[Senate Hearing 118-138]
[From the U.S. Government Publishing Office]


                                                        S. Hrg. 118-138

                     TO CONSIDER THE NOMINATION OF
                            JOSHUA D. JACOBS
                  TO BE UNDER SECRETARY FOR BENEFITS,
                     DEPARTMENT OF VETERANS AFFAIRS

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

                                HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION
                               __________

                           FEBRUARY 16, 2023
                               __________

       Printed for the use of the Committee on Veterans' Affairs
       
       
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        Available via the World Wide Web: http://www.govinfo.gov
        
                               __________

                    U.S. GOVERNMENT PUBLISHING OFFICE
                    
53-727 PDF                 WASHINGTON : 2023        
        
        
                 SENATE COMMITTEE ON VETERANS' AFFAIRS

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

                            C O N T E N T S

                              ----------                              

                           February 16, 2023

                                SENATORS

                                                                   Page
Tester, Hon. Jon, Chairman, U.S. Senator from Montana............     1
Moran, Hon. Jerry, Ranking Member, U.S. Senator from Kansas......     2
Hassan, Hon. Maggie, U.S. Senator from New Hampshire.............    12

                        INTRODUCTION OF WITNESS

The Honorable Patty Murray, U.S. Senator from the State of 
  Washington.....................................................     3

                                WITNESS

Joshua D. Jacobs, Nominee to be Under Secretary for Benefits, 
  Department of Veterans Affairs.................................     4

                                APPENDIX
                          Nomination Material

Joshua D. Jacobs, Nominee

  Prepared Statement.............................................    21

  Response to Pre-Hearing Questions for the Record submitted by:
    Hon. Jerry Moran.............................................    24
    Hon. Jon Tester..............................................    37

  Response to Questions for the Record submitted by:
    Hon. Marsha Blackburn........................................    43
    Hon. Sherrod Brown...........................................    46
    Hon. Kevin Cramer............................................    49
    Hon. Angus S. King, Jr.......................................    51
    Hon. Jerry Moran.............................................    53
    Hon. Kyrsten Sinema..........................................    58
    Hon. Dan Sullivan............................................    62

  Response to Supplemental Questions for the Record submitted by:
    Hon. Chuck Grassley..........................................    66
    Letter dated April 24, 2023 from Michael Waldman, Special 
      Counsel, Department of Veterans Affairs....................    74

  Questionnaire for Presidential Nominees........................    76

                        Statement for the Record

Hon. Kyrsten Sinema..............................................    91

 
                     TO CONSIDER THE NOMINATION OF
                            JOSHUA D. JACOBS
                  TO BE UNDER SECRETARY FOR BENEFITS,
                     DEPARTMENT OF VETERANS AFFAIRS

                              ----------                              


                      THURSDAY, FEBRUARY 16, 2023

                                       U.S. Senate,
                            Committee on Veterans' Affairs,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 10 a.m., in Room 
418, Russell Senate Office Building, Hon. Jon Tester, Chairman 
of the Committee, presiding.
    Present: Senators Tester, Murray, Blumenthal, Hirono, 
Sinema, Hassan, Moran, Boozman, Tillis, and Tuberville.

              OPENING STATEMENT OF CHAIRMAN TESTER

    Chairman Tester. So I call this meeting to order, to 
examine the qualifications of the President's nominee to serve 
as Under Secretary of Benefits.
    Mr. Jacobs, I want to acknowledge your experience 
supporting veterans, both in the VA as well as here in the 
Senate, and specifically during your tenure with this 
Committee. Our purpose today is to determine whether you are 
the right person to head and to lead the Veterans Benefit 
Administration. That said, we know you have been performing 
many of the duties since July of last year. I expect some of us 
will want to know what you have learned and what you have 
accomplished during that time.
    As we start the 118th Congress, VBA faces several 
challenges, including a backlog of more than 194,000 disability 
compensation claims, that number is expected to grow as more 
veterans seek benefits through the PACT Act.
    Whether it is through a carefully crafted automation system 
or a form of a complex disability examination program, VBA 
needs a leader that protects veterans at every stop in the 
process. And while compensation will inevitably take up a fair 
amount of time and your attention, we need a leader who will 
not lose sight of the other critical benefits and the services 
from VBA, including life insurance and home loan support.
    If confirmed, we are also counting on you to provide 
focused oversight of education and employment programs to 
ensure veterans, transitioning servicemembers, and their 
families have all the tools that they need to succeed in 
civilian life. I am hoping your answers to members' inquiries 
on these matters and others will help this Committee make the 
determination of whether you are the right person to be 
confirmed as Under Secretary for Benefits.
    I very much look forward to our dialogue today and I want 
to thank you for your willingness to serve in this very 
important role. With that I will turn it over to Senator Moran 
for his opening statement, which I hope includes a lot of 
compliments.

               OPENING STATEMENT OF SENATOR MORAN

    Senator Moran. I suppose again, Mr. Chairman, I could start 
by saying thank you, Mr. Chairman. That is written in my 
remarks. Thank you, Mr. Chairman, for holding this hearing and 
thank you to our witness today for joining us. Thank you for 
the conversations that we had earlier this week.
    Mr. Jacobs, you have been nominated to lead the Veterans 
Benefit Administration and to make certain our veterans get the 
right benefits at the right time. The VBA is critical to the 
well-being of veterans and the dependents it serves. Disability 
payments provide financial security to veterans who are unable 
to work due to service-connected injuries and survivor benefits 
to help families mitigate the financial challenges of losing a 
loved one.
    Readjustment benefits like the GI Bill and the VA Home Loan 
Guarantee provide transformational opportunities for veterans 
to achieve economic success in their careers and in the 
communities that they serve.
    VBA is in the midst of implementing the Robinson PACT Act 
to make certain veterans impacted by toxic exposure have a 
disability claim process that works as well for them as it does 
for any other veteran with a service-connect disability. I am 
sure you will recall that a lot of the conversation in this 
Committee is how do we pass the PACT Act and not disadvantage 
those veterans who are already in the queue. As you implement 
this law, it is imperative that the other services and benefits 
that the VBA is charged with administering do not fall short. 
When these benefits are made available to veterans they often 
make consequential choices, counting on the VA's assurance that 
these benefits will be available to them.
    Unfortunately, we have seen instances where the VBA has 
failed to deliver the benefits a veteran deserved or 
erroneously awarded a benefit that a veteran came to rely on 
but then was determined could not have. In some cases, a claim 
decision has taken so long that the benefits became meaningless 
or the veteran had already passed away. The failure to deliver 
the right benefit at the right time can have a serious impact 
on the veteran just as much as a missed medical diagnosis.
    Mr. Jacobs, my staff tells me that since you have been in 
the acting role leading the VBA that you have made a point of 
being more collaborative with them and other congressional 
staff. I appreciate that effort and I look forward to hearing 
how you will make certain veterans are getting the benefits 
they deserve in a timely manner, how you would position the VBA 
to provide more positive, measurable outcomes for veterans in 
the future, and how you will bring the VBA bureaucracy together 
to work with VBA partners to put the customer first.
    I thank you. I thank you for your interest in serving our 
country.
    Mr. Chairman?
    Chairman Tester. Thank you, Senator Moran.
    I will now recognize Senator Murray for the purpose of 
introduction of the nominee.

               INTRODUCTION BY HON. PATTY MURRAY

    Senator Murray. Thank you very much, Chairman Tester, 
Ranking Member Moran, members of this Committee. It is my 
privilege to introduce Joshua Jacobs, President Biden's nominee 
to serve as Under Secretary for Benefits at the U.S. Department 
of Veteran Affairs. And I am pleased to welcome his family here 
today, his parents, Linda and Richard, his wife, Julia, and 
their children, Yael, Amir, and Laura. Welcome to all of you.
    Mr. Jacobs is an exceptionally qualified pick to fill this 
role. He will work day in and day out to make sure our nation 
lives up to its obligation to take care of our veterans, and I 
should know because that is exactly what he did when he worked 
in my office back in the day. Joshua came to work every day 
focused on Washington State veterans and their families and how 
to prepare the VA for an influx of veterans, expand clinics and 
facilities, and make sure veterans had the services they need 
to transition to civilian life, especially when it comes to 
employment.
    That track record is why I was thrilled to have him return 
to work for me as Deputy Staff Director of this Committee later 
on when I became Chair. He helped to lead our efforts to get 
veterans more mental health services, expand support and 
service for women veterans, and ensure veterans had a seamless 
transition from the DoD to the VA, where too often, as we know, 
servicemembers and veterans faced too much red tape and VA 
faced too little accountability.
    Given his drive back then it is no surprise to me the work 
he has done since shows his deep commitment to serving those 
who served our nation and why he is such an inspired choice for 
this role. When Mr. Jacobs was a senior advisor to the Office 
of the VA Secretary under President Obama he was awarded the 
Secretary's Meritorious Service Award. When President Biden was 
elected, he was chosen to serve on the incoming 
administration's VA transition team.
    After Mr. Jacobs returned to the Department as a senior 
advisor in 2021, he improved its decision-making process by 
establishing and leading the new evidence-based Policy Council 
and developing a new interagency policy development process to 
coordinate and implement more than 50 interagency policy 
efforts. As the Senior Advisor for Policy performing the 
delegable duties of the Under Secretary for Benefits, Mr. 
Jacobs has taken on the enormous task of coordinating a team of 
25,000 people, from 56 regional offices, processing centers, 
and headquarters as they work to manage over $100 billion in 
benefits and make good on our promise to millions of veterans 
and their families.
    He knows full well how important a smoothly functioning VA 
is to the Americans who are relying on the benefits our nation 
promised them, and I have no doubt he will go to work every day 
determined to make sure our nation lives up to its promises.
    I know Mr. Jacobs, who happens to be a Washington State 
native, and his family is here today from there, and graduate 
of the University of Washington, will do great work for 
America's veterans as Under Secretary of Benefits. I am very 
proud to support his nomination. I look forward to working with 
him once he is confirmed.
    Chairman Tester. Thank you, Senator Murray, for the 
introduction. Mr. Jacobs, I would ask you to stand and raise 
your right hand.
    Do you, Joshua Jacobs, solemnly swear or affirm that the 
testimony you are about to give before the United States Senate 
Committee on Veterans' Affairs will be the truth, the whole 
truth, and nothing but the truth, so help you God?
    Mr. Jacobs. I do.
    Chairman Tester. Let the record show that the nominee 
answered in the affirmative.
    Mr. Jacobs, you have time for your opening statement now. I 
would ask you take as long as you need, but try to keep it to 5 
minutes.
    Mr. Jacobs. Yes, sir, Mr. Chairman.

                 STATEMENT OF JOSHUA D. JACOBS

    Mr. Jacobs. Chairman Tester, Ranking Member Moran, and 
distinguished members of the Committee, Thank you very much for 
the opportunity to testify before you today. And Senator 
Murray, thank you for your kind introduction and for providing 
me with my first opportunity to work on behalf of veterans as 
well as for your own lifetime of advocacy on behalf of veterans 
and their families. Yours is a standard I strive to meet every 
day.
    I am honored and humbled by the opportunity, if confirmed, 
to serve veterans as the Under Secretary for Benefits at the 
Department of Veterans Affairs. I am grateful to President 
Biden, Secretary McDonough, and Deputy Secretary Remy for their 
trust.
    I would like to recognize some of the family, friends, 
colleagues, and mentors who have supported me. I want to thank 
my parents, Richard and Linda, for a lifetime of support, and 
for teaching me to always do my best and to do good for others. 
I want to thank my wife, Julia, and our three kids, Yael, Zev, 
and Amir. There is no way I could do my job without their 
endless support, love, and patience.
    I would like to also recognize my Grandpa Mel Jacobs, or 
Papa. Papa served in the Army during World War II, and VA 
education benefits let him pursue his educational and career 
goals and provide for his family. Those are just a few of the 
generous people who have helped guide my life, both 
professionally and personally, and I am indebted to them and so 
many more.
    I appreciate how significant the responsibilities of the 
Under Secretary for Benefits are. Over the last 15 years, I 
have dedicated myself to advocating and advancing policies and 
implementing solutions that help improve the lives of veterans. 
As I noted, I had the good fortune of working for Senator 
Murray for nearly a decade, and I learned the importance and 
the kind of impact veteran advocacy can have and the value of 
practical solutions that ensure government solves problems 
rather than creating them.
    During my time as Deputy Staff Director I worked for the 
Senate Veterans' Affairs Committee. I worked shoulder-to-
shoulder with members and staff from both parties and veteran 
service organizations to provide the critical oversight and 
enact legislation that improved benefits and services for 
veterans. So I understand and I deeply respect this Committee's 
dedication and the spirit of cooperation to get the job done 
right for veterans, and if confirmed, I look forward to working 
collaboratively with each of you as a proud alumnus of this 
Committee.
    In addition to my work in the Senate, I have had the 
privilege of working at VA on three separate occasions. During 
my first tour in VA, I served in the Office of Congressional 
and Legislative Affairs where I learned the importance of open 
and transparent engagement between VA and Congress. And I saw 
firsthand how effective engagement and oversight leads to 
better outcomes for veterans. During my second time at VA, as 
Senior Advisor for Benefits, the disability claims backlog was 
near its peak. Working with FBA, we implemented a series of 
solutions that helped drive down the backlog by 90 percent. 
That experience taught me to appreciate the enormous scope and 
scale of the challenges VA faces in delivering benefits and the 
dedication it takes for employees to accomplish this noble 
mission.
    And during my current tenure at VA, I first served as a 
Senior Advisor for Policy and helped develop an enterprise 
governance model to drive integrated decision-making and 
execution across VA. I also helped to expedite the development, 
review, and approval of two regulations that added asthma, 
rhinitis, and sinusitis, and nine rare respiratory cancers to 
the list of presumed service-connected disabilities due to 
military environmental toxic exposures.
    For the past 6 months, I have served as Senior Advisor for 
Policy Performing the Delegable Duties of the Under Secretary 
for Benefits. In this current role, I have worked to ensure VBA 
continues providing quality and timely benefits and services to 
the veterans, family members, caregivers, and survivors we are 
privileged to serve, delivering more benefits to more veterans 
and survivors more quickly and accurately than ever before.
    Today the benefits and services delivered by the more than 
25,000 talented and hardworking VBA employees, over half of 
whom are veterans themselves, not only help fulfill the promise 
of a grateful nation but also empower veterans to be 
homeowners, to pursue further educational and training, and to 
live healthier and more prosperous lives, to help them thrive, 
not just survive. And I am proud to say, because of VBA's 
people and their hard work, last fiscal year VBA processed a 
record number of claims, and we are on track to break that 
record this year for veterans.
    If confirmed, I look forward to continuing this work, 
especially as we receive and process claims from generations of 
veterans seeking benefits relating to toxic exposures under the 
bipartisan PACT Act, which Congress passed last year. I will 
fight every day to ensure veterans and their families receive 
timely claims decisions and access to crucial VBA programs, and 
I will also continue focusing on increased transparency, better 
collaboration, and keeping veterans at the center of everything 
we do.
    As former VA Administrator Omar Bradley once reminded us, 
``We are dealing with veterans, not procedures; with their 
problems, not ours.'' Our country's obligation to those who 
have who have served is one that I know we all share, and if 
confirmed, I will do everything I can to continue to be a 
fierce, advocate for veterans, their families, caregivers, and 
survivors.
    Thank you again for considering my nomination. I look 
forward to your questions.

    [The prepared statement of Mr. Jacobs appears on page 21 of 
the Appendix.]

    Chairman Tester. Thank you for your statement. And before I 
yield my time to Senator Murray I would just say it is good to 
have your family here, and I just want to know if the kids are 
enjoying themselves.
    [Laughter.]
    Chairman Tester. Senator Murray.
    Senator Murray. They are glad to be here to visit, and all 
those things I am sure.
    Thank you so much, and it is great to see you back here. 
Let me just start with the fact that the Veterans Benefit 
Administration is really experiencing a backlog of claims--we 
talked about this last night--which I know really worsened 
during the COVID-19 pandemic, and then, of course, with the 
passage of the PACT Act last year the number of veterans 
seeking benefits is only going to rise.
    So I wanted to ask you, if confirmed, what are you going to 
do to make sure that veterans are receiving timely responses to 
their claims?
    Mr. Jacobs. Senator Murray, thank you very much for that 
question. You know, when I was here about 10 years ago as a 
Senior Advisor of Benefits I was here when General Hickey led 
the transformation through a series of people-process-
technology transformational efforts to include moving from a 
paper to a paperless process. We are building on that 
foundation that has been laid. We are driving new people-
process-technology solutions, and we are importantly focusing 
on both the veteran and the employee experience.
    So number one, with people we are undertaking a significant 
hiring expansion. Over the last year we have hired an 
additional 2,000 employees. Thanks to the PACT Act, we are able 
to hire another 1,900, of which we have been able to bring on 
board about 65 percent. Just this past week we had three 
separate hiring fairs. We had hundreds of people in St. 
Petersburg, Florida, Waco, Texas, and Los Angeles, and we were 
able to make hundreds of job offers as a result of those job 
fairs. We are continuing that effort.
    We are also continuing to invest in training, so that as 
the new employees come in that they are brought up to speed and 
they are able to make timely and accurate decisions.
    The second piece is focused on process. We are concerned 
about how we can bring more efficiency to the process and 
overdevelopment is one of the main concerns we have. We do not 
want to send veterans out to get an exam if they do not need 
it. That takes time away from their busy lives and potentially 
results in them losing income. So we are looking at efforts 
like overdevelopment.
    And then third I would add we are also employing 
technology. So we are in the early stages of leveraging 
automated decision support. But I think this is the real 
potential game-changer as we move forward. It is going to give 
our employees more tools to make more decisions more quickly, 
accurately, and equitably across the system, and I think it 
will help us ensure that we do not have to linearly increase 
employee staffing to meet the growing demand.
    Senator Murray. Okay. Excellent. The VA Office of Inspector 
General and Government Accountability Office have issued 
several reports over the last couple of years detailing the 
mishandling of veterans' military sexual trauma claims. In a 
2021 report, the inspector general estimated that about 57 
percent of denied claims related to MST were not processed 
correctly.
    Talk to us about what plans you have to work on the MST 
claims to make sure that veterans are receiving the care that 
they deserve.
    Mr. Jacobs. I really appreciate you raising that question 
and your leadership on this issue. MST claims are some of the 
most horrific issues that we have to deal with. We have to deal 
with them with the sensitivity and the urgency that they 
demand, and do so in an appropriate manner.
    One of the things that we have done to try to improve the 
accuracy and the consistency of our decisions is by 
consolidating the processing of those individual claims. They 
are quite complex and oftentimes it is hard for the veteran to 
provide sufficient evidence for us to make a decision. So we 
are working to ensure that we have our most qualified, 
experienced staff who can solely focus on MST.
    And second, we are also going to be looking at the broader 
evidentiary standards to understand how we can make it easier 
for veterans, and operate with sensitivity so we do not 
retraumatize veterans as they are going through this process.
    Senator Murray. Okay. I will be following this closely so I 
look forward to hearing more from you as you go through that.
    Finally, let me just say something. You will not be 
surprised to hear that there are two million women veterans 
living in the United States today and they are the fastest-
growing demographic. This is something I have long cared about, 
but I have to say I am still hearing from a lot of women 
veterans that they are not aware of or taking advantage of the 
benefits they have earned. How do we deal with that?
    Mr. Jacobs. I think it is a really important question and 
we need to do more. Since I have come into this organization 
back in 2021, I have observed that VA is more forward leaning 
with respect to outreach. We are getting the word out. We are 
trying to partner with veteran service organizations, with 
state Departments of Veterans Affairs, with county veteran 
service organizations, with the Center for Women Veterans. And 
importantly, we need to make sure that we are listening, we are 
asking questions, we are listening to women veterans and we are 
responding. Because the tools that we use to provide 
information and support to certain parts of the veteran 
population may not work here, so we are partnering with the 
Veteran Experience Office to apply human-centered design and 
make sure that we take those insights and we use them to inform 
how we provide outreach and connect female veterans with the 
support and the services that they have earned.
    Senator Murray. Thank you very much. I look forward to 
supporting this nomination, Mr. Chairman. Thank you for your 
consideration.
    Chairman Tester. Yep. Senator Moran.
    Senator Moran. Mr. Jacobs, the Office of Legal Counsel at 
the Department of Justice issued an opinion letter in 2017, 
stating that oversight requests from, quote, ``individual 
Members of Congress, including ranking minority members, do not 
trigger any obligation to accommodate congressional needs.'' 
Despite that DOJ opinion on this matter, will you commit to 
accommodating congressional oversight requests regardless of 
party affiliation or committee status of the member making the 
request?
    Mr. Jacobs. Yes, Senator.
    Senator Moran. Thank you. In working with the VA this 
Committee frequently request data, material, and policy views 
from the Department to inform our oversight and legislative 
work. Responses to these inquiries frequently get cleared 
through the Office of the Under Secretary, and unfortunately 
that process often involves time delays and keeps us from 
receiving a timely response.
    If you are confirmed, how will you prioritize responses to 
this Committee to make certain we have the information we need 
to serve veterans in a timely manner? I have no doubt you will 
answer this question to my satisfaction as a former staff 
member of this Committee.
    Mr. Jacobs. Well, Senator, as you have rightly indicated, I 
have shared your frustration over the past 15 years with both 
untimely and insufficient responses from the Department. I 
would also say that since I have been in this role over the 
last 6 months I have probably contributed to the timeline 
delays because the answers that have come to me have been 
unsatisfactory. I do not think that they have responded 
directly to the questions that have been asked, so oftentimes I 
go back and I work with the team to make sure that we revise 
the answer to appropriately address it.
    But, you know, as a former Senate staffer, I know that it 
is critical we have transparent, ongoing, and timely 
deliberations and communications, so I will promise, if 
confirmed, to make it a priority to improve both the quality 
and the timeliness of our responses to your inquiries.
    Senator Moran. Thank you. Mr. Jacobs, when we met earlier 
this week I told you that often what I know of the 
circumstances of veterans and their VA experience comes to me 
from Kansas veterans through case work. In addition through 
conversations, emails, but it is generally people who are 
raising a problem, an experience they have had with the 
Department of Veterans Affairs.
    One such veteran traveled 65 miles each way for a contract 
disability exam as part of his disability benefits claim. The 
contract examiner was supposed to provide a mileage 
reimbursement for that travel, but after 5 months, multiple 
phone calls, and multiple checks, a proposal supposedly being 
sent, this veteran does still not have his reimbursement or any 
answer.
    What should this process look like from the veteran's 
experience and where is the disconnect between VBA and the 
regional offices and the examination contractors?
    Mr. Jacobs. Well, Senator, it is an excellent point that 
you raise and I appreciated our conversation in your office. I 
would start by saying that veterans should not have to go to 
their Member of Congress to get their issues resolved. That is, 
to me, unacceptable, and it is something that we need to fix. 
But I am glad that they do have that recourse.
    Second, I would say that as we look at the types of issues 
that are raised through case workers I think that gives us an 
opportunity to not only fix the issue at the local level--so 
our regional offices should be working closely with each of 
your case workers--but we also have an opportunity to identify 
trends that we should be addressing at the national level and 
trying to respond and remediate them, if necessary.
    In the particular case of the veteran that you just 
explained, I would ask if it would be possible to get the 
information so I can personally look into that and take care of 
it, and make sure that any broader systemic issues that are 
underlying it are also addressed.
    Senator Moran. I would welcome that, providing that 
information to you, and I appreciate your response indicating 
that one case is often more than just one veteran who has 
experienced the same circumstance.
    I have heard from my staff, who work for veterans in our 
office, and veterans in Kansas about their frustrations of 
receiving notices that claims are--let me say that sentence 
better--that frustration arises from the veteran receiving a 
notice. The notice indicates that their claims are, quote, 
``ready for decision.'' However, the veteran still does not 
receive a final decision for months on end. So, in a sense, we 
are building up the expectation, ``I have got this notice that 
says it is ready for decision but nothing has happened.''
    Especially now with the PACT Act on top of the other 
claims, it is more important than ever to properly notify 
veterans about their pending claims and where they are in the 
process. If confirmed, how will you improve these 
communications with veterans as they await a decision on their 
claim, as well as work with your regional offices to ensure 
veterans are receiving timely and accurate information about 
their claims in the process of receiving a final determination?
    Mr. Jacobs. Well, I appreciate the question. I think the 
reason we have so many claims--and it is out of balance right 
now--in this ready-for-decision cycle is it is a byproduct, in 
part, of us catching up from the work coming out of COVID, 
where we were able to work through a number of claims. We had 
to pause a bit because of the supply chain challenges, not 
being able to get veterans safely to C&P examiners, or obtain 
their records.
    And so we have got this kind of a ``pig in a python'' type 
of challenge, but that does not matter to the veteran. That is 
a context. What matters to the veteran is that they understand 
where their claim is and that they understand what is 
happening.
    I agree that there are challenges with the way that we 
categorize the nomenclature of ready-for-decision, because in 
many cases it is, in fact, not ready for decision.
    So one of the key things that we are going to be working 
on, and I will pay significant attention to, if confirmed, is 
focusing on how we improve the communications to manage 
expectations. It is confusing for veterans. It is not only that 
the categorization of ready-for-decision but our notification 
letters.
    I was in Philadelphia at a regional office and I was 
listening in to one of the call center agents. They got a call 
from a veteran. He was trying to decipher what this letter 
meant for him. These letters are written for lawyers, by 
lawyers. We have got to change that so that veterans actually 
understand what is happening. And one of the key actions coming 
out of a PACT Act offsite we held in December, which a number 
of your staff attended, is a concerted effort to improve how we 
communicate status and through multiple channels, not only 
through the app, through the website, but also through the 
letters.
    And then finally I would add that we also just have to kind 
of buckle down and get those claims decided and a decision to 
the veteran.
    Senator Moran. Yes, that is a good point, that the decision 
is really what they want, not the notice.
    Mr. Jacobs. Correct.
    Senator Moran. Mr. Chairman, thank you. You are going to 
lose me momentarily. While Mr. Jacobs is hugely important, I 
have to go see that we pass a resolution related to the Chief's 
success in the Super Bowl. So you will miss me for a portion of 
the remainder of your hearing.
    Chairman Tester. We absolutely will miss you, Senator 
Moran, especially the compliments. I am going to miss those. 
But thank you very much.
    Look, there are a couple of things that came to mind as you 
were answering questions. The first one was that you drew back 
some of the answers and actually read them and made sure they 
addressed the questions. I am going to tell you, there are a 
lot of folks that serve here in the halls of Congress that I 
think take pride in the fact of not answering questions, and 
the truth is that you are able to do that is really important. 
And the second thing that stood out was the fact that you want 
to put it in language that people can understand, not an 
attorney. And I cannot thank you enough for both of those. I 
hope you never forget that during your service because it is 
really important.
    We should also fundamentally agree that veterans should not 
have to pay to get their VA benefits. That is why we all need 
to work together to make sure that the application and 
receiving those benefits are as user-friendly, veteran-friendly 
as possible.
    In cases where a veteran has questions or needs assistance 
we look to a number of different folks--the VSOs, the county 
veteran service officers created by the VA and held to a 
standard of ethics to assist the veterans with filing those 
claims. Do you agree that veterans should not have to pay for 
assistance in filing their claims?
    Mr. Jacobs. Mr. Chairman, I think veterans have earned 
these benefits and they should not have to pay someone to help 
them get them.
    Chairman Tester. So the question here is what are you going 
to do to better educate veterans of the resources that are 
available to them to help them file the claims or get other 
assistance from the VA?
    Mr. Jacobs. Yes. You know, let me start by just 
acknowledging that the claims process is confusing, it is 
complicated, and at times it is perceived as adversarial. We 
are working to change that. One of the ways that we are working 
to do that, and if confirmed, I will double down and continue 
to do a whole lot more, is by doing proactive outreach. In 
December, we did national PACT Act awareness events across the 
country. I was in Seattle, and we had claims clinics. We had 
VBA staff onsite, advertised. A whole lot of veterans came in. 
We helped them file their claims. We are doing that again next 
month across the country.
    We need to do more of that. But we cannot do it ourselves. 
We have to do it in partnership with VSOs, with county veteran 
service officers, with state Departments of Veterans Affairs.
    The second piece that I think we have to do is we have to 
drive more focus on the veteran experience because veterans 
often do not know about the process, and when they do not know 
about the process and they do not know what to look out for in 
terms of predatory actors, they can make the wrong decisions. 
We need to continue to proactively get information out so that 
they have resources that are going to help them for free.
    Chairman Tester. Super. The Sergeant First Class Heath 
Robinson PACT Act has been referenced several times during this 
hearing. It is a big expansion of benefits and health care for 
our folks, and we continue to see things that bounce up that I 
do not think are happening by coincidence, like the blood 
cancers at Malmstrom Air Force Base that was talked about, 
about a month ago. So this thing is going to continue to be an 
issue for you, once you are confirmed. I hope you are 
confirmed.
    So the questions fall in a couple of different buckets 
here. What progress has VBA made within implementing the PACT 
Act's presumptive decision-making framework to identify the 
need for new presumptive exposures?
    Mr. Jacobs. Mr. Chairman, we are starting on a foundation 
that was laid prior to passage of the PACT Act. I referenced in 
my opening statement the process we use to establish asthma, 
rhinitis, sinusitis as well as the nine rare respiratory 
cancers. We are building on that with the new authorities that 
were provided in the PACT Act to include a requirement that we 
formally publish, in the Federal Register, a list of the 
conditions that we will evaluate to consider potential 
establishment of a presumptive service connection.
    So our team, it is a combination of VHA and VBA experts, 
are working to finalize that list and then get ready to publish 
it into the Federal Register, and I think the benefit of that 
is we get other people grading our homework, and if we are not 
including the right conditions people have an opportunity to 
tell us, and we have an opportunity to make adjustments.
    The second piece I would add is we also are moving forward, 
and we are not grading our own homework so we are going to have 
the National Academies, as required under the PACT Act, 
formally review the decision-making framework. And so as we 
move forward and we work to implement it we will have an 
opportunity to have that external subject matter review to 
inform whether or not we need to continue as designed or make 
adjustments.
    Chairman Tester. Thank you. As of Monday the claims 
inventory was 743,000, and the backlog is about 194,000. What 
is VBA's claims projection over the next 5 years, and how has 
VBA prepared to address the increases?
    Mr. Jacobs. We have, to date, received a little more than 
300,000 PACT Act claims since the bill was signed into law on 
August 10th. We are expecting about 700,000 PACT claims in this 
fiscal year and upwards of 5 million total, both PACT and non-
PACT, as we move forward. The calculations fluctuate depending 
on certain assumptions, but the bottom line is we are going to 
see a significant increase in the number of claims filed 
because, for the first time ever, the PACT Act is allowing us 
to provide benefits to generations of veterans who have not 
been able to get those benefits under law.
    And so what we are doing to prepare is we are working 
through a robust people-process-technology solution. That 
includes increased hiring, expanded training, process 
improvements in efficiencies, and then technology. And I think 
the technology piece is really going to be the game-changer 
moving forward. It is still in the early stages. We need to 
verify, validate, and graduate it before we expand it more 
broadly across the system. And we, importantly, need to ensure 
that the veterans we serve, the Members of Congress who provide 
oversight, and the employees who use that system have trust 
that it will provide the right decisions at the right time.
    Chairman Tester. My last question, before I turn it over to 
Senator Hassan, actually follows on with what Senator Moran had 
asked earlier, and that is do we have your commitment to 
provide regular, accurate metrics as it relates to the claims 
backlog as well as PACT Act claims backlog?
    Mr. Jacobs. Mr. Chairman, you have my commitment, if 
confirmed, yes.
    Chairman Tester. Okay. Senator Hassan.

                     SENATOR MAGGIE HASSAN

    Senator Hassan. Thank you, Mr. Chair, and thanks to you and 
Ranking Member Moran for this nomination hearing, and Mr. 
Jacobs, thank you for your willingness to serve.
    I want to start by just following up on an issue similar to 
the one that Senator Moran raised about delays in disability 
claims. Recently I have heard stories from veterans about how 
far they have to travel for their compensation and pension 
claim examinations, and the stresses that puts on them. Leon 
Rideout, the VFW commander in New Hampshire, was recently 
scheduled for a compensation and pension claim exam 4 hours 
away, in New York. Attending this exam would have forced him to 
miss a full day of work. He could not attend and now he may be 
forced to wait even longer to get his exam.
    Exams that are far away can be even more burdensome, 
obviously, for veterans who have a condition that impedes their 
ability to travel long distances. So how do you plan to address 
this challenge and schedule veterans at the facility that is 
closest and most convenient for them to travel to?
    Mr. Jacobs. Senator, thanks very much for raising that 
important issue. This is a key part of the veteran experience. 
This is oftentimes the only time a veteran will engage with 
someone representing VBA because the majority of our staff are 
working in offices, at home in front of a computer, and not 
directly engaging face-to-face. And so often it will indicate 
whether they want to continue with the process and pursue the 
other earned benefits that they have or not, and lose trust.
    What we are doing to address specifically the issue of 
drive time is working with our four vendors--the majority of 
the C&P exams that we do are done by vendor companies--and 
enforcing certain contractual standards with respect to 
timeliness and length of distance. Where they are falling short 
they then have to pay penalties.
    But I think what we also have to do, and first and foremost 
is make sure that the veteran actually needs the exam. We need 
to check and make sure if there is sufficient evidence already 
in their file, we should not be sending a veteran to go get 
that exam.
    Senator Hassan. Right.
    Mr. Jacobs. And so if you have an example of the particular 
veteran you mentioned, I would love to look into it, follow up, 
understand what happened, figure out how to resolve it, and 
then also identify the broader system issues.
    Senator Hassan. All right. Well, I appreciate that and we 
will follow up with you.
    I want to touch now on an education benefits issue. Members 
of the National Guard and Reserve make up more than 40 percent 
of the United States Armed Forces. As you know, members of the 
reserve component can qualify for VA education benefits but 
they can also be called up to active duty at any moment. Their 
service is obviously really important to our nation and to our 
security, but it may also disrupt their education and lead to 
servicemembers not receiving school credit and wasting tuition 
dollars because their education has been interrupted.
    So if confirmed, what will you do to support members of the 
reserve component and ensure that they can take full advantage 
of their education benefits?
    Mr. Jacobs. Senator, this is actually an issue I am quite 
interested in, and I am glad that you raised it. I think the VA 
has historically, and VBA specifically, has focused on the 
digital GI Bill. So we focused on the modernization of our 
infrastructure, and we have appropriately focused on preserving 
the integrity of the GI Bill. But we have not done enough to 
focus on ensuring we are supporting the majority of veterans 
who are using their benefits and giving them the leg up to 
advance their careers.
    So what I would love to do is work with your office. I am 
actually pulling together a roundtable filled with student 
veterans, schools, and employers to explore how we can identify 
additional ways to support veterans there. I know that there 
are certain authorities that can help veterans that are called 
back up to active duty to preserve some of their education 
benefits, but we need to do a whole lot more, and if confirmed, 
I would love to work with you.
    Senator Hassan. I would look forward to that too.
    I want to talk a little bit about the transition process, 
and I expect that you have heard a great deal from Committee 
members and will continue about that. Every year approximately 
200,000 servicemembers make the complex and difficult 
transition from military service to civilian life. Last year I 
worked to get the Solid Start Act passed into law, and I 
continue to believe that that program is essential to ensuring 
that veterans are aware of their benefits immediately after 
separation. But we still need to do more for these veterans in 
these early years.
    How do you plan to prioritize the needs of transitioning 
servicemembers to ensure that they are receiving information 
and access to VA benefits that they have earned, they deserve, 
and can make a real difference, obviously, in their next 
chapter?
    Mr. Jacobs. First let me just thank you for your leadership 
on Solid Start. This is a really impactful program. I think GAO 
highlighted that in a recent report, but it also highlighted we 
have got some work to do in better communicating with younger 
transitioning servicemembers. And we importantly have to 
partner with VSOs to make sure that we are tailoring the 
program and the outreach to meet their needs.
    One of the most important things we can do here is not come 
up with a 3,000-mile screwdriver with ideas that we think are 
best from our seats in DC, but to actually go and talk to the 
transitioning servicemembers. So partnering with the Veteran 
Experience Office we are leading an interagency effort to 
perform human-centered design where we are having interviews 
with transitioning servicemembers and their families, and then 
taking the insights along that transition journey to identify 
the pain points, the moments that matter, and then use that to 
drive improvements.
    We have multiple interagency partners involved, and so we 
need to deconflict this. We need to make sure that we are 
designing and implementing support to transitioning 
servicemembers that is designed around their needs and not our 
organizational structure.
    Senator Hassan. Okay. Well, I would appreciate learning 
more about that effort, working with you on it. One of the 
things I am also aware of and I think has been highlighted in 
other work that you all have done, when I talk to veterans, 
women veterans in particular, I think find the transition 
process not really necessarily suited to their needs. So it is 
one of the things that we need to focus on too.
    Thank you. Thank you, Mr. Chair.
    Chairman Tester. Thank you, Senator Hassan. I want to thank 
you, Joshua Jacobs. We have had a number of folks in front of 
this Committee for confirmation. I do not know that anybody has 
done any better than you as far as knowing the subject area and 
knowing the job and answering the questions forthright and 
straightforward, and I want to thank you for that.
    Normally when you say there are not a lot of folks here, 
you think, well, the job is not that important. I do not think 
that is the case at all. I think the fact that you have worked 
at this job, that you have done your work on the Hill, talking 
to folks, and we are incredibly busy right now is why they are 
not here. And the other thing is--and I will step out on a limb 
and say this--if you were controversial they would have been 
here. Okay? So that is good sign.
    I would ask that any post-hearing questions be sent to the 
Clerk no later than 5 p.m. tomorrow. I am going to do my best 
to try to get you confirmed as soon as possible, and with that 
this hearing is adjourned.
    [Whereupon, at 10:39 a.m., the hearing was adjourned.]


                            A P P E N D I X


                        Nomination Material for

                            JOSHUA D. JACOBS

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                        Statement for the Record


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