[Senate Hearing 118-175]
[From the U.S. Government Publishing Office]



 


                               



                                                        S. Hrg. 118-175
 
                 REVIEW OF THE FISCAL YEAR 2024 BUDGET
                AND 2025 ADVANCE APPROPRIATIONS REQUESTS
                 FOR THE DEPARTMENT OF VETERANS AFFAIRS

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

                                HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS
                          UNITED STATES SENATE

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                               __________

                              MAY 17, 2023

                               __________

       Printed for the use of the Committee on Veterans' Affairs
       
       
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             U.S. GOVERNMENT PUBLISHING OFFICE 
 54-222 PDF            WASHINGTON : 2024        
        
        
        
        
                 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
               
               
                            C O N T E N T S

                              ----------                              

                              May 17, 2023

                                SENATORS

                                                                   Page
Hon. Jon Tester, Chairman, U.S. Senator from Montana.............     1
Hon. Jerry Moran, Ranking Member, U.S. Senator from Kansas.......     2
Hon. Sherrod Brown, U.S. Senator from Ohio.......................     8
Hon. Thom Tillis, U.S. Senator from North Carolina...............     9
Hon. Patty Murray, U.S. Senator from Washington..................    11
Hon. John Boozman, U.S. Senator from Arkansas....................    12
Hon. Angus S. King, Jr., U.S. Senator from Maine.................    14
Hon. Marsha Blackburn, U.S. Senator from Tennessee...............    16
Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......    18
Hon. Richard Blumenthal, U.S. Senator from Connecticut...........    20
Hon. Dan Sullivan, U.S. Senator from Alaska......................    21

                               WITNESSES
                                Panel I

The Honorable Denis McDonough, Secretary of Veterans Affairs.....     4

                                Panel II

Morgan Brown, National Legislative Director, Paralyzed Veterans 
  of America.....................................................    27

Shane Liermann, Deputy National Legislative Director, Disabled 
  American Veterans..............................................    27

Patrick Murray, Director, National Legislative Service, Veterans 
  of Foreign Wars................................................    28

                                APPENDIX
                           Opening Statement

The Honorable Denis McDonough, Secretary of Veterans Affairs.....    37

                          Prepared Statements

The Honorable Denis McDonough, Secretary of Veterans Affairs.....    47

Joint statement from the co-authors of The Independent Budget: 
  Disabled American Veterans, Paralyzed Veterans of America, and 
  Veterans of Foreign Wars.......................................    72

  Attachment--``The Independent Budget: Veterans Agenda for the 
    118th Congress''.............................................    75

                              Pre-Hearing
                        Questions for the Record

Hon. Jerry Moran.................................................   121

  (For information regarding Department of Veterans Affairs 
    response to Pre-Hearing Question 10B, contact the Chief 
    Clerk, U.S. Senate Committee on Veterans' Affairs, 412 
    Russell Senate Office Building, Washington, DC 20510-6050 / 
    Phone (202) 224-9126)

                        Questions for the Record

Department of Veterans Affairs response to questions submitted 
  by:

  Hon. Thom Tillis...............................................   149

  Hon. Tommy Tuberville..........................................   157

  Hon. Jerry Moran...............................................   162

  Hon. Dan Sullivan..............................................   164

                        Statement for the Record

Hon. Kyrsten Sinema..............................................   179


                 REVIEW OF THE FISCAL YEAR 2024 BUDGET



                    AND 2025 ADVANCE APPROPRIATIONS



                            REQUESTS FOR THE



                     DEPARTMENT OF VETERANS AFFAIRS

                              ----------                              


                        WEDNESDAY, MAY 17, 2023

                                       U.S. Senate,
                            Committee on Veterans' Affairs,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 3 p.m., in Room 
SR-418, Russell Senate Office Building, Hon. Jon Tester, 
Chairman of the Committee, presiding.

    Present: Senators Tester, Murray, Brown, Blumenthal, 
Sinema, Hassan, King, Moran, Boozman, Tillis, Sullivan, and 
Blackburn.

            OPENING STATEMENT OF CHAIRMAN JON TESTER

    Chairman Tester. I am going to call this hearing to order. 
We are a little bit ahead of schedule but not so much. I want 
to thank Secretary McDonough and our VSO friends and partners 
for joining us today.
    For those of you who are joining us on television, I would 
just say you will hear a great opening and questioning of the 
Secretary of the VA, and then what is really going to be 
interesting is we have three folks from the VSOs--Morgan Brown, 
Shane Liermann, and Patrick Murray--who are going to give a 
combined statement, which will be particularly entertaining, I 
think. So it will be good.
    Senator Moran. So we have something to look forward to.
    Chairman Tester. We do. We do.
    We are here to take a closer look at the President's fiscal 
year 2024 budget request from the Department of Veterans 
Affairs. At a time when there is unprecedented demand for VA 
health care and services, we have to ensure the Department is 
well equipped to care for our veterans.
    Over the last fiscal year, VBA completed more than 1.7 
million disability compensation and pension claims, a lot, and 
a new record it was. And VHA has served over 6.3 million 
veteran patients, or more than 115 million appointments. The 
truth is, demand is only increasing. Last summer Congress came 
together to pass the PACT Act, a historic step that has already 
delivered all eras of toxic-exposed veterans and survivors 
their VA care and benefits, that they have earned, by the way. 
This law created the Cost of War Toxic Exposure Fund to cover 
the new costs of delivering this earned support.
    I have serious concerns with proposals out of the House to 
gut the fund. Whether it is attempts to relitigate the nature 
or purpose of the fund or to place artificial caps or make 
dramatic cuts to the fund, it is all bad news.
    And I might say this. We send folks off to war, we put it 
on the credit card. They come back and we make excuses not to 
fund their benefits. In Montana, they say that that is 
something that comes out of the backside of a bull. Anyway, 
after finally making good on our long-overdue pledge to address 
the costs of war for toxic-exposed veterans, our next step 
cannot be to immediately renege on that pledge.
    I am also concerned with House efforts to rescind $1.8 
billion we already appropriated for delivering veterans' health 
care, reimbursing community care providers, and improving 
health care facilities. And let's not forget, even if our House 
colleagues make good on their promise to not gut VA health 
care, there are plenty of programs outside the VA that are 
absolutely critical for veterans and their families. Job 
training programs and efforts to combat veteran homelessness 
are just a couple of examples of what will most certainly next 
be on the chopping block. And make no mistake, by tying drastic 
cuts to the debt ceiling, my House colleagues are putting 
veterans' benefits and livelihoods at risk. Each month Treasury 
makes approximately $25 billion in payments on behalf of the 
VA, $25 billion in payments. Of that $25 billion, nearly half 
is for benefits payments for more than 7 million veterans and 
their families, folks who have served this country. The rest 
pays for VA employees' salaries, keeps VA medical clinics open, 
and reimburses private providers for folks who receive care in 
the community. If the debt limit is reached, all these payments 
could be delayed or stopped, creating incredible uncertainty 
for this Nation and for the veterans who have served this 
country and made the Nation what it is today.
    So let's get past the political posturing and ensure our 
Nation's veterans are not harmed because their representatives 
in Congress cannot act like adults and do what they were sent 
here to do. They have forgotten their mission.
    With that said, I look forward to hearing directly from 
Secretary McDonough and the VSOs here today on their concerns, 
priorities, and impressions of the fiscal year 2024 budget for 
the VA.
    With that I turn it over to my friend, Senator Jerry Moran.

            OPENING STATEMENT OF SENATOR JERRY MORAN

    Senator Moran. Chairman Tester, thank you, and good 
afternoon to you, and welcome to Secretary McDonough and to our 
VSO witnesses. I appreciate all of you being with us today, and 
I look forward to hearing your testimony about the VA's fiscal 
year 2024 budget request.
    There have been some big changes that the Chairman 
mentioned since the last time we met for this purpose, namely 
the enactment of the Sergeant First Class Heath Robinson 
Honoring our PACT Act. I know that one thing that has not 
changed is that there is bipartisan, bicameral commitment to 
provide resources that are needed to support veterans and their 
caregivers, survivors, and dependents. I am committed to 
protecting and prioritizing support for veterans in the ongoing 
budget talks, and I know that my colleagues in the House and 
Senate share that commitment.
    Nearly 70 percent of the Federal spending is on autopilot, 
or what is known as mandatory programming. This passive 
approach to the Federal budget is what got us in this deficit 
mess in the first place. Veterans are not insulated from rising 
inflation and slowed economic growth caused by out-of-control 
spending.
    As a long-time member and now Ranking Member of this 
Committee, my priority will always be to make certain that the 
VA has the funding it needs to provide timely and high-quality 
health care benefits and services to the men and women who 
served our Nation. I believe this and every VA budget request 
could be judged through a single lens, and that is what will it 
deliver for veterans?
    This year's budget request is once again the largest yet 
for the VA, totally $325.1 billion. That is a big number, and 
it should lead to big improvements for veterans.
    My point that I am trying to make is that we ought not--and 
I have done it, perhaps, myself. I do not need to say 
``perhaps.'' I have done it myself from time to time, in which 
we brag about the amount of money that we have spent, or the 
increases that we are providing for veterans. But if bigger 
numbers were all that is needed to deliver, we would have 
better results. And so it is what we can deliver.
    But bigger numbers and better results, we still would not 
have higher veteran suicide rates, hundreds of thousands of 
veterans waiting on claim backlog for their earned benefits, a 
troubled new electronic health record, 12 months' trend of 
meaningful decline in access to care, according to the VA's own 
quality data, scores of recent reports from the inspector 
general and Government Accounting Office detailing serious and 
sometimes fatal failures, persistent problems getting the VA to 
provide timely responses to basic requests for information from 
this Committee. I am interested in hearing from the Secretary 
this afternoon on how this budget request will produce 
different results from past years.
    I am also interested in hearing the Secretary justify 
budget increases for VA health care that far outpace the demand 
for VA health care. The Veterans Health Administration is 
requesting an 11 percent increase, but the projected need for 
that increase is 3.5 percent.
    This is also the first budget request that includes the 
Toxic Exposure Fund, and the VA is asking for $20 billion for 
the fund in fiscal year 2024. However, when the fund was 
established in the PACT Act nine months ago, it was not 
projected to reach $20 billion until the fiscal year of 2030, 
six years from now. Given that the VA still does not have a way 
to track the number of veterans who are enrolling under the 
PACT Act's enhanced eligibility authorities and has certainly 
not raised this concern about an unexpectedly high influx of 
veteran patients or claimants, this request needs explaining. 
Delivering more money for veterans is not the solution, but 
delivering better outcomes is.
    I have no doubt but what the Secretary shares. I would not 
want to put you in my category, but I have no doubt that there 
is any disagreement about the need to better results.
    For these reasons, it is critical that Congress put 
veterans first by remaining engaged in the budget process and 
avoiding the urge to turn a blind eye to issues facing the VA 
through more mandatory spending. It is time we get it right for 
our veterans, their loved ones, and I thank you once again for 
all being here, and Mr. Secretary, I look forward to our 
conversation.
    Chairman Tester. Thank you, Senator Moran, and I think I 
agree with the point you made on the money, and we all talk 
about how much money it has increased, when, in fact, it is how 
the money is spent that is really important here. And that not 
only includes the VA, that includes every budget we put our 
hands on.
    Today's hearing, as I said earlier, will consist of two 
panels. First, we have the great honor to have the Secretary of 
the VA, Secretary Denis McDonough, to talk about the VA 2024 
budget, and the good, the bad, and the ugly of it. Thank you.

                            PANEL I

                              ----------                              


             STATEMENT OF THE HON. DENIS MCDONOUGH

    Secretary McDonough. Mr. Chairman, Senator Moran, Senator 
Brown, Senator Tillis, thanks so much for the opportunity to be 
here. If it is all the same to you, I will submit my prepared 
remarks into the record, and we can just get straight to your 
questions. I know you have my longer statement, but if you 
would not mind making the shorter one part of the record too, 
we might as well just get right at it.

    [The opening statement and prepared statement of Secretary 
McDonough appear on pages 37 and 47 of the Appendix.]

    Chairman Tester. Well, that is good. Is that okay with you?
    Senator Moran. Now I feel guilty.
    Chairman Tester. Yes, I know. I know. That is a great 
opening statement. That will get you points right off the bat, 
right?
    Mr. Secretary, in your testimony that you have written you 
highlighted the VA has delivered more care and more benefits to 
more veterans over the last two years than any time in our 
Nation's history. Put more of that in perspective for us.
    Secretary McDonough. Yes, well, thank you very much, Mr. 
Chairman. It is important to keep in mind that these big 
numbers do lead to better outcomes, and we are not big on just 
measuring what you give us to put into veterans' care, but we 
actually measure what it means for veterans and their families.
    And just last Thursday there was a release of a report, 
actually it was a consolidation of 40 separate reports, looking 
at care provided by the VA, including throughout the pandemic. 
And what that report, from one of the leading medical journals 
in the country found is that VA-provided care is at least as 
good as, and in an overwhelming number of cases, better than 
care provided in other settings, including private health care 
settings. So we are very proud of that.
    But if you just consider the clinical appointments and 
engagements we have had with vets in the last year, 115 million 
clinical encounters, 40 million inpatient encounters at VA 
facilities, 31 million telehealth appointments, 38 million 
community care appointments.
    So you already talked through the benefits side of this, at 
the 1.5 million claims that we processed last year. Right now 
we are 15 percent ahead of that number, year on year.
    But the point is these dollars mean real engagements. These 
engagements mean better outcomes for veterans. And I stand by 
the assertion that we are now providing more benefits and more 
care to more vets than at any time in the VA's history.
    Chairman Tester. Could you tell me what that looks like for 
the first-time veterans entering the system? Who are they?
    Secretary McDonough. Well, the fastest growing cohort of 
veterans right now are women veterans. We have, just as a 
result of the PACT Act, we publish this data every two weeks, 
we have 77,000 new enrollees in VA health care. You know, as I 
say, the fastest growing cohort are women veterans. But the 
beauty of the PACT Act that you all gave us last year, and the 
President signed in August, is that it allows us to restart a 
conversation with younger and more diverse veterans at the same 
time that we are deepening our engagement with Vietnam 
veterans, including those who have hypertension, as a result of 
their exposure to Agent Orange.
    So we are seeing younger veterans, more diverse veterans, 
including more gender diverse veterans, meaning more women, in 
our care, and we are seeing that directly as a result of the 
PACT Act.
    Chairman Tester. So there has been debate over the last 
couple of weeks about the bill that the House passed that cut 
programs, and most of the debate has actually revolved around 
veteran benefits. In fact, Senator Moran addressed it in his 
opening statement, and by the way, Senator Moran is an honest 
broker and I believe what he says when he says that we want to 
make sure that veterans' benefits and health care and programs 
are funded.
    But as I look at that bill, they attempt to rescind $1.8 
billion for VA medical services, ID modernization, and 
facilities--$1.8 billion. And the question for me becomes if we 
did not cut any veteran benefits, this is not called benefits 
because it has to do with administration? I guess that is the 
way they look at it, although VA Medical Services is VA Medical 
Services.
    You have had a chance to look at that bill. You have had a 
chance to look at the proposal put out by your agency. Just 
give me a blush of what you see that comes out of that and what 
kind of impacts that would have if that came to fruition, a 
bill that, by the way, the Speaker said did not cut benefits, 
in fact, called the President a liar, when, in fact, the 
President was the one who was telling the truth.
    Secretary McDonough. Thank you, Mr. Chairman. You know, 
obviously the bill itself is vague, for the reasons that you 
talked about, and so it is difficult to ascertain. But we have 
looked at this a lot of different ways. We have been talking 
with members on all sides of this debate since January, when 
this debate really got engaged.
    And so if you just apply the 22 percent budget cut to VA, 
which again may not be what ends up happening at the end of the 
day. Maybe it is less than that. But if you just take the top 
lines of the bill and you recognize that VA is not held 
harmless, the way, for example, DoD is held harmless in the 
bill, then we are going to be confronted with very significant 
challenges. I would just give two examples.
    We think that if, again, if that 22 percent cut is applied 
to VA health care, that would mean 30 million fewer outpatient 
visits, of the type that I just talked through that we had last 
year, and those are outpatient visits in the direct care system 
or in the community care system.
    Alternatively, if you look at it from the Benefits 
Administration, again I talked about the fact that claims filed 
are 30 percent above where they were a year ago, we are 
fulfilling 15 percent more claims year on year than we did a 
year ago, and we are able to do that because of some efficiency 
we found but also because of hiring we have carried out.
    If you apply the 22 percent reduction at VBA, that would 
mean 6,000 fewer staff there. We have 28,000 staff there for 
the first time. You know, we have talked many of the Members of 
this Committee through how our staffing model works, where we 
are in that staffing model. But if there are 6,000 fewer 
personnel to process claims, that will be an extension of a 
timeline that is already too long for vets to get their 
benefits.
    Chairman Tester. More delays. Senator Moran.
    Senator Moran. Chairman, thank you. Mr. Secretary, the VA 
inspector general recently found that there was a substantial 
comingling between the $14.4 billion in supplemental funding 
the VA received under COVID-19-related care and the VA's 
regular appropriations. It seems to me that would be separate 
accounts, but that is not what the inspector found, is my 
understanding, of what I read.
    Secretary McDonough. Yes.
    Senator Moran. The intent of the supplemental was to 
support urgent time-limited needs, kind of one time or one 
period of time circumstances, not to create an artificial 
increasing of the VA's budget. What steps did the VA take to 
make sure cost projections for the fiscal years that we are 
talking about, 2024 and 2025, were not based upon those 
supposed one-time amounts of money?
    Secretary McDonough. Yes, that is a fair question. So this 
has been an historic challenge for VA. How does it account for 
supplemental funding? And this goes back many, many years, and 
has to do with the age of our infrastructure and how we track 
this stuff, and it also has to do with where we push the money 
to for our operators to execute it.
    So the important thing we have done is we have now taken 
responsibility for the outlays of those dollars and put it in 
the hands of the CFO here in headquarters, and we are making 
sure that he and I are directly responsible, ultimately, for 
how we pay those.
    Senator Moran. Those being the COVID funds?
    Secretary McDonough. Those funds being the medical care 
funds. So rather than making every individual facility have to 
account and try to figure out where this money comes from and 
what color it is, we are going to make sure that we do it at 
headquarters. We have worked that out with OMB, and we have 
been briefing your staff about this, as we think this is an 
important change.
    Secondly, we have regularly updated the Committee on how it 
is that we are spending these funds, and that is why we can 
have the confidence that we have now that we will use the 
overages that we have had to date--which, remember, those 
overages were for what we expected to be a surge of care as 
people come back to us at the end of the pandemic. We have had 
that conversation in this room. We have great confidence that 
we will use that money this year, and partially into next year. 
Our regular updates to you guys help us do that.
    But the IG has routinely raised this issue of supplemental 
funds with us. We are trying to figure out a good way to do it. 
We think, as I said, bringing responsibility of this to the CFO 
level is the way to do it. But none of this obviates the need 
to continue to stay in close touch with the Committee and make 
sure that the Committee sees very clearly how we are spending 
the money.
    Senator Moran. I understand that the VA plans to track 
expenditures from the Toxic Exposure Fund to ensure they are 
justified.
    Secretary McDonough. Yes.
    Senator Moran. How will the VA define and track which 
health care is associated with exposure to environmental 
hazards and which care is not, pursuant to the law that created 
the fund?
    Secretary McDonough. So we have had now, I think, a handful 
of discussions with your teams here in the Committee and then 
with others among the appropriators, and in the House as well, 
about our methodology. We are comfortable with our methodology. 
We have worked this through with OMB. We are working it through 
with your team. I will let them characterize to you their 
degree of comfort. If we have to change that methodology, we 
will do it.
    But the base case for the TEF is that we are in a position 
to ensure that as the law envisioned, Toxic Exposure Funds will 
be spent only for toxic exposure requirements, and we have made 
sure that we have given clear guidance to the field, again, 
operating as we do with the CFO and me responsible for this, to 
make sure that we can execute in that way.
    Senator Moran. So the problems, or the lack of accounting 
of the money from COVID, which you are now trying to address by 
bringing it to the Central Office, that is not anything that 
would suggest the same problem will occur for the money in the 
fund for toxic exposure. We will not have the same problem we 
had with COVID money being comingled. The Department will be 
able to determine what is appropriately spent for toxic 
exposure benefits.
    Secretary McDonough. Yes. We think yes, and again, the 
methodology, the basis on which we have established that 
methodology to track that funding is something that we are 
talking through with your teams in very minute detail. But we 
are also going to obviously continue to not only talk to you 
but continue to be subject to the IG's oversight, to the GAO's 
oversight, to OMB's oversight. And if there is something we 
need to change we will change it.
    But we have great confidence that we will be able to invest 
the toxic exposure dollars for toxic exposure care.
    Senator Moran. Mr. Secretary, thank you.
    Chairman Tester. Senator Brown.

                     SENATOR SHERROD BROWN

    Senator Brown. Thank you, Mr. Chairman. I appreciate what 
you said about DoD being held harmless and the VA not. Chairman 
Tester and I, and others, fighting for the PACT Act remember 
last summer when it was perilous whether it was going to pass 
because some people said it was too expensive. And I do 
roundtables. I am going to do one on the PACT Act in every 
county in the State. I did the 31st one the other day. And 
there is a sentiment that, you know, there is always money for 
defense but too many people want to skimp on spending on the 
VA. So Mr. Chairman, thank you for your work on that.
    Mr. Secretary, thank you for all that you are doing in so 
many ways. I want to thank you for taking the right step in 
stopping the electronic health records issue, rollout. I know 
we have talked many times. I appreciate your attention to that 
and your understanding there. The staff at Chalmers in 
Columbus, their hard work. I have visited there, as you have 
and as your staff has, and you did the right thing, and we want 
to keep working with you.
    I want to talk about the PACT Act a little bit. Do you have 
numbers, up-to-date numbers, of how many veterans have already 
taken advantage of it? Because I like to say, when I do these 
roundtables, that this is government done right. This bill 
passed, if I remember, in August 2022. By January, you were 
headed up and running, and hundreds of thousands of veterans 
were getting care, and that is exactly the way government 
should run, and all of us are proud to be part of that.
    Do you have any up-to-date numbers on how many people have 
been served?
    Secretary McDonough. Yes. Thank you very much. As of May 
6th, 251,584 total veterans or survivors have had completed 
PACT Act-related claims. We are granting at about 80 percent. 
That is the beauty of the presumption, is that we are able to 
grant at a much higher rate. It is 79.7 percent. The average--
this is a troubling number--the average days for completing a 
PACT Act-related claim right now is 155 days. I think there is 
a series of reasons for that. I think the biggest is that some 
claims were filed either related to our initial three 
presumptive claims or filed shortly after the President signed 
the law, and we did not begin to process the PACT Act claims 
until January. So we should see that average number of days go 
down.
    And we have about, as I said earlier, about 77,000, a 
little over 77,000 new enrollees in VHA health care as a result 
of that. We have many more existing enrollees who qualify for 
greater access to care as a result of the PACT Act as well.
    Senator Brown. Thank you. I participated, as an observer, 
in a screening event at the Toledo CBOC in northwest Ohio in 
March, and it was an illuminating experience to see what 
veterans go through. I know you have been more hands-on than 
any VA Secretary I have ever seen in terms of going out and 
seeing that in action. I heard from burn pit veterans and 
advocates who need additional screening. Many of them are in 
poor health and had to have invasive lung biopsies in order to 
complete these diagnoses.
    What steps is the VA taking to implement less invasive 
diagnostic techniques such as advanced technology screenings?
    Secretary McDonough. Well, so the toxic exposure screenings 
that you talked about, and that are enabled by the law, we have 
now had about 3.3 million veterans complete those screening. 
Very interesting because in somewhere between 35 and 40 
percent--I do not have the most recent number; it fluctuates in 
there--of cases of those screenings we have veterans about whom 
we learned some new exposure that that veteran may have 
experienced. So that is allowing us to get to know the veterans 
already in our care better.
    There are technological challenges on one of the things 
that we think most veterans suffer from, which is 
bronchiolitis, which the test for which are so invasive as to 
make them actually not useful, potentially harmful to the 
veteran.
    So that is why we have stood up and the PACT Act enabled us 
to stand up a special organization focused just on the science 
of the exposures as well as new techniques to verify the 
existence of the condition. That team meets on a regular basis. 
We just met with them late last week on this. But not only did 
you set up the presumptive process for us, but you have also 
given us additional authorities to make sure that we are 
testing new technologies to make the confirmation of these 
conditions, including bronchiolitis, less invasive.
    Senator Brown. Thank you, Mr. Chairman, thank you, Mr. 
Secretary, for your help, especially since you have taken 
office, especially in Chillicothe and Cincinnati and Columbus, 
and your help for the National VA History Center in Dayton. 
Thank you for all that.
    Secretary McDonough. Thank you.
    Chairman Tester. Senator Tillis.

                      SENATOR THOM TILLIS

    Senator Tillis. Thank you, Mr. Chairman. Secretary 
McDonough, thank you for your opening statement, and 
congratulations on your daughter's incoming graduation from a 
fine institution, 15 minutes from my home, Davidson College.
    I want to thank you for the briefing you gave me back in my 
office. It is probably known to most folks I voted against the 
PACT Act, in fact, in spite of the fact that I worked a lot on 
it. And it did not have anything to do with the numbers. It had 
to do with operational challenges that I hope we were going to 
be able to clear up.
    But you gave me a reason to be optimistic based on the 
briefing you gave me in the room. Can you give me a 60-second 
CliffsNotes, or give the Committee a 60-second CliffsNotes 
version on some of the risks and how you have managed them? I 
did hear the 150 days. You have got to bend that down, but I 
think you have a plan for doing that.
    Secretary McDonough. Yes.
    Senator Tillis. Share that with me.
    Secretary McDonough. Yes, so thank you very much, Senator 
Tillis. What we know now, after years of watching the benefits 
process, in particular, the claims filing process, since that 
is overwhelmingly the main door that vets first enter at VA, is 
it is a very human-intensive process. So we need to make 
assessments about how many vets we anticipate filing claims, 
and we need to make sure that we have trained people ready to 
handle those claims.
    So starting in the end of fiscal year 2021, we began 
hiring. We now have 28,000 VBA professionals. Importantly, they 
are not only hired but a good chunk of them are now through the 
training process, such that they can begin to add to our 
ability to reduce the backlog of claims that get filed.
    A good example of this is that yesterday we had the single 
biggest day of claims completion in the history of VA. We 
completed 9,245 claims yesterday. We are still getting more 
claims in any given day than that, but we are able now to move 
many more claims through the process.
    We can see, through the expected surge of claims right now, 
to the other side of this.
    Senator Tillis. And you have a strategy?
    Secretary McDonough. And we have a strategy on how to then 
manage the size of that workforce through attrition on the 
other side.
    Senator Tillis. I think managing to the peak, but then 
getting down to what you think the future run rate is going to 
be is good news. So count me in to help as we go forward.
    Secretary McDonough. Thank you.
    Senator Tillis. With respect to the discussion about the 
House bill, the House bill was a House bill. We know that the 
negotiation that is going to come from the President and 
Speaker McCarthy is going to produce something different, and I 
think that it is going to be fair to veterans.
    I wanted to talk about one other thing. You mentioned 
77,000 new people. PACT Act was much publicized. We got more 
people to contact the VA. Even if 20 percent of them are not 
getting the presumption, we now have a relationship and 
hopefully that is positive for those who maybe did not get the 
news on the presumption, but at least they are engaged.
    We know that the suicide rate among veterans who have no 
relationship with the VA is higher than those who do. There are 
a lot of reasons why we need to get people to VA.
    There are also a lot of reasons why I am absolutely sick of 
the Camp Lejeune toxics ads that are on TV. However, I think 
there is a great opportunity there to connect with more 
veterans. But I heard, I think it was at a prior Committee, an 
exchange between Senator Sullivan and Senator Hirono on capping 
fees, which is going to be very difficult to get any consensus 
on.
    So I asked my staff to take a look at drafting a bill that 
we call the Patriot Bill of Rights. One of the things that I 
would like to do is to get support in Congress for an informed 
veteran, before they sign a retainer for these attorneys that 
are spending millions of dollars in ads. And I think it 
represents a great opportunity for the VA. I know that they 
contact the Department of the Navy, but I was thinking 
something as simple as a document, before they sign a retainer 
agreement, that says you need to understand what your rights 
are, independently, without representation of an attorney. 
Number one, contact the VA. Number two, contact a local 
congressional representative. We do thousands of VA cases every 
year in our office. I am sure the other members do the same.
    So make them aware of the fact that Congressmembers' State 
offices help veterans every day. Their case may or may not rise 
to a level to where they need a legal representation. Make them 
aware of the recognized VSOs who also have experience in this 
case and let them go through that process before they sign that 
retainer agreement.
    What is wrong with that idea?
    Secretary McDonough. You know, you and I talked about this 
in your office, and we, especially on Camp Lejeune, where we 
just had a study published last week where a veteran at Camp 
Lejeune is 70 percent more likely to suffer Parkinson's than 
one not so deployed. We have a lot of presumptives already for 
Camp Lejeune, so we want to make sure that vets understand you 
do not have to hire a lawyer to get your VA benefits.
    And so we are aggressively using all of our communications 
tools to do that and having some success with that. So anything 
that will allow us to get to more of what we call the 
untethered vets, those vets not yet in relationship with us, is 
a positive thing as far as we are concerned.
    Senator Tillis. Senator Murray.

                      SENATOR PATTY MURRAY

    Senator Murray. Thank you very much, Mr. Chairman. Mr. 
Secretary, welcome. Good to see you here.
    Secretary McDonough. Thank you.
    Senator Murray. As you know and have told us, yesterday the 
VA announced that an agreement for the new HER contract had 
been made with Oracle, and it is really important to see that 
VA is prioritizing reliability and responsiveness and patient 
safety across the contract, so I appreciate that.
    Now just last week, GAO released a report indicating that 
the VA had not established target goals to assess user 
satisfaction, and that until it does VA lacks a basis for 
determining when satisfaction has improved enough for the 
system to be deployed at any other sites.
    I support the reset period, as you know, and I support 
efforts to move forward, but only after, of course, that you 
are confident about the safety and effectiveness of the system 
and have clear, established satisfaction markers. And what 
matters is what the providers and veterans on the ground think. 
Our veterans, you and I both know, deserve the best health care 
we can offer, and it is our job to make sure that the VA and 
Oracle Cerner really get this right.
    I have a couple of questions around this. When do you 
expect to have a revised request for the EHR account in fiscal 
year 2024 as well as an estimate of whether you need the funds 
requested to support the rollout in the IT and medical facility 
accounts?
    Secretary McDonough. So first of all, I just want to make 
sure that we are absolutely clear that a little bit over $400 
million that was set aside for this year, we have communicated 
to you and the Appropriations Committee that we do not 
anticipate needing that money this year. So I want to be very 
clear about that, one.
    Two, on the updated requests, both for the rest of this 
year and then into next, I think we need a little bit of time 
but not much. So I do not have a specific timeline for you 
here. But we recognize that this 1-year option that we have 
just exercised is a great opportunity for us to test whether we 
can get those five sites working. And not only that, but we 
have providers in each of those five sites, that you have 
brought to our attention, and we have vets in each of those 
five sites who have big expectations, and they are tired of 
waiting.
    So we are not asking for a lot of extra time, but we want 
to get this right rather than get it fast. So I think rather 
than give you a firm commitment I can tell you that this is the 
number one issue for us at the Department, to come to the 
Committee with a revised request.
    Senator Murray. Okay. And do you have plans to establish 
targets to assess user satisfaction?
    Secretary McDonough. User satisfaction is going to end up 
being--it is a critical part of this. Whether we have a 
specific target set, I will get back to you on that. But one of 
the principal ways we are going to be able to figure out 
whether we are working in the five sites is going to be user 
satisfaction.
    Senator Murray. So that will be part of the evaluation.
    Secretary McDonough. Correct.
    Senator Murray. Okay.
    Secretary McDonough. Whether we have specific targets that 
are laid out on some timeline is what I am not aware of.
    Senator Murray. Are there any changes that you have made, 
and plan to make, based on provider feedback at this point?
    Secretary McDonough. Well, a big part of it is the enhanced 
accountability measures around uptime and system reliability. 
That comes directly from the user experience.
    Senator Murray. Okay. Thank you. As you know, we are 
following this very closely----
    Secretary McDonough. I have noticed.
    Senator Murray [continuing]. And I really appreciate the 
VA's diligence on this and want to keep working with you. So 
thank you.
    Secretary McDonough. Thank you.
    Senator Murray [presiding]. Senator Boozman.

                      SENATOR JOHN BOOZMAN

    Senator Boozman. Thank you. Mr. Secretary, again, thank you 
for being here today. We enjoyed hearing your priorities 
regarding the budget last week, and we do appreciate all that 
you are doing, all the hard work for the men and women that 
have served.
    In regard to EHRM, one of the things that I hear from 
people that are not on either the Authorizing Committee or on 
the Appropriations Committee is DoD has successfully got a 
bunch of things going in various installations. We are 
struggling. I support the move to back off. I think that was 
wise of you to do, and I think you have got really good support 
for doing that.
    Can you explain why DoD is having success? What is the 
difference? Why are we struggling when they did not? I know 
there are good reasons, but would you just expound on that?
    Secretary McDonough. Yes. Look, I think the number one 
reason is that we have health systems that are built for 
different populations and for different outcomes. As a general 
matter, our patients are with us longer and our veterans have 
more complicated health care situations. And so as a result, 
our system is that much more complicated. So I think that is 
the main issue.
    You know, the other question is when we have struggled with 
reliability, oftentimes, in fact in the last three weeks, we 
have had these two outages for the first time in some 70-plus 
days. Those outages impact the entire system. So it is not just 
VA. They also impact DoD. And so my point is that because of 
your pressure on us, we, I think, are making the entire system 
more reliable, including for DoD.
    So I think, notwithstanding the fact that our system is 
more complex, our patients have more demanding health care 
situations, I think the work that you have put us through is 
going to make the whole system, including for DoD, for Coast 
Guard, that much more effective.
    Senator Boozman. Good. That is helpful.
    When you came and talked about your budget you recognized 
the growth of the number of women veterans seeking care in the 
VA, which has more than tripled over the last 20 years. The 
fiscal year 2024 request includes more than $1 billion for 
gender-specific women's health care and $257 million to support 
the Women's Health Program Office. Last Congress we had 
legislation, the Dr. Kate Hendricks Thomas SERVICE Act, which 
was signed into law. The law expands the eligibility for VHA 
mammography screenings to veterans who were exposed to toxic 
substances. That is really a good story about all that we have 
been able to do, in various ways.
    Secretary McDonough. I agree.
    Senator Boozman. Can you touch on how the implementation 
for the SERVICE Act is going, and are there any challenges that 
you are facing that we can be helpful with you?
    Secretary McDonough. Yes. Well, let me start by saying that 
you have been tireless in giving us additional authorities and 
additional funding to do exactly all the things that you just 
ticked through, and we are not only very proud of that, but we 
are very grateful for that.
    On the SERVICE Act, its implementation is well underway. We 
began providing breast cancer risk assessments in March of this 
year, including coincident with the toxic exposure risk 
assessments. We are working through the development of a 
dashboard to make sure that you can follow along with the 
implementation of that.
    We project that in this fiscal year, as a result of the 
SERVICE Act, there will be an additional 52,000 breast cancer 
risk assessments across all sites. Incidentally, as we learned 
last week, new guidance is that breast cancer screening should 
start at 40. It is pretty clear that your advocacy for the 
SERVICE Act was well ahead of even this more cutting-edge 
assessment last week.
    There are going to be challenges in some facilities where 
women veterans are coming to us unenrolled because they have 
heard about this screening. So that is going to create some 
administrative burden, but I just want to name that. There is 
not anything we need from you for that, but that will be a 
challenge. But that means we are taking more vets into our 
care.
    Senator Boozman. That is actually good news.
    Secretary McDonough. Absolutely good news. Absolutely good 
news.
    Senator Boozman [presiding]. Well, thank you, Mr. 
Secretary. Senator King.

                   SENATOR ANGUS S. KING, JR.

    Senator King. Thank you, Senator. Mr. Secretary, welcome to 
the Committee.
    Secretary McDonough. Thank you.
    Senator King. One of the issues--I serve on both Armed 
Services and this Committee--is the transition.
    Secretary McDonough. Yes.
    Senator King. And it seems to me even though we have made 
great progress we are still not there.
    Secretary McDonough. Yes.
    Senator King. And what I would like to get from you are 
some thoughts about how we can make this a warmer handoff, if 
you will, because the data suggests that that transition, that 
2- or 3-year period after leaving active duty is a moment of 
danger. And so I wondered if you had some thoughts about some 
things we might be able to do to make this a more effective 
process in order to protect our veterans.
    Secretary McDonough. Yes. I think your instinct is exactly 
correct, in my view. I have talked about this with SecDef. We 
are looking at this a lot. I worry sometimes that we think the 
answer is to overload the transition, the TAP program.
    Senator King. Yes, handing a veteran a 300-page form is not 
the answer.
    Secretary McDonough. Right. As you know, I am not a vet, 
but I have signed out of jobs before, like when I was leaving 
the White House I signed a lot of different things, but I was 
not going to go to any extra thing that I did not want to go 
to.
    So what we think, very strongly, is we need to fit our 
programming and our opportunities into veterans' lives through 
a customer experience journey, rather than make them fit our 
stuff, on our schedule. So we are making good progress on this, 
and that may mean that we are talking to veterans outside the 
TAP program, and we are using that time, as you say, in that 
year to 3 years after they have transitioned to establish a 
connection with them.
    Senator King. Well, one suggestion that I have been looking 
at is right now an active duty servicemember has to opt in to 
have their data conveyed to the Veteran Service Officer in the 
State. If we made that an opt-out it would probably increase 
the amount of contact. My vision is, frankly, someone meeting 
the veteran at the airport----
    Secretary McDonough. Yes.
    Senator King [continuing]. Saying, ``Welcome home. Here are 
some resources. Here is my number. Here is the VA number.'' But 
we have to be able to contact the veteran. Now if they do not 
want to be contacted, that is fine. But we have got this cadre 
of VSOs and people out there that are very willing to help, but 
we have got to make that connection easier.
    Secretary McDonough. We are in conversations with National 
Association of State Directors of Veterans Affairs.
    Senator King. That would be the contact, I think.
    Secretary McDonough. Yes. So we have not been a first-rate 
partner to our State partners on this. We give them data. It is 
not readable. It is not usable. We are trying to make that 
better.
    Senator King. Here is a suggestion. When I was Governor, I 
would call our State's 800 numbers just to see what I got as a 
consumer. You know, think of yourself as the customer is a good 
way to approach something like this.
    Secretary McDonough. Well, these State Directors of 
Veterans Affairs in each State, we are working with each of 
them, in each of your States. They are not shrinking violets, 
and we are hearing from them that we have not been a good 
partner. We are working that, because we do think that that 
ready handoff is really important.
    Senator King. Just in my limited time just a couple of 
points. I am still concerned about onboarding time and the 
cumbersomeness of the hiring process. It strikes me that 
decentralizing it, to some extent, would be good, number one. 
If you need to hire an administrative assistant at Togus 
Hospital in Maine, you should not have to go through Boston and 
Washington, number one.
    Number two, some reciprocity. So if you have got somebody 
that is Customs and Border Patrol, they do not have to go 
through a whole new process of background checks and those 
kinds of things. Some reciprocity would speed up the process.
    So I hope that, again, this is one of those things where 
back away and say, if we were going to design a hiring process 
from scratch with a blank sheet of paper, what would it look 
like, and then compare it to what we have now.
    Secretary McDonough. Yes. Well, I appreciate that very 
much. We feel like we have had the best two quarters in hiring 
in basically two decades, but onboarding is still a major 
headache. So we are looking at that process from soup to nuts. 
I talked with you yesterday about a couple of things, in 
particular the way we handle drug testing does not make any 
sense to me, for example. But we are getting into the specifics 
on this to ratchet down that time to onboard.
    We are losing people because----
    Senator King. It is an opportunity cost. We are losing 
people we need.
    Secretary McDonough. Massive opportunity cost, and these 
are people who want to come to work for VA, and we should not 
make it so hard.
    So our time to onboard is coming down----
    Senator King. Good.
    Secretary McDonough [continuing]. But it is coming down in 
some places, in some VISNs, from four months. Nobody can take a 
job and then not be paid for four months. So we are on this. I 
will continue to report to you on it.
    Senator King. Please.
    Secretary McDonough. But some of those things that you are 
talking about are things we are looking at. Moving authority to 
hire to the field, simultaneously carrying out the onboarding 
steps rather than doing them sequentially--these are all things 
that we are making good progress on.
    Senator King. Mr. Chairman, can you indulge me for one more 
question.
    Chairman Tester. Make it short.
    Senator King. Thank you. I knew you would understand.
    The medical records. It is short. Accountability is 
crucial, and I share with Senator Murray, I think there ought 
to be targets. If you do not have a destination, you will never 
get there. And I think this contract is very important, but you 
have got to have standards in it that provide some 
accountability and some penalties if they are not met. 
Otherwise, you know, this is such a complex, large process, but 
ultimately it has got to work. And if it does not work, the 
people who we are contracting with should not get paid.
    So I hope you will be very tough about accountability. And 
you have got this one year, you have got something hanging over 
them, and I want you to be very aggressive about that.
    Secretary McDonough. Yes. We are going to do that. I think 
Senator Murray is challenging us. So I 100 percent agree. I 
think we got improved accountability metrics, including 
enhanced credits to VA when the system is down, as it has been, 
inexplicably, twice in the last--I said three weeks, I think it 
is the last month. It is maddening.
    Senator King. Yes. There ought to be a cost to that.
    Secretary McDonough. There is always a cost to that, and we 
have to measure it in dollars. But it is really measured in 
vets' outcomes.
    Senator Murray is also challenging us to be very deliberate 
about user satisfaction measurement. I take what both of you 
are saying on that, and we will get to the bottom of it.
    Senator King. Thank you.
    Chairman Tester. Thank you. Senator Blackburn.

                    SENATOR MARSHA BLACKBURN

    Senator Blackburn. And thank you, Mr. Chairman. Senator 
King gave such a great devotion this morning at prayer 
breakfast. I was happy to let him move forward and take that 
time.
    Secretary McDonough, very quickly, we have talked a lot 
about staff and return to work.
    Secretary McDonough. Yes.
    Senator Blackburn. What percentage of the VA's DC staff has 
returned to in-person work?
    Secretary McDonough. I do not have a specific number, but I 
will get you that specific number.
    Senator Blackburn. Yes. And then also submit to me the 
agency's official telework policy.
    Secretary McDonough. Sure.
    Senator Blackburn. We want to know that. I have got 
legislation called the SHOW UP Act, in order to try to get 
people back to work in these agencies. The wait times and the 
backlogs are continuing to grow, and I think that is a problem.
    Let me ask you also, some of the employers I have talked to 
in Tennessee have talked about people taking second jobs, 
second remote work jobs. So do you have any employees that have 
taken second jobs where they are working two jobs remotely? Has 
that happened?
    Secretary McDonough. Not that I am aware of, but let me 
take that and I will come back to you.
    Senator Blackburn. Yes, I would appreciate knowing that, 
and seeing where you are with those issues.
    I know you were working on a work environment plan.
    Secretary McDonough. Yep.
    Senator Blackburn. Okay. What is the status on that?
    Secretary McDonough. The status is that we have submitted 
our first draft of that to the OMB. In fact, when I am done 
here I will be going to a meeting on that over in the 
interagency. So we are working on that. We feel really strongly 
about it.
    I feel quite proud of the work that our workforce has 
carried out the last couple of years. Productivity, for 
example, at VBA, the Veterans Benefits Administration, is the 
highest it has ever been. Even though they are max telework 
right now, they are at higher productivity rates than we were 
in 2019, and I feel good about that.
    Senator Blackburn. So what is the case backlog now?
    Secretary McDonough. Right now the case backlog is about 
215,000. It is a little less than----
    Senator Blackburn. I read somewhere that PACT Act, you were 
seeing a half million requests for service because of the PACT 
Act. Is that accurate?
    Secretary McDonough. Overall, yes, we have seen about 
500,000 PACT-specific claims filed.
    Senator Blackburn. Okay.
    Secretary McDonough. But we will get you the exact data if 
you want to see----
    Senator Blackburn. I would love to see that.
    Secretary McDonough [continuing]. How many claims filed, 
how many claims completed, average time to completion. I will 
make sure we get you that.
    Senator Blackburn. Well, of course, as you know, I believe 
Community Care is a big part of that, and we have got more 
legislation we are working on that we think would help with 
that, and we would appreciate hearing from you.
    I do want to come to something that to me was very 
troubling as I was reading it last night and looking through 
the Durham report. And I know you were President Obama's Chief 
of Staff from January '13 to January '17. And as I was reading 
through some of this I would like to know from you, during that 
time as Chief of Staff, did you participate in any meetings 
with the FBI regarding the investigation of the Trump campaign?
    Secretary McDonough. It has been a long time since I have 
thought about that, but I will be more than happy to go back 
and take a hard look at that and get you an answer.
    Senator Blackburn. I would appreciate knowing that. And I 
think it is important to know what your involvement was with 
the FBI in pushing for that. And my understanding is that you 
were in the 2016 meeting in the Situation Room with President 
Obama, Susan Rice, and other top officials, where they 
discussed the Russia collusion issue. Is that accurate?
    Secretary McDonough. I am not sure I know which meeting you 
are talking about, but I would be more than happy to look at 
that.
    Senator Blackburn. I think it was July 2016.
    Secretary McDonough. Again, I----
    Senator Blackburn. It was reported in the report that you 
were in there, and that is of concern to me. You are charged 
with leading a very important agency. The work that you do is 
vital to our veterans. And it is of tremendous concern to me, 
as I was reading this report last night, and it was also a 
source of disappointment to me, that you would have been 
involved in this process of weaponizing the FBI. This is 
something that should never happen.
    People do not want to see two tiers of justice. And as we 
talk about the VA, they want to see a standard of service for 
everybody, and they want to see that consistency. And to know 
that you may have been a participant in this investigation, 
that you were a part of this meeting, as detailed in the 
Situation Room, that they carried out this, this hoax, this 
made-it-all-up, figment of her imagination, to discredit 
someone. I would not want someone discrediting Maggie in that 
regard, or the Chairman, or any of us, or you. So it is with 
great disappointment that I read all of that.
    Thank you, Mr. Chairman.
    Chairman Tester [presiding]. Senator Hassan.

                  SENATOR MARGARET WOOD HASSAN

    Senator Hassan. Thank you, Mr. Chairman, and thank you and 
Ranking Member Moran for this hearing. Thank you, Secretary 
McDonough, for being here today and also for our recent 
conversations.
    And just before I talk a little bit about what we have 
covered in those recent conversations I just want to reaffirm 
that it is my understanding that you agree that all Americans 
should be equal before the law.
    Secretary McDonough. Absolutely.
    Senator Hassan. Thank you.
    So what we have been talking about in recent weeks is 
really major concerns to New Hampshire veterans. It is the 
condition of our Manchester Medical Center. As you know, the 
Manchester VA Medical Center is 73 years old, and facility 
maintenance failures have led to the cancellation of many 
veterans' appointments in just the past few years.
    So I really appreciate you taking the time to walk me and 
Senator Shaheen through the plans that you and your team are 
working on to ensure that these problems do not continue to 
recur. I know from our conversation that you and I both care a 
lot about getting these renovations at Manchester up to date 
and completed. We also talked about the importance of 
transparency and ensuring that veterans know what is being 
planned and when they can expect each project to be completed.
    When will you be able to make public a comprehensive plan 
on projects for the Manchester VA so that veterans will know 
what to expect?
    Secretary McDonough. Yes, thanks very much for the 
question, and thanks for all the work on this. Our goal would 
be to be able to make something public this summer, the summer 
of 2023, and by that I mean July or August.
    Senator Hassan. Okay. And I appreciate that, and I think it 
will be very important to New Hampshire veterans and for our 
whole community to meet that deadline, if not earlier.
    Secretary McDonough. Yes.
    Senator Hassan. I appreciate the VA's work to complete 
much-needed repairs at the Manchester VA that were caused by 
flooding when a pipe burst last year, and I know that your team 
has been working hard to get these important repairs done as 
fast as they can. What are the next steps beyond these initial 
reports to ensure that the Manchester VA is fully renovated to 
prevent these types of problems in the future? When will the VA 
start on this work, and what is the expected timeline for 
completion?
    Secretary McDonough. Yes. So, you know, I will just talk 
through a couple of things here, for the record. One is, you 
know, many of these renovations are complete guttings of these 
facilities. We are able to fund those through non-recurring 
maintenance projects. We have minor constructions projects 
onsite, including the new Women's Clinic and Specialty Care 
addition. We do also have a major construction issue on the 
seismic project on campus. And the plan is to fully renovate 
the facility, floor by floor, so that the facility remains in 
use during those sequential upgrades. Those renovations include 
removal and replacement of all obsolete utilities--that 
includes plumbing--installation of new insulation on exterior 
walls to prevent the kind of freezing that we have seen, 
installation of new windows, installation of new, modern 
heating, air conditioning, and ventilation systems, 
installation of new finished, and optimized space layout for 
designed clinical use.
    Now, here are our approximate schedule. Fall of 2023, the 
fourth-floor operating room and the PAC use suites will be 
completed and returned to use. December 2024, the third-floor 
construction will be completed. Spring 2025, the fourth-floor 
construction, which will be partially completed. And then 
Spring 2025, the second-floor construction will be completed. 
Winter 2027, the fifth-floor construction completed. And then 
Winter 2026, the sixth-floor construction completed.
    The Women's Clinic is expected to be posted for an award 
this summer, and the awarded granted in the fourth quarter of 
this year.
    Senator Hassan. And then for the Women's Clinic, the award 
granted in the fourth quarter of this year, what is the 
timeline for completion?
    Secretary McDonough. The timeline for completion--I am just 
looking to make sure. Can I take that one and get back to you, 
just to make sure that I give you the exact number?
    Senator Hassan. Yep. And that is fine. What I, of course, 
am trying to communicate is what we have talked about.
    Secretary McDonough. Exactly, and I am sorry I just do not 
have that number.
    Senator Hassan. No, that is okay, but let's get it so that 
we can make it public to people so you all have a timeline to 
go by. And I also just think it is really important for people 
to understand not only the timeline but with the overall 
renovations, what you all are trying to do is make sure that 
you are repairing this facility to a point where we will not 
see these kinds of ongoing failures, which have really been 
incredibly disruptive to veterans in New Hampshire.
    Secretary McDonough. Yes.
    Senator Hassan. Thank you.
    Chairman Tester. Senator ``Quick-Healing'' Blumenthal.

                   SENATOR RICHARD BLUMENTHAL

    Senator Blumenthal. Good afternoon, Mr. Secretary.
    Secretary McDonough. Hello, Senator.
    Senator Blumenthal. The Chairman is referring to my leg, 
which was broken in a Yukon Huskies victory parade.
    Secretary McDonough. I saw that. I sent you a note too, but 
it might have gotten stuck somewhere.
    Senator Blumenthal. I was just going to say, thank you for 
your note. I apologize for my delay in responding. You are very 
kind. Thank you.
    And I want to focus on health care for the veterans of 
Connecticut, and just say I am hoping that plans for continued 
work on the VA facility in West Haven are proceeding and I can 
touch base with you and [inaudible] on that.
    Secretary McDonough. You can count on that.
    Senator Blumenthal. Thank you. I also want to follow up on 
a letter that I sent to your office regarding veterans who were 
stationed at a base in Uzbekistan----
    Secretary McDonough. K2.
    Senator Blumenthal [continuing]. Karshi-Khanabad, also 
known as K2. The Yale Veterans Clinic has brought a lawsuit on 
behalf of veterans who were stationed there and who were 
exposed to Soviet-era hazardous waste, including uranium, 
asbestos, and chemical weapons. There is ample evidence that 
they were exposed to these toxins, but there is also tremendous 
amount of information in possession of the Department of 
Defense----
    Secretary McDonough. Yes.
    Senator Blumenthal [continuing]. Records that are still 
classified, for reasons I do not understand. And so I have 
written to Secretary Austin, urging him to declassify those 
records. And I would simply ask you for your commitment that 
you will support expanding health care to these veterans who 
were exposed.
    Secretary McDonough. You have got that commitment.
    Senator Blumenthal. Thank you.
    I want to take a moment to talk about education benefits.
    Secretary McDonough. Yes.
    Senator Blumenthal. The next generation of veterans is 
entering a civilian marketplace that is much more dynamic and 
competitive, as you well know. I strongly believe the VA can 
play a critical role in enabling veteran success, as the dad of 
two veterans who have made use of education benefits, 
thankfully. Programs like the Transition Assistance Program, 
Veterans Readiness and Employment Service, and the GI Bill 
provide invaluable resources to veterans and their families. I 
believe that the Post-9/11 GI Bill, in particular, is one of 
the most powerful tools at a veteran's disposal right now, but 
the educational landscape has changed significantly since 
President Roosevelt signed the law about 80 years ago.
    In your view, how does the VA need to change to meet the 
needs of these younger veterans? Many of them are of a 
different mindset. They are exiting the service and want to 
pursue higher education, and how does the VA need to change its 
practices or methods to meet those needs?
    Secretary McDonough. Yes. I mean, I think the main thing we 
have to do is we have to make sure we are meeting veterans 
where they are, as I say, fitting our programs into their lives 
rather than us expecting them to change their lives to meet our 
requirements, making sure that they understand the full suite 
of support that is available to them, irrespective of what they 
want to go study or what skills they want to go develop next.
    And the more we fit that programming into their lives, the 
better case that we are able to make to them about the 
usefulness of these investments, the better informed they will 
be to make those decisions. It is on us to make that case to 
individual veterans.
    Senator Blumenthal. Thank you. I want to offer a sort of 
personal testimonial to the importance of the PACT Act. One of 
my sons had just gone for screening, at the urging of his----
    Secretary McDonough. Dad.
    Senator Blumenthal [continuing]. His dad----
    Secretary McDonough. Good.
    Senator Blumenthal [continuing]. And was extremely 
impressed by the quality of the questions and the caring and so 
forth.
    Secretary McDonough. Great. Excellent.
    Senator Blumenthal. Thank you.
    Secretary McDonough. Thank you.
    Chairman Tester. Senator Sullivan, you are up.

                      SENATOR DAN SULLIVAN

    Senator Sullivan. Thank you, Mr. Chairman, and Mr. 
Secretary, good to see you again.
    Secretary McDonough. Nice to see you.
    Senator Sullivan. I want to begin by thanking you for the 
visit to Alaska.
    Secretary McDonough. It was fun.
    Senator Sullivan. I appreciated it. I appreciate you 
getting out all over the State, and hopefully you had a good 
time.
    Secretary McDonough. Very much.
    Senator Sullivan. You had a good time?
    Secretary McDonough. Very much.
    Senator Sullivan. Hopefully you enjoyed the steak night at 
the VFW.
    Secretary McDonough. I did, but I ate fish, but it was 
good.
    Senator Sullivan. I know you did eat fish. You are a better 
Catholic than I am. And I appreciated the broad diversity of 
meetings that you engaged in, and again, getting all over the 
State with me and Senator Murkowski and Congresswoman Peltola. 
I very much appreciate it.
    I wanted to follow up on the meeting you had with Valerie 
Davidson and the ANTHC, the Alaska Native Tribal Health 
Consortium. And this is on the 26 different reimbursement 
agreements with the VA and these Tribal health providers.
    Secretary McDonough. Yes.
    Senator Sullivan. On January 5, 2021, the Proper and 
Reimbursed Care for Native Veterans Act was signed into law and 
required the PRC services to be covered, the Purchased/Referred 
Care. Again, I know you guys had a good discussion on that. I 
was part of a lot of that.
    Secretary McDonough. Yes.
    Senator Sullivan. When you met with ANTHC it was one of the 
issues that you discussed. Do you guys have, or maybe can you 
provide the Committee a firm date when the Tribal health 
providers can expect the agreements to include reimbursements 
for the PRC services?
    Secretary McDonough. Can I get back to you with that?
    Senator Sullivan. Yep.
    Secretary McDonough. Absolutely.
    Senator Sullivan. Yes, I know it is complicated, but it is 
important issues you talked in Alaska.
    Secretary McDonough. Absolutely.
    Senator Sullivan. Okay. Look, the next issue, it is an 
issue I raise every time. I sure hope we can get the VA's 
support. I thought we had it, and this is on the Camp Lejeune 
Victims Act and the lack of any contingency fee caps. Like I 
said, I do not know why this is taking so long. We have put 
forward a bill that is compromised up to 17 percent caps. The 
VFW supports it. The American Legion supports it. There is a 
whole host of reasons why the 33 percent that some of my 
colleagues are suggesting is--it is just too much. I mean, this 
is literally an example of here is a pot of money. Is it going 
to go to sick Marines and their families or is it going to go 
to trial lawyers? Okay, I can see how trial lawyers can be 
helpful on some of this, but not at 33 percent.
    We were just on the phone with some DOJ folks, who, by the 
way, agree with our bill. I am trying to get Biden DOJ to come 
out officially for that. Some of them think that 17 percent is 
actually too high. But they are already talking about, just 
today we heard that some of these law firms are charging 50 
percent contingency fees. I mean, it is robbery. We all know 
it. Everybody on this Committee knows it. Everybody in the 
Congress knows that it is wrong.
    And here is the problem. The deadline for the Camp Lejeune 
filings is August 2024, so I am being rope-a-doped. We all know 
why. The trial lawyers are going to win, and sick Marines and 
their families are going to lose.
    So anyways, your team has been good on this. There are all 
these arguments--oh, you need good lawyers. I mean, we are 
going to get good lawyers. You are seeing the ads on TV. These 
guys are not doing it out of the goodness of their heart to 
help the Marines. They are doing it to get rich.
    So can I get your commitment, Mr. Secretary, just in the 
next week or so to sit down with us, saying, hey, here is where 
we are, we support the Sullivan bill, it is reasonable, he has 
compromised up, the American Legion wants it, the VFW wants it. 
It is one of their top priorities. And the more we delay--and 
by the way, you guys wanted it when we were working on the PACT 
Act. It just got blocked by some of my colleagues here, for 
reasons we all know about.
    So any thoughts on that now? We talked about it in Alaska. 
I care deeply about it, because it is just wrong. We all known 
it is wrong.
    Secretary McDonough. Like I know what a priority this is 
for you, and----
    Senator Sullivan. But it is for the Marines and their 
families, and the VFW and the American Legion.
    Secretary McDonough [continuing]. And I am not disputing 
that.
    Senator Sullivan. For all veterans.
    Secretary McDonough. I am not disputing that either.
    Let me say two things. One, and you know this because you 
used to work downtown too, on the other side, it is hard for me 
to get in the lane of DOJ and DoD on their requirements. But I 
will say this. So this question of the right number and whether 
or not there are caps, that is not really our thing. But I can 
tell you that we use caps.
    Senator Sullivan. Every law uses caps. The Federal Claims 
Torts Act uses caps.
    Secretary McDonough. So----
    Senator Sullivan. This is one of the few that has no caps. 
I think it is almost exclusively one of the few, and it is 
just----
    Secretary McDonough. So, I mean, I think you understand the 
spot I am in, which is my interagency partners--the DOJ, the 
lead, it is a DoD account and I want to make sure that I am 
doing my part by them.
    Senator Sullivan. DOJ, I think, is very for caps.
    Secretary McDonough. Yes. Well, again, you know----
    Senator Sullivan. Well, how would you recommend we try to 
resolve this, because you guys obviously play a role because it 
is veterans. It is the Department of the Navy, as you 
mentioned, so it is DoD.
    By the way, even the numbers we have from the Department of 
the Navy, just talking to them today, almost none of these are 
going through the adjudication with the Navy. They are going to 
trial. And the reason they are going to trial is average claim 
is $10 million. Okay, so one of the arguments of Senator Durbin 
and others, well, you will not get good lawyers if it is a 
small contingency fee. Just do the math of that. If you take 
away $2 million for what is called the health award, health 
care received, out of $10 million that is $8. Seventeen percent 
of $8 million is $1.36 million. That is a pretty good payday 
for a lawyer.
    That is from the Navy today.
    So the Navy wants it. DOJ wants it. I think you guys want 
it. It kind of sickens me that we cannot get progress on this. 
So do you have a suggestion on what we would do, seriously, the 
Congress, the Committee, those three agencies, because this is 
an injustice. The money is going to trial lawyers, 50 percent 
contingency fees. We heard that today. Some of your guys 
testified last fall, you know, it was up to 60 percent. Jeez 
Louise. How greedy can you be?
    Secretary McDonough. So my commitment to you is why don't 
you let me talk to Secretary Austin, or to the Attorney 
General, and to the Secretary of the Navy and let me see if I 
understand precisely what they are doing on this. I want to 
not, in public session, get ahead of them on whatever it is 
that they are doing.
    Senator Sullivan. All right. Okay, Mr. Chairman, it is an 
issue, and Ranking Member. I am just kind of baffled that we 
are letting this linger. And look, I know why some people want 
it to linger, because August 2024 is the deadline, and then it 
is over. Then the trial lawyers win and the Marines get 
screwed. And that is just wrong, totally wrong. Everybody knows 
it. Everybody knows it, and we are not doing a damn thing about 
it.
    You guys are going to rope-a-dope me. You are going to 
rope-a-dope me. You are not rope-a-doping me. You are rope-a-
doping sick Marines and their families. Really, really, really 
makes me mad. And everybody knows it is the wrong thing to do. 
I do not know why we are not more urgent about this, all of us.
    Chairman Tester. Senator Sullivan, you have brought this up 
in many different forums, and I appreciate it. I know you feel 
passionate about it. But I want to give you a little history so 
you know. I do not know if you were on this Committee when 
Senator Byrd served in leadership on this Committee, but he is 
the one that started the Camp Lejeune. Senator Tillis took that 
up, that bill, along with Senator Blumenthal. And it was 
debated many, many times. And it was introduced, and we put it 
into the PACT Act.
    Senator Sullivan. With no contingencies. With no caps.
    Chairman Tester. The fact----
    Senator Sullivan. We wanted caps, Mr. Chairman.
    Chairman Tester. No, no, no.
    Senator Sullivan [continuing]. And your side----
    Chairman Tester. Let me tell you----
    Senator Sullivan [continuing]. Fought the caps.
    Chairman Tester.--I was in nearly every one of these 
hearings, and I did not hear anything----
    Senator Sullivan. I know the truth.
    Chairman Tester.--About caps, and I was at every one of the 
hearings. Let us be clear.
    Senator Sullivan. Yes, I know the truth.
    Chairman Tester. Okay?
    Senator Sullivan. Then why do you not----
    Chairman Tester. Let us be clear.
    Senator Sullivan [continuing]. Why do you not agree to my 
17 percent bill right now?
    Chairman Tester. Because it is my bill or the highway. 
Senator Durbin also has a bill that is supported by VFW.
    Senator Sullivan. I moved up from 10 percent to 17 percent.
    Chairman Tester. Senator Durbin also has a bill----
    Senator Sullivan. You commit to me to work with me to get 
caps----
    Chairman Tester. And I am all about reasonable fees. But I 
will also tell you something else I am about. I am about 
choice, and I do not want the Federal Government telling me who 
I am going to hire for an attorney. And I do not think we 
should be telling Marines that----
    Senator Sullivan. Do not give me that----
    Chairman Tester.--And trust me, you know that is exactly 
the case.
    Senator Sullivan. That is baloney.
    Chairman Tester. You know that is exactly the case.
    Senator Sullivan. Do not give me that. You have no idea 
what you are talking about. Every Federal law----
    Chairman Tester. No, don't, don't, don't----
    Senator Sullivan [continuing]. Every----
    Chairman Tester.--Give me the high and mighty crap.
    Senator Sullivan. I am giving you high and mighty----
    Chairman Tester. No.
    Senator Sullivan [continuing]. Because I am doing the right 
thing for the Marines.
    Chairman Tester. And I want to do the right thing by the 
Marines too.
    Senator Sullivan. Then you should do it.
    Chairman Tester. But you know this is a place of 
compromise.
    Senator Sullivan. I moved from 10 percent to 17 percent 
already. That is called compromise.
    Chairman Tester. We continue to have this conversation.
    Senator Sullivan. Right now you guys--right now you guys 
are going to rope-a-dope this so the deadline happens, and 
there are no caps.
    Chairman Tester. Let's be honest.
    Senator Sullivan. Do you think having no caps----
    Chairman Tester. We could have caps tomorrow if you would 
come to the table.
    Senator Sullivan. That is ridiculous. I have been working 
this----
    Chairman Tester. We are going to move on----
    Senator Sullivan [continuing]. Do not give me that, Mr. 
Chairman. You know what?
    Chairman Tester. We are going to move on.
    Senator Sullivan. As the Chairman of the Veterans' Affairs 
Committee, this is a dereliction of duty on your part, right 
now.
    Chairman Tester. I love----
    Senator Sullivan. It burns me up.
    Chairman Tester.--I love your claims, but back them up with 
facts.
    Senator Sullivan. Yes. I have all the facts in the world.
    Chairman Tester. You make them up.
    Senator Sullivan. You guys made sure there were no caps. 
That is what happened.
    Chairman Tester. That is total baloney.
    Senator Sullivan. Then agree to my bill.
    Chairman Tester. Total baloney. And there are bills out 
there supported by the VSOs that will get caps.
    Senator Sullivan. The VSOs support my bill.
    Chairman Tester. VSOs support Durbin's bill too. And by the 
way, this is an issue that needs to be taken up by Durbin's 
Committee.
    Senator Sullivan. It is the jurisdiction of this Committee.
    Chairman Tester. No, it is not. It is a jurisdiction----
    Senator Sullivan. Where did the Camp Lejeune Act come from?
    Chairman Tester. It came from here.
    Senator Sullivan. Right.
    Chairman Tester. But when you are talking about legal 
issues it automatically goes----
    Senator Sullivan. Come on, Mr. Chairman. You are stumbling 
over your words.
    Chairman Tester. No, I am not.
    Senator Sullivan. You need to fix this.
    Chairman Tester. And it is fixable.
    Senator Sullivan. And when the VSOs were--the American 
Legion, and when all the veterans were here in front of this 
Committee, 500, and I asked you to work with this with me, and 
they all cheered. They want it. They support my bill.
    Chairman Tester. And they support Durbin's bill too.
    Senator Sullivan. Why would they support----
    Chairman Tester. That one does not count?
    Senator Sullivan [continuing]. Why would they support a 
bill that takes 20 percent more of a chunk out of their----
    Chairman Tester. That one does not count?
    Senator Sullivan [continuing]. Award, that they have 
earned?
    Chairman Tester. They do.
    Senator Sullivan. Well, I wish you would commit right now 
to work with me on this.
    Chairman Tester. It is pretty hard to work with somebody 
who wants to make a political issue out of something we can 
fix.
    Senator Sullivan. I am not making a political issue at all. 
All I have been trying to do is put caps on awards, which is 
what every Federal bill in the country, that we pass, has. I 
think this is one of the few that has no caps.
    Chairman Tester. And that can happen. It can happen.
    Senator Sullivan. All right. I am ready to work.
    Chairman Tester. You do not want it to happen.
    Senator Sullivan. Thank you.
    Chairman Tester. Thank you, Secretary McDonough. We 
appreciate your testimony. We appreciate your answers. I would 
ask there will be other questions by Members of the Committee. 
Make sure you respond to them in a timely manner.
    That concludes our first panel, and we will start with the 
second panel now. Interestingly enough, on the second panel we 
are going to hear from VSOs. Each year, the Independent Budget 
offers an informed perspective on the VA needs in order to live 
up to the promises we made those who served our Nation. I have 
said many times that Congress needs to take its cues from the 
veterans, and we do, and I look forward to hearing your 
thoughts on this year's budget proposal.
    First, I want to introduce Morgan Brown, National 
Legislative Director of PVA, Paralyzed Veterans of America. I 
also have Shane Liermann, Deputy National Legislative Director 
of Disabled American Veterans. Last, we have Patrick Murray, 
Director of the National Legislative Services of VFW, Veterans 
of Foreign Wars. They are going to provide, as I said in my 
opening statement, one joint statement on behalf of one.
    Before you begin, gentlemen, though, I want to say that we 
have a nomination hearing coming up on a Deputy Secretary for 
the VA, Tonya Bradsher. That hearing is going to be held on May 
31st at 3 p.m. I would just encourage all of the Members of 
this Committee to meet with her and visit with her and find out 
what she is made of.
    With that I turn over the floor to you three gentlemen, and 
whoever wants to start, can.

                            PANEL II

                              ----------                              


                   STATEMENT OF MORGAN BROWN

    Mr. Brown. Chairman Tester, Ranking Member Moran, and 
Members of the Committee, on behalf of the Independent Budget 
Veterans Service Organizations--DAV, PVA, and VFW--I want to 
thank you for the opportunity to offer our comments on VA's 
budget request for fiscal year 2024 and advanced appropriations 
for fiscal year 2025.
    Our recommendation of nearly $140 billion for medical care 
spending in fiscal year 2024, and $157 billion of advanced 
appropriations for fiscal year 2025, represents our best 
estimates of the funding VA needs to fully and timely deliver 
all authorized programs, services, and benefits to America's 
veterans.
    We were encouraged by the Administration's proposed budget 
for the VA and believe much of it accurately reflects the 
rising need for health care and benefits by those who have 
served, their families, caregivers, and survivors. However, it 
missed the mark in a few areas.
    For example, VA's Medical and Prosthetic Research Program 
generates discoveries that significantly contribute to 
improving the health of veterans and all Americans. The 
Administration requested $938 million in fiscal year 2024, 
compared to the $980 million recommended by the IB.
    As you know, the VA health care system has faced 
significant challenges and undergone historic reforms in recent 
years to improve veterans' access to timely and high-quality 
health care. While VA has received increased funding levels to 
support the veterans health care system and an increasing 
number of veterans are seeking VA care, the lack of resources 
for adequate staffing and facility improvements are adversely 
impacting accessibility to care and benefits and must be 
addressed.
    We urge Congress to honor the promise made to the men and 
women who served our country by continuing your longstanding, 
bipartisan support of those who have borne the battle.
    This concludes our remarks on health care. Mr. Liermann, 
from DAV, will now discuss benefits programs.

    [The joint statement of the Independent Budget appears on 
page 72 of the Appendix.]

                  STATEMENT OF SHANE LIERMANN

    Mr. Liermann. Thank you. The IB VSOs recommend 
approximately $4.1 billion for VBA's operation, an increase of 
roughly $406 million over the current appropriations level. 
This includes an additional $100 million for overtime. In 
fiscal year 2022, VBA completed over 1.7 million rating 
decisions, done with mandatory overtime. VBA has already 
completed 1.1 million decisions in this fiscal year. This $100 
million in overtime will greatly enhance VBA's production to 
address the increase in claims due to the PACT Act, the 
existing pending claims, and drive down the backlog.
    Mr. Chairman, within VA call centers there are 
approximately 1,600 employees. It is estimated that one VA 
claim generates eight separate contacts to VA call centers. As 
of May 6th, there are over 800,000 pending claims, and VA is 
predicting over 1 million new claims, which means that VA could 
receive over 8 million phone calls to the call centers, which 
would significantly strain the existing workforce. Therefore, 
we are recommending $50 million for an additional 400 VA call 
center employees.
    In reference to the Board of Veterans Appeals, we recommend 
approximately $325 million, an increase roughly of $40 million. 
In fiscal year 2022, the Board scheduled over 56,000 hearings, 
but held only a little over 30,000 hearings. At the beginning 
of this fiscal year, the Board had over 75,000 hearings 
pending. We recommend an additional 20 veterans law judges and 
an additional 200 FTE and other positions to assist in driving 
down the backlog. The estimated cost is approximately $20 
million.
    Thank you. This concludes my remarks, and I turn to VFW's 
Pat Murray.

                  STATEMENT OF PATRICK MURRAY

    Mr. Murray. Mr. Chairman, although the asset and 
infrastructure review process broke down and stalled last year, 
due in part to concerns about assumptions and market 
assessments, many of VA's recommendations for expansion and 
construction of new health care facilities, as well as repairs 
and maintenance of existing ones, were widely supported and 
merit funding.
    VA capital infrastructure's backlog of projects continues 
to grow faster than VA can address them. Neither VA's Office of 
Construction and Facilities Management nor the individual VA 
facilities have the staff to oversee the amount of work 
necessary to decrease the backlog. Investing in the oversight 
and completion of these critical projects will save VA money in 
the long term and potentially save lives if done correctly.
    VA must hire additional FTE to oversee infrastructure 
projects. Adding personnel to an Office of Strategic Planning 
and increasing the personnel at individual major facilities to 
oversee local projects is critical to decreasing this backlog.
    As stated in previous hearings, VA has an infrastructure 
backlog of $105 to $129 billion. VA should be requesting at 
least $10 to $13 billion annually to address this. If we keep 
underfunding VA infrastructure beneath the necessary amounts, 
in 5 years we will be talking about the $120 to $150 billion 
backlog in projects.
    The details in the SCIP list outline the true need for the 
infrastructure work at VA, but VA's request does not match the 
real need. It is only a fraction of the total amount necessary. 
We urge this Committee and the Appropriations Committee to look 
at the actual need for infrastructure and provide VA the 
resources they need instead of what they are asking for.
    Chairman Tester, Ranking Member Moran, I thank you for the 
opportunity for the authors of the Independent Budget to 
provide our remarks on these important topics. We are prepared 
to answer any questions that you may have.
    Chairman Tester. I appreciate all three of testimonies. 
Thank you very much for being here. I am going to start with 
you, Mr. Brown.
    Last month, we tried to do a package of bills to do right 
by veterans, call the Elizabeth Dole Veterans Program 
Improvement Act of 2023. These were five bills that were 
introduced in this Committee that we combined. They were sent 
out of Committee in February unanimously. However, many of my 
colleagues blocked it from advancing and becoming law.
    What this bill did, as you well know, I believe, is it 
improved home care options for veterans, which basically would 
save money in the long run, and improve quality of life. It 
would direct VA to study the use of medicinal cannabis for 
treating the invisible wounds of war. That does not mean the VA 
was out growing cannabis. They would actually be interviewing 
veterans and finding out the impact that cannabis has on them. 
And it would help Native Americans and Alaska veterans achieve 
ownership of homes.
    I know that PVA was a supporter of this legislation. Mr. 
Brown, can you just tell us what further delayed passage of 
this bill means for the folks who are part of your 
organization?
    Mr. Brown. Certainly, Mr. Chairman. The Members of this 
Committee well know that the number of veterans that are going 
to be needing long-term care is expected to significantly 
increase over the next decade, and it is important that VA 
implements policies now to ensure that these veterans can 
safely age at home and remain active participants in their 
communities.
    Unfortunately, VA and home and community-based services are 
not offered at all VA health care facilities, even though they 
are desperately needed. The Elizabeth Dole Veterans Programs 
Improvement Act would have ensured programs like veterans 
directed care, homemaker home health, and home-based primary 
care are available at all VA medical centers, giving greater 
number of veterans, catastrophically disabled veterans, the 
ability to receive care in their homes, which is where they 
would prefer to receive it.
    It also instructs VA to test a program that would provide 
home health aides for veterans residing in communities where 
there is a shortage of home health aides, and as you know, the 
shortage of home health aides is severely impeding access for 
veterans as well as many aging Americans to receive needed home 
care. The IB VSOs have been very supportive of efforts like 
this to help curb the effects of these shortages and bolster 
the direct care workforce.
    And although it was not included in the Elizabeth Dole 
Improvement Act, we appreciate your and the Ranking Member's 
commitment to finding a way to raise the cap on the amount that 
VA can pay for the cost of home care. This provision, in 
particular, is extremely important to the few hundred veterans 
whose care of their service-connected conditions exceeds the 
cap, and therefore they must pay out of their pocket, rely on 
Medicaid, or be placed in an institutional setting.
    Chairman Tester. Okay. This question is for all three of 
you, and I will try to make it very quick, and you guys be 
quick on your answers.
    As you know, the Veterans Employment and Training Service 
at the Department of Labor handles the transition, employment, 
and homeless veterans programs. This includes TAP classes, 
Homeless Veteran Reintegration Program. Labor has indicated 
that budget cuts would affect all these programs and lead to 
reduced services for our veterans. I am particularly concerned 
about cutting services to our homeless veterans, who need help 
from the Department to be able to find living-wage jobs.
    So please tell us about the real-world effects of cutting 
DOL's Veteran Services, and if a return to fiscal year 2022 
levels of funding would hurt homeless, jobless, transitioning 
veterans.
    You can start again, Morgan.
    Mr. Liermann. Thank you, Mr. Chairman. This is going to 
have a huge impact on DOL for a lot of reasons, but 
specifically it is going to hurt their Homeless Veteran 
Reintegration Program through the Department of Labor and for 
veterans. It is estimated that it is going to basically take 
away that potential for up to 5,000 homeless veterans for job 
training, for additional skills, even those homeless and those 
at risk.
    We are also concerned that it could potentially even have 
some overlap and some problems with the DOL and with TAP, 
specifically, which will impact hundreds of thousands of 
veterans being separated from service.
    Chairman Tester. Okay. Would anybody like to add to that?
    Mr. Brown. I can add just a little bit, if I may. The VA's 
annual suicide report noted that the largest cohort of veterans 
dying by suicide are those that are age 18 to 24, and it is 
important to remember that DOL VETS is one of the few agencies 
that engages with this particular group of veterans, either 
through the TAP program or through employment services. So many 
of these positions have already been impacted by reduced 
budgeting, and cutting them even further could be detrimental 
to the lives of these veterans.
    Chairman Tester. One final question. Pat, you got to hear 
the conversation between Senator Sullivan and myself about two 
bills, one that he has and one that Senator Durbin has. On 
caps, could you let us know, but I think your organization 
supports both bills? Could you let us know your thoughts?
    Mr. Murray. We do, Senator Tester. We support putting 
reasonable caps on any bills that affect Camp Lejeune Justice 
Act. It is similar to our concern about unaccredited claims 
assistance taking exorbitant amounts of money from veterans. We 
want to see reasonable caps put in place. We hope that our 
supporters in the House and Senate will come to a good 
compromise to make sure that veterans, and specifically in this 
case, those Marines from years ago, are taken care of.
    Chairman Tester. Thank you. Senator Moran.
    Senator Moran. Chairman, thank you. One of the things I 
think about the PACT Act that I appreciate is its attempt at 
trying to provide some fairness to veterans who separated from 
service more than 10 years ago--within the last 10 years. 
Excuse me. And what is your view of how well the Department is 
conducting the outreach necessary to get those and really other 
veterans? Do we need to be focused on encouraging, insisting, 
reviewing, asking questions of the VA about that effort?
    Mr. Liermann. I will go ahead and take that one real quick, 
Senator. For 25 years I have been a DAV accredited benefits 
advocate. I have seen all of the different programs that have 
come into effect over the last 25 years. And I would have to 
say, unequivocally, I have never seen an outreach campaign like 
the VA is doing now with the PACT Act ever before in my career, 
never with when they added additional benefits for Vietnam 
veterans, not when they made changes in the late '90s, not even 
in the 2000s.
    So I think it is impressive of what they have already done, 
and I think that they can do more, but specifically, they have 
already conducted 1,560 PACT Act awareness events around the 
country. I have attended several myself. I think VA has been 
more collaborative with the VSO community in a lot of these 
events and conversations than I have seen in any other programs 
since the Appeals Modernization Act.
    Senator Moran. Shane, Mr. Liermann, I am happy when I hear 
compliments that good things are happening. It is not that I am 
looking for an answer that says they are failing.
    Does anybody else need to comment on that arena? Okay.
    One of the problems that we are experiencing--I understand 
it is a budgetary issue; it is one that we raised during the 
debate about the PACT Act--is that we created the Toxic 
Exposure Fund, and it has been a bit of a battle from time to 
time in this Committee. But it certainly has been successful in 
setting aside resources. I understand that is important. But it 
has also unintentionally created new mandatory scoring 
implications for VA legislation that previously relied on 
discretionary funding only. We saw that, in fact, in the bill 
we took to the floor that Senator Tester just asked Mr. Brown 
about.
    We need to find a way that gets us in a position in which 
every other bill is not handicapped by the score of CBO 
creating the necessary PAYGO rules to be complied with.
    Any thoughts about, I mean, maybe your answer is that we 
forego PAYGO, not probably a solution that is going to happen 
in these days. But I would suggest that we need some help in 
figuring out how we, without being accused of doing anything 
harmful to the PACT Act, I want to be--not only just not 
accused, not doing anything harmful to the PACT Act--I want to 
find a way in which we can solve this problem so that we can 
move forward with other pieces of legislation that are 
important to other veterans as well. Any thoughts?
    Mr. Murray. Senator Moran, I am very glad you brought up 
first skipping PAYGO. But what we really want to do, we 
received a briefing just last week, I believe it was, from CBO, 
and they talked about some of the, what we believe, some of the 
more outrageous things that they are looking at could come from 
the Toxic Exposure Fund. I believe it was VA police scheduling 
system was one of the more outlandish examples they used. That 
is not what the PACT Act Toxic Exposure Fund was intended for.
    We hope that we can clarify that, that we believe will help 
ease the scoring problem.
    Senator Moran. So your suggestion, PACT Act is that it is 
education of CBO and its scoring information?
    Mr. Murray. I think that would be step one. What was in the 
law is not VA police scheduling system. So some clarification 
on that, I think, would help.
    Senator Moran. Okay. Anybody else?
    I appreciate that answer, and at least the second part of 
your answer, because I think this is really important. It is 
going to be a problem for us, time and time again, if we do not 
get this scoring issue with CBO resolved, and I am pleased that 
the VFW, and perhaps others, are doing some of our work in 
education of the CBO. Thank you.
    Mr. Brown, I wanted to follow up on your point on raising 
the cap for non-institutional extended care services. If you 
want to contradict me, you may, certainly, and I would not be 
offended, but my understanding is that we are working to 
fulfill the commitment that we made to work to find a solution. 
Thirteen billion dollars was the score for that provision. We 
do not think that is accurate, and we are trying, at this 
point, to get information from the Department of Veterans 
Affairs so that we can go back to CBO to get something much 
more, which we believe, realistic than what they are currently 
thinking.
    So we are trying to educate the CBO as well, but to do that 
we need the help from the Department of Veterans Affairs with 
the information and data, the statistics that they have. Am I 
missing anything?
    Mr. Brown. No, sir. It sounds like we are in 100 percent 
agreement on that.
    Senator Moran. Great. Thank you all.
    Chairman Tester. I, too, want to thank you for being here. 
I appreciate what you guys do, how you represent your members, 
and being able to be here. Some of you guys have been caught in 
the back room because you hear it at every hearing, and I 
appreciate that. We make a promise to those who serve our 
country to deliver for them, and if the VA is going to make 
good on that promise, they have to have resources to do so.
    I think that both the Secretary and you gentlemen have 
shared valuable insight as we move forward with the 
appropriations process for 2024. This includes ensuring the VA 
has resources it needs to implement the PACT Act and continue 
to improve care and services for veterans of all eras.
    With that we will keep the record open for a week, and this 
hearing is adjourned.
    [Whereupon, at 4:38 p.m., the hearing was adjourned.]






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