[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]


                   RESTORING FOCUS: PUTTING VETERANS
                        FIRST IN COMMUNITY CARE

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

                                HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS

                     U.S. HOUSE OF REPRESENTATIVES

                    ONE HUNDRED NINETEENTH CONGRESS

                             FIRST SESSION

                               __________

                      WEDNESDAY, JANUARY 22, 2025

                               __________

                            Serial No. 119-1

                               __________

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


                    Available via http://govinfo.gov
                    
                                __________

                   U.S. GOVERNMENT PUBLISHING OFFICE                    
59-611                     WASHINGTON : 2025                  
          
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                     COMMITTEE ON VETERANS' AFFAIRS

                     MIKE BOST, Illinois, Chairman

AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking 
    American Samoa, Vice-Chairwoman      Member
JACK BERGMAN, Michigan               JULIA BROWNLEY, California
NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK, 
GREGORY F. MURPHY, North Carolina        Florida
DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky
MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois
JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois
KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York
JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon
ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey
KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota
    Mariana Islands
TOM BARRETT, Michigan

                       Jon Clark, Staff Director
                  Matt Reel, Democratic Staff Director

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public 
hearing records of the Committee on Veterans' Affairs are also 
published in electronic form. The printed hearing record remains the 
official version. Because electronic submissions are used to prepare 
both printed and electronic versions of the hearing record, the process 
of converting between various electronic formats may introduce 
unintentional errors or omissions. Such occurrences are inherent in the 
current publication process and should diminish as the process is 
further refined.
                         
                         
                         C  O  N  T  E  N  T  S

                              ----------                              

                      WEDNESDAY, JANUARY 22, 2025

                                                                   Page

                           OPENING STATEMENTS

The Honorable Mike Bost, Chairman................................     1
The Honorable Mark Takano, Ranking Member........................     2

                               WITNESSES

Mr. Paul McKenna, Sergeant Major (Ret.), United States Marine 
  Corps..........................................................     6

Mr. William Dooley, Master Sergeant (Ret.), United States Army...     6

Ms. Lori Willis Locklear, Mother of Navy Veteran Logan Willis....     9

Ms. Brittany Dymond Murray, Associate Director, Veterans of 
  Foreign Wars...................................................    11

Dr. Kelley Saindon, DNP, RN, CHPN, Secretary/Treasurer, Nurses 
  Organization of Veterans Affairs...............................    12

                                APPENDIX
                    Prepared Statements Of Witnesses

Mr. Paul McKenna Prepared Statement..............................    41
Mr. William Dooley Prepared Statement............................    42
Ms. Lori Willis Locklear Prepared Statement......................    46
Ms. Brittany Dymond Murray Prepared Statement....................    49
Dr. Kelley Saindon, DNP, RN, CHPN Prepared Statement.............    52

                       Statements For The Record

Alzheimer's Association and Alzheimer's Impact Movement Prepared 
  Statement......................................................    55
Mission Roll Call Prepared Statement.............................    58
American Psychological Association, Association of VA 
  Psychologist Leaders, Association of VA Social Workers, 
  National Association of Veterans Affairs Physicians and 
  Dentists, National Association of Veterans' Research and 
  Educational Foundations, Veterans Affairs PA Association, 
  Veterans Healthcare Policy Institute Prepared Statement........    62
The American Legion Prepared Statement...........................    67
American Association of Nurse Anesthesiology Prepared Statement..    70

 
                   RESTORING FOCUS: PUTTING VETERANS
                        FIRST IN COMMUNITY CARE

                              ----------                              


                      WEDNESDAY, JANUARY 22, 2025

                    Committee on Veterans' Affairs,
                             U.S. House of Representatives,
                                                   Washington, D.C.
    The committee met, pursuant to notice, at 1:02 p.m., in 
room 360, Cannon House Office Building, Hon. Mike Bost 
(chairman of the committee) presiding.
    Present: Representatives Bost, Bergman, Mace, Miller-Meeks, 
Murphy, Van Orden, Luttrell, Self, Kiggans, Hamadeh, King-
Hinds, Barrett, Takano, Brownley, Pappas, Cherfilus-McCormick, 
McGarvey, Ramirez, Kennedy, Dexter, Conaway, and Morrison.

            OPENING STATEMENT OF MIKE BOST, CHAIRMAN

    The Chairman. The committee will come to order. Good 
afternoon, everyone. I want to thank you for being here. 
Welcome to the House Committee on Veterans' Affairs' first 
oversight hearing for the 119th Congress.
    Now, before we start, I wanted to recognize and thank my 
colleague and friend Chairwoman Miller-Meeks for her 
leadership. Chairwoman Miller-Meeks originally proposed this 
hearing topic to be held in a subcommittee, but ultimately, I 
decided this is an important enough issue to discuss that 
requires full committee attention. As chairman, I am deeply 
committed to our shared mission of improving the delivery of 
care and services to our Nation's veterans. I look forward to 
working alongside my colleagues on both sides of the aisle to 
fulfill this mission.
    Last Congress, this committee did meaningful work toward 
the mission by passing the Senator Elizabeth Dole 21st Century 
Veterans Healthcare and Benefits Improvement Act. The committee 
also performed critical oversight of the Biden administration 
VA to find where the shortfalls were. Today we turn our focus 
on VA's Community Care Program, which, as we know today, was 
enacted in the VA Maintaining Internal Systems and 
Strengthening Integrated Outside Networks (MISSION) Act. The VA 
MISSION Act passed in 2018 with overwhelming bipartisan 
support. It was a promise to veterans, a promise to ensure they 
would never again face delays and access to the healthcare they 
have earned. It was a solution born from necessity and on the 
shoulders of what was the Veterans Access, Choice and 
Accountability (Choice) Act. It was designed to eliminate 
barriers to care and expand access for veterans nationwide.
    It is not a solution to private--and it is not a solution 
to privatize VA healthcare. Let me say it again, not to 
privatize healthcare, the VA healthcare, anyone who suggests 
otherwise should step outside the Beltway and talk to the 
veterans who live 3 hours from a VA medical center. Community 
care is that veteran's lifeline.
    Healthcare decisions are deeply personal and they should be 
made by veterans themselves. They know where and when and they 
need care to fix their needs. However, under the Biden-Harris 
administration, the program has been hijacked. Biden-Harris 
administration has prioritized bureaucratic limitations and 
control of a community care over veterans' needs. Scheduling 
practices have been manipulated to distort wait times. 
Appointments have been canceled or rescheduled without 
veterans' consent. Internal VA guidance has actively 
discouraged veterans from seeking care outside the VA system. 
That is dead wrong and likely, like everywhere--and like every 
other law that that is enacted, it is not optional and it is 
not a suggestion, it is the law.
    When VA inserts itself as the sole decision-maker and plays 
politics with veterans' health, people get hurt. These actions 
have real-life consequences, and we are going to hear some of 
those consequences today from actual veterans, not bureaucrats.
    Make no mistake, community care is VA care. It is not a 
substitute, but an essential extension of VA's mission to serve 
veterans where and when they need it without delay. With the 
Trump administration in place, we have the opportunity to 
ensure VA adheres to the MISSION Act and returns healthcare 
decisions to the hands of the only authority that matters, the 
veteran.
    Today we will hear from witnesses who have experienced 
these barriers firsthand. Their stories will remind us that the 
decisions made here in Washington have a far-reaching impact on 
the lives of veterans and their families.
    To our veteran--or to our witnesses, first off, thank you 
for the courage and sharing your experiences. Your experiences 
matter and we are here to listen.
    Now with that, I now recognize Ranking Member Takano for 
his opening comments.

        OPENING STATEMENT OF MARK TAKANO, RANKING MEMBER

    Mr. Takano. Well, thank you, Mr. Chairman. Today we will 
hear perspectives from several veterans who have faced barriers 
in trying to access timely and high-quality healthcare from the 
Department of Veterans Affairs.
    I want to say to our witnesses that I am truly anguished by 
the unacceptable delays to you and your veteran loved ones. I 
am anguished by what they have faced and what you have faced in 
getting the care that you and they need. Your experiences are 
deeply troubling and I have many questions about how things 
went wrong. Unfortunately, I am afraid that today's hearing 
will not help the committee get sufficient answers to those 
questions and it will not enable us to hold those responsible 
accountable. That is because the majority has opted not to 
invite any witnesses from VA or the two third-party 
administrators of its Community Care Program.
    They also opted not to include witnesses from agencies like 
VA's Office of Inspector General or the U.S. Government 
Accountability Office, who could provide us with objective, 
fact-based information about how and why veterans experience 
delays in accessing healthcare. This hearing was hastily 
organized just hours after our committee organizing meeting 
last Thursday. We have six members who are new to this 
committee, to Congress, three of whom are physicians and 
understand better than anyone the importance of proper care 
coordination and the risks of delayed care.
    Mr. Chairman, today's VA community care oversight hearing 
is the first, the first, that you have convened since becoming 
chairman more than 2 years ago. More than 40 percent of 
veterans' care is now being delivered in the community and VA 
is on track to spend more than $42 billion on private sector 
care this fiscal year. When I was chair of this committee from 
2019 to 2022, the full committee and the Health Subcommittee 
collectively convened six oversight hearings that examined the 
timeliness of veterans' access to healthcare and payments to 
community providers, as well as VA's initial implementation of 
the MISSION Act.
    I am explaining all this because what I am about to say may 
shock members, veterans, and other stakeholders watching today. 
Last Thursday, we were informed that this one panel hearing 
will be the only full committee oversight hearing on community 
care before we advance major legislation on the subject and 
that we had to content ourselves with two closed-door committee 
staff-only meetings with stakeholders.
    However, since the committee had not formally organized at 
the time these meetings occurred, no members of their staff 
were present. Moreover, because these meetings were held behind 
closed doors, there is no public record of what was discussed.
    The minority is only permitted to invite one witness to a 
hearing and given that the current transition in Presidential 
administration presents challenges with inviting government 
officials to testify, so I asked the majority to invite Optum 
Serve Federal Health Services, one of the third-party 
administrators for VA's Community Care Program. Optum is a 
subsidiary of UnitedHealth Group and has contracted with VA 
since 2019 to establish networks of community providers and 
process payments to those providers. UnitedHealthcare also 
holds a contract with VA to conduct medical disability 
examinations, the exams veterans receive when they are applying 
for VA disability benefits.
    Today, UnitedHealthcare's VA contracts are worth more than 
$72 billion. That is billion with a B. Worse, that money is not 
all spent on providing care to veterans. A considerable amount 
is going to administrative overhead. Imagine how many new 
hospitals and clinics VA could build and how many clinical 
staff that VA could hire with that amount of money. However, 
UnitedHealthcare declined the invitation declined the 
invitation to testify, citing the lack of sufficient time to 
prepare for the hearing. Now, I do not know about you, but I do 
not have much sympathy for a company that is receiving tens of 
billions of taxpayer dollars complaining that they need more 
advance notice to appear at a hearing. The chairman's staff, 
however, apparently do sympathize because they accepted 
UnitedHealthcare's excuse.
    Now that brings me to Dr. Saindon, who is appearing today 
as the minority's witness. She serves on the Board of Directors 
of the Nurses Organization of Veterans Affairs, otherwise known 
as NOVA. NOVA is a nonprofit professional association whose 
mission is to educate, communicate, and advocate for VA nurses. 
NOVA is not a part of VA nor is a union. NOVA managed to do 
what UnitedHealthcare could not: arrange to get Dr. Saindon to 
D.C. to testify with less than 2 business days' notice. I want 
to thank Dr. Saindon for being here today.
    Now, I know we will not get answers to all our questions in 
this single hearing. Veteran stories are an important part of 
oversight and I thank our witnesses again for their bravery and 
candor in participating in today's hearing. However, oversight 
is not complete without accountability, and there are no 
accountable individuals here today. No accountable individuals 
are appearing before us today.
    I want to be clear that I recognize the importance of 
community care. However, I also do believe any further 
expansion of community care must be met with similar 
investments in VA direct care. The two systems should be 
complementary, in balance with one another to ensure veterans 
can access the best, most timely, culturally competent care.
    That is what is not happening right now. Community care has 
expanded at the expense of VA direct care. If we continue down 
this path, VA will crumble. This is where I draw the hard line. 
Our veterans cannot afford for us to dismantle VA direct care 
in favor of shifting more care to the community nor, by all 
accounts, do they want us to. Rushing to pass this legislation 
without sufficient oversight and diligent efforts to uncover 
the root cause of problems is a recipe for disaster.
    For example, in 2014, after news of ``secret VA waiting 
lists'' broke, Congress acted quickly to create the Veterans 
Choice Program, a temporary program that allowed veterans to 
receive community care when they faced long wait times or 
lengthy travel distances. We went from bill to law in the 
course of 3 months. As we found out over nearly 4 years, over 
the 3 or 4 years that followed, the Choice Program actually 
resulted in longer wait times, confusion about payments, and 
administrative headaches for veterans and staff at VA.
    Then in 2018, Congress passed the MISSION Act, further 
expanding community care eligibility. Yet here we are today, 
with veterans and VA staff facing many of those same issues 
with access, care coordination, and transparency. All the 
while, VA has been rolling out more policies and contract 
modifications altering the administration of the Community Care 
Program. How can we address the effect of these administrative 
changes if we are not conducting proper oversight?
    This committee also needs to conduct more oversight of the 
quality of care veterans are receiving in the community. As we 
will hear from many of the witnesses today, simply getting a 
referral to the community is only the first step. We must also 
ensure that these referrals are actually leading to veterans 
receiving high-quality care.
    Furthermore, we need to ensure that we are being good 
stewards of taxpayer dollars, as our majority so often reminds 
us. Care provided in the community is often--often comes at a 
higher price tag and can be less efficient and less effective 
than care that VA can provide directly.
    We must also consider the long-term future of VA, which 
serves not only our veterans, but all Americans, through its 
role in providing world-class and groundbreaking medical 
research, its Fourth Mission emergency preparedness mandate, as 
well as providing residency and fellowship training for more 
than 70 percent of all U.S. healthcare providers at some point 
in their careers. As a committee, we must candidly assess the 
long-term and far-reaching consequences of undermining the VA 
direct care system in favor of prioritizing private healthcare 
profits.
    With that, I yield back.
    The Chairman. I thank the ranking member for his testimony. 
Let me tell you that this is the first of many hearings focused 
on community care. We are in our very first hearing. That gives 
us a golden opportunity for a lot of them. This hearing is 
solely focused on the hearing the veterans stories so that we 
can work on this.
    Let me explain this to you. The VA, and I have said it so 
many times, the VA was created not for the VA, not for the 
bureaucracy, but providing for the veterans. In this hearing, 
we decided we want to hear from the veterans.
    As my position as chair, let me say this again, it is not 
the majority's position to privatize the VA, but to make sure 
the VA delivers to our veterans at the level that they need to 
have their care given to them when and where they need it, with 
less bureaucracy and given in a way so that incident after 
incident after incident does not occur where someone falls 
through the crack for whatever reason, whether it is in the 
community or at the VA.
    With that, we will turn to our witnesses. Testifying before 
us today is Paul McKenna. Say that correctly for me there, 
Sergeant Major.
    Mr. McKenna. Good afternoon, Chairman Bost.
    The Chairman. I am just introducing. I was just trying to 
pronounce it correctly.
    Mr. McKenna. Paul McKenna.
    The Chairman. McKenna, thank you. Now, he is a sergeant 
major of the Marines, traveled from Representative Murphy's 
district in North Carolina. We also have William Dooley, a 20-
year Army veteran, traveling away from Congressman Self's 
district in Texas; Ms. Lori Willis Locklear, a former VA 
employee and mother of a Navy veteran, Logan Willis, traveling 
from Representative Harris' district in North Carolina; Ms. 
Brittany ``Demond,'' ``Diamond''? Just Dymond, there you go. I 
always wonder why they put that out whenever it was just pretty 
well that way. Associated director of Veterans of Foreign Wars 
(VFW); and Dr. Kelley Saindon, secretary/treasurer of the 
Nurses Organization of Veterans Affairs.
    Will the witnesses please stand and raise their right hand?
    [Witnesses sworn.]
    The Chairman. Thank you and let the record reflect--you may 
say thank you and let the record reflect that the witnesses 
answered in the affirmative.
    I now recognize Sergeant Major McKenna for the 5 minutes to 
deliver your testimony. Sergeant Major.

                   STATEMENT OF PAUL MCKENNA

    Mr. McKenna. Good afternoon, Chairman Bost. For the record, 
I am retired. Chairman Bost, Ranking Member Takano, and members 
of the House Committee on Veterans' Affairs, thank you for 
inviting me to testify for the record of today's hearing on 
veterans' experiences using the Department of Veterans Affairs' 
Community Care Network. I am here today as a voice for 
countless veterans in Eastern North Carolina who continue to 
struggle to effectively and efficiently utilize the critical 
part of the VA's healthcare system.
    As the committee is aware, the VA MISSION Act became law in 
2018 and was intended to improve access to healthcare for 
veterans. My aim today is to illustrate the gaps and seams 
within the pillars of this legislation that are present in 
Eastern North Carolina, with specific attention on access to 
care, the Community Care Network, and the education and 
training of the VA workforce that coordinates access to care in 
the community. My hope is that my testimony will offer the 
committee some insight to the real challenges that veterans 
face when using the Community Care Network in Eastern North 
Carolina.
    Additionally, and what may sound anecdotal, is to share 
with you my experiences with using the services of the VA 
Community Care Network in two different geographical locations, 
and the experiences of many veterans I have talked to who must 
utilize community-based services.
    My name is Paul McKenna. I retired in 2021 after 36 years 
of active duty service in the United States Marine Corps. I 
have learned many lessons, life lessons, from my nearly four 
decades of service as a U.S. Marine, and at the very top of 
that list is that no American can afford to be disinterested in 
any part of their government: county, city, state or nation.
    One of the great lessons the Marine Corps taught me was to 
never take for granted of being in the presence of other 
Marines and their greatness. For 36 years I walked amongst 
giants. I will forever cherish those relationships, especially 
the relationships of those American heroes that never came 
home. I truly hope that my actions and words today bring honor 
to their memory and their sacrifice.

    [The Prepared Statement Of Paul McKenna Appears In The 
Appendix]

    The Chairman. Thank you, Mr. McKenna.
    Mr. Dooley, you are recognized for 5 minutes.

                  STATEMENT OF WILLIAM DOOLEY

    Mr. Dooley. Thank you, Chairman Bost, Ranking Member 
Takano, for inviting me to testify on my frustrating experience 
with VA Community Care, specifically Dallas, Texas Veterans 
Affairs Medical Center. I sit here today as a veteran, father, 
husband, and cancer patient. I apologize for my appearance, any 
speech deficiencies that I may have while reading my statement. 
I finished my final chemo treatment a week ago and I am still 
having several single--several side effects.
    I will start from the beginning of my cancer journey. In 
September 2023, I voiced my concerns for symptoms while at a 
regular scheduled doctor's appointment. In November 2023, I 
voiced my concerns again by scheduling a doctor's appointment 
for these same symptoms in Bonham, Texas. I completed a sample 
submission for the doctor and he ordered a colonoscopy. I was 
told by the scheduling that they were backlogged and community 
care would be my best route to get care.
    I was referred to Community Care in December 2023. I was 
matched with the Community Care provider, Jenny Sang, at the 
time. My Community Care provider informed me that May 20th, 
2024, was her first available for the colonoscopy. I was 
scheduled for a colonoscopy 9 months after I voiced my concerns 
with my primary physician and 5 months after being referred to 
Community Care program.
    On May 20th, I received the colonoscopy and woke up with 
the dreaded words: you have cancer and need surgery 
immediately. Multiple phone calls from myself and my wife to 
the Veterans Affairs resulted in almost no movement forward. I 
was told it will be September before I would receive the cancer 
testing required prior to surgery. I was told I had cancer and 
the best they could do was get me tested in 4 months. This was 
not acceptable. Community Care was my best option to survive.
    We scheduled my first appointment with University of Texas 
(UT) Southwestern Oncology. With assistance from UT 
Southwestern, we were able to get scheduling for all required 
tests set up the following week, not 4 months. Community Care 
was no assistance and we used our personal insurance for the 
doctor visit. We eventually received referral and approval from 
the required testing and received approval for cancer treatment 
at UT Southwestern. This was only after reaching out for 
assistance from Representative Self's office.
    Unfortunately, after the testing was conducted, it was 
revealed that I did not have stage 1 cancer and, due to too 
many--too much time passing for the original colonoscopy, I was 
currently stage 3 cancer and my lymph node system had been 
compromised. At this point I was informed by the oncologist 
that surgery first was not an option and that a very aggressive 
chemotherapy and radiation treatment was my best option for 
survivability. The treatment would consist of eight rounds and 
two types of chemotherapy and five rounds of concentrated 
radiation. Followed by successful treatment, I would be 
evaluated to determine the level of surgery required.
    I was informed in August after receiving several bills that 
the treatment I received was not covered. This was due to the 
referral for cancer treatment not including chemotherapy or 
radiation. I was informed that of this unit because the billing 
was rejected only. Once again, we reached out to Representative 
Self's office for assistance. I do not believe we would have 
received this approval without the assistance from his office.
    Three major problems I encountered during this process. 
First, the Community Care Program does not communicate directly 
with the provider other than the original scheduling. This 
leads to confusion for the veteran, Adds possibility of poor 
case management and the treatment for the veteran. In my case, 
the Community Care worker could have assisted by contacting me 
and letting me know if 5 months wait was the only option or if 
other care providers had availability sooner.
    Second, the approval of one of the procedures but not the 
others that is known to be required together. Cancer treatments 
for us nondoctors usually comes in three forms and in most 
times all three are used: surgery, chemotherapy, and radiation. 
Why is it standard procedure to approve surgery but not the 
other two? It is very confusing to need three separate 
referrals for the same treatment plan. It adds to the confusion 
for billing and for referral management, especially when all 
three have different expiration dates. At no point did my 
caseworker have direct contact with the provider to discuss the 
issue and how to resolve it. Any attempt to call my caseworker 
and facilitate a three-way call resulted in leaving a message 
and waiting for a call back. This was due to my caseworker 
being a remote employee and not being provided a direct phone 
number to her.
    Third is a lack of professionalism and compassion from the 
VA employees. From the beginning of this journey we have been 
sighed at, told to wait, told to be--treated with disdain by 
the employees we encountered. I was treated like I was asking 
for charity and not treated as a disabled veteran that was 
trying to receive life-saving treatment. Case management 
displays some of the worst incompetence I have seen in decades. 
One of the most--on one of the occasions the response that I 
received from the VA was intertwined with mistruths and blatant 
lies about timeline and what happened. This was very 
concerning.
    At no point has anyone taken ownership or conducted an 
assessment of what could have done differently. The response 
was deny, deny, and counter accuse. Accountability for poor 
performance and low proficiency is not a strong point of 
Veterans Affairs.
    All these problems were shown last Friday after my 
submission of my written testimony. On Friday, I received a 
phone call from the Veterans Affairs. It was my primary 
healthcare provider. The message was primary healthcare 
provider asking if I had been scheduled for treatment for the 
two referrals for chemotherapy and radiation. I just found 
finished eight rounds of chemotherapy and five rounds of 
radiation. They would been scheduled over a 5-month period and 
paid for by the VA. My primary care provider had no idea if I 
would even started chemo or radiation, and still does not 
today. This shows the direct breakdown in any communication 
between Community Care, my primary doctor, and a Community Care 
provider.
    A lot of these questions and concerns could easily be fixed 
if someone cared enough to do their job as a case manager. The 
upper level bureaucracy and lack of accountability for poor 
performance in the Veterans Affairs has become just as much as 
a cancer as what courses through my body today. I can work on 
fixing my personal health, but I am asking you to work on 
fixing the Veterans Affairs because it is unhealthy and full of 
cancer.
    I appreciate the time and opportunity to share my story. 
More detailed information with names and dates has been 
provided in my official written statement. I look forward to 
any questions you may have at this time.

    [The Prepared Statement Of William Dooley Appears In The 
Appendix]

    The Chairman. Thank you, Mr. Dooley.
    Ms. Willis Locklear, you are recognized for 5 minutes.

               STATEMENT OF LORI WILLIS LOCKLEAR

    Ms. Locklear. Hello, Chairman Bost and Ranking Member 
Takano and the House of Representatives' Committee on Veterans 
Affairs. My name is Lori Willis Locklear.
    First, I want to thank God for getting us here. Thank you 
for the opportunity to speak on behalf of my son, Logan F. 
Willis, who served in the United States Navy from August 2017 
until December 2018. Logan was our only child and his dad, 
Raymond F. Willis, was an Army veteran. I was a VA employee for 
12 years. Logan spent his summers volunteering at the VA. His 
father passed away in 2015 from lung cancer. It was very 
difficult on us both. He graduated from high school in 2014 and 
the University of North Carolina at Pembroke in 2016.
    Logan wanted to further his education, so he enlisted. His 
first duty station was Sasebo, Japan, aboard the United States 
Ship (USS) Wasp. It was during that time that Logan's mental 
health began to decline and he attempted suicide multiple times 
on the ship and later in San Diego.
    Logan received an honorable discharge on December 31, 2018, 
and returned home. I noticed many changes in Logan's demeanor 
and behavior. He was not the same person. As a VA employee, I 
directed Logan to seek help from the VA, but was told, we 
cannot help you. At this point, he developed a distrust for the 
VA system. Logan was so distraught with the lack of support he 
had received at the VA one day I came home and Logan had packed 
up all his belongings and left. Later, he stated he could no 
longer live in a place where he felt unsupported. The saddest 
part for me as a mother is that Logan saw me as the VA. 
Unfortunately, Logan could not see that I was working as hard 
as possible to help him. I was the mother of a veteran and an 
employee, but the mother always came first.
    In the fall of 2019, he entered the master's program at 
Wake Forest University. He was still struggling with depression 
and anxiety, but he was focused on earning his degree. He was 
receiving counseling that he paid for himself and his 
medications. As we all know, 2020 was the year of COVID and 
everything shut down. His classes were all online. There were 
times when Logan would not leave his home for weeks. I checked 
on Logan, visited, encouraged him constantly. He became more 
isolated. As a VA employee, I saw a veteran who was in trouble 
and needed help. With no trust in the system, he would rather 
suffer than seek help. Sadly, we see this so much with too many 
of our veterans who have served their country.
    Logan graduated on May 14, 2022, with a master's degree in 
divinity. After graduation, he was unable to find a job and had 
to move back home. As his mother, I encouraged him to seek the 
services he was eligible for, but, once again, he was 
skeptical, but decided to reach out to the local veterans 
service center for help in June. At the meeting with the 
veterans service officer, he seemed encouraged.
    As a pharmacy technician, I feared that Logan was over 
medicated. On September 1, 2022, I requested a session for 
Logan to speak with our pharmacist so he could ask questions 
about his meds and their side effects. Afterwards, I sent Logan 
to check in and request a mental health provider. He said later 
that he had been given an appointment. However, I learned after 
Logan's death that his appointment was not until 5 months 
later, for February 2023. Logan's mental health issues needed 
immediate help and again was not met. He was met with a broken 
system.
    The Community Care Act, to my knowledge, was not offered. 
Protocol at that time was a veteran request--if a veteran 
requested a mental health provider, they were to be seen or 
sent to Community Care within 20 days. Logan died 63 days 
later. He was never contacted. November came and there was 
still no action in regards to the services Logan had requested, 
to my knowledge. Again, he was disappointed in the VA and, as a 
result, his anxiety and depression increased. As his mother I 
was still working to help find help for my son.
    On November 4th, 2022, my worst nightmare occurred. Logan 
was found in the bathtub at my home by his stepfather with a 
plastic bag over his head and a helium tank with a hose beside 
him. I returned 2 weeks after Logan's burial. I was very 
unstable and not well, but I knew I had to go back to work and 
report a suicide. After doing so, I waited for weeks and I was 
never contacted as an employee or a veteran's family member. It 
was not until February 23rd, I contacted the director to make 
sure she was aware. She stated she did not have knowledge of 
said death.
    I continued to work for as long as I could. I missed most 
of `23 from my job. I was not able to function. I took an early 
retirement. I had to go home. The next year I contacted 
everybody and anybody that would honestly would speak to me. No 
one wanted to talk to me and I was treated like a 
whistleblower. Today I feel like a whistleblower. That is all I 
have to say.

    [The Prepared Statement Of Lori Willis Locklear Appears In 
The Appendix]

    The Chairman. First off, thank you for your testimony. 
Thank you for the three of you. We are going to come back. A 
vote has been called in the House. The committee will stand--
and I hate to do this right in the middle of this, but it is 
what happens here. Okay? This is a very serious subject.
    If the members would please go to the floor, we have two 
votes, and then return as quick as possible. The committee will 
stand in recess at the subject of the call to chair. We expect 
to reconvene about 10 minutes after the last vote has been 
called. Thank you.
    [Recess.]
    The Chairman. The committee will come to order. I do want 
to apologize to our witnesses. It is part of what we do around 
here. The timing was not--well, anyway.
    Ms. Dymond, you are recognized for 5 minutes to provide 
your testimony.

              STATEMENT OF BRITTANY DYMOND MURRAY

    Ms. Murray. Chairman Bost, Ranking Member Takano, and 
members of the committee, on behalf of the men and women of the 
VFW and its auxiliary, thank you for the opportunity to provide 
our remarks on this critical topic.
    The VFW believes the VA Community Care Program and its 
network of providers are a vital component of VA healthcare. 
However, it does not always work as Congress intended. My story 
is just one example of a negative experience that could have 
been avoided. For 10 years, I exclusively received Department 
of Defense (DOD) and VA-provided mental healthcare. Not only 
did DOD not diagnose me with Post-Traumatic Stress Disorder 
(PTSD), the VA did, but VA providers also failed to identify 
the complexity of my PTSD diagnosis, resulting in treatments 
that did not fully help. Despite consistent care, I battled 
crippling emotional numbness and had come to blame myself for 
being defective. I also started experiencing passive suicidal 
ideations.
    In late fall 2021, I was referred to a civilian therapist 
through VA Community Care, and she diagnosed me with complex 
PTSD, the first time I recall a mental health professional 
using that term. In May 2022, based on my trauma history, 
symptoms, and her clinical expertise, she recommended a PTSD 
inpatient program with very specific treatment criteria. 
However, D.C. VA staff would not authorize a referral to the 
program because it was in Utah and its physical location was in 
Community Care Network 4. We were told to choose a local 
program instead.
    Following a service-connected surgery, I revisited the 
inpatient treatment discussion with my therapist. This time 
around, however, I had done extensive personal research which 
indicated that in addition to a method called Eye Movement 
Desensitization ad Reprocessing (EMDR), a relatively rare 
therapy called Internal Family Systems (IFS) was effective in 
treating complex PTSD. My therapist and I decided to try to get 
approval for an Arizona program that was also in Community Care 
Network 4 on the West Coast, but offered both EMDR and IFS.
    In July 2023, frustrated with the seeming lack of urgency 
on VA's part, I physically went to the Washington D.C. VA and 
spoke with a social worker, who promised to advocate for a 
referral on my behalf. Again, the referral was denied due to 
its geographic location, but the social worker promised that he 
would keep trying. Unfortunately, he went on emergency medical 
leave and my request for inpatient treatment fell through the 
cracks for over a month.
    In September 2024, VA staff tried helping me find East 
Coast treatment options. However, so much time had passed since 
my initial request in July, I would have to wait until January 
2024 for my next opportunity to enter treatment. I tried 
finding Utah and Arizona comparable programs while the VA 
employees offered in-network options on the East Coast. It felt 
like trying to find a needle in a haystack and VA's suggestions 
generally fell short. Some programs were too long while others 
were only part time. Some had poor reputations while others did 
not offer the correct treatments or they were primarily focused 
on mental health conditions I did not have, like eating or 
substance use disorders. One facility was for patients who were 
dangerous to themselves or others, which was inappropriate for 
me, while another was coed and did not understand why I would 
want to go to a women-only treatment program.
    After weeks of searching, we found a comprehensive 
program--or sorry, a compromise program in Pennsylvania that 
met some of my criteria, but did not offer the EMDR or IFS 
treatment modalities that I needed. I agreed to go there and, 
fortunately, my assigned therapist was able to help me 
understand my complex PTSD symptoms and she ensured my follow-
on care was with a qualified professional, who did provide 
those needed treatments. I am lucky to have landed with the 
civilian therapist that I did and for the resources family, 
friends, coworkers and accommodating employer that I have. Not 
all veterans can say the same.
    However, getting the right mental healthcare should never 
hinge on luck. I have since learned that suicidal ideations are 
actually a product of the fight element in one's fight or 
flight response essentially giving out. Had I not been 
knowledgeable and advocated for my treatment needs and as a 
result been sent to a treatment program that could not truly 
help me, it could have been my last attempt at getting better.
    VA must stop its practice of rationing inpatient mental 
healthcare based on arbitrary, seemingly thoughtless 
guidelines. Arbitrary location rules should never be the only 
factor in determining which veterans have access to life-saving 
care. Providing veterans with the correct mental healthcare the 
first time means saving lives.
    Chairman Bost, Ranking Member Takano, this concludes my 
testimony. Again, the VFW thanks you for the opportunity to 
testify on this critical issue. I am prepared to take any 
questions you or members of the committee may have.

    [The Prepared Statement Of Brittany Dymond Murray Appears 
In The Appendix]

    The Chairman. Thank you, Ms. Dymond.
    Dr. Saindon, you are recognized for 5 minutes to provide 
your testimony.

                  STATEMENT OF KELLEY SAINDON

    Dr. Saindon. Chairman Bost, Ranking Member Takano, 
distinguished members of the committee, on behalf of the 
members of Nurses Organization of Veteran Affairs, or NOVA, 
thank you for allowing us an opportunity to present our views 
on the topic, ``Restoring Focus: Putting Veterans first in 
Community Care.''
    As a VA nurse, I want to begin by expressing my sincere 
sorrow hearing the stories from these witnesses at this table. 
It is important that we learn from these cases to improve care 
in the veteran experience throughout the VA. NOVA understands 
and supports community care when access to VA is not readily 
available, the distance is too far, or the VA does not provide 
the needed care. We recognize and acknowledge that we cannot 
serve everyone everywhere. Our priority is to ensure veterans 
receive the highest level of care within the VA and utilize 
community care as needed to enhance the healthcare experience.
    Since the passage of Choice and MISSION Acts, community 
care has rapidly expanded. Community care referrals have risen 
by approximately 20 percent annually and 44 percent of Veterans 
Health Administration (VHA) healthcare funds are spent on 
community care. While the MISSION Act expanded community care, 
it was not meant to replace VA's integrated health care system. 
The legislation was meant to provide a balance between non-VA 
care when necessary while bolstering VA direct care.
    We are beginning to see shifts in care and staffing that 
risk diminishing the superior care that VA provides veterans. 
Provider shortages and budgetary constraints continue to affect 
VA care and community care. The constriction and closure of 
community healthcare systems have raised concerns about how and 
when veterans can be referred to the community. The community 
healthcare systems are saturated and cannot absorb the 
continued increased demand for veteran care in the community.
    Despite innovation and improvement focused on efficiency 
for community care coordination, the policy-driven steps remain 
laborious. Inconsistency in scheduling and authorizations 
across the system create confusion for veterans and for our 
community partners. A public-facing site that provides detailed 
information about community wait times, quality metrics, 
provider credentials, and provider training is imperative for 
veterans to make informed decisions about their healthcare.
    VA clinicians are more likely to have experience and 
specialized training in recognizing, diagnosing, and treating 
conditions often encountered by veterans. They are uniquely 
trained not only on military culture, but on veteran-specific 
exposures. The standards for our community providers should be 
no different.
    The oversight of care in the community is inadequate at 
best. We recommend Congress implement strong action and 
enforcement of mechanisms to increase quality and oversight of 
community care. Failure to meet quality expectations should 
result in removal from the network.
    It is vital that VA facilities have more control over 
services provided in the community. Records must be received 
promptly so the VA can direct further care, including any 
necessary diagnostic testing. Without proper coordination 
between VA and community providers regarding the timely return 
of medical records, veterans may not receive the necessary 
information to make informed healthcare decisions.
    For example, this vulnerability is especially important 
with lung cancer screening, lung nodule, follow-up mammograms, 
and colonoscopies. Stories from our membership include VA 
Community Care staff requesting records three or four times to 
the community provider with no response. This leaves the 
veteran at risk for serious and, in some cases, life-
threatening poor outcomes.
    We recommend the Community Care Network have prescriptive 
guidelines for record sharing. Current practice leaves much 
risk for healthcare decision delays. We encourage Congress to 
implement business rules that permit payment upon receipt of 
medical records. Studies have consistently shown that VA care 
equals or exceeds the quality care provided by the private 
sector. Recent star rating reviews demonstrate that VA 
hospitals score higher than non-VA facilities in both patient 
satisfaction and quality of care.
    My hospital, White River Junction, Vermont, received a 
five-star overall hospital and five-star quality rating in 
September 2024. It was the only facility in Vermont and New 
Hampshire to earn the top rating.
    A 2024 VFW survey showed overwhelming support for VA to 
remain the primary deliverer of care for veterans, with most of 
them saying they prefer using VA medical facilities for their 
healthcare needs. The VA must remain the primary provider and 
coordinator of veterans' healthcare, using community care as a 
supplement when VA services are unavailable. Authorizations and 
referrals should follow access and eligibility standards. 
Requirement for both VA and Community Care should include 
consistent quality and training standards.
    Listening to veterans stories helps us understand their 
needs. NOVA is committed to working with Congress, community 
partners, and VA leaders to ensure veterans receive timely 
access to the highest level of care.
    Thank you again for this invitation to testify. I am happy 
to answer any questions many may have.

    [The Prepared Statement Of Kelley Saindon Appears In The 
Appendix]

    The Chairman. Thank you. Before we get started, I would 
like to thank Representative Harris, who represents Ms. 
Locklear in Congress. He will be joining us later on, but we 
need to make sure that in accordance with committee rule number 
5(e), unanimous consent that Representative Harris from North 
Carolina be permitted to participate in today's committee 
hearing.
    Without objection, so ordered.
    I recognize myself for 5 minutes of questions. Ms. 
Locklear, you shared how your son struggled to access mental 
healthcare. If VA had told Logan about his community care 
eligibility early on, do you think it would have made a 
difference?
    Ms. Locklear. Logan died and I got some bank statements, 
his last bank statements. I have bank statements that shows he 
spent $800-and-some in like 2 months for his mental healthcare. 
He called me one day at work frantic, saying, Mom, I am out of 
my medications. What am I going to do? What am I going to do? I 
said, Logan, you. I directed him to go to his local pharmacy. I 
said, no pharmacist is going to withhold your mental health 
meds from you till you can get a new prescription.
    He did so, he came home, he had bought $288 worth of 
medication that day. I looked at the receipt and I was like, 
Logan. He said, Mama, that is what they said it was, so I just 
paid it. I was like--and that is one of the reasons why I 
brought him into our facility, set him down with their 
pharmacist, and because they--I--they knew the meds he was on 
and they said, Lori, these drugs he is on are dangerous.
    That is the reason after we had that discussion, I said, 
check into the--check in. I told him, I said, if I could get 
you into my facility, I can help manage and take care of your 
mental health--with your mental health needs and his 
medications; $288 that he paid for out of his pocket. My son 
was going into a hole trying to take care of his mental health.
    The Chairman. He did not know that it was available to him.
    Ms. Locklear. He knew it was available, but, I mean, he had 
no faith in the VA. Then when I finally talked him into it, 
there was error after error after error that was done in 
paperwork. He checked in, he got a 5-month appointment, mental 
health. If he had came home and told me that they had given him 
a 5-month appointment, I would have said, you come right back 
to the VA tomorrow, I am going to go down there with you. I 
would have questioned them. Why are you giving a mental 
health--a young man, if you looked at his record, he had tried 
to attempt suicide multiple times in the military. I do not 
understand why he did not have an appointment when they allowed 
him to--an honorable discharge in December. Why would not he 
give him a mental health appointment right then? Why was not he 
locked into a facility right then for from the military?
    The Chairman. Mr. McKenna, you testified the VA counselors 
and parents advocate in your written testimony were unable to 
provide clear guidance on your care options. How do you think 
VA needs to fix this?
    Mr. McKenna. Chairman, if I understand the question 
correctly, it talks about the dichotomy of the two experiences 
I have had. First, when my wife and I retired, we moved to 
northwest Florida, specifically in the Pensacola region. Very 
similar with respect to services as it is in eastern North 
Carolina, meaning the main VA hospital center for northwest 
Florida is located in Biloxi, Mississippi. That is about 2-1/2 
hours from our home.
    Same situation, when I went to the VA clinic in 
Jacksonville after relocating a year later in eastern North 
Carolina, the main VA clinic is in Fayetteville, North 
Carolina. That is again 2-1/2 hours from my residence in 
Richlands, North Carolina.
    These two VA clinics, both in Pensacola and Jacksonville, 
North Carolina, are completely different in the fact that, one, 
the process in Pensacola, Florida, was seamless. The quality of 
care I received from that VA clinic, from meeting with Dr. 
Sandoval and his team, to talking to VA counselors in the 
network, Community Care Network, to actually seeing providers 
out in the community, that entire process from flash to bang 
was about 10 to 15 days depending on what that specialty care 
was.
    Conversely, in eastern North Carolina, same specialist care 
I need, one, I cannot be seen at that VA clinic by either a 
doctor or a nurse because they do not have that capability or 
capacity there. Additionally, they are not taking any new 
patients. They, in turn, set me up with care in the community, 
to a clinic, a Med First clinic. It is a primary and an urgent 
care clinic. Only thing on staff there are nurse practitioners. 
No doctors, no nurses. Good people, but probably from drawing 
your blood to basic medical care like a flu shot, it is beyond 
the scope of their capability.
    They, in turn, will put a referral in. Now, unfortunately, 
they have to use a third-party vendor to do this. The third-
party vendor puts that referral into the VA, again delaying the 
process.
    I think to answer your question more directly, the friction 
point in eastern North Carolina lies with the third-party 
vendor. There appears to be no oversight either from the VA or 
from Med. First. When I tried to advocate for my own healthcare 
by saying, hey, can I get an email or a phone number to talk to 
this third-party vendor, I was told both by the VA and Med 
First that they are not authorized to provide me that 
information to be able to communicate, to understand why this 
process is taking so long.
    Then finally, when you do try to, or at least when I try 
to, understand what is causing these delays and when you talk 
to the VA counselors either on the telephone or through 
MyHealtheVet online, I get responses like that is just the way 
it is here, or we did not receive the required paperwork from 
your primary care provider out in town.
    Now, to the latter statement, I personally watched that 
nurse practitioner at Med First in Richlands, North Carolina, 
fax that form to the VA. Then when I followed up the next day 
having a fax receipt of that, I was basically told, ``I do not 
know what to tell you.''
    Again, sir, to answer your question more directly, more 
oversight on that third-party vendor and then better training 
and education to the VA workforce that works the Community Care 
Network.
    The Chairman. Thank you. I am way over time, but Ranking 
Member, you are recognized.
    Mr. Takano. Well, with that, Mr. Chairman, I am very glad 
to hear that you intend to hold more oversight hearings and I 
hope you do that before we rush a bill to the floor that 
purports to be a solution. Who is precisely missing this panel 
is the third-party administrator and anyone from VA.
    I want to change my question to Ms. Saindon. You know, I 
find it curious that my majority counterparts want to see VA 
function more like a private sector actor. They force VA to 
abide by standards that no one in the private sector would ever 
accept. For example, can you imagine that UnitedHealthcare 
would pay claims without receiving a patient's health record or 
any proof of medical necessity? Medical necessity. Yet through 
the third-party administrator, in this case Optum, which is in 
reality UnitedHealthcare, renders payment on behalf of VA 
without requiring their providers to transmit veterans' medical 
records back to VA.
    Now, Dr. Saindon, do you think that VA's contracts should 
require network providers to submit medical records as a 
condition of payment?
    Dr. Saindon. On behalf of the membership at NOVA, yes, 
absolutely. We have discussed this ad nauseam. It is a huge 
threat for good coordination of veteran care. We are aware that 
the contract, the next generation of the contract, is imminent 
and we strongly advise Congress to consider modifications to 
that where payment is issued upon receipt of those medical 
records. We have countless examples of how healthcare has 
failed those veterans as a result of not having those medical 
records readily accessible.
    Mr. Takano. Thank you for that answer. Again, I would point 
out that Optum, otherwise known as UnitedHealthcare, is not 
here. They were given a pass for not being here and they are an 
accountable party and they are a third-party administrator.
    I hold VA accountable also for not having contracts written 
so that this is part of how you do business. VA is forced to 
operate not as a private sector company would not think of 
operating. Any private healthcare network would make this a 
condition of reimbursement.
    How does not having these records affect VA's ability to 
properly coordinate veterans' care?
    Dr. Saindon. Countless ways.
    Mr. Takano. Yes.
    Dr. Saindon. Significantly, it poses a real threat to good 
coordination of care. A good example of this is a veteran gets 
referred out to a community network provider as a result of a 
specialty that they may need and have a follow-up with primary 
care provider a week later, 2 weeks later, whatnot. The 
veteran's information yet has still come over to the VA from 
the community provider. That puts the VA providers in a real 
problem situation, unable to determine what recommendations, 
what were the treatment plans, et cetera.
    Mr. Takano. Yes. I would have loved to have VA and 
UnitedHealthcare here to explain why this has gone on and why 
it continues to go on.
    There are kinds of care that, Dr. Saindon, that private 
sector care is simply not equipped to provide. They are just 
not going to invest the money or the resources or research into 
it. It is unwilling to provide because there is no profit to be 
made. No profit. That is why the public backs up our veterans 
when the private sector is just--there is not the incentives to 
do it.
    For example, VA has invested billions of dollars to provide 
care for veterans with complex spinal cord injuries, traumatic 
brain injuries, limb loss and prosthetic needs. What will 
happen to this very specialized care if we continue down this 
path of community care expenditures outpacing investments in 
the VA direct care system?
    Dr. Saindon. Community care for these specialized services 
that you just mentioned are just simply not available. More so 
in the rural settings. The care is not comparable. If there is 
a spar resource in the community for that specific specialized 
care, it is too finite to take care of our veterans adequately.
    Mr. Takano. Well, thank you. In your testimony you 
highlight the anticipated national shortage of primary care 
physicians that the national healthcare system will face in the 
coming years. That is not just VA doctors, but the national. 
Can you elaborate on why this makes it more important than ever 
to invest in a strong direct care network at VA?
    Dr. Saindon. NOVA is incredibly proud of our educational 
mission. We train 70 percent of healthcare professionals 
nationwide. In other words, if you ask a healthcare provider if 
they have had any type of training or stepped foot in a VA 
during the course of their training, you will hear a lot of the 
yeses there. Our goal is to grow our own, maintain those 
trainees, support training the healthcare infrastructure as it 
relates to providers. Robust scholarships, incentives, 
continuing education opportunities is a way that we could 
incentivize that. NOVA strongly supports considering those 
options.
    Mr. Takano. Not having a strong direct care network at VA 
will definitely impact the training of our future 
professionals?
    Dr. Saindon. Absolutely. We have already seen it. In fact, 
there is a gross shortage of educators in the healthcare 
industry as well as preceptors on the front lines in the field, 
limiting our ability to take student trainee placements. If we 
continue to struggle budgetary and/or with veteran care, access 
to veteran care, we will have to continue to limit our 
capabilities of taking trainee placements, which will 
ultimately collapse healthcare.
    Mr. Takano. Thank you. I yield back.
    The Chairman. Dr. Murphy.
    Mr. Murphy. Thank you, Mr. Chairman, and thank you all for 
coming today. Thank you for the service to your country. These 
are some real difficult stories to hear from somebody who has 
taken care of VA patients for 35 years and actually continues 
to do so.
    I find it somewhat ironic the ranking member brings out the 
stories that we are talking about the failures of the VA over 
the last, good Lord, I do not know how many years, but 
especially over the last administration where they continue an 
electronic medical record (EMR) system that is outdated, 
incompetent, inefficient, does not communicate. I can say this 
on the front end and the back end, it does not cost a penny, a 
penny, for me to click a button and send something, a medical 
record as a community care provider to the VA. Does not cost a 
penny. We do it all the time when we communicate with all the 
other doctors. That is not true. It is not anything has to do 
with profit. It has to do with the fact that we have a 
inefficient organization that is becoming more and more 
inefficient. I am so optimistic that with the next 
administration we are going to crack it down and actually make 
it like a private organization would be efficient and for the 
people who actually should benefit from this, our veterans.
    You know, I have said this many times here, I have veterans 
show up and I have no records in front of me, nothing. 
Community Care is supposed to take care of them. Community Care 
exists because the VA does not have the medical expertise or 
the physicians to take care of them. We have our national 
institutes that govern our medical schools now, which are 
absolutely being negligent in how they are creating doctors. 
This situation is not getting any better. It is going to get 
much worse.
    As specialties occur, I just tried to get on a website here 
to see what urologists were needed in the VA. They are all over 
the place. If you want, if a veteran needs urologic care, they 
are either going to not get it at all or they are going to have 
to go out into the community. It is just a fact. Specialty 
care, as I have said this before, costs more than other care.
    Anyway, enough of that rant. You know, I am happy. I would 
love to see UnitedHealthcare come in here. I would love to see 
that. I look forward to that day because they are killing 
people out in the regular community and they are by denying 
care and they are doing the same thing with our veterans. The 
third party stuff, I am looking so much forward to creating 
some true efficiency within the VA.
    Sergeant Major McKenna, thank you for your service. Welcome 
to--I love, you know, eastern North Carolina. We got a little 
snow today, by the way, out of the blue. I want you to tell 
your experience because you were in Florida and you thought you 
had an efficient community care system. You have come to North 
Carolina and it is not. Can you tell me the pros, cons, what 
you think that is all about?
    Mr. McKenna. Thank you, Dr. Murphy. Just to pile on your 
point, if I may, what would further assist the VA is building 
that electronic bridge with respect to medical records from our 
servicemembers, whether they do 4 years or 40 years, to be able 
to have those VA doctors and even the care and the community 
doctors access ALTA or other VA medical and dental records 
would again bring us into the 21st century.
    Mr. Murphy. Yes, I have gone on about how broken the system 
is----
    Mr. McKenna. Yes, sir.
    Mr. Murphy [continuing]. and continues to be inefficient.
    Mr. McKenna. Back to your question, sir. You know, my wife 
and I initially resided in Northwest Florida upon my retirement 
in 2021. There were several factors that drove us to that 
geographical location to retire. Number one, my wife Michela, 
who is a Federal employee, took a job in government service at 
Naval Air Station Whiting Field in Milton, Florida. Number two, 
the quality of cardiac care in northwest Florida. Michella 
received a mechanical heart valve after being diagnosed and 
treated for endocarditis in 2013. Then finally, the word from 
my fellow retired Marines that the VA healthcare system was 
first rate in that location.
    Michella's healthcare is covered by Treatment, Resources, 
and Insurance for Care or Active Duty and Retired Military 
Personnel (TRICARE) for life. As you all are well aware, that 
insurance.
    Mr. Murphy. Sergeant Major, I do not mean to interrupt, my 
time is limited, but if you can talk about the 6 months versus 
the year.
    Mr. McKenna. Oh, absolutely, sir. The process, and I think 
I already alluded to it in an earlier statement that in 
Pensacola, from seeing a doctor at the VA to getting a referral 
to be in care in the community, to being actually seen in the 
community 10 to 15 days. Conversely, eastern North Carolina, 
seeing a doctor not at the VA out in the community, to getting 
a referral, and I am talking about for specialty care needs, 
Traumatic Brain Injury (TBI), mental health, orthopedics, 
urology, I am waiting personally 9 months still for that 
referral to be approved. Let me repeat that. I am waiting 9 
months for that referral to be approved.
    Now, my fellow veterans in eastern North Carolina, this 
story is not unique. We are talking 6 to 9 months to get any 
type of specialty care in eastern North Carolina. Despite my 
best efforts to advocate for my health, you know, contacting 
the VA advocate, those calls go unreturned, you know.
    Mr. Murphy. I have got to close up with my time. The bottom 
line is, my understanding it is the bureaucracy is not allowing 
you to see the doctor in a timely fashion. As Mr. Dooley has 
shown us, that can have up to lethal consequences. Thank you 
for your service. Thank you for your testimony.
    Mr. McKenna. Thank you, Dr. Murphy.
    The Chairman. Ms. Brownley.
    Ms. Brownley. Thank you, Mr. Chairman. Thank you to the 
panel for being here and sharing your stories. I am, you know, 
deeply sorry that the VA did not provide the services and the 
quality of healthcare that each and every one of you and Ms. 
Locklear's, in your son's case, that they earned and deserve. I 
am sorry to hear that.
    I have to say I have been on this committee for 12 years, 
and over that 12-year period, I have heard over and over and 
over again that a very large percentage of veterans say they 
prefer receiving their healthcare at the VA over Community 
Care. They believe that the quality of care within the VA is 
very good and in some cases superior. What we have to kind of 
wrestle with here on the committee is the more we invest in 
Community Care, the less we invest in VA care. I think, you 
know, we have been wrestling with that and we need to continue 
to find where that balance really is.
    I believe in Community Care. For 12 years on this 
committee, I have advocated for better equality for healthcare 
for our women veterans. Women veterans have to receive a large 
portion of their healthcare outside of the VA. It is clear that 
to provide those services to our women veterans, we have to 
have Community Care. That is a true phenomena, you know, beyond 
one population, meaning women veterans.
    You know, I think in many cases also that wait times are 
largely longer in the community than in the VA. Now, I know, 
Mr. McKenna, you have talked about the processing and sort of 
the bureaucracy that goes on, and I think that is certainly 
part of the problem when we talk about longer wait times in the 
community. It is also true that in most circumstances, wait 
times in community care are just--they are just simply longer. 
It is just a fact. The way I see it, the facts that I see is 
that--and although every VA is not the same, and Mr. McKenna, 
you have pointed that out--or was it, I am sorry, Mr. Dooley, 
were you the one that said you got good healthcare one place 
and not so good?
    Mr. Dooley. That was actually Mr. McKenna.
    Ms. Brownley. Mr. McKenna. Mr. McKenna has pointed that 
out, that not every VA is not the same. If you receive 
healthcare in the VA, I think this is a fair fact to say, that 
if you receive healthcare in the VA, it is usually quality 
care. The care is also less expensive. The National Bureau of 
Economic Research recently came out with a working paper that 
found that VA also reduces total spending by 21 percent 
relative to non-VA providers. The care is less expensive in the 
VA.
    If we invest more in the VA, wait times will improve and it 
is what the veterans want. They want the large propensity, the 
larger percentage of veterans, they want their healthcare 
within the VA. That is, I think, that is in essence what we 
kind of have to wrestle with here. You know, where is the right 
balance?
    I think it is--I do not know whether all of you are 
advocating for--it sounds to me like you are advocating--I am 
not sure whether you are advocating for more community care or 
better community care. I am not sure which one it is. If it is 
better community care, I am with you all the way. If it is more 
community care, I am not sure that we have found the right 
balance. That is kind of where I am.
    Ms. Dymond, can you just respond to what I have just said?
    Ms. Murray. Absolutely, and thank you for the question. I 
would say absolutely better community care. There are many 
holes which have been illustrated by, you know, the panel, 
including myself, and I think there needs to be more meaningful 
effort put behind how veterans are assisted in accessing that 
community care. A lot of the pressure is put on the veteran 
themselves to do the work. We were handed off to--I should 
speaking for myself, I have been handed off. What I have 
illustrated here and in other experiences, interactions I have 
had with Community Care where an overwhelming amount of the 
pressure is put on me to figure out what care I need and find 
the correct providers because VA is not doing it on their own. 
It is really tough, better, absolutely.
    Ms. Brownley. Well, my time is out. I will just say, Mr. 
Chairman, I am happy to work with you to improve the process by 
which we get veterans' Community Care when we need it. I am not 
willing to, you know, have a large conversation about just 
increasing, increasing, increasing, increasing.
    The Chairman. That is not what the conversation is. The 
conversation is providing the best for our veterans and doing 
it correctly. Right now the system is broken and we have got to 
fix it because of things like this. It is a quality. The thing 
is obviously Veterans Benefits Administration (VBA) getting 
paperwork right and all of that. We have got to quit arguing on 
whether it is--whether I am right or you are right or who is 
Republican, who is Democrat, and start arguing for the 
veterans. That is what we are trying to do.
    I have told--and I will tell you this, we will also bring 
the other ones that the ranking member has asked for. To say 
that we did not bring them in because we were trying to do some 
kind of ridiculous thing about arguing over the community and 
over VA, I think that what we have to do is make sure the 
veterans get what they want, when they need it, where they need 
it, at the level that they need. I agree with you that there 
are a tremendous amount of people that have a tremendous 
experience at VA if they can get when they need it and if I am 
not traveling five hours to get there.
    We have got to keep working on it together. We cannot just 
all of a sudden say, well, you believe this and you believe 
this, and we have got to start working on it together. We have 
got to.
    Ms. Brownley. I believe we have to work on it together, 
too, but I think we have to have more hearings around this 
debate----
    The Chairman. I got it.
    Ms. Brownley [continuing]. a lot more issues and----
    The Chairman. When----
    Ms. Brownley [continuing]. make sure that we are working 
off common facts.
    The Chairman. When our staff writes our script, maybe what 
they should also pay attention to is the fact we are trying to 
work together and quit trying to make look like it is a 
partisan act. Just saying, so.
    Ms. Brownley. I yield back.
    The Chairman. All right. Mr. Hamadeh.
    Mr. Hamadeh. Thank you, Mr. Chairman. As a veteran, I 
understand the obligations we owe to our fellow veterans. Now, 
President Trump got it right when he signed the bipartisan 
MISSION Act, putting veterans in charge of their healthcare 
decisions. Yet today we are seeing bureaucratic roadblocks that 
prevent veterans from accessing timely care, especially with 
mental health services.
    Now, the stories we heard today are deeply troubling. I 
want to commend President Trump's incoming Veteran Affairs 
Secretary, Doug Collins, who many here know him very well when 
he served in Congress, for his commitment to accountability at 
the VA. We must do more to ensure veterans can choose where 
they receive care. The VA system should work for the veteran, 
not the other way around. When a veteran needs help, they 
should not face a maze of prior authorizations and arbitrary 
denials.
    The data is clear. Expanding community care access does not 
increase cost, it increases quality. We must codify access 
standards to guarantee veterans' rights to seek care outside 
the VA when needed. I want to thank all the witnesses for 
coming today and for their service and for being sharing your 
brave stories as well.
    Now, Mr. Dooley, my first question is for you. You waited 9 
months for critical treatment. If you could redesign the VA's 
authorization process for veterans seeking urgent care, like 
cancer treatments, what specific changes would ensure veterans 
get immediate access to the nearest qualified provider, whether 
VA or Community Care?
    Mr. Dooley. I think to start that off, the first thing 
would be to know how fast they can get it from the VA. That is 
the first thing to know and inform the veteran of that, of when 
they could get that treatment. The second would be going into 
community care, if that is the route that they decide to go, 
being able to reach out to different care--community care 
providers and finding what amount of time that they could 
actually get it done. In my case, if it could be done in the VA 
in, say, 3 months, that is too long. Let us see what community 
care can do. Then if community care is 5 months, obviously the 
servicemember being allowed to know that and then make a 
choice, but then also going back and seeing what other care 
providers may be available that could get it done earlier, that 
would provide me with the earliest treatment I could, and then 
also the knowledge of knowing which one would provide that so I 
can make an educated decision.
    Mr. Hamadeh. Thank you. Now, would you support eliminating 
prior authorization requirements entirely for certain urgent 
medical services, similar to how we handle emergency care?
    Mr. Dooley. Without knowing the full specifics of that, I 
cannot say that I would recommend one thing or the other. What 
I could say is I would like the opportunity to cut through the 
red tape and allowed to get my screening prior to that. It 
could have made all the difference. If anything, that would be 
cutting through the red tape and getting the servicemember to 
that type of treatment as soon as possible, I would recommend.
    Mr. Hamadeh. Thank you. Now, Ms. Locklear, you witnessed 
firsthand, tragically, how delays in mental health affected 
your son's trust in the VA system. Now, should not veterans 
have the immediate right to seek mental healthcare from any 
qualified provider in their community without jumping through 
bureaucratic hoops?
    Ms. Locklear. Yes.
    Mr. Hamadeh. How would this have impacted your family 
differently if that were to have been the case?
    Ms. Locklear. Well, Logan did that. I mean, he took it upon 
himself to get the care that he needed because of his distrust 
in the VA. Unfortunately for Logan, I think he got a provider 
that just--she just continued to prescribe him medications and 
he was so desperate to get better, to honestly get better. I 
think she was over medicating him.
    I found out recently, just a few days ago, I knew he had 
went into the Emergency Room (ER) and I found out he was in the 
ER because he had lithium toxicity. She had put him on lithium. 
When I spoke to my pharmacist about it, they said, Lori, that 
is a dangerous drug. It is old. I cannot believe It is even 
being used. He was on it and he had to go to the emergency room 
because he--it became toxic.
    I would like to say something in regards to what you are 
already saying, if you will let me do that. Sixty days to get 
community care, okay. When Logan checked in, and by the time it 
took Community Care to sign off on what he needed was 2 days 
prior to his death. Well, in those 2 days, he still did not get 
called, so.
    At the time, COVID, when COVID came in, we had staff that 
left our hospital to went home to work remote. They never came 
back. They worked from home the entire time. Still working from 
home. Trump telling these the employees to come back to work, 
they need to come back to work. I do not know that that did not 
take part and why it took 60 days for someone to look at my 
child's chart and say he has already tried to commit suicide a 
number of times. He's depression. We might need to go ahead and 
get him taken care of as soon as possible. That did not happen.
    Mr. Hamadeh. Thank you. Mr. Chairman, I yield back.
    The Chairman. Thank you. Dr. Conaway.
    Mr. Conaway. Thank you, Mr. Chairman. Thank you to the 
witnesses for bringing forward their experiences for the 
edification of this committee.
    We as a Nation should be deeply grateful for the sacrifices 
that our veterans have made on behalf of all of us and their 
families have made on behalf of all of us. As a physician and 
veteran myself and someone who spent the last 25 years trying 
to figure out how to expand access to quality care in my own 
state of New Jersey, as I listen to your testimony, I can 
easily point out the many failures on a bipartisan basis that 
have occurred in advancing access to quality care for members 
of our society. It is particularly troubling and concerning 
when we are seeing these problems among our veterans to whom we 
owe so much.
    There are failures to invest in the technology that will 
allow us to understand what is going on. If we do not 
understand data about who is being seen, when they are being 
seen, what paperwork and information that needs to flow from 
those experiences so that care can be examined and improved, 
then we are failing. This is anytime you put more and more 
bureaucracy in a situation in healthcare, and we see this all 
over the place, whether it be prior authorizations, which has 
been mentioned, all of this paperwork flowing back and forth, 
someone goes to see the physician, they get a referral, they 
follow up to make sure that referral is taken care of. You do 
not need a lot of technology around that. This idea of 
exploring how we get rid of all this paperwork and all these 
hurdles is certainly a very valuable exercise.
    Understand, as I hope everyone in this room does, that 
these hurdles have been put in place because of a concern about 
the spend. Every person who works in healthcare, every person 
receives a service, there is a dollar behind that. Our concern, 
right concern, about how much we are spending on a particular 
line item for veterans healthcare, depending on what our 
priorities are--and, again, in my view, the Veterans 
Administration has not been properly funded. It has not--does 
not have the staff it should. That says, in my view, that we 
are not paying the kind of attention we need to pay to the 
veterans who deserve our thanks.
    I am concerned, as has been raised here, that we do not 
have--and we are going to have more, and I take the chairman at 
his word, that we are going to have additional hearings on 
this, because we certainly need to see and hear from the Third 
Party Administrators (TPA)s that are managing this healthcare. 
We certainly need to hear from the VA about their processes and 
what they plan to do about these very troubling things we have 
heard today. We need to hear from the Office of the Inspector 
General about their review of the situation and what we can do 
to ensure that the data is made available to us so that we can 
actually know what is going on and where the failures are.
    Every time we have applied data, whether it is in the 
financial services, sending people to the moon, developing the 
latest technologies, it is all developing the right plans for 
healthcare so we get the outcomes we want. It is all a data-
driven process. We sit here today with a very disturbing lack 
of the kind of data we need to decide actually what is going 
on.
    I am very sorry, ma'am, for the tragic loss of your son. 
You do not need to have children for that--I happen to have a 
couple kids. I cannot imagine the pain of losing a child, 
particularly when you did so much to try to protect that child 
as parents do.
    We have heard from the administration that there is a 
hiring freeze. I have heard from perhaps some or all of you 
that there is a real concern, and certainly, Ms. Saindon, 
excuse me, about the staffing shortages there. People need to 
power the system of care. We understand that. If there is--and 
it has been years that it has been recognized that we do not 
have enough staff in the VA, again, because of our lack of 
investment, on a bipartisan basis, by the way, in the VA.
    Can you shed some insight on how this hiring freeze will 
impact a situation which is already dramatically problematic 
and which, if it continues, will prevent the kind of 
improvements that need to be made to ensure that veterans get 
the care we need? Discuss the hiring freeze in the context of 
the current staffing shortages that we have and the difficulty 
that it will bring to making the kind of improvements that 
clearly need to be made in the provision of care through the 
VA?
    Dr. Saindon. Thank you. The hiring freeze was shocking 
yesterday for many of our membership. There is already been 
conversations as to what we can do to advocate to respond to 
this. We are grossly concerned about the impact it will have on 
bringing in new nurses, bringing in new providers, also the 
reputation for the VA. These individuals, from what we 
understand, membership, individuals that had been selected and/
or were in the process for recruitment, received automated 
messages. That is not the way we do business in the VA. We like 
to have conversations with our candidates and our applicants. 
Yesterday they got automated messages from the platform we use 
in VA USAJobs saying that the position was rescinded. We are 
concerned about our reputation to continue to get the most 
qualified individuals within the VA system and maintain them.
    Inability to continue to staff at our ceiling levels or at 
our approved levels within budget will impact our ability to 
provide inpatient care. It will impact our ability to maintain 
clinical access and will be a continued need to coordinate care 
in the community, which is a threat, also, because that is a 
heavy, laborious process that requires more staff from the VA 
to support the coordination of care in the community.
    Mr. Conaway. I do not know if anyone wants to answer. That 
is my time, Mr. Chairman. I do not want to go over it, but if 
you permit anyone else to answer it, I would certainly 
appreciate that and I will thank you for the time.
    The Chairman. Thank you. Mr. Self.
    Mr. Self. Thank you, Mr. Chairman. On behalf of the 
veterans across America, like my constituent Mr. Dooley, thank 
you so much for making the trip to be here with us and tell us 
your story.
    I am ready to turn the page to a bright future. That last 
questioning. We are going to right size this stuff and we are 
going to get it right and I will leave it at that. Thanks to 
the Trump administration, we are going to be able to offer our 
veterans a helping hand after 4 years of cold shoulders, 
failures, and broken promises from the Biden administration VA. 
It is unforgivable that the hard-working Americans who served 
our country honorably paid the price because VA employees 
choose to serve bureaucracy rather than our veterans. There is 
a new sheriff in town and I assure you that I think the changes 
are coming.
    Mr. Dooley, in this committee in the past, I always make 
the point about the VA wants to talk about inputs. We started 
this new program, we spent this new money, we did this. They 
never want to talk about outputs. I want to thank the four of 
you for coming to talk about outputs in the VA system because 
that is what this committee ought to be talking about, outputs. 
Mr. Dooley, it took you 9 months to receive a colonoscopy. What 
do you think that did to your body over 9 months? Any ideas?
    Mr. Dooley. I am not a doctor. However, I do know time 
matters, especially when it comes to cancer. I know that from 
stage 1 my possibilities of surviving and remaining a long life 
with my children drastically goes down when it goes to stage 3. 
Stage 3--stage 1 to stage 3 is literally the mass got big 
enough and it got into my lymph node system making it stage 3. 
In that case it is a lot better possibility that it will move 
to other parts. Even if I am cancer-free now, the chances of it 
moving on and coming to another part of my body is actually a 
lot greater.
    To answer it very shortly, my life and my chances for 
remaining and living a longer life got reduced by those 9 
months. Could have taken years off of my life.
    Mr. Self. I understand. What broke through after 9 months? 
What broke through to your treatment?
    Mr. Dooley. Me waiting. Unfortunately, I waited 5 months 
for the appointment and then once I found out I had cancer, 
they said to wait another 4. To be totally honest, your office 
is the only reason that I got seen.
    Mr. Self. I want to stop right there, Mr. Chairman, and say 
our veterans should not have to have their Member of Congress 
be the first line of defense with the VA. That is my most 
important point today. The Member of Congress is not the first 
line of defense to get an appointment. Yet for my constituent, 
it was. That to me is a crucial point in this hearing.
    The system that you encountered, Mr. Dooley, do you think 
it was designed to help our veterans or to put up obstacles and 
barriers to actual care?
    Mr. Dooley. From what I personally experienced, it looked 
like it was--they made incompetence absolutely vulnerable for 
the area. I saw a lot of people that did not do their job and 
there was no way to hold them accountable for it. That was very 
as simple as I was not even given a name and a number to call 
back. The number that I would call back would be a hotline, and 
then I could not even leave a message for that person. My 
written testimony does not have a lot of names in it and 
definitely does not have any direct numbers. There is a very 
good reason for that: because I was not provided any. It is 
really hard to hold somebody accountable when you do not even 
know who they are.
    Mr. Self. With that, Mr. Chairman, I think those are 
excellent points and I yield back. Thank you.
    The Chairman. Dr. Morrison.
    Mr. Morrison. Thank you, Mr. Chair. My sincere gratitude to 
our witnesses for joining us today. Thank you to you and your 
families for your service to our Nation.
    I am glad to be here with all of you today for our first 
committee hearing of the year and my first as a Member of 
Congress. I am honored to serve on this committee because 
military service runs deep in my family. My husband John and my 
father-in-law are both combat veterans, both former proud Army 
Rangers. My dad and my grandfathers all served as well. I 
firmly believe it is our duty here in Congress to provide our 
veterans with the resources that they deserve and have earned.
    I am a physician by trade. I am one of the 70 percent who 
received some of my training at a VA. Having had the 
opportunity to care for these brave men and women, I take 
seriously our congressional oversight responsibilities on this 
committee and look forward to working in a bipartisan manner to 
ensure that VA provides the highest quality of care to our 
veterans.
    Now, I am admittedly new to the committee, but it strikes 
me that we both need community care and we need better 
oversight of community care. It also sounds like we need to 
invest in a new EMR. Honestly, as Dr. Conaway referenced, we 
are grappling with the same workforce shortages that many 
sectors of our society are facing. I am concerned about the 
hiring freeze that you just discussed.
    Dr. Saindon, as you know and referenced, VA clinicians are 
particularly well equipped to treat conditions that frequently 
affect veterans, such as PTSD, substance use disorder, and 
traumatic brain injuries. Are there currently standards in 
place to ensure that Community Care providers are adequately 
trained to treat these types of conditions?
    Dr. Saindon. This is another frequent topic of discussion 
among NOVA membership. To our awareness, there does not exist 
community indication of competencies, training, or quality, and 
it is concerning that we entrust those providers in the 
community with our veterans unaware of those data points.
    Mr. Morrison. Thank you for that answer. I assume then that 
you are concerned that the lack of training and educational 
requirements may threaten the standard of care that a 
beneficiary may receive outside of the VA. Thank you.
    Thank you, Mr. Chair. I yield my time.
    The Chairman. Thank you. General Bergman.
    Mr. Bergman. Thank you, Mr. Chairman, and thank of all of 
you for being here. This has been a long hearing when you have 
to, you know, the break for vote, so we just appreciate your 
patience. In life, you got to be patient. You got to be, but 
you got to be persistent. You have to persevere, all of those 
things. Some of us who have been on this committee for a while 
are, I am not going to say getting a little long in the tooth, 
but we are definitely getting a little frustrated, okay, over 
the lack of movement of the bureaucracy.
    During the 115th Congress, those of us who here were here, 
it was when the MISSION Act was crafted. Now, I am going to use 
a visual example. We put the MISSION Act into play, and since 
then, anybody here not know what the game Whac-A-Mole is, okay? 
That is what it has been. From the committee's standpoint, and 
even I would suggest to you from the veterans' standpoint, you 
hit one mole and it goes down and another one pops up. It is a 
moving target. It is such that in our roles and 
responsibilities here, we owe it to the veterans and we owe it 
to the doctors and the nurses, all the healthcare providers in 
the VA system to actually eliminate the Whac-A-Mole nature of 
this so the care can get right to the patient.
    What we have seen is that the mid-level bureaucrats in the 
VA have prioritized to a great extent the bureaucracy over the 
veterans themselves. They are focused on, well, let us adjust 
this process or let us do that or that, without concern that 
the end game of providing care is not there. We have not talked 
about it today and then I am going to ask a couple questions 
here, because there is an assumption if you live in an urban or 
suburban area, you either get in your car, get in the VA 
service officer's van, get in an Uber, getting on the 
transportation, and go to your local veterans, you know, 
hospital or wherever the clinic is. Well, we got rural and 
remote in our country, too, and especially add a snowstorm. I 
got a hunch there is probably nobody in South Carolina today on 
the road. Now, in Michigan, with a snowstorm, they are still 
going to go on the road to get there. Okay? We have the whole 
spectrum here of the urban, suburban, rural, and remote to 
provide the care.
    Mr. McKenna, just a quick reaction here. What is your 
reaction--was your reaction when you discovered that VA 
counselors were unfamiliar with the basics of the MISSION Act, 
and by the way, in polite Marine terms?
    Mr. McKenna. Thank you, sir. Again, to use your analogy of 
Whac-A-Mole, I think if you go back to the MISSION Act itself 
and to prevent knocking things down that you have already hit 
before with respect to training and education, training and 
education must happen continuous.
    Mr. Bergman. I am going to cut you off----
    Mr. McKenna. Yes, sir.
    Mr. Bergman [continuing]. because my time, as you know, as 
a Marine here, we are not going to waste time. You are 
absolutely right. Do not waste time. We waste enough money. You 
can recover money, but you cannot waste time once it is gone in 
veterans care. Do you think, when you mention training, that 
the VA employees should be required to undergo periodic 
training and updates to familiarize themselves, in this case 
with the Community Care Program?
    Mr. McKenna. Yes, sir. I will give you one small example. 
If you ask a VA counselor, at least my experience has been, can 
you give me any elements of the MISSION Act, specifically care 
in the community, and I am talking numerous people, not just 
one, are completely clueless to this legislation. If that is 
not an indictment on the VA and their training and education 
program, I do not know what is.
    Mr. Bergman. Yes, and it is an indictment, quite honestly, 
of the leadership, especially at mid-level. Why is the United 
States military so successful regardless of service? Our staff 
Non-Commissioned Officer (NCO) corps, our NCOs and our staff 
NCOs. It has got nothing to do with the officers. It is the 
staff NCOs and those mid-level folks within the system is what 
is going to make it work. That is where I believe we need to 
focus bipartisan because it is not Democrat or Republican. It 
is about getting the care and it is about retooling, if you 
will, the bureaucracy. I did not say eliminating it, retooling 
it, so it actually functions in a 21st century world with 
electronic health records and all of that data sharing.
    With that, I yield back, Mr. Chairman.
    The Chairman. Mrs. Ramirez.
    Ms. Ramirez. Thank you, Chairman. I want to start by 
thanking our witnesses. As you heard from other colleagues 
here, I know that between the votes and coming back, the 
schedule was a little difficult, but I want to thank you for 
being here.
    I want to especially thank Ms. Locklear for your testimony. 
I want you to know that your sharing and the pain that you feel 
was felt by every member here. I want to thank you for your 
courage to be here and to speak truth to the experience that 
you have had and the experience you do not want any other 
parent to have. I just really want to thank you from the bottom 
of my heart.
    One of the most pressing issues our veterans are facing is 
that quality healthcare, is that access. It is a concern shared 
by so many everyday Americans really trying to navigate our 
system of privatized care. In hearings like today, I think it 
is important that we reflect on some of the assumptions that we 
are making. You know, I assume we are committed to meeting the 
healthcare needs of every single veteran. I want to assume that 
caring for every veteran means providing them the full spectrum 
of services. You see, I assume we want our veterans to have the 
best, the most comprehensive, the most coordinated, the most 
timely, and the most accountable healthcare we can offer them. 
I want that for every veteran. Frankly, I want that for every 
American. I assume we mean the same thing when we talk about 
community care, but I am learning that we mean different 
things. Some of my colleagues just mean private care.
    Finally, there is another assumption operating of which I 
cannot get behind, and that is increasing access to private 
care that would automatically result in better healthcare 
outcomes for some veterans, but not the others. The evidence 
shows that public VA facilities provide higher quality veteran-
specific care. If you believe that the private sector can do it 
better, which I do not, then you may be comfortable with the 
concerning amount of money being funneled away from the VA into 
privatized care.
    Folks, I am concerned that we are not asking whether that 
care is really leading to healthier and better outcomes, 
because choice alone is not the point. We want choice, but we 
also want quality. That is what we should be after. As we have 
heard from many of my colleagues, there are instances when our 
veterans cannot access a VA healthcare center due to distances 
or due to other barriers. However, the VA healthcare system is 
set up specifically to address the needs of veterans.
    Dr. Saindon, did I pronounce it correctly? Good, good. 
Pronunciation is important for me. Can you tell me how the VA 
healthcare providers and clinicians are uniquely prepared to 
care for our veterans? I specifically want you to tell me what 
trainings are required for you to take to ensure that you are 
providing culturally competent care to our veterans.
    Dr. Saindon. Every employee is required to do military 
competence training. In addition to that, based on the 
occupation or based on the role of the healthcare provider at 
the VA, they have a whole slew of different trainings that are 
specific to meeting the needs of those populations that they 
serve in that role specific.
    Ms. Ramirez. Dr. Saindon, let me ask you a follow-up 
question to that. Are Community Care providers required to take 
those trainings?
    Dr. Saindon. Not that we are aware of.
    Ms. Ramirez. Additionally, are there third-party 
administrators who manage a network of Community Care providers 
required to ensure that providers in the network complete these 
trainings?
    Dr. Saindon. Membership has spoke about this several times. 
It is in our written testimony. We are very concerned that 
there is no such requirement.
    Ms. Ramirez. Got it. Thank you, Doctor. Look, Community 
Care is part of the equation that we need to be discussing 
today. Yes, we certainly need to do everything in our power to 
ensure our veterans are receiving care. We need to make sure 
that that care is high-quality care in a timely manner. 
Veterans have the best, the most comprehensive, the most 
coordinated, the most timely, most accountable healthcare, that 
is what we need to be working toward in this place. As we 
discuss this conversation today about community care, as we 
talk about the impact that our veterans are experiencing every 
single day, as we talk about their own families, I truly hope 
that choice and quality are going to go hand-in-hand.
    I want to thank our witnesses here today. I want to thank 
the chairman and the ranking member and the vice ranking member 
here today as well. I look forward to having a fruitful 
conversation over the work that we do over the next few months 
where it is centered on our veterans and their career. Thank 
you.
    With that, I yield back.
    The Chairman. Thank you. Mr. Van Orden.
    Mr. Van Orden. Thank you, Mr. Chairman. I appreciate being 
here. I am very sorry I had to step away. This place pulls you 
in 50 different directions. I have read all your testimony and 
I want to thank you for coming out here.
    I spent my first day in Congress calling the widow of a 
veteran, the brother of a veteran, and the sister of a 
veteran--sister-in-law of a veteran who committed suicide 
because he did not get a mental health consultation. I printed 
that letter. It has been sitting on my desk for 2 years. It has 
got a note on there. It says, this is why I am here.
    I have learned a couple things. I chair a subcommittee. 
Learned a couple things over the last 2 years. This is the 
first Congress here. I have been in Congress for 2 minutes--or 
2 years and 5 minutes. I do not want to hear from the VA right 
now. Our ranking member said, why is not the VA here? You know 
why, because they do not tell us anything. I have essentially 
had 10 of the same damn hearings with these guys because 
nothing changes. No one is held accountable at the VA. Nobody.
    Check this out. They made a $25 million estimate to do the 
digital GI bill. It is going to be a billion dollars, 25 
million to a billion. No one is being held accountable. The 
Cerner trash, I just got off the phone again with two doctors. 
I just want to check civilians who are using this. Cerner was 
sole-sourced a contract to do the electronic medical record, 
$16 billion. They spent 14, they want to do 18. They are saying 
they had to delay it to 2026 because it does not work, $14 
billion into it. You know how much they say it is going to cost 
to get it across all the business? Take a guess. I will tell 
you: $50 billion. No one is being held accountable.
    Mr. Dooley, I am terribly sorry. I am going to formally 
apologize to you from the Federal Government. I am so sorry. 
Let me ask you something, Mr. Dooley. Has anybody that had 
anything to do with the travesty that has taken place in your 
life at the VA been held accountable? Anybody?
    Mr. Dooley. To answer shortly, no.
    Mr. Van Orden. Ms. Locklear, my heart breaks with you. It 
does, and we talked and I thank you for that. We know what it 
is like. I know what it is like to lose a child. I do not know 
where you would be and how you hold up with this grief knowing 
that it was much more preventable than the loss of our 
daughter. To your knowledge, has anyone been held--or, excuse 
me, your son. I apologize. It is our daughter. To your 
knowledge, has anyone been held accountable at the VA?
    Ms. Locklear. No.
    Mr. Van Orden. Nobody. Ms. Murray, to your knowledge, has 
anyone been held accountable for dragging you around and 
treating you like a hobo who is begging for help, for injuries 
and PTSD is an injury? Has anyone been held accountable for 
treating you like a beggar and kicking you around the country?
    Ms. Murray. None to my knowledge, sir.
    Mr. Van Orden. Okay. Well, I personally am looking forward 
to our new Secretary Collins getting in here and the people 
that are responsible for these billions and billions of dollars 
of waste are held accountable. Every single dollar that is 
wasted is a dollar that cannot go to making sure you can go to 
a program in a different region. To making sure, sir, that when 
the VA cannot possibly help you, that you go immediately to 
Community Care and that you do not have to have 57 different 
referrals for the same treatment plan. Ma'am, to make sure that 
no mother or father or brother or sister ever has to find their 
child in a bathtub after they have committed suicide because 
they did not get the mental healthcare that they needed.
    I know that the men and women on this committee mean what 
we say. I just believe that some of my Democrat colleagues are 
misguided. I get all my healthcare through the VA. I am a 100 
percent service-connected disabled veteran. I get all my 
healthcare through the VA. The people that treat me in La 
Crosse, Wisconsin, are fantastic. That is from the people that 
are checking me in to my primary healthcare facility. I am so 
proud of them. Wautoma, Wisconsin, I am so proud of them. Do we 
have problems? Yes.
    The farther up the chain we get, the farther away from 
reality we get, and I want to have some of these people that 
have been sitting in these offices at the VA collecting a 
paycheck go out and talk to you, ma'am. I want them, sir, to go 
to a medical appointment with you and your family and let them 
explain to you and your family why you could not get the 
healthcare you needed because they are too damn lazy and they 
are more concerned about protecting a bureaucracy than the 
veteran. That is what needs to happen. Nothing is changed until 
it does. That is what we are going to do under the new 
Secretary's leadership and the leadership of this chairman. 
That is my promise to you.
    I yield back.
    The Chairman. Thank you. Dr. Miller-Meeks.
    Ms. Miller-Meeks. Thank you so much, Chairman Bost, for 
this hearing.
    It is interesting, my conversation and my thoughts as we 
have listened to this hearing and listened to both members on 
this side of the aisle and the other side of the aisle proper 
questions. My questions are different now than they were when I 
first came in here.
    First, Sergeant Major McKenna, my family, my husband's 
family is all from Richland, North Carolina, and I know that 
system well. Ms. Saindon, you mentioned about, you know, 
everything being automated and how concerned you are. Let me 
just say that I applied for a job as a physician, I am a nurse 
and a doctor, applied for a job at the VA in 2014. All of my 
responses were automated, so I am not sure how that is not how 
we do things at the VA. As I recall, the President at that time 
was President Obama, and all the responses were automated and 
went through USA.gov. That is one of the issues we have with 
hiring.
    In the 4 years that I have been on this committee, there 
has not been a lack of funding to the VA. As a matter of fact, 
funding has increased every year. Even in this hearing room, we 
had a hearing on mental healthcare and suicide prevention. I, 
as the chair of the Subcommittee on Health, and through that 
hearing with the VA present, found out that the VA did not 
consider residential mental healthcare or substance abuse 
disorder healthcare to fall under the MISSION Act. Therefore, 
they did not have to get somebody in, a veteran in within 30 
days.
    Now, as a nurse and as a doctor and a person who has family 
members who had PTSD and mental health issues, if you are at a 
point where you think you need residential care for substance 
use disorder or mental health, you need mental healthcare now. 
We put forward a bill that it had to be within 10 days.
    The first bill that I passed and had signed by a President 
in 2021 was Brandon Caserta, who 5 hours after he visited the 
VA in Iowa City, which is an excellent VA, committed suicide. 
As a nurse and as a doctor and as a veteran, but most 
importantly as a mother, Ms. Locklear, we feel that we are 
responsible for our children's happiness and success. I know 
the burden that you bear, and it is not your fault. It is the 
responsibility of this committee and members on both sides of 
the aisle to make sure that what happened to your son does not 
happen to any other sons and daughters. That is why you are 
here today.
    Ms. Saindon, does the VA send veterans to get care at 
Veterans Integrated Services networks (VISN)s far away from 
where a veteran may reside?
    Dr. Saindon. To my knowledge and membership, yes.
    Ms. Miller-Meeks. Exactly. I am not sure why it is a 
problem with a veteran such as Ms. Murray, and I do not know 
your rank, Ms. Murray, my apologies, a veteran to get care for 
a specialized condition at a place because it happens to be out 
of network. That is the type of stuff we hear from private 
insurers, and both of them have problems. If their veteran is 
not able to get the care at the closest VA to them, and there 
is the care that they need recommended to them by a provider, 
they should be able to get that care. I do not give a hoot if 
it is on the East Coast or the West Coast, because the VA 
already sends people to other VISNs two or three VISNs away, 
hundreds of miles away and months away. When we consider the 
cost of care within the community, not private care, let me re-
emphasize this once again, but care within the community.
    Let me also say I am a provider of care. I gave community 
care. I do not think I had to have training for PTSD as an 
ophthalmologist to do cataract surgery.
    Ms. Saindon, is it well known that men in age 40, if they 
have blood in their stool, that is considered cancer unless 
otherwise you are a doctor, nurse practitioner?
    Dr. Saindon. To clarify, I am a DNP, Doctor of Nurse in 
Practice.
    Ms. Miller-Meeks. Yes.
    Dr. Saindon. Not a prescriber or provider.
    Ms. Miller-Meeks. Okay. Then I will not ask you that 
question. Let me just say it is common knowledge. It is common 
knowledge, we are trained in medical school that if a male has 
blood in their stool, especially under age 40, which I think 
Master Sergeant Dooley was, if my math is correct from your 
testimony, that it is cancer unless proven otherwise. How is it 
quality of care for the VA not to order a colonoscopy from a VA 
provider? That is not quality care. Let me say that quality 
care is no--if no care is provided, that is not quality, 
whether it is at the VA or Community Care.
    Do you think the cost would have been lower, Master 
Sergeant Dooley, if when you told your physician what your 
symptoms were, and I am implying what you were, I am presuming 
as a physician, if you relayed your symptoms, they would have 
ordered a colonoscopy and then they would have allowed you to 
go for care and had your appropriate treatment? Do you think 
maybe the cost would have been less if it was a stage 1 cancer 
or stage 2 rather than a stage 3?
    Mr. Dooley. I would like the chance to live, so I would not 
have cared what the cost was. To answer your question, yes, I 
do believe treating stage 1 would have been a lot more cost-
effective and efficient than in treating stage 3 and for the 
rest of my life.
    Ms. Miller-Meeks. As a provider and someone who knows the 
healthcare system, I am going to wholeheartedly agree with you. 
That is why we do screening. That is why we do colonoscopies 
and recommend them over age 50. Why if someone presented with 
the symptoms you had, even as an ophthalmologist at the VA, I 
would refer you for an urgent colonoscopy.
    My point is this. Our obligation is to make sure veterans 
have access to care. If you do not have access to care in a 
close-by VA and your symptoms warrant, then you should get care 
within the community. That is our responsibility as an 
organization. As a committee and as Members of Congress, you 
should not have to come to see your Member of Congress to get 
the care you have earned. You have earned the care. We are 
going to make sure that we hold the VA accountable and the 
community accountable for getting you the proper care in a 
timely fashion that you so richly deserve.
    Thank you and I yield back.
    The Chairman. Representative King-Hinds, you are recognized 
for 5 minutes.
    Ms. King-Hinds. Thank you, Chairman Bost, and ``Hafa Adai'' 
to all of you. Thank you for being here today. Thank you for 
your service.
    To Ms. Locklear, my deepest condolences. Your story is too 
common to so many families and parents across America.
    I come from the Northern Mariana Islands, about 8,000 miles 
away from Washington, DC, that is my district. It is a chain of 
islands that, you know, have a lot of people signing up for the 
military. We have a lot of veterans and our issue basically is 
just access to service. We have one local physician contracted 
part-time by the VA to treat veterans 2 days a week. Referrals 
to available specialists in the district can be made out 
prior--with prior authorization from VA office in Honolulu, 
which is thousands of miles away. VHA also occasionally sends 
specialty care doctors to include neurologists and podiatrists 
about three times a year. We do have emergency care, although 
very limited even to nonveterans.
    The point is, you know, access to these services is an 
issue in the Marianas, and I have always assumed that that 
issue was limited to our islands. One of the reasons why I ran 
for Congress was to be able to improve the quality of service. 
As I am sitting here and I look at all of you and I am hearing 
about all these different challenges, I am crushed. If we are 
here on the mainland and we are not able to provide the quality 
of care here in America, then how are we going to be able to be 
able to address the challenges of our remote islands?
    I do not have any questions. I just wanted to say thank you 
and you deserve better. I truly believe in my heart that 
through Chairman Bost's leadership in this committee, that 
everybody has your best interest at heart. I am certainly here 
to fight not just for my community, but for you as well. Thank 
you so much.
    I yield my time, Mr. Chairman.
    The Chairman. We are glad we have Mr. Harris with us today. 
Mr. Harris, you are recognized for 5 minutes.
    Mr. Harris. Well, thank you, Mr. Chairman, for the 
invitation to be a part of your committee today and for the 
consent to allow me to share.
    Ms. Locklear, first of all, I want to thank you for having 
the bravery to come in today and to share your son Logan's 
story. It is truly an honor to have the privilege of 
representing a selfless American such as yourself. Your 
willingness to come and share your testimony, I really pray, is 
going to help us ensure that what happened to you and to Logan 
will not happen to future veterans and to their families.
    Your son had to wait 5 months between his initial contact 
for a mental healthcare appointment and the scheduled 
appointment date. Now, the law says that a wait time should be 
no longer than 20 days before referral to the Community Care 
Program.
    I guess I want to ask you, are you aware of any efforts the 
VA has made to improve wait times or improve awareness among 
veterans of the Community Care Program eligibility?
    Ms. Locklear. Yes, I think so.
    Mr. Harris. Well, sadly, looking at the VA wait time list 
last night at the Fayetteville VA Medical center, there is 
currently a 60-day wait time for new patients to get access to 
individual mental healthcare. You see, I am concerned about 
what you went through. I just want you to have an opportunity 
to really help us understand how this experience has affected 
you mentally and what this has led to in your own life.
    Ms. Locklear. I had worked for the VA for 12 years. I 
believed in the VA system. I love the veterans. To have my own 
veteran that I saw in front of me 4 years suffering through 
what he was suffering through, I was trying to help him. Could 
not get him to go. When I finally got him to go, this happened. 
The week he died, I thought he was actually better that 
Wednesday before he died. I thought he was doing better. Then 
that Friday when we found him, I was just crushed.
    When I went back to my facility, of course my department 
knew what had happened. They had rallied around me. They had 
taken care of me, they had provided for me. I knew I had the 
knowledge of a suicide, that it needed to be reported. When I 
went in to report it, they appeared to be very receptive, 
wanted to know what had happened. They wanted to know how--like 
I had known for 12 years. How do we fix this? How did he fall 
through the cracks?
    Then when I told him that he was my son, everything I felt 
like stopped. I kept waiting for someone to call me and say 
how--can we talk to you? How can we fix this? What happened? 
All the while I was trying to work and still trying to figure 
it out. I did not understand what was going on. I knew my child 
was gone. I did not know he had--I did not know they had given 
him a 5-month appointment. I did not know that. I did not know 
that till March of the next year. I kept asking, you know, I 
just kept waiting.
    Finally, I just called. I just called the director of the 
facility myself and I asked her about it. She was not--she 
said, I was not aware of that. From the very beginning, I just 
felt like it became a cover-up. Nobody would speak to me. I 
kept asking, you know, when I made her aware of it, she said 
she would get back to me. She never did.
    As the months continued, my work performance continued to 
fail. I worked in the pharmacy department. I have a lot of--I 
had a lot of responsibility in my job in regards to handling 
medications, handling drugs. I spent a lot of time the first 
year after Logan died, I was not at work. I could not function. 
I could not think. By half the year, I just--I had exhausted 
every opportunity, everything that I could use to help me to 
continue to work my job and stay where I was at till I finally 
decided I--I realized I could not work there. Every time I came 
through the back doors, I felt like they were--the VA did not 
help my child. Therefore, I just--in my head, I felt like the 
VA had caused my child's death. It made me feel like I 
contributed because I was part of the VA.
    In my head, I had to get away from the VA. I said, I have 
got to get away from this place. I have been diagnosed with 
PTSD, anxiety, depression. All I asked was, when my child died, 
I went in and I just said, can you help me? Can you explain to 
me? Just explain to me what happened, what happened to him? No 
one--they just--they acted like they did not see me. Now I feel 
like I am disabled. I still do not function well.
    Mr. Harris. Well, let me say this. You said something a 
moment ago that the whole attitude had been, oftentimes, you 
heard it, how did he fall through the cracks? How did they fall 
through the cracks? How did they fall through the cracks? I 
hope that you sharing your testimony today is going to help 
assure that that does not happen again.
    That, Mr. Chairman, I yield back my time.
    The Chairman. I now recognize Dr. Dexter for 5 minutes. 
Welcome to Congress.
    Ms. Dexter. Thank you so much, Mr. Chair. I apologize.
    The Chairman. I just want to let you know, this every day.
    Ms. Dexter. I am feeling indoctrinated, so thank you. Very 
much appreciate the testimony from all of the guests here. 
Particularly as a physician, as a mother, I want to acknowledge 
the challenges that our system faces.
    Having been a VA physician within the system as well as a 
physician in the private sector who has taken care of patients 
from the Veterans Administration system, we have a lot of 
challenges ahead of us. What Mr. Dooley went through, I have 
had my own patients go through. That delay in care and the lack 
of continuity of care from the outside is a frustration as a 
physician, but it is also a failure of the system. We know that 
building a more comprehensive system that is accessible to the 
veterans is better care. Our veterans want to be seen within 
the VA administration. They want to have the physicians who 
know them, who understand the challenges of having been a 
veteran. We provide better quality of care, more comprehensive 
care, and more timely care in an integrated system when it is 
appropriately resourced. I believe that that is the challenge 
that we need to rise up to.
    We need to have access for mental health, for addiction, 
for cancer services. The answer is not going to the private 
sector. It is building the VA Administration services so that 
we can build capacity within the system.
    I also speak as somebody who was a leader in a capitated 
system that provides coordinated care. When we were struggling 
financially, we made margin. We made a successful business by 
bringing services to within our system, to stop paying the 
bills outside that we have no control over, to stop the 
escalating costs that will continue. We understand that we are 
effectively supporting private practices outside of the VA 
Administration.
    Respectfully, Mr. Chair, and to our community members here 
who have so bravely and candidly spoken for veterans, I will 
fight for this system and I believe it is enforcing our need to 
serve veterans from within and to make sure that we resource it 
appropriately.
    With that, I yield back. Thank you, Mr. Chair.
    The Chairman. Thank you. As the ranking member, does Dr. 
Conaway want to have a closing?
    Mr. Conaway. Thank you, Mr. Chairman, for holding this 
oversight hearing. We understand that there is a lot more 
information we need to collect as a committee in order to 
ensure that we as a Nation are doing right by our veterans and 
making sure that they get the care that they richly deserve.
    Thank you to the witnesses for taking your time today and 
enlightening us with your personal experiences. In particular, 
thank you to Ms. Locklear for your bravery today. It is not 
easy to come and to talk about tragedy and to be as forthcoming 
as you have been. We are grateful for that and we are sorry for 
your loss.
    We look forward to working with you in a bipartisan way. 
This committee has a bipartisan history. May it always be so. 
We do better when we work together. We do things that are 
lasting and more sustainable. We look forward to our future 
work to bring attention to those things which need fixing and 
to work to make sure that our government does the job it needs 
to do by our veterans. Thank you all.
    The Chairman. I want to thank the witnesses for joining us 
here today. It is clear that the previous administration had 
problem implementing the Community Care Program. The Community 
Care Program and the MISSION Act are law. They are not 
suggestion, they are law. There is a reason for that.
    Let me clarify this, no Republican, and I guarantee you no 
Republican on this committee, has ever said we want to 
privatize, ever. Democrats have accused us of wanting to 
privatize. We do not want to privatize. We do understand that 
the VA was not created for the bureaucrats at the VA. The VA 
was created for the veterans. If we have people around this 
Nation and veterans around the world that need services, the 
MISSION Act should be able to do that.
    Now, unfortunately, I think that sometimes the bureaucrats 
in the VA, for the fear of privatization, refuse to do the job 
which we have assigned to them and that is what things have 
shown up. That is the problems--that is some of the problems we 
have. There is a lot of problems we have trying to get the 
services to the veteran at the time when they need it. As 
quickly and efficiently as we can. There is waste in the VA. 
There is. We need to make sure that it is the most unwasteful, 
best medical provider that it can be.
    Now, remember, there is a whole lot more than the medical 
side of VA. All those other things that we deal with in this 
second largest bureaucracy in the world that this committee is 
over, we are going to work to try to correct those. This is one 
issue.
    I am also going to say this. This is not the last hearing 
we are having on this. Others will be brought before us that 
are those people who are the providers and the connection 
between the patient and the Community Care provider in which 
they--and how they contract and how they communicate. It is a 
communication problem both between the VA and the Community 
Care. As Representative Van Orden said, we care about the 
veteran. We have got to figure out how to get that there and 
not put people in this condition again.
    I want to say thank you so much for being here. I want to 
thank the members for a long meeting. With that, we are looking 
forward to continuing to work on this.
    With that point, I want to ask unanimous consent that all 
members shall have 5 legislative days to revise and extend 
their remarks and include extraneous material.
    Hearing no objection, so ordered. This hearing is now 
adjourned.
    [Whereupon, at 3:49 p.m., the committee was adjourned.]
    
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                         A  P  P  E  N  D  I  X

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                    Prepared Statements of Witnesses

                              ----------                              


                   Prepared Statement of Paul McKenna

    Chairman Bost, Ranking Member Takano, and members of the House 
Committee on Veterans' Affairs - thank you for inviting me to submit 
this written statement for the record of today's hearing on veterans' 
experiences using the Department of Veterans Affairs (VA) Community 
Care Network. I am here today as a voice for countless Veterans in 
Eastern North Carolina who continue to struggle to effectively and 
efficiently utilize this critical part of VA's health care system.
    As the committee is aware, the VA MISSION Act became law in 2018 
and was intended to improve access to health care for Veterans. My aim 
today is to illustrate the gaps and seams within several pillars of 
this legislation that are present in Eastern North Carolina, with 
specific attention on access to care, the Community Care Network, and 
the education and training of the VA workforce that coordinates access 
to care in the community. My hope is that my statement will offer the 
committee some insight to the real challenges that Veterans face with 
when using the Community Care Network in Eastern North Carolina. 
Additionally, and what may sound anecdotal, is to share with you my 
experience with using the services of VA's Community Care Network in 
two different geographical locations and the experiences of many 
Veterans I have talked to who must utilize community-based services.
    My name is Paul McKenna. I retired in 2021 after 36 years of 
active-duty service in the United States Marine Corps. I have held 
numerous Military Occupational Specialties (MOSs) throughout my career, 
with the last 20 years being spent primarily with the infantry and 
combat arms MOSs. I have 9 combat deployments in support of Operation 
Restore Hope (Somalia), Operation Iraqi Freedom (Iraq), Operation 
Enduring Freedom (Afghanistan) and Operation Enduring Freedom, Joint 
Task Force, Special Operations Force, (Southern Philippines). I have 
learned many life lessons from my nearly four decades of service as a 
US Marine, and at the top of that list is that no American can afford 
to be disinterested in any part of his government, whether it is 
county, city, state, or nation. One of the great lessons the Marine 
Corps taught me was to never take for granted of being the presence of 
other Marines and their greatness. For 36 years I walked amongst 
giants, I will forever cherish those relationships, especially the 
relationships of the American Heroes that never came home. I truly hope 
that my actions and words today bring honor to their memory and 
sacrifice.
    My wife and I initially resided in Northwest Florida after my 
retirement, and I was able to receive timely and adequate medical care 
from the VA in that region. There were several factors that drove us to 
this part of the country; one, my wife, Michela, who is a federal 
employee, took a new position within government service at Naval Air 
Station Whiting Field in Milton, Florida. Two, the quality of cardiac 
care within the area of Northwest Florida. Michela received a 
mechanical heart valve after being diagnosed and treated for 
endocarditis in 2013. And three, the word from fellow retired Marines 
that the VA health care system was first rate. Michela's medical care 
is covered by TRICARE for Life, and that insurance involves expensive 
copays for her continued care.
    The primary reason for choosing the VA for my medical needs was for 
our financial wellness and the fact that I earned it. I am 100 percent 
permanent and total disabled and I use the VA as my primary medical 
provider. The VA in Northwest Florida (Pensacola) is a VA Clinic 
associated with the Biloxi VA Medical Center in Mississippi, which was 
two hours from our home in Milton, Florida. The care at the VA 
Pensacola Clinic was first rate and Dr. Sandoval and his team always 
treated me with the highest degree of professionalism, dignity, and 
compassion. Because I require a specialist in some areas of health 
care, and the fact that the Pensacola VA clinic does not have that 
capability or capacity, I was referred to the Community Care Network, 
i.e., Mental Health (PTSD), Neurology (TBI), Orthopedics, Podiatry, and 
Dermatology. The process in Pensacola was seamless. Starting with 
seeing Dr. Sandoval and his Team to scheduling with the Community Care 
Network counselors to be seen out in the community. The entire process 
took no longer than 10 to 15 days.
    In June 2022, I relocated to Richlands, North Carolina and 
registered with the VA clinic in Jacksonville, North Carolina. Just 
like Pensacola the Main VA Hospital for this region is in Fayetteville, 
North Carolina, two and half hours away from my residence in Richlands. 
After registration at the Jacksonville VA clinic, I was informed that I 
would have to contact the Community Care Network and seek a provider 
out in the community. This was due to the lack of capacity of doctors 
and nurses at the clinic and that they were not taking any new 
patients. Community Care set me up with MEDFIRST in Richlands, North 
Carolina.
    MEDFIRST is a primary and urgent care clinic that only has nurse 
practitioners on staff. The MEDFIRST nurse practitioners can draw blood 
and perform only basic medical care. This clinic (MEDFIRST) does not 
have the expertise or capacity to treat my medical issues which include 
mental health, traumatic brain injury (TBI), post-traumatic stress 
disorder, neurology, orthopedics, podiatry, dermatology, and urology. 
MEDFIRST must put a referral in the VA system for me to be seen out in 
the community for medical treatment. That referral goes through a 
third-party vendor who then submits the referral request to the VA. 
When I call the VA Community Care line or contact the VA through 
MyHealtheVet to understand why the process is taking so long, all I 
hear is ``That's just the way it is'' or ``your primary care provider 
did not submit the correct form.'' As to the latter statement, I 
personally watched my primary care provider at MEDFIRST fax the request 
and the next day when I called to follow up was still told that the VA 
did not receive it and when I stated that I have the fax receipt, I was 
told ``sorry don't know what to tell ya.''
    More generally, the third-party vendor appears to have little to no 
oversight from either the VA or MEDFIRST. I have been waiting for over 
nine months for some of these referrals to be processed. I draw this 
conclusion as I attempted to gain their contact information, phone or 
email and was informed by MEDFIRST and the VA that they are not 
authorized to provide the contact information of this third party-
vendor to the Veteran. My experience is not unique. I have heard the 
same concerns and complaints from countless Veterans here in Eastern 
North Carolina. Since moving to Richlands, NC, I continue to experience 
delays in care from the VA Care in the Community Network.
    Despite my best efforts to advocate for my care, I never receive a 
clear answer from the VA counselors who answer the phones. When I quiz 
the VA counselors on the fundamentals of the VA MISSION Act, they are 
clueless of this legislation. I have contacted my VA patient advocate 
(Sheldon Edwards) numerous times and left voicemails and have yet to 
hear back from him or his office. No human being, let alone a Veteran 
should have to wait six to nine months to receive treatment for any 
medical issue, especially when the injuries occurred while in service 
to their country.
    I am asking this committee to investigate why there is no capacity 
to properly treat our Veterans in Eastern North Carolina in a timely 
and adequate manner and direct the VA to properly educate and train 
their workforce within the Community Care Network on the VA MISSIOIN 
Act in Eastern North Carolina.
    Thank you again for the opportunity to participate in today's 
hearing on the VA Community Care Network. It is my hope that Congress 
and the VA can take some of those things that were working in Northwest 
Florida like the referral process and the access to care and help 
replicate those qualities for Veterans across the country so that they 
can get the care they need in a timely manner no matter where they 
choose to live after service. I look forward to answering any questions 
you may have.
                                 ______
                                 

                  Prepared Statement of William Dooley

    Thank you, Chairman Bost and Ranking Member Takano, for the 
opportunity to discuss my frustrating experiences with the VA Community 
Care program. I am a U.S. Army Veteran who enlisted in 1998, serving 20 
years on active duty and received a rating of 100 percent permanent and 
total from the Veteran Affairs. I served in several units over the 
years, including the 101st Airborne Division, 2nd Infantry Division and 
The NCO Academy at Ft. Benning, Georgia. In these short years since my 
retirement, I pursued my Master's in Public Administration, served my 
community with an appointment as the Chairman of my local county's VA 
Committee, and obtained my Juris Doctor from Creighton University. I am 
currently a Prosecutor within the DFW area and proud father of three 
amazing children between the ages of 22 to 10. I am in front of you 
today as a Veteran, Father, Husband and a Cancer Patient fighting for a 
chance to live.
    By providing the timeline of my most recent VA Healthcare 
interactions and points of discussion, I hope to provide insight and 
perspective of the current problems Veterans are facing today while 
seeking care under the VA's Community Care Program. I will highlight 
network inefficiencies, employee complacency, and incomplete case 
management with the optimism that it will create opportunities to 
improve this beneficial program and help correct current ongoing and 
systemic problems present within the Organization.

BACKGROUND

    September 11, 2023, I attended an appointment at the Bonham VA 
Medical Clinic for a routine health check and to establish my transfer 
of care from the Omaha, NE VAMC. During this appointment I discussed a 
rising concern I had regarding a significant medical symptom. The 
physician rejected my concern and waived off any need to investigate 
the symptom further. I returned to this physician as the symptoms 
persisted around November 7th to insist that we investigate the cause 
and again inquired if a colonoscopy would bebeneficial. At this point 
the physician decided to order a lab test for me to conduct at home.
    On November 20, I received a call from the physician informing me 
that the test confirmed my reports of blood present in my stool and 
that I was being referred to GI for consultation. During this 
conversation my physician told me that there was a backlog to schedule 
a colonoscopy within the VA Network and he advised it would be faster 
to go through Community Care. Acknowledging the physician's 
recommendation and my desire to obtain answers as soon as possible, I 
agreed to his recommendations to seek the screening under Community 
Care in hopes the results would ease my concern.
    On December 8, 2023, I received the authorization to schedule a 
colonoscopy with Dr. Jenny Tseng, who was selected by the VA. The only 
information I was provided with was the physician's name, phone number, 
and the initial appointment of February 8. During this appointment, I 
was able to schedule the colonoscopy for May 20th. From the time I 
presented the concern to my Primary Care Physician at the Bonham VA 
Clinic with my initial request, to the time I was able to receive the 
screening was nine (9) months.
    On the morning of May 20th, immediately upon waking from 
anesthesia, my wife and I were informed that during the exam, Dr. Tseng 
located a large mass. She emphasized to us that it was medically urgent 
to seek an immediate consultation with a surgeon as soon as possible 
and strongly advised it needs to occur within the next week. The exam 
findings noted that the mass within my colon was already over 5 cm in 
length and occupied two-thirds of the space within the circumference of 
my colon. Think of a Hot Wheels car stuck to the inside of a cardboard 
toilet paper roll. Not only did this indicate an obvious concern of 
advanced cancer growth, but this also put me at a high possibility of 
experiencing severe risks stemming from a bowel obstruction.
    On May 22, assuming two days would give adequate paperwork 
processing time, my wife called the community care number listed on the 
Dallas VAMC website that did not work. She had to eventually call the 
VAMC general number and request to be directly transferred to the 
Community Care personnel.
    On the line with Community Care personnel, she explained the 
provider's concern for medical urgency. The personnel informed her that 
they could not locate the documentation, and they were experiencing a 
backlog. At that point CC personnel advised her that she might be able 
to receive help from the Patient Advocate and transferred. While 
communicating with Patient Advocacy, my wife inquired what the next 
step is for a Community Care referral that finds an urgent medical 
need. The Patient Advocate was not able to provide any tangible 
information regarding rules, regulations, or procedures to her. The 
Patient Advocate only advised her to wait until someone from the VA 
initiated the call. The Patient Advocate responded dismissively and 
told my wife that she could put in a complaint, but don't expect anyone 
to reach out for a week because they don't have to respond to 
complaints until a certain number of days and with the Memorial Day 
holiday coming up that would extend the deadline over that week 
anyways.
    Immediately following that interaction with the Patient Advocate we 
sought options that could produce access to care in accordance to the 
current medical urgency. We were able to schedule an appointment with a 
GI surgeon at the UTSW Harold C. Simmons Comprehensive Cancer Center 
who had an existing contract of service with Community Care and 
immediately received support and advocacy from their Nurse Navigator 
starting on May 22. On top of not having the ability to seek 
authorization for care under the VA Community Care program, I was 
unable to get ahold of my primary care physician to explore VA Facility 
options. At one point I physically walked the results indicating the 
presence of my tumor to the Greenville, TX CBOC, and requested that a 
doctor contact me as soon as possible as it is an Urgent Medical 
concern. I did not hear back from the clinic.
    It is my belief that we finally received communication from the VA 
due to the requests for assistance sent through Congressional 
inquiries. I was contacted by a VA Nurse Navigator on the afternoon of 
May 23rd. She explained that the VA has a tumor board, but I would need 
to have imaging complete prior to being put on their schedule. It was 
dependent on me, the patient, to schedule with the VA imaging 
facilities. After another round of inaccurate VA listed numbers and 
waiting multiple hours, the imaging scheduler informed us that I would 
not be able to receive complete imaging until September, having to wait 
an additional 4 months. After informing the UTSW Nurse Navigator of 
this scenario, she advocated for us and was able to coordinate with the 
VA staff to have imaging completed under Community Care at a civilian 
location. Around this time, I spoke with Patient Advocate, Ms. Veronica 
Lopez, who informed me that the Community Care Referral to be seen at 
UTSW was authorized for Six (6) months to cover treatment needed for 
Colorectal Cancer. I was not provided with any documentation that 
outlined details of this authorization and what it covered.
    After my initial appointment with the Colorectal Surgeon on May 
30th, we unfortunately learned that the imaging and testing indicated 
that I had T3N1 Colorectal cancer, more commonly referred to as Stage 3 
Cancer. This indicates that the cancer was further advanced than we 
were hoping for, and the Standard of Care directs for a Neoadjuvant 
Treatment plan prior to surgical removal. My treatment plan over the 
duration of 6 months consists of 8 rounds of two different types of 
chemotherapy, 5 rounds of concentrated radiation, and assessment for 
surgical removal of remaining cancer upon completion. I started 
receiving treatment in July 2024, under the belief that it was being 
covered by the VA Community Care authorization.
    On August 15, 2024, my wife contacted UTSW over pending billing 
statements on my account to inquire why they were not being covered by 
the VA Community Care authorization that should be on file. She was 
told by UTSW billing department that the VA rejected the billing. At 
that time, I reached out to Patient Advocate Veronica Lopez who 
informed me there was no authorization from the VA to receive 
chemotherapy or radiation, I would have to ask the UTSW staff to send 
in a request for services for additional approval. I inquired with Ms. 
Lopez why personnel at the VA were unable to contact the UTSW staff, 
she told me that she didn't have the time, and it would be best if I 
were to do it. My wife coordinated with the UTSW staff to submit the 
requested documents, on the first submission the VA rejected the form, 
and we were informed by the UTSW staff that when they also tried to 
speak to personnel at the VA to inquire what was needed, they could not 
get a hold of a single VA personnel member on the number they were 
provided. I once again reached out to Representative Self's office to 
seek assistance.
    On August 23, 2024, Savanna Douglas, RN was able to back date the 
referrals for Medical Oncology and Radiation Oncology. With the 
previous interactions of the initial authorization and the unclear 
details, I requested a copy of these documents. She informed me that it 
was not standard procedure to provide the Veteran with these documents, 
but acknowledging my concern pertaining to the miscommunication of 
previous authorizations, she was able to email me the authorization 
forms. With these forms my wife was able to coordinate with the UTSW 
billing personnel to correctly code and submit all appointments.

Discussion of Issues

    1. The Community Care program does not communicate directly with 
the provider after original scheduling.

    As the Community Care program sets the original scheduling and only 
alerts the Veteran of the contact information, there are many 
opportunities for poor communication and misunderstandings. 
Specifically addressing my scheduling of the colonoscopy, there was no 
information provided regarding the wait time and how it compares to the 
VA facility. Relying on the Veteran to be the main individual to 
coordinate treatment and authorizations is the main reason there was 
such a misunderstanding for the billing of my treatments. Multiple 
times we were unsure of what would be covered for the comprehensive 
plan and received very little support to navigate it.
    I also believe there is a risk to evaluate within the VA use of 
Community Care. With the lack of transparency between Community Care 
scheduling combined with little to no follow up by Case Management 
personnel, there could generate a risk that wait times for procedures 
are not being accurately assessed and inaccurate information is being 
provided to Veterans to make important informed consent decisions 
regarding their access to care.

    2. Community Care Authorizations pertaining to Complicated 
Diagnosis

    I was not provided with any referral numbers or what the scope of 
treatment authorized encompassed. I was asked to fix a problem on my 
own with no resources and no information on what had or had not been 
approved. There was no coordination of care provided; however, the 
authorization was limited in scope. Is it possible for a severe 
diagnosis, such as cancer, that have an industry standard of care, to 
be approached with a duty to accept/approve, should the billing be 
submitted for a patient with a diagnosis known by the VA, by a provider 
known to the VA, and for a Veteran that is within a patient category, 
such as 100 percent P&T, that are already established to receive full 
spectrum care from the VA Medical Network and any care associated.

    3. Lack of Professionalism and Compassion from VA Employees.

    The Veteran begins their journey typically with an extremely 
frustrating phone system. Something as tangible as the phone line 
infrastructure solely lies on the accountability of the Facility's 
Director. Many phone lines listed or attached to automated menus simply 
do not work. It is extremely complicated to get in contact with the 
necessary personnel for any specific requirement. Often a caller must 
be transferred multiple times and direct numbers provided by employees 
are not answered with no consistency of availability to leave messages. 
The default response from VA employees is to take a message and wait 
for a call back. Throughout this entire process not one time has 
someone from the VA system offered to schedule any communication. In 
their responses to our inquiries, the VA claims to operate Community 
Care within a case management model but refuses to offer appointment 
scheduling to discuss their case. This is extremely difficult for 
Veterans, like me, that are working their own jobs, have obligations of 
family, and are navigating very difficult treatment plans.
    Multiple occasions have we been treated with disdain, sighed at, 
told to wait and dismissed by employees we encountered. Case Management 
is extremely inefficient and often incomplete. I did not receive end to 
end case management or proactive engagement. For complicated medical 
conditions, such as cancer, follow up by Community Care personnel to 
ensure treatment plans align with authorizations would help decrease 
misunderstandings and reduce errors that have great potential to 
negatively impact the Veteran. In my scenario, it seemed that no one 
cared until we received assistance from Representative Self's office, 
and I believe that the result would be very different if we had not 
asked and received intervention on two occasions. I have experienced 
great care from some amazing VA employees, but an attitude toward 
complacency and seemingly no accountability permeates many of my 
interactions. Often VA employees display an attitude that they would do 
whatever possible to reduce their workload, burden the Veteran with 
tasks that the employee is hired to conduct, and possess no regard to 
the fact their actions affect a Veteran's access to care. This is seen 
top to bottom by the lack of reporting of community care wait times, 
broken phone infrastructures across the entire facility and network, 
difficult scheduling procedures, and non-existent case management.
    This was especially highlighted by the responses provided to the 
inquiries submitted on my behalf. At no point has anyone taken 
ownership or assessed what could have improved the scenario. I, as the 
Veteran, was regarded as part of the problem, because I chose community 
care and not care through the Dallas VA. The response reads that I 
sought care that was not authorized, when I simply sought care, so I 
don't die.

Conclusion

    Community Care is a great program that has expanded previously 
prohibited access to care and has the potential to continue to improve 
this access for many Veterans. I believe that Veteran Affairs has 
amazing employees that work for them. However, accountability for poor 
performance, a lack of proficiency, and low procedural transparency has 
generated a toxic atmosphere, that leaves the Veteran having to jump 
through bureaucratic hoops, holding large financial obligations for 
uncovered costs, or being denied access to life-saving and critical 
care.
    Communication between the Health care provider and the Case manager 
should be ongoing with feedback from both sides for this program to be 
successful. Especially for complex and complicated medical diagnosis 
that may require comprehensive treatment plans, case management should 
go beyond the initial scheduling interaction. Clear policies and 
procedures should be available and known to Veterans in the program. 
Wait times for services within the VA Network and the Community Care 
Network should be constantly evaluated and made transparent.
    I appreciate the time and opportunity this Committee has given me 
to share my story. I hope that it will help provide opportunities to 
improve access to care for other Veterans. I would like to thank 
Representative Self and his staff for their advocacy and assistance as 
my family has navigated this challenging time and to each and every 
member of this Veteran Affairs Committee for their continued interest 
in the care of Veterans.
                                 ______
                                 

               Prepared Statement of Lori Willis Locklear

    Hello. I am Lori Willis Locklear. Thank you for your time and 
effort in this important matter.
    I've been a Pharmacy Technician for 30 years until recently when I 
took an early retirement from the Department of Veteran Health Care 
System at the Fayetteville VA Health Care Clinic where I was employed 
for 12 years of my service. Prior to that, I worked for the State of 
North Carolina for almost 4 years. The first years of my career were 
spent at a local hospital, Scotland Memorial and then to a private 
pharmacy in Raeford, NC.
    Let me begin by telling you a little bit about me. On August 27, 
1988, I married Raymond F. Willis, who was an Army Veteran, and he was 
so proud to have served his country. On August 16, 1995 at 8:16 am, we 
had our only child, Logan F. Willis, and it was such a wonderful day 
for us both. On July 16, 2015 my husband died and I had to learn how to 
navigate life again as a single woman with a child in college. I have 
been a woman of great faith in God and in our Nation. I believed in the 
system but I knew that there were areas that needed to be improved 
upon. I gave all I had to my job and to all my veterans that I came in 
contact with daily because I was the wife of a veteran who loved his 
country and so do I. I was proud to serve our nations veterans but 
things changed for me when my son, My Veteran, died by suicide in my 
home because of the lack of support that he received from the very 
place that I had spent years as an employee. Not only was I 
disappointed in the Fayetteville, NC VA, but there was a part of me 
that was disappointed in myself because I truly believed in Veterans 
Affairs. As an employee and mother, I felt that I had failed because I 
believed the VA would take care of my son and at times it was hard for 
me to determine if I was speaking from a mother's perspective or that 
of an employee. I believed that Logan felt that I was only the employee 
and not his mother for he would share that the VA was not willing to 
help him but I kept telling him to return to the VA. I tried as much as 
possible to follow the proper protocol, yet, MY Veteran died by suicide 
in my home, from what I believe was a failure to follow the Community 
Care Act. I believed that our trust in the system was betrayed, 
promises were not kept, and Logan's life was not valued just like so 
many other veterans who have sacrificed so much for our country.
    The year 2015 was a very difficult time for Logan and I because his 
father died of lung cancer. We were a very close knit family and Logan 
idolized his father. After his death, Logan and I received counseling 
and I struggled for a long time. Logan was in college at the time and 
he graduated from the University of North Carolina at Pembroke. He 
enjoyed his time in school and wanted to further his education. So we 
thought the military was an option for him and he wanted to be a 
Veteran just like his dad because his dad always spoke so highly of his 
service. He originally wanted to go to the Air Force, but the Navy 
talked him into going with them. I personally did not think that it was 
a good fit but Logan believed that he could do it. At the last moment, 
I tried to talk him out of it because there was something that did not 
feel right and I wish I had. Later, Logan told me that joining the Navy 
was the worst decision of his life.
    Logan enlisted in the Navy in 2018 and his first duty station was 
in Sasebo, Japan where he served as an intelligence officer. Shortly 
after he was on board, he began to mentally deteriorate; I began 
receiving emails at 3 am from him stating that he couldn't do this, he 
could not stay on the ship. I constantly told him that things would get 
better but as the days went on, he became more insistent that he had to 
get off the ship. He complained the food was terrible, often there was 
no silverware, the sailors had to eat with their fingers, his computer 
was constantly down, so his intelligence reports would not be up to 
date which resulted in him getting in trouble. He was extremely 
disturbed about the fact that he had been photographed naked while he 
was in the shower. I believe he also became claustrophobic in his 
barracks, he had not experienced it to that extreme on board the ship. 
After some time, he was transferred to San Diego Medical Center. I 
hoped and prayed that while he was in San Diego and on land that he 
would get better. One day, the doctor called and requested that I fly 
to San Diego immediately. When I arrived, I was informed that Logan had 
attempted suicide while being there and that he was being released from 
the hospital. My stay was horrible because I did not recognize the man 
who was in front of me. My son had always been kind and humble, a young 
man with a gentle spirit but this person was angry, disappointed, and 
this was not my Logan. I also discovered later that he had attempted 
suicide while aboard the ship. Due to all that Logan was dealing with, 
the Navy gave him an honorable discharge.
    Logan came home on December 31, 2018 but he was so different; it 
was so heartbreaking to witness the transformation that had occurred 
with my child. Logan was always a kind, loving person and would do 
anything to help anyone in need. During his younger years, Logan spent 
a lot of time at the Fayetteville, NC VA where he volunteered all 
through his high school years and worked at our local library for three 
years. He had an associate and a bachelor's degree. Another sad part of 
this story is that Logan was a support for a lot of individuals who had 
suicidal thoughts. So many have shared how it was Logan who talked them 
through their trauma and kept them from following through on their 
desire to commit suicide. Logan had a beautiful spirit but the man that 
returned was not the man that left home to serve his country. Logan 
felt that no one cared for him and that his life was not valued and 
sadly, this is a common theme among many who have served our country. 
The VA doesn't exist for the VA, it exists for our Veterans and their 
families and it should do everything possible to help those who are 
struggling mentally, physically, and financially. I believe my child 
would still be here if the VA had lived up to their promises that were 
made to him. Many promises are made to these young men when they enlist 
to serve their country. Some of these men are broken so much in 
training that they are never the same and that was my Logan.
    In January 2019, I told Logan to go to the VA, get his VA card and 
request a mental health provider. He came back and he said he was told 
that they were unable to help him. It was at that time, that he began 
to hate the very organization that he loved volunteering at during his 
high school summers; he lost all trust in the VA. The things he had 
experienced brought about his anxiety and depression but the way the VA 
treated him increased his mental illness. He was so angry and 
regardless of how I tried to defend the VA, the response he got from 
them led him to believe that the VA was not willing to help veterans. 
During this time, I felt like the worst mother in the world but I 
continued to encourage him to seek help but instead of seeing me as a 
support, Logan began to see me as part of the VA instead of his mother.
    In June, 2019, Logan used his GI Bill and was enrolled in Wake 
Forest University in the Master's of Divinity Program in Winston Salem, 
NC. We all know what happened in 2020, Covid, and this really took a 
toll on Logan because he was beginning to feel a little better because 
he became a part of the college community. I thought things might be 
looking up. However, when all his classes were virtual, Logan became 
more and more depressed. He would stay inside for weeks and isolate 
himself from everyone. I became more and more worried about him. He 
struggled in school and later I learned that his professors noticed 
that he was struggling and several reached out to help him. He was able 
to graduate with their help and I truly believe that is why he lasted 
as long as he did.
    I believe Logan felt trapped; in his mind, the Navy had taken his 
life and now the VA was taking from him as well. On one occasion he 
called me because he was running low on his medications and was worried 
about refills. I assured him that a pharmacy would help with his 
medication; however, I have receipts where he had to pay for his 
medications. I also have receipts where he had to pay $300 for the 
multiple calls he made to his mental health provider. When he was in 
college, he had to pay for health insurance which was very costly. 
Needless to say, I was so upset to know the lengths that he went to in 
order to receive help from an organization that was created to protect 
those who served to protect us.
    On May 14, 2022, Logan graduated from Wake Forest University and we 
were so proud to see him graduate after all the struggles he had been 
through. He seemed so happy that day and I prayed that day would be a 
new beginning for my son but little did I know it was the beginning of 
the end of my child's life. He tried to find a job and an apartment 
after graduation but was unable to find either. He was forced to return 
home so once again, he felt like a failure. I began to see him 
isolating himself again and I constantly encouraged him to seek 
additional help so he agreed to meet with our local VSO Office in 
Raeford. Officer Flagg was the officer who appeared to be helping him. 
I found out later, after his death that multiple mistakes were made on 
Logan's paperwork (i.e., wrong address). When I informed Officer Flagg 
of his death, he completed the paperwork for burial expenses and once 
again, mistakes were made. I informed his supervisor of the multiple 
mistakes so he decided to complete the paperwork himself. This is 
another example of why Logan didn't trust the VA and by this time, 
neither did I.
    In September 2022, I felt more and more that his mental health 
provider was over medicating him. I was a pharmacy technician so I 
would ask our pharmacist about his meds and they would provide 
information. I asked Logan to visit the VA and let our pharmacist go 
over his meds with him. Afterwards, I sent him to check in and request 
to be seen or given a mental health appointment. I was adamant about 
him being seen or provided an appointment. When he returned home that 
day, I questioned him, and he said I got an appointment but he didn't 
say when the appointment was and I never asked; that was my big 
mistake. I found out after his death, in March 2023, that he was given 
a mental health appointment for February 2023 which was five months out 
from when he reached out to the VA in September 2022. I was told after 
Logan's death that our protocol at that time was, if a veteran asked 
for a mental health appointment, they were either to be seen or sent to 
community care within 20 days, my child died 60 days after that and was 
never called. Once again a promise not kept.
    A few days after I buried my only child, I telephoned Washington DC 
to alert them that my child had died by suicide because he was 40 
percent service connected for his disability. Upon returning to work on 
November 22, 2022, two weeks after my son's death, my service 
department was aware of Logan's death, but per protocol I knew I had a 
responsibility as an employee to report a death. Therefore, at the 
time, I felt the patient advocate's office would be appropriate but 
truly I was not thinking clearly and as I write this today, two years 
later it is still hard to think. They seemed very interested and 
shocked to hear of a suicide from our facility and was eager to get the 
information; yet, when they realized it was my son, things changed. I 
came in as an employee, one they knew, but then I became the mother. It 
was at that time, I felt that a cover up began to take place. Over and 
over, I tried to uncover the truth and it was during that time that I 
was treated as a whistleblower. They assured me they would get back 
with me but I was never contacted. Although I returned on November 22, 
2022, it wasn't until February 2023 when I personally contacted 
Director Fryar about my child's suicide that had occurred in our home. 
She stated that she was totally unaware and sympathetic to what had 
occurred and that she would be in touch with me as soon as possible; 
yet, it was not until April 2023 that someone reached out to me. Based 
on what information was provide to me, it states that a suicide team 
was supposed to contact the veterans family as soon as they are made 
aware of the suicide but I guess that policy does not apply to 
employees of the VA.
    After waiting for weeks just for someone to help me to understand 
what had happened, the first call I received from the facility's risk 
manager informed me that I had to come and fill out a tort claim which 
I did understand what a tort claim entailed. On the tort claim, I 
claimed negligence because I felt that the VA did not help my child. 
The VA denied my initial claim because they stated they did give him an 
appointment. A week after filling the claim, I requested his medical 
records and discovered that the VA had given him an appointment but it 
was five months from the day we requested help. Why would the VA wait 
five months when someone is struggling and needing help? When I asked, 
I was informed that the computer electronically gave him the 
appointment. Someone should have looked at the date and changed it. Due 
to the new knowledge, I filled out another claim with a different 
description but once again it was denied. When I asked why, they stated 
they were unable to talk with me. I continued to speak with countless 
people and I ran into roadblock after roadblock within the VA. At this 
time, I was mentally and physically deteriorating and I could not focus 
on my job; thus, I took FMLA to go home and try to heal. I felt that my 
healing would never come as long as I was working for a system that in 
my mind contributed to the death of my son. In order to bring some sort 
of closure and healing, I sought therapy and I am still in counseling 
today. My therapist helped me realize that I have PTSD and every time I 
walked through the back door to the VA, I literally began to suffer 
because I blamed the VA for his death. I worked as best as I could to 
get to my minimum retirement age and then I left. I felt I had no 
choice because I could no longer do my job. I was holding up my 
department and causing a hardship. I simply could no longer function as 
I had prior to Logan's death. I was never processed out of the system 
as every other employee had been. When I asked my supervisor, she 
stated that she had not been informed and frankly she was as surprised 
as I was. Once again, another promise not kept. Another VA employee 
shared with me that I should seek disability because of my treatment 
from the VA after my son's death which brought on all the mental and 
physical issues that I now have. I have been sicker in the past two 
years since Logan's death than I have been my entire life. I'm almost 
58 years old. I applied for disability in November 2023 and have not 
heard back from the Office of Personnel Management.
    I called a local NC representative in January 2023 for help and he 
was very instrumental in helping me. I have also shared my story with 
other state representatives. There is so much emphasis put on the Gold 
Star families for their sacrifice what about the families when a 
veteran dies by suicide. Personally, I think the least that could be 
done is the military or VA should have to lay these young people to 
rest and not their families who entrusted their well being to them when 
they enlisted to serve. I also think the sole survivors benefits rules 
should be revisited, how old exactly is this rule. What family can live 
off of $35,000 a year to qualify for these benefits? I am my child's 
sole survivor, his father, an Army veteran, is deceased as well. 
Haven't I lost enough? So, I got remarried a year before my child died 
and so it disqualified me for this service? Really, I think it's the 
least that could be done for me! Not to mention, this entire last 2 
years of my life has been debilitating because of everything that the 
VA did to me by treating me like a ``whistleblower'' because no one 
wanted to speak to me. I was finally given a meeting over a year later 
in January 2024 and all of my questions were not answered to my 
satisfaction nor was I satisfied with the outcome of my tort claim. I 
hope my efforts will not only bring closure to me but will also help 
military families in the years to come and the VA will adhere to the 
Community Care Act which is the law. My hope is that no other veteran 
dies because the laws are not being followed. I do not want another 
mother to find their child in a bathtub with a plastic bag over his 
head with a helium tank inside. This was a total nightmare that never 
goes away.
    In closing, thank you for the opportunity to share Logan's story, 
he deserved this; his life mattered. My hope is that by sharing his 
story, this will bring some healing to my broken heart, help me reclaim 
my life and my prayer is that one day I will be able to think clearly. 
Last, I hope that no other VA employee who has a deceased veteran will 
have to endure the hardships that I had to endure. I feel like I was 
labeled a whistleblower but if it brings positive change to a broken 
system then it was worth it. I will always wear the title of mother 
with pride, Logan, my son, you will always be. I also want to thank my 
husband, Ray Locklear, who has been my constant support during this 
horrible ordeal. Once again, thank you and God bless you all.
                                 ______
                                 

              Prepared Statement of Brittany Dymond Murray

    Chairman Bost, Ranking Member Takano, and members of the committee, 
on behalf of the men and women of the Veterans of Foreign Wars of the 
United States (VFW) and its Auxiliary, thank you for the opportunity to 
provide the VFW's and my personal remarks on this critical topic.
    The VFW believes the Department of Veterans Affairs (VA) community 
care program and its Community Care Network (CCN) of providers are a 
vital component of VA health care as it delivers the care and services 
that VA hospitals and community-based outpatient clinics either cannot 
or do not provide. Since no institution can be everything for 
everybody, community care options are force multipliers as they permit 
VA to continue providing the world-class health care that veterans 
prefer, deserve, and have earned while also ensuring they have access 
to the range of health care services they may need throughout their 
lives.
    When used properly, CCN can save lives and improve the health 
outcomes for countless veterans, but when problems with CCN arise it 
can drive people away from the care they have earned. We have also 
called on VA to lean on its third-party administrators to ensure 
consistent delivery of community care to veterans who are eligible. 
Unfortunately, VA has not heeded these calls, and we regularly hear 
from veterans whose potential community care eligibility has been 
stifled by bureaucrats at the local level. The VFW has been unequivocal 
since the Phoenix crisis in 2014 that community care must be a part of 
VA care. It always has been. However, veterans expect consistency. When 
23 Veterans Integrated Services Networks interpret the VA MISSION Act 
of 2018 in 23 different ways, veterans are overlooked, as the VA 
Inspector General pointed out earlier this year in Buffalo, New York.
    VA's CCN is plagued with too many problems that need thoughtful 
solutions. Care in the community is necessary for some veterans but, if 
given the choice, our members routinely tell us they prefer VA direct 
care. We believe some of that sentiment is driven by negative 
experiences with the community care process. We must fix those issues 
because our veterans have earned quality care regardless of who 
provides it. My story below is just one example of a negative 
experience that could have been easily avoided.
    As a nearly decade-long VA patient, I wholeheartedly agree with the 
VFW in its view of the necessity of the VA community care program, and 
it is not because I am a VFW employee or hold a life membership 
therein. I have interacted with VA community care on numerous 
occasions, including a successful surgery that VA was unable to 
perform. However, I was called here today to illustrate my recent 
experience obtaining inpatient mental health treatment through VA.
    My journey with mental health care began on active duty during my 
first deployment in 2010. Initially spurred by relational challenges 
and interest in addressing childhood traumas, my needs intensified 
after I experienced the devastating 2011 earthquake in Japan and was in 
a combat zone in 2012 where I endured months of harassment from members 
of my unit in Afghanistan. For years, I struggled to sleep because I 
was flooded with recurring nightmares and night sweats. Among other 
symptoms, I also battled persistent and sometimes explosive anger at 
home and at work, and went emotionally numb. I did not understand what 
was happening to me and, quite frankly, no one else genuinely did 
either.
    The Department of Defense (DOD) did not accurately diagnose my 
symptoms as post-traumatic stress disorder (PTSD), which meant that 
while I was receiving mental health care the treatments were merely 
band-aids that helped only to a point. I was not diagnosed with PTSD 
until after I was discharged from the Navy in 2015 and a local Vet 
Center therapist suggested I file a VA disability claim. PTSD became 
and remains my highest service-connected VA disability rating.
    My PTSD symptoms continued with little meaningful improvement after 
my transition to VA health care where, until I moved to Washington, DC, 
in 2021, I had been under the care of only VA therapists and 
psychiatrists. With medication and various forms of therapy, some 
symptoms improved while others changed and new, seemingly more 
insidious ones presented themselves. Despite consistent mental health 
care from multiple providers with the tried-and-true treatment 
modalities available at VA, I continued to battle crippling emotional 
numbness and had come to blame myself for being ``defective.'' I also 
started silently contending with what I came to learn were passive 
suicidal ideations, and concluded that my brain and my very being were 
beyond repair.
    During fall 2021, after ten years of trying to find understanding 
and relief, I was referred to a civilian trauma therapist through VA 
community care due to capacity constraints in the Washington, D.C., VA 
hospital's mental health clinic. My new therapist quickly diagnosed me 
with complex PTSD (CPTSD), which is the first time I can recall a 
mental health professional using that term. Shortly thereafter in early 
2022, I called the Veterans Crisis Line and after following up with my 
therapist, she decided that my chronic CPTSD symptoms met the criteria 
for a higher level of care including inpatient or residential mental 
health treatment.
    It took me a while to warm up to the idea of live-in mental health 
care, as I was not sure whether things were truly ``bad enough'' to put 
my life and new job on pause for a month or more. However, it soon 
became clear that my passive suicidal ideations were not abating, and 
neither was my battle with emotional numbness. Going about regular life 
with weekly therapy appointments was not enough, and I needed my 
primary daily focus to be my mental health. I agreed to pursue 
inpatient treatment in May 2022 and my community care therapist quickly 
acted.
    Based on my trauma history and symptoms as well as her clinical 
expertise, she recommended a military-and veteran-specific PTSD 
treatment program in Utah. Specifically, my therapist felt it was 
critical that I go to a women's program that had military cultural 
competence, approached treatment holistically, offered specific 
treatment modalities like Eye Movement Desensitization and Reprocessing 
(EMDR), addressed a range of traumas including those sustained during 
childhood and during military service like military sexual trauma, and 
could be completed in roughly 30 days. Since the Utah facility met 
those requirements and she had heard positive feedback about its 
program, my therapist began the nuanced community care referral process 
with VA.
    After months of trial and error submitting my referral, my 
therapist learned in September 2022 that the Washington, D.C., VA could 
not authorize a referral to the Utah treatment program due to its 
physical location in VA Community Care Network Four (CCN 4), which is 
managed by TriWest Healthcare Alliance. The VA employee assisting with 
the referral noted that we were in CCN 1, which is managed by Optum 
Serve, and requested that we choose an alternative facility in the 
Washington, D.C./Maryland/Virginia area. It is noteworthy that a 
representative at the Utah facility warned us about this by stating,``. 
. . we are not in-network with the East region. We have tried several 
times but have been told `we do not need any additional providers at 
this time.' It is frustrating because we get a lot of calls from the 
East Coast and we haven't been able to help.''
    Shortly after my referral to the Utah treatment program was denied, 
I learned that I also needed reconstructive hip surgery. Disgusted with 
the denial and knowing that I could not do both due to employment 
factors, I chose to have surgery even though it meant I would have to 
wait even longer to go to mental health treatment.
    Following my surgery recovery, and with an emboldened need to go to 
treatment, I revisited the conversation with my therapist to find a 
suitable inpatient program. However, this time around I had done an 
immense amount of research on the many symptoms I was experiencing and 
their root causes. In doing so, I came to learn that in addition to 
EMDR and other evidence-based methods, an uncommon treatment modality 
called Internal Family Systems (IFS) therapy was also effective in 
treating CPTSD. Together with my therapist, we decided to try to get 
authorization to a treatment program in Arizona that, like the Utah 
program, was in CCN 4 and offered the highly specialized and tailored 
CPTSD treatment options and holistic care that my therapist and I 
agreed were necessary. They also offered IFS, which I quickly realized 
is difficult to find.
    I had reason to believe this time would be different because while 
speaking with a representative from the Arizona program, it was 
mentioned that service members and veterans from the East Coast had 
come there in the past. However, it was noted that I would need to 
convince my VA doctor that an out-of-network exemption was needed to 
advocate for a community care referral on my behalf. So, on July 10, 
2023, I sent a detailed two-page request to my VA psychiatrist via 
secure message substantiating my interest in the Arizona program. He 
acknowledged and submitted the request, but I received no updates for 
about a week thereafter.
    Frustrated with the seeming lack of urgency on VA's part, I 
physically went to the Washington, D.C., VA hospital and found a mental 
health professional who agreed to speak with me right away without an 
appointment. She then introduced me to a social worker who could help 
me with my referral. Without hesitation, the social worker listened to 
me, did a thorough review of my symptoms and, to my great surprise and 
relief, he named the emotional numbing that had plagued me for so many 
years. He agreed that my CPTSD symptoms required the specialized 
treatment that the Arizona facility could provide and promised to 
advocate on my behalf that its program was the right fit for my 
recovery.
    On July 21, 2023, the social worker who promised to try to help me 
get into the Arizona program informed me that since the facility was in 
CCN 4, it was outside their community care consult area. He said they 
were able to submit consults only for programs in CCN 1 or CCN 2. 
Furthermore, he said he talked with the same representative from the 
Arizona facility with whom I had previously spoken, and that he would 
continue to try to find a way to get a referral authorization.
    Unfortunately, I did not hear back from the social worker, and my 
request for inpatient mental health treatment was overlooked for more 
than a month. I later learned that he went on emergency medical leave 
and my file was not given to anyone else until September 2023.
    Two VA employees -- another social worker and a community care 
referral manager -- began to help me find a treatment program in early 
to mid-September. Unfortunately, so much time had passed since my 
initial treatment request in July, that I could no longer go as soon as 
a suitable program was found that also had space available to admit me. 
I would have to wait until January 2024 for my next available window of 
opportunity to enter treatment.
    Nonetheless, the VA employees continued to help me find inpatient 
programs, but insisted that they be on the East Coast because going to 
a program in CCN 4 was not an option. At that point, I was firmly put 
in a position of having to find CPTSD treatment programs comparable 
with those in Utah and Arizona, which was the proverbial ``needle in a 
haystack.'' The employees asked what my criteria were, and they began 
presenting me with myriad in-network options.
    None of the programs they suggested were directly comparable to 
those offered in Utah and Arizona. Some programs were too long (e.g., 
90 days, while others were not the right structure for my needs (e.g., 
intensive outpatient programs). Some had poor reputations and my 
therapist steered me away from them. Still yet, others did not offer 
the range of treatment modalities I needed, or they were primarily 
focused on treating mental health conditions I did not have such as 
eating or substance use disorders. One facility was for patients who 
were dangers to themselves or others, which was not only inappropriate 
for me but also would have been more detrimental than therapeutic. 
Another facility I personally interviewed did not understand why I 
would want to be in a women-only program. To say I was angry and 
frustrated was an understatement, and I felt bad because while the VA 
employees were trying to help, the in-network options they presented 
always seemed to fall short in some way.
    After a few weeks of searching, we finally found an in-network 
treatment facility in Pennsylvania that met most of my criteria. 
Although the program was not military-centric and did not use EMDR or 
IFS treatment modalities, it was 30 days long, women-only, holistic, 
and employed one treatment method called Dialectical Behavior Therapy 
that could help me manage my CPTSD symptoms. After much consideration 
and knowing that it was a significant departure from the Utah and 
Arizona programs, I agreed to compromise and go to the Pennsylvania 
program.
    I checked into treatment on January 3, 2024, and was extremely 
fortunate to have been matched with a military-connected trauma 
therapist who helped me begin to identify the root causes of my CPTSD 
diagnosis and related symptoms. She also ensured that my follow-on care 
was with a qualified professional who practices both EMDR and IFS 
treatment methods. I am currently under the care of that professional, 
who agreed to join the VA CCN in order to treat me. I consider myself 
very lucky, but getting the right mental health care should never be a 
matter of luck.
    I cannot adequately express how difficult it was to simply 
acknowledge to myself, let alone others, that my mental health had 
deteriorated enough to need intensive treatment. After a decade of not 
receiving the correct diagnoses and related treatments, I felt 
defeated, defective, and helpless. I learned that passive suicidal 
ideations are actually a product of the ``fight'' portion in one's 
fight-or-flight response essentially giving out. It is unconscionable 
that I was allowed to get to that point despite consistent DOD-and VA-
provided therapy. Considering military and veteran suicide statistics, 
I am not alone. Had I not advocated for my needs, and as a result been 
sent to a treatment program that was unequipped to truly help me, it 
could have been my last attempt at getting better. I trust that I do 
not need to spell out what that means.
    VA must stop its practice of rationing inpatient and residential 
mental health treatment based on arbitrary, seemingly thoughtless 
guidelines. Timely diagnosis and placement based on specific needs are 
crucial, regardless of location. Failure to do so is short-sighted at 
best and dangerous at worst. Providing veterans with the correct and 
appropriate mental health care the first time maximizes savings lives.
    Chairman Bost and Ranking Member Takano, this concludes my 
testimony. Again, the VFW thanks you for the opportunity to testify on 
this critical issue. I am prepared to take any questions you or members 
of the committee may have.

Information Required by Rule XI2(g)(4) of the House of Representatives

    Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW 
has not received any federal grants in Fiscal Year 2025, nor has it 
received any federal grants in the two previous Fiscal Years.

    The VFW has not received payments or contracts from any foreign 
governments in the current year or preceding two calendar years.
                                 ______
                                 

                  Prepared Statement of Kelley Saindon

    Chairman Bost, Ranking Member Takano and Distinguished Members of 
the Committee, thank you for inviting us to testify today on the U.S. 
Department of Veterans Affairs (VA) Community Care Program (VCCP).
    NOVA is a professional organization for nurses employed by the 
Department of Veterans' Affairs (VA). The opinions provided here are 
not that of the VA, but of our members who are nurse managers, 
frontline and specialty healthcare professionals taking care of 
Veterans at VA facilities around the country.
    As nurses coordinating care and directly involved in referring 
Veterans into the community, we would like to provide our thoughts on 
the VCCP program with a focus on Veterans enrolled in the system.
    Currently there are 9.1 million Veterans enrolled in VA healthcare. 
VHA's 2024 Annual Report noted that VA delivered more than 130 million 
health care appointments of which 78.8 million involved direct care and 
48.8 million were in the community.\1\
---------------------------------------------------------------------------
    \1\ VHA 2024 Annual Report VA Health Care: A Strong Foundation. A 
Healthy Future.
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    NOVA understands and supports Community Care when access to VA is 
not readily available, the distance is too far, or the VA does not 
provide the needed care. We recognize and acknowledge that we cannot 
serve everyone everywhere. Our priority is to ensure Veterans receive 
the highest level of health care within the VHA and utilize community 
care as needed to enhance their health care experience.
    Since the passage of CHOICE and MISSION Acts, the VCCP has rapidly 
expanded. Referrals have risen to 15-20 percent annually, and in 2023, 
44 percent of VHA health funds were spent on external care. While the 
MISSION Act expanded community care it was not meant to replace VA's 
Integrated healthcare system. The legislation was meant to provide a 
balance between non-VA care when necessary while bolstering VA direct 
care.
    Community care is an integral part of our healthcare delivery 
system. VHA continues to collaborate and build strong community 
coalitions. These partnerships are crucial to providing safe care 
efficiently for veterans. Provider shortages and budgetary constraints 
continue to affect care in the community. According to the Association 
of American Medical Colleges there is an anticipated national shortage 
of 21,400 to 55,200 primary care physicians by the year 2033.\2\ 
Constriction and closures of community healthcare systems have raised 
questions and concerns about how and when Veterans can be referred to 
the community. Our healthcare communities are saturated, unable to 
absorb the needs of Veterans. As such, VHA continues to prioritize 
enhancing partnerships with CCN to deliver care to our Veterans.
---------------------------------------------------------------------------
    \2\ Tim Dall et al., The Complexities of Physician Supply and 
Demand: Projections from 2018 to 2033 (Washington, DC: Association of 
American Medical Colleges, June 2020).
---------------------------------------------------------------------------
    Veterans in rural communities are at a higher risk, where the 
provider shortage is worse, leaving them without access to primary 
care, mental health, hospital, emergency, and pharmacy services. VHA 
has worked tirelessly to bring healthcare to the Veterans, technologies 
have bridged a gap in these rural settings.
    Despite much innovation and improvement work focused on expanding 
efficiency for Community Care coordination, the steps are laborious. 
Inconsistencies in scheduling and authorizations across the system 
create confusion for Veterans and our community partners. It is vital 
that VA facilities have more control over services provided. Records 
must be received timely so the VA can coordinate additional care, if 
needed, including scheduling any diagnostic testing that may be 
requested.
    We recommend a public facing site that Veterans can view to make 
informed decisions as to where they are receiving care. The site should 
include detailed information on provider wait times, quality metrics, 
credentials, and training for both VA and VCCP providers.
    Training is critical and not required of VCCP providers at this 
time. Focusing on the veteran should require that all VCCP providers be 
mandated to complete education and training related to military culture 
and illnesses seen in veterans.
    VHA clinicians are more likely to have experience and specialized 
training in recognizing, diagnosing, and treating conditions often 
encountered by Veterans, such as trauma-related injuries, substance 
abuse, mental health disorders and toxic exposures. VHA providers have 
logged over three million toxic exposure screenings as of April 2023 
with almost 42 percent of those screenings revealing at least one 
potential exposure.\3\ VHA staff are uniquely trained not only on 
military culture but also on disease and exposures specific to the 
veteran population.
---------------------------------------------------------------------------
    \3\ ``VA PACT Act Performance Dashboard,'' VA https://
www.accesstocare.va.gov/VA_PACTActDashboard.pdf
---------------------------------------------------------------------------
    As a VHA employee, new employee education provides Veteran specific 
training to ensure competencies are in place before administering care. 
The standards for our community network should be no different. Our 
Veterans and caregivers deserve it. As a nurse, in addition to new 
employee orientation, VA medical centers provide clinical employees an 
additional clinically focused orientation. At White River Junction 
(WRJ) the new employee education is three days for all employees, the 
clinical orientation for nursing staff is a week-long.
    Robust training includes clinical reminders, which are nationally 
generated screening assessment in the electronic health record specific 
to disease and illness commonly experienced by Veterans. This 
individualized preventative care and evidence-based practice cannot be 
found in the community. For example, suicide risk is assessed at each 
episode of care at a VA medical center. Whether the Veteran is in the 
eye clinic or the mental health clinic, this is standard. These 
standards should be no different for community providers treating 
Veterans.
    Care oversight in the community network is minimal at best, we 
recommend there is strong action to bolster quality and oversight of 
care. Failure to meet quality expectations should result in removal 
from the network. Without proper coordination between VHA and community 
providers with respect to returning medical documentation in a timely 
manner puts the Veterans at risk of not receiving relevant information 
to make sound and accurate health care decisions. For example, this 
vulnerability is especially important with lung cancer screening, lung 
nodule follow-up, mammograms, and colonoscopies. Often the community 
care staff request records 3 or 4 times with no results sent by the 
community provider, leaving the Veteran at risk for serious, in some 
cases, life-threatening poor outcomes.
    We recommend the community network have prescriptive guidelines for 
record sharing. Current practice of faxing leaves much risk for 
healthcare decision delays. We encourage Congress to reimplement 
business rules that permits payment to VCCP upon receipt of medical 
records.
    The U.S. Dept. of Veterans Affairs healthcare system in White River 
Junction (WRJ) is a fully accredited acute medical and surgical care 
facility offering primary and subspecialty outpatient care, including 
rehabilitation, and mental health services.
    The WRJ Healthcare system serves veterans in Vermont and the four 
contiguous counties of New Hampshire. Veterans are being redirected to 
the VA as primary care and certain specialty services in the community 
are not taking on new patients. The continued increase in community 
care is a threat to safe and timely access to care for Veterans.
    Studies have consistently shown that VHA care equals or exceeds the 
quality of care provided by the private healthcare sector. Recent star-
rating reviews demonstrate that VHA hospitals score higher than non-VA 
facilities in both patient satisfaction and quality of care.
    White River Junction received a 5-star Overall Hospital Quality 
Star Rating in September 2024. It was the only facility in Vermont and 
New Hampshire to earn the top rating. The measures used to calculate 
overall CMS Star Ratings are mortality, safety of care, readmission, 
patient experience, and timely and effective care. The more stars (out 
of 5), the better a hospital performed on the available quality 
measures. Across both VA and non-VA hospitals nationwide, just over 8 
percent of facilities rated received a 5-star rating in the 2024 data. 
These findings are the latest in a series of recent evaluations showing 
the effectiveness of VA health care compared to non-VA health care, 
revealing that VA health care is consistently as good as--or better 
than--non-VA health care and the choice of most Veterans.\4\
---------------------------------------------------------------------------
    \4\ HCAHPS: Patients' Perspectives of Care Survey CMS
---------------------------------------------------------------------------
    A 2024 VFW survey showed ``overwhelming support for VA to remain 
the primary deliverer of care for veterans.'', with a majority of the 
Veterans saying they prefer using VA medical facilities for their 
health care needs.
    The VA must remain the primary provider and coordinator of Veterans 
healthcare, using community care as a supplement only when VHA services 
are unavailable. Authorizations and referrals should follow access and 
eligibility standards. Requirements for both VHA and VCCP should 
include consistent quality standards and training.
    Listening to Veterans' stories helps us understand their needs. 
NOVA is committed to working with Congress, community partners, and VA 
leaders to ensure Veterans receive timely access to the highest level 
of care.
    Thank you for the opportunity to provide our perspective on this 
critically critical issue. We look forward to working with the 
Committee as we focus on ensuring Veterans continue to receive timely, 
high quality compassionate care now and into the future.

                       Statements for the Record

                              ----------                              


 Prepared Statement of Alzheimer's Association and Alzheimer's Impact 
                                Movement

    The Alzheimer's Association and Alzheimer's Impact Movement (AIM) 
appreciate the opportunity to submit this statement for the record for 
the United States House Committee on Veterans' Affairs Hearing on 
``Restoring Focus: Putting Veterans First in Community Care.'' The 
Association and AIM thank the Committee for its continued leadership in 
ensuring our nation's veterans have the proper health care and 
resources that are important to those who are living with Alzheimer's 
and other dementia and their caregivers. We also wanted to thank the 
Committee for the enactment of The Senator Elizabeth Dole 21st Century 
Veterans Healthcare and Benefits Improvement Act (P.L. 118-210), which 
included several bipartisan and bicameral proposals to reform and 
improve the delivery of healthcare, benefits, and services at the 
Department of Veterans Affairs (VA). This statement highlights the 
importance of dementia care and support programs at the VA and outlines 
how our nation's veterans living with dementia are benefiting from such 
programs.
    Founded in 1980, the Alzheimer's Association is the world's leading 
voluntary health organization in Alzheimer's care, support, and 
research. Our mission is to eliminate Alzheimer's and other dementia 
through the advancement of research, to provide and enhance care and 
support for all affected, and to reduce the risk of dementia through 
the promotion of brain health. AIM is the Association's advocacy 
affiliate, working in a strategic partnership to make Alzheimer's a 
national priority. Together, the Alzheimer's Association and AIM 
advocate for policies to fight Alzheimer's disease, including increased 
investment in research, improved care and support, and the development 
of approaches to reduce the risk of developing dementia.
    Nearly half a million American veterans have Alzheimer's--and as 
the population ages, that number is expected to grow. In 2022, an 
estimated 451,000 veterans were living with Alzheimer's, and more than 
130,000 new cases were diagnosed. The VA has projected the number of 
veterans living with Alzheimer's dementia will increase by 8.4 percent 
through 2033 to more than 488,000.
    For veterans, the prevalence of Alzheimer's may grow even faster in 
future years because they have a higher risk of developing dementia. 
The significant increase in the number of veterans with Alzheimer's and 
other dementias will place a heavy burden on the VA health care system. 
Veterans with dementia are 2.6 times more likely to be hospitalized 
than other veterans--and hospital stays are, on average, 2.4 times 
longer. The average number of outpatient psychiatric visits is three 
times greater among veterans with dementia than veterans without. More 
than 60 percent of the VA's costs of caring for those with Alzheimer's 
are for nursing home care.
    We are grateful for the VA's participation in the Department of 
Health and Human Services (HHS) Advisory Council on Alzheimer's 
Research, Care, and Services, which plays a key role in developing and 
annually updating the National Plan to Address Alzheimer's Disease, as 
set forth by the National Alzheimer's Project Act (P.L. 111-375). The 
National Plan is a roadmap of strategies and actions of how HHS and its 
partners can accelerate research, expand treatments, improve care, 
support people living with dementia and their caregivers, and encourage 
action to reduce risk factors. The most recent update to the Plan was 
released in December 2024 and includes several highlights on the VA's 
continued work to better serve our nation's veterans living with 
dementia. We were excited to see Congress take action in the 118th and 
enact the bipartisan NAPA Reauthorization Act (P.L. 118-92) and 
Alzheimer's Accountability and Investment Act (P.L. 118-93) that will 
extend the National Plan to Address Alzheimer's Disease and ensure 
researchers at the National Institutes of Health continue to receive 
the funding necessary to sustain vital Alzheimer's and dementia 
research. These laws will ensure the nation continues addressing 
Alzheimer's as a national priority, providing continuity for the 
community.

The VA's Continued Role in Increasing Enrollment in Clinical Trials

    The VA continues to collaborate with federal agencies on a number 
of the key goals of the National Plan, including Action 1.B.3 to 
increase enrollment in clinical trials. The VA Office of Research and 
Development (ORD) and the National Institute on Aging (NIA) have a 
strong, ongoing collaboration. Among many activities, the VA and NIA 
have partnered on a program launched in 2020 in which the NIA provided 
supplemental funds to five Alzheimer's Disease Research Centers (ADRCs) 
co-localized with VA facilities or research centers to increase the 
recruitment of veterans into NIA-funded studies. Strategic priorities 
for the pilot include recruiting veterans, especially from diverse 
populations, and investigating unique risk factors for this population. 
Research coordinators at each participating ADRC have worked directly 
with the VA and NIA staff to identify and address challenges, develop 
pragmatic solutions, and share best practices and materials to increase 
veteran outreach and sustain enrollment. The pilot program successfully 
enrolled 99 veterans into ADRC studies, including 39 individuals from 
historically underrepresented racial and ethnic groups. The project 
also registered 172 veterans in AD registries. The results and impact 
of this pilot program were published in February 2024 and laid the 
groundwork for future collaborations between the NIA and the VA. Last, 
tools specific to veteran recruitment have also been included in the 
NIA's Alzheimer's and Dementia Outreach, Recruitment, and Engagement 
(ADORE) repository.

The VA's Continued Role in Addressing Alzheimer's Disease in Rural 
Areas

    The VA continues to collaborate with federal agencies on a number 
of the key goals of the National Plan, including Action 2.A.1 to 
educate health care providers on Alzheimer's disease. The VA's 
GeriScholars program offers staff training to integrate geriatrics into 
primary care practices in three training programs: (1) intensive 
individual training with didactics, quality improvement coaching, and 
clinical practicum experiences; (2) limited team-based training, 
including Rural Interdisciplinary Team Training (RITT); and (3) self-
directed learning through webinars, simulation learning, case studies, 
and enduring educational materials (such as dissemination of pocket 
cards on dementia, delirium, and depression). VA GeriScholars includes 
a wide variety of training activities, many of which include or are 
focused on dementia training. Examples of Fiscal Year 2022 trainings 
include webinars such as ``Treating PTSD in the Context of Cognitive 
Impairment,'' ``Dementia and the Age-Friendly Health Systems 
Initiative: Integrating the 4M's of Mobility, Mind, Medications, and 
What Matters into the Care of Older Veterans'', and ``Enduring 
Education''--as well as case studies and virtual geriatrics 
conferences, such as Healthcare Planning and Management for Older 
Adults with Dementia and Geriatric Patient with Cognitive Impairment.
    We also ask that the Committee continue to support the Veterans 
Health Administration's 20 Geriatric Research, Education, and Clinical 
Centers (GRECCs), which are geriatric centers of excellence focused on 
aging. GRECCs reported in the 2024 National Plan Update that their work 
included 78 research grants in dementia covering basic science to 
clinical care and health services research and 25 clinical innovation 
projects that directly served veterans with dementia and their 
families. GRECC faculty have developed numerous clinical programs to 
aid family members and care providers, including e-Consults for 
Behaviors in Dementia, Health Care Directives for Veterans with 
Dementia, Reaching Out to Rural Caregivers and Veterans with Dementia 
Utilizing Clinical Video-Telehealth, and Virtual Dementia Caregiver 
Support Programs. The GRECC Program produced 56 educational programs 
for staff and trainees on best practices in dementia care, including 
the use of simulation technology to demonstrate techniques for 
communication and facilitating activities of daily living for veterans 
with dementia. Finally, GRECC authors published 259 manuscripts in 
peer-reviewed journals in Fiscal Year 2022 on their research and 
clinical work in dementia. The VA must continue supporting the GRECCs 
in disseminating findings from this research to integrate 
scientifically proven dementia interventions into local and rural 
communities.

Educating Health Care Providers in the Indian Health Service and Tribal 
Care Systems

    The VA also continues to collaborate with the Indian Health Service 
(IHS) and Centers for Disease Control and Prevention (CDC) on the 
National Plan Action 2.A.6 to strengthen the ability of primary care 
teams in Indian country to meet the needs of people with Alzheimer's 
and related dementias and their caregivers. For example, in 2022, the 
IHS launched the Indian Health GeriScholars Pilot, developed with the 
support and collaboration of the VA Office of Rural Health. Modeled 
after the highly successful VA GeriScholars Program that has built 
geriatric expertise into the primary care workforce over the past 
decade, the Indian Health GeriScholars pilot is providing primary care 
clinicians at IHS, Tribal, and Urban Indian Organizations (UIO) 
programs with an individual intensive learning track for professional 
continuing education, including a week-long intensive training in 
geriatrics through an approved Geriatrics Board Review course, mentored 
geriatric improvement project at their local facility, mentorship in 
geriatric practice, and ongoing education, training, and peer support 
as an Indian Health GeriScholar.
    During the pilot's first two years, 31 providers and pharmacists at 
28 sites across 10 IHS areas participated in training and finished 
projects focused on detecting and diagnosing dementia, medication 
safety, fall prevention, and other locally relevant topics. Demand 
increased for the 2024 cohort to include eight physicians, one nurse 
practitioner, and 14 pharmacists from 21 sites, representing seven IHS 
areas. The Indian Health GeriScholars are encouraged to participate in 
the educational offerings available to the VA GeriScholars.
    These are only a few examples of ways in which the VA remains 
involved in working to ensure a high-quality, well-trained dementia 
care workforce and continue bridging the gap in cognitive services in 
rural areas. The National Alzheimer's Project Act as a whole has led to 
great achievements in the treatment and research of Alzheimer's 
disease, and we are looking forward to seeing more progress in the 
119th Congress.

Conclusion

    The Alzheimer's Association and AIM appreciate the Committee's 
steadfast support for veterans and their caregivers and the continued 
commitment to advancing issues important to the millions of military 
families affected by Alzheimer's and other dementia. We look forward to 
working with the Committee and other members of Congress in a 
bipartisan way to advance policies that will ensure access to high-
quality dementia care and support in rural areas, especially as the 
population of veterans living with dementia continues to grow.
                                 ______
                                 

                Prepared Statement of Mission Roll Call
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

 Prepared Statement of American Psychological Association, Association 
of VA Psychologist Leaders, Association of VA Social Workers, National 
   Association of Veterans Affairs Physicians and Dentists, National 
Association of Veterans' Research and Educational Foundations, Veterans 
      Affairs PA Association, Veterans Healthcare Policy Institute

    Chairman Bost, Ranking Member Takano, and distinguished members of 
the committee:
    On behalf of our organizations, we thank you for inviting us to 
submit a statement for the record for today's hearing on how the U.S. 
Department of Veterans Affairs (VA) can improve the care of veterans in 
the community. Many members of our organizations are veterans or have 
family members who are veterans. Many of us have had long careers 
serving veterans, have published papers on veterans' healthcare in 
peer-reviewed journals, or have previously presented testimony to your 
committee. In today's statement, we wish to convey our appreciation for 
your leadership and abiding commitment to ensuring that veterans 
receive the highest level of health care within the Veterans Health 
Administration (VHA) and supplementary care in the private sector when 
it's both needed and authorized by the VHA.
    Problems in VHA scheduling and coordinating community care--a focus 
of the hearing--are real, and every veteran's experience deserves 
careful attention and efforts to rectify. There are stories from 
multiple vantage points, including veterans who received substandard 
care in the community. For example, we have a report of a Gulf War 
combat veteran who, after unusual sleep study results, was referred to 
a community cardiologist. The cardiologist recommended implanting a 
pacemaker and offered to perform the invasive procedure the next week. 
The self-referring and possibly profit-motivated aspect raised doubts 
in the veteran's mind about whether a pacemaker was necessary, and a 
second opinion from another cardiologist confirmed that it was 
contraindicated. Consider also the Vietnam veteran who, despite 
indicating his strong preference to wait for VHA services, faced 
pressure from a scheduler to accept community care because the facility 
felt compelled to reduce its' average wait times. Or reflect on the 
Iraq War veteran in need of posttraumatic stress disorder treatment who 
did not feel understood by his community care clinician.
    It is essential, however, that we not just listen to the individual 
stories brought to us, but take into account the aggregate data and 
research that represent the experiences of all our veterans. 
Information that encompasses the 9.1 million veterans enrolled in the 
VHA system is the strongest foundation upon which to base policy 
decisions and craft legislation. That is putting veterans first.
    Our organizations support the need for supplemental community care 
options when access to VHA services is too delayed or too far away. We 
share the bipartisan goal of ensuring that the Veterans Community Care 
Program (VCCP) lives up to its promise--still unrealized--of delivering 
timely, high-quality care without the prospect of undermining VHA care. 
To help achieve this aim, we delineate significant challenges within 
the VCCP that merit thoughtful review and offer recommended 
improvements.
    These are:

    1. Ensuring VCCP quality standards,

    2. Ensuring VHA authorization for care is not bypassed,

    3. Addressing the impact of VCCP usage on VHA staffing and 
exceptional veteran-centric care,

    4. Ensuring the defined meaning of ``veterans' health care choice'' 
is applied,

    5. Providing veterans with crucial information needed to make 
educated health care decisions,

    6. Addressing the VCCP payment model that encourages unnecessary, 
costly overtreatment,

    7. Addressing the deficiencies with health information sharing 
between the VA and VCCP,

    8. Properly including telehealth in VHA access standards,

    9. Protecting the VHA's 2nd, 3rd and 4th Missions by ensuring VHA 
is fully funded and staffed

Ensuring VCCP quality standards

    The VA MISSION Act of 2018 established the VCCP with a laudable 
purpose: ensuring veterans could access high-quality healthcare, 
whether at VHA facilities or in their communities when VA care was not 
quickly available or conveniently located. The strong focus on quality 
was unmistakable. In its charter language, the word ``quality'' appears 
50 times, far surpassing mentions of both ``choice'' and 
``community''--a point we'll explore further when discussing veterans' 
choice.
    The quality of veterans' healthcare should always be the north star 
of Congressional policymaking, yet it has failed to set and enforce 
quality standards for contract providers. Study after study has found 
that veterans referred for care in the community have a higher 
likelihood of dying and are more likely to receive lower quality care 
than those treated at VHA facilities. Another study published earlier 
this month in Health Affairs found that the quality of care metrics of 
VCCP providers are substantially lower than those of other private 
sector clinicians, especially in primary care and mental health care. 
Given this track record of lower quality of healthcare and potential 
risks to veterans' health, it is imperative that Congress mandate 
uniformity on quality and training metrics for VHA and VCCP providers 
and programs.

Ensuring VHA authorization for care is not bypassed

    With increasing frequency in recent years, legislative proposals 
have sought to give veterans unfettered access to private healthcare, 
bypassing VHA referrals, authorization, and oversight entirely. Though 
they have not yet come to pass, we mention them here because enacting 
such legislation would fundamentally alter the VHA's core function. 
Instead of primarily serving as the provider of specialized, high-
quality care for the unique health needs of veterans, the VHA would 
become more of a payer of private sector services. This would 
essentially transform the VHA from a comprehensive healthcare system 
into an insurance company. Notably, many Congressional proposals even 
omit traditional insurance company utilization review functions, which 
would make the care paid for even more risky to veterans.

Addressing the impact of VCCP usage on VHA staffing and exceptional 
veteran-centric care

    A comprehensive report last year by six healthcare experts raised 
serious concerns that community care utilization was endangering 
Congress's intent for the VCCP to supplement, not supplant, the VHA. 
VCCP care has been relentlessly increasing 15-20 percent year after 
year, and by 2022, its share of VHA health dollars reached 44 percent. 
The report concludes that even if no additional changes are made as to 
who is eligible to receive private sector care, the VHA system's future 
is at risk due to this unsustainable growth. It is incumbent upon the 
committee to ensure that new legislation doesn't further exacerbate the 
issues that the report raises. Should Congress further widen 
eligibility for the VCCP, it will accelerate spending and imperil the 
basic survival of the VHA system and thus, the continued availability 
of choice that so many on this committee have deemed essential to 
veterans.
    Expanding VCCP eligibility, including by allowing the bypassing of 
VHA authorization, will intensify private sector referrals and divert 
funding from VHA facilities, forcing staff reductions, curtailment of 
programs, and closures of inpatient units, emergency rooms, and entire 
facilities. It would also prevent needed infrastructure upgrades 
despite growing demand for services.
    If the VHA does not maintain its position as the sole authorizer of 
care, and receive sufficient funds to fully meet care demand, its 
indispensable integrated healthcare system specifically designed to 
serve veterans will be gradually dismantled. This includes coordinated 
team-based care, comprehensive prevention screenings, wrap-around legal 
and transportation services, homelessness programs, caregiving, and 
enrollment in VA registries. It includes veteran-centric care 
specialization that deftly address veterans' complex military-related 
conditions. (For example, VHA clinicians are more likely to have 
experience and specialized training in recognizing, diagnosing and 
treating problems such as posttraumatic stress disorder (PTSD), 
traumatic brain injury (TBI), and exposure-related illnesses.)
    As we elaborate further below, jeopardizing the VHA will also have 
a devastating impact on the training of our nation's healthcare 
workforce and deprive future clinicians of expertise in veterans' 
complex health conditions. Additionally, research on veterans' health 
conditions--research that also helps non-veterans--will also be 
compromised, as will the ability of the VHA to serve as the nation's 
healthcare safety net during public health emergencies. It also 
undermines VA's ability to support the military in time of war or 
terrorist attacks (a critical capacity in maintaining military 
readiness) or communities in times of natural disasters.
    It is true that many veterans deeply appreciate the convenience of 
receiving authorized care closer to home rather than traveling long 
distances to VHA facilities. But when they are polled about preserving 
the VHA system, veterans' priorities are clear. A VFW survey last month 
of its members found ``overwhelming support for VA to remain the 
primary deliverer of care for veterans.'' A prior VFW report of over 
10,000 members found that 92 percent explicitly prefer that the VHA to 
be ``fixed not dismantled.'' As a Veterans Healthcare Policy Institute 
report noted, and many studies confirm, many veterans who live in rural 
areas would have no choice of care providers should the VHA be turned 
into an insurance provider. This is because of a long-standing crisis 
in rural healthcare that now deprives rural residents of primary care, 
mental health care, as well as access to hospital, emergency, and 
pharmacy services.

Ensuring the defined meaning of ``veterans' health care choice'' is 
applied

    In the years since the passage of the VA MISSION Act of 2018, there 
has been a pervasive mischaracterization that the bill gave veterans 
the ``choice to obtain their health care where and when they 
preferred.'' That was not the case. In the legislative language, a 
veteran would be offered the option of receiving healthcare outside of 
the VHA under six clearly defined criteria. Veterans could choose 
whether to exercise the option of private sector care only after they 
first qualified under the eligibility rules and were authorized by VHA. 
The Independent Budget's analysis of the MISSION Act affirmed the 
understanding at that time that eligibility for VCCP care should not 
occur ``solely based on convenience or preference of a veteran.'' 
However, the critical phrases ``when eligible,'' ``when qualified'' or 
``when authorized'' are often dropped when alluding to veterans having 
the choice of where and when to receive their healthcare.
    Should the VHA be eliminated as the authorizer of care under the 
promise of more choice, there will be fewer, not more, options for 
veterans. When VHA funds are diverted to the private sector, millions 
of veterans who depend on the VHA--especially those with service-
connected conditions who rely exclusively or near exclusively on the 
VHA for all their health care needs--will be deprived of the freedom to 
choose the VHA when units and programs they depend on vanish. Many have 
catastrophic war-related ailments, like lost limbs, traumatic brain 
injuries, or a variety of toxic exposures, which civilian providers are 
ill-equipped to recognize, much less treat. Granting the option for 
unrestricted personal choice is not unequivocally advantageous; it 
comes at the expense of the majority of veterans, many of whom are in 
extreme need.

Addressing the VCCP payment model that encourages unnecessary costly 
overtreatment

    VCCP overtreatment and the overuse of expensive testing have been 
identified in recent scientific and governmental studies. One study 
scrutinized the care of veterans with prostate cancer. This is the most 
common cancer among veterans, particularly those who served in the 
Vietnam War, and were exposed to the carcinogenic herbicide Agent 
Orange which was used as a defoliant. The study, in the medical journal 
JAMA, tracked 10,000 veterans with newly diagnosed prostate cancer 
whose biopsies revealed ``clinically insignificant'' low-risk disease. 
The JAMA authors explained that the professionally recommended standard 
of care for these patients is what is called ``watchful waiting.'' 
Watchful waiting is the accepted standard because recommending 
aggressive testing and procedures does little good and can cause 
serious harm to patients whose tumors aren't progressing. Complications 
of prostate surgery and radiation of include impotence, incontinence, 
hair loss, bowel problems, and even death. Despite these well-known 
problems, the JAMA study found that VCCP providers were twice as likely 
to provide veterans whose prostate cancer was deemed low risk with 
expensive, unwarranted, and potentially risky surgery or radiation.
    Reviewing the use of imaging services in the VCCP for various other 
medical conditions, a 2021 Congressional Budget Office (CBO) analysis 
mirrored the findings of the JAMA study. When veterans were referred 
for imaging services, VCCP contractors used magnetic resonance imaging 
instead of less costly tests like computed tomography scans and X-rays. 
The CBO explained, ``Some of those practice differences might stem from 
the cost control and incentive structures of VHA physicians and private 
sector providers. VHA does not control the amount or type of services 
veterans receive once they have been referred to outside providers for 
a particular episode of care.''
    Excessive use of expensive and/or unnecessary procedures isn't the 
only way that VCCP providers endanger veterans and extract resources 
from the VHA's healthcare system. Another is overcharging for services. 
One form of this is called ``upcoding,'' i.e., assigning an inaccurate 
billing code to a medical procedure to increase reimbursement. For 
example, a provider bills for a ``Level 4'' complex evaluation and 
management procedure even though the documented medical notes reveal 
only Level 3 elements were furnished.
    The VA's Office of Inspector General (OIG) found that, in FY 2020, 
``at least 37,900 providers of about 218,000 community care providers 
billed level 4 and level 5 evaluation and management services 
significantly more often than all other providers in their specialty--a 
potential flag for upcoding.'' A separate 2021 OIG audit found that 76 
percent of acupuncture claim treatments and 55 percent of chiropractic 
claim treatments were not supported by medical documentation. Another 
well-designed ambulance study found that non-VA hospitals were five 
times more likely to report high complexity (and more highly 
reimbursed) evaluation and management services than VHA facilities.
    This pattern of overtreatment and fraudulent billing in the VCCP is 
hardly unexpected. VHA providers, all on salary, work in a mission-
driven system that focuses on enhancing patient outcomes. VCCP 
providers are paid fees for discrete services and work in a system that 
emphasizes profit maximization. (Our first anecdote above speaks to 
this trend.)
    Also, the rising cost of outsourced dental care has become 
financially unsustainable. Medical centers are spending anywhere from 
$25 to $80 million annually on community dental services alone. While 
some facilities carefully monitor community care referrals, others 
automatically refer all eligible veterans to outside providers without 
considering quality and cost. The situation is further complicated by 
community dentists who routinely propose treatment plans costing tens 
of thousands of dollars per veteran. The recently enacted Dole Act 
pilots, in two VISNs, a stringent review process of community dentist 
treatment plans, but the most cost-effective solution would be to 
expand the VHA's in-house dental staff. By providing these services 
directly, the VHA could deliver the same or better quality of care at a 
fraction of what is currently being spent on community providers.

Providing veterans with crucial information needed to make educated 
health care decisions

    Another issue in dire need of overhauling in the community care 
program is the lack of available information that veterans need to make 
informed health care decisions. Future community care legislation must 
require private sector transparency about comparative VHA-VCCP wait 
times and quality metrics.
    Veterans also deserve easy access to information as to whether 
providers treating them have the training, education, and competence to 
address their specific health concerns. Yet, the directory that is 
available online doesn't include all the providers in the network, and 
the listings lack any details about providers' qualifications.
    Further, third party administrators evaluate their providers and 
designate those delivering high-quality care as ``High Performing 
Providers'' (HPPs). However, this assessment ignores behavioral and 
mental health providers, despite the prevalence of mental health 
challenges that many veterans face. The evaluation system should expand 
to include mental health providers, and veterans should have direct 
access to HPP designations through the public directory.

Addressing deficiencies with health information sharing between the VHA 
and VCCP

    For years, including last week, the OIG has documented 
``difficulties caused by community care providers failing to return 
medical documentation.'' When all the relevant healthcare information 
isn't properly shared between VHA and community providers, care becomes 
fragmented, and veterans are put at risk. VCCP mental health providers 
routinely submit requests for treatment reauthorization that lack 
clinical documentation needed to make decisions. To address these 
serious issues, Congress should establish sanctions for failures to bi-
directionally share information between the VHA and VCCP in a timely 
manner.

Properly including telehealth in VHA access standards

    When establishing the VA MISSION Act eligibility rules, the VHA 
made a significant oversight: they did not include the availability of 
VHA telehealth when calculating distance or wait times for care. We 
believe this was a shortsighted decision that has had serious negative 
consequences. By not considering telehealth options, the VHA has 
unnecessarily limited veterans' access to quality healthcare while 
wasting taxpayer money. Telehealth is a valid means of providing health 
care to veterans who prefer that option. In a survey of veterans 
engaged in mental health care, 80 percent reported that VHA virtual 
care via video and/or telephone is as helpful or more helpful than in-
person services. And yet, because of existing regulations, VHA 
telemental health (TMH) does not qualify as access, resulting in 
hundreds of thousands of TMH visits being outsourced yearly to 
community practitioners that could be expeditiously and beneficially 
furnished by VHA clinicians. The best action that Congress can take is 
to stipulate that VHA telehealth care constitutes ``access to 
treatment.'' If implemented, this correction would save taxpayers a 
vast sum--up to 1.1 billion dollars yearly according to a VA's 
September 2022 ``Congressionally Mandated Report: Access to Care 
Standards.''

Protecting the VHA's 2nd, 3rd and 4th Missions by ensuring VHA is fully 
funded and staffed

    Congressional legislation on community care must attend to the 
impact on the VA's vital role in researching veterans' complex health 
conditions. For decades, VHA's electronic health records and access to 
VHA patients have enabled groundbreaking discoveries and treatments 
through large-scale data analysis of veterans' healthcare conditions. 
The VA's innovations in diagnostic testing, disease management, 
rehabilitation, geriatrics, patient safety, and numerous other fields 
have advanced healthcare for all Americans. The VHA has also proved 
invaluable and irreplaceable in its ability to study and compare the 
efficacy of different medications on patients' health This crucial 
research capability would disappear if veterans' care fragments across 
the private sector, where no unified system exists to study veterans' 
health outcomes or implement and evaluate innovative treatments 
systematically.
    Congress should also be wary of expanding access to community care 
in a way that would jeopardize the critical role the VHA plays in the 
training of future healthcare professionals across the nation. More 
than 70 percent of all U.S. physicians train at a VHA facility early in 
their careers. At a time of dire mental health professional shortages, 
VHA is the largest single educator of psychiatrists and psychologists. 
Expanding care in the community will have jarring effects far beyond 
VHA itself by constraining the development of a critically needed 
workforce.
    Likewise, expanding care in the community that downsizes VHAs will 
degrade VHA's capacity to support its ``Fourth Mission:''-assisting the 
nation in times of emergencies and disasters. The VHA has supported 
this mandated mission with direct patient clinical care, testing, 
education and training in response to natural disasters, pandemics 
(like COVID-19), and other crises. VHA also serves as the first 
fallback to the military health system in times of war. The VHA is 
uniquely suited to support these missions because of the national 
distribution of its facilities, the unique training and experience of 
its staff, and the exceptional integration of its services.

Suggested solutions to improve the provision of community care.

    To strengthen use of community care, we propose these essential 
reforms:

    1. The VHA and VCCP must operate under uniform quality standards 
and training requirements.

    2. The VHA and VCCP should publicly disclose wait times, and 
provider directories must detail healthcare professionals' 
qualifications and quality metrics.

    3. Predictive modeling capabilities to forecast how varying levels 
of VCCP utilization will impact VHA's operational capacity should be 
quickly developed.

    4. The VHA's internal staffing should be expanded to fully meet 
demand.

    5. The VHA should retain clear authority in determining community 
care eligibility.

    6. It's crucial to reinforce the message that veterans' access to 
community care depends on first meeting established criteria.

    7. Timely VHA telehealth should be recognized as meeting the access 
to care standard.

    8. Timely health record sharing between VHA and community providers 
should be reinforced through meaningful penalties for non-compliance.

    9. Rigorous monitoring must be implemented to identify and sanction 
community providers who engage in unnecessary testing, optional 
procedures, or fraudulent billing practices.

    We respectfully thank you for the opportunity to provide our 
perspectives on these essential matters. We look forward to working 
with the committee to ensure that veterans can receive timely, high-
quality compassionate care in the VHA and the community now and in the 
future.

               Prepared Statement of The American Legion
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

   Prepared Statement of American Association of Nurse Anesthesiology
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]


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