    [Senate Hearing 116-257]
    [From the U.S. Government Publishing Office]

                                                           S. Hrg. 116-257

      JOINT HEARING ON THE LEGISLATIVE PRESENTATION OF THE AMERICAN LEGION

    =======================================================================

                                 JOINT HEARING

                                     OF THE

                         COMMITTEE ON VETERANS' AFFAIRS

                                   BEFORE THE

                                  U.S. SENATE

                                    AND THE

                         U.S. HOUSE OF REPRESENTATIVES

                         ONE HUNDRED SIXTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 MARCH 11, 2020

                                   __________

          Formatted for the use of the Committee on Veterans' Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                   __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    41-270 PDF                  WASHINGTON : 2021

    --------------------------------------------------------------------------------------

                     SENATE COMMITTEE ON VETERANS' AFFAIRS

                         Jerry Moran, Kansas, Chairman

    John Boozman, Arkansas               Jon Tester, Montana, Ranking
    Bill Cassidy, Louisiana                  Member
    Mike Rounds, South Dakota            Patty Murray, Washington
    Thom Tillis, North Carolina          Bernard Sanders, (I) Vermont
    Dan Sullivan, Alaska                 Sherrod Brown, Ohio
    Marsha Blackburn, Tennessee          Richard Blumenthal, Connecticut
    Kevin Cramer, North Dakota           Mazie K. Hirono, Hawaii
    Kelly Loeffler, Georgia              Joe Manchin III, West Virginia
                                         Kyrsten Sinema, Arizona

                Caroline R. Canfield, Republican Staff Director
                    Tony McClain, Democratic Staff Director

            HOUSE OF REPRESENTATIVES COMMITTEE ON VETERANS' AFFAIRS

                       Mark Takano, California, Chairman

    Julia Brownley, California           Dr. Phil Roe, Tennessee, Ranking
    Kathleen Rice, New York                  Member
    Conor Lamb, Pennsylvania             Gus M. Bilirakis, Florida
    Mike Levin, California               Amata C. Radewagen, American Samoa
    Anthony Brindisi, New York           Mike Bost, Illinois
    Max Rose, New York                   Dr. Neal Dunn, Florida
    Chris Pappas, New Hampshire          Jack Bergman, Michigan
    Elaine Luria, Virginia               Jim Banks, Indiana
    Susie Lee, Nevada                    Andy Barr, Kentucky
    Joe Cunningham, South Carolina       Dan Meuser, Pennsylvania
    Gil Cisneros, California             Steve Watkins, Kansas
    Collin Peterson, Minnesota           Chip Roy, Texas
    Gregorio Kilili Camacho Sablan,      Greg Steube, Florida
        Northern Mariana Islands
    Colin Allred, Texas
    Lauren Underwood, Illinois

                           Ray Kelley, Staff Director
                     Jon Towers, Republican Staff Director

                                C O N T E N T S

                                  ----------

                           Wednesday, March 11, 2020

                          SENATORS AND REPRESENTATIVES

                                                                       Page
    Moran, Hon. Jerry, Chairman, U.S. Senator from Kansas............     1
    Takano, Hon. Mark, Chairman, U.S. Representative from California.     2
    Roe, Hon. Phil, M.D., Ranking Member, U.S. Representative from
      Tennessee......................................................     4
    Tillis, Hon. Thom, U.S. Senator from North Carolina..............     6
    Tester, Hon. Jon, Ranking Member, U.S. Senator from Montana......    15
    Bost, Hon. Mike, U.S. Representative from Illinois...............    17
    Pappas, Hon. Chris, U.S. Representative from New Hampshire.......    18
    Lamb, Hon. Conor, U.S. Representative from Pennsylvania..........    22
    Cisneros, Hon. Gil, U.S. Representative from California..........    23
    Boozman, Hon. John, U.S. Senator from Arkansas...................    25
    Sinema, Hon. Kyrsten, U.S. Senator from Arizona..................    26
    Sullivan, Hon. Dan, U.S. Senator from Alaska.....................    31

                                   WITNESSES

    Oxford, James W. ``Bill,'' National Commander, The American
      Legion; accompanied by Joseph Sharpe, Director, Veterans
      Employment and Education Division; Daniel Seehafer, Chairman,
      Veterans Employment and Education Commission; Melissa Bryant,
      National Legislative Director; Chanon Nuntavong, Director,
      National Veterans Affairs and Rehabilitation Division; Ralph
      Bozella, Chairman, Veterans Affairs and Rehabilitation
      Commission; and Vincent Troiola, Chairman, National Legislative
      Commission.....................................................     7

                                    APPENDIX

    Moran, Hon. Jerry, Chairman, U.S. Senator from Kansas, Prepared
      Statement......................................................    36
    Oxford, James W. ``Bill,'' National Commander, The American
      Legion, Prepared Statement.....................................    37

      JOINT HEARING ON THE LEGISLATIVE PRESENTATION OF THE AMERICAN LEGION

                                  ----------

                           WEDNESDAY, MARCH 11, 2020

                                   U.S. Senate,
                     and U.S. House of Representatives,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        The Committees met, pursuant to notice, at 10 a.m., in room
    SD-G50, Dirksen Senate Office Building, Hon. Jerry Moran and
    Hon. Mark Takano, Chairmen of the Committees, presiding.
        Senators present: Moran, Boozman, Rounds, Tillis, Sullivan,
    Tester, Brown, Manchin, and Sinema.
        Representatives Present: Takano, Lamb, Brindisi, Rose,
    Pappas, Cunningham, Cisneros, Peterson, Allred, Underwood, Roe,
    and Bost.

                 OPENING STATEMENT OF HON. JERRY MORAN

        Chairman Moran. The hush suggests that it is time to
    commence our meeting, and I am happy to do that.
        Over the past few weeks we have had the pleasure and the
    ability to learn from a number of veterans and veteran service
    organizations. Today we gather with The American Legion, and
    this is our fifth hearing and final legislative presentation by
    a VSO.
        Commander Oxford, thank you and your fellow Legionnaires
    for joining us, my colleagues and I, one of which is seated
    next to you. We are looking forward to hearing from you and
    learning the Legion's top legislative priorities.
        As we have done previously, only to keep up with my
    colleagues here, I would take a moment to recognize the Kansans
    who are here from my State, members of The American Legion,
    friends and important citizens of our State, one and all. If
    they would stand and be recognized, I would appreciate seeing
    their presence.
        [Applause.]
        Chairman Moran. Thank you and thank you for the
    conversation we had in my office yesterday.
        All of you, your willingness to join us today is a
    testament of your unwavering commitment to your brothers and
    sisters in arms. As we all know, transforming the VA into a
    21st century VA is a monumental task that requires all hands on
    deck. Veteran service organizations, like The American Legion
    and their members, play a critical role in this process. You
    are the front lines and see first-hand where the VA is thriving
    and where it faces challenges.
        I have indicated many times that what I know, and my
    legislative priorities are in large part determined by the
    conversations I have in Kansas and across the country with
    veterans, and certainly The American Legion is a significant
    component of my knowledge of where attention is needed.
        The American Legion gives voice to veterans who at times
    can feel unheard or marginalized. You also provide an annual
    check for our communities and help make certain that we are on
    the right track. My father was a member of The American Legion
    post in my hometown and I am the son of The American Legion and
    I am honored to have that distinction and honored to do so in
    respect for my father.
        Commander Oxford, while I was reading over your written
    testimony I noticed the Legion and I share a number of
    priorities, and I am glad for that, from enhancing suicide
    prevention to addressing toxic exposure to improving women's
    health care. You have my commitment that the Senate Veterans'
    Affairs Committee will continue to work with you and the larger
    veteran community on addressing these and other priorities.
        We look forward to your presentation today and will
    continue to work with you to make certain that veterans' voices
    are heard and that they receive the care and attention that
    they deserve.
        It is my pleasure now to turn to Chairman Takano, the
    Chairman of the House Veterans' Affairs Committee.

                 OPENING STATEMENT OF HON. MARK TAKANO

        Chairman Takano. Thank you, Chairman Moran. It is a honor
    to be here for the last, but certainly not the least, joint
    House and Senate veteran service organization hearing of the
    year. I would like to welcome all of The American Legion
    members and auxiliary members who have joined us today, and I
    look forward to your testimony.
        Before we get started I would like to recognize all of our
    members from my home State of California. Would all the
    Californians please stand or raise their hand.
        [Applause.]
        Chairman Takano. Welcome. Welcome.
        Reading today's testimony it is clear that we share many of
    the same priorities. We must address the national crisis of
    veteran suicide. Veterans must receive high quality health
    care. We must understand the full impacts of toxic exposures
    and make sure that another generation of veterans does not have
    to wait for the benefits and care they need and deserve.
        In addition, as our veteran population grows increasingly
    more diverse, we must support our women, LGBTQ, minority, and
    Native American veterans. The legislation we passed must
    improve access to culturally competent care for all veterans.
        As Chairman, I have made reducing veteran suicide my number
    one priority. It is our job to create sound, well-researched
    policy and not simply perpetuate approaches that are not proven
    to prevent suicide. We take that responsibility very seriously.
    Our approach to suicide prevention takes into account multiple
    factors that could reduce veteran suicide, everything from
    lowering the economic burdens on veterans to increasing access
    to care and improving crisis intervention for those at high
    risk.
        One critical step toward addressing veteran suicide is to
    expand access to emergency mental health care for veterans in
    crisis. That is why I introduced H.R. 5697, the Veterans Access
    Act. This legislation would ensure all veterans, regardless of
    their discharge status or eligibility for other VA health care
    benefits, have access to the emergency mental health care they
    need. I look forward to working with The American Legion to
    pass this bill and save veterans' lives.
        We also have a duty to ensure this administration
    recognizes the impact of toxic exposure during military
    service, and that VA takes action before it is too late. Our
    veterans should not have to wait 40 years for the VA to
    recognize that a veteran is suffering from past exposure in
    order to get the benefits they earned.
        For example, I am urging the administration to add four
    diseases to the Department's presumption list that we know to
    be linked to Agent Orange exposure. This will ensure many more
    veterans can access crucial VA disability and health care
    benefits. I know that with the support and insight of The
    American Legion we can continue to hold the administration
    accountable and work to fulfill the promises that we have made
    to our veterans. Let me just emphasize, our Vietnam veterans
    have waited too long. Now is the time to add those conditions
    to the presumptive list.
        I look forward to hearing your testimony and thank you all
    for the work that you have done and service to veterans and
    their families.
        I now yield back, Mr. Chairman.
        Chairman Moran. Mr. Chairman, thank you, and I now
    recognize the Ranking Member of the House Committee,
    Congressman Roe.

                   OPENING STATEMENT OF HON. PHIL ROE

        Dr. Roe. Thank you, Mr. Chairman, and good morning,
    Commander Oxford. It is a pleasure for me to be here with
    Chairman Takano, Chairman Moran, and Ranking Member Tester to
    welcome you and your fellow Legionnaires to Washington. This is
    my 12th and final year in Congress and so my final time
    attending this hearing, and when you leave, Commander, they
    send you this sheet called Departing Members. I am not planning
    on departing. I am just leaving Congress.
        It has been an honor for me to attend the Legion's annual
    hearing, joint hearing, all these years. As I prepare for my
    retirement I can say, without a moment's hesitation, I am
    filled with tremendous pride and hope for our country's future,
    because the patriotism and the passion of Legionnaires across
    this country, many of whom I have had the privilege of meeting
    and getting to know personally.
        I want to thank each and every one of you for your
    continued service. In particular, I want to welcome the
    Legion's stellar national leadership team who work tirelessly
    day in and day out under the direction of Commander Oxford. I
    thank you for your staff. They have been great to work with.
        Sir, I am so grateful for your decades that you spent
    defending our freedoms, first in the Marine Corps and then in
    the Army, and now as the National Commander of The American
    Legion. I am glad to see you are here with us today, and I also
    want to acknowledge the members of The American Legion
    auxiliary. We know who does all the work, the auxiliary. The
    many hats that you wear as spouses, as volunteers, as
    caregivers and more, it does not go unnoticed or under
    appreciated, and I thank you for that.
        Finally, I want to say a special hello and thanks to the
    Legionnaires who are here today from my great State of
    Tennessee. I met with you. If you would please stand so we can
    recognize you. I know Bob is here. Yep, there we are.
        [Applause.]
        Dr. Roe. Commander Oxford, you know, in your testimony,
    ``The American Legion believes veterans have given this country
    far more than what is asked in return.'' I could not agree more
    with you. It would be impossible for me to detail all of the
    work that The American Legion has performed throughout your
    more than a century of service or the value that the Legion
    continues to bring to bear on matters of military veteran
    national security policy even now.
        It is with the help of the Legion and working with our
    Committees and with our partners in the Trump administration
    that the Department of Veterans Affairs has undergone such a
    positive transformation over the last few years. Thanks to our
    mutual efforts I am proud to report that veterans today have
    greater access to care, greater control over their care than
    ever before. Veterans can use their GI Bill benefits whenever
    they choose.
        Veteran unemployment reached near record lows. Veterans
    getting their appeals for disability compensation decided
    faster and more efficiently, thanks to Mr. Bost right here, his
    bill. Veterans of the Blue Water Navy are receiving the
    benefits they have earned, and that took way too long to get
    done. Fewer veterans are homeless. Fewer veterans are dependent
    on opioids. The widows tax has been repealed. The VA has more
    funding, more staff, and has risen from one of the lowest-
    ranking agencies to one of the top six best places to work in
    the Federal Government.
        I know in my own hometown of Johnson City, TN, I almost
    never hear a negative comment about the VA hospital there. I am
    extremely proud of that.
        We should all be proud of those successes, even as we
    acknowledge that work remains, much of which is detailed in the
    commander's testimony. Looking ahead, we must remain steadfast
    in our efforts to prevent veteran suicide by instilling hope
    and purpose in all of those who have served and doing a better
    job of leveraging communities of care to support them and their
    families; to empower veterans to succeed in their civilian
    lives, to realign and modernize the VA health care system so
    that it meets our Nation's veterans where they live and serves
    them well; to expand VA's caregiver program so that it serves
    caregiver veterans of all eras; to those who have experienced
    toxic exposures during their time in uniform; and to continue
    aggressive oversight of very aspect of VA, our Nation's second-
    largest bureaucracy; to ensure that every veteran who walks
    into a VA office, facility, or clinic receives timely, quality
    care.
        I look forward to discussing these issues and more with you
    today, Commander Oxford, and to building on our successes over
    the past 3 years on behalf of Legionnaires and veterans across
    the country. I salute you and I yield back my time.
        Chairman Moran. Congressman Roe, thank you very much. I am
    going to recognize, in just a moment, Senator Tillis.
    Commander, I want you to know that you are going to see me
    depart just momentarily, about the time that you begin to
    testify, and I hate that.
        Dr. Roe. Please leave, not depart.
        Chairman Moran. Oh, depart. I am not departing. Thank you.
        [Laughter.]
        Chairman Moran. I intend to come back alive and well in
    just a few moments. I have a couple of bills pending another
    committee that are being voted on. But, I will return to make
    certain that we pay significant attention to what you have to
    say and the questions and answers that I will learn from.
        At this moment let me now turn to my colleague from North
    Carolina, Senator Thom Tillis. Thom is a member of our Senate
    Veterans' Affairs Committee, active, fully engaged, and a great
    ally in the effort to make sure that veterans are well cared
    for.
        I now recognize, you, Senator Tillis.

                          SENATOR THOM TILLIS

        Senator Tillis. Thank you, Chairman Moran, Chairman Takano,
    Ranking Member Roe, and distinguished Members of the Committee.
    If I may, as a point of personal privilege, ask, anybody who is
    from North Carolina, either currently or passed through North
    Carolina in relation to your service, please stand up or raise
    your hand.
        [Applause.]
        Chairman Moran. Senator Tillis, you one-upped all of us,
    and with that I am going to walk out on you, not the Commander.
        [Laughter.]
        Senator Tillis. Well, thank you, Mr. Chairman, and first I
    am very proud to be sitting next to Bill Oxford. I have had the
    distinct pleasure of getting to work with him many times over
    the past several years in his many capacities, as he has
    continued to serve after his military service. He has virtually
    held every position one could hold within The American Legion,
    both in North Carolina and at the national level.
        Bill Oxford was elected National Commander of The American
    Legion on August 29, 2019, during the organization's 101st
    national convention in Indianapolis. He has been a member of
    the Nation's largest veterans' organization since 1986. A
    native of Lenoir, North Carolina, Mr. Oxford is a paid-up-for-
    life member as well as the past commander of Post 29 in Lenoir.
    He served as the Department Commander of North Carolina
    American Legion from 2010 to 2011.
        He is a veteran of the U.S. Marine Corps. Mr. Oxford was an
    aviation electronic technician for the A6 Intruder and served
    in Vietnam during his initial enlistment. After being
    discharged as a sergeant in 1970, Mr. Oxford joined the North
    Carolina National Guard. He subsequently attended Officer's
    Candidate School and transferred to the U.S. Army Reserve where
    he ultimately retired as colonel after more than 34 years of
    military service.
        A former mayor and city councilmember of Cajah's Mountain,
    North Carolina--I think I did not think I could pronounce that
    right, they gave me a phonetic one--he has worked since his
    high school as a high school student with most of his career
    choices being in maintenance and engineering field.
        Mr. Oxford has also served his community by volunteering as
    a coach, umpire, referee, administrator in several youth
    athletic programs, and he has also served as the public address
    announcer for Post 29 American Legion baseball team.
        Mr. Oxford's lifelong record of service to our Nation and
    to our community have prepared him well to lead The American
    Legion. His theme as National Commander of The American Legion
    is ``a foundation for the future,'' as the organization enters
    its second century of service. That is a fitting theme for Mr.
    Oxford's tenure, given our work together on the Legion Act, a
    bill that expands eligibility for membership for The American
    Legion to veterans of all eras. I was proud to co-lead this
    bill with Senator Sinema and worked closely with The American
    Legion to successfully get the bill signed into law just last
    summer.
        With that, it is my great privilege and honor to welcome a
    fellow North Carolinian, Bill Oxford, to this hearing on behalf
    of The American Legion. I know you are going to do us proud.
        [Applause.]
        Senator Tillis. Mr. Chairman, I did tell him not to mess
    up.

     STATEMENT OF JAMES W. ``BILL'' OXFORD; ACCOMPANIED BY JOSEPH
      SHARPE; DANIEL SEEHAFER; MELISSA BRYANT; CHANIN NUNTAVONG;
                   RALPH BOZELLA; AND VINCENT TROIOLA

        Mr. Oxford. I will try my best. Thank you, Senator Tillis,
    for the kind introduction and for your bipartisan leadership in
    such areas of concern to The American Legion as burn pit
    exposure, timely VA health care delivery, and career
    opportunities for veterans.
        Chairman, if I might, before I proceed I would like to take
    a moment to recognize all of the past national commanders of
    The American Legion. Gentleman and lady, would you please
    stand?
        [Applause.]
        Mr. Oxford. The American Legion Auxiliary past National
    President and current President, Nicole Clapp.
        [Applause.]
        Mr. Oxford. And, past National Commander of the Sons of The
    American Legion and their current National Commander, Clint
    Bolt.
        [Applause.]
        Mr. Oxford. Folks, we have got a great team.
        I would also like to say thank you to the members of the
    House and Senate Committees on Veterans' Affairs for once again
    giving us this opportunity. The American Legion has delivered
    the legislative priorities of our Nation's veterans and their
    families to Congress in hearings just like this for more than
    10 decades, and those priorities have produced impressive
    results--fair health care and timely benefits for veterans
    disabled by military service, from mustard gas to Agent Orange
    to IEDs; a code of respect for the U.S. flag; an arm of the
    Federal Government solely dedicated to the needs of veterans;
    veterans preference hiring; a GI Bill of Rights that changed
    the world and continues to do so; recognition and pursuit of
    effective treatment for Post Traumatic Stress Disorder among
    veterans; support for caregivers of disabled veterans; improved
    services for women.
        Our journey can be traced back to the original purpose of
    The American Legion when World War I veterans came home to
    virtually no help or support from the government that sent them
    to fight. Our mission today is a continuation of the work they
    began. From World War I we learned that we needed a VA. From
    World War II we saw what could be accomplished for the entire
    nation through GI Bill benefits and veterans' preference
    hiring.
        The Vietnam War later produced an expectation of
    accountability from the Federal Government that veterans
    exposed to toxic herbicides during their service, and those who
    came home with invisible wounds, would not be dismissed or
    forgotten.
        We continue this mission on all those fronts. Between
    Vietnam and 9/11, The American Legion and Congress worked
    together to reinvent the Veterans Administration, one that is
    now described, and I quote, ``the best care anywhere.'' Today
    so many of these issues, and new ones for a new generation,
    continue to occupy The American Legion's priority list.
        That is because The American Legion, Congress, the VA, the
    Pentagon, and the White House all share in a continuous mission
    to ensure that these important laws and policies are
    effectively implemented, given critical oversight, and are
    constantly improved. Implementation, oversight and
    improvement--that triad is the prevailing theme in The American
    Legion legislative priority list for the second session of the
    116th Congress.
        Let me start with VA health care. Much has been promised,
    and even more is expected, from the VA MISSION Act. That
    legislation was borne of a deadly crisis 6 years ago when
    veterans whose medical appointments were not scheduled, even
    though some in the VA thoughtfully claimed they were. We all
    worked hard over the last 6 years to convert that crisis into
    confidence in the VA's future.
        Today we are in a better place on VA accountability, but an
    overriding issue attached to the meltdown of 2014 persists--
    timely access to care. As we press forward with such
    innovations as Project Atlas, which aims to make good use of
    American Legion post homes to provide VA telehealth services
    for veterans, we remain highly concerned about another issue--
    oversight of non-VA providers.
        We understand the primary objective, delivery of care for
    veterans as quickly and efficiently as possible, but the long-
    term strategy must not lead the VA any further down the road to
    privatization.
        In some areas where community care has been offered through
    the Choice program, which the MISSION Act replaces, non-VA
    providers are unwilling to accept VA patients, due to
    compensation differences or timely payments. That leaves
    serious concern that veterans will be forced to seek out the
    provider of least resistance rather than VA's best care
    anywhere.
        We must always remember why the VA is special and must be
    protected. You will find these reasons in the testimony books
    before you today. In them you will see, for instance, how
    treatment for combat-caused PTSD and TBI is a VA
    responsibility, not one delegated to the private sector.
    Advances in alternative therapies for these conditions are
    coming from veterans and VA success stories, stories we are
    still discovering every day, from equine therapy to yoga to
    peer support to clown therapy to PTR MS. These are dots for the
    VA to connect in support of veterans facing PTSD, not for other
    providers.
        When you combine the chronic pain of military injuries with
    PTSD or TBI, and then prescribe a pharmaceutical cocktail to
    blot it all out, a common result is isolation, and isolation is
    a major contributor and the most heartbreaking issue facing
    veterans today, the high suicide rate.
        The American Legion conducted an online mental health
    survey in 2019 that showed our respondents, 30 percent,
    personally, knew a veteran who died by suicide. Sixty-seven
    percent indicated they would be willing to get formal suicide
    prevention training to help reduce the rate.
        As more and more victims of military sexual trauma step
    forward to report these unthinkable violations of trust, we
    must stand together behind The American Legion policy on this
    matter--zero tolerance. But, for survivors, we call on Congress
    to provide emphatic oversight to ensure that VA is well
    resourced to install effective, discreet, and easily accessed
    services, administered by qualified professionals for these
    veterans.
        Like treatment for PTSD and TBI, care for MST survivors is
    a VA responsibility, not a provider unlikely to understand the
    military dynamics involved.
        Women veterans are currently over 2 million, and are
    increasing by nearly 18,000 per year, and represent the
    fastest-growing group entering the VA system. We have found
    that VA medical services specific to their needs are
    inconsistent and lacking in many areas.
        In our shared vision to provide oversight and make
    improvement in critical areas, we must continue to ask our
    Nation's VA health care facilities how they are fulfilling the
    needs of women veterans, hold them accountable to necessary
    changes, and critically measure their performance in the name
    of responsible oversight.
        The American Legion's System Worth Saving and regional
    office action review site visits provide our organization
    important insights into the challenges and best practices of
    the VA medical system in local communities. Typically, these
    visits begin with town hall meetings where veterans openly
    discuss the performance of their VHA and VBA providers. I would
    like to invite Members of Congress and their staff to join us
    in these events for the most important level of oversight,
    first-hand from the veterans we serve. Each year, The American
    Legion prepares and distributes a System Worth Saving report to
    Members of Congress and the Veterans Administration so they can
    use our findings to implement changes and share success stories
    that can be emulated elsewhere in the system.
        Significant progress has been made at VBA to reduce the
    backlog of undecided claims and appeals, and the Appeals
    Modernization Act is already exceeding expectations. We are
    confident this will continue as we watch the backlog shrink in
    the months ahead.
        Significant progress has also been made to roll out the
    Forever GI Bill, the biggest expansion of that benefit in over
    a decade. But, The American Legion has some serious GI Bill
    concerns that need legislative attention, one of which is
    immediate, the other to help prevent the problem in the future.
        We call on Congress to pass the Protect the GI Bill Act to
    reinstate benefits for student whose for-profit schools went
    out of business before they finished their degree programs.
    These veterans were often aggressively recruited by for-profit
    schools and are stuck with no degree and no GI Bill benefits to
    seek an education elsewhere.
        Once that is accomplished, we further ask Congress to pass
    the Veterans Education and Taxpayer Spending Act to close what
    is known as the 90/10 loophole, which now counts VA and DOD
    education funding as, and I quote, ``private dollars.'' They
    are not private dollars. They are government dollars, just like
    any other Federal student aid. This loophole has led to
    aggressive and even deceptive recruitment by for-profit
    schools, which in the worst cases have left veterans without
    degrees and drained of their GI Bill benefits.
        If history has taught us anything, the Forever GI Bill will
    not, by any means, be the final GI Bill. The American Legion
    will always be looking to improve it.
        On January 1, 2020, VBA began reviewing Blue Water Navy Act
    claims. We are thankful that this bipartisan legislation was
    finally signed into last law year on behalf of tens of
    thousands of Vietnam War veterans suffering from diseases
    related to their offshore exposure to Agent Orange. Disability
    benefits for those veterans were wrongly suspended many years
    ago, and many of them have died from their service-connected
    conditions, since then, so this implementation is long overdue.
        More recently, the National Academy of Medicine has
    recommended that four new conditions be added to the list as
    presumptively caused by Agent Orange exposure--bladder cancer,
    hyperthyroidism, hypertension, and Parkinson's-like symptoms.
    Science backs up the argument that these conditions need to be
    added now, but to our knowledge no action has been taken. We
    call on Congress to give those disabled veterans the care and
    recognition they so rightly earned--implementation, oversight,
    improvement.
        We have, in military terms, a target-rich environment. The
    American Legion is firing on those targets at the community,
    State, and national level. One example of the Legion's
    commitment to veterans and military personnel came a little
    over a year ago when our organization raised and delivered over
    $1 million in cash grants--not loans--to junior enlisted Coast
    Guard families whose paychecks were delayed by the government
    shutdown. In addition to the grants, local posts across the
    country collected food, diapers, toiletries, and fulfilled
    other needs for these Coast Guard families with children at
    home.
        To prevent this from ever happening again, we ask that you
    urge your colleagues, and appropriate committees, to pass the
    Pay Our Coast Guard Act. That measure will exempt members of
    the Coast Guard, just like any other branch of service, from
    pay disruption in the event of a shutdown.
        Passage of the Legion Act last summer gave long-awaited
    recognition to more than 1,600 Americans who have died or were
    wounded in service outside previously designated war areas. It
    is fact that our Nation has been in a perpetual state of armed
    conflict since December 7, 1941. We owe all who have served
    since then the same level of respect as others who swore with
    their lives to protect our Nation.
        We are confident that the VBA will continue to improve the
    VA claims and appeals processes. Like Dr. Paul Lawrence, Under
    Secretary for Benefits at VA, we want 2020 to be--VBA's hashtag
    campaign says ``the best year ever.''
        We stand against privatizing the VA health care system, but
    we continue to stand for its improvement. That kind of
    oversight and advocacy, we believe, can and will make the VA
    the best care anywhere.
        We intend to work hard, arm's length with Congress and the
    administration, to improve treatment of PTSD, build a better
    care environment for women veterans, help the homeless get on
    their feet, demand that VA claims are resolved faster and
    accurately, protect student veterans from GI Bill abuses, and
    continue assisting in the difficult transition from military
    service to civilian life.
        Nearly all of our marching orders can be found in one form
    or another throughout the history of The American Legion's
    relationship with Congress. Many of our shared accomplishments
    can be credited to a generation of veterans whose war ended 75
    years ago this year, the men and women who turned their GI Bill
    benefits into a half-century of American prosperity and fought
    to make the VA what it is today.
        In 2017, The American Legion National Convention passed a
    resolution to exempt from means testing all living World War II
    veterans not already enrolled in the Veterans Administration.
    This is not unprecedented. A similar measure was passed in
    1996, for the last living veterans of the Spanish-American War
    and World War I. About 75 percent of surviving World War II
    veterans are already enrolled in the Veterans Administration,
    so this does not amount to a large number. It would be a small
    gesture of gratitude for these men and women to whom the world
    owes so much.
        As we renew our vows to those who served our Nation so
    effectively and bravely today, let's remember those who came
    before us and grant them access into the system of respect and
    care they helped invent.
        Thank you, God bless America's veterans, and God bless
    America.
        [Applause.]
        Chairman Takano [presiding]. Well, thank you, Commander
    Oxford, for your testimony. I am going to recognize myself for
    5 minutes to begin the questioning. Actually 3 minutes.
        Commander, I will begin with this question. I am very
    pleased you made comment about the abuse of for-profit
    colleges. The Department recently announced plans to halt new
    GI Bill enrollment at institutions that engaged in predatory
    practices.
        In light of this decision, what are the next steps that you
    think Congress should take to protect student veterans?
        Mr. Oxford. I would like to turn that question over to
    Chairman Seehafer for his idea.
        Mr. Seehafer. Thank you very much, sir, for the question.
    You know, as the family members behind me, we always say that
    we are boots on the ground, and obviously preparing for your
    question and these things that come in front of us, I wanted to
    share with you something that I know you are concerned about,
    as well as ourselves.
        This is really, I would say, hot off the press. Last year,
    we had a young Legionnaire, also on part of our staff, that
    attended the Army's Advanced Leadership Course, right, and one
    of his battle buddies was pursuing a doctorate in national
    security from a particular university. It was inspiring to him
    to see him stay up late, you know, those nights, extra,
    studying away, being in those barracks and working on his
    dissertation.
        So, a little over a month after they graduated, this
    university abruptly closed its doors, back in March of last
    year. It was painful enough to think that, you know, all the
    time and effort that his friend was putting into getting his
    doctorate, but worse, was that he lost most of his GI Bill
    pursuing something that fell apart due to no fault of his own.
        We are definitely looking to change that. Again, we
    understand, being transparent on this, of course, another
    university stepped in. But still, the pain and all the things
    that this veteran went through--and it is not just one. There
    are numerous. We would like that changed, and recommend that.
        And, of course, there are--we do not want to punish other
    universities that are doing things right, obviously. So, we
    encourage, again, oversight. We encourage, obviously,
    improvement on this statement here.
        Again, I hope that answers your question then.
        Chairman Takano. Thank you very much. Have you done
    specific policy proposal like closing the 90/10 loophole, you
    know, making sure that we have borrowers' defense in place for
    our veterans as well who get put into debt.
        Mr. Oxford. Mr. Chairman, if I might, I would recommend and
    endorse the closing of the 90/10 loophole and pass the Protect
    the GI Bill Act.
        Chairman Takano. Wonderful. Thank you for that. I am glad
    the Legion has taken that position.
        My time is up. Actually, I am over. I am going to recognize
    ranking Member Dr. Roe for his 3 minutes.
        Dr. Roe. Thank you very much, and Commander, I am a dues-
    paying member, Post 24, Johnson City, TN, I might add, and my
    dues are paid up.
        [Laughter.]
        Dr. Roe. A couple of things, Commander, on PTSD, that when
    I helped write the MISSION Act it makes this a little more
    difficult. I am a veteran and I saw veteran patients outside
    the VA. Some were for PTSD, others for other things. There are
    doctors inside the VA that never served, so we have got to find
    the best way, I think, to treat these veterans. A lot of times
    it may be outside the VA. I have run across veterans who will
    not go to the VA. We have got to reach out to them, I think. I
    think you guys are the ones--both ladies and gentlemen--are the
    ones that are critical to doing that.
        The VA cannot be everywhere. I mean, there are two million
    members of The American Legion, and that is a huge organization
    that can reach out and touch people, and we need to get them
    into care. Because I agree with you. To me it is the most
    heart-breaking thing in the world--20 men and women a day
    committing suicide. That is 6,000 people a year, that is
    totally preventable. So, how do we do that? We want to work
    with you and work together doing that.
        Another thing you did not mention in your statement was
    that I have asked DOD and VA, mainly DOD, to identify how many
    basis in Thailand got sprayed, and you were not mentioning it
    but we have got to work on that. There are a lot of people that
    are not included in Agent Orange, and we have had a hard time
    reconciling how many bases. So, if you would help us with that
    and nudge DOD a little bit to help us get that information so
    we can do what is right there, I would appreciate that. We need
    your help on that, Commander.
        Mr. Oxford. Thank you, sir. Our staff will be happy to work
    on that Agent Orange issue in Thailand. Melissa, if you will
    work with Dr. Roe's staff on that issue.
        When we think about the mental health issues, and you
    specifically mentioned veteran suicide, there is no veteran--
    and that is a tragic loss that is preventable--but no veteran
    should die by his own hands. That is an atrocity. When we think
    about the 20 veterans a day who are committing suicide, only 6
    of those are enrolled with the Veterans Administration. We need
    to do our part, and we will be doing that to help the VA do
    their part.
        I think I agree with you, the fact that veterans' treatment
    at the VA for PTSD and TBI is the only way to go. That is the
    best source of help for VA as far as mental health goes.
        I think you mentioned the fact that we are all veterans, we
    are all stubborn, and the willingness to move over to the VA
    for that kind of help is a critical part, and that is where we
    can come in. We all have the ability to make those people
    understand the VA is the best source of help available. As we
    do that, we need to make sure the VA is equipped with their
    necessary resources. We need to make sure the VA is hiring
    qualified, professional, competent mental health professionals,
    and we need to increase our DOD funding of VA's suicide
    prevention program. If we do that and pass the Commander John
    Scott Hannon Veterans Mental Health Care Improvement Act, I
    think that will have an impact.
        From our side, The American Legion has instituted a program
    called the Buddy Check program. That buddy check is to reach
    out from the Legion side to all Legionnaires to check and say,
    ``Hey, how are you doing? Are you Ok? Can we help? Do you need
    anything? Can we help you with anything?''
        So, as far as reaching out, The American Legion is doing
    that, but we need to continue to emphasize to society that it
    is Ok to ask for help. Asking for help is not--it used to be a
    blog on our record but it's not anymore. It is important. It is
    critical. We need to make sure every veteran realizes help is
    out there. Let us help you.
        [Applause.]
        Dr. Roe. Commander, thank you for your service in the
    Marine Corps and in the U.S. Army, and I yield back.
        Chairman Takano. Thank you, Dr. Roe. Senator Tester, you
    are recognized for 3 minutes.

                OPENING STATEMENT OF SENATOR JON TESTER

        Senator Tester. Thank you, Mr. Chairman. I want to thank
    you, Commander Oxford, for your statement today, and I want to
    thank you for your answer to the question that Congressman Roe
    put forward. Just as a little update, you probably already know
    this, the Commander John Scott Hannon bill passed out of the
    Senate Veterans' Affairs Committee by a unanimous 17-0. We got
    everybody from Blackburn to Bernie to vote for that bad boy.
        [Laughter.]
        Senator Tester. So, now all we have got to do is get
    Senator McConnell to take it up on the floor, and it will be
    off, and then Chairman Takano can work his magic on the House
    side of things, if you do not already have it passed over
    there. I do not know.
        I just want to thank you, and I appreciate your comments on
    the VA MISSION Act. I appreciate your comments on gender
    disparity within the VA. The fastest-growing population of VA
    is women. We have got to figure out how to do this right, and
    VA is not doing it right yet. I want to thank you for your
    comments on Agent Orange and that exposure, and the Colmery GI
    Bill.
        You know, we got a lot of good work done last Congress, but
    we really do depend on VSOs like The American Legion, with your
    members, to really tell us how things are working and take our
    lead from your direction.
        There are a lot of issues out there, from presumptives to
    Blue Water to the caregivers program, and it makes me want to
    ask your membership, how many folks served in Vietnam? Raise
    your hand.
        [Show of hands.]
        Senator Tester. Yeah, and raise your hand if you are under
    the age of 60 and served in Vietnam.
        [Laughter.]
        Senator Tester. Exactly. No hands went up. And so the
    question becomes, when it comes to Blue Water Navy, which is a
    Vietnam issue, and when it comes to caregiver, which is
    everybody's issue but we just open it up for the Vietnam vet.
    When it comes to presumptives, we have got to do a better job.
    I mean, the fact of the matter is, Commander, you know, the VA
    is trying to outlive you and, by God, they are getting it done.
    We should not do this.
        The Blue Water Navy was a struggle. We finally got it done.
    Caregivers is a struggle. And, by the way, Blue Water is not
    where it needs to be, and the caregiver situation, we have got
    a computer program that is not doing what it needs to do. This
    is 21st century, and you guys are getting older, and we need to
    step up.
        I would just say one thing, and I am going to ask you a
    question, I promise. But, the presumptives issue is really
    important, and the science is there. I will tell you that a
    previous Secretary of the VA was getting ready to declare these
    presumptives as being eligible for coverage. That was several
    years ago, and now we are still here.
        Could you just talk, very briefly, because I talked too
    long, could you talk very briefly, Commander Oxford, or whoever
    you want to send this to, what would it mean to your members if
    these conditions are added? The reason I say that is because I
    just dropped a bill in to make sure those presumptives are
    included in the Care program.
        [Applause.]
        Mr. Oxford. Sir, we support that bill and we would just
    specifically call on the VA to approve those four new
    presumptives--bladder cancer, hypertension, hyperthyroidism,
    and Parkinson-like symptoms. Those are symptoms that we face
    every day. So, I just want to thank you for that bill.
        Senator Tester. Thank you for your leadership.
        Chairman Takano. Thank you, Senator Tester. I now call on
    Mr. Bost for 3 minutes.

                        REPRESENTATIVE MIKE BOST

        Mr. Bost. Thank you, Mr. Chairman, and Commander, thank
    you. Thank you for your service. Thank you for being here.
    Semper fi. Not to be outdone by the Ranking Member, I also am
    very much up on my dues at the Paul Stout, in Murphysburo,
    Illinois.
        But, let me also say hi to all the members out there from
    Illinois. If you want to just stand up, raise your hand, we
    would like to recognize you. Thank you for being here.
        [Applause.]
        Mr. Bost. It was brought up about the Blue Water Navy, and,
    you know, we have done a lot of things these last couple of
    years to improve in a lot of areas, but getting that done, I
    want to thank the members at this dais that were involved with
    that, and how long and how hard they worked on that. You know,
    I have been there 5 years, 6 years, and we finally got that
    done.
        But, it is only as good as, the law itself, unless it is
    implemented correctly, so I need to find out what are you
    hearing on the ground about how quick they are reaching out to
    this long-overdue ability for these veterans, that were on the
    ships off Vietnam, there in the South China Sea, how are they
    being reached out and how fast is that going?
        Mr. Oxford. Sir, can I pass that over to Chairman Bozella?
        Mr. Bost. You bet.
        Mr. Bozella. Thank you, Commander. Senator Bost, that is a
    very important question, because since the Blue Water Navy bill
    was passed last year, we have been asking veterans in all of
    our communities to file a claim now, even though VA was not
    going to start adjudicating those claims until January 1, 2020.
    So, we are collecting that information.
        The second thing we asked was that VA health care, VA
    hospitals would begin allowing those veterans, whether they
    were eligible or not, to get in their hospitals, pending the
    fact that they have a claim on Blue Water Navy presumptives,
    and so that we could get these people seen. Now some hospitals
    were doing that and some were not. Those that were, we have
    people that are actually being seen.
        So, the anticipation is high and veterans are waiting now
    for the claims to be adjudicated. They are waiting for this.
        Mr. Bost. Ok. Good. Any suggestions you have at all for
    speeding the process up, that we could give to the Secretary.
        Mr. Nuntavong. Congressman, I think that the claims process
    needs to be done appropriately. We do not want to rush things
    and have things overlooked. So, we ask that they be done
    accurately.
        Mr. Bost. On a positive note, there was a guy that I have
    known and have worked with, and was in the trucking business
    for years, and I can remember when he had one truck, and he was
    a Vietnam veteran. Not knowing this, his son talked to me just
    the other day and said they reached out to him. He did not
    reach out to them. He had tried to claim several years ago and
    they called him up and he was getting treated, and he has had
    all the problems you can imagine from Agent Orange.
        Thank you all for being here today. My time has expired.
        Chairman Takano. Thank you, Mr. Bost.
        I now recognize Mr. Pappas for 3 minutes.

                      REPRESENTATIVE CHRIS PAPPAS

        Mr. Pappas. Thank you very much, Mr. Chairman. Commander,
    thank you for your testimony, and I want to thank the
    leadership of the Legion and the Auxiliary as well as the
    members who are here who have been communicating the message
    very powerfully to us on the Hill, about your priorities. We
    stand with you and want to continue to work with you all.
        If there are folks here from my State of New Hampshire I
    would love to see you stand up and take your applause. If not--
    oh, here we go.
        [Applause.]
        Mr. Pappas. Thank you for your service. I like to say we
    support our vets as good as anywhere else in this country, if
    not better, and the support that exists across our State is
    really evident when you are out there.
        One of the things that I have been focused on, in our
    Oversight Investigation Subcommittee is VA provider payments,
    and I was appreciative that you mentioned that. If we are going
    to see MISSION Act succeed and really see community care as a
    force multiplier for VA we have got to make sure we have
    adequate networks and make sure these bills are paid. But, we
    also have to stand firm against privatization, and so I am glad
    that you mentioned that as well.
        One of the other things our subcommittee has dealt with, in
    a legislative hearing yesterday, is the issue of benefit
    overpayments, which places an undue burden on our veterans.
    These are vets who do everything right and are not expecting to
    be overpaid, and then are, you know, hit with a letter and a
    bill and have their credit scores dinged.
        So, I know the Legion has worked directly with some of
    these vets, and congressional offices have as well. Could you
    speak to the burden that these overpayments place on our
    veterans?
        Mr. Oxford. Yes, sir. I would be happy to do that. We have
    visited many VA hospitals across the country. We continue to
    believe the VA is the best care anywhere. We continue to hear
    issues like lack of payments and those kinds of issues that
    delay payments to providers.
        I would like to ask Chairman Nuntavong about your question.
        Mr. Nuntavong. Congressman, the overpayment issue, a lot of
    our members may be reservists or National Guard, and they go on
    orders, and they are receiving VA benefits as well as their
    Guard and Reserve pay. VA needs to advertise more about letting
    them know that they are being put on active duty, and stopping
    the process before they become indebted. We have out in all the
    debt management centers, Legion folks that assist veterans at
    no cost, to help them facilitate and navigate through this. It
    is a difficult problem.
        Mr. Bozella. Mr. Representative, a very important issue
    with that, that we are tracking through our System Worth Saving
    program, is that these payments that were a huge problem under
    the previous Choice Act, we thought were going to go away.
    Well, they are still a problem with the new care in the
    community act. The veterans are getting collection notices as
    they are waiting for these payments to be processed, and then
    there is also an issue with the transference of records that
    may or may not be taking place on time.
        It is a critical issue as well as a financial issue, so we
    are very concerned about that.
        Mr. Pappas. Thank you very much for your comments, and best
    wishes in the organization's second 100 years, and I yield
    back, Mr. Chairman.
        Chairman Takano. Thank you, Mr. Pappas. I now call on
    Senator Tillis for 3 minutes.
        Senator Tillis. Thank you, Mr. Chairman. Thanks again for
    being here, Commander Oxford, and your lovely wife Frances. I
    know we talked about--I asked you where you were going to be
    next, and I do not think I could keep track of the number of
    places that you are traveling across the country. Thank you for
    that service and personal sacrifice.
        I want to, first off, we went through the legislative
    priorities with the delegation from North Carolina yesterday,
    and we met in my office before the hearing, and I agree with
    and want to help all of the legislative priorities that The
    American Legion has put forth. I think we have got to make
    progress on women's health, we have got to make progress on
    preventing suicide, and that progress absolutely is rooted in
    reaching out to veterans who are not connected to the VA.
        In fact, I left my meeting with you and went to meet with
    the League of Municipalities, and I have done it with the
    Association of County Commissioners in North Carolina. I said,
    ``Create a place where veterans can convene, so that we can
    find these other men and women who need service, and we can
    provide--and potentially--and will save lives.''
        The other thing I would like to really encourage all of the
    members of The American Legion is to make sure that you expect
    every Member of Congress to help you clear casework, instead of
    doing what you all do--you are stubborn and you see a task and
    you want to complete it--recognize many of us got elected so we
    could help veterans. If we are helping them, you are able to
    free your resources up to find the next one. Count me in, and I
    think every Member of Congress want to have their staff down in
    the State and here in Washington, helping clear casework.
        Now, I want to talk about toxic exposures. I chair the
    Personnel Subcommittee on Senate Armed Services and I have been
    a member of the Veterans Committee since I have been here, and
    I will continue to be as long as I am in service. I think one
    of the things we need to do is get ahead of the next Agent
    Orange.
        We still need to do right by those who were exposed to
    Agent Orange, but I think there is a whole area of information
    that we did not capture when men and women were serving that we
    have got to go back and figure out how to capture it in the VA,
    which will provide a better case and I think a faster track to
    presumptions, that age-old problem that we have when we are
    trying to get care to the veterans who deserve it.
        We are working, in my capacity on Personnel Subcommittee.
    We will have a hearing on what more information we can capture
    and the underlying health record, when the man or woman is
    serving, and make sure that that gets transferred to the new
    health record so that we can even potentially predict a problem
    before the veteran does. We do not want to stop until we are at
    that level where we are calling them up and think that you need
    care, and we may be aware, just based on the data, we may be
    aware of a problem that we can get ahead of. That is the best
    standard of care that we should work toward, and I will
    continue to work toward as long as I am in the Senate.
        [Applause.]
        Senator Tillis. The last thing I will leave you with is on
    May 9th, in North Carolina, we are hosting, in cooperation with
    the Library of Congress, a history project, where we are kind
    of connecting the dots on history but we are also making it a
    veteran's fair. We expect several hundred veterans to be there.
    We will get in touch with you all to make sure that you have
    good representation. I will have all of my caseworkers there,
    along with caseworkers from other congressional offices to live
    up to what I am telling you. We want to clear the caseload for
    you so you can go after the next crunch.
        Thank you all for your service in the past, your continued
    service, and God bless every one of you.
        [Applause.]
        Mr. Oxford. Thank you, Senator Tillis.
        Chairman Takano. Thank you, Senator Tillis. I appreciate
    your role on the Senate Armed Services Committee on the
    Personnel and Readiness Subcommittee. You are very
    strategically located. I hope that we can cooperate in a
    bicameral way, because I associate myself completely with your
    remarks about toxic exposure and your background in IT and how
    we can do that systematically. Given today's technology, I
    agree with you. We should be able to anticipate problems before
    they arise, and not repeat the 4-year delay that Vietnam
    veterans have experienced. I fully appreciate your remarks.
        Let me now call on Mr. Lamb for 3 minutes.
        Mr. Oxford. Mr. Chairman, may I address that burn pit
    issue?
        Chairman Takano. Go ahead, sir.
        Mr. Oxford. I think we have got to realize we have had
    millions of folks deployed in the global war on terror, and
    currently the DOD is working on maps of those burn pit
    locations. As we perceive and recognize that many people were
    exposed to those airborne toxins, we have got to lay the
    foundation for future claims, just like the Senator said. We
    need to presume exposure, because all of those folks were
    exposed to those toxins, and then just review the presumptive
    process as we go through that, and ensure veterans who need and
    deserve care get it.
        Chairman Takano. Well, thank you for that, Commander, and I
    understand the VSOs have formed a working consortium on the
    issue of toxic exposure and that you are all working on a
    comprehensive bill. I want you to know that on the House side
    that we are working aggressively to have roundtables, to
    broaden our understanding. I am asking that we come up with a
    master plan on how to address toxic exposures of all the
    generations of veterans out there.
        It is going to be a big bill and we need to build--I mean,
    by bill, I mean it is going to be a big price tag on all this.
    We owe this to our veterans, and we need to address this in a
    comprehensive way.
        Mr. Oxford. Thank you, sir. I would just like to add, we
    support Senators Manchin and Sullivan's Senate 2950, so that
    might be the bill that you are talking about.
        Chairman Takano. Wonderful. Wonderful.
        Well, I now call on Senator--Congressman Lamb for 3
    minutes. Congressman Lamb.

                       REPRESENTATIVE CONOR LAMB

        Mr. Lamb. Thank you, Mr. Chairman. Thank you all for being
    here. I want to especially thank Paul Kennedy and Carl Curtis,
    my constituents from western Pennsylvania. I think Paul is
    still here. They had a great visit to my office yesterday. Both
    are a huge presence in the lives of veterans in western
    Pennsylvania and do a great job keeping me and my staff
    informed as to what is going on. I really appreciate their
    work.
        I think that yesterday they really emphasized the role that
    the Legion plays in sitting down with veterans, especially
    newer members of the Legion, to just kind of talk about their
    experiences and do a lot of that one-on-one, guard-your-buddy
    type of intervention that is so important if we are ever going
    to get ahead of the problem of mental health and suicide and
    drug abuse that we still see among our veterans.
        I just want to thank all of you and let you know that we do
    see the role that you are playing and we want to help you play
    it even more.
        The good news, and something you can go home and tell your
    members, if they are asking what happened in Washington, DC,
    this week, yesterday the House of Representatives passed the
    Freed Veterans Act, which was a bill designed to make it
    automatic that 100 percent disabled veterans have their student
    loans forgiven, which is a great thing.
        [Applause.]
        Mr. Lamb. Absolutely, and it was a--the most important
    thing about how this came to be was that we had a lot of
    cooperation from both Republicans and Democrats and cooperation
    between the House of Representatives and the White House on
    this same policy, which is very rare down here but it does
    happen.
        Now, you know, we found out 100 percent disabled veterans
    have actually been eligible for this relief for quite some time
    but they weren't taking advantage of it because there was all
    this paperwork and they had to apply. It was like 20 percent of
    people were taking advantage of something, and 25,000 of these
    veterans were in default on their student loans, so they were
    at real risk to their credit.
        Now it is going to be the job of the government to make
    sure they get this relief without having to actually apply for
    it. It will be automatic. So, that was a big victory, and to
    any Senators that we have remaining here, plus Senate staffers,
    you will be seeing that bill coming over from us pretty soon. I
    just hope you will give it a good look and maybe we can move it
    forward.
        I wanted to revisit quickly what Senator Tester was talking
    about with the four presumptive conditions. He had folks in
    here raise their hand just if they had served in Vietnam. I
    would like you to raise your hand if you know anyone with one
    of those four conditions--hypertension, Parkinson-like
    syndrome, thyroid cancer, and I am blanking on the fourth.
        Ms. Bryant. Bladder cancer.
        Mr. Lamb. Bladder cancer. Thank you, Melissa. She is always
    on the ball--related to Agent Orange.
        [Show of hands.]
        Mr. Lamb. Yeah, so pretty much just as many hands as we had
    for Vietnam service, if not more. This is such a burden on the
    folks who are suffering from these conditions that is unfair,
    and the numbers are extremely high. So, please continue to work
    with us in advocating to those in the administration that they
    should add these.
        Just so you know, the VA is requesting a budget increase
    this year from Congress, a $22 billion budget increase, which
    is more--more money than it would cost to treat people with
    these four conditions as presumptive. It is not a question of
    there being no money, or, you know, a total scarcity. It is
    just a question of which veterans you are going to treat for
    what. The money is there. We just have to enact it into law and
    make sure these veterans get the treatment they deserve.
        Those are my only points. I am already out of time, and you
    all have answered any questions I had already, so thank you for
    coming and sharing everything with us.
        Mr. Chairman, I yield back.
        Chairman Takano. Thank you, Representative Lamb, for your
    advocacy on those four conditions.
        I now call on Congressman Cisneros for 3 minutes.

                      REPRESENTATIVE GIL CISNEROS

        Mr. Cisneros. Thank you, Mr. Chairman, and Commander Oxford
    and everybody else, thank you for being here this morning.
        I am a member of Post 277 in Placentia, California, and--
    well, thank you--but rather than paying my dues I actually
    became a lifetime member this year.
        [Applause.]
        Mr. Cisneros. Just take it out of the equation there, and
    that way I do not have to worry about it anymore.
        You know, this past weekend I was also in Brea, which is in
    my district. Brea, California, Post 181, celebrated their 100th
    anniversary this year. It was a great celebration, to get over
    there and kind of celebrate the achievements of that post and
    how long it has been serving veterans in the 39th District
    there of California.
        Commander, I want to bring up a subject about women
    veterans. They are the largest-growing demographic, you know,
    not only in the military but also become our largest
    demographic in the veterans. I would just really like your
    opinion on really what can we do to kind of get rid of some of
    these barriers and make sure that we are taking care of our
    women veterans going into the future.
        Mr. Oxford. Thank you, sir, for that question. As you
    mentioned, over 2 million female veterans. That is the fastest-
    growing population of people who participate in the Veterans
    Administration.
        First of all, we have got to recognize the contribution
    that women have made to the military services, that they
    continue to make, and to this country. We need to make sure the
    VA is responsive to the specific gender requirements. That
    includes diagnostic and treatment. Then we would also ask you
    to think about passing the Deborah Sampson Act. That should
    embrace those things we just talked about.
        But, we have got to recognize the contribution of female
    veterans, most of all.
        Mr. Cisneros. Thank you for that. You know, it is--I was
    down at the VA in Long Beach not that long ago, and really kind
    of talking to them, and really how they are trying to, you
    know, ramp up the care of the female veterans that are there.
    Yet, they still do not have an OB-GYN on staff. So, there is
    still a lot of ground that we need to make up and make sure
    that we are taking care of our women veterans.
        So, with that I just want to thank you all for your service
    and for being here today, and I yield back, Mr. Chairman.
        Chairman Takano. Thank you, Mr. Cisneros. Maybe you could
    consider some supplemental dues besides the lifetime.
        [Laughter.]
        Mr. Cisneros. I was forgetting to pay my dues every year so
    I thought I would just get right at it and take it out of the
    question, and I just became a lifetime member.
        Chairman Takano. Ok. You are at a place in life where you
    can do more, but whatever.
        [Laughter.]
        Chairman Takano. Senator Boozman, you are recognized for 3
    minutes.

                          SENATOR JOHN BOOZMAN

        Senator Boozman. Thank you, Mr. Chairman, and thank all of
    you all for being here. Where are my Arkansas folks? Very good.
    Thank you all so much.
        [Applause.]
        Senator Boozman. We appreciate you all and appreciate the
    great work that is going on in Arkansas, as all over the
    country. You know, you look out and you see so many of you
    here. That is a great statement in and of itself. The Committee
    works together in a very bipartisan way.
        I have had the opportunity to serve on the House Veterans'
    Affairs Committee and now the Senate, and that really has been
    the hallmark of both of those Committees and is carrying on
    now. We can work hard, we can do our thing, but if you do not
    have the grassroots, if you do not have you all, pushing hard,
    it just does not work.
        The other thing is we know who does all the work. A special
    thanks to the Auxiliary and all that you do.
        I would really like you to comment on a couple of things.
    Recently, in the Senate, and again, a companion bill in the
    House, Senators Tester and Moran, the John Scott Hannon
    Veterans Mental Health Care Improvement Act. We appreciate the
    fact that you all are supporting that. That is good
    legislation, getting us moving forward.
        One of the things that we were able to include is having
    some metrics. Right now we are measuring VA suicide by the
    amount of money that we are spending. We have greatly increased
    that but we are not reducing the amount of suicide. Then,
    access. Again, you know, greater access now but suicides are
    not coming down. So, we need the ability to actually measure
    what these programs are doing, get rid of the ones that are not
    working, you know, and then increase the others.
        Can you or some of your folks talk to us a little bit about
    how we can reach those veterans that are not part of the VA
    system? You know, about 20 are committing suicide and only 6 or
    so of those are actually in the system. What do we do to get to
    those that are not in the system?
        Mr. Oxford. If I might address that, sir. The American
    Legion Buddy Check program that we have is the best way that I
    know of to do that. We have got Legionnaires reaching out to
    other Legionnaires, just to say, ``Hey, how are you doing? Do
    you need anything? Can we help? Is there something we can do to
    help?''
        We also need to education--and this is a public education
    process, I think--to identify the veterans that are not
    involved with the Veterans Administration, and get them to
    enroll. That is the biggest thing we can do. You mentioned 20 a
    day--6 are enrolled but those other 14, that has got to be a
    public society issue, as we reach out to those veterans and
    say, ``It is Ok to ask for help. We need you to let us help
    you.''
        We also have our System Worth Saving. You mentioned
    metrics. Our System Worth Saving reviews, are constantly
    visiting VA hospitals to review those kind of metrics that you
    are discussing. The System Worth Saving site review is not an
    inspection. What we want to do is identify the good things that
    are happening and maybe identify some things that are not going
    so well, and provide that information back to Congress and the
    Veterans Administration. The metrics we have, we are using, so
    please continue to provide that information.
        Senator Boozman. Very good. Then, I will close with
    thanking you for your support of the Deborah Sampson issue
    which was expounded on earlier. Again, I would just second that
    as to how important that is, which we all know.
        Thank you, Mr. Chairman.
        Mr. Oxford. Thank you, sir.
        Chairman Takano. Thank you, Senator Boozman.
        I recognize Senator Sinema for 3 minutes.

                         SENATOR KYRSTEN SINEMA

        Senator Sinema. Thank you, Mr. Chairman, and good morning.
    Thank you to our witnesses for being here, and for all our
    veterans who have joined us today, especially those from
    Arizona.
        Commander Oxford, it was a pleasure working with The
    American Legion to pass the Legion Act, and I am so excited to
    be working with you again to establish a pilot site for Project
    Atlas in Arizona. This program is an innovative partnership
    between the VA, Philips Health *Care Systems, and The American
    Legion, and it is bringing remote telehealth exam rooms that
    connect veterans with the VA to regions where those connections
    are hard to establish.
        Arizona's rural veterans will be greatly served by this
    partnership, and thank you for your leadership with this
    effort.
        I share The American Legion's position that we must
    continue to improve access to care for military sexual assault
    survivors. Research has shown that peer support specialists are
    a significant factor for veterans seeking help with experiences
    such as military sexual trauma. Can you speak about the VA's
    peer support specialists and their impact on veterans seeking
    treatment for MST?
        Mr. Oxford. I would like to ask Director Bryant to address
    that question.
        Senator Sinema. Thank you.
        Ms. Bryant. Thank you, Senator. We recognize that peer-to-
    peer support is critical in navigating the VA, especially for
    survivors of military sexual trauma or assault. There is the
    potential of revictimization, retraumatization as you are
    retelling and recounting your stories repeatedly throughout
    that process. It is necessary for medical documentation, but we
    know that it can also be extremely painful to the veteran, and
    not just to women, but to me as well, because men are also
    survivors of MST.
        So, those peers that help you navigate the system are vital
    in going forth and having your service connection annotated in
    a way that is safe both the veteran, and they are in an
    inclusive environment where they are safe to share their
    experiences and then also receive the desperate care that they
    need.
        Senator Sinema. Thank you. Ms. Bryant, a follow-up
    question. What are some other steps that we in Congress can
    take to make military sexual trauma care more available to
    survivors throughout the military?
        Ms. Bryant. To make it more available to those throughout
    the military is, one, expanding what are doing in our community
    partnerships. We want to ensure that the provisions that are
    under the House version of the Deborah Sampson Act, that those
    possibly can get reconciled with the Senate version that is
    going forward, and thank you again to Senator Boozman for your
    support with the Deborah Sampson Act.
        But, there is a lot that we can continue to do to have our
    arms wrapped around those women and male survivors of military
    sexual trauma. We look forward to working with you and your
    staff on this further.
        Senator Sinema. Thank you so much. Commander Oxford, a
    skilled VA workforce is crucial to the delivery of care and
    services to veterans. Since fiscal year 2011, the VA Office of
    the Inspector General has listed human resources management in
    the top 10 nonclinical occupational shortage areas across the
    Veterans Health Administration. How do you think that this
    shortage impacts VA's ability to provide timely and quality
    care to our veterans?
        Mr. Oxford. As we tour the country, and we have been to
    several veterans hospitals, VA hospitals, we have seen several
    staff shortages because of lack of the ability to find and hire
    qualified professionals. In addition to that, I would like to
    ask Chairman Bozella to address the issue.
        Mr. Bozella. Thank you, Commander. Thank you, Senator. The
    H.R. problem of not enough providers is one of the number 1
    issues that we see within VA, but it goes beyond providers, as
    you suggested. The American Legion is trying to help VA with
    the onboarding process, for one issue, and onboarding, again,
    for health care providers as well as non-providers. It could
    take four to 6 months for somebody who has applied for a job in
    the VA to be able to finally accept that position, get on
    board, and be working at that particular facility.
        There is another problem with transference of jobs, and
    again, non-health care providers, it is a difficult process.
        That is the number 1 thing we think, outside of
    recruitment, that people have to work on, is how quickly can we
    get somebody into that job.
        Senator Sinema. Chairman, if I might follow up, what should
    the VA and Congress do to address that specific issue and other
    personnel challenges we face?
        Mr. Bozella. I believe there is a bill--I do not know where
    it is; it has not reached committee yet on the Senate side--
    that is looking at that as a pilot study, and I believe it is
    Senator Gardner who has put that forward. What we understand is
    that bill may be looked at soon. That is all I know about the
    bill at this point. But, that is a start. So, at least on a
    pilot you will be able to trial things to see how they are
    working and maybe if it becomes a well enough practice that
    could be replicated.
        Senator Sinema. Thank you. Commander Oxford, as the VA
    implements the expansion of the caregiver support program under
    the MISSION Act, what should it to do ensure a more holistic
    and inclusive support program for our caregivers?
        Mr. Oxford. Thank you for that question. I think first of
    all we have got to recognize the caregivers of all of the
    injured service men and women since the global war on terror,
    but we also need to recognize the caregivers from other
    periods, and there are several. But, these caregivers have been
    essential to the readjustment of those injured veterans during
    their time of need. As we think about caregivers we have got to
    realize they are saving us money. If a caregiver is providing
    those services at home then we do not have to pay somebody else
    to do it. So, it is a savings to us, and we just need to
    continue the oversight of that issue.
        Let me turn this over to Director Nuntavong for his
    comments.
        Mr. Nuntavong. Senator, thank you for your question. After
    a year to prepare, VA missed another mark in the MISSION Act
    deadline, implementing the expansion of these benefits to these
    caregivers. It is a shame that these individuals do not have
    access to the financial benefit that, by law, they deserve and
    they have earned, based on a technicality that VA themselves
    created with their IT issue.
        We would like to work with both Committees to draft
    legislation that will guarantee effective dates for these
    caregivers so they can be compensated appropriately, just like
    disability compensation, for these hardworking individuals.
        Senator Sinema. Thank you. Thank you all for your time
    being here, and, Mr. Chairman, I yield back.
        Chairman Takano. Thank you to Senator Sinema. I now turn
    the meeting back over to Chairman Moran.
        Chairman Moran [presiding]. Is there someone who has not
    been recognized?
        Chairman Takano. Everyone has been recognized and if we
    have another Senator coming in, I heard one is en route, but
    the question is yours, sir.
        Chairman Moran. Thank you very much.
        Commander, I, of course, have not had the benefit of
    hearing what you had to say, and so I would not intend to ask
    questions that might cause either your testimony or answers to
    my colleagues' questions to be repeated. But, I guess I would
    want to give you the opportunity in my presence to make any
    statement or any request that you specifically would like, or
    to reiterate to my colleagues what you would like for me and
    others to know.
        Mr. Oxford. Yes, sir. Thank you for that opportunity.
    Before I conclude I would just like to reiterate three
    important issues. First of all would be Agent Orange. It is
    time to end the unnecessary delays and give those veterans the
    care they deserve, and it is imperative the Secretary approves
    the presumptives that we have talked about, being recommended
    for bladder cancer, hypertension, Parkinson-like symptoms, and
    hyperthyroidism.
        Second of all would be the issue we just discussed,
    caregivers, continued oversight on the expansion of the VA
    program, Comprehensive Assistance for Family Caregivers, under
    the caregiver support program, to ensure those folks are
    provided the care that they need and deserve.
        Our World War II veterans, The American Legion has been
    working with Senator Menendez's office to draft legislation to
    accomplish this, and we are looking for cosponsors to ensure a
    bipartisan bill before introduction. That would end means
    testing for World War II veterans to receive VA benefits.
    Congress has already done this for soldiers who served during
    the Mexican Border War and World War I, and it is only fitting
    that the Greatest Generation should be exempt from means
    testing to become enrolled.
        The American Legion would urge Congress to pass a
    bipartisan bill to address this issue immediately.
        Senator, if I might, before I leave, I would like to
    correct a major mistake that I made. I would like to introduce
    my wife before we go too far along.
        [Laughter and applause.]
        Mr. Oxford. Thank you for that opportunity, Senator.
        Chairman Moran. Commander, I wanted to see how you operated
    under fire, and I was hoping to deny you that request----
        [Laughter.]
        Chairman Moran [continuing]. So that I could learn more
    about the man. We are honored to have your spouse, your wife
    here with you, and we thank her for her service and support of
    you and The American Legion.
        Let me ask a final question and then we will conclude. I
    want to know how we can--what are the criteria, the metrics
    that we can use to determine the long-term effect of veterans'
    interaction with VA? How is the VA doing, not just today but
    are there measures that would tell us that, in the long run,
    the VA is on the right path and veterans are getting the care
    and attention that they deserve and are entitled to?
        Mr. Oxford. Well, Senator, I am going to take a little
    personal privilege here. Our System Worth Saving reviews are
    the best way to do that. We visit VA hospitals regularly, and I
    think we currently have 18 visits scheduled. We visit we look
    for things that are going well, things that are not going well,
    and provide that information back to you and the VA.
        As we move forward, those metrics are out there. We are
    looking at those kinds of things regularly, and we will
    continue to do so, and invite you or your staff to participate
    any time.
        Chairman Moran. I was waiting to see if you had
    instructions.
        Mr. Oxford. Well, I have just got one more piece of
    instruction. The veterans that we talk to really think the VA
    is the best care available. We prefer the VA. So, if there is a
    way we can continue to do that, that is the right answer.
        Chairman Moran. I thank you for that answer, and it
    corresponds with my view that I learn the most when I am
    talking to veterans at all stages of their care and treatment,
    all stages of their life, how they are being cared for. It is
    an opportunity for us to get the best information, and I thank
    you for that.
        I certainly would make clear to you that while we were--I
    was fully engaged in this Committee, the Senate Committee, and
    the Senate passed the MISSION Act, in my view it is nothing to
    replace the VA. It is fully to augment the VA in providing care
    and services for those who, in their best interest, need
    another venue.
        My views are often reflective of my days as a House member,
    although still as a Kansan my House days I represented a
    congressional district as large as the State of Illinois. No VA
    hospital. Hours and miles are a huge component of the way I
    look at how do we get services to people in certain
    circumstances.
        But, despite that bias, in that regard, I want to do
    everything I can to make certain that veterans are cared for
    within the VA. Again, we are looking for the best interests and
    give veterans some options. I appreciate that opportunity.
        Finally, I would say that I appreciate the role that The
    American Legion played in the original GI Bill, and I
    appreciate the role that a Kansan had in its creation and
    enactment. An American Legion member from Emporia, KS, wrote
    down on a napkin the ideas of a GI Bill, and we had a President
    named Eisenhower who made it into law, and we take great pride
    in that history of our State.
        It may appear that I am stalling, and my stall has been
    successful.
        [Laughter.]
        Chairman Moran. Senator Sullivan has been recognized.

                          SENATOR DAN SULLIVAN

        Senator Sullivan. Mr. Chairman, thank you for stalling.
    Sorry. We have a number of hearings going on this morning, but
    fortunately one of the hearings I was just in, in the Commerce
    Committee, my colleague sitting next to me was Senator Moran,
    who happens to be the Chairman of this wonderful Committee in
    the Senate. When he left I said, ``Hey, can you tap dance a
    little bit for me until I can get there?'' So, thank you, Mr.
    Chairman, for that stalling.
        I want to first do--you know, I learned that this hearing
    is so popular that there has to be tickets for is. It is like a
    rock concert or something. I want to do a shout-out. I know
    that there are more Alaskans here, but do we have at least two
    of my fellow Alaskans in the audience here? How about a thank
    you and a round of applause.
        [Applause.]
        Senator Sullivan. They usually get the award for the
    furthest travel, and we like to acknowledge our State as having
    more vets per capita than any State in the country, so I want
    to thank them for that.
        Well, I want to thank our leadership here, and I do want to
    mention it is great to see our Commander is a fellow U.S.
    Marine, so Commander, thank you, sir.
        I also want to just express my appreciation to The American
    Legion for having officially endorsed the legislation that
    Senator Manchin and I have introduced, S. 2950. That is the
    Veterans Burn Pit Exposure Recognition Act. Commander, perhaps
    you can say a word on that.
        The whole point of this legislation, having been through,
    for our incredible Vietnam vets, the Agent Orange, the Blue
    Water Navy, all of these issues where, let's face it, Congress
    was playing catch-up for way too many years, decades. Our
    veterans were waiting, waiting, waiting. Many died before there
    was direct action. What we are trying to do with this burn pit
    legislation is get in front of an issue that we know is going
    to impact the next generation of our veterans.
        So, that is the goal, and I am very honored, Commander,
    plus the rest of the leadership here, that you are supporting
    the legislation. It is getting a lot of momentum, Mr. Chairman,
    we are hopefully going to move it out of the Committee in the
    Senate and House and get it passed into law here soon.
        But, sir, can you comment on that?
        Mr. Oxford. Yes, sir. I would be happy to. Sir, if you need
    a ticket, let me know and I will get you a ticket.
        [Laughter.]
        Mr. Oxford. I would also like to say semper fi, always and
    forever.
        We do support S. 2950, sir, so just look forward to working
    with you on that as we move forward.
        But, when we think about burn pits, we are facing similar
    questions as we did with Agent Orange. We have got to assume
    that the millions of people deployed to the global war on
    terror are facing those kinds of airborne toxins that we saw
    with Agent Orange, and it is primarily because of burn pits.
        The DOD has started the process of drawing maps and
    establishing locations of those burn pits, so we will have a
    way to assume those presumptives. That is what we have got to
    do is presume the exposure to those airborne toxins and then
    just review the process to make sure those veterans who need
    and deserve care get it.
        Senator Sullivan. Great. Mr. Chairman, if I may, one final
    thing on that. What we have been trying to do on this is work
    with, of course, the VSOs, right, all of you, but also with the
    VA. So, we want to make sure this is collaborative with
    everybody--our veterans, first and foremost, the Congress, in a
    bipartisan way--and the VA. That is the goal here and we are
    hopeful that we can move that soon.
        So, thanks again for all of your great service, every
    member here, and it is an honor to serve all of you.
        Chairman Moran. Senator Sullivan, thank you. Thank you for
    your extraordinary effort to get here and to be able to spend
    time with The American Legion.
        Commander Oxford, I would give you a final opportunity if
    there is anything else you forgot to say today, to do so.
        Mr. Oxford. Thank you for that opportunity, sir. It is just
    a privilege and a pleasure to be able to sit before you and
    represent the 1.8 million Legionnaires from across the country.
    It is just an honor to be here, and thank you for the
    opportunity. We so much appreciate our opportunities to work
    together, and continue to offer American Legion help, and
    anything else we can do to help you do your job because you are
    helping us do our job so much.
        Chairman Moran. Commander, thank you for that. Thank you
    for your presence here today. Thanks for your leadership team
    and all the members of The American Legion and the Auxiliary
    who are present with us. I know many traveled long distances
    for the purpose of making their case to Members of Congress,
    and we welcome that.
        I also would thank you, as Congressman Roe did, for the
    expertise and the team that you have here on a daily basis that
    work with our Committees to provide us with information and
    input and to see that we do our jobs better. I am grateful for
    their help.
        I would now ask unanimous consent that members have five
    legislative days to revise and extend their remarks and include
    any extraneous material.
        With that, without objection, so ordered, and the hearing
    is now adjourned.
        [Applause.]
        [Whereupon, at 11:25 a.m. the Committees were adjourned.]

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