    [Senate Hearing 118-132]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 118-252

                          LEGISLATIVE PRESENTATION OF
                           DISABLED AMERICAN VETERANS

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

                                 JOINT HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS
                                  U.S. SENATE

                                    AND THE

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

                        ONE HUNDRED EIGHTEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 MARCH 7, 2024

                                   __________

          Formatted for the use of the Committee on Veterans' Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

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

                                   __________

                       U.S. GOVERNMENT PUBLISHING OFFICE
    55-119 PDF                  WASHINGTON : 2024

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

                     SENATE COMMITTEE ON VETERANS' AFFAIRS

                         Jon Tester, Montana, Chairman

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

                          Tony McClain, Staff Director
                   David Shearman, Republican Staff Director

                                  ----------

            HOUSE OF REPRESENTATIVES COMMITTEE ON VETERANS' AFFAIRS

                         Mike Bost, Illinois, Chairman

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

                           Jon Clark, Staff Director
                      Matt Reel, Democratic Staff Director

                               C O N T E N T S

                                  ----------

                                 March 7, 2024

                                                                       Page

                                    SENATORS

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

                                REPRESENTATIVES

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

                         INTRODUCTION OF NANCY ESPINOSA

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

                                   WITNESSES

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

      accompanied by

      Barry Jesinoski, National Adjutant

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

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

      Jim Marszalek, DAV National Service Director

      Joy Ilem, DAV National Legislative Director

      John Kleindienst, National Director of Voluntary Service

      Ryan Burgos, National Employment Director

      AnnMarie Hurley, Auxiliary National Commander

                                    APPENDIX
                               Prepared Statement

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

                           Submissions for the Record

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

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

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

                          LEGISLATIVE PRESENTATION OF
                           DISABLED AMERICAN VETERANS

                                  ----------

                            THURSDAY, MARCH 7, 2024

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

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

        Present:

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

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

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

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

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

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

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

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

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

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

                  INTRODUCTION BY THE HON. MITT ROMNEY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

                                A P P E N D I X

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