[Senate Hearing 117-543]
[From the U.S. Government Publishing Office]
S. Hrg. 117-543
VA AND DOD COLLABORATION:
IMPROVING OUTCOMES
FOR SERVICEMEMBERS AND VETERANS
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTEENTH CONGRESS
FIRST SESSION
__________
NOVEMBER 3, 2021
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
50-287 PDF WASHINGTON : 2023
COMMITTEE ON VETERANS' AFFAIRS
Jon Tester, Montana, Chairman
Patty Murray, Washington Jerry Moran, Kansas, Ranking
Bernard Sanders, Vermont Member
Sherrod Brown, Ohio John Boozman, Arkansas
Richard Blumenthal, Connecticut Bill Cassidy, Louisiana
Mazie K. Hirono, Hawaii Mike Rounds, South Dakota
Joe Manchin III, West Virginia Thom Tillis, North Carolina
Kyrsten Sinema, Arizona Dan Sullivan, Alaska
Margaret Wood Hassan, New Hampshire Marsha Blackburn, Tennessee
Kevin Cramer, North Dakota
Tommy Tuberville, Alabama
Tony McClain, Staff Director
Jon Towers, Republican Staff Director
C O N T E N T S
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NOVEMBER 3, 2021
SENATORS
Page
Tester, Hon. Jon, Chairman, U.S. Senator from Montana............ 1
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas...... 2
Brown, Hon. Sherrod, U.S. Senator from Ohio...................... 7
Hirono, Hon. Mazie K., U.S. Senator from Hawaii.................. 11
Cassidy, Hon. Bill, U.S. Senator from Louisiana.................. 13
Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire...... 15
Boozman, Hon. John, U.S. Senator from Arkansas................... 16
Blumenthal, Hon. Richard, U.S. Senator from Connecticut.......... 18
Tillis, Hon. Thom, U.S. Senator from North Carolina.............. 20
Blackburn, Hon. Marsha, U.S. Senator from Tennessee.............. 24
Sinema, Hon. Kyrsten, U.S. Senator from Arizona.................. 25
Sullivan, Hon. Dan, U.S. Senator from Alaska..................... 27
WITNESSES
Panel I
The Honorable Donald Remy, Deputy Secretary of Veterans Affairs.. 4
The Honorable Gilbert R. Cisneros, Jr., Under Secretary of
Defense for Personnel and Readiness............................ 5
Panel II
Nicholas J. Armstrong, PhD, Managing Director, Research and Data,
Institute for Veterans and Military Families (IVMF), Syracuse
University..................................................... 29
Mike Hutchings, Chief Executive Officer, Combined Arms........... 31
Thomas Winkel, Founder and Director, Arizona Coalition for
Military Families.............................................. 33
APPENDIX
Prepared Statements
The Honorable Donald Remy, Deputy Secretary of Veterans Affairs.. 45
The Honorable Gilbert R. Cisneros, Jr., Under Secretary of
Defense for Personnel and Readiness............................ 54
Nicholas J. Armstrong, PhD, Managing Director, Research and Data,
Institute for Veterans and Military Families (IVMF), Syracuse
University..................................................... 63
Mike Hutchings, Chief Executive Officer, Combined Arms........... 72
Thomas Winkel, Founder and Director, Arizona Coalition for
Military Families.............................................. 77
Questions for the Record
IVMF response to questions asked during the hearing by:
Hon. John Boozman.............................................. 83
Department of Veterans Affairs response to questions submitted
by:
Hon. Jon Tester................................................ 86
Hon. Patty Murray.............................................. 90
Hon. Mazie Hirono.............................................. 94
Hon. Jerry Moran............................................... 104
Hon. Marsha Blackburn.......................................... 106
Hon. Tommy Tuberville.......................................... 108
IVMF response to Question for the Record submitted by:
Hon. Tommy Tuberville.......................................... 110
Additional Resources
Reports with associated links submitted by IVMF
GA National Veterans Strategy: The Economic, Social
and Security Imperative...................................... 113
GImproving the Delivery of Services and Care for
Veterans: A Case Study of Enterprise Government.............. 113
Supplemental documents submitted by ACMF
GHistory and Highlights of Arizona Coalition for
Military Families (ACMF)..................................... 115
GEmpowering Veteran Communities (EVC): Community
Integration and Supportive Services for Suicide Prevention... 147
VA AND DOD COLLABORATION:
IMPROVING OUTCOMES
FOR SERVICEMEMBERS AND VETERANS
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WEDNESDAY, NOVEMBER 3, 2021
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 3:05 p.m., via
Webex and in Room SR-418, Russell Senate Office Building, Hon.
Jon Tester, Chairman of the Committee, presiding.
Present: Senators Tester, Murray, Brown, Blumenthal,
Hirono, Sinema, Hassan, Moran, Boozman, Cassidy, Tillis,
Sullivan, Blackburn, and Tuberville.
OPENING STATEMENT OF CHAIRMAN TESTER
Chairman Tester. I want to call this meeting to order, and
I want to start out today a little different. Mike Rounds is
not here today. We all know that Mike's wife has been fighting
cancer for a good part of this year and maybe long before that,
but she passed away yesterday morning. And I just want to--you
know, we argue. We fight. We do all this stuff here. But in the
end, we are a big family, and I just want to let the folks out
there know that Mike Rounds is an important part of this
Committee and our thoughts are certainly with him and the
Rounds family today as they prepare for the future.
I want to thank you all for joining us today to discuss the
collaborative efforts of the Departments of Veterans Affairs
and Defense to meet the needs of our military and veteran
communities.
Today, we will hear from the co-chairs of the Joint
Executive Committee, the Honorable Donald Remy, Deputy
Secretary of Veterans Affairs, and the Honorable Gil Cisneros,
Under Secretary of Defense for Personnel and Readiness. As co-
chairs of the JEC, their job is to lead interagency cooperation
between the VA and the DOD. They partner on a number of
initiatives, including the delivery of healthcare and benefits,
the military to civilian transition, and health data
interoperability. This interagency work must be a consistent,
collaborative effort. Our servicemembers and veterans depend on
it.
One of the most critical intersections of the VA's and
DOD's responsibilities is ensuring the seamless transition from
DOD to VA healthcare. This requires health exams upon
separation that are comprehensive and that can be used to
inform post-service treatment and determine eligibility for
benefits before they leave the Service.
But a servicemember's transition to civilian life extends
beyond just healthcare and benefits from the VA. Choosing a
next step after the military, whether it be education or
employment, requires guidance from the VA and the DOD on what
makes the most sense for that servicemember and his or her
family. VA, DOD, and Department of Labor all have a role to
play through the Transition Assistance Program, ensuring these
men and women are prepared for life after service.
This stressful time places significant strain on a
veteran's mental health. In Congress, we have made some strides
in the provision of mental health care to our veterans,
including passage of the Commander John Scott Hannon Act. Now
VA must do its part to implement. But the DOD has a role to
play, particularly in the development and deployment of joint
mental health programs.
And I want to applaud the Biden administration for
releasing a new strategy on veteran and military suicide
prevention just yesterday. I look forward to working with your
departments on this shared mission.
VA and DOD are also on parallel paths to deploying the
Cerner electronic health record. Both departments' programs
have had their setbacks, and it is important for the VA to
learn anything it can from DOD's challenges and successes as
they implement reforms coming out of Secretary McDonough's
strategic review.
Another critical area for action is toxic exposure. Right
now it is far too difficult for veterans to prove they were
exposed to toxic substances. New programs like the Individual
Longitudinal Exposure Record, or ILER, will enhance VA's access
to DOD records on exposures, but that information is only as
good as the DOD's recordkeeping.
Collaboration between your agencies goes beyond preparation
for transition and servicemembers' records. It also includes
shared facilities and supply chains. And as you continue
working to improve the lives of servicemembers and veterans,
there are opportunities to save taxpayer dollars through joint
purchasing power.
We will cover these topics today with Under Secretary
Cisneros and Deputy Secretary Remy. We will also hear testimony
from community organizations who partner with the Federal
Government to assist our Nation's veterans. These groups
experience the collaborative efforts between these two agencies
firsthand, both their successes and their failures, and their
on-the-ground perspective is absolutely critical.
With that, I turn the chair--the mike over to Senator
Moran.
Senator Moran. I would take what you said first; I would
turn the chair over to. But in the absence of that, I will take
the mike.
Chairman Tester. Well, that has been happening far too
often.
OPENING STATEMENT OF SENATOR MORAN
Senator Moran. Mr. Chairman, thank you for conducting and
holding this hearing.
Both Secretaries, welcome to the Senate Committee on
Veterans' Affairs and thank you for your presence with us
today.
And, Mr. Chairman, thank you for your recognition of the
sadness that is occurring in the--that has occurred in the
Rounds family. And I, too, join--all of us join you in offering
our sympathies and condolences to Senator Rounds and his family
in the loss of his wife. And, what a tremendous family. And we
are all saddened today.
This hearing is an excellent opportunity for us to discuss
the current state of affairs between the VA and DOD in their
collaboration, especially regarding how to better assist
servicemembers and their families that are transitioning out of
military service into civilian life.
I want to highlight the words I have noticed that are
consistently used throughout the last 10 iterations of the
Joint Strategic Plan to describe the JEC's goals for
transition: collaborative, comprehensive, personalized,
interoperative, seamless, and efficient.
However, when conducting oversight of the transition
process, we continue to witness a fundamental problem of DOD
and the military services balancing military readiness with
prioritization of a servicemember's post-military readiness and
entrance into civilian life. I would be remiss if I did not
remind the Under Secretary Cisneros today that supporting a
successful transition to a civilian life is a vital recruiting
tool and impacts our Nation's ability to sustain an all
voluntary force now and in the future.
The military is known to invest a lot of effort and
resources into training and developing leaders while they are
in uniform, and it should be everyone's mission to ensure that
veterans are given the opportunity to use these positive
attributes to give back to their communities after service and
to benefit themselves and their families.
I look forward to hearing from the second panel as well.
Your organizations represent the gold standard for how
community programs can be maximized nationwide. It is my hope
that both departments here today will listen closely and find
value, as we will, in your testimony.
Lastly, I would like to discuss the impact of the vaccine
mandate, what that impact has been, what it will be and will
have. I would like to know what it will have on the operations
of ineligibility for Services as well as the readiness levels
at DOD. I look forward to hearing from you about the impact of
the mandate on an individual's character of discharge and
eligibility for VA benefits.
Thank you, Deputy Secretary Remy and Under Secretary
Cisneros, for being here today on behalf of VA and DOD. And,
Mr. Winkel, Dr. Armstrong, and Mr. Hutchings, I want to
especially thank you for your work as you continue to do so
many good things on behalf of veterans in our communities
across the country.
Mr. Chairman, again, thank you.
Chairman Tester. Thank you, Senator Moran. And we will
start with the first panel. I want to welcome co-chairs of the
JEC to the first panel: Honorable Donald Remy, Deputy Secretary
of Veterans Affairs, and Honorable Gil Cisneros, Under
Secretary of Defense for Personnel and Readiness.
Secretary Remy, you can start.
PANEL I
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STATEMENT OF THE HONORABLE DONALD REMY
Mr. Remy. Chairman Tester, Ranking Member Moran, and
distinguished members of the Committee, good afternoon to all
of you. I, too, would like to start off with my condolences to
Senator Rounds and to his family on the loss of Jean. I pray
for the family's strength at this moment.
I want to thank you for the opportunity to appear before
you with my colleague, Under Secretary Gil Cisneros, to testify
on Veterans Affairs's collaboration with DOD, and I want to
thank you for your strong support of this work.
To begin, however, I want to touch on concerns related to
the supply chain, which I heard mentioned in the opening
comments, and let you know that we are ready to deal with those
challenges. The pandemic exposed global and U.S. supply chain
weaknesses, and we expect the manufacturing and distribution
disruptions to continue. As the virus spread, overall consumer
demand decreased, and industrial activity, in turn, decreased.
With the increasing level of vaccination globally and the end
of lockdowns in many nations, however, consumer demand has
increased dramatically.
While supply chains continue to face big challenges,
including worker shortages and limitations in access to raw
materials and key components, VA is actively addressing these
challenges, implementing near-term methods to ensure internal
VA supply chain resiliency, including monitoring the ability of
our suppliers to fill orders completely and timely, identifying
alternatives for preferred products, and treating medical
products as enterprise assets.
We know that effective national response requires a durable
public health supply chain anchored in domestic manufacturing
so that care and preventative measures can reach our veterans.
Sustaining that supply chain is critical for ensuring the
health and the wellness of the Nation as well as for national
security, and VA is working closely with the White House, with
all Executive Branch agencies, to develop and implement the
actions identified in the National Strategy for a Resilient
Public Health Supply Chain. Bottom line here, those challenges
are very real, and we are mobilizing to address them.
I want to focus on our collaboration with DOD. And thank
you for that word, Senator Moran. During my confirmation
hearing in May, I committed to ensuring that VA has a strong
relationship with DOD, to ensuring that we have a long-term
strategic approach and resolve all of our challenges together,
and I committed to efficiently and responsibly using the
resources that you appropriate for us.
After about three months on the job, here is what I can
report: Our direction is clear. We are guided by the needs of
servicemembers and our veterans. Our partnership is strong, and
we are on the path to grow stronger. Secretary Cisneros and I
are devoted to improving the delivery of healthcare, benefits,
and services and transition support for those we serve.
We recently signed our VA-DOD Joint Strategic Plan for FY
'22 through '27. That shifts us from a three-year to a six-year
planning cycle. The plan establishes our shared vision and five
goals critical to caring for servicemembers and veterans as
well as they have cared for us. It is our charter for the
future, our contract with those we serve. And we are completely
aligned on what matters most, fulfilling our Nation's sacred
obligation to keep our troops safe when they send them into
battle--when we send them into battle, I should say, and to
care for them when they come home.
Fulfilling that obligation means collaborating effectively
and efficiently on the healthcare that we deliver to the more
than 18 million servicemembers, veterans, and their
beneficiaries, a patient-centered system delivering quality,
access, and value seamlessly across our two departments. It
means integrating benefits and services delivery across joint
business operations, a beneficiary-centric approach providing
excellent customer service, eliminating gaps and discrepancies
in benefits, and improving communication with beneficiaries.
It means helping veterans build fulfilling civilian lives
with education and jobs worthy of their skills and service
after they leave the ranks. That is enhancing the transition
and post-separation experience with planning services and
programs that ensure access to the highest quality care,
benefits programs, and job training, and that is post-service
placement at the right time in their lives' journey.
It means modernizing our shared business operations with a
joint approach and innovative technology solutions that gain
efficiencies, avoid cost, achieve better outcomes for
servicemembers and veterans, all the while being good stewards
of the taxpayers' dollars. And it means strengthening our
interoperability and expanding our network of interagency and
public-private partnerships to bolster our agility and promote
operational efficiency, improving data interoperability,
shaping policy, facilitating data-driven decisions, and
enabling seamless experience for beneficiaries.
Chairman Tester, Ranking Moran, distinguished members of
the Committee, we are committed to driving collaborative
efforts to realize our shared vision, and Secretary Cisneros is
a great partner in this endeavor. Thank you for your support
and devotion to those we share this service--to those that have
shared and served this country. I look forward to your
questions.
[The prepared statement of Mr. Remy appears on page 45 of
the Appendix.]
Chairman Tester. Thank you, Secretary Remy. And please know
for both of you your entire written statement will be a part of
the record. Thanks for being in the five-minute time block.
Secretary Cisneros, you are up.
STATEMENT OF THE HONORABLE GILBERT R. CISNEROS, JR.
Mr. Cisneros. First, sir, let me offer my condolences as
well to Senator Rounds and his family.
Chairman Tester, Ranking Moran, and other distinguished
members of this Committee, thank you for the opportunity to
appear before you today along with Deputy Secretary of Veterans
Affairs, Mr. Donald Remy, to discuss the important partnership
between VA and the Department of Defense. We look forward to
discussing our collaboration, including joint efforts on
healthcare, benefits delivery, transition and post-service
placement, interoperability, and efficiencies in operations.
I would first like to take a moment to say that I am proud
and humbled to be leading this critical joint work in concert
with VA Secretary Remy. As some of you may know, I enlisted in
the Navy in 1989 and finished my 10-year naval career as a
commissioned officer. It was at that time I first had my
experience with transitioning from military to civilian life.
Later, while serving in the House of Representatives, I co-
founded the Military Transition Assistance Pathway Caucus to
support and advocate on behalf of servicemembers returning to
civilian life and an area that I will continue to champion in
my role as Under Secretary of Defense for Personnel and
Readiness and as the co-chair of the Joint Executive Committee.
I am passionate about this work, and I am motivated by what we
can accomplish together.
Strategic planning is the bedrock of joint efforts and sets
the condition for our collaborative work. It reflects our
vision for the future and our enduring commitment to
servicemembers, veterans, their families and caregivers. I am
also pleased to share that Secretary Remy and I recently signed
the VA-DOD Joint Strategic Plan, chartering our joint endeavor
for the next six years. The VA-DOD partnership has never been
stronger. Our roles and responsibilities position us well to
ensure open and frequent dialog, lead change, resolve conflict,
guide joint actions, initiatives, programs, and policies.
It may sound bureaucratic, but our relationship is anything
but. We have already developed a meaningful, open-door,
cooperative relationship which has yielded results, some of
which I have highlighted in my written testimony.
Military-to-civilian readiness, or M2C Ready, as we call
it, is one area Secretary Remy and I are both committed to. M2C
Ready aligns more than 20 transitional programs, activities,
and actions owned by multiple offices and agencies, under an
overachieving framework during the critical and officially
designed transition period, which extends from 365 days pre- to
365 days post-separation. Standardized assessments and exams,
integrated programs, mental health touchpoints, and a new
online, single, authoritative, tailored statement of benefits
are all components of this important framework that we continue
to champion.
Finally, interoperability and shared business practices are
critical to increasing access and improving outcomes for our
servicemembers and veterans. As of September 2021, there are
147 active healthcare resource-sharing agreements and 35 active
non-medical agreements nationally. These agreements cover a
wide range of support services, operating and integrating
programs, like the VA-DOD Integrated Disability Evaluation
System.
We continue to improve performance in other areas,
including our effort to reduce the payment reconciliation
timelines to 30 days or less between the departments. We also
continue to advance joint IT architecture, a DOD-VA common
identity, and enterprise-wide implementation of the electronic
health record, a project pivotal to the future of VA-DOD
healthcare.
I am grateful for the opportunity to speak with you today
and discuss VA-DOD collaboration and the Joint Executive
Committee. Secretary Remy and I are committed to the
collaborative efforts needed to realize the strategic vision
laid out in the VA-DOD joint strategy.
In closing, Mr. Chairman, I thank you, the Ranking Member,
and the members of your Committee for your steadfast dedication
and support of our Nation's servicemembers, veterans, their
families and caregivers. Thank you.
[The prepared statement of Mr. Cisneros appears on page 54
of the Appendix.]
Chairman Tester. Thank you, Secretary Cisneros. Thank you
both.
I will yield my time to Senator Brown.
SENATOR SHERROD BROWN
Senator Brown. Thank you, Chairman Tester, and thank you
for your comments about--all of your comments about our
colleague, Senator Rounds.
Secretary Cisneros, I will start with you. Yesterday, the
Administration announced its Military and Veteran Suicide
Prevention Strategy. I appreciate that two of the main topics
addressed in the strategy are upstream risk and lethal means.
Data released by the VA--the most recent I believe we have is
for 2018--shows that, in Ohio, 211 veterans died in my State of
12 million. Two-thirds of them involved a--two-thirds of those
involved a firearm. I look forward to learning more about the
joint public safety education initiatives among DOD, VA, and
HHS, and DHS.
Senator Tester and I have been on this Committee--the
Chairman and I have been on this Committee since our first day
in the Senate in 2007. We continue to hear about the threat of
far too many suicides or the incidence of far too many
suicides, and yet, it just seems we--just I do not understand
why we are not doing everything we can to increase the--to make
better the handoff between DOD and the VA.
Legislation I am working on to create a pilot project in
TAP to educate servicemembers about these challenges and the
impact on the mental health can help. But, how are you going to
address upstream risk? How are you going to, particularly for
servicemembers transitioning from DOD to VA?
Mr. Cisneros. Well, Senator, thank you for that question.
You know, one life by suicide is just way too many. And this is
an issue that is important to the Administration, the
Secretary, the Deputy and myself, as well as my colleagues at
the VA, is how can we take care--better care of our
servicemembers and veterans when it comes to suicide.
You know, through the JEC and working with DOD, the focus
that we have talked about taking is really to focus on mental
health, how we can do that, and ensure that the transition from
when servicemembers are coming forward with issues that they
need support with their mental health, that those issues are
going to continue to be treated. They are going to continue to
be treated for those issues once they leave the Department of
Defense and move on to the VA. That transition is something
that I know we are going to work collaboratively on, and we
know it is very important to make sure that those individuals
receive the treatment that they deserve.
Senator Brown. Thank you. Secretary Remy, well, actually,
both of you, if you would answer this. A couple of years ago,
the Burn Pits Accountability Act was passed into law, requiring
DOD to evaluate servicemembers for toxic exposure. I think most
Americans know enough about what happened with Agent Orange and
how long it took us to respond to it and how most Americans
believe that the military knew a lot more about exposure to
Agent Orange and knew a lot more about the companies that were
exposing our servicemen and women and nobody paid much--nobody
took much responsibility or paid much of a price. Burn pits,
not exactly parallel or analogous but not too far off from
that.
Talk to me about your efforts to do implementation of this
law. Start, I guess, with you, Mr. Cisneros, and then Secretary
Remy, too.
Mr. Cisneros. Well, Senator, you know, you spoke of Agent
Orange and the lack of effort there in the past, and that is
something that is very personal to me. My father was a Vietnam
veteran. He suffers today from side effects of Agent Orange.
And that is not something we want to see our servicemembers
have to go through again.
We are moving on this. You know, we have the ILER in place
now to track where the burn pits took place to ensure that
servicemembers who might have been in those areas, been exposed
to those, those effects of the burn pits, that that information
is being tracked. We will continue to do that and ensure that
is information that can be passed on to the VA, that once those
individuals have been kind of identified as exposed to that,
that they can ensure they will receive the treatment that they
deserve and that they have earned.
Senator Brown. So if I were a servicemember about to leave
the Service, would I be asked about my exposures during my
separation history and physical examination? Would I get asked
those questions?
Mr. Cisneros. Senator, toxic exposure registry education
and communication is being conducted at DOD. And again, the
ILER is tracking the data, and it is continually being updated.
And we do have a working group working on this, but they--that
information is collected. They are educated on it, and it is
communicated to them.
Senator Brown. Okay. Thank you. I have other--another--I am
sorry I did not get to you, Secretary Remy. I will follow up
with a written question to you. And, Mr. Cisneros, I want to
follow up on that with--I have run out of time.
But I just--I mean, it is still pretty shocking to me when
we expose so many servicemen and women to burn pits and how
higher-ups in the military simply were not thinking that
through, about what that could mean for our men and women who
served, and where taxpayers are going to be paying for that for
the next 30 years as we paid--as we still pay for Agent Orange,
even though we still have not taken care of enough people. But
worse than taxpayers paying for it are the men and women that
have been exposed, and it is pretty shameful.
Thank you, Mr. Chair.
Chairman Tester. Senator Moran.
Senator Moran. Chairman, thank you. The character of
discharge--I am going to direct this question first to you, Mr.
Cisneros. The character of discharge for servicemembers could
potentially cause serious second and third-order effects when
it comes to eligibility for VA services and benefits. Mr.
Secretary, can you explain to the Committee your guidance to
commanders regarding how to proceed with discharge when a
servicemember declines the vaccine?
Mr. Cisneros. Senator, the--you know, we see the vaccine as
a readiness issue. This is something the Secretary has talked
about. The servicemembers right now receive 12 different
vaccines that they are required to take.
Senator Moran. I am not really questioning at this point
the desire or the attention to have people vaccinated. My
interest is about the discharge for their failure to do so.
Mr. Cisneros. So the discharge is up to the individual
Service as to how they proceed with that, and that is how it is
being handled.
Senator Moran. And is there any guidance coming from DOD to
those Service commanders, the sectors?
Mr. Cisneros. Right now, sir, it is pretty much the
guidance has been that they are--it is within their realm to
how they issue those discharges, and it is up to the Services.
Senator Moran. Has any of those commanders made a
determination?
Mr. Cisneros. Sir, that I do not know. I can take that for
the record as to what that will be. I do know the Air Force
discharged 40 recruits recently, but they were left with the
option to come back. You know, if they did receive the vaccine,
they would still be able to come back into the Service.
Senator Moran. Thank you, Mr. Secretary.
Secretary Remy, tell me about what VA services and benefits
might be impacted by discharges other than honorable.
Mr. Remy. Thank you, Senator. And that is a determination,
as Secretary Cisneros just indicated, that would be made by the
Service in terms of the nature of the discharge.
If someone was discharged as other than honorable, we would
look at their circumstances on a case-by-case basis. There may
be an impact to their benefits. We would consider all factors
before making a determination of whether or not there would be
an impact to their benefits, factors including mitigating or
extenuating circumstances, supporting evidence provided by
third parties, the length of service, performance and
accomplishments during service, the nature of the infraction,
and the character of their service at the time of their
discharge.
In an other-than-honorable discharge circumstance, there
are some benefits that are available. Of course, crisis mental
health care is available to all of our veterans regardless of
the nature of their discharge.
Senator Moran. Mr. Secretary, it appears to me, based upon
your answer, that the Department, the Department of Veterans
Affairs has considered the answer to the question I asked you.
And there are prepared--what you just described is now a policy
or a statement of the Department, what its intentions are?
Mr. Remy. Senator, this is how we approach any discharge of
any servicemember. There is a process that we go through in
evaluating whether or not the benefits would be available, and
what I described to you is the process that we use under those
circumstances when someone has an other-than-honorable
discharge.
Senator Moran. So under the--it is under a broad range of
circumstances. A discharge.
Mr. Remy. Yes. This is not specific----
Senator Moran. And those are the criteria not specific to
this issue.
Mr. Remy. That is correct, sir.
Senator Moran. Okay. Thank you.
Let me ask about transition. We have found there is not
consistency among installations regarding senior leader
engagement in the transition process. Understanding that the
readiness and training of troops is a number one priority, a
part of being able to sustain an all-voluntary force relies
upon supporting those individuals during their service and
after they take off the uniform. To you, Secretary Cisneros,
can you opine on how commanders could be motivated to invest in
facilitating access to all programs and counseling during
transition?
My point in my opening statement was that they are
different from commander to commander and circumstance to
circumstance. How do we engage the commanders in every
instance?
Mr. Cisneros. Thank you for that question, Senator. You are
correct. TAP class, or the transition--when we typically think
of transition, we think of the Transition Assistance Program
that members are required to attend before they separate from
the Service, and that really is different from command to
command, installation to installation. You know, that is
something I personally, coming in to this job, want to work on
and fix about how we can make it more uniform, how we can
institute that no matter where you go to TAP class that it
would kind of be the same class, whether you are attending TAP
class at Fort Bragg or whether you are attending down at 32nd
Street in San Diego, the naval station. That is one of the
things coming into this job that I definitely want to work on
with Mr. Remy and see how we can work that through the JEC to
make a more uniform TAP class.
Senator Moran. Secretary Cisneros, my time is expired. So I
will not ask a question, but last week in this Committee we
heard from Dr. Arthur DeGroat. Art DeGroat is Executive
Director of the Military and Veterans at Kansas State
University, someone the Chairman called ``white-hot smart.''
And what we learned was, from your report, that 80 percent of
TAP participants found it useful, a good thing. But we learned
from Dr. DeGroat that there is a lack of any true personal
connection, ultimately resulting in pointing to a computer
screen, to websites, and asking veterans to seek their own
assistance. That is not a good circumstance, assuming that this
``white-hot smart'' witness knew the facts of the circumstances
of many.
So I would explore that with you to make certain that there
is--it goes back to this personal engagement that you indicate
you are pursuing. It seems to me there is lots of gaps in that
regard.
Mr. Cisneros. Yes, Senator. And again, you know, this TAP
class is not perfect, but I will say where it has come and
where it is going is a lot different. As I said, when I got out
17 years ago, it was basically you have got to go to this,
check the box, and move on. I think we have made a lot of
progress since then, but I still think we have a lot of
progress to continue to make.
Senator Moran. I consider myself an ally of yours in
accomplishing that. Thank you.
Mr. Cisneros. Thank you, sir.
Chairman Tester. All I have to say is Senator Moran is from
Kansas State, as I recall, and anybody from Kansas State is
``white-hot smart.'' Right?
Senator Hirono.
SENATOR MAZIE HIRONO
Senator Hirono. Thank you, Mr. Chairman. I will just leave
that last statement alone, I think.
Senator Moran. I did not hear you what you said.
Senator Hirono. Let's not go there. Okay. So thank you very
much to both of you. And making the transition from active to
veteran status as seamless as possible is a really important
goal, and so I applaud your efforts toward that.
And one of the areas that we have long addressed was the
ability of a servicemember to make sure that all of his or her
health records go with him or her or them to the veteran
status. And that has always been an issue because I remember
commitments made many, many years ago between the VA and the
DOD to effect this kind of capacity, and a billion dollars was
spent towards that goal. And I think we are only now reaching
that point where we can talk about these electronic records.
So as the VA--this is for Secretary Remy. As the VA moves
forward with their own electronic health record rollout, as the
DOD is doing, will the Department be using feedback from DOD's
experience to help determine best practices, and if so, are any
of these best practices location-specific, Secretary Remy?
Mr. Remy. Thank you for that question, Senator Hirono, and
the short answer to that is, yes, and we do that in a number of
different ways. We have a group that is a DOD-VA
interoperability functional group called the FEHRM, and through
the Federal Electronic Health Records Modernization group that
supports both DOD and VA. And through that body, we are able to
tap into the lessons learned from DOD in their prior deployment
at all of their sites, and the information that is provided
there can help us better prepare as we move forward in
deploying the VA's electronic health record system.
They are systems that are provided by the same contractor,
so there are synergies that are designed to be achieved there.
And what we are trying to do is to make sure that we do not
make mistakes that have been made in the past and, if we do,
that we quickly remedy them, that we can leverage the
experiences of DOD and others in our deployment.
Senator Hirono. Well, we have all heard of veterans who
have incomplete or piecemeal health records. So will this
system enable tracking or going back to during their time in
service to complete their health records? Is there any capacity
in the system to do that?
Mr. Remy. That is the ultimate goal. The goal is to make
sure that the records of a servicemember from the time that
they put on the uniform to the time that they separate from
service to the time of death are all captured in this system,
that our clinicians are able to use those records in a way to
provide the care that the veterans need.
Senator Hirono. I can see that going forward, yes. But what
about all veterans who are currently trying to find their
records so that they--for example, trying to determine whether
they were in any kind of environment that would have exposed
them to toxic substances. In fact, those records should even
contain where they were deployed, where they served, so that if
a health situation develops in the future it can be connected
up to some exposure that they had. Don't you think that kind of
information should also be in the health records? Because, you
know, you were asked about burn pits, and there have been many
exposures that only much, much later have been determined to be
detrimental, and a lot of our servicemembers would not even be
able to remember where they were deployed, where they might
have been exposed to such substances.
So in terms of the kind of--even the kind of information
that gets put on the records, that is also important, don't you
think?
Mr. Remy. Yes. Yes, ma'am. Senator Brown asked this
question earlier, and I know Senator Tester mentioned it in his
opening remarks. And my colleague, Under Secretary Cisneros,
talked about ILER which is a program that is designed to do
exactly that, to track the locations----
Senator Hirono. Okay.
Mr. Remy [continuing]. To track the exposure of
servicemembers from the time they are on active duty to the
time that they become veterans. And we hope one day to make
sure that the data and information through the ILER system is
also put into our electronic health record system.
Senator Hirono. Good. Senator Brown also asked about the
White House rolling out a new strategy for military and veteran
suicide prevention that includes tailoring solutions to
subpopulations where possible. I previously questioned the VA
on suicide prevention efforts tailored to women veterans and
API veterans, both identified as high risk groups.
Has the VA determined the best way to tailor outreach to
these high risk subgroups? Are there cultural competency
trainings for ethnic and racial subpopulations? Are those
deemed important components for the suicide prevention program?
Mr. Remy. They are in fact, Senator Hirono. They are a
component of the information that we provide to those veterans
who are seeking and information that we provide to even those
veterans that may not necessarily come to us. We do it through
our vet centers, through our medical centers. But we have
determined that we need to make sure that we meet our veterans
where they are, that we provide the information that they need,
and if it is information that is based on cultural uniqueness,
we provide that information as well.
Senator Hirono. If I could just ask one more? So I hope
that you have a matrix on this kind of outreach so that you
have some kind of a basis from which you are operating and then
you can tell us how successful these outreach programs are in
suicide prevention.
Mr. Remy. I can take that back, Senator, and make sure that
we get back to you on that.
Senator Hirono. Thank you.
Thank you, Mr. Chairman.
Chairman Tester. I have got to alternate parties. Senator
Tillis, you are up, virtually. Five, four, three, two, one.
Senator Cassidy. You got me? Hey, thank you, Thom, I
appreciate that. So----
Chairman Tester. Senator Tillis. Senator Tillis.
Senator Tillis. No, Senator Tester, I was just saying that
Bill got on just before me.
Chairman Tester. Okay. Sounds good. Senator Cassidy. Sounds
good. Thanks for the clarification.
SENATOR BILL CASSIDY
Senator Cassidy. Thank you, Thom.
So, Mr. Remy, great to see you and so glad you have been
able to get into this position. You have inherited some issues.
So I do not want to pinpoint you as the person responsible for
anything, but rather, obviously, you are now the person who--
for things past. Now we are talking about going to the future.
We have had a lot of conversation in this Committee. We put
a lot of money for EHR interoperability between Department of
Defense and the VA. We had a hearing not long ago from the OIG,
and he had some interesting thoughts. So for example, he
thought that the VA's approach to training employees on the new
electronic health record, he said it was not thought through
adequately. Now knowing it takes two to tango, so DOD is also
involved, concisely please, what is the VA doing to better
think through this interoperability with the EHR of the
Department of Defense?
Mr. Remy. Thank you, Senator. It is good to be here. It is
good to be with you, and it is good to be able to answer your
questions. That OIG report recommendation was one with which we
agreed, and since then we have been working together with
Cerner, the contractor, to build a better training program to
assure that we provide the information that the clinician needs
in order for the system to be deployed successfully. We
mentioned----
Senator Cassidy. Now can I ask you--I do not mean to
interrupt. We just have limited time. One of the specifics in
my conversation with Mr. Case was that physicians were--
doctors, nurses were initially involved in the workflows of the
EHR, but they were not--quote, notably not involved in the
design of the training and how to present the training to the
clinicians.
So as a physician and knowing that ultimately the physician
is, you know, a heavy user of EHR and oftentimes a choke point
in terms of moving patients through the interaction with EHR,
what has been done to improve this abyss, if you will, the
involvement of the clinician in the EHR?
Mr. Remy. Sir, we have involved--we have directly placed
the clinician in the process of developing the work streams to
assure that the training is adequate and effective. We have
enhanced our Office of Functional Champion, which is part of
our VHA team where the clinicians sit. And we have made sure
that at every step of the way, as we build the future success
of the electronic health record system, the clinician's voice
is heard in that process.
Senator Cassidy. Now when you say ``the clinician's voice
is heard,'' if a clinician is not in the room and does not have
the ability to say, ``This is not going to work. Do not go
forward with it,'' then really that is a voice but is a voice
as a forest falling in--a tree falling in a forest. There has
to be some sort of authority given to that voice. Can you
specifically mention the authority given to that voice?
Mr. Remy. Absolutely. The Office of Functional Champion,
which is part of the VHA, which is where our clinicians rest,
is now deeply involved and has authority to help build the
training modules and to help deploy the system. And so to the
extent that they are articulating challenges, issues or
circumstances where things just will not work, we have that
data. They are part of the decision-making process. They are
part of our governance structure. So as the decisions are made
about how to move forward, their voice is not only heard, but
their voice is part of how we make a decision as to which
direction we are going to go in the future.
Senator Cassidy. So let me ask you--let me change the
subject. I will go first to Mr. Cisneros. Senator Hirono was
asking about suicide. And I previously learned that the peak
suicide rate is within six months of separation, and I have
been recently told that there has not been a significant
improvement in veteran suicide rates despite the various
interventions that have been implemented.
So your testimony states that significant work has gone
into creating a Baseline Well-being Assessment administered by
Department of Defense to measure and address the
servicemembers' susceptibility to social pitfalls of
transition. I guess, have you seen any--on the one hand,
obviously work has taken place.
And, Mr. Remy, you may want to reply because the transition
you speak of a year before and a year after post-separation.
But so far, there has not been improvement in suicide
rates. Now you may tell me the first six months has decreased,
and if that is the case, then I would like to know that. But if
the six-month separation suicide rate has not gone down, what
are we doing to look at these new programs and to see whether
or not they need to be tweaked, et cetera?
Mr. Cisneros. Senator, I will go first. I know the program
that we are starting, the BWA program to kind of look at this,
how we can move the--have that baseline start, is really just a
pilot program right now that is beginning. We are looking to
create that baseline so that we can move forward, but you know,
as Mr. Remy and I, Secretary Remy--we are both committed to
this. We are working on this issue through the JEC, and we are
doing--you know, moving forward, this is going to be one of the
top issues that we deal with and really how we can put a dent
in both suicide for our servicemembers and our veterans.
Senator Cassidy. Okay.
Mr. Remy. And if I may add to that, indeed it is part of
our strategic priorities that we have laid out in terms of how
we are going to move forward and what we are going to look at
and what we can collaborate on in order to make a difference
for our servicemembers and our veterans.
Senator Cassidy. I am out of time. I yield back. Thank you
both for your service.
Chairman Tester. Thank you, Senator Cassidy.
Senator Hassan.
SENATOR MARGARET WOOOD HASSAN
Senator Hassan. Thank you, Chairman Tester and Ranking
Moran, for this hearing.
Thank you for the witnesses--to the witnesses for being
here today and for your work.
And I also want to acknowledge the Administration's recent
announcement on the Military and Veteran Suicide Prevention
Strategy as addressing this issue is not only obviously a
priority of mine but, as you can hear from our colleagues, a
priority of all of ours.
Under Secretary Cisneros, with that in mind, I want to
start with you. This Committee has focused on the tragically
high rate of veteran suicide, but unfortunately, servicemembers
also die by suicide far too often.
I want to talk about Sean Cloutier from Concord, New
Hampshire. On 9/11, he was just turning five years old. It was
his birthday. He was wearing his birthday crown when Al Qaeda
terrorists attacked our country. Sean announced that day that
he wanted to join the military. Fourteen years later, he did
just that, signing up for the Army right out of high school. A
few years after joining the Army, Sean attempted suicide. He
received some medical attention but not enough, and two months
later Sean died by suicide at the age of 22. His mother,
Patricia Cloutier, is an advocate for suicide prevention among
servicemembers and veterans.
So, Under Secretary Cisneros, it is clear that the
Department of Defense has to do more to help stop preventable
tragedies like Sean's. You have gotten questions about this
already from Senators Brown, Hirono, just now Cassidy. But, can
you discuss with more specifics how the Administration's new
suicide prevention plan would help current servicemembers and
what more the Agency can do?
Mr. Cisneros. Thank you for that question, Senator, and
really, my sympathies are with Sean and his family. It is a
tragic story that we have heard about from one too many
servicemembers who have gone through this.
I think the initial thing when I read that report was that
I was excited to see that the Administration at first was just
taking this as an initiative that they wanted to work on and in
putting it forward as one of their priorities. I think that
alone is going to be something that is going to help move this
forward. That is going to make it a priority not only for the
VA and the Department of Defense but for the entire
Administration and, hopefully, the entire country.
I believe there is a section on there about lethal means.
Senator Hassan. Yes.
Mr. Cisneros. That needs to be addressed as part of, you
know, one of the reasons that this is happening. And so I think
hopefully that we will focus on that, the lethal means, as part
of why this is happening and really kind of start to work on
that issue as that being the number one means of suicide
amongst our servicemembers.
Senator Hassan. Thank you.
Deputy Secretary Remy, I wanted to talk to you about the
Solid Start program. I have a bipartisan bill with Senators
Cramer and Cassidy that focuses on servicemembers' transition
to civilian life, and it strengthens the Solid Start program
which, as you know, is a VA initiative that the prior
administration started. It is an initiative that requires
contact to every veteran three times in the first year after
they leave active duty to check in and help connect them to VA
programs and benefits. Those contacts can help support veterans
in any number of ways, including helping to address veteran
suicide. I was pleased that this Committee recently voted
unanimously to pass this bill, and I will keep pushing to get
it signed into law by the end of the year.
Can you speak to the successes that you have seen with the
Solid Start program for veterans readjusting to civilian life
and how strengthening it will benefit veterans?
Mr. Remy. Thank you, Senator, for that question. And I,
too, am saddened by the story that you described when you were
asking Secretary Cisneros his question.
This is a really good program, and I am excited about it.
It has demonstrated to be very successful for our veterans and
our community in terms of understanding what benefits are
available to them and what resources are available. And so we
have seen since the beginning of the program a significant
increase in the use and effectiveness. As you know, we touch in
with the veterans 90 days, 180 days, 365 days after departure,
and that connectivity has been very beneficial to the veteran
community.
Senator Hassan. Well, I appreciate that, and I look forward
to working with you on that.
I have two additional questions that I will submit for the
record, one about the Transition Assistance Program and one
about the impact of substance misuse disorders and opioids in
particular for our servicemembers and our veterans, and I would
look forward to working with you both on that. Again, thank you
for being here.
Thank you, Mr. Chair.
Chairman Tester. Thank you, Senator Hassan.
Senator Boozman.
SENATOR JOHN BOOZMAN
Senator Boozman. Well, thank you, Mr. Chairman.
Thank you all for being here, and we appreciate the role
that you play in helping our servicemembers transition, which
is so, so very important.
Mr. Cisneros, in 2017, the budget included roughly $31
million for transition assistance compared to $100 million in
unemployment benefits for transitioning servicemembers. Is the
SkillBridge program something DOD can leverage to partner with
industry and community nonprofits to provide job training and
credentialing programs for transitioning servicemembers and
spouses?
Mr. Cisneros. Senator, thank you for that question. The
SkillBridge program is a popular program. It has support within
DOD. It has support amongst the Services. It definitely is one
that I think we can continue to grow.
You know, we tried to make it more uniform now, where there
is a website where individuals can go there and search the
different programs, the different opportunities that are out
there for them. I think here at JEC and what we can do more is
really within DOD, is try and bring more businesses into that,
to provide more opportunity. But it is a program, and it really
is something that is a good part of helping individuals
transition from military life to civilian life.
Senator Boozman. So currently, the VA's data only captures
veterans in the VA system, leaving out a significant part of
the veteran population. To fully understand its population's
needs and challenges, the VA and DOD could utilize community
organizations that have complementary data to gain access to a
more complete picture of veterans' needs. So I guess the
question is: What are VA and DOD currently doing to share data
with community-serving organizations who have additional
information not currently captured by DOD and VA systems, if
anything?
[IVMF response to Senator Boozman appears on page 83 of the
Appendix.]
Mr. Cisneros. Yes, sir.
Mr. Remy. If I may, Senator--and I am pleased that you are
having the second panel here today, and they can foot-stomp
this. That is a new word I learned since I came into the VA.
Senator Boozman. I like that.
Mr. Remy. That there really is a connectivity and a sharing
of data and information and perspectives around these issues
and what the VSO community is doing and what the community
organizations are doing to work with us to provide the
transition for our servicemembers. So it is an exciting time to
be able to partner with them and to share information with them
and to watch them work with us and watch us work with them to
serve our veteran community.
Senator Boozman. So did that come from Senator Tester?
Mr. Remy. Senator Tester is ``white-hot smart,'' so I
probably got that from somebody else.
Mr. Cisneros. Senator, if I could chime in on that as well.
Senator Boozman. Yes, sir.
Mr. Cisneros. You know, I think one of the great benefits
of the electronic health records and really what we are working
on through this benefits delivery discharge as we can expand
that program is that, you know, more members will go and they
will get that.
You know, right now currently, or it has been in the past,
is that you had to go, you get your separation physical at DOD,
whatever branch you might be in, and then you go to the VA and
have to get another physical, and that is how you get into the
VA program.
Really, kind of moving forward with the programs that we
have, or what we are working on, is--and with the electronic
health records is that it will just be a smooth transition so
that hopefully one day nobody will be missed and everybody will
just transition with their health record right from the active
duty service into the VA. And I should not just say active duty
service but also our Reservists and our Guardsmen as well,
those that are serving right from military service into the VA.
Senator Boozman. Right. Health is such an essential factor
in the success of transitioning as a servicemember. Based on a
2010 study, female servicemembers are 20 to 40 percent more
likely to be diagnosed with breast cancer. Currently, what is
DOD's current screening policy for transitioning members? And
based on findings related to the link between toxic exposure
and breast cancer, would you recommend DOD, or could you
recommend DOD, incorporate mammogram screenings during the
separation physical?
Mr. Cisneros. Senator, I would--you know, hopefully, the
physicals are a holistic approach when members are separating.
I cannot comment exactly what the female----
Senator Boozman. I understand.
Mr. Cisneros [continuing]. Record or the female examination
is like, but I can take that for the record to see what that
entails.
Senator Boozman. Yes, I would appreciate if you would just
follow up on that and make sure that, you know, that we are
looking into that based on the study and the experience that we
are seeing now, you know, with these veterans.
Mr. Cisneros. Yes, sir.
Senator Boozman. Thank you.
Chairman Tester. Thank you, Senator Boozman.
Senator Blumenthal.
SENATOR RICHARD BLUMENTHAL
Senator Blumenthal. Thanks, Chairman Tester.
Thank you for being here. Thank you for your service to our
Nation.
I know this question is repetitive, but I want to make sure
I hear it with my own ears. The current state of
interoperability of the healthcare computer software,
electronic medical systems, is now done? Interoperable? Working
fine? If not, what are the problems?
Mr. Remy. If I could start, Senator Blumenthal, then turn
to my colleague. The legacy systems that both DOD and VA
previously had, had some level of interoperability. We are now
modernizing those systems and moving to a new electronic health
system that is a modern system. And the goal of that system is
that it be interoperable, that you have an electronic record
that moves from point A to point Z. Once we get the system up
and running, that is how it will operate, but while we are
modernizing, there still is a level of interoperability.
And one of the things we talked about earlier----
Senator Blumenthal. There is some level of
interoperability, but it is not complete.
Mr. Remy. The two systems are at different points in time
in their maturity and their deployment within DOD and VA. And
the two new systems, I should say.
Senator Blumenthal. Do you agree with that, Secretary
Cisneros?
Mr. Cisneros. Yes, sir. You know, DOD should have its
electronic health record's implementation done by--completely
by the end of 2023, and I believe--I am not sure the exact
date, but the VA will follow after that.
Senator Blumenthal. Gentlemen, this is not a personal
criticism of you, and I suspect others have made this point
already. But I came to the Armed Services and the Veterans'
Affairs Committee 10 years ago, and I daresay the answers you
have just given me are slightly different but not much from
what I heard then. There is a new system in the works.
It is just over the horizon, maybe a couple years from now.
In the meantime, we are trying to make the two work together.
So I do not know enough about the software and the
computers. I know that there have been new approaches,
revisions, revisiting, under different administrations, not
personal to you. But I suspect at some point the VA and DOD
computer operations will be a case study for a business school
somewhere, and it is not going to be this is how it should be.
And I guess, Mr. Chairman, I raise this issue. We have all
heard it. I know it has been raised in this hearing. I just
wanted to hear it with my own ears, and I am going to move on.
I think we need to address this issue with the vigor and
aggressiveness that it demands.
Mr. Cisneros. Senator, if I could just comment on this, it
is--I feel very confident of the success that we are going to
have in this. It is very--I am very confident that it is going
to be successful because basically we are using the same
record. It is--you know, it is the same system that DOD and VA
are using. We are just in different, you know, lines as far as
the implementation goes.
So it is not different systems like it has been in the
past, trying to get them to talk together. It is the same
system, and so there is no bit of trying to get them to talk to
each other because it is the same system.
Senator Blumenthal. Right. Okay.
Mr. Cisneros. So I am confident that, unlike in the past,
our electronic health records that we are working on right now
will be implemented and it will continue to--it will be--make
for a smooth transfer to follow the----
Senator Blumenthal. I appreciate that. And I am
interrupting you only because I want to move on to another
topic, but thank you for that answer.
The Solid Start program, which reaches out to servicemen
and women as they leave if they have had mental or behavioral
health issues, the number I got was the VA has successfully
connected with over 70 percent of veterans who engaged with a
mental health provider during their last year of service. Does
that include men and women who are discharged with less than
honorable? Are they reached with the same frequency and
thoroughness as the honorably discharged?
Mr. Remy. Senator, if I could respond, I do not know the
data, and I can get back to you for the record on the data. But
what I can tell you is that the efforts to try to reach those
veterans are the same, to make sure that they have the mental
health resources available to them.
Senator Blumenthal. I would be interested in more data on
that program.
Mr. Remy. Yes, sir.
Senator Blumenthal. I have introduced a measure called the
Unlawful Turn-Aways Act of 2021, which would require the VA to
conduct outreach to less-than-honorably discharged veterans in
the same way that they do currently the honorably discharged.
If they are--if you are doing it already, that would be great.
I am also co-sponsoring an NDAA amendment that will accomplish
the same end. But in the past, as you know, it has been a
problem for whatever reason. Maybe some of them just leave
without the same kind of thoroughness of recordkeeping, but I
would be interested in any additional data that you have.
I apologize, Mr. Chairman, for going over my time.
Chairman Tester. That is all right. Before I get to Senator
Tillis, I just want to say that Senator Blumenthal is
absolutely correct. Whether it was Obama or Trump or Biden,
whatever these administrations are, we continue to have the
same conversation. Only the difference is we appropriate
billions of dollars and still have the same conversation. If
you guys get this done, we will build a statute to both of you.
Okay?
Senator Blumenthal. And one for Senator Tester, too.
Chairman Tester. That is right. Because of the generosity
of the good Senator from Alaska, I will call on Senator Tillis,
virtually.
SENATOR THOM TILLIS
Senator Tillis. Well, thank you, Mr. Chairman, and thank
you, Senator Sullivan.
Gentlemen, thank you for being here. I have got a real
quick question. I signed onto a letter to you all about the
impact the vaccine mandate is going to have, and I want to get
down--and I suspect you are busy. We may not get a response to
that letter in the time that we may feel some of the impact. So
can you give me some sense of--with both agencies now, I think,
in or near the window to get the first phase of the vaccine if
you are doing a two-phase vaccine, can you give me an idea
operationally where we are going to be in terms of people who
are not vaccinated?
And then secondly, what will be the policy for the
unvaccinated? Will it be a separation? An unpaid leave of
absence? What personnel policies are you gaming out now? I
assume the departments have spent time on this because it is
imminent and its impact on the labor force.
And, Mr. Remy, we will start with you, and then, Mr.
Cisneros, we will go to you.
Mr. Remy. Thank you, Senator Tillis. We are at a point now
where we are still gathering the data with respect to the
responses to the surveys and the gathering of information
around vaccinations. We have around 85 percent response rate
for all of our employees that we have asked to provide
information with respect to vaccinations, and we are continuing
to gather more information that is coming in regularly.
Senator Tillis. Mr. Remy, I am sorry to interrupt. Eighty-
five percent response rate. Is that responding that they have
been vaccinated or just responding with the status be either
vaccinated or unvaccinated?
Mr. Remy. I am sorry. I should have been clearer. That is
just responding to the survey of that group. We are gathering
the data on how many have been vaccinated, how many have not
been vaccinated, and why they fall into that category.
What we are also doing--and if you may recall, our process
started a little earlier for our VHA employees who are those
individuals that are providing healthcare services for
veterans. And we have started our process in terms of what
happens if they do not get vaccinated, your question there of
providing counseling and information to them. We have a
progressive discipline process that, you know, at the end of
that process, could result in separation from employment. But
at this stage, what we are doing is we are providing counseling
and information and education to those individuals who have
indicated that they have not been vaccinated or to those people
who have not responded to the survey.
Senator Tillis. Okay. Mr. Cisneros?
Mr. Cisneros. Senator, yes, our response is very similar to
Mr. Remy's. Right now we are gathering the information as far
as our civilian workforce, who has been vaccinated. We have
created a form. We have got a process for them to get online in
order to go and to register, in order to have them input that
so their supervisor can approve it. Just as Mr. Remy said with
the VA, we do kind of a process as well for those that will not
get the vaccine, a form of counseling that they have to and
then also different steps along the way as far as there may be
a suspension before there may actually be a termination.
Senator Tillis. Okay. I am sorry. I do want to get to a
couple of other policy questions. I think if you game this out
I met with a major defense contractor yesterday, and they are
looking at either a high single-digit or mid- double-digit
reduction in force as a result of it. And I would guess that
even after the counseling and the outreach we are talking about
a pretty significant potential reduction in force or leave of
absence, whatever you come up with. So I would be very
interested in getting a response to the letter to see how we
deal with that operationally.
Mr. Cisneros, I did want to ask you a question about the
Individual Longitudinal Exposure Record and how important that
is for information, health information that is in the DOD. That
can be very helpful if that information is available to the
veteran with respect to toxic exposures. Is the system on track
to receive--or, to achieve full capability by the September 23
date?
Mr. Cisneros. Senator, I know with the ILER program the
individual can go, and they can request from a medical
professional to see actually that form in order to--that will
enable them to kind of access to it in order to see it. I
believe that program, it is on track. It is on track right now,
but that is a program that we will continue to work on and
continue to improve to ensure that individuals have access to
their information.
Senator Tillis. Okay. Well, since the Chair was gracious to
recognize me, I am not going to go over. But, Mr. Remy and Mr.
Cisneros, I will be submitting some questions for the record.
One of them relates to the separation health assessments, and I
have got a couple of other things on collaborations with
nonprofits, with the VA, but I will submit those for the
record.
Thank you, Chair.
Chairman Tester. Thank you, Senator Tillis. I will take my
first round of questions now. I am thinking back, Secretary
Cisneros, about Brown's question about--he asked if--when folks
are getting out of the military, if they are asked or talked to
about toxic exposure. What I heard you say was, no, on a
personal basis, they are not talked about toxic exposure. There
is work being done behind the scenes, but as far as the soon to
be veteran, when they are leaving the military, they are not
talked about toxic exposure. Was that the correct read I should
have got from that answer?
Mr. Cisneros. Sir, they have access to ILER which would,
you know, document whether or not they have been exposed.
Chairman Tester. Do they have the ability to change the
ILER if they think they have been exposed?
Mr. Cisneros. They do not have right there to go in that
process, like get in there and change it. They can raise that
up with the medical professionals and go through the process of
doing that, but that is not something that can be done like
immediately.
Chairman Tester. Are they made aware of the ILER?
Mr. Cisneros. They are; they are made aware of it, and
again, they can get that from a medical professional. You know,
when they are seeing a doctor, they provide it to them.
Chairman Tester. Okay. And I do not know what happened to
our sound system, but we will just keep going.
The prevalence of military sexual trauma and the fear of
retaliation for reporting is too high in the Armed Services.
While it falls upon the VA to care for survivors of MST, it is
up to DOD to reduce the occurrence of MST altogether. So,
Secretary Cisneros, what efforts is the military taking to
transform the culture--what efforts are you taking,
specifically--in each Service so that no servicemember has to
endure sexual trauma while in uniform.
Mr. Cisneros. Senator, this is an issue that is very
important to the Secretary and Deputy, as well as myself. When
Secretary Austin came into office, he instituted the IRC, which
got going, a mission in which the VA participated in as well.
In just this past month, we implemented the guidance, for the
[inaudible] communication process, the 82 recommendations that
the IRC came up with. It addresses everything prevention to
care. There are other issues as well.
But this is a top issue of ours, and this is something that
needs to be, and is, one of my biggest priorities serving as
the Under Secretary for Personnel and Readiness, to work with
the Services. And those Services do have buy-ins to this
program, this implementation of the IRC, and we will--are going
to work to get this done to really make sure that we not only--
that we focus on prevention, as you mentioned. And that is a
key issue that needs to be done and taken care of soon.
Chairman Tester. And so how long have you been in this
position?
Mr. Cisneros. About two months, sir.
Chairman Tester. Two months. We will probably come back and
revisit this down the line to make sure that things are
progressing because this is a big issue.
Secretary Remy, same issue. When processing claims related
to MST, what is the biggest barrier that the VA faces in having
the necessary evidence to evaluate the claim?
Mr. Remy. Thank you, Senator, for that question, and I will
also reiterate the reality that this is a high priority for
Secretary McDonough and for the JEC and working with Secretary
Cisneros.
You know, one of the things we need to make sure that we
have is data. We need to make sure that we understand the
circumstances that an individual may have been in when they
were on active duty, if they are a survivor of military sexual
trauma, the data associated with that and any information that
was provided in their discharge that might have affected their
discharge so that when we provide benefits to those former
servicemembers, now veterans, we can understand the landscape.
And we have been working closely with DOD to make sure that we
get that data.
Chairman Tester. Okay. We are going to switch to the Hannon
Act. One of the provisions that I fought for in the Hannon Act
to include was the joint development of a strategic plan on the
expansion of healthcare for transitioning veterans. It was
meant to be a VA product with DOD input. The report was due
more than two weeks ago. We were told that it would not be on
time due to delayed concurrence from the DOD.
So look, can either of you, number one, tell us when we are
going to get the report and, number two, speak to why there was
a delay? We have had the Hannon Act out for some time now. The
reports are--I will just be honest with you. The reports are
necessary if we are going to do our job, making sure that
Hannon is implemented. And Hannon passed by a good, solid
margin. We have talked about suicide here a number of times. We
have talked about mental health here a number of times. These
reports may be a pain in the neck, but they are something that
we need to get as a Congress and as a VA Committee. So can you
talk to me why we do not have it and when we expect to have it?
Mr. Remy. If I could start and then turn to my colleague,
you should have it this winter, in early 2022. And you know, as
Secretary Cisneros just mentioned, he has been on the job now
for two months. I have been on the job now for a little over
three months. And this is an issue that we are talking about,
and we are trying to make sure that we get to you what you
expect from us and responsiveness around the Hannon Act. And we
know that it is in the process of finalization, and we will get
it to you soon.
Mr. Cisneros. Yes, Senator, you know, again this is a very
important piece of legislation, one that goes into great
detail. We are currently looking at a piece of the legislation
right now, the one that goes into healthcare, if healthcare can
be provided for a period of time after that. We should,
hopefully, have that back to the VA as we are going through it
in a matter of two weeks.
Chairman Tester. So that is good. He is going to have it
back in two weeks. We should get it quicker than January. Okay.
The other thing I would just say is I do not know how you
implement Hannon without a strategic plan, and this baby has
been out for a while. Thank you.
Senator Blackburn.
SENATOR MARSHA BLACKBURN
Senator Blackburn. Thank you, Mr. Chairman, and thank you
to you all for being here.
Mr. Remy, let me come to you on FEHRM and the
implementation on that. We have talked a lot about the need to
have that one, centralized, single electronic health record to
enhance patient care and efficiencies and effectiveness, and be
certain that we have that data share, meaningful data share
between DOD and VA, and working toward a seamless transition.
And we think that is important for the care of the veteran, and
we are now three years into a 10-year implementation. And at
this point, there should have been 30 medical centers that had
been put into the system, and right now, by the end of the
fiscal year, the VA will have fielded one.
So it seems to be plagued, absolutely plagued, by a true
lack of concordance between the Office of Electronic Health
Record Modernization and the Veterans Health Administration and
the Office of Information Technology. And the rollout at the
Mann-Grandstaff VA Medical Center is an example of how
mismanagement really puts lives at risk. So what I am hopeful
of is that you and your team will step it up.
And what I would like to ask you for is a written report on
reorganization or changes to the governance structure, the
removal of accountable personnel from some of the past failures
which have been there in the rollout and implementation, and a
new life cycle cost estimate for the program. And I would like
to have that in 30 days so that we can look at this and see
what it is that is happening with this rollout and with the
mismanagement that seems to have just plagued this program. And
we think the success is crucial, and I would like to ask your
help on that.
Mr. Remy. Well, Senator Blackburn, this is something that I
have been working on since the day that I got to VA. You may
recall in the confirmation hearing----
Senator Blackburn. Yes, I do.
Mr. Remy [continuing]. It was something I talked a lot
about.
I can commit to providing a report. The one thing that I
will note is the life cycle cost estimate that we are securing,
it is an independent life cycle cost estimate being provided by
IDA. It is going to take probably 9 to 12 months in order for
them to provide it to us. They are the provider that knows the
most about the electronic health record system, so that is why
we went to them.
But the other issues that you have described are issues
that I have been working on since day one.
Senator Blackburn. Okay.
Mr. Remy. And I do have a plan, and I am happy to share it.
Senator Blackburn. And you are happy to share that plan
with us?
Mr. Remy. Yes, ma'am.
Senator Blackburn. That would be great. And if we could get
it in the next 30 days, I would like to have that within 30
days. Is that possible for you?
Mr. Remy. With the exception of the life cycle cost
estimate.
Senator Blackburn. Yes.
Mr. Remy. Yes.
Senator Blackburn. With the exception of the cost, but
there again, we are going to have to go in and review that cost
and look at what the overruns are going to be on that because,
obviously, if we were to have 30 by now and we have got 1 we
are looking at some significant cost differences. And there
will have to be a reevaluation on that.
Okay. I want to ask a couple of things about the ILER. In
your testimony, Mr. Remy, you mentioned that all facilities
have someone trained on the ILER. And so talk about what that
functionally means because we seem to get different, I guess,
different assessments from different facilities.
Mr. Remy. Yes, ma'am. It means that the system is a system
that is available to assure that we have the information around
exposure and location during a particular time period, and we
have people at all the facilities that know that that system is
available and that can input the data.
Senator Blackburn. Are they doing it, though?
Mr. Remy. They can receive the data. I believe that they
are. You know, it is an interesting question that I recognize I
need to gather more data to provide to you, but I have no
reason to believe that they are not utilizing the system the
way that it was intended. In fact, some of the data that we
have show that there has been an increase in usage of the ILER
system year over year.
Senator Blackburn. I think what we would want to look at is
the ability of those--the functionality of the individuals that
are doing that input and then the ability for the Office of
Electronic Health Record Modernization to use that data, making
certain that it is something that is usable, that is
transportable, it is applicable, that it is usable.
So we will--my time is out, but I will send you a couple of
questions regarding that. Thank you.
Mr. Remy. Thank you, Senator.
Chairman Tester. Thank you, Senator Blackburn.
Senator Sinema, virtually.
SENATOR KYRSTEN SINEMA
Senator Sinema. Well, thank you, Chairman Tester, and thank
you to Ranking Member Moran, for holding this hearing and thank
you to our witnesses. I am particularly grateful that Thomas
Winkel, the Director of the Arizona Coalition for Military
Families, is here to share the important work they have been
doing to create a coalition of support for Arizona's
servicemembers, veterans, and their families.
Like many of my colleagues on this Committee, I continue to
be very concerned about the number of lives that are lost to
suicide, and the transition period can be a really challenging
time. It is critical that the DOD and VA work together with
community partners to best prepare servicemembers and their
family members for the transition.
You know, Arizona is a great example of what can be
achieved when you focus on building relationships across
community partners, the VA, and DOD. Our efforts show that no
one agency or entity can do it all, but as a network of support
we can have a great impact.
So my first question is for Mr. Cisneros and then Mr. Remy.
I have often found that family members and loved ones have a
profound influence on servicemembers and veterans but can often
feel left out of the transition process. That is why I
introduced the Sergeant Daniel Somers Veterans Network of
Support legislation. It was signed into law last year and
establishes a program at the VA so transitioning servicemembers
identify loved ones who will get updates from the VA to help
them feel better informed during the transition process. You
know, transitioning out of the military can be a challenging
time for servicemembers and for their families who serve
alongside them, and the more people who have the right
information the more successful that transition can be.
So can you tell me what steps the DOD is taking with the VA
to engage these family members to ensure that they are part of
the transition and what more can be done?
Mr. Cisneros. Senator, thank you for that question. Look,
you know, at TAP family members have always been welcome to
attend the TAP with the servicemember. You are right; it is
important that the families are included in this process. And
we definitely support that initiative and want to make sure
that they have the information that they need in order to make
sure because it is not just the individual. It is the entire
family transitioning out of military life into civilian life.
And so, you know, we want to--as you stated right earlier as
well, we want to make sure that we work with the MSOs and the
VSOs to include that process and include the families. But
family members have always been welcome at the Transition
Assistance Program, and they will continue to be so.
Mr. Remy. And, Senator, the same is true on the VA side. It
certainly is the case that we recognize the importance of the
family members in the transition, and we want to make sure that
they are included in the process so that the transition can be
as smooth as possible.
Senator Sinema. Well, Mr. Cisneros, the COVID pandemic has
upended how we operate in our daily lives. Most notably is the
increased reliance on virtual environments. Before COVID, only
certain servicemembers were allowed to participate in TAP
virtually. So that quickly changed when the pandemic started.
So how is the program operating now? Is it all virtual, a
hybrid model, or back to people in person?
Mr. Cisneros. Ma'am, that is--the TAP classes are run at
the installations, at the installation level, and that is--it
is a variety that it has been doing, but no member should have
ever been excluded from attending TAP. That is mandatory for
all members, to go through TAP when they transition out of the
military. And if that is something that was happening, that is
definitely something I will look into.
Senator Sinema. Thank you. So following up, this question
is for both Mr. Cisneros and Mr. Remy. What steps is DOD taking
to understand the impact of the transition to a virtual
environment for TAP, and what challenges or benefits are you
seeing? Has this opened up participation for family members?
Mr. Cisneros. The virtual environment for TAP? Ma'am, I
would have to take that for the record, to look and see how
many family members have actually participated in TAP when it
was virtual, but that is something we can try and get some data
on and get back to you on that.
Mr. Remy. And the same is true here, but you know, I will
say that the virtual environment does currently exist for our
veterans as well as opening up in-person opportunities for
people to gather information about what their benefits might be
moving forward.
Mr. Cisneros. If I could make one more comment, ma'am,
regarding the separation and the family members, it is Military
OneSource, which is our website as well as a 1-800 number that
servicemembers and their family members can utilize. They are
authorized to utilize that after separation, up to a year after
separation, as well.
Senator Sinema. Thank you. Mr. Chairman, I have additional
questions, but I see my time is expired. I will submit them for
the record, and I yield back. Thank you.
Chairman Tester. Thank you, Senator Sinema.
Next is the very generous Senator from Alaska, Senator
Sullivan.
SENATOR DAN SULLIVAN
Senator Sullivan. Well, thank you, Mr. Chairman, and I
appreciate you and the Ranking Member holding this hearing. It
is an issue that I care deeply about as a member of the Armed
Services Committee, this Committee, as somebody who is still
serving in the Reserves myself. So I think it is really, really
important work that the VA and the DOD are doing, particularly
in the area of healthcare.
So I wanted to get both of your views on some issues that
relate to the integration, particularly Secretary Remy, as the
JEC co-chair, I think that your views are particularly
important. So can you give me a sense, given your four months
on board, on how you have dug into these issues of continued
integration of the DOD and VA healthcare systems? You might
recall I asked you a number of questions during your
confirmation hearing. And what insights or lessons learned have
you already seen in your position?
Mr. Remy. Thank you for the question, Senator. And one of
the things that I have learned since I have been in the role is
how that interoperability, that integration actually, is
effective both for our servicemembers and our veterans. And
what I mean by that is the ability of our servicemembers to,
for example, use our vet centers----
Senator Sullivan. Yes.
Mr. Remy [continuing]. If they need mental health
assistance and the ability of our veterans, for example, to use
our military hospitals in rural areas when that is necessary
for them.
Senator Sullivan. Good. I mean, I am glad you mention it
that way because, as we know, the goal here is better services
for either our veterans with your organization or our military
members, Mr. Secretary, with yours.
So let me get to that. I have a bill that I have been very
focused on--it is S. 2526--that would authorize the SecDef and
Secretary of the VA to enter into agreements for planning,
design, and construction of facilities to be operated as shared
medical facilities. The VA, as you might know, Mr. Secretary,
in the hearing just a couple weeks ago said they were fully
supportive of this legislation.
I want to know if either of you have looked at the example
of the Lovell Federal Healthcare Center in north Chicago, which
is really the only place in the country that has actually done
this, believe it or not, and what lessons you may have learned
from the successes and pitfalls from the VHA and DHA
integration that has occurred there. I would like either of you
to take a crack at that. Go ahead, Mr. Secretary.
Mr. Cisneros. Senator, I have not had a chance to go to the
Lovell Center over there, and I believe it is in north Chicago.
Senator Sullivan. Yes.
Mr. Cisneros. But that is on my list of places to visit.
Senator Sullivan. Good.
Mr. Cisneros. I believe it is a model that we can use for
the future.
Senator Sullivan. It is a model, no doubt, but it is not
perfect. And what we want to do is the next time we do this is
to learn lessons from that model. It is pretty good. It is the
only one in the country.
Let me give you an example of ones that I have looked at
from that north Chicago facility. They still have restrictions
on DOD physicians not being able to see VA patients, which kind
of defeats the whole purpose. So have you had an opportunity to
look, Mr. Secretary, at this model, lessons learned? Because my
bill is already in the NDAA, this year's NDAA. So this is going
to happen, and we want the VA and DOD to be ready when it does,
with good thoughts and ideas on how to improve upon what we are
doing in north Chicago.
Mr. Remy. Well, first of all, thank you, sir, for your
bill, and we do, of course, support it. And second, I have had
an opportunity, and I know that our teams have had an
opportunity to look at the model in north Chicago.
Senator Sullivan. Good.
Mr. Remy. In fact, just last week we a had a meeting to
talk about how we can look at this model and maybe move it into
other locations but understand first what the challenges might
be.
Senator Sullivan. Good. And what are they? I mean, if you
can give us quickly.
Mr. Remy. You have just identified one, but the other is
the joint use of the facilities. This is where your legislation
is going to be incredibly helpful to both DOD and to VA in
making sure that we can acquire facilities or lease facilities
that are necessary in order to do this work.
Senator Sullivan. Good. I plan on hosting Secretary
McDonough up in Alaska next month, and we are going to be doing
a lot of discussion on these topics. I am going to bring some
of our facilities. But it is an area that I think we could
really improve on.
Mr. Remy. Yes.
Senator Sullivan. Let me have one final question. Secretary
Cisneros, can you give us an update on the situation with
vaccines, the vaccine mandate in the military? And you know I
have concerns about that, but what I really have concerns about
is somehow, you know, a servicemember serving his country for
years and doing a great job and then having this end their
career or somehow getting a bad conduct discharge or something
like that, which I would totally oppose. What is the thinking
right now? I know it is a fluid issue. But, can you give us an
update? It is important.
Mr. Cisneros. Well, sir, you know, the first thing is I am
happy to report that our active duty forces are getting no--the
vast majority of them have gotten the vaccine. I believe the
number was over 97 percent today that we reported. The Navy is
over 99 percent of their active duty force has gotten the
vaccine. So the servicemembers see the importance of it.
As far as discharges or those who might refuse, you know,
they can ask for an exemption, either it be for medical reasons
or for religious reasons, but that has--you know, discharges
and what that will be is left up to each individual Service as
to how they will approach that.
Senator Sullivan. Okay. Thank you, Mr. Chairman.
Chairman Tester. Thank you, Senator Sullivan.
Thank you, gentlemen. Appreciate your testimony. We will
move on to the next panel now, but thank you very much.
Appreciate you being here.
Mr. Remy. Thank you, Mr. Chairman.
Chairman Tester. You bet. We are now going to hear from
some community organizations who work in partnership with the
VA and the DOD to serve veterans. Today, we have with us Dr.
Nicholas Armstrong, Managing Director of Research and Data at
Syracuse University's Institute for Veterans and Military
Families. We have Mr. Mike Hutchings, Chief Executive Officer
of Combined Arms. We have Mr. Thomas Winkel, Founder and
Director of the Arizona Coalition for Military Families.
Appreciate all of you being here.
Dr. Armstrong, we are going to start with you.
PANEL II
----------
STATEMENT OF NICHOLAS J. ARMSTRONG
Mr. Armstrong. Mr. Chairman, I would like to start by
offering my condolences to Senator Rounds and his family.
Good afternoon, Chairman Tester, Ranking Member Moran,
members of the Committee. I would like to thank you for the
opportunity to testify on the topic of collaborative efforts
between the Departments of Defense and Veterans Affairs to
improve the military to civilian transition. I would also like
to thank you for all the important work this Committee has
accomplished over the last few years.
In addition to serving as Managing Director at the
Institute for Veterans and Military Families at Syracuse
University, I am a veteran. I served eight years in the United
States Army, including nearly three years deployed in Iraq,
Afghanistan, and Bosnia with the 10th Mountain Division. Upon
my separation, I attended Syracuse University as the
university's first post-9/11 GI Bill student and eventually
earned my Ph.D. All this is to say I understand transition not
only because I study it every day but because I also lived it.
I know firsthand how critical it is that we as a Nation get
transition right for our servicemembers and their families.
Therefore, I would like to start with a statistic. In 2018, the
combined funding from DOD, VA, Labor, and the Small Business
Administration devoted specifically to the Transition
Assistance Program was approximately $182 million. With roughly
200,000 members separating from active service each year, this
equates to an investment of about $910 per veteran. I say
again, $910 worth of transition support for each exiting
servicemember.
This contrast seems stark compared to the tens of thousands
it costs to recruit and screen a basic trainee and the over
$200 billion spent annually on post-service health, wellness,
and benefit programs. It is stark considering that research
consistently shows a strong connection between a positive
transition experience and better health and well-being outcomes
later in life. Conversely, a negative transition experience can
linger for decades, sometimes spiraling into the most
devastating outcome such as homelessness or suicide. Even VA
researchers have coined the initial period after separation as
``the deadly gap,'' when transitioning servicemembers are more
likely to die by suicide than others.
To improve the transition experience, the DOD and VA must
further integrate their efforts. However, this task is bigger
than the VA and DOD alone. In fact, it is bigger than the
entirety of the Federal Government. Supporting transition is a
whole-of-the-nation task, one that government must lead but in
close partnership with the nonprofit and private sectors.
This Committee and those who serve in the VA and DOD have
made great progress. Last year marked historic legislative
achievements. Legislation like the Hannon Act and the Phil Roe
and Johnny Isakson Veterans Healthcare and Benefits Improvement
Act have the potential to significantly improve the way DOD and
VA support transition. I want to thank you for passing this
legislation and for all the work this Committee, the VA, and
DOD are doing to ensure implementation of this legislation is
both effective and timely.
Still, there is more work to do. As you will see in greater
detail in my written testimony, I believe there are three major
ways we can improve collaboration between the DOD and VA to
improve the transition experience.
First, we must take legislative action to create a
permanent National Veterans Strategy and expanded interagency
process. The Joint Executive Committee and this
Administration's Joining Forces initiative are good blueprints
for a permanent interagency council positioned to spur broader,
whole-of-government collaboration between the DOD, VA, and
other agencies.
However, these efforts cannot wax and wane across
administrations. They must endure. Congress should take action
to make permanent an elevated and expanded interagency
mechanism with the power to set and execute a National Veterans
Strategy that evolves with the changing needs of veterans and
their families and actively integrates with the nonprofit and
private sectors as partners in these efforts.
Second, we must enhance collaboration and coordination
between the DOD, VA, and local communities. Ultimately, policy
becomes reality in the communities where veterans live, work,
and raise families. Community collaboration at VA medical
centers and DOD installations often depend on local leadership.
With congressional authority, VA and DOD can do more to enhance
local engagement with community social service providers to
integrate health and social care for transitioning
servicemembers and veterans.
Third and finally, we must expand credentialing and job
training offerings through public-private partnerships. Job
training and credentialing programs must be available to
transitioning servicemembers and their families regardless of
where they transition from. The nonprofit sector has made great
strides in providing job training services inclusive of family
members, but nonprofits need continued investment to scale
sustainably. Public-private partnerships, including financial
investments on behalf of DOD and VA, can expand equitable
access to these services.
Serving the veterans of tomorrow requires us to improve the
transition process today. Ensuring an all-volunteer force for
our Nation's future requires us to set transitioning
servicemembers and veterans up for success in the present.
Action is required, and success is in our reach. Thank you.
[The prepared statement of Mr. Armstrong appears on page 63
of the Appendix.]
Chairman Tester. Appreciate your testimony, Dr. Armstrong,
and now we will go with Mike Hutchings, virtually.
STATEMENT OF MIKE HUTCHINGS
Mr. Hutchings. Chairman Tester, Ranking Member Moran,
distinguished members of the Committee, thank you for this
opportunity to discuss how collaboration among the VA, DOD and
through multisectoral partnerships can improve outcomes for
servicemembers and veterans.
I am excited to report that in Texas and in various parts
of the Nation community collaboration with the VA has never
been stronger. It is stronger because local VHAs and VBA
leadership understand the value that additional resources and
member organizations can bring to the shared mission of
improving the veteran transition experience, advancing health
outcomes for veterans, and most importantly, preventing veteran
suicide.
Composed of other government agencies and local, regional,
and national nonprofit organizations, Combined Arms's 177
member agencies serve as effective force multipliers for VA and
DOD programming and customer service. We are able to fill gaps
in programming through our network of trusted providers. We
execute interagency referrals between government agencies and
nonprofits, and we provide increased client enrollment in VA
programs.
While the DOD and VA in collaboration can provide A through
F with transition support services, it is community based
organizations like Combined Arms that fulfil G through Z or
service those ineligible for VA services. Working in tandem
enables a complete continuum of care, and Combined Arms stands
ready to scale existing programming and partnerships to meet
the ever evolving needs of our veteran and military families.
Combined Arms operates innovative, collaborative systems
through four major pillars:
We have created an integrated technology platform that
ensures veterans have access to thousands of social services
provided by our vetted member organizations, and we flip the
accountability from the veteran to the service organization by
requiring all member organizations of the collaborative respond
to a veteran request within 72 hours or less.
We deployed a white-labeled technology referral platform to
veteran nonprofit hubs and collaboratives across the Nation.
Currently, Combined Arms's technology platform is live and
powering projects or veteran hub ecosystems in 26 states.
We have also created and developed an interagency referral
tool called Check-In. This application is available via desktop
and mobile and can refer a veteran to an organization in the
collaborative in less than 30 seconds.
We also have a Texas-based transition center which serves
as a co-working space available to all of our member agencies
and creates intentional collaborative collisions for
organizations that serve veterans.
Partnership, collaboration, and large-scale convening of
resources are the cornerstone of our methodology and success. I
would like to highlight a handful of our partnerships with
Federal entities that have yielded increased collaboration
among organizations and, more importantly, better care for our
Nation's veterans:
Fifteen different VA programs and clinics at the Michael E.
DeBakey VA Medical Center have been assigned to work within the
Combined Arms system. This partnership allows the VA to utilize
our system to refer veterans to nonprofit agencies delivering
social services not provided by the DeBakey VA. Similarly,
Combined Arms member organizations and Combined Arms can refer
veterans into the VBA and VHA programs at the DeBakey Center.
We have worked with the Department of Labor's Veterans
Employment and Training Services Navigator and Partnership
Pilot since September of this year to directly connect
transitioning servicemembers and spouses to quality employment
and training resources.
And since launching the Texas Veterans Network in April of
2020, we have established a regular presence at all the major
military installations in Texas. Each visit allows Combined
Arms the opportunity to demonstrate the importance of community
based resources as well as how to connect transitioning
servicemembers to our technology.
To ensure that no servicemember falls through the cracks,
Combined Arms should be included in transition workshops or
transition checklists, which would encourage the servicemember
to create a Combined Arms profile prior to separation.
In summary, Combined Arms has developed, perfected, and
scaled a downstream model to directly connect veterans and
military families with organizations that serve them. By having
Federal, state, and community-based organizations working in
closer collaboration, we can accelerate and streamline
transitioning servicemember and veteran access to critically
needed resources, which will help prevent unemployment,
underemployment, substance abuse, family challenges,
homelessness, criminal behavior and, in turn, save veteran
lives.
Thank you again for your consideration of this testimony
and for your continued service to our military and veteran
community.
[The prepared statement of Mr. Hutchings appears on page 72
of the Appendix.]
Chairman Tester. Thank you for your testimony, Mr.
Hutchings.
Mr. Winkel, also virtually. Mr. Winkel?
Mr. Winkel. All right. You got me?
Chairman Tester. We got you.
Mr. Winkel. Outstanding. Thank you, sir.
STATEMENT OF THOMAS WINKEL
Mr. Winkel. All right. Thank you, Chairman Tester, Ranking
Member Moran, Senator Sinema from Arizona, and members of the
Committee on Veterans' Affairs, for inviting a simple ``Mud
Marine'' to speak today.
As a veteran, I am heartened by the question before this
Committee. Why? Well, because in Arizona we have an incredibly
strong, nationally recognized partnership with the VA, military
installations, the Arizona Department of Veterans' Services,
and the community, and through all that we have built an
ecosystem of support to do what none of us could do alone. It
is my strong belief that every State's service members,
veterans, and their families should have the same sustainable,
robust ecosystem as Arizona's, or better.
In my 12-plus years working in this field, I have seen the
VA and DOD grow in their collaborative efforts with each other
and with the community to address some of the most complex
challenges. So what do the VA and the DOD need in order to
accept the community as an equal partner? Well, they need the
legal authority and framework to partner, and they need State
and community partners that they can trust, that have stability
and data-driven approaches.
In Arizona, that community partner is a collective impact
initiative called the Arizona Coalition for Military Families.
With over 450 truly vetted partners and over 3,000 resources,
we have served over 60,000 veterans, Service members, and their
families.
Here are some examples of our collective effectiveness:
From 2008 to 2010, the Arizona National Guard had three
consecutive years of the highest number of deaths by suicide in
the history of the organization. The Coalition was asked to
assist with a solution. We included the VA and other community
partners. There were zero suicides for the three years the
program was in operation.
In 2016, the Clay Hunt Suicide Prevention Act opened a door
for the VA to collaborate with the community in a more
comprehensive way. We created the Be Connected Program, which
uses the lessons learned from the successes of the National
Guard program for a statewide focus. Appreciation goes to the
late Senator John McCain and Senator Sinema for their support
of this effort.
In 2018, all five of our active duty bases and other key
stakeholders signed a DOD SkillBridge program MOU. The result
is an average post-SkillBridge yearly salary of over $70,000.
The three VA health centers are part of the Be Connected
program. So we have this continuity of care throughout the
State. Directors of our three Arizona VA healthcare systems
have shared that statewide partnership helped them work more
effectively with each other during COVID-19.
These and literally hundreds of other examples are what we
get when we include the community as an equal partner.
The VA and the DOD should have an organization in every
State that they can fully trust. Fortunately, there is a
collaboration already taking place that supports this. SAMHSA
and the VA have an effort called the Governor's Challenge to
Prevent Suicide. Governor-appointed teams comprised of the
military, government, and community receive an extensive amount
of technical assistance on best practices. Arizona has been a
part of this project for over a decade now, and it has been
instrumental.
Given that we have this pathway available, I have
recommendations here and in my supplementary material. For the
Senate, please authorize the DOD to update the Joint Ethics
Regulations so that they can engage more easily with
established public-private partnerships.
For the DOD, add the Governor's Challenge Team efforts to
the list of sanctioned public-private efforts so that the base
commanders and personnel from family programs, suicide
prevention, and TAP can more easily engage.
For the VA, the Governor's Challenge effort needs to
increase the emphasis on building collective impact initiative
models or other such models. It also needs to fund their
staffing and program needs with the Staff Sergeant Parker
Gordon Fox Suicide Prevention Program. It was the original
iteration of that.
Include input on the Governor's Challenge grant process
from the National Association of State Directors of Veteran
Affairs. They are waiting for you.
Utilize the CDC and the CDC Foundation work with the State
Scorecard, the Vulnerability Index and the Warrior Built effort
to assist the Governor's Challenge Teams. Ensure that the
Community Veteran Engagement Boards, the CVEBs, are
incorporated fully into the Governor's Challenge Teams.
Increase efforts with qualified research institutions like
Arizona State University and Syracuse IVFM to track and report
data for those Governor's Challenge Teams.
I would like to recognize Governor Doug Ducey and the
Governor's Office for Youth, Faith, and Family and also the
leadership of the Arizona Department of Veterans' Services,
VISN 22, Arizona's three VA healthcare systems, and the
Regional Benefits Office for their ongoing partnership in
supporting all servicemembers, veterans, and their families.
Chairman Tester, Ranking Member Moran, and members of the
Committee, I appreciate the time to speak.
[The prepared statement of Mr. Winkel appears on page 77 of
the Appendix.]
Chairman Tester. Yes, thank you, Mr. Winkel. I want to
thank all three of you for testimony.
I am going to go with Senator Moran now.
Senator Moran. Chairman, thank you very much and thank you
to our three witnesses. Thanks for joining us.
Mr. Winkel, let me begin with you. I have met you, and it
is nice to see you again although it would be better to see you
I would enjoy seeing you in person. Thank you for your service
as a Marine and your continued service for other veterans.
I continue to hear about how good ACMF is as an example how
to maximize the community involvement in partnerships with our
veterans, particularly as it relates to transition. Let me ask
this question. As part of the team that designated and
implemented the ACMF in 2009, what startup best practices can
you share with members of this Committee who do not yet have an
organization like yours in our States?
Mr. Winkel. I really appreciate it, Senator Moran. Yes, I
look forward to seeing you in person as well. One of the
biggest things that I would recommend is contacting the
Governor's Teams, ensure that they understand that the
community is really the third leg of the stool that supports
servicemembers and veterans and their families. It is
incredibly important. Without it, you have got a wobbly stool.
I mean, you know, there are lots of analogies for that.
But the reality is with a Senator on their side as a
champion you should encourage them to go big with the efforts.
This is really tough work, and so they are going to need folks
in their corner, if you will. We were incredibly fortunate back
in 2008 to have that type of support, and we have benefited
from that ever since.
Senator Moran. With the John Scott Hannon Act
implementation, as we highlighted earlier, we need a number of
steps to occur so that that implementation can be more quickly
accomplished. But it creates partnerships with--let me say it
differently. It gives opportunities for not-for-profit
organizations in home communities the opportunity to engage in
the efforts to reduce the number of suicides, eliminate
suicide, and provide mental health services within a community.
I think it is one of the best features of the many good
features in that Act, and again, it highlights what we believe
we can do as we further engage local organizations and local
communities in the well-being of those members of their
community who served the Nation. So I think the whole issue of
this effort at home becomes even more important.
You mentioned, Mr. Winkel, the DOD ethics regulations that
creates barriers on these partnerships. Would you highlight or
elaborate on what you are talking about? What is an example so
I can fasten it in my brain?
Mr. Winkel. Well, I appreciate this question as well,
Senator Moran. First of all, I would say the Joint Ethics
Regulations are really important. They are--it is needed, in
essence, to be able to protect the military from getting too
far into the weeds. There are some organizations out there that
do not always practice the best practices that are available,
and it has a variety of other uses. So I do not want to
eliminate it by any stretch.
But when we have had pushback from the bases--now I am
going back 13 years. We do not have that experience anymore. I
will say the bases now are fantastic, and we work with all
different levels, up and down the chain of command. It is
amazing really and eye-opening.
But in the past, it has been used--and I worry about my
other fellow States--to block, in essence, efforts to come on
base or to do good work. The actual National Guard program that
I mentioned, where we ended suicide for over three years, there
were some wonderful proponents of it, but there was some
archaic thinking that was going along. One of the individuals
ended up being able to use that Joint Ethics Regulation to push
us out. This person was quoted oftentimes as saying that
suicide was just kind of a natural condition of training and
that we should expect a couple of suicides a year.
And so you know, with that level of thinking and them being
able to use that as a block, it creates some real difficulties
for programs. I have got plenty of other examples of that.
Fortunately, in Arizona, they are long past, but now I am
worried about my fellow States.
Senator Moran. Thank you very much.
Dr. Armstrong, thank you for your service to our Nation and
to other veterans. Congress has looked for ways to include
community organizations in the transition process. And as we
have looked to overhaul the military to civilian aspect of that
transition, your organization, IVMF, has always been a relevant
and key player in those discussions that we have had. And I
think I am always interested in the relationship, the working
effort you have with Syracuse University and veterans groups to
craft those opportunities for that transition to be better.
Can you lay out for the Committee the ongoing gaps that you
see in the transition process when it comes to collaboration
between organizations like yours, Federal agencies like DOL,
VA, DOD, and veterans and military service organizations? How
do we get it all to come together?
Mr. Armstrong. Thank you, Senator, for that question. It is
really a question we have been tackling from the very beginning
as a research center. We have looked to different research in
terms of what the needs are of servicemembers in transition,
and often navigation rises to the top, among other needs,
particularly with respect to employment, but trying to knit
together all the sea of goodwill, both the programs that are
offered by government but also by the nonprofit sector. And so,
trying to pull that all together.
You know, we see in my testimony one of the leading points
is around driving toward creation of a National Veterans
Strategy and an expanded process that pulls in other Federal
agencies, states, and local governments, as well as nonprofit
and private sector and all the investment in that sea of
goodwill, to align that work, to make it more accessible to
those further upstream and helping provide that access even
before servicemembers take that uniform off and transition into
their communities.
Senator Moran. Thank you for your efforts and for your
answer. I may borrow ``sea of goodwill'' as a phrase I would
like to use. I like it. It expresses a circumstance that
certainly exists.
Mr. Armstrong. Thank you.
Senator Moran. Thank you.
Chairman Tester. Thank you, Senator Moran.
I am going to start with you, Dr. Armstrong. When you
transitioned out of the military, I do not want to date you,
but when was that?
Mr. Armstrong. It was 2007.
Chairman Tester. Okay. And so what was your personal
experience with that transition? And the next question is going
to be: How have they improved, and what do they need to improve
upon? I am talking both from a DOD perspective and a VA
perspective.
Mr. Armstrong. Thank you, Senator. So my experience was
almost an optional set of potential transition workshops,
things of that nature. Frankly, it is hard to remember because
it was such a blur because the experience--and I think many
others in transition would often relate to this in the sense
that it often happens quickly in the sense that like having
access to information about--you know, you are so ready to
transition into your next role in life that sometimes you miss
some of the key information, whether it is related to benefits
or things that you will need when you arrive in your local
community.
Certainly, a ton has been--has helped, has advanced with
respect to the Transition Assistance Program. And certainly
organizations like ours, which run programs that are
complementary to the Transition Assistance Program, like
programs like Onward to Opportunity which is a career training
program that we operate on 19 military installations, actually
with access to another 45 or so installations that provide
access to industry, in-demand industries, specific training and
credentialing opportunities that help to enhance that
Transition Assistance Program experience. Certainly, that has
been a huge advancement from what was not available when I
transitioned personally.
Chairman Tester. Okay. So you have done some work with
SkillBridge?
Mr. Armstrong. Yes, sir.
Chairman Tester. Can you tell us what is required to
provide access to SkillBridge on a new base?
Mr. Armstrong. Early on for us, it was finding local
leadership buy-in to help us bring our program onto the
installations.
Chairman Tester. Military leadership?
Mr. Armstrong. Yes, sir.
Chairman Tester. Yes. Okay. And do you find that the
military is--and I do not want to get you in trouble. But, do
you find the military is open to the things like SkillBridge,
or is it kind of a pain in the neck?
Mr. Armstrong. Very open, Senator, yes.
Chairman Tester. Okay. Good, good. Is there anything we
need to do with SkillBridge to make it more effective?
Mr. Armstrong. Senator, yes, I think it could be more
effective in the sense of, you know, providing more equitable
access to those in transition. So if our program--for example,
I mentioned we operate that program on 19 military
installations. That has been a function of initially local base
leadership, willingness to help us come on base to provide
access to that.
But certainly with the resources of being able to expand
those offerings, we do offer the program online and have
actually seen a huge uptake in terms of both servicemembers,
those from the National Guard and Reserve, and military spouses
take advantage of that.
But in terms of scale, it is a matter of resources, and we
deliver the program at no cost because these programs are
largely funded by private philanthropy.
Chairman Tester. So this question is for all three of our
witnesses that testified on the second panel. The credentialing
programs are an important tool in ensuring that transitioning
servicemen have--servicemembers, I should say, have in-demand
skill sets to meet the changing needs of employers. The
Military Services also have credentialing programs that allow
servicemembers to attain employment credentials outside their
transition window, including on-the-job training for
credentials related to their military occupation.
And we will start with you, Dr. Armstrong, go to Mr.
Hutchings and Mr. Winkel. Are your organizations seeing an
impact in the transitioning veteran population from these
credentialing programs that are outside the transition window?
Mr. Armstrong. Thank you, Senator, for that question. I can
speak to our program in particular. We are seeing impacts for
those programs. We have a robust data collection and
measurement evaluation approach to the program itself. So we
are capturing outcomes as transitioning servicemembers not only
complete the programs but when they take and sit for
certifications. And we also follow up with them at six month
and annual intervals to understand their employment status. And
we can report retention rates close to 80 percent, which is
very good compared to many industry benchmarks. And I will pass
that on to my colleagues.
Chairman Tester. Mr. Hutchings.
Mr. Hutchings. Thank you, Senator, for your question. Over
the past year and a half, we have seen a slight increase in
veterans coming into Combined Arms's system with additional
credentialing that we had not seen in the past. Some brief
examples of that would be certification while in the Service in
yellow belt, green belt programs, many Six Sigma programs. We
have seen some SAP credentialing software-style certifications
that are happening as well. So it is something we have noticed
over the past year and a half, two years, and it ultimately
does help make them more competitive in the civilian
marketplace as they seek to gain employment after their time in
the Service.
Chairman Tester. Mr. Winkel.
Mr. Winkel. Yes, certainly, Senator, we have seen a massive
impact on--actually, upscaling is huge. We use O2O, Onward to
Opportunity and a variety of other things, including programs
from DOL and WIOA to help folks become higher certified.
And when we are talking about just that wedge of
individuals, I mentioned $70,000 for the overall SkillBridge.
Well, those tend to range when you are looking at the upscaling
elements of it, between $81,000 up to $144,000. So is it having
an impact on the servicemembers' lives? Yes.
Chairman Tester. Mr. Winkel, you might as well stay on. I
want to talk to you a little bit about the suicide program that
you had as it related to the Arizona National Guard. They went
from many suicides to zero. That is pretty good success. In
fact, that is really good success.
You talked about the different entities involved. But, what
did you really focus on to get that to zero? Was there any one
thing that you focused on, or was there multiple things? And if
there were multiple things, what were they?
Mr. Winkel. Wonderful question. Huge question. I will
attempt to answer it precisely. Technically, we went after the
culture, and that included things like leadership support,
sincere leadership support, engaged leadership support.
We had a variety of different programs. We retrained
everything. We used prevention, intervention, and postvention.
The blessing of it is we never had to use the postvention. We
were only using the prevention and the intervention modalities.
We did a ton of training. So the Guard was about 8,000
strong at that particular point, 8,500 maybe. And we trained
every single person in a couple of things, and then we worked
it up the ladders. By the time we got to the chaplains and
first sergeants and things like that, they were all assist-
trained, which was an excellent addition.
There were some wonderful programs out of the Joint Chiefs
at that time, comprehensive soldier fitness and master
resilience training, and we just flood the market. I think we
had a total of 700 folks trained in master resilience training.
They ate it up because they saw that it worked. And it not
only stopped the suicides, but it improved their overall
general lives and their functioning and things like that. That
was upstream; so was that prevention.
Chairman Tester. So, Mr. Winkel, you dealt with these folks
while they were in the Guard; is that correct?
Mr. Winkel. That is correct. Yes, sir.
Chairman Tester. Okay. Can any of the three of you speak to
the connection between successful transition, meaningful
employment, and veterans' mental health? And I am speaking
after transition on these. Go ahead, Dr. Armstrong. I see you
pushing the mike.
Mr. Armstrong. Thank you, Senator. I can speak to
meaningful employment being a protective factor specific to
suicide, and so we see that helping folks transition,
particularly with a focus around employment. While there are
many social needs that folks may have in their transition, both
themselves and their family members, securing employment, and
also anecdotally for their spouse having employment, at the
point of transition also are very important buffers from both a
mental health and suicide prevention standpoint.
Chairman Tester. Thank you. The other two panelists like to
respond to that? You do not have to, but if you want to, please
do.
Mr. Hutchings. Yes, Senator. You know, I will highlight
something specific from our data. So since, you know, really
2017, Combined Arms has served over 50,000 unique veteran and
military families through the system. And the three most
requested resources that we have, looking at all of our data
points, is: Number one is employment, career search and
placement. Number two is social connectivity. And number three
is volunteerism. Those are the three most requested things from
the data points in our system.
That is showing and telling us that veterans or a
transitioning servicemember, as they are transitioning, their
focus is getting a job, connecting with their tribe of
likeminded individuals, people they have shared experiences
with, and giving back to their community. So veterans are truly
economic assets, and they want to go back to the communities
that they left long ago and have an impact on those communities
and help the overall betterment.
Mr. Winkel. I think, Senator, I would probably just throw
in that we look and work a lot with Thomas Joiner's theories on
suicide and suicide prevention. And what he is looking at are
things like familiarity with lethal means. Okay. Well, you
know, everyone in the military is familiar with those, with
weapons and how to handle them and get used to the concept of
death and putting their life on the line. The other two things
are a sense of belongingness and a sense of burdensomeness. And
so we directly go after those as well in both our statewide
program and back when we were working with the National Guard.
Belongingness, that is tribe and all those other, you know,
wonderful words. And then burdensomeness is, are there people
reaching out to me? Are there folks that are interested in
helping me?
The VA's and the DOD's outreach and attempts to support
servicemembers is valuable to folks that are struggling.
Chairman Tester. Thank you, guys. Thanks. Thank you for all
you do. I appreciate it very much. I want to thank both panels
for their words today.
Look, we have got challenges out there, but working
together I think we can solve those challenges that we have.
And I look forward to working with everybody that we heard from
today to make sure we do right by our servicemembers in this
country. It is important that the VA and the DOD and Congress
are all on the same page, working together to meet the
objectives of our servicemembers and our veterans.
So we will keep this record open for a week. Once again,
thank you all for testifying today.
This hearing is now adjourned.
[Whereupon, at 5:11 p.m., the Committee was adjourned.]
A P P E N D I X
Prepared Statements
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Questions for the Record
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Additional Resources
Reports with associated links submitted by IVMF
The following reports are available for download:
A National Veterans Strategy: The Economic, Social and
Security Imperative
ivmf.syracuse.edu/article/a-national-veterans-strategy
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Improving the Delivery of Services and Care for Veterans: A
Case Study of Enterprise Government
www.businessofgovernment.org/report/improving-delivery-
services-and-care-veterans
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
[all]