[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING ON: TOXIC EXPOSURE
FUND IMPROVEMENT ACT OF 2024
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HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED EIGHTEENTH CONGRESS
SECOND SESSION
__________
THURSDAY, MARCH 21, 2024
__________
Serial No. 118-56
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Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via http://govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
55-438 WASHINGTON : 2025
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COMMITTEE ON VETERANS' AFFAIRS
MIKE BOST, Illinois, Chairman
AUMUA AMATA COLEMAN RADEWAGEN, MARK TAKANO, California, Ranking
American Samoa, Vice-Chairwoman 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 CHRISTOPHER R. DELUZIO,
MORGAN LUTTRELL, Texas Pennsylvania
JUAN CISCOMANI, Arizona MORGAN MCGARVEY, Kentucky
ELIJAH CRANE, Arizona DELIA C. RAMIREZ, Illinois
KEITH SELF, Texas GREG LANDSMAN, Ohio
JENNIFER A. KIGGANS, Virginia NIKKI BUDZINSKI, Illinois
Jon Clark, Staff Director
Matt Reel, Democratic Staff Director
Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains the
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of converting between various electronic formats may introduce
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further refined.
C O N T E N T S
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THURSDAY, MARCH 21, 2024
Page
OPENING STATEMENTS
The Honorable Mike Bost, Chairman................................ 1
The Honorable Mark Takano, Ranking Member........................ 3
WITNESSES
Panel 1
The Honorable Jon Rychalski, Assistant Secretary for Management
and Chief Financial Officer, U.S. Department of Veterans
Affairs........................................................ 7
Accompanied by:
Ms. Laura Duke, Chief Financial Officer, Veterans Health
Administration, U.S. Department of Veterans Affairs
Ms. Lasheeco Graham, Chief Financial Officer, Veterans
Benefits Administration, U.S. Department of Veterans
Affairs
APPENDIX
Prepared Statement Of Witnesses
The Honorable Jon Rychalski Prepared Statement................... 37
LEGISLATIVE HEARING ON: TOXIC EXPOSURE
FUND IMPROVEMENT ACT OF 2024
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THURSDAY, MARCH 21, 2024
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The committee met, pursuant to notice, at 10:30 a.m., in
room 360, Cannon House Office Building, Hon. Mike Bost
(chairman of the committee) presiding.
Present: Representatives Bost, Radewagen, Rosendale,
Miller-Meeks, Murphy, Ciscomani, Crane, Self, Takano, Brownley,
Pappas, Cherfilus-McCormick, Deluzio, McGarvey, Ramirez,
Landsman, and Budzinski.
OPENING STATEMENT OF MIKE BOST, CHAIRMAN
The Chairman. Good morning. The committee will come to
order. You know, today we want to consider the Toxic Exposure
Fund Improvement Act. Now, before we get that I want to address
the business meeting that we scheduled and then canceled last
week. The committee staff met to hold another transcribed
interview on the witness of--in the sexual harassment
investigation, and without warning 2 minutes prior, or 10
minutes--2 minutes prior to interview the minority declared
they would not participate in the interview and the VA quickly
followed suit.
I was prepared to hold another subpoena vote to compel the
Department of Veterans Affairs (VA) to participate. VA assured
us that they will cooperate in transcribed interviews
regardless of whether the minority is in attendance or not.
This is consistent with House rules.
Therefore, I decided a business meeting to consider another
subpoena is not necessary today, and I hope that you will be--
will not be--there will not be any more obstructions to the
committee's oversight.
There is, and I will not hesitate--if there is I will not
hesitate to ask for a subpoena vote. Now back to the matter at
hand here today.
This bill is attempting to fix the unintended consequences
of creation of the toxic exposure fund (TEF) that have
handcuffed this committee from moving legislation forward. Some
of the mechanics are complicated, but the goal is very simple.
We need a toxic exposure fund that pays for the healthcare
expansions and the cost to deliver the benefits under the The
Sergeant First Class Heath Robinson Honoring our Promise to
Address Comprehensive Toxics (PACT) Act. Let me say that again.
We need a toxic exposure fund that pays for the health
expansion and the cost to deliver the benefits under the PACT
Act.
However, the TEF was never intended to cover VA healthcare
on or benefits not related to the toxic exposure or that
existed before the PACT Act. Everything we were covering before
it should not take away from that and should not be used for
that. We should actually--and should not be counted against it.
There is no reason that the fund has to meddle with the Budget
Act and create budget problems for other pieces of veterans
legislation that we think are vitally important.
I want to address the bad faith policy attacks and scary
rumors right now. Right now. This bill would not abolish, let
me say that again, would absolutely not abolish or cut or
undermine the toxic exposure fund under any circumstances.
In fact, the bill is even more generous than the VA says
they will need to deliver--what they will need to deliver the
PACT Act care and benefits to our veterans and their families.
My bill would continue the dollar amounts that Congress
already appropriated to fund for Fiscal Year 2024 and 2025, and
the bill would allow almost $4 billion more, if you will look,
than VA has requested for 2026.
After that, the amount available increases by 8 percent
every year. The rate of increase is larger than VA's own
healthcare inflation numbers.
Now, beyond 2033 the bill requires proposing the next 10
years of funding and that would receive special consideration
in Congress. It would also give VA more flexibility to carry
dollars over from year-to-year to the fund. It would finally
solve a wonky inside Beltway problem that has stopped a lot of
good bipartisan legislation from moving through this committee.
Right now, any bill that we try to advance relating to
healthcare, research, VA administrative operations, or
Information Technology (IT) has a mandatory cost. As many of
you know, this committee only has one major offset to pay for
our legislation to get it passed out of the House. Now, once
that offset is used up and unless stakeholders want to identify
new offsets, our ability to pass bills is limited for the rest
of the year.
We have been working for months to finalize with the
Senator Elizabeth Dole's veterans package, and this issue has
made doing that much more difficult. The Toxic Exposure Fund
Improvement Act is my proposal to solve this problem without,
let me say that again, without impacting PACT Act authorities.
We have been discussing how unfortunate the situation is
since the fall of 2022. It is time to stop playing Monday
morning quarterback. We all have to get off the sidelines and
get on the field and start doing something about it.
I have said this before and I will say it again. If anyone
has a proposal I will welcome it. Let us work together. Let us
find a compromise. Let us be bipartisan.
Without a doubt this is a bipartisan problem, but if we do
not fix it the Congressional Budget Office (CBO) has assured us
that it will continue to plague the next chairman and future
committee members while they try to legislate. That is a
disservice to every single veteran, caregiver, and survivor.
The PACT Act was a historic achievement, and I want to
thank the ranking member for his hard work on that, but it
would be a tragedy if it was the last major law this committee
is able to produce. We are responsible for authorizing all VA
programs and services for all veterans so that they can get
care and benefits they have earned.
Now, in order to carry out that responsibility, we need to
get these handcuffs off.
I want to welcome our witnesses, and I hope to have a
productive conversation about the best way to accomplish that.
Ranking Member Takano, I now recognize you for your opening
statement.
OPENING STATEMENT OF MARK TAKANO, RANKING MEMBER
Mr. Takano. Well, thank you for yielding, Mr. Chairman.
The cost of War Toxic Exposure Fund created by my and our
PACT Act is a vital component of the law and represents our
promise to toxic exposed veterans that we will not waver in our
commitment to delivering the care and benefits they have
earned.
Congress voted to establish this fund to ensure that the
Department of Veterans Affairs, and most importantly veterans,
would have access to the funding necessary to carry out this
law in perpetuity. Honoring our pact is a promise, one that I
have no interest in reneging on.
The majority is proposing to hamstring that fund less than
2 years after the PACT Act became law by capping appropriations
and narrowing its purpose. This would seriously impair VA's
ability to perform the task we have signed it to do. In short,
it would undermine the PACT Act, and I cannot support that.
The PACT Act is a huge step forward for America's veterans
because it takes seriously the implicit promise our Nation
makes to servicemembers when they enlist in our military. If
you get injured or disabled or sick because of your service we
will have your back. You will get medical care. You and your
dependents will get compensation if you are disabled.
Fulfilling this promise is clear when a servicemember loses
a limb from a roadside bomb or suffers a neurological
complication from a nerve agent deployed by the enemy. The
immediate effects of war are seen as the costs of war. It would
be untenable for anyone to say these costs should be met based
on whether we could afford to pay them. We have an obligation
to pay for them, therefore we must pay for them as the cost of
war.
The effects of toxic exposure are often not so immediate,
but they are no less debilitating. Chronic respiratory
illnesses linked to exposure to burn pits, for example, can
show up in veterans many years after their deployments are
done. Cancers that show up disproportionately in young adults
after their service can reasonably be linked to service-
connected toxic exposure, but they do not manifest themselves
immediately either.
Congress decided that 23 categories of illnesses would be
presumed to be service-connected for servicemembers known to
have deployed in geographic areas where they could have been
exposed to toxins. We decided to treat these debilitating
illnesses as the cost of war and not as expenses that we would
decide on an annual basis because it was the morally right
thing to do.
Classifying care and benefits for toxic exposed veterans as
a mandatory cost instead of an optional or discretionary cost
is what we owe veterans. This was our promise through the PACT
Act, much like Medicare and Social Security are our promises to
the broader public.
This means not subjecting veterans to a Hunger Game
scenario of pitting veteran against veteran or veterans against
other Americans to fight for funding. We agreed that we would
not pit toxic exposed veterans against other Americans in need,
whether it be hungry children, seniors, those going to college,
Americans who need job training, or even other veterans who use
these programs.
This legislation could have the effect of, I mean, the
majority's legislation could have the effect of taking us back
to a situation of deciding which veterans programs would get
cut or whether we would have to deny benefits to some cohort of
toxic exposed veterans.
However, we have today a wonderful opportunity to once
again lay bare the differences between our sides and our
respective approaches to providing care and treatment to toxic
exposed veterans. Sadly, it seems that from my colleagues this
has only ever been a budgetary issue to solve, or more
accurately, that our solution to addressing toxic exposure
should be constrained by fiscal concerns instead of doing what
is right for veterans.
When the committee began consideration of the PACT Act in
June 2021, my colleagues were strongly opposed with the then
ranking member now Chairman Bost saying, ``We need to stop
wasting time marking up legislation that we know has no path to
success.'' In fact, the chairman was the very first no vote
against the PACT Act in committee. Dr. Murphy even went on to
state, ``We simply cannot spend away because of emotional
needs.''
Toxic health--excuse me--healthcare for toxic exposed
veterans is not an emotional need. It is a medical one that
deserves our time, attention, and investment.
Now fast-forward to this time 2 years ago and the House for
the first time passed the most expansive increase in veterans'
healthcare and benefits since the GI Bill, a vote which
Chairman Bost was not present for. Yet my colleagues on the
other side of the aisle still largely objected to it, both in
scope and cost.
Led by then Minority Leader McCarthy and Whip Scalise, 174
Republicans voted against the bill. As Chairman Bost said at
the time, ``House Democrats shoved the deeply flawed policies
of wildly expensive costs of the PACT Act through the House,''
and then referred to the PACT Act as, ``empty promises''.
I doubt any of the hundreds of thousands who have benefited
from the law views the PACT Act as deeply flawed. Thankfully,
there were 34 Republicans who showed leadership and courage and
voted for the bill, but it should have been unanimous from the
beginning.
Indeed, Chairman Bost chose to push a less than half
measure in the Healthcare for Burn Pits Veterans Act a
provision, mind you, that we included in the PACT Act, but that
in its entirety alone increased healthcare access by only
24,000 veterans compared to the over 270,000 and growing list
added because of the full PACT Act being enacted. Apparently,
shutting out the other 250,000 veterans was okay with our
majority because it kept the ``wildly expensive'' costs down.
Thankfully, when the House voted for the final time on the
PACT Act in July 2022, most of my Republican colleagues,
including the chairman, had seen the light or read the
political tea leaves and came around to supporting the
legislation.
Yet even though my colleagues expressed reservations about
the funding mechanism in the bill, so again quote the chairman,
``The fund is also a budgetary ploy by the Democrats to take
existing healthcare costs that have nothing to do with toxic
exposure and transfer them from discretionary to mandatory
spending.''
Well, Mr. Chairman, shifting healthcare costs from the
discretionary side of the ledger to the mandatory side was
exactly the point. We have made a promise through the PACT Act
to our veterans, and that is what the P in PACT stands for,
that they will have access to health care for conditions
related to toxic exposure.
The cost of war toxic exposure fund is the mechanism
through which we are ensuring that promise is kept for this
generation and future ones as well. Why are you now trying to
walk away from that?
I refuse to go back to a time when veterans must compete
with other domestic spending priorities for funding, and I
refuse to concede that cost should be an issue when addressing
the legacy of toxic exposure among our veterans.
Does the majority propose to tell us today which of the
270,000 veterans newly enrolled into VA healthcare they do not
want to serve? I doubt it.
Will you detail for us today which of the 830,000 veterans
with approved PACT Act disability claims you feel should not
have been awarded benefits? Of course, you will not, but
perhaps the majority intends to send with caps on the cost of
toxic war exposure fund is that what--is that VA has done
enough. That perhaps--that they should not have--that they
should not approve any more disability claims or add any more
veterans to the healthcare rolls or create any new presumptions
of service connection. I highly doubt that that is the case
either.
Then why are we here? The only answer to that question that
I can muster is that the majority once again wants to pretend
that it is the party of fiscal conservatism, only this time it
comes at the expense of toxic exposed veterans and their care.
To that, Mr. Chairman, I will leave you with another quote,
this time from the gentleman from Montana, Representative
Rosendale, who so aptly said, ``We are willing to spend far too
much money to engage in conflict and far too little to care for
warriors, our warriors, once they come home.''
Mr. Chairman, I could not agree more and I yield back.
The Chairman. Well, I thank the ranking member for his
opening statement. We both read our scripts now, and now I am
going off script.
I just came off of an election where half-truths and
misquotes were used against me. I think I just saw that again
because let me explain to you when the first PACT Act first
tried to move out of the House, even the Senate itself and the
VA said under the existing language they could not implement
the PACT Act to what we know today as being very good and being
able to achieve the goal of the PACT Act. Instead, it was
trying to be shoved out of the House for what I believe was a
political move.
Now, we came to a point where we got to an agreement and we
used the PACT Act. Even then though I talked about the concern
that we had with the toxic exposure fund of double-counting,
and that is the problem. It double counts the dollars and
therefore takes away from the ability for us to implement
things like the Elizabeth Dole Act, which we are trying so
desperately to do.
It is an error in the way that we wrote it. I am in no way,
let me make very, very clear and very honest, like I said, I am
not scripted here, it is in no way wanting to, regardless of
the political spin, saying we want to take away from our
veterans. We want to add to what we can do for our veterans.
We need to drop the political rhetoric that our staff
writes and actually start setting down together and working,
and that is what this hearing is about today.
Listening from the VA on where they are at with this,
whether they are opposed or not to my particular legislation,
and I said if you have got other ideas come forward because
right now we are being dragged down by the fact when CBO scores
what we are doing and we do not have the advantage of actually
doing the things that many of you on your side of the aisle and
our side of the aisle want to continue to do for our veterans
because of a improper, what I believe an improper, counting of
the dollars that we are spending.
Why in the world if someone is already receiving their
medical care do we double count it the way this legislation is
written? Why in the world would we all of a sudden write this
so that when the VA decides to move forward with something that
really does not have to do with toxic exposure we are going to
go ahead and say, oh, well, the way it is written you can take
money from the TEF and not go for toxic exposure but building a
building over here or do something else over here, instead of
providing it for our veterans, who I believe both I and the
ranking member want to support.
Now, we have listened to the rhetoric, because I went on
like that, I will be glad to let you have a response, but then
we will listen to the witnesses and such.
Mr. Takano. Well, thank you, Mr. Chairman, for the time to
respond. Let me just first of all dispense with the notion that
the TEF was the reason why the Elizabeth Dole Act was not able
to go forward.
My staff spent a lot of time with CBO to come up with a
revised score, a modicum of which might have been related to
TEF, but most of all it was, we pointed out, the mistaken way
in which they were calculating the sheer costs of Elizabeth
Dole. Also let us not associate the difficulties with Elizabeth
Dole with primarily being connected with the TEF. That is not
true.
We are going to hear testimony today from our witness from
the VA that will show the very rigorous way in which they
account for the cost and how the way the TEF is structured has
facilitated VA to be able to reach out to so many people, to
have a backlog that is far less than everybody agreed. I agree
that we do need to take a look at how CBO scores in light of
the TEF. but that is something that we can take care of by
working with our appropriators and with each other. To
fundamentally change the way that we have assigned the costs of
toxic exposure to the mandatory account and now revising it
back to a discretionary frame I think is a big mistake and is
the fundamental disagreement.
I do not want to go back to the good old bad days,
especially when we have a very, very large new obligation that
we said we must take on that we are going to pit veterans
against other veterans' programs and pit them against other
Americans in need.
I will stop there. I am eager to hear from our witness from
VA to actually hear how the TEF has worked with their being
able to facilitate reaching so many veterans and how they are
going to reach so many more.
I yield back.
The Chairman. Thank you.
Now, I would like to introduce the witnesses for the
Department of Veterans Affairs. First we have Hon. John
Rychalski, the assistant secretary of management and chief
financial officer.
We also have Laura Duke, the chief financial officer of
Veterans Health Administration (VHA) and Ms. Lasheeco Graham,
the chief financial officer of the Veterans Benefits
Administration (VBA).
If each one of you would rise? I would ask the witnesses to
rise and raise their right hand. Do you solemnly swear under
penalty of perjury that the testimony you are about to provide
is the truth, the whole truth, and nothing but the truth?
[Witnesses sworn.]
The Chairman. Thank you, and let the record reflect that
the witnesses answered in the affirmative.
Mr. Rychalski, you are recognized for 5 minutes to deliver
your opening statement, and we thank you for being here.
STATEMENT OF JON RYCHALSKI
Mr. Rychalski. Thank you. Good morning, Chairman Bost,
Ranking Member Takano, and members of the committee. Thank you
for inviting us here today to present our views on the draft
Toxic Exposure Fund Improvement Act. Joining me today, as you
introduced, are Laura Duke from VHA and Lasheeco Graham from
VBA.
The Sergeant First Class Heath Robinson Honoring our
Promise to Address Comprehensive Toxics, or PACT Act, signed
into law by President Biden on August 10, 2022, authorizes VA
to deliver veterans' healthcare and benefits associated with
exposure to environmental hazards during military service.
Section 324 of the PACT Act established the cost of war
toxic exposures fund, or TEF. The pairing of this
transformational legislation with a highly effective funding
mechanism, the toxic exposures fund, has unquestionably
benefited veterans in substantial ways. I would like to
illustrate one example of that.
A veteran exposed to herbicides while serving in Thailand
in the early 1970's had been trying to get service connection
for Parkinson's disease, Type 2 diabetes, and peripheral
neuropathy for the last 7 years. All his previous claims and
appeals had been denied.
On the first day we granted PACT Act benefits, that vet was
granted a service connection for 13 disabilities. That is
because the PACT Act added a presumptive for his service in
Thailand. For him that is a retroactive and monthly benefit
that will go a long way in supporting his well-being for the
rest of his life, and the toxic exposures fund provided the
resources to make that possible.
The same scenario is playing out thousands of times each
day. As of February 2024, VA has completed more than 5 million
toxic exposure screenings and there are more than 4 million
current enrollees in the PACT Act planning population. VA has
approved over 700,000 claims related to the PACT Act for
veterans or survivors and over 900,000 total veterans and
survivors have completed PACT Act-related claims.
The toxic exposures fund has allowed us to fully deliver
what we owe to this veteran and many others in health and
compensation benefits without jeopardizing other VA programs
because of competing funding requirements.
We have approached our use of the toxic exposures fund
responsibly with great care and thought. The fund is not
available for use for all PACT Act provisions. We have worked
closely with our general counsel, the Office of Management and
Budget (OMB), as well as the organizations receiving toxic
exposure funding to develop allocation methodologies that
adhere to the intent of the law and are effective, traceable,
and auditable, while not impeding our ability to serve
veterans.
Once all parties agree an allocation methodology has met
this high standard, we publish the methodology and requirements
in a financial policy. In 2023, we asked the Office of the
Inspector General (IG) to review our work. In February 2024
they issued a report that commended the Office of Management
for proactively seeking legal guidance from the Office of
General Counsel to ensure (OGC) that TEF allocations are used
in accordance with their authorized purposes.
We have since briefed the details of our approach on the
use of this fund and our methodologies to numerous authorizer
and appropriator staff, as well as veteran service
organizations and the Office of the Inspector General. We have
made our TEF use policies available on our policy website, and
we provide monthly execution reports to oversight committees
detailing our use of the funds.
Given the great success of the PACT Act and the toxic
exposures funds, we are concerned about the certain provisions
contained in the Toxic Exposure Fund Improvement Act and
potential unintended consequences that may adversely affect
veterans. We are happy to discuss the proposed legislation and
look forward to working with this committee to ensure veterans
continue to receive the healthcare and benefits they have
earned without jeopardizing other VA programs. Thank you and I
look forward to your questions.
[The Prepared Statement Of Jon Rychalski Appears In The
Appendix]
The Chairman. Thank you, Mr. Rychalski. Let the written
statement of Mr. Rychalski will be entered into the hearing
record.
We will now proceed to questions, and I will recognize
myself for 5 minutes as soon as I get to my questions. Mr.
Rychalski, if we do not solve the mandatory cost problem and
restore this committee's ability to legislate, sooner or later
VA will ground to a halt. There will be legislation that you
need that we cannot pass. Do you agree that the problem has to
be solved?
Mr. Rychalski. Yes. I do agree that problem needs to be
solved.
The Chairman. Okay. Also then going that way, the
administration and the VA oppose my legislation. How do you
propose to solve the problem?
Mr. Rychalski. Well, I believe that Congress, you know,
created this problem and Congress is going to have to solve it.
Congress did not ask us for an opinion on creating the TEF for
mandatory funding at that time----
The Chairman. But you----
Mr. Rychalski. Now they are asking us to fix it, so I guess
we see how that works.
The Chairman. Yet you say you are opposed to this proposal
but we still have the prior one, so----
Mr. Rychalski. Right. What I would say, Chairman Bost, is I
recognize the problem. We just have concerns with how this is
structured and maybe what some of the longer term effects of it
will be. I do not dispute the problem. The solution is
complicated. You know, if it were easy it would already be
solved here.
The Chairman. Well, putting the budget jargon aside, so let
us go to the VA receives the toxic exposure fund dollars from
Congress, just like any other dollar. You do not really have
any guarantee now, but my bill sets spending levels through
2033 that lets VA propose funding through 2045. Is not that
actually more of a guarantee than what we have now?
Mr. Rychalski. Well, I think that, sort of, the elephant in
the room is if discretionary funding was possible it would have
been used initially. I think that the problem is discretionary
funding was not available, which is why they used mandatory and
that makes me skeptical that you are going to be able to turn
this into discretionary funding and that we are going to be
able to see that funding.
The Chairman. Okay. The administration is using the toxic
exposure fund to move VA spending out of discretionary so they
can spend more money on other agencies. You mentioned Labor,
Housing and Urban Development (HUD), and Health and Human
Services (HHS). Republicans have never had a problem
prioritizing veterans. We have proved that over and over again
when even people are saying, oh, no, they are going to cut
veterans. We have shown over and over again we do not.
Now, your opposition to the bill seems to be more about the
other agencies and less about VA. How do you respond to that?
Mr. Rychalski. Well, it is definitely about--I mean, that
is a concern but it is more about the VA. Let me just give you
a couple, just a short example. We are early in the PACT Act.
You know, just 2 weeks ago we expanded health benefits under
Section 103. We do not know what that is going to cost.
We were given the authority to expand, look at presumptives
in relation to toxic exposure. We do not know where that is
going to lead us. My concern is that it is premature to narrow
the scope, sunset this and to put caps at this point in time.
We just do not know.
We need a guaranteed source of funding. You have seen we
have been able to do with the funding and the PACT Act. We have
done a lot for veterans. My concern is that this bill may--the
intended consequence may be to limit our ability to do that.
The Chairman. Here is the thing. If we do not go forward
with this bill, and believe me I am not the person that says
okay, I am always going to be right on every bill, but if we do
not have this conversation that we are having here today what
is going to happen is we are going to be like the guy who jumps
off the Empire State building and they ask him at the 30th
floor how is everything going? They are fine just now.
We are going to hit the bottom and when we do all of these
things that we want to do as members we are not going to be
able to do it because we are double counting. Do you agree with
me that we are double counting, according to CBO not according
to VA, but the CBO is double counting. Do you believe that?
Mr. Rychalski. I mean, I cannot speak to CBO's estimates.
With respect to what our counting and our execution I
absolutely do not agree with that. We are not double counting.
The Chairman. Okay. VA is not, but when it counts against
us when we are trying to present any bill through we have got
to have an advantage that allows us to say no, no, no. This
person was already receiving care.
Now they do qualify under the PACT Act, but they were
already receiving care, but now we are going to count them
again. You do not do that because you are going to do your
budget just the way your budget is, but CBO does. Therefore it
ties us, as I said in my opening, it handcuffs us.
I am not bound to this particular piece of legislation, but
it is the idea that we have come up with that we can clearly
see that we meet those requirements, above and beyond at times,
what VA estimates the cost are going to be. When and how, and I
am out of time here and I want to keep this on schedule today,
but I would like to know as the other witnesses are asking
question, or other members are asking questions, each of us
need to weigh out when we are told we do not want to pit
veteran against veteran, but we actually are because of the way
CBO is scoring this.
With that, I will yield back and turn it over to the
ranking member for his questions.
Mr. Takano. With regard to the way CBO is scoring all of
this, I believe that, you know, we do have ways to get with the
appropriators, and so that is a whole other question. I just
want to point out that on the first page of this bill, the
majority changes the name of the fund dropping the cost of war
section. Instead of calling it the cost of war toxic exposure
bill they just call it--so I want to know what the purpose of
that is?
They claim to agree with us that the true cost of war
includes care for veterans when they return home, yet the very
first action of the bill undermines or belies that fact. The
same party that cheered and high-fived when Senate Republicans,
led by former Senator Toomey, blocked passage of the PACT Act
because of the fund, which they labeled a slush fund, and that
was sort of implied by the chairman's comments. The same party
that had to be shamed by veterans sleeping on the steps of the
Capitol into doing the right thing is now asking veterans to
simply trust that they are not undermining the law's promise.
Yet we have before us this poorly drafted bill with no
guarantees of funding for care and benefits either now or in
the future. The majority uses a shell game proposing to take
money that only exists on paper and transferring that to an
imaginary lockbox at the Treasury.
Then they would prevent that money from being used by the
VA to help toxic exposed veterans until Congress gives its
blessing. That would hinder VA's agility implementing the law
and inject a great deal of uncertainty into the system as VA
could not count on funding being available in any given year.
This uncertainty would start now in Fiscal Year 2024. All of
this to achieve less than 1 year of relief from the TEF tax
according to CBO analysis of the bill.
As I mentioned, I view this bill, at best, as a serious
impediment to VA's ability to implement the PACT Act for
current and future veterans and at worst a cynical attempt to
shrink a law they always thought was too big.
Mr. Rychalski, how has the cost of war toxic exposure fund
helped VA implement the PACT Act?
Mr. Rychalski. Well, it has helped us tremendously and I
will just give a couple of examples. Before the TEF fund, VBA
claims production was, like, in the 5,000, 6,000, 7,000 range.
Today after TEF and hiring it is approaching 11,000 a day.
They had projected a backlog of 600,000 to 700,000 because
TEF and hiring. The backlog is between 300,000 and 350,000, so
almost half of that.
You know, we had the gradual ramp in of the healthcare
benefits, enhanced healthcare benefits under Section 103. It
was supposed to, I think, go through 2032, but we opened that
to all veterans this year. Like for some veterans that is 8
years earlier and that is because of the TEF funding so it has
been remarkable.
Mr. Takano. We have been able to accelerate to all
potential beneficiaries. That is an extraordinary achievement.
Mr. Rychalski. It is. It is an extraordinary achievement.
That is 8 years for some veterans, 8 years sooner that they are
getting healthcare and that is because we are adequately
funded, which is why we are--whether it is the TEF, however it
is, adequate funding is critical and----
Mr. Takano. Well, I remember arguments actually on the
Senate side against passing the PACT Act, that this was going
to cause a huge backlog, that they did not trust VA's ability
to. They looked at previous history, but the TEF has shown--the
TEF has enabled the ability to move tremendous numbers of
people. Well, we see it, 820,000 claims being approved.
There seems to be some disagreement between CBO and VA
regarding whether the new TEF would be mandatory or
discretionary. As the agency that is tasked with implementing
this law in conjunction with OMB, what is your take on this?
Mr. Rychalski. If the bill came over as it is written today
it would be discretionary and that is affirmed by OMB, their
budget division and also their general counsel. Whether that
was the intent or not I do not know, but that is how it is
read.
Mr. Takano. Well, what feels like a gimmick to me is that
the majority is proposing to put monopoly money in the fund
that is funded that just exists on paper. VA cannot use it
until Congress appropriates it a second time. I do not know
about you, but I would not have high confidence in this
Congress appropriating anything once, let alone a second time.
Is that VA's understanding of how this legislation works?
Mr. Rychalski. Well, it is true that the scoring does not
generate cash to put into the account and that gets back to my
previous comment about it. Because discretionary funding was
not available to fund this initially, I do have concerns going
forward if it is changed to discretionary and the ability to
appropriate and receive those funds.
Mr. Takano. Well, thank you very much.
My time is up and I yield back.
The Chairman. Thank you.
Representative Radewagen, you are recognized for 5 minutes.
Ms. Radewagen. Thank you, Chairman Bost and Ranking Member
Takano for holding this hearing. Thank you to the panel for
your testimony.
Mr. Rychalski, what prevents the Toxic Exposure Act from
becoming a slush fund?
Mr. Rychalski. Well, first is the legislation and how it is
written, but second, how we are implementing it. We are doing
that in strict consult with our general counsel, OMB, their
general counsel, and asking for the IG's review of our
execution to make sure that it does not become a slush fund.
Ms. Radewagen. You have been using the toxic exposure fund
to move VA activities out of discretionary funding and into
mandatory spending. Putting aside the budget implications of
that, I am also concerned that it limits Congress' oversight.
Do you commit to cooperating with the committee as we give
these activities extra scrutiny?
Mr. Rychalski. Absolutely, yes.
Ms. Radewagen. Thank you, Mr. Chairman. I yield back the
balance of my time.
The Chairman. Thank you.
Representative Pappas, please.
Mr. Pappas. Thank you very much, Mr. Chairman.
Maybe, Mr. Rychalski, if we could build on that a little
bit, these claims, when the bill was being considered and being
implemented that there is some sort of a slush fund here with
the TEF.
You spoke a little bit about the internal controls that
exist to comply with the statute. Can you give us a little bit
more detail about how VA, or even Ms. Graham how VBA determines
what is TEF-eligible and what is not and how it reports those
expenditures?
Mr. Rychalski. Yes, and I will let Lasheeco speak as well,
but what I would say is that we work very closely with each
account each account. I mean, each account is different and we
looked at the costs.
I will give you an example. When VBA looked at the TEF we
thought, you know, if a claim comes in and it has one condition
that is toxic exposed we are going to count that as a TEF claim
and we are going to pay for it with toxic exposure dollars.
When we consulted with our lawyers they said you cannot do
that, that you can only charge the part of the claim that is
related to toxic exposure.
They had to go through an exercise figuring out the cost of
a claim, how much of it would be toxic exposure. That is the
kind of detail that we are going in.
The other thing I would say is we are reviewing every
receipt. Before we charge the toxic exposure fund we are
reviewing every receipt before we charge the fund.
Lasheeco, you may have some more detail.
Ms. Graham. Absolutely. As we finalized our operating plan
and business that was associated with the PACT Act claims, we
wanted to ensure that we were being consistent with the TEF as
it stands in the appropriations. We consulted with the Office
of Field Operations. We consulted with OMB, as well as
Performance Analysis Integration team to make sure that the
individuals that were hired for PACT Act purposes would be
coded properly in our HR system, as well as in our finance
systems.
Therefore as we go through, as Mr. Rychalski said, and we
are looking at the various costs associated with processing a
claim, we are able to determine the employees that actually
worked that particular claim and then do a reconciliation at
the end of each month to ensure that the funds are in the
appropriate account, whether it is the TEF account or our
general operating expense funds.
We also require that before individuals hired or any
funding that is spent on TEF related to contracts, salaries or
travel, or anything of the sort, that there is a clear and
direct nexus to the TEF itself. It is not--we are very clear in
working with OGC that TEF and PACT Act are not synonymous. We
make sure that it is definitely tied to the toxic exposure
fund.
Mr. Pappas. Okay. Thank you for helping us understand those
internal controls.
Mr. Rychalski, you talked a little bit about how there were
predictions, both from members of this committee as well as
from VA about a ballooning of the disability claims backlog
with the passage of PACT Act, and we have not seen those
numbers because of a couple of things. One, dedicated VA
employees that are doing this work day in and day out and are
working incredibly hard to meet the moment for our veterans,
and number two, the authorities within the PACT Act.
Because VA has been able to hire and train significant
numbers of claims processing staff, they have used money from
the toxic exposure fund to do that and recognizing that veteran
service representatives currently do not just work on PACT Act
claims.
One of my concerns is that for the purposes of the fund if
they are restricted only to those expenses necessary to carry
out the PACT Act you will end up with two classes of employees,
TEF-funded and non-TEF-funded employees. That would
potentially, you know, risk some of the progress you have made
with the backlog.
Could you talk a little bit about the implications for the
way VBA does business with this legislation?
Mr. Rychalski. Well, what I can say is if it becomes so
complicated that we cannot operationalize it and make sure that
we are using the money appropriately, for example, for toxic
exposure, then we do not use it and we have to use base
funding. If we do that too much then we end up having to pull
it from other programs.
It is important that the fund that we use is clear and
concise and executable enough that we are able to support and
do the things that we have done. That is where I would say, you
know, Congress should definitely take a victory lap with PACT
Act and the toxic exposure fund. I am not saying that is the
only way to fund this. All I am saying is with adequate funding
we can do a lot, which we have seen, and that is why we are,
sort of, jealously protecting that aspect of it.
Mr. Pappas. Well, thank you for those comments. I do
believe and I think we all agree that PACT Act was a landmark
law. It is delivering important help and benefits to millions
of American veterans who deserve it, some who have waited a
real long time to get this assistance. I think we should be
working together to deal with some of the challenges that we
face with respect to the scoring of legislation, but we should
not be jeopardizing the future of this law and the help that it
is going to provide and make a difference for so many veterans
that we care deeply about on this committee. Thanks for those
comments.
I yield back.
The Chairman. Representative Rosendale.
Mr. Rosendale. Thank you very much, Mr. Chairman.
Thank you, Ranking Member Takano for quoting me there
today. I stand by those comments still, by that quote, and I
know also that Chairman Bost does.
Like Chairman Bost, we want to make sure that all of the
dollars that are appropriated to the VA reach their intended
destination. That is really what this is all about.
Thank you, Chairman Bost, for holding this hearing. I was
proud to vote for the PACT Act last Congress. The legislation
expands VA healthcare and benefits for veterans exposed to burn
pits, Agent Orange, and other toxic substances.
The legislation created the toxic exposure fund as a
reliable funding mechanism to remove the cost of the PACT Act's
healthcare expansion and administrative cost of its benefit
expansion from the VA's discretionary budget.
The VA has used the toxic exposure fund as a flex fund to
cover expenses that are not directly related to the PACT Act.
The chairman's legislation attempts to clarify that the toxic
exposure fund should be used to fund healthcare and benefits
related to administrative and IT expenses and medical research
under the PACT Act and not siphoned off for other purposes.
That is all that legislation is for.
Just as I said in my quote, we are always willing to spend
an enormous amount of money to send our warriors into war, but
we do not make the investment when they come home. Let us make
sure that the investment is going where Congress directs it,
where Congress directs it. That is our job.
Mr. Rychalski, the toxic exposure fund seems to be moving
money around rather than actually increasing the resources to
take care of the veterans. Looking at your 2025 request for
your base budget and the TEF together, medical services is up
by about $4 billion. Community care is taking roughly a $7
billion cut. Can you explain that to me, please?
Mr. Rychalski. I want to let Laura, but I am going to speak
to it. If you look at the request, it is misleading because
that does not include the total funds we have available. We do
have the TEF fund available. We do have carryover available.
When you look at those total sources of funds in 2025 it
actually does increase.
I do not know, Laura, if you want to add some color
commentary to that?
Ms. Duke. Yes. If you look at the total obligation,
anticipated growth in 2025, we do expect to obligate almost $41
billion for medical community care, which will be a 12 percent
increase over 2024. It is the largest increase across our four
appropriations, and that includes the resources that will be
available under the TEF for the purpose of community care, as
well as anticipated carryover expenses where we still have
extra funds to the extent because of the timing of when the
budget was requested and when the PACT Act was implemented
creating the TEF.
Mr. Rosendale. Mr. Rychalski, I think you are using the TEF
the way a lot of states have been using their lotteries, quite
frankly. They promise to boost education funding, almost every
state. That is what they sold the lottery systems on. In
reality they diverted part of the regular budget to pet
projects and schools did not wind up with any money at all.
The VA promised veterans dedicated funding for their toxic
exposure-related healthcare, but in reality you are using toxic
exposure fund to dump costs out of your regular budget so that
other agencies can spend more money. How does that benefit the
veterans?
Mr. Rychalski. I mean, well, I would dispute the premise.
Mr. Rosendale. We are going to have to dig through the
accounting, and I am not a forensic accountant, but we
certainly have people on staff that will show that those moneys
are being directed to other parts. We want to be able to
quantify how it is delivering healthcare. If there are
deficiencies for funding in other areas within your control,
should not those requests be made through the Appropriations
Committee to Congress?
Mr. Rychalski. I am not exactly sure what you are referring
to. I mean, we have requested through our budget what we need.
Mr. Rosendale. If you have deficiencies, again, we have
toxic exposure fund and that has been defined of what is to be
used for. Unfortunately, it has not had enough, as they always
say in this place, sideboards placed upon it to make sure that
they can be specifically used for delivering that healthcare
for people that have been exposed.
If there are deficiencies in other areas should those
requests not come through Congress and through the
appropriations process?
Mr. Rychalski. Well, Congressman Rosendale, you know, the
IG looked at our healthcare approach for using the TEF and----
Mr. Rosendale. If you have----
Mr. Rychalski [continuing]. and endorsed it.
Mr. Rosendale. Mr. Rychalski, this is not a really complex
question. If you have deficiencies in other areas, rather than
utilizing those funds should not you be going to Congress and
requesting through the appropriations process support in those
areas?
Mr. Rychalski. That is such a highly speculative question.
I would have to see this specific incident.
Mr. Rosendale. I yield back, Mr. Chair. Thank you very
much.
The Chairman. Thank you.
Representative Sheila Cherfilus-McCormick.
Ms. Cherfilus-McCormick. Thank you, Mr. Chairman.
VA has used funding from cost of war toxic exposure funds
to great effect to manage their growing workload brought about
because of the PACT Act. In particular, the Office of
Information Technology (OIT) has used TEF funding for several
significant projects, including automated benefits delivery,
va.gov updates, modernization of VA Benefits News (VBN), and
software at the Board of Veterans Appeals. I think we would all
agree that those are vital uses.
However, as we have so many other lines of business at the
VA, those IT systems are not used solely for the purpose of the
PACT Act. I am concerned that any attempt to limit tech funding
to only IT updates related to the PACT Act would in effect shut
it off as sources of funding for modernization.
My question to you is how has OIT already included TEF
funding into future years' budget requests?
Mr. Rychalski [continuing]. specifics to our budget
materials that we consider. Okay. We have, you know, we
consider TEF, the TEF requirements in our IT budget VBA,
healthcare, obviously, and that is included, for example, in
our 2025 budget, the amounts that we are going to use. We
actually go down to the specific program and project and system
and what they are going to do for those systems that is TEF-
related.
We can provide additional detail to you if you are
interested in that, but it is, sort of, all built into our
total budget request.
Ms. Cherfilus-McCormick. Can you talk about what limiting
the TEF funding might mean for OIT's ability to modernize and
maintain VA's many IT systems?
Mr. Rychalski. I mean, it has definitely been a force
multiplier for us, and we have been able to accelerate
modernization of some of these systems. You know, we talked
about the backlog that we had anticipated in the 600,000 to
700,000 range that is only 350,000, the production of 11,000
claims a day where it used to be 6,000 to 7,000. IT systems
figure prominently in that.
The additional TEF funding has enabled them to speed up the
modernization to support those new TEF claims so it has been,
you know, absolutely invaluable.
Ms. Cherfilus-McCormick. Would you agree that limiting it
would actually stifle modernization?
Mr. Rychalski. Oh, absolutely yes.
Ms. Cherfilus-McCormick. Thank you.
I yield back.
The Chairman. Representative Self, you are recognized for 5
minutes.
Mr. Self. Thank you, Mr. Chairman. I want to talk about--I
am a freshman. I was not here when the PACT Act was passed, and
I have no quotes to be given in this forum, but I do have some
questions because I was not here. I want to explore the
authorities and I want to quote one of my colleagues that has
been here longer than I have been. ``Occasionally rule agencies
and departments write rules that are diametrically opposed to
the will and the intent of Congress.''
The authorities that you are talking about, and I will pick
up on Mr. Rosendale's comments, have you written the rules to
activate, to execute the PACT Act? Do you believe that your
rules follow the intent and will of Congress?
Mr. Rychalski. Well, we have written the policy for each of
the organizations receiving the toxic exposure fund money, and
I do believe those follow the intent of the law.
Mr. Self. Then specifically in your testimony you said that
you expanded Section 103, I believe?
Mr. Rychalski. Yes.
Mr. Self. I want to know specifically by what authority did
you expand Section 103? I have no idea what Section 103 is. By
what authority did you expand?
Mr. Rychalski. You know, you are getting a little out of my
area of expertise. Maybe I could take that for the record? I
think that seems like a lawyer question to me.
Mr. Self. Yes, but I want to know is it from the bill? When
you expand it indicates to me that you may be expanding your
authority under your department as opposed to under the law,
because as my colleague says, ``diametrically opposed to the
will and the intent of Congress.'' I would like an answer to
that question.
I want to go back to--and part of this is a larger issue in
this Congress because we have got to start to claw back Article
1 authority from the departments and the agencies, and I think
we may have a good case here. We must start to understand that
we are $34 trillion in debt. When you say that other VA
programs, you do not want to affect other VA programs across
the Government, we are going to have to start making choices if
we are ever going to address our $34 trillion in debt. Not the
VA, not only the VA, not any of the departments. We are going
to have to start doing it because to quote Ronald Reagan, ``The
closest thing to eternal life on earth is a Government
program.''
Why is that? Every program has a constituency and every
constituency wants to make sure that their program is not cut.
We are going to have to start balancing that if we are ever
going to get a handle on our $34 trillion in debt.
Mandatory cannot mean unlimited, and regardless of how we
get at this problem that you have agreed with the chairman
exists, we have got to get at this problem. I think that we are
going to need your help to get to the solution to the problem.
When you say it is Congress' problem do not disabuse
yourself of your help to the chairman in this committee as we
move forward.
With that, Mr. Chairman, I yield back.
Mr. Rychalski. Let me just for a moment, actually let me
respond to your question. It actually is in the law, 117168 at
the end of Section 103, Paragraph BI states, ``The secretary
may modify a date specified in subparagraph A,'' which is
Section 103, ``to an earlier date as the secretary determines
appropriate based on the number of veterans receiving hospital
care, medical services, nursing home care in the subparagraph's
reference and the resources available to the Secretary.''
The Chairman. Thank you.
Representative Deluzio.
Mr. Deluzio. Thank you, Mr. Chairman, and good morning
folks. You know, I want to start with something I think we all
agree with that there is a sacred obligation in this country to
care for those we send to fight, those who signed up to serve.
I think then Chairman Takano's PACT Act is a substantial
recognition of that obligation of this Congress meeting it, to
take care of not just veterans but my fellow toxic exposed
veterans who were sent to places where they dealt with some
pretty horrible stuff in the air and otherwise.
There has been a lot of discussion of the toxic exposure
fund, but that is not quite the right name. Mr. Rychalski, what
is the actual name under the law of that fund?
Mr. Rychalski. Uh----
Mr. Deluzio. The cost of war----
Mr. Rychalski. The cost of war, I am sorry, yes, the cost
of war toxic exposure fund.
Mr. Deluzio. The cost of war toxic exposure fund.
Mr. Rychalski. Yes. Yep.
Mr. Deluzio. I think when the American people send our
fellow Americans to fight they expect us to meet those costs.
That could be bullets and guns. That can be armor. That can be
tanks. That is medical beds, doctors.
Some of those wounds show up years later, and I think that
is the cost of war that we are dealing with in this piece of
legislation and the proposal here today. I cannot understand
why Section 2 of the majority's bill cuts cost of war from the
name of the fund. I hope it is an oversight. It seems to me a
way to avoid the politics of not--thank you, sir, very good,
Mr. Chairman. I think it is important because it is part of
what we are doing in this Congress to care for my fellow
veterans.
Now, at its core I understand there are some debates and
discussions around what fiscal obligations we have. The
American people, I think, expect us to care for veterans. The
folks we have sent off to fight and serve they will bear that
cost.
If we have problems in our budget or otherwise, well, maybe
we ought to tax the rich. Maybe the very people who for every
generation we sent folks off to fight had their taxes increased
ought to pay a little more to care for the folks sent off to
fight. I do not think this is a fiscal problem that should be
solved on the backs of veterans. I think it is a revenue issue
that we have to address.
I am also concerned. I do not see Veterans Service
Organizations (VSO) in this hearing. I do not see them on this
panel. I think they have something to say about their care and
about the impact of this legislation on toxic exposed veterans.
I hope we will see good engagement from the VSOs as we go
forward.
Mr. Rychalski, I want to ask you a question, and I am going
to go to your testimony. You wrote, ``Amending the PACT Act as
suggested by the bill would severely constrained VA's ability
to provide timely, high quality healthcare and benefits to all
veterans, including those with toxic exposure.''
You also wrote, "The impact of the majority's bill would
be, quote, `That VA's ability to provide benefits and services
for toxic exposed veterans would be significantly
jeopardized.'" Why?
Mr. Rychalski. Well, just let me give you an example. You
can just do a simple math exercise. If you added up the total
amounts provided in the Toxic Exposure Fund Improvement Act,
add up those total amounts of funding that they would deposit
in the account and you compare that in the OMB budget tables
for the Fiscal Year 2025 budget we just released, we would
receive $17 billion less in funding. That would be difficult to
make up.
I mean, we would have to make that up somewhere else. That
is why it is----
Mr. Deluzio. What would those ``somewhere else'' be within
VA for instance?
Mr. Rychalski. I mean, we would take it from other
programs. It could be infrastructure. It could be equipment. I
mean, it could be rural health. It could be wherever we needed
to.
Obviously, we are going to provide the care to veterans so
other things are going to--and that is our concern with, you
know, pulling back on funding too soon or sunsetting the fund
too soon. We are really early into this.
The other thing I would say, and this is an important
aspect here, you know, we are just, kind of, coming out of
years of denial of, you know, the effects of toxic exposure to
the age of enlightenment. We have now the statutory authority
in the PACT Act or the statutory process to look at
presumptives, you know, and we have to have the resources to do
that.
The current toxic exposure fund provides those resources.
The Toxic Exposure Improvement Act does not. It narrowly scopes
that.
For presumptives coming down the line it would not be
covered under this fund and so that is a problem. I mean, we
are just really getting our hands around this.
Mr. Deluzio. In the 30 seconds I have left I will be brief.
To confirm, the president's budget request did not request any
changes that would cap appropriations for the cost of war toxic
exposure fund?
Mr. Rychalski. That is correct. In fact, the OMB tables
provide $17 billion more between 2026 and 2033 than this
legislation does.
Mr. Deluzio. Nor did the president's request have anything
about making this funding--shifting this funding into
discretionary?
Mr. Rychalski. Correct.
Mr. Deluzio. Very good.
Mr. Chairman, I yield back.
The Chairman. Thank you. For the record I would like to say
that the VSOs were and have been meeting on this issue on a
regular basis. They chose not to testify here today.
With that, Dr. Miller-Meeks.
Ms. Miller-Meeks. Thank you very much, Mr. Chair, and thank
you for this important hearing.
The questions I ask are coming both from the fact that I am
a 24-year Army veteran, as is my husband, and I am also a
physician and former director of the Iowa Department of Public
Health. We looked into toxic exposure, especially where we have
the Iowa Army ammunition facility, which is within my district.
I voted for the PACT Act, the improved PACT Act when it
came back from the Senate, voted for it but still had some
reservations about this bill, not our obligation to take care
of veterans who may be injured at the time or in the future
from their service, especially in combat, but in other parts of
the bill which I will address.
Mr. Rychalski, the toxic exposure fund statute is somewhat
ambiguous, and the VA has written policies to govern how the
money can be spent. What is not allowed?
Mr. Rychalski. Well, let me back up and give you an
example--the best example I can give of that is we have a PACT,
a program management office. We have a director of that program
office.
When the PACT Act was passed and the toxic exposure fund
was created we thought, well, certainly the director of the
PACT Act project management office his salary would be funded,
but when we worked through that with our general counsel they
said absolutely not. The toxic exposure fund is only for costs
related to toxic exposures. That individual does not spend all
of his time or even most of his time specifically on toxic
exposure so you really cannot charge, well, certainly not all
of this salary and probably not most, maybe not even any of his
salary.
That is an example of the type of thing we have to go
through to make sure that it is related to toxic exposure only,
not just costs with the PACT Act.
Ms. Miller-Meeks. Can you get us the other things that are
not allowed or covered? You can submit that in writing.
Mr. Rychalski. Okay.
Ms. Miller-Meeks. Most people thought that toxic exposure
fund, which was part of the PACT Act, was intended to pay for
implementing the PACT Act, but the VA has also been using it to
pay for toxic exposure-related programs that already existed.
Can you identify those programs?
Mr. Rychalski. Well, we only use it in most cases to the
extent, well, really all cases to the extent that it exceeds,
for example, healthcare of the 2021 baseline or that it is
related to toxic exposure itself. We are not shifting baseline
costs to TEF. I know people say that, but that is just simply
not the case.
Ms. Miller-Meeks. I am sorry. You just said that you are
using it for healthcare costs that exceed the 2021 amounts that
were already allocated and appropriated for toxic exposure and
programs that existed prior to the PACT Act or the toxic
exposure fund. Why would that be permissible?
Mr. Rychalski. Well, let me--Laura Duke wanted to make a
comment on this.
Ms. Duke. If I may, the way in which we execute healthcare
in our system does not lend itself to the strict fencing that
we have done because we did not want a situation where we hired
a provider and that provider was only approved to deliver
medical care to PACT-eligible veterans. We wanted to ensure
that we were maximizing the use of our providers' time and that
we were helping as many veterans as possible to receive the
care timely.
What we are looking at is we are taking the PACT and the
TEF and baseline funding as the total that is available for us
to run our system. Then after the care is administered we then
are accounting for the total cost of the care the visits where
toxic exposed veterans are receiving the care. Those are the
costs that we are----
Ms. Miller-Meeks. I am going to reclaim my time----
Ms. Duke. Yes.
Ms. Miller-Meeks [continuing]. but I am going to say that
it is a nebulous, ambiguous cost shifting as a physician who
takes care of patients.
My next question is the concerns I had about the PACT Act
and presumption and presumption of toxic exposure leading to a
disease either now or in the future. Part of the PACT Act has
research. Why do we want to continue research and development
and to find out if there really is--and if an exposure is, in
fact, related to a disease status, if we are going to presume
that every disease is related to some toxic exposure whether it
is or not?
Then number two, the follow up to that is in the PACT Act
we also continue all of the healthcare, all of the benefits,
even if it is proven through scientific measures that there is
not a causality. Is this a portion of the PACT Act and funding
that we do not need because in the PACT Act the presumption is
that any toxic exposure has created disease now or in the
future? You are talking about future presumptive exposure.
Ms. Duke. I think our research program first improves the
quality of the health care that we deliver by learning better
ways to treat the conditions in question. To the extent that
the future disability qualifications is making sure that not
only are we providing the healthcare but that veterans whose
quality of life has been compromised as a result of their
exposures are adequately compensated.
Ms. Miller-Meeks. So care, the treatment care, treatment
modalities is different than research into presumption, which a
lot of that, I think, if we have a proper implementation of the
electronic health record and coordination with the Department
of Defense (DOD) would help that.
I yield back my time.
The Chairman. Representative Budzinski.
Ms. Budzinski. Thank you. Thank you, Mr. Chairman. Thank
you Mr. Ranking Member. Good morning to everyone.
I just wanted to say thank you to the witnesses for being
here for this important discussion around the PACT Act and the
cost of war toxic exposure fund.
I would like to take a moment to just share two stories of
my constituents and how the PACT Act and the cost of war toxic
exposure fund has directly benefited actually both of them.
Willie Williams and his wife April Williams of Belleville,
Illinois, have both seen the real benefits again of the PACT
Act and the cost of war toxic exposure fund. Willie served in
the US Navy and the Air National Guard for 20 years. He was a
part of Operation Desert Storm and Operation Desert Shield.
While in service Willie was exposed to toxic burn pits that
led him to have a disability. This significantly impacted his
quality of life for both him and his family. Before the PACT
Act he could not understand what was going on with him. He was
not able to get the right care because they could not
understand the type of care that he needed and almost all of
his claims were denied at that point by the VA.
This was the case for many of his veteran friends that he
shared with me back home who were also exposed to burn pits.
They just could not get the answers to the questions that they
had or the care that they really needed.
Thanks to the PACT Act and the cost of war toxic exposure
fund he submitted the claims with information on his service
locations and was approved for a higher percentage in his
disability rating. Because of this, his physicians were able to
explain to him the exact kind of care that he needed for his
unique condition.
His wife April, who I was really privileged to have come
with me as my guest at the State of the Union address, is a
certified wound care nurse at the St. Louis VA Hospital. She
did her best to care for Willie during and before the PACT Act,
but also faces many hurdles in getting him the unique care he
needed due to his exposure to the burn pits.
Willie and April have seen significant improvements in
their quality of life. They are able to move forward with their
future, and Willie is getting the unique care that he needs.
I bring this story with their permission today because I am
concerned about the majority's bill, that it will impact future
veterans with similar situations and conditions like Willie.
Veterans put their lives and health on the line to protect us,
as has been stated in this committee. We know many of them who
were exposed to extremely toxic chemicals that have been linked
to a number of serious diseases.
It is our duty now to provide them with the care that they
have earned and deserve. The VA has had the ability to provide
this critical care to toxically exposed veterans thanks again
to the cost of war toxic exposure fund.
Additionally, certain positions at the VA medical
facilities may be at least partially funded by the cost of war
toxic exposure fund, and I am extremely worried that this could
hurt crucial positions, such as April Williams, a certified,
again, wound care nurse. If the cost of war toxic exposure fund
was restricted in the way proposed by the majority's
legislation, the VA may have to find other discretionary
dollars to pay for the salaries and benefits of these important
positions.
Really quickly with the time remaining, I just wanted to
ask again to anyone on the panel, do you believe that the caps
proposed in the majority's legislation to the cost of war toxic
exposure fund could hinder the VA's ability to provide this
important care to veterans?
Mr. Rychalski. We do think--yes, we do believe that.
Ms. Budzinski. An additional question I would have, too, is
could this, you know, and could be enforced to pay more for
care from the discretionary spending pit veterans groups
against each other?
Mr. Rychalski. I mean, to the extent that--we are going to
deliver the care. To the extent that we have to take from other
programs we will do so, but eventually it will affect veterans.
It could be in different groups or, you know, it could be all
groups, to be honest, but we are going to make sure that we
deliver the care that we need to.
Ms. Budzinski. Okay. Again for anyone on the panel, if the
majority bill is passed there is no guarantee that Congress
would actually appropriate up to the proposed caps. Has the VA
contemplated what would happen if Congress failed to
appropriate that funding and what kind of services would be
impacted?
Mr. Rychalski. As I described, we would look for other
sources for that funding. It could be from infrastructure. You
know, our average age of our infrastructure is 60 years. I
mean, we cannot take money from that but we would. We would
take it from new equipment purchases. You know, it could be
from, you know, rural health programs. It could be from many
programs so other programs will suffer.
Ms. Budzinski. Okay. Would anyone like to add anything
additional? Okay, great. Thank you very much.
I yield back.
The Chairman. Dr. Murphy, you are now recognized.
Mr. Murphy. Thank you, Mr. Chairman, and thank you to the
witnesses coming in today. I come from a very large veteran-
laden district, 1 in 10 essentially of my constituents are
veterans so this is a big deal for me.
Also helped to champion the Camp Lejeune Justice Act. That
is a huge deal because I serve Camp Lejeune.
Mr. Rychalski, going back, I just want to continue actually
that line of questioning. The statute is a little bit ambiguous
and VA has some written policies on how to govern this. What is
not allowed to be spent for the toxic fund?
Mr. Rychalski. Really anything that is not directly related
to a toxic exposure. That is maybe too--I mean, I can give you
specific examples. You know, we have to work through each case
basically to find out what is the link to the toxic exposure
before we can use the funding.
To give you some example of how restrictive we are, of the
$26 billion, or $25 billion or $26 billion in TEF that we have
available so far we have only charged that account with about
$3 billion because we are going receipt by receipt. It is not
that the costs are not there. It is that we are making sure
that when we charge that account we can clearly link it back
with documentation to a toxic exposure cost.
Mr. Murphy. Okay. Last year during our budget hearing
Chairman Bost asked the secretary why the VA was planning on
using the toxic exposure fund to furnish newly constructed VA
buildings. The secretary's response was that because the PACT
Act allows him to do it. That is a little concerning. Are you
guys still spending the TEF money for this purpose?
Mr. Rychalski. I am not familiar with that reference other
than there were lease authorizations and funding in the PACT
Act for leases, which I am assuming----
Mr. Murphy. Well, no. This was furnishing newly constructed
buildings.
Mr. Rychalski. I am not familiar. I would have to see that
for the record.
Mr. Murphy. All right. I need you to look back and I need a
response.
Mr. Rychalski. We will.
Mr. Murphy. Actually, the chairman should demand a
response. Hopefully, we get one as to why this is, because the
VA has been given a large amount of money and our job is to
make sure it is used efficiently. The VA spends 5-to-1 what the
British healthcare system spends on each patient, and we want
to make sure that it is spent wisely, not just in the budget of
a slush fund, as it will.
I need you to get back to us, please, with a definitive
answer. If so, how can anybody justify doing that because if
this is supposed to be for patients not furnishing buildings
with nice new chairs and computers, this, that and the other
stuff, the VA has those things, and has access to funds for
those things it should not be coming from the fund. I am
working on actually trying to get something rectified with the
Camp Lejeune Justice Act. There are some technical corrections
that we are needing to do to make sure that actually our
veterans actually have access to money like that and to limit
attorney fees. They understand this is coming, but to make sure
that they have their day in court.
Are there any exposures, anything that are going on with
our veterans that the toxic fund does not fund? Are we
delinquent in making sure that we are covering things that
should be covered?
Mr. Rychalski. I mean, Congress really has done an
exceptional job with this. We have everything, absolutely
everything we need.
Mr. Murphy. Wow. I have not heard that before from a
Government agency. You are good. We do not need to give you any
more money, is that what you are saying?
Mr. Rychalski. I mean, we are----
Mr. Murphy. No, I----
Mr. Rychalski [continuing]. have requesting what we need,
but this has been a real success. I mean, in the years I have
worked for Government this is probably the most successful I
have seen.
Mr. Murphy. I think it is successful and I think the intent
is very, very pure. We just also cannot relinquish our duty to
make sure that funds are used efficiently. That is a big deal,
you know, for me, especially with all that goes on in
healthcare with our VA. It has to be first and foremost number
one is care for our veterans, and two, are we being good
stewards of the taxpayer dollar with all this?
Mr. Rychalski. I 100 percent--I share that sentiment and we
are working hard in that regard.
Mr. Murphy. All right. Well, thank you for that.
Mr. Chairman, again, I will yield back. Thank you.
The Chairman. Thank you.
Representative Brownley.
Ms. Brownley. Thank you, Mr. Chairman. I appreciate it. I
appreciate the panel being here. Mr. Chairman, I cannot help
myself, but you in your opening remarks you mentioned the
Elizabeth Dole bill and your sentiment that it really cannot be
funded due to the current TEF funding.
I just have to say that I disagree with that wholeheartedly
because we could pass the Elizabeth Dole bill today if we
utilize the four corners agreed-upon language which makes the
CBO scoring on the Elizabeth Dole bill absolutely de minimis. I
think the strategy of your leadership, not you necessarily, Mr.
Chair, but your leadership, has been to handicap the Elizabeth
Dole bill so you could put some--so you could put the very
popular Elizabeth Dole bill into a package to also get some of
the other, sort of, Republican priorities.
Rather than putting the Elizabeth Dole bill on the floor
that both Republicans and Democrats could proudly pass, the
leadership has chosen to delay it. It is not being delayed
because of cost. CBO has scored the bill very minimally, the
cost is. I do not think the cost of the Elizabeth Dole has any
impact on what we are talking about today on the TEF funding,
so I just want to make that point abundantly clear.
I also--so I got that off my chest. Thank you very much.
The Chairman. (Inaudible 0:31:50.5)
Ms. Brownley. Yep, yep, yep, yep. I also today--yesterday I
met, this is to the panel, yesterday I met with some women
veterans who shared some anecdotal data that women who are
enrolling for healthcare benefits, whether it is Military
Sexual Trauma (MST) claims or Post-traumatic Stress Disorder
(PTSD) claims, sometimes a litany of very complicated claims,
that those claims are not being addressed as quickly as male
claims are generally of similar dimensions because of the PACT
Act.
I am not talking about the PACT Act right now. I am talking
about because of the focus on the PACT Act which, you know, we
must do and I understand that, but because of that some of
these other claims that are, kind of, in backlog, if you will,
women veterans are telling me again anecdotal data but telling
me that those claims are falling behind male claims of similar
dimensions, as I said.
I do not know whether you can speak to that today or not,
but I would certainly like someone to go back and look at that
data. I would like the data beyond anecdotal data. If it is
true we need to do something about it.
Mr. Rychalski. Yes, and we will look into that. That is not
something I have heard of. That is interesting and something
that we absolutely need to look into. If we could take that for
the record and get back to you we will do so.
Ms. Brownley. Very good.
Mr. Rychalski. Thank you.
Ms. Brownley. The last thing I wanted to mention or to talk
about, too, is the research that is built into the PACT Act. I
think the Republican legislation would severely curtail the
research unless it is related to the covered, you know, related
to what is already being covered by the bill. Sorry. I am
having trouble getting that out.
I really want to know, you know, what the intention is with
regards to research, particularly how it relates to women
veterans, whether it be, you know, breast cancer, cervical
cancer, but primarily infertility. You know, most physicians
will say infertility is very hard to diagnose in terms of what
the cause may be. I have heard statistics anywhere up to 80
percent of the time they cannot diagnose the reason for
infertility.
I happen to have an in vitro fertilization (IVF) bill that
says, you know, we should treat infertility as healthcare and
it should not be related to a specific cause. I am just curious
to know if any of this research is related to women veterans? I
see I do not have very much time left.
Mr. Rychalski. We do not have very much of an answer. Can
we take that for the record, too? You ask tough questions for
financial people, so could we take that for the record and----
Ms. Brownley. Absolutely.
Mr. Rychalski [continuing]. and get back to you? Yes, thank
you.
Ms. Brownley. Absolutely.
Mr. Rychalski. All right.
Ms. Brownley. Thank you.
Mr. Chair, I yield back.
The Chairman. Representative Crane.
Mr. Crane. Thank you, Mr. Chairman.
Thank you to the panel for coming here today to talk about
this very important issue. I deployed to Iraq in 2006, 2008,
and 2010. On every major base that we were on we had burn pits.
I remember a couple afternoons I actually spent several hours
in burn pits searching for mistakenly discarded serialized
equipment.
It was not something that, you know, we thought about
necessarily at the time. We did not know how harmful burn pits
were. I was just worried that we were going to get in trouble
because we could not find the serialized equipment. I do have a
little bit of experience with, you know, this hazard that many
of our veterans are coming back and getting very sick from.
One of the things that I hope comes out of this hearing and
others like it, I hope that we start to count the cost of these
wars that we continue to have an infatuation with engaging in
all over the world. I do agree with Mr. Rosendale's sentiments
and statements that Mr. Takano posted right back here on the
board. I think, you know, here we go again. It looks like there
are multiple wars on the horizon, and I do not think we are
doing a good job counting the cost, not only what it could mean
for our active duty individuals and sending our blood and
treasure over to these spots in the world, but how were even
going to afford it when they come back because clearly we
cannot afford even to take care of the veterans we have right
now.
I mean, nobody can make the logical argument that when,
like Mr. Self said, when we are $34 trillion in debt we cannot
even afford the ones that we have now. I hope that we start
really thinking about counting the cost. What does this cost?
You know, if we truly cared about our veterans we would not
just be worried about--because we love to sit on these panels
and say cheer our veterans, oh, we love veterans, but do we? Do
we really?
If we really did we would not just be worried about this
piece of legislation or the one coming down the pipe right
after it. We would be worried about making sure that we could
provide health care for our veterans 5, 10, 15, 20, 25 years
down the road.
Looking at the trajectory that we are on now, that is what
keeps me up at night. I do not think we are going to be able to
do it.
Now, on to my question, Mr. Rychalski. Can you give us a
better idea of where the moneys designated for these toxic
exposure funds, where they are going to be spent in the
Department of Labor, Health and Human Services and Housing and
Urban Development?
Mr. Rychalski. There are no toxic exposure funds. Our funds
are not going to those programs, so----
Mr. Crane. Okay. The shuffling of these moneys that we have
been talking about, kind of, moving them around because this
bill seemed to be written with flexibility in the language,
these moneys are not being sent to other places?
Mr. Rychalski. Nowhere else. Nowhere.
Mr. Crane. Okay. Thank you very much.
I yield back.
The Chairman. Mr. Landsman.
Mr. Landsman. Oh, so I am sorry. Thank you, Mr. Chair.
Thank you for being here and for everything that you do on
behalf of our veterans and our communities and for working with
the committee. I think there are really good questions that
have been raised today from colleagues on both sides here and
would just encourage you, as I know you will based on your
answers today, to be engaged with the committee, each member,
answering these questions.
Maybe even going beyond what would be typically expected
because, you know, part of, you know, this hearing has to do
with concerns, legitimate concerns about making sure dollars
are going to where they need to go. I think those concerns have
been addressed in some ways today, at least that is my sense.
In the follow up to questions I think can also help to
alleviate some of the concerns. You know, potentially there are
certain things you want to do and, you know, moving forward
that does not require congressional action but does ensure that
there is the kind of transparency and certitude about where
these dollars are going that people are looking for.
You know, the there is consensus that this investment is a
smart one, that the cost of war toxic exposure fund is
successful. It does make a big difference. We have to continue
to make those investments.
There also is a very legitimate concern that I share about
the debt that this country is dealing with. I mean, $34
trillion is a huge problem for us long term. Part of what we
have to do is deal with wasteful spending. I do not--there is
no one up here that thinks that this fund is wasteful spending,
though I think there are questions that can be easily answered
to ensure that there are no dollars being spent on anything
other than helping our veterans.
I think the area of common ground, hopefully, is
understanding that tackling this deficit and debt can be done
on the spending side or on the fixing of the tax code side. One
of my colleagues brought this up.
I believe, in addition to dealing with wasteful spending,
that the tax code has to be fixed. The question should not be,
okay, well, what should we limit in terms of veterans or
seniors or others and avoid trying to say, hey, we can only
give you this much, but to say to billionaires and to big
corporations you have got to pay all your taxes like the rest
of us. That will help to alleviate some of the pressure on
these investments.
You know, a lot of people make a lot of money, and I really
appreciate what Mr. Crane said about his experience but also
the cost of war. A lot of people do make a lot of money on
these wars. This has been brought up before so this is not a
new idea, but the, you know, putting a fee on these defense
contractors and others who make billions and billions of
dollars on these wars that will pay for all of these programs
to support our veterans so that they do not have to worry that
anything is going to be taken from them.
You know, the chair mentioned common ground and bipartisan
path forward, a partisan path forward. I hope that that is part
of the discussion.
I do not mean this in an argumentative way. I do think this
is part of what we have to talk about. That was really for my
colleagues.
Then for you all my hope is that, and then I will yield
back, the questions that I suspect you will to follow up with
the information but to also appreciate that there may be some
things that you all could do to alleviate some of the concerns
that would mean we do not have to pursue caps. Thank you.
I yield back.
Mr. Rychalski. Can we just make one comment? We absolutely
will do so. We are mindful when this fund was first established
we know that Congress looked at this and thought this is going
to be something the VA takes. They are going to use it as a
slush fund. They are going to abuse it and not without
precedent, right?
We have taken it very seriously, and I am going to stand by
our work. We are going to prove to you that we are using this
responsibly and you are going to see that. We have been very
transparent, and we are riding herd on this like no other.
The Chairman. Mr. Ciscomani.
Mr. Ciscomani. Thank you, Mr. Chairman.
Thank you to the witnesses for coming to testify today. The
passage of the PACT Act was a landmark achievement in
signifying Congress' support for our veterans in receiving the
care they were promised and as they sacrificed so much
obviously for our country. Many of my colleagues on this on
this panel, this committee, have done that.
We have a solemn duty to care for them when they returned
home, and I have about 70,000, over 70,000 veterans in my
district so I appreciate your testimony being here today.
Now, my question is for you, Mr. Rychalski. The toxic
exposure fund, I mean that is what we are here to talk about
and you have answered a lot of questions around this, but if
you could just entertain a couple more here for me? It is
pretty complicated and it got more complicated as the PACT Act
moved through the House and the Senate.
What challenges specifically have you faced in using the
fund to carry out the PACT Act?
Mr. Rychalski. Well, believe it or not, and not that it is,
you know, overly restrictive, but initially when we received
the PACT Act and the toxic exposure fund it looked to us like
we could use the toxic exposure fund for a lot of things like I
described, right? It turned out we cannot use it for a lot of
things that are in the PACT Act that are not toxic exposure-
related.
You know, give you an example. It took us 7 months to come
up with the policies for how we could use toxic exposure
funding for VBA and that was going line by line with our
general counsel, fiscal lawyers, OMB, asking the IG for reviews
to make sure. A lot of it is just making sure that we are
adhering to the intent of the law.
Seven months is a long time to come up with a methodology
and a policy, but that is the care that we are taking. Some of
it is just that. It is just making sure that we are following
your intent.
Mr. Ciscomani. All right. You know, we have talked about
this as well, but you oppose the chairman's legislation because
you say it would constrain the VA's ability to update care as
the toxic exposure science evolves. Without a doubt it took
decades of legislation and science for VA to admit service
connection for Agent Orange and other exposures.
More often than not, I believe this committee is a force
for change within the VA. Would not removing this committee's
ability to pass new legislation also hold the VA back?
Mr. Rychalski. It will and that is a problem that has got
to be solved. Agreed, yes.
Mr. Ciscomani. Thank you.
Ms. Duke, if I can transfer over to you real quick, as an
appropriator, I sit in the Appropriations Committee, I hear
constantly from my constituents about the need to rein in
Federal spending. We talked about the trillions of dollars in
debt that we have, which are very troubling for us. The value
Congress of appropriating on an annual basis is that we can
continuously look at the program's effectiveness and evaluate
spending levels.
If the VA, for whatever reason, spent all the toxic
exposure fund money before the end of the Fiscal Year how would
you fund healthcare under the PACT Act?
Ms. Duke. To the extent that our request includes both
discretionary and TEF funds balanced across the 2 fiscal years,
we believe that we are adequately funded through the two
sources of money through 2024 and into 2025 to meet veterans'
needs. I think even whether it is TEF or base we will use those
funds to continue to provide care through 2025.
Mr. Ciscomani. You are basically saying there is
practically zero chance that the money runs out? The money is,
you know, well, for whatever reason spent quicker than it
should be and the fund goes away what would happen? I want to
make sure that--the purpose of my question here is if this
money runs out or if it is, for whatever reason, spent sooner
than it is intended for, as you laid out it is planned to, but
things happen.
I am trying to make a point here of the value of Congress'
involvement here, and I am speaking both as a member of this
committee but also an appropriator. As we look at the funding
mechanism of this we have to make sure that our veterans are
going to be taken care of and that Congress has an ability to
have a say in this on an annual basis.
Ms. Duke. Which is why we include the TEF resources as part
of our annual request to the Congress, both in terms of 2025
and in 2026. If you look in our budget, we have an annual TEF
request to accompany our advance appropriation request for
2026. We are communicating the need across both of the
appropriations, and we would ask that you as an appropriator
and the rest of Congress provide those resources in order for
us to deliver the care as projected in the budget.
Mr. Ciscomani. Well, my time is almost up. As an
appropriator I will always support our veterans, and I want to
make sure that they have all the resources that they need. I
also wholeheartedly believe in the involvement of Congress
through this process and the oversight of these funds to make
sure that they are properly used and responsibly managed for
our veterans so that they are there when they need them.
That is my job both as a member of this committee and the
Appropriations Committee as well. Expect me to be asking more
questions on this. Thank you both.
The Chairman. Representative McGarvey.
Mr. McGarvey. Thank you, Mr. Chairman.
Thank you all for your testimony here today. When I get
into my questions I do want to talk about these caps and what
they ultimately mean for the care of our veterans.
Let me start by saying, though, one of the reasons I like
this committee, I think you have seen it today, is that there
is a real passion to come together in a bipartisan way and make
sure that our veterans have the care not just that they need
but that they deserve and that they have earned,
When we are talking about this I think it is important, as
Representative Deluzio pointed out, that we are talking about
the cost of war toxic exposure fund, cost of war. From Agent
Orange to toxic burn pits, these are wounds of war. They are
just like a bullet wound or something else, but just because
they do not show up immediately does not mean they are any less
serious or any less deadly.
Just yesterday I spoke to a veteran who she said she has
been exposed to toxic burn pits and has developed asthma
because of the scarring in her lungs. We hope that is it. There
are many more who have worse.
When we are here today and we are talking about funding and
affordability, I also want to make sure we spend money
efficiently and effectively. I want to make sure--I came from
state government where we had to balance a budget. We know that
the PACT Act is working. It is benefiting millions of veterans
across this country and back in my district in Louisville,
Kentucky.
I am a little taken aback by the efforts to curtail a
program that is working for our veterans for wounds they
sustained during the course of war. We are talking about
affordability. The question is not whether we can afford to
take care of our veterans. The question is can we afford not
to?
If we are going to talk about affordability, I think we
have some answers. In other rooms in this building they are
talking about cutting taxes for the billionaires and wealthiest
corporations in America. Why is it in this room the veterans
are on the chopping block? I think we can do more.
These are the same veterans who have to pay Federal income
tax on their military retirement while, according to a March
2024 report from Americans for Tax Fairness, 35 major U.S.
corporations between 2018 and 2022 paid less in Federal income
taxes than they paid to their top five executives.
We have the money to take care of our veterans. It is a
question of priority. It is the question of can we afford not
to take care of the men and women who put on a uniform and were
willing to sacrifice everything to keep this the greatest
country in the world?
I want to specifically ask about Title II of the PACT Act
which created a new expedited process for developing new
presumptive illnesses and service locations. The PACT Act was
not intended to be a definitive or a one-and-done. Obviously,
the research the VA is conducting on toxic exposure can
currently be funded by the cost of war toxic exposure fund as
is some portion of the salary of those who are evaluating that
evidence.
However, it seems as though the legislation we have before
us today is ambiguous as to whether that research can even be
conducted using this funding. In the time I have remaining, Mr.
Rychalski, what would the caps on the cost of war toxic
exposure fund mean for future presumptives if, for example, the
VA wanted to add coverage and benefits for Fort McClellan or
Karshi-Khanabad Air Base (K2) or Per- and Polyflyoralkyl
Substances (PFAS)?
Mr. Rychalski. That is one of our concerns, the narrowing
of the scope. Our understanding or our read of the law would be
that we would not be able to use the fund under the improvement
act for the costs associated with that so we would have to use
base funding or find other funding for that.
The same is true for some veterans that were already
awarded a disability for environmental conditions before the
PACT Act if they--they would not be eligible under some
scenarios for care funded by the toxic exposure fund.
Both before and after the PACT Act because it is more
narrowly scoped we would have to fund that out of existing
resources, which could be problematic for us, especially going
forward because we do not know where this is going to lead.
Mr. McGarvey. Thank you for that. What is the VA's sense on
how the majority's proposed legislation may affect the ability
to execute the new presumptive decision process as delineated
by Title II of PACT?
Mr. Rychalski. I refer that to Lasheeco.
Mr. McGarvey. Perfect.
Ms. Graham. Thank you. The process that VA historically has
used to determine the presumptive conditions often took decades
to work through in order to complete that particular process.
It was often very frustrating, obviously, for veterans, for
their families and caregivers, as well as their clinical teams
and led to delays in veterans receiving the healthcare and
benefits they earned and needed.
The new provisions under the Title II establish a process
by which VA may streamline presumptions of service connection
based on toxic exposure in a clear and transparent manner.
Mr. McGarvey. Thank you.
I see my time has expired. Mr. Chairman, I yield back.
The Chairman. Thank you.
Representative Takano, do you have closing remarks?
Mr. Takano. I do, sir.
The Chairman. Thank you.
Mr. Takano. Well, thank you, Mr. Chairman, for recognizing
me. We have discussed the effects of the cost of war toxic
exposure fund on the Congressional Budget Office scoring in the
past, and we will discuss it again in the future.
As I have said in the past, I recognize that under normal
circumstances CBO scoring related to the cost of war toxic
exposure fund could prove an impediment to moving new and
expanded legislation on behalf of veterans.
However, this Congress under this majority has been about
the furthest thing from normal circumstances as we can get. In
fact, the toxic exposure fund has not proven to be an
impediment to passing legislation at all and there are two main
reasons why that is.
One, the House majority leadership has deviated from past
precedent and required offsets to both discretionary and
mandatory spending. In the face of that CBO scoring related to
the cost of war toxic exposure fund is largely irrelevant
because if the entire cost of a bill must be offset then it
does not matter which side of the ledger the cost is on.
Second, the House majority is woefully inept and they
cannot even muster sufficient votes among their members for
their own priorities. We have seen paralysis as a result,
leading to one of the least productive Congresses in history.
In fact, the majority has only seen fit to dedicate less than 6
hours of actual floor time to veterans legislation. Surely
veterans are worth more than 6 hours of this Congress' time.
Proceeding with this legislation now is both unnecessary
and unproductive. Instead, as I have said all along, we need to
have a more fulsome conversation with all of the interested
parties and get buy-in from the appropriators and the budget
committee, the appropriations and budget committees in both the
House and the Senate.
We need also the VA, the VSOs, and other stakeholders to be
a part of these discussions before proceeding down a path of
changing the cost of war toxic exposure fund because there is
very little upside to this bill and an enormous risk of
downside.
I would ask the members present here today, do you think
everyday Americans care about how CBO evaluates the cost of
care we provide to our veterans? Do you think veterans exposed
to toxic substances as they walk into the VA wonder whether the
cost of their healthcare will be labeled mandatory or
discretionary? Of course they do not. They care about whether
or not this country will uphold the promise it made to care for
them after their service.
Do you think that a military spouse or a child whose
veteran is dying of cancer cares about budget deficits? No.
They want care for their sick family member.
This fund is absolutely crucial to ensuring VA has the
resources necessary to fully support our veterans and to
deliver the new benefits available to them without having to
sacrifice existing programs. The mandatory nature of this fund
is our guarantee that those resources will be available for
generations to come.
Not protecting funding for PACT is essentially defunding
other VA programs or pitting PACT beneficiaries against other
domestic programs. Scaling back the fund, as Republicans have
suggested, would force unconscionable choices. Which life-
threatening conditions does the minority propose not to cover?
Which veteran do they suggest we ask to live with their
diseases untreated?
Eliminating the healthcare and benefits our veterans are
entitled to because we are concerned about scores is lunacy.
The intent of Congress in the PACT Act was to stop pitting
funding for veterans against other domestic priorities such as
funding for cancer research or vaccine development, aid to
school districts for educating students with disabilities, or
funding for housing assistance for the elderly and special
needs populations. We achieve that.
Would the majority rather fund long-term care for elderly
veterans or healthcare for toxic exposed veterans? Should we
fund programs to continue to reduce the rate of homelessness
among veterans or prioritize funding for veterans who now have
Parkinson's disease because of their toxic exposure?
We passed the PACT Act because toxic exposure is a cost of
war and our country needs to pay for the healthcare and
benefits these veterans have earned.
I am sure folks are tired of hearing me say that, but it
seems that some in this House and on this committee need
reminding. I share no sympathy for those who voted for this
bill but suddenly have buyer's remorse now that the PACT is
law.
We ask men and women to sacrifice their lives to protect
our freedom. The least we can do is to take care of them when
they return home.
I hope my colleagues here today keep this in mind so that
we do not have to make the mistake of previous Congresses by
ignoring the needs of veterans. We did the right thing when we
passed my PACT Act. We listened to veterans and then followed
through on our promise. We must now commit ourselves to keeping
that promise. Thank you and I yield back.
The Chairman. I thank the ranking member.
I would like to make a couple notes into the record here.
First off, according to CBO, the mandatory cost of the
Elizabeth Dole veterans package was $2.86 billion over 10 years
before we started revising the bill.
Now, a significant portion of that is due to the fact that
the toxic exposure fund double counted existing problems. We
are continuing to work on the bill to get the cost down to
watch and do our offset.
I would also remind the ranking member and my Democrat
colleagues that if they are so fortunate to persuade the
American people to put them back in the majority, this problem
is still and will not go away. We have got to fix it or we will
be frozen without the ability to continue to offer significant
things to improve the lives of our veterans and deal with
existing problems.
I do not think the rhetoric that has existed, now, let me
tell you that I think this hearing was good in the fact that we
were getting it out there. I do not care about the words. If
you if you want to change a first line or whatever but quit
being offended by the words and let us deal with the actual
issue.
How do we do that? We realize that we cannot double count
the costs. We need to make sure that we implement the PACT Act
like it was meant to be and provide those services. No one on
our side of the aisle said that we do not want to provide those
services.
We are saying that we need to be wise in providing those
services so that the people anywhere on our VA list that need
the help are not shortchanged.
I appreciate the witnesses being here today to discuss the
important issue, and I appreciate the give and take. I think it
has been good give and take. I want to repeat it, if anyone has
a proposal besides this one fix the problem I am here. We do
not want to say, oh, we own it as Republicans. We do not want
to say, oh, we do not want the Democrat--this is a bipartisan
problem that we have got to get fixed.
We have handcuffed ourselves on this committee. To try to
figure out and be responsible now we have got to unhandcuff
ourselves so that all veterans and family members and survivors
can receive the benefits they deserve. We can accomplish that a
lot--we have accomplished a lot over the last few years, but
this is no time to quit. Veterans deserve a VA that is involved
to meet their needs, not one that is stuck in the past.
With that, I ask unanimous consent that all members shall
have 5 legislative days in which to revise and extend their
remarks and include any extraneous materials. Hearing no
objection, so ordered. This hearing is now adjourned.
[Whereupon, at 12:19 p.m., the committee was adjourned.]
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A P P E N D I X
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Prepared Statement of Witnesses
----------
Prepared Statement of Jon Rychalski
Good morning, Chairman Bost, Ranking Member Takano, and other
Members of the Committee. Thank you for inviting us here today to
present our views on the draft Toxic Exposure Fund Improvement Act
(dated February 21, 2024), which would affect Department of Veterans
Affairs (VA) programs and services. Joining me today are Laura Duke,
Chief Financial Officer, Veterans Health Administration (VHA), and
Lasheeco Graham, Chief Financial Officer, Office of Financial
Management, Veterans Benefits Administration (VBA).
While our testimony will address the elements of the hearing
invitation, I want to first take this opportunity to thank the
Committee and the Congress for the tremendous work done by you and your
professional staff members in working with VA to deliver world-class
health care and benefits to millions of Veterans, their families, and
caregivers. In recent years, Veterans have been empowered with more
health care options through laws such as the VA MISSION Act of 2018
(P.L. 115-182). Women Veterans now have greater access to critical care
and services following the enactment of the Deborah Sampson Act of 2020
(title V of P.L. 116-315). In August 2023, we celebrated the 1-year
anniversary of the Honoring our PACT Act of 2022 (the PACT Act) - one
of the largest expansions of VA health care and benefits our country
has ever seen. The impact these laws have on the health and well-being
of the brave men and women who have served our country fulfills a
promise we have made to care for them and ensure they receive the
benefits they have dutifully earned.
I am excited to share that VA recently announced that all Veterans
who meet basic service and discharge requirements and were exposed to
toxins and other hazards while serving in the military-at home or
abroad -are eligible to enroll directly in VA health care as of March
5, 2024. This means that all Veterans who served in the Vietnam War,
Gulf War, Iraq, Afghanistan, the Global War on Terror, or any other
combat zone after 9/11 are eligible to enroll directly in VA health
care without first applying for VA benefits. Additionally, Veterans who
never deployed but were exposed to toxins or hazards while training or
on active duty in the United States are also eligible to enroll.
A. PACT Act Implementation and the Cost of War Toxic Exposures Fund
As of February 25, 2024, VA has completed more than 5.25 million
toxic exposure screenings, and there are more than 4 million current
enrollees in the PACT Act planning population.\1\ VA has approved
720,945 claims related to the PACT Act for Veterans or Survivors, and
approximately 911,777 total Veterans and Survivors have completed PACT
Act related claims.\2\ These numbers, however, do not convey the true
impact. Let me share with you one Veteran's journey with the PACT Act.
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\1\ VA-PACT-Act-Dashboard-Issue-28-030124_FINAL_508.pdf
\2\ VA-PACT-Act-Dashboard-Issue-28-030124_FINAL_508.pdf
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Randall Doerr, a retired Marine Corps gunnery sergeant (GYSGT),
served with distinction through combat tours in Afghanistan and Iraq.
During these deployments, GYSGT Doerr was exposed to burn pits and fine
particulate matter. On February 6, 2019, he submitted a claim for his
newly diagnosed Non-Hodgkin's lymphoma (NHL), attributing the condition
to environmental hazard exposure in the Southwest Asia theater.
Although his claim was initially denied, the enactment of the PACT Act
on August 10, 2022, proved significant for GYSGT Doerr. VA received his
supplemental claim for NHL on February 23, 2023, with a VA examiner
opining that the diagnosed NHL is at least as likely as not due to
Southwest Asia exposures. A subsequent rating decision assigned a 100
percent evaluation and generated a retroactive award of $11,409.\3\
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\3\ VA-PACT-Act-Dashboard-Issue-28-030124_FINAL_508.pdf
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The PACT Act is having an impact, but our work is far from over. We
are applying lessons learned and best practices as we implement
potentially the largest health care and benefits expansion in VA
history. We are improving the way we reach Veterans and strive to
continuously improve delivery of care and services. We acknowledge we
have a commitment to the American public to ensure proper oversight and
transparency of the funds and resources we have been entrusted to
manage. This testimony will describe VA's views on the draft bill, our
ongoing efforts on TEF oversight and methodology, and lessons learned
that we are applying as we strive for excellence.
B. VA's Position on the Toxic Exposure Fund Improvement Act
Given the complexities and dynamics of our experience with PACT Act
implementation, VA is confident that its current authorities are
sufficient to continue implementing the PACT Act's expansion of health
care and benefits to Veterans with environmental exposures in the
manner intended by Congress. While VA appreciates the opportunity to
work with the Committee to offer technical assistance on prior drafts
of the bill, amending the PACT Act as suggested by the bill would
severely constrain VA's ability to provide timely, high-quality health
care and benefits to all Veterans, including those with toxic exposure.
While the draft bill reflects some input from VA on critical
implementation issues, there remain significant and substantial
technical and programmatic issues that would frustrate operationalizing
the bill if enacted.
VA opposes this draft bill.
C. Analysis of the Toxic Exposure Fund Improvement Act
Section 2(a) of the bill would replace the current 38 U.S.C. Sec.
324 with a new statute. The proposed section 324(a) would direct VA to
use any funds appropriated pursuant to the authorization of
appropriations in proposed section 324(b)(3) to carry out the purposes
of the Toxic Exposure Fund described in proposed section 324(b)(4).
Proposed section 324(b)(1) would establish in the Treasury an
account, known as the Toxic Exposure Fund (the Fund), to carry out the
purposes described in proposed section 324(b)(4). Proposed section
324(b)(2)(A) would require transfer from the savings described in
section 324(e)(1) to the Toxic Exposure Fund the following amounts:
$26.411 billion for Fiscal Year (FY) 2026, $28.524 billion for Fiscal
Year 2027, $30.806 billion for Fiscal Year 2028, $33.271 billion for
Fiscal Year 2029, $35.932 billion for Fiscal Year 2030, $38.807 billion
for Fiscal Year 2031, $41.912 billion for Fiscal Year 2032, and $45.264
billion for FY 2033. Proposed section 324(b)(2)(B) would provide that
any amounts transferred under subparagraph (A) would remain unavailable
for obligation or expenditure until such amounts are appropriated.
Proposed section 324(b)(2)(C) would provide that any of these amounts
not appropriated for an fiscal year would be available for
appropriation, under certain terms and conditions, during the
subsequent FY.
Under proposed section 324(b)(2)(C)(ii), the Office of Management
and Budget (OMB) would have to calculate, and the budget would have to
include, adjustments reflecting such carried over amounts. Proposed
section 324(b)(3)(A) would authorize to be appropriated for each of FYs
2026-2033 an amount not to exceed the total amount transferred to the
Fund under paragraph (2); these amounts, if appropriated, would remain
available until expended. Proposed section 324(b)(3)(B) would provide
that, for any of FYs 2026-2033 for any discretionary appropriation
under the heading ``Toxic Exposure Fund'' provided to VA, the total
amount of such appropriations for the applicable fiscal year (not to
exceed the total amount remaining in the Fund) would be subtracted from
the estimate of discretionary budget authority and the resulting
outlays for any estimate under the Congressional Budget and Impoundment
Control Act of 1974 or the Balanced Budget and Emergency Deficit
Control Act of 1985, and the amount transferred to the Fund would be
reduced by the same amount. Proposed section 324(b)(4) would state that
amounts appropriated from the Fund would be available for: (1) the
delivery of Veterans' health care under the PACT Act, subject to the
eligibility criteria in 38 U.S.C. Sec. 1710(e), as added by the PACT
Act; (2) any expenses, including administrative and information
technology (IT) expenses, incident to the delivery of such Veterans'
health care or the delivery of benefits under the PACT Act, including
to carry out section 701 of the PACT Act; and (3) medical research
under the PACT Act. Amounts appropriated from the Fund would not be
available for leases as authorized or approved under 38 U.S.C. Sec.
8104.
Proposed section 324(c) would set forth requirements relating to
accountability and oversight. Proposed paragraph (1) would require VA,
not later than 180 days after the date of enactment of this Act, to
submit a work plan to Congress that includes the proposed allocation of
funds authorized to be appropriated pursuant to section 324(b)(3) for
each of Fiscal Year 2025-2033. The workplan would have to include the
amount of money to be obligated or expended in each year from the Fund
and a description of how each such account supports the strategic goal
of serving Veterans exposed to toxic materials. VA would have to submit
a report to Congress annually (not later than January 1 of each of
Fiscal Year 2027-2033 that includes the amount of money obligated or
expended in the prior fiscal year from the Fund, a description of any
such project using funds, and whether such projects are serving
Veterans exposed to toxic materials. VA would have to provide an update
in the form of testimony and any additional reports to Congress upon
request.
Proposed section 324(d) would state that no amounts could be
transferred into the Fund from amounts that were designated by Congress
as an emergency requirement pursuant to a concurrent resolution on the
budget or the Balanced Budget and Emergency Deficit Control Act of
1985.
Proposed section 324(e) would provide that the amounts made
available under section 324(b)(2) would be derived from savings
generated through the modification of the Fund by enactment of this Act
to cover the cost of the Fund; any funds in excess of the total amounts
so made available would be returned to the Treasury's general fund. VA
would have to include in the documents supporting the President's
budget request detailed estimates of the sums described in section
324(b) for the applicable FY. VA could establish policies and
procedures for developing the annual detailed estimates, after
consultation with Congress.
Proposed section 324(f) would state that the budgetary effects of
this section would not be entered on either PAYGO scorecard maintained
pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010 (2
U.S.C. Sec. 933(d)). Similarly, the budgetary effects of this section
would not be entered on any PAYGO scorecard maintained for purposes of
section 4106 of H. Con. Res. 71 from the 115th Congress. No amounts in
the Fund could be made available except to the extent provided in
advance in appropriations acts; any act that rescinded or reduced
amounts in such accounts would not be estimated as a reduction in
direct spending under the Congressional Budget and Impoundment Control
Act of 1974 or the Balanced Budget and Emergency Deficit Control Act of
1985.
Section 2(c) of the bill would specify that amounts made available
by the Fiscal Responsibility Act of 2023 (FRA, P.L. 118-5) would be
carried out consistent with requirements of 38 U.S.C. Sec. 324, as
amended. Section 2(c) would also deem the amounts appropriated by the
FRA for Fiscal Year 2024 and Fiscal Year 2025 to the TEF as amounts
transferred to the Fund, and such funds would be treated in the same
manner as amounts so transferred for each of Fiscal Year 2026-2033.
Nothing in section 2(c) could be construed to require such amounts for
Fiscal Year 2024 and 2025 to be reappropriated by Congress, and such
funds would be available for obligation and expenditure without being
subject to future appropriation.
Section 3(a) of the bill would require VA to submit an annual
assessment on the funding provided to carry out the Fund, beginning not
later than November 1, 2024. Section 3(b) would require VA to submit to
Congress by October 1, 2033, a report containing proposed funding
levels for the Fund for each of Fiscal Year 2034-2045. Section 3(c)
would provide that, unless a joint resolution of disapproval is enacted
into law, on October 1, 2034, and on October 1 of each of Fiscal Year
2035-2045, there would be appropriated to the Fund the amount submitted
by VA under section 3(b)(1), which would then be subject to
appropriation for the purposes of the Fund. Section 3(d) would
establish a process for a joint resolution, as referenced in section
3(c).
We understand that the draft bill was written with the intent to
change the budgetary treatment of the TEF from scoring as direct
spending to discretionary spending for purposes of how the
Congressional Budget Office (CBO) and OMB estimate the effects of
future authorizing legislation on spending from the TEF. As previously
noted by CBO and OMB, some of the costs of such legislation that would
otherwise have been paid from discretionary appropriations for VA will
now be paid in part from the TEF. As a result, cost estimates for
future legislation that would affect activities potentially covered by
the TEF now show effects on both discretionary authorization levels and
direct spending (most commonly called mandatory spending). In general,
legislation that would result in an increase in mandatory spending is
required to be offset with a reduction in mandatory spending or
increase in revenues under the Statutory Pay-As-You-Go Act of 2010
(PAYGO). As a result, certain VA authorization bills under
consideration in Congress have been newly subject to this PAYGO
requirement, and we appreciate the Committee's desire to solve this
issue. However, this bill leads to undesirable effects on TEF execution
and budgeting. There are six primary issues that would adversely affect
VA, as outlined below.
Initially, there is no existing mechanism that would allow VA to
execute the transfer of savings under the proposed section 324(e). It
appears that the intent is to transfer savings from the reduction in
direct spending that CBO would score to this bill. The savings
transferred into the Fund would then be subject to future appropriation
but exempt from being counted for purposes of discretionary budgetary
enforcement. However, the savings referred to is based on scoring and
does not correlate to actual dollars that can be transferred. Due to a
real difference in the timing between when amounts are scored by CBO
and when amounts are appropriated into an account, the savings
identified are not able to be transferred into an account for future
spending. In other words, the reduction in direct spending that is
anticipated to be scored by CBO does not generate actual cash in a
Treasury account that can be transferred for future use. Because there
is no funding in a Treasury account, it is unclear how the funding
would be transferred to the Fund.
The impact of this is that VA's ability to provide benefits and
services for toxic-exposed Veterans would be significantly jeopardized.
The draft bill authorizes appropriations from the Fund, but without
balances in the Fund, no appropriation could be provided from existing
funds. As a result, additional appropriations from other sources would
be needed to replace the funding that was intended to be appropriated
from the Fund, and these additional appropriations would score as a
cost for budget enforcement.
Second, the draft bill would both sunset the authority and impose a
fixed limit on the amount that could be appropriated to the new Fund
without being scored for budget enforcement. The current authority in
38 U.S.C. Sec. 324 is permanent (i.e., without a sunset date) and
limits the appropriation to the amount necessary to increase funding
over the Fiscal Year 2021 baseline for Veterans' health care and
benefits associated with exposure to environmental hazards and medical
and other research relating to exposure to environmental hazards.
Unless funds are appropriated that exceed the fixed amount
authorized and exempt from budget enforcement, it could significantly
constrain VA's ability to respond to needs in future years as VA
continues to evaluate, research, and determine costs related to toxic
exposures, including for conditions that may be established in the
future to be related to toxic exposure. The sunset date creates
uncertainty about the source of funding for allowable activities under
the Fund when that date is reached.
Third, the bill would change the allowable purposes of the Fund.
Under its current authorization, the TEF is available to fund Veterans'
health care and benefits associated with exposure to environmental
hazards, as well as research associated with exposure to environmental
hazards, and to carry out the continuation of modernization,
development, and expansion of capabilities and capacity of information
technology systems and infrastructure of VBA, including for claims
automation, under section 701 of the PACT Act. Under the draft bill,
the new purposes would authorize the Fund to fund the delivery of
Veterans' health care under the PACT Act, any expenses incident to the
delivery of Veteran's health care or benefits under the PACT Act, and
medical research under the PACT Act, and would maintain the same
purpose related to section 701.
This would narrow the purpose of the new Fund and complicate
implementation, particularly as it pertains to Veterans who, prior to
PACT Act implementation, were already eligible for health care or
benefits as a result of exposure to environmental hazards. Moreover,
the draft bill would complicate implementation in Fiscal Year 2024, as
section 2(c) would specify that the Fiscal Year 2024 appropriation
provided by the FRA would also be required to conform to the new
purpose. Because Fiscal Year 2024 is already underway, the bill would
introduce significant uncertainty as to whether current execution of
the TEF funding would align with the new purpose. Additionally, because
the bill would narrow the purpose of the new Fund, VA would face
further pressure to fund Veterans' health care, benefits delivery, and
research with limited discretionary resources, potentially constraining
VA's ability to provide timely, high-quality care and benefits to all
Veterans, including those with toxic exposures. In addition, to the
extent VA would require additional discretionary funding to replace
resources previously provided in the TEF, Veterans services provided by
other executive branch agencies, such as the Departments of Labor,
Health and Human Services, and Housing and Urban Development, could be
impacted, thereby reducing critical resources to Veterans who need them
most.
Fourth, Title II of the PACT Act provides VA a statutory process to
establish presumptions of service connection in relation to toxic
exposures. However, it is unclear whether, under the draft bill, the
Fund would be available for benefits created pursuant to Title II that
were not specifically included in the PACT Act.
If the draft bill does have the impact of limiting the availability
of the Fund to support future presumptive conditions, the draft bill
would significantly and adversely affect Veterans and their dependents.
For example, by limiting the Fund to only administrative expenses
incident to the delivery of benefits under the PACT Act, the draft bill
may not allow the Fund to support outreach related to the establishment
and implementation of presumptions created in the future regarding
toxic exposure but not expressly included in the PACT Act. VA is
continuing to evaluate the health consequences of Veterans' toxic
exposures, but the costs of these efforts would potentially be excluded
from the Fund's coverage. VA recently announced expanded outreach
beyond our efforts in 2023 to ensure we reach more Veterans, with
greater emphasis on Veterans in under-represented communities. As
written, this bill could potentially prohibit spending for enhanced
outreach and would exclude pre-PACT Act herbicide issues from the Fund.
Other affected populations could include radiation-exposed Veterans,
combat Veterans, and Camp Lejeune Veterans and family members, among
others.
Fifth, the proposed Sec. 324(b) identifies the first applicable
fiscal year as 2026. However, under the proposed Sec. 324(c)(1), VA
would be required to submit a workplan associated with Fiscal Year 2025
as well. Additionally, the current language for the TEF in Sec. 324(c)
refers to the authorization of investment in three identified
categories, but under the proposed bill this ``investment'' term would
no longer appear. This would create ambiguity that would result in
operational challenges. It is unclear if the language in the proposed
Sec. 324(c) is meant for flexibility or exclusion. Section 2(c) of the
bill would allow for the use of funds already appropriated for Fiscal
Year 2024 and Fiscal Year 2025, but it is unclear if it would be
appropriate to submit a workplan for Fiscal Year 2025 as well.
The bill would also introduce further confusion given technical
issues with the language. For example, the bill uses the term ``toxic
materials'' in proposed Sec. 324(c)(1)(B)(ii) and (2)(A)(iii), but
this term is not used in any other statute. These references are in the
context of the required workplan and reporting requirements, but it is
unclear if this is intended to refer to some other concept than
``environmental hazards'' as currently used in Sec. 324(c), or more
generally ``toxic exposure'' or ``toxic-exposed veterans'', as those
terms were defined in the PACT Act. Additionally, the bill's inclusion
of limits on the use of the Fund to the costs of health care ``under
the PACT Act'' misses that Veterans may be eligible under multiple
authorities, some of which were added by the PACT Act and some of which
predated the PACT Act. For example, combat Veterans are eligible for a
10-year window following their discharge or release under 38 U.S.C.
1710(e)(1)(D), but many of these Veterans are also ``covered veterans''
under 38 USC 1710(e)(1)(H), as added by the PACT Act. The bill is
ambiguous as to whether VA could use resources in the Fund for health
care for these Veterans, whose enrollment may have predated the PACT
Act but who are nevertheless eligible ``under the PACT Act'' as well.
In summary, the bill could significantly complicate VA's ability to
implement the PACT Act and furnish health care and benefits for
Veterans and family members with toxic exposures. The complexity and
construct of the draft bill, even given changes made based on VA's
discussions with the Committee, remain. The draft bill could limit
funding for health care delivery, information technology and Veteran
outreach efforts, benefits administration, and critical research in
toxic exposure. In doing so, this draft bill would short-change
Veterans and make it more difficult for them to receive the timely and
high-quality care and services they have earned.
D. TEF Methodology and Oversight
The TEF is not available to implement and operationalize the entire
PACT Act. As enacted at 38 U.S.C. Sec. 324(c), the TEF is available to
increase funding for investment in: (1) the delivery of Veterans'
health care associated with exposure to environmental hazards in the
active military, naval, air, or space service; (2) expenses incident to
the delivery of Veterans' health care and benefits associated with
exposure to environmental hazards in the active military, naval, air,
or space service, including administrative expenses, such as
information technology and claims processing and appeals, and excluding
leases as authorized or approved under 38 U.S.C. Sec. 8104; (3)
medical and other research relating to exposure to environmental
hazards (38 U.S.C. Sec. 324(c)(3)), and (4) continuation of the
modernization, development, and expansion of capabilities and capacity
of IT systems and VBA infrastructure, including for claims automation,
to support expected increased claims processing for newly eligible
Veterans pursuant to the PACT Act.
VA's Financial Policy Documents are publicly available on our
website at https://department.va.gov/financial-policy-documents; VA has
provided a specific methodology to estimate the health care
expenditures and expenses incident to the delivery of Veterans' health
care and benefits associated with exposure to environmental hazards as
well as medical and other research relating to exposure to
environmental hazards.\4\ VA exercises oversight of TEF funding through
VA's governance process consistent with the TEF spend plan approved by
Congress in 2022. Spending oversight and funding execution will be
routinely reviewed by the VA Investment Review Council and during
monthly budget reviews hosted by VA's Office of Management. VA provides
regular briefings to the Eight Corners on TEF spending and methodology
and section 254 of the Military Construction, Veterans Affairs, and
Related Agencies Appropriations, Act, 2024 (Div. A of P.L. 118-40),
requires quarterly TEF reporting, and VA will continue to provide
transparency and oversight as good stewards of the Nation's resources.
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\4\ Chapter 12--Toxic Exposures Fund--Financial Policy Documents
(va.gov)
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E. TEF Lessons Learned and Way Ahead
VA has acknowledged and sought to improve our internal controls
around the TEF by implementing lessons learned from previous
supplemental funding. To help ensure Administrations and Staff Offices
are using TEF appropriately, we have been diligently reviewing our
legal requirements to develop individual methodologies and codify those
within our VA Financial Policy. The key tenet of each methodology is
the ability to estimate, track, and reconcile costs and expenses
incident to the delivery of Veterans' health care and benefits as well
as medical research associated with environmental exposures.
Conclusion
VA appreciates the opportunity to present VA's position on this
bill. The issues and impact addressed today are both technical and
programmatic. We emphasize, though, the true impact this bill would
have, if enacted, on Veterans. Congress enacted the PACT Act to honor
our pledge to the men and women who served and sacrificed and came home
needing care. Our Veterans are not technical or programmatic issues -
they are people--people like Randall Doerr, who look to VA to honor our
promise and deliver world-class care they can count on, now and in the
future. I am proud to be part of this noble mission to care for the
Nation's Veterans.
This concludes my testimony. My colleagues and I are prepared to
respond to any questions you may have.
[all]