[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

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

                                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

                              ----------                              

                            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

                              ----------                              


                      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

                              ----------                              


             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


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]




                        Questions for the Record


[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]



                          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

                              ----------                              


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]