Veterans Affairs Committee on March 27th, 2012

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Mr. Chair.

Thank you to our witnesses for coming to present. I'm very interested in what you have to say.

I'm going to ask a number of questions, and whoever feels most comfortable answering, please, go ahead.

I noticed in our briefing material that the Department of Veterans Affairs maintains databases or a registry for specific situations, for example, exposures to hazardous substances during the Persian Gulf War and in Iraq; exposure to depleted uranium in Iraq, the Gulf War, Bosnia, as well as Afghanistan; exposure to Agent Orange and other defoliants; and exposure to ionizing radiation during nuclear tests or bombardment. The testing is done free of charge and these registries are maintained.

On the purpose of maintaining these registries, are you looking at research on the impact of these exposures? Also, is there any dispute about the effects of these exposures on human beings, on veterans?

This is something we are still debating here in Canada, and I wonder if you could enlighten me at all.

[Dr. Joel Scholten]

I can jump in and take that question first.

Certainly the registries are meant to define or identify those individuals who have had exposures and to keep a list, because as the science or the state of research improves, there may be care or an intervention developed that would require contacting veterans with certain exposures.

Some information can be used for research purposes, but it's very closely guarded. In order for an investigator to use this data, it would have to be de-identified. They would have to go through a data transfer agreement, ensuring privacy and information security. So it's a bit of both: we want to promote health care as well as promote the state of the science.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

For those who've been exposed, is there ever any dispute about their eligibility to care, whatever that care may be?

[Dr. Joel Scholten]

I'm certain there is. As the state of the science emerges, there are questions about different exposures and what conditions they may be related to, either right now or possibly 20 years down the line. So that's the reason for the registry.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

I was quite interested in the record-keeping, the medical records through a secure website, the My HealtheVet. You did explain that only veterans, unless there's some kind of mental incapacity, have access to those files.

I wondered if the confidentiality of those files has ever been compromised. Has there ever been an inappropriate sharing of that medical information that would cause you concern?

[Dr. Joel Scholten]

Tremendous safeguards have been put in place for data privacy and to maintain the security of that information. Specifically mentioning My HealtheVet, that's actually the portion of the medical record the veteran can access through the Internet. It doesn't have their entire medical record on yet because of working through the security issues, but they are able to look at their medications, reorder medications, look at lab results, future appointments.

But it doesn't have the entire medical record on there for them to access from home, at least not yet.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Is that security of person part and parcel of maintaining the separateness of the accessible records and the ones that are not accessible?

[Dr. Joel Scholten]

Part of your question was cut off, but you mentioned which part of the record is separate, that's in our record. Could you actually repeat the question?

[Irene Mathyssen, NDP, London—Fanshawe, ON]

I hope I can.

The fact that what's accessible through the Internet is less sensitive than the records that are maintained in stricter confidence, is that essentially the concern?

[Dr. Joel Scholten]

Yes, that's correct.

[The Chair, Conservative, Greg Kerr]

Thank you very much. We're over, believe it or not. Doesn't it go quickly?

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you, Mr. Chair.

[The Chair, Conservative, Greg Kerr]

It goes quickly.

Mr. Lobb, for five minutes, please.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Thanks, Mr. Chair.

And thank you to the guests for taking the time. It's very much appreciated.

I'm sure I missed this in your presentation, but how many veterans are there in the United States?

[Cheryl Flohr]

There are between 22 million and 23 million.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Between 22 million and 23 million....

I probably missed this, too, but what's the annual budget in Veterans Affairs in the U.S.?

[Margarita Cocker]

Unfortunately, we did not bring budget information. We're not prepared to answer that. I apologize.

[Susan McCrea]

For 2013, it's proposed to be $140 billion.

[Ben Lobb, Conservative, Huron—Bruce, ON]

So it's $140 billion. Okay.

The vast majority, 99%, of benefits that veterans receive in Canada here are legislated, so regardless of how many apply and what they need, Veterans Affairs supports it financially, whether it's $3 billion or $13 billion. Is that the same in the U.S. with the way the budget goes?

[Margarita Cocker]

I mentioned earlier there are two different budgetary categories: discretionary and mandatory. What you've just described falls into our mandatory expenditures. That is the same way we operate. We do not turn down a veteran based on budget. We budget according to our anticipated needs. It's probably realistic to say that we're pretty good at estimating what our benefit payments will be. I believe the only category where we do prioritize care would be at the medical centres, and I'll defer to....

[Dr. Joel Scholten]

Veterans eligible for health care are prioritized in categories 1 through 8, and it's based on the number or the severity of their service-connected injuries or disabilities. It kind of stratifies out. That categorization may determine the amount of co-pay. They might have to pay for a medication or a health care visit.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Go ahead.

[Michael Fisher]

In the Vet Center program, our services are actually at no cost to the veteran. They are earned through their military service and are about time limitation. Those co-pays the medical centre might have are not transferred over to the Vet Center.

[Ben Lobb, Conservative, Huron—Bruce, ON]

In Canada, Veterans Affairs is, surprisingly enough, in the year 2012, still working on getting all the medical files put in electronic format for easy use and transfer. Where's Veterans Affairs in the United States with respect to electronic medical files?

[Dr. Joel Scholten]

Our health care record has been electronic since approximately 2000. I was at a different facility then. I was at one of the test facilities in 1998. I believe that since 2000, give or take a year, the health care record, at least, has all been electronic.