[Senate Hearing 117-072]
[From the U.S. Government Publishing Office]


                                                        S. Hrg. 117-072

                     NOMINATION HEARING OF DENIS R.
                    McDONOUGH TO BE SECRETARY OF THE 
                      DEPARTMENT OF VETERANS AFFAIRS

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                                HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEETH CONGRESS

                             FIRST SESSION

                               __________

                            JANUARY 27, 2021

                               __________

       Printed for the use of the Committee on Veterans' Affairs
       
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        Available via the World Wide Web: http://www.govinfo.gov
        
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                SENATE COMMITTEE ON VETERANS' AFFAIRS

                     Jon Tester, Montana, Chairman
Patty Murray, Washington             Jerry Moran, Kansas, Ranking 
Bernard Sanders, (I) 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, Democratic Staff Director
                 Jon Towers, Republican Staff Director


                            
                            
                            C O N T E N T S

                              ----------                              

                      Wednesday, January 27, 2021

                                SENATORS

                                                                   Page
Tester, Hon. Jon, Chairman, U.S. Senator from Montana............     1
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas......     3
Murray, Hon. Patty, U.S. Senator from Washington.................    13
Boozman, Hon. John, U.S. Senator from Arkansas...................    14
Brown, Hon. Sherrod, U.S. Senator from Ohio......................    16
Cassidy, Hon. Bill, U.S. Senator from Louisiana..................    17
Hirono, Hon. Mazie K., U.S. Senator from Hawaii..................    19
Rounds, Hon. Mike, U.S. Senator from South Dakota................    20
Blumenthal, Hon. Richard, U.S. Senator from Connecticut..........    22
Tillis, Hon. Thom, U.S. Senator from North Carolina..............    24
Sanders, Hon. Bernard, U.S. Senator from Vermont.................    25
Sullivan, Hon. Dan, U.S. Senator from Alaska.....................    27
Manchin III, Hon. Joe, U.S. Senator from West Virginia...........    28
Blackburn, Hon. Marsha, U.S. Senator from Tennessee..............    30
Sinema, Hon. Kyrsten, U.S. Senator from Arizona..................    32
Cramer, Hon. Kevin, U.S. Senator from North Dakota...............    33

                        INTRODUCTION OF WITNESS

The Hon. Amy Klobuchar, U.S. Senator from the State of Minnesota.     5

                                WITNESS

Denis R. McDonough, Nominee to be Secretary of Veterans Affairs..     7

                                APPENDIX

Moran, Hon. Jerry, Ranking member, prepared statement............    40
Mr. Denis R. McDonough, Nominee to be Secretary of Veterans 
  Affairs, prepared statement....................................    42
American Federation of Government Employees, AFL-CIO, prepared 
  statement......................................................    44

                        Questions for the Record

  Response to Pre-hearing questions submitted by:
      Hon. Jerry Moran...........................................    56
      Hon. Jon Tester............................................    65
      Hon. Richard Blumenthal....................................    71
      Hon. Kyrsten Sinema........................................    74
      Hon. Sherrod Brown.........................................    81
      Hon. Mazie Hirono..........................................    83
      Hon. Bernie Sanders........................................    86

  Response to Post-hearing questions submitted by:
      Hon. Mazie Hirono..........................................    90
      Hon. Joe Manchin...........................................    91
      Hon. Jerry Moran...........................................    92
      Hon. John Boozman..........................................   101
      Hon. Bill Cassidy..........................................   103
      Hon. Mike Rounds...........................................   104
      Hon. Thom Tillis...........................................   106
      Hon. Dan Sullivan..........................................   110
      Hon. Marsha Blackburn......................................   111
      Hon. Kevin Cramer..........................................   114

 
                     NOMINATION HEARING OF DENIS R.
    McDONOUGH TO BE SECRETARY OF THE DEPARTMENT OF VETERANS AFFAIRS

                              ----------                              


                      WEDNESDAY, JANUARY 27, 2021

                                       U.S. Senate,
                            Committee on Veterans' Affairs,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 3:00 p.m., in 
room SD-106, Dirksen Senate Office Building, and via Webex, 
Hon. Jon Tester, Chairman of the Committee, presiding.
    Present: Tester, Murray, Sanders, Brown, Blumenthal, 
Hirono, Manchin, Sinema, Moran, Boozman, Cassidy, Rounds, 
Tillis, Sullivan, Blackburn, and Cramer.

              OPENING STATEMENT OF CHAIRMAN TESTER

    Chairman Tester. I call this hearing to order. I want to 
welcome everybody. I appreciate all of you that are here, that 
are online. The purpose of this hearing is to hear from the 
President's nominee to serve as Secretary of Veterans Affairs, 
Denis R. McDonough.
    Before I talk about Denis I just want to say I appreciate 
this Committee for all the reasons that we sit on this 
Committee, that it has been bipartisan, it has been non-
political, and we have tried to do the best by our veterans, 
whether you are on the Republican side of the aisle or the 
Democratic side of the aisle. And I particularly appreciate the 
relationship I had with the former Chairman, Johnny Isakson, 
and with my good friend, Jerry Moran.
    And this is not going to change. We are going to continue 
to operate this Committee in a way that the veterans are No. 1, 
and that is just the way it is going to be, and we are going to 
continue to work together in every way possible and communicate 
together, and not surprise one another, and move forth the 
policies that work for this country's veterans.
    Denis, I appreciate your commitment to public service and 
your willingness to step forward. If confirmed, you will be 
tasked with ensuring that our Nation's veterans have access to 
timely care, services, and the benefits that they have earned 
and deserve. Today we are here to determine whether you are 
right for this job. I appreciate you taking the time to meet 
with members of this Committee over the past few weeks and for 
your timely responses to the pre-hearing questions sent by many 
of us, and at this time I would ask unanimous consent that 
those question and responses be made part of the record of this 
hearing.
    The transition period between administrations can be a time 
of turmoil and confusion, and can generate uncertainty inside 
and outside an agency. At VA there is simply too much at stake 
to let that happen. The coronavirus pandemic is still raging, 
with more than 400,000 Americans succumbing to the virus in 
less than a year.
    Denis, you will be responsible for ensuring that the VA has 
everything it needs to treat our veterans and care for the VA 
employees. VA has tested nearly 1.3 million veterans and 
employees for COVID-19. The agency is tracking nearly 198,000 
cases among veterans, staff, and others admitted to VA for 
care, including nearly 14,000 active veteran cases. And now 
there are more than 8,300 veteran families who are without 
their loved ones, including the more than 3,100 VA has cared 
for within its facilities.
    Denis, simply put, your chief responsibility during this 
unprecedented time will be to save as many lives as possible. 
That includes advocating within the administration for VA's 
fair share of vaccines and ensuring timely and efficient 
deployment of those vaccines. And it includes efforts to ensure 
front-line workers have everything they need to take care of 
our sick veterans and protect themselves from coronavirus.
    How you care for your staff will mean everything. VA 
recently reported nearly 3,200 VHA staff with active COVID-19, 
and another 2,300 clinical staff are quarantined and unable to 
work. Sadly, 118 VA staff have died from this coronavirus. The 
virus is taking a toll on those VA heroes who care for veterans 
and we are entrusting you with their safety.
    I am pleased the administration has kept Dr. Richard Stone 
to ensure a smooth transition for VHA, Veterans Health 
Administration. But it will be a while before you have a full 
leadership team in place, so there is a lot riding on your 
shoulders. One area in need of scrutiny is claims processing. 
Nearly 500,000 claims are pending, with more than 200,000 
considered to be backlogged. While so much focus is on health 
care right now we must ensure this important issue gets the 
attention it needs.
    Additionally, this Committee reaffirms its bipartisan 
reputation in the last Congress. A number of historic reforms 
were enacted, from John Scott Hannon Veterans Mental Health 
Improvement Act to the Deborah Sampson Act to the expansion of 
presumptive coverage for thousands of additional Vietnam 
veterans exposed to Agent Orange. The implementation of these 
reforms must be consistent with congressional intent and it 
must be swift. Veterans are counting on it. And with the case 
of Vietnam veterans, they have already been waiting for 
decades.
    There are other critical reforms that have been in the 
works for years and need serious attention. From an expansion 
of caregiver program that has seen its number of speed bumps to 
electronic health record modernization effort that has taken 
way too long and cost taxpayers way too much, and everything in 
between.
    You will certainly have your hands full but know that this 
Committee is here to help. If you are transparent and 
respectful of oversight, we can be your biggest proponents and 
your best partners. During your predecessor's nomination 
hearing I told him the sacred mission of serving the veterans 
and their families must always transcend personal agendas or 
political affiliations. In the end, I believe he lost sight of 
that, and I called him out for it, and I will hold you to the 
same standard.
    There is a great political divide in this Nation, but 
veterans across the country and the members of this Committee 
are united by a very basic expectation. The next VA Secretary 
needs to be an individual of honesty, integrity, and vision, 
who listens to the veterans and puts their well-being above all 
else. If you keep your head down and live up to that 
expectation, you will be successful. And in the end, we all 
want you to succeed because veterans across this country need 
you to succeed.
    I look forward to our discussion today. Thank you again for 
your willingness to serve on behalf of our Nation's veterans. 
With that I will turn it over to you, Senator Moran.

               OPENING STATEMENT OF SENATOR MORAN

    Senator Moran. Chairman Tester, thank you. Thank you for 
the comments. Thank you for the working relationship, your care 
and concern for veterans, the way this Committee has operated 
during my chairmanship, and I agree with you that that 
cooperation, bipartisanship, should and will continue.
    You will be the eighth Chairman. I have served on the House 
Veterans' Affairs Committee under Chairman Bob Stump, Chairman 
Chris Smith, Chairman Steve Boyer, Chairman Bob Filner, and in 
the Senate under Chairwoman Patty Murray, Chairman Bernie 
Sanders, Chairman Johnny Isakson, and now you. In all 
circumstances I want to be a productive member of this 
Committee and want to work with my colleagues to see that good 
things happy for all veterans. And I have, in some instances, 
when we say things like that we have the sense that we are just 
talking. And I am not just talking, and you were not just 
talking. We have no option and no desire to do anything other 
than the way we have operated in the past, and will continue to 
work with you in that way to serve our Nation's veterans.
    Mr. McDonough, welcome. No mission is more noble than the 
one you will lead if you are confirmed, and so I thank you and 
your family for your willingness to re-enter government 
service.
    We are going into this new Congress with new leadership and 
a new administration. The challenges we aim to address on 
behalf of our veterans will be a mix of those existing and 
ongoing issues we will struggle to sort out, alongside new 
challenges and new opportunities for our country to not only 
honor our veterans for their service that they provided but to 
harness their values and their talents to help them lead again.
    Mr. McDonough, in 2014, your White House deputy chief of 
staff, Rob Nabors, reviewed the nationwide wait time scandal 
and described the root causes using phrases such as ``little 
transparency,'' ``corrosive culture,'' ``lack of accountability 
across all grade levels,'' and ``significant and chronic system 
failures.''
    Six years later, thanks to the collective effort of three 
VA Secretaries and thousands of dedicated employees, it is fair 
to say the VA looks very different now than it did then. 
Employee engagement is at its highest level in over a decade. 
The VA ranks 6th out of 17 among large government organizations 
as the best place to work. A vast improvement in just four 
years. And patient trust in VA health care is now over 90 
percent. Your job, if confirmed, will be to solidify and build 
off those improvements.
    At the same time, several major modernization programs are 
underway, with electronic health record modernization, 
financial business transformation, caregiver expansion, and 
Community Care Networks, just to name a few. These and other 
modernization efforts will require billions of dollars per year 
on top of VA's regular operations, just to catch the VA up with 
the latest and best practices. The VA desperately needs strong 
leadership to make certain these investments achieve results 
and they are not wastes of taxpayer dollars.
    With the help of our VSO partners, Congress has enacted 
several recent reforms to improve mental health care, protect 
educational assistance, enhance disability and survivor 
benefits, and expand burial benefits. The next Secretary of 
Veterans Affairs must be ready on day one--on day one--to 
advance and build on the progress that has been made over the 
last four years, must ensure that the laws are faithfully 
executed, and must measure results so we know veterans are 
benefiting as intended.
    Additionally, the next Secretary must continue to fight 
against COVID-19, support an already strained work force, 
deliver timely vaccinations to VA patients, and be ready to 
assist civilian health care system in places where it is 
overburdened. Furthermore, backlogs in health care and benefit 
claims appointments that have piled up due to the pandemic, 
they must be addressed as we return to a more stable operating 
environment in the coming months.
    A top concern for me, and for, I think, many of my 
colleagues, is how the VA will care for veterans living in 
rural communities. Before coming to the Senate, I represented a 
congressional district roughly the size of Illinois with no VA 
medical center. I look at the VA through the eyes of our Kansas 
veterans and the feedback I receive in speaking to them is that 
health care access has always been a challenge. VA provides 
excellent health care in its own facilities but those 
facilities are not in every community.
    The MISSION Act, the act that you worked on, the Choice 
Act, and now the MISSION Act, gives veterans permanent choice 
to utilize community health care providers when it makes sense 
for them, and not when it is convenient for VA bureaucrats. I 
asked President Biden, and will also ask for your commitment, 
to uphold the law by supporting this common-sense notion that 
it is the veteran who should be at the center of their health 
care decisions.
    We know that public health measures that reduce the spread 
of COVID also increase the risk of social isolation and mental 
health conditions. VA has its tools that they can use to help. 
Community care authorities, telehealth options, and funding 
provided by Congress can work together to mitigate the 
pandemic's impact on veterans' physical, mental, social, and 
economic well-being.
    Furthermore, programs like the GI Bill, Veterans Readiness 
and Employment, and transition assistance programs can help 
veterans transition out of the military successfully and help 
launch them on what the VA terms a ``solid start.'' Entering 
the civilian world should not be the challenge that it is 
today. Research has shown higher incomes likely lead to better 
health and outcomes, so investing in these programs does not 
just aid the veteran in his or her transition but it helps the 
long-term well-being, and it could reduce the burden on the 
VA's health system.
    I would ask you to consider not just how the VA is doing at 
delivering the benefits provided by law but also what 
outcomes--what outcomes--we are trying to achieve for veterans 
with these benefits, and if they are doing enough to measure 
those outcomes relative to the benefits the VA is providing.
    Again, Mr. McDonough, congratulations. Thank you for our 
conversations, both in person and by Zoom. Your commitment to 
our Nation's veterans is seemingly--let me take out the word 
``seemingly''--is sincere and real, and I appreciate that very 
much. Caring for our veterans has always been a unifying force 
during my time in Congress. It is my great hope that continues 
to be the case if you are confirmed as Secretary.
    Mr. McDonough, I look forward to hearing your Statement and 
engaging with you further on these questions, this 
conversation, during the remainder of our hearing, and I thank 
the Chairman.
    Chairman Tester. Thank you, Senator Moran, and before we 
get to Denis McDonough's Statement we have the incredible 
pleasure and honor to have our chamber graced by the senior 
Senator from Minnesota, Senator Klobuchar, for an introduction.

            STATEMENT BY THE HONORABLE AMY KLOBUCHAR

    Senator Klobuchar. Well, thank you very much, Mr. Chairman 
and Ranking Member Moran, and distinguished members of this 
Committee. Thank you for the good work you do, the bipartisan 
work you do. That is the hallmark of this Committee. And I am 
proud today to introduce my friend and fellow Minnesotan, Denis 
McDonough, as President Biden's nominee for Secretary of 
Veterans Affairs.
    Today Denis is joined by his wonderful wife, Kari, as well 
as two of his three kids. Denis grew up in Stillwater, 
Minnesota, which is on the Wisconsin border, as opposed to our 
other greater border, Senator Rounds, with South Dakota. And he 
is the grandson of Irish immigrants, the son of devout Catholic 
parents, and brother to 10 siblings. He attended St. John's 
College in Collegeville, Minnesota, and in addition to 
graduating summa cum laude he played safety on the very proud 
championship St. John's football team.
    I have been privileged to call Denis a friend for years, 
and I know he will serve our country so well as a Secretary. As 
he has done his whole life, he will honor the promises our 
country has made to our veterans and their families. Denis' 
commitment to our Nation's veterans was clear during his time 
as President Obama's chief of staff, when he made sure that 
every decision impacting our servicemembers, veterans, and 
their families was befitting of their sacrifices. Showing 
respect and gratitude for our Nation's veterans is not 
something he just prioritizes. It is a value for him.
    He is an adept manager who understands how to tackle 
complex challenges throughout our government, which will be 
vital for the next Secretary. As we all know, and you have 
mentioned, Chair and Ranking member, the VA is facing a number 
of challenges from helping veterans to stay safe during the 
pandemic to improving the quality of care for veterans around 
the country. And as you also note, great improvements have been 
made thanks to all of you and many others. These are not simple 
problems, and these are not simple challenges, and they will 
require true leadership and vision, which have been, again, the 
hallmark of Denis' time in public service.
    I also know he will work with you tirelessly to find 
bipartisan solutions, which has never been more important as we 
move our country forward. So much of our work with veterans is 
about keeping our promises and showing respect, not just in our 
words but in our actions. When you get to know Denis, for those 
of you who are just getting to know him, you will see the 
qualities of honor and loyalty in his commitment to his family, 
which also includes his family in Minnesota. I know this first 
hand. You see it in how he has treated everyone that he works 
with, when he worked in the Senate, when he worked as President 
Obama's chief of staff. You see it in that loyalty, and he puts 
our country first.
    During his distinguished career he has approached each and 
every job with a spirit of respect, honesty, and collaboration, 
and a willingness to make himself accessible to his colleagues 
and to his team. Members of the Committee, I know he will do 
the same with you in this job. He is deeply committed to 
supporting his work force.
    One of the things I want to tell our veterans is I know he 
will do two things so well. He will listen and then he will get 
things done for you. One of my favorite stories about Denis 
involves this. We were having a lot of trouble in northern 
Minnesota with mines closing down because of steel dumping from 
China, and Denis was President Obama's chief of staff and he 
went up to northern Minnesota--I think it was very cold, I will 
add--and met with about 50 people, and it was this long, long 
table. And Denis sat and listened to every single one of them, 
and the very last person to speak was a guy named Dan Hill, who 
was a miner, an iron ore miner. And Dan told the story of how, 
at his son's preschool, when they graduated, the teacher had 
asked them, ``What do you want to be when you grow up?'' And 
the kids were saying things like an astronaut, and a basketball 
player, and Dan Hill's son said, ``I want to be a miner''--and 
Joe Manchin can relate to this--``I want to be a miner like my 
Daddy.''
    And then the miner takes this tee-shirt, a steelworker tee-
shirt, and he throws it down this long table to Denis, saying 
the words, ``Make it come true, Mr. McDonough. Make it come 
true.'' And I am sitting there next to Denis saying, ``You were 
a football star. Catch the tee-shirt,'' and he did. And he not 
only caught the tee-shirt but he put Dan back to work, and he 
put so many miners back to work, because he came back to 
Washington, helped us pass legislation, and most importantly 
for this job, implemented things through the bureaucracy of 
government by getting many different Cabinet Secretaries and 
others to hold hearings and the like.
    I tell that story because I believe, in my heart, this is 
the guy you are going to get as Veterans Affairs Secretary who 
is actually going to follow through and listen and get things 
done.
    I am going to end with the words of a poet who President 
Biden happens to love, Seamus Heaney, and given Denis' Irish 
roots I cannot think of a better person to quote at today's 
hearing. Heaney once wrote, ``Anyone with gumption and a sharp 
mind will take the measures of two things: what is said and 
what is done.'' He will not just say the words as your 
Secretary. He will get things done. I urge the Committee to 
support his nomination. Thank you.
    Chairman Tester. Thank you, Senator Klobuchar. Before we 
get to your Statement, Mr. McDonough, I would ask you to rise 
as I administer the oath. Raise your right hand, please.
    Do you, Denis Richard McDonough, solemnly swear or affirm 
that the testimony you are about to give before the
    U.S. Senate Committee on Veterans Affairs will be the 
truth, the whole truth, and nothing but the truth, so help you 
God?
    Mr. McDonough. I do.
    Chairman Tester. Let the record reflect that the nominee 
Stated in the affirmative. You have the floor, Denis.

                STATEMENT OF DENIS R. McDONOUGH

    Mr. McDonough. Thank you, Chairman Tester, Senator Moran, 
and members of the Committee. Good afternoon and thank you for 
the opportunity to appear before you today. I do so with great 
respect for your constitutional obligations to advise and 
consent, to fund and oversee the Department of Veterans 
Affairs, and the bipartisan tradition of this Committee in 
service to our Nation's veterans.
    At a moment when our country must come together, the 
partnership between the Chairman, Senator Moran, and members of 
this Committee is inspiring. If given the honor of serving as 
Secretary of Veterans Affairs, I will strive to emulate that 
partnership in my work with you, as individual members and as 
members of the Committee.
    We can meet today in peace and freedom because generations 
of servicemembers have stepped forward and sacrificed in our 
name. And though only a small percentage of Americans have 
served in our armed forces, the President has called on every 
American to embrace our responsibility to support our veterans 
and their families. President and Dr. Biden take this duty 
seriously and personally, as I know each of you do, perhaps 
especially since they, like so many of you, are members of a 
proud military family.
    If confirmed, I will dedicate myself, with every fiber of 
my being, to fulfilling what President Biden rightly refers to 
as our country's most sacred obligation: to prepare and equip 
our troops that we send into harm's way and to care for them, 
and their families, when they return.
    It is true that I am not a veteran, but in my years of 
public service I have had the privilege afforded to relatively 
few Americans. I have seen up close, and been deeply moved by, 
the excellence, talents, dedication of our men and women in 
uniform. When visiting our soldiers, sailors, airmen, Marines, 
and Coast Guardsmen on our bases in Afghanistan and Iraq, I 
have witnessed the heavy burdens of long deployments away from 
their families.
    Beside their hospital beds when they come home, I have seen 
their resilience in the face of wounds, visible and invisible, 
that can last a lifetime. Standing there at Dover, when our 
fallen heroes come home one final time, I have seen the 
unimaginable grief of military families, to whom we owe a debt 
that cannot be repaid, and whom we will stand with forever.
    Inside and outside of government I have been inspired how 
our veterans continue to strengthen our communities and our 
country out of uniform, as teachers, coaches, first responders, 
public servants.
    Most of all, like every American, I owe a profound debt of 
gratitude to those who have worn the cloth of our Nation. It 
would be a tremendous honor to serve our veterans and their 
families, caregivers, and survivors by leading the VA, to 
ensure our Nation serves our veterans as well as they have 
served us.
    If confirmed, I will make it my mission to fight for our 
veterans with a relentless focus on three core responsibilities 
of the Department: providing our veterans with timely, world-
class health care; ensuring our veterans and their families 
have timely access to their benefits; and honoring our veterans 
with their final resting place and lasting tributes to their 
service.
    At the same time, the President has directed me to focus on 
getting our veterans through this pandemic; helping our 
veterans build civilian lives of opportunity with the education 
and jobs worthy of their skills, talents, and service; ensuring 
that the VA welcomes all our veterans, including women, 
veterans of color, and LBGTQ veterans; working to eliminate 
veteran homelessness and reducing suicide; and keeping faith 
with our families and caregivers.
    In short, if confirmed, I will work tirelessly to build and 
restore VA's trust as the premier agency for ensuring the well-
being of America's veterans. After all, there is no more sacred 
obligation nor noble undertaking than to uphold our promises to 
our veterans, whether they came home decades ago, or days ago.
    I am ready for this mission. As a former White House chief 
of staff, I bring a deep, extensive knowledge of government. I 
understand how to untangle and solve large, complex challenges, 
both across and within large agencies. I have seen first-hand 
that when our government is at its best it can help the 
American people, including our veterans, and allow them to live 
in security and dignity.
    This will not be easy. The Department of Veterans Affairs 
faces great challenges, challenges made more daunting by the 
coronavirus pandemic. Its capabilities have not always risen to 
the needs of our veterans. If confirmed, I promise to fight 
every single day to ensure that our veterans have the access to 
world-class, compassionate care that they have earned.
    I look forward to being a true partner with the men and 
women of the VA, dedicated, highly skilled professionals, many 
veterans themselves, veterans serving veterans, who deserve our 
profound respect and support. I will also build strong 
partnerships with the veteran service organizations who devote 
themselves to their fellow veterans, to their communities, and 
to our country.
    I have been given a clear mission by President Biden, to be 
a fierce, staunch advocate for veterans and their families. If 
confirmed, I will embrace that assignment with the solemnity it 
demands.
    This is not a mission I take on alone. Every Federal agency 
has a role in supporting our veterans. If confirmed, I will 
make that happen, because again, when it comes to supporting 
our veterans and their families, every American has a role to 
play.
    Chairman Tester, Senator Moran, distinguished members of 
this Committee, thank you again for the opportunity to appear 
before you today and for the opportunity to join you in caring 
for our veterans, who have served and sacrificed so that we can 
live in freedom today.
    May God bless our troops, our veterans and their families, 
and as a nation may we always give them our very best.
    I look forward to your questions.
    Chairman Tester. Thank you for your Statement, Denis. I 
appreciate that. Amy, you are welcome to leave if you want, but 
you can stay to watch the best Committee in the Senate work, if 
you would like.
    Senator Klobuchar. I think he is in good hands with you.
    Chairman Tester. All right. I will just start out. Denis, 
out of the top jobs in this administration which you would be 
well-qualified for, why this one?
    Mr. McDonough. Mr. Chairman, I am a fighter and I am 
relentless, and I am particularly relentless about things I 
have a passion for. And having had the professional experience 
of the last 20 years, since September 11, 2001, and having 
witnessed up close the tremendous service, excellence, and 
sacrifice of our military and our veterans, I have great 
passion for making sure that we treat them as well as they have 
treated us.
    So, when the President called me to talk about this 
assignment I could not have been more excited, more humbled, 
and more committed to seeing it through. And if confirmed, I 
will apply that fight and that passion to ensure that we do 
live up to our promises.
    Chairman Tester. Okay. Thank you. Do you have the autonomy 
to do what you believe is best for this Nation's veterans, even 
when you disagree with the President?
    Mr. McDonough. I do. I would also say I have a very good 
relationship with the President. He encouraged me to be very 
candid with him. So, in the event that there is a disagreement, 
I am confident that I would have an opportunity to vigorously 
make my case, draw on the experience and expertise in the 
Department to bolster that case, and to work with you all to 
fulfill that case.
    Chairman Tester. Many, if not all of us, on this Committee 
believe the importance of the inspector general, the IG. If 
confirmed, will you commit to not interfere or hinder with the 
independent work of the IG?
    Mr. McDonough. Yes, I will so commit.
    Chairman Tester. All right. We have passed a number of 
bills, and if you are not familiar with them you can certainly 
ask. But two of the bills that we passed, and we passed many of 
them, need a timeline for implementation, the John Scott Hannon 
Veterans Mental Health Bill, that Senator Moran was so gracious 
to co-sponsor, and the Deborah Sampson Act, which Senator 
Boozman was so gracious to co-sponsor.
    Will you agree to provide a timeline for implementation of 
both those bills, and if so, would you agree to provide regular 
updates to the Committee on the progress of the implementation?
    Mr. McDonough. I will absolutely provide an implementation 
timeline on those bills. I will keep you updated on the 
progress of that, but more than that, Mr. Chairman, I have 
discussed these bills at length, both with you, with Senator 
Moran, and with Senator Boozman, and my commitment to you is to 
not just give you updates but to consult with you and to work 
with you in true bipartisan consultative fashion to ensure that 
we are implementing them, that the Department implements them, 
if confirmed, consistent with the intent of this Committee.
    Chairman Tester. Coming into the most senior role at the 
VA, how are you going to approach reviewing VA's COVID-19 
response to date and determining if changes need to be made?
    Mr. McDonough. Thank you, Mr. Chairman. Every question that 
I approach, if confirmed, at the Department will be around two 
questions: will it give greater access to veterans and will it 
ensure better outcomes, as you and Senator Moran both laid out 
in your opening Statements.
    As it relates to a review on COVID-19, I will review 
whether performance to date has been as good as it can be on 
those two questions for our veterans. The questions are going 
to be around communication, around access, both to vaccines but 
then access to care in the case of infections.
    Similarly, we have to be serious about communicating 
clearly with the work force, ensuring that the work force has 
access to vaccinations and protection, and the work force has, 
as you said in your opening remarks, access to all the material 
that they will need to do their job safely.
    Chairman Tester. Numerous reports, oversight reports, have 
shown that sexual harassment assault remains a key issue across 
the Department. Creating a self-welcoming environment for all 
veterans, staff, and guests at the VA is critical. Defense 
Secretary Austin recently issued a memo to the Pentagon 
leadership requesting an expedited review of DoD's sexual 
harassment, assault prevention, and accountability measures. As 
head of the VA, do you plan on doing something similar?
    Mr. McDonough. I do, Chairman. If confirmed, on day one I 
will lean into this issue to try to set a culture that 
underscores that such activity will not be tolerated, that the 
Department has to ensure that not only the Department's work 
force but also importantly the fastest-growing cohort of 
veterans, namely women veterans, have confidence that they will 
be treated with respect and given the access that they have 
earned.
    Chairman Tester. Thank you, Denis McDonough. Senator Moran?
    Senator Moran. Chairman Tester, thank you. Mr. McDonough, I 
have been a critic of what I describe as executive overreach. I 
happen to believe that Article I has the ability to give 
Congress significant and important responsibilities. And 
administrations, over a long period of time, have chipped away 
at that balance that I think would be better if the Executive 
branch was less aggressive and the congressional Legislative 
branch was more aggressive.
    You were involved in an administration which I criticized 
for being so aggressive on Executive orders, for example, but I 
always tried to balance that by saying, well, part of the 
problem is that Congress does not do its job, and so it leaves 
this wide space open for an executive of either party to 
advance their agenda. And I would love to see this Congress 
work better than it does, and I want to try to make certain 
that I do my part that that occurs.
    But where I would find fault is the area in which agencies, 
the Executive branch, the Department of Veterans Affairs, and 
others, when there is clear legislation, and clear legislative 
intent, so both language and intention, that then that language 
and intention is not followed. In our conversation that you and 
I have had, I would love, for the record, for you to confirm 
your understanding. And let me give you a couple of topics in 
which that will become important.
    The President's campaign, President Biden's campaign, and 
your own response to my pre-hearing questions, mentioned 
rebalancing Community Care. I am concerned that these plans 
may, depending on what those words mean, may erode the core 
tenets of the mission's Community Care program, and that would 
cross a red line for me. Access standards, in particular, are 
the cornerstone of the Community Care program, and veterans 
have come to rely on those standards over the past 2 years.
    One of the difficulties we have had is as we move from 
Choice to MISSION things changed. Veterans got accustomed to 
something and then it was something new. And I take serious 
issue with any effort to change those access standards or 
restrict veterans' eligibility for the program.
    If confirmed, will you uphold the current access standards 
that veterans--my notes here say ``universally understand.'' I 
wish that was the case--but understand, and do you plan to 
change those standards as part of that rebalance?
    Mr. McDonough. Thank you, Senator Moran. Let me be very 
clear that Community Care will continue to be a key part of how 
the Department cares for our veterans, full stop. I intend to 
implement the statutes that you all have enacted consistent 
with your intention, and to do that in consultation with you on 
any decisions that come before me. And as it relates to access 
standards, I will treat those sets of questions in exactly that 
same way, which is that I will work on those fully in 
consultation with you.
    Senator Moran. Let me highlight a reason that I have the 
concern that I am expressing to you. One of your responses to 
my pre-hearing question, you promised to work with Congress, as 
you just did, to ensure that veterans are the center of their 
own health care decisions. However, one of the proposed 
Community Care updates in the campaign plan would allow the VA 
to send veterans back to the VA when community providers failed 
to meet the yet determined access in quality standards. This 
directly contradicts the mission's intent by enabling the VA to 
override the veteran's choice.
    So what I am hoping to hear you say is that you understand 
that the MISSION Act is designed, in fact written, for the 
veteran and his or her provider at the VA to make a choice 
about where to receive care, based upon what is in the best 
interest of the veteran. Is there anything there that, in your 
view or the Biden administration's plans, that I should have 
concern about overriding that decision between the VA provider 
and the veteran?
    Mr. McDonough. No, Senator. There is not.
    Senator Moran. The same theme I would have with the John 
Hannon act that Senator Tester and I introduced and got passed 
through this Committee and the Senate and the House and signed 
by the President. Will you faithfully commit that you will 
implement the John Hannon Act in that same manner?
    Mr. McDonough. Yes, Senator, I will.
    Senator Moran. If confirmed, will you commit your staff to 
work with the Committee staff and to my staff, to me, to ensure 
congressional intent is met during each of the phases of 
implementation for that bill and other legislation?
    Mr. McDonough. Yes.
    Senator Moran. So, Mr. McDonough, one of the complaints 
that I have had for a long time is that when Congress does act, 
on the occasions in which we get our act together and succeed 
in passing legislation, that the VA, in particular, but I 
assume it is true in other departments, the VA, in particular, 
seems to ignore the things that we have just talked about. And 
what I think you are telling me is that that I should be less 
concerned about with you in charge than what I have experienced 
over the eight--one, two, three, four, five, six, seven, 
eight--nine Secretaries that have been in office while I have 
been a member of the Veterans' Committee. Is that a fair 
assessment that I can trust you to fulfill the role that the 
Executive has in implementing legislation passed by Congress?
    Mr. McDonough. Yes, Senator, and I would elaborate on that 
in the following way. One is that I believe, as you do, and as 
I said earlier, everybody has a role to play in supporting the 
veterans. The Constitution actually divvies that up quite 
clearly for you all and for the Executive, in Articles I and 
II, so it is a constitutional question. Second, I also believe 
it is a question of best outcome. When the Executive works 
closely with Congress, in a collaborative and consultative way, 
that is the best way to ensure more durable policy, more 
durable outcomes, and especially if we are both working with 
the fundamental premise that every decision should answer, is 
this getting better access and better outcomes for our 
veterans.
    Senator Moran. Mr. McDonough, thank you. Your comments 
remind me about durability. What that really means is that a 
veteran can come to expect a certain outcome or a response to a 
question and it is not different from 1 day to the next, 1 week 
to the next, or one location to the next.
    Mr. McDonough. Correct.
    Senator Moran. And the point I would make is that in so 
many instances, over a long period of time, no particular 
administration to be specific about, the conversations I have 
with the Secretary or his or her team resulted in assuring me 
that this problem is being taken care of and this is our plan, 
but what I discover when I am home, that has never been 
communicated to the people who implement the plan and care for 
veterans at home in Kansas. And so there is a communication 
issue related to this. You can assure me that you support 
implementing with congressional intent, but it has to be told 
and insisted on by those who actually provide the services to 
veterans at home. And I would encourage you to make certain 
that when you tell me and other Members of Congress this is the 
policy at the Department, that that policy is then known and 
implemented by those across the country.
    Mr. McDonough. Understood.
    Senator Moran. Thank you very much. Thank you, Mr. 
Chairman.
    Chairman Tester. We are going by seniority order, so next 
we have Senator Murray, remotely.

                      SENATOR PATTY MURRAY

    Senator Murray. McDonough. I am Delighted to see you today. 
Welcome, and we all really appreciate your being with us today. 
You know, the VA is the largest integrated health care system 
in the country so it really demands a strong, effective 
leadership, so we appreciate your willingness to take this one.
    You and I have had a chance to talk about some issues in 
December, and I wanted to ask you about some of those again 
today for the record. Let me just start, as part of the MISSION 
Act, Congress expanded eligibility for the caregivers program 
to make sure veterans of all eras suffering from service-
connected illnesses would have access to caregiver support. 
However, under the previous administration, regulations were 
imposed that limit that eligibility and remove many veterans 
needing assistance from that caregivers program. Those 
restricting regulations like requiring a minimum 70 percent 
service-connected disability rating as well as the need for 
assistance each time an ADL is performed unduly restricts 
eligibility in a way Congress never intended, and make it 
harder for our veterans to get care.
    So if confirmed, will you take action to roll back those 
recently imposed restrictions and make it a top priority for VA 
to fully implement the caregivers' law as Congress intended?
    Mr. McDonough. Thank you, Senator, and I appreciate the 
question and I appreciated our discussion of it. My commitment, 
as I indicated earlier, is to immediately begin to address this 
issue upon confirmation, to work closely with you and the rest 
of the members of this Committee as it relates to 
implementation of that act, and to ensure that we do it 
consistent with the expectation and the intention of Congress.
    Senator Murray. Thank you very much. Let me turn to another 
part of our promise to take care of our veterans after they 
return from duty, which is allowing them to fulfill their dream 
of having a family. Congress has given the VA authority 
appropriations to provide IVF and other necessary fertility 
treatments for ill or injured veterans and their spouses, but 
access to that care is far too difficult, and I have been 
working for nearly a decade to fix this. My bill, which is the 
Women Veterans and Families Health Care Services Act will 
permanently authorize fertility treatment and counseling for 
veterans and their spouses and provide adoption assistance.
    Mr. McDonough, it is extremely important that we empower 
veterans to start families when the time is right for them. 
Will you commit to work with me to make sure veterans have ease 
of access to IVF and other fertility treatments?
    Mr. McDonough. Senator, I will.
    Senator Murray. Thank you. I look forward to working with 
you.
    One of the largest challenges that is facing the VA is the 
implementation of the electronic health record modernization 
program. The VA Medical Center in Spokane, my State, is the 
pilot site for this project. The process has highlighted 
infrastructure and staffing shortfalls, and veterans in Spokane 
have experienced unacceptable delays in getting care. Full 
implementation across every VA medical center is expected to 
take at least seven more years. Given that timeline and the 
scope of this project, if confirmed, how will you protect 
veterans' access to high-quality care at the VA while ensuring 
the success of this modernization effort?
    Mr. McDonough. Thank you, Senator. As I indicated, every 
decision that I am involved in, if confirmed as Secretary, will 
come back to the fundamental premise of whether the decision is 
increasing access and improving outcomes for veterans. This has 
got to be the case as it relates to the electronic health 
record as well, and my commitment to you and to members of this 
Committee is to continue to work in a collaborative, 
consultative fashion with you in the implementation of that 
program, to ensure that, at the end of the day, increased 
access and better outcome for veterans is the result of that 
health record, that the work force understands and can use the 
health record consistent with those principles, and that I can 
continue to confirm to this Committee that that is the outcome 
of that process.
    Senator Murray. Okay. And one final question. Improving the 
information VA shares with veterans on the GI Bill comparison 
tool is essential to make sure veterans can get informed 
choices about their education. I have previously called for DoD 
and VA to develop a joint policy to counter aggressive 
recruiting and misleading marketing aimed at our veterans, and 
I want to see improved availability of crucial information such 
as levels of student debt and transferability of credits. Can 
you commit to providing thorough oversight of the GI Bill 
funds, fully implementing the protections in the GI Bill Act, 
and making sure that when there is evidence of fraudulent 
conduct you will take steps to make sure the schools are not 
allowed to continue to recruit veterans?
    Mr. McDonough. Thank you, Senator. The President has 
indicated to me that a fundamental priority for me, if 
confirmed, must be ensuring that our vets have access to 
employment and education opportunities consistent with their 
experience, skills, and talent. And consistent with that, I 
would intend to, working collaboratively with you and this 
Committee, ensure that there is appropriate, aggressive 
oversight and measurement on quality outcomes of that 
programming.
    Senator Murray. Okay. Thank you very much, and thank you, 
Mr. Chairman. I appreciate the opportunity.
    Chairman Tester. Senator Boozman.

                      SENATOR JOHN BOOZMAN

    Senator Boozman. Thank you, Mr. Chairman, and thank you for 
being here. You served in a variety of different ways in the 
Executive branch, I know in national security and then also 
chief of staff to President Obama. And I have had the 
opportunity to be around the table with you on many occasions 
and always found you somebody that was willing to listen and 
then also very, very informed on whatever issue that we were 
talking about.
    Mr. McDonough. Thank you.
    Senator Boozman. And then, very importantly, I know that 
the President has a great deal of trust in you and respects 
your opinion. So I think that is good for veterans. So we 
appreciate your willingness to serve very, very much and look 
forward to working with you.
    We had a good conversation not too long ago. I want to 
followup on something that really is a significant issue facing 
veterans in the country. Some of these are too large for any 
one organization or department to solve. Veteran's suicide is 
one of those enormous issues. Last Congress we passed a 
bipartisan bill, the Commander John Scott Hannon bill, to begin 
to encourage the VA to work more closely with communities in 
trying to address the issue of veteran suicide.
    If confirmed, would you describe how you would lead the VA 
to create more partnerships with veteran-serving community 
organizations while, at the same time, incentivizing those same 
organizations to partner and work with the VA?
    Mr. McDonough. Thank you so much, Senator. The crisis 
facing the country related to veteran suicide is tragic. We 
face a national crisis on suicide as well. The first and most 
important thing that I will do, if confirmed, is underscore 
that comprehensive health for our veterans includes mental 
health, it includes effective mental health, includes reducing 
the stigma associated with seeking help, and that also includes 
increasing access to mental health services through any number 
of opportunities, and in particular, given the enhanced 
authorities that you have now made available to the Department 
through community organizations.
    So, using those resources and using the networks that are 
being built around Community Care gives the Department a unique 
opportunity to ensure that it is drawing on all the available 
resources on this national crisis.
    Senator Boozman. We appreciate that. The VA does a very, 
very good job and works really hard at this crisis. On the 
other hand, there are so many entities out in the community 
that also are doing a very good job and ready and willing. So 
many of these people fall through the cracks, and for one 
reason are not in the VA. So, if we can get them in a program 
and then encourage those programs to get them back into the VA 
we will be in good stead.
    One of the most common things I hear from veterans in 
Arkansas is regarding the multiple different enrollment 
processes for VHA, VBA, sometimes NCA, when in fact they are 
all part of the same agency. So you have got different 
processes within the same agency.
    If confirmed, can we work together, can we work together as 
a committee, and explore a more human-centric design approach, 
in other words, making it simpler to help the enrollment 
process for veterans, more of a one-shop approach?
    Mr. McDonough. Absolutely, Senator. I would look forward to 
the opportunity to work together on that.
    Senator Boozman. Very good. And I yield back. Thank you, 
Mr. Chairman.
    Chairman Tester. Thank you, Senator Boozman. Senator Brown 
remotely.

                     SENATOR SHERROD BROWN

    Senator Brown. Thank you, Mr. Chairman. Nice to see you 
there and call you that. And I thank Senator Moran for his 
gracious comments also. Mr. McDonough, I enjoyed the 
conversation we had remote or remotely--whatever is 
grammatically correct--the other day. Thank you, and thanks for 
your commitment to work with VSOs and VA employees and VA 
unions like AFGE, so thank you for that.
    We see unprecedented backlog in claims processing in 
compensation and pension exams because of the pandemic, and the 
pandemic is affecting operations in National Personnel Records 
Center. I know you will be busy on day one, working on that and 
so many other things. With my staff I met with veterans and VA 
employees throughout Ohio. Recently there have been concerns 
about VA closing units and downsizing services, at one specific 
facility especially, because of the virus. The VA has not 
committed as of yet to reopening the unit once the pandemic is 
over. My concern with that approach is that if VA starts to 
close units or services or facilities it will push veterans 
into the community for care. Some want to do that, but others, 
most want the option of always going back to the VA.
    Would you commit to reopening those units or services lines 
closed due to COVID-19, and will you work with OMB and the 
White House to make sure that VA has the resources and 
personnel to reopen those facilities?
    Mr. McDonough. Thank you very much, Senator. Obviously the 
slow-down in fulfillment of claims processing as a result of 
the pandemic is a principal concern that I would have, if 
confirmed, and making sure then that we have the resourcing 
after the pandemic to not fall back into backlog once the 
Department gets its hands around the existing cases would be 
really important.
    So, I will absolutely take this question of those 
facilities. I will work with the White House and work with OMB 
on it, to make sure that we have the resources to fulfill a 
critical assignment of timely access to benefits that veterans 
and their families have earned.
    Senator Brown. Okay. Thank you. We have seen far too many 
veterans and military families targeted by predatory, for-
profit institutions since passing the post-9/11 GI Bill. Those 
institutions misrepresent themselves and often saddle student 
veterans with mounds of debt. Do you plan to exercise 
additional oversight to root out misrepresentation of 
predatory, for-profit institutions that target student 
veterans?
    Mr. McDonough. Every decision that I make, if confirmed as 
Secretary of the Department, will be asking two simple 
questions and to advance two simple principles, which is are 
the decisions we are taking increasing access for veterans and 
are they improving outcomes for veterans? Outcomes on education 
programming and employment programming have to be a critical 
part of how the Department implements that and executes those 
programs, so the short answer is yes.
    Senator Brown. Thank you. And we know that the Protect the 
GI Bill Act's provisions bans the deceptive recruiting of 
college third-party lead generators and following the law to 
cutoff the flow of GI benefits to those kinds of schools. 
Obviously that is really important.
    Let me shift. I hope you will come to Dayton at some point 
to visit the National VA History Center. I will followup and 
talk to you about that. I wanted to talk about veteran 
homelessness. I will soon be the chair of the Banking Housing 
Committee. Veteran homelessness is an important part of your 
mission and an important part of my mission too there. We made 
great progress there but still have a way to go to complete the 
job, including making sure that VA has adequate staffing to 
support the successful HUD-VASH housing voucher program. Will 
you work with Chairman Tester and HUD nominee Marcia Fudge, 
whom I just spoke to literally 30 minutes ago, and make sure 
all veterans have a place to call home? That is a really high 
priority.
    Mr. McDonough. Yes, I will.
    Senator Brown. Okay. Thank you. Last thing, last month VA 
proposed a program that would require military borrowers 
exiting a COVID-19 mortgage forbearance to pay back their 
missed payments with interest within 10 years. This is more 
expensive than what other Fed mortgage programs are offering. 
It would make it more likely that VA borrowers will fall behind 
on these new highly monthly payments. Veterans and 
servicemembers should not be given worse options than other 
borrowers with federally backed loans. Do you agree with that?
    Mr. McDonough. I do.
    Senator Brown. Okay. Will you look into the rule and work 
with us, look into the rule and make sure that no VA homeowner 
is left with worse options than borrowers in other federally 
backed loan programs?
    Mr. McDonough. I would be happy to work with you on that.
    Senator Brown. Okay. We will followup. Thank you, Mr. 
McDonough and good luck on your confirmation.
    Chairman Tester. Thank you, Senator Brown. Senator Cassidy.

                      SENATOR BILL CASSIDY

    Senator Cassidy. Hey, thanks for being here.
    Mr. McDonough. Thank you.
    Senator Cassidy. I enjoyed our conversations. Thank you for 
the phone conversation. Some of this will be repeated, just 
because I think it is so important for my colleagues. We spoke 
about how those of us on this Committee will ask questions of 
the VA--I used the term ``rope-a-dope'' and you immediately got 
it. We got a reply back which is off-point, about 2 months 
later. We asked for clarification and 2 months later we get 
another slightly off-point, or more than off-point. And then 
finally it just kind of tapers out.
    You have a different philosophy, so do you mind sharing 
with us all how you intend to share data with us as regards the 
VA itself?
    Mr. McDonough. Thank you for the question, Senator. I think 
the free flow of accurate data is the lifeblood of a well-
functioning organization. Consistent with that and consistent 
with the view I have been espousing of close collaborative, 
consultative relationship with this Committee and with 
Congress, I would intend to make sure that we have the free 
flow of information between and among us. I also said, when we 
talked earlier, that it could be that because we are moving 
quickly we provide inaccurate information, and I will work to 
quickly come back with more accurate information on that. But 
as I said, the lifeblood of any well-functioning agency or 
organization is accurate, timely data.
    Senator Cassidy. You know, you used a couple of adjectives 
there, and I am going to explore them because I loved them--
``quickly'' and ``timely.''
    Mr. McDonough. Yes, fair enough.
    Senator Cassidy. Which is not really--now the VA, by the 
way, recently they answered a question very quickly, and so I 
am saying that at times it works and at times it does not. But 
can you just give me a sense of, when you say ``quickly'' and 
``timely,'' like the timeframes that you would be considering 
quick and timely?
    Mr. McDonough. Well, it is hard to answer that question in 
the abstract, but I guess what I would say to that question, 
Senator, is I would want it back to you in a timeframe that is 
useful to you.
    Senator Cassidy. That works. Okay. Thank you.
    Following up on something that Senator Brown said, that 
Senator Murray alluded to, Senators Carper, Lankford, Tester, 
and I will soon be reintroducing the Protect Vets Act. Now I do 
not expect you to be up to speed on this because you are just 
starting, but it seeks to close the 90/10 loophole to ensure 
that veterans' educational benefits, such as the GI Bill, are 
treated as Federal funds for accountability purposes. And just 
kind of background, if a for-profit university is allowed to 
get 90 percent of its funds from the Federal Government and 10 
percent from outside the Federal Government, veterans' benefits 
have been included in that 10 percent.
    And so when Senator Murray speaks of targeting veterans, 
yes, they have been targeted because they would fill up this 
gap that the free market would not provide, but rather people 
with veterans' benefits could provide that 10 percent match for 
the remainder of the 90.
    We worked very hard to get a compromise that would protect 
the veteran, protect the good schools, and that would kind of 
be sensitive to sensibilities in both the Republican and the 
Democratic caucus. And again, protecting the good schools but 
isolating out the bad.
    So just to say that we are going to be bringing this 
forward, knowing that you will have to look at this, but we 
would love your engagement on this issue because we think it is 
important that we address it.
    Mr. McDonough. I would be happy to work with you on it, and 
I commit to being engaged, if confirmed. Absolutely.
    Senator Cassidy. I appreciate that. With that I yield back.
    Chairman Tester. Thank you, Senator Cassidy. Remotely, 
Senator Hirono.

                      SENATOR MAZIE HIRONO

    Senator Hirono. Thank you very much, Mr. Chairman, and 
welcome, Mr. McDonough. It was good to talk with you when I had 
the opportunity.
    I think my colleague, Amy Klobuchar, gave one of the best 
testimonies where she made it very clear that you listen and 
then you actually do something. You get things done. And you 
are about to head, should you be confirmed, one of the largest 
Federal agencies and the largest health care system, and very 
uniquely the VA actually provides health care across 50 States 
and territories. So this is a very unique agency with just 
ongoing challenges--homelessness, mental health, health 
disparity treatments, all kinds of things.
    Not to mention, by the way, when I talked with you, you 
said that from a very pragmatic standpoint that getting the 
veterans vaccinated and dealing with the pandemic is one of 
your first priorities. Joe Biden has said that he is going to 
have 100 million people vaccinated within the first 100 days, 
so should you be confirmed, do you have an idea, or would you 
determine how many veterans you would want to get vaccinated, 
and would you have a way to determine whether you are actually 
meeting those goals? Would that be one of the ways that you 
will tackle this pandemic with regard to our veterans?
    Mr. McDonough. Thank you, Senator. In fact, it would be. A 
principal priority in helping veterans through the pandemic is 
ensuring that they have access to care, if sick, and 
vaccinations to prevent getting sick. The way I intend to work 
this question is I will demand a seat at the table, and I will, 
as the President has asked me to do, be a staunch and fierce 
advocate for veterans getting access to the kind of care and 
the kind of resources that ensures the kind of outcome that you 
have just highlighted.
    Senator Hirono. I think that you actually have to have 
numbers, such as you are going to have X percent of the 
veterans out there, and you are going to need to find some of 
them because they are not all in the system. And then you need 
to figure out a way to make sure that those vaccinations are 
actually occurring.
    One of the initial questions I ask of every nominee for 
these kinds of appointed positions, just to ensure their 
fitness to serve, I ask the following two questions, which I 
will now ask you. Since you became a legal adult, have you ever 
made unwanted requests for sexual favors or committed any 
verbal or physical harassment or assault of a sexual nature?
    Mr. McDonough. No, I have not.
    Senator Hirono. Have you ever faced discipline or entered 
into a settlement relating to this kind of conduct?
    Mr. McDonough. No, I have not.
    Senator Hirono. One of the ways that we can really ensure 
that our veterans get the health care they need is to create 
community-based outpatient clinics, and I talked with you about 
some of the long delays with regard to some of these clinics on 
Oahu as well as on some of the neighbor islands. And each one 
of these projects is unique. There may be some unique State 
requirements or limitations that make it really hard for these 
projects to proceed.
    So it requires somebody within the VA to pay attention and 
move these projects along, whatever the specific concern might 
be, so that the veterans in these places are not waiting for a 
decade, as is the case with some of the projects in Hawaii.
    I would just like you to really focus on the need for 
community-based clinics where the veterans can have access to 
the care that they need. Will you commit to making that happen?
    Mr. McDonough. Senator, I will. If confirmed, I will.
    Senator Hirono. So one of your predecessors made 
eliminating homelessness among veterans to be a top priority, 
and he engaged a whole-of-government kind of approach and yet 
homelessness continues to be a concern. And yes, you responded 
to my questions to you, but truly, what are you going to do 
that is different from what one of your predecessors, who said, 
``I am going to eliminate homelessness among veterans,'' and 
that did not happen. What are you going to do to ensure that 
there will be more measurable success in eliminating 
homelessness among veterans?
    Mr. McDonough. Thank you, Senator. The President has made 
clear that this will be a priority of the administration. What 
I will do to implement that priority is obviously make it an 
intentional priority, one. Two, work with the other agencies in 
the Federal Government to increase access to available options. 
And three, make sure that the VA is providing access to all the 
other services that are important as it relates to access to 
mental health, access to substance use disorder, treatment, 
access to education, employment, and training support. And 
using all of those tools, working with other Federal agencies, 
and the holding ourselves to account to you to measure that 
progress is how we fulfill that objective.
    Senator Hirono. I think you have a commitment from Sherrod 
Brown and from Marcia Fudge to enable you to succeed, and I 
will certainly be wanting to engage with you on that score, 
because nothing could be as important as to have a roof over 
their head, food, and a job, if that is what is available to 
them, made available to them.
    I do not know. I cannot see the timer.
    Chairman Tester. You are over by about a minute and a half, 
and we can have a second round if you would like.
    Senator Hirono. Thank you very much.
    Chairman Tester. You bet. Thank you, Senator Hirono. 
Senator Rounds.

                      SENATOR MIKE ROUNDS

    Senator Rounds. Thank you, Mr. Chairman, and it is truly 
refreshing to see that we have a Chairman and a Ranking Member 
who are both concerned about our rural veterans as well, and I 
thank you and I look forward to working with you.
    Mr. McDonough, first of all, I want to thank you for the 
phone call the other day. The opportunity to visit with you was 
good, and I appreciate the knowledge that you bring, your 
preparation for our visit, and your understanding of some of 
the challenges that the VA faces. I also--look, I plan on 
supporting you in your nomination for this position, and I 
thank you for your service to our country.
    Mr. McDonough, the Hot Springs VA facility in Hot Springs, 
South Dakota, is a critical part of the Department's Black 
Hills health care system. In October, Secretary Wilkie 
rescinded a record of decision on the future of the campus 
which provides vital health care services not only to South 
Dakotans but to residents of Nebraska, Colorado, Wyoming, and 
so forth.
    I would like your commitment, if confirmed, to work on 
moving the Hot Springs facility and literally the Black Hills 
facilities themselves up into the century with regard to the 
services that they are providing, and literally lay out a long-
term plan for their success for the veterans in the rural 
areas.
    Mr. McDonough. Thank you, Senator. I really appreciated our 
conversation on this, and I committed to you then, and I 
recommit myself to you now to work closely with you on this, 
and addressing the needs in and around the Hot Springs 
facility, in as much as it is such a critical piece of the 
delivery capability, not only in South Dakota, but as you say, 
in Nebraska, Montana, Wyoming.
    Senator Rounds. The MISSION Act, which is what we operate 
under now for our health care, is an item that I did not vote 
for. I did not vote for it because it took away guarantees of a 
veteran to be able to find a physician of their own choice if 
they could not get an appointment within 30 days or if they 
were more than 40 miles away from a health care facility that 
the VA sponsored. I thought they were making promises in the 
MISSION Act that we might not be able to keep.
    I think you step into the administration of this facility, 
of this agency, this administration, in which you are being 
asked to do a lot of things and you are going to get pulled in 
a lot of different directions. I do not expect you to be able 
to see the detail of this chart, but this is a chart of the VA 
and what it has. You are expected to provide educational 
opportunities, you are expected to provide housing, you are 
expected to provide final expenses, a final resting place, and 
you are also expected to provide health care to VAs across the 
entire country.
    If you look at this, you can go down 13 levels before you 
actually get to where a real doctor is at, where a hospital is 
at in the chart. And for me, that says a lot about the 
challenge that you face. I do not think that is something that 
a lot of people realize, when they talk about the VA and what 
happens. When you promise everything to everybody and lay it 
within an administration like this, whether it is a Republican 
or a Democrat administration, the challenges of handling a 
bureaucracy are huge. You walk into a bureaucracy with perhaps 
as many as 380,000 individuals, some of which are providing 
direct care, others of which are trying to find reasons why the 
care can't be provided.
    Specifically, what my concern is, is this. Right now, in 
the approval process, when we ask for someone to participate in 
the care for the community, it is not veteran-friendly. Too 
many of the approvals are made by people who work to make sure 
that the veteran stays within the VA system, regardless of 
whether or not it is good for the veteran or not. While the 
flow chart says that the veteran's decision is the veteran's 
decision, as Senator Moran suggested it always come back to the 
VA for approval. In my opinion, it is tailored for an urban 
veteran with easy access to tertiary services and not the rural 
veteran who may have to drive well over 50 miles for access to 
see a primary care provider.
    If confirmed, what will you do to afford veterans their 
choices as to where they receive their health care?
    Mr. McDonough. Thank you, Senator, and I really appreciated 
our conversation before on these questions as well. Any 
credible strategy as it relates to rural care for our vets has 
to have at least three components. One, community care, and 
community care has to ensure that more timely payment of bills. 
It also has to ensure a more vibrant network of providers, 
providers who want to be part of that network. And I think in 
both of those cases a more active, or a higher set of 
expectations for the third-party administration, for example, 
is probably wise.
    The second thing is using access to new platforms. We had a 
very useful conversation, I thought, about telehealth, as I did 
with several other members of the Committee. Consolidating 
those gains and growing those.
    And then third is getting more aggressive about using the 
authorities that you have given the Department to recruit and 
to fill the vacancies in the facilities that VA already has.
    And so, among those three prongs of a strategy I think are 
the answers to ensure that the best medical outcome for the 
vet, which as I read the statute is what you all have demanded, 
ends up being the deciding variable in the equation.
    Senator Rounds. My time has more than expired, Mr. 
Chairman. Thank you for your thoughts, and particularly the one 
about timely payments for those providers.
    Mr. McDonough. Thank you.
    Senator Rounds. Thank you, sir.
    Chairman Tester. Thank you, Senator Rounds. Senator 
Blumenthal.

                   SENATOR RICHARD BLUMENTHAL

    Senator Blumenthal. Thanks, Mr. Chairman. Thank you for 
having the hearing. Thank you, Mr. McDonough, for your service, 
your very extensive service, your commitment to veterans, your 
conversation with me about your dedication to them, and your 
testimony here today, which has been excellent. I have been 
following it from afar, and apologize I was not here before 
now.
    I want to first of all followup on part of a conversation 
we had about the VA facility in West Haven, where there were 
two deaths. It is an aging, in fact, aged facility that is 
badly in need of reconstruction Like many facilities across the 
country, it was built in another century, literally, and we owe 
it to our veterans to rebuild that infrastructure. There are 
several critical construction projects in the design phase at 
the West Haven VA, including a new sterile processing service 
building and surgical and clinical space tower, but what is 
really needed is a reconstruction of the entire facility, which 
does great care for our veterans. The doctors, nurses, 
administrative staff are superlative, and they are really 
dedicated patriots, but they are working a structure of bricks 
and mortar that fails to keep faith with our veterans.
    So I would like your commitment to work with this Committee 
and ensure that the VA prioritizes infrastructure, rebuilding, 
and most especially, obviously, for the interests of our 
Connecticut veterans, the facility in West Haven.
    Mr. McDonough. Thank you, Senator, and my commitment--my 
recommitment now, as it was in our earlier conversation, is to 
really dig in on these questions upon confirmation, to keep a 
very close collaborative relationship with you on it, to ensure 
that it is proceeding consistent with the needs of our vets and 
consistent with the two principles that I have laid out, which 
is increasing access for vets and improving outcome for vets.
    Senator Blumenthal. And I would like to invite you to West 
Haven, as I did privately, to come visit. They are doing a 
great job there, by the way, on vaccines. I have visited the 
clinic where they are administering vaccinations. They are 
increasing the number.
    I would like to know from you how you will ensure that 
there is adequate access to vaccinations by minority veterans, 
communities of black and brown veterans, and staff members in 
that category.
    Mr. McDonough. So, I thank you very much, Senator. The 
President has made clear that equity will be a fundamental 
consideration across the pandemic preparedness and response, 
and it would be my expectation, if confirmed, that I will 
assume my seat at that table, in those deliberations, and I 
will be a fierce, staunch advocate for all vets to have access 
to care and treatment and vaccines, consistent with the 
improved access and the improved outcomes that will drive any 
decision I make as Secretary, if confirmed.
    Senator Blumenthal. You are familiar, no doubt, with the 
reports about the numbers of veterans who were involved in the 
assault on the Capitol, which reflects a phenomenon that 
probably is no news to a lot of folks, that white supremacists, 
extremists ideology often find fertile ground among veterans, 
just as they do in the general population, regretfully, 
tragically, and unnecessarily. So I wonder if you could tell us 
a little bit about how, under your leadership, you will take 
steps to educate veterans about online disinformation and 
coordinate with other agencies like the Department of Defense 
in this effort.
    Mr. McDonough. Thank you, Senator. I would just say I was 
struck by the activity, the actions that you and your 
colleagues took the evening of January 6th, reconvening to 
continue the democratic process. I thought that was a very 
strong Statement. I am also struck that both throughout that 
day and in the days hence there were remarkable stories of 
veterans associated with the Washington D.C. police force, 
Capitol police force, veterans who are members themselves, all 
taking valiant action to defend democracy, a continuation, as 
we have said throughout the day, of how veterans continue to 
serve outside of uniform.
    On the question of the threat of mis-and disinformation, it 
is as important an assignment to protect our democracy as any. 
I could see a variety of opportunities for the VA to be an 
important actor in those efforts, to protect vets, to highlight 
the threats of online activity, trying to provide or insert 
disinformation. And it would be my intention to work with my 
interagency colleagues, the NSC and others, to make sure that 
is receiving appropriate consideration.
    Senator Blumenthal. Thank you. My time has expired but I 
want to congratulate and thank you again, and I will very 
enthusiastically support your nomination on the condition that 
you come to Connecticut and visit us there.
    Mr. McDonough. I would be happy to go to Connecticut. Thank 
you, Senator.
    Senator Blumenthal. Thank you.
    Chairman Tester. Thank you, Senator Blumenthal. Senator 
Tillis.

                      SENATOR THOM TILLIS

    Senator Tillis. Thank you, Mr. Chairman. Mr. McDonough, 
congratulations to you and your family and thank you for years 
of service, including a lot up here on Capitol Hill.
    First I want to apologize for our not being able to talk 
before the hearing. I think you did have an opportunity to 
speak with everyone else, and I would like to get your 
commitment between now and the time we report you out of 
Committee to go in, maybe to have a discussion----
    Mr. McDonough. Happy to.
    Senator Tillis [continuing]. so that we could drill down on 
some issues that cannot be covered in 5 minutes. So thank you.
    I think in your testimony you made reference to rebuilding 
trust in the VA, and I think always we take steps forward, we 
take steps back, and we have always got to make sure that we 
have the trust for our veterans.
    I just wanted to note that I think we are at about 80 
percent in trust at the VA overall and about 90 percent on 
outpatient health care, so it seems like we are doing something 
right. One of the things I would be curious, if you are 
confirmed, is if the metrics that we are using right now to 
measure our progress are appropriate, and then if you deem them 
appropriate then continue to commit to reporting back so that 
we can see the trend lines moving the right direction. If you 
do not think they are appropriate then make suggestions on 
things that we can better tailor to make sure that we are doing 
the best for our veterans.
    So I suspect that when you get into this role, and some 
questions have already been asked, the question of your not 
being a veteran--I am not a veteran; I think there are some 
here who have not also served. But can you talk a little bit 
about the experience that you bring and why you think it makes 
you well-suited to take on the role of Secretary of the VA?
    Mr. McDonough. Yes, thank you very much, Senator. One, I am 
fighter and I am relentless. I think anybody you talk to who 
has worked with me will affirm that. Those attributes will 
serve me well to fulfill the fundamental assignment the 
President asked me to carry out, which is to be a fierce and 
stanch advocate for our veterans.
    Two, I know and understand the Federal Government, from 
both ends of Pennsylvania Avenue. I can unstick problems inside 
agencies and across agencies, and especially an agency as large 
as VA, that is an important skill, and in fact, I have spent a 
lot of time working with many members of this Committee on 
doing just that.
    And then there is something more. Going back to those 
attacks on 9/11, for 20 years I have been afforded, in my 
public service, something relatively few Americans are granted, 
which is to see up close the excellence, the execution, the 
talent of Armed Forces. And I have been deeply moved by that. 
And I have also seen, in trips into the field, in Iraq and 
Afghanistan, on a very regular basis, the impact of our troops 
and the impact of long deployments on them and their families. 
And I have made it a point to visit at Walter Reed, and to even 
be at Dover on the final arrival home for some of our heroes.
    And I am not telling you that I am a vet, but I am telling 
you that I have come to understand the massive sacrifices that 
they have made, and I have come to witness the amazing skill 
with which they have done it. And there is no higher calling 
than to use my skills to ensure that we make good on our 
promises to them, to serve them as well as they have served us.
    Senator Tillis. Well, thank you. I am going to try to keep 
to time for my other colleagues who have yet to speak.
    But I actually wanted to thank the Chairman. For the past, 
I do not know, Jon, going back four years, with Chairman 
Isakson's approval, he and I met with two Secretaries to track 
on some of the transformation efforts, the electronic health 
record system, which is something I want to continue to be 
focused on. I am hoping the Chair, now that you are in that 
lofty role of Chair you may want to have somebody else on the 
Committee meet with them. But to meet with you all on a regular 
basis. I really believe in the electronic health record 
implementation. I think the integration with the DoD, as I 
think some other member may have alluded to it, is critical to 
provide that seamless transition. There are some other 
transformation projects that I am very interested in. Also, 
when we have a follow-up discussion, I want to talk about the 
concept of rebalancing Community Care, what that would really 
mean. And I look forward to setting up a phone call or in-
person visit over the next few days.
    Thank you all. Again, congratulations to your family. Did 
you say you came from a family of 10 kids?
    Mr. McDonough. Yes, 11. So I have 10 brothers and sister.
    Senator Tillis. Were you an altar boy?
    Mr. McDonough. I was.
    Senator Tillis. One of the best jobs I ever head.
    Mr. McDonough. Yes. There is a nice honoraria every once in 
a while.
    Senator Tillis. Yes. Thank you.
    Chairman Tester. Thank you, Senator Tillis, and we will 
continue to work on EHR. Thank you.
    Next we have up Senator Bernie Sanders, remotely.

                     SENATOR BERNIE SANDERS

    Senator Sanders. Mr. Chairman, thank you very much, and 
Denis, great to see you again.
    Mr. McDonough. Nice to see you, sir.
    Senator Sanders. I am sorry we did not have a chance to 
chat before the hearing, but I am more than aware of your years 
of public service, and I have absolute confidence that your 
knowledge of the bureaucracy is exactly what we need to head up 
the VA and make that important institution as efficient and 
useful to our veterans as it can be. So I look forward to 
working with you. And if it's Okay with you, let's see if we 
can chat a little bit in the next couple of days. Is that 
something we can do?
    Mr. McDonough. Very much. Yes, I would very much appreciate 
that.
    Senator Sanders. Okay. I would also love to welcome you to 
come to Vermont and chat with some of the folks at our very 
good hospital in White River Junction. They would love to meet 
with you and have you learn a little bit about the problems 
facing veterans' care in rural America. Is that something you 
might be interested in?
    Mr. McDonough. I would be happy to do that. I would be 
happy to do that, absolutely.
    Senator Sanders. Okay. A couple of issues that I wanted to 
touch on--and I apologize, I was in another meeting--is the 
trend that we have seen in recent years toward privatization. 
In talking to veterans in Vermont, and as former Chair of the 
VA Committee, talking to veterans all across this country, I 
find that veterans, by and large, with exception, feel that the 
quality of care that they are getting at the VA is very good, 
and they very much appreciate the level of staffing and people 
who often come from their backgrounds, and many of them 
veterans themselves, who understand the particular problems 
that veterans face.
    Can you say a word about trying to maybe reverse the 
efforts toward privatization and adequately fund the VA so that 
veterans can get the quality care in a timely manner that they 
deserve?
    Mr. McDonough. Thank you, Senator. I have indicated that 
every decision that I make will flow from two principles, which 
is does the decision increase access for veterans and does it 
improve outcomes for veterans. And that, at the end of the day, 
has got to be the defining set of principles on every decision.
    I think, as I have discussed with many members of the 
Committee, I do not support privatization. I do recognize that 
Community Care will continue to be a part of how the VA 
provides care to veterans, so we have to ensure that Community 
Care, that VA is being a good partner in Community Care, timely 
paying of bills, maintaining an effective, vibrant network.
    At the same time, we have to ensure that this integrated 
health model continues to draw on the success and the 
excellence that is obvious throughout its work force. So that 
is how I see this, Senator.
    Senator Sanders. And I would agree with you. I just wanted 
to touch on an issue which is of concern in Vermont, and I 
think nationally. When I look at health care, Dennis, I see 
dental care as an integral part of health care, and yet dental 
care is not available to the average veteran except when there 
is--when it is associated with an injury, a service-related 
injury. Would you work with me in trying, perhaps, to expand 
dental care as a basic benefit for our veterans?
    Mr. McDonough. Thank you, Senator. I will absolutely dig 
into this question, if confirmed, and continue to work with you 
and other members of the Committee in a consultative, 
collaborative way to try to address these concerns, absolutely.
    Senator Sanders. Okay. Well, Mr. Chairman, that is all that 
I have. I think we are looking at somebody who stands the 
chance of being a really, really great VA Secretary, and I 
certainly look forward to working with him in the future. So 
thank you very much, Denis, and I look forward to chatting with 
you shortly.
    Mr. McDonough. Thank you so much, Senator.
    Chairman Tester. Yes, thank you, Senator Sanders. Next we 
have Senator Sullivan.

                      SENATOR DAN SULLIVAN

    Senator Sullivan. Thank you, Mr. Chairman, and Mr. 
McDonough, thanks for your conversation and meeting yesterday. 
As I mentioned, I am proudly serving the State with more vets 
per capita than any State in the country--Joe, it is true, 
sorry. West Virginia is close, patriotic communities, both of 
ours. And I reached out to a number of our veterans for 
questions that they can ask you, and I got a lot, of course. 
And I would say that you could boil them down to a couple 
things. They want a Secretary who understands what it means to 
serve, who will vigorously tackle the benefit and health care 
challenges facing them, and who listens, who does not 
prioritize the needs of, say, a veteran in Los Angeles or a big 
city over the needs of those in rural communities like 
Utqiagvik or Kotzebue, who works with Congress on finding 
solutions, not politicizing.
    And in the spirit of a great Marine, former constituent of 
mine, unfortunately we lost him last year, Marine Gunnery 
Sargent ``Cajun Bob'' Thoms from Wasilla, Alaska, six Purple 
hearts, on the cover of Life magazine, for his Silver Star of 
valiant heroic for his tour in Vietnam, in the confirmation of 
Secretary Shulkin, he had asked the question of saying he 
simply wants a VA Secretary who ``will kick ass and take 
names.''
    So what do you say to my veterans on these issues, and can 
you take a minute--I know you did with Senator Tillis--to speak 
directly to the legitimate concerns that Alaska veterans have 
raised who feel as though military experience is the 
prerequisite for the VA Secretary, to understand and have a 
baseline understanding of their needs, their service, their 
experience.
    So if you can address all those I would appreciate it.
    Mr. McDonough. Thank you, Senator, and I appreciate the 
question, and I appreciate the concern at the heart of the 
question about who is best prepared to be VA Secretary.
    I am not a gunnery sergeant, but I am a fighter and I am 
relentless. Anybody who has worked with me knows that. Two, I 
know how the government works, and importantly, I know when and 
how it does not work. And I will fight relentlessly to ensure 
that it works for our vets.
    Senator Sullivan. So I think my constituents, my veterans, 
their families, they want to know, will you have their back?
    Mr. McDonough. I have spent the last 20 years involved in 
decisions about when and where--as a staff person I am not 
going to over state my role, but as a staff person, when and 
where our men and women go to fight. And I have gone and seen 
and met and witnessed what they are doing, and I have gone to 
visit them when they are injured, here at home. And I have seen 
and internalized their excellence, and I know that the basic 
requirement of VA Secretary is to have their back, to ensure 
that I will fight like hell to take as good a care of them as 
they have taken of us.
    Senator Sullivan. So in the immortal words of Cajun Bob, 
you will----
    Mr. McDonough. Kick ass and take names.
    Senator Sullivan [continuing]. kick ass and take names on 
behalf of our veterans?
    Mr. McDonough. Yes, sir.
    Senator Sullivan. That is important. They need to know it.
    Mr. McDonough. Yes, sir.
    Senator Sullivan. I also want to get your commitment, first 
year of your tenure, to get up to Alaska and meet with my 
veterans, see our State, see the challenges. Can I get your 
commitment on that?
    Mr. McDonough. You have got that commitment.
    Senator Sullivan. Can I get your commitment--you know, if 
confirmed you are going to be running a big bureaucracy--can I 
get your commitment to kind of do a VFR direct with all of us 
on this Committee, when we have issues, we can go directly to 
you and not through the 18 layers of bureaucracy?
    Mr. McDonough. Yes, you have that commitment.
    Senator Sullivan. Let me ask one final question. Again, 
these were concerns from my veterans. You served in the Obama 
Administration. My first 2 years in the Senate were the last 2 
years of the Obama Administration. A lot of the issues I was 
dealing with were some of the big VA problems. The Choice 
program, which, in my State, the implementation was an utter 
disaster. It actually collapsed the system in Alaska. I mean, 
total disaster. The Phoenix wait time scandal. What did you 
learn from these, and do you think that experience is going to 
help you? Is that a liability, give your background? And can 
you assure my veterans that we are not going to go back to 
those days, which I do not think anyone on this Committee 
thinks were good days for our veterans. We have made a lot of 
progress since that, we have made a lot of progress back home 
in Alaska, particularly as it relates to putting together an 
Alaska plan that got us out of the hole the Choice program put 
us in.
    Mr. McDonough. Thank you, Senator. The lifeblood of a well-
run, well-functioning organization or agency is timely, 
accurate information. That was not the case in Phoenix. The 
lifeblood of a well-run organization is accountability. 
Accountability happened in Phoenix, but it was slow. You all 
have subsequently changed the statute to make that easier, and 
it will not ever happen again.
    At the end of the day, the principle that will inform my 
leadership of the VA, if I am confirmed, is whether any 
decision increases access and improves outcomes for our vets. 
That is what we owe the vets. That is what my commitment to 
you, to the VSOs, and to them, and to the President, is that I 
will deliver, if confirmed as Secretary.
    Senator Sullivan. Thank you. Thank you, Mr. Chairman.
    Chairman Tester. Thank you, Senator Sullivan. Senator Joe 
Manchin III. Hallelujah.

                      SENATOR JOE MANCHIN

    Senator Manchin. Thank you, Mr. Chairman, and 
congratulations on your lofty position. First of all, Mr. 
McDonough, thank you very much, and if I may say, Denis, we 
have known each other for a while, and I am glad my colleagues 
brought up about, you know, sometimes they think we need to be 
veterans, and I never had the honor and the pleasure of being 
able to be a veteran. I think that is a void in my life. I 
think back--I was an altar boy for 12 years. I was a Boy Scout 
for a long time. I never made it to the military, and that is 
something I really think there is a void, and I think it is a 
special opportunity. But we know that it takes a person who 
cares and has the experience to do the job, and that is where 
you come in. And I think, Denis, that says everything.
    Let me tell you a little bit of what you are facing and 
what I have faced in the 5-years I have been on this Committee. 
I came on this Committee in the 114th Congress in 2015. Since 
then, they talked about the wait time scandals. That led to the 
VA Choice Act. It led to the MISSION Act, which needs a lot of 
repairs, as you know. The veterans' unemployment and hiring 
after the financial crisis, we had more veterans unemployed. It 
took longer to get them back employed, and we started I Hire a 
Vet, a campaign all over the country.
    Toxic exposure, Agent Orange, burn pits--I know you are 
very much aware of those and it is really wreaking havoc today. 
The veteran suicide and mental health that we deal with on a 
daily basis. Veteran homelessness is something that I cannot 
comprehend at all how we can have any veterans that we would 
not have better care for.
    The women veteran health care access. Women think they have 
been left out or are not a high priority, and they are an 
integral part of our military and our defense today. The hiring 
backlog, over 40,000 vacancies in the VA. Veterans Affairs IT 
infrastructure delay. At Clarksburg VA, murders. If anything I 
have ever experienced in my life is knowing that we could have 
veterans who were murdered in a veteran's hospital, and we have 
eight confirmed, a woman that will be serving many life 
sentences over and over. And there might be as many as three 
more. We have had sexual abuse, just found it in another 
Beckley VA hospital, four veterans we know of and probably 40 
more over a 25-year span.
    There is a breakdown somewhere, sir, and we are just going 
to need someone like you who can dig into that, because to me 
it would be vetting. We are not vetting people properly. We are 
not having strict rules adhered to.
    But more importantly, we passed, in 2017, the 
Accountability and Whistleblower Protection Act. We wanted to 
make sure that we could basically get rid of the people that 
were not doing their job. I do not think that has been 
exercised much since then, and I will give you a perfect 
example. The people that I hold responsible for the VA hospital 
deaths in Clarksburg have been moved to other places in the VA 
system. Unheard of. And I knew way back when this happened, in 
a meeting with them, that someone was either lying to me or 
totally incompetent. And now when I found out, we brought new 
leadership in, they were moved somewhere. I cannot find them. 
And I would like to know on that, if we could bring that to the 
highest priority.
    I think to put the credibility back in the VA, the care and 
the desire for the care that they deserve, I would ask you, as 
one of your first visits, to come to Clarksburg VA and set down 
what your mission would be. And I think, sir, that could set 
the tone for the entire VA system all over the country. It is 
just unbelievable, totally unbelievable. And now families--I 
have families calling me daily. Did my father or grandfather 
lose their life because someone murdered them when they were 
there, still not knowing for sure. These are all the things 
that we are dealing with today. You can help ease that pain, I 
think.
    But, Denis, I look forward to you. We need someone of your 
ability more now than ever, and like I said, I am in awe today 
of every person I see in uniform, all the people you see out 
here guarding this great republic of ours, and anybody who has 
served, to give them the greatest care.
    So with that I know the challenges are great. If you would 
like to comment on any of that, I know you have probably been 
following some of this, but I do not know to what extent on 
that.
    Mr. McDonough. Well, I thank you very much, Senator, and I 
have been following it, and we had a very good conversation, 
which I appreciated.
    Senator Manchin. Thank you for that.
    Mr. McDonough. And my commitment is, as I assured you 
before, which is to work in close consultation and 
collaboratively with you and with the rest of the members of 
the Committee on these question.
    Senator Manchin. I think you are going to find a committee 
that has worked in--I am just about finished--a committee that 
has worked in a most bipartisan way. And I have said this 
before, and I mean this with all my heart. Men and women in 
uniform are the glue of this country. They keep us together. 
They keep us talking. They keep us finding ways to work 
together, to make sure that we are taking care of those who are 
taking care of us. So you have got it in your hands now, the 
cradle, basically, of the people who have made the country what 
we are today, and we owe it to them.
    So with that being said, you are going to find all the 
support. If we do not have a piece of legislation that allows 
you to reorganize, that allows you to basically get rid of the 
dead wood and the people who do not care--my grandmother always 
said, ``People don't care how much you know until they know how 
much you care.'' I know how much you care. Now you have to show 
the rest of the world.
    Mr. McDonough. Thank you.
    Senator Manchin. Thank you, sir. I look forward to voting 
for you too.
    Mr. McDonough. Thank you.
    Senator Manchin. Count me in. Put me in again, Coach.
    Chairman Tester. You have got it, big boy. Thank you, 
Senator Manchin. Remotely we have Senator Blackburn.

                    SENATOR MARSHA BLACKBURN

    Senator Blackburn. Yes, thank you. I appreciate that, and 
Mr. McDonough, thank you so much for the time this week. It was 
wonderful to visit with you by phone. Let me just--and I 
appreciate your commitment. You have talked some about your 
passion and that relentless commitment to doing the job and to 
public service. So very quickly, what would uniquely qualify 
you to lead the VA, with a budget that is nearly a quarter of a 
trillion dollars and 400,000 employees, and it serves 9 million 
enrolled veterans? So kind of following on to Senator Manchin's 
question, what is your unique qualification?
    Mr. McDonough. Thank you, Senator. As you have indicated, I 
am a fighter and I am relentless, and that means I will fight 
to get our vets' backs, and I will ensure, relentlessly, that 
the resources that you have authorized and appropriated for the 
Committee are invested wisely and with the veteran at the 
center of those investments.
    I also understand how the government works, from both ends 
of Pennsylvania Avenue. That means demanding excellence. That 
means enforcing accountability. That means being in close 
collaboration and consultation with you and other members of 
this Committee, to ensure that we are using all the available 
power of the U.S. Government to get our vets' backs.
    Lastly, for 20 years now I have been involved in these 
decisions about when and where to send our men and women to 
war, not as a decider--I am not trying to over state my role---
but as a staff person. And I have also seen the excellence of 
our military and I have seen the challenges of long 
deployments, and I have seen the sacrifices, but I have seen 
the resilience. And there is no higher calling than to be able 
to use my skills and my experience to repay and to ensure that 
we live up to the promises we have made to our vets.
    Senator Blackburn. Yes. Let me jump in there, because 
Senator Moran and others have talked about Community Care, and 
you and I talked a little bit about this. You have got Choice. 
You have got MISSION. We have got, as part of repaying these 
veterans, many that want to get care in their communities. You 
talked about the right balance of care, and I would like for 
you to bring just a little bit of clarity to that. What do you 
see as the right balance of care, and would you commit that you 
are not going to roll back on standards and reverse the intent 
of a veteran-centric care and addressing the whole health of 
the veteran?
    Mr. McDonough. Thank you, Senator. Community Care will 
continue to be a fundamental way that the Department provides 
care to our veterans, one. Two, the statute is clear on this. 
It says that best medical outcome for the veteran is the 
objective, and that will continue to be my priority, if 
confirmed as Secretary.
    Third, every decision I make as Secretary will come back to 
this principle, which is, is it increasing access for veterans 
and is it improving outcomes for veterans? If the answer to 
those questions are no then we will not do it.
    Senator Blackburn. Okay. Well, and you and I discussed the 
health records, the electronic health records.
    Mr. McDonough. Yes, ma'am.
    Senator Blackburn. And others have brought that up today. 
And, you know, my frustration with a $4 billion IT budget and 
they cannot seem to get it right, indeed Senator Tester and I 
had legislation this year that would have improved the 
management of that. And for the record, we are about out of 
time. I will send you a QFR on the management of those 
programs, and then you and I also discussed purchasing, and for 
the record I will send you a question delving a little bit more 
into that purchasing.
    But thank you for the time today. Thank you for your 
commitment. And, Mr. Chairman, I will send the time back to 
you.
    Chairman Tester. Thank you, Senator Blackburn. Next we 
have, remotely, Senator Sinema.

                     SENATOR KYRSTEN SINEMA

    Senator Sinema. Thank you, Mr. Chairman. I appreciate Mr. 
McDonough joining us today. My office is increasingly hearing 
from Arizona veterans asking for clarification on how to 
receive the COVID vaccine from the VA and when they will be 
able to receive it. My staff has been working locally to make 
sure information is getting out to the community, and this 
highlights the importance of having Senate-confirmed leadership 
at the Department of Veterans Affairs as quickly as possible.
    I have introduced, with Senator Tillis, the Ensuring 
Survivor Benefits During COVID legislation to address concerns 
that survivors of veterans who died from COVID may not be 
granted their earned benefits if the death certificate only 
identifies COVID-19 as the cause of death, without considering 
the impact of other service-connected illnesses.
    If confirmed, will you work with me to ensure that 
processes are in place to address these concerns?
    Mr. McDonough. Yes, Senator, I will.
    Senator Sinema. Thank you. Over the last year, my office 
has worked with the VA, American Legion, and Philips North 
America to bring an Atlas site to Arizona. We hope to provide 
more details about that site in the coming weeks. The Atlas, or 
the Accessing Telehealth through Local Area Stations program, 
is part of VA's Anywhere to Anywhere telehealth initiative to 
bring a VA telehealth access point to underserved communities. 
In Arizona, there may be many rural and tribal communities that 
could benefit from this and other telehealth initiatives.
    If confirmed, will you continue to work with our office to 
expand telehealth opportunities to rural and tribal 
communities?
    Mr. McDonough. Yes, I will.
    Senator Sinema. As we consider expansion, we have to 
acknowledge the challenges of access to broadband in these 
communities. As the VA continues to expand its telehealth 
initiatives, what role do you feel the VA should play in 
addressing broadband access?
    Mr. McDonough. Thank you, Senator. I think the VA has a key 
role to play in coordinating with other Federal agencies and 
with the FCC to ensure that the kinds of access questions that 
VA can lead on, including on telehealth, can be expanded by 
better broadband access more universally available. So I think 
there is a critical role to play within the interagency, and 
that, if confirmed, would be precisely what I intend to do.
    Senator Sinema. Thank you. You know, in Arizona the Navajo 
Nation has been hit particularly hard by COVID. The CDC notes 
that Native Americans are at a disproportionate risk for 
complications from COVID due to health and socioeconomic 
disparities in these communities. They also experience other 
inequities such as high instances of homelessness and 
challenges accessing clean drinking water and sanitation.
    If confirmed, what steps will you take to ensure the VA is 
best serving Native American veterans?
    Mr. McDonough. This would be a fundamental priority, 
consistent with the President's Stated priorities on equity and 
consistent with what I have said throughout the day today, 
which is how are we increasing access and improving outcomes 
for all vets. And third, consistent with the direction to me 
from the President to ensure that VA is welcoming of all 
veterans, including, obviously, Navajo and other Native 
American veterans.
    So, there is a fundamental role for us, for the VA to play 
there, and if confirmed I would intend to play that role.
    Senator Sinema. I appreciate that. Thank you.
    Information technology modernization has been and continues 
to be a central focus for the VA. If confirmed, you will be 
responsible for overseeing these major modernization efforts. 
As cybersecurity threats continue to increase across the U.S., 
what steps will you take to ensure that VA is equipped to 
protect against cyber threats and is practicing good cyber 
hygiene?
    Mr. McDonough. Thank you, Senator. Obviously, the range of 
cyber threats that we confront as a country is only growing. 
Having cybersecurity, cyber hygiene front and center, not only 
for the major programmatic efforts at the Department but also 
for individuals in the work force at the Department will have 
to be a fundamental priority for the next Secretary, and if 
that is me I would intend to make cybersecurity a key priority.
    Senator Sinema. Thanks. You know, the VA still has a number 
of legacy systems it is supporting. These cannot only be costly 
but also generally do not follow or accommodate today's 
security best practices.
    Mr. McDonough. Right.
    Senator Sinema. What would be your approach to addressing 
legacy systems, if confirmed as VA Secretary?
    Mr. McDonough. Thank you, Senator. Obviously there has to 
be a fundamental focus on cybersecurity and cyber hygiene 
across the enterprise, one, and then two is effectively 
performing on the modernization efforts will allow VA to not 
only increase security and increase performance and outcomes 
for vets but will also reduce costs over time of these legacy 
systems. So executing on the modernization has to be a key 
priority.
    Senator Sinema. And I see that my time has expired. With 
your indulgence, Mr. Chair, I will submit the rest of my 
questions for our nominee, and I want to thank him for joining 
us here today.
    Chairman Tester. Thank you, Senator Sinema, and in that 
regard the questions need to be in by tomorrow at 5 p.m.
    Last but certainly not least, and I have been in your 
position before, Senator Cramer. Senator Cramer.

                      SENATOR KEVIN CRAMER

    Senator Cramer. Thank you, Mr. Chairman. Thank you, Mr. 
McDonough, and I do not mind, frankly. It means that I do not 
have to ask Denis about rural veterans, Native American 
veterans, telehealth, COVID-19, MISSION Act or Community Care 
Network. So we can get right down to the business of Clemens 
Stadium, Johnnies football, and Jake Christiansen Stadium 
versus the Cobbers. How about that?
    Mr. McDonough. I like that.
    Senator Cramer. All right. Well, we will get to that on 
your way to Alaska, when you stop in Fargo. Okay? But you and I 
did have a wonderful discussion. I want to tell you how much I 
appreciated the meeting we had earlier this week. We did drill 
down on a number of these issues, as well as one of my most 
important issues, that is probably a little more unique to me, 
and that is, of course, the use of alternative forms of 
therapies, treatments, particularly hyperbaric oxygen 
treatment.
    And the reason I am such a proponent of hyperbaric oxygen 
treatment and therapies for veterans is because I have seen it 
work so well. A number of veterans that I know have really had 
their lives changed, and in some cases saved, by this important 
therapy, as well as others, who have had injuries that come 
from sports, particularly head trauma, traumatic brain 
injuries.
    And so I am a strong proponent of it, and by the way, I 
very much appreciated your dialog with Senator Moran, because 
he was getting to the heart of an issue that I think a lot of 
us, as you could probably tell, are challenged by, and that is 
just how large the bureaucracy is and how difficult it can be 
to maneuver it, and how often we will actually pass legislation 
that is signed into law only to have it sort of either slow 
walked, whether intentionally or unintentionally, and I happen 
to believe that most of the time it is with good intentions.
    But with regard to HBOT, I was able to get language in the 
John Scott legislation, that you are very familiar with, that 
would authorize the Secretary of the VA to enter into public-
private partnerships to research the effectiveness of 
hyperbaric oxygen therapy. And it would require--and I stress 
require--the VA to use an objective test to measure the 
effectiveness of hyperbaric oxygen therapy, and it would 
commission a comprehensive review and study of HBOT, both 
within the VA, and I think importantly, with outside 
organizations as well, because there is just a lot of 
experience out there that, to this point, has not been brought, 
in my view, into a good peer-reviewed objective study. But it 
would be completed with a recommendation then from the VA about 
the effectiveness of HBOT.
    I stress that because that is language in the bill that 
makes it law, and I believe there are, as I said, real benefits 
to this innovative therapy, and by the way, other innovative 
therapies. And I think you and I talked about the important 
role the VA has played, the leadership role it has played in 
some very effective alternatives to traditional medicine or in 
addition to traditional medicine.
    And really want to just, I guess again, thank you for 
listening and get a reaffirmation of your commitment to fulfill 
both the letter of that law and then the spirit of it, and then 
accept my invitation to Fargo on your way to Alaska to see Dan 
Sullivan.
    Mr. McDonough. Any time I can go to Fargo I will take it, 
one. Two is I would be happy to recommit to making sure that we 
dig into the analysis of the therapy, consistent with the 
intent in the statute, and consistent with getting to the brass 
tack here, to find out what is the best way and best vehicle to 
deliver the kind of care to our vets that they have earned.
    Senator Cramer. I appreciate that. I have written down a 
number of the things you have said, in quotes. I will not 
repeat all of them, but one thing you have said a couple of 
times in response to the question about your cred, if you will, 
your street cred for this job--and I love when you say ``I know 
how government works.'' I think that is oftentimes an 
underappreciated skill set and gift and experience. So I 
believe you when you say that. You have every reason to know 
how government works. As you have said, you have seen it from 
both ends of Pennsylvania Avenue. And count me as an 
affirmative vote----
    Mr. McDonough. Thank you.
    Senator Cramer [continuing]. and someone who looks forward 
to working with you once you are confirmed.
    Mr. McDonough. Thank you, Senator.
    Senator Cramer. And with that I yield the rest of my time, 
Mr. Chairman.
    Mr. McDonough. Thank you.
    Chairman Tester. Yes, thank you, Senator Cramer. Before I 
have my closing remarks I will turn it over to the Ranking 
Member, Senator Moran.
    Senator Moran. Chairman Tester, thank you very much. It was 
tolerable to have you in the chair today, and it is not exactly 
what I wanted but it is not a bad deal either, so thank you for 
working with me and my colleagues on this side of the aisle as 
we commit to do to you and your colleagues.
    Mr. McDonough, before I ask you a question I wanted to 
point out to the Committee that we have a new staff director, 
now on the minority side, who came from the House minority side 
but was in both the minority and majority staff world in the 
Senate, and is returning now to the Senate. This is his first 
meeting since his arrival, and John Towers is behind me, and we 
look forward to having him and his help. And we make him 
available to you, Mr. McDonough, should you be confirmed.
    Mr. McDonough. Thank you.
    Senator Moran. Mr. McDonough, would you commit to me that 
you are a fan of the Chiefs?
    [Laughter.]
    Mr. McDonough. Senator Moran, I am a big fan of Patrick 
Mahomes, but I am a Vikings fan, and I hate to admit that I am 
kind of old school that way.
    Senator Moran. Well, you could have answered the question 
in a worse way.
    Mr. McDonough, I thank you for your interest in serving as 
the Secretary of the Department of Veterans Affairs. I thank 
you for your testimony today. I just wanted you to know, based 
upon what you have said and what I have learned about you that 
I will vote for your confirmation.
    Mr. McDonough. Thank you.
    Senator Moran. And I will ask my Republican colleagues to 
do the same. And I look forward to working with you, and your 
commitment is evident to me, and I think we can accomplish a 
lot on behalf of those who served our Nation, working together.
    So best wishes to you and your family, and I thank them. I 
know your wife, in particular, is involved in veterans' 
services, and I would express my gratitude, as I did personally 
to her, but here publicly, for her efforts. And so as a family 
we wish you all well in this new endeavor----
    Mr. McDonough. Thank you very much.
    Senator Moran [continuing]. and I am grateful for your 
service. Thank you.
    Mr. McDonough. Thank you so much, Senator.
    Chairman Tester. Senator Moran, Mr. McDonough, I do not 
know if Moran had that question that he asked you and knew the 
real impact of it, but not only is Jerry Moran a Chiefs fan but 
my Committee director is also a Chiefs fan. So, you know, I 
mean, I guess it does not matter if you are a Vikings fan as 
long as you root for the Chiefs in the Super Bowl. So, Okay.
    I also want to welcome John Towers. John is somebody that 
both Jerry and I had the opportunity to work with when he was 
in the House. And as you well know, Denis, oftentimes a 
relationship between the principles is important, but the 
relationship between the staff is more important.
    Mr. McDonough. Hear, hear.
    Chairman Tester. And so I want to welcome you on board, 
John.
    And I also want to thank your wife and your family that 
have sat attentively behind you, nodding their heads and paying 
attention. I cannot see their eyes so I do not think they 
nodded off, very often anyway.
    But the truth is, as we all know, that the power and the 
ability for any of us to serve in any of these positions, 
whether it is elected or staffed, really relies with the family 
and how important they are to our ability to do our job. And I 
want to thank our Committee today for their thoughtful 
questions and their belief and the way they put across the fact 
that veterans are No. 1 in this Committee, and that is why we 
work on this Committee so well.
    You know, I looked at the FBI report the day before 
yesterday, and I think Senator Moran is going to do it 
tomorrow, and I do not think I am out of school by saying that 
it was pretty darn stellar. In fact, I told the lady that 
brought it in I would have to pay a lot of money to get this 
many recommendations of what a fine fellow I am. And so you are 
a highly qualified candidate, and I believe that you will work 
with this Committee to ensure that we keep the promises to the 
men and women who have served their country, and their families 
too, by the way.
    And Senator Moran visited, and we have an agreement that we 
plan to meet again on Tuesday to vote on Denis McDonough's 
nomination to be Secretary of the Veterans Affairs, as well the 
Committee rules and the budget. And that is what we are going 
to do. I think the fact that you had not met with Senator 
Tillis or Senator Sanders yet, and the fact that the Ranking 
Member had not seen the FBI report requires us to do it then. 
Otherwise, I would have tried to move it up, but I am not going 
to, based on that.
    I would ask, as I pointed out to Senator Sinema, that any 
post-hearing questions be sent to the clerk by tomorrow at 5 
p.m. And then we will need those responses back from you before 
we vote on Tuesday.
    With that once again I want to thank you and your family 
for being here. Always a pleasure to work with Senator Moran. 
This hearing is adjourned.
    Mr. McDonough. Thank you.
    [Whereupon, at 5:08 p.m., the Committee was adjourned.]

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