eligible for outpatient care generally unless for a condition adjudicated to be service-connected our outpatient care was deemed necessary to "obviate the need" for hospitalization. The Committee never intended to make permanent a program whereby non- veterans, including family members, were eligible for certain services at Vet Centers when those same services would not be available for combat veterans of World War II or the Korean conflict. It was for these reasons that the Committee stated in its Committee Report 96-100 that, “. . . the readjustment counseling program is establishing an entirely new area of eligibility and the Committee believes that proceeding with caution is fully warranted." Given these facts, we believe it prudent that the Committee adhere to its admonition.

Title III of S. 1464, which is derived from S. 1501, would make major and fundamental changes to the Vet Center Program. This title would also effectively make permanent the "storefront" operations through which readjustment couseling services are provided by making it extremely administratively difficult to relocate a Vet Center onto the grounds of a VA medical center. It would do so without any hearings of the opportunity for careful deliberations by the Congress. In addition, those who would be affected by these changes and those who are charged with administering active-duty military and veteran medical-care programs have not testified on this matter. Occasionally, the emergent nature of an issue demands immediate Congressional action. This is simply not such an occasion.

Just a few months ago, the Senate passed legislation, as part of S. 477, to provide the VA with an additional year, through September 30, 1990, to complete the transition whereby readjustment counseling services would be provided primarily on the grounds of VA medical centers as required by current law. Let us be clear, we do expect that the VA will look at each Vet Center to determine the appropriateness of moving the Center onto the grounds of the medical center. In some cases, due to lack of space or distance to the medical center, it may not be wise to move. However, those decisions should be made by the VA-not the Congress.

So, we must ask the question-what is the emergency? Why are we foregoing the appropriate legislative hearing process? The Vet Center Program is not threatened with extinction. Since the inception of the program some eight years ago, the availability of readjustment counseling has not been diminished. In fact, the program has grown far beyond what was envisioned by Congress when this temporary and short-term program was established. This is further evidenced by the fact that at the program's inception the five year cost was estimated by the Congressional Budget Office to be $45 million. In fact, that is now the annual cost of the Vet Center Program.

The American Legion with 800,000 Vietnam veteran members, the Veterans of Foreign Wars with 700,000 Vietnam veteran members, and the AMVETS with 40,000 Vietnam veteran members have formally requested the Committee not to proceed with consideration of these provisions. These organizations-representing the interests of all veterans, including those of the Vietnam era-have asked for time to study the impact of these provisions and to com

ment on their merits and shortcomings. We velieve that their request is reasonable and should be honored by the Committee. Copies of their letters are included for your consideration.

Additionally, we have several serious concerns-many of which are shared by certain veterans' service organizations-about the substance of the title.

First, S. 1464 proposes to extend eligibility for readjustment counseling services to certain active duty military personnel. We strongly oppose an expansion of eligibility for this VA benefit to individuals who are currently serving on active duty. The Department of Defense is responsible for providing services to these individuals, and it has adequate resources to do so. Additionally, the Secretary of Defense, in an August 7, 1987, letter to Senator Murkowski stated his strong opposition to this proposal. Mr. Weinberger stated, "It is imperative that the Department remain fully cognizant of the psychological status of its active duty personnel. The Military Health Services System (MHSS) maintains a medical record on every active duty person that is annotated each time this member seeks care. By retaining responsibility for providing medical care to all active duty personnel, the MHSS ensures that a complete record of each individual's medical and psychological history is maintained. These records form the basis for medical opinions concerning flight status, fitness for duty, security clearances, and a host of other equally important medical readiness determinations. Should these records be incomplete because medical treatment was provided by another agency, one of these determinations could be fatally flawed."

In addition, eligibility for readjustment counseling would be extended to veterans of World War II and Korea. We believe that these veterans need hospital and nursing home care far more than counseling to "readjust to civilian life." These veterans participated in conflicts many many years ago and, in fact, experience different health and social problems as a result of the aging process. Limited resources should be directed at providing more services to address the needs of an aging veteran population and not on expanding eligibility for Vet Centers and the costs associated with doing so.

S. 1464 also requires that, if a Vet Center is moved onto the grounds of the medical center, the budget remain the same. We ask our colleagues: If the client load did decrease, is it wise to require that the resources for staff remain the same? We think not, especially when veterans are waiting in long lines at the other end of the hospital.

The August 1987 General Accounting Office (GAO) report on the Vet Center Program found several significant problems associated with it. First, the VA has little assurance that Vet Centers provide quality care to veterans. For example, no quality assurance reviews are conducted. Second, the data base which contains information needed to determine workload is questionable. Therefore, it is difficult to determine if client workload data is underestimated or overestimated. For example, 35 out of 100 files which GAO sampled indicated that contact sheets were completed on clients for visits that simply did not occur or when no assistance to the client was provided. Valid workload data is essential if the Va is to determine if

a Vet Center is being operated in a cost-effective manner and if staffing levels are adequate. GAO made unannounced visits to six Vet Centers and, in our view, made some interesting observations. During the nine hour work day, the Vet Centers saw between 5 and 17 clients. The average number was nine. The average visit lasted about one hour. Between one and four Vet Center staff members were present during the GAO visit. This staff per client workload is very low. Let us look further into the VA's data as reported by the GAO. Out of a total eligible population of 8.3 million Vietnam-era veterans, since the inception of the program in 1979, the total number of veterans seen has been 305,000. However, of this figure, 11 percent are not Vietnam-era veterans-this group includes World War II and Korean veterans as well as active duty military personnel-and, thus, are not even eligible to receive counseling under this program. Thus, about 271,000 Vietnam-era veterans have used Vet Centers. The average Vet Center sees about 486 clients annually. According to GAO, 49 percent of the clients were seen for military-related problems. The remaining 51 percent were seen for problems which, according to Vet Center counselors, were either not related to military service or staff could not determine the cause of their problems. It therefore appears that about 140,000 veterans may have used Vet Centers for military-related problems. Finally, according to GAO, the VA's data base indicated that 56 percent of the Vet Center clients had served in combat. Again, one can conclude that since the program's inception, about 151,760 Vietnam veterans, who served in the Vietnam theater of operations, were seen in Vet Centers. VA's definition of "combat" was defined as service in a "war-zone theatre." This would include service in Vietnam, Laos, Cambodia, and their contiguous waters and air space. However, the Department of Defense has long believed that one out of every four who serves in a "war-zone theatre" actually serves in combat. This being the case, the actual number of combat Vietnam veterans who have been seen in Vet Centers since 1979 may be closer to 37,000.

A report on the effectiveness of the Vet Center Program-conducted under contract with Development Associates, Inc. was recently provided to the Committee by the VA. Although this study generally found that the program was effective in accomplishing its objectives, the report stated "A staff of three to five persons to serve only one or two new clients per month-as found at a number of Vet Centers-would not seem to be a cost-effective use of limited program resources." Further, the study concluded "The Vet Centers seem to fill an important role as part of a network of providers of readjustment and other veterans services. In this role there appears to be room for better alignment with traditional VA organizations in the interest of improving services to veterans." Finally, that same study noted 60 percent of the Vet Center clients mentioned employment related problems most often. We are pleased that the Senate addressed the employment issue as part of S. 999.

Most importantly, we believe it is counterproductive to the psychological well-being of Vietnam veterans to continue to encourage the perception that these individuals have not adjusted to civilian life. Certainly there are some who still need readjustment assist

ance, but let us not make Vietnam Veterans believe that the people of our Nation and the dedicated employees of the VA cannot understand their needs. That is simply not true.

In conclusion, we can think of no words which can better express the need to proceed with an orderly transition than the very eloquent and powerful statement of the past National Commander of the Disabled American Veterans, Ken Musselmann-himself a very severely disabled Vietnam veteran-"[I]F we establish an official policy that says to Vietnam veterans that they are so different from all veterans of prior wars that services of this type will always have to be provided in a segregated setting, we are encouraging and perpetuating the very things we wish to abolish".

As the Senate deliberates on legislation which would continue to perpetuate a segregated system of services for Vietnam veterans and which could serve to reinforce a false and often self-defeating stereotype of these gallant men and woman, the last of who returned home more than 15 years ago, we urge our colleagues to reflect on the words of Commander Musselmann.

FRANK H. MURKOWSKI,

Ranking Minority Member. ALAN K. SIMPSON.

STROM THURMOND.

ROBERT T. Stafford.

This letter presents the views of the Department of Defense with respect to Section 3 of S.1501, 100th Congress, a bill to amend Title 38, United States Code, to eliminate the requirement that the Administrator of Veterans Affairs carry out a transition under which community based Vet Centers would be moved to Veterans Administration medical facilities, and for other purposes.

Section 3 of S.1501 would establish authority for the Veterans Administration to furnish psychological counseling to active duty military personnel who had served on active duty during the Vietnam era or during a period of hostilities. By permitting the Veterans Administration to furnish counseling to assist such persons in "readjusting to active duty" following such service, S.1501 circumvents the primary goal of the Military Health Care System which is to maintain the medical (including psychological) readiness of the active duty force.

The Department of Defense is strongly opposed to the readjustment counseling program provisions of Section 3 as they pertain to active duty personnel. The Department of Defense operates a comprehensive health care system which provides quality psychological counseling to all active duty personnel in need of such care. Further, it is imperative that the Department remain fully cognizant of the psychological status of its active duty personnel. The Military Health Services System (MHSS) maintains a medical record on every active duty person that is annotated each time this member seeks care. By retaining responsibility for providing medical care to all active duty personnel, the MHSS ensures that a complete record of each individual's medical and psychological history is maintained. These records form the basis for medical opinions concerning flight status, fitness for duty, security clearances, and a host of other equally important medical readiness determinations. Should these records be incomplete because medical treatment was provided by another agency, one of these determinations could be fatally flawed.