[Senate Hearing 117-137]
[From the U.S. Government Publishing Office]


                                                        S. Hrg. 117-137

                     HEARING ON PENDING LEGISLATION

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

                                HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             FIRST SESSION

                               __________

                             APRIL 28, 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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                     COMMITTEE ON VETERANS' AFFAIRS

                     Jon Tester, Montana, Chairman
Patty Murray, Washington             Jerry Moran,Kansas, Ranking Member
Bernard Sanders, Vermont             John Boozman, Arkansas
Sherrod Brown, Ohio                  Bill Cassidy, Louisiana
Richard Blumenthal, Connecticut      Mike Rounds, South Dakota
Mazie K. Hirono, Hawaii              Thom Tillis, North Carolina
Joe Manchin III, West Virginia       Dan Sullivan, Alaska
Kyrsten Sinema, Arizona              Marsha Blackburn, Tennessee
Margaret Wood Hassan, New Hampshire  Kevin Cramer, North Dakota
                                     Tommy Tuberville, Alabama
                      Tony McClain, Staff Director
                 Jon Towers, Republican Staff Director
                            
                            
                            C O N T E N T S

                              ----------                              

                       Wednesday, April 28, 2021

                                SENATORS

                                                                   Page
Tester, Hon. Jon, Chairman, U.S. Senator from Montana............     1
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas......     2
Tillis, Hon. Thom, U.S. Senator from North Carolina..............    16
Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire......    18
Blackburn, Hon. Marsha, U.S. Senator from Tennessee..............    22
Brown, Sherrod, U.S. Senator from Ohio...........................    24
Boozman, Hon. John, U.S. Senator from Arkansas...................    28
Sinema, Hon. Kyrsten U.S. Senator from Arizona...................    29

                               WITNESSES

Ronald Burke, Deputy Under Secretary For Policy And Oversight, 
  Veterans Benefits Administration, Department Of Veterans 
  Affairs, Accompanied By; Beth Murphy, Executive Director For 
  Compensation Service, Veterans Benefits Administration; 
  Patricia R. Hastings, DO, MPH, FACEP, RN, Chief Consultant For 
  Post Deployment Health Services, Veterans Health Administration 
  and Paul Brubaker, Deputy Chief Information Officer For Account 
  Management, Office Of Information And Technology...............     3
Shane Liermann, Deputy National Legislative Director, Disabled 
  American Veterans..............................................     5
Aleksandr Morosky, Government Affairs Specialist, Wounded Warrior 
  Project........................................................     6
Patrick Murray, Director, National Legislative Service, Veterans 
  of Foreign Wars................................................     8
John Rowan, National President, Vietnam Veterans of America......     9
Candace Wheeler, Director of Policy, Tragedy Assistance Program 
  For Survivors..................................................    11

                                APPENDIX
                     Witnesses prepared statements

Ronald Burke, Deputy Under Secretary For Policy And Oversight, 
  Veterans Benefits Administration, Department of Veterans 
  Affairs........................................................    34
Shane Liermann, Deputy National Legislative Director, Disabled 
  American Veterans..............................................    54
Aleksandr Morosky, Government Affairs Specialist, Wounded Warrior 
  Project........................................................    69
Patrick Murray, Director, National Legislative Service, Veterans 
  of Foreign Wars................................................    84
John Rowan, National President, Vietnam Veterans of America......    94
Candace Wheeler, Director of Policy, Tragedy Assistance Program 
  For Survivors..................................................   104
                        Questions for the Record

Department of Veterans Affairs Questions for the Record submitted 
  by:
  Hon. Manchin...................................................   123
  Hon. Blackburn.................................................   127
  Hon. Sullivan..................................................   129
  Manchin Fact sheet.............................................   131

Disabled American Veterans Questions for the Record submitted by:
  Hon. Manchin...................................................   135

                       Statements for the Record

Senator Portman..................................................   136
Bart Stichman, Co-Founder and Executive Director, National 
  Veterans Legal Services Program................................   137
Anthony Hardie, National Chair and Director, Veterans for Common 
  Sense..........................................................   145
Air Force Sergeants Association..................................   160
Everett B. Kelley, National President, American Federation of 
  Government Employees, AFL-CIO..................................   169
David Schless, President, American Seniors Housing Association...   173
Environmental Working Group......................................   174
Theo Lawson, Fleet Reserve Association...........................   184
Chelsey Poisson, Executive Director, HunterSeven Foundation......   188
Travis Horr, Director, Government Affairs, Iraq and Afghanistan 
  Veterans of America............................................   189
Kate Hendricks Thomas, PhD, Marine Corps Veteran Researcher, 
  University of Alabama Center for Evaluation Adjunct Faculty, 
  George Mason University's Department of Global and Community 
  Health.........................................................   193
Victoria L. Collier, J.D., CELA, CEPA, USAF AND USAR Veteran, Co-
  Owner, Patriot Angels..........................................   197
Military Officers Association of America.........................   200
Commander John B. Wells, USN (Retired) Chairman, Military 
  Veterans Advocacy..............................................   210
Paralyzed Veterans of America....................................   225
Sharri L. Briley, Surviving Spouse of CW03 Donovan Lee Briley, US 
  Army...........................................................   233
Peter Sullivan on behalf of the Seargeant Sullivan Circle........   236
Kenneth Greenberg, Policy Director, VetsFirst, a Program of 
  United Spinal Association......................................   239

 
                     HEARING ON PENDING LEGISLATION

                              ----------                              


                       WEDNESDAY, APRIL 28, 2021

                                       U.S. Senate,
                            Committee on Veterans' Affairs,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 3 p.m., via Webex 
and in room 216, Hart Senate Office Building, Hon. Jon Tester, 
Chairman of the Committee, presiding.
    Present: Senators Tester, Sanders, Brown, Manchin, Sinema, 
Hassan, Moran, Boozman, Tillis, Sullivan, Blackburn, and 
Tuberville.

              OPENING STATEMENT OF CHAIRMAN TESTER

    Chairman Tester. I want to call this hearing to order, and 
I want to say good afternoon. Thank you for joining us today to 
hear views from the Department of Veterans Affairs and veteran 
service organizations on pending legislation.
    Every year, Congress considers numerous exposure-related 
bills, each focusing on a specific generation of veterans or 
one particular disease or condition. What has emerged is a 
broken process and disjointed coverage for veterans. While each 
legislative victory is a step in the right direction, it is 
clear that our next step must be bold, and veterans deserve 
nothing less. And, in my opinion, that step should be 
comprehensive legislation that is veteran-focused, consistent, 
and science-based. As Chairman, that is my top priority this 
Congress. I know I share that priority with many of the folks 
here today.
    We must provide health care and benefits to all veterans 
suffering from the effects of toxic exposure, past, present and 
future. It is a cost of war. That is pure and simple. And I am 
confident that we can do so because this is not a partisan 
issue. It is a matter of doing what is right for the people who 
served this country.
    I am thankful for the bipartisan leadership for members of 
this Committee, and I commit to working with each of you on 
your priorities as we move forward. To our witnesses, I ask 
that you help us understand the impact of these bills, how they 
can work together, and what gaps need to be addressed. If we 
work together, we can finally fulfill our promise to our 
veterans, and reassure them that when they fight for us we will 
fight for them.
    That fight, of course, is not just limited to toxic 
exposures. Today we learn about a variety of efforts to improve 
the delivery of health care and benefits for veterans. I look 
forward to a productive hearing from our witnesses, and helping 
us in that regard.
    I will tell you what my schedule is. There are a number of 
bills out there. They all have good points to them. We need to 
put those bills together, and we will, in a comprehensive 
package that I hope to mark up in this Committee before 
Memorial Day. If we are able to do that, I believe that gets us 
time to get something done this year.
    With that, I turn it over to the Ranking Member, Senator 
Moran.

               OPENING STATEMENT OF SENATOR MORAN

    Senator Moran. Chairman Tester, thank you. Thank you for 
explaining and outlining that schedule, which I fully agree 
with and support, and will be trying to help you accomplish 
that goal.
    Chairman Tester. Thank you.
    Senator Moran. Chairman Tester and each of our many 
witnesses, thank you for providing your expertise on important 
topics of benefits for veterans and their families, including 
health care for veterans who have been exposed to toxic 
substances during their service. Although the VA has the 
authority to grant benefits to those veterans who are impacted 
by their exposures to toxic substances, the Department's 
sluggishness in creating a pathway to those benefits suggests 
that legislation is necessary to mandate a clear process.
    To that end, on today's agenda is Senator Tillis' 
bipartisan TEAM Act, which I support and co-sponsored. This 
legislation was brought to Congress by a coalition of more than 
30 VSOs to reform the way veterans exposed to toxic substances 
access health care. It is my hope that we can come to a 
consensus on how to perfect this concept in this bill so it can 
be approved by this Committee and ultimately passed into law.
    While the number of bills related to toxic exposure on 
today's agenda suggest the topic is to be the focus of today's 
hearing, I do want to acknowledge the importance of legislation 
related to the lives and benefits of severely disabled veterans 
and the surviving children and spouses of those veterans and 
servicemembers who have passed.
    Particularly, I want to highlight that our agenda includes 
the Colonel John M. McHugh Tuition Fairness for Survivors Act, 
which would expand in-State tuition eligibility for families of 
veterans who have passed away due to service-connected 
disabilities. To honor his memory and the ultimate sacrifice he 
and his family made, this bill is named after U.S. Army Colonel 
John McHugh, who was killed in Kabul, Afghanistan in 2010, 
while he and his family were stationed at Fort Leavenworth, 
Kansas.
    Last, I want to say thank you to the TAPS, DAV, VFW, VVA, 
and WWP for being our eyes and ears on the ground and to help 
this Committee make sense of the Fargo of veterans' benefits as 
we work to create clear and impactful legislation.
    Mr. Chairman, thank you for the opportunity.
    Chairman Tester. Thank you, Senator Moran. Today we are 
going to hear from the VA and veterans' advocates about the 
toxic exposure and benefits legislation pending before the 
Committee. I am going to introduce the folks who are going to 
testify today. You will speak in the order that I am 
introducing you in.
    First I would like to introduce Ron Burke, who is Deputy 
Under Secretary for Policy and Oversight for Veterans Benefits 
Administration, to deliver the VA's opening Statement. Mr. 
Burke, you, after all the Statements are done, as with all of 
you, we will be asking you questions. You have a number of 
people with you, which I will introduce in a moment, that you 
can defer the questions to if you so choose.
    Mr. Burke is accompanied by Beth Murphy, who is Executive 
Director for Compensation Services at VBA; he is accompanied by 
Dr. Pat Hastings, Chief Consultant for Post Deployment Health 
Services at VHA; and Paul Brubaker, Deputy Chief Information 
Officer for Account Management at the Office of Information and 
Technology.
    Before I introduce the VSO folks I just want to say to Mr. 
Burke and the other folks from the VA, thank you for being 
here. Thank you for being a part of this panel.
    Then we are going to hear from Shane Liermann from DAV---we 
all know Shane; Aleks Morosky from the Wounded Warrior 
Project--the same; Patrick Murray from VFW; John Rowan from the 
Vietnam Veterans of America; and Candace Wheeler, from the 
Tragedy Assistance Program for Survivors, or TAPS. Mr. Burke, 
you have the floor.

STATEMENT OF RONALD BURKE, ACCOMPANIED BY BETH MURPHY; PATRICIA 
                 R. HASTINGS; AND PAUL BRUBAKER

    Mr. Burke. Thank you, sir. Good morning, Mr. Chairman, 
Ranking Member Moran, and members of the Committee. I 
appreciate the opportunity to appear before you today, along 
with my colleagues, who are here in person and virtually, to 
discuss pending legislation, including bills pertaining to 
disability compensation, health care, education, transition 
assistance, and other benefits.
    In the opening Statement of his confirmation hearing, 
Secretary McDonough made it clear that VA would provide 
veterans with timely, world-class health care, and ensure 
veterans and their families have timely access to their 
benefits. It is clear by the number of toxic exposure bills 
before us today that military toxic and environmental exposure 
is a critical congressional interest item.
    For decades, veterans and their families have sought 
answers to questions about health issues and potential 
connections to service-related toxic exposures. Secretary 
McDonough is committed to taking immediate and deliberate steps 
to ensure the Department leans forward in its approach to 
getting answers to key environmental exposure questions. We 
recognize that to succeed, the new approach will require the 
collective efforts of VA, our academic partners, other Federal 
agencies, and Congress.
    Secretary McDonough has outlined a list of priorities that 
form the foundation for the work that he has directed the 
Department to undertake. To ensure an in-depth analysis of 
high-priority issues, the Secretary re-established the VA 
Executive Board, consisting of subject matter experts and 
senior leaders. The VAEB met on March 23d of this year and 
received clear guidance to focus on issues related to toxic 
exposures and providing input to inform solutions.
    Historically, VA's presumptive decisionmaking process has 
been guided by statutory requirements. However, certain 
provisions of the Agent Orange Act and Persian Gulf War 
Veterans Act, notably those governing the use of the National 
Academies of Sciences, Engineering, and Medicine reports, and 
requiring the Secretary to respond to such reports within 60 
days have expired.
    With that expiration, we see an opportunity. VA is creating 
a new, comprehensive, modernized decisionmaking model for 
determining presumptions based on environmental exposures. Our 
model includes leveraging improved science and surveillance, 
better use of VA benefit claims data, and consideration of 
other factors. We are moving with a sense of urgency and hope 
to share the proposed model with Congress, VSOs, and other key 
partners for feedback within the next 180 days.
    In order to do a better job researching exposure to toxic 
substances and military environmental hazards, we need more 
insight into the health issues that veterans are experiencing. 
Our research indicates that an overly cumbersome process and an 
assumption of denial discourages veterans from filing toxic and 
environmental exposure-related claims. At the Secretary's 
direction, we are undertaking efforts to encourage veterans who 
believe that their symptoms are related to toxic exposure to 
participate in health registries. Part of that effort will 
include encouraging veterans to get an exam and to submit a 
claim.
    With one in three veterans reporting a possible exposure to 
military environmental hazards, and one in four veterans 
reporting health concerns due to deployment exposures, VA must 
take decisive action. While Secretary McDonough's end-to-end 
review is being completed, VA will take the following 
additional steps: (1) Expand training for health care 
providers; (2) Improve science, surveillance, epidemiology, and 
research; (3) Make better use of benefits data and consider 
other factors; and (4), and most importantly, encourage 
veterans to file the claim.
    I refer you to the written testimony for additional details 
regarding these steps.
    As indicated in VA's written testimony submitted before 
this hearing, and Mr. Frueh's testimony last week before the 
HVAC Subcommittee on Economic Opportunity, VA does not support 
S. 1093, which would establish the Veterans Economic 
Opportunity and Transition Administration within VA. While VA 
appreciates the Committee's intent to improve the services and 
resources offered by these programs, the current structure of 
the Department appropriately reflects the significant 
interrelationship of all veterans' benefits programs. The 
current structure provides for a single advocate for veteran 
benefits at the Department, working to ensure resources among 
the other administration and staff offices.
    Mr. Chairman, this concludes my testimony. My colleagues 
and I are prepared to respond to any questions that you or 
other members of the Committee may have.
    Chairman Tester. Thank you, Mr. Burke. A couple of 
housekeeping things before we get to the further witnesses. 
There will be two votes starting at 3:30, so there will be 
people filing in and out. Senator Moran and I will be 
exchanging the gavel for a few times there. That is No. 1.
    No. 2, as I said at the last hearing we had, I will be 
giving priority to the people who are in person when it comes 
to asking questions, and then we will take the folks online.
    And No. 3, for the folks who are testifying, try to keep 
your testimony to 5 minutes. We have your written testimony. It 
will be in the record in full. Shane, you have the floor.

                  STATEMENT OF SHANE LIERMANN

    Mr. Liermann. Thank you. Chairman Tester, Ranking Member 
Moran, and members of the Committee, on behalf of DAV's more 
than one million members who have wartime service-related 
wounds, injuries, diseases, and illnesses, we thank you for the 
opportunity to offer our views on the multiple bills impacting 
service-disabled veterans, their families, and the programs 
administered by the VA. Our written testimony discusses all of 
the bills that will be before us today, as I will focus my 
remarks on just a few of them.
    Mr. Chairman, as of April 26th, VA reports more than 11,000 
veteran deaths related to COVID-19. We are concerned that 
survivors of some service-disabled veterans will be denied 
benefits because their death certificates list the cause of 
death as COVID-19 but does not mention the service-connected 
conditions which may have been contributing factors.
    DAV supports S.89, the Ensuring Survivor Benefits During 
COVID-19 Act, which would address this issue by requiring the 
VA to seek a medical opinion in the case of any veteran who has 
a service-connected condition and who passes away due to the 
coronavirus. If a veteran's death is due to their service-
connected disabilities or if they have been totally disabled 
for ten consecutive years, their survivors are entitled to 
dependency and indemnity compensation, or DIC. We are concerned 
that since its creation in 1993, major improvements for DIC 
have been legislated only once.
    DAV supports S.976, the Caring for Survivors Act, as it 
would increase the rate of compensation for DIC to 55 percent 
of a totally disabled veteran's compensation. This would 
correspond with what Federal employee survivors currently 
receive.
    Additionally, instead of requiring veterans to be totally 
disabled for 10 years, S. 976 would modify DIC and allow 
survivors, starting with veterans totally disabled for 5 years, 
to be eligible for 50 percent of the total DIC benefit, 
increasing until the 10-year threshold, when the maximum DIC 
amount is awarded. We need to ensure that veterans' families 
and survivors are provided the resources they need, which is 
why DAV supports S. 976, the Caring for Survivors Act.
    Mr. Chairman, for more than 100 years, our fighting men and 
women have been vulnerable to the horrors of mustard gas, 
atomic radiation, Agent Orange, oil fires, nerve agents, burn 
pits, and other lethal hazards. Too often our Nation has been 
slow to provide these men and women with the needed health care 
and benefits they have earned. Right now there are more pieces 
of legislation addressing toxic exposures than ever before. 
Individually, not one of these bills will solve the toxic 
exposures puzzle, but collectively, they can address issues of 
direct service-connected benefits, health care, presumptive 
diseases, and establish a framework for the future.
    S.437, the Veterans Burn Pits Exposure Recognition Act, 
would concede exposure to dozens of chemicals, for all veterans 
who served in areas where burn pits are known to have been 
widely used, meaning those seeking health care and benefits for 
illnesses not yet considered presumptive would no longer have 
to provide specific evidence of such exposures.
    S.927, the TEAM Act, would provide permanent health care 
enrollment eligibility for all veterans who were exposed, 
regardless of their disability claim status. It would also 
create a framework with an independent commission charged with 
establishing additional presumptive conditions that stem from 
all toxic exposures, foreign and domestic, now and in the 
future.
    S.952, the Presumptive Benefits for War Fighters Exposed to 
Burn Pits and Other Toxins Act, would extend presumptive 
service connection for more than 20 serious respiratory 
conditions and cancers that may be linked to exposures to burn 
pits and other chemicals. After two decades, it is unreasonable 
to ask critically ill veterans to continue to wait for more 
data and more science that might never come. We can help them 
today.
    Mr. Chairman, we have a unique opportunity to address toxic 
exposures, remove barriers for direct service connection, 
provide health care, establish presumptive diseases, and create 
a future framework. For the estimated 3.5 million veterans 
exposed to burn pits and other toxic hazards, we must not miss 
this opportunity.
    This concludes my testimony, and I look forward to any 
questions you and the Committee may have.
    Chairman Tester. Thank you, Shane. Next we have Aleks 
Morosky from Wounded Warrior Project. Aleks?

                 STATEMENT OF ALEKSANDR MOROSKY

    Mr. Morosky. Thank you. Chairman Tester, Ranking Member 
Moran, and members of the Committee, thank you for inviting 
Wounded Warrior Project to testify at today's hearing, to offer 
our views on pending legislation. Although we have already 
submitted positions on other bills on the agenda today, I will 
limit my Statement to three bills that address the issue of 
toxic exposure, a top priority for our organization and the 
warriors we represent.
    This year will mark the 20th anniversary of the beginning 
of the global war on terrorism, and an estimated 3.5 million 
post-9/11 veterans served in areas where they were exposed to 
burn pits and other toxic substances. Now many of them have 
developed rare and early onset diseases, like cancers, 
respiratory conditions, and other serious illnesses, and due to 
the unique challenges associated with toxic exposure claims, 
long latency periods, and inability to produce evidence of 
exposure that was often never documented, and the unwillingness 
of many examiners to offer a favorable nexus opinion, most of 
these veterans have been unsuccessful in their attempt to have 
their illnesses accepted by VA as service connected.
    Compounding these issues is the fact that after two decades 
of war the science remains disappointingly inconclusive. While 
the National Academies have yet to find an association between 
these conditions and exposures, they have made clear that this 
is due to insufficient data. As a result, they recommend new 
epidemiologic studies, but these can take years, and that is 
time that many seriously ill veterans just do not have.
    To bypass this scientific gridlock, Wounded Warrior Project 
strongly supports S.952, the Presumptive Benefits for War 
Fighters Exposed to Burn Pits and Other Toxins Act, which would 
establish a presumption of service connection for any veteran 
who served in an area of known exposure and is now suffering 
from any one of over 20 different cancers, serious respiratory 
conditions, or certain other illnesses. For them, disability 
compensation would be a lifeline, giving them a chance to 
support themselves and their families while they continue to 
battle their illnesses, and those whose conditions are terminal 
would be afforded a sense of peace, knowing that their families 
would have the support of DIC after they pass.
    Already far too many of them have lost their health, their 
jobs, and even their lives. With no end in sight, it is 
unreasonable to continue to ask them to wait for science that 
may never come, when we clearly have the ability to help them 
now. For this reason, we believe S. 952 must be included in any 
comprehensive toxic exposure solution this Congress.
    The second key bill I would like to highlight is S.437, the 
Veterans Burn Pits Exposure Recognition Act, which would 
concede exposure to burn pits and other toxic substances for 
veterans who served in areas where they are known to have been 
in use. All too often, a veteran's claim is denied simply 
because they are unable to produce evidence of an exposure that 
was never documented in the first place. Current law grants 
concession of exposure for Vietnam veterans, many of whom lack 
documentation of where and when they were exposed to Agent 
Orange. Current-era veterans deserve concession of exposure for 
the same reason.
    We note that even if the list of presumptive disabilities 
was established for burn pit exposures, a concession of 
exposure would still be necessary for veterans claiming direct 
service connection for any illness that is not on the list. And 
for this reason we strongly support S.437, and see it as 
another critical piece of any comprehensive toxic exposure 
solution.
    Finally, I would like to highlight S.927, the Toxic 
Exposure in the American Military, or TEAM, Act. This forward-
thinking bill would grant permanent VA health care eligibility 
to all veterans who served in areas of known exposure, 
regardless of their disability claim status. This would prevent 
veterans who were already ill for having to wait months while 
their claims are decided, to access potentially lifesaving 
care, and those who were exposed but may not be ill will have 
access to preventative care. Veterans of previous generations 
who were exposed have permanent access to care for these 
reasons, and we see this as absolutely critical for the current 
era and beyond as well.
    The TEAM Act would also establish a permanent independent 
commission and a scientific framework to trigger VA 
determinations on additional conditions for presumptive service 
connection, and unlike previous frameworks, this would not be 
limited to specific conflicts or exposures.
    What is truly remarkable about the TEAM Act is that it 
would extend, on a permanent basis, two important components of 
any toxic exposure legislation: health care eligibility and a 
scientific framework to apply to all toxic exposures, 
regardless of era or location, foreign or domestic, now and in 
the future, and this would finally ensure that the next 
generation of veterans who are exposed to toxic substances are 
not, once again, starting from square one, like every 
generation before them.
    Furthermore, when taken together, S.952, S.437, and S.927, 
we see these three complementary bills fitting together like 
pieces of a puzzle, to fully address toxic exposure concerns 
not only for the current generation but for future generations 
as well. Accordingly, we ask this Committee and Congress to 
pass all three pieces of legislation, finally creating a 
lasting solution for all veterans who have been made ill as a 
result of military toxic exposures.
    Chairman Tester, Ranking Member Moran, thank you once again 
for offering Wounded Warrior Project the opportunity to testify 
today. This concludes my Statement, and I look forward to your 
questions.
    Chairman Tester. Thank you, Aleks. Next, virtually, we have 
Patrick Murray, from the Veterans of Foreign Wars. Patrick?

                  STATEMENT OF PATRICK MURRAY

    Mr. Murray. Chairman Tester, Ranking Member Moran, and 
members of the Committee, on behalf of the men and women of the 
Veterans of Foreign Wars of the United States and its 
Auxiliary, thank you for the opportunity to provide our remarks 
on legislation pending before this Committee.
    The VFW's top priority for the 117th Congress is 
comprehensive toxic exposure reform. Toxic exposure is a cross-
generational issue that affects almost every veteran who has 
ever worn the uniform. In World War I, troops were exposed to 
gas, in World War II, radiation, in Vietnam, Agent Orange, the 
Gulf War, oil fires, and in Iraq and Afghanistan they were 
exposed to burn pits and other environmental hazards. Toxic 
exposure for our troops has been synonymous with service for 
more than 100 years, but every time we are faced with sick 
veterans we act as if it has never happened before, or asked 
them for proof.
    Since we seem to expose nearly 100 percent of our troops to 
hazardous substances and environments, it is entirely 
unreasonable that almost 75 percent of their claims are denied 
for exposure. For this reason, it is time for Congress to 
change the framework through VA care and benefits are granted 
for individuals with conditions associated with toxic exposures 
and environmental hazards.
    All of the toxic exposure-related bills listed in this 
session only have portions that, if combined, would form a 
complete package that would cover as many veterans as possible. 
The VFW believes all of these proposals are complementary, and 
in combination would accomplish the goal of true toxic exposure 
reform for all generations of veterans. We ask that Congress 
assemble the various parts of each bill, just like pieces of a 
puzzle, to form a finished product that will provide care for 
all veterans, past, present, and future.
    The Presumptive Benefits for War Fights Exposed to Burn 
Pits and Other Toxins Act would extend presumptive service 
connection to more than 20 serious respiratory conditions and 
cancers that may be linked to exposure to burn pits and other 
chemicals. This would provide immediate care for veterans with 
serious illnesses resulting in exposure. It also proposes a 
petition model that would allow for veterans' voices to be 
heard regarding new exposures.
    The Veterans Burn Pits Exposure Recognition Act would 
concede exposure to dozens of chemicals for all veterans who 
served in areas where burn pits are known to have been widely 
used, meaning those seeking health care and benefits for 
illnesses not yet considered presumptive would no longer have 
to provide specific evidence of such exposures.
    The TEAM Act would provide permanent health care enrollment 
eligibility for all veterans who were exposed, regardless of 
their disability claim status. It would also create a framework 
with an independent commission charged with establishing 
additional presumptive conditions that stem from all toxic 
exposures, foreign, domestic, now, and in the future.
    S.952 will take care of veterans right now. S.437 will 
definitively link veterans exposed to these hazards. S.927 will 
provide health care eligibility for anyone linked to those 
hazards. Together, these three bills, along with others such as 
K2 Care Act, Fair Care for Vietnam Veterans Act, Gulf War 
veterans' coverage bills, and training packages will align like 
the pieces of a puzzle to solve this problem once and for all.
    Additionally, the VFW has long supported the creation of a 
fourth administration under VA, with its own Under Secretary, 
whose sole responsibility is the economic opportunity programs. 
This new Under Secretary for Economic Opportunity will refocus 
resources, provide a champion for these programs, and create a 
central point of contact for VSOs and Congress.
    We urge Congress to pass this legislation that would 
establish a fourth administration within VA, to oversee 
benefits such as GI Bill, VR&E, home loan, and other economic 
opportunity-centered benefits. We believe we should separate 
the C&P programs and the economic opportunity programs from 
each other so that each can receive the full attention of their 
own leadership and IT resources. Both areas necessitate their 
own focus, and by creating a fourth administration it would 
allow VA to properly manage and grow these programs that they 
each rightfully deserve.
    Last, the VFW strongly opposes S.1071. VA should never 
charge veterans to receive the care and benefits they deserve. 
Entering into formal agreements with companies who charge 
veterans for the claims services signals to veterans that VA is 
OK with them having to pay for what was already earned through 
service. VA should never officially endorse agreements such as 
these.
    Chairman Tester, Ranking Member Moran, this concludes my 
testimony. I am prepared to answer any questions you may have. 
Thank you.
    Chairman Tester. Thank you, Patrick. Next, virtually, we 
have John Rowan with Vietnam Veterans of America. John?

                    STATEMENT OF JOHN ROWAN

    Mr. Rowan. Chairman Tester, Ranking Member Moran, and the 
other members of the Committee, and for that matter, all of 
your colleagues in the House, I commend you all for finally 
bringing together all of the issues related to toxic exposure 
that we have been dealing with as Vietnam veterans for over 50 
years.
    The bills that are in this batch that are all connected, we 
support everything, and we agree with everything my colleagues 
said ahead of me. The truth is that this is an unbelievable 
time, and we are very grateful to the House and Senate's 
efforts on our behalf.
    All of the different bills have a little piece of the pie, 
and it is interesting. It seems like somebody cleaned out the 
Committee's file cabinet when we start seeing discussions about 
K2 and discussions about the atomic veterans, going back to the 
1960's. Even the Palomares incident that I think was in 1966, 
and those poor veterans have been trying to get benefits ever 
since. And so we are really, again, grateful for everybody's 
efforts to bring all of these things into the light, and to 
create, I believe, also, that you will create an omnibus bill 
that will hopefully take care of all of these veterans, and all 
of the problems that they have been having from their exposures 
for all these years.
    We also are very interested in some of the non-exposure 
bills as well. S. 89, as was mentioned earlier, the issue with 
the death certificates is a very important one with regards to 
COVID. We were realizing this very early last year, when we 
started to have some problems with some of our veterans 
applying for dependency and indemnity compensation, their 
families actually applying, and having problems because the VA 
was saying, ``Well, the service-connected illness isn't listed 
on the death certificate.''
    So we actually had some conversations with the National 
Association of Coroners and Medical Examiners and the National 
Association of Medical Examiners, and they highlighted the fact 
that the certificate form itself allows for more than one issue 
with regards to what was the cause of death. And we want to 
make sure that, yes, we understand COVID may have started this 
whole thing, but it was really the underlying conditions that 
really killed the veteran, and we want to make sure that their 
families are going to get their due.
    There are several other of the programs--we are also in 
favor of the fourth administration to try to deal with economic 
development issues for veterans. We believe also that should be 
a separate organization.
    One of the things that concerns us, however, while all of 
these exposure bills particularly have been very good and cover 
a lot of areas that have been forgotten about, in many cases, 
for many years, the one thing we did not see much about, and we 
hope to see that changed as we go forward, and perhaps in your 
discussions on this omnibus bill, is the issue of the children 
of exposed veterans. We know, from our own experiences, Vietnam 
veterans, that many of our children have all kinds of 
developmental disabilities, all kinds of physical disabilities, 
that we believe were associated with our exposure to Agent 
Orange. We are still, I believe, the only veterans who have 
children who can get their own benefits because of exposures 
for spina bifida, and a little bit more if you are a female 
veteran, there are other issues involved.
    We think that issue, multigenerational effects of these 
toxic exposures, needs to be understood much much more 
significantly. The research needs to go into it, and we need 
those programs that were supposed to be researched by the VA to 
finally get done. And we would hope that Congress reviews its 
oversight powers with the VA to make sure they proceed with 
those cases.
    So again, we want to thank everybody for really coming to 
the table with a lot of these bills, coming to finally deal 
with the issue of toxic exposure once and for all, and making 
sure that all veterans, no matter when you served, are going to 
get what you are entitled to. It is bad enough that you got 
exposed to things that you should never have been exposed to in 
the first place, but now we have to realize what we can do with 
the people involved.
    So again, I thank you all, and I look forward to a big 
bill, and if you have any questions I would be certainly happy 
to answer on any specific piece of legislation. And again, as 
was mentioned earlier, it is interesting now people are 
starting to put together these three bills already, S.952, 437, 
and 927. I am going to be looking forward to see what the final 
legislation looks like.
    So again, thank you for the opportunity. Thank you for 
coming forward with all of these bills, and I want to thank all 
of the members, particularly with the idea of being that 
veterans, thank God, are the only bipartisan thing I think left 
that Congress can talk about, so we appreciate everybody on all 
sides. Thank you.
    Chairman Tester. Thank you, John. I appreciate your 
testimony and your kudos.
    Finally, we have got Candace Wheeler, who is the Tragedy 
Assistance Program for Survivors, otherwise called TAPS. 
Candace?

                  STATEMENT OF CANDACE WHEELER

    Ms. Wheeler. Chairman Tester, Ranking Member Moran, and 
distinguished Committee members, the Tragedy Assistance Program 
for Survivors appreciates the opportunity to testify on behalf 
of over 500,000 survivors of military and veteran loss. Every 
survivor in our Nation benefits from the critical work of this 
Committee, and we thank you.
    TAPS is grateful to Chairman Tester and Senator Boozman for 
reintroducing the Caring for Survivors Act of 2021. This 
important legislation increases dependency and indemnity 
compensation for more than 450,000 eligible beneficiaries, and 
reduces the timeframe a veteran needs to be rated totally 
disabled from ten to 5 years, allowing more survivors to 
eligibility for DIC.
    For survivors like Katie Hubbard, an increase in DIC would 
help put food on the table and reduce her monthly worries. We 
ask that the base rate be increased the same for all DIC 
recipients, pre and post 1993, and that added monthly amounts 
are protected. Increasing DIC is a top priority for TAPS and 
the survivor community, and we urge passage this year.
    TAPS thanks Ranking Member Moran and Chairman Tester for 
introducing the Colonel John M. McHugh Tuition Fairness for 
Survivors Act of 2021. There are nearly 152,000 eligible 
recipients of dependence education assistance under Chapter 35, 
which includes dependents of 100 percent disabled veterans or 
those who died of a service-connected death. Chapter 35 pays 
$11,000 per year for all college expenses, half of Montgomery 
GI Bill, and minimal compared to the post-9/11 GI Bill and Fry 
Scholarship. Survivors using Fry, dependents using transferred 
entitlement, and veterans using the post-9/11 GI Bill are all 
eligible for in-State tuition, at any State school in the 
country. Survivors using Chapter 35 are excluded. Guaranteeing 
in-State tuition for these families is a no-cost lift that will 
drastically improve education options and reduce their need for 
student loans.
    TAPS appreciates Senators Lankford and Carper for 
introducing the Fry Scholarship Enhancement Act, which expands 
eligibility to families of those who die in the 120-day release 
from active duty period. If a veteran dies from a service-
connected injury or illness with the 120-day REFRAD period, 
they are considered to have died on active duty, for all 
benefits except the Fry scholarship. Currently, these families 
are eligible for Chapter 35 but not Fry. Passing this bill will 
provide long overdue parity for these surviving families.
    TAPS thanks Senators Sinema, Tillis, Shaheen, Boozman, 
Blumenthal, Warren, and Coons for reintroducing the Ensuring 
Survivor Benefits During COVID-19 Act of 2021. Veterans who 
pass away from the coronavirus may have their cause of death 
labeled as COVID-19, without accounting for service-connected 
disabilities that may have contributed to their death. This 
bill will ensure these disabilities are taken into account by 
the VA to ensure family members have access to the survivor 
benefits they are eligible to receive.
    TAPS applauds members of this Committee for introducing 
significant legislation which collectively addresses the 
devastating effects of Agent Orange, burn pits, and toxic 
exposure on our veterans, their families, caregivers, and 
survivors. TAPS strongly supports all eight bills. As the 
leading voice for the families of those who died as a result of 
illnesses connected to toxic exposure, TAPS supports every 
effort to ensure veterans receive the health care and benefits 
they have earned and that we honor our commitment to their 
survivors.
    Exposures to deadly toxins as a result of military service 
are not new. Generations of veterans have been exposed to 
toxins, and many have died as a result. We must do more to 
prevent exposures, properly diagnose and treat illnesses, and 
provide benefits to impacted veterans and their survivors. 
Their loved ones will make up a large portion of the next 
generation of TAPS.
    Thirty-one percent of all military survivors connecting 
with TAPS have experienced the loss due to illness. Sadly, we 
project this number to increase by more than 2,300 each year. 
We must provide answers to our survivors of illness loss. So 
many are left wondering how their loved one survived multiple 
deployments and returned home safely, only to succumb to 
illnesses or rare cancers.
    Coleen Bowman, surviving spouse of Army Sergeant Major 
Robert Bowman, States, ``Had we known Rob had been exposed to 
toxins, we could have shared the information with doctors, and 
it wouldn't have taken 6 months of misdiagnoses before we 
learned he had Stage IV inoperable cancer. Had we known earlier 
he might still be alive today.''
    TAPS appreciates the opportunity to testify, and I welcome 
your questions. Thank you.
    Chairman Tester. Candace, thank you for your testimony. I 
want to thank everybody for their testimony today. There will 
be 5-minute rounds of questions and I will start.
    This is for you, Mr. Burke. For decades, the VA and 
Congress have relied on National Academies to summarize the 
latest scientific research and association between health 
effects and a particular toxic exposure. Historically, VA and 
Congress extended presumptions for conditions in the second-
highest category of association. Apparently, that is not good 
enough.
    For example, when the National Academies placed 
hypertension in the second-highest level of association with 
Agent Orange in 2014, and the highest level in 2018, VA decided 
that they needed more evidence, more scientific evidence. I 
believe that the VA has all the information it needs right now 
to presume that veterans who were exposed to Agent Orange have 
a higher rate of hypertension than a veteran who has not. The 
National Academies have reported that already.
    So, Mr. Burke, I guess to quote my older brother, the 
Vietnam War has been over for nearly 50 years. What does the VA 
expect to find in another study?
    Mr. Burke. Mr. Chairman, thank you for that question, and 
more importantly, thank you to you and the Committee for your 
interest on this very complex matter. Very important matter, as 
well.
    What I can tell you is that our Secretary has taken a very 
strong position on this matter, and one that he is moving out 
with urgency on. In fact, the new approach that our Secretary 
has directed us to take will leverage not only existing 
partnerships but also build on new partnerships--the collection 
of data, the better use of science and innovation. And so we 
believe that a more thorough review, a different review, one 
that encompasses our I CARE values of advocacy, respect, our 
commitment, is exactly what the Secretary is asking us to do 
today.
    We want to do this right. This is extremely important, as 
evident by the number of bills on toxic exposure specifically. 
And I can tell you that this has not been lost on our Secretary 
or the employees of the Department of Veterans Affairs.
    So we are committed to using the framework that is being 
established by our Secretary. He is leveraging the experience 
and input from the VA Executive Board, and again, leveraging 
existing partnerships that we have used throughout time, but 
also building on the ability to extend partnerships and build 
those coalitions going further. So I hope that answers your 
question, sir.
    Chairman Tester. Yes. Well, I would just say this. 
Partnerships and coalitions are very, very important. What I do 
not need to point out, because I know you know this, is Vietnam 
veterans are getting older. We have been talking about this for 
a while. We were very close to getting hypertension in last 
Congress. I believe it was not put in because of cost reasons. 
That is not how we should look at it, and I think everybody on 
this Committee understands that money is important and how we 
spend taxpayer dollars are important.
    But I think we also understand that taking care of our 
veterans is the cost of war. And I appreciate the Secretary's 
attention to this matter, but in the end--and I think Mr. Rowan 
would attest to this--Vietnam veterans have been talked about a 
long time. We just never have provided what they have needed, 
and hypertension is a huge issue.
    The VA's testimony mentions new criteria to determine if 
associations are causal. Does that mean the VA is going to 
require causation to establish new presumptions?
    Mr. Burke. Thank you for that question. I am going to ask 
my colleague from VHA to assist with this response, and so I 
will refer this one to Dr. Hastings from VHA.
    Chairman Tester. You bet. Dr. Hastings.
    Dr. Hastings. Sir, we are not looking at causal, but we are 
looking at a better scientific framework. And as Mr. Burke 
mentioned, pulling in those things that we know about from the 
claims, working the National Academy but with other 
organizations, to get the best science. Because when we look at 
the framework, it does need to have a focus on science, but we 
need more surveillance, we need more epidemiology, and more 
research.
    So we are not looking at causation, but we are looking at 
criteria, that would be the Bradford Hill criteria, looking at 
the strength of an association, looking at the consistency, 
looking at the biological causability, a couple of other 
things, and looking at what we call equipoise, which is 
basically tie goes to the runner. If it is more likely than 
not, the benefit, the decision would go to the veteran. So that 
is what we are looking for, and have put together for the 
Secretary's consideration.
    Chairman Tester. Okay. Mr. Rowan, I would like you to 
respond. If the VA required causation, which I am told they are 
not, but if they did for Agent Orange presumptions, how would 
that have impacted Vietnam veterans? That is for you, John 
Rowan.
    Mr. Rowan. I think some of that could be very problematic, 
to be honest. I mean, we went through this whole thing 
originally with Vietnam veterans, with causation and all the 
rest of it, and they tried to pinpoint every dot on the map, 
where Agent Orange had been sprayed and everything else, and 
finally they gave it up and just said, ``Listen, if you stepped 
foot in Vietnam you were exposed, and that is all there is to 
it.''
    So I think that that is the way a lot of this needs to be 
done, and that is what is going to happen to the newer 
veterans, at least with the burn pits and others. So to try to 
make a very specific causation on things I think just makes it 
harder and harder, and they always denied us for many years. I 
mean, we have had to jump through all kinds of scientific 
hoops.
    Chairman Tester. Yes. Thank you, John.
    This is for each of the VSOs that are a part of this 
hearing, to ensure that you have your opportunity to express 
your toxic exposure priorities. So for each witness, what are 
the top one or two most pressing concerns for your members, 
right now, when it comes to changing the way VA handles toxic 
exposure? And we will start with you, Shane.
    Mr. Liermann. Thank you, Chairman. I think the top two 
priorities for DAV and our members, specifically, would be 
start to look at burn pits and toxic exposures, as we 
mentioned, and S. 437. And another big priority for toxic 
exposures is Agent Orange. When we start looking at 810, adding 
hypertension as well as the bill to include veterans who served 
in Thailand as well, those are two huge priorities for DAV, 
burn pits and the Agent Orange bill that are currently pending.
    Chairman Tester. I appreciate that. Aleks?
    Mr. Morosky. Mr. Chairman, our priorities are focused 
primarily on the post-9/11 generation and beyond. When we look 
at previous generations, like the Vietnam generation, we see 
that they have access to care without having to establish 
service-connected disability, they have a framework to 
establish presumption, they have a list of presumptions, and 
they have concession of exposure. Those are our priorities for 
the current era. We believe that we deserve parity with 
previous eras, sir.
    Chairman Tester. Thank you. Patrick Murray.
    Mr. Murray. Thank you, Senator. The biggest thing that we 
need to address is actually getting these claims through and 
accepted and approved by VA. VA mentioned, in their testimony, 
that there is an assumption of denial. That is not correct. It 
is a reality. It is not an assumption. Over 70 percent of 
claims get denied. That is what we need to change. One hundred 
percent of our servicemembers are exposed. They need to stop 
denying claims at such a high rate.
    Chairman Tester. Thank you. John Rowan.
    Mr. Rowan. Yes, that's interesting, the access to care. I 
mean, one of the things that I think the COVID crisis has 
proven is when the VA started to give out the shots, they ended 
up doing such a great job, and I commend the Congress for 
enabling us to bring every veteran in to get a shot, as well as 
their spouse. Frankly, my wife and I have been hiding out now 
for over a year because of COVID, and it was really crazy that 
I went and got a shot a month and a half earlier than she did, 
because she had to deal with the regular system, and she lives 
with me. So that was not very helpful.
    So I think access to care is very crucial, and it is a good 
thing we can build that into the system, and just bring all of 
the veterans in. I do not know we exclude people.
    Chairman Tester. Thanks, John. Candace Wheeler?
    Ms. Wheeler. Yes. Thank you, Chairman Tester. We want to 
make certain that our veterans get the health care and benefits 
that they have earned, and that we continue to look to their 
survivors and their caregivers and make sure that we are giving 
them all the support necessary, and the benefits that they are 
eligible to receive.
    What we are also concerned about is the amount of 
misdiagnosis that we see within the community. We want to see 
that treatment and care is delivered right away, because our 
veterans do not have the time on their hands. We are seeing 
more and more aggressive cancers that are taking lives very 
quickly. And so we ask that we really look at access to care, 
but timely access to care.
    Chairman Tester. Thanks, Candace. Senator Moran.
    Senator Moran. Mr. Chairman, thanks. Let me see if Senator 
Tillis needs to ask his questions before I do.

                      SENATOR THOM TILLIS

    Senator Tillis. That would be very kind of you. We are 
keeping count of those voting. For everybody watching this, we 
are in the middle of a vote.
    Senator Moran. [Presiding.) Senator Tillis is recognized.
    Senator Tillis. Thank you. Chair Tester and Chair Moran do 
an excellent job of getting these meetings right in the middle 
of a vote, so I apologize for the members who come back and 
forth.
    Mr. Morosky, thank you so much for your leadership and hard 
work with the Wounded Warrior Project and the TEAM Coalition. I 
think it has been a great effort, and I appreciate everybody 
who is formally in the TEAM Coalition or others who have 
support the bill.
    But I do want to go back to your testimony and highlight 
that key statistic. Approximately 750,000 current-era veterans 
who served in areas known for exposure are present ineligible 
for VA health care, and that list is growing. So this is a 
group of people who would be turned away and told to return, at 
this point, until they can prove that it is service connected. 
Is that correct?
    Mr. Morosky. That is correct, sir.
    Senator Tillis. Do you believe that the TEAM Act fixes that 
and puts us on a better posture for current-era warriors?
    Mr. Morosky. Absolutely, sir. You know, the TEAM Act would 
grant Priority Group 6 health care eligibility on a permanent 
basis to all veterans who served in areas of known exposure. 
Now right now, post-9/11 veterans have a 5-year eligibility, 
but any condition that manifests after that 5 years is over, 
they are turned away until they can establish a service-
connected disability. We do not think that this should happen 
for a veteran that was exposed to toxic substances, and like 
you said, with 750,000 now sort of operating without a safety 
net, we think the TEAM Act provision for health care is 
absolutely a must-pass.
    Senator Tillis. Mr. Burke, I understand that right now the 
VA is not taking a specific position on the bills before us. Is 
that correct, pending the work that you are going to be doing?
    Mr. Burke. That is correct, sir. We believe that 
legislation at this point is premature, and does not give the 
Secretary the opportunity to implement his changes in the way 
that we approach these very sensitive matters.
    Senator Tillis. I, for one, think that it has been a long 
time coming, trying to get the framework. So right now I know 
that is not what you said but I will consider silence to be 
consent. We are going to continue to press forward and 
hopefully harmonize it with a best way to implement it. So I 
encourage the VA, as they are moving through it, to give us 
advice on some of the contours of the bills before us, but I 
think at the end of the day we know what we need to do, we have 
got a great framework, and the various titles in the TEAM Act, 
some of other bills before us that I do think are the puzzle 
pieces that need to come together. I would be happy to meet 
with you all outside of a committee hearing to hear any 
concerns, and keep track of your progress as you move forward.
    For all the VSOs, just reading through your testimony, many 
of you are calling for a permanent framework to get some 
certainty, and after we have gotten the new information on 
toxic exposures, we are getting additional data to try and 
create the links. That is what these legislative proposals are 
about.
    Because we have so many witnesses, if I can get some yes-
or-no questions related to some of the elements of the TEAM 
Act, just going around the horn. Do you support the framework 
that the TEAM Act establishes? We will start here in the 
chamber, and them move forward.
    Mr. Liermann. Yes, Senator. DAV supports the TEAM Act and 
the framework.
    Senator Tillis. You better.
    Mr. Morosky. We do, Senator. We thank you and Senator 
Hassan for introducing this bill.
    Senator Tillis. Thank you, Mr. Morosky. I do not have the 
list of virtual attendees before me. If you all can chime in 
and just say whether or not you have taken a former position on 
the TEAM Act provisions.
    Ms. Wheeler. Senator Tillis, this is TAPS. It is Candace 
with TAPS. And having worked really closely with you we 
absolutely support the TEAM Act.
    Senator Tillis. Thank you.
    Mr. Murray. Yes, Patrick Murray. The VFW strongly supports 
the framework reinstitution of the TEAM Act.
    Senator Tillis. We should have at least two others, perhaps 
three virtually? I do not have the list.
    Mr. Rowan. John Rowan from VVA. We support the general 
concepts. We like the idea of merging them with the other 
bills. One thing in particular about the War Fighters Act is 
setting the specific timelines for getting the VA to do things.
    Senator Tillis. I guess the last question I will have--and 
again, thank you, Ranking Member Moran, for letting me ask the 
questions--you know, it would seem to me where the VA wants to 
go, at least with the way we have structured the elements of 
the TEAM Act, it is where the TEAM Act wants to go as well. So 
do you all support--I have got a list now--do you all support 
the whole framework that we are trying to establish for 
addressing these criteria?
    And we will just go down the list here, with Shane and 
Aleks, and then we'll move to Patrick, John, and Candace. Just 
yes or no, framework make sense? Need any changing?
    Mr. Liermann. We believe it does make sense, because 
without the framework we would be in the position that we were 
with the five different disabilities for Agent Orange exposure.
    Senator Tillis. Right.
    Mr. Liermann. So having that framework established now, and 
time requirements, absolutely is a must.
    Senator Tillis. Thank you. Aleks?
    Mr. Morosky. Sir, the framework is absolutely necessary. We 
support it 100 percent.
    Senator Tillis. Patrick?
    Mr. Murray. It is necessary so we do not need to come back 
every couple of years with new veterans who are sick and need 
care immediately.
    Senator Tillis. John?
    Mr. Rowan. Yes, sir, I agree.
    Senator Tillis. Candace?
    Ms. Wheeler. Yes, we are actually in support of that, and 
we believe we need a framework to protect our veterans and 
their survivors.
    Senator Tillis. Well, thank you all again, Aleks and all 
the members of the TEAM Coalition. I would really encourage the 
VA, as you are moving forward, it may be helpful to take a look 
at some of the bills before us and have them be instructive in 
a way that--I know that you all are looking at operational--you 
have got to create an operational framework that makes sense 
within the complexities of the VA. But I think you would be 
well served to let those absolutely guide some of the 
boundaries, the contours of whatever you would recommend.
    Mr. Burke. Senator, if I could, you have our commitment 
that we will continue to work with Congress, moving forward, 
without a doubt.
    Senator Tillis. Thank you. Thank you all. Thanks to all the 
VSOs for the awesome work you do.
    Senator Moran. Senator Tillis, thank you for your questions 
and thank you for your leadership on this particular piece of 
legislation, but generally in this Committee.
    Senator Hassan, your colleague on this topic.

                  SENATOR MARGARET WOOD HASSAN

    Senator Hassan. Well, thank you very much, Ranking Member 
Moran, and I want to thank you and the Chair for this hearing. 
I want to thank all of the witnesses, both here and virtually, 
for your testimony and for your service.
    I really just want to echo what Senator Tillis has been 
saying about the TEAM Act. I was proud and honored to be able 
to join him in introducing the TEAM Act earlier this year, and 
I just want to emphasize, again, the VA, we have so many 
veterans who were exposed to toxic substances, lasting 
detrimental impacts upon their health. They really need to be 
able to get treatment, and they need to have the certainty, and 
we need this framework. So I would look forward to being part 
of the group that works with you on this bipartisan bill.
    I also just want to drill down on one aspect of the bill. 
The TEAM Act would also, in addition to all the other things 
that we talked about, require the VA to develop a questionnaire 
to be used in primary care appointments to help physicians 
determine whether a veteran was exposed to toxic substances 
during their service.
    So, Mr. Burke, can you please speak to how a questionnaire 
would provide targeted data from veterans that could lead to 
further research, health care, disability benefits for veterans 
exposed to toxins, and would the VA consider just doing this, 
even without the bill?
    Mr. Burke. Thank you, Senator, for that question and the 
comments, and again, you have our reassurance that we will 
continue to work with Congress, moving forward.
    I am going to ask Dr. Hastings to speak about that 
specifically, but one of the things that I will say, it is of 
utmost importance that I stress and impart our commitment to 
addressing these toxic exposures. This is a critical and 
important issue for the Secretary, but I have to stress that he 
is determined to do it right, and that will be done 
collaboratively.
    Senator Hassan. Right.
    Mr. Burke. But I will refer your specific question about 
the questionnaire to Dr. Hastings. Thank you.
    Senator Hassan. Thank you. Dr. Hastings?
    Dr. Hastings. Ma'am, we have been working with DoD in the 
Deployment Health Working Group and also with VBA on what is 
called the SHPE, the Separation Health Physical Exam, and at 
the time that a person leaves service they have the option of a 
medical exam, and most people opt into that. And we are 
including exposures in that, because we do recognize that that 
is critically important, and want to document it as soon as 
possible.
    We also have training that we give for the VA physicians 
that is available online, and I would be happy to share that 
with you.
    Senator Hassan. That would be helpful. We will reach out to 
do that, because, obviously, collecting this information--I 
think we are all in agreement, it sounds like, that collecting 
this information is critical, moving forward.
    The other thing I will just add is I appreciate the 
Secretary wanting to do this right, all of you wanting to do it 
right. I will say our job is to think about it from the 
veterans' perspective, from the patient's perspective, and to 
push the institution to do what it needs to do. So we will keep 
doing that, because that is really who should be at the center 
of this discussion.
    Mr. Burke, I wanted to talk to you a little bit about the 
2020 report by the VA Office of the Inspector General, which 
found there were widespread and severe staffing shortages in 
many occupations at VA health facilities. To help address this 
issue, I joined Senator Braun in introducing legislation that 
would help veterans with a health care background gain 
employment at the VHA. The Hire Veteran Health Heroes Act 
directs the VA to recruit and hire Department of Defense 
medical department personnel who are transitioning out of 
military service for open positions at the VA, by referring 
them to the appropriate hiring authority.
    So can you please speak to the number of open jobs in the 
medical field at the VA has, and how referring medical 
personnel who are leaving military service to the VA might help 
with recruitment?
    Mr. Burke. Yes, ma'am. Thank you for your interest in this 
and your question. I am going to again defer to my colleague 
from VHA, on this as well. So, Dr. Hastings.
    Senator Hassan. Thank you.
    Dr. Hastings. Coming from DoD, one of the things that is 
great is we sort of know how the Veterans system, how the VA 
system will work and being Veterans, we are committed to other 
Veterans.
    We do the targeted outreach at the time that we know that 
people are getting within 1 year of their departure from 
service. The change in this bill will have a recruiter there. I 
do not know that that will be necessary, but certainly getting 
people from the DoD at the time they are leaving for DoD is an 
excellent idea.
    Senator Hassan. Thank you. I have one more question that I 
will submit to Mr. Murray for the record, but I just wanted to 
note that I am a co-sponsor of the VET OPP Act, and I would 
look forward to additional commentary from Mr. Murray on how 
veterans would benefit from stronger institutional emphasis on 
employment and education benefits within the VA, and I will 
submit that for the record. Thank you.
    Senator Moran. Senator Hassan, thank you. Ms. Wheeler, I 
want to thank you and TAPS for their ongoing advocacy and 
engagement with this Committee to advance important measures 
that are beneficial to surviving families. It was an honor for 
me to introduce the Colonel John McHugh Tuition Fairness for 
Survivors Act, and I thank Chairman Tester for joining me in 
that introduction. It would extend the in-State tuition 
requirement to recipients of dependent education assistance to 
align with all other VA education programs.
    My question is, would you explain for the Committee, in a 
little bit more depth, how this change will positively impact 
survivors nationwide, and why this is common-sense parity 
change to align with other VA educational benefits.
    Ms. Wheeler. Thank you, Senator, for the question. We 
greatly appreciate it.
    As a military family, we have moved every two to 3 years, 
sometimes even after a 10-month assignment. And our veterans' 
families, and ultimately our surviving families, may not 
consider home where they are currently living, or they may not 
have ever lived in their veteran's home of record.
    Extending in-State tuition to recipients choosing 
dependence education assistance, under Chapter 35, will provide 
these survivors nationwide with more flexibility and school 
choice. It also ensures these benefits go further, since 
Chapter 35 pays less in tuition assistance. Those receiving the 
Fry scholarship and post-9/11 GI Bill are already eligible for 
automatic in-State tuition, but our Chapter 35 recipients are 
excluded from previous bills. And your bill rightfully 
addresses this inequity and will bring parity to these 
surviving families, and we thank you.
    Senator Moran. Thank you for that explanation. I am going 
to turn now to toxic exposure, and let me start with you, Mr. 
Burke. Rather than provide feedback on the legislation before 
this Committee pertaining to toxic exposure, you have laid out 
the VA's regulatory plan. Your testimony lays out the VA's 
regulatory plan to provide health care and benefits for 
veterans exposed to toxic substances during their service.
    A bit concerns me, because although you have the authority 
to grant benefits to this group through regulatory action, the 
VA has continued to drag its feet when it comes to taking 
action. Some of the toxic exposure bills on today's agenda are 
proposals driving by the VA's lack of action. The TEAM Act 
mandates a path forward for the VA, similar to what you 
outlined today, yet you came--well, let me say it this way--you 
declined to provide views on that legislation.
    Am I to assume that it is your testimony today that the 
Department has the statutory authority to grant benefits to 
this class of veterans, including the enrollment of VHA 
Priority Group 6?
    Mr. Burke. Senator, thank you for that question. If I could 
be very clear, there is a big difference between direct service 
connection and presumption of service connection. We are 
encouraging veterans to file claims, because we are deciding 
claims on a direct basis. And so any veteran that has a claim 
that they believe is a disability as a result of exposure to 
toxins, burn pits, et cetera, we are asking them--we are 
encouraging them to file a claim.
    Those claims are reviewed not on a presumptive basis but on 
a direct basis, which means the evidentiary record for each 
claim is reviewed, and service connection can be granted. So we 
do have the authority, and we do exercise that authority to 
decide claims, not on a presumptive basis but on a direct 
service connection, and that is ongoing.
    Senator Moran. Well, let me ask--explain to me why you did 
not provide commentary on the bills that are being considered 
by the Committee today.
    Mr. Burke. Great question, sir, and I appreciate that. I 
will say that in the absence of giving a position, we do 
believe it is premature to legislate these very important 
issues. Primarily, our Secretary has directed us, and we 
believe in this direction, to look at this in a different way, 
a way that would be faster for veterans, one that would include 
more data analysis, one that would utilize not only existing 
partnerships but create new ones. And he has a sense of 
urgency. This is not something that the Secretary has an 
interest in delaying. But it is imperative that we do this 
right.
    And again, I spoke earlier in this hearing about our I CARE 
values. We are committed to veterans. We are advocates for 
veterans, and we respect their service. And so I believe the 
Secretary's vision is going to serve us well. It is going to 
have us look at things, you know, differently than in the past. 
It is going to include things that we have looked at before, 
but include opening the aperture on the amount of data and 
analysis that we use to make these very important decisions.
    Senator Moran. So this may not be the way you would say it, 
but this is the way I take what you are telling me now, is 
there are not bills that the Committee is considering today 
that VA--and I will help you in your answer by saying there is 
no bill in this Committee's agenda in regard to toxic exposure 
that currently the Department of Veterans Affairs supports?
    Mr. Burke. There are no bills with respect to toxic 
exposures that we have a position on, sir.
    Senator Moran. Have you reviewed the bills sufficiently to 
reach a conclusion whether there are things in there that are 
of value for us to know?
    Mr. Burke. Sir, our commitment to working with Congress is 
sound. There is, in each of these bills, there is goodness in 
each of these. But this needs to be more of a holistic 
approach. Our position of implementing the Secretary's vision 
should not be seen or taken as our lack of value for what is in 
these proposals. I think it needs a more holistic review, and I 
believe the Secretary's vision, how he has charged us to look 
at this, and who he has charged us to collaborate with, will 
get us to that picture.
    Senator Moran. Mr. Burke, I hope you understand that I am 
not in any way trying to attempt to cause you to say something 
that you do not want to say. In fact, I wanted you to have the 
opportunity to explain the reason that you have not taken 
positions on these bills.
    Mr. Burke. Understood, sir. Thank you.
    Senator Moran. Let me ask Mr. Morosky, you noted in your 
testimony, and several other witnesses did as well, the 
importance of health care eligibility for veterans affected by 
toxic exposure. Can you speak to the critical nature of making 
certain that veterans have access to preventive care and the 
opportunities for early diagnosis of any toxic exposure related 
to health effects?
    Mr. Morosky. Yes, Senator. Thank you for that question. You 
know, certainly any veteran that is already sick and has been 
exposed to toxic substances should have access to VA health 
care, but even those who were exposed and are not sick yet 
should have access to preventative care. You know, we find that 
when a veteran becomes so ill that a cancer or another serious 
illness is diagnosed in the emergency room, the prognosis is 
much worse than when it is caught in routine tests, and so 
forth. So we think that preventative care is very important for 
veterans' health outcomes.
    Senator Moran. Thank you very much for that answer, and I 
now turn to Senator Blackburn.

                    SENATOR MARSHA BLACKBURN

    Senator Blackburn. Thank you, Mr. Chairman. I appreciate 
that, and I appreciate the attention that has been given to 
toxic exposure. At Fort Campbell, we have the K2 veterans, and 
those that served there, and, of course, the Burn Pit Registry 
is something that we have worked on, and we continue to make 
that a priority.
    I want to talk just a little bit with you all about various 
IT programs that have really led to delays in delivering 
critical projects, including initial implementation of the 
Forever GI Bill, a 2-year delay of the Caregivers Program 
expansion, and there have been some advancement, but whether it 
is procurement, whether it is delivery of service, whether it 
is wait times, whether it is getting the IT right, which, by 
the way, VA spends $4 billion a year on this, and just cannot 
seem to get these systems implemented, which is incredibly 
frustration.
    You know, the VA Technology Reform Act is something that we 
are pushing. Mr. Burke, I think I am hearing for you that you 
all do not support this--you have no position on it, or do not 
support. So you mentioned, in your written testimony, that you 
did not support the VA Information Technology Reform Act--I 
will say it that way--and you laid out several concerns with 
the language of the bill, most notably within proposed Section 
8175, Information Technology, and I am quoting you, 
``Information technology matters to be included in budget 
justification materials for the Department.''
    So does the VA believe it is unnecessary for Congress to 
have a report on resources spent on the project to date, 
planning expenditures for the upcoming fiscal year, scheduled 
completion date, any known deviations from schedule to date, 
and what the IT project will deliver for veterans?
    Mr. Burke. So, Senator, thank you for that question. 
Joining today, virtually, this panel, is a member of VA's 
Office of Information and Technology, and I will defer that 
question to him to respond.
    Mr. Brubaker. Yes, ma'am. This is Paul Brubaker with the 
Office of Information and Technology. While we do not support 
the language in its current form, we do agree with some of the 
objectives here, which is really about shoring up our program 
for IT investment management. We do believe that you should 
receive reports, but they should be insightful and substantive 
and really focus on cost schedule and, most importantly, the 
performance impacts of the investments we make as an 
organization.
    We have undertaken, over the course of the last year, a 
pretty aggressive move toward implementing a number of 
provisions in existing law, regulation, and policy, designed to 
get at exactly that--accountability, transparency, 
traceability, and report to Congress as well as ONB----
    Senator Blackburn. Okay, let me ask you this. You are 
talking around my question. What kind of completion date, where 
are you on scheduling a completion date? When are you looking 
at implementing? And tell me how long you have been over there, 
at the IT Department?
    Mr. Brubaker. Well, ma'am, I have been within the Office of 
Information and Technology for about a year and a half, all in 
total service. I spent a little time over at the Department of 
Energy and then came back----
    Senator Blackburn. Okay. What is the scheduled completion 
date for the project, for the implementation?
    Mr. Brubaker. Well, the CARMA project that you cited, 
ma'am, was completed last fall, and it was successfully 
deployed. The issue with any delays that you might have in 
processing those applications is not related to the technology. 
In fact, we have had a record number of applications as we 
modernize the CARMA program. So the technology itself is 
successful, but what we need to do is ensure that as a 
Department we are taking a much more holistic view of the 
people, processes, and technologies that have to come together 
to deliver outcomes for our Nation's veterans, and we are doing 
that as part of our----
    Senator Blackburn. So is it lack of training--not to 
interrupt you, I know it is more difficult to do when you are 
not here in person. So is it lack of training by personnel at 
the VA, or is it lack of desire to use this system?
    Mr. Brubaker. Well, ma'am, I think it is structural. I 
think it is related to the framework that we have in place and 
have not had in place in the past for managing our IT 
investments. We are required by OMB Regulation A-130 and A-11 
to construct business cases around programs and projects that 
we ask for funding for, and in the past we have not been as 
rigorous and disciplined as we needed to be in order to ensure 
both Congress and the administration that we are focusing our 
investment strategy on moving the needle on improvements, on 
measurable improvements to mission and operational performance.
    The investment management framework that we are putting in 
place, and that we would welcome the Committee's collaboration 
with, is designed to make much more informative IT investment 
and management decisions, No. 1, and No. 2, ensure that you can 
track the effectiveness of those over a period of time.
    We think that we have got an alternative reporting 
structure that we would love to talk to you and your staff 
about, and we would look forward to working with you on 
improving some of the language that would leverage some of the 
existing model regulation policy that applies, but also shoring 
up some deficiencies that we see, that we think will achieve 
the objectives that you have.
    Senator Blackburn. I would appreciate that conversation, 
because as we look at DoD systemwide, we should have as a goal 
to begin a record, a medical record, for everyone, the day they 
enlist, and have this follow them throughout their career, and 
into their time as a veteran, and they should be appropriately 
honored and cared for during that time. And we have talked 
about those that have been adversely impacted by the toxic 
exposures.
    It would be so helpful--we work with so many veterans--it 
would be so helpful if all that information was in one place, 
and there was ready access to that information. It would be 
better for them. It would be better for you all. They would get 
care more quickly and in a more timely manner.
    So I think each of us on this Committee are tired of 
hearing excuses of we cannot do this because of that, and we 
cannot meet this deadline because this other deadline did not 
get met. And so my hope is that we will indeed see some 
improvement before the next time that you all join us. So thank 
you.
    I yield back, Mr. Chairman.
    Senator Moran. Senator Blackburn, thank you, although you 
have nothing to yield back. Senator Brown?

                     SENATOR SHERROD BROWN

    Senator Brown. Thank you, Mr. Chairman. Thanks, Senator 
Moran, to you and Senator Tester, thank you for holding this 
hearing. I have worked with both of you on toxic exposures over 
the years. I was heartened to learn of Secretary McDonough's 
end-of-year, end-to-end review. It is time that we start 
delivering benefits for veterans.
    Mr. Burke, I would like to ask you a question, 
understanding what you said of wanting to look at this in a 
holistic way.
    Two weeks ago, Senator Portman and I, my Republican 
colleague, bipartisan, from Ohio, introduced the SFC Heath 
Robinson Burn Pit Transparency Act on what would have been 
Heath's 40th birthday. I have a short Statement from Senator 
Portman, Senator Moran, that I would like to include in the 
record, if I could.
    [No response.]
    Senator Brown. I guess that means yes. Doing this remote.
    Heath was twice named Noncommissioned Officer of the Year 
by the Ohio Army National Guard. He was deployed to Iraq. He 
was exposed to so many toxic burn pits. He was later diagnosed 
with Stage IV cancer. Last year he died. Our bill would require 
VA to report how many veterans report burn pit exposure, how 
many make disability claims, what the outcome of those claims 
are, a comprehensive list of conditions reported by burn pit-
exposed veterans. It seems that part of your VA review would do 
the same thing.
    So, Mr. Burke, again understanding your reluctance now and 
your desire for something holistic, I want to just pose a 
question. We hope that the information will help to make a 
connection between the illnesses and burn pit exposure so 
veterans can get additional benefits. Do you think VA will make 
a similar correlation after your review?
    Mr. Burke. Senator, thank you for that question. I do 
believe that our holistic approach will lead us to some 
resolutions such as what you mentioned. I will also defer to my 
colleague from VHA, Dr. Hastings, to see if she has any input 
there. But the real goal of the end-to-end review is to take a 
look at everything that we are doing with respect to this 
approach to toxic exposures, to include looking at our internal 
processes. But I do believe the conclusions that you referenced 
are what we are hoping a holistic review will accomplish for 
us. But Dr. Hastings, if you had anything you can add.
    Senator Brown. But before, if I could, Mr. Burke, Dr. 
Hastings, before you answer that let me throw in sort of a side 
question for you to put together. Is DoD providing its 
environmental health site assessments to you, and what 
additional data would you need to make a determination about 
what chemicals were airborne? So answer that sort of together, 
if you would.
    Dr. Hastings. Yes, Senator Brown. We have the Deployment 
Health Working Group, and we will be meeting with them, in 
fact, Thursday. We meet once a month. We share information back 
and forth. DoD is very open. They have given us the POEMS, the 
Periodic Environmental Monitoring Surveys, the POEMS. Those are 
going into what is called ILER, the Individual Longitudinal 
Exposure Record, which does create an exposure record for a 
soldier, for an airman, a marine, a servicemember, at the time 
they enter service, and follows them across to the VA when they 
do terminate service, either at retirement or electively 
earlier. But yes, DoD shares that with us.
    I would like to note that with the National Academy report, 
some of that did not make sense to us, so Dr. Stone and the 
Secretary asked us to do a relook at some of the data, using 
good science, as well as claims data. And we have gone forward. 
We have put together a report that has gone to the Secretary 
that does have some findings that we have used with the VA. Our 
epidemiologic research, a lot of that comes from my office. And 
I think we will have better answers with the new framework that 
the Secretary is putting together.
    Senator Brown. Thank you, Dr. Hastings. Let me follow that. 
How is VA ensuring, Dr. Hastings, that community practitioners 
are trained and held to the same standard, the same high 
standard, as VHA professionals?
    Dr. Hastings. You are absolutely correct. you know, they do 
not train physicians, nurse practitioners, and PAs in school to 
look at environmental exposures, in general, or military 
environmental exposures, toxic exposures. And we have a very 
robust training program in VA. There are some things that VA 
does very well. We take care of amputations. We take care of 
trauma. We are really good at PTSD. We are also good at 
military environmental exposures.
    We want to help the community physicians. We do have the 
training that is available to the VA physicians and nurse 
practitioners and PAs available to civilians on a platform 
called TRAIN. We get information out to the field. We work 
through the Community Care office to get that out to the field. 
I would be very happy to share that training with you so you 
can take a look at it.
    Senator Brown. Thank you. And I want to also hear--Dr. 
Hastings, thank you for that answer--I know the VA is 
outstanding at those and a number of other things, but I want 
to hear especially how you are going to reach out. I know you 
can do the training and the right kind of instruction to 
community health providers, but whether you can reach them, and 
how you do that, how you sort of pre-empt that is just really 
important. So Anna Gokaldas on my staff, and Drew Martineau, 
will be reaching out to you. But thank you so much.
    Dr. Hastings. Absolutely.
    Senator Brown. Senator Moran, thank you for allowing me 40 
extra seconds.
    Senator Moran. You were the best-behaved member of the 
Committee today, Senator Brown.
    Senator Brown. And, if I could add, that Senator Moran, I 
just found out today, has had his first two grandchildren 
during the pandemic. So that is pretty cool.
    Senator Moran. It is the only two grandchildren we had 
during the pandemic. Sherrod, thanks.
    Let me make sure there is no other member of the Committee 
that is online. I do not believe that is the case. Is anybody 
on that I did not recognize?
    In the absence of Senator Tester's return, and before I go 
vote, I have got a couple more questions that I would like to 
ask them. This is for Mr. Murray, Mr. Rowan, and Mr. Liermann. 
I know your three organizations have been long in their strong 
support for the creation of a fourth administration at the VA, 
which would lift up all the economic empowerment services such 
as education, employment services, transition assistance, home 
loans, voc rehab, those kinds of programs, out from under the 
VBA and into its own administration, which would presumably 
allow the rest of VBA to focus on claims processing and the 
backlog.
    Let me ask each of you if you would expound on why you 
think that this realignment and changes are important to occur, 
why you believe that creating this new administration would 
benefit veterans and improve their economic stability, and what 
would you say to individuals who argue that it would just 
create another level of bureaucracy at the Department, and how 
would you refute the VA's pushback on this legislation, that 
these programs are already running smoothly and, therefore, do 
not need their own administration? Mr. Murray, Mr. Rowan, and 
Mr. Liermann.
    Mr. Murray. Thank you, Senator, for bringing up this 
important subject. A fourth administration we believe has been 
needed for years. The programs you described--GI Bill, home 
loans, VR&E--have had a series of problems over the past few 
years, and so to say that they are running smoothly I do not 
believe is totally accurate, in a defense of that. Two years 
ago, student veterans went bust without any kind of payment 
because of an IT resource issue.
    Right now, in this hearing, we are asking VBA to take on a 
huge undertaking with this toxic exposure effort that we are 
trying to pass through. We think allowing them to separate and 
focus on this, and allow GI Bill and VR&E and home loans, all 
the other great economic benefits to grow and strive is what is 
best for everybody involved.
    Senator Moran. Thank you. The others?
    Mr. Liermann. Yes, Senator Moran. Thank you. DAV does 
support it, and we believe that it is going to be lopsided 
either way you look at it. A few years ago there was definitely 
some serious issues within education and voc rehab. A few years 
ago, they started pouring more and more resources into that. 
Now we have a backlog of cases and some other issues within 
VBA.
    So our concern is, when you are trying to split your 
priorities on two major groups, issues and benefits, it is 
always going to be lopsided, and you are never going to have it 
even. By elevating economic opportunities to a separate 
department, you are advancing those issues, and, at the same 
time, you are allowing VBA to focus on what VBA does well--rate 
claims and give veterans benefits.
    So we believe, yes, they should be separate, and that is 
why.
    Senator Moran. Mr. Rowan?
    Mr. Rowan. Yes, Senator, this is John Rowan from VVA. Yes, 
we have always been in support of this bill, this idea of a 
fourth administration. We found it was always getting short-
shrift on employment issues, work-study programs, all of those 
things.
    I also think it is interesting to look at these younger 
veterans today. They are very much business oriented, they are 
very much more entrepreneurs, perhaps because they are so tech 
oriented, which leads to a whole different way of doing 
business today. And they need all the help and assistance they 
can get, and to get lost into the VBA has been a problem 
forever, and we wholeheartedly support this, and have for many 
years.
    Senator Moran. Thank you very much. The Chairman is en 
route.
    Mr. Burke, your testimony is that VA opposes S. 89, citing 
that the VA should not require an additional medical opinion in 
the case of an individual whose death certificate States the 
cause of death being as a result of COVID-19, despite the fact 
that veterans could have had an underlying health issue due to 
service-connected disabilities, which we now know makes this 
population more susceptible to succumbing to the effects of 
COVID-19.
    In your testimony, you said, quote, ``The VA issued a 
specific reminder to claims processors on April 23, 2020, 
regarding the processing of service-connected death claims. 
There have been many COVID-specific changes that Congress has 
passed that have been narrowly tailored to respond to the 
adverse impacts that we have seen of COVID-19. This bill is 
another example of that.''
    Would you agree that an unprecedented pandemic like we have 
seen that there is a possibility that without this legislative 
change veterans' surviving families would not receive the same 
benefit they would have received if they had died as a result 
of their underlying service-connected disability, had COVID 
never been a factor? Expand upon your analysis or explanation 
of the value of S.89.
    Mr. Burke. Senator, first let me congratulate you on your 
two grandchildren. I also had my first and only two 
grandchildren during the pandemic as well.
    Senator Moran. I am pleased to share that with you. 
Congratulations to you.
    Mr. Burke. Thank you. Thank you, sir.
    With respect to S.89, we believe, through 38 CFR, that we 
already have sound guidance and principles in processing these 
very important claims. Specifically, we issued guidance at the 
beginning of the COVID-19 pandemic, reminding our claims 
processors of the policies and procedures relative to utilizing 
the information on the death certificate to process these 
claims.
    In fact, since COVID, we have conducted a special focus 
review, and that focus review shows that we are compliant with 
the policies and procedures in excess of 95 percent of the 
cases that we have sampled. We do not believe that this 
legislation is necessary because of the parameters of 38 CFR 
that we apply to processing these cases.
    In fact, the clear instructions sent to our field claims 
processors reminded them that on the death certificate, as 
somebody alluded to in their prior testimony, there is space 
for both the principal and contributory cause of death. And so 
when a death certificate comes in, I will use an example of a 
veteran that has service connection for a foot condition, but 
COVID listed on the death certificate. Our claims processors 
will look at the information on the death certificate and also 
a review of the evidentiary record, and in a case such as that, 
a medical opinion would not be beneficial. In fact, from the 
fiscal steward perspective, requesting medical opinions on 
every claim is not only financially unsound but would also add 
to the claims inventory unnecessarily.
    And so we believe that we are following sound practices. 
Our special focus review validated that, and it is something 
that we treat with a high level of importance and continue to 
monitor.
    Senator Moran. Thank you for that answer, Mr. Burke, and 
again, congratulations with the grandchildren.
    Mr. Burke. Thank you, sir. Same to you.
    Chairman Tester. [Presiding.] Senator Boozman?

                      SENATOR JOHN BOOZMAN

    Senator Boozman. Thank you, Mr. Chairman, and thank you, 
Senator Moran, for this hearing on pending legislation before 
the Committee. These bills are wide-ranging, covering toxic 
exposures of different generations, veterans' benefits, and 
support to veterans' spouses. I am grateful for the bipartisan 
work on this Committee. We must continue to honor those who 
have sacrificed so much for our country. I would like to say 
thank you to our panel for participating today and all the 
great work you do in support of our veterans.
    I want to thank the Military Veterans Advocacy and other 
VSOs on this panel for support of S.657, which supports 
veterans who were exposed to toxic herbicide agents while 
serving in Thailand during the Vietnam War.
    I also want to highlight and thank and Arkansas native, 
Sharri Briley for her Statement in support of Senate Bill 976, 
Caring for Survivors Act of 2021. Sharri's husband, Chief 
Warrant Officer Donovan Briley, paid the ultimate sacrifice in 
1993, as a Black Hawk helicopter pilot supporting Special 
Forces in Mogadishu, Somalia. The events of that tragic day 
were depicted in the film, ``Black Hawk Down.''
    The film actually showed the moment that Chief Warrant 
Officer Briley attempted to call Sharri before the mission. She 
was not there to pick up the phone, and he never got to say 
goodbye that day. This Committee must work to honor Sharri's 
sacrifice and ensure they are supported. Mr. Chairman and 
Senator Moran, thank you for your leadership on this issue, and 
I look forward to working to get this bill passed.
    Mr. Morosky, WWP, in your testimony you mentioned that the 
Dependency and Indemnity Compensation, the DIC program, has 
been historically resistant to modernization, and excludes 
benefits to certain survivors of veterans. Can you expand on 
some of the existing challenges with the DIC program and how 
the Caring for Survivors Act would improve benefits for the 
families of fallen veterans like Sharri Briley?
    Mr. Morosky. Yes, Senator. Thank you for that question. 
And, you know, resistant to modernization, I think to put that 
another way, just needs an update. It has been too long, and 
the Caring for Survivors Act would do just that. You know, No. 
1, under no circumstances should DIC payments be at a lower 
rate than other Federal survivor benefits. They need parity 
with that.
    And as far as the 10-year rule that it addresses, 10 years 
is a long time for a veteran to be permanently and totally 
disabled before their spouse qualifies for full DIC benefits, 
probably too long. Five years is a long time too, but it is not 
as long, and so we support switching from the 10-year to the 5-
year rule, and we strongly support this bill.
    Senator Boozman. Thank you very much. Mr. Murray of the 
VFW, your organization has continually been supportive of 
legislation that would include veterans who served in Thailand 
with the same presumption of service connection for exposure to 
toxic herbicides. Can you briefly explain why the current law 
does not make sense and why it is important that S.B. 657 be 
passed?
    Mr. Murray. Thank you, Senator Boozman, for your leadership 
on this issue. The current set of standards for those veterans 
exposed is expecting that Agent Orange is, for some reason, 
going to follow arbitrary lines on a map. The veterans who were 
in one part of the base using Agent Orange are potentially 
covered, but veterans who were standing ten feet away from 
them, or the chow hall, or wherever it might be, are not. As we 
learned in Vietnam, Agent Orange is so pervasive. It gets in 
the water. It gets in the soil. It gets in the air. It is 
everywhere, and we cannot keep asking a chemical that we have 
no control of to not expose people, because we did not draw the 
lines on a map the way that we wanted it to.
    Senator Boozman. Very good. Again, thanks to the panel, and 
thank you, Chairman Tester.
    Chairman Tester. Thank you, Senator Boozman. Senator 
Sinema?

                     SENATOR KYRSTEN SINEMA

    Senator Sinema. Thank you, Chairman Tester and Ranking 
Member Moran, for organizing this important hearing, and thank 
you to our witnesses for participating today and for your 
continued efforts to support veterans and their families.
    I reintroduced the Ensuring Survivor Benefits During COVID 
Act with Senator Tillis because of continued calls from 
veteran-serving organizations and survivors, expressing 
concerns that survivors of veterans who die from COVID-19 may 
not be granted their survivor benefit if the death certificate 
does not list that service-connected disability as a 
contributing cause.
    My Arizona case work team is working on a case right now to 
help a surviving spouse in this situation. In February 2021, 
our office was contacted by a representative from a local VSO, 
requesting assistance for a surviving military spouse whose 
husband passed away after contracting COVID-19. The 
constituent's husband served in Vietnam and was a 100 percent 
service-connected disabled veteran. Her husband was suffering 
from cancer related to his Agent Orange exposure, and sadly he 
passed after being hospitalized for COVID.
    The constituent was informed by a service officer that she 
would not be eligible for survivor benefits because her 
husband's death certificate did not State that the cause of 
death was related to his service-connected disability. She was 
obviously extremely disappointed, and expressed to our office 
that being denied her survivor benefit added a great amount of 
stress to her life, so soon after losing her spouse. Our office 
coordinated with the local VSO office and we ensured that the 
constituent did have assistance applying for her survivor 
benefit.
    After submitting her application, we then followed up with 
the VA's Pension Management Center and conveyed her request 
that her late spouse's medical history and service connection 
be taken into consideration when determining her eligibility 
for survivor benefits. Her application is currently being 
processed.
    If our bill is signed into law, this spouse, and other 
survivors like her, would have more certainty in the process as 
the claim is adjudicated. The VA maintains that they have 
enough guidance to ensure that survivors are not overlooked, 
but the VA has not offered any data to back up that Statement. 
When we asked for that analysis, the VA told us that they 
cannot track survivor claims related to COVID-19 deaths because 
the IT system is not set up for this kind of analysis. That is 
not an acceptable answer.
    So my first question is for Mr. Burke. I spoke with 
Secretary McDonough in March, emphasizing the importance that 
the VA back its opinion that survivors are not being denied 
benefits with data. We are still waiting for a briefing on the 
outcome of the VA's special focus review of COVID-19 claims to 
understand whether this review can provide data to back up the 
VA's assumption. It is tentatively scheduled for next week. 
Have you reviewed the findings from the special focus review?
    Mr. Burke. Senator, yes, ma'am, I have, and, in fact, I 
know that we are scheduled for the briefing with you and your 
staff next week, but I have, in fact, reviewed those results.
    Senator Sinema. And based on that review, is the VA able to 
conclusively rule out that there are no barriers to survivors 
applying for DIC benefits in cases where the veteran has died 
of COVID-19 and the death certificate only States COVID-19 as 
the cause of death?
    Mr. Burke. Ma'am, based on the review of the cases and the 
analysis that I received and what we are prepared to share with 
you and your staff next week, it shows a 95-plus percent 
compliance rate with the 38 CFR provisions and the refresher 
materials that we provided to our claims processors. Based on 
that review, I would say I am confident, highly confident, in 
the accuracy of the claims processing.
    With respect to the overall impact and angst caused by 
COVID-19, certainly this and other areas are ones where I would 
say continued outreach and partnership are in order. I am happy 
to have the conversation with you and your staff next week, 
ma'am, and see where we need to go from there. But the reviews 
were hopefully something that you will find helpful as well, 
next week.
    Senator Sinema. I appreciate that, Mr. Burke, and I look 
forward to that briefing. I also look forward to determining 
how we can resolve cases like my constituent's, if indeed those 
are aberrations from the standard practice.
    I want to thank each of the VSOs on the panel for 
supporting S.89, and I would like to give you a little more 
opportunity to talk about why it is so important to pass this 
legislation. So, Ms. Wheeler, TAPS has been a great partner 
since we introduced this legislation last Congress. Can you 
tell me what you have seen and heard from survivors in this 
situation and how this legislation will help?
    Ms. Wheeler. Yes, thank you very much for the question and 
for introducing this legislation for us. What we are hearing, 
first of all, is if a veteran's death certificate States COVID-
19, as you Stated, and does not take into account their 
service-connected injury or illness, these surviving families 
must prove service connection before receiving benefits. And 
what we are hearing is that the VA's current practice is to 
have a second processor review each case before a decision is 
made.
    But this is not being done every single time. We are 
hearing from survivors that processing errors are occurring. In 
addition, the second processor review is creating a longer wait 
time for these families. For example, the Hickock family is the 
first National Guard family to have lost a guardsman after his 
exposure to COVID-19. He had an underlying heart condition that 
was in the process of being service connected by the VA. It has 
been over a year since his death, and his family is still 
waiting for benefits as late as this month.
    TAPS wants to see this regulation codified in law to 
protect surviving families like the Hickocks, in perpetuity, 
and we fully support this legislation, and we thank you.
    Senator Sinema. Thanks. Mr. Chairman, I would love to hear 
from the other VSOs but I see that my time has expired, so I 
will have my team followup with them individually after the 
hearing. Thank you so much.
    Chairman Tester. Yes, thank you, Senator Sinema. Senator 
Sanders?
    [No response.]
    Chairman Tester. Okay. I have a couple of questions here. 
These are for you, Mr. Burke. VA testimony speaks to 
authorities and requirements under the Agent Orange Act of 
1991, that has expired, including the requirement to respond to 
National Academies reports with a decision to create or defer 
new presumptions.
    The testimony goes on further to say that this is an 
opportunity to create a new, comprehensive, modernized 
decisionmaking model for determining presumptions based on 
environmental exposures. I am encouraged by this position, 
which is a significant change from past Statements, and look 
forward to seeing this proposed model.
    So, Mr. Burke, as the VA is developing this model, which 
sounds to be in line with many legislative efforts before the 
Committee, do you expect it will need new legal authorities to 
replace the expired portions of old laws?
    Mr. Burke. Senator, thank you. I think it is too early for 
me to weigh in on that. Again, I think with a holistic approach 
it is going to be literally the Secretary driving us to turn 
over every stone possible in assessing this entire process. I 
think it is premature for me to weigh in whether it is a yes or 
not. But those are the things that will be uncovered during 
this end-to-end review and the full approach driven by the 
Secretary.
    Chairman Tester. Okay. Does the VA see where any of the 
legislation currently before the Committee can help achieve 
those goals, or is it too early in the process for that?
    Mr. Burke. So with respect to the bills on toxic exposure, 
our position is it is premature to legislate. That being said, 
there is goodness in each of these bills. Our lack of a 
position, yea or nay, should not be taken, sir, with all due 
respect, as us not seeing value in the proposals.
    Chairman Tester. Okay. Thank you.
    If there are no more questions I think we will close this 
out. The record will remain open until next Wednesday. I would 
ask if questions are asked to any of the witnesses that they 
respond as quickly as you possibly can.
    We have a lot of hearings in this Committee. I do not know 
that there is going to be any more important than this one, so 
I very much appreciate everybody who testified.
    I also want to give a special thank-you to the VA for 
allowing us to have one panel here. It is very, very important, 
and I think it allows for a better exchange, quite frankly. So 
I want to thank you for that.
    With that, this hearing is adjourned.
    [Whereupon, at 4:43 p.m., the Committee was adjourned.]

                                APPENDIX

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