[Joint House and Senate Hearing, 117 Congress]
[From the U.S. Government Publishing Office]





                                                        S. Hrg. 117-744
 
                    LEGISLATIVE PRESENTATION OF THE
                       DISABLED AMERICAN VETERANS

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

                             JOINT HEARING

                                 OF THE

                     COMMITTEE ON VETERANS' AFFAIRS

                               BEFORE THE

                     U.S. HOUSE OF REPRESENTATIVES

                                AND THE

                              U.S. SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             SECOND SESSION

                               __________

                             MARCH 1, 2022

                               __________

      Formatted for the use of the Committee on Veterans' Affairs
      
      
      
      
      
     [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]  
      
      
      


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


             U.S. GOVERNMENT PUBLISHING OFFICE 
 53-629PDF           WASHINGTON : 2023    
        
        
        
        
        
                 SENATE COMMITTEE ON VETERANS' AFFAIRS

                     Jon Tester, Montana, Chairman

Patty Murray, Washington             Jerry Moran, Kansas, Ranking 
Bernard Sanders, Vermont                 Member
Sherrod Brown, Ohio                  John Boozman, Arkansas
Richard Blumenthal, Connecticut      Bill Cassidy, Louisiana
Mazie K. Hirono, Hawaii              Mike Rounds, South Dakota
Joe Manchin III, West Virginia       Thom Tillis, North Carolina
Kyrsten Sinema, Arizona              Dan Sullivan, Alaska
Margaret Wood Hassan, New Hampshire  Marsha Blackburn, Tennessee
                                     Kevin Cramer, North Dakota
                                     Tommy Tuberville, Alabama

                      Tony McClain, Staff Director
                 Jon Towers, Republican Staff Director

                              ----------                              

        HOUSE OF REPRESENTATIVES COMMITTEE ON VETERANS' AFFAIRS

                   Mark Takano, California, Chairman

Julia Brownley, California           Mike Bost, Illinois, Ranking 
Conor Lamb, Pennsylvania                 Member
Mike Levin, California               Aumua Amata Coleman Radewagen, 
Chris Pappas, New Hampshire              American Samoa
Elaine G. Luria, Virginia            Jack Bergman, Michigan
Frank J. Mrvan, Indiana              Jim Banks, Indiana
Sheila Cherfilus-McCormick, Florida  Chip Roy, Texas
Gregorio Kilili Camacho Sablan,      Tracey Mann, Kansas
    Northern Mariana Islands         Barry Moore, Alabama
Lauren Underwood, Illinois           Nancy Mace, South Carolina
Colin Z. Allred, Texas               Madison Cawthorn, North Carolina
Lois Frankel, Florida                Troy E. Nehls, Texas
Elissa Slotkin, Michigan             Matthew M. Rosendale, Montana
David J. Trone, Maryland             Mariannette Miller-Meeks, Iowa
Marcy Kaptur, Ohio                   Jake Ellzey, Texas
Raul Ruiz, California
Ruben Gallego, Arizona

                       Matt Reel, Staff Director
               Maria Tripplaar, Republican Staff Director
                            C O N T E N T S

                              ----------                              

                             March 1, 2022

                                                                   Page

                                SENATORS

Tester, Hon. Jon, Chairman, U.S. Senator from Montana............     1
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas......     4
Hirono, Hon. Mazie K., U.S. Senator from Hawaii..................    15
Blumenthal, Hon. Richard, U.S. Senator from Connecticut..........    17
Cassidy, Hon. Bill, U.S. Senator from Louisiana..................    18
Murray, Hon. Patty, U.S. Senator from Washington.................    20
Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire......    27
Sinema, Hon. Kyrsten, U.S. Senator from Arizona..................    29

                            REPRESENTATIVES

Takano, Hon. Mark, Chairman, U.S. Representative from California.     2
Bost, Hon. Mike, Ranking Member, U.S. Representative from 
  Illinois.......................................................     5
Brownley, Hon. Julia, U.S. Representative from California........    16
Rosendale, Hon. Matthew, U.S. Representative from Montana........    19
Pappas Hon. Chris, U.S. Representative from New Hampshire........    21
Miller-Meeks, Hon. Mariannette, U.S. Representative from Iowa....    23
Mrvan, Hon. Frank, U.S. Representative from Indiana..............    24
Cerfilus-McCormick, Hon. Sheila, U.S. Representative from Florida    25
Sablan, Hon. Gregorio Kilili Camacho, U.S. Representative from 
  Northern Mariana Islands.......................................    25
Gallego, Hon. Ruben, U.S. Representative from Arizona............    26
Banks, Hon. Jim, U.S. Representative from Indiana................    31

                   INTRODUCTION OF ANDREW H. MARSHALL

The Honorable Mark Takano, U.S. Representative from the State of 
  California.....................................................     5

                               WITNESSES

Andrew H. Marshall, National Commander, Disabled American 
  Veterans.......................................................     6

  accompanied by

  J. Marc Burgess, National Adjutant, Disabled American Veterans

  Barry Jesinoski, Executive Director, National Headquarters, 
    Disabled American Veterans

  Edward R. Reese Jr., Executive Director, Washington 
    Headquarters, Disabled American Veterans

  Jim Marszalek, National Service Director, Disabled American 
    Veterans

  Joy Ilem, National Legislative Director, Disabled American 
    Veterans

  John Kleindienst, National Director, Voluntary Services, 
    Disabled American Veterans

                                APPENDIX
                           Prepared Statement

Andrew H. Marshall, National Commander, Disabled American 
  Veterans.......................................................    41


                    LEGISLATIVE PRESENTATION OF THE



                       DISABLED AMERICAN VETERANS

                              ----------                              


                         TUESDAY, MARCH 1, 2022

             U.S. House of Representatives,
                                   and U.S. Senate,
                            Committee on Veterans' Affairs,
                                                    Washington, DC.
    The Committees met, pursuant to notice, at 10 a.m., in Room 
210, House Visitors Center, Hon. Jon Tester and Hon. Mark 
Takano, Chairmen of the Committees, presiding.

    Present:

    Representatives Takano, Brownley, Lamb, Pappas, Mrvan, 
Cherfilus-McCormick, Sablan, Underwood, Allred, Gallego, Bost, 
Banks, Rosendale, Miller-Meeks, and Ellzey.

    Senators Tester, Murray, Brown, Blumenthal, Hirono, Sinema, 
Hassan, Moran, Cassidy, and Tillis.

        OPENING STATEMENT OF HON. JON TESTER, CHAIRMAN,
                   U.S. SENATOR FROM MONTANA

    Chairman Tester. Good morning, and I want to welcome the 
leadership of the Disabled American Veterans to the hearing 
today. We are honored to have you here.
    Congress relies on the DAV and your team of advocates in 
Washington to keep us apprised of how we are meeting the needs 
of veterans. I know that addressing toxic exposure in a 
comprehensive manner has been a longstanding issue for the DAV. 
It is a longstanding priority for me too.
    Last year, I vowed to work across the aisle to deliver 
bipartisan, comprehensive toxic exposure reform. After 
consulting with the VA on a path forward, and with my friend 
Ranking Member Jerry Moran, we have developed a three-phased 
approach for getting this done. That includes offering life-
saving VA health care to more combat veterans, including those 
suffering from conditions caused by toxic exposures.
    It also includes improved training on toxic exposures for 
VA employees and more investment into research. And, together, 
we continue to work closely with the VA to build upon their 
efforts to establish and improve a presumption process that is 
more fair, more transparent, and more timely for our veterans.
    And the time is long past for us to provide benefits to 
previous generations of toxic-exposed veterans, including the 
establishment of new presumptions of service connection. We 
started this fight and, together, we will finish it.
    I also want to thank the DAV for their input in support of 
my bipartisan Servicemembers and Veterans Empowerment and 
Support Act, which would improve access to care and benefits 
for MST survivors, many of whom were wrongly denied.
    Ranking Member Moran and his team have been great partners 
on this bill and I am hopeful it will pass the Senate very 
soon.
    In addition, mental health and suicide prevention must 
remain a top priority. We need to expand mental health care 
access for more veterans and increase VA's capacity to meet 
those needs. This means strengthening the Veterans Crisis Line 
through the bipartisan REACH for Veterans Act and making sure 
VA is well-resourced to provide both inpatient and outpatient 
mental health care, including the highly trained staff to 
deliver it, through the Post-9/11 Veterans Mental Health Care 
Improvement Act, another top priority of mine.
    Commander Marshall and team, we obviously have a lot left 
to do and your voice is invaluable as we prioritize our 
efforts. We want to thank you for your work that you do every 
single day on behalf of disabled veterans across this Nation, 
and we stand by to hear your marching orders.
    I just want to close with one thing. I have always said in 
these sessions before and I will say it again today, this 
committee takes its direction from the Veterans Service 
Organizations and the people you represent. Your testimony here 
is very, very important as we schedule the remaining agenda in 
this Congress, and I appreciate you being here.
    And I also appreciate my friend Joe Parsetich, who happens 
to be watching this today from the great State of Montana.
    Thanks, gentlemen and ladies.
    With that, I will turn it over to Chairman Takano for your 
opening remarks.

        OPENING STATEMENT OF HON. MARK TAKANO, CHAIRMAN,
              U.S. REPRESENTATIVE FROM CALIFORNIA

    Chairman Takano. Well, thank you, Senator Tester.
    It is an honor to join all the members of the House and 
Senate Committees on Veterans' Affairs virtually and in person 
to hear directly from the National Commander and 
representatives of the Disabled American Veterans. I would like 
to welcome all DAV members who have joined us online today as 
well. And a special hello to my friend Richard Valdez in the 
Inland Empire of California.
    The opportunity to hear from our VSO partners is incredibly 
important to me. I was encouraged to see the overwhelming 
support that DAV and other VSOs provided last Thursday in a 
letter to House leadership supporting the Honoring Our PACT 
Act. This is a very exciting and busy week where we are going 
to debate and pass the PACT Act, and I want to personally thank 
you for the tremendous support you have provided during this 
process.
    I would like to submit the letter from our VSO partners 
into the record, if there is no objection.
    Chairman Tester. Without objection.
    Chairman Takano. I would also like to express my thanks to 
Senator Tester for his continued efforts to work with me on 
this issue.
    Our bipartisan bill finally provides access to VA health 
care to over 3.5 million veterans exposed to toxic substances. 
It requires that VA presumes veterans were exposed to toxic 
substances rather than placing the burden on veterans to prove 
this link themselves.
    Vietnam veterans waited more than 40 years for benefits 
related to Agent Orange exposure because of Congress' piecemeal 
solutions. Toxic-exposed veterans have held up their part of 
the pact and they deserve our action.
    This week, we are keeping our promise and I look forward to 
continuing to work with the Senate to make this the law of the 
land.
    VSO partners like DAV represent veterans and their families 
at all stages of life and service. Hearing from these partners 
allows the committees the opportunity to hear directly about 
what is most important to your members and how we can be of 
service to our Nation's veterans. In the last Congress, 
together we secured several important wins for veterans, 
including passing the Blue Water Navy Vietnam Veterans Act, the 
Deborah Sampson Act, the Veterans COMPACT Act, and the 
Commander Scott Hannon Act.
    I am very proud of these accomplishments, but they are only 
the beginning. We need to build on these achievements and 
continue our fight for better health care and benefits in this 
Congress and beyond.
    Reading your testimony, it is clear your priorities are 
aligned with mine. My committee's top priorities for this 
Congress include creating a more inclusive and welcoming VA; 
building equity for an increasingly diverse veteran community; 
reducing veteran suicide; addressing toxic exposure; ensuring 
student veterans receive quality education; advocating for 
women veterans; modernizing VA; supporting VA's long-term care 
facilities; improving the VA's management and oversight; and 
ensuring our legislative accomplishments are implemented 
effectively.
    Our diverse veteran community includes higher numbers of 
women, LGBTQ+, Black, Asian, Hispanic, and Native veterans than 
ever before. It is our country's diversity that strengthens our 
Armed Forces and veteran communities, and minority veterans 
deserve to feel safe and welcome when they enter through its 
doors, with outreach, programming, and solutions that address 
their unique needs.
    Now, additionally, VA must acknowledge the diversity of its 
workforce to address systematic discrimination in the 
workplace. We must ensure that health care and benefits are 
fairly and equitably distributed to all eligible veterans and, 
to do that, we must also ensure a safe and equitable workplace 
for VA employees.
    Our work to prevent veteran suicide continues. We must 
relentlessly pursue well-researched and scientifically sound 
policies that are proven to prevent suicide.
    We have big goals, but I know that with your support and 
insight here today, along with the support of the 
Administration, we will be able to deliver on them and fulfill 
the promises we have made to our Nation's veterans. I look 
forward to hearing your testimony today.
    I fully associate myself with the sentiments of Chairman 
Tester in regard to the absolute paramount importance of your 
testimony and the situation of our VSOs in terms of the respect 
that they carry with the American people. Your word means a lot 
here on Capitol Hill. We are honored to hear from you today. I 
thank you for your continued advocacy and your support for the 
veterans community.
    I yield back, Mr. Chairman.
    Chairman Tester. Thank you, Chairman Takano.
    Ranking Member Moran.

             OPENING STATEMENT OF HON. JERRY MORAN,
            RANKING MEMBER, U.S. SENATOR FROM KANSAS

    Senator Moran. Chairman Tester, thank you very much. It is 
good to see Ranking Member Bost and Chairman Takano, for us to 
be back together in this setting.
    And welcome to our DAV witnesses this morning, and all who 
are watching here and at home. I say a particular hello to the 
DAV members tuning in today from Kansas and I appreciate the 
opportunity last night to spend time in my office with Kansas 
Commander Karen Hansen, Junior Vice Commander Ron Boykins, 
Senior Vice Commander James Bunker, and Adjutant Eric Owens.
    And, Commander, it was a pleasure to spend time with you 
and your team as well.
    I want to thank the DAV leaders for being here today in 
person, and thank each of you for your great passion and 
expertise that you have in supporting veterans, their families, 
and our survivors.
    We are accomplishing a lot working together in recent 
years. Our legislation helped reduce veteran suicide; improve 
access and choice in health care; resources to improve 
disability claims and appeals process; educational benefits, 
protections, and expansions; and flexibility to assist veterans 
through COVID-19 pandemic. I expect these bipartisan efforts to 
continue in the second half of this Congress, and I know DAV 
will continue to be an important advocate and resource as we 
continue to work on measures addressing toxic exposure and the 
disability claims backlog.
    As most of you all know, however, the real measure of 
success is not simply passing legislation. I often tell people 
who thank me for my efforts, I wish you could thank me for my 
results, and we need to ensure the effective execution of laws 
that we have passed and seeing concrete results that are 
efficient, effective, and in the best interest of America's 
veterans.
    This is especially true when we discuss how to 
appropriately address toxic exposure both on the health care 
side and the disability compensation side. I want to thank 
Chairman Tester and Ranking Member Bost for our work on the 
Health Care for Burn Pits Veterans Act, and I look forward to 
working with all four corners on a solution that is in the best 
interest of all veterans.
    Commander Marshall's and DAV's advocacy and partnership 
will be vital in these continued discussions and relationships 
as we work to get issues like toxic exposure, MST reforms, and 
disability compensation improvements across the finish line in 
the coming months and years.
    Before I yield back, I want to thank all of the U.S. 
service members currently serving in NATO countries, those back 
home at the First Infantry Division who are in Romania and 
Poland, those who have been recently deployed to the region, 
they and the people of Ukraine are in my thoughts, in our 
thoughts and prayers.
    And in conclusion, Commander, I thank you for your 
testimony and our friendship.
    And I yield back.
    Chairman Tester. Thank you, Senator Moran.
    Next up, virtually, we have Ranking Member Bost.

              OPENING STATEMENT OF HON. MIKE BOST,
       RANKING MEMBER, U.S. REPRESENTATIVE FROM ILLINOIS

    Mr. Bost. Thank you, Chairman. And I am glad to be here 
with you today to join in with Chairman Tester, Chairman 
Takano, Ranking Member Moran.
    And as we move forward, first off, let me say welcome to 
all of those Illinois veterans that are from DAV that are here 
with us today. Let me also say thank you to all the veterans. 
As many of you know, I am a veteran myself, the son and 
grandson of Korean War veterans, the nephew of a Vietnam 
veteran who had experienced the ultimate oxymoron that is--most 
of you veterans understand that, that is friendly fire. He is 
100-percent disabled, but doing very, very well. Also, my son 
is a Lieutenant Colonel, and my grandson is a Lance Corporal in 
the Corps at this time. So, semper fi to all of you out there 
that are Marines.
    And let me tell you that as we are moving forward together 
as the four corners, I want to associate my remarks with 
Ranking Member Moran on the fact that we need to work together 
on the toxic exposures to come to a bill that we can move and 
actually get across the finish line, and actually get it to the 
President's desk so that we can provide as much as we possibly 
can for our veterans, and I will strive to do that.
    Let me also say that, you know, I want to associate my 
remarks as well with the Chairman Takano on the fact of why we 
need to make sure we focus that the VA provides for our women 
veterans. They are the fastest growing group of veterans and we 
need to make sure that the services that are provided are 
beneficial to all and that everyone feels comfortable in 
entering the VA and dealing with any VA issues that are out 
there.
    We look forward to having the DAV have testimony today. We 
thank you for the leadership that is here to give testimony to 
us and we are looking forward to that testimony.
    And, with that, I yield back.
    Chairman Tester. Thank you, Congressman Bost. And now I 
will turn it over to Congressman--I mean, sorry about that, 
Chairman Takano for his introduction of the DAV National 
Commander.

           INTRODUCTION BY THE HONORABLE MARK TAKANO

    Chairman Takano. Well, I am pleased to introduce DAV's 
National Commander Andrew Marshall, who was elected to lead the 
one-million-member DAV, Disabled American Veterans, at their 
national convention in Orlando, Florida last August.
    Commander Marshall is a service-disabled combat veteran of 
the Vietnam War. He was twice wounded and medically retired 
from the U.S. Army after receiving the Bronze Heart, the Purple 
Heart with oak leaf cluster, and Army Commendation Medal with V 
Device.
    After leaving the military, he devoted most of his life to 
serving his fellow veterans, working for DAV for 41 years. He 
retired from DAV as a National Service Office Supervisor in St. 
Petersburg, Florida, and was also assigned to the DAV Judicial 
Appeals Office in Washington, DC, and was one of DAV's first 
National Area Supervisors.
    During his career, he has had a lasting impact on countless 
veterans' lives.
    As Supervisor of DAV's National Service Office in Bay 
Pines, Florida, Commander Marshall initiated a claim on behalf 
of a veteran that ultimately resulted in a change to the 
Department of Veterans Affairs policy by allotting multiple 
clothing allowances for amputees and other severely disabled 
veterans.
    He has been a member of DAV since 1975, and has been active 
leader at the chapter, State, and national levels. He is a past 
commander for the DAV Department of Florida and currently 
serves as the State's adjutant and executive director.
    He also served for three years on the Florida Veteran 
Advisory Council. Commander Marshall and his wife, Susan, who 
is here with us today and who continues to be his biggest 
supporter, live in Palm Beach--excuse me, Palm Harbor, Palm 
Harbor, Florida.
    It is my privilege to introduce DAV National Commander 
Andrew Marshall.

    STATEMENT OF ANDREW H. MARSHALL, ACCOMPANIED BY J. MARC 
 BURGESS, BARRY JESINOSKI, EDWARD R. REESE JR., JIM MARSZALEK, 
                 JOY ILEM; AND JOHN KLEINDIENST

    Mr. Marshall. Congressman Takano, thank you for that kind 
introduction.
    Chairman Tester and members of the Committees on Veterans' 
Affairs, thank you for providing me the opportunity to present 
the 2022 legislative program of DAV, Disabled American 
Veterans, an organization of more than one million members 
forever changed in wartime service.
    My written statement thoroughly details DAV's key 
legislative priorities for the 117th Congress, and reports on 
our many programs and accomplishments, so today I will just 
highlight some of our most crucial policy goals.
    I want to start by introducing my DAV colleagues joining me 
today. National Adjutant, Marc Burgess; National Headquarters 
Executive Director, Barry Jesinoski; Washington Headquarters 
Executive Director, Randy Reese; National Service Director, Jim 
Marszalek; National Legislative Director, Joy Ilem; National 
Voluntary Services Director, John Kleindienst.
    Though they couldn't be here today in person, many of DAV's 
members are together watching this hearing from our Annual 
Midwinter Conference just outside Washington, DC. I want to 
recognize the many DAV leaders who have been vital to our 
organization mission over the course of many years, including 
senior and junior vice commanders and leaders of the DAV 
Auxiliary.
    I also wish to extend my gratitude to our National 
Executive Committee and our National Legislative Interim 
Committee, as well as my Chief of Staff, Thomas Aiello, for all 
their support.
    Of course, I want to recognize our many dedicated DAV 
members across the country who are supporting us from their 
hometowns.
    And, finally, I wish to thank my wife, Susan, who remains 
my most steadfast supporter and partner.
    Messrs. Chairman, I am a combat-wounded Army veteran of the 
Vietnam War. I served as an airborne infantryman with the 
Americal Division in the Khe Sanh Valley in December 1970. But, 
after being wounded by friendly fire, I was transferred to the 
173rd Airborne Brigade.
    On patrol in January 1971, I was wounded again when I 
stepped on an IED. The explosion resulted in extensive damage 
to my left leg and foot, and I spent the next 15 months 
recovering at Walter Reed.
    Four years later, I began working for DAV as a National 
Service Officer and spent the next 4 decades advocating for my 
fellow veterans so they could have access to the health care 
and benefits they had earned.
    Early in my career, I met a Vietnam veteran named Tom who 
desperately needed help. Like so many, he struggled with PTSD 
and the lingering physical and psychological tolls of combat. 
His disability and demons became so severe he could no longer 
work. And, after VA denied his claim, Tom began contemplating 
taking his own life. I knew he was particularly vulnerable to 
self-harm and accompanied him to a meeting with his Vet Center 
counselor.
    DAV took on his claim, appealed, and ultimately won, 
providing him with additional financial support. With each 
small step, I could see the weight lift from Tom's shoulders. 
And, after VA acknowledged his trauma and granted him the 
benefits and care he needed, Tom never considered taking his 
own life again.
    Tom was saved by the right combination of life-saving 
factors, but there are far too many situations that have ended 
in tragedy.
    Messrs. Chairman, veterans' need for mental health services 
has grown substantially following two decades of wartime 
service.
    Today, VA's crisis line receives hundreds of thousands of 
calls, texts, and chat messages annually. In addition, VA's Vet 
Centers have seen a 35-percent uptick in the past 5 years. As 
these needs continue to grow, it is critical that Congress 
provide VA with all the mental health resources, staffing, and 
support necessary to prevent suicide.
    Messrs. Chairman, the VA MISSION Act was designed to 
increase VA's capacity to deliver care, both inside the VA and 
in the community. We know that most enrolled veterans prefer to 
receive their care directly from the VA and clinical studies 
continue to show that the quality of care provided by VA is as 
good as or better than that provided by the private sector. 
That is why it is critical that VA remain the primary provider 
and coordinator of health care for enrolled veterans even while 
continuing to improve the new community care network created by 
the VA MISSION Act.
    And, as we have seen over the past 2 years of the pandemic, 
VA has been one of the most successful and reliable health care 
systems in the Nation, providing timely access to care for more 
than nine million enrolled veterans.
    VA also provided help to other health care systems and non-
veterans under its fourth mission to provide support to the 
Nation during national emergencies, disasters, and wars.
    At the same time, VA is a national leader in medical care 
and training clinical professionals. That is why it is so 
important to maintain a robust VA health care system that is 
able to deliver a full spectrum of care.
    Messrs. Chairman, a key section of the VA MISSION Act was 
the creation of an asset and infrastructure review to develop 
and implement a plan to modernize and realign VA's health care 
infrastructure for the future.
    In just a couple weeks, VA will put forward its facility 
recommendations. In order for the process to be successful, VA 
must provide complete transparency of the data and assumptions 
used to make their facility recommendations, particularly the 
market assessments. With more and more veterans turning to VA, 
Congress must ensure it has the right health care 
infrastructure in the right locations to meet the rising demand 
for care.
    Messrs. Chairman, as VA works to increase its capacity to 
meet the physical and mental health care needs for those who 
served, it must continue to create an environment that is free 
from harassment. We must truly welcome all veterans.
    The VA has made notable strides to reduce harassment, 
including the introduction of bystander intervention for 
training staff and veterans. Congress must continue to oversee 
the implementation of VA's zero tolerance policy for harassment 
at all VA facilities.
    We also look to Congress to ensure that veterans who have 
experienced military sexual trauma are able to receive the 
benefits and services they deserve. For these veterans, 
fighting to prove their case to the VA, sometimes for years, 
takes a damaging emotional toll. We call on Congress to pass 
legislation that would codify evidentiary standards within the 
MST claims process, enhance communication with affected 
veterans, and improve VBA's training and procedures and expand 
mental health services for MST providers.
    Another way that VA supports seriously injured and ill 
veterans is by supporting their family caregivers. Thanks to 
the leadership's work in these two committees, the 
comprehensive caregiver program is expanding to veterans of all 
eras. However, according to VA, through January 6th of this 
year, over 86 percent of these new applicants have been denied 
eligibility. Clearly, something is wrong.
    A couple of weeks ago, Secretary McDonough announced VA was 
undertaking a comprehensive review of the program and new 
eligibility regulations that went into effect last year. We 
call on these committees to hold oversight hearings and work 
with VA to ensure severely disabled veterans who rely on family 
caregivers get access to these life-changing benefits.
    Finally, Messrs. Chairman, I want to take a few minutes to 
talk about the importance of Congress taking action to address 
a toxic legacy of burn pits and other exposures.
    As a Vietnam veteran and a DAV benefits advocate for 41 
years, I know the long-term negative health effects of Agent 
Orange. I lived through the long struggle before Congress and 
VA took action to recognize the damage from these toxic 
exposures. That struggle continues for some Vietnam veterans 
even today. It is long past due for VA to recognize that 
hypertension is associated with Agent Orange exposure and, if 
VA won't act, then Congress must do so through legislation.
    Unfortunately, the same inaction has plagued generations of 
veterans suffering from conditions linked to other toxic 
exposures like radiation, contaminated water, and burn pits.
    After years of work by DAV and other veterans 
organizations, together with good faith efforts by leaders of 
these committees on both sides of the aisle, Congress may 
finally be nearly decisive action, but only if you work 
together.
    Later this week, the House will be voting on the PACT Act, 
the most comprehensive legislation on burn pits and toxic 
exposures ever introduced. For members of the House, we urge 
you to vote yes on passage of this bill and to oppose any 
amendments that would weaken or limit this legislation.
    The Senate has taken critical steps toward the same goal, 
though with a different tactical approach. Last month, the 
Senate passed legislation to expand health care coverage for 
combat veterans, and this committee is working on at least two 
additional bills to create a legal framework and establish new 
presumptions related to burn pits. We urge all Senators to 
continue working in good faith to pass the most comprehensive 
package of burn pit and toxic exposure bills possible in the 
Senate.
    Ultimately, it will take true bipartisan for the House and 
Senate to reach a compromise on significant legislation to be 
approved before the end of the year. I want you all to know 
that DAV and our members across the country are ready to help 
and that we will be watching. There is precious little time to 
lose. Veterans' lives and well-being are truly on the line and 
they deserve better.
    Messrs. Chairman, the 1921 novel ``All Quiet on the Western 
Front'' captured the intense mental stress felt by soldiers 
during World War I, as well as the difficulty they experienced 
transitioning back to normal life after returning home from the 
front lines. Erich Maria Remarque wrote that his book would 
tell of a generation of men who, even though they may have 
escaped the shells, were destroyed by the war.
    Much has changed since the time of its writing, both about 
war and about how we are able to care for those scarred during 
their time in military service. Our brave men and women need 
not be resigned to the fate Remarque wrote about; yet, for all 
of our medical and scientific advances, we are still losing 
veterans each and every day due to their pain and despair. 
Together, we have the opportunity and the obligation to do 
better.
    May God continue to bless DAV, the men and women who serve 
this great Nation, and the United States of America.
    Thank you.
    [Applause.]

    [The prepared statement of Mr. Marshall appears on page 41 
of the Appendix.]

    Chairman Tester. Commander Marshall, I want to thank you 
for your comments, and I also want to thank all your conference 
attendees that happen to be watching this over the internet.
    For the folks who are asking questions here, because we are 
at this part of the program, I am going to ask you to try to 
keep your questions to 3 minutes because there are a lot of 
people here and virtually also, but I will begin now.
    Over the last few years, these committees have given the VA 
more responsibility. You have already addressed some of it. We 
have passed bills around caregivers expansion around the 
MISSION Act, the Deb Sampson Act, the John Scott Hannon Act 
with mental health, VBA appeals modernization, the COVID-19 
response, and the fourth MISSION role, Blue Water Navy, three 
new Agent Orange conditions, the Colmery GI Bill, just to name 
a few. I believe you guys supported all of them.
    Are we giving--now we are talking about toxic exposure, 
which is going to add some more workload--from your 
perspective--and feel free to defer this question to anybody 
you would like on your team, but do you think we are giving the 
VA too much of a workload for them to handle?
    Mr. Marshall. Mr. Chairman, those other programs you 
mentioned increase the VA's workload; however, lately, by being 
more focused on electronic issues and programs that they now 
have, they did not have before, they are rating more cases than 
ever in their history, and toxic exposures goes back to mustard 
gas exposure all the way up to now. So they have been able to 
handle that.
    But I will refer additional comments to Mr. Marszalek.
    Mr. Marszalek. Thank you, Commander.
    And I think the Commander answered it perfectly. I think 
the advancement of technology and I think, again, working 
together to create more efficient methods on how to process 
claims is the answer. These service members made a commitment 
to fight for us, we need to make the commitment to fight for 
them and give them the benefits that they deserve.
    So we need to work together to create these processes so 
they can get the job done and they can get it done right the 
first time.
    Chairman Tester. I couldn't agree with you more and that 
brings me to toxic exposure.
    And, Commander Marshall, can you tell me what the expansion 
of toxic exposure health care would mean for your Post-9/11 
membership?
    Mr. Marshall. It would mean that they would receive the 
care that they are entitled and have earned, Mr. Chairman. They 
would be better off and possibly save lives, save families.
    And, again, I will refer to Mr. Marszalek.
    Mr. Marszalek. Thank you, Commander.
    We know there is an estimated 3.5 million veterans that 
have been exposed to burn pits and even more that have been 
exposed to other Agent Orange, radiation, and contaminated 
water. Many are struggling now without access to these 
benefits. So it is time now to make the decision and take care 
of them.
    Chairman Tester. Phase III of the bills that we are working 
on in Senate side is going to deal with presumptions, 
presumptive exposure. Can you explain why presumptive exposure 
is so important for your members, Commander Marshall or who 
else?
    Mr. Marszalek. Yes. Thank you, Commander.
    Yes, thank you, Senator. It is so important that they don't 
have to fight. I mean, to me, you have to enable the concession 
of exposure, so these veterans who served in these combat zones 
and these war zones, we need to be able to tell them, hey, if 
you have an illness associated with exposure to those burn 
pits, then you are eligible to come in and file for benefits 
and get the health care that you need.
    So it is very important that we define this process, we 
actually codify it--we know the VA is working on a new 
presumptive model themselves, but we still urge Congress to 
codify, to enact legislation that will put that into law that 
they must follow.
    Chairman Tester. Thank you.
    Chairman Takano?
    Chairman Takano. Thank you, Chairman Tester.
    Commander, as a Vietnam veteran, you know that--I know that 
you can appreciate the struggles that veterans have faced while 
waiting for VA to recognize presumptive conditions related to 
toxic exposure. Can you speak to the impact passage of the PACT 
Act would have to the veterans you represent?
    Mr. Marshall. The PACT Act. Well, some of them were 
fighting a year or two in combat, some of them have been 
fighting more than that, depending on their length of service, 
it is time to end the fights. They have earned these benefits.
    And I would yield to Mr. Marszalek again.
    Mr. Marszalek. Thank you, Commander.
    I agree with the Commander. It is time, it is time to do 
it. And so the PACT Act, you know, adding the additional 
presumptives, the health care, hypertension as a presumptive 
disability, these veterans have waited long enough. It is time 
to take care of it now. That is why we support that bill so 
strongly.
    Chairman Takano. Well, thank you.
    DAV is extremely important in supporting veterans in claims 
processing. Would the expansion of presumptions in the PACT 
Act, what additional support will you need from Congress and 
the VA to assist you in this extremely important function?
    Mr. Marshall. Again, as stated previously, their technology 
has improved vastly in the past 5 years, again, allowing them 
to rate and process more cases than ever before, and it still 
is increasing, according to the Secretary.
    Mr. Marszalek?
    Mr. Marszalek. Thank you again, Commander.
    I think he is spot on that the automation and the 
technology, we have to take advantage of those things. Do we 
know that the impact is going to be significant when you add 
additional disabilities that veterans are able to claim? 
Absolutely, it is going to have to an impact. The backlog is 
going to go up, it is going to take longer to process claims. 
However, let's get together, let's work out processes that work 
for everybody. Make it easy for veterans to come in the door 
and file those claims. Let's not complicate it any more than it 
is; let's make it easier for them to come in the door and be 
able to process those claims.
    I know VA is working on automation already, they are 
compiling that process right now. So we are looking at that 
very closely; how does that work, what are the outcomes, and 
can we expand those to other potential claimed conditions.
    Chairman Takano. Well, thank you.
    Commander, I was so pleased to see you lead from the front 
as a VSO talking openly about the importance of lethal means 
safety training and discussions. And we know that safely 
storing firearms at home could drop the suicide rate 
immediately for veterans and others living in their homes. Do 
you agree that VA should move swiftly to expand its safety 
training beyond just clinical staff to include all VA staff and 
contractors?
    Mr. Marshall. Yes, sir, Mr. Chairman, I do.
    As a veterans benefits advocate for 40-some years, you can 
never get too much training, no matter what profession you are 
in. So, you know, for the VA to have the gun locks and 
distribute them free to veterans is a great stride and will 
help, we hope, make it harder for them to take their own life 
by that means.
    I will ask Ms. Ilem.
    Ms. Ilem. And I would just add, we are very pleased that VA 
is moving forward with that initiative and the expansion of it 
is essential. We know the research indicates that the enrolled 
veterans that use VA services, those that do take their lives 
by suicide, a very high percentage do that by firearms. And VA 
is really talking about how do we talk to our veterans to make 
sure everybody feels comfortable to talk about these issues 
when a veteran is in crisis.
    We want them to be safe, we want their families to be safe, 
and the lethal means safety is a huge part of that of reducing 
suicide, it is a must, and one part of their toolkit.
    Chairman Takano. Thank you.
    I yield back, Mr. Chairman.
    Chairman Tester. Ranking Member Moran.
    Senator Moran. Sir, thank you.
    Commander, thank you for your testimony that I have now 
heard. Yesterday, I sent a letter to the President regarding 
the need to fill long-standing vacancies in critical positions, 
leadership positions at the VA. Can you speak to how the 
absence of an Under Secretary for Health and Under Secretary 
for Benefits has impacted veterans, their dependents, health 
care, and benefits?
    Mr. Marshall. That is a good question, sir, and I will 
yield to our Executive Director, Mr. Reese.
    Mr. Reese. Thank you, Mr. Chairman, for that question. And, 
as you know, it is imperative that we have leadership in the 
right places for the very simple purpose of accountability. And 
what we have had in the absence of an Under Secretary for 
Health for more than 5 years and a void for the Under Secretary 
for Benefits during this Administration, you know, we are going 
through an actual national crisis of the pandemic, a world 
crisis of the pandemic. The largest integrated health system in 
the United States of America is leaderless. That is 
unconscionable.
    I mean, veterans deserve better than that and the leaders 
at VA deserve better than that. And we have great confidence at 
the Veterans Health Administration, at the VA medical centers, 
and the VA regional office level that we have great leaders 
that are doing great things for veterans, but in order to steer 
that ship you have to have the top of those positions filled. 
It needs to be a priority for the Administration, for the 
President, and certainly for the Department of Veterans Affairs 
to have leaders in place that can lead and that this body can 
hold accountable for delivering on the promises being made and 
the laws being passed.
    Senator Moran. Mr. Reese, I thank you for your strong 
answer to that question.
    Let me follow up on this conversation about toxic exposure. 
As Chairman Tester indicated, we are on a pursuit of a three-
phase approach to deal with toxic exposure. One of the things 
we learned just recently is that this administration supports 
establishing new presumptions, and in every instance that I 
know of, they have the authority to do so. That is not exactly 
what I took from the conversations and testimony from the 
Department of Veterans Affairs during Senate consideration of 
this legislation.
    So if the truth is that we don't want to wait any longer, 
the administration supports the utilization, the presumptions, 
the Department of Veterans Affairs has the legal authority to 
pursue those presumptions, then why would we wait for what will 
be a period of time before the Senate can complete its work on 
legislation related toxic exposures. Isn't it now time for the 
focus to turn to the VA and the department to do what the 
administration is indicating they want done?
    Mr. Marshall. Thank you. Let me turn to my staff to provide 
a very detailed answer to your question.
    Mr. Reese. Mr. Chairman, I absolutely agree. First, I think 
the responsibility for taking care of our Nation's veterans is 
vested in this body. And obviously, that responsibility was 
delegated to the Secretary of Veterans Affairs to make 
decisions on behalf of our Nation's veterans for presumptions. 
And that legal authority has been established by long-lasting 
framework. Unfortunately, some of the provisions of that 
framework has faded from the Agent Orange Act.
    And now, we have a debate as to what should the current 
framework look like. And we have a discussion between a legal 
framework, as governed by statute and regulation, versus an 
internal framework, where the Secretary of Veterans Affairs has 
an internal team of advisors that present to him a body of 
knowledge review and then a recommendation for presumptions, 
which as you know a pilot model is being designed now.
    Regardless of the pilot being successful or not, each 
administration can interpret those rules separately and very 
differently. We truly believe that this body has the ultimate 
responsibility to craft legislation statute that directs the 
Secretary of Veterans Affairs in regards to the execution of 
those functions. That has been neglected since the expiration 
of the Agent Orange Act. It gives a great model already in 
place. And we can change words, and we can change standards. 
All we want, internal to the Department of Veterans Affairs, 
and the next administration is going to do the same thing. They 
will interpret it differently, more stringently, and 
ultimately, regardless of what they recommend to the Secretary, 
let's all remember, he can say no.
    And while the Secretary holds a cabinet position, he is not 
truly the boss. OMB can say no. The president can say no. There 
is just too many people saying no when this chamber can say 
yes.
    Chairman Tester. Ranking Member Bost.
    Mr. Bost. Thank you, Mr. Chairman. Some paperwork here that 
we can take care of, if at all possible, Mr. Chairman, I would 
like to--before I begin my questioning, I would like to ask 
unanimous consent to insert into the record the statement from 
my friend, and a fierce advocate for our veterans, 
Representative Gus Bilirakis. He has prepared a statement that 
needs to be put in the record.
    Chairman Tester. Without objection.
    Mr. Bost. Thank you, Mr. Chairman. Mr. Bilirakis had 
planned to be here today and introduce Mr. Marshall. 
Unfortunately, he needed to lead a hearing in another 
subcommittee, and he was sorry and he apologizes that he could 
not be here.
    With that, I would like to ask just a few questions, if I 
might. I am a little concerned--we are hearing increased 
concerns from veterans who cannot get timely appointments still 
in the VA health care system. And I am also hearing that we are 
not being informed about options--that they are not being 
informed about options that are available through the MISSIONS 
Act. Some of these veterans have serious conditions, like 
cancer, where delays could cost them their lives.
    Are you hearing similar concerns about access to care from 
your members?
    Mr. Marshall. Personally, I receive my care, all of my 
medical care from the Department of Veterans Affairs at Bay 
Pines.
    I am familiar with Florida only, sir, mostly, and I have 
received very little complaints regarding being able to get 
their appointments on a timely basis. And if they do, be 
referred out to the private sector. There are times, sir, that 
the private sector takes longer than the VA to schedule them an 
appointment. But I will yield to our legislative director for 
further comments.
    Ms. Ilem. Ranking Member, the independent budget, which DAV 
has been a part of for over 30 years also has talked about 
access issues. Although we are not hearing about significant 
delays in any large way right now, we want to make sure that 
all veterans can have access to quality and timely care.
    Access to timely care depends on resources. The resources 
to make sure that staff vacancies have been filled, that have 
been open, and it is essential that space is available for 
them, and working with the community through the VA's community 
care network.
    So we want to make sure that all veterans have access to 
care when and where they need it.
    Mr. Bost. Thank you. And we have heard some--strictly some 
real concerns coming through my office. I have got a very short 
period of time here, but I would like to ask very quickly, I 
appreciate the fact, as did the chairman, that the--that you 
are in support of what is being done to try to keep firearms, 
and SAFE training, and all of those things because of the 20 
people that are committing suicide every day.
    The problem is about only six of them are actually seeking 
help, and we need to make sure that they do seek help through 
the VA. But right now, there is a situation in our VA that has 
been going on for several years, and many of the veterans I 
talk with do not seek help from the VA because they are 
concerned that they would lose their Second Amendment rights 
under the fact that if they receive a fiduciary, they are 
automatically over to the NICS, and then their right to bear 
arms is taken away without going through the courts. Have you 
heard concerns about that as well, and I am going to be 
carrying--I have got a bill out there that has not been called 
yet, but tries to deal with this, so that they get the exact 
same treatment as someone who is not a veteran, in the fact 
that if they are a danger to themselves or a danger to someone 
else, then the courts can get involved, but not automatically 
have someone, just because they receive a fiduciary from the 
VA, that they are going to be not able to carry a weapon, or 
own them.
    Mr. Marshall. Yes, sir. I have heard that same complaint. 
And I will yield to our legislative director or executive 
director for further comment.
    Mr. Reese. Thank you, Ranking Member Bost. In DAV, we have 
a very firm stance, part of our constitution speaks to the 
constitution of the United States. We believe that all veterans 
are citizens of this country. They should have all of their 
rights, and they should certainly have due process, regardless 
what that means in regards to a fiduciary or not.
    The simple fact that they have a fiduciary for financial 
purposes doesn't mean that they are incompetent for purposes of 
handling a firearm. So due process is the key ingredient to 
making sure that the jurisdiction is clear, that the Department 
of Veterans Affairs is not a court, and that a court is the 
competent authority to make those decisions.
    Mr. Bost. Thank you. And I appreciate the answer to those 
questions. And with that, I yield back. I am sorry I went over, 
Mr. Chairman.
    Chairman Tester. Senator Hirono.

                       HON. MAZIE HIRONO,
                    U.S. SENATOR FROM HAWAII

    Senator Hirono. Thank you, Mr. Chairman, to both chairs. 
Thank you, Commander, for being here and for all of your--the 
other people who are here. You provide a very extensive 
testimony and I appreciate it very much.
    I think that informed decisions requires information. So 
you mentioned in several parts of your testimony, Commander, 
the need for data. So I appreciate the support DAV has shown to 
my legislation with Congresswoman Brownley and the Every 
Veteran Counts Act, which would help fill in some of the gaps 
you mentioned in your testimony and give us a more complete 
picture of our current veteran population.
    Can you talk a little bit more about the way insufficient 
data can be harmful, especially to minority veterans, to women, 
and other underserved veterans. And I would like to also give 
an opportunity for your legislative director to add her 
comments.
    Mr. Marshall. Yes, ma'am. Thank you for that question and 
your Statement. Insufficient data is not good for any 
government agency, any private business, large or small, and I 
will yield to our legislative director, Ms. Ilem, for that.
    Ms. Ilem. We appreciate your efforts in that regard. Data 
is essential. With VA serving an increasingly diverse patient 
population, we want to make sure that no one's unique needs are 
left unmet. And that will require to have good data. We know 
that VA can do that without--with research, and that is so 
important to be able to back good legislation that is needed. 
We see the gaps where they exist. Whether that is veterans that 
we have poor health outcomes, we need to know why. If it is 
based on race, ethnicity, you know, some LGBTQ veterans. If we 
don't have the data and information, their provider can't 
provide them the care that they really truly need by asking the 
pertinent questions and also addressing those unique needs.
    So we completely appreciate that--understand the need for 
it and appreciate that--those efforts in that regard with the 
legislation.
    Senator Hirono. Thank you very much. I think it is really 
important for us to acknowledge the importance of disaggregated 
data. So we need to continue to encourage the VA, which has the 
data, they just have to provide it in a way that will enable 
what I would call informed decisions, because we are talking 
about a VA population that is not monolithic by any stretch of 
the imagination. So thank you for your support.
    Ahoy has been struggling with a shortage of--we don't have 
5 minutes, Mr. Chairman.
    Chairman Tester. No. You only get 3.
    Senator Hirono. Well, perhaps I can submit some of these 
questions for the record, Mr. Chairman?
    Chairman Tester. You absolutely can.
    Senator Hirono. Thank you so much.
    Chairman Tester. Thank you, Senator Hirono.
    Senator Hirono. Mahalo.
    Chairman Tester. Representative Brownley?

                      HON. JULIA BROWNLEY,
              U.S. REPRESENTATIVE FROM CALIFORNIA

    Ms. Brownley. Thank you, Senator.
    Mr. Marshall, as we all watch Ukrainian soldiers and 
Ukrainian civilians respond to Russia, who are demonstrating 
really great acts of heroism, I am reminded of all the heroes 
that you represent, and who have fought bravely for our 
freedoms. And so today, I just want to say thank you.
    The first question I have is in your oral testimony, Mr. 
Marshall, you stressed the importance of the caregiver program, 
which I couldn't agree with you more. I recently introduced the 
Elizabeth Dole Home and Community Based Services for Veterans 
and Caregivers Act of 2022, to provide all veterans the ability 
to be at home for their care when they need it, and to stay 
away from institutionalized nursing home care. Over half of the 
veteran population today who use the VA are over 65 years of 
age.
    So I was wondering how you felt about this bill that I just 
introduced.
    Mr. Marshall. Thank you for that question, and I will yield 
to our legislative director, Ms. Ilem.
    Ms. Ilem. Thank you, Congresswoman. Excellent bill. DAV is 
very appreciative and supports the bill. Lots of provisions in 
there that are going to make a real difference in veterans' 
lives. We need to make sure that veterans do have those home-
based primary care services to continue to be able to live in 
their homes as they age, to the extent possible. And we need to 
make sure that our aging veteran population, which is really 
going to increase over the next 20 years, that VA is prepared 
both with the internal VA services that will be needed, the 
inpatient community living centers, our veteran estate homes, 
as well as that home based directed care.
    So we really appreciate the hard work from you and your 
staff on that issue. And a very thoughtful bill, and I am happy 
to have supported it.
    Ms. Brownley. Thank you, Ms. Ilem. And thank you for your 
leadership. I will stick with questions to you since I have 
very limited time.
    I know Mr. Marshall talked a lot about, and stressed a lot 
around women veterans, sexual harassment, MST, and the need for 
all of that. Can you talk a little bit about where we still 
need to go with regards to women veterans? I know I only have 
about 20 seconds left, but if you could just highlight a few.
    Ms. Ilem. I will make this quick then. Certainly, we 
appreciate all of those efforts that you have made in this 
regard. It has made a huge difference, as has both of these 
committees. And I think moving forward, we are seeing progress 
with regard to the zero tolerance policy that the Secretary has 
put forth, and letters that are starting to go out to every 
veteran. I have received one myself for those that use the VA 
health care system. That is a great first step. We are going to 
need Congress to continue to do oversight. This has been a 
longstanding issue. So we will be there behind you to make it 
happen.
    Ms. Brownley. Thank you, Ms. Ilem. Thank you.
    Chairman Tester. Senator Blumenthal.

                    HON. RICHARD BLUMENTHAL,
                 U.S. SENATOR FROM CONNECTICUT

    Senator Blumenthal. Thank you, Mr. Chairman. Thank you, Mr. 
Marshall, and all of your team for being with us today. We 
really appreciate your insightful and really powerful 
testimony.
    I want to focus on one aspect of your testimony, the 
exposure to toxic substances, and you summarized very well how 
this Nation after World War II ignored radiation, and mustard 
gas exposure, Agent Orange after the Vietnam War, and now burn 
pits, contaminated water at Camp Lejeune and in Hawaii at the 
Red Hill Fuel tank. Again, and again, and again, the Nation has 
delayed far too long, literally decades, in recognizing the 
effects of these toxic substances on the long-term, lifetime 
health of our veterans.
    And I think very few Americans realize that there is that 
five-year limit right now without the recognition of 
eligibility. Now, let me ask you, sir, Commander Marshall, how 
do we mobilize America? Can we get the faces and voices. Can 
you provide us with people whose names and backgrounds of 
service, and the harms they have suffered as a result of these 
toxic substances?
    Mr. Marshall. It is unfortunate that it took so long for 
Agent Orange exposure to be recognized, and that veterans had 
died before that law was actually passed due to some of the 
presumptive disabilities. But I will yield to our executive 
director, Mr. Reese, for further detailed comments.
    Mr. Reese. Thank you for the question. And, you know, today 
in the Department of Veterans Affairs, there exists a host of 
registries for purposes of those who believe that they have 
been harmed by toxic substances to go out and register so that 
there is at least a longitudinal study that can be conducted 
based upon the information that they provide.
    It is unfortunate that oftentimes we put veteran's 
illnesses and injuries in context of just combat. These are 
things that happen right here on our home shores. And as 
catastrophic as it can be, and sometimes we think, well, you 
know, we will do the best that we can by giving health care, 
and that is great. And we appreciate the advances and moving 
forward with health care, but the bottom line is then we 
deprive them and then impoverish them because it not delivering 
the food, clothing, and shelter that we would expect. There are 
economic impairments due to the fact that they can't provide 
for their family is devastating. And that leads people to 
making hasty decisions, homelessness, and suicide.
    So we have got to address this once and for all as a total 
package. And that is why we are backing the PACT Act, and that 
is why all of the toxic exposures need to be addressed, not 
just those in combat theater.
    Senator Blumenthal. Thanks for your excellent testimony. 
And we are going to carry forward this effort. I am leading the 
bill, bipartisan, on K2, and my thanks to my colleagues and to 
you for highlighting this issue. Thanks, Mr. Chairman.
    Chairman Tester. Senator Cassidy.

                       HON. BILL CASSIDY,
                  U.S. SENATOR FROM LOUISIANA

    Senator Cassidy. Thank you, Mr. Chairman. Commander, a 
couple of facts that I have learned, and I think they are still 
up-to-date, but if not, they can't be that out-of-date, that 
most veteran suicides occur within six months of separation. 
Now, we have discussed this with VA, and they have given us an 
account of a very impressive kind of warm handoff as people 
leave the service, and they are kind of ushered into the VA 
services.
    Now, one thing that kind of is contrary to that, I am told 
that the average delay between separation and the first 
appointment within the VA is six months. But that is also the 
period in which there is a higher rate of suicide.
    So your legislative materials highlights the needs for 
improved mental health services. Can you--do you have an 
impression of the adequacy of that first six months after 
separation? What is being done to identify those that might be 
at risk of suicide and giving them the services proactively?
    Mr. Marshall. I believe now that some are being diagnosed 
with PTSD upon leaving the military, which did not happen in my 
era when I served. But I will yield to Ms. Ilem for a detailed 
response.
    Ms. Ilem. Excellent question. I think the warm handoffs are 
really important, and VA's public health model is essential. We 
need to educate family members, spouses, and friends. If a 
veteran needs help and starts to have challenges right away, 
being able to spot the red flags, getting them the help they 
need early, at the time when they need it is essential. There 
has to be a collaboration between DOD and VA, which we 
understand they are trying to do more of that, but it is not 
quite there yet.
    So those--it is a great question for reducing suicide rate. 
Also have to have--veterans may not come to the VA first and 
foremost. We need to maybe get them there, but the community 
grants program that is just going to be coming forward based on 
legislation passed last year, we are really looking to see can 
that make a difference to meet them wherever they are: if they 
are in the community, but joining an organization like DAV, or 
other service organizations, so critical to be surrounded by 
people that are going to look out for your welfare.
    Senator Cassidy. Okay. Well, I am almost out of time. I 
thank you all for your service, and thank you, Mr. Chairman. I 
yield.
    Chairman Tester. The Congressman from Montana, 
Representative Rosendale.

                    HON. MATTHEW ROSENDALE,
                U.S. REPRESENTATIVE FROM MONTANA

    Mr. Rosendale. Thank you, Mr. Chair. I am going to dive 
right in.
    Mr. Marshall, we have invested somewhere in the 
neighborhood of $2.7 billion, and appropriated that for the 
electronic health records system. The ranking member on the 
Technology Modernization Subcommittee. And this is a critical 
part of being able to deliver health care to our veterans to 
make sure we have this smooth transition from the benefits that 
they generate while they were in active military, and what they 
are going to receive. Are you familiar with this rollout that 
they have tried to begin at Spokane Hospital?
    Mr. Marshall. Unfortunately, sir, I am not, but our 
executive director Mr. Reese is.
    Mr. Rosendale. Okay. Mr. Reese, are you familiar with the 
rollout that they tried--they attempted in Spokane?
    Mr. Reese. I am.
    Mr. Rosendale. Okay. Are you satisfied with the 18 months 
of rollout that they have--the Cerner Corporation who was 
managing that, are you satisfied with that their performance?
    Mr. Reese. We have met with both Department of Veterans 
Affairs and the Cerner Corporation in regards to some of the 
false start pieces that happened there. And certainly, I think 
it was a great effort on behalf of the Secretary to stop the 
process, do a pause, take a look, find out what was off the 
tracks, and to start that program back up.
    I do think that the issues that were there, unfortunately, 
with any large modernization project you are going to have some 
of, but some of it came down to the basics. You have got to 
make sure that you have a product, that you trained the people, 
and then you work with them through execution, and some of 
those were fatally flawed. So----
    Mr. Rosendale. So are you satisfied with that rollout?
    Mr. Reese. We are not satisfied with that rollout.
    Mr. Rosendale. Okay. So what we had were assurances from 
Secretary McDonough that this was not going to be at any other 
of the 179 facilities around this country until Spokane was 
fully functional. Is Spokane fully functional right now?
    Mr. Reese. Spokane has--again, it has a long list of 
logistical challenges that is still faced there.
    Mr. Rosendale. That is what I thought. Okay.
    Mr. Reese. Now, there is a second prong----
    Mr. Rosendale. So are you familiar with the 500 safety 
violation claims that have been introduced in Spokane?
    Mr. Reese. I am not familiar with their safety claims.
    Mr. Rosendale. Okay. There is over 500 safety violation 
claims that have been attributed specifically to the 
deficiencies that the Cerner organization has been responsible 
for because of the failures in their system. Would you be in 
favor of supporting Secretary McDonough's assurances to us that 
they will not be rolled out in other facilities until it is 
fully functional in Spokane?
    Mr. Reese. Well, I absolutely think that the health and 
safety of our Nation's veterans has to come before everything 
else. And if they can't get it right at one place, they 
certainly shouldn't spread that as a disease to another.
    Mr. Rosendale. I greatly appreciate that. Mr. Chair, I am 
right on my button. I will yield back. Thank you.
    Chairman Tester. Thank you. Senator Murray.

                       HON. PATTY MURRAY,
                  U.S. SENATOR FROM WASHINGTON

    Senator Murray. Thank you very much to all of you. Mr. 
Marshall, thank you for being here today, and for your 
continued advocacy on behalf of our veterans.
    I wanted to ask about the experience your members are 
having with the caregivers program. As you know, the expansion 
of the program is behind schedule, but the plan is to complete 
phase 2 expansion by October 1st. I am already hearing from 
families in Washington State that are being dropped from this 
program, and I have been pushing the VA since the department 
first proposed those regulations under the previous 
administration to fix the eligibility criteria to prevent 
families from losing access to this critical program.
    I wanted to know what you are hearing from your members in 
regards to navigating this existing program.
    Mr. Marshall. As I said in my testimony, 86 percent are 
denied in original applications. And now, they are being 
reviewed--those who were found eligible are now being reviewed 
and having their subsistence allowance reduced or completely 
eliminated based upon VHA. But Mr. Marszalek, do you have any 
further comments?
    Mr. Marszalek. Thank you, Commander. As the commander 
mentioned, 86 percent of the denial rate, there is something 
clearly wrong. We are confident this doesn't reflect the 
congressional intent of the program when it was first created, 
nor when it was expanded.
    Secretary McDonough has expressed serious concern with the 
implementation of it. So this is very concerning to us. And we 
urge the committee to continuing working with VA, DAV, and 
other veterans organizations supporting caregivers to ensure 
this invaluable program has the proper rules and resources to 
meet our Nation's veterans needs.
    Now, we do believe there are some good things once you are 
in the program. For one, you have got to get in, you have got 
to stay in. And I think the eligibility is a significant 
concern at this point. And now, the recent court decision that 
allows caregivers to appeal their decisions to VA, to the Board 
of Veterans Appeals, is another implementation issue that we 
have to figure out. And all of this is very concerning now that 
we are going to open it up in October to all veterans of all 
eras.
    So it is very important that we work together to figure out 
a solution here. And we believe that a summit is needed with 
all the stakeholders, VSOs, VA, everybody at the table. And I 
go back to the Appeals Modernization Act on how successful that 
was, the implementation of it, and how it is benefiting 
veterans today. If you get everybody together at the table to 
figure out a solution, I think we could work together to figure 
out what is best for the veterans and their caregivers.
    Senator Murray. Well, Mr. Chairman, I am determined, and I 
hope the committee is to work with you--all of you on that. And 
I just have a few seconds left.
    Let me just mention that I am really concerned about the 
personal sacrifices of children in military families that are 
going unnoticed. We--the Elizabeth Dole Foundation found that 
2.3 million children under the age of 18 live with a veteran 
who is disabled, and the responsibilities for caring for an 
injured parent as some children do, can be pretty tough on 
kids.
    So, Mr. Chairman, I hope we can have a discussion with all 
of our reps here. And I am out of time for me today, but I want 
to find out how we can be helpful in making sure children who 
showed their caregiving responsibilities in veterans' 
households also receive the support that they need. Thank you.
    Chairman Tester. Representative Pappas.

                       HON. CHRIS PAPPAS,
             U.S. REPRESENTATIVE FROM NEW HAMPSHIRE

    Mr. Pappas. Thank you very much, Mr. Chairman. And thank 
you to Commander Marshall, and the leadership of DAV for your 
strong testimony here today. And a quick shout out to anyone 
from New Hampshire DAV who may be watching. Thanks for all that 
you do.
    I wanted to bring up the issue of PFAS contamination as we 
think about the Honoring Our PACT Act. I know that I have an 
Air Force base in my district, Pease, that has seen significant 
contamination from the AFFF, where PFAS has got into the 
groundwater and into the environment. It has made individuals 
sick.
    So as we think about the risks of PFAS, which are widely 
accepted nationwide in terms of health studies, we have no way 
of connecting everyone who may have been exposed, not just on 
the base in my district, but hundreds of others across the 
country and around the world. And we need to be providing them 
with the information that they need about these health impacts.
    So I have introduced legislation, the PFAS Registry Act. It 
is included in the Honoring Our PACT Act. It directs VA to 
establish a health registry for current or past members of the 
Armed Forces who may have been exposed to PFAS.
    So I heard you reference health registries earlier. I am 
wondering, Commander, if you think that veterans would benefit 
from a centralized registry where they could access health 
information, research updates, other resources, specifically as 
it pertains to PFAS.
    Mr. Marshall. The VA's health records--you could walk in 
any VA facility and they can instantly bring up your health 
record. You cannot do that in private facilities. But that is 
an important issue with DAV, and I will ask Mr. Marszalek, our 
service director, to respond to that further.
    Mr. Marszalek. Thank you, Commander. And a great question. 
They certainly could benefit from a registry. The more we can 
do to be proactive in reaching out to these veterans who were 
exposed to these contaminants, the better off we are going to 
be. And the more information we could provide them about those 
exposures and what illnesses may be associated with them, the 
more educated they are going to be about them.
    So creating a registry would be--is a great idea.
    Mr. Pappas. Well, thanks very much for that answer. In the 
remaining time I have, I wanted to address the issue of LGBTQ+ 
veterans. I know that in your testimony, you indicated that VA 
needs to take additional steps to ensure that there is a 
welcoming, inclusive environment, where all veterans feel 
comfortable accessing care.
    We have got legislation called the SERVE Act, which looks 
to build upon the steps that VA has taken recently to make good 
on connecting veterans with care and benefits, who may have 
been caught up in Don't Ask, Don't Tell. And I am wondering if 
you have any specific thoughts on the LGBTQ veteran population, 
your members, and additional steps we might need to take to 
make sure that they have the care and benefits that they 
deserve.
    Mr. Marshall. Sexual harassment has no place in our 
country, especially for veterans. And I will ask our 
legislative director for further comments.
    Ms. Ilem. Thank you, Commander. Absolutely. The findings 
from one of the reports about sexual harassment in VA 
facilities was a real eye opener. Many women veterans have told 
you this has been happening for some time. And we are pleased 
with the administration that the Secretary is making this a top 
priority to have a safe and welcoming environment for all 
veterans. So our LGBTQ veterans, our minority veterans, 
everyone should be able to walk into a facility and not expect 
to be harassed, because that, we know, is a barrier to care. 
They are not going to return to get the best care and the care 
that they need if they are afraid to go to VA, or they have a 
horrible experience.
    So it is a first good start, but it is going to need, 
again, that public model where we know our membership is part 
of the solution. And we want to educate our members, if they 
see harassment, say something, alert the VA staff, and put an 
end to this so that all veterans have the opportunity to have 
the greatest care available.
    Mr. Pappas. Thanks very much. I yield back.
    Chairman Tester. Representative Miller-Meeks.

                 HON. MARIANNETTE MILLER-MEEKS,
                 U.S. REPRESENTATIVE FROM IOWA

    Mrs. Miller-Meeks. Thank you. Thank you so much. I think I 
am unmuted.
    Chairman Tester. You are good to go.
    Mrs. Miller-Meeks. Okay. Thank you. Well, thank you so 
much. Thank you, Chair Takano. And, you know, as a 24-year 
military veteran, I was really proud to put forward increased 
funding for the Vet Tech program last year. And as you know, we 
increased funding for the Vet Tech pilot program from 15 
million a year to 45 million a year, to allow more eligible 
veterans to participate.
    This was also a program that was highlighted to me as a 
member of the Wapello County Veterans Commission, as a 
commissioner on my local board, which unfortunately I had to 
resign from that as a Member of Congress.
    But the program provides veterans with the opportunity to 
use a GI-bill style benefits to participate in short-term 
training programs for jobs in the IT industry. The program has 
been extremely successful with a graduation rate of 87 percent, 
and has a 72 percent job placement rate. What feedback have you 
received on the pilot program, and could you please identify 
any improvements that are needed to help more veterans access 
the program?
    Mr. Marshall. Thank you for your comments and support for 
that bill. And I will ask our executive director, Mr. Reese, to 
respond.
    Mr. Reese. Thank you for the question. And I will tell you 
that the undersecretary for benefits, Tom Murphy, and the 
principal deputy undersecretary, Mike Frueh, speak very highly 
of the program, the efficiency of the program, and the cost 
share. And that is what makes this program great is, you know, 
you get into an actual career path, and some of the 
responsibility is on the school, some of the responsibility is 
on the government, and there is responsibility on the student 
to be successful. And the further you go, you get success in 
the end from all three parties.
    We use a similar program for purposes of vocational 
rehabilitation and education, or are--for our national service 
officers, and we think that this is a great program, especially 
for a direct career path into one of the leading industries in 
America. So nothing but thumbs up from us.
    Mrs. Miller-Meeks. Great. Thank you so much for that, and 
it is one of the few programs that as a pilot goes on to be 
extremely successful, so I appreciate the program. I know my 
veterans appreciate the program.
    Chairman Tester. Representative? Are we done, 
Representative Miller? Okay. Representative Mrvan.

                       HON. FRANK MRVAN,
                U.S. REPRESENTATIVE FROM INDIANA

    Mr. Mrvan. Thank you, Chairman. One, I want to thank the 
DAV for your service and what you have done. I want to thank, 
Donald Peak, the past State commander of Indiana, who I met 
with earlier, and Kevin Cooley, the State adjutant, for sharing 
with me your concerns. And I also--Mr. Marshall, the DAV is a 
current user of the Veteran Benefits Management System, as we 
know from the Independent Budget recommendations for the VA, 
that modernization of this system is a priority for you. What 
is the current state of the system, and how is that impacting 
your ability to assist veterans with access to benefits? And 
secondly, is the VBMS technologically equipped to handle and 
anticipate the influx of toxic exposure claims following the 
anticipated congressional action on this issue?
    Mr. Marshall. That is an interesting question, sir.
    And, you know, the VBMS, it was about the time--right 
before I retired as a veterans' advocate, that came into 
existence and that was an amazing advancement to what they had 
previously.
    But for further comments, Mr. Marszalek?
    Mr. Marszalek. Thank you, Commander.
    Great question. When I first got to Washington, DC, I had 
the opportunity to work alongside the VA as a VSO, and provide 
the VSO perspective. So, I actually went over to VA and worked 
there for 30 days when they created the VBMS and provided the 
perspective of VSOs and what should be in it, how it should 
work, what it should look like. And so, I think we need to do 
that again.
    There certainly needs to be modernization of the system. 
The system is over 12 years old and it is certainly at end of 
life, so the more we can do--and, again, working automation in 
some parts of that will be key. Allowing veterans potential 
access to their records. You can do that in VHA; you can't do 
it in VBA. You still have to do a 4-year request inside VBA. 
They should have access. We should be able to file claims more 
easily electronically. A single source for veterans to come in 
and file for benefits.
    So, I certainly think that working together, and again, I 
think that is crucial here, is that the collaboration has to be 
there so we can provide that perspective and you get all the 
stakeholders in a room together, working together to build a 
system that works for everybody.
    Over the years, there have been many asks by VSOs for 
different things in VBMS. They just didn't happen because there 
was no money for it inside VA and, obviously, their priorities 
take priority over the representatives sometimes. And I think 
we need to do a better job of that, of giving the 
representatives the access and the tools they need to work 
inside that system, as well.
    They did this recently, integrate the VBMS notification 
queue where we receive our notifications electronically inside 
of VBMS and so that has been a really welcomed new feature of 
the system.
    Mr. Mrvan. I thank you for that answer.
    And as chairman of the Technology Modernization Committee, 
I want you to know that we will be committed to working in that 
collaborative effort to be able to achieve those goals that 
provide world-class benefits to our veterans.
    I thank you and I yield back.
    Chairman Tester. Representative Cherfilus-McCormick?

                HON. SHEILA CHERFILUS-MCCORMICK,
                U.S. REPRESENTATIVE FROM FLORIDA

    Ms. Cherfilus-McCormick. Thank you so much, DAV, for the 
work that you do.
    I was able to tour some of your facilities in Florida and 
witness some of the great work that you guys are doing. I look 
forward to helping you however we can.
    But I have a question about the [inaudible]. The Secretary 
has taken several important steps during the past year to 
ensure that the [inaudible] is welcome into all veterans, no 
matter what their gender, race, sexual orientation, or 
background. Last summer, VA completed the Department-wide 
review by the Inclusion, Diversity, Equity, and Access, or the 
IDEA, Task Force, which came up with a number of very 
[inaudible], very useful [inaudible] improving inclusion and 
equity.
    Could you provide us with any updates of those 
recommendations and how they have been implemented?
    Mr. Reese. Well, thank you for the question, and I will 
answer on behalf of the national commander. You know, when we 
talk about diversity, equity, and inclusion, we are talking 
about leadership; leadership from the top. And I think that 
this administration did an overall review, they set the 
standard on day one to the administration and they are going in 
the right direction, but for a detailed, deep-dive, I will ask 
our national legislative director, Joy Ilem.
    Ms. Ilem. We were very pleasantly surprised early on in the 
administration to be invited with some one-on-one, really, 
almost with the Secretary. It was small groups of people, women 
veterans, veterans that had experienced sexual trauma, veterans 
that had had some barriers and problems and challenges using VA 
services, and met succinctly, you know, a couple months apart, 
just to advise us on what VA is doing and they certainly have 
made, I think, strides in moving in that direction, especially 
with regard to their Veterans Experience Office. I think that 
office is going to be key, continue to be key because it really 
does focus groups. They need to talk to veterans with real-life 
experience using the system. So, I think they are moving 
forward. There is still a long way to go, a lot of work to do, 
but I am very pleased with the first steps.
    Ms. Cherfilus-McCormick. Thank you so much for answering 
that question, and I would will have to get more information as 
we go forward on how that implementation is going, any 
utilization rates of who is actually using the services. That 
would be a great starting point for us to understand if there 
is any more help we can do in ensuring that everyone has 
access.
    So, thank you so much, and Mr. Chairman, I yield back.
    Chairman Tester. Representative Sablan?

              HON. GREGORIO KILILI CAMACHO SABLAN,
       U.S. REPRESENTATIVE FROM NORTHERN MARIANA ISLANDS

    Mr. Sablan. Thank you, Mr. Chairman.
    Thank you Commander Marshall for joining us today. Welcome 
to you and all, sir. Thank you for all that VBA does for 
veterans.
    Commander, you noted testimony [Audio malfunction.] You 
noted in your testimony the many barriers and inequities facing 
minority veteran populations. You mention that one key to 
[inaudible] barriers and inequities is giving voice directly it 
the underserved population.
    My bipartisan bill H.R. 3730 passed by the House last year, 
provides a voice to veterans living in the U.S. territories and 
the freely associated States by establishing a dedicated 
advisory committee within the VA. The advisory committee will 
provide recommendations to the VA Secretary to address the 
disparities in service and health outcomes which are in greater 
numbers and have not been looked at.
    Would the Disabled American Veterans be willing to support 
H.R. 3730, Commander?
    Mr. Marshall. That is an interesting question, sir. And 
thank you for that question.
    I will yield to our legislative director, Ms. Ilem for that 
response.
    Ms. Ilem. Thank you, Commander.
    We do believe that advisory committees are an important way 
to ensure that VA is taking into account all veterans' 
challenges for using the system, gaps that are in services, and 
you have been a tireless advocate on this issue to make sure 
that all veterans' voices, especially in remote areas, are 
heard, and we certainly want to be able to support that, moving 
that ball forward.
    The central piece, I think, is listening to those veterans, 
making sure that we understand the unique challenges that they 
face. You have brought a number of these forward and we will 
happy to help move that forward for you.
    Mr. Sablan. Thank you very much. I will take that as a 
``yes.''
    Thank you. I yield.
    Chairman Tester. Representative Gallego?
    You better unmute yourself, Ruben.
    Mr. Gallego. The host has to unmute me.
    Chairman Tester. I liked it better muted, but go ahead.
    [Laughter.]
    Mr. Gallego. Yes. You and a lot of other people in Arizona.

                      HON. RUBEN GALLEGO,
                U.S. REPRESENTATIVE FROM ARIZONA

    Mr. Marshall, in your testimony, you discussed the fact 
that while disabled black and Latino veterans use VA services 
disproportionately, there is still inequities in their access 
to care.
    In your opinion, what is the single most important step 
that Congress can do to close that gap?
    Mr. Marshall. I don't know if there is a single most 
important, but I will let Mr. Reese reply to that.
    Mr. Gallego. Well, take the top three, then.
    Mr. Reese. Well, I do believe that you have got to know the 
information and right now, as COVID showed us, that there is 
disparities throughout care in the system, not a deliberate 
attempt to do that, but the reality was, once you looked at the 
information, you came to that conclusion.
    So I think better research and understanding, and again, 
that research and understanding has to take in the diversity of 
the veterans population as it exists today, not the past, but 
how we are delivering care today and who can get the access to 
those care and benefits and what the deliverables are in the 
form of outcomes. It does no good at all to be able to access 
it and have poor outcomes or not be able to access it at all. 
So, the only way we can put the whole package together, are 
they getting what they need in a timely manner, in a quality 
manner, and having favorable outcomes is to make sure we have 
the data behind it and the research behind it.
    Mr. Gallego. Thank you.
    I also want to thank the DAV for endorsing my bill, the 
Restore Veterans' Compensation Act, and thank your legislative 
team for its help in making sure veterans receive their full VA 
disability payments. Our bill would end the practice of forcing 
veterans to pay back their administrative separation pay before 
they receive VA disability benefits.
    Can you expand a little bit about why it is harmful to 
deduct benefits from veterans who qualify for VA disability.
    Mr. Marshall. I will yield, again, to Mr. Reese.
    Mr. Reese. Well, you know, the whole scheme of the 
Department of Veterans Affairs is to make a veteran whole and 
once we have concluded that a veteran has a disability and is 
not whole, it is the obligation of the Nation to make them as 
whole as possible, and part of that is economic relief. 
Economic relief, in the form of financial payments, to offset 
their industrial impairments caused by their injuries or 
disease.
    In the event that somebody got out of service and received 
whatever form of severance and then they are found to be 
disabled, should have certainly happened in transition, but 
often times we find that down the road. To go back and take 
that money at the same time that we know that they already are 
disadvantaged from their counterparts in the private sector, 
that is certainly something that we have to consider. There 
should be no offset there because if the DoD and the VA 
cooperated to start with, that veteran should never have left 
service with a service-connected disability and had to receive 
the severance pay. So, we need to fix that.
    And I will add one thing that is not a part of this bill, 
but, you know, we talked about concurrent receipt for those who 
were injured and became ill in combat and this chamber said, 
well, we are going to phase that in. Well, we got to 50 percent 
and the phasing stopped. So, you know, the phase-in approach 
just does not really deliver for our Nation's veterans, so we 
have got to do better.
    Mr. Gallego. Thank you. I yield back.
    Chairman Tester. Senator Hassan?

                   HON. MARGARET WOOD HASSAN,
                U.S. SENATOR FROM NEW HAMPSHIRE

    Senator Hassan. Thank you, Mr. Chairman.
    I want to thank you and Ranking Member Moran and Chairman 
Takano and Ranking Member Bost for holding this hearing in 
these presentations today and I want to thank all of our 
witnesses. I am deeply appreciative of DAV's service and 
advocacy on behalf of Granite State veterans and veterans all 
across the country.
    So, this is a question to Mr. Marshall. In 2021, DAV's 
Transportation Network provided more than 163,000 rides to VA 
healthcare facilities. Granite State veterans, especially from 
the rural parts of my State, consistently share with me that 
transportation often represents a significant barrier to 
getting care at the VA.
    DAV's Department of New Hampshire does an incredible job at 
helping to reduce this barrier to care and I want to thank all 
the volunteers who make this service possible. But knowing how 
vital transportation is for veterans needing VA care, what can 
the VA and Congress do to support DAV's Transportation Network 
to help meet veterans' needs?
    Mr. Marshall. Well, unfortunately, the COVID pandemic 
caused some issues with transportation because of social 
distancing. We could not transport as many veterans in a 
transportation vehicle as we could in the past, prior to COVID, 
but I will ask our voluntary services director Mr. Kleindienst 
to respond.
    Senator Hassan. Thank you.
    Mr. Kleindienst. Thank you for your question, ma'am.
    The Transportation Network is a remarkable program that DAV 
overtook in 1987. COVID-19 did put a traffic impact on this 
program. I think it is imperative that we have a consistent 
practice across the board for onboarding our volunteers and 
making it a timely priority at VA to recognize these people who 
are willing to dedicate their time and efforts to transporting 
veterans to their medical appointments.
    If we were to make a streamline process consistent across 
the country, we could improve this process and recruit 
individuals that would be willing to donate their time.
    Senator Hassan. Thank you very much.
    And I yield back, Mr. Chair.
    Chairman Tester. We are going to do a second round of 
questions. Unfortunately, I am not going to be able to 
participate, so I will turn the gavel over to Chairman Takano.
    You may proceed.
    Chairman Takano [presiding]. I do see Mr. Lamb.
    Did Mr. Lamb have his time?
    Chairman Tester. He had no questions.
    Chairman Takano. Oh, no questions. Okay. Thank you. Thank 
you, Chairman Tester.
    I just have a few questions. Ms. Ilem, in your response to 
Senator Cassidy's question related to the suicides that occur 
in the first 6 months, I am wondering if EVEST, the bill that 
passed the House with 44 Republicans voting in favor of it, 
might also be relevant to addressing the suicides that occur 
within the first 6 months of separation?
    Ms. Ilem. Yes, I think that could definitely have a 
positive impact, so, you know, we would definitely be able to--
we have offered our support for that.
    Chairman Takano. And so, of course, EVEST is an opt-out 
provision which, instead of veterans having to opt-in by 
enrolling, we automatically enroll them and we capture quite a 
number of veterans who ordinarily would not have been enrolled 
in VA. And of course we know, the more connected that veterans 
are to VA, the less likely they are to die by suicide.
    Commander, in your testimony, you note the years of data 
showing that community mental health providers are not as well 
trained as VA providers to treat veterans with PTSD, suicide 
ideology, histories of sexual assault, and traumatic brain 
injury. You make a compelling case for legislation I have 
trying to advance to mandate free, online training in evidence-
based treatments for VA's community mental health providers.
    Can you tell my colleagues here today why it is so vital 
that we require MISSION Act network providers to be better 
trained, mental health providers.
    Mr. Marshall. Thank you for that question.
    You know, years ago when veterans were discharged, they had 
the VA for mental health care but the VA, nor the public, was 
equipped for post-traumatic stress disorder treatment until the 
vet centers were established. And the DAV was the main driving 
force behind that, establishment of the vet centers, and we 
even had our service officers travel around the country and 
provide training, not only to VA, but the public on PTSD, and I 
will let Ms. Ilem provide further details.
    Ms. Ilem. An excellent point and so critical.
    Every veteran should be able to expect the same quality of 
care if they have to go to the community to get it. We know 
that VA has the expertise. They are the main provider we want 
them to see, especially if they have PTSD. But in cases where 
they do go to the community, having that training is so 
important.
    We do need to, I think, work with VA to figure out how--I 
mean, that is extensive training that VA does. Evidence-based 
treatments, I mean, there is a mentoring phase. There is a lot 
that goes along with that. But it is a great idea and I think 
we should work toward that. I mean, that is what you want to 
see, that network tightly linked to VA.
    Chairman Takano. Thank you, Ms. Ilem.
    Let me just add that I recall several years ago, VA making 
a very important correction in terms of how it dealt with 
opioids after having had several terrible incidents around the 
country. And they implemented a much more stringent 
prescription policy among its own providers.
    Unfortunately, the administrative policies that they set 
within the VHA did not extend to the Community Care network and 
so the opioid sorts of restrictions and rules and regulations 
that our own VA providers were obligated to observe did not 
extend to the Community Care providers. So, it is not just 
training, but it is also the type of guidelines that, and 
actual policies that our internal providers have to follow, I 
believe, that we need to find ways in which those policies 
extend out to our Community Care providers.
    Does any other member--Senator Sinema, then I will call on 
Mr. Banks.
    Senator Sinema, you are recognized.

                      HON. KYRSTEN SINEMA,
                   U.S. SENATOR FROM ARIZONA

    Senator Sinema. Thank you, Chairman Takano.
    Commander Marshall, thank you for your service to this 
Nation and for the service your organization does for America's 
veterans. I want to acknowledge DAV for your support of the 
ensuring survivor benefits during COVID legislation that I 
introduced with Senator Tillis. We introduced our legislation 
have hearing concerns from family members who lost a veteran to 
COVID and were worried that they wouldn't receive the survivor 
benefits they had earned, because the death certificate did not 
list service-connected illnesses as a contributing cause of 
death.
    We know that people with underlying conditions are more at 
risk for COVID, so it makes sense that service-connected 
illnesses should be considered as a contributing cause of 
death.
    I also want to say thank you, to Chairman Tester who helped 
pass our bill out of the Senate Veterans Committee and pass out 
of the full Senate.
    Chairman Takano, I hope that you and your House colleagues 
will move to pick it up soon.
    My first question is following up on Senator Murray's 
question regarding the Family Caregiver Program. Commander 
Marshall, my office has been hearing from Arizona veterans and 
caregivers with concerns about the VA's implementation of the 
VA MISSION Act. Congress was proud to expand the Family 
Caregiver Program, but that has not been the experience for 
those 6700 legacy caregivers who participated as Post-9/11 
veterans and are now being removed from the program.
    So, my first question is, do you believe that those legacy 
participants needed the support of the Family Caregiver 
Program?
    Mr. Marshall. Interesting question.
    It is essential that they receive all the support necessary 
for Family Caregiver Program.
    Mr. Reese?
    Mr. Reese. Thank you for the question.
    And they absolutely did. I mean, we are talking about two 
schemes, as you will, of articulating different versions of 
eligibility. So, the first version of eligibility was based on 
activities of daily living. It was a single. And it was for the 
entire totality of the program supports.
    And then when we did the second expansion and new IT 
system, they basically created a whole new rule set which they 
were merging the first with the second. And as you know, there 
were difficulties in that eligibility piece in the first 
program to the degree that this chamber asked the Secretary and 
the Secretary acquiesced with actually suspending any further 
discharges from the program, pending review.
    We had hoped that that second set of regulations would have 
clarified for consistency and application of those who apply 
for those benefits; unfortunately, it has caused a greater 
complexity and it has actually caused great concern across the 
country that those who are at legacy that might be removed from 
the program or those who have applied, that 86 percent are 
being turned away from a program. Because after all, I think 
everybody here understands, we are talking about our Nation's 
most catastrophically disabled veterans. It is a sad day, but, 
unfortunately, it is the front door that is the problem. The 
program, itself, does wonderful supports for our veterans.
    Senator Sinema. Well, thank you.
    To follow up, what can be done to protect those families 
who have been relying on this program for years and are now 
being dropped from the roles?
    Mr. Reese. Well, our understanding, in speaking with the 
Secretary, he has certainly put a review process in place. He 
has actually dedicated the resources of the Deputy Secretary of 
Veterans Affairs to put together a review to make sure that 
these are actually analyzed before those final discharges are 
actually taking place. And then, in addition, for the second 
phase or second set of rules, they have extended the deadline 
for making discharges into 2023.
    So, I think the oversight is the key piece. I think the 
administration gets the first bite at that apple, but if it 
fails, we will be back in this chamber to tell you that we have 
to fix it.
    Senator Sinema. Thank you.
    Mr. Chairman, I know that my time has expired. I want to 
thank Commander Marshall and others for testifying today. I do 
have some follow-up questions, so I will submit those for the 
record.
    Thank you, Mr. Chair.
    Chairman Takano. Well, thank you, Senator Sinema, and I am 
happy to tell you that the Health Care for Burn Pit Veterans 
Act, which you passed out of the Senate is in Title 1 of the 
PACT Act and we will be debating that tomorrow, and thank you 
so much.
    I now call on----
    Senator Sinema. Chairman, I just want to thank you for 
that. I really appreciate it. We are proud to see the burn pits 
bill go through. Thanks.
    Chairman Takano. Thank you.
    Representative Banks?

                        HON. JIM BANKS,
                U.S. REPRESENTATIVE FROM INDIANA

    Mr. Banks. Thank you, Mr. Chairman.
    And thank you to the DAV for being with us today. I 
appreciate all that you do and your leadership.
    I am wondering, Commander Marshall, if you could talk for a 
moment about the main problems you see regarding rural veterans 
and their ability to travel to receive care and how can 
Congress better address some of those issues for our rural 
veterans?
    Mr. Marshall. Well, rural veterans' access to care, you 
know, in those States, when you are not populated and you have 
to travel to the nearest VA system, which may be over 100 miles 
away and now with the MISSION Act, they can schedule you 
closer.
    But for a further response, Ms. Ilem?
    Ms. Ilem. For rural veterans, there has always been a 
problem in terms of access to healthcare. Just those 
communities, it is very hard to attract and have resources 
available there to meet all of their healthcare needs. And I 
think the Office of Rural Health in VA, since that has been 
established, a number of pilots that have been very successful 
in coordinating care with the community, but I know--we know 
that the majority--a high percentage of veterans who use VA 
healthcare are living in rural communities.
    With the advent of really increasing telehealth, we do see 
some promising outlook, but we really need to make sure that 
that care is effective for them. And I know VA is very 
interested in that, given the pandemic for the past 2 years, 
and how that has really expanded care in rural communities.
    But there is still a lot of work to do. Technology will 
help, but there is still need for transportation to make sure 
that we can get veterans to the care they need.
    Mr. Banks. I appreciate that feedback.
    Commander Marshall, one last question for you. What do some 
of your members think about the MISSION Act and can you give us 
some advice on what Congress can do to improve on the program.
    Mr. Reese. Well, thank you for the question.
    And as you know, the MISSION Act, when it was implemented, 
had some very strong criteria. By definition, the actual 
acronym MISSION: Maintaining Internal Systems and Strengthening 
Integrated Outside Networks. You know, sometimes when we look 
across the VA system as a whole, we see that the Department of 
Veterans Affairs wants to go one way or the other and sometimes 
that is resource-driven.
    We have to do both. The internal systems is the key 
component. We have to have a strong backbone of the U.S. 
Department of Veterans Affairs for multiple missions and that 
is to make sure that we educate those new clinician that are--
and we are talking about the entire healthcare provision in the 
United States. We also have to make sure we have a backup, a 
contingency for emergencies in the United States. We have to 
deliver the healthcare for our veterans and we have to do so in 
a timely manner. And then we have to be, you know, 
significantly considerate of all the resources. So, we have 
the--that is bearing down.
    So, regardless of how long those processes take to stand 
up, we can't stop maintaining the internal U.S. Department of 
Veterans Affairs. So, we have got to get the infrastructure 
fixed. We have got to make sure that veterans have a place to 
go, get care in a prompt and timely manner at the high 
standards in which we expect to see from the Department of 
Veterans Affairs.
    Mr. Banks. Thank you, again.
    I yield back.
    Chairman Takano. Thank you, Mr. Banks.
    Mr. Mrvan?
    Mr. Mrvan. Commander Marshall, I understand that providers 
in VA's Community Care Network may not be equipped to provide 
evidence-based treatment for survivors of military sexual 
trauma. Recognizing that women veterans, many of whom are MST 
survivors, are highly dependent on Community Care, I find this 
deeply concerning.
    In your view, is the Veterans' Culturally Competent Care 
Act critical legislation introduced by my colleague 
Representative Blunt Rochester, sufficient to address these 
issues, since it mandates brief, free, and online training in 
treating MST and other conditions; if not, what additional 
authorities or resources are needed to ensure MST survivors 
receive evidence-based treatment, regardless of where they 
receive their care?
    Mr. Marshall. Well, if they were subject to MST while in 
active-duty, that should have been the last time that happened 
to them. It should not happen in the VA system or any other 
system, but I will let Ms. Ilem respond.
    Ms. Ilem. It is essential that veterans, especially those 
that have experienced sexual trauma, have access to that state-
of-the-art, evidence-based treatment. It is very lengthy. There 
is a training period that is required.
    And while the legislation definitely is a step in the right 
direction, we are also going to need VA to also make incentives 
for those community network providers to want to take that 
training and to follow through on the mentoring process that 
goes with it. And that is truly the only way we are going to 
ensure that if a veteran has to seek care outside from a 
private community provider that is within the network, that 
they are going to get the state-of-the-art treatments that are 
available to them.
    So, I think it is a great step, first step, and we are 
going to have to work with VA to make sure that they have the 
providers that can provide that training, as well, and do the 
follow-up and the mentoring.
    Mr. Mrvan. May I ask, you had mentioned just from your 
level, incentives. Can you kind of drill down and kind of give 
me examples of what incentives you might be talking about.
    Ms. Ilem. Well, I had asked VA that question, actually, and 
that is where I am coming from on that, because I said, what 
are you going to try to do if you can't mandate it? It is not 
in their contracts for community providers.
    And, you know, VA noted, we are looking at some incentives 
and we have agreed to do a roundtable discussion with VA to 
look at what some of those incentives could be to really move 
those providers. What could it be that is going to encourage 
them to want to take that route.
    So, I think, you know, facilitating some discussion on that 
would be excellent in the months ahead for this session.
    Mr. Mrvan. I thank you very much and I yield back at this 
time.
    Chairman Takano. Thank you, Mr. Mrvan.
    Mr. Rosendale?
    Mr. Rosendale. Thank you, Mr. Chair.
    Thank you, Commander Marshall.
    I want to go into the educational benefits for our veterans 
right now. Dating back to the first G.I. Bill, the recruiters 
and the veterans have relied heavily on that benefit. It has 
been very good for all of us. It has been good for the Nation.
    And it has come to my attention that a lot of the 
educational facilities now are having problems because the VA 
has made a determination that they are going to start 
recognizing any assistance that a veteran receives, whether it 
is from the VA or whether it is from the school, itself, as 
assistance when they evaluate the 85:15 rule, as far as the 
ratio of students that they are allowed to accept into that 
facility. Eighty-five percent cannot be supported by Veterans 
Administration and 15 percent can be. And they can't go beyond 
that 15 percent number.
    I think most of you all would agree that virtually every 
student receives some kind of assistance, and so if we change 
the interpretation of that simple rule, then we are going to 
eliminate the ability for a lot of veterans to attend 
educational facilities and we are going to eliminate a lot of 
educational facilities.
    Is anybody aware on this panel that that is taking place, 
that the Veterans Administration is looking at changing that 
interpretation?
    Mr. Kleindienst. I am not aware of that, but that wouldn't 
be something that we would be open to, to taking benefits away 
from veterans based upon that they have earned through their 
service.
    Mr. Rosendale. Okay. So, what I would ask is, can I then 
count on you and this panel to give me support to make sure 
that we revert that interpretation back to the traditional 
recognition of assistance, that it would come only from the 
Veterans Administration and that would go toward that 15 
percent number?
    Mr. Kleindienst. Yes, absolutely.
    Mr. Rosendale. Thank you very much.
    The next thing I would like to ask of Commander is that 
when we spoke about the burn pits and the exposure, and it is a 
terrible thing. I have a lot of cancer in my family, so I have 
seen both, the emotional and financial hardships that it 
causes. I have been very close to it. We need to define the 
exposure. We need to define the conditions and then we can 
start delivering treatment.
    And this is something, in your words, that we have precious 
time to lose, and I agree with you. So, wouldn't it be 
beneficial for the House to go in this week and pass the 
legislation that the Senate has already passed down to us 
instead of going back-and-forth, so that we can start 
delivering benefits immediately?
    Mr. Marshall. Yes, sir. As I said in my testimony, it is 
time to work together to bring this issue to the forefront and 
get it passed.
    Mr. Rosendale. And, again, with having a piece of 
legislation from the Senate that has been approved, wouldn't it 
be beneficial to have the House pass that today?
    Mr. Reese. Well, I think the biggest concern that we have 
is--that is great step forward, first of all, and there is 
great legislation on both sides of the aisle and both chambers 
today that both, acknowledges these conditions exist, 
acknowledges the concession of exposure, and that we are 
willing to move forward with. And that is great because, again, 
we have got 40 years from Vietnam, 30 years from the first Gulf 
War, and 20 years in the last wars. It is time to act.
    However, when we are looking at the PACT Act, it 
incorporates that into it and it delivers a comprehensive plan 
that delivers more benefits for all generations and it also 
delivers more than just healthcare. Because, again in the 
portfolio that is designed----
    Mr. Rosendale. Mr. Reese, look, I understand. We can always 
do better. There is nothing that we can't do better. Wouldn't 
it be beneficial to the veterans who are out there literally 
dying right now, to pass that Senate legislation this week so 
that we could start delivering some treatment?
    Mr. Reese. It would be wonderful if we passed the PACT Act 
that incorporates that legislation.
    Mr. Rosendale. I yield back, Mr. Chairman.
    Chairman Takano. Thank you, Mr. Rosendale.
    I think all members who have asked questions on the second 
round have asked those questions and I am now prepared to bring 
us to a close.
    And I have a closing statement. I would like to thank all 
the representatives from DAV, again, for coming to the Hill 
today to participate in this joint hearing. Your participation 
and insights into the needs and priorities of the veteran 
community are invaluable to our work. Your overwhelming support 
of the PACT Act is going to be integral to it passing the House 
this week with bipartisan support and will help to keep the 
momentum going as we work with our colleagues in the Senate to 
make this law.
    I would also like to express my thanks, again, to Senator 
Tester for his continued efforts to work with me on the issue. 
Toxic-exposed veterans have held up their part of the pact and 
they deserve our action.
    This week we are keeping our promise and I look forward to 
continuing our work with the Senate to deliver comprehensive, 
toxic exposure legislation to the President's desk to be 
inclined into law.
    And with that, the former part of this Committee hearing 
is--the joint session is now adjourned.
    [Whereupon, at 12 p.m., the Joint Committee was adjourned.]






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