    [House Hearing, 118 Congress]
    [From the U.S. Government Publishing Office]

                                                        S. Hrg. 118-139

                          LEGISLATIVE PRESENTATION OF
                           DISABLED AMERICAN VETERANS

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

                                 JOINT HEARING

                                     OF THE

                         COMMITTEE ON VETERANS' AFFAIRS

                                   BEFORE THE

                                  U.S. SENATE

                                    AND THE

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED EIGHTEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                               FEBRUARY 28, 2023

                                   __________

          Formatted for the use of the Committee on Veterans' Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

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

                                   __________

                        U.S. GOVERNMENT PUBLISHING OFFICE
    53-728 PDF                  WASHINGTON : 2023

    -----------------------------------------------------------------------------------

                     SENATE 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
    Maggie Hassan, New Hampshire         Marsha Blackburn, Tennessee
    Angus S. King, Jr., Maine            Kevin Cramer, North Dakota
                                         Tommy Tuberville, Alabama

                          Tony McClain, Staff Director
                     Jon Towers, Republican Staff Director

                                  ----------

            HOUSE OF REPRESENTATIVES COMMITTEE ON VETERANS' AFFAIRS

                         Mike Bost, Illinois, Chairman

    Aumua Amata Coleman Radewagen,       Mark Takano, California, Ranking
        American Samoa                       Member
    Jack Bergman, Michigan               Julia Brownley, California
    Nancy Mace, South Carolina           Mike Levin, California
    Matthew M. Rosendale, Sr., Montana   Chris Pappas, New Hampshire
    Mariannette Miller-Meeks, Iowa       Frank J. Mrvan, Indiana
    Gregory F. Murphy, North Carolina    Sheila Cherfilus-McCormick,
    C. Scott Franklin, Florida               Florida
    Derrick Van Orden, Wisconsin         Delia C. Ramirez, Illinois
    Morgan Luttrell, Texas               Christopher R. Deluzio,
    Juan Ciscomani, Arizona                  Pennsylvania
    Elijah Crane, Arizona                Morgan McGarvey, Kentucky
    Keith Self, Texas                    Greg Landsman, Ohio
    Jennifer A. Kiggans, Virginia        Nikki Budzinski, Illinois

                           Jon Clark, Staff Director
                      Matt Reel, Democratic Staff Director

                                C O N T E N T S

                                  ----------

                               February 28, 2023

                                                                       Page

                                    SENATORS

    Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas......     4
    Tester, Hon. Jon, Chairman, U.S. Senator from Montana............     5
    Murray, Hon. Patty, U.S. Senator from Washington.................    13
    Blackburn, Hon. Marsha, U.S. Senator from Tennessee..............    15
    Hassan, Hon. Maggie, U.S. Senator from New Hampshire.............    16
    Tuberville, Hon. Tommy, U.S. Senator from Alabama................    17
    King, Jr., Hon. Angus S., U.S. Senator from Maine................    19
    Boozman, Hon. John, U.S. Senator from Arkansas...................    20

                                REPRESENTATIVES

    Bost, Hon. Mike, Chairman, U.S. Representative from Illinois.....     1
    Takano, Hon. Mark, Ranking Member, U.S. Representative from
      California.....................................................     2
    Rosendale, Hon. Matthew, U.S. Representative from Montana........    14
    Budzinski, Hon. Nikki, U.S. Representative from Illinois.........    16

                        INTRODUCTION OF JOSEPH PARSETICH

    The Honorable Jon Tester, U.S. Senator from the State of Montana.     6

                                   WITNESSES

    Joseph Parsetich, National Commander, Disabled American Veterans.     7

      accompanied by

      J. Marc Burgess, National Adjutant

      Barry Jesinoski, Executive Director, National Headquarters

      Edward R. Reese Jr., Executive Director, Washington
        Headquarters

      Jim Marszalek, DAV National Service Director

      Joy Ilem, DAV National Legislative Director

      John Kleindienst, National Director of Voluntary Service

      Ryan Burgos, National Employment Director

      Darlene Spence, Auxiliary National Commander

                                    APPENDIX
                               Prepared Statement

    Joseph Parsetich, National Commander, Disabled American Veterans.    29

                          LEGISLATIVE PRESENTATION OF
                           DISABLED AMERICAN VETERANS

                                  ----------

                           TUESDAY, FEBRUARY 28, 2023

                               U.S. Senate, and
                         U.S. House of Representatives,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        The Committees met, pursuant to notice, at 10 a.m., in Room
    SD-G50, Dirksen Senate Office Building, Hon. Jon Tester,
    Chairman of the Senate Committee, presiding.

        Present:

        Senators Tester, Murray, Brown, Blumenthal, Hassan, King,
    Moran, Boozman, Blackburn, and Tuberville.

        Representatives Bost, Rosendale, Miller-Meeks, Takano,
    Pappas, Ramirez, Deluzio, and Budzinski.

             OPENING STATEMENT OF HON. MIKE BOST, CHAIRMAN,
                   U.S. REPRESENTATIVE FROM ILLINOIS

        Chairman Bost. Good morning. Just so you know, Chairman
    Tester, he will be along in a little bit but we are going to go
    ahead and start today.
        I want thank all of you for being here, and I want to thank
    our friends on the other side of the aisle in the Capitol for
    hosting our first joint hearing of the 118th Congress. It is
    our honor to be joined by friends, as I said, Chairman Tester
    will be along later, Ranking Member Moran, Ranking Member
    Takano, and welcoming you to today's joint VSO hearing.
        And before I begin I want to welcome Commander Joe
    Parsetich--I want to make sure I get it right--and the whole
    DAV team who are with us today. I also want to welcome his
    wife, Meg, and thank you for your service as well to this
    nation, ma'am.
        I also want to welcome the DAV members that are here from
    Illinois, and if I can I would like for the Illinois members,
    if you could please stand. I want to recognize you.
        Absolutely no one here from Illinois. How about that.
        [Laughter.]
        Chairman Bost. There are some from Tennessee. All right.
    Just so you know.
        So I have been attending these VSO hearings for 9 years now
    as a member of the Committee, but this is the first time I am
    doing so as Chairman. Let me first off say that it is very
    humbling and an honor to do that. I could have never dreamed
    that an enlisted Marine, corporal by the way, from Southern
    Illinois would be sitting in a seat today that is the Chairman
    of the Committee charged with fighting for our nation's men and
    women in uniform. You know, it is a deep honor, and it is not a
    responsibility that I take lightly. But as you all know, it is
    not about me. It is about you and the millions of veterans and
    voices you represent across this country, our brothers and
    sisters in arms.
        You understand the struggles veterans and their families
    face. You know where VA is falling short. The DAV's superb
    advocates in D.C. have made a tremendous difference, and we
    thank you for that. You have my commitment that we will fight
    for you, and that the voices of the Representatives just as
    hard as you fought for us. And you know better than anyone else
    that the veteran community has earned a system that works for
    them.
        And I am proud of all that we have accomplished together
    this last Congress, including the President signing the
    bipartisan PACT Act into law. The legislation means a lot to
    veterans and their families, and it was long overdue, and I was
    extremely proud to see it land on the President's desk. Now we
    will be focusing on how VA implements that law. We will need
    all of you to let us know what is happening out there in the
    field when it comes to wait times for toxic-exposed veterans
    care and claims decisions. Boots-on-the-ground testimonials are
    vitally important for our oversight of the PACT Act.
        We have also made great progress to expand mental health
    opportunities through the Fox Grant Program and the STRONG Act
    to support the veterans and their families, and we continue to
    see a decline in veteran homeless nationwide.
        However, our work is not finished. Veterans are still
    fighting a VA bureaucracy to access health care they want and
    when and where they need it; being discriminated against and
    having their Second Amendment rights taken away from them; if
    they need help managing their health benefits, enduring long
    wait times for either access to earned benefits or getting a
    simple question answered; dealing with underperforming VA
    employees who do not have the veteran's best interest in mind;
    and reeling with the impacts of a flawed implementation of a
    new electronic health record system.
        These might seem like small things, but when it comes down
    to it they add up, and they impact veterans every single day.
        I am focused on bringing a VA into the 21st century, even
    if I'm going to do it kicking and screaming, to ensure
    generations of veterans have access to good care and services
    that they have earned. And I will ensure the VA getting the
    budget it needs to complete its mission. And I look forward to
    accomplishing that goal alongside of you, and I thank you all
    again for being here today.
        And with that I want to turn it over to Mr. Takano, the
    Ranking Member, for his comments.

                 OPENING STATEMENT OF HON. MARK TAKANO,
          RANKING MEMBER, U.S. REPRESENTATIVE FROM CALIFORNIA

        Mr. Takano. Thank you, Chairman Bost, and it is wonderful
    to see a Marine veteran corporal in the Chairman's seat, so
    congratulations.
        It is great to be back in open format, in person. First of
    all, the most important question of the day is are there any
    Californians in the room?
        [Applause.]
        Mr. Takano. Welcome, California.
        It is an honor to join all the members of the House and
    Senate Committees on Veterans' Affairs to hear directly from
    the National Commander and representatives of Disabled American
    Veterans. The opportunity to hear from our VSO partners is
    incredibly important to me. Partners like DAV represent
    veterans and their families at all stages of life and service.
        And hearing from these partners allows the Committees the
    opportunity to hear directly about what is most important to
    your members and how we can be of service to our nation's
    veterans. For example, for years we have heard from members of
    many VSOs about taking comprehensive action on the effects of
    toxic exposure. I was encouraged to see the overwhelming
    support that DAV and other VSOs provided last Congress, to pass
    my bill, the Honoring Our PACT Act, and get it signed into law.
    Thank you for the tremendous support you provided throughout
    the process. Getting the PACT Act to President Biden's desk is
    a testament to the strong advocacy and support from passionate
    groups like yours.
        I also would like to express my thanks to Chairman Tester,
    Ranking Member Moran, and Chairman Bost for their efforts to
    work with me on passing this law. Our bipartisan bill expands
    VA health care to over 3.5 million veterans living with the
    effects of toxic exposure. Our bill removes the burden of
    proof, which, for too long, has prevented toxic-exposed
    veterans from accessing the care and benefits they need to
    treat their rare conditions. In total, the PACT Act establishes
    a presumption of service connection to 23 respiratory illnesses
    and cancers. Thank you, thank you for your help.
        Blue Water Navy veterans waited more than 40 years for
    benefits related to Agent Orange exposure because of Congress'
    piecemeal solutions. We were not going to let this happen
    again, and thanks to our efforts last Congress we kept our
    promise. Now the hard work begins, and I look forward to
    continuing to work with my colleagues to make sure this
    transformational law is implemented effectively.
        In the last Congress together we secured several important
    wins for veterans, including, as already mentioned, the passage
    of the landmark PACT Act. In addition, passing the Veteran Auto
    and Education Improvement Act, the Military Sexual Trauma
    Claims Coordination Act, the REMOTE Act, the THRIVE Act, and
    the Sergeant Ketcham Rural Veterans Mental Health Act, we were
    also able to wrap up the 117th Congress with packages of
    veterans legislation, including the STRONG Veteran Act and the
    Cleland-Dole Memorial Veterans Benefits and Health Care
    Improvement Act.
        I am very proud of these accomplishments, but we need to
    build on these achievements and continue our fight for better
    health care and benefits in this Congress and beyond.
        In reading your testimony it is clear your priorities align
    with my own. My priorities for this Congress include opposing
    efforts to cut over $31 billion in VA funding, including
    funding for the 3.5 million newly eligible toxic-exposed
    veterans; preserving women veterans' freedoms; delivering a VA
    for all veterans; modernizing VA care for the next generation
    of veterans; ensuring that no veteran is forgotten; and working
    to end veteran homelessness and food insecurity; ensuring
    benefits parity for America's veterans; rejecting efforts to
    privatize VA; conducting critical oversight and implementation
    of suicide prevention and toxic exposure bills; and empowering
    VA to fulfill its fourth mission capabilities.
        So we have big goals, and I know with your support and
    insight here today, along with the support of the Biden-Harris
    administration, we will be able to achieve these goals and
    fulfill the sacred promises we made to our nation's veterans.
        So I look forward to hearing your testimony today, and
    thank you for your continued advocacy and support for the
    veteran community. Thank you, and I yield back the balance of
    my time.
        Chairman Bost. Thank you, Ranking Member Takano, and at
    this time we would like to recognize the Ranking Member of the
    Senate VA Committee, Senator Moran.

                 OPENING STATEMENT OF HON. JERRY MORAN,
                RANKING MEMBER, U.S. SENATOR FROM KANSAS

        Senator Moran. Chairman Bost, Ranking Member Takano,
    welcome to the United States Senate. On behalf of Senator
    Tester and my Senate colleagues we are glad to have you here,
    and congratulations to you, Chairman Bost, on your ascension. I
    can tell you, Congressman Takano, all leadership here is
    fleeting. It can change every 2 years. I have experienced it
    myself. So hang in there, and there is hope.
        [Laughter.]
        Senator Moran. Welcome to our DAV witnesses this morning,
    and I thank all of you across this room and across the country
    who are watching at home for joining us here today. I
    especially thank my DAV members from Kansas who met with me
    earlier this week in my office and had significantly valuable
    and enjoyable conversations. I thank them for their leadership
    at home and here in Washington, DC.
        I want to thank the DAV leaders for being here in person.
    Thank you for your passion and expertise in supporting
    veterans. The knowledge you have of veterans and their families
    are hugely important to us, and the experiences each of you
    have encountered in your lives allow us to fashion legislation
    and to lobby the Department of Veterans Affairs to do things in
    a way that benefit all veterans.
        My view is that we have accomplished a lot working
    together, we have accomplished a lot in recent years, and I
    expect bipartisan efforts to continue in this Congress, and I
    know the DAV will continue to advocate for those legislative
    improvements.
        A couple of things I want to highlight. Next month marks
    two significant anniversaries. March 20th will be 20 years
    since the start of Operation Iraqi Freedom. Millions of U.S.
    servicemembers and their families have, and continue to serve
    and sacrifice to defeat our enemies. We remember all those who
    gave their lives in that conflict, and we commit to taking care
    of their surviving families.
        March 29th marks 50 years since the end of U.S. forces
    combat operations in Vietnam. To all our veterans we say what
    should have been said to every one of them 50 years ago--
    Welcome Home. We recognize and honor your service to our
    country and we commit to seeing that you receive the support
    and gratitude that many did not receive those 50 years ago.
        Commander Parsetich, DAV's advocacy and its partnership
    will be vital as we go forward, as we work to make certain that
    veterans and their survivors can access the care and benefits
    they deserve in a timely, effective manner that delivers
    positive, measurable outcomes.
        The legislative accomplishments that you have helped to
    achieve are important. Some receive little attention and some
    receive a lot of attention, but each one of those successes are
    worthy on behalf of our veterans. Now we must all work together
    to see that the VA MISSION Act, the Hannon Mental Health Care
    Improvement Act, and the PACT Act are implemented and adhered
    to in a way that Congress and the legislative intent that you
    helped create is fulfilled.
        I will keep working to make certain the VA has everything
    it needs to deliver the care and benefits under these new laws,
    and we will count on the DAV to help us identify where
    additional resources or legislative changes are required.
        Thank you again, Commander, for your testimony, and I look
    forward to hearing it, and I yield back.

            OPENING STATEMENT OF HON. JON TESTER, CHAIRMAN,
                       U.S. SENATOR FROM MONTANA

        Chairman Tester. Senator Moran, thank you. It is a pleasure
    to be here and I am sorry I am a bit late, but it is great to
    be here with Congressmen Bost and Takano and my good friend,
    Jerry Moran.
        I have got a big advantage today in that Joe Parsetich is
    from the State of Montana, so I get to watch you guys butcher
    his name, up and down the roster.
        [Laughter.]
        Chairman Tester. Not to point anything out, Jerry, but that
    even got a laugh out of Joe, just so you know.
        But good morning to DAV Commander Parsetich. You have come
    a long ways, because I made the same flight yesterday, and you
    have been a good friend and I welcome you to Washington, DC and
    the Joint Committee. And I also want to welcome Ken Weinheimer,
    Chase Natalie, Kevin Grantier, and anybody else from Montana
    who made the trek. I look forward to meeting with all of you
    later in the day.
        You know, Congress relies on the DAV and your team of
    advocates in Washington to keep us apprised of the needs of
    veterans and how we can meet those needs. Nothing more
    important, by the way, than our disabled veterans. Last year
    your support was critical in helping Congress address the
    longstanding priority of caring for toxic-exposed veterans and
    doing right by those who are served this country.
        The Sergeant First Class Keith Robinson Honoring Our PACT
    Act is the largest expanse of VA care and benefits in decades,
    and we could not have gotten it done without the DAV. Now we
    turn our attention to implement of this law and ensuring that
    the Department has the capacity to deliver the timely care and
    benefits that veterans deserve. This means addressing VA
    staffing shortages, offering more competitive salaries and
    benefits. It means fostering a culture that tracks and retains
    the best and the brightest, and it also means building and
    maintaining modern facilities.
        By the way, none of this is going to be done if we roll the
    budget back 5 years. Okay?
        This Congress and our Committee are leading bipartisan,
    common sense efforts to build on historic investments made by
    this PACT Act. The VA CAREERS Act, BUILD for Veterans Act, both
    crafted and supported by the DAV. We must also address an
    injustice that has been impacting medically retired veterans
    for far too long that, as I told the American Legion this
    morning, makes absolutely no sense whatsoever. We need to get
    the Richard Star Act passed. It is a top priority of mine.
        [Applause.]
        Chairman Tester. This bill--you guys are very familiar
    with--ensures that our combat-injured veterans will receive
    full DoD and VA benefits that they have earned. We could not
    have gotten the PACT Act done without you and other VSO
    partners, and the same goes for the Major Richard Star Act. We
    will need your support. We will need your strong support and
    advocacy to get this bad boy across the finish line. Together I
    am confident that we will get this right.
        Commander Parsetich and your team, we have a lot to get to.
    Your voice is invaluable in prioritizing our efforts on these
    two committees, and we thank you. We thank you for your work on
    behalf of disabled veterans, but we thank your membership for
    the sacrifices that they have given to this country, and they
    have been great.
        And with that I will turn the podium over to you, Joe. Good
    luck.
        Oh God, you are right. I screwed up. I have got voluminous
    things to say about Joe Parsetich.
        It is now my pleasure to--I thought everybody knew him,
    right Jerry?----
        [Laughter.]

                    INTRODUCTION BY HON. JON TESTER

        Chairman Tester [continuing]. Introduce DAV's National
    Commander, a Montana boy who hails from Great Falls, a stone's
    throw away from my hometown of Big Sandy. He is a Vietnam
    veteran. Joe served honorably in the U.S. Air Force and is
    himself a service-connected disabled veteran.
        Widely known as a champion for veterans of Montana and
    across the nation, Joe was elected this summer to serve as
    DAV's National Commander, and I might say that was a damn good
    choice.
        He understands the challenges rural veterans face and
    conveys the expertise of the VA from his role on the Veterans
    Rural Health Advisory Committee. He has also served on many
    other executive committees and governance bodies, working on
    veteran suicide prevention, addressing veteran homelessness,
    and much, much, much more.
        Joe and his wife Meg have a family that includes 7
    children, 3 foster children, 32 grandchildren, 8 great-great
    grandchildren--I do not know how the hell you do it, man, I
    tell you.
        [Laughter.]
        Chairman Tester. Even with his service commitments and a
    family with more members than this Committee, he finds time to
    serve veterans in his community as a volunteer in DAV's
    transportation network and on the Honor Guard.
        Joe, I cannot thank you enough for being here today. More
    importantly, I want to thank you for your service and your
    tireless commitment to the military and veterans community.
        Joe Parsetich, Commander Parsetich, you may now introduce
    your leadership team and begin with your opening statement. And
    I hope I did not miss anything.

    STATEMENT OF JOSEPH PARSETICH, ACCOMPANIED BY J. MARC BURGESS,
    BARRY JESINOSKI, EDWARD R. REESE JR., JIM MARSZALEK, JOY ILEM,
           JOHN KLEINDIENST, RYAN BURGOS; AND DARLENE SPENCE

        Mr. Parsetich. Thank you so much for that kind
    introduction.
        Chairman Tester, Chairman Bost, Ranking Members Moran and
    Takano, and members of the Committees on Veterans Affairs,
    thank you for providing me the opportunity to deliver the 2023
    Legislative Program of DAV, Disabled American Veterans, an
    organization of more than million members, all of whom were
    injured or became ill as a result of wartime service.
        My written statement thoroughly details DAV's key
    legislative priorities for the 118th Congress and reports on
    our many programs and accomplishments, so today I am just going
    to highlight some of more critical policy goals. But first I
    would like to start off by introducing my DAV colleagues
    joining me here today: National Adjutant Marc Burgess; National
    Headquarters Executive Director Barry Jesinoski; Washington
    Headquarters Executive Director Randy Reese; National Service
    Director Jim Marszalek; National Legislative Director Joy Ilem;
    National Voluntary Services Director John Kleindienst; National
    Employment Director Ryan Burgos; and National Auxiliary
    Commander Darlene Spence.
        In addition to those here with me today many more DAV
    members are together watching this hearing from our annual
    Midwinter Conference across the river in Arlington, and there
    are thousands of dedicated DAV members across the country also
    watching and supporting us from their hometowns.
        I also want to recognize the many DAV leaders who have been
    vital to our organization's mission over the course of many
    years, including my Senior and Junior Vice Commanders and
    leaders in our DAV Auxiliary. Let me also extend my gratitude
    to our National Executive Committee and the members of the
    National Legislative Interim Committee as well as my Chief of
    Staff, Danny Oliver, for their continued support.
        And finally I want to thank my wife, Meg, who remains my
    most steadfast supporter and partner.
        Messrs. Chairmen, I am a service-connected disabled Air
    Force veteran of the Vietnam War. At just 17 years old I
    requested assignment in Vietnam, where I served as a military
    policeman with the 377th Security Police Squadron in the guard
    towers at Tan Son Nhut Air Base from 1968 to 1969. And although
    I did not know it them, the truth is my time in Vietnam lived
    with me long after I returned home. I do not have any John
    Wayne stories from my time in theater, and fortunately I did
    not experience any physical injuries. But for many years I
    could not shake the sounds of the enemy rockets whistling past
    my post, and I brought back with me the memories of those who
    lost their lives over there.
        I was honorably discharged in 1972, and carried the burden
    of surviving Vietnam for decades until 2009, when I woke up in
    an intensive care unit. That is because after 59 years on this
    beautiful earth I no longer saw my life as being valuable. I
    saw myself as an unworthy burden to those around me, and I
    attempted to end it all.
        Messrs. Chairmen, I sit before you today with the humble
    admission that I have never been so happy or so fortunate to
    have failed at something.
        So from personal experience I know just how important
    veterans' access to mental health services are. DAV appreciates
    Congress' continued attention to this issue and the significant
    resources provided to support the VA's inclusive array of
    specialized mental health programs and services. As these needs
    continue to grow, it is crucial that Congress provide the VA
    with all the mental health resources, staffing, and support
    necessary to prevent veteran suicide. We appreciate Congress'
    recent enactment of the comprehensive mental health legislation
    aimed at reducing barriers to care for veterans in crisis by
    collaborating with community partners. We all have to play a
    role.
        DAV has a mentorship program that supports alternative
    programming to help veterans overcome difficult transitional
    challenges after deployment is over. Through our Charitable
    Service Trust, the DAV provided $2.2 million in grants to
    support Save A Warrior, a nonprofit organization dedicated to
    providing a unique healing outlet and intensive therapy options
    for veterans combatting mental health issues.
        DAV has also provided nearly $1 million to Boulder Crest
    retreats, where DAV leaders and spouses serve as mentors for
    the latest generation of seriously injured veterans and their
    caregivers.
        DAV has also been a longtime partner in cohosting our
    annual National Disabled Veterans Winter Sports and Golf
    Clinics. We are very proud of these adaptive sports programs
    that directly impact and transform the lives and mental well-
    being of our most profoundly injured veterans.
        We can and we must do more to end the national tragedy of
    veteran suicide.
        [Applause.]
        Mr. Parsetich. There is no more fundamental obligation of
    our nation than to care for the men and women who were forever
    changed in wartime service. Over the past decade, the VA has
    experienced unprecedented stress trying to fulfill that sacred
    charge, and they have undertaken historic reforms to ensure
    veterans have timely access to earned benefits and high-quality
    health care.
        The DAV is proud to provide ill and injured veterans free
    representation with filing claims for their service-related
    conditions, and we have the largest and most well-trained
    benefits advocacy initiative in the country, with over 1
    million veterans choosing DAV to represent them.
        Last year our nationwide corps of 3,700 benefits experts
    took more than 2.4 million actions to advocate for veterans and
    their families and file claims for their earned benefits, more
    than any other organization.
        [Applause.]
        Mr. Parsetich. Messrs. Chairmen, DAV is a fierce advocate
    of the VA health care system and its specialized programs. Over
    the past decade, there has been one consistent trend: an
    increasing number of veterans continuing to choose the VA for
    their medical needs. Unfortunately, the rising demand for care,
    coupled with significant staffing shortages and an aging
    infrastructure, continues to outstrip the VA's capacity to
    provide timely and convenient access for all veterans enrolled
    in the VA health care system.
        This is especially critical for disabled veterans who rely
    on the VA for most or all of their care. Congress must ensure
    that VA has the resources necessary to maintain sufficient
    staffing to deliver timely care and serve as the primary care
    provider and coordinator for all veterans using the VA system,
    and that is why we also ask that funding increases, not funding
    cuts, be implemented.
        [Applause.]
        Mr. Parsetich. You know, the VA and Congress must work
    together to modernize, realign, and rebuild our aging medical
    infrastructure to meet the veterans' health care needs both now
    and in the future. In DAV, we call upon you and your colleagues
    to work in concert with the VA to develop a workable
    infrastructure plan and authorize sufficient funding to address
    this long-standing issue. The VA must have modern facilities to
    efficiently deliver quality care to the veterans who have
    earned it.
        [Applause.]
        Mr. Parsetich. To help veterans access VA health care, DAV
    also operates a national Transportation Network, offering
    veterans free transportation to and from VA health care
    facilities. You know, last year, DAV volunteers drove more than
    500,000 hours, transporting more than 200,000 veterans to their
    medical appointments, saving taxpayers more than $16 million.
        [Applause.]
        Mr. Parsetich. Messrs. Chairmen, providing safe, high-
    quality health care requires a modern electronic health record
    system. Unfortunately, VA's initial EHR rollout resulted in
    some serious concerns about patient safety and training. We
    know this is a complex issue, but whatever decisions Congress
    makes on the path forward it is essential that veteran safety
    and health outcomes remain the first priority.
        [Applause.]
        Mr. Parsetich. Another DAV critical goal for the 118th
    Congress is to ensure equity in services, benefits, and health
    outcomes for all underserved veteran populations, including our
    women veterans. And despite shifts in policy and increased
    staff training, evidence still suggests that many underserved
    populations are still at higher risk for health disparities and
    suicide. If the VA is to live up to its mission to care for
    those who have the borne the battle, it must rebuild trust,
    tailor programs to meet the unique needs, and ensure a safe and
    welcoming environment for all veterans that it serves.
        [Applause.]
        Mr. Parsetich. Messrs. Chairmen, it is critical to support
    the veterans during their transition from military service to
    civilian life, and DAV is committed to providing veterans and
    their spouses with the tools, resources, and opportunities to
    pursue meaningful careers or even start their own business.
    Last year we hosted over 80 job fairs across the country, and
    our efforts resulted in thousands of job offers to veterans and
    their spouses, and the DAV also now helps veterans and their
    spouses pursue their dreams as entrepreneurs, so they can
    become job creators and benefits providers for veterans.
        [Applause.]
        Mr. Parsetich. Finally, Messrs. Chairmen, we thank you and
    all of your members here today for the historic passage of the
    Honoring Our PACT Act. With the enactment of this legislation,
    millions of veterans exposed to burn pits and other toxic
    substances are now eligible for VA's life-changing benefits and
    health care. Now it is up to Congress to ensure that this law
    is fully and faithfully implemented. We need you to monitor the
    number and type of PACT Act claims filed. We must make certain
    that the VA has the resources and staffing to provide timely
    decisions and benefits to all toxic-exposed veterans and their
    survivors.
        [Applause.]
        Mr. Parsetich. For over 100 years, DAV has been providing
    critical services and support to our nation's ill and injured
    veterans. Through our program's 1 million-plus members,
    volunteers, and supporters, we provide direct help to those who
    need it. That is our mission.
        Film producer, Maria Cuomo Cole, said that we must give
    veterans ``the tools to empower themselves and reclaim the
    self-worth and dignity which comes from occupying a place in
    the American dream. It is a dream they fought so hard to defend
    for the rest of us.''
        If ever there was a need for us to focus our efforts to be
    united, to be the best, and to rise to meet the occasion, this
    is it. Our veterans need us and are worth the fight, and
    together we have the opportunity and the obligation to do
    better.
        Messrs. Chairmen, this completes my testimony. May God
    bless the DAV, the men and women who have served our great
    nation, their families, their survivors and caregivers, and, of
    course, this wonderful country, the United States of America.
        [Applause.]

        [The prepared statement of Mr. Parsetich appears on page 29
    of the Appendix.]

        Chairman Tester. Commander Parsetich, thank you very much.
    A few housekeeping things to begin with. First of all, the
    questions will be 3-minute rounds, so pick your best question.
    And then, Commander Parsetich, questions will be directed to
    you but you can defer to anybody in your leadership team, and I
    will go first.
        Commander Parsetich, about 2 years ago Senator Boozman and
    I sponsored a bill called the Deborah Sampson Act, and we got
    it across the finish line, but we only got it across the finish
    line because the DAV, who has long been a champion for women
    veterans, was a major force in getting that job done.
        Two years ago, post-enactment now of Deborah Sampson, how
    well do you think the VA is doing implementing the law, and
    what gaps still remain?
        Mr. Parsetich. Thank you for that question, Senator,
    because the VA has been working on implementing the Deborah
    Sampson Act. We have a good groundwork laid. There is still a
    lot of work to do, a lot of gaps that we have.
        I am going to direct that question to Director Ilem to
    expound on that a little bit more, if I may.
        Chairman Tester. Okay. Joy?
        Ms. Ilem. Thank you, Commander. We want to thank you
    specifically on the Deborah Sampson Act but everyone working
    together to really make sure that our nation's women veterans
    were a priority. And while the Deborah Sampson Act has so many
    great provisions in it, it does take time for implementation.
        I think that VA still struggles with hiring enough women
    veteran providers that have expertise in women's health. And if
    I had to say one other point it would be to make sure that
    their anti-harassment campaign is, you know, that they are
    fully staffed and they can really work on that issue. I do not
    think that is quite where we want it to be yet, although it has
    got a good start. It is going to take a lot of work to complete
    that.
        But we do appreciate all the work on women veterans that
    has been done. Oversight will be essential, and holding
    hearings and roundtables, I think, to make sure VA completes
    all of the provisions within that bill, that important bill.
    Thank you.
        Chairman Tester. Thank you very, very much.
        The PACT Act has been talked about a bit here this morning.
    DAV and its service officers are eyes and ears on the ground,
    and we need to ensure that the VA implements the PACT Act
    properly.
        For you, Commander Parsetich, or your team, has the VA
    included you, the DAV, in PACT Act implementation?
        Mr. Parsetich. You know, we have been in very close
    communication with the Secretary. He shared with us, as far as
    staffing needs, from a funding perspective as well as
    facilities. DAV is well plugged into VA. Their passion to
    implement this much needed bill is tremendous.
        But I am going to ask Director Marszalek if he can expound
    a little bit further on that, if I may.
        Mr. Marszalek. Thank you, Commander. I appreciate it.
        You know, we have been working very closely with Josh
    Jacobs and his team. We think it is more collaboration now than
    ever. They have really pulled us in, working on overdevelopment
    task force. But it is critical that we ensure they have the
    resources necessary to be able to process these claims, not
    only timely but accurately. We want decisions right the first
    time, so we are paying very, very close attention. We urge
    Congress to make sure that we are taking a look at the number
    of claims that are filed, the decisions that are made, the
    denials, and why they are being denied. So we have got to
    continue to work together.
        Chairman Tester. Thank you all for being here. And by the
    way, it is great to have a crowd meeting in person again. It
    beats the hell out of teleconferencing.
        Senator Moran.
        Senator Moran. Mr. Chairman, thank you. I will call your
    fellow resident of Montana by the name I can pronounce,
    Commander. Good day.
        [Laughter.]
        Senator Moran. Senator Tester may try to demonstrate that
    he is smarter than I am, but I think I can find a way to prove
    that we at least have equal intelligence.
        I am pleased that you are here and I appreciate the
    testimony, and I listened closely. I stepped out to speak to a
    couple of groups of University of Kansas and Kansas State
    University students who are in the Capitol today, and I told
    them of your presentation and why we were here. And I was
    pleased to hear them say what respect they had for veterans,
    and wanted to make sure that they gave me the instructions,
    these 19-, 20-year-old kids, to make sure that we take care of
    those who served our nation, and we want to do that.
        Let me ask, I guess in my 3 minutes, my priority question.
    Congress has never failed to provide the resources that the VA
    needs to care for veterans. Sometimes it takes us a little
    while to get it done. We are not going to miss the opportunity
    to make sure the resources are there. I am an appropriator as
    well as a member of this Committee.
        You can see that in significant budget increases that the
    VA continues to receive year after year, even when we
    supposedly have strict austerity measures in place, than the
    rest of government. But the VA is not immune from waste, fraud,
    and abuse. I heard you testify particularly about
    infrastructure and buildings. What would be your suggestion for
    ways that we can find the necessary resources to put into those
    new structures? It probably takes reducing or eliminating
    structures that are no longer as important, but those are
    difficult priorities to make, and we need your help in trying
    to reach a conclusion about how we can spend less here on
    something that is deteriorating to make sure we have something
    new and available for veterans across our nation.
        So a bit of an infrastructure question but also anything
    that you see in which the VA could do a better job in being
    more efficient.
        Mr. Parsetich. Thank you for that question, Senator, or
    Congressman, because it is critically important, and also thank
    you for your constituents' kind comments.
        But I am glad you brought that up because our men and women
    have already paid the price once to this country. We should not
    have to pay the price a second time as far as having the
    facilities and services that we have earned.
        That being said, however, having updated facilities are
    very important, but not to the extent where we close the other
    ones that exist prior to having the new ones in place so that
    our veterans out in remote areas can still access the health
    care facilities that they need to address their injuries or
    illnesses that they are receiving services from.
        Senator Moran. I thank you for your answer, and I share
    with your state, Kansas shares that rural aspect for access to
    care. Part of that is the MISSION Act, but part of that is
    making sure the facilities, the physical facilities we have in
    the VA are updated, and we ought not discriminate against a
    single veteran by where he or she lives. Thank you.
        Chairman Tester. Thank you, Senator Moran. Senator Murray.

                           HON. PATTY MURRAY,
                      U.S. SENATOR FROM WASHINGTON

        Senator Murray. Thank you very much, Mr. Chairman.
    Commander, welcome. It is great to have you here, and I can say
    Parsetich because I am from the great State of Washington. My
    mother was born in Butte, so Senator Tester has nothing on me
    there, so great.
        Good to have you here and thank you for your comments.
    Thank you to all of your members who are here supporting you
    and all of your team and for all the work that you do.
        I appreciate your answer to Senator Tester on the Deborah
    Sampson Act and know we have more work to do there, as well as
    making sure that we have the resources for the VA to implement
    the PACT Act.
        But in my few minutes I did want to talk about the millions
    of children who are living with a disabled veteran and how we
    make sure we are taking care of them as well. Senator Boozman,
    who just left, and I are introducing the Helping Heroes Act,
    that will help support the families of disabled veterans,
    including those children who are taking on caregiving roles,
    because I really believe that we have a serious obligation to
    support our veterans when they come home, and that includes
    supporting the children and grandchildren of those veterans who
    are helping care for their families.
        So I wanted to ask you today about what else we can do and
    what the VA should be doing to support those families who are
    supporting veterans.
        Mr. Parsetich. Thank you for that question because I think
    that the very start of the solution for that is just what you
    brought out, your compassion and obvious recognition of the
    criticalness of making sure that our veterans' families and
    caregivers do have adequate compensation so that they can stay
    home and take care of their loved ones who came back with
    injured conditions.
        Director Ilem, do you have anything you would like to add
    to that?
        Ms. Ilem. I would just add, you know, we are happy to
    support your bill, and it is important to remember that the
    entire family is impacted, and obviously the children of
    service-disabled veterans, our members are fully aware of that
    and we are happy to support that legislation.
        Senator Murray. Thank you very much, and I will yield back
    my time because there are many members here, but thank you all
    again for all the work you do.
        Senator Moran [presiding]. Senator Murray, thank you.
    Representative Rosendale.

                        HON. MATTHEW ROSENDALE,
                    U.S. REPRESENTATIVE FROM MONTANA

        Mr. Rosendale. Thank you very much, Mr. Chair. Thank you,
    Commander Parsetich, Joe, and the rest of the Disabled American
    Veterans for coming to Washington, DC to testify before us. I
    enjoyed meeting with your whole delegation yesterday--Ken
    Weinheimer, Kevin Grantier, and Chase Natalie--and I always
    value your insight on veteran issues.
        Commander Parsetich is from my district, and I have my
    first granddaughter there in Great Falls, so I am hoping maybe
    she will grow up with one of your 25 that you have already got
    going there.
        I really appreciate your willingness to speak so openly
    about your own personal battle with PTSD. Your bravery serves
    as an inspiration for other veterans who are facing similar
    challenges, and makes them more likely to come forward and get
    the treatment that they deserve. That is really, really
    admirable and I appreciate it.
        I agree with your written testimony that the Oracle Cerner
    electronic health record system's initial rollout in Spokane,
    Washington, resulted in serious concerns pertaining to patient
    safety, and led to the burnout among staff. It was a really big
    problem.
        As Chairman of the Technology Modernization Subcommittee I
    introduced the Department of Veteran Affairs Electronic Health
    Record Modernization Termination Act, which ends the Oracle
    Cerner EHR system. We must hold the VA to a high standard of
    care promised to our veterans, and be good stewards of taxpayer
    dollars. I welcome the opportunity to work with you to ensure
    that we have an EHR system that works for our veterans. We
    absolutely cannot be putting the safety of our veterans at risk
    by dumping money into a system that has failed and shown that
    it is not functioning properly.
        Can you please touch on some of the problems your members
    have experienced with the Oracle Cerner EHR system.
        Mr. Parsetich. Thank you so much for that question,
    Congressman, because, you know how much I respect you and all
    of the 535 men and women in the body. But I would encourage you
    not to throw out the baby with the bathwater because, yes, it
    had problems when it first came out. But rather than doing away
    with it we just need to dig in and fix those problems because
    it is the start of a tremendous process that is going to enable
    the veterans to get better-quality care by having the
    collaboration between the various physicians, something that
    has been lacking right now, because if they do not get the hard
    copy medical records many times the veteran is finding that
    they are starting over or a contraindication or problem that
    they may have been encountering the first time, the new person
    is not going to know.
        So the electronic record system is so critical, and you are
    right, we need repairs on it. But again, repairs do not come by
    doing away with it completely. So would just ask that we would
    continue to get the support that is going to benefit the
    veterans in a safe and effective manner and enhance physicians'
    capability to give us the best quality care possible.
        Mr. Rosendale. Thank you so much. It seems my time has
    expired. I yield back.
        Senator Moran. Thank you, Congressman. Senator Blackburn.

                         HON. MARSHA BLACKBURN,
                      U.S. SENATOR FROM TENNESSEE

        Senator Blackburn. Thank you, Mr. Chairman, and Commander,
    thank you so much. We appreciate that each of you are here. And
    in Tennessee we really appreciate the work that DAV and the
    VSOs do for our veterans.
        Commander, I want to go back to something you said in your
    testimony about access to care in a timely manner. I agree with
    you that that access to care in a timely manner should be a top
    priority of this Committee, and that is why I have been such a
    proponent of expanding the Veterans Community Care Program, so
    veterans can get that. When you look at wait times in
    Tennessee, sometimes it is 100 days to get a primary care
    appointment, and that is not acceptable. And this program's
    success is going to be vitally important to the proper
    implementation of the PACT Act.
        So I would like to know if DAV has done any outreach to
    educate veterans on the Community Care Program and informing
    them when they are eligible for this care, allowing veterans to
    make informed decisions about how they seek their care, whether
    they want it through the VA system or in their local
    communities. I know many times it is hard to get somebody to
    take off work and get you 180 miles to the VA, and I find it
    inappropriate that many times the VA is the middleman between
    the veteran and that access to care. So if you would speak to
    that.
        Mr. Parsetich. You bet, and thank you for that question
    because, you know, one of the things--and I will answer your
    question first as far as where you asked if the DAV is doing
    anything proactively to get the word out, how to circumvent and
    interact with the community care process. Our NSOs nationwide,
    national service officers, are putting out what is called
    information seminars, where the entire community, not just our
    DAV members, are invited to address these various things,
    questions, procedural type things. Because so many times
    various issues come up where they say, ``Well, should we do
    this? Should we do that?'' and they are listening to their
    neighbors and not knowledgeable people.
        So yes, DAV is very proactive when it comes to getting the
    word out, and also through our commercials that we try to have,
    and our website is very informative. But for those who are not
    part of our members, veterans nationwide are able to access
    that information.
        But also when it comes to a little bit further knowledge I
    am going to see if Director Ilem can expound a little bit.
        Ms. Ilem. I would just add that Community Care Network is
    an important part of VA health care, and while we want to make
    sure that VA can be a primary provider and coordinator of that
    care, we know that VA cannot be in every location, and there
    are often times when veterans have to seek care in the
    community. We want to see improvements in that care, transition
    that process, because we think that is where a lot of the
    delays are occurring.
        So we are on board. We want to help make sure that smooth
    transition, that veterans get care when they need it, where
    they need it.
        Senator Blackburn. Thank you.
        Senator Moran. Thank you. Representative Budzinski.

                         HON. NIKKI BUDZINSKI,
                   U.S. REPRESENTATIVE FROM ILLINOIS

        Ms. Budzinski. Thank you, Mr. Chairman, and it is great to
    be with you, Commander, and thank you to all the Disabled
    American Veterans for being here today.
        You know, as well documented, suicide rates for our
    veterans are at a historic high. In fact, veterans are 1.5
    times more likely to die by suicide than non-veterans. We know
    there are many reasons for this, including trauma experienced
    while in service, stress, burnout, isolation, and difficulties
    transitioning back to civilian life. So I want to thank you,
    Commander, for sharing, in your testimony, your personal
    experience and your story, which for me, representing the 13th
    District in Illinois, is not unique for many of the veterans
    that I have the privilege of representing.
        So my question for you, Commander, is in your opinion and
    from your professional and personal experiences, what are some
    of the actions that Congress needs to take to improve access to
    behavioral health services for our veterans? Thank you.
        Mr. Parsetich. You are welcome, and thank you for that
    question. One of the challenges that not just military
    environment with veterans face as well as civilian sectors is
    that many times the invisible traumatic scars of injuries,
    whether it be, like I said, as a child, as a person who has
    been violated, whether it be women or men, but especially our
    military. When they come back many of them that are faced with
    the invisible scars are not getting the support that many who
    have the visible wounds are getting as far as in the way of
    encouragement, validation that is lacking. And after a while,
    those who are struggling with those invisible scars start
    believing, and sometimes we are even given judgmentalism which
    makes you question whether or not, you know, why you should
    even be in that state.
        So I think with the VA's thrust to make more services
    available to the veterans and their families--because they have
    many support groups for veterans who are having suicidal
    tendencies or have dealt with those in the past--the VA has
    come a long way. And we just want to make sure that they have
    adequate funding and staffing to continue with the progress
    that they have been making so far and need to continue to make.
        Ms. Budzinski. Thank you, and I will yield back my time,
    Mr. Chairman.
        Senator Moran. Thank you very much. Senator Hassan.

                          HON. MAGGIE HASSAN,
                    U.S. SENATOR FROM NEW HAMPSHIRE

        Senator Hassan. Well thank you, Ranking Member Moran, and
    to Ranking Members and Chairs in both chambers for this
    hearing. Thank you, Commander Parsetich, for testifying before
    us today, and to add to the Congresswoman's comments, for being
    so candid. It is really, really important.
        In New Hampshire, many veterans have to travel significant
    distances for their VA health care, as we have been talking
    about, and in many places there is no public transportation
    available. For disabled veterans or those simply without a car,
    this is a huge barrier to care and can lead to veterans missing
    appointments, among other things. As a result, many Granite
    State veterans turn to DAV's dedicated network of volunteer
    drivers who drive them to their VA health care free of charge,
    and Commander, I understand that you volunteer to do this
    driving as well, so thank you very much.
        The service that DAV drivers are providing is critical to
    veterans accessing care and it provides a lifeline for many
    disabled veterans. So how can the VA better support DAV's
    volunteer drivers, and what could the VA do to ensure that no
    veteran has to worry about finding a ride to an appointment?
        Mr. Parsetich. Thank you for that question because I am
    very passionate about that. This country is not lacking in
    volunteers wanting to serve the veterans by volunteering
    driving, helping out in different facilities, and problems with
    getting volunteers processed and cleared to be able to
    volunteer is not coming from the Federal level. National VA is
    very, very supportive.
        But we find nationwide that the lack of communication
    between the director encouraging the voluntary services, to get
    these applications processed in an expedient fashion, dragging
    out for 3 to 6 months or longer, in many cases, and it is just
    unacceptable.
        So I think it is going to come from, to use a secular term,
    we need to have some coaching going on, first from the VA to
    the directors, saying, ``Hey, you need to get busy with
    coaching your voluntary services people,'' and then voluntary
    services approaching it with the severity and the criticalness
    of getting those drivers cleared, because like you pointed out,
    it is critical to getting these veterans to their medical
    appointments, and many times that can make the difference of
    life or death, in many cases.
        Thank you for that question.
        Senator Hassan. Well thank you so much, and thank you for
    your service. And I will yield back and submit a couple more
    questions, particularly about the caregiver program, for the
    record. Thank you.
        Senator Moran. Senator, thank you. Senator Tuberville.

                         HON. TOMMY TUBERVILLE,
                       U.S. SENATOR FROM ALABAMA

        Senator Tuberville. Thank you, Mr. Chairman. I want to
    start by saying thank you to Disabled American Veterans for
    everything you do, day in and day out, for veterans across the
    world.
        To address PTSD and TBI, veterans are trying innovative
    alternate treatments and therapies through clinical trials
    every day. Some even leave the U.S. to access these therapies.
    If you hear of effective treatments among your members do you
    raise it to the VA? Anybody. Is that information passed on?
        Mr. Parsetich. You know, with our younger veterans there
    are many effective programs, like CPT, they have electronic
    programs, there are different programs for the younger veterans
    where it is fresh, still in their memory.
        I find that what I am hearing from my era, back not only
    Vietnam, Korea, and even a few World War II stragglers around,
    that we are very honored to be in their presence, is that it is
    not as effective dredging up those old memories.
        I am going to ask Director Ilem to expound a little more
    because she also has her hand on that pulse.
        Ms. Ilem. To address your question specifically, yes, when
    we do hear about new treatments, alternative treatments, we are
    always curious about what VA is doing. Certainly we encourage
    VA to give us briefings on different treatments for PTSD,
    military sexual trauma related PTSD. So we think that is an
    important thing to continue to grow and see what is available.
    And what veterans want to use is often not more of a standard
    treatment but some of these new treatments that are available
    to them.
        Senator Tuberville. Do you encourage members to report
    anything that has helped them, you know, anything that has been
    successful?
        Ms. Ilem. Yes, and we have actually done a couple of
    magazine articles about some of the different new drugs and
    treatments that are being provided that would be considered
    alternative treatments.
        Senator Tuberville. If a veteran claims a certain alternate
    treatment has helped him, what does the DAV consider successful
    enough as a result to share with the VA? Does it have to be a
    certain number?
        Ms. Ilem. Well, we think that research is important. VA is
    very focused on evidence-based treatments, and we courage them
    to expeditiously do any research that is needed. We want to
    make sure treatments are effective not harming in any way.
        Senator Tuberville. Thank you.
        Commander, in your testimony you also mentioned the
    dissatisfaction among veterans with the Community Care referral
    process. I too, and I think we are dissatisfied with the red
    tape veterans go through to get referred to a provider in the
    community, especially as it relates to treatment for substance
    use disorders. What experience have your members have with
    accessing treatment clinics in the community through the
    Community Care system?
        Mr. Parsetich. You know, care in the community process
    where you contact your primary provider first to get the
    referral to other resources available, and understand we
    encourage those being utilized if and only if the VA does not
    have a specialized person that can address that within the
    mileage or time element aspect. That being said, however, you
    are 100 percent right that it is not uncommon for veterans
    being asked to wait 4 to 6 weeks or more just trying to get a
    referral and then get the runaround.
        So we need encouragement when it comes to that because we
    are very grateful and appreciative as far as to have these
    services available to us, but like I said, we have to just work
    on refinement. We have a good foundation. Care in the community
    was a tremendous benefit for the veterans as far as when we
    cannot access other specialists. It kind of like an
    alternative. Sometimes we can get telemed, but telemeds are not
    always going to address the situation where you need a face-to-
    face, because many veterans respond better when they are
    sitting across from somebody than looking on a screen.
        But thank you for bringing up the point that, yes, we have
    challenges, but challenges mean that we are doing something in
    the right direction. We just have to refine it.
        Senator Tuberville. Yes. Yes. Are you hearing a lot of
    lengthy wait times? Is there a lot of wait times for our vets?
        Mr. Parsetich. Sometimes, and again, many times it depends
    on the availability of whoever they are trying to access.
    Sometimes it is just with the paperwork glitch. But the VA is
    very much on top of that and the Secretary does have a hotline.
    We have real good relationships with the Secretary, and when we
    find a particular problem area he usually addresses it right
    away to make sure that we can smooth out some of these rough
    edges.
        Senator Tuberville. Thank you very much. Thank you, Mr.
    Chairman.
        Senator Moran. Thank you, Senator Tuberville. Senator King.

                        HON. ANGUS S. KING, JR.,
                        U.S. SENATOR FROM MAINE

        Senator King. Thank you, Mr. Chairman. First I want to
    explain to the DAV members here what is going on. If you think
    the computer system at the VA is inadequate, they have not
    figured out how to schedule committee meetings.
        [Laughter.]
        Senator King. Two floors above us I am in a meeting of the
    Armed Services Committee on Ukraine, a meeting that I think you
    will all agree is worth going to. So Senator Tuberville and I,
    if you see us bouncing back and forth and in and out it is not
    a lack of attention or interest. It is because we are trying to
    do our duty as best we can, to the multiple responsibilities
    that we have. I am sure you are thinking, where are all these
    people going? We are not going out for coffee, I can assure
    you.
        Commander Parsetich, I want to look ahead a little bit. The
    VA estimates that in the next 25 years or so the number of
    veterans over 85 is going to go up by like 40 percent. There is
    going to be a huge demand for long-term care. I do not expect a
    short answer here, but I want to put the DAV's good thinking to
    help us think through this problem that I think is coming at
    us. It is much better to prepare and think ahead rather than to
    react to a crisis when it sweeps over us. Is that something the
    DAV can help us with?
        Mr. Parsetich. You bet there is, Senator King, and thank
    you for that question. But I am going to give you the short
    answer. Director Marszalek, can you address that?
        [Laughter.]
        Senator King. Hey, I like that deal.
        Ms. Ilem. I will take this one, Jim. Yes, we see the
    impending number of aging veterans coming. In fact, it is one
    of DAV's critical policy goals for this and this Congress. And
    we know veterans want to remain at home as long as they can,
    with their loved ones and their families, and that requires
    support.
        When we do need community living centers or nursing homes
    or state veterans home that is key to have that option, but
    there are so many steps in between, from assisted living to
    veteran-directed care, just to having support in the home to be
    able to maintain that. So we want to work with you.
        Senator King. I am a great believer in home care. I have
    never met anybody yet who wants to go to a nursing home.
        Ms. Ilem. Right.
        Senator King. You want to stay home. It is also less
    expensive for the taxpayers, and I just think that is
    something. There is bill that we just reported out, the
    Elizabeth Dole Home Care Act. We want to keep working on that.
    Help us get that through the Senate, would you please?
        Ms. Ilem. Absolutely. We will be 100 percent behind you
    there.
        Senator King. In just a few seconds, the other issue that I
    am really concerned about is the transition, and you mentioned
    that, Commander, in your comments. That is where there is a
    disproportionate number of suicides in the first 2 or 3 years
    after separation. I hope you can work with us to develop a
    program of a truly warm handoff. I have told the Department of
    Defense and the committee upstairs, in Armed Services, I think
    they should spend as much time, money, and effort on the
    transition out as they do on the recruiting in, and I hope that
    is something you can help me with.
        [Applause.]
        Mr. Parsetich. Senator, the DAV would be honored to support
    such legislation because the transition is critical. And giving
    our men and women the encouragement, resources, programs that
    they deserve to make a successful transition--and I am not
    talking from a pharmacological perspective right now. I am
    talking from a peer perspective, where they can help each other
    and be guided by the professionals in a way to where they are
    going to be able to reestablish self-respect, self-esteem, and
    self-worth, that they can be reestablished, not only within
    themselves but within their communities.
        Senator King. My vision is a VSO officer meeting the
    veteran at the airport, saying, ``Welcome back. Here are the
    resources that are available to you.'' Literally. I mean,
    literally meeting them at the airport to know that there is
    that community of veterans in their state. That is the
    direction I want to move in.
        Thank you very much, Commander, for being here. Thank you,
    Mr. Chairman. I have got to go back upstairs.
        Chairman Tester [presiding]. Thank you, Senator. Senator
    Boozman.

                           HON. JOHN BOOZMAN,
                       U.S. SENATOR FROM ARKANSAS

        Senator Boozman. Thank you, Mr. Chairman, and first of all
    I have got to give a big shout-out to my Arkansas folks. Thank
    you for making the trip and the great job that you do at home
    representing the state, and again, all you do for veterans.
        Commander, thank you. You and your team do an outstanding
    job. We really do appreciate that.
        I had the opportunity to serve in the House on the
    Veterans' Affairs Committee and now in the Senate, and I know
    firsthand that we have been able to achieve a lot, but it
    simply would not have gotten done without your help. So thank
    you for your advocacy. The idea of looking out and seeing so
    many people sitting here, talking to their representatives,
    there is just no substitute for that. So again, that is a big
    deal.
        The VA CAREERS Act is a crucial piece of legislation for
    reducing vacancies and staffing shortages in the VA. VA
    continues to be at a disadvantage when it comes to recruiting
    and retaining those talented medical professionals across the
    country, especially in rural areas. Can you briefly speak to
    what this legislation would mean for the VA and why it is
    important to ensure the VA has the ability to recruit and
    retain the best health care professionals?
        Mr. Parsetich. You bet. You know, I have had the pleasure
    of serving under three Secretaries of the VA right now on
    veterans rural health and that is always the very first topic
    of conversation--what can we do to recruit and retain those
    professionals. But to give you further information I am going
    to defer over to Director Ilem to expound a little bit more.
        Senator Boozman. Thank you.
        Ms. Ilem. DAV is a proud sponsor of that legislation. We
    know right now that it is more critical than ever to be able to
    hire and recruit the best and the brightest for VA. Our
    veterans deserve no less. And the bill is jam-packed with
    provisions that will really help to do that. It is essential
    the VA is able to be competitive for some of these scarce
    medical specialties, and again, our veterans deserve to have
    the very best and brightest, and we are happy to be behind you
    to get that across the finish line.
        Senator Boozman. We appreciate that. And one of the things
    that we were able to get put in it was how do you deal with
    directors being detailed to different positions, being gone for
    long periods of time. Leadership truly does make a huge
    difference. Can you talk specifically about that, about not
    having leadership in place at the medical centers and filling
    those? And it is hard because, you know, we are competing with
    the private sector, and they probably pay them many times more.
    On the other hand, we simply have to get those positions
    filled.
        Ms. Ilem. And we really appreciate that provision
    specifically because we know when there is poor care that
    happens or a problem, it is usually a place where the
    leadership has been lacking, or to move somebody in and out
    that was not able to be there to really advocate and make sure
    that facility is run top notch. And VA has to be able to
    attract those people that have the experience and the ability
    to really run a medical center. It is essential.
        Senator Boozman. Thank you very much. Thank you, Commander,
    and again, thanks to all of your team for the great job they
    do, and for all of you that made the trip and do such a
    tremendous job in your states. Thank you, Mr. Chairman.
        Chairman Tester. Thank you, Senator Boozman. Ranking Member
    Takano.
        Mr. Takano. Thank you, Chairman Tester. Commander
    Parsetich, I just got to personally express my gratitude for
    just the courageous way that you have spoken about your own
    personal struggles and what a great service you are to veterans
    who are struggling themselves, to know.
        But yes, I want to reiterate probably something that has
    already been reiterated here but I think it needs reiteration.
    Republican leadership in the House has suggested funding levels
    for departments and the agency should be capped at fiscal year
    2022 levels while the Department of Defense is held harmless.
    In the case of VA, that would mean a loss of $31 billion, or
    roughly 24 percent of VA's budget, just as Congress is tasked
    with implementing the PACT Act, opening up medical eligibility
    for 3.1 million veterans.
        As members of the independent budget VSOs, DAV has vital
    insight into the annual budget and VA funding. Do you believe
    that this stake, this stance that the House Republicans have
    taken puts veterans' access to care and services in jeopardy?
        Mr. Parsetich. Congressman, thank you for bringing that
    forward because any cuts to our veterans would be devastating
    financial cuts. These men and women have earned the right to
    get the highest quality care, and we are not insensitive to
    budgets and things of this nature, but we have already paid the
    price in full, many times over. Some of whom who did not make
    it back, they paid the ultimate price, and those of us left
    behind.
        I think we deserve the best.
        [Applause.]
        Mr. Takano. Well, I do too, and what was demonstrated in an
    unprecedented way was the way that the political will was
    generated by you, the veteran service organizations, to change
    the way that the Federal Government and this Congress have
    looked at toxic exposure. No longer should you have the burden
    of proof on your shoulders, but you should have the benefit of
    the doubt, in my opinion. You should be given the benefit of
    the doubt. And we created the toxic exposure fund so that
    funding toxic-exposed veterans would not pit you against other
    veterans. There would not be a Hunger Games played by veterans
    having to compete against one another, and more than that, for
    veterans to not compete with programs that benefit all
    Americans.
        And so you can count on me, and I know that you can count
    on Senator Tester, that we are simply not going to stand for
    any kind of talk about returning to 2022 funding levels, which
    would put the VA and all veterans just in an untenable place. I
    hope that as all of you visit folks on Capitol Hill you let
    them know the true skinny on all of this. So thank you.
        Mr. Parsetich. Thank you for that.
        [Applause.]
        Chairman Tester. Thank you, Ranking Member Takano. I
    appreciate those comments, and I do not usually have you speak
    for me but I like those comments. That is fine. That is good.
    We appreciate it.
        Look, I am going to close this out, and I am going to close
    it out by thanking the DAV. You have got some of the best folks
    on the Hill that you could ever get. These folks are straight
    shooters. They tell us what you need. They do not BS around.
    And I am going to tell you because of the DAV's influence up
    here on the Hill we have been able to get some good things
    done. So all you guys' memberships and gals' memberships out
    there, just know that they are doing really, really, really
    good work representing you in Congress.
        I have been here long enough, both as the Ranking Member,
    Chair, and as a member of this Committee to watch people come
    up and give you lip service and then do things like fist bump
    on the Senate floor or vote against a budget that actually
    funds things like the PACT Act or the Deborah Sampson Act. You
    guys see through that stuff, and you guys pull away all the
    chafe from the wheat and make sure that we are doing our job.
        So what I am saying to you is thank God for the DAV. Thank
    you guys for the work you are doing.
        [Applause.]
        Chairman Tester. Thank you very much.
        Joe Parsetich, Commander Parsetich, you make Montana proud.
    We appreciate you being here. I want to thank you for giving
    the 2023 legislative priorities for the DAV and putting them
    out there very clear and forthright. We appreciate that.
        Look folks, we have got a lot of work to do ahead of us. We
    have got a couple of great Committees here, and I will not
    speak for the House side. We have got a great Committee in the
    Senate, and we are going to work together to make sure we do
    right for the veterans. But we have got a lot of work to do,
    and your input is going to be critically important.
        With that we will keep the record open for a week if you
    have additional comments you would like to put forth, and this
    hearing is now adjourned.
        [Whereupon, at 11:13 a.m., the hearing was adjourned.]

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