Please click here to read NAVREF's analysis of HR 748. 

As some of you may have seen, the House Military Construction, Veterans Affairs, and Related Agencies Appropriations Subcommittee this afternoon released text of its draft FY 2020 spending bill and an accompanying press release. The subcommittee is scheduled to mark up its draft spending bill today, Wednesday, May 1 at 3 p.m. in HT-2 in the Capitol (the subcommittee also will be airing the markup live via webcast).

Based on a preliminary review of the text, the draft bill appears to provide a total of $840 million for the VA Medical and Prosthetic Research program in FY 2020, in line with FOVA’s funding request for FY 2020. This total funding level would represent a $61 million or 7.8 percent increase over the comparable FY 2019 funding level.

Additional details will be available in report language once the full House Appropriations Committee considers the spending bill, currently expected on Thursday, May 9.

Also of note, both House and Senate “Dear Colleague” letters for the VA research program are now posted on the FOVA website. Again, the House letter was led by Reps. Hastings (D-Fla.) and González-Colón (R-P.R.), and closed with 84 signatories, an increase from 67 in FY 2019. The Senate letter was led by Senators Dick Durbin (D-Ill.) and Tammy Duckworth (D-Ill.), and closed with 23 signatories, an increase from 19 in FY 2019. Please be sure to thank your delegation for their support of VA research!

We need you to act! Advocacy plays a major role in how we ultimately operate and NAVREF needs everyone in our extended to community to reach out to your legislators and their staff to voice your opinion and educate them on the following topics: 

1. The Senate needs to support more robust VA research funding for Fiscal Year 2020. If you haven't already, please reach out to you Senator's office and tell them that you support the "Dear Colleague" letter in circulation that calls for $834 million for VA research appropriations. This number is supported by the Independent Budget and by the Friends of VA Medical Care and Health Research. Contact the NAVREF office for more information. 
2. H.R. 1947 was introduced on March 28, 2019, by Rep Roe (R-TN-1) and co-sponsored by Rep Brindisi (D-NY-22), and has already been referred to the House Committee on Veterans Affairs (of which Rep Roe is the Ranking Member).  We’re encouraging you to please reach out to your House Representative to encourage them to support passage of this bill (especially if they sit on the House VA Committee). This bill will enable NPCs to handle Interagency Agreement funding transferred to them by VA without regard to fiscal year limitations (the funds will have no expiration date).  It allows NPCs to continue serving as the “flexible funding mechanisms” originally authorized by Congress in 1988 and codifies how we have been operating for the past 30+ years. A draft email is available is being circulated among NPC executive directors. Please let us know if you haven't seen it yet!

The Friends of VA Medical Care and Health Research (FOVA) coalition is thankful for Congress’s recent investment in the VA Medical and Prosthetic Research Program, allowing the program to make up lost ground after nearly a decade of underfunding. FOVA’s FY 2020 recommendation of $840 million for VA research would allow for meaningful growth above inflation and continued investment in groundbreaking programs like the Million Veteran Program (MVP), while also supporting VA research on chronic and emerging needs of our nation’s veterans. Sustained and steady VA research funding growth is important to help ensure the best return on investment in improving the health of veterans and all Americans.

Read the full recommendation here.

Although the FY18 budget still remains to be settled, FOVA will move ahead and continue to advocate for the FY18 request of $722 million for VA research, and $823 million for FY19. The FY19 calculation is based on the Biomedical Research and Development Price Index adjusted for inflation, a second back-up repository for MVP, VA Secretary Priorities, and for the VA-Department of Energy Partnership to process MVP data. NAVREF is committed to advocating for these requests across FY18 and FY19, and will continue meeting with members in both chambers of Congress.

UPDATE: With FY18 budget approval, FOVA has published an updated and final FY19 budget recommendation. You can download the one pager here.

 

Veterans, Traumatic Brain Injury, and Suicide | Lisa Brenner, Ph.D., ABPP

The Role of Sleep in Veteran Suicide and Suicide Prevention | Wilfred Pigeon, Ph.D.

Improving Primary Care Risk Detection, Healthcare Response, and Self-Care to Support Veteran Suicide Prevention | Steven Dobscha, M.D.

The following text was taken from our FOVA letter expressing concerns around the implementation of a provision to reduce the unnecessary use of animals in research and its impact on medical research:

On behalf of the Executive Committee of the Friends of VA Health Care and Medical Research coalition – better known as FOVA – we want to express our strong concerns with a provision in the Defense, Military Construction, Veterans Affairs, Legislative Branch, and Energy and Water Development National Security Appropriations Act, 2018 that bars the VA Medical and Prosthetics Research program from conducting research using dogs.  We believe implementation of this provision impedes progress on medical research.

Animal models play an essential role in advancing our understanding of human health and disease.  Animal models are used to reveal and describe basic cell and tissue function, discover disease processes, understand disease progression and test interventions to treat disease.  Specifically, dog studies have advance our understanding of immunodeficiency, narcolepsy, metabolic disease, cancer, autoimmune function, vision and epilepsy.  In short, animal models, including dogs, help advance science which has helped save human and animal lives.

FOVA strongly supports efforts to reduce unnecessary use of animals in all scientific research. We further support ethical treatment of all animals, including dogs, where use of animals in research is appropriate.  Currently, over 99% of all VA sponsored animal studies are conducted on mice or rats.  The percentage is consistent with lab animal use patterns across U.S. research institutions.  VA researchers only use dogs in research when the dog model is clearly the most suitable for the scientific study.  There are only 85 dogs used in VA sponsored studies – approximately 0.05% of VA lab animal use.

While we understand and appreciate the efforts to reduce use of dogs in animal research, we believe the policy included in the appropriations bill will impede scientific research and unnecessarily delay research advances for our nation’s veterans.  

The original letter can be viewed here.

House and Senate Appropriations Committees Recommend Increase for VA Research

On July 13, the Senate Appropriations Committee approved its FY 2018 Military Construction, Veterans Affairs, and Related Agencies spending bill. Thanks to an amendment offered by Senator Richard Durbin (D-Ill.) and supported by FOVA, the bill includes $722 million for Medical and Prosthetic Research, a $49 million (7.3 percent) increase over the FY 2017 enacted level. In May, Durbin authored a letter to the Appropriations Committee requesting a five percent increase for the VA research program. The Senate Mil-Con/VA Subcommittee’s initial recommendation was $705 million but the Durbin amendment achieved the goal of a 5 percent increase.

 Last month, the House Appropriations Committee passed a separate Mil-Con/VA spending bill that provides $691 million for VA Research, a $16 million (2.4 percent) increase over FY 2017. 

 The president’s budget for FY 2018 proposed $640 million for VA Medical and Prosthetic Research, a $35 million (5.2 percent) cut from the FY 2017 comparable level.

 Please encourage the House of Representatives, and members of the House Appropriations Committee in particular, to support the Senate’s approved level for VA Research ($722 million).  Attached is the FY 2018 FOVA Brochure, which you can use to advocate for this important program to improve Veterans’ health.  

FOVA Briefing Highlights VA Research Program

FOVA hosted a May 16 congressional briefing in partnership with the VA Office of Research and Development, titled “Veterans Health Research: A Showcase and Advancements.” The event introduced the new VA Chief Research and Development Officer, Rachel Ramoni, DMD, ScD. Patricia A. Dorn, PhD, director of VA rehabilitation research and development service, also provided opening remarks. The briefing featured live demonstrations of VA rehabilitation research including brain-computer interface, peripheral nerve interfaces for natural sensation and control in amputees, the standing wheelchair, and exoskeleton-assisted walking in persons with spinal cord injury. [summary provided courtesy of AAMC]

FOVA Executive Committee Members Testify Before House Appropriations Committee

Two members of the FOVA Executive Committee testified at a March 29 House Appropriations Subcommittee on Military Construction, Veterans Affairs and Related Agencies public witness hearing regarding FY 2018 funding for the Department of Veterans Affairs (VA). The FOVA witnesses included Carl Blake, Paralyzed Veterans of America Associate Executive Director of Government Relations, as well as Heather O’Beirne Kelly, PhD, American Psychological Association Director of Veterans and Military Health Policy. Dr. Kelly and Mr. Blake both advocated for increased FY 2018 funding for VA Medical and Prosthetic Research, in line with FOVA and the VSO’s Independent Budget.

 Rep. Sanford Bishop (D-Ga.) mentioned VA research facilities, and noted that, in 2012, the VA Office of Research and Development “did an in-depth study and an analysis of the physical condition of the V.A.’s aging research infrastructure, and they reported that the average VA building that houses research laboratories is over 50 years old.” Bishop continued, citing Dr. Kelly’s testimony and FOVA’s position, “VA lacks the state-of-the-art research facilities and that modern research can't be conducted in facilities that closely resemble a high school science lab. As a result, they are recommending $50 million for five major research facility construction projects and $175 million for minor construction maintenance projects.” [summary provided courtesy of AAMC]

The information above originally appears in a July 21, 2017 newsletter communication from the Friends of VA Medical Care and Health Research (FOVA) coalition where NAVREF is an executive committee member.

Senator Durbin successfully offered an amendment during the markup of the MilCon/VA Appropriations bill to boost VA Medical and Prosthetic Research funding to $722 million. Senator Durbin led a letter on this issue in May of this year, and their office hopes to make it an annual sign on letter. The increase marks five percent real growth over the FY17 figure which is also in line with the Senator’s American Cures Act.

NAVREF is pleased to have signed-on in support of this letter back in May and we appreciate Senator Durbin's office for all the work they have put into this amendment. We truly are proud to have Senator Durbin as a champion for VA research. 

The May letter on the amendment can be found here. 

As part of the Friends of VA Medical Care and Health Research (FOVA) executive committee, NAVREF joined voices with others in the coalition to endorse testimony submitted to the the Senate Committee on Appropriations, Subcommittee on Military Construction, Veterans Affairs, and Related Agencies asking for the VA Medical and Prosthetic Research Program funding approval of $713 million for FY18. FOVA additionally requested funding to address critical research laboratory and related deficiencies of $50 million for up to five major construction projects in VA research facilities, and $175 million for nonrecurring maintenance and minor construction (separate from funding for medical facilities). The full text is below.

Testimony of the

Friends of VA Medical Care and Health Research (FOVA)

on

Fiscal Year 2018 Appropriations for the U.S. Department of Veterans Affairs Medical and Prosthetic Research Program

submitted to the

Senate Committee on Appropriations

Subcommittee on Military Construction, Veterans Affairs, and Related Agencies

Chairman Jerry Moran, Ranking Member Brian Schatz, and Members of the Subcommittee—

The Friends of VA Medical Care and Health Research (FOVA) respectfully urges the Subcommittee to approve funding for the Medical and Prosthetic Research Program within the U.S. Department of Veterans Affairs (VA) at $713 million in fiscal year (FY) 2018. In addition, FOVA requests funding to address critical research laboratory and related deficiencies of $50 million for up to five major construction projects in VA research facilities, and $175 million for nonrecurring maintenance and minor construction (separate from funding for medical facilities).

FOVA is a diverse coalition representing national academic, medical, and scientific societies; voluntary health and patient advocacy groups; and veterans service organizations. FOVA was founded almost 25 years ago, to ensure that America's veterans receive high-quality health care. We believe an important connection exists among VA health care, VA’s academic affiliates, and the VA Research and Development program.  This relationship supports advanced practice and effective, safe care for veterans, helps veterans recover from war, disease and illness, and pays even more dividends to the nation, including promoting better health for all.

The Administration and Congress should provide at least $713 million for the VA Medical and Prosthetic Research program for FY 2018 to support current research on chronic conditions of aging veterans and for emerging research on conditions prevalent among younger Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans.

The VA Research program is uniquely positioned to advance genomic medicine through the Million Veteran Program (MVP), an effort that seeks to collect genetic samples and general health information from 1 million veterans over the next five years. When completed, the MVP will constitute one of the largest genetic repositories in existence, offering tremendous potential to study the health of veterans. To date, more than 550,000 veterans have enrolled in MVP. While the FOVAs recommend $65 million to support this transformative and innovative program, this program should not impede other critical VA research priorities.

The Administration and Congress should provide funding for up to five major construction projects in VA research facilities in the amount of at least $50 million and appropriate $175 million in nonrecurring maintenance and for minor construction projects to address deficiencies identified in the independent VA research facilities review provided to Congress.

The Administration and Congress should preserve the integrity of the VA research program as an exclusively intramural program, firmly grounded in scientific peer review, and should oppose designated funding for specific areas of research outside of the VA national management of the entire VA research portfolio.

Background and Justification

The VA Medical and Prosthetic Research and Development program is widely acknowledged as a success on many levels, all directly leading to improved care for veterans and an elevated standard of care for all Americans:

•           Advancing Patient Care - VA Research has made critical contributions to advance standards of care for veterans in areas ranging from tuberculosis in the 1940s to immunoassay in the 1950s to today’s ongoing projects dealing with Alzheimer’s disease, developing and perfecting the DEKA advanced prosthetic arm and other inventions to help the recovery of veterans grievously injured in war, studies in genomics and in chronic pain, cardiology, diabetes, and improved treatments for PTSD and other mental health challenges. These studies and their findings ultimately aid the health of all American.

•           Recruitment and Retention - VA Research is a completely intramural program that recruits clinicians to care for veterans while conducting biomedical research. More than 70 percent of these clinicians are VA-funded researchers. VA also awards over 500 career development grants each year designed to help retain its best and brightest researchers for long and productive careers in VA health care.

•           High-Quality Research - VA researchers are well published (between 8,000 and 10,000 refereed articles annually) and boast three Nobel laureates and seven awardees of the Lasker Award (the “American Nobel Prize”); this level of success translates effectively from the bench to the veteran’s bedside.

•           Investing Taxpayers’ Dollars Wisely - Through a nationwide array of synergistic relationships with other federal agencies, academic affiliates, nonprofit organizations, and for-profit industries, the program leverages its modest annual appropriation into a nearly $2 billion overall research enterprise.

Despite numerous successes in research and innovation, since FY 2010 appropriated funding for VA research and development has lagged biomedical research inflation, resulting in stagnant VA purchasing power. As estimated by the Department of Commerce Bureau of Economic Analysis and the National Institutes of Health (NIH), to maintain VA research at current service levels, the VA Medical and Prosthetic Research appropriation would require $19 million in FY 2018 (a 2.8 percent increase over the FY 2017 level). Should availability of research awards decline as a function of budgetary policy, VA risks terminating ongoing research projects and losing these clinician researchers who are integral to providing direct care for our nation’s veterans. Numerous meritorious proposals for new VA research cannot be awarded without a significant infusion of additional funding for this vital program.

The FOVAs believe an additional $19 million in FY 2018, beyond uncontrollable inflation, is necessary for expanding research on conditions prevalent among O IF/O EF/OND veterans as well as continuing inquiries in chronic conditions of aging veterans from previous wartime periods. Additional funding will also help VA support emerging areas that remain critically underfunded, including:

•           post-deployment mental health concerns such as PTSD, depression, anxiety, and suicide;

•           the gender-specific health care needs of the VA growing population of women veterans;

•           engineering and technology to improve the lives of veterans with prosthetic systems that replace lost limbs or activate paralyzed nerves, muscles, and limbs;

•           studies dedicated to understanding chronic multi-symptom illnesses among Gulf War veterans and the long-term health effects of potentially hazardous substances to which they may have been exposed; and

•           innovative health services strategies, such as telehealth and self-directed care, relatively new concepts that lead to accessible, high-quality, cost-effective care for all veterans, as VA works to address chronic patient backlogs and reduce waiting times.

State-of-the-art research also requires an investment in state-of-the-art technology, equipment, and facilities. For decades, VA construction and maintenance appropriations have failed to provide the resources VA needs to replace, maintain, or upgrade its aging research facilities. The impact of this funding shortage was observed in a congressionally mandated report that found a clear need for research infrastructure improvements system wide. Nearly 40 percent of the deficiencies found were designated “Priority 1: Immediate needs, including corrective action to return components to normal service or operation; stop accelerated deterioration; replace items that are at or beyond their useful life; and/or correct life safety hazards.”

Contact: FOVA Executive Committee - http://www.friendsofva.org/committee.htm