[Senate Hearing 117-587]
[From the U.S. Government Publishing Office]







                                                        S. Hrg. 117-587
 
                       SUPPORTING SERVICE MEMBERS
                DURING THEIR TRANSITION TO CIVILIAN LIFE

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

                             FIELD HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                          UNITED STATES SENATE

                    ONE HUNDRED SEVENTEENTH CONGRESS

                             SECOND SESSION

                               __________

                             APRIL 21, 2022

                               __________

       Printed for the use of the Committee on Veterans' Affairs


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

             U.S. GOVERNMENT PUBLISHING OFFICE 
 51-170               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

                              ----------                              

                             April 21, 2022

                                SENATOR

                                                                   Page
Hassan, Hon. Margaret Wood, U.S. Senator from New Hampshire......     1

                             REPRESENTATIVE

Pappas, Hon. Chris, U.S. Representative from New Hampshire.......     3

                               WITNESSES

Cheryl Rawls, Executive Director, Outreach, Transition and 
  Economic Development Service, Veterans Benefits Administration; 
  accompanied by Ryan Lilly, Director, Veterans Integrated 
  Service Network 1, VA New England Healthcare System; and Kevin 
  Forrest, Director, VA Manchester Medical Center................     5

Amy Cook, Administrator, Division of Community Based Military 
  Programs, New Hampshire Department of Military and Veteran 
  Affairs........................................................    11

Paul Lloyd, Chairman, New Hampshire State Veterans Advisory 
  Committee and State Adjutant, Veterans of Foreign Wars.........    13

                                APPENDIX
                          Prepared Statements

Cheryl Rawls, Executive Director, Outreach, Transition and 
  Economic Development Service, Veterans Benefits Administration.    37

Amy Cook, Administrator, Division of Community Based Military 
  Programs, New Hampshire Department of Military and Veteran 
  Affairs........................................................    43

Paul Lloyd, Chairman, New Hampshire State Veterans Advisory 
  Committee and State Adjutant, Veterans of Foreign Wars.........    48


  SUPPORTING SERVICE MEMBERS DURING THEIR TRANSITION TO CIVILIAN LIFE

                              ----------                              


                        THURSDAY, APRIL 21, 2022

                                       U.S. Senate,
                            Committee on Veterans' Affairs,
                                                    Manchester, NH.
    The Committee met, pursuant to notice, at 10 a.m., in New 
Hampshire Institute of Politics Auditorium, Saint Anselm 
College, 100 Saint Anselm Drive, Manchester, New Hampshire, 
Hon. Margaret Hassan, presiding.
    Present: Representative Pappas and Senate staff members 
Simon Coon, Weston Haycock, and Lindsay Dearing.

           OPENING STATEMENT OF MARGARET WOOD HASSAN,

        ACTING CHAIRMAN, U.S. SENATOR FROM NEW HAMPSHIRE

    Senator Hassan. This hearing will come to order. Good 
morning, everybody. It is really great to see all of you. And 
for those of you who are not from New Hampshire, and especially 
those of you who are making your first trip to New Hampshire, 
welcome. We're really glad to have you here.
    I'm Senator Maggie Hassan, member of the Senate Veterans' 
Affairs Committee, and chair of this hearing.
    I'd like to welcome you to our field hearing where we're 
going to discuss ways to strengthen support for service members 
during their transition to civilian life in New Hampshire and 
all across the United States.
    Every year, 200,000 service members transition from 
military to civilian life. The majority are in the 18 to 34 
years old age range; and troublingly, this group also has the 
highest veteran suicide rate.
    More than 8,000 veterans under the age of 34 live in New 
Hampshire.
    Too often, service members do not get the support that they 
need when they transition from working with the Department of 
Defense to the Department of Veterans Affairs, especially when 
it comes to mental health services provided by the VA.
    As a member of the Senate Veterans' Affairs Committee, I 
have worked with my colleagues from both parties on solutions 
to strengthen VA services and ensure that veterans have the 
health care, benefits, and support that they earned and that 
they deserve.
    As part of those efforts, we invested in mental health care 
and suicide prevention, including $13 billion to provide 
treatment and support for the nearly 2 million veterans who 
receive mental health services through the VA.
    We also recently secured funding to tackle the disability 
claims backlog, which includes increasing staffing at the VA.
    Veterans deserve the timely processing of their claims, and 
the pandemic added to that already existing backlog.
    For service members, transitioning to civilian life, filing 
a benefits claim, navigating VA health care services, and 
finding VA programs to assist them, can be daunting.
    Because of this, I introduced the bipartisan Solid Start 
Act, which would strengthen and make permanent the VA's Solid 
Start program, an effort begun under the prior administration 
through which the VA contacts every veteran three times by 
phone in the first year after they leave active duty to check 
in and help connect them to VA programs and benefits.
    I was glad to work with the Veterans' Affairs Committee to 
unanimously pass this bill through our committee, and it's now 
part of a comprehensive mental health package for veterans that 
we are working on.
    From mental health services to surgical care, veterans 
deserve the ability to get high-quality health care from the 
VA.
    I'm concerned that recent recommendations made by the VA to 
the Asset and Infrastructure Review Commission could reduce 
access to care for veterans in New Hampshire, including VA's 
proposed closure of clinics.
    I recently led my Senate colleagues in urging the VA to not 
make any decisions that could impact the services Granite State 
veterans get, and additionally, I raised this issue of 
bolstering services like surgical care, directly to Secretary 
McDonough.
    We know that we have more work to do to honor and assist 
all veterans, including those transitioning to civilian life.
    That's why today we will hear from our witnesses about how 
the VA currently supports service members and their families 
making the transition to civilian life, and what gaps remain.
    We will also discuss what additional measures Congress can 
take to support veterans and promote programs and efforts to 
help make VA services stronger.
    Our hearing will address health care, suicide prevention, 
employment, and benefits, with a focus on how to support 
recently separated veterans and their families.
    I'm pleased to be joined today by officials from the 
Department of Veterans Affairs, as well as the New Hampshire 
State Veterans Advisory Committee, and New Hampshire Department 
of Military Affairs and Veterans Services.
    From the VA, we have witnesses from three different 
divisions.
    First, the Transition and Economic Development Service at 
the Veterans Benefits Administration, which oversees the VA's 
Transition Assistance Program, or TAP.
    Second, the VA New England Healthcare System oversees the 
administration of veterans' health care in New Hampshire, 
including VA Vet Centers and community-based outpatient 
clinics.
    Third, the Manchester VA Medical Center, which is part of 
the VA New England Healthcare System, and provides primary care 
and specialty health services, including prosthetics and mental 
health services.
    And from the State of New Hampshire, we have witnesses from 
the New Hampshire Department of Military Affairs and Veterans 
Services, which provides resources and community collaboration 
to support service members and veterans here in New Hampshire.
    And the New Hampshire State Veterans Advisory Committee, 
which evaluates the status of services to Granite State 
veterans, provides a forum for discussion, and is a beacon for 
many veterans in New Hampshire.
    These entities all work together to serve our veterans, and 
I look forward to our discussion today about how we can 
continue to improve VA services and benefits, and provide 
critical resources and support to service members transitioning 
to civilian life.
    I want to thank all of our witnesses for their service to 
New Hampshire, and our country, and for being here today.
    I also just want to take a minute to let everybody know 
that, in addition to Congressman Pappas and me, there are two 
other key folks here who work each and every day on issues 
affecting our veterans.
    They are a staff member from Chairman Tester's office, as 
well as a staff member from Ranking Member Moran's office. 
Simon Coon and Lindsay Dearing are both here today to make sure 
that they are bringing back to the Chair and Ranking Member of 
the Senate Veterans' Affairs Committee everything they hear 
today.
    They both are also subject matter experts on the issue of 
toxic exposure.
    So I want people to know that this is a hearing with strong 
bipartisan support and interest in attendance, and I also just 
want to reinforce that when it comes to veterans' issues in the 
United States Senate, and I also know in the United States 
House, this is a bipartisan commitment, and it's one that we 
take very, very seriously.
    We can never fully repay our veterans for the sacrifices 
that they've made, but we have to make consistent efforts to 
ensure that they receive the health care and the benefits that 
they've earned and that they deserve.
    And with that, I'm now going to recognize Representative 
Pappas for his opening remarks. Thank you so much, Congressman, 
for being here.

               OPENING STATEMENT OF CHRIS PAPPAS,

             U.S. REPRESENTATIVE FROM NEW HAMPSHIRE

    Mr. Pappas. Well, thank you very much, Senator Hassan, for 
the invitation to join you to make this bicameral hearing 
today. And I'm really appreciative of the members of the panel 
that have joined us here today for providing their testimony 
and for answering our questions.
    And it's really great to see a lot of friends and allies 
who are here in the audience.
    Thank you to all those who have worn the uniform of this 
country, and I want to thank all the veteran advocates that are 
out there.
    I think New Hampshire is second to none in the way that we 
come together and support those who have served, and that's a 
tremendous asset for our State.
    As we talk about some of the deficiencies that we might see 
in VA or the bureaucracy in Washington, we know that people of 
New Hampshire are ready to come together and do whatever it 
takes to support those who have served and help open doors to 
make sure that people can have a healthy and secure and, you 
know, just prosperous life after their service in the military.
    So that's really important and I think speaks of the desire 
of folks here in New Hampshire to continue to do that work.
    Look, after serving the Nation in uniform, we know that 
many veterans find that New Hampshire is a great place to live 
and that our State has so much to offer. It's a great place to 
start a business, to attend college, to raise a family. There 
are benefits for folks to retire here too, which is one reason 
why New Hampshire happens to be one of the older States, based 
on population, in the country.
    But we know that like elsewhere in the Nation, the 
transition period for those who have served can present many 
problems and frustrations for service members and their 
families as they settle into civilian life.
    And I want to commend the staff of VA and the New Hampshire 
Department of Military Affairs and Veterans Services for 
providing so many helpful transition services, along with 
veteran service organizations like the VFW and others who are 
represented in the room here today.
    Now, Congress has passed numerous pieces of legislation 
over the years to help improve the transition process. Earlier 
in this Congress, the House passed H.R. 4673. It's the EVEST 
Act. It's got bipartisan support, and it addresses glaring gaps 
in the months following transition out of the military.
    We know that this period can be stressful and particularly 
risky for new veterans in terms of mental health, and that 
legislation provides a long-term fix to advance automatic 
enrollment in VA health care.
    With programs like the VET TEC program or the VRRAP 
program, we're slowly starting to make progress and see more 
veterans enter a field that requires their particular skills 
that they offer.
    Our office hears from veterans who need help accessing VA 
services and benefits that they have earned, and sometimes the 
application process, we know, can prove to be a maze of steps 
and rules.
    In working with the Department of Defense, the Department 
of Veterans Affairs delivers a course through the Transition 
Assistance Program on a range of VA benefit programs that are 
available to existing service members, which is a helpful way 
to educate them.
    But we know that's not enough; and transition support is 
often needed, not just at that moment of separation, but for 
months and years following an individual's military service.
    Of course, many States like New Hampshire, which have rural 
and underserved communities in terms of VA health care, 
presents some challenges as well, and we know that our 
communities have fewer health care practitioners than other 
States that may have large urban areas.
    In a State like New Hampshire, there just aren't enough 
medical specialists out in the community. That's why it's 
important that we continue to work to bolster VA health care, 
both at the medical center in Manchester and our community-
based outpatient clinics that do a tremendous job all across 
the State.
    I want to echo what Senator Hassan has said about the 
recommendations of the AIR Commission. I find them deeply 
concerning, and we're going to work to make sure that we're not 
going backward in terms of the commitment to VA health care 
here in New Hampshire; that we're continuing to look for ways 
to fill in the gaps and make sure that those services are 
available no matter what city the veteran might live in.
    So I really look forward to the conversation here today. 
Thank you to our witnesses, again, for joining this panel. And 
I think this is just a terrific demonstration of the ability of 
folks here in New Hampshire to come together to highlight 
issues that are important to veterans and their families and 
how we can move forward together. Thank you.
    Senator Hassan. Thank you, Congressman Pappas.
    I'm now going to introduce each of our witnesses, who will 
have about five minutes to make an opening statement, and then 
we'll go to questions.
    So I'm going to start with Cheryl Rawls. Good morning.
    Our first witness is Cheryl Rawls. She is executive 
director of the Outreach, Transition, and Economic Development 
Service at the Veterans Benefits Administration.
    She has more than 20 years of experience at the VA. And in 
her current role, she is the primary advisor to VA on 
transition and employment-related initiatives for service 
members and veterans. And as I learned this morning, she is 
also a veteran of the United States Army.
    So thank you for your service, ma'am. You are recognized 
for your opening statement.

   STATEMENT OF CHERYL RAWLS, EXECUTIVE DIRECTOR, OUTREACH, 
TRANSITION AND ECONOMIC DEVELOPMENT SERVICE, VETERANS BENEFITS 
 ADMINISTRATION; ACCOMPANIED BY RYAN LILLY, DIRECTOR, VETERANS 
INTEGRATED SERVICE NETWORK 1, VA NEW ENGLAND HEALTHCARE SYSTEM; 
   AND KEVIN FORREST, DIRECTOR, VA MANCHESTER MEDICAL CENTER

    Ms. Rawls. Thank you very much. Good morning, Senator 
Hassan and Congressman Pappas. Thank you for the opportunity to 
testify about the support for service members during their 
transition to civilian life at the Department of Veterans 
Affairs.
    I am accompanied today, as was mentioned, by some of my 
peers in this fight, the director of the VA Manchester Medical 
Center, Kevin Forrest, and Ryan Lilly, the director of the 
Veterans Integrated Service Network 1.
    I want to express my appreciation for your continued 
support of our Nation's veterans, their families, caregivers, 
and survivors.
    Our Secretary McDonough has defined his four guiding 
principles as advocacy, access, outcomes, and excellence to be 
the foundation of serving veterans and their families. This 
sacred mission is both professional and personal for me, and it 
remains the honor of my life to have an opportunity to serve 
veterans, their families, survivors, and caregivers.
    It is critical today that service members are appropriately 
and adequately prepared to transition to civilian life and seek 
a meaningful post-military career.
    So established in 1991, the Veterans Opportunity to Work to 
Hire Heroes Act of 2011, the Transition Assistance Program is 
an interagency effort to help approximately 200,000 service 
members who separate annually, help them separate successfully 
and transition to civilian life.
    Currently, this entity is made up of the Department of VA, 
Defense, Labor, Homeland Security, and Education, along with 
Small Business Administration, and Office of Personnel 
Management.
    We also reach out to other partners for their assistance to 
come together to execute the TAP program to provide information 
on counseling, resources, tools for service members, as well as 
support for their families so they can smoothly, successfully 
transition from military to civilian life.
    The tools include the VA Benefits and Services courses that 
was mentioned, that help service members understand how to 
navigate VA and the benefits and services they have earned 
through their military careers.
    The VA TAP provides the skills, resources, and tools 
service members need to achieve emotional health, physical 
health, career readiness, and economic stability in civilian 
life.
    In addition to the one-day TAP service that family members 
can also attend, they may have access to our Military Life 
Cycle modules to help them plan for the future. These Military 
Life Cycle modules are 45 to 60 minutes long. They can access 
this information throughout their service member's career, and 
they are especially valuable during major events like permanent 
change of station, marriage, birth of a child.
    They offer connections of lifelong support systems from the 
first duty station, as well as separation and beyond.
    Each Military Life Cycle module is specific, in-depth, and 
topics cover benefits; education; home loans; insurance; social 
and emotional health resources; integration into the civilian 
community; or survivor and casualty assistance.
    One module that VA is particularly proud of is our Women's 
Health Transition Training module, which is a five-phase course 
that can be taken anytime, anywhere, and is open to all service 
women and women veterans. The topics included here are civilian 
life, and health and benefits, as well as mental well-being, VA 
care modules, VA culture, managing health care, eligibility, 
and enrolling in VA Transition Assistance Programs.
    We know that this first year is very challenging during 
transition. When you're getting out of the military, it is also 
crucial for service members to be able to connect to VHA and 
their resources.
    Our research shows that the first year following discharge 
from active-duty services may pose significant challenges, 
including homelessness, family integration, unemployment, 
underemployment, post-traumatic stress disorder, and substance 
use, all of which can increase the risk of suicide.
    With that in mind, we created the VA Solid Start program 
that was already mentioned, where we call our transitioning 
service members at periodic points of time: 90, 180, 365. We 
make the attempt to call them. If you do not answer our call, 
all in all, we are actually going to call you about 21 times. 
So each one of those times we are going to contact and reach 
out to you.
    In addition to this, we also are partnering with the DoD 
and offering our SkillBridge programs to ensure that you have 
an opportunity to take advantage of getting acclimated and 
getting connected to jobs, and we provide programs such as 
Personalized Career programs so that you are able to connect 
and help with your resume writing.
    We have so many different programs and partnerships that 
are out there, but as we mentioned, we know that there's always 
room for growth.
    And at this point, sir, ma'am, we would be very happy to 
answer any questions that you may have.

    [The prepared statement of Ms. Rawls appears on page 37 of 
the Appendix.]

    Senator Hassan. Well, thank you very much. Before we go 
forward with the next, can everybody just do a mic check? We've 
had the mics going in and out a little bit.
    [Witnesses testing microphones.]
    Senator Hassan. Okay. It may still go in and out a little 
bit, but we'll keep going. The folks here at St. A's are great.
    Now, our next witness is Ryan Lilly, director in charge of 
the VA New England Healthcare System.
    Ryan Lilly has served in this role since 2018 and has more 
than 20 years of leadership experience at the VA, including 
serving as the director of the VA Maine Healthcare System and 
chief financial officer of the White River Junction VA Medical 
Center.
    Welcome, Mr. Lilly, you are recognized for your opening 
statement.

                    STATEMENT OF RYAN LILLY

    Mr. Lilly. Thank you. Good morning, Senator Hassan, 
Congressman Pappas, and other distinguished guests.
    I appreciate the opportunity to discuss the Department of 
Veterans Affairs' VA New England Healthcare System's outreach 
efforts supporting service members during their transition to 
civilian life. I am accompanied today by Kevin Forrest, 
director of the VA Manchester Healthcare System.
    VISN 1's outreach to transitioning service members has been 
a priority for over a decade. We recognize that the transition 
from the military to civilian life can be daunting, 
particularly because many service members are very young, some 
are injured and already navigating a medical evaluation board 
through the military, and some are just ready to get their 
post-military lives started and have no interest in accessing 
the VA at that time.
    From a clinical standpoint, suicide prevention remains a 
top clinical priority, and we recognize the fact that veterans 
are at greatest risk for adverse outcomes such as suicide in 
the first year after discharge, so connecting veterans to 
mental health resources is a vital part of all of our outreach 
efforts.
    Our current outreach to active-duty service members is to 
conduct VHA benefits briefings at Transition Assistance or TAP 
programs at bases in Groton, Connecticut; Newport, Rhode 
Island; Hanscom Air Force Base, Massachusetts; and Portsmouth 
Naval Shipyard, New Hampshire. While these are a good 
opportunity for a first contact with separating service 
members, we acknowledge that we are just one of multiple 
briefings they receive, and we don't always get their full 
attention.
    Yellow Ribbon Reintegration Program events are held for 
National Guard and Reserve members and their families who have 
returned from deployment. We attend these events throughout New 
England and provide briefings and information on VHA benefits.
    Some local units, both Active and Reserve, will request 
specific benefit briefings from our team. The units realize 
they need more time to discuss VA services than the more formal 
events allow. These briefings will include more in-depth 
information and can include representatives from the Veterans 
Benefit Administration, who can bring the necessary resources 
to file claims on the spot, in addition to providing more 
general information about the claims process.
    VISN 1 Outreach also works with some employers who tend to 
employ veterans, for example, State and local police 
departments, to bring benefit information during brown bag-type 
lunch events. These are more informal and conversational.
    VA Manchester's Outreach Program coordinator position was 
created in 2015 to ensure that Granite State veterans were made 
aware of their options to access VA health care. This position 
is part of our regionally consolidated team and ultimately 
reports to me, works with veterans and their families and 
community members to first educate veterans on VA health 
options and then assist them with enrollment so that they can 
get care--to care so that they can get the benefits they have 
earned and deserve for their service to our Nation.
    In fiscal year '22 alone, Manchester's Outreach coordinator 
has participated in 98 events and is scheduled for 74 more 
events throughout the end of the fiscal year. Many of these 
events are for units returning from deployment.
    Others are at events that tend to attract a significant 
number of veterans, such as county fairs, boat shows, and the 
like. Our team strives to be at any event where a large number 
of veterans are gathering so that we can educate them about VA 
health care and how they can access it.
    While our regional and local outreach efforts are robust, 
we are continuing to discover new and better ways to reach both 
new veterans and those who haven't yet enrolled. We recognize 
it is all of our partnerships, with our congressional, 
military, and community partners that will make our outreach 
efforts successful. Thank you for your continued work on this 
important topic.
    I would be remiss if I did not conclude my testimony by 
noting that the most important outreach that we do is to 
continue to provide exceptional health care to the veterans of 
New England. Each day our dedicated staff strive to improve the 
lives and well-being of the veterans in our care across more 
than 50 sites of care, including several here in New Hampshire. 
The personal testimony from veterans in our care of the quality 
of health care that they receive and the skill and compassion 
of the staff that deliver that care remains the most effective 
means of advertising our care to newly transitioning service 
members.
    Senator Hassan, this concludes my testimony. My colleague 
and I look forward to answering any questions.
    Senator Hassan. Thank you very much, Mr. Lilly.
    Our final VA witness today is Kevin Forrest, director of 
Manchester's VA Medical Center.
    Kevin Forrest oversees the administration of New 
Hampshire's VA medical facility. He is an experienced health 
care executive, holding leadership positions at both VA and 
Department of Defense facilities.
    Welcome, Mr. Forrest, you are recognized for your opening 
statement.

                   STATEMENT OF KEVIN FOREST

    Mr. Forrest. Good morning, Senator Hassan, Congressman 
Pappas, distinguished guests and colleagues.
    Thanks for the opportunity to discuss the Manchester VA 
Healthcare System's programs and efforts to assist service 
members during their transition to civilian life and access to 
VA health care.
    Manchester VA places a priority on outreach programs to 
ensure veterans can easily access VA health care services when 
exiting the service. As a retired Army veteran, I understand 
the importance of a smooth transition to civilian life and 
being able to benefit from the multiple programs offered by 
both the Department of Defense and the Department of Veterans 
Affairs. Manchester VA has a strong relationship with the VA 
Regional Office and the New Hampshire Department of Military 
and Veterans Affairs. We provide office space at the medical 
center, so veterans have both face to face and virtual access 
to all agencies as they transition from service.
    In concert with the local VA Regional Benefits Office, the 
Manchester VA Outreach team is very active in New Hampshire. We 
participate in both active duty and National Guard Transition 
Assistance Programs, attending multiple community events 
throughout the year where we actively start the VHA enrollment 
process for veterans and follow that up with an offer of 
primary care. These outreach events also include critical 
program information on suicide prevention and mental health 
services, women's health services, and the Military2VA program.
    Veterans needing mental health care are at an elevated risk 
during periods of transition such as when they exit the 
service. The Manchester VA mental health service and 
Military2VA program manager meet regularly to facilitate mental 
health referrals for transitioning service members.
    Mental health services are provided at our main campus in 
Manchester and four community-based outpatient clinics in 
Portsmouth, Somersworth, Tilton, and Conway. Services include 
psychiatry, individual and group therapy, substance use 
treatment, integration with primary care, vocational rehab, 
homeless and housing service, veteran justice outreach, and 
LGBTQ+ mental health care.
    Manchester VA has three suicide prevention coordinators on 
staff who conduct outreach, and we're in the process of hiring 
a community engagement and partnership coordinator.
    Since 2017, we have fully implemented mental health 
services for other than honorable discharged veterans. The most 
common entry point for OTH veterans is our urgent care service 
and the M2VA program. The Manchester VA works closely with our 
Vet Center for shared patients to ensure continuity of care.
    The M2VA program supports post-9/11 service members and 
veterans in navigating the transition from military to civilian 
life. Our program receives direct referrals from DoD military 
treatment facilities, during community and VA outreach events, 
and through the Wounded Care Network. All post-9/11 veterans 
who attend a new patient appointment are identified for post-9/
11 case management screening and complete a suicide safety 
screen.
    We continue to foster strong partnerships in New Hampshire 
to ensure all veterans can access services to help in 
transition, whether it be from the VA or the community. 
Manchester VA participates in the New Hampshire State Veterans 
Advisory Committee to educate members and community 
stakeholders on the broad spectrum of services available to 
veterans.
    I would like to conclude my testimony by recognizing the 
great Manchester VA employees who provided exceptional health 
care to veterans during this COVID-19 pandemic, which 
challenged not only the VA, but the U.S. health care system. 
These employees made great personal sacrifice and often put 
veterans before their families to ensure we continued 
delivering high-quality care during that time.
    So Senator Hassan, Congressman Pappas, you know, I thank 
you and the entire New Hampshire Congressional Delegation for 
your ongoing support to improve care for veterans in New 
Hampshire and helping service members smoothly transition to 
civilian life and access the VA benefits they deserve.
    This concludes my testimony, and I look forward to 
answering any questions.
    Senator Hassan. Well, thank you, Mr. Forrest, and thank you 
for your service as well.
    Our fourth witness today is Amy Cook, administrator in 
charge of the Division of Community Based Military Programs for 
the New Hampshire Department of Military and Veteran Affairs. 
Ms. Cook has years of expertise in social services and has 
focused her efforts on serving those in our communities who 
face unique circumstances.
    She's responsible for formulating strategies and 
coordinating resources that merge government agencies, Federal 
partners, and local service providers to benefit Granite State 
veterans and their families.
    Welcome, Ms. Cook, you are recognized for your opening 
statement.

  STATEMENT OF AMY COOK, ADMINISTRATOR, DIVISION OF COMMUNITY 
 BASED MILITARY PROGRAMS, NEW HAMPSHIRE DEPARTMENT OF MILITARY 
                      AND VETERAN AFFAIRS

    Ms. Cook. Thank you. Good morning, Senator Hassan and 
Representative Pappas. I was honored to be asked to participate 
in today's hearing and dialogue.
    To begin my testimony, though, I'd like to briefly orient 
everybody to the role of the Division of Community Based 
Military Programs. The division is unique. It's powered by a 
team of State employees who strive to honor the service and 
sacrifices of our military members and veterans every day 
throughout the work that they do.
    The division acts as a bridge between military, the veteran 
population, and the civilian community. We share information 
about resources available with those in the veteran community, 
and we provide information----
    [Microphone malfunction.]
    Ms. Cook. All right. At the division we share information 
about resources available with those in the veteran community, 
and we provide information, resources, and tools to civilian 
providers and employers so they are effectively prepared to 
serve veteran customers, clients, and patients, and hire, 
employ, and retain veteran employees.
    All of us here today have a role in educating and preparing 
service members for a successful transition to civilian life. 
At the Division of Community Based Military Programs, we do not 
work directly with individual service members or veterans. 
Instead, our role is to prepare our providers and employers to 
welcome service members and their families, integrate them into 
new communities, and meet any needs that may arise in the 
future as a result of their service.
    Since the inception of the department in New Hampshire, we 
have viewed all initiatives within the division through a lens 
of suicide prevention, as well as a whole-person approach to 
that. One of the realizations that we had early on was that 
veterans in New Hampshire have a very low unemployment rate. So 
tapping into the private sector to positively impact veterans 
made sense and was also backed by research.
    Forty-three percent of veterans leave their first civilian 
job within their first year, 80 percent leave before the end of 
their second year, citing a lack of opportunity for career 
advancement and personal development. The rate of veteran 
employment has improved nationally and in New Hampshire, but 
the issue of underemployment has become a strong barrier to a 
meaningful post-service career.
    A national study done by the Call of Duty Endowment showed 
that 33 percent of veterans are underemployed, and veterans are 
15.6 percent more likely to be underemployed than nonveterans.
    Finding purpose and meaning in civilian life and financial 
stability are two factors that lead to better long-term 
outcomes, and both can be accomplished through addressing 
underemployment, retainment, and opportunities for career 
growth.
    In 2020, we worked with New Hampshire Employment Security 
and private sector contributors to launch the New Hampshire 
Veteran-Friendly Business Network. We recognize eligible New 
Hampshire businesses of all types and sizes as New Hampshire 
veteran-friendly. Businesses awarded this recognition meet 
various criteria in four different categories designed to 
encourage practices that honor, fortify, empower, and impact 
the lives of veterans and their families in New Hampshire.
    Recently, businesses and partners participating in this 
network began discussing how to create a pipeline here in New 
Hampshire through which service members can be supported as 
they transition to civilian life. There is an ample opportunity 
for the VA to collaborate in formalized ways to make such a 
pipeline a success.
    For example, within this network there are opportunities 
for the VA to collaborate and help us to enhance the education 
and support provided to employers of veterans. There is some 
innovative approaches being tested currently by VA Medical 
Centers in other States that involve lending the expertise of 
VA clinicians to local employers for educational purposes. We 
would love that opportunity to try that here in New Hampshire.
    Additionally, positioning the VA to be the first intercept 
point for all transitioning service members once they arrive in 
their civilian home State, regardless of VA eligibility, could 
be extremely beneficial. National research shows that the 
suicide rate is lower among veterans who are connected to the 
VA. If service members are required to check in at the VA, 
perhaps in order to obtain a DD-214, when they arrive at their 
civilian home State, they could immediately be encouraged to 
meet with the veteran service officer to determine eligibility 
for benefits, enroll with the VA for services, and access 
State-specific information about a variety of resources 
available. This would serve as a warm hand-off from active 
service to civilian life.
    In addition to a potential collaboration with employment-
focused and workforce recruitment initiatives, there are a 
variety of other opportunities for the VA to partner and 
collaborate with initiatives in our State. One of particular 
importance is the closed-loop referral system currently under 
development by the New Hampshire Department of Health and Human 
Services.
    This Statewide referral system will be available to health 
care and social service providers of all types for the purpose 
of making and accepting referrals and confirming closure of 
successful referrals. Use of this system will result in more 
appropriate and better quality referrals, more timely access to 
services, and valuable data the department will use to identify 
trends and ensure we are meeting emerging needs of New 
Hampshire veterans.
    Two-thirds of New Hampshire's veteran population are not 
enrolled for services at the VA. They are instead receiving 
care in their local communities. The VA Medical Centers can 
enroll in this system to make and/or receive referrals. 
Providers in the VA Community Care Network can be contractually 
required to enroll in the system.
    Making a commitment to this piece of State infrastructure 
will serve to enhance the services and supports available to 
those who will be choosing New Hampshire as their civilian home 
regardless of their VA eligibility.
    We look forward to continuing our partnerships with the 
U.S. Department of Veterans Affairs and our local VA Medical 
Centers to best meet the needs of service members transitioning 
to civilian lives here in New Hampshire. I believe that truly 
impactful outcomes can result from innovative and strong 
collaborations, and my team is inspired by the energy and 
passion we feel from all of our partners here at the table and 
elsewhere. We stand ready to turn that energy into actions and 
outcomes.
    So thank you for your invitation to share my thoughts with 
you today. Pending any questions, this concludes my testimony 
on behalf of the New Hampshire Department of Military Affairs 
and Veterans Services. Thank you.

    [The prepared statement of Ms. Cook appears on page 43 of 
the Appendix.]

    Senator Hassan. Well, thank you very much, Ms. Cook. A good 
partnership going on between SVAC and the New Hampshire 
Department of Military and Veterans Services here, so well 
done.
    Our fifth witness is Paul Lloyd, chairman of the New 
Hampshire State Veterans Advisory Committee. Chairman Lloyd is 
a Navy veteran and also represents the New Hampshire VFW as a 
State adjutant. Thank you for your service, Mr. Lloyd.
    In his role as chairman, Paul Lloyd leads key veteran 
stakeholders and actively participates in public dialog and 
advocacy for veterans' issues.
    Welcome, Chairman Lloyd, you are recognized for your 
opening statement.

STATEMENT OF PAUL LLOYD, CHAIRMAN, NEW HAMPSHIRE STATE VETERANS 
ADVISORY COMMITTEE AND STATE ADJUTANT, VETERANS OF FOREIGN WARS

    Mr. Lloyd. Thank you, Senator, Congressman Pappas, and 
members of the committee. On behalf of the men and women of the 
Veterans of Foreign Wars Department of New Hampshire, thank you 
for the opportunity to provide our remarks on this important 
topic.
    The VFW believes a proper and well-rounded transition from 
the military is one of the most important things our service 
members need in order to ease back into our society. To that 
extent, the VFW places great emphasis on ensuring transitioning 
service members receive the best counseling and mentorship 
before they leave military service. Veterans who make smooth 
transitions by properly utilizing the tools and programs 
available will face less uncertainty regarding their moves from 
military to civilian life.
    The VFW views transition programs such as TAP as key 
stepping stones. The information provided to service members on 
Department of Veterans Affairs benefits, financial management, 
and higher education is invaluable.
    The VFW is happy to see changes that have been made in TAP 
in the past few years to bring a more tailored, personalized 
experience, and increase access to family members. TAP is a 
critical program that should be accessed as early and as often 
as needed by service members and by their family members.
    We are excited to learn this year of outcomes from DOL's 
newly launched Employment Navigator and Partnership Pilot and 
discover the impact of providing individualized counseling to 
help service members find their paths. We look forward to data 
on these results and recommendations for improvement of this 
program and expansion beyond its current 18 locations.
    The VFW is also encouraged by significant changes that have 
been made by Department of Labor to revamp transitioning 
programming available for veterans and those without 
installation access. We are excited by the newly launched Off-
Base Transition Training Program, which will allow both in-
person and virtual opportunities in key geographic transition 
hubs.
    We are also pleased to learn that the VFW's recommendations 
have been heard, and these resources will be interactive and 
provided under a facilitator. The VFW believes that access to 
transition resources and support is integral throughout a 
veteran's journey and should not and cannot be limited to just 
their time in service.
    The VFW's accredited service officers have been a resource 
for transitioning members since 2001 and continue to aid those 
men and women during this difficult time of change. We provide 
pre-discharge claims representation at 24 bases around the 
country and are available for the service members at the same 
time they receive their training in TAP. This service offers 
the opportunity to bridge the gap of health care and benefits 
coverage when leaving active duty.
    While the primary role of the VFW staff in the Benefits 
Delivery at Discharge program is to help service members 
navigate their VA disability claims, they are also able to 
assist with many other benefits and available opportunities, 
disability claims--or opportunities, excuse me.
    Last year, between individual meetings and classroom 
briefings, the VFW met with over 20,000 service members, 
including those transitioning to New Hampshire.
    As part of the 2019 NDAA, DoD established a three-tiered 
evaluation system to allow for a one-on-one analysis of an 
individual's readiness for transition. As a byproduct of these 
evaluations, if a service member is deemed ready for transition 
and has a transition plan for success, the individual can 
choose to forego an otherwise required two-day track focused on 
accessing higher education, vocational training, or employment.
    Throughout 2021, over 60 percent of survey participants 
reported not having completed a two-day focused career track. 
While the VFW is pleased that TAP is providing a more 
individualized approach and increasing overall access, we are 
concerned that service members may be waived of track 
requirements to their detriment.
    We ask Congress to require in-depth reporting on the use of 
this tier system, its impact on track participation, and its 
overall effect on outcomes following transition.
    Additionally, we ask for reporting on military spouse and 
dependent participation and overall outcomes to assess any 
needed improvements to programming tailored to family members.
    Furthermore, within the 2019 NDAA, it was made mandatory 
that a service member was to start TAP no later than 365 days 
prior to separation from the military. While there was a slight 
improvement regarding the timely attendance of TAP, 40 percent 
of service members reported not attending TAP classes at least 
six months prior to separation.
    Additionally, speaking with several veterans, we have found 
that there are situations where this timeframe is impossible. 
Some veterans were denied re-enlistment and were separated 
within 60 days. Some other veterans who were medically retired 
experienced the same problem. The changes that have been signed 
into law were meant to improve the transition of service 
members. Yet, the VFW is greatly concerned some of these new 
mandates are not being adhered to.
    We were pleased with the restructured and enhanced five-day 
TAP classes and are eager to see what improvements the more 
efficient and holistic approach has generated. However, the VFW 
sees additional areas for improvement, such as including 
accredited service officers in the formal TAP curriculum. We 
also want, as the law requires, a connection made between the 
service members and resources in the community to which they 
are transitioning.
    With the recent implementation of the Staff Sergeant Parker 
Gordon Fox grant program, these connections with organizations 
in the community is increasingly important. We would also like 
the timely return of TAP classes to an in-person format across 
DoD.
    Senator Hassan, Congressman Pappas, this concludes my 
testimony. I'm prepared to answer any questions you or the 
committee members may have.

    [The prepared statement of Mr. Lloyd appears on page 48 of 
the Appendix.]

    Senator Hassan. Thank you very much, Chairman Lloyd. We're 
now going to proceed. I'm going to ask some questions for about 
seven minutes, and then Congressman Pappas will have a round, 
and we'll go back and forth.
    My first question I'm going to start directing to you, Ms. 
Rawls, and to you, Mr. Lilly, about the particular importance 
of connecting veterans to VA services, and then I will likely 
ask you a follow-up about it, Chairman Lloyd.
    So I am working to ensure that veterans can access VA 
services, which is why I am pushing to advance my bipartisan 
Solid Start Act. And as Ms. Rawls talked about the Solid Start 
program, it connects service members separating from active 
duty to VA services and benefits. What the act will do is make 
that a permanent program under law.
    I also led a separate bipartisan effort to urge the VA to 
conduct outreach to veterans of The Global War on Terrorism to 
connect them to mental health services last year. More than 
10,000 post-9/11 veterans call New Hampshire home, and they 
face unique health care and benefit needs.
    Ms. Rawls and Mr. Lilly, what is the VA doing to ensure 
that post-9/11 veterans, including those who served in Iraq and 
Afghanistan, are connected to VA health care and benefits? Are 
there particular challenges with expanding the VA patient base 
that Congress could help alleviate?
    Ms. Rawls. Thank you, ma'am, for that question. I'll start 
out, and then I will tag team with my----
    Senator Hassan. That's great.
    Mr. Lilly. Sure.
    Ms. Rawls [continuing]. My partner, if that's okay with 
you?
    Mr. Lilly. Of course.
    Ms. Rawls. So for the post-9/11--and the number of people 
that we actually have here in the State of New Hampshire, there 
are approximately 8,000, as you mentioned, that are veterans 
here. And we do have approximately 3100 that are drawing 
compensation claims and benefits. And when we drilled down to 
the post-
9/11, we do have a little less than--I want to say about 1800, 
that we are continuing to reach out and know that they are on 
the roll, and those are the veterans that we can capture right 
now, those that have actually filed a claim.
    When you connect that to that larger picture of transition, 
as you mentioned, we have brought in a standardized process of 
connecting at least a year before and continuing a year 
afterwards and engaging with the Solid Start.
    We do have the opportunity before with the one-day TAP 
program, the modules that I mentioned, but also the 
opportunities for the individuals to have one-on-one meetings 
with our benefits advisors that are rotating out of the service 
now. We know that that's not enough, but we are continuing to 
look to ensure that we put those things in place for Solid 
Start. So we are identifying them and capturing what service 
area that they're coming from.
    And from a local and regional perspective, I'll hand it off 
now to Director Lilly to talk about.
    Mr. Lilly. Sure. Yes, so we're certainly working hard to 
first identify them and then work with them to encourage them 
to apply for health care on the VHA side.
    It's a challenge as years go by. So we've talked a lot 
about TAP briefings and things, where immediately post-
deployment or post-service. And then as the years go by, this 
is really where our partnership with the State and with the VFW 
and the other VSOs really takes on more meaning, because 
they're more likely to help us find them, frankly, and then we 
can reach out to them.
    As far as your second question about any particular 
challenges. So we've always thought that's a good problem to 
have. So, you know, we are open for business at all of our 
sites of care here in New Hampshire and taking new patients 
everywhere. So there's no particular short-term challenges. If 
every single veteran enrolled that was eligible, we would 
probably hit capacity and add more sites of care, frankly. So 
that would be another good problem to have from my perspective.
    Senator Hassan. But in terms of specifics about what--are 
there things that Congress can be helpful with at this point in 
terms of alleviating some of the barriers or disconnects here?
    Mr. Lilly. Yes, so for me, getting a binding list is the 
most helpful thing. So we often have that at discharge. If 
their DD-214 goes to the State, if we can get access to that 
and overcome some of the privacy issues of just handing that 
list directly to the VA so we can directly outreach to them, 
rather than trying to catch them at a more global event.
    Senator Hassan. Thank you. Mr. Lloyd, so I just also want 
to hear the perspective of New Hampshire veterans. What's the 
VA doing to connect veterans from Iraq and Afghanistan with VA 
health care services? Do these veterans face particular 
challenges that Congress could help address?
    Mr. Lloyd. So I'm not aware of any--anything that you 
could--Congress could do to complete--knock down any barriers. 
The folks that I have talked to, whether it's Vietnam veterans 
or post-9/11, it's: ``I don't need those services. Somebody, 
you know, might need them more than I do.''
    Senator Hassan. Yes. So I think part of the message there 
from what I'm hearing from our folks in the VA is we've got the 
capacity to help them, and our job is to worry about making 
sure we have the capacity to help everybody.
    Mr. Lloyd. Correct. And a lot of the VSOs, you know, they 
push back on that with, ``you know, that's not how it works; 
this is how it works.''
    Senator Hassan. Yes, got it. Well, thank you. And I 
apologize, I think talking close to the mic is helpful, too. 
I'm going to ask one more question that may go over a little 
bit, and then I'll turn it to Congressman Pappas.
    This is directed to you, Mr. Lilly. In March, the VA 
released its recommendations to the Asset and Infrastructure 
Review Commission, which will focus on evaluating VA 
facilities.
    I am concerned that the recommendations could reduce access 
to care for veterans in New Hampshire, including rural 
veterans, given the VA's proposed closure of clinics in 
Littleton and Conway.
    Furthermore, the proposal to move outpatient surgical care 
from Manchester to community providers is a top concern of 
mine. VA services should be bolstered, not moved outside of the 
VA.
    I raised my concerns directly with Secretary McDonough, 
urging him not to decrease access to care for Granite State 
veterans. And today, I raise these same concerns here and 
respectfully disagree with many of the VA's recommendations.
    The VA's own data show an increase in demand in every 
category of care for New Hampshire, including primary care, 
mental health, specialty care, and inpatient surgery. Yet, the 
recommendations do not reflect VA investment in these health 
care services.
    So Mr. Lilly, will you commit to working with my office to 
ensure that we have the data and information we need from the 
VA to address our concerns with the VA's recommendations?
    Mr. Lilly. Certainly.
    Senator Hassan. Thank you. I'm committed to ensuring that 
veterans receive the care that they've earned and deserve from 
VA facilities in New Hampshire, and I look forward to pushing 
more on this issue.
    A follow-up to Chairman Lloyd. These recommendations impact 
all Granite State veterans, including those recently separated 
from service. Chairman, can you please speak to the concerns 
veterans have with the VA's recent recommendations for VA 
facilities?
    Mr. Lloyd. Yes, ma'am. The--I'll pick on Conway, the CBOC 
in Conway.
    Senator Hassan. Yes.
    Mr. Lloyd. Pushing veterans out into the community might 
sound like a good idea, but, you know, the community care 
program, we have a veteran, one of my members, lives in 
Lancaster and needed a podiatry appointment, and they were 
going to send him to Albany, New York, for an appointment. 
Obviously, he pushed back on that. That's not an ideal 
situation at all.
    Senator Hassan. Thank you. Congressman Pappas.
    Mr. Pappas. Well, thank you very much. I had some similar 
questions about the AIR Commission. I appreciate, Paul, your 
perspective there. I was up at the Conway CBOC recently, got to 
meet the team there, and they are terrific. So Kevin, you are 
to be commended for the work that goes on there.
    And look, I think community care is an important 
development, but it by no means should take the place of VA 
health care. It should be a force multiplier for VA, and should 
also allow us to capture more folks to sign up for VA care. So 
I look forward to continuing to connect with both of you about 
VA health care in this region.
    I'm wondering if you could address at all, Mr. Lilly, the 
issues that were identified by the market analysis. I know that 
this didn't take into consideration a number of factors that I 
think the AIR Commission should look closely at.
    First, I believe the cost of community care was not part of 
the formula. If we're sending veterans to the community, that 
could escalate costs for VA and not constrain them.
    Number two, you know, I think that this doesn't capture the 
direction that we hope to go in, which is to provide more 
connection to service, especially for those who have been 
exposed to toxic substances as a result of their service to 
this country, which we know could increase demands for VA 
health care.
    So I don't know if you can reference what that market 
analysis took into consideration.
    Mr. Lilly. Sure, yes.
    Mr. Pappas. And, you know, how we might better represent 
the full picture.
    Mr. Lilly. Sure, I'd be glad to. So first, let me just 
state a personal bias. I have a strong, personal bias toward VA 
as the provider of health care for veterans. So to sort of know 
that as part of what I'm about to say.
    So the VA did publish standards for volume, essentially. So 
there is a link between volume and quality, and then volume and 
efficiency, obviously. And generally speaking, the more you do 
of something, the better you get at it. And so there was a bias 
toward having some level of volume at a particular site of care 
for a particular service, which really became the foundation of 
some of the recommendations, including some that you both 
mentioned as--and Paul mentioned as the most objectionable.
    And reasonable people can certainly reasonably disagree on 
whether those were the right volume targets, and there are--you 
know, specific to Conway, for example, there are a number of 
possible ways to provide veterans' health care in Conway. That 
may, in fact, be a VA clinic. That may be some sort of private 
clinic working with VA in some cooperative fashion.
    So to me, this is really the beginning of the conversation. 
Now that we've laid out that this is an option, we should 
really evaluate this, absolutely.
    So the market assessment looked mostly at projections into 
the future for demographics in terms of what's happening with 
veterans' population in terms of the size of that population. 
Is it growing or shrinking? And then what type of services 
should those veterans need into the future.
    It did not, as you pointed out, Congressman, include a 
robust analysis of the cost, and I would expect that would be a 
primary function of the AIR Commission. As they're evaluating 
all the recommendations, they should say, how much would this 
cost relative to how much it would cost for the VA to provide 
that care, and we certainly look forward to participating in 
those discussions.
    Yes, I'm strongly in favor of VA care everywhere. 
Everywhere it makes sense economically, and certainly it makes 
the most sense from a quality perspective.
    Mr. Pappas. Well, I am too, and I share the concerns 
expressed by Senator Hassan. I know our House Veterans' Affairs 
Committee is intending to continue to dig into this issue.
    I personally will continue to communicate with the upper 
levels of the department and the secretary to make sure that 
folks understand and appreciate the dynamics here in New 
Hampshire, which are at play. And I think it's very relevant to 
the conversation we're having here today, because the 
statistics don't lie.
    Veterans that are connected to care and benefits and 
services through VA are much less likely to experience suicidal 
ideation, homelessness, addiction after their service. And so 
this is important to get right.
    So I appreciate the analysis that's gone on, but when you 
get out there and go across New Hampshire, we know there are 
people who are already traveling distances that are far too 
long to get to a VA facility. We know there are already far too 
many veterans who can't easily access VA care or services in a 
community near them. So we've got to take steps forward and not 
be undoing the good work that has been done over the last many 
years.
    Maybe I can switch gears here in the few minutes that I've 
got left for this first round, and just talk, maybe I can start 
with you, Ms. Rawls, about the pandemic experience over the 
last few years and the impact that has had on the Transition 
Assistance Program and other vital programs for veterans. I'm 
wondering if you can comment on sort of how some of these 
efforts have been taken virtually, and if that has created new 
barriers for veterans to get connected to the support they 
need.
    Ms. Rawls. Thank you very much for the question, sir. The 
pandemic really did allow us to magnify and pivot our online 
training. And so taking a page out of the online training, as 
was mentioned, that many times service members are not in the 
right space to be able to attend the in-person transition 
training. We already had an online training available that you 
could access.
    So we pivoted from there and created a virtual instructor-
led online program. And that came into existence probably about 
nine months, you know, after we were all taken aback by the 
pandemic and the posture it put us in.
    So now what we have is three different offerings of 
transition for the one-day VA. You have the in-person, which is 
now--its installation has opened up worldwide. Our benefits 
advisors are out there and they're providing the in-person, but 
you have the instructor-led, in-person training now and the 
online training that is there. We are still in the early stages 
of getting feedback on how successful the instructor-led 
program is, but we are getting feedback that it is right up 
there with industry standards and customer satisfaction.
    So we're continuing to look to make those improvements and 
working with our DoD installations to offer them in-person.
    Mr. Pappas. Perfect. Thank you for that. And, you know, if 
I can turn to the other witnesses here and just ask about 
virtual access, how that's working for veterans for, you know, 
a range of programs that are out there, and if there are 
continued barriers that we need to work to address to make sure 
that vets have access to the technology.
    Mr. Forrest. Thank you for the question. You know, virtual 
care, our Connected Care program is certainly part of our 
health care delivery system and will be into the future. You 
know, I'm proud of the VA for having an active position in that 
before the pandemic, and I think the pandemic certainly sped 
that up and allowed us to see veterans, you know, for health 
care needs at an accelerated rate.
    I think what we do now is, you know, we continue to exploit 
those technologies and get it out to veterans, especially in 
rural areas, not as a substitute, but to be able to augment 
care and provide that care to veterans.
    We've been very focused on providing care to veterans in 
the way they want to receive it and whether that's face-to-face 
care or virtual care, and it's really a mix. It's an 
independent decision sometimes, you know, based on veterans, 
which if I go back to, you know, why--I watch very closely 
where clinics are located and that we're able to provide that 
care throughout our whole area of responsibility. It's 
important to me.
    We do need to continue to look at providing training for 
veterans to be able to use that technology. Sometimes, you 
know, our older-generation veterans sometimes have challenges 
with that, which is why it's important for our outreach teams 
to go out and they've trained individuals, you know, train 
veterans on how to use that technology.
    And then also making sure that the bandwidth exists 
throughout the entire area, because, you know, with no 
bandwidth, there is no virtual care.
    Mr. Pappas. That's right. Well, thanks for making those 
points. I share your concern there, and hopefully we have some 
additional opportunities in New Hampshire to close those gaps. 
I'll give it back.
    Senator Hassan. Thank you so much, Congressman. I'm going 
to start this round with a question to you, Mr. Forrest, about 
the VA Caregivers Program.
    Many service members and their families need VA's programs 
once they transition to civilian life, and one of these 
programs is the VA's Program of Comprehensive Assistance for 
Family Caregivers, which provides financial assistance, as well 
as access to training and counseling to the family members who 
play a critical role in caring for veterans severely injured in 
the line of duty.
    Iraq War veteran, Eric, who is here today, and his wife, 
Jennifer McNail, of Littleton, were kicked out of the VA 
Caregivers Program after eligibility requirements were narrowed 
by the previous administration. After hearing how those changes 
impacted Granite State veterans and their families, I led a 
bipartisan effort with my colleagues asking the VA to reverse 
the previous administration's changes.
    I was glad to see the VA announce in March that it will not 
remove anyone from the program before they reexamine the 
eligibility criteria for the program. I was also glad to hear 
that the VA implemented a plan to call legacy participants and 
their caregivers to inform them of the pause of this 
cancellation of their benefits, and I know that you and your 
team recently made calls to Granite State veterans, so I'm very 
grateful.
    Will you commit to continuing to work with my office to 
ensure that we coordinate and continue to provide the most 
accurate information to veterans and their caregivers about the 
status of the program and their eligibility?
    Mr. Forrest. Absolutely, Senator Hassan. You know, I'll say 
last week, as those--as that communication went out, those were 
some of the best phone calls that the caregiver support team 
made in a long time and felt committed to really giving some 
comfort to, you know, veterans who had caregivers enrolled in 
that program.
    You absolutely have my commitment to be transparent and to, 
you know, continue providing information on the future state of 
the Caregiver Support Program and how we will deploy that 
through New Hampshire and really make sure that the veterans 
are taken care of.
    I would also add that I think it's so, so important with a 
program like this, as we look at providing care to veterans and 
actually keeping them out of institutionalized care----
    Senator Hassan. Yes.
    Mr. Forrest [continuing]. In a time when long-term care is 
a challenge, not only in the VA, but, you know, throughout the 
health care system. And whatever we can do that, you know, 
allows a veteran to stay in a home at a significantly less cost 
than a long-term care facility is great for quality of life 
and, you know, for the veterans.
    So yes, you have my commitment, certainly.
    Senator Hassan. Well, and I thank you for that, and I share 
your commitment to home-based care and community-based care 
wherever possible. This is a challenge not only in the 
veterans' community, but for the community at large.
    Ms. Cook, I wanted to turn to you. Both as a Senator and as 
a former Governor, I have focused on bolstering employment 
opportunities for service members transitioning to civilian 
life and veterans.
    I was glad to see that the President signed into law my 
bipartisan Hire Veteran Health Heroes Act directing the VA to 
recruit and hire Department of Defense medical personnel who 
are transitioning out of military service for open positions at 
the VA.
    Additionally, I introduced the Federal Cybersecurity 
Workforce Expansion Act, which would provide cybersecurity 
training for veterans, with a focus on employing veterans in 
the Federal Government. As you know, we need cyber experts 
pretty much everywhere, but we certainly need them in the 
Federal Government.
    Your work has also focused on this issue. As you noted in 
your testimony, in 2020 New Hampshire launched the Veteran-
Friendly Business Recognition Program, which focuses on 
matching veterans with jobs.
    From your perspective, what are the obstacles service 
members transitioning to civilian life face in terms of finding 
employment, and how can we learn from the challenges and 
successes in New Hampshire and make improvements in programs 
and coordination between the Federal, State, and local levels?
    Ms. Cook. Thank you for that question. We are extremely 
excited about the network that we've put together already, and 
it's going to be moving forward an instrumental tool in New 
Hampshire to address all of those problems.
    One of the things that the network has identified--so the 
business is--the network consists of businesses that are 
recognized, and then also some partners that we've brought in. 
So the U.S. Department of Labor goes to these network meetings. 
ESGR is part of that. Business and Economic Affairs in New 
Hampshire is part of it.
    So we have partners and the businesses that have been 
recognized. And some of the discussion that has gone on has 
been about educating employers. So how do they look at resumes 
and translate those military skills into positions that won't 
result in underemployment.
    [Microphone malfunction.]
    Senator Hassan. Try it again.
    Ms. Cook. Paul taught me. You just give it a little whack.
    Senator Hassan. My dad always said the Army fixed 
everything, so . . .
    Ms. Cook. So we were talking about just education for 
employers, number one, right? So they're looking at resumes. 
Sometimes when people are writing resumes coming out of the 
military, they're not--the communication between what--the 
skills that they have and their talents and what they're able 
to do in their experience isn't then being translated to the 
other side.
    And so that's no fault of their own, but we're working with 
the employers on the other side to learn about, how do you take 
this type of experience, how do you translate it into something 
that's meaningful and matches what they can do.
    There's a lot of different programs. Another aspect to that 
that we're working on is to get the word out about all the 
programs that are available. So the Department of Defense has 
SkillBridge. There's apprenticeships. Some of the businesses 
that we've recognized have some amazing programs. BAE Systems 
in New Hampshire, you're familiar with, has a Warrior 
Integration Program that is just, you know, state-of-the-art.
    So we want people who are transitioning into civilian life 
to know about those ahead of time. We're trying to get that 
word spread before they even choose New Hampshire, because we 
think it's one of the reasons they should choose New Hampshire, 
is there is a lot of opportunities here for them.
    So getting the word out, and then education for that 
employer, the employer side, and the private sector.
    Senator Hassan. Well, thank you for that. Ms. Rawls, I 
wanted to just follow up and give you an opportunity, from your 
perspective, how can the VA learn from initiatives in New 
Hampshire to help with partnerships between the VA and the 
public and private sectors?
    Ms. Rawls. Thank you very much for that question. As I was 
listening, I couldn't help but think that one of the items that 
we all have to wrap our brain around is being able to talk up 
the great things that we are doing so people will know and be 
able to connect our transitioning service members to all of 
these SkillBridge programs.
    The SkillBridge program that is offered at every transition 
site depends on the local companies that are working in that 
area. The VA has its own SkillBridge program in which they look 
to bring in others, whether it's health care or to become 
veteran service representatives.
    The notion that we can do too much has to go away, and we 
all have to think that we are going to repeat that message over 
and over again for people.
    I think having an opportunity to talk about how we are 
connecting transitioning service members to them and allowing 
the companies to know that there are skill sets that can be 
useful to them, we have to keep putting that out there for 
those companies, so they can make it a lot easier for those 
transitioning service members to acclimate within their culture 
and their community.
    Senator Hassan. Well, thank you. I am well over my time. I 
am going to come back for a third round, because I want to get 
to the issue of suicide prevention, among other things, but I'm 
going to turn it over now to Congressman Pappas.
    Mr. Pappas. Thank you. And Ms. Rawls, maybe I can just ask 
a follow-up on one program I wanted to highlight, is the VRRAP 
program, the Veteran Rapid Retraining and Assistance Program, 
which offers education and training for high-demand jobs, 
including things like health care, education, and engineering 
to veterans who are unemployed or underemployed.
    And I'm wondering what steps you think we need to take to 
make sure that folks know about this program; that there's 
greater awareness. I believe it's underutilized but holds a 
great degree of promise.
    So could you offer some comments on that particular 
program?
    Ms. Rawls. Yes, sir, and thank you very much. This program 
just came about and grew so quickly, but you're absolutely 
right, and we need to be better at getting this information out 
there to the community about the offerings for VRRAP and 
allowing our transitioning service members and veterans to know 
that everyone and anyone that they come to can be a door for 
them to have access to the VRRAP program.
    So again, I believe in having, you know, opportunities like 
this to talk up that program and to partner with our State 
VSOs, as well as all of our national veteran service 
organizations, to push that information out there. Thank you.
    Mr. Pappas. Thank you. Ms. Cook, I don't know if you wanted 
to comment at all on that one.
    Ms. Cook. Yes, I just wrote a little note to myself that if 
I had the opportunity, the--all of the--the programs that are 
out there, specifically in New Hampshire, we're working with 
the Office of Public Licensure--Professional Licensure, and 
military skill waiver programs. So one of the things that we're 
doing at the State level, we've actually hired a position, a 
full-time position, to work on exactly that and to get the word 
out.
    We're trying to connect at this point in time with some of 
the Transition Assistance Programs to let--to sort of partner 
with them in a way that we can let people going through those 
programs know specifically about what New Hampshire has to 
offer. And part of that would be letting them know that they 
can take advantage of programs like Troops to Trucks in New 
Hampshire to boost that critical workforce. There's some 
programs that we're trying to get established for LNA licensure 
to be easily transferred over.
    So there's going to be some opportunities coming up in the 
near future that we're definitely going to be very interested 
in getting the word out and about, and I think it'll help the 
whole transition process.
    Mr. Pappas. Thanks very much for those comments.
    My office receives requests from a lot of veterans who need 
help in accessing their military records, and that's something 
that's become a real acute problem during the last couple of 
years. The backlog for retrieving these records from the 
National Archives, National Personnel Records Center, has been 
just an ongoing challenge for a lot of years, but we know it's 
worsened during the pandemic.
    My office is in touch with one veteran who's been waiting 
over a year for military records. That's an extreme case, I 
think, but unfortunately, there are others like it out there. 
And so something has to be done to address this.
    And I'm just wondering, maybe I can start with you, Ms. 
Cook and Mr. Lloyd, if you have comments on access to military 
records, and how important that is for individuals then to get 
the care and services that they need.
    Ms. Cook. Yes. My comment will be extremely short, because 
it's sort of out of my realm of knowledge, to be quite honest. 
But I do know at the Department of Military Affairs, we have a 
full-time person who does help to do that. So he's kind of my 
go-to--when the question comes to me or comes across my desk, I 
would just pass that over to him.
    So we often hear about the same types of stories, that 
people are just facing some challenges, and we try to do the 
best that we can to help them through it, but . . .
    Mr. Lloyd. Thank you. I'm not sure how to fix it. I know 
that I have three on my desk waiting, and I have been waiting 
for about 18 months for it. And it's not for health care. It's 
more for membership in the organization, but we're still 
waiting 18 months out, which is just a bit ridiculous.
    Mr. Pappas. Yes, I agree with those comments. It's very 
ridiculous, and I know our offices work very closely with a lot 
of veterans who reach out. We encourage folks to do that if 
they need assistance accessing records, but we certainly have 
to work on some of the systems to make sure that can happen in 
a much more timely fashion.
    Ms. Rawls, I don't know if you wanted to address that.
    Ms. Rawls. I am in agreement that we are going through this 
from the remnants of the pandemic, but I also wanted to just 
note that one of the things that the director did in the St. 
Louis regional facility was actually to put employees in the 
facility to work through it as we were going through that 
pandemic, and we also pushed through getting the vaccinations 
for those employees so they could be in that building.
    The secretary worked really hard on ensuring that the 
employees were safe and that they could transition that skill 
set to move those files as quickly as possible. And I know 
we've put a lot of effort in it, and we've seen significant 
results there in just crossing over and integrating with DoD in 
getting those records.
    Mr. Pappas. Thanks. Well, we'll continue to stay in touch 
with the administration on this one. It's really important for 
vets here in New Hampshire. I yield back.
    Senator Hassan. Well, thank you, Congressman, and thank you 
all for testimony on that issue. I do want to turn now to the 
issue of suicide prevention.
    VA data shows veterans are most vulnerable in their first 
three months following separation from military service, and 
suicide risk remains elevated for years after their transition.
    Furthermore, New Hampshire's veteran population has a 
higher incidence of suicide than the national veteran 
population and national general population.
    One way veterans get connected to mental health services is 
through their fellow veterans, and that's why I introduced 
legislation with Senator Ernst, a veteran herself, which 
directs the VA to designate a National Buddy Check Week to 
expand the efforts of volunteer veterans at peer-wellness 
checks, and I was glad to see that the Senate passed this bill 
recently.
    We know that connecting service members transitioning to 
civilian life to VHA services is instrumental in suicide 
prevention.
    Kevin, how is the VA Medical Center in Manchester 
conducting outreach to service members transitioning to 
civilian life about the VA services available to them? Are 
there additional resources you or volunteers need to more 
effectively target service members and veterans?
    Mr. Forrest. Thank you for that question, Senator Hassan. I 
think this goes back to what Mr. Lilly had mentioned about our 
aggressive outreach campaign during TAP, and actually, at all 
the community events that are here.
    This is also part of our zero suicide initiative here in 
this State and our partnership with the community, where it's 
not just the VA; it's an entire network of all of us to 
identify at-risk veterans to make sure that they're aware of 
the resources that are available to get the health care that 
they need.
    I think when we look at that Military2VA program, which I 
had mentioned in my opening comments here, it's a program like 
that where our social work team that comprises that program has 
the direct link from a VHA liaison, you know, at a DoD facility 
that identifies at-risk veterans as they are departing the 
service and being able to link them up with the right 
appointment or mental health appointment, you know, before they 
even get to their final destination, is the step in the right 
direction. But that takes resources.
    We continue to bring our--recruit for a social work team to 
be able to provide that support. It's a lot of hard work, and 
they do wonderful, wonderful work with that, but I think in 
being able to do that is one direct way.
    The indirect way, I would add, is having veterans reach out 
and campaign--or reach out to their fellow veterans and make 
them aware of our services. And this is why we focused on our 
Stand Up to Stigma series that we've done here, and we've 
brought, you know, very influential veterans and other members 
of the community to speak to not only our staff but to veterans 
throughout New Hampshire about reducing mental health stigma 
and why it's okay and the resources that are available. And 
that's just been such a powerful message, really, I think, of 
us as a team tackling this problem--program--or problem in 
making sure that veterans come to the medical center in their 
greatest time of need.
    Senator Hassan. I'm going to ask Mr. Lloyd and Ms. Cook 
just to comment on this too, if you'd like to, before I move on 
to another question.
    Ms. Cook. Thank you. A couple things I would add to suicide 
prevention efforts in New Hampshire. It's something that we're 
always, every day--everything we do at the Division of 
Community Based Military Programs is looked at through that 
lens.
    We have the Ask the Question campaign in New Hampshire 
that's been nationally recognized in the past year. I've met 
with about 15 or 16 different States to help them launch their 
own Ask the Question campaign. New Mexico yesterday, I spent 
some time on the phone with them, helping them figure out how 
to do that.
    So that's a really important--it asks the question--and 
some people mix up Ask the Question in terms of, are you at 
suicide risk, with, have you previously served? So when I say, 
Ask the Question campaign, I'm referring to, have you or a 
family member ever previously served?
    But it is a suicide prevention effort, because community-
based programs need to know if there's any kind of military 
connection there, and it can just open the door for 
conversations that can then identify any potential suicide 
risk.
    We also were--New Hampshire was one of the first of seven 
States in 2018 to participate in the Governor's Challenge to 
Prevent Suicide among service members, veterans, and their 
families. And now they have--almost all the States have 
participated at this point, but through that, we created a team 
of about 50 people who've been actively working on suicide 
prevention strategies throughout the State of New Hampshire for 
the past few years. And we merged with the New Hampshire 
Suicide Prevention Council.
    So why that's important is because we're aligning efforts. 
We have so many organizations in New Hampshire, you know, 
Federal partners, State partners, locally based programs, and 
we all need to be moving in the same direction. So if we all 
have different programs, and we're really proud of them, but 
we're not talking to each other, we're not moving as fast-
forward as we could.
    So our role in that council and that committee has been to 
try to bring everybody to the table so we can align our 
efforts; we can braid our resources, Federal resources, State 
resources, private sector resources, and really start to move 
the needle in that.
    Senator Hassan. I appreciate that. And Chairman Lloyd, VSOs 
have been just incredible leaders, including the VFW. Almost 
every meeting I have with a VSO in this State, the first thing 
they ask me about is to work harder on suicide prevention 
resources. So I'd just love your thoughts, especially about the 
importance of peer-to-peer outreach.
    Mr. Lloyd. Yes, and so peer-to-peer, buddy check, those all 
work and have been working for years within the organizations: 
VFW, American Legion, DAV. Just having conversations with other 
folks and you know that they went through the same kind of 
stuff. So those really work, and nationalize them, and it seems 
to be helping as well.
    Senator Hassan. Good. Thank you. I'm going to use a little 
bit more time to get through a couple more questions, and then 
I will--we'll turn back to Congressman Pappas, and then offer 
you all a chance to wrap up.
    But Chairman Lloyd, I wanted to talk with you about some 
benefits issues that I know have been a concern for you and 
your members. Together we raised the issue of veteran service 
organizations' reviewing benefits claims and the backlog of VA 
claims.
    Are there particular challenges that service members 
transitioning to civilian life encounter when they are 
navigating VA benefits? How can Congress help alleviate these 
challenges?
    Mr. Lloyd. So one of the things that we have seen with 
service officers, we don't have a service officer at every 
installation. The benefits at delivery, at discharge and 
delivery, the BDD one, it's left up to the installation 
commander whether they will allow the VSO on base or not. If 
somehow or other we could get that so that each installation 
has a VSO available for their TAP program, I think that would 
be a goal on a way to help.
    Senator Hassan. Thank you. I want to turn to you, Mr. 
Lilly, again, on drilling down on health care for post-9/11 
veterans.
    I introduced legislation that would provide health care to 
veterans exposed to toxic substances. Additionally, I supported 
legislation that focuses on the health care needs of post-9/11 
veterans. I am particularly concerned about veterans who served 
during the Global War on Terrorism with unmet health care needs 
and health conditions who have not yet--conditions that have 
not yet exhibited themselves.
    How is the VA analyzing and focusing on the future health 
care needs of post-9/11 veterans?
    Mr. Lilly. Sure. Thanks. So it's important for post-9/11 
veterans first to enroll for care in the VA, and then 
ultimately to have a registry exam, which we encourage all 
post-9/11 veterans to do.
    That's important, because knowledge is upstream of 
treatment. So we first need to understand better what health 
conditions veterans that are post-9/11 have had, burn exposures 
or other toxic exposures, what are the unique health care 
conditions that they are presenting with, and then treatment 
ultimately follows that. So that's the most important piece, is 
to enroll with us and have a registry exam so we can start to 
see what we're dealing with here clinically and then begin to 
treat it.
    Of course, once they're enrolled for health care, we will 
begin treating them for whatever they have, or what we know 
they have, but often these things, as you know, take many years 
to emerge. So it's important for us to get a knowledge-base 
start and so we can really provide better treatment down the 
road.
    Senator Hassan. Thank you. One additional question to you, 
Director Lilly, and then I'll turn back to Congressman Pappas.
    Many veterans benefit from getting their care at VA 
facilities, because they keep and form relationships with their 
fellow veterans who receive care and volunteer their time at VA 
facilities. Service members, their families, and veterans have 
unique needs that require health care providers who understand 
the special challenges of those who have served. And earlier 
when you were answering one of our questions, you talked about 
your own belief that it's preferable for veterans to get health 
care at VA facilities.
    Can you please just drill down on that a little bit?
    Mr. Lilly. Sure.
    Senator Hassan. Speak to why veterans are best served by VA 
providers who understand the context of their service, 
especially when they're transitioning into civilian life.
    Mr. Lilly. I'd be glad to, and I probably should have 
mentioned before, this is not a belief that is just sort of out 
there. This is really founded in 20 years of experience of 
seeing veterans and seeing outcome data that shows the quality 
of care for veterans is better when they get their care through 
the VA.
    So there's clearly a quality component. So veterans, 
there's any number of studies that show VA health care 
quality's comparable to or better than the private sector. But 
what you're talking about also is the experience of care, and 
there really is nothing like a VA facility in terms of the 
ability for veterans across generations, across periods of 
service, to share camaraderie and talk about their experiences 
together.
    We've mentioned suicide prevention and the importance of 
the buddy system. That extends to not just suicide prevention, 
but really all types of care that they receive from the VA. And 
it's a vitally important part of their recovery, frankly, is to 
be around other veterans. It's one of the things that makes VA 
special, and it's one of the reasons I strongly favor VA care.
    Senator Hassan. I appreciate that very much, and I am 
committed to ensuring that Granite State veterans get the 
unique care that they need at VA facilities here in New 
Hampshire, so I look forward to continuing to work on these 
issues with you.
    Congressman.
    Mr. Pappas. Thank you, Senator. I just have a couple 
additional questions here before we close.
    One issue I wanted to draw attention to is the issue of 
accreditation of individuals that, you know, help veterans who 
are accessing VA benefits.
    We know that for many veterans filing a disability claim, 
it can be a very long and cumbersome process. According to the 
VA, it takes five months on average to complete a disability-
related claim. And VSOs, like the Veterans of Foreign Wars, 
like the American Legion, and DAV, offer free assistance to 
veterans who need help navigating this process. But we also 
have seen a number of unaccredited, for-profit companies that 
are using aggressive marketing tactics, and deceptive tactics 
as well, to draw veterans in, and often are charging them 
thousands of dollars for services that VSOs can provide for 
free.
    So our House Veterans' Affairs Committee, our Subcommittee 
on Oversight and Investigations, is going to be holding a 
hearing on this topic next week. We'll be examining how VA's 
oversight of the individuals and organizations who assist 
veterans with their disability claims can be strengthened.
    I'm especially concerned about some of the feedback I've 
received from veterans in New Hampshire about these 
unaccredited companies that are charging veterans excessive 
fees just to help out with disability claims when we know 
there's so many other folks out there who can assist.
    So maybe I can turn to some of my New Hampshire experts 
here. And Ms. Cook, I don't know if this is an issue that 
you've heard about, but as we move forward, we'd appreciate the 
opportunity to connect about how to get the right information 
out to veterans so that, you know, they're able to, you know, 
file a disability claim if they need to without being charged 
thousands of dollars.
    Ms. Cook. Yes, we have the same concern, and we've heard 
many of the same stories. We have the Division of Veterans 
Services at our department, and they have a staff of VSOs that 
work across the State, again, free of charge. There's no cost. 
And so we often--when we hear those stories, we're always 
telling people, you know, we have--you can get that for free, 
really quality services with people who do it every day, so 
they're experienced. They know what they're doing.
    So we try to message them as much as we can. We certainly 
will appreciate any extra help to spread--you know, spread that 
word and pass some laws about that. So yes, we're on the same 
page with you.
    Mr. Pappas. Thank you. Mr. Lloyd?
    Mr. Lloyd. Yes, we have run into a lot of them. I won't say 
a lot of them, but the lawyer part of it, look into--do the 
appeals. That's where we're seeing a lot of it now is the--some 
lawyers out there, willing to do the work to get the appeal and 
make sure that they're guaranteed, you know, an uptick in their 
disability, raising their disability, if you will.
    It's just disheartening that when that does come to 
fruition, the veteran doesn't get anything; it all goes to the 
company that did the work because of their legal agreement.
    Mr. Pappas. And Ms. Cook, maybe I can follow up on that 
topic, because I know that veterans contact our office 
oftentimes looking for pro bono legal services specifically 
geared toward veterans, and, you know, the individuals may need 
help filing a claim or starting a business or, you know, 
navigating VA somehow. And it's no surprise, because laws and 
rules determining a veteran's eligibility for certain programs 
sometimes can be very complicated. So I know that the nonprofit 
organizations that used to be equipped to provide these kind of 
services no longer have the same capacity to provide this 
support. Could you educate us a little bit on that, and do you 
have any thoughts about a solution?
    Ms. Cook. It's a problem. We definitely need to build some 
capacity in that area. The programs that used to do those pro 
bono services, legal services over the years, the people who 
have been really leading that have either retired, you know, 
moved on. Then COVID, we lost some people there.
    So we've been actually--it came up in conversation just a 
couple weeks ago in our department to start looking a little 
more strategically at that for the future. There's some 
initiatives going on in New Hampshire right now that I think 
may provide an opportunity to revise some of that, to boost 
some of that, and enhance capacity.
    So we're really in the infancy stages. There's not even 
anything to share in terms of details, but it's something that 
we're monitoring, looking at, and trying to think strategically 
about the future for. So it's definitely on our radar.
    Mr. Pappas. Well, thanks for those comments. It's an 
important issue, and we look forward to hearing more about how 
things move forward. I yield back my time.
    Senator Hassan. Thank you so much, Congressman. So that 
concludes the questions that we both have had, but I wanted to 
give each of the witnesses an opportunity to make one final 
recommendation to Congress and other policymakers on how best 
to support service members.
    So is there one recommendation each of you would make that 
you would want to highlight for policymakers on how to better 
support service members transitioning to civilian life and 
veterans new to VA benefits and services?
    And I'll start with you, Ms. Rawls.
    Ms. Rawls. Well, thank you very much, ma'am. I think that 
one item that I will bring to the table is the need to engage 
the family. A lot of times when we talk about transition, we're 
totally focused on that service member.
    Senator Hassan. Right.
    Ms. Rawls. And that's great, but that family has a role in 
ensuring the economic stability and future of the family. The 
children need to understand there's subsequent benefits, a 
possibility of those.
    And I know there is lots of conversation around putting 
together the buddy systems. Whether that is having the service 
member at the middle of it, or for that matter, peer-to-peer, 
we still need to bring in that information about how do we get 
the family involved in transition.
    Senator Hassan. Right.
    Ms. Rawls. That's a family event moving through transition. 
Whether you have a spouse or not, you still have your parents 
who are a part of that fabric. So that that one thing--and it 
escapes me, so I'm happy to talk to you guys about it. That one 
thing is very important, and I think there is a gap there that 
I've seen as I go out doing executive site visits. Thank you.
    Senator Hassan. Thank you. Thank you. Mr. Lilly.
    Mr. Lilly. From the health care side, if we could--anything 
we can do to simplify the eligibility process and making 
enrollment in health care easier. That is by far the number-one 
piece of feedback I get from our outreach team, the frustration 
of speaking to veterans at a large event, and then they may or 
may not be eligible, or they may or may not have the desire to 
sort of follow through with the lengthy process to become 
eligible. So if we can simplify that, that would be great.
    If I could make one other----
    Senator Hassan. Yes, sure.
    Mr. Lilly [continuing]. Other comment about suicide 
prevention just from a clinical standpoint. It's important for 
folks to understand.
    Suicidality is episodic and it's dynamic, and so the 
important factor for suicide prevention is for the veterans 
themselves or those around them to recognize the warning signs 
when they are actively suicidal.
    Senator Hassan. Right.
    Mr. Lilly. And then they really need to understand what 
those signs are and what are the resources available. That is 
why we have this all-hands-on-deck approach. And it really is. 
This is not just sort of nice language. It really does take 
anybody that interacts with veterans in any setting, because we 
really don't know when they may shift from non-suicidal to 
actively suicidal.
    And if we can intervene in that moment that matters, 
recognize those signs and connect them to services in that 
moment, that's the key. And to do that properly, you have to do 
a lot of education before that moment for all those folks, the 
veteran themselves, and all their family members, or anybody 
else that interacts with them routinely to say, okay, now I see 
the sign and what do I do about it? What's the resource? They 
need to know that beforehand. They can't sort of fumble through 
in the moment when it's too late.
    Senator Hassan. I really appreciate that. I actually was 
meeting with young people yesterday about the rise in death-by-
suicide among New Hampshire's youth, and that was a theme from 
some of the organizations there too. We have to give people the 
tools to understand and recognize the signs of suicide and work 
to intervene at the right moment.
    Mr. Lilly. Right.
    Senator Hassan. Not to mention getting the workforce in 
place and all that. Thank you. Thank you for adding that. Mr. 
Forrest?
    Mr. Forrest. First, I'd like to say thank you for the 
opportunity to have this dialogue for us to be able to 
showcase, you know, programs that the VA has. Even more 
importantly, to identify gaps in how we can continue to improve 
the program for veterans.
    I think my one ask would be to piggyback off what Mr. Lilly 
had mentioned. As the veteran exits from service, the whole 
reason--or the theme here today is to continue to close that 
gap.
    When I say that, I think of my own experience as I left the 
service, although it was quite a while ago, and came back to 
New Hampshire. But to look at like auto enrollment.
    If you leave it, you know, to me to--you know, as we exit 
an installation, and then we move to our home of record and 
then apply for health care services, you know, or benefits 
and--you know, we went through TAP. I know we've done so much 
to help bridge that gap, you know, in the last 12 years since I 
had retired. But I think being able to set a veteran and their 
family up as they leave an installation with contacts, and on 
the converse, with the VA Medical Center on the other end 
knowing that somebody is on their way into New Hampshire and 
can be more active in linking them up with the services they 
need, it would go a long way towards the increased enrollment 
and just reducing that gap in letting the veteran figure it out 
for themselves on the other end. So anything we can do to help 
bridge that gap.
    Senator Hassan. Thank you. Ms. Cook.
    Ms. Cook. I would definitely echo what's been said already 
in terms of helping families, not just the individual service 
member. That's definitely a key point.
    And then I definitely agree with the all-hands-on-deck 
approach that Mr. Lilly referenced. We can't meet all the needs 
of service members and their families with only Federal 
programs, nor can we meet them all with just State or local 
programs. So we need to enhance collaboration and braiding 
resources. I think we've done an amazing job in New Hampshire, 
but there's always room for improvement there.
    And as a State department, we would love to see 
opportunities to embed State-specific information, just like 
Mr. Forrest was referencing, and resources into Department of 
Defense, VA, and any other Federal processes. So that the 
people who are--you know, as they're transitioning out of the 
military, they're not only getting information about what's 
available to them everywhere, but if they know that they're 
choosing New Hampshire, they're returning to New Hampshire, or 
coming here for the first time, they can get some information 
before they land here about what we can offer in New Hampshire.
    So thank you for the opportunity today.
    Senator Hassan. Thank you very much. Mr. Lloyd.
    Mr. Lloyd. So I won't repeat what they all said. So I will 
just leave with, if we want to help veterans that are leaving 
the military, then I urge the Senate to pass the Honor the PACT 
Act.
    Senator Hassan. Thank you. Well said. Well, I want to thank 
all of you for joining us this morning and for your testimony, 
for your service to our veterans, and to those of you on the 
panel who are veterans yourselves. Thank you for your service 
to our country through the military as well.
    Your insights into the situation on the ground are really, 
really important to us in our policymaking roles, and your 
testimony here today is going to help us craft better 
bipartisan solutions to help veterans in our communities in New 
Hampshire, but also all across the country.
    It's really good to get an update from you, Ms. Cook, about 
the State's efforts too, and I think they remain a model for a 
lot of the rest of the country.
    The hearing record will remain open for five calendar days 
until 10 a.m. on April 28th for submissions of statements and 
questions for the record.
    To all the veterans here this morning, thank you so much 
for your service. This hearing is adjourned.
    [Whereupon the Committee was adjourned.]






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