S. HRG. 113–452 MILITARY CONSTRUCTION AND VETERANS AF- FAIRS, AND RELATED AGENCIES APPROPRIA- TIONS FOR FISCAL YEAR 2014 HEARINGS BEFORE A SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE ONE HUNDRED THIRTEENTH CONGRESS FIRST SESSION ON H.R. 2216 MAKING APPROPRIATIONS FOR MILITARY CONSTRUCTION, THE DE- PARTMENT OF VETERANS AFFAIRS, AND RELATED AGENCIES FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2014, AND FOR OTHER PURPOSES Department of Defense Department of Veterans Affairs Printed for the use of the Committee on Appropriations ( Available via the World Wide Web: http://www.gpo.gov/fdsys/browse/ committee.action?chamber=senate&committee=appropriations U.S. GOVERNMENT PRINTING OFFICE 78–069 PDF WASHINGTON : 2014 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 COMMITTEE ON APPROPRIATIONS BARBARA A. MIKULSKI, Maryland, Chairwoman PATRICK J. LEAHY, Vermont RICHARD C. SHELBY, Alabama, Vice TOM HARKIN, Iowa Chairman PATTY MURRAY, Washington THAD COCHRAN, Mississippi DIANNE FEINSTEIN, California MITCH MCCONNELL, Kentucky RICHARD J. DURBIN, Illinois LAMAR ALEXANDER, Tennessee TIM JOHNSON, South Dakota SUSAN M. COLLINS, Maine MARY L. LANDRIEU, Louisiana LISA MURKOWSKI, Alaska JACK REED, Rhode Island LINDSEY GRAHAM, South Carolina FRANK R. LAUTENBERG, New Jersey MARK KIRK, Illinois MARK L. PRYOR, Arkansas DANIEL COATS, Indiana JON TESTER, Montana ROY BLUNT, Missouri TOM UDALL, New Mexico JERRY MORAN, Kansas JEANNE SHAHEEN, New Hampshire JOHN HOEVEN, North Dakota JEFF MERKLEY, Oregon MIKE JOHANNS, Nebraska MARK BEGICH, Alaska JOHN BOOZMAN, Arkansas CHARLES E. KIEFFER, Staff Director GABRIELLE BATKIN, Deputy Staff Director WILLIAM D. DUHNKE III, Minority Staff Director SUBCOMMITTEE ON MILITARY CONSTRUCTION AND VETERANS AFFAIRS, AND RELATED AGENCIES TIM JOHNSON, South Dakota, Chairman PATTY MURRAY, Washington MARK KIRK, Illinois JACK REED, Rhode Island MITCH MCCONNELL, Kentucky MARK L. PRYOR, Arkansas SUSAN M. COLLINS, Maine JON TESTER, Montana LISA MURKOWSKI, Alaska TOM UDALL, New Mexico DANIEL COATS, Indiana JEANNE SHAHEEN, New Hampshire JOHN HOEVEN, North Dakota MARK BEGICH, Alaska MIKE JOHANNS, Nebraska BARBARA A. MIKULSKI, Maryland RICHARD C. SHELBY, Alabama (ex officio) (ex officio) Professional Staff CHRISTINA EVANS CHAD SCHULKEN MICHAEL BAIN DENNIS BALKHAM (Minority) D’ANN LETTIERI (Minority) Administrative Support KALI MATALON COURTNEY STEVENS (Minority) (II) CONTENTS THURSDAY, APRIL 18, 2013 Page Department of Veterans Affairs ............................................................................. 1 Office of Inspector General .............................................................................. 39 THURSDAY, MAY 9, 2013 Department of Defense: Office of the Secretary of Defense ................................................................... 93 Department of the Navy .................................................................................. 131 WEDNESDAY, MAY 15, 2013 Department of Defense: Department of the Army .................................................................................. 151 Department of the Air Force ........................................................................... 169 (III) MILITARY CONSTRUCTION AND VETERANS AFFAIRS, AND RELATED AGENCIES APPRO- PRIATIONS FOR FISCAL YEAR 2014 THURSDAY, APRIL 18, 2013 U.S. SENATE, SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, Washington, DC. The subcommittee met at 2:43 p.m., in room SD–124, Dirksen Senate Office Building, Hon. Tim Johnson (chairman) presiding. Present: Senators Johnson, Reed, Udall, Begich, Mikulski, Kirk, Collins, Murkowski, and Hoeven. DEPARTMENT OF VETERANS AFFAIRS STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY OF VETERANS AFFAIRS ACCOMPANIED BY: HON. ROBERT A. PETZEL, M.D., UNDER SECRETARY FOR HEALTH HON. ALLISON HICKEY, UNDER SECRETARY FOR BENEFITS W. TODD GRAMS, EXECUTIVE IN CHARGE, OFFICE OF MANAGE- MENT AND CHIEF FINANCIAL OFFICER HON. STEVE L. MURO, UNDER SECRETARY FOR MEMORIAL AF- FAIRS STEPHEN WARREN, ACTING ASSISTANT SECRETARY FOR INFOR- MATION AND TECHNOLOGY OPENING STATEMENT OF SENATOR TIM JOHNSON Senator JOHNSON. Good afternoon. This hearing will come to order. We meet today to review the President’s fiscal year 2014 budget request for the Department of Veterans Affairs (VA). Secretary Shinseki, I welcome you and your colleagues, and I thank you for your appearance before this subcommittee. I’m also very pleased to welcome back my colleague and ranking member, Senator Mark Kirk. Senator Kirk has made great progress in his recovery due, I’m sure, as much to his sheer grit and determination as to his medical team. Senator Kirk has been a strong supporter and partner on this subcommittee, and I look forward to continuing our work on behalf of the Nation’s vets. Mr. Secretary, I’m pleased to see that eliminating the backlog in claims processing is among your top priorities. We must fix this problem once and for all. After fighting for our Nation on the bat- tlefield, our vets simply cannot be subject to months, if not years, of fighting redtape to secure the benefits they have earned. (1) 2 This subcommittee has provided every time the VA has re- quested to improve claims processing. I understand the challenges posed by the growing number and complexity of claims. I understand the challenges of recruiting and training additional claims processors. But despite the VA’s best efforts, the situation has grown worse, not better. Mr. Secretary, I know you share my frustration. I look forward to hearing the VA’s way forward to solve this problem sooner rath- er than later. I’m also concerned with progress of efforts to integrate the De- partment of Defense (DOD) and VA health records. It is imperative that the DOD and VA develop an electronic health record system that will allow the seamless exchange of vets’ medical records be- tween the two agencies. The original plan was to develop a single integrated system to serve both agencies. Recently, the agencies changed course and are now pursuing separate systems that can essentially talk to each other. I certainly support a faster, cheaper way to allow DOD and the VA to share vets’ health records, but I’m wary of any change in strategy that might result in the quick surface improvements, but not capture the full range of a patient’s health history; in other words, settling for an executive summary instead of a full report. Mr. Secretary, I look forward to your testimony, and I now ask my ranking member for any opening remarks he cares to make. Senator Kirk. STATEMENT OF SENATOR MARK KIRK Senator KIRK. I’m mad at you for announcing your retirement. You have been an honorary member of my medical recovery team, with your wife and her support to my girlfriend. That has been really something. Constantly through my medical recovery, I was asking, ‘‘What can Tim do?’’ and meet that area. It was always great to think about you back here rocking and rolling. I will say, Mr. Secretary, very good to see you here today. I want to thank you. And I’ve thanked you over and over again for shep- herding the Stryker vehicle through the U.S. Army. As a reservist in Afghanistan, I had an opportunity to use it. I will say, in the small time that I had in the vehicle, we did have a little problem with the coffeemaker. The espresso setting wasn’t quite fully func- tional. Let me just continue slightly. I want to continue on the unified record issue. Our vision is to have someone join the Navy and then retire, and the record all passes straight into the VA. That is what we were hoping. My understanding is we have a choice between two software systems—one in the VA called VistA, which handles the VA systems. And the one thing I want to commend you on, Mr. Secretary, is you have released the code to what you own, is what I understand. My hope is that someday we would go with, for lack of a better term, we would have an android-kind of culture, an explosion of apps that the private sector can develop on the VistA or AHLTA backbone now that it’s open source, and we have an explosion of 3 innovation in health records management of advantage to veterans and sailors everywhere. PREPARED STATEMENT Just a last thing to say, I have been in touch with Chairman Culberson to eventually bring an end to this combination process. I think at some date prior to the big markup of this subcommittee, that we should pick either VistA or AHLTA as the backbone, so just VA or DOD wins and so the taxpayer only pays for one soft- ware management system. [The statement follows:] PREPARED STATEMENT OF SENATOR MARK KIRK Thank you, Mr. Chairman. I’m pleased to be back here today as ranking member of this subcommittee. I would like to join you in welcoming Secretary Shinseki and our other witnesses and guests to discuss the President’s 2014 budget request for the Department of Veterans Affairs (VA). OVERVIEW The 2014 request for the Department of Veterans Affairs proposes $149.6 billion, which consists of $63.5 billion in discretionary funding, which is 4 percent above the 2013 enacted level, and $86.1 billion in mandatory funding, which is 18 percent above the 2013 enacted level. In addition, the Department is requesting $55.6 billion in advance appropriations for the medical care accounts in 2015. That is a total of $205 billion before us today—a tremendous amount of money—and in a time of record-high deficits and debt, my priority and the priority of this subcommittee is not only to give our veterans the very best care this Nation can provide, but also to analyze this budget to ensure we are spending our taxpayers’ dollars wisely, with- out excess or redundancy. Mr. Chairman, the VA under the leadership of Secretary Shinseki is doing a great job taking care of our Nation’s veterans and I would like to thank him for his hard work and dedication. There are many issues we need to discuss today but I want to focus on two issues that will play a significant role in the lives of all veterans: electronic health record and claims processing.