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


                                                        S. Hrg. 118-252

                      LEGISLATIVE PRESENTATION OF
                       DISABLED AMERICAN VETERANS

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

                             JOINT HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                              U.S. SENATE

                                AND THE

                     COMMITTEE ON VETERANS' AFFAIRS
                     U.S. HOUSE OF REPRESENTATIVES

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             SECOND SESSION

                               __________

                             MARCH 7, 2024

                               __________

      Formatted for the use of the Committee on Veterans' Affairs
      
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]      


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

                   U.S. GOVERNMENT PUBLISHING OFFICE                    
55-119 PDF                  WASHINGTON : 2024                    
          
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                 SENATE COMMITTEE ON VETERANS' AFFAIRS

                     Jon Tester, Montana, Chairman

Patty Murray, Washington             Jerry Moran, Kansas, Ranking 
Bernard Sanders, Vermont                 Member
Sherrod Brown, Ohio                  John Boozman, Arkansas
Richard Blumenthal, Connecticut      Bill Cassidy, Louisiana
Mazie K. Hirono, Hawaii              Mike Rounds, South Dakota
Joe Manchin III, West Virginia       Thom Tillis, North Carolina
Kyrsten Sinema, Arizona              Dan Sullivan, Alaska
Margaret Wood Hassan, New Hampshire  Marsha Blackburn, Tennessee
Angus S. King, Jr., Maine            Kevin Cramer, North Dakota
                                     Tommy Tuberville, Alabama

                      Tony McClain, Staff Director
               David Shearman, Republican Staff Director

                              ----------                              

        HOUSE OF REPRESENTATIVES COMMITTEE ON VETERANS' AFFAIRS

                     Mike Bost, Illinois, Chairman

Aumua Amata Coleman Radewagen,       Mark Takano, California, Ranking 
    American Samoa                       Member
Jack Bergman, Michigan               Julia Brownley, California
Nancy Mace, South Carolina           Mike Levin, California
Matthew M. Rosendale, Sr., Montana   Chris Pappas, New Hampshire
Mariannette Miller-Meeks, Iowa       Frank J. Mrvan, Indiana
Gregory F. Murphy, North Carolina    Sheila Cherfilus-McCormick, 
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
                           
                           
                           C O N T E N T S

                              ----------                              

                             March 7, 2024

                                                                   Page

                                SENATORS

Hon. Jon Tester, Chairman, U.S. Senator from Montana.............     1
Hon. Jerry Moran, Ranking Member, U.S. Senator from Kansas.......     4
Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......    14
Hon. Angus S. King, Jr., U.S. Senator from Maine.................    18
Hon. Richard Blumenthal, U.S. Senator from Connecticut...........    23

                            REPRESENTATIVES

Hon. Mike Bost, Chairman, U.S. Representative from Illinois......     2
Hon. Mark Takano, Ranking Member, U.S. Representative from 
  California.....................................................     4
Hon. Morgan Luttrell, U.S. Representative from Texas.............    15
Hon. Chris Pappas, U.S. Representative from New Hampshire........    17
Hon. Keith Self, U.S. Representative from Texas..................    19
Hon. Morgan McGarvey, U.S. Representative from Kentucky..........    20
Hon. Greg Landsman, U.S. Representative from Ohio................    21
Hon. Nikki Budzinski, U.S. Representative from Illinois..........    22

                     INTRODUCTION OF NANCY ESPINOSA

The Honorable Mitt Romney, U.S. Senator from Utah................     6

                               WITNESSES

Nancy Espinosa, National Commander, Disabled American Veterans...     7

  accompanied by

  Barry Jesinoski, National Adjutant

  Bryan ``Cody'' VanBoxel, Executive Director, National 
    Headquarters

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

  Jim Marszalek, DAV National Service Director

  Joy Ilem, DAV National Legislative Director

  John Kleindienst, National Director of Voluntary Service

  Ryan Burgos, National Employment Director

  AnnMarie Hurley, Auxiliary National Commander

                                APPENDIX
                           Prepared Statement

Nancy Espinosa, National Commander, Disabled American Veterans...    29

                       Submissions for the Record

Disabled American Veterans response to Representative Morgan 
  Luttrell for questions asked during the hearing:

  Supplemental Statement.........................................    69

  Attachment--``Women Veterans: The Journey to Mental Wellness''.    73

 
                      LEGISLATIVE PRESENTATION OF
                       DISABLED AMERICAN VETERANS

                              ----------                              


                        THURSDAY, MARCH 7, 2024

                           U.S. Senate, and
                     U.S. House of Representatives,
                            Committee on Veterans' Affairs,
                                                    Washington, DC.

    The Committee met, pursuant to notice, at 10 a.m., in Room 
SD-G50, Dirksen Senate Office Building, Hon. Jon Tester, 
Chairman of the Committee, presiding.

    Present:

    Senators Tester, Brown, Blumenthal, Hassan, King, and 
Moran.

    Representatives Bost, Luttrell, Self, Takano, Pappas, 
McGarvey, Ramirez, Landsman, and Budzinski.

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

    Chairman Tester. I call this hearing to order, and I want 
to wish you all a good morning, and I want to welcome you to 
the Senate and House Veterans' Affairs Committee hearing.
    I am honored to welcome the national leadership of the 
Disabled American Veterans, and I want to extend a special 
welcome to the DAV members who traveled across this nation to 
be here, particularly those who have traveled from the great 
State of Montana. We are fortunate to have Joe Parsetich, a 
Montanan, and DAV's former National Commander here; Kevin 
Grantier, who is Commander of the Montana DAV; Chase Natalie, 
Adjutant of the Montana DAV. Thank you for being here, 
gentlemen. We appreciate it.
    Each of us can always count on the DAV to let us know how 
Congress can best support our nation's veterans. DAV has been 
integral in helping us pass life-changing legislation like the 
Deborah Sampson Act, the Hannon Act, and most recently the PACT 
Act.
    DAV was at the forefront of the effort to ensure Members of 
Congress did the right thing for multiple generations of toxic-
exposed veterans and survivors by passing the PACT Act. This 
came as no surprise, as this was not the DAV's first rodeo. DAV 
has been helping Congress pass legislation to support veterans 
and their families for decades. That is why I am proud to have 
DAV's support for one of my top priorities this year, passing 
the Major Richard Star Act, to help deliver combat-injured 
veterans their full DoD and VA benefits.
    We have also been working in a bipartisan and bicameral way 
to improve VA's Community Care Programs, respond to the mental 
health needs of our veterans, and bolster long-term care 
services for aging and disabled vets. That legislation, the 
Senator Elizabeth Dole 21st Century Veterans Health Care and 
Benefits Improvement Act, will help our veterans access the 
care, benefits, and services they need and deserve, and we will 
need the continued support of DAV to help get it over the 
finish line.
    We hold DAV's views in high regard here, and we will look 
to you to ensure that we have our priorities straight. So thank 
you for being here.
    Now I want to turn it over to Chairman Bost, who I want to 
personally thank for him holding down the fort and sharing a 
good portion of yesterday's VSO hearing. Thank you, Chairman 
Bost. You have the floor.

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

    Chairman Bost. Thank you, Chairman Tester, and good morning 
to all of you, and thank you for being here. I would like to 
thank the DAV's National Commander, Ms. Nancy Espine--I am 
going to say it correctly--Espinoza. Yes, all right. That is 
pretty good for a deep southern Illinois boy--for being here 
today. Thank you. And I would also like to give a shoutout to 
DAV's Auxiliary National Commander, AnnMarie Hurley, and thank 
you also for being here.
    [Applause.]
    Chairman Bost. And I am pleased that there are folks here 
from the great State of Illinois as well. If you would raise 
your hand, we want to recognize you. From Union, Illinois, we 
want to also especially welcome Don Houghland from my district, 
and thank you for being here. Thank you for traveling here from 
our home state, and please, I already recognized you.
    So being Chairman of this Committee is very, very personal 
to me, and I want to explain that. I explained it to the group 
yesterday. I am a Marine. There is an oorah out there. Yes, 
okay. And my grandfather on my mother's side was a Korean War 
Marine. My uncle was a Vietnam Marine, a victim of the ultimate 
oxymoron, friendly fire. He did survive but got hit in 1965, 
came home, woke up in Virginia about five weeks later. He got 
100 percent disability but had a very successful life, thanks 
to the VA.
    My son is a lieutenant colonel this time, and is a JAG. My 
grandson is an F-18 mechanic in Miramar, California. My dad's 
side of the family, they were all Army. We will not hold that 
against them. So as you can tell, it is really, really personal 
to me to make sure we are providing for you. And we want to say 
thank you for the sacrifices you have made, especially this 
group. All veterans we want to say thank you to, but especially 
this group.
    Each of you have fought to protect our constitutional 
rights. However, for far too long veterans that merely needed a 
fiduciary from the VA to help them manage their benefits, 
including disabled veterans, have been wronged, for about 30 
years. For years, VA has automatically stripped veterans with 
fiduciaries of their Second Amendment rights, a constitutional 
right they actually fought to keep in place.
    Now, I am proud to report that the fiscal year 2024 MILCON 
VA Appropriations Act, which recently passed the House, just 
yesterday, will now protect all veterans' constitutional right 
to bear arms.
    [Applause.]
    Chairman Bost. By incorporating a bill that I have 
championed for years--and I thank Senators Moran and Tester for 
their work with me to get this fixed, and know that I will 
continue to ensure we enact a permanent fix. DAV plays a vital, 
important role to making sure we meet the needs of disabled 
veterans.
    You, like me, understand the struggles veterans and their 
families and their survivors have. You know where the VA is 
falling short. DAV is a great advocate here in DC and across 
the country to make a difference for our veterans. You have my 
commitment that we will continue to fight for you and the 
voices you represent just as hard as you fought for us.
    As you all know, the PACT Act is the largest expansion of 
health care and benefits for veterans and their families in 
recent history, and we are going to make sure VA gets it right. 
And when they make mistakes I will be the first one to hold 
them accountable and get answers back to you.
    Looking ahead, I am focusing on making improvements where 
we can to modernize VA's delivery of health care services. We 
made great progress improving the VA claims and appeals process 
when we passed the Veterans Appeals Improvement and 
Modernization Act. But we must make sure VA is providing 
veterans with high quality disability compensation exams and 
timely decisions on their claims that they have earned, and we 
are going to keep pushing to make sure veterans can get the 
help that works for them, and where they need it and when they 
need it.
    The bipartisan negotiations we are in right now to get a 
package of veterans bills to the President's desk will help us 
do that. This comprehensive package includes things like the 
Dole Act, VET TEC, and HOME Act. Strengthening the Community 
Care Program, the Dole Act would put veterans in control of 
where they want to live out the days of their lives. The HOME 
Act would help homeless veterans. And the expansion of the 
successful VET TEC pilot program would help veterans find high-
paying jobs and more. We will get this package done in the 
coming weeks.
    Now you may hear some discussion from my colleagues on the 
other side of the aisle that the House Republicans are somehow 
holding up this legislation. Nothing could be further from the 
truth. As long as I am Chairman, I will continue to work with 
my colleagues in both chambers to find bipartisan solutions to 
the problems, regardless of the action of others. Disabled 
veterans and all veterans deserve nothing less.
    But make no mistake, our work is nowhere close to being 
finished, and my door has and will continue to always be open 
to you. I promise to keep up the fight. We are all in together. 
And now is not the time to take our foot off the gas, and I 
will assure that the VA gets the budget it needs to complete 
its goals.
    I look forward to this meeting today and working on this 
mission alongside you, and I want to thank you again for being 
here today. And with that I yield back.
    Chairman Tester. I want to recognize Ranking Member Jerry 
Moran.

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

    Senator Moran. Chairman Tester, thank you. Chairman Bost, 
Ranking Member Takano, my House and Senate colleagues, it is a 
pleasure to be here with the DAV. Commander Espinosa, you 
should know that your team represents not only you but disabled 
American veterans and veterans generally across the country in 
a very admirable way and a very effective way. Their voice 
matters, it is heard, and it is acted upon.
    And I want to thank all of you for being here, and thank 
particularly my Kansas members of DAV. I had an enjoyable and 
valuable visit with them yesterday, and I look forward to 
hearing what is said this morning in today's hearing. This is a 
valuable hearing, and the time that you are with us is 
something that we cherish.
    Lots of critical pieces of legislation. I would highlight, 
as the Chairmen said, I was impressed, and members of DAV and 
the veteran community should be impressed, really, with all the 
work of our veteran service organizations when it came to the 
PACT Act. But particularly DAV was a leader in that effort, and 
absolutely, as a result of DAV's efforts, that PACT Act was 
able to advance, something that has been talked about and 
worked on for a long period of time, but without the success 
that we saw now, just a little more than a year ago.
    I look forward to hearing what you have to tell me today. I 
would guess that you have suggestions how we address the 
backlog of disability claims within the Department. Too many 
veterans are waiting far too long to receive the benefits. This 
backlog not only delays critical support for those who need it 
but also creates unnecessary stress and so much uncertainty in 
veterans' and their families' lives.
    Mental health remains a critical concern--PTSD, depression, 
substance abuse, and our continued battle against veteran and 
military suicide.
    And finally, I appreciate DAV again for always being at the 
forefront of caregivers, family members, and in this case, our 
efforts with Senator Dole to see that we provide support for 
those who provide selfless care for ill and injured veterans. 
These caregivers play a vital role in recovery and well-being 
of our veterans, and yet too often lack the recognition and 
support they deserve. I am anxious to hear what DAV thinks that 
VA can do to make certain that caregivers fill that essential 
role.
    And again, I thank you all for being here and I look 
forward to working with you, continuing to work with you, as we 
care for those who served. Thank you.
    Chairman Tester. I now recognize Ranking Member Takano.

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

    Mr. Takano. Well thank you, Chairman Tester, and thank you 
Ranking Member Moran and my colleague, Chairman Bost. I am 
happy to join all of you this morning in this hearing.
    I am honored to gather this morning with members of the 
House and Senate Committees on Veterans' Affairs, and we look 
forward to hearing from the National Commander and 
representatives of Disabled American Veterans about your 
legislative priorities for the second session of the 118th 
Congress.
    First of all, let me get an important piece of business out 
of the way. Are there any Californians in the room this 
morning? All right. Well, I would like to give a special 
shoutout to DAV's Junior Vice Commander, Dan Contreras, from 
California. Welcome, Dan, and welcome DAV-ers from California.
    We convene this hearing with a deep sense of duty and 
commitment to the brave men and women who have served our 
nation. We must not waiver in our commitment to ensuring that 
they are able to access health care and benefits they have 
earned. I look forward to discussing DAV's legislative 
priorities this morning, and may your insights, experiences, 
and advocacy efforts serve as guiding lights to my colleagues 
and me as we fulfill our legislative and oversight 
responsibilities through the remainder of the 118th Congress.
    After reviewing your written testimony, Commander Espinosa, 
it is clear that DAV's priorities align with many of my own. I 
share your commitment to reducing veteran suicide, increasing 
access to VA health care, and ensuring faithful implementation 
of the PACT Act.
    We must also make VA more welcoming and a safer place for 
veterans of all backgrounds and ethnicities. Last week, DAV 
published a new report, ``Women Veterans: The Journey to Mental 
Wellness.'' This is the third report about women veterans that 
DAV has published since 2014. I cannot thank you enough for the 
important contributions you have made through these reports, 
which have contained dozens of policy recommendations. We made 
important strides with the enactment of the Deborah Sampson Act 
three years ago, but more work remains to be done, and your new 
report will help guide further improvements.
    The best way for us to honor the legacy of veterans and 
their survivors is to translate our words into meaningful 
action that uplifts and empowers those who have given so much 
in service to us all.
    I wish we, in Congress, had more to show for ourselves in 
terms of legislative productivity in the 118th Congress. 
Unfortunately, legislation like the HOME Act and the Elizabeth 
Dole Home Care Act are currently being held up by those whose 
priorities lead the privatization of veterans' health care, 
enrichment of special interest groups, and the hollowing out of 
the VA health care system.
    I remain very grateful for the overwhelming support that 
DAV and other VSOs provided in 2022 to pass my bill, the 
Honoring our PACT Act and get it signed into law. Your voices 
are powerful, and we look to you to guide us in our 
policymaking.
    And as we approach the two-year anniversary of the 
enactment of the PACT Act, I look forward to working with DAV 
to continue to strengthen and protect this landmark law and 
ensure the more than 3.5 million veterans living with the 
effects of toxic exposure can receive the maximum benefits and 
comprehensive health care they have earned.
    As part of these efforts, the Biden administration recently 
announced it is accelerating the timeline for veterans who were 
exposed to toxins to be eligible to enroll in VA health care. 
That means, as of this Tuesday, any veteran who was exposed to 
toxins or hazards has access to the effective, affordable, and 
quality health care that VA can offer without having to apply 
for disability compensation first. This is a huge deal, and I 
want to be very clear that it is due, in no small part, to the 
advocacy of the VSO community.
    I look forward to continuing my work with my colleagues to 
make sure this transformational law is implemented effectively. 
This includes protecting the Toxic Exposure Fund, a mandatory 
funding mechanism that makes this law possible.
    I have said it before and I will say it again. Toxic 
exposure is a cost of war. We must vigorously resist any 
attempts to return to the bad old days where veterans' health 
care was fully funded through discretionary appropriations, 
pitting veterans against each other and against other 
discretionary spending programs.
    In closing, I look forward to hearing DAV's testimony 
today, and thank you for your advocacy and support for the 
veteran community, and I yield back the balance of my time.
    Chairman Tester. It is now my honor to welcome to the Joint 
House and Senate VA Committee my friend and colleague, Senator 
Mitt Romney. And I am just going to tell you, Mitt, you will 
never address a finer group of House and Senate members than 
you are about to address now.
    [Laughter.]
    Chairman Tester. And he is here to introduce Commander 
Espinosa.

              INTRODUCTION BY THE HON. MITT ROMNEY

    Mr. Romney. Thank you, Mr. Chairman, a good friend. I am 
not sure I agree entirely with your assessment of the entire 
panel, but I will take it into consideration. Thank you.
    [Laughter.]
    I appreciate the chance to be here with you today, and I am 
proud to introduce a fellow Utahan, the National Commander of 
the Disabled American Veterans, Nancy Espinosa. I have had the 
pleasure of meeting with Commander Espinosa to discuss efforts 
to increase our support for disabled veterans.
    Since 2023, Commander Espinosa has served as National 
Commander for the DAV. She is a service-connected disabled 
veteran of the Army, and was a member of the Army Reserve from 
1975 until becoming an active-duty soldier in 1985. Four years 
later, she joined the New Mexico Army National Guard and served 
there until her honorable discharge in 1990.
    Commander Espinosa is currently a member of the DAV Chapter 
14 in Layton, Utah, as well as the Department of Utah Adjutant. 
She is an active member of DAV's Commanders and Adjutants 
Association, and a Commissioner of the Utah Legislative 
Veterans and Military Affairs Commission.
    DAV has more than 1 million members across the country. 
Commander Espinosa understands firsthand the issues that impact 
veterans. The work she does is vital to ensuring that veterans 
and their families have access to the benefits they need to 
live long and full lives.
    Thank you, Commander Espinosa, for your willingness to 
appear before the Committee today, for your service to our 
country, and thank you to the members of this esteemed panel.
    Chairman Tester. Thank you, Senator Romney.
    [Applause.]
    Chairman Tester. We appreciate your statement very, very 
much. Now, Commander Espinosa, I will turn it over to you for 
the DAV's opening statement.

   STATEMENT OF NANCY ESPINOSA, NATIONAL COMMANDER, DISABLED 
  AMERICAN VETERANS, ACCOMPANIED BY BARRY JESINOSKI, NATIONAL 
ADJUTANT; BRYAN ``CODY'' VANBOXEL, EXECUTIVE DIRECTOR, NATIONAL 
    HEADQUARTERS; EDWARD R. REESE, JR., EXECUTIVE DIRECTOR, 
 WASHINGTON HEADQUARTERS; JIM MARSZALEK, DAV NATIONAL SERVICE 
  DIRECTOR; JOY ILEM, DAV NATIONAL LEGISLATIVE DIRECTOR; JOHN 
   KLEINDIENST, NATIONAL DIRECTOR OF VOLUNTARY SERVICE; RYAN 
  BURGOS, NATIONAL EMPLOYMENT DIRECTOR; AND ANNMARIE HURLEY, 
                  AUXILIARY NATIONAL COMMANDER

    Ms. Espinosa. Thank you very much, Chairman Tester. Thank 
you so much for that kind introduction, Senator Romney, and 
thank you for your dedication to America's veterans. I am proud 
to call you a fellow Utahan.
    Chairman Tester, Chairman Bost, Ranking Members Moran and 
Takano, and members of the Committees on Veterans' Affairs, 
thank you for providing me the opportunity to deliver the 2024 
Legislative Program of DAV, Disabled American Veterans, an 
organization of more than 1 million members, all of whom were 
injured or became ill as a result of their military service.
    My written statement thoroughly details DAV's key 
legislative priorities for the 118th Congress and reports on 
our many programs and accomplishments. So today I will 
highlight some of our most critical policy goals.
    First, I would like to start by introducing my DAV 
colleagues joining me today: National Adjutant, Barry 
Jesinoski; National Headquarters Executive Director, Cody 
VanBoxel; Washington Headquarters Executive Director, Randy 
Reese; National Service Director, Jim Marszalek; National 
Legislative Director, Joy Ilem; National Voluntary Services 
Director, John Kleindienst; National Employment Director, Ryan 
Burgos; and Auxiliary National Commander, AnnMarie Hurley.
    I also want to recognize the DAV and Auxiliary leaders who 
have been vital to our organization's mission over the course 
of many years. Let me extend my gratitude to our National 
Executive Committee and the members of the National Legislative 
Interim Committee, as well as my Chief of Staff, Floyd Watson, 
Jr., for all of their support.
    And finally, I want to thank my sons, Ian, who is a Navy 
veteran, and Eric, who served in the Air Force. While I am 
surrounded by countless impressive and selfless servants within 
DAV's ranks, my sons hold the distinction of being my most 
dedicated and unwavering supporters.
    [Applause.]
    Ms. Espinosa. Messrs. Chairman, I am a service-connected 
disabled Army veteran of the Gulf War era, with a family legacy 
of military service dating back to the Civil War. My journey 
began when I responded to an ad for a clerk typist that said, 
``No experience necessary.'' The position turned out to be with 
the U.S. Army. That call to the Reserves launched my 15-year 
military career. But my service in the Army was marked by 
obstacles and loss.
    While on active duty in 1989, doctors told me they found an 
aggressive cancer that could leave me with just six months to 
live. They operated, and it turned out to be a misdiagnosis. 
But as you can imagine, the entire ordeal was quite traumatic.
    Shortly after I suffered the unexpected deaths of my sister 
and young stepdaughter, in rapid succession. The combined 
losses and health issues left me in a deep depression, so I 
took a hardship discharge and transitioned into the New Mexico 
National Guard to continue my military service.
    When I separated from the Guard in 1990, I turned to VA for 
care. Unfortunately, VA was ill-equipped to address my needs as 
a woman, and was not conveniently located, so I did not start 
using VA for many years, and I did not even realize that VA 
mental health care was an option for my depression. I am happy 
to say that today I regularly use VA health care, and overall I 
am very satisfied with the quality and timeliness of my care.
    But my experience of being dismissed and misunderstood by 
VA was not unique. Women veterans have historically been 
overlooked and underserved. While VA has made tremendous 
progress in recent decades in caring for women veterans, there 
is still much to be done. This is particularly critical now 
with the suicide rate skyrocketing among women veterans. With 
more women than ever serving in the military, we must ensure 
that VA has the resources and expertise to meet all the 
physical and mental health care needs of women veterans.
    [Applause.]
    Ms. Espinosa. I am pleased to announce that just last week 
DAV released a new report entitled ``Women Veterans: The 
Journey to Mental Wellness.'' It is our third report focused on 
women veterans' issues in the last 10 years, this time digging 
deeply into the unique factors contributing to the staggering 
rate of suicide among women veterans. We look forward to 
working with you to begin implementing its 50-plus policy and 
legislative recommendations. Together we can save lives.
    [Applause.]
    Ms. Espinosa. Messrs. Chairmen, DAV is a fierce advocate of 
the VA health care system and its specialized programs. Over 
the past decade, there has been one consistent trend--an 
increasing number of veterans turning to VA. Unfortunately, 
there are still significant staffing shortages and an aging 
infrastructure that prevents and delays many veterans from 
receiving the care they need. Congress must ensure that VA has 
sufficient funding to provide timely, convenient, and high-
quality care.
    [Applause.]
    Ms. Espinosa. Messrs. Chairmen, we again want to thank you 
and all the members here today for the historic passage of the 
Honoring our PACT Act in 2022. As you may remember, DAV was the 
first organization to bring the subject of burn pits to light 
in 2008, but we have been advocating about the harms of 
military toxic exposures dating back to World War I. We should 
all celebrate that millions of veterans exposed to burn pits 
and other toxic substances are now eligible for VA's life-
changing benefits and health care.
    However, many others remain ineligible because their 
conditions are not currently covered in the law but are linked 
to toxic and radiological hazard exposures. If our nation is to 
provide true equity for all toxic-exposed veterans, Congress 
must enact legislation to recognize the specific exposures and 
related diseases for veterans who served at K-2 in Uzbekistan, 
ensure parity for radiation-exposed veterans and address the 
exceptionally widespread PFAS water contamination. All toxic-
exposed veterans deserve care now and into the future.
    [Applause.]
    Ms. Espinosa. In order to build on the success of the PACT 
Act, DAV and MOAA have been engaged a toxic exposure research 
project, and will soon release a report entitled ``Ending the 
Wait for Toxic-Exposed Veterans,'' which includes detailed 
policy recommendations. We found, on average, it takes more 
than 30 years for Congress or VA to establish presumptive 
diseases, such as those for Agent Orange and the PACT Act. 
These presumptions help to ensure that all veterans receive 
their earned benefits. No veteran should have to wait three 
decades for justice.
    [Applause.]
    Ms. Espinosa. Messrs. Chairmen, DAV knows that 
servicemembers' families share in the sacrifices made by their 
loved ones. That is why we fully support the Major Richard Star 
Act, the Restore Veterans' Compensation Act, the Caring for 
Survivors Act, and the Love Lives On Act, each of which would 
remove barriers and correct inequities faced by wounded, ill, 
and injured veterans and their survivors. With your help, we 
can and we must get these bills enacted this year.
    [Applause.]
    Ms. Espinosa. But we know that passing new laws is not 
enough. We must also ensure that veterans are able to access 
the services and benefits they have earned. That is why one of 
DAV's core missions is to provide ill and injured veterans free 
representation with their benefits claims. With over 1 million 
veterans choosing DAV to represent them, I am proud to say we 
have the largest and best benefits advocacy initiative in the 
country, second to none.
    [Applause.]
    Ms. Espinosa. To help veterans access VA health care, DAV 
operates a national transportation network, offering veterans 
rides to and from VA health care facilities at no cost. Last 
year, DAV volunteers drove more than 575,000 hours, 
transporting more than 245,000 veterans to their medical 
appointments, saving taxpayers more than $18 million.
    [Applause.]
    Ms. Espinosa. We also help veterans achieve economic 
security through employment support and by empowering veteran 
entrepreneurs to make the business world accessible to them and 
their spouses. I am proud to say that in the past decade our 
job fairs have resulted in over 180,000 job offers.
    [Applause.]
    Ms. Espinosa. Finally, DAV has long advocated on behalf of 
veterans' family caregivers. They not only share in the 
sacrifices made by veterans but also enhance their quality of 
life. That is why, in October, we launched DAV Caregivers 
Support, a program to provide tailored assistance and resources 
to those who care for veterans. Through our program, caregivers 
can access online resources and receive personalized care 
plans. They also get one-on-one support from a trained 
specialist. And like all of our services for veterans, DAV 
Caregivers Support is provided at no cost to the caregiver or 
the veteran.
    [Applause.]
    Ms. Espinosa. Messrs. Chairmen, in conclusion I would like 
to share some words from Thomas Jefferson that are inscribed on 
his memorial: ``I am not an advocate for frequent changes in 
laws and constitutions, but laws and institutions must go hand 
in hand with the progress of the human mind. As that becomes 
more developed, more enlightened, as new discoveries are made, 
new truths discovered, and manner and opinions change, with the 
change of circumstances, institutions must advance also to keep 
pace with the times.''
    That statement remains true today as it did more than 200 
years ago.
    Our veterans need a VA that keeps up with the times, and we 
need you to join with us so that together we can create a 
better VA that our veterans deserve, today and into the future.
    [Applause.]
    Ms. Espinosa. Messrs. Chairmen, thank you for the 
opportunity to testify today. As always, my heart remains with 
DAV, the men and women who have served our great nation, and 
their families, caregivers, and survivors, and of course, the 
United States of America.
    [Applause.]
    Ms. Espinosa. Thank you. This concludes my statement.
    [Applause.]

    [The prepared statement of Ms. Espinosa appears on page 29 
of the Appendix.]

    Chairman Tester. Thank you, Commander Espinosa. We 
appreciate those words. There will be three-minute rounds. I 
would ask the members to obey that as close as possible. I will 
be first.
    Three years ago we passed the Deborah Sampson Act, a bill 
introduced by Senator Boozman. It will help eliminate barriers 
to care and services faced by many women veterans, and it was 
signed into law. This legislation also helped expand and 
improve access to care and benefits for survivors of military 
sexual trauma. The Deborah Sampson Act was a big win, but as 
DAV notes in a recent report on women veterans, we still have 
much work to do to improve care for those who have experienced 
MST.
    So my question is this to you, Commander. Where is VA 
currently succeeding in providing care for veterans who have 
experienced MST, and where can improvements be made?
    Ms. Espinosa. Thank you very much for that question, 
Senator. I would like to ask our Legislative Chairman, Joy 
Ilem, to respond.
    Ms. Ilem. Thank you, Commander. Thank you. I think one of 
the key things that is positive is that DoD and VA were 
starting to work together to address the MST issue, and that is 
absolutely critical. But we know that far too many veterans, 
both male and female, experience military sexual trauma. We 
have to have a culture change, both in the DoD and VA. The 
positive steps have been made, moving that forward, but there 
is so much more to do, especially warm handoffs are so 
important, making sure there is care coordinators to address 
issues with women veterans, and male veterans who experience 
sexual trauma, trauma-informed care, continued resources to 
make sure evidence-based treatments are developed.
    So there are a number of positive things, but we still have 
a number of issues that we still need to address, and we have 
to have welcoming, safe environment for all veterans using VA, 
no harassment, and we have to hold VA accountable for that.
    Chairman Tester. Thank you Joy, and thank you for the work 
that you do.
    On Tuesday, DAV members and other veteran service 
organizations joined me at a press conference to call for swift 
passage of the Major Richard Star Act. This bill has 
overwhelming bipartisan support and would allow combat-disabled 
veterans to collect their full DoD retirement pay and VA 
disability pay, and quite frankly, this bill is a no-brainer.
    So for you, Commander, what would this change mean to DAV 
members, and why is it so important we get this legislation 
passed?
    Ms. Espinosa. That is a very important question, Senator. 
Thank you for asking. I would like to ask our Service Director, 
Jim Marszalek, to respond.
    Mr. Marszalek. Thank you, Commander. Senator, we do support 
the passage, and like you said, it is a no-brainer. These are 
combat veterans who suffered significant injuries as a result 
of their service. They should be able to receive their 
retirement and their VA compensation separately, absolutely.
    Chairman Tester. Thank you. Chairman Bost.
    Chairman Bost. Thank you, Chairman. Commander, after 
working with Senator Moran and Senator Tester and Speaker 
Johnson I was pleased to be able to get the language for H.R. 
705 to protect Second Amendment rights of our veterans included 
in the appropriation bill and considered this week, and I am 
grateful for the DAV's support of this issue.
    I just want to know, as things move forward, can we 
continue to count on that support?
    Ms. Espinosa. Thank you very much for that question, 
Congressman. DAV believes that veterans must have all their 
rights protected, including their due process rights, and we 
support that legislation.
    Chairman Bost. Thank you very much. Commander, also DAV's 
national services officers have helped other veterans navigate 
this labyrinth of VA claims appeals process, and it really is a 
labyrinth. Can you elaborate on the meaningful claims and 
appeals reform that Congress should support that allows you and 
helps you work with them to get that done, get their claims 
processed?
    Ms. Espinosa. Thank you very much for that question, 
Congressman. I would like to ask Service Director Jim Marszalek 
to respond.
    Mr. Marszalek. Thank you. Great question. At the end of the 
day it starts with VA forms and how veterans are introduced to 
filing a claim for benefits. It is very complex. The complexity 
of the forms, then the letters they receive as a result of 
filing those forms is complex. We have to start there. There 
should be no wrong door at VA. It does not make any sense to us 
that a veteran would have to think about what claim they filed 
20 years ago in order to determine what form they use.
    I was just looking at forms the other day through the VBMS 
notification queue, and we found so many issues with them in 
regard to, it is confusing to veterans, for sure. So we have to 
fix that first. Again, no wrong door at VBA has to be the 
attitude going forward, so veterans are comfortable and they 
are not punished in any way for filing the wrong form. They are 
asking for help for a benefit. We need to be able to help them 
do that as best as we possibly can. We need to make it as easy 
as possible for them.
    Chairman Bost. Well, let me tell you this, to the VBA, 
thank you for doing that. As a person who has went through this 
process several times, and frustration--and I am going to tell 
you that there are many veterans out there that give up before 
getting the process done, and that is wrong. Whenever I first 
got here we did move a bill to try to improve that process, but 
we have got to have your help--and thank you for your help--to 
allow us to continue to try to make it an easy process so that 
it does not drive our veterans away and that would give up.
    So thank you, and with that I will yield back.
    Chairman Tester. Senator Moran.
    Senator Moran. Chairman Tester, thank you. Commander, thank 
you very much for your words. They are valuable and meaningful.
    Let me remind the DAV that Senator Sinema and I have 
introduced the Veteran Caregiver Re-education, Re-employment, 
and Retirement Act to provide caregivers with needed support as 
they reenter the workforce or transition into retirement once 
they are no longer needed as a family caregiver. Would you be 
willing, would the DAV be willing to take a look at that 
legislation and consider supporting it?
    Ms. Espinosa. Thank you very much for that question, 
Senator. It is very important to many of our members. I would 
like to ask our Legislative Director, Joy Ilem, to respond.
    Ms. Ilem. Absolutely, Senator Moran, we would be happy to 
take a look at that. And you know how important caregivers are 
to our members, and anything we can do to support them and make 
sure that they have every opportunity is key. Thank you.
    Senator Moran. Thank you. I look forward to working with 
you, Joy, and DAV in this regard.
    Commander Espinosa, the VA has been closing beds in 
community living centers, CLCs, due to an inability to find 
staff and to retain staff. My question that is written in front 
of me is do you have any concerns. I assume the answer to that 
question is yes. But do you have suggestions of how we can help 
the VA employ and retain staff and make sure that the needs of 
our veterans who are in community living centers, their needs 
continue to be met?
    Ms. Espinosa. I appreciate that question, Senator. We do a 
lot for caregivers, as I mentioned in my remarks. I would like 
to ask our Legislative Director, Joy Ilem, to give detail on 
that.
    Senator Moran. Thank you.
    Ms. Ilem. Absolutely. Long-term care, we have so many aging 
veterans and service-disabled veterans deserve to have options, 
from home-based primary care services through, we know that no 
one wants to have to end up in a community living center or a 
nursing home, but at times that is just the reality of it. They 
need that support. They need that help. So being able to 
recruit and retain the best and the brightest to care for our 
nation's veterans is so key, and we will do everything we can 
to work with you on that issue. We hope that this is an issue 
that will be taken up by Congress because we have an aging 
veteran population that is really going to be critical in the 
next decade.
    Senator Moran. And apparently an aging workforce.
    Ms. Ilem. Yes.
    Senator Moran. Commander, thank you. You came to see me 
shortly after you became Commander. I appreciate that 
conversation and appreciate the relationship I have with you 
and the members of DAV. Thank you.
    Ms. Espinosa. Thank you.
    Chairman Tester. Ranking Member Takano.
    Mr. Takano. Thank you, Mr. Chairman. Commander, I was 
pleased to see in your written testimony that DAV supports 
enacting legislation that would require specific training 
protocols for community providers to ensure that these 
providers meet the same clinical competency and quality of care 
standards to which we hold VA providers.
    So my question, I have a few questions here. What sort of 
training do you think is most critical for VA community 
providers to have, particularly mental health providers? And 
second, what would you say to those who question whether 
Congress should mandate training for VA's community providers 
at all?
    Ms. Espinosa. I appreciate the question, Congressman. I 
would like to ask our Legislative Director, Joy Ilem, to 
respond.
    Mr. Takano. Great.
    Ms. Ilem. Thank you, Commander. It is an absolutely 
critical point to make sure that all providers, whether they 
are VA or community providers, have the proper training, 
especially in mental health. Suicide prevention is VA's number 
one clinical priority, and as such all providers in VA are 
trained. They are mandated and required to take training in 
suicide prevention efforts and lethal means safety counseling.
    Unfortunately, VA's network of community providers, that is 
not mandated. While it is encouraged, it is not mandated. But 
we know so many veterans use the Community Care Network as 
well. We believe they should have the same requirements and 
mandate. Our veterans deserve no less, and with suicide, again, 
on the rise we absolutely, that is a critical point.
    Mr. Takano. Thank you. Commander, thank you for 
highlighting in your testimony the importance of modernizing 
the VA medical facilities to ensure that they can best support 
the delivery of health care in the 21st century. For fiscal 
year 2024, appropriators have provided a modest plus-up over 
the President's budget request, but the $2.1 billion that will 
be appropriated is still a far cry from the $7 billion that DAV 
and other independent budget VSOs are recommending for fiscal 
year 2025.
    Why are these infrastructure investments so critical, and 
in the absence of sufficient funding, how should Congress and 
VA prioritize available resources?
    Ms. Espinosa. Thank you very much for that question, 
Congressman. There are many areas in VA that need 
modernization--building, equipment, et cetera--but I would like 
to ask our Legislative Director, Joy Ilem, to add more detail.
    Ms. Ilem. Thank you, Commander. With an aging 
infrastructure in VA, it is absolutely essential that Congress 
and VA work together to modernize the VA health care system. We 
know that, on average, buildings are 60 years old or greater, 
and compared to the private sector, where we are seeing more 
between 12 and 15 years for a facility.
    Infrastructure is key in recruitment and retention of good 
people, modernization to have all of the IT equipment and new 
technologies that are available.
    So the modest amount in the budget is not there. We have 
been advocating, as you noted, $7 billion, at least. VA's own 
SCIP plan, which is their Strategic Capital Infrastructure 
Plan, says that they need $150 billion to correct and build and 
modernize its system. So we have got to start making those 
investments. Our veterans deserve that.
    Mr. Takano. Thank you. Thank you. I might note that this 
polls really high with the American public. We asked them, 
``Should we modernize these buildings?'' and it is off the 
charts.
    Chairman Tester. Senator Hassan.

                   HON. MARGARET WOOD HASSAN,
                U.S. SENATOR FROM NEW HAMPSHIRE

    Senator Hassan. Thank you, Mr. Chair, and to you and your 
co-Chair and Ranking Members, thank you all for having this 
hearing. Ms. Espinosa, thank you so much for being here and to 
all of your colleagues.
    I would like to acknowledge, I was able to meet with the 
New Hampshire leadership of DAV back home at the end of last 
week, but I want to acknowledge all the Granite Staters who are 
here today, and as I did yesterday, a special welcome home to 
Vietnam vets. We are really, really glad to have you here.
    Ms. Espinosa, I would also like to thank you and your 
family for your military service and for your work leading DAV. 
In your written testimony you mentioned the DAV's Caregivers 
Support Program, which provides support and resources to those 
who serve as caregivers for veterans. I know how important 
caregivers are to people who experience disabilities and how 
difficult it can be to juggle all of the other responsibilities 
that we have in life with also caring for a loved one.
    So Ms. Espinosa, can you please discuss the role that 
caregivers play in supporting disabled veterans and how 
Congress can continue to support them as well as the veterans 
that they serve?
    Ms. Espinosa. Thank you very much for the question, 
Senator. I appreciate that. We have many caregivers in our DAV 
Auxiliary, and they work very hard to take care of their 
veterans and give them a good quality of life. The support that 
they need is a priority for them, whether it is the stipend or 
training to take care of the veterans. It is very important 
that they have that training and the backing of the VA to be 
able to provide care for their veteran.
    Senator Hassan. Thank you. I also wanted to follow up on 
another area of your testimony. Many veterans struggle with 
finding transportation to and from the VA. This issue affects 
not only disabled veterans but also veterans who live in rural 
areas without easy access to public transportation, and it is 
an issue that affects many people in New Hampshire.
    In your testimony you describe the work DAV does to provide 
vehicles and drivers to assist veterans with getting to their 
VA medical appointments. I discussed how important this work 
was at last year's hearing, and it is even more important now 
as so many new veterans will be coming to VA facilities for 
care they are entitled to under the PACT Act. So what can the 
VA do to continue to support DAV's transportation network, 
especially as the number of veterans coming into VA facilities 
increases under the PACT Act?
    Ms. Espinosa. I appreciate that question, Senator. It is 
very important to us. I would like to ask our Voluntary 
Services Director, John Kleindienst, to respond.
    Senator Hassan. Sure.
    Mr. Kleindienst. Thank you, Commander. That is a great 
question. The VA would need to standardize and streamline the 
onboarding process for volunteers and prioritize what 
volunteers bring to VA as a without-compensation employee. The 
standardization needs to take place immediately, because if you 
go to one VA and another VA the priority and the 
standardizations are totally different. So that needs to change 
immediately.
    We have many people willing to donate their most precious 
commodity, which is time, to transport veterans to and from 
their appointments, and lose interest when the VA drags their 
feet on onboarding these volunteers.
    Senator Hassan. I appreciate that, and just to my 
colleagues here, this is something we hear a lot about.
    [Applause.]
    Senator Hassan. We lose volunteers to do this work because 
it takes so long, and the onboarding process is so irregular. 
So I hope we can work on that together. Thank you.
    Chairman Tester. Congressman Luttrell.

                     HON. MORGAN LUTTRELL,
                 U.S. REPRESENTATIVE FROM TEXAS

    Mr. Luttrell. Thank you, sir. Thank you all for your 
service. I would feel remiss if I did not ask if there were any 
Texans in the room. That is what I am talking about. Well, I am 
glad you are here too because I was going to take all of it and 
say there only needs to be one. Okay.
    My question is, and reading over the information that you 
provided with us I want to talk about suicide and suicide 
prevention. In the VA system as a whole, in one of my 
subcommittees for VA I had the opportunity to discuss suicide 
prevention. And I am not saying I make it very uncomfortable 
for the VA members that are sitting in front of me when we are 
talking about suicide prevention because if there is anything 
that I would say is broken or missing in the VA it is our 
suicide prevention capabilities, because the number continues 
to grow. If you peel back the onion far enough, the one thing 
that continues to exponentially exceed itself is the number of 
veterans that are taking their lives. And I constantly get on 
the VA that it is their job, their job to be proactive in 
preventing the loss of our brothers and sisters.
    But VA is a machine, a very large, capable machine, but 
with lots of intricacies that they also focus on, even though 
suicide prevention is their number one issue that they state. 
So Commander or--I do not know if you are going to shift this 
one over to Ms. Ilem--we veterans depend on our service 
organizations to fill the gap, whether it is retrospective, 
prospective information and research, to solve our veterans' 
problems. Veterans solve veterans' problems, plain and simple.
    How are you leaning forward in this problem set? Because 
the 10-year plan that we have passed Congresses ago, that 
seemed to think that suicide prevention is a sustainable pay 
pipeline that we can just cookie cutter, and every single 
individual is different. Every single person's emotional and 
cognitive stability is different. You cannot treat one person 
like you treat the other.
    So I think that we need to focus in on that and lean in on 
innovative ideas and modalities for our veterans to solve this 
suicide problem. What is DAV doing on this?
    [Applause.]
    Mr. Luttrell. Are you going to go to Ms. Ilem? I know you 
are.
    Ms. Espinosa. Yea.
    Mr. Luttrell. Okay.
    Ms. Espinosa. Thank you very much for the question. I will 
ask Legislative Director, Joy Ilem, to respond. Thank you.
    Ms. Ilem. Thank you for those passionate comments. We 
agree. This is going to take all of us together. I mean, that 
is one thing that we are really trying to push out there for 
our membership. It takes everyone to be a peer to our fellow 
veterans. And we need to look out for each other, and we need 
to take action when action is needed, and we need to make sure 
that crisis care is available.
    Congress has done so much in terms of mental health and 
suicide prevention, a number of things. Everyone is looking at 
every type of solution. But again, it is going to require 
vigilance, and as you said, veterans will talk to other 
veterans. And we also know when somebody is in trouble and we 
need to take action, and we cannot be shy or worried. We need 
to help, right when help is needed.
    Mr. Luttrell. And please communicate. I am talking to every 
veteran in this room and the brothers and sisters that are not 
here. You have to communicate those innovative ideas that you 
stumble across in our communities and share that with this 
panel, so we can help move into the VA and let the VA be aware 
of it, as well. Because if we do not do that, we are our own 
worst enemy. Sir, I yield back.
    Chairman Tester. Representative Pappas.

                       HON. CHRIS PAPPAS,
             U.S. REPRESENTATIVE FROM NEW HAMPSHIRE

    Mr. Pappas. Thank you very much, Mr. Chairman. Commander, 
Thanks very much for your powerful testimony and the way that 
you related your own personal experiences through your service 
and as a veteran, and the challenges that you have faced. We 
are really grateful for everything that you have done and the 
advocacy of your team, which is terrific.
    Thank you to all the veterans in the room, all the 
survivors and caregivers and advocates who are here, who help 
us get on track with respect to what we need to do together for 
America's veterans. And there really should be no party when it 
comes to this. We do not work for VA. We do not work for our 
party. We work all of you, so we cannot forget that. And we 
really appreciate the priorities you have highlighted today.
    I want to commend DAV for their campaign to highlight the 
need to ensure long-term care options for veterans, including 
seriously disabled veterans with traumatic brain injuries. 
While efforts to research and better understand the impact TBIs 
have had on veterans, they have improved in recent years, but I 
share your concern that not enough consideration is being given 
to veterans with TBIs who may ultimately require specialized 
long-term care, ideally within their community, due to their 
injuries.
    That is why I was pleased that language was included in the 
2024 ``minibus'' that was just presented. It directs the 
Department to continue its efforts to partner with providers to 
ensure that veterans with TBIs are able to receive such long-
term specialty care in their communities, and furthermore, it 
directs VA to educate case managers on the resources available 
to provide these veterans with the specialty care they so 
desperately need.
    So I am wondering if you could comment on what VA is doing 
in terms of research into the long-term effects of TBIs and the 
planning and provisions of long-term specialty care, and how 
can Congress best advocate to support these efforts?
    Ms. Espinosa. I appreciate the question, Congressman, thank 
you, and it is a very important area. I would like to ask our 
Legislative Director, Joy Ilem, to respond.
    Ms. Ilem. Thank you, Commander, and thank you for that 
question. TBI, as we know, there are going to be these long-
term effects that are still completely not known, but we have 
to be prepared. And VA is doing some critical research out 
there. We need to make sure that treatments are available.
    And we need to make sure we are following along with these 
veterans to meet their unique needs. We know that could be 
younger veterans that require assisted living options, and we 
have recommended a number of proposals, to have a variety of 
complementary services, to make sure that veterans with TBI can 
live as independent as possible but have the support that they 
need to be able to do that safely.
    Mr. Pappas. Thanks very much for your response. I also want 
to thank DAV for being part of the coalition supporting the 
GUARD VA Benefits Act, which is an important piece of 
legislation that would reinstitute criminal penalties for folks 
that are violating the law, these claim sharks that are taking 
advantage of veterans, charging them an arm and a leg for 
services that we know DAV and other VSOs provide and take very 
seriously. We should support accredited agents, not these claim 
sharks that are ripping off our veterans.
    I yield back, Mr. Chairman.
    [Applause.]
    Chairman Tester. Senator King.

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

    Senator King. Thank you, Mr. Chairman. First I want to 
thank you for the work that you do generally, and that DAV 
does, the irreplaceable work that you do for the disabled 
American veterans, but specifically for the advocacy around the 
PACT Act. We would not have the PACT Act if it were not for 
you, and I want to thank you for that work. The benefits will 
be paying dividends for veterans for years to come.
    The second thing is I want to thank you for the rides. The 
transportation system in my State of Maine is so important, in 
a rural state, and it just makes an enormous difference. I 
think my delegation, Steve Santos, and my delegation are over 
visiting on the other side of the Capitol right now, but they 
do fantastic work helping people to get to those appointments. 
Sometimes it seems like a sort of afterthought, but it is not. 
If you cannot get there, you cannot get the help. So thank you 
for the service that you provide.
    A couple of issues. Joy, you mentioned long-term care is 
critical. That was the issue. We have got a wave coming at us. 
In Maine, we know about waves, and we have got a big wave 
heading for us right now in terms of long-term care, and it is 
only going to get more difficult. We have got problems with 
reimbursement rates, and we have got problems with staffing. So 
to the extent you have ideas or suggestions that can help us on 
the long-term care issue.
    And one thing. We had a hearing up in Maine a few weeks ago 
on the issue of long-term care for veterans. We need navigation 
help. We need people that can help veterans know what the 
programs are, what is available, and how to navigate what is 
sometimes a pretty daunting system. So I hope that you can help 
us with that.
    The other problem that we are seeing growth, unfortunately, 
is in mental health. We have talked about suicide. We need help 
with telehealth, which can be very effective in delivery of 
mental health. So I am asking you for help on these issues.
    The final one that I am spending a lot of time on is 
transition. One of my first hearings over here, over 10 years 
ago, in the Armed Services Committee, I listened and listened 
about recruiting and everything, and then I said, ``We should 
spend as much time, money, and effort on transition out as we 
do on recruiting in.''
    [Applause.]
    Senator King. There are several bills pending in this 
Congress. One is the Welcome Home Veterans, which would allow 
the notification to state veterans' offices. I think you are on 
record as supporting that. The Combat Veterans Pre-Enrollment 
Act--this is particularly important for your members--so you 
can enroll in the VA medical system before you leave, during 
the transition process, and then you can get medical care from 
day one. So I hope you will look at that bill. And then finally 
there is the TAP Promotion Act, which would allow VSO presence 
in the TAP program before the soon-to-be veterans leave 
service.
    So those are all things I hope you can help us with. Those 
are things I think we can get done this year.
    I want to, again, end where I began. Thank you for all you 
have done. Thank you for all you have done for veterans, in 
Maine and across the country.
    Thank you, Mr. Chairman.
    Ms. Espinosa. Thank you, Senator. Thank you.
    Chairman Bost [presiding]. Representative Self.

                        HON. KEITH SELF,
                 U.S. REPRESENTATIVE FROM TEXAS

    Mr. Self. Thank you, Mr. Chairman. As an Army Green Beret 
it is always an honor to sit next to my Navy SEAL brother here, 
and I appreciate----
    [Applause.]
    Mr. Self [continuing]. And I appreciate his setup because, 
Commander, in your written testimony, you highlighted the need 
to bolster mental health resources to prevent veteran suicide. 
It is a very important mission to us and the Committee as a 
whole, the House Committee as a whole.
    As you know, the Staff Sergeant Gordon Fox Suicide 
Prevention Grant Program will need to be reauthorized in the 
next few years. We often focus on inputs--what we are doing, 
what the inputs are. I want to focus on the output of this 
program--what are the results, how are they measured--not 
inputs, but outputs.
    So who, on this panel, can tell me how effective has the 
Staff Sergeant Fox Suicide Prevention Act been in preventing 
suicides, how is it measured, and how do you measure it? How 
effective is the program?
    Ms. Espinosa. Thank you for that question, Representative. 
I would ask our Legislative Director, Joy Ilem, to respond.
    Ms. Ilem. Thank you for that question. That is really 
important, and we are looking for that information as well. And 
I think being able to have--there have been a lot of new ideas 
and innovative ways to try to look for prevention, financial 
assistance and trying to get at points before somebody is 
homeless or in crisis or spiraling down.
    And it is going to be key to look at the results of how 
those grants have been distributed, how helpful they have been 
in terms of the numbers of people that have been assisted, and 
again, how do you measure that in an effective way?
    Mr. Self. So you do not have those numbers for us yet.
    Ms. Ilem. Right.
    Mr. Self. Because we will need that as we discuss, as a 
Committee, the reauthorization.
    Ms. Ilem. Yes.
    Mr. Self. Which leads me to my next question. Well, you 
probably do not have an answer to this. Are there ways we can 
improve the application process? What other additional 
information do you need? So I will just leave that in your 
hands because we need the effects first.
    In my district I have a lot of peer-to-peer counseling 
organizations for veteran PTSD to suicide, the whole gamut. One 
of them, Veterans Outpost, applied for a Fox grant last year, 
did not get it. And I want to ask you about what are the 
challenges that you are hearing on these peer-to-peer 
counseling, because as you know, some veterans like to go to 
big VA, some like to go to a community clinic, some like to go 
to peer-to-peer organizations.
    What are the challenges faced by the peer-to-peer 
organizations, that you know of, for these grants?
    Ms. Ilem. Well, I would note, DAV has a Charitable Service 
Trust where we have also provided grants to people within our 
different locations that can request a grant to do something 
special, and one that comes to mind was, I believe, in 
Arkansas, that was really effective.
    It was a clinician who had been retired and then got a 
couple of folks that wanted to work with him to go out to the 
community and make sure that they were talking to veterans, 
one-on-one, and contacting everyone, letting them know that 
they were available there. And they felt very good about the 
success that they had in reaching those, and I think it is 
innovative ideas like that that are going to be key. And we 
need to continue to have that type of initiatives.
    Mr. Self. Well, I ask you to get us that information in the 
House Committee, certainly for the Fox Grants, the 
effectiveness of the program, and I look forward to working 
with you to see how we can, if we do need to improve it when we 
reauthorize it.
    Mr. Chairman, I yield back.
    Chairman Bost. Thank you. Representative McGarvey.

                     HON. MORGAN MCGARVEY,
               U.S. REPRESENTATIVE FROM KENTUCKY

    Mr. McGarvey. Thank you, Mr. Chairman. Commander Espinosa, 
I want to thank you for your service, both during your time in 
uniform and, of course, as a committed advocate for the 
millions of veterans and servicemembers across the country.
    I also want to thank you, in particular, a report you just 
published last week, and I found this report really 
interesting. You did a lot of work, and the things that went 
into your research, you presented a lot of really thoughtful 
solutions.
    In Louisville I hear about the great need for mental health 
clinicians who are specifically trained in issues that affect 
women, and for therapies that consider unique life transitions 
in family systems that affect women's overall health and well-
being.
    As women veterans in Kentucky navigate challenges related 
to aging, I hear about the need for better-informed VA 
clinicians on things like menopause. For example, when reading 
your report I was really surprised to read about the 
correlation between menopause and suicide. And I agree that 
this warrants much more research and knowledge-sharing between 
both the VA and the non-VA experts.
    So Commander Espinosa, I want to ask you, what are some of 
the specific changes that the VA can make to mental health 
programs and services to better meet the needs of aging women 
veterans right now, and what are your thoughts on how we, as a 
Committee, can provide the resources and support necessary to 
make these changes?
    Ms. Espinosa. Thank you very much for that question, 
Congressman. It is very important. One thing that comes to my 
mind that VA could do, the formula that is used to assess risk 
for suicide for all veterans is based on men's experience. If 
that calculation could include MST or intimate partner 
violence, those kinds of categories should be added to that 
calculation. And women that have had MST are very high risk for 
suicide, and they should be evaluated and then reevaluated as 
they go along in their health care process. So that is one 
thing they could do.
    Mr. McGarvey. Thank you. I appreciate that recommendation, 
Mr. Chairman, and I yield back.
    Chairman Bost. Thank you. Representative Landsman.

                      HON. GREG LANDSMAN,
                 U.S. REPRESENTATIVE FROM OHIO

    Mr. Landsman. Thank you, Mr. Chair, and thank you for all 
of the work that you all do, and to all of the veterans and 
supporters here, we really do appreciate you. DAV was founded 
in Cincinnati. I am from Cincinnati. So over 100 years ago--
yes, you can clap for that. That is exciting, yes.
    [Applause.]
    Mr. Landsman. Cincinnati, we had the first baseball team, 
the first fire department, DAV. I was told once that the first 
fillet of fish sandwich was sold in a McDonald's restaurant in 
Cincinnati.
    I want to join my Republican colleagues in their questions, 
comments, about the Fox Grants. We are talking a lot about 
veteran suicide, as we should be, and I think your points about 
making sure that we are collecting data and then developing 
supports for both men and women, because of the alarming rates 
that we are seeing women veterans take their lives. Anyways.
    Getting a better understanding, and Mr. Self and Mr. 
Luttrell brought this up, that getting a much better sense of 
the data. I mean, it is really important, not just in terms of 
additional funding and what kind of decisions we made, but what 
is working and what is not working? And this is the Fox Grants, 
hugely important, but all of the work that we are doing to try 
to reduce, eliminate suicides, we have to get a much better 
grasp of what is actually working.
    So I am curious what you would say to this question, which 
is, you know, we do not really have a sense right now, whether 
it is the Fox Grants or something else, what is working, and if 
we do we are not really sharing that with our partners. Is that 
fair? Is it unfair? I mean, this is clearly something that we 
are going to keep pushing on, and it is not a criticism as much 
as it is that we have to get serious about understanding what 
works and then spreading it quickly.
    Ms. Espinosa. I agree. Thank you very much for that, 
Representative. I would like to ask our Legislative Director, 
Joy Ilem, to add information.
    Ms. Ilem. Thank you, Commander. I would just add that I 
think everyone wants to solve this issue and really tackle it 
head-on, and the grants, we need to be able to look at that 
data, that information, how effective they are. But we also 
need to know--I mean, we also look at the volume of veterans 
who do not use VA services. And so this is a great way, with 
these grants, for veterans in the community, with peers, that 
they may not have engaged with VA yet, but also learning about 
the services and resources that are available to them.
    You know, because sometimes they have been out there on 
their own. That might be their first contact. But definitely if 
they may have long-term mental health issues that are serious 
we want to make sure they are connected with VA, from those 
grantees, because VA has the wraparound services and has a 
number of programs that are really going to be beneficial for 
them in the long run.
    Mr. McGarvey. Thank you. I yield back.
    Chairman Bost. Representative Budzinski.

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

    Ms. Budzinski. Thank you, Mr. Chairman, and good morning, 
everyone. I want to first start out by thanking all the brave 
veterans and military members in the room for taking time to be 
with us here today.
    The veteran service organizations like Disabled American 
Veterans play a crucial role in ensuring our veterans are 
getting the care they need, understand their benefits, and 
protect them from the claim sharks and bad actors that 
Congressman Pappas was discussing. And you all serve as the 
catalysts between Congress and the Veteran.
    In my first year I just want to mention, I started my own 
Veterans Council, and in particular started a roundtable 
regular discussion with women veterans, in particular, in my 
district. And I just have to say, as a freshman serving on the 
House Veterans' Affairs Committee it is truly an honor to serve 
on this Committee and hear from you all on how we can better be 
serving the veterans in our communities.
    It was with the help of the feedback from the VSOs that I 
was honored to introduce the bipartisan Edith Nourse Rogers 
STEM Scholarship Opportunity, H.R. 5785, with several VSOs, 
including DAV, having endorsed this legislation. My bill would 
modify requirements for the Edith Nourse Rogers STEM 
Scholarship to expand Post-9/11 GI Bill benefits, making it 
easier for our student veterans to access STEM education, and 
it would direct the VA to submit demographic information on 
denied applicants so that we can identify what gaps remain to 
be filled in the application process.
    My question for Commander Espinosa, I appreciated your 
testimony and DAV's support, of course, of H.R. 5785. Can you 
speak to why we need more veterans in the STEM fields and how 
STEM expansion bills like the Edith Nourse Rogers STEM 
Scholarship Opportunity Act can benefit veterans, in particular 
women veterans who are underrepresented in STEM fields today?
    Ms. Espinosa. Thank you very much for that question, 
Representative. As a previous or a past IT person I can really 
relate to the need for STEM in education. I would like to ask 
our Legislative Director, Joy Ilem, to add information.
    Ms. Budzinski. Great.
    Ms. Ilem. Thank you, Commander. I think both of you have 
already made the case for why it is important. Veterans deserve 
to have these scholarships, and especially trying to encourage 
women veterans to do their graduate work and doctoral work for 
really careers that are essential. And we need to have women in 
those positions to be able to be, just like our Million Veteran 
Program, and others, that we want to make sure that women are 
represented adequately, because those are big, important fields 
that are going to determine our future, and we need to have 
women there.
    Ms. Budzinski. Absolutely. Thank you very much. I yield 
back, Chairman.
    Chairman Bost. Senator Blumenthal, you are recognized for 
three minutes.

                    HON. RICHARD BLUMENTHAL,
                 U.S. SENATOR FROM CONNECTICUT

    Senator Blumenthal. Thank you, Mr. Chairman. Thank you to 
our House colleagues for being here, and to all of you for your 
service to our country and your extraordinary service, not only 
in uniform but afterwards. It is really exemplary and 
inspiring.
    I have been greatly heartened and encouraged by the 
expansion of the PACT Act--I am sure there has been a good deal 
of discussion about it--to include all men and women exposed 
while in the military to any kind of toxic substances, whether 
here or abroad, whether during training or in combat. As a dad 
of two sons who have served--one as a Marine Corps infantry 
officer in Afghanistan and the other as a Navy SEAL--I am 
deeply concerned about the effects of exposure to toxic 
substances. The effects may not manifest right away. It may be 
only years later. And the passage of the PACT Act and now 
expansion is one of the ways that we are keeping faith with our 
men and women who serve.
    But I am very concerned that many of our veterans simply do 
not know about it, and I would like to ask you whether there is 
more that we can and should do to make them aware of it, and 
what specifically you would recommend.
    Ms. Espinosa. Thank you very much for that question, 
Senator. It is very important. I would like to ask our Service 
Director, Jim Marszalek, to respond.
    Mr. Marszalek. Thank you, Commander, and great question, 
Senator. The outreach that VA has done as a result of the 
passage of the PACT Act has been pretty significant. DAV also 
has done significant research. We have done over 400 
information seminars throughout the community just last year, 
informing veterans about the PACT Act and all other VA benefits 
they may be entitled to. We collaborate alongside VA in a lot 
of those, as well, so they come to some of our outreach events.
    I think not only the PACT Act outreach itself but it has 
also brought in a lot of veterans who maybe have filed claims 
many, many years ago who had a distrust in VA, come back. I was 
just at a recent event with Under Secretary Josh Jacobs, and he 
talked about a story where they were at a DAV outreach event 
where a Vietnam veteran heard about the PACT Act that he may be 
entitled to benefits and came back, but had filed a claim many, 
many years before and was denied, and did not think that he was 
entitled to benefits any longer.
    So we have to continue doing that outreach, so DAV is going 
to continue doing our information seminars in communities 
throughout the country. It is one of our proudest programs to 
get out there and really talk to veterans and their spouses 
about entitlement.
    Senator Blumenthal. I would be very interested in any 
ongoing suggestions or recommendations you have that we can 
bring the attention or emphasize with the VA, because obviously 
you are in touch, on the ground. I am in Connecticut, but you 
are nationwide. And I think this kind of outreach is critical.
    Thanks, Mr. Chairman.
    Chairman Bost. Thank you. Thank you. So what we would like 
to say now is we want to thank the DAV for their time and 
efforts to bring forward their priorities. And let me say, as 
Chairman--and I will speak for myself as Chairman and I know 
the Ranking Member of both the House and the Senate--we are 
here for you. We want to advance the causes, to make sure our 
veterans are taken of. We would love to wave a magic wand and 
fix everything, but working together we can try to fix as much 
as we possibly can.
    Remember, DoD, unfortunately, they have got jobs to do, and 
when they do that job quite often our veterans need the help 
that VA provides, to try to make them as whole as possible. We 
want to make sure that they continue to do that effort.
    And with that, we will be keeping the record open for a 
week for any other input you might want to have on this 
hearing. And with that we will adjourn.
    [Applause.]
    [Whereupon, at 11:19 a.m., the hearing was adjourned.]

                            A P P E N D I X

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