin by thanking you, what theyre doing today is very powerful, very impactful and it is set up i think some excellent questions that this could within ask the va. You are helping us to hold the va accountable. So i wanted to say that. I also want to make you aware of a bill that we offered this session of congress, h. R. 3045 which would require the dod to provide every Transition Service member with a portable electronic record so that they have that, they own it and they can bring it to their visit with a va doctor, can bring it to the visit with a private medical doctor. They can just have it and refer to it as they need it. You have given us a poignant example of why that is so badly needed. I will say that we have cosponsors that included chairman of this committee and Ranking Member of this committee, mr. Walz, mr. Takano, members from both parties. We welcome Additional Support but as you continue to advocate on this issue, and mr. Minney and mr. Kebbel as well, we certainly encourage you to make sure that members are aware that was a bill that would provide part of the solution to some of these problems. You, mr. Fugate, offered some good advice when asked what she would ask other veterans to do who might be in your situation. You said that working within the va ge give found to be helpful versus working within the private sector. And let me also say i really appreciate your evenhanded description of the services. You talk about providers both on the physical and Mental Health side who were there to help you. The great quality care you got once you got in, despite the unfortunate decision that was made initially. I really appreciate that. What else, the size inflicting this committee besides influencing this committee and to the adventures of wider public listening to be. Thathe veterans who are returnig from afghanistan today who have sight impairment, what is your advice to the veteran . What would you like them to keep in mind . I would hope that they would understand that the va is there for them. Its a veterans community. Ive enjoyed sitting in the waiting rooms and meeting veterans from the past wars, and their wives and their families, and having coffee with them from down the hall while were waiting. Its a community, and the system is slow and jeff to reach really deep to find the patients sometimes to allow, to allow the system to turn. The system is not turning fast in the. The people in the va are not out to get you. They are not against you. The system just is turning. People care deeply about the returning veterans. Think you. And begin, thank you for finding good within the system that we can build upon while also recognizing the frustrations that you and others have with parts of that system that didnt work. Mr. Kebbel, im about out of time and i may ask you some questions following the hearing, but i did want to follow up on a point that youre making about in excess of those on the vas website. And really make sure that this committee is also doing everything it can. Mr. Walz leaned over earlier during her testimony and asked, is this Committee Website fully compliant and accessible to you and others who are sight impaired to editing the answer we received from staff initially is that it is not. I think we needed our part to make sure that we are not just blaming the va and not just listen accountable, which we should do, but also holding ourselves accountable. You mentioned the library of congress as an example of a federal agency that is doing it right. Im going to have to give my time back to the chairman but i would like to followup with you after the ring to bind other agencies in federal departments are doing the job the right way to we can learn from them. I wanted to thank you and mr. Minney also for being here. With that, mr. Chairman, i will yield back. Thank you your ms. Kuster, state of new hampshire. Thank you very much, mr. Chair, and thank you to our witnesses here today, both for your courage and articulating the problem but also i want to join my college, mr. Orourke and his comments, because i want you to understand i am also a new member of congress, a new member of this committee. And mr. Fugate, when you say people care deeply within the va but the system is slow, this has been our experience within the United States congress. People care deeply but the system is very slow. I want to revisit a letter that i lead with my colleagues, a bipartisan letter, that we wrote last summer july 22, 2003, to secretary defends chuck hagel and second of Veterans Affairs eric shinseki, where we raised our concerns about the Vision Centers of excellence, and asked for information to get a sense, sometimes around its difficult to even get the information about where things stand. Because i guess he wouldve colleagues on both sides of the all that came before us that care deeply about creating this Vision Center of excellence. And parts of the response that i find troubling, this is dated january 4, 2014, from secretary shinseki, is that there seems to be a number of positions that are open. The va can she did 6. 6 fulltime equivalent to equivalent employees. It doesnt sound very many to making the scope of this project. 2. 6 are currently filled, four are in the hiring process. And then this is also the case with the Hearing Center of excellence, for fccs, of which one position was filled, and three were in the hiring process. And i dont know if anyone on this panel can help us with this, but i do want to convey to you as mr. Were cast, that you focus our attention on this issue and that we intend to press this case forward. Because of the very purpose setting up the Vision Center of excellence is to address these concerns. We have so many new veterans from iraq and afghanistan with sight impairments from the war, and then aging veterans with sight issues. To comment on, could you comment on comment if you know, any member of the panel, what is the current progress and to think there are sufficient resources, including people power, to address these concerns about registering the people into the system and the computer issue that you have raised . Mr. Minney . Well, i know the last word that we got was on the va side, there is a blind rehab specialist position that they are interviewing for, and then the va side will have all their ftps filled. But now they are looking theyre putting bits out for contractors. My question is, the inception was in 2009, no contractors yet . There was 6. 9 million that was budgeted for the va side, for 2. 6 and poised between 20102014. I like to have that salary, 6. 9 million split between 2. 6 employs over four years . My question, i dont know where that funding went. So thats what i would ask. I also think the comment was well taken about the funds that are returned to the treasury. Its a fine thing in this world to be frugal. Well see a lot of that around here, but the point is how can funds be returned to the treasury if there are issues like this that remain unresolved and not addressed . So im going to close my time, and i just want to thank you for coming. And i also want to join dr. Roe in addressing, i have a constituent here in, dakota, who is join us in the back of the room. And foster not child, young person come here to learn more about congress. Mr. Fugate, i think you have a bright future, and i can just hope and pray that you might choose to address it to resolving the computer issues at the va. So thank you for joining us. Thank you, ms. Kuster. Before the panel leaves, id like to have mr. Handel discuss an issue that mr. Orourke raised relative to the compliance of this committees website. Thank the chairman. To your question, sir, the committees website does use a reader, and its called browsealoud which is in compliance. So happy folks at the panel been able to access that . Could you say the name again . Browsealoud. I have not used it. Okay. Then we will get with you after this and you can walk us through to make sure that it does address your needs. Can i make a comment on the . Yes, sir. Please. There are standard Screen Reading Software that blind folks use, and when you introduce a Screen Reader that a blind person isnt accustomed to using, its hard to expect that they will be able to interact with the information the weight that they are accustomed to interacting with information on other webpages. So in my opinion, a custom screen reading solution for a webpage is an adequate. Can i addressed that, to . Yes. This is terry kebbel. The problem with an Automated System is that it is designed by someone who looks at the script and says, this is what it is supposed to do. So i would say most of the time is probably accurate, okay . But there is a lot of times where it will look at a tag and will be a description of a tag of the label and the label will say button. It passes the test but the button, i dont know what the button does. Is it a button for searching something . Is this a blue button we are talking about . Is it a button that sends me know where . So yes, it will all pass the test but is it effectively labeled . Is effectively described . You can probably go through the form fields website on the va website and look at the link. I bet you every one of those links will pass inspection. But everyone of those links are numerically described. Theres no description of what that form is. So yes, you can use that, but as i spoke later that you really needed someone to sit down and evaluate it for uses a Screen Reader. Voiceover a whatever screen writer aspect Screen Reader you are using. [inaudible] mr. Takano and then we need to move to the second panel. Very briefly, thank you. I appreciate you and your staff are going to work with mr. Kebbel after the ring. Could we not share this information with House Administration committee and our counterparts in the senate . I think its important the entire institution of congress, every members website should be able to accommodate blind veterans and the Blind Community in general. We will certainly do that. This is the same system i think that is on the House Va Committee that the library of congress uses, as i understand it, but i think theres always room for improvement and we will certainly look at that. I want to thank you all so much for coming and testifying here today. Really appreciate your service to our country. Mr. Kebbel . As a vietnam veteran, what i hear concerns me because we talking about all the young veterans coming back. What concerns me about us Vietnam Veterans is agent orange are okay . I had a catastrophic Heart Failure that led to a heart transplant, okay. I feel thats because of agent orange and led to my blind as. There are a lot of us Vietnam Veterans out there who are dying without any health care right now. And i have a concern about that. I dont think weve addressed that. Thank you. Thank you very much. Appreciate your service to our country and all three of you. Thank you very much. And now well move to the next panel. The second panel. I now invite the second panel to the witness table. On our second panel we will hear from dr. Maureen mccarthy, deputy chief of Patient Care Services for the Veterans Health administration, and ms. Lorraine landry, Deputy Lorraine landfried, deputy chief Information Officer for product development. They are accompanied by dr. Mary lawrence, Deputy Director of the Vision Center of excellence, and mr. Pat sheehan, director of vas 508 compliance office. [inaudible conversations] i think we will continue for committee members, we will continue the process as stating your name so those that are vision impaired in the audience to know who is speaking. I would ask the panel to do the same. Dr. Mccarthy, your complete a written statement will be made part of the hearing record, and you are now recognized for five minutes. Thank you. Good morning, chairman coffman, Ranking Member kirkpatrick, and members of the committee. I appreciate the opportunity to discuss the department of Veterans Affairs contributions to the Vision Center of excellence and they care and Services Provided to veterans with visual impairment. I am accompanied today by dr. Mary lawrence, Deputy Director of the Vision Center of excellence. The Vision Center of excellence, or vcd, was established by the National Defense authorization act in january 2008. In october 2009 a deity and the memorandum of understanding defined the roles and responsibility of the department and the establishment and operation of the vce. B. C. These efforts are directed at improved vision health, optimize redness and enhance quality of life. The National Defense authorization act, also requires the invitation of the defense and veterans eye injury in vision registry. The vision registry collects longitudinal data on eye injuries, Guides Research and clinical education, promotes best practices, and informs policy for the treatment of eye and vision related injuries for servicemembers and veterans. I am pleased to share that the vision registry is on schedule and on budget. Vce has achieved many significant accomplishments since its inception. Vce has identified and addressed 33 process improvement opportunities through the monthly vce hosted worldwide ocular trauma video teleconferences which connect providers across the continuum from combat support hospitals and coalition providers to be a polytrauma centers. It has also led the way to initial inclusion of fox protected the eye shields in joint first aid kits, and is attempting to expand them into individual first aid kits. In addition vce in collaboration with the a lined Rehab Services has designed an educational pamphlets geared towards inpatient care teams and hospitalized settings to assist with transitions. Mr. Chairman, the consequences of vision injuries to her servicemembers and veterans will be with us for decades to come. Therefore, va will continue to partner with dod to provide eye care providers, Clinical Care practitioners and researchers. Who have access to the information needed to develop strategies that will enhance and improve patient care outcomes. Mr. Chairman, this concludes my testimony. I am prepared to answer any questions you may have. Next i would like to introduce lorraine landry, deputy chief Information Officer for product development, office of information and technology to address issues related to 508 compliance. [inaudible] good morning chairman coffman, Ranking Member kirkpatrick, and members of the committee. We appreciate the opportunity to discuss Veterans Affairs work to improve access to Information Technology resources, for visually impaired veterans, stakeholders and opposed to accompany me to is mr. Pat sheehan, director of our 508 program office. Since 1001 of his office 100 10f his office to provide validation testing on the websites and applications using a combination of automated tools and manual auditing. The latter of which is performed by users of other disabilities including those with a visual impairment. When the identifies nonconforming applications or websites, action 508 staff work with other parties to great a remedy accessibility issues. As critical as it is for us to audit and improve our existing website, it is just as important to ensure that all future applications and websites are in conformance with 508 standards as well. To do this with implemented formal policies requiring all Information Technologies developed by va to complete a four step milestone process. This helps us ensure accessibility is planned for and building up front rather than trying to inspect it in the future. We also provide training to be a system, providing them with the tools and the knowhow to make va information 508 conformant. Weve made tremendous progress over the past year. For example, we improved the performance of the my healthy web site from 60 to 95 today. We will continue to pursue an aggressive strategy to ensure access to all covered systems and electronic information to we are committed to working with our veterans of stakeholder groups. V8 will attend a blinded Veterans Associations Upcoming National conference to review recent updates typically used applications and websites, and work with them to identify ways that usability can be improved. Even in areas where were technically already section five what conformant. This concludes my prepared remarks and we look forward to answering any questions you may have. Thank you. Thank you. Are there for the remarks . Okay. Dr. Mccarthy, again this is mike coffman. According to your testimony there were 23,664 unique Patients Enrolled in the vision registry. How many of those patients were enrolled by the department of defense . And how many from the Veterans Administration . Mr. Coffman, thats an important question. The actual entry of the data was primarily done by the department of defense. You heard mentioned that there was one Person Injured by va and that was to test this was to test this is the i wanted when the registry for a minute if i could. The registry is seated at the department of defense, and so it is set up to take information more directly from the department of defense for servicemembers who do receive eye injuries. Okay, v8 set up the architecture for the registry. And over 50 of it was used by the department of defense and older to enter their servicemembers and data into it. Va has to go through a twostep process to enter the data into the registry. Its a typical with cancer registries and all kinds of registries of that sort that information is harvested from a particular medical record, placed in the repository and then entered into the registry. Va has contracted human effort is currently up for bid that we, the bid close to nine for the completion of the data entered into the registry. Well, first into the repository to go into the registry. So its a twostep process with va is underwear under way. We did look at how many veterans, let me rephrase that. How many people have been treated in the va because some active duty Service Member has been who are blind rehab program. How many people have actually been treated at the v8 that already have data in the registry, and currently there are at least 2400 veterans who have data in the registry. But your accurate that data was entered by if we could just go back to the question. And that is, i get the Vision Center of excellence because they will have service, so they will enter that in. But this registry is also for nonserviceconnected veterans i issues, is it not . Its about eye injuries spent so whether its a serviceconnected are not serviceconnected its about veteran eye injuries. And so, but the fact remains you havent entered into a single person. So what it does because youre not participating. I understand why you say that and it is regrettable that none have been injured entered. But the framework is in place. The target date for the registry to be functional is by the end of fy 15. And so the fact that the contract is up for bid at this point is progress. We are looking forward to getting injured by the end of the fiscal year. Well, we had a lot of those definitions of progress last night before the full committee, and its disconcerting. Ms. Landfried, nbas february 2014 response to a letter i wrote in october 2013, i was told that he had not awarded a data abstraction a contract to to contracting delays. What were those delays and other problems that caused him been corrected . Thats actually probably better answered by dr. Mccarthy. Mr. Coffman, i am not aware of the exact delays. I would be happy to take it for the record and get back to before the hearing. I did ask if we could find a timeline for the price of the contract awards and what the delays were. I dont have that at this point but we will get back with you. Mike coffman again. Ms. Landfried, according to a july 26, 2012 memo from the assistant secretary for information and technology, all va i. T. Software is required to be compliant with section 508 a january 2013. Is all va software compliant at this point in time . At this point in time its not weve not achieved 100 conformance with the 508 standard. We have made significant progress since that time spent what percentage are you at right now . This is mike coffman again and what remind people to identify themselves for this hearing before they speak. What percentage are you at right now . This is pat sheehan. Thank you. The percentage is difficult for me to address right now because the software that we are looking at, particularly on the web and particularly the software that we look at as far as applications are concerned, are pretty much in development. I think the important point that i want to make here is that the process that, what were doing with the software is working through the processes that weve established so that we can build software in at the beginning of the software ive cycle after the test lifecycle. I think the simple and would be you are not compliant this point. Thank you very much. Ranking member kirkpatrick. This is Ann Kirkpatrick. Dr. Mccarthy, id like to go back to description about the vce. Does the va have access to the records that are at dod speak with yes. It would be the opportunity for the va provider to access that record. Does that happen . At this point im going to defer to dr. Lawrence on the. Yes, Ranking Member kirkpatrick. The registry is designed so that eventually individual providers from dod or va will be able to access the information in the registry on their individual patient. And the identified data on other patients. So they could, for example, put in some criteria that may be characteristic of a patient they are seeing and look at the identified data and look at the outcome of that identified data to help inform the provider and the patient. I appreciate that. My concern is, suppose that milton never transitions out today, goes to a doctor tomorrow, technically in the va system europe will that doctor be able to see that person, records, regarding the eye injury that is serviceconnected . This is dr. Mccarthy speaking. To our multiple opportunities for va doctors to be able to access records from the department of defense in our records system, bringing an opportunity to use a webbased interface in order to have access to those records. So im still not clear what your answer is but will that doctor be able to see that patients military medical record the day after the transition o out . Its my understanding that if those records are electronic, those records can be accessed. Most of the records are electronic at this point. Do you know what percentage . I do not have that number but we could check with dod and get back with you. So then the vas portion of this is just eye injuries, not necessarily military connected. And thats where you are contracting out to have somebody into that information . What we are contracting for is for someone to go through our records and pull out information such as eye exams, data from those exams, visual acuity, treatment interventions that were made, so that over time progress can be tracked by the individuals but looked at collaboratively. Thats the point of the registry. I have a question about funding to dr. Mccarthy, again this is Ann Kirkpatrick. Your testimony is a total of 6. 9 million of the va has budgeted for the center from fiscal year 2010 to fiscal year 2014. Has the funding been consistent each year . Can you provide a year by your breakdown of the funding over the past five years . Thank you, Ranking Member kirkpatrick. This is dr. Mccarthy speaking. The 6. 9 million was allocated in akin to the amount for the period of initially from fy nine to 13, extended to 14. So really over a five to six year period. What happened was an initial kind of ramping up of salary dollars but in addition, kind of fencing the money for contracting to enter the data that were talking about from that va medical record into the repository. So that money has kind of been kept separate, but the money that has been used over time, and ill be happy to provide those dollars for you for the record if you would like, that is a gradual increase over time as salaries have increased and functions have increased. Thank you. I would like to see the breakdown, if you buy your breakdown since the funny started and then how much is set aside for the contractor. And thank you. I yield back. [inaudible] thank you, Ranking Member kirkpatrick. Dr. Benishek. Thank you, mr. Chairman. I cant believe it takes five years to get this thing going. Whats the story with that . I mean, apparently its not even all passed up yet, this Vision Center of excellence. Why has it taken five years. The Second World War was four years for us. This is dr. Mccarthy speaking. I would like to respond. There have been processes involved in getting this setup, the joint executive committee, five years of . Thats the target for the registry to be functional. But five years seems like a really long time. Let me get you let me get to something a little more pertinent. Dr. Mccarthy, its come to my attention that theres been issues with our veterans with their eye diseases, glaucoma. Dr. Roe brought it up with her, this diabetic retinopathy, macular degeneration. Blinding eye conditions that if left untreated will lead to blindness and theyre very prevalent in our aging veterans population. So what procedures are in place to ensure that the veterans with these i diseases are seen by an ophthalmologist . Sir, this is dr. Mccarthy speaking again. What ill be happy to say about is some the processes we have in place. For instance, a patient who has diabetes is at risk for diabetic retinopathy. There are screening processes in place in which we used telemedicine and photographs of the right now of every patient with diabetes are taken and read by an optometrist or an optimal a just and if needed that patient is referred to a optimal just for care. But its part of the routine screening for diabetics. In addition patients with glaucoma are followed regularly in our eye clinic, and you mentioned one of the disease, im sorry. Macro degeneration. Macro degeneration is a tragedy. We do have ophthalmologist carefully following people with macro degeneration. I cant speak to the exact screening procedures that are developed for those patients but i i have a concern because, you know, i worked in the va hospital and its tough to staff many of these clinics with ophthalmologist. They have a hard time keeping people. Are you aware of any of the procedures for hiring local ophthalmologists for staffing va centers on a parttime basis . Are you familiar with any of the . Im a former chief of staff of the va facility in its emerging and it was our experience of their that would be tried to hire fulltime ophthalmologist or we would ask for people to come in on a contract basis. Because we were an academic facility, we had a Strong Partnership with the university of virginia and we were able to recruit people effectively there. But im aware that other institutions to have contracts for folks to guide. Im somewhat concerned because some of my friends are ophthalmologist that work at the va, and they are concerned with the fact that the va limits the ability to work at the va because once they reach a certain dollar amount, and they cant work anymore for the year. Because they think may be more costeffective fulltime ophthalmologist than the va. But, of course, they dont have any fulltime ophthalmologist to the patient traveled 250 miles to milwaukee to get to see the ophthalmologist. So they say you cant pay them or because the be more efficient to hire a fulltime ophthalmologist the yet they dont hire a fulltime ophthalmologist so the patient just goes without. Where as if they just would allow him to work there a little longer, he could continue to provide the care and not have the patient go to milwaukee. I dont understand the reasoning for that rule. You say its more efficient to hire a fulltime ophthalmologist, can hire a fulltime ophthalmologist. It seems like its kind of a catch22 problem. Let me ask another question. Apparently, ive also heard that in order to improve access to i care that they are having like icac nations do some of the work rather than physicians. Some of the screening work. You mentioned the screening, the retinal pictures. It concerns me when people other than physicians are providing care. I mean, how do we know those patients are trained properly . Denote the status of that situation is . Yes, sir. This is dr. Mccarthy speaking again. I can talk about the training or telling retinal images are conduct by the typical eye doctor appointment in which there are other nonphysician people that are involved, you know, that might check visual acuity or might be involved in checking i know but im talking like things that a physician typically does but im always concerned about the quality of care. When physicians are doing arne duncan things are supposed to do. Im sorry, i guess amount of time. Maybe we can further that later. Mr. Takano, state of california. Thank you, mr. Chairman. Dr. Mccarthy, just help me. It is this center, where is your Center Located . Physically. The Vision Center of excellence . Im going to defer to dr. Lawrence. This is dr. Mary lawrence. The Vision Center of excellence has two locations in the National Capital region. One, our headquarters is at Walter Reed National Medical Center in bethesda and we also have an office in crystal city arlington, virginia, and we also have a small office in tacoma, washington,. Walter reed is under the aegis of dod, right . But nevertheless this veterans Vision Center of excellence is located at walter reed, right . Yes, sir. This is dr. Mccarthy again. The Vision Center of excellence is a joint effort between dod and va, and all the centers of excellence, dod authorized navy to be involved with this Authority Partnership between the navy on behalf of dod with that clears up ive been to walter reed and i saw the center. Is that the same center . But nevertheless, we are still having problems with the registry being popular. Help me understand this registry. The registry has not been populated. Were waiting for the contract to be sold and using by the end of fiscal year 2015 is when we expect this registry work to be done, or begin . No, sir. Dr. Mccarthy again. The registry contract is out for bid at this point. Its on the streets and will have the bids in by midjune and we expect it to be awarded and the data entry to start by the end of the fiscal year. Dock or access the record . As long as its an electronic record, yes. And as it was stated earlier most of the records in dod are now in electronic form in the Health Record system. I guess the daylight or the gap is between the interoperability and seamless interoperability. So if it is the dod data essentially you have to push a button to say bring it to me. It is not locally as much of the va system. And that is what a lot of the work recently has been about is to go from interoperability to seamless interoperability. So as you are conducting a clinical workflow with the information that you need with the step that youre doing. It has to do with accounting for diversity. I know that inserted ethnic groups agents in particular glaucoma can show up much earlier they would be about to accommodate the Different Health needs among Service Members according to that in a city. In the office of healthcare equity and diversity i would want to yield to them so if its possible i would like to take that for the record and get back to you. Related to mr. Cabell you raised the point about agent orange and its connected to his pointed this. Is there anything done to sort of deal with this huge agent orange population we are going to have to address i can talk about agent orange but not specifically related to blindness. El paso texas. Some of these questions you may have already answered and it may be reprinted if buying new to this and i want to make sure i fully understand it january was the start date for the injury and the envisioned registry. I mentioned im sorry, i mentioned that the act that established it was january, 2008. Thats when it became the law and the funding was appropriated the next year . The funding i can tell you it was signed between the dod and that was october, 2009. There was a total of 6. 9 million appropriated to the 5 million spent. What is the 5 million being spent on . 2. 8 set aside for the contract so that brings us to 4. The 4. 1 million has been used for the salary for individuals as weve ramped up the employment over the past five years. Not just yet. Thank you though. In responding to an earlier question about how long its taking you said its regrettable but you also mentioned that we are on schedule and on budget. So, when this became law in january of 08 and the funding was appropriated in the year there after wasnt always understood that june 9, 2014 is when we would go out to bid or make a decision on closing those of its . It was always understood that by the end of the fiscal year 2015 the registry would be operational. Thank you. It does seem like a very long time. Compared to the amount of time we spend in world war ii and the number of people that are affected by these issues that do not have access to this care. And i would like to take the one that we had as an example today. Based on the testimony to the extent that you are familiar with and his testimony today do you have anything to offer response to concerns that he raised the concerns that he raised or that specific case study that hes offered and how we are or have not yet learned from it and not just to provide the kind of care that might have provided for a better outcome in the case of after the hearing i would be interested in offering support in that way. I do want to mention the 33 process improvement activities that were identified as a part of the Vision Center of excellence calls in which the people who deal and at the Vision Center of excellence and the centers have worked together to try to solve those kind of communication issues. How the interoperability between the dod wreck or attend the medical recommendations and decisions and those in the va might provide a better outcome or it might not. Would we still have some ground to make up and so i think its very important for us if nothing else to learn from his specific case and show that its not repeated and i think that you could probably agree with me on that. And then the section 508 issues i think this discussion today is happening within the larger context of the American Public and congress and then again just looking at the backup and all of the chances the va had to come into compliance and the waivers that were issued to allow them to remain out of and the fact that on some of the most Critical Issues like the ability to fill out the form that was brought to our attention it seems like not only would that be a then affixed to the veterans at the va to but the va to be able to have that information entered by the veteran himself or herself instead of having to go to the office. How do you answer in the plainest terms possible but i feel is very justified frustration at the amount of time that the va has had to get it right and you and mr. Sheehan spoke earlier of the processes involved that are lost on me. I think that we just really want to know what has taken so long and where is the accountability of when will you be able to assure this committee and the veterans who depend on the services through the web that you will be 100 compliant . We are absolutely committed to making sure that all of the information veterans need about benefits, about Health Care Available to them and Everything Else we have to offer is available to them as electronic products through our website and forums. And the memo that was mentioned earlier by the chairman, that was lighting i think a wakeup call and accountability to say what are we doing with them. Give a date by which every single page and website will be. The reason we keep talking about the process is that if i was 100 compliant tomorrow the new systems are going to come online and additional forms are going to be added and additional webpages are going to be added. I dont think that its too much to expect and that is what the veterans deserve so with that i yield back to the chair. Ranking member kirkpatrick. I appreciate your willingness to provide the committee with your breakdown of how the money has been spent. Thats part of our responsibility on the committee is to be overseeing at how taxpayers dollars are being spent. So im going to ask within that year by year breakdown you also categorize that and work with the Committee Staff on what categories seem to be appropriate. Just so we have an idea of how that is being spent and i think the panel for being here today and you mr. Chairman for having this hearing. Thank you and thanks to the panel. You are now excused. We have had a chance to hear about problems. Virtually and visually impaired veterans continue to be denied equivalent access to the va services due to the va failures. As such, the hearing was necessary to become pushing number of items to identity the reasoning for the lack of progress in implementing the vision registry despite years of having passed the senate authorization. The americans with disabilities act and third, to determine what steps are being taken to correct these issues and improve the care provided to veterans and their ability to access critical crucial information. I ask unanimous consent all members have five legislative days to provide the extent of remarks and include extraneous material without objection so ordered. I would like to once again thank all of the essays and the audience members for joining us in todays conversation. With the outcome of the hearing is adjourned. [inaudible conversations] a look now and now todays edition of washington journal in its entirety. We started off todays program by asking viewers what they thought the foreignpolicy challenges were facing the obama administration. We also look at items in the news. This is about 35