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V.A. nominee stresses medical care

James Peake said he would fight to close care gaps and end delays. He offered few specifics.

WASHINGTON - Pledging to "do the right thing," Veterans Affairs nominee James Peake said yesterday that he would be an independent advocate for thousands of injured veterans and would fight for money necessary for their care.

In a 21/2-hour confirmation hearing, the retired Army lieutenant general also vowed to work on making significant headway in fixing gaps in care and reducing delays in disability pay.

But Peake hedged on offering specific solutions, deferring to detailed briefings he will receive later if confirmed. He said his greatest mark on the agency in the waning months of the Bush administration might be improved communications with the Defense Department.

"I'm not much of a legacy guy," Peake said.

No major veterans organization is opposing Peake, a former Army surgeon general who has spent 40 years in military medicine. The full Senate was expected to confirm his nomination soon, perhaps before the end of the year.

Still, members from both parties on the Senate Veterans Affairs Committee questioned Peake closely about his independence and how he would set himself apart from former VA Secretary Jim Nicholson, who almost immediately after taking office in 2005 was forced to admit to a $1.3 billion agency shortfall that put veterans' health care at risk.

Nicholson stepped down in October amid allegations of shoddy outpatient treatment at the Pentagon-run Walter Reed Army Medical Center and VA facilities.

If confirmed, Peake will appear before the committee again early next year to discuss the VA's annual budget. "I will work closely with this committee to do the right thing," he said.

Peake, 63, said that as Army surgeon general he sometimes clashed with an administration unwilling to provide adequate funding. Stressing that he believed in "working within the system," Peake said he eventually got the money by explaining "what we couldn't do."

"I understand I'm part of the administration," he said. "But I also have a responsibility to the administration and this committee to lay out the situation openly and honestly and to fight for the resources to do my job, which is to take care of veterans."

Peake also said he would closely consider a proposal - generally opposed by the VA - to guarantee a minimum level of annual funding. Veterans groups say that would shield the VA budget process from politics and eliminate future shortfall risks.

"I do have an open mind on the subject and intend to carefully study it," he said.

Sen. Arlen Specter (R., Pa.) pressed him further.

"It's a rough-and-tumble process with the Office of Management and Budget. How tough can you be?" Specter asked.

"I think I can be pretty tough," Peake responded.

During the hearing, Peake also:

Said he hoped to foster greater VA cooperation with the Pentagon in providing better treatment for mental-health problems such as post-traumatic stress disorder and traumatic brain injury.

Cited the sharing of medical records between the two departments as a "very high" priority. "I do believe we can make substantial progress" in 2008, he said.

Said delays in disability pay - which average 177 days - could be reduced by "simplifying" the system, but did not offer specifics.

Expressed a commitment to improving veterans' health care in hard-to-reach rural areas.