[House Hearing, 119 Congress]
[From the U.S. Government Publishing Office]
LEGISLATIVE HEARING
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HEARING
BEFORE THE
SUBCOMMITTEE ON HEALTH
OF THE
COMMITTEE ON VETERANS' AFFAIRS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
TUESDAY, MARCH 11, 2025
__________
Serial No. 119-10
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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
60-671 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
SUBCOMMITTEE ON HEALTH
MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman
JACK BERGMAN, Michigan JULIA BROWNLEY, California,
GREGORY F. MURPHY, North Carolina Ranking Member
DERRICK VAN ORDEN, Wisconsin SHEILA CHERFILUS-MCCORMICK,
JEN KIGGANS, Virginia Florida
ABE HAMADEH, Arizona MAXINE DEXTER, Oregon
KIMBERLYN KING-HINDS, Northern HERB CONAWAY, New Jersey
Mariana Islands KELLY MORRISON, Minnesota
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
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TUESDAY, MARCH 11, 2025
Page
OPENING STATEMENTS
The Honorable Mariannette Miller-Meeks, Chairwoman............... 1
The Honorable Julia Brownley, Ranking Member..................... 2
SPEAKING FROM THE DAIS
The Honorable Steve Womack, U.S. House of Representatives, (AR-3) 4
The Honorable Sylvia Garcia, U.S. House of Representatives, (TX-
29)............................................................ 5
The Honorable Greg Murphy, U.S. House of Representatives, (NC-3). 6
The Honorable Chris Deluzio, U.S. House of Representatives, (PA-
17)............................................................ 6
The Honorable Lauren Underwood, U.S. House of Representatives,
(IL-14)........................................................ 7
The Honorable Don Bacon, U.S. House of Representatives, (NE-2)... 11
WITNESSES
Panel I
Dr. Thomas O'Toole, Deputy Assistant Under Secretary for Health
for Clinical Services, Quality and Field Operations, Veterans
Health Administration, U.S. Department of Veterans Affairs..... 8
Accompanied by:
Dr. Antoinette Shappell, Deputy Assistant Under Secretary for
Health for Patient Services, Veterans Health
Administration, U.S. Department of Veterans Affairs
Dr. Thomas Emmendorfer, Executive Director, Pharmacy Benefits
Management, Veterans Health Administration, U.S.
Department of Veterans Affairs
Dr. Jeffrey Gold, President, University of Nebraska System....... 10
Panel II
Ms. Sue Morris, President, Veterans Trust........................ 23
Mr. Brian Dempsey, Director of Government Affairs, Wounded
Warrior Project................................................ 24
Dr. Andrew Kozminski, Medical Director of Hyperbaric Medicine,
University of Iowa Health Care................................. 26
Mr. Ed Harries, President, National Association of State Veterans
Homes.......................................................... 27
Mr. Jon Retzer, Deputy National Legislative Director for Health,
Disabled American Veterans..................................... 29
APPENDIX
Prepared Statements Of Witnesses
Dr. Thomas O'Toole Prepared Statement............................ 43
Dr. Jeffrey Gold Prepared Statement.............................. 62
Ms. Sue Morris Prepared Statement................................ 74
APPENDIX--continued
Mr. Brian Dempsey Prepared Statement............................. 75
Dr. Andrew Kozminski Prepared Statement.......................... 81
Mr. Ed Harries Prepared Statement................................ 89
Mr. Jon Retzer Prepared Statement................................ 96
Statements For The Record
Veterans Healthcare Policy Institute Prepared Statement.......... 103
American Association for Marriage and Family Therapy and
California Association of Marriage and Family Therapists
Prepared Statement............................................. 105
Paralyzed Veterans of America Prepared Statement................. 107
American Federation of Government Employees, AFL-CIO Prepared
Statement...................................................... 111
Trajector Medical Prepared Statement............................. 112
Document for the Record Submitted by Greg Murphy................. 123
LEGISLATIVE HEARING
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TUESDAY, MARCH 11, 2025
Subcommittee on Health,
Committee on Veterans' Affairs,
U.S. House of Representatives,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:15 p.m., in
room 360, Cannon House Office Building, Hon. Mariannette
Miller-Meek [chairwoman of the subcommittee] presiding.
Present: Representatives Miller-Meek, Murphy, Hamadah,
King-Hinds, Brownley, Cherfilus-McCormick, Dexter, Conaway, and
Morrison.
Also present: Representatives Deluzio, Womack, Underwood,
Garcia, and Bacon.
OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN
Ms. Miller-Meeks. The legislative hearing of the
Subcommittee on Health will now come to order. I would like to
welcome all members and witnesses for today's hearing. We look
forward to a very productive discussion on some impactful
veterans legislation.
Today we will discuss 12 bills, including bills which would
enable the U.S. Department of Veterans Affairs (VA) to enter
into innovative public-private partnerships, research cutting-
edge hyperbaric oxygen therapy, and provide some long overdue
oversight of the VA's budget management. Also on today's agenda
are four bills I have had the pleasure of introducing.
Before I discuss my bills, I would like to thank our
witnesses again for being here today. I would like to
especially thank Dr. Andrew Kozminski, who is the medical
director of the Hyperbaric Medicine at my beloved University of
Iowa. I had the pleasure of touring Dr. Kozminski's office a
few months ago and learned about the incredible healing
properties that hyperbaric oxygen therapies can provide. Dr.
Kozminski, welcome to my office and I would like to look
forward to hearing your thoughts about Dr. Murphy's bill, the
Veterans National Traumatic Brain Injury Treatment Act.
Now to my bills. First, the Supporting Prosthetics
Opportunities an Recreational Therapy (SPORT) Act. The SPORT
Act would make sure athletic prosthetics are defined as
medically necessary for amputee veterans. Every year in my
district, severely disabled veterans gather to play golf. I am
not a golfer except for miniature golf, but it is amazing to
see how many sports, even golf can improve veterans' mental and
physical well-being. I think all veterans should be able to
enjoy the benefits and camaraderie sports provide, and my
legislation would achieve just that.
I am also proud to introduce the No Wrong Door for Veterans
Act. This bill would reauthorize VA's successful Fox grant
Program. Fox grants enable community organizations to provide
services to veterans, screen them for suicidal ideation, and
connect them with the VA so they can receive the mental health
support that meets their individual needs. My bill would ensure
organizations who have been successful in our mission to expand
mental health can receive additional funds by partnering with
the VA to reach even more veterans. The Fox Grant Program is a
great example of public-private partnerships working for the
better. House Republicans will continue to push the needle and
protect programs like this one.
Next, I am proud to lead the Providing Veterans Essential
Medications Act. This bill would allow the VA to provide very
high-cost medications to severely disabled veterans receiving
care at State veterans homes. VA pays for these medications for
all other veteran patients, but antiquated laws require VA to
pay State veterans home a fixed per diem, limiting their
ability to provide for veterans who desperately need these
medications while residing at a veterans home. Unfortunately,
these high-cost medications can cost as much as $1,000 per day,
meaning State veterans homes are not able to house many of our
most deserving veterans. My bill would fix this clear mistake
and ensure veterans with complex needs are cared for.
Ironically, the last bill I would like to mention is the
Standardizing Treatment and Referral Times (START) Act. Far too
often our veterans receive community care referrals that are
only valid for a fixed period of time, but due to provider
shortages and bureaucratic delays, veterans might not even get
in until halfway through the authorized time period. My START
Act addresses this issue by ensuring that the validity of the
referral begins only once a veteran has attended their initial
appointment. It is pretty common sense.
It is a privilege to collaborate on crafting impactful
legislation for our veterans and to address critical issues in
the delivery of their healthcare.
I would now like to turn to Representative Brownley for any
opening remarks she may have. Representative Brownley, you are
now recognized.
OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER
Ms. Brownley. Thank you, Madam Chair.
At the outset, I have to say I find it a bit crazy that we
are having a legislative hearing today rather than an oversight
hearing. The Trump administration's executive orders, mass
firings of VA employees, reckless contract terminations, and $1
spending limit on purchase cards are causing significant
upheaval within the Veterans Health Administration (VHA). That
we are here today proceeding to consider new legislation as if
these changes are not already significantly impacting veterans
access to care is absurd.
Our time today would be much better spent examining the
administration's plan to gut VA's workforce by 80,000 employees
before September. This would be in addition to the 2,400 or
more VA employees who have already been terminated. Committee
Democrats have already heard a multitude of instances of these
terminations negatively impacting patient care, despite
Secretary Collins insisting that they are not. The terminations
that have already occurred include positions like procurement
professionals who play a critical role in purchasing
prosthetics and medical devices veterans need. We are aware of
numerous VA medical facilities where such terminations have
occurred.
Supply chain staff who are responsible for equipping
surgical suites with necessary supplies, the committee has
heard from several supply chain professionals who were
terminated from the VA facilities in Florida, Texas, Oklahoma,
and in California. Human resources professionals who are
necessary for filling clinical staff vacancies. While clinical
staff have largely been exempted from the Trump
administration's hiring freeze, VA cannot efficiently fill
clinical positions without human resources professionals.
Psychology technicians at the Cleveland Veterans Affairs
Medical Center (VAMC), who perform neuropsychological tests for
individuals with neurological conditions, like strokes,
Traumatic Brain Injury (TBI), Post-Traumatic Stress Disorder
(PTSD), and concussions. Staff that perform, manage, and
analyze mammogram results at the Hampton VAMC. One veteran
whose mammogram was canceled due to a staffing shortage at the
Hampton VAMC just found out the earliest she could reschedule
her appointment elsewhere is June, 4 months from now. These are
just a few examples that the committee has heard about from
across the Nation.
Unfortunately, none of the bills we are considering today
will address the very real threat to VA healthcare access,
quality, and safety that veterans are facing. In just the last
few days, my Democratic colleagues and I have received tens of
thousands of emails from veterans across the country asking
that we do all we can to stop the VA workforce cuts and
eliminations of crucial contracts. I certainly hope that our
Republican colleagues are receiving the same messages.
Veterans do not support these cuts. I would encourage the
witnesses and members here today to keep in mind that if we
continue to see efforts to dismantle VA by firing hardworking
employees, canceling vital research, terminating healthcare
contracts, and eroding veterans' trust in VA, it will not
matter what excellent legislation we put forth. There will not
be employees or even an infrastructure left at VA to implement
these bills, and veterans' care will suffer because of it.
I would hope the chair shares these same concerns and I
understand that we must protect the many VA employees that
provide critical care to our Nation's veterans. However, I
understand that despite what I have laid out today, we are here
to consider legislation today on this committee.
I am pleased today's agenda includes my VA Marriage and
Family Therapist Equity Act. I am also glad that a bill I am
coleading with my friend from Texas, Congresswoman Garcia, the
Women Veterans Cancer Care Coordination Act, is on the agenda.
I look forward to hearing from our witnesses on all of the
bills on today's agenda.
With that, Madam Chair, I will yield back.
Ms. Miller-Meeks. Thank you very much, Ranking Member
Brownley.
We have a full agenda today, so I will be holding everyone
to 3 minutes per bill to ensure we can move in a timely manner.
This morning we are joined by several of our colleagues who
will speak in support of their bills. We appreciate the
dedication to serving our Nation's veterans. With that, I ask
unanimous consent that all non-subcommittee members be waived
on to speak on their bills from the dais. Hearing no objection,
we will move forward.
I now recognize Representative Womack for 3 minutes.
STATEMENT OF STEVE WOMACK
Mr. Womack. I thank the chairwoman.
Chairwoman Miller-Meeks, Ranking Member Brownley, and
distinguished members of this subcommittee thank you for
considering my bill, H.R. 1107, Protecting Veteran Access to
Telemedicine Services Act of 2025. I also want to express my
sincere gratitude for allowing me to speak in support of this
legislation.
This bill aims to guarantee that our Nation's veterans,
whether in bustling cities or remote rural areas, have
continuous access to the healthcare services they need and
deserve. The Ryan Haight Online Pharmacy Consumer Protection
Act, enacted in 2008, was designed to regulate the prescription
of controlled substances via telemedicine in response to the
rise of online pharmacies and the risk of misuse. While this
law plays a crucial role in protecting public health, it has
not been updated to reflect the realities of 2025, nor does it
account for the fundamental differences between the VA and
civilian online pharmacies.
During the COVID-19 pandemic, the Ryan Haight Act's in-
person consultation requirement for prescribing controlled
substances was temporarily waived. The Drug Enforcement (DEA)
and U.S. Department of Health and Human Services (HHS) later
extended these flexibilities through the end of this year. My
bill, the Protecting Veteran Access to Telemedicine Services
Act of 2025, would make this exemption permanent for the VA,
allowing VA healthcare professionals to prescribe medically
necessary controlled substances via telemedicine under specific
conditions. This exemption has been a lifeline for our
veterans. Without it, many will face severe restrictions in
accessing vital healthcare.
For veterans in urban areas, letting this exemption expire
would mean longer wait times for in-person appointments,
further straining an already overburdened VA healthcare system.
The impact is even greater for veterans in rural communities
where geographic isolation and limited healthcare providers
create significant barriers. The exemption has allowed them to
receive care from VA specialists hundreds of miles away without
the burden of costly and time-consuming travel.
Continuing this exemption is not just a matter of
convenience, it is a necessity. It ensures that every veteran,
no matter where they live, has equal access to the care they
have earned and deserve. I am honored to speak in support of
this legislation today. I urge my colleagues to act swiftly in
passing the bill. Our veterans have sacrificed so much for all
of us. It is our duty to ensure they receive the care they need
in a way that meets the demands of today's world.
Madam Chairwoman, thank you for the time and a yield back
my balance.
Ms. Miller-Meeks. Thank you very much. Representative
Womack.
The chair now recognizes Representative Garcia for 3
minutes.
STATEMENT OF SYLVIA GARCIA
Ms. Garcia. Thank you, Madam Chair. Thank you to the
ranking member for giving me a few minutes to talk about my
bill, the Women Veterans Cancer Care Coordinator Act. I am
pleased to lead this bill with Ranking Member Brownley to
improve the breast and gynecological cancer care that the VA
provides to our heroines.
Every day, more and more American women sign up to serve in
these U.S. military. As women sign up, the women veteran
community also grows. In Fiscal Year 2000, women veterans made
up just about 4 percent of all the veteran population. Today,
they rank at about 11.3 percent, over 2.1 million women
veterans nationwide. However, as the women veteran community
ages, breast and gynecological care rates in this population
will also increase. The VA responded to this need by
establishing the Breast and Gynecological Oncology System of
Excellence in late 2020, a program that ensures women veterans
are getting the appropriate cancer care they deserve.
The VA also partners with community care providers to treat
these veterans when the VA does not have the means to provide
care. Now, that sounds great, but the system that we set up for
women is not entirely working as it should. Veterans must
navigate multiple facilities alone and ensure that providers
communicate with the VA. The lack of coordination between both
the VA and these providers lead to treatment delays,
miscommunication, and unnecessary stress. Without a well-
coordinated care team, a lot can go wrong. No veteran fighting
cancer should struggle with red tape. They should be focused on
getting better.
My bill will effectively address these challenges by
creating dedicated regional cancer care coordinators at the VA.
These professionals would guide veterans through their
treatment journey, improve communication between the VA and
community care providers, track patient progress, and address
the existing delays in their care. These coordinators would
also provide veterans with emergency health information and
mental health resources to support their well-being.
I firmly believe that a grateful nation shows its gratitude
in the care and benefits we provide to our heroines. Supporting
our veterans is one of the solemn promises we have made, and it
is a promise we must keep.
Thank you again, Madam Chairwoman, and, of course, to
Ranking Member Brownley for support on this issue. I yield
back.
Ms. Miller-Meeks. Thank you very much, Representative
Garcia.
The chair now recognizes representative Dr. Murphy for 3
minutes.
STATEMENT OF GREG MURPHY
Mr. Murphy. Thank you, Madam Chair. Thank you, Ranking
Member Brownley.
Delighted for the second time to introduce my bipartisan
bill, H.R. 1336, the Veterans National Traumatic Brain Injury
Treatment Act, being discussed here today. It is long overdue
that we do something further for our veterans who suffer from
PTSD and TBI. Sadly enough, we lose 17, up to 22 veterans a day
due to suicide, many who are suffering from TBI and PTSD.
I am a big fan and have been for over 30 years of the
treatments of hyperbaric oxygen therapy. We have used this in
surgical wounds for wounds that will not heal. It has enjoyed
great success amongst many different maladies. It has been my
own experience now in exploring this issue for TBI and PTSD
that this is not only a viable but a very, very successful
intervention.
I am going to introduce into the record a meta analysis
study from National Institutes of Health (NIH). This was done
in January to March 2020, which is an exhaustive list of mostly
randomized double-blind control studies which shows great
objective improvement for those veterans who have suffered from
TBI and PTSD, not only in cognitive function but mood disorder.
I ask this be submitted for the record.
This organization now, HBOT4Heroes in North Carolina, has
successfully treated over 200 veterans who suffer from TBI and
PTSD. We had a witness here before the executive director, Mr.
Ed Di Girolamo, who gave very compelling testimony at a
roundtable concerning alternative therapy specifically for
Hyperbaric Oxygen Therapy (HBOT). My bipartisan bill sets up a
pilot program for 5 years at three veterans service networks.
Costs are borne by donations, not to the taxpayer, but by
donations. The veterans service organizations are supportive,
multiple, and listed here. We also have expert witness from Dr.
Andrew Kozminski, an M.D. from the great University of Iowa, I
think somebody went there or knows there, who is a Hyperbaric
Oxygen (HBO) medicine specialist.
I have thought this through and through. I believe it is
sad that we get our veterans when they hit the wall, when there
is literally nothing else that the VA can offer that we are not
offering this therapy to them. It is a proven alternative and a
successful alternative. I will say it again, and I have said
this before, I believe it is medical malpractice that is not
being offered to our veterans at this point in time.
I thank you for your support. I would ask that this
committee at some point review this favorably, bring this to
the floor so that we can get our veterans the care that they
need.
Thank you Madam Chairman. I will yield back.
Ms. Miller-Meeks. The chair now recognizes Representative
Deluzio for 3 minutes.
STATEMENT OF CHRIS DELUZIO
Mr. Deluzio. Thank you, Chairman Miller-Meeks, Ranking
Member Brownley, and members of the Health Subcommittee. It is
great to be back with all of you and appreciate your
flexibility working with me and my team on my bill, considering
this important measure to reduce veteran suicide, Saving Our
Veterans Lives Act of 2025. It is H.R. 1987.
I am proud to say this has been a bipartisan effort from
the start. Although they are not here, I commend
Representatives Fitzpatrick, James, and Landsman, alongside
Senators King and Sheehy, and a wide variety of organizations
who have come together and worked with me and others on such an
important issue of veteran suicide.
This bill will create a program at VA to provide and
distribute gun lockboxes to veterans, including those who are
not enrolled with the Veterans Health Administration. This
aspect of the bill is very important. Cited in VA's 2024
National Veterans Suicide Prevention Annual Report, the rate of
veteran suicide is about 17-1/2 per day, and the majority of
those come, those terrible deaths, from veterans outside of
VHA. We have got to do a better job at reaching these veterans
and connecting them with resources that could make a difference
in their lives, and this bill will help bridge that gap.
That said, I have read the VA's testimony. I know VA
recommends some changes in the bill text. I welcome amendments
and working with the subcommittee and its members to make this
legislation stronger so we can save more of my fellow veterans'
lives from the scourge of veteran suicide.
Madam Chairwoman, thank you for your time and engagement. I
yield back.
Ms. Miller-Meeks. Thank you very much, Representative
Deluzio.
The chair now recognizes Representative Underwood for 3
minutes.
STATEMENT OF LAUREN UNDERWOOD
Ms. Underwood. Thank you, Madam Chair. As a nurse, I am
really proud to be here to testify before you today on one of
the first bills that I introduced in Congress with my friend
Senator Duckworth, the Copay Fairness for Veterans Act.
While I currently sit on the Appropriations Committee, I
have the honor of serving on the House of Veterans' Affairs
Committee in the 116th and 117th Congresses. Our veterans are
heroes who have given so much to our country, and serving
veterans and their families is one of the greatest privileges
we have as Members of Congress. At a time where research shows
us that veterans face worse health outcomes than the general
public and have higher burden of chronic diseases, no veteran
should go without the ready access to preventive healthcare
services that can improve their healthcare and quality of life.
That is why my legislation would eliminate, once and for all,
all of the financial barriers that could prevent veterans from
accessing basic care.
Under the Affordable Care Act (ACA), almost all private
health insurance plans are required to provide coverage of
preventive services without charging copays. However, while
most civilians have been able to access preventive services
without copays for nearly 15 years thanks to the ACA, this same
guarantee does not exist for our veterans, at least who get
their healthcare through the VA. Despite their sacrifices and
commitment to our country, veterans are still at risk of being
charged out-of-pocket costs for services like cancer
screenings, mammograms, diabetes care, and screenings for
depression and anxiety. That is just unfair. Luckily, friends,
we can fix it.
My Copay Fairness for Veterans Act rights this wrong by
eliminating out-of-pocket costs for veterans seeking the
preventive services that they need and deserve at the VA. My
bill will ensure that veterans are not charged copays for basic
essential care, such as screenings for cancer, depression,
anxiety, diabetes, and other diseases; interventions to prevent
and treat heart disease; maternal healthcare and breastfeeding
support for new moms; help with alcohol and tobacco abuse; well
woman visits; and other critical healthcare services for
veterans and their families.
I am proud to say that this bill is endorsed by the
Disabled American Veterans (DAV) and the Minority Veterans of
America, among others. Our veterans have earned the best, and I
urge my colleagues on both sides of the aisle to support this
critically important legislation.
Thank you, Madam Chair, for including this bill in today's
legislative hearing. Thank you to our witnesses for being here.
I yield back.
Ms. Miller-Meeks. Thank you, Representative Underwood.
As is our practice, we will forego a round of questioning
for the members. For those off committee members, you may stay
around to ask questions of the witnesses if you have time.
Our first panel is already at the table. Thank you. Joining
us from the Department of Veterans Affairs is Dr. Thomas
O'Toole, the VA's deputy assistant under secretary for Health
and Clinical Services for Quality and Field Operations. He is
accompanied by Dr. Antoinette Shappell, VA's deputy assistant
undersecretary for Health and Patient Care Services, and Dr.
Thomas Emmendorfer, VA's executive director of Pharmacy
Benefits Managers. Also on our first panel, we have Dr. Jeffrey
Gold, president of the University of Nebraska System. Welcome,
Dr. Gold.
Dr. O'Toole, you are now recognized for 5 minutes to
present the Department's testimony.
STATEMENT OF THOMAS O'TOOLE
Dr. O'Toole. Great. Thank you and good afternoon,
Chairwoman Miller-Meeks, Ranking Member Brownley, and members
of the subcommittee. Thank you for inviting us here today to
present our views on several bills that will affect Department
of Veterans Affairs' programs and services. Joining me today
are Dr. Antoinette Shappell, deputy assistant undersecretary
for Health for Patient Care Services, and Dr. Thomas
Emmendorfer, executive director of Pharmacy Benefits
Management.
I joined the VA 19 years ago, leaving a senior position at
a large academic health center to work at the VA Hospital in
Providence, Rhode Island. The surge in deployments needed for
the Iraq War was underway. We were seeing more and more
veterans returning from the war needing our help, and it is a
decision I have never regretted. I have been incredibly proud
to work in the VA. Our commitment to mission, the
professionalism and dedication of my colleagues, and the
excellence in care and quality that VA provides to our Nation's
veterans defines us as an agency. Much of this has come from
the strong partnership, guidance, and oversight we receive from
Congress, and the thoughtfulness and intent of the legislation
being discussed today reflects that. While the Department views
are provided in detail in written testimony, I would like to
highlight several bills in my opening remarks.
The No Wrong Door for Veterans Act makes several amendments
to the Staff Sergeant Parker Gordon Fox Suicide Prevention
Grant Program. VA strongly supports the intent in some of the
amendments the bill would make, particularly extending the
program through Fiscal Year 2028 and requiring grantees to
inform individuals about emergent suicide care. However, we do
have concerns about some of the bill's amendments and look
forward to working with the subcommittee to address those
further. This bill aligns with the Department's priority of
reaching veterans at risk for suicide.
VA also supports the Standardizing Treatment and Referrals
Act, or START Act. This bill ensures that the referral period
for care from a non-VA provider begins on the date of the first
appointment. VA supports this bill. However, we would like the
opportunity to work with the subcommittee to ensure the text is
clear and does not result in any unintended consequences.
VA strongly supports, we all support efforts to reduce
veteran suicide. However, in its current writing, we do not
support the Saving Our Veterans Lives Act. As written, the bill
is overly broad and the resources needed to implement would
significantly exceed the authorized appropriation of $5 million
per year.
VA supports with amendments the Women Veterans Cancer Care
Coordination Act and the Veterans Supporting Prosthetics
Opportunities and Recreation Therapy Act. VA supports H.R. 217,
the Communities Helping Invest through Property and Improvement
Needs (CHIP IN) for Veteran Acts, which would allow VA to
modernize infrastructure more efficiently and cost effectively.
VA supports efforts to ensure veteran State homes are
adequately supported in covering the costs of care for
veterans.
Though we do not support the Providing Veterans Essential
Medications Act, we would appreciate the opportunity to discuss
this bill and VA's concerns with the committee. VA supports the
Copayment Fairness for Veterans Act with amendments and subject
to appropriations.
Regarding the Veterans National TBI Treatment Act, this
bill requires VA to implement a pilot program for hyperbaric
oxygen therapy, or HBOT, for veterans with TBI or PTSD. VA does
not support this bill due to the lack of scientific evidence
supporting HBOT for these conditions and we have concerns about
the proposed funding mechanism. VA does not support H.R. 658,
qualifications for marriage and family therapists. We defer to
the Comptroller General regarding H.R. 1823, directing VA and
the Comptroller General to report on certain funding shortfalls
in VA.
Finally, VA does not have views on H.R. 1107, Protecting
Veteran Access to Telemedicine Services of 2025, and we will
provide these views in a letter to the subcommittee after the
hearing.
This concludes my statement. We appreciate the continued
support and oversight of the committee. My colleagues and I are
prepared to respond to any questions you or other members of
the subcommittee may have about the legislation before us.
Thank you.
[The Prepared Statement Of Thomas O'Toole Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Dr. O'Toole.
The chair now recognizes Dr. Gold for 5 minutes.
STATEMENT OF JEFFREY GOLD
Dr. Gold. Thank you and good afternoon, Chairwoman Miller-
Meeks, Ranking Member Brownley, and other members of the
committee and Congressman Bacon. I am Dr. Jeff Gold and I have
the distinct privilege of serving as the president of the
University of Nebraska System, which has campuses in Lincoln,
Omaha, and Kearney, as well as a top-ranked academic medical
center in Omaha. We educate approximately 50,000 students, do
approximately $700 million in peer-reviewed medical research. I
myself am a recovering pediatric heart surgeon by training, but
for the last 10 years, prior to my current position, I had the
privilege of serving as the chancellor of the University of
Nebraska Medical Center.
For many decades, UNMC, University of Nebraska Medical
Center, has had a broad and deep relationship with civilian and
military Federal departments focused on training, research, and
quality clinical care. However, over the past decade there has
been intense multi-departmental focus with key partnerships in
civilian and military Chemical, Biological, Radiological,
Nuclear, and High-yield Explosives (CBRNE) global health
security challenges.
Thank you for the opportunity to testify today to support
Congressman Bacon's H.R. 217, which seeks to make permanent the
CHIP IN for Veterans Act. This bill supports our service
members through innovative and productive approaches to develop
and finance VA facilities through public-private partnerships.
In 2016, Congressman Brad Ashford of Nebraska and Senator
Deb Fischer were instrumental in passing this new legislation
creating a unique pilot program that allowed public-private
partnerships with the VA. This opportunity led to remarkable
improvement in care for local veterans in our community,
including the construction of a new ambulatory center that
today serves as a key resource for outpatient diagnostic,
procedural, and interventional veterans care services in the
Nebraska Western Iowa region. This project was funded through
Federal dollars and private philanthropic support, and has been
recognized nationally as a true pillar of success.
However, at this time, the University of Nebraska Medical
Center, one key of the University of Nebraska system, has
identified a significant need to replace several of our own
aging academic facilities on the Omaha campus, and among these
projects is a forthcoming $2.19 billion project known as
``Project Health''. This will serve as a state-of-the-art
medical facility with unique training opportunities focused on
meeting Nebraska's growing need for medical professionals. This
project will also provide access to high-quality advanced
medical care, a unique interprofessional multidisciplinary
learning environment, and access to life-saving clinical trials
for patients across the State and in the region. Project HEALTH
is a collaboration of the State of Nebraska, the city of Omaha,
the University of Nebraska, the Academic Medical Center and, of
course, extensive participation by Nebraska's philanthropic
community.
Therefore, we have proposed that the much needed
replacement local VA hospital now be repositioned on the UNMC
campus to better meet the needs of veterans in Nebraska and
Western Iowa. This would be constructed to replace the aging
facility currently in use on the VA campus. This new
freestanding facility would be branded, staffed, and operated
by the VA with physical connectivity to Project Health for
potentially shared diagnostic, interventional, laboratory, and
support services. This would also provide proximity for
university clinicians and learners from UNMC and also remain
open to staffing and training for other public and private
academic medical center professional staff.
Leveraging private construction and adjacent resources
significantly creates more cost-effective facilities and
opportunities for renovating and replacing the existing VA
hospital that was opened in 1950. Our approach is not only
cost-effective, but also ensures that veterans will receive the
highest standard of care by utilizing private sector
construction efficiencies and philanthropic support. We can
significantly reduce construction timelines and costs, ensuring
timely delivery of quality services to those that have served
our country.
Our community has demonstrated the potential of highly
successful public-private partnerships, the Veterans Health
Care and the CHIP IN Act born in your committee. This is just
one example of proven success. By effecting the proposed
partnership in Omaha, we together can set the standard for
future care for those that have worn the cloth of our Nation
and protected our freedom.
I thank you for your time and look forward to your
question.
[The Prepared Statement Of Jeffrey Gold Appears In The
Appendix]
Ms. Miller-Meeks. Thank you, Dr. Gold.
The chair now recognizes General Bacon for 3 minutes to
speak on his bill H.R. 217.
STATEMENT OF DON BACON
Mr. Bacon. Thank you, Madam Chair. I appreciate the
opportunity to advocate on this bill in the subcommittee and
the bill is H.R. 217, Communities Helping Invest through
Property and Improvements Needed for Veterans Act, otherwise
known as the CHIP IN for Veterans Act.
This bill will make the current pilot program a permanent
site. Chairman Bost has been out to our district and seen the
new facility. I appreciate that Chairwoman Miller-Meeks has
been out there. I invite the ranking member and, frankly,
anybody that wants to go to Omaha to see literally one of the
most beautiful VA facilities in the country, and it was done
through this bill that was temporary that we would like to make
permanent.
I also want to thank President Gold for being here and Ms.
Sue Morris, who helps manage the philanthropic operation here
to make this possible.
The CHIP IN for Veterans Act enables communities to take
the lead, contribute resources, and complete VA construction
projects on time and in a cost-efficient manner, benefiting
taxpayers, the communities, and, most importantly, our
veterans. The Ambulatory Care Center in Omaha, Nebraska, was
the first public-private partnership project for the VA. Now, I
would like to get your attention on this because this is what
makes this so important. The VA had budgeted this for $135
million. That was going to be the cost. The community doing
with State and local financing and philanthropic, plus Federal,
was able to do this for $85 million. Right away we saved $50
million for the taxpayer.
It gets even better. Out of that $85 million, $35 million
came from not Federal sources; philanthropic, State, and local.
In other words, this cost went from $135 million for the VA
down to approximately $50 million. This is why this bill is so
important. We can do this all over the country where folks want
to donate and contribute and where states, local governments
want to help.
Since the doors opened in August 2020, the Ambulatory Care
Center has provided--cares for 31,744 patients and over 261,000
visits. Now, we want to replace the inpatient facility now. We
already have approximately $100 million outside of the VA ready
to invest in this facility. It will be a great deal for the VA.
Look forward to working with the committee to enact this
legislation and with the Department of VA and the philanthropic
community to bring this to fruition. Another innovative
facility for the benefit of veterans across the country.
I yield back.
Ms. Miller-Meeks. Thank you, Representative Bacon.
As is my typical practice, I will reserve my time until all
other members have had a chance to ask their questions.
I now recognize Ranking Member Brownley for 5 minutes for
any questions she may have.
Ms. Brownley. Thank you, Madam Chair.
Dr. O'Toole, I am disappointed that the VA is opposing my
bill, the VA Marriage and Family Therapist Equity Act. You
know, VA is an outlier among its peers, including TRICARE, in
terms of requiring licensed marriage and family therapists to
have graduated from a Commission on Accreditation for Marriage
and Family Therapy (MFT) Education program in order to be
promoted within the VA. MFTs are among the occupations for
which VA has been developing national standards of practice for
the last several years. Perhaps you can reconsider this
standard as part of that effort if it is still underway under
the new administration. Can you share any updates on the
National Standards of Practice Initiative?
Dr. O'Toole. Thank you, Chair--thank you, Congresswoman.
The national standards work is ongoing. The intent behind that
effort is to ensure that there is minimized variance across
states in terms of accreditation and licensure.
The VA is very supportive of position of marriage and
family therapists. We see it as an integral part of the VA. Our
primary concern with this is that there are currently no
statutory requirements for supervisorial roles in any of our
Title 38 positions and our concerns with State variances that
currently exist and how those supervisorial roles are
supported. We are very open and would be happy to work with the
subcommittee further to, you know, further advance this
legislation in a way that would work or that our rules would
work.
Ms. Brownley. Thank you for that. I mean, I just believe
that this kind of clinician is so critically important to the
veteran community. You know, for a while, we did not even
accept marriage and family therapists. Now we do. In order to
keep them, they have to have a road of opportunity to be
promoted. I just think it is so many other states, TRICARE, so
forth, does not require this. It requires another accreditation
and it works pretty well. Anyway, I hope that you will continue
to consider it because I think it is really, really important.
Next question I had is I wanted to talk a little bit about
the VA and its undertaking to expand access to lockboxes and
other suicide prevention tools for veterans. You know, I think
Mr. Deluzio's bill is a good one, and I think we need to
strengthen those efforts. Can you sort of expand on the lockbox
distribution program that you are already providing?
Dr. O'Toole. Thank you, Congresswoman. To begin, we very
much share the concerns about the need and the essential
capacity of we have to be there to reduce veteran suicides. I
can speak personally to having had patients who have died by
suicide. I think all of us know, sadly, individuals who have
family members who have friends who have died by suicide. This
is an emergency.
Currently, the VA does have a lockbox program that began
last year. It is run jointly between our Office of Suicide
Prevention and the Prosthetics Department to provide lockboxes
for veterans identified as part of a clinical encounter and
clinical screening who are determined to have risk for suicide,
moderate to high risk; who have access to firearms or
peripheral access to firearms, meaning a member of the family
or household has access to firearms. In which case they are
provided a lockbox, which is a proven method of trying to
create space between the impulsivity of wanting to commit
suicide and having access to a lethal means.
Our concern with this bill is that----
Ms. Brownley. I am not asking about the bill. I am asking
about the program and what you are doing.
I want to know, it is my understanding that under the
current program, lockboxes have to be requested by their
provider. How would a veteran or their provider know this
program is available?
Dr. O'Toole. Thank you, ma'am. We have an extensive
education experience both to the veteran as well as to the
provider to promote this program to both groups to try to, you
know, encourage its application and use.
Ms. Brownley. Okay. We know it is a good program. You have
already said that it is a good program. I just, you know, it
seems to me that making sure that any veteran who wanted a
lockbox should receive a lockbox because there are many
veterans out there where we might not know their situation or
their vulnerabilities. I think it is important to do that.
I guess what kind of--oh, I have run out of time. I yield
back, Madam Chair.
Ms. Miller-Meeks. Thank you, Representative Brownley.
The chair now recognizes Representative Hamadeh for 5
minutes.
Mr. Hamadeh. Thank you, Chairwoman.
As an Army intelligence officer who served overseas, I
understand firsthand the obligation we have to the those who
wore our uniform. Our veterans deserve more than gratitude.
They deserve action. That is why I am proud to support several
of the bills before us today that will directly improve
healthcare access and quality of life for veterans all across
Arizona and our country.
My first question is for Dr. O'Toole. The alleged budget
shortfall within the VA raises serious concerns about your
organization's financial planning and resource allocation. Do
you believe the VA should undergo an annual forensic audit?
Dr. Emmendorfer. Thank you, Congressman. First, I just
wanted to say thank you for your service in the military as
well as here with us today.
On this particular bill, we do defer to the Comptroller
General.
Mr. Hamadeh. What is their recommendation?
Dr. Emmendorfer. By deferring, we are deferring to the
Comptroller General on the forensic audit.
Mr. Hamadeh. Do you believe that having a forensic audit
would give confidence to veterans and the taxpayers that their
money is being spent wisely?
Dr. Emmendorfer. I do appreciate the question, Congressman,
but we would defer to the Comptroller General.
Mr. Hamadeh. Dr. O'Toole, the Parker Gordon Fox Suicide
Prevention Grant Program has helped expand access to mental
healthcare for veterans. In what ways has the program been most
effective and how can it be further improved to ensure veterans
and crisis receive timely mental healthcare?
Dr. O'Toole. Thank you, Congressman. This act has been
serving our veterans very well, and we support many of the
amendments, several of the amendments that are in the bill. The
grant program in particular, we have found very helpful and has
been very supportive. Four of the amendments in particular we
are supportive of, including the extending the duration of the
pilot program because of its successes; requiring grantees to
inform individuals about their ability to receive emergency
suicide care, which we currently do, but I think codifying it
is going to be a strength; ensuring that eligible entities have
provided mental healthcare and support for veterans over the--
excuse me, support services in the U.S. for the previous 2
years, we feel strengthens it. There is some technical
corrections as well we support.
The concern we have with this bill is the $500,000 cap and
the $10,000 per grantee additional payment, which we think
would be difficult logistically to manage in the context of how
Federal grants are currently managed with providers in that
form.
Mr. Hamadeh. Thank you. Going off of Congressman Bacon's
comments earlier, it is a very impressive facility from what I
see and I would like to visit that, Congressman.
My first question--or third question is to Dr. Gold. What
were the biggest advantages of using the public-private
partnership for the Omaha center project and how can this model
be replicated across the country?
Dr. Gold. Thank you for asking, sir. Of course, thank you
for your service.
There are so many different advantages. One was to, of
course, save a lot of money. What would have cost the VA $136
million ended up costing $56 million out of the VA budget.
Second was this project was finished not only exactly on
budget, but ahead of schedule, which does not always happen in
large Federal construction projects. At least that has been my
multidecade experience. It also was able to bring to bear the
experience that our university had with being part of this
small, but very effective 501(c)(3) corporation, in that we
have built lots of different healthcare facilities, ambulatory
care centers, ambulatory surgery centers, and many other
inpatient and out patient health care facilities, women's
health centers, imaging centers, et cetera. Being able to bring
all that to bear with the architects, the engineers, and with
the construction contractors allowed us to accelerate the
planning for the process in partnership with the local VA and
deliver it on time and on budget.
Mr. Hamadeh. A truly, truly impressive project.
Dr. Gold. It is a beautiful facility, an award-winning
facility.
Mr. Hamadeh. Right. On time and under budget. That is
pretty rare for the Federal Government.
I yield back.
Mr. Bacon. Like $85 million under budget.
Ms. Miller-Meeks. Thank you very much, Representative
Hamadeh.
The chair now recognizes Representative Cherfilus-McCormick
for 5 minutes.
Ms. Cherfilus-McCormick. Thank you so much. I would first
like to say thank you to our panelists for testifying today.
Thank you for your dedication and service.
Dr. O'Toole, Representative Garcia's Women Veterans Cancer
Care Coordination Act identifies the difficulties veterans face
in navigating transitions to and from community care. For
instance, I have heard of cases where medical records from
community providers took weeks to return, delaying crucial
treatment and causing unnecessary stress for the veterans and
their families. No veteran should navigate their battle with
cancer alone.
Dr. O'Toole, do you have--Dr. O'Toole, do VA hospitals need
dedicated community care coordinators, teams, to help veterans
navigate and keep contractors accountable?
Dr. O'Toole. Thank you, Congresswoman. First, we agree with
you absolutely that no veteran, no person, should have to
navigate the management of cancer by themselves. We strongly
support the role of care coordinators in helping them both
navigate the care within the VA and navigating the care in the
community.
Ms. Cherfilus-McCormick. What is the impact to the
veteran's care when there is not a seamless through line
between community care and the VA?
Dr. O'Toole. The biggest challenge, Congresswoman. I think,
as we would all acknowledge, is the concern about care falling
through the cracks, not being communicated well to different
providers who were involved in that care for the veteran, not
knowing what was going on with their care. These are things
that nobody should have to experience in their care journey.
Ms. Cherfilus-McCormick. Dr. O'Toole, my second question,
having a regional breast and gynecological care cancer care
coordinator for each Veterans Integrated Service Network (VISN)
has the potential to save many lives if Representative Garcia's
bill were to become law. However, I have deep concerns that
Department of Government Efficiency (DOGE) may work to stop
this position from being in existence. Over the weekend, the
New York Times uncovered a horrifying consequence of DOGE's
indiscriminate workforce cuts. The VA hospital employees
responsible for enrolling veterans with throat cancer in an NIH
clinical trial was fired. As a result, the clinical trial was
put on hold and veterans with cancer were left without access
to potential life-saving medication.
Dr. Gold, should we exempt clinical trial coordinators and
the coordinator position established by the Women Veterans
Cancer Care Coordination Act from DOGE's indiscriminate firing?
Dr. Gold. There is no question that access to clinical
trials is life-saving, particularly in cancer, but also in end
stage congestive heart failure, in neurodegenerative diseases,
and so many others. Our veterans should be afforded the very
best quality care that our Nation can provide, which means they
need to have access to all of those trials. In order to do
that, we must have qualified personnel to enroll and to perform
those trials and to monitor them.
Ms. Cherfilus-McCormick. You would recommend expanding the
exemption to other areas and other positions, also?
Dr. Gold. Access to clinical trials is absolutely state-of-
the-art care and needs to be available to all patients in our
Nation.
Ms. Cherfilus-McCormick. Do you believe VA's plan to lay
off 83,000 workers will help facilitate veterans access to
cancer care?
Dr. Gold. I know that the staffing of any medical center,
large or small, is what makes it work. Buildings are beautiful,
the coffee shops are important, but at the end of the day, it
is the doctors, the nurses, the pharmacists, and the therapists
that make it all work. I also know that you need a critical
mass of that workforce to make it successful.
Ms. Cherfilus-McCormick. Is that a yes or a no?
Dr. Gold. Do you mind repeating your question?
Ms. Cherfilus-McCormick. Do you believe that VA's plan to
lay off 83,000 workers will help facilitate the VA's access to
cancer care?
Dr. Gold. Without understanding the details of which 83,000
workers will be laid off, it is difficult to give you a
specific answer. Anything that materially reduces the workforce
will materially reduce access to care and quality of care.
Ms. Cherfilus-McCormick. I will take that as a yes. Well,
thank you.
I would like to know that the VA research has led to the
best treatment in the world when it comes to prosthetics,
spinal cord injuries, and TBI. In addition, VA researchers also
brought use of the pacemaker, nicotine patches, and aspirin as
a method to preventing heart attacks. Attacks on these
healthcare researchers and the VA affects every veteran in
America, not just the veterans who are presently receiving
care.
Thank you so much for your time. I yield back.
Ms. Miller-Meeks. Thank you very much, Representative
Cherfilus-McCormick.
The chair now recognizes Representative King-Hinds for 5
minutes.
Ms. King-Hinds. Thank you, Madam Chair.
My question is to Dr. O'Toole. I come from the territories
and I just wanted to get your thoughts. Given that the Parker
Gordon Fox Suicide Prevention Grant Program is designed to
reach veterans who may not necessarily be engaged with the VA,
how is the program ensuring that the resources are effectively
reaching veterans in remote or underserved areas, such as U.S.
territories, like the Commonwealth of the Northern Mariana
Islands (CNMI)?
Dr. O'Toole. Thank you, Congresswoman. That is obviously of
great importance. I think the intent and design of the grantee
process is critical to that, to ensuring and both also our
monitoring of grantees to ensure that that is appropriately
managed and distributed to every veteran no matter where they
live.
Ms. King-Hinds. Okay. Then, in addition to that question,
what strategies are in place to support community-based
organizations in these areas that may lack the infrastructure
or capacity to apply for and manage these grants effectively so
that we do meet the mission of certain serving our veterans,
especially in underserved, remote areas?
Dr. O'Toole. Thank you, ma'am. I would have to take the
specifics of that response on the record and defer to our
subject matter experts in that program. It is something,
though, we fully agree with in terms of its importance.
Ms. King-Hinds. Thank you, I appreciate that. I yield my
time, Madam Chair.
Ms. Miller-Meeks. Thank you very much, Representative King-
Hinds.
The chair now recognizes Dr. Dexter for 5 minutes.
Ms. Dexter. Thank you, Chairwoman Miller-Meeks, and thank
you to our witnesses for being here today and for your service
to our veterans.
Although I am very grateful for the opportunity to consider
this legislation before us today, I have to state the obvious.
We are proceeding with business as usual when nothing about
what is happening in the world is business as usual. In a
matter of hours, everyone on this dais will leave this room to
vote on legislation put forth by my Republican colleagues to
cut nearly $23 billion in advance funding to ensure we can care
for our veterans exposed to toxic chemicals in the line of
duty. If that were not bad enough, that vote comes just days
after we found out that Trump's team will fire an additional
83,000 VA workers on top of the 2,400 they have already
stripped of their jobs, and return us to the staffing levels we
saw before implementation of the Sergeant First Class Heath
Robinson Honoring our Promise to Address Comprehensive Toxics
(PACT) Act, the biggest expansion of veterans' benefits in
generations.
Make no mistake, these firings are as good as a cut for
veterans. Without those dedicated workers, our veterans will
absolutely have trouble accessing the care and benefits they
have earned, waiting longer for their claims to be processed,
or, worse, not being able to access new benefits at all. Look,
I built a track record at the State level for being able to
reach across the aisle. I absolutely want to get things done.
Several of the bills before us--and several of the bills before
us are good policy, whether it is ensuring veterans have access
to essential medicines regardless of where they are cared for,
improving care coordination for women veterans, or advancing
cost-effective gun safety measures. I have serious doubts about
our ability to implement any of these policies if the VA does
not have the staffing or the funding that it needs.
I spent much of my professional career practicing as a
physician at Kaiser Permanente in Oregon and served first as a
board member and then as chair of the board. I understand
intimately the challenges of running a large medical system.
I simply have a--I have a simple question for you, I hope,
Dr. O'Toole. First, would it make it easier or harder to
implement a new initiative at the VA if it were uncertain that
the VA would be provided with the funding required to do so?
Dr. O'Toole. Thank you, Congresswoman. I am, you know,
trying to fully, I guess, understand the question. Obviously,
any bill that comes through, it helps to have the
authorizations associated with that bill to be able to
implement it.
Ms. Dexter. Okay, thank you. Would it make it easier or
harder to implement a new initiative at the VA if there were no
staff to do so?
Dr. O'Toole. Thank you, Congresswoman. Again, you know, I
think in--I am not--I would have to take for the record
specifics related to, you know, current issues related to
staffing and the staffing proposals underway. I think, in
general, though, I think your question is rather self obvious.
Ms. Dexter. Thank you. Following up on my colleague's
questions regarding care coordination, do you have objective
reasons to believe that care coordination within the VAMC,
especially around cancer care, is superior to care outside
coordination with our community care systems?
Dr. O'Toole. I would need to defer to our subject matter
experts who have spent, you know, many of them have spent their
careers studying differences in quality between the VA and care
outside the VA. I have been very proud to be a clinician in the
VA system and very proud of the care that we provide and the
outcomes we provide. You know, it is not to say we could never
do better. We always can. I think the role of care
coordination, particularly in complex care that involves
multiple providers, it has been well proven to be an important
element of that care.
Ms. Dexter. I absolutely agree with you having had access
to care coordinators throughout my practice as well on lung
cancer treatment.
I am going to ask, Madam Chair, if we can submit some
studies for the record looking at the comparison of outside
versus inside care, one of which is titled, ``VA Delivered or
VA Purchased Care: Important Factors for Veterans Navigating
Care Decisions.''
Ms. Miller-Meeks. No objection.
Ms. Dexter. Thank you.
I just urge my colleagues to keep in mind the importance of
this legislation. I certainly appreciate the work that folks
are doing, but that we cannot expect better care when we gut
the system that has to deliver it.
With that, I yield back, Madam Chair.
Ms. Miller-Meeks. Thank you very much, Dr. Dexter.
The chair now recognizes Dr. Conaway for 5 minutes.
Mr. Conaway. Thank you, Madam Chair, and thank you, thanks
to our witnesses for presenting themselves to us today and
offering information on the bills at hand.
Mr. O'Toole, this question is, I think, directed at you.
You are taking most of the incoming now, it seems. In the last
Congress, the No Wrong Door Act was introduced to demonstrate
improvements in veterans' mental health, a very critical issue.
We are seeing, sadly, the number of suicides among that cohort
going up. The updated version has changed that requirement that
now grantees must show that funds are being used to assist a
significant number of veterans. My concern is it went from
showing that you have good outcomes to showing that you have,
quote, unquote, ``significant numbers of veterans'' who are
receiving assistance.
The question is, what does ``significant'' mean in that
context? How do we measure it? When do people meet the bar?
Dr. O'Toole. Thank you, sir. That reflects similar concerns
that we have to the construct of this bill. Absolutely, these
pilot programs have made a difference and we are strong
supporters of them. The bill as drafted and changing from the
$750,000 grant amount to $500,000 with an additional $10,000
per individual served, we feel would create challenges and
logistics to both how the grant would be administered, but also
challenges to how we would be assessing performance of those
grants.
We stand very much in support of this legislation and the
intent of it. You know, I think we share the subcommittee's
concerns and try to make sure we have the best bill going
forward.
Mr. Conaway. I agree that the effort is more than
worthwhile, the concerns that we are seeing among the veterans
community and indeed mental health more broadly, and certainly
would have a particular need and duty to provide that care to
those who have given so much to our country.
Next, I want to address H.R. 1336, the Veterans National
Traumatic Brain Injury Treatment Act. This bill aims to direct
the Secretary of Veterans Affairs to establish a pilot program
to provide hyperbaric oxygen therapy to veterans suffering from
traumatic brain injuries or post-traumatic stress disorder.
Indeed, we have seen studies in the traumatic brain injury
space which suggests that the use of hyperbaric oxygen therapy
would be really quite beneficial.
The VA conducted its own study and which showed, you know,
great promise. Does the VA have any reservations regarding this
pilot program and the potential impact of this therapy on
veterans?
Dr. Shappell. Thank you. Thank you for your question. VA
shares your concerns. Mental health and suicide preventions are
huge priorities for VA. We do not support this bill.
Our VA subject matter experts are continuously reviewing
scientific literature and updating and publishing our clinical
practice guidelines. Published results of the scientific
rigorous research that has been done by VA and U.S. Department
of Defense (DOD) repeatedly they have shown hyperbaric oxygen
therapy has the same impact as a placebo.
Mr. Conaway. What is that? If you would speak into the mic,
it would be very helpful.
Dr. Shappell. Published studies----
Mr. Conaway. There you go.
Dr. Shappell. Published results of the scientifically
rigorous research that has been done by both VA and DOD has
shown repeatedly that hyperbaric oxygen therapy has the same
impact as placebo. There is no scientific basis to support the
use of hyperbaric oxygen therapy for PTSD. There is strong
scientific basis that hyperbaric oxygen therapy is not
recommended for traumatic brain injury.
Mr. Conaway. We are looking at a study here on our desk
that would suggest otherwise. It is an NIH study and certainly
we do want to look at the preponderance of evidence across
multiple studies. They are done, hopefully, according to the
most rigorous standards. Therefore, if you do not like the
hyperbaric oxygen as a treatment, could you suggest alternate
therapies that--alternative therapies that we are perhaps not
using now that ought to be deployed deal with these important
conditions?
Dr. Shappell. Thank you. As I mentioned, our subject matter
experts are continuously reviewing scientific literature. I
would be happy to provide you a review of other alternate
therapies that we are currently considering.
Mr. Conaway. Great. Thank you, Madam Chair.
Ms. Miller-Meeks. Thank you, Dr. Conaway.
I now recognize General Bacon for 5 minutes for any
questions you may have.
Mr. Bacon. Thank you, Madam Chair, for the opportunity to
be part of your subcommittee today. I would like to follow up
with President Gold and some of his comments on the numbers
because I think they are worthy of repeating.
What he said is that the VA--we saved the VA, or the
Federal Government, approximately $80 million. What was going
to cost the VA $135 million ended up costing the Federal
Government $56 million. I think I got the numbers that you said
right there.
President Gold, could you lay out what can we expect for
the inpatient hospital, rough numbers? Like, what does the
Federal Government or the VA think it is going to cost versus
what we can probably build it at versus how much State and
local philanthropic money we may get? We just want to show the
benefit of this for our future facility.
Dr. Gold. A great deal would depend upon how much shared
services we are talking about. Certainly replacing inpatient
med surg, critical care, and other bed space would be
essentially at the standard construction rates for large, high-
quality academic medical centers. However, a lot of the cost of
construction in healthcare now really is not on the inpatient
bed space, but it is in the extremely expensive equipment
including diagnostics, procedural, and interventional space.
Biplane fluoroscopy, for instance, some of the modern
laparoscopic and endoscopic operating rooms, et cetera. Even in
the ophthalmology world, the equipment has gotten incredibly
expensive with the operating microscopes interventional
technology.
To the extent that some of that diagnostic and procedural
space could be shared, some of the clinical and anatomic
pathologies space, some of the imaging space, some of the--even
some of the central sterile supply space that would need to be
connected, shared parking, shared logistics, and
infrastructure. Right now, the project is on the VA
construction priority list, as, I believe, the number two
priority for 2029 and, if I am correct, at $1.56 billion. I
would estimate based on discussions with the local VA and VISN
leadership, that we could probably save the Federal Government
if we did this in a shared fashion and shared these types of
resources, we estimate you could save a half a billion dollars
to the taxpayers.
Mr. Bacon. That is what I was waiting to hear.
Dr. Gold. Well, it all depends on how much you saved due to
shared very expensive space and equipment.
Mr. Bacon. That is the savings right there. If I may ask
our VA representatives, and I will defer to which one, could
you talk about what this CHIP IN bill has done, what it means
to you? I would love to get your perspective on this.
Dr. O'Toole. Thank you, Congressman. I think we are adding
to the chorus, VA supports this bill. As you know, we were
authorized as part of the pilot for up to five projects. Two
have been undertaken, one completed in Omaha, as you have
heard, and the hospital in Oklahoma is currently under
construction. We do support this legislation.
Mr. Bacon. With that, Madam Chair, I yield back.
Ms. Miller-Meeks. Thank you very much, General Bacon.
I now yield myself 5 minutes.
I am going to follow up on something Dr. Gold said, which
is carrying the public-private partnership even beyond, i.e.,
sharing facilities, especially those expensive facilities, and
sharing parking, and some people may be aghast at that. Dr.
O'Toole, do not many VA hospitals, are not they staffed by
people that have dual appointment between a medical center and
a VA center?
Dr. O'Toole. Thank you, Congressman. Yes, actually we have
a very deep academic partnership and footprint and particularly
in our level 1A, 1B, and C facilities. I would note that 70
percent of doctors practicing in the United States all went
through a veteran hospital as part of their training.
Ms. Miller-Meeks. As did I. Dr. Gold, the Omaha VA
Ambulatory Care Center was completed a year ahead of schedule
and over $40 million under budget thanks to the CHIP IN for
Veterans pilot program. How did the VA's CHIP IN authorities
foster such a successful public-private partnership?
Dr. Gold. Thank you for the question. One of the biggest
advantages that we shared was that we were able to plan this
the way we would plan a commercial, large academic medical
center clinic and then deliver it on a schedule that we would
normally do it. Over my decade of leadership at the University
of Nebraska Medical Center, we have done over a billion dollars
of healthcare and academic construction and have never exceeded
the budget and really never significantly exceeded the
timeline, except minimally during the early months of the
COVID-19 pandemic.
The construction standards are absolutely critical because
of the penalties associated with going over budget and going
over timeline. Anybody that has been involved with large
academic medical centers understands that, that time is money
for all of these types of projects. That type of precision was
used through the 501(c)(3) and you will hear from Sue Morris in
a little bit of how that actually worked. That type of
precision was used in a very, very careful way to ensure we
delivered this project.
Ms. Miller-Meeks. Thank you. It is one of the reasons we
are hoping to make this permanent. For those who are
interested, there is a pamphlet here that shows that clinic. It
is quite outstanding.
Dr. O'Toole, the Parker Gordon Fox Suicide Prevention Grant
has made tremendous progress in connecting veterans with timely
mental healthcare in their communities. Why is it vital that we
quit quickly reauthorize the program?
Dr. O'Toole. Excuse me while I catch up to my notes here on
this. Thank you. Yes, we fully endorse the importance of this.
My understanding is that the concern is obviously being
able to reauthorize it before the pilot project expires, which
my understanding is September 30, 2028. We strongly endorse
this legislation as an important armament in our effort to
reduce veteran suicide. Thank Congress definitely for all of
your work and support on this effort.
Ms. Miller-Meeks. Then again, Dr. O'Toole, the START Act
would ensure community care referrals remain valid through the
veterans standard episode of care. Would this help veterans
receive all the care that the VA has determined necessary?
Dr. O'Toole. We think so, ma'am. I think this is an
important element where this legislation will help the VA
practice to its policy. Obviously, our intent is obviously
ensuring that it is not just the episode of care or the first
appointment, but rather the episode of care, which can be up to
1 year and renewable beyond that. More importantly, it is about
helping the VA, I think, you know, shore up its practices to
ensure that we are doing a better job of ensuring that that is
actually what we are practicing, too.
Ms. Miller-Meeks. I think, Dr. Gold, you were asked a
question that may be difficult for you to answer, was in
letting people go and managing a very large healthcare
facility. Let me just say that if you were given an increase in
your budget by 126 million over a 4-year period, and over that
same past 4 years, you had an increase in full-time employees
of 60,000 and part-time employees for 23,000 and you were
looking at 80,000 employees, exempting hiring of nurses and
doctors, would you consider that gutting a program?
Dr. Gold. It would depend on the role of those individuals
employees. You know, having been a pediatric heart surgeon for
over two decades of my life, it is not just the person that
stands at the operating room or over the ether screen, but it
is the person that mops the floors and stocks the supply
cabinets and does so much else in our system.
Ms. Miller-Meeks. You would need to know----
Dr. Gold. I would need to know.
Ms. Miller-Meeks [continuing]. what those positions are.
Thank you so much. With that, I yield back.
I am going to ask if we would have our--on behalf of the
subcommittee, I want to thank all of our witnesses for their
testimony and joining us. You are now excused. We are going to
wait a moment while the second panel comes to the witness
table.
Welcome, everyone, and I thank you for your participation
today.
On our second panel we have Ms. Sue Morris, president and
CEO of Veterans Trust; Mr. Brian Dempsey, director of
Government Affairs for Wounded Warrior Project; Dr. Andrew
Kozminski, medical director of hyperbaric medicine for the
University of Iowa Healthcare; Mr. Ed Harries, president of the
National Association of State Veterans Homes; and Jon Retzer,
deputy national legislative director for Health, Disabled
American Veterans.
Ms. Morris, you are now recognized for 5 minutes.
STATEMENT OF SUE MORRIS
Ms. Morris. Good afternoon, Chairman Miller-Meeks, Ranking
Member Brownley, and members of the Health Subcommittee. My
name is Sue Morris. I am the president of Veterans Trust, the
nonprofit philanthropic entity that partnered with the
Department of Veterans Affairs under the CHIP IN Act to
construct VA's Ambulatory Care center in Omaha, Nebraska,
serving Western Nebraska and Western Iowa.
Our nationally award-winning ambulatory care center project
was completed and donated to Veterans Affairs in July 2020 as
the first public-private partnership to be completed under the
CHIP IN Act. The project received several national awards for
healthcare design and construction. I am here today to speak in
favor of taking the pilot program authorized under the CHIP IN
Act and making it permanent, as H.R. 217 would do. Our project
showed how VA, in partnership with the private sector,
delivered a truly superb facility in a cost-effective and
efficient manner.
What allowed the Omaha project to be successful? First, the
project was owned by Veterans Trust during the development and
construction phases and then donated to Veterans Affairs upon
completion. While there was very close coordination and
cooperation between Veterans Trust and VA officials at both the
national and local levels, it was not a government construction
project. This structure allowed Veterans Trust, whose
leadership had a history of facilitating or over a billion
dollars on local projects, to use local vendors and suppliers
in its procurement of services and materials, leveraging
demonstrated relationships for best pricing. We were able to
tell our partners in design and construction that they will
make money on the project, but not a lot of money, as this is a
community project to serve our veterans.
Second was a strong commitment from Veterans Affairs'
senior leadership. We met regularly at VA headquarters,
including three meetings directly with the Secretary, to ensure
project milestones were achieved. There was zero scope creep,
which helped the project to be delivered on time and on budget.
One key factor in this regard was Veterans Affairs'
willingness to review VA's normally applicable construction and
physical security standards. We were able to come to agreement
on which of those standards made sense, resulting in value
engineered savings of $23 million. In the end we delivered the
facility for a total of $86 million when it was originally
budgeted at $135 million, saving the taxpayers $50 million. In
addition, the private philanthropic contribution to the project
was $30 million.
Based upon our experience and success with this effort, we
recommend that H.R. 217 go further than simply making CHIP IN
permanent to also consider other changes. In particular, we
suggest the following. Add the option to construct facilities
on land leased to VA, not just owned or donated real property.
Add the ability to use the program for minor construction, not
just major projects, and make clear that the act applies to
more than just healthcare, but also to construction projects
providing other types of facilities to veterans, such as
housing and community centers.
In amending the act itself, we suggest the subcommittee and
staff engage a small group of VA leadership and private sector
representatives to recommend forward-looking best practices and
new models for public-private partnerships. My team and board
would be pleased to have been included in this effort.
In summary, we wholeheartedly support the effort to make
CHIP IN a permanent tool to deliver state-of-the-art
facilities. The act allows Veterans Affairs the ability to
leverage advantages of private sector construction processes to
deliver significant cost savings. We are tremendously proud of
our role in helping lead in this effort to deliver a world
class facility to our veterans and cost savings to our
taxpayers.
I want to add one final point. As Dr. Gold mentioned, there
is no doubt that a new inpatient facility to replace Omaha's
aging VA hospital is sorely needed. Veterans Trust stands ready
to partner with Veterans Affairs and the University of Nebraska
Medical Center to assist in developing a new, state-of-the-art,
inpatient facility that will better serve the veteran
community.
I am happy to answer any questions that you might have.
Thank you for including me today.
[The Prepared Statement Of Sue Morris Appears In The
Appendix]
Ms. Miller-Meeks. Thank you.
Mr. Dempsey, you are now recognized for 5 minutes.
STATEMENT OF BRIAN DEMPSEY
Mr. Dempsey. Chairwoman Miller-Meeks, Ranking Member
Brownley, and distinguished Health Subcommittee members, thank
you for inviting Wounded Warrior Project to testify on
legislation intended to improve VA's ability to provide better
access to care and ensure better health outcomes for our
Nation's veterans.
Over 20 years ago, when the first wounded servicemembers
returned from the battlefields of Iraq and Afghanistan, the
founders of our organization made a promise: to be there for
these warriors no matter what. In the years since, our
organization has grown to provide more than a dozen programs
and services to more than 227,000 veterans and servicemembers,
and our reach continues to grow by the day. These programs and
the relationships we have built with warriors along the way are
what inform our advocacy before Congress. Today, I am pleased
to speak on three bills from the agenda that we believe will
have the biggest impact on those who serve.
First, we strongly support the Veterans Support Act. This
bill would amend VA's legal definition of medical services to
clarify that the agency's existing ability to provide
artificial limbs includes the authority to provide adaptive
prosthesis and terminal devices for sports and other
recreational activities. If you are unfamiliar with what an
adaptive prosthesis or terminal device is, think of the curved-
shaped blades you might see on someone who has lost a lower
limb or a waterproof fin that allows someone with an upper body
prosthetic to swim in a pool. Now think about stress relief you
may know from running, the community you found playing in a
local softball league, or the body transformation you may have
seen from lifting heavy weights. Participating in activities
like these should be simple, but for veterans who use VA for
prosthesis, it can be a challenge.
Under current law and stated as simply as possible,
veterans often struggle to get this kind of prosthetic support
if they are not actively pursuing a rehabilitation plan, even
if they have completed one in the past and are very familiar
with what they need to do what they want. These regulations
focus on the clinical need for adaptive prosthetics, but
disregard their potential to improve a veteran's quality of
life. If a clinical need cannot be found, providers cannot
offer the equipment.
The Veterans Support Act would help these veterans by
effectively removing the requirement that they be enrolled in a
VA rehabilitative program in order to receive the adaptive
prosthetics for sports and recreation. The current population
of post 9-11 veterans as young, young, mobile and energetic. We
believe that VA should be building an ecosystem of care that
encourages an active lifestyle and makes it easier to
experience the profound health benefits, both mental and
physical provided by sports and other recreational activities.
Second, we support efforts to renew the Staff Sergeant
Parker Gordon Fox Suicide Prevention Grant pilot program,
including the No Wrong Door for Veterans Act. Our
organization's approach to mental healthcare appreciates that
no one organization and no single agency can fully meet all
veterans' needs. Evidence-based mental health treatment
absolutely works when available and when pursued, but the best
results will be found by incorporating a public health approach
focused on increasing resilience and psychological well-being.
This kind of suicide prevention strategy embraces upstream
prevention efforts, like helping with case management, peer
support, work outreach, and establishing financial wellness,
all of which are recognized as suicide prevention services
through the Fox Grant Pilot program. Each year since the Fox
Grant Pilot was launched, VA has discussed it as a key
initiative for helping prevent suicide in its National Suicide
Data Report.
Previous congressional oversight and legislative hearings
have revealed that the pilot program is not perfect, but we
appreciate efforts like the No Wrong Door Act that would
continue to refine the pilot's operation and foster community
collaboration in ways tailored to local needs. We hope that
this legislation can be prioritized as a vehicle for
bipartisan, bicameral action to renew this program in time and
disperse grants in Fiscal Year 2025.
Third and finally, we support the Protecting Veteran Access
to Telemedicine Services Act. This legislation would extend a
COVID-19 era waiver from a law that requires patients to
complete at least one in-person visit with a healthcare
provider before that provider can prescribe them a controlled
substance. If the waiver expires as planned in December 2025,
rural veterans who do not live near VA or community healthcare
facilities, who rely primarily on telehealth services, likely
will be negatively impacted. Appointment coordination
challenges and travel logistics may lead to interruptions in
their care or lapses in prescriptions. The list of controlled
substances contains not only pain medications, but also
multiple mental health drugs that are important parts of
treatment plans for many veterans dealing with mental health
issues and for whom an in-person appointment may present
additional challenges.
Members of the committee, it is my distinct honor to be
here on behalf of Wounded Warrior Project to speak to the needs
of our Nation's wounded warriors and their families. Thank you
for letting us do our part to keep the promise. This concludes
my testimony and I look forward to your questions.
[The Prepared Statement Of Brian Dempsey Appears In The
Appendix]
Ms. Miller-Meeks. Thank you.
Dr. Kozminski, you are now recognized for 5 minutes.
STATEMENT OF ANDREW KOZMINSKI
Dr. Kozminski. Good afternoon, Chairwoman Dr. Miller-Meeks,
Ranking Member Brownley, and members of the subcommittee. Thank
you for inviting me to participate in this hearing to discuss
H.R. 1336, the Veterans National Traumatic Brain Injury
Treatment Act.
I am Dr. Andrew Kozminski, an emergency medicine physician
with a specialization in undersea and hyperbaric medicine. I am
the current medical director for Hyperbaric Medicine at
University of Iowa Healthcare and medical director for the
United Hospital Center (UHC) Wound Center.
This legislation aims to improve the health of our
veterans, establishing a pilot program for the implementation
of hyperbaric oxygen therapy for veterans with traumatic brain
injury or post-traumatic stress disorder. As an emergency
medicine physician, I have cared for numerous veterans
suffering from TBIs and PTSD. With my experience in hyperbaric
medicine, I think the implementation of hyperbaric oxygen for
these ailments would be uncomplicated. Veterans already use
this therapy through their VA insurance for currently approved
HBO indications. Consequently, HBO, hyperbaric oxygen, has
proven its safety after many decades of use by the medical
community. For these reasons, this legislation has been
potential to help improve the lives of our friends, families,
and neighbors.
I want to comment on the potential for an increased
likelihood of oxygen toxicity seizures in this patient
population as 1 in 50 TBI patients develop post-traumatic
epilepsy. However, an oxygen toxicity seizure is a complication
that trained hyperbaric medicine professionals are well versed
in how to manage and should be able to ensure continued patient
safety throughout a treatment course. Clinical trials, I will
mention, even utilize a protective pressure of 1.5 Atmospheres
Absolute (ATA), which should reduce the likelihood of this
complication. However, this is an important reason to create a
pilot program through the VA Health System, as this would
provide a safe option for patients seeking treatment for what
is currently an off-label indication. Without this program,
desperate patients may find themselves at the mercy of popular
health spas. Businesses that might not have adequately trained
staff may use incorrect treatment profiles and at times pose
serious risk to their patients or their clients.
The research that investigators in my field have completed
on the utility of HBO for TBI and PTSD shows promise for
improving health outcomes in these patient populations. For
chronic TBI cases, HBO has been found to improve cellular
metabolism, reduce cell death and oxidative stress, and enhance
mitochondrial function. These mechanisms aim to promote
neuronal repair and regeneration. The Brain Injury and
Mechanism of Action, BIMA, trial published in 2016 demonstrated
improved post-concussive symptoms, PTSD, cognitive processing
speed, sleep quality, and balance function by 13 weeks after 40
60-minute HBO sessions at 1.5 ATA.
Unfortunately, these improvements did not persist beyond
that 6-month follow up. In February 2025, however, just last
month Dr. Lindell Weaver, a leader in my field, and his team
published their most recent study a double-blind randomized
trial of hyperbaric oxygen for persistent symptoms after brain
injury. This study showed similar results to what was observed
in the BIMA trial for both sham and HBO groups at 13 weeks,
with the HBO treatment group maintaining the neuropsychiatric
benefits at 6 months.
A second phase within the trial offered another 40 HBO
sessions to all participants. Final follow up 3 months after
the last of the second round of HBO treatments were given,
patients who received 80 HBO treatments had greater
neuropsychiatric improvement compared to their results after 40
sessions. Patients who received a maximum of 40 treatments also
showed neuropsychiatric improvements compared to their baseline
scores, but less improvement than their counterparts received
80 treatments.
In conclusion, I find the outcomes of these clinical trials
seem promising. Establishing a pilot program for the VA to
offer HBO therapy for veterans with TBIs and PTSD could help
improve these patients' quality of life, provide access to safe
healthcare environments in which to receive these treatments,
and continue to build insight on how best to construct and
administer treatment courses in the future. Thank you.
[The Prepared Statement Of Andrew Kozminiski Appears In The
Appendix]
Ms. King-Hinds. [Presiding.] Mr. Harries, you are
recognized for 5 minutes.
STATEMENT OF ED HARRIES
Mr. Harries. Members of the subcommittee, as president of
the National Association of State Veterans Homes, thank you for
the opportunity to testify today and offer our strong support
for the Providing Veterans Essential Medications Act. This
legislation would remove an inequity in the law concerning
high-cost medication for veterans that are preventing many of
them from living in State veterans homes.
As you know, State veterans homes are not able to receive
reimbursement from the VA for high-cost medications provided to
seriously disabled veterans, even though private nursing homes
that contract with the VA can. As a result, many State homes
are losing hundreds of thousands of dollars every year that
could be used to improve the lives of aging and disabled
veterans.
For example, at the Iowa State Veterans Home they are
caring for a 55-year-old service-connected Air Force veteran
who suffers from Crohn's disease. Fortunately, a drug called
Stelara can help control his symptoms. However, this medication
costs about $20,000 a month, which is more than the full cost
of care prevailing rate the VA pays the home. Despite the
financial burden, the Iowa State Home decided to care for this
veteran at a significant operating loss. However, that likely
means that they will have to cut costs elsewhere, perhaps
admitting fewer veterans, spouses, or Gold Star parents, or
maybe cutting back on social, recreational, or other nonmedical
services.
The same situation is occurring at State veterans homes
across the country. At an Idaho State Veterans Home, a 63-year-
old service-connected Army veteran is receiving a medication
called Duopa for Parkinson's disease, which costs the home
about $16,000 a month. The prevailing rate that Idaho receives
for this veteran does not fully cover the cost of this one
medication, let alone the cost of all the other care provided.
Unfortunately, due to the financial strain from high-cost
medications, some State homes can only afford to care for a
limited number of such veterans who need these medications.
For example, a 76-year-old 100 percent service-connected
Air Force veteran living in a VA contracted community nursing
home in Idaho was taking a special medication called Promacta.
The cost of that drug was $18,000 a month. The VA was providing
this medication to the veteran's spouse, who took it to the
private nursing home where they would administer it to him.
Although the private nursing home was receiving a prevailing
rate for the full cost of care, just like the State homes do,
their contract included a provision for them to receive or be
reimbursed for these high-cost medications. The veteran wanted
to move into the State veterans home and his spouse asked if
she could continue to pick up the medication and bring it to
the home. The VA told her that by law they could not allow it,
effectively denying this veteran the ability to live in State
veterans home, which was his choice.
There are also cases where this inequity in the law is
literally throwing away money that could be used to improve the
care of veterans. In Wisconsin, a 76-year-old veteran who 100
percent service-connected veteran, a Marine sharpshooter, was
admitted to the State veterans home while receiving
chemotherapy medication free of charge through an Astellas
Patient Assistance Program. After the veteran moved to the
State veterans home, his wife brought the medication so that it
could be administered to him. However, according to the VA's
rules, they could not use the free medication. Instead, the
facility itself incurred a cost of $12,000.
Wisconsin also had a service-connected army veteran living
in one of their homes who was prescribed a chemotherapy drug by
his VA oncologist, which was shipped directly from the VA
pharmacy to the State home. When the medication arrived, the
home contacted the VA, aware knew that it could not utilize the
drug because they had not purchased it themselves under the
program. When inquiring how to avoid wasting the $20,000
medication, the VA told them it could not be returned even
though it was in its original sealed packaging and to dispose
of it.
Madam Chairwoman, the Providing Veterans Essential
Medication Act would require VA to furnish or reimburse State
veterans homes for these high-cost medications, just like they
are doing for the private homes. This would ensure that
veterans could choose where they want to spend their twilight
years without illogical statutes and regulations limiting their
choices.
That concludes my statement and I will be pleased to answer
any questions that you or the members of the subcommittee may
have.
[The Prepared Statement Of Ed Harries Appears In The
Appendix]
Ms. Miller-Meeks. Mr. Retzer, you are now recognized. Thank
you.
Mr. Retzer, you are now recognized for 5 minutes.
STATEMENT OF JON RETZER
Mr. Retzer. Chairwoman Miller-Meeks, Ranking Member
Brownley, and members of the subcommittee, thank you for
inviting DAV to testify at today's legislative hearing. DAV is
pleased to support the following bills.
The SPORT Act seeks to include adaptive prosthesis terminal
devices for sports and other recreational activities and the
medical services provided to eligible veterans of the VA. DAV
has long recognized and continues to support the importance of
adaptive sports through our involvement with the National
Disabled Veterans Winter Sports and Golf Clinics, which helps
veterans improve their physical and mental health by overcoming
limitations and challenge their perceived disabilities.
The Saving Our Veterans Lives Act aims to tackle the
devastating issue of veteran suicide by providing secure
firearm storage. Firearms are involved in nearly 72 percent of
veteran suicides and offering lockboxes creates time and space,
reducing access to lethal means during moments of crisis,
allowing veterans to reconsider their actions and seek help.
The Marriage and Family Therapist Qualification of Veterans
Health Administration Act aims to ensure that veterans receive
care for high qualified marriage and family therapists through
effective supervision and improved therapeutic practices.
Incorporating family and relationships into mental health
treatment can result in more effective outcomes, reinforcing
coping strategies and provide a sense of belonging and
stability.
The Protecting Veterans Access to Telemedicine Service Act
would ensure veterans can access controlled medications and
consultations remotely, enabling convenience scheduling and
thus improving treatment adherence and health outcomes. It
breaks down barriers, such as distance, mobility challenges,
and transportation limitations, particularly for those in
underserved areas.
The Women Veterans Cancer Care Coordination Act aims to
ensure that women veterans diagnosed with breast and
gynecological cancers receive seamless and tailored support
through regional care coordinators. This would ensure veterans
receive timely and appropriate care.
The START Act aims to streamline the referral process for
veterans receiving community care, ensuring smoother
transitions and reducing administrative barriers. By
establishing a clear referral period, it would ensure better
care coordination.
The Providing Veterans Essential Medication Act aims to
address the financial burdens faced by safe veterans homes,
ensuring veterans have access to high cost medications without
added strain to the facilities. The bill guarantees continued
high-quality care for veterans in long-term care, reflecting
our commitment to their well-being.
The Copay Fairness for Veterans Act aims to eliminate
copayments for medications and preventive health services
provided by the VA. Removing financial barriers will encourage
routine checkups and screenings, leading to better overall
health management and fewer emergency medical situations. We
commend the thoughtful intent beyond the next two bills and
encourage incorporating our recommendations to enhance their
effectiveness.
The No Wrong Door for Veterans Act reauthorizing and
extending the Staff Sergeant Gordon Fox Grant Program,
providing ongoing support for community-based mental health
services. To enhance its impact, DAV recommends reiterating the
importance of the original requirements of baseline mental
health screening, using validating tools, and measuring the
effectiveness of suicide prevention services with pre and post
evaluations.
Furthermore, funding criteria should focus on improvements
in veterans' well-being rather than the number of participants
served. Payment structure should be clearly defined to avoid
overcompensation for minimal services. An annual renewal
process is recommended until comprehensive data confirms the
program's efficacy and identifies the most effective services
in reducing suicide risk among veterans.
The Veterans National Traumatic Brain Injury Treatment Act
aims to establish a pilot program to provide hyperbaric oxygen
therapy for veterans whose PTSD and TBI symptoms have not
responded to traditional therapies. While initial research
shows promise, researchers suggest further rigorous studies are
necessary to validate its efficacy and safety. DVA recommends
amending the bill to prioritize research along treatment axis
to ensure veterans receive care that is both effective and
evidence based.
In conclusion, these legislative bills represent a
comprehensive approach to addressing the urgent needs of our
veterans to receive the services and healthcare that they have
earned. This concludes my testimony on behalf of DAV and I am
pleased to answer questions you subcommittee may have.
[The Prepared Statement Of Jon Retzer Appears In The
Appendix]
Ms. Miller-Meeks. Thank you very much.
Ranking Member Brownley, you are now recognized for 5
minutes.
Ms. Brownley. Thank you, Madam Chair.
Mr. Retzer, thank you for your testimony and I certainly
appreciate DAV's support of the VA Marriage and Family
Therapists Equity Act as well as your support for the Women
Veterans Cancer Care Coordination Act, which I am coleading
with Representative Garcia. On the Cancer Care Coordination
bill, can you sort of elaborate a little bit more? I know you
did somewhat in your testimony, but can you elaborate a little
bit more on why this legislation would be beneficial,
especially in the light of previously enacted legislation, like
the Making Advances in Mammography and Medical Options for
Veterans (MAMMO) Act, which expanded veterans' access to high-
quality breast imaging services, and the Service Act and the
PACT Act, which expanded access to screening and made breast
cancer a presumptive condition for veterans who were exposed to
toxins during their military service?
Mr. Retzer. This bill is very important to us on a couple
different facets. As in our written testimony, we outline the
importance for our women veterans to get specialized care. The
coordination of care is so important and the challenges that VA
has with addressing women veterans' special needs, especially
when we look at, for example, breast cancer prevention. We need
to ensure that VA, being that their infrastructure is not built
to sustain all women veterans care at every VA facility, we
rely on partnerships and affiliates to be able to supply the
technical and lab work requirements plus the clinical
specialists that are out there to provide that care.
Another thing that we saw that was really meaningful in
this bill with regards to the care coordinators is the impact
it has with honoring our PACT Act. Now that we have found that
male veterans who have been exposed to toxic exposures can also
be, unfortunately, suffering from the same illness of breast
cancer, we feel that this piece of legislation will open up the
door to developing good care coordination not only for women
veterans who suffer with breast cancer, but also for our male
veterans who have been exposed to toxic exposures. We feel it
is very important with the research and the clinical findings
that they work with.
Ms. Brownley. Thank you for that. Speaking of the PACT Act,
I mean, I have to ask you with 83,000 folks being laid off or
fired in the VA and significant cuts to the PACT Act, what
impacts--I think it is 23 billion cuts to the PACT Act. What
are the implications?
Mr. Retzer. What we are hoping for that the administration
and VA and Congress itself work together in a bipartisan manner
to ensure that these bills, and they are very thoughtful bills,
continue to strengthen the VA system and that is the
infrastructure, staffing, and technology.
Ms. Brownley. Thank you. Dr. Kozminski, in your testimony
you briefly discussed the importance of sufficient training and
strict safety standards and the potential risks faced by
patients who are seeking hyperbaric oxygen treatment for off-
label indications, like TBI and PTSD, at health spas. You also
mentioned the recent tragic explosion of a hyperbaric chamber
at a facility in Michigan, which killed a 5-year-old child. Dr.
Murphy's legislation, H.R. 1336, does not seem to include any
limitations or guardrails on which types of providers veterans
with TBI or PTSD could receive treatment from under this
proposed pilot program.
Do you think we should consider amending it to include
safeguards such as ensuring that veterans would go to
institutions that have been accredited by the Undersea and
Hyperbaric Medical Society or another body? Would you recommend
other safeguards? The bill literally is like two pages, maybe
two and a half pages. It is just about funding and having the
program and starting the program, but no safeguards whatsoever.
Dr. Kozminski. Frankly, I mean, I do agree that it would be
best to make sure that whatever treatment they receive, what
our veterans receive, is done at an accredited facility.
Amending the bill for that would be probably best for patient
safety.
Ms. Brownley. That is it?
Dr. Kozminski. I am good.
Ms. Brownley. Thank you. I will yield back.
Ms. Miller-Meeks. Thank you very much.
The chair now recognizes Representative King-Hinds for 5
minutes.
Ms. King-Hinds. More along the lines of this traumatic
brain injury treatment option. I guess this is a question for
Dr. Retzer because it is a policy conversation. Right?
What additional research or oversight do you suggest or
recommend is needed basically, that one we could actually
explore this type of treatment, right, that a lot of folks
support? How do we ensure balancing the safety of our veterans?
Mr. Retzer. I think as we see all the research that we see
and what VA is doing and what NIH is doing, and also the
Journal of Medicine, we are seeing all these factors that have
progressed throughout the year, showing from a point of where
there was an imbalance, where it was not positive, that age
HBOT was reducing outcomes for traumatic brain injury and PTSD.
As we started to move through the years, we started to see some
progress and that is the promise that we are hearing, that we
are wanting to see that more research. As a resolution-based
organization, we support research, strongly support
continuation of VA's research, and also the research partners
and affiliates out there to ensure that they are looking at
safe clinical practices, evidence-based methods to ensuring
that we are providing alternative options of care for our
veterans.
Ms. King-Hinds. Okay. Thank you for that. This question is
also for you. Given the importance of telemedicine in providing
timely care to veterans, especially those who live in remote
and underserved communities, like mine, the CNMI, what specific
safeguards are being considered to ensure that prescriptions
for controlled substances via telehealth are both safe and
effective?
Mr. Retzer. Thank you for that question. With
pharmaceutical care and trying to address the issues of mental
health and suicide prevention along with substance use abuse,
there is a responsibility on VA to ensure when they are
providing patient care in direct environment or in the
community care, that there are direct communication, clear
communications on the treatment processes and what medications
are given so that the veterans themselves understand being
informed what those interactions are and what the risk factors
are and, at the same time, that VA and community are speaking
directly with themselves.
For example, my time when I was stationed up in Alaska,
very remote area, it is very difficult to find clinicians in
every part of it. When you are dealing with the VA and
community care and you look at their infrastructure up there,
it is not built to communicate very directly or well. We hope
that as we continue with the modernization of electronic health
record modernization, that is something that will be worked
very robustly into the system of the pharmaceutical safety
measures and making sure that patient safety is paramount
throughout the whole development.
Ms. King-Hinds. All right, thank you. I yield my time
Ms. Miller-Meeks. Thank you. The chair now recognizes Dr.
Morrison for 5 minutes.
Ms. Morrison. Thank you, Madam Chair. It has been my
distinct privilege to join in the work that this committee
leads, ensuring that VA is meeting veterans diverse and
evolving needs. As a physician myself, I have been part of
teams that work together to help patients receive the highest
quality of care and have witnessed firsthand the impact,
positive impact of building comprehensive care coordination
that enables effective communication and supports patients
through their care. With the number of women veterans expected
to continue growing, obviously we should be proactive in our
efforts to coordinate care for one of the most pressing health
issues women veterans face.
Mr. Retzer, you answered ranking member Brownley's
question. I am going to direct it to you now, Mr. Dempsey, if I
may, and thank you for being here today. We have highlighted
that breast cancer is the most diagnosed cancer for women
within VA and that we will likely see a rise in the volume of
cancer care that veterans need. Can you expand a little bit on
the importance of care coordination for improving health
outcomes and women veterans overall VA experience?
Mr. Dempsey. Of course and thank you for the question.
Thank you additionally for pointing out that breast cancer
ranks as the second most common cancer among women in the U.S.
and within VA, it is the most diagnosed cancer. I think for any
veteran coming through the VA health system, in this case the
increased volume of female patients that VA sees, it is
important that patients feel supported with cancer care. In
particular, where a lot of that care is received in the
community, it is critically important to make sure that there
is good coordination between the VA direct care system and
those community providers. There is no gap in service, whether
it be transfer of records back and forth, communication between
the providers to make sure there is gaps in care. I think
overall just creating a culture where veteran patients feel
supported by their care providers.
Ms. Morrison. Thank you. Appreciate that answer. I would
also like to highlight another health issue that we have
discussed that affects veterans at 1.5 times greater than
nonveterans. Suicide rates among servicemembers have risen
gradually over the decade, with veterans experiencing an
alarmingly disproportionate rate of suicide by firearm. As the
wife of a veteran, I find this absolutely heartbreaking.
While we understand that mental health issues facing our
veterans do not stem from a single cause, of course, it is
important that we take any and every path to prevent these
tragedies and empower veterans to address their mental health
conditions. Safe firearm storage, education, and resources are
integral to addressing the elevated risk veterans face for
firearm suicide.
With firearms reported to be involved in up to 72 percent
of veteran suicides, as you noted, Mr. Retzer, the evidence for
continued support of intervention programs that promote
potentially life-saving time delays is clear.
Mr. Retzer, in your testimony you do discuss time and space
as critical components in preventing suicides. Why is
approaching suicide prevention through safe firearm storage
particularly impactful for veterans and their families?
Mr. Retzer. I can speak as a veteran who owns firearms and
who suffers with mental health. It is very meaningful to have
this conversation because it is a responsibility not just of
the veterans, but to the clinicians and the families integrated
to understand how to save the veteran and themselves. In our
testimony we wrote about the community being safe, and that is
the end goal is to make that community safe, but where it
starts is that veteran is safe.
I have gone through the VA process of the clinical side,
and I wish I was offered a lockbox. I was not. I met all the
criteria that were actually testified, and I was not given an
option for the lockbox. The good thing is that VA, throughout
the process, has been doing and taking steps to ensuring that
they offer these security measures to our veterans.
Ms. Morrison. Thank you. The Saving Our Veterans Lives Act
considered by the committee today includes an education
element. How do you anticipate the educational component of the
initiative will work with the resource component of the bill?
Mr. Retzer. That is a great question and education is
always very important. That is something we, the veterans, have
to also own for ourselves, for our responsibilities, something
that we come from. We come from an environment of being
educated on how to handle firearms in the military. Hopefully
that VA will build upon that knowledge that we have and the way
that we are taught those, so that it relates to us in a manner
that is meaningful and it also has highlights the importance.
Education, I think, is going to be very important because it is
going to open up the dialog for us to talk about something that
is not always easy to talk about.
Ms. Morrison. Thank you, Mr. Retzer. The legislative
efforts considered in today's hearing demonstrate critical
steps toward delivering the quality care that VHA should
continuously pursue. I sincerely believe that finding common
ground on ways to improve VA is a goal that is shared by all of
my colleagues that sit on this committee.
In recent weeks, there is been a lot of conversation about
ramping up efficiency in our government. Every single one of
the bills we have discussed today would require implementation
actions that are the responsibility of VA employees. We cannot
hope to continue to deliver care to our veterans if we throw
the folks responsible for its delivery into instability and
uncertainty. We cannot wish for improved access to care if we
allow the disruption of essential food functions in our VA
hospitals and facilities. We cannot tell our servicemembers we
value their well being if we permit critical contracts and
research initiatives to be slashed.
I urge my colleagues, particularly those that have
presented their bills before the committee today, to recognize
the importance----
Ms. Miller-Meeks. Your time has expired. I am sorry. We
have votes that are coming up----
Ms. Morrison [continuing]. of supporting the workforce.
Thank you, Madam Chair. I yield back.
Ms. Miller-Meeks [continuing]. so please wrap-up your time.
The chair now recognizes Dr. Dexter for 5 minutes.
Ms. Dexter. Thank you, Madam Chair. Again, thank you to our
panelists for being here and for the work that you do with our
veterans.
As I alluded to earlier, I spent my career in a
comprehensive coordinated care system very similar to the VA,
and so I appreciate the ability to really embrace our veterans
within the system and deliver care. I know that these systems
work for patients, as you have spoken to, and we have clear
data that we will submit for the record showing that care
outcomes and satisfaction for care received inside of the VA is
superior to outside. We also want to make clear that our
veterans have access to care and mitigate the need for our
veterans to be able to access care and have that intervention
at the moment of impulsivity and despair for our veterans at
high risk for suicide is critical. Thank you for your support
for the lockbox display policy. I think that is proven very
high yield and critical.
It also is critical that our veterans have time to talk
with a provider, be able to reach out when they are feeling
most impulsive and desperate. I believe that is the intention
with the No Wrong Door Act is to be able to help people at that
moment. However, I am concerned about our requirement for in-
person care delivery for mental healthcare and the fact that we
are not going to allow telemedicine mental health any longer,
that everyone is going to have to be in person because an
established care provider is trusted and certainly preferable
having worked in an emergency room to walking into an emergency
room and expecting high-quality personalized care.
Despite the good intentions of the Wrong Door Act, it seems
to run counter to the principles of a capitated inclusive body.
I also have concerns about the reauthorization of a program for
which we have collected good outcome data for only 4 percent of
the participants.
I wonder, Mr. Retzer, if you would be willing to share your
thoughts on when VA led interventions are looking to be most
impactful for our high-risk suicide patients, do you feel like
we have sufficient data to be confident that the No Wrong Door
Act is actually saving lives more than further investing in VA
comprehensive care and even telehealth mental healthcare?
Mr. Retzer. Thank you for that question. That is such an
important issue that we have No Wrong Door Act really addresses
alternative options where VA cannot do it by themselves. That
is something that we are very realistic to. With having over 9
million veterans enrolled in the VA healthcare system and you
have 2.7 million in the rural, we have to be able to provide
that type of a resource. When the Compact Act came out and that
was a great win for Congress and for American veterans to be
able to get healthcare when they were in acute crisis, that is
another tool. The No Wrong Door has the potential to do what we
need to do to provide alternative resources and clinical
support out in the community where veterans may not be enrolled
in the healthcare system. I think that is the most Important
thing is that we do not shut the door on this.
We continue to see what we can do with this. That is why we
recommended our recommendations and testimony to be fiscally
responsible, to make sure that it is not participants that are
being gauged, and we are not a production of veterans going
through the shop. We want quality care, the same kind of care
that we get within the VA system and the wraparound services
that were actually noted in the bill with regards to ensuring
that they are going back to VA and being informed about how to
utilize VA.
We see promise in there, but we are waiting for the report
and we hope to see the final report and become public for us to
be able to make a determination.
Ms. Dexter. I absolutely share the intentions and the
suppositions of the bill. I just am concerned about only 4
percent of output being really looked at for the outcomes. It
is not a question, it is just I think that compelling data
before we invest when we have so modest resources available to
us is important.
What do you think Congress can be doing better to bolster
interventions to help prevent suicide, which is at a critical
crisis point for our veterans right now?
Mr. Retzer. Thank you for that question. I think like I
said earlier, it is multifaceted. We have to look at every
avenue directly within the VA healthcare system, making sure we
have proper staffing. We have clinical psychologists,
psychiatry shortages in staffing, but also to support them, we
have to ensure that the VA staffing itself in general is on
par.
For example, if we go to the phone call for the crisis
line, someone has to be manning that line. If we go to the
phone to call the public contact office, someone has to be
there. If we go into a VA medical center, the facility has to
be cleaned where we have our people who are custodians that
they are working. All the employees that support their VA, it
is very important that we look at it.
The other thing is we need more peer-to-peer. Our veterans
who work within the VA system, they themselves know what the
life is like and they have the experience to become peer-to-
peer counselors or peer-to-peer to be able to mentor through
us.
Ms. Dexter. I recognize that I am over time, so thank you
for your tolerance, Madam Chair. I thank you for your
testimony.
Ms. Miller-Meeks. Thank you. The gentlewoman yields.
The chair now recognizes herself. I was going to recognize
Dr. Conaway, but he slipped out. Thank you very much.
Ms. Morris, were there difficulties executing the
construction of the VA clinic in Omaha, Nebraska, in
coordination with the VA? If you could improve the CHIP IN
authorities, what would you suggest if there, in fact, were
difficulties?
Ms. Morris. Really did not experience a lot of difficulties
in construction. If you remember, probably the biggest
challenge was the last 4 months. COVID hit March 2020, and we
needed to finish up the project by the end of July in order to
do the transfer in August. Our construction team and our design
team worked diligently to be able to get that done on time,
which is really kind of amazing that that was able to happen at
that period.
Ms. Miller-Meeks. Were there certain waivers or exemptions
that you sought from the VA in order to get construction done
under budget and under time?
Ms. Morris. Well, certainly I referenced the construction
manuals and the security manuals. Those were critical. We
actually spent a 2-day time period in Omaha, Nebraska, where
about 15, 20 VA employees came out. We went through those
manuals with great precision and, at that point in time, we
were able to have value engineering of about $23 million.
Ms. Miller-Meeks. Thank you. Dr. Kozminski, many aging
veterans and those suffering from diabetes-related
complications sadly receive amputations due to chronic limb
ischemia. Could HBOT therapies be potential preventive
treatment for our veterans suffering from those conditions?
Dr. Kozminski. Just to clarify, so preventative in the
sense of preventing those infections or preventing----
Ms. Miller-Meeks. Amputations.
Dr. Kozminski. Yes. I do think that hyperbaric oxygen
therapy has been a fairly well proven implementation for
salvage therapy in those cases for sure.
Ms. Miller-Meeks. Thank you so much for coming in. Go Hogs.
Mr. Harries, I understand the difficulties your members are
experiencing as a result of the VA's inability to reimburse for
high-cost medications that the patient may have been on prior
to coming to a facility. VA testified the status quo is okay.
Do you agree?
Mr. Harries. No, we do not. The costs of these drugs that
are coming in are climbing rapidly. The other thing that is
happening, with the exposure to toxic chemicals that our
veterans are having, we are having more and more cancer
diagnoses. Some of these high-cost drugs, or a good portion of
them, are related to chemotherapy.
Ms. Miller-Meeks. They, in fact, cover these drugs if the
patient was at a different facility or at their home.
Mr. Harries. Correct. You know, looking at it from a cost
perspective, the average institutional per diem is $262 for
State veterans home, whereas with the community homes, it is
$424. If you looked at balancing that out, it may be a net
neutral event.
Ms. Miller-Meeks. Thank you. Mr. Dempsey, how could the
SPORT Act assist post 9-11 veterans?
Mr. Dempsey. Thank you for the question. The SPORT Act
would, I think, do a tremendous job of reforming the way that
amputee veterans engage with the VA prosthetic department.
Currently, with the limitation that adaptive and support-
related prosthetics only be provided as part of a clinical
program, expediting that process and getting these into a
veteran's life is a great way to re-engage in the community,
whether it just be participating in athletics, whether it be
involved in community outings, golf, running, any number of
activities I think a lot of people take for granted, but which
could be greatly danced by better access to these prosthetics.
Ms. Miller-Meeks. Does it seem to you that the VA's current
status and parameters are geared toward elderly veterans who
perhaps have amputations from medical conditions, such as
diabetes, rather than to our younger, much more active post 9-
11 veterans?
Mr. Dempsey. Well, thank you for the question. To be
honest, I do not know that I could speak to that. I would say
that most of the voices that come to our post 9-11 serving
generation are those who were injured in the early 2000's for
whom, you know, getting adaptive prosthetics became part of
their post-injury life very early. They have become familiar
with how to use them, how they want them, and so ensuring that
the process works a bit more smoothly for them is the priority
here.
Ms. Miller-Meeks. Thank you. I yield my time.
Thank you to all of you. Thank you to our witnesses and for
all your thoughtful input.
Ranking Member Brownley, I am going to ask if you have any
closing remarks.
Ms. Brownley. Thank you, Madam Chair. I just wanted to
associate myself with Representatives Dexter and Morrison and
their comments that they have made today. I will just repeat
what I said in my opening remarks and that I find it a bit
crazy that we are having a legislative hearing today rather
than an oversight hearing while the Trump administration's
careless executive orders, mass firings of VA employees, and
reckless contract terminations are causing significant upheaval
within the Veterans Health Administration. As I said earlier,
none of these bills we are considering today will address the
very real threat to VA healthcare, to VA access to healthcare,
quality, and safety that our Nation's veterans are facing
today.
Veterans do not support these proposed cuts, nor do they
support cutting 83,000 employees within the VA. If we continue
to see efforts to dismantle the VA by firing hardworking
employees, canceling vital research, terminating healthcare
contracts, and eroding veterans' trust in VA, it will not
matter what excellent legislation we put forth. There will not
be employees or even an infrastructure left at VA to implement
these bills and veterans care will suffer because of it. We can
do better than that.
I yield back.
Ms. Miller-Meeks. Thank you very much.
Perhaps it is because I am a physician and a 24-year
military veteran, married to a 30-year military veteran, that I
find it completely plausible that we as Members of Congress can
actually make legislation, go through legislation, in addition
to respond to things that are happening through other parts of
the Federal Government as well.
Let me also say that I just need to address some
misinformation I have heard here today. Whether it is
intentional or unintentional, there is a $6 billion increase to
the Toxic Exposure Fund, not a decrease. Let me repeat that.
The Toxic Exposure Fund in the Continuing Resolution that we
may be voting on has a $6 billion increase.
Let me also say that over the past 4 years the VA's budget
has increased $240 billion--or has increased from $243 billion
to $369 billion, an over $126 billion increase, while
nationally the level of veterans seeking care is level. Is
level. Of that, in the past 4 years an increase of 60,000 full-
time employees and 23,000 part-time employees.
Given my time in the military, I remember as an Operating
Room (OR) nurse, I will not say what facility I was in, it was
1:30 in the afternoon. All of the staff, with the exception of
three of us, and I can see Dr. Kozminski smiling because he
knows what I am going to say, three of us were back putting
together the instruments and putting up our instrument sets.
Everybody else was in the break room. I would say to look at
how we spend money in the Federal Government, so precisely what
Ranking Member Brownley has said, so that we can continue to
have the funds to deliver high-quality care to our veterans in
a timely fashion, be it at the VA or in community care, is a
priority for all of us. None of this dismantles or guts or
defunds the VA or the Toxic Exposure Fund.
I want to thank our witnesses who have been here today. I
appreciate your coming and testifying. I want to thank our
veterans, most importantly who give us the opportunity to be
here and to vote this afternoon. On behalf of the subcommittee,
I want to thank you all again, the witnesses, members who are
here today. I am looking forward to working with you to address
the issues facing our veterans.
The complete written statement of today's witnesses will be
entered into the hearing record. I ask unanimous consent that
all members 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 4:20 p.m., the subcommittee was adjourned.]
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A P P E N D I X
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Prepared Statements of Witnesses
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Prepared Statement of Thomas O'Toole
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Jeffrey Gold
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Sue Morris
Good afternoon, Chairwoman Miller-Meeks, Ranking Member Brownley,
Members of the Health Subcommittee.
My name is Sue Morris. I am the President of Veterans Trust,
formerly known as Veterans Ambulatory Center Development Corporation,
the nonprofit philanthropic entity that partnered with the Department
of Veterans Affairs under the CHIP-IN Act to construct VA's ambulatory
care center in Omaha, Nebraska, serving Western Iowa and Nebraska. I
want to note first that our non-profit entity is led by Veterans. Our
Chairman, John Henderson, is a retired Army Colonel and our Secretary,
Mike Pallesen who is with me today, is a retired Navy Commander.
Our nationally award-winning Ambulatory Care Center project was
completed and donated to Veterans Affairs in July 2020 as the first
public-private partnership to be completed under the CHIP-In Act. The
project received several national awards for health care design and
construction.
I am here today to speak in favor of taking the pilot program
authorized under the CHIP-In Act and making it permanent, as H.R. 217
would do. Our project showed how VA, in partnership with the private
sector, can deliver a truly superb facility, in a cost-effective and
efficient manner.
What allowed the Omaha project to be successful? First, the project
was ``owned'' by Veterans Trust during the development and construction
phases and donated to Veterans Affairs upon completion. While there was
very close coordination and cooperation between Veterans Trust and VA
officials at both the national and local levels, it was not a
``government construction project''. This structure allowed Veterans
Trust, whose leadership had a history of facilitating $1 billion on
local projects, to use local vendors and suppliers in its procurement
of services and materials, leveraging demonstrated relationships for
best pricing. We were able to tell our partners in design and
construction that they will make money on the project, but not a lot of
money, as this is a community project for the Veterans.
Second, was a strong commitment from Veterans Affairs senior
leadership. We met regularly at VA's headquarters, including three
meetings directly with the Secretary, to ensure project milestones were
achieved. There was zero scope creep which helped the project to be
delivered on-time and on-budget. One key factor in this regard was
Veterans Affairs' willingness to review VA's normally applicable
construction and physical security standards. We were able to come to
agreement on which of those standards made sense, resulting in value
engineered savings of over $23 million.
In the end, we delivered a facility for a total of $86 million when
it was originally budgeted at $135 million, saving the taxpayers $50
million. The private philanthropic contribution to the project was $30
million.
Based upon our experience and success with this effort, we
recommend that H.R. 217 go further than simply making CHIP-In permanent
but to also consider other changes that will allow the public-private
partnership structure to provide even greater opportunities to deliver
best in class facilities to our Veterans while doing so in a way that
saves taxpayer dollars. In particular, we suggest the following:
Add the option to construct facilities on land leased to
VA, not just owned or donated real property.
Add the ability to use the program for minor
construction, not just major projects.
Make clear that the Act applies to more than just
healthcare but also to construction projects providing other types of
facilities to Veterans such as housing and community centers.
In addition to amending the Act itself, we suggest that the
Subcommittee and staff engage a small group of VA leadership and
private sector representatives to recommend forward-looking best
practices and new models for public--private partnerships. My team and
Board would be pleased to be included in this effort.
In summary, we wholeheartedly support the effort to make CHIP-In a
permanent tool to deliver state-of-the-art facilities. The Act allows
Veterans Affairs the ability to leverage the advantages of private
sector construction processes to deliver significant cost-savings.
Thank you again for the opportunity to express our support for H.R.
217 and further expansion of the CHIP-In Act. We are tremendously proud
of our role in helping lead in this nationally groundbreaking effort to
deliver a world-class facility to our Veterans and cost-savings to
taxpayers.
I want to add one final point. As Dr. Gold mentioned, there is no
doubt that a new in-patient facility to replace Omaha's ageing VA
hospital is sorely needed. Veterans Trust stands ready to partner with
Veterans Affairs and the University of Nebraska Medical Center to
assist in designing and constructing a new state-of-the-art facility
that will better serve the Veteran community in Nebraska and Western
Iowa while taking advantage of the public-private partnership model
offered by the CHIP-In Act.
I am happy to answer any questions that you might have.
Prepared Statement of Brian Dempsey
Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished
members of the House Committee on Veterans' Affairs, Subcommittee on
Health - thank you for the opportunity to submit Wounded Warrior
Project's views on pending legislation.
Wounded Warrior Project (WWP) was founded to connect, serve, and
empower our Nation's wounded, ill, and injured veterans, Service
members, and their families and caregivers. We are fulfilling this
mission by providing life-changing programs and services to more than
227,000 registered post-9/11 warriors and 56,000 of their family
support members, continually engaging with those we serve, and
capturing an informed assessment of the challenges this community
faces. We are pleased to share that perspective for this hearing on
pending legislation that would likely have a direct impact on many we
serve.
Draft legislation: No Wrong Door for Veterans Act
Launched in 2022, the Department of Veterans' Affairs (VA) Staff
Sergeant Parker Gordon Fox Suicide Prevention Grant (``Fox Grant'')
Program is a groundbreaking initiative that empowers community-based
organizations to provide targeted mental health and crisis intervention
services to veterans. The program was established through the Commander
John Scott Hannon Veterans Mental Health Care Improvement Act (P.L.
116-171 Sec. 201) and facilitated VA's financial support to more than
80 organizations in Fiscal Year 2024 to provide or coordinate a range
of suicide prevention programs for veterans and their families.\1\ In
each year since its implementation, the program has been discussed as a
key initiative for helping prevent suicide in VA's national suicide
data report.
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\1\ Press Release, U.S. Dep't of Vet. Aff., VA Awards $52.5 Million
in Veteran Suicide Prevention Grants, Announces Key Updates in the
Fight to End Veteran Suicide (Sep. 2023), https://news.va.gov/press-
room/va-awards-veteran-suicide-prevention-grants/.
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The No Wrong Door Act is one of several legislative initiatives to
renew the Fox Grant pilot program (see S. 2793; S. 5210 (118th Cong.)).
This specific effort reflects the most comprehensive legislative effort
to extend the current Fox Grant pilot and includes provisions to make
clear that prior grant recipients shall not receive preference from VA
for future grants; to require prior grantees to include evidence of
services delivered to a ``significant number'' of veterans in
applications for future Fox grants; to require that VA brief
``appropriate personnel'' of each VA medical center within 100 miles of
a Fox grantee about the Fox grant program in an effort to improve
coordination; to require Fox grantees to inform veterans receiving Fox
grant services that they may receive emergent suicide care through VA;
and to require Fox grantees to use a VA-selected screening protocol
when using Fox grant funding to provide baseline mental health
screening.
The changes outlined above would be welcomed; however, WWP
encourages the Subcommittee to consider amendments that would lead to
bipartisan, bicameral support to extend the Fox Grant program with
enough time to allow for grants to continue to be dispersed to
community-based grantees at the start of the next fiscal year. We would
also encourage adoption of language from S. 793 focused on measures and
metrics.
Draft legislation: Providing Veterans Essential Medications Act
State Veterans Homes (SVHs) - state-owned and--operated facilities
that work in tandem with VA - play an important role in meeting the
nursing home, domiciliary, and adult day health care needs of veterans
across the country. While SVHs primarily serve an elderly population,
the future long-term care needs of post-9/11 veterans can be mitigated
by addressing critical priorities today. Part of that effort includes
ensuring that veterans residing in SVHs receive the medical care they
deserve, particularly access to life-saving and high-cost medications.
Under current law, VA provides per diem payments to SVHs for each
eligible veteran receiving nursing home, domiciliary, or adult day
health care.\2\ For veterans with service-connected disabilities rated
50 percent or greater, the law requires VA to cover the cost of all
medications administered by SVHs. However, if the veteran has service-
connected disabilities rated 70 percent or greater, VA pays a higher
``prevailing rate'' to the SVH, but does not pay for any medications,
even high-cost drugs that can cost upwards of $20,000 a month. These
medications would otherwise be covered by VA when a veteran is not
being cared for at an SVH. For example, existing law permits private
nursing homes to receive VA reimbursement for high-cost medications.
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\2\ JARED SUSSMAN, CONG. RSCH. SERV., IF11656, STATE VETERANS HOMES
(2020).
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The Providing Veterans Essential Medications Act seeks to amend 38
U.S.C.Sec. 1745(a)(3) to direct VA to either reimburse SVHs for the
cost of expensive medications or directly provide these medications to
the facilities. As defined in this bill, medications would be
considered ``costly'' if their average wholesale price for a 1-month
supply, plus a 3 percent transaction fee, exceeds 8.5 percent of VA's
monthly payment to the SVH for the care of the veteran receiving the
medication.
Wounded Warrior Project supports the Providing Veterans Essential
Medications Act. By requiring VA to either reimburse or directly
provide these essential medications, this legislation would help
alleviate the financial strain on SVHs, ensuring they can continue to
offer quality care without risk of budget constraints that limit
veterans' access to necessary treatments.
Draft legislation: Veterans Supporting Prosthetics Opportunities and
Recreational Therapy Act, or Veterans SPORT Act
The highest priority for amputees requiring prosthetics should be
improved quality of life. In addition to enabling veterans to live more
independently and complete activities of daily living, adaptive
prosthetic devices and equipment can have positive and life-changing
impacts on a warrior's life through exercise and recreation. WWP has
witnessed this when assisting warriors through our Adaptive Sports and
Soldier Ride programs. Adaptive sports equipment empowers warriors to
engage in modified athletic opportunities designed for their individual
abilities, resulting in profound improvements to physical and mental
health.
VA's current definition of ``medical services'' includes
``wheelchairs, artificial limbs, trusses, and similar appliances,'' \3\
but does not include adaptive prostheses or terminal devices. Although
VA clinicians work with veterans to identify recreation activities and
needed adaptive recreation equipment to support a veteran's
rehabilitation goals, VA will not provide adaptive recreation equipment
if the purpose of the equipment is to support the veteran's
participation in an activity for personal enjoyment. Specifically, VA
regulations only provide adaptive prosthetics and terminal devices for
sports and other recreational activities for veterans if the device (1)
is needed to promote, preserve or restore the health of the veteran;
(2) serves as a direct and active component of the veteran's medical
treatment and rehabilitation; and (3) does not solely support the
comfort or convenience of the veteran.\4\ These regulations focus on
the clinical need for adaptive prosthetics but disregard their
potential to improve veterans' quality of life.
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\3\ 38 U.S.C. Sec. 1701(6)(F)(i).
\4\ 38 C.F.R. Sec. 17.3230(a)(1).
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If a veteran is interested in adaptive recreation equipment, VA
regulations require that he or she must use it to support
rehabilitation goals and, accordingly, must be enrolled in a VA
rehabilitation program. The necessity to participate in such
rehabilitation programs can be a deterrent for some veterans who may
not be able to travel or devote the time required. These programs are
also repetitive as they require that veterans be retrained to use
replacement adaptive equipment for which veterans completed
rehabilitation training in the past. For these reasons, some veterans
may choose not to obtain or replace adaptive recreation equipment,
hindering a veteran's ability to maintain an active and healthy
lifestyle.
Wounded Warrior Project supports the Veterans SPORT Act, which
would amend 38 U.S.C. Sec. 1701 to add adaptive prostheses and
terminal devices for sports and other recreational activities to VA's
definition of ``medical services.'' The current population of post-9/11
veterans is young, mobile, and energetic. WWP believes that VA should
be building an ecosystem of care that is encouraging of such an active
lifestyle. We recommend that VA authorize adaptive equipment for
amputees without requiring that they be enrolled in a VA rehabilitative
program for the profound benefits provided by sports and other
recreational activities.
Draft legislation: To direct the Secretary of Veterans Affairs and the
Comptroller General of the United States to report on certain funding
shortfalls in the Department of Veterans Affairs
In July 2024, VA notified Congress about a forecasted $2.8 billion
shortfall that would prevent the agency from delivering VA benefits to
veterans at the start of Fiscal Year 2025 (October 1, 2024). VA also
reported a potential 2025 shortfall of approximately $12 billion for
its health care system. Those estimates have since been adjusted, as
the Veterans Benefits Administration (VBA) reported a $5.1 billion
surplus from Fiscal Year 2024, and the Veterans Health Administration
(VHA) more recently estimated its 2025 shortfall to be $6.6 billion.
Wounded Warrior Project is grateful for Congress's action to take
precautionary steps when it passed the Veterans Benefits Continuity and
Accountability Supplemental Appropriations Act (P.L. 118-82) to avoid
any potential harm to veterans through VBA funding challenges. As a new
budget cycle begins, we appreciate congressional commitment to ensure
that VHA can meet its solemn obligation to deliver high-quality, timey
care to veterans throughout 2025 and beyond.
H.R. 217: CHIP IN for Veterans Act
In 2016, the Communities Helping Invest through Property and
Improvements Needed (CHIP IN) for Veterans Act of 2016 (P.L. 114-294)
became law. It authorized VA to carry out a 5-year pilot program to
improve and expand its medical facilities by allowing private donors,
local governments, and other organizations to contribute funding or
property for VA construction projects. The bill was designed to address
VA's backlog of construction needs - without solely relying on Federal
funding - by leveraging community involvement to improve veterans'
healthcare facilities more efficiently.
The VA Omaha Ambulatory Care Center was the first project completed
under the CHIP IN Act for Veterans Act of 2016. The facility, which
opened in 2020, was successfully built using $56 million in Federal
funding and $30 million in private donations.\5\ In 2021, the CHIP IN
pilot program was extended for an additional 5 years through the
Department of Veterans Affairs Expiring Authorities Act of 2021 (P.L.
117-42). As of today, many VA construction projects continue to face
delays and budget challenges. VA's Fiscal Year 2024 Budget in Brief
estimates that between $106 billion and $129 billion will be needed
over the next 10 years to maintain and enhance VA infrastructure.
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\5\ Marc Thomas, U.S. Dep't of Vet. Aff., Redefining Healthcare
Spaces: The ACC Wins the AIA National Design Award (Nov. 29, 2023),
https://www.va.gov/nebraska-western-iowa-health-care/stories/
redefining-healthcare-spaces-the-acc-wins-the-aia-national-design-
award/.
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The CHIP IN for Veterans Act would permanently authorize the
program, allowing VA to accept private donations to help fund new
construction and facility improvements. It would also remove the limit
on the number of donations that VA may accept under the program. The
CHIP IN for Veterans Act would expand the ability of local communities
and organizations to invest in and directly support VA medical center
projects to accelerate the development of VA infrastructure, make these
projects more affordable, and increase transparency.
Wounded Warrior Project supports the CHIP IN for Veterans Act.
H.R. 1107: Protecting Veteran Access to Telemedicine Services Act of
2025
In 2008, the Ryan Haight Online Pharmacy Consumer Protection Act
(P.L. 110-425) became law and required patients to complete at least
one in-person visit with a health care provider before that provider
could prescribe them a controlled substance. In consideration of the
COVID-19 public health emergency, this requirement was temporarily
suspended in March 2020. In November 2024, both the Drug Enforcement
Agency (DEA) as well as the Department of Health and Human Services
(HHS) agreed to continue this temporary suspension until December 31,
2025.\6\ The Protecting Veteran Access to Telemedicine Services Act of
2025 would make this exemption permanent for veterans and VA providers
by authorizing the delivery, distribution, and dispensing of controlled
substances to veterans from VA providers without requiring an in-person
appointment.
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\6\ Third Temporary Extension of COVID-19 Telemedicine
Flexibilities for Prescription of Controlled Medications, 89 Fed. Reg.
91,253 (Nov. 19, 2024) (codified at 21 C.F.R. pt. 1307).
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If the current COVID-era extension expires, rural veterans who do
not live near VA or community health care facilities - and who rely
primarily on telehealth services - would likely be negatively impacted.
Appointment coordination challenges and travel logistics may lead to
interruptions in their care or lapses in prescriptions. The list of
controlled substances contains not only pain medications, but also
multiple mental health drugs that are important parts of treatment
plans for many veterans dealing with mental health issues and for whom
an in-person appointment may present additional challenges.
Many veterans who began treatment plans that included controlled
substance prescriptions during the period of this exemption may not be
aware of, or prepared for, the potential interruptions of their care
plan. For instance, the PACT Act (P.L. 117-168), the most comprehensive
authorization of VA benefits in recent history, became law in August
2022 while this exemption was in place. More than 1.5 million PACT Act-
related claims have since been granted by VA,\7\ meaning that none of
those veterans have been subject to pre-exemption requirements. This
dramatically increases the number of veterans who could have their
current treatment plan impacted by the expiration of this exemption.
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\7\ U.S. DEP'T OF VET. AFF., PACT ACT PERFORMANCE DASHBOARD (Feb.
21, 2025), https://department.va.gov/pactdata/interactive-dashboard/.
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Wounded Warrior Project supports this bill in its current form;
however, we recognize that laws surrounding in-person visits may be
brought back to scale as we move further away from the COVID-19 public
health emergency. In such a case, we would also support a modified
version of this legislation that would authorize the renewal of
controlled substance prescriptions written for veterans when the
exemption was in place - and who are still seeing the same provider who
issued the prescription - to help prevent unexpected disruptions of
veteran treatment plans.
H.R. 1336: Veterans National Traumatic Brain Injury Treatment Act
The prevalence of PTSD and TBI among post-9/11 veterans remains
alarmingly high. WWP's 2025 Warrior Survey \8\ revealed that more than
3 in 4 responding warriors (76.5 percent) self-reported having PTSD and
approximately half (52.3 percent) of those respondents screened
positive for PTSD symptoms using the PCL-5 test.\9\ Another 35.2
percent self-reported a TBI incurred during military service. As we
continue to learn more about these invisible wounds and their
prognosis, investments in research and treatment now and into the
future must embrace innovation - and VA has an important role in
leading those efforts.
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\8\ To review WWP's Warrior Survey in more detail, please visit
https://www.woundedwarriorproject.org/mission/warrior-survey.
\9\ The PCL-5 is a validated tool used by VA that assesses symptoms
over the past month.
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Hyperbaric oxygen therapy treatments involve a patient entering a
special chamber where they breathe pure oxygen in air pressure levels
1.5 to 3 times higher than average. This helps fill the blood with
enough oxygen to repair brain tissue and restore normal body function.
Currently this treatment is approved by the Food and Drug
Administration (FDA) for treatment of inflammation in the body, and
some doctors believe that both TBI and PTSD are the result of brain
inflammation due to trauma. While some research recommends caution when
administering HBOT treatment to individuals with PTSD, results are
generally encouraging. \10\
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\10\ Keren Doenyas-Barak et al., The Use of Hyperbaric Oxygen for
Veterans with PTSD: Basic Physiology and Current Available Clinical
Data, FRONT NEUROSCI.(Oct. 2023), available at https://
www.frontiersin.org/journals/neuroscience/articles/10.3389/
fnins.2023.1259473/full.
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The Veterans National Traumatic Brain Injury Treatment Act would
establish a 5-year pilot program at VA to supply hyperbaric oxygen
therapy (HBOT) to veterans with traumatic brain injuries (TBI) or post-
traumatic stress disorder (PTSD). The pilot program would be funded
through a general fund of the Treasury, known as the ``VA HBOT Fund''
that is supplied solely by donations received for express purposes of
the Fund. The effort would be implemented in three Veteran Integrated
Service Networks (VISNs).
Given these early signs of promise and frequent requests heard from
warriors for access to HBOT, WWP supports the Veterans National
Traumatic Brain Injury Treatment Act. If expanded to include reporting
requirements on clinical outcomes and impact on health care access, we
believe that this pilot has potential to contribute to the growing body
of research and longitudinal studies on innovative treatments for TBI
and PTSD.
Draft legislation: Saving Our Veterans Lives Act
Gun lockers, also known as firearm storage safes or cabinets, can
play a significant role in reducing the risk of suicide by limiting
access to firearms, particularly in moments of crisis. Increasing space
and time between an individual and lethal means can create
opportunities for interventions by another or through personally driven
changes in thought. Many empirical studies have demonstrated that
creating time and space between an individual and lethal means is
effective in preventing suicide, and although some individuals might
seek other methods, many do not.\11\ In such cases, the means chosen
are often less lethal and are associated with fewer deaths than when
more dangerous ones are available. In a veterans context, research like
this helped drive the PREVENTS Task Force to recommend ``increase[d]
implementation of programs focused on lethal means safety (e.g.,
voluntary reduction of access to lethal means by individuals in crisis,
free/inexpensive and easy/safe storage options).'' \12\
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\11\ See, e.g., Paul Yip et al., Means Restriction for Suicide
Prevention, 379(9834) THE LANCET 2,393-99 (June 2012), available at
https://www.thelancet.com/journals/lancet/article/PIIS0140-
6736(12)60521-2/abstract.
\12\ PREVENTS TASK FORCE, PREVENTS: THE PRESIDENT'S ROADMAP TO
EMPOWER VETERANS AND END A NATIONAL TRAGEDY OF VETERAN SUICIDE (June
2020), available at https://www.va.gov/PREVENTS/docs/PRE-007-The-
PREVENTS-Roadmap-1-2_508.pdf.
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The Saving Our Veterans Lives Act would create a new program to
provide veterans with lock boxes intended for the secure storage of a
firearm. It would authorize $5 million per year over a 10-year period
for VA to carry out this program while also requiring an annual report
that addresses topics including compliance with the new statute,
outreach to veterans, obstacles with implementation, and how many lock
boxes were distributed. The bill makes clear that VA would not be
permitted to collect personally identifiable information on veterans
who request a lockbox under the program, require mandatory storage,
require firearm registration, or prohibit participating veterans from
purchasing, owning, or possessing a firearm.
This effort would build upon existing efforts at VA to distribute
free firearm cable locks to any veteran who requests one, as well as
more limited availability of gun lockers. As our Nation continues to
explore new investments and opportunities to end veteran suicide, WWP
supports the Saving Our Veterans Lives Act.
Draft legislation: Women Veterans Cancer Care Coordination Act
Breast cancer ranks as the second most common cancer among women in
the U.S., and within VA, it is the most diagnosed cancer for women.\13\
The trend may continue as the recently passed Dr. Kate Hendricks Thomas
SERVICE Act (P.L. 117-133) allows veterans who served in certain combat
locations and periods to receive services to check their risk of breast
cancer and get a screening mammogram if needed. And as the number of
women veterans continues to increase \14\, VA will likely see a rise in
the number of female veterans needing cancer care in the coming years.
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\13\ How Common is Breast Cancer?, AM. CANCER SOC'Y, https://
www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-
cancer.html (last visited Mar. 7, 2025).
\14\ Katherine Schaeffer, The Changing Face of America's Veteran
Population, PEW RESEARCH CTR. (Nov. 8, 2023), https://
www.pewresearch.org/short-reads/2023/11/08/the-changing-face-of-
americas-veteran-population/.
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In its most recent annual budget submission to Congress \15\, VA
stated that its ``policy requires that facilities have personnel
assigned to breast and cervical cancer care coordination. To ensure
accuracy, timeliness and reliability, VA tracks the provision of breast
and cervical cancer screening and the availability of breast and
cervical cancer care coordinators across the system.'' The submission
further elaborated that ``[t]he Breast and Gynecologic Cancer System of
Excellence is providing state-of-the-art breast and gynecologic cancer
care and care coordination across the system through VA's tele-oncology
program.''
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\15\ U.S. DEP'T OF VET. AFF., Fiscal Year 2025 BUDGET SUBMISSION -
MEDICAL PROGRAMS, VOL. 2 OF 5 at VHA-23.
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The Women Veterans Cancer Care Coordination Act would build upon
this foundation by requiring VA to appoint a Regional Breast Cancer and
Gynecologic Cancer Care Coordinator in each Veterans Integrated
Services Network (VISN). These coordinators will report directly to the
Director of the Breast and Gynecologic Oncology System of Excellence.
The bill sets eligibility standards for patients to receive care
coordination through a Regional Coordinator and sets several
responsibilities for those coordinators including ensuring seamless
care coordination between VA clinicians and community care providers
specializing in breast and gynecologic cancers and maintaining regular
contact with veterans based on individual medical needs during
community care treatments. Notably, the bill would also require VA to
submit a report to Congress comparing health outcomes between veterans
receiving cancer care at VA facilities and those treated by non-VA
providers, evaluating necessary changes or resources to improve cancer
care coordination, and addressing any other relevant matters.
Wounded Warrior Project is pleased to support the Women Veterans
Cancer Care Coordination Act; however, we look forward to increased
dialog among stakeholders to ensure that existing efforts at VA are
enhanced and not duplicated.
Agenda items not addressed in this Statement for the Record
Draft legislation: Standardizing Treatment and Referral
Times Act
Draft legislation: Copay Fairness for Veterans Act
H.R. 658: To amend title 38, United States Code, to
establish qualifications for the appointment of a person as a marriage
and family therapist, qualified to provide clinical supervision, in the
Veterans Health Administration
Concluding Remarks
Wounded Warrior Project once again extends our thanks to the
Subcommittee on Health for its continued dedication to our Nation's
veterans. Our commitment to keeping the promise by rebuilding the lives
of warriors impacted by war and military service remains as strong as
ever, and we are honored to contribute our voice to your discussion
about pending legislation. As your partner in advocating for these and
other critical issues, we stand ready to assist and look forward to our
continued collaboration.
Prepared Statement of Andrew Kozminski
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Ed Harries
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Jon Retzer
Chairwoman Miller-Meeks, Ranking Member Brownley and Members of the
Subcommittee:
Thank you for inviting DAV (Disabled American Veterans) to testify
at today's legislative hearing of the Subcommittee on Health. DAV is a
congressionally chartered non-profit veterans service organization
composed of nearly one million wartime service-disabled veterans. Our
single purpose is to empower veterans to lead high-quality lives with
respect and dignity.
It is crucial to provide timely, coordinated, and comprehensive
health care tailored to meet the diverse needs of veterans. DAV is
pleased to offer our views on the bills under consideration today by
the Subcommittee. These bills address the necessity for timely access
to medical services, infrastructure improvements, the removal of
financial barriers, better understanding of health outcomes, the
incorporation of adaptive sports prosthetics, hyperbaric oxygen
therapy, secure firearm storage programs and effective care
coordination.
H.R. 217, the Communities Helping Invest through Property and
Improvements Needed or CHIP IN for Veterans Act
The CHIP IN for Veterans Act includes provisions that would make
permanent a pilot program that authorized the Department of Veterans
Affairs (VA) to accept donated facilities or donations to make facility
infrastructure improvements. This legislation would eliminate the cap
on the number of projects allowed in the pilot program and enhance the
quality and availability of veteran services without additional Federal
costs. For example, in Omaha, Nebraska, there was a project/donation
for construction of an ambulatory care center and in Tulsa, Oklahoma a
project/donation to construct an inpatient facility and parking garage
to support the Muskogee Veterans Affairs Medical Center (VAMC). In
2021, VA received $120 million for a capital contribution to execute
the Muskogee plan. These collaborations lead to improved access to care
and services for veterans, while fostering community support and
involvement.
We support the CHIP IN for Veterans Act in accordance with DAV
Resolution No. 193, urging necessary infrastructure funding and
exploring new funding models.
H.R. 658, to establish qualifications for the appointment of a person
as a marriage and family therapist, qualified to provide clinical
supervision, in the Veterans Health Administration
H.R. 658 seeks to establish qualifications for marriage and family
therapists (MFTs) providing clinical supervision within the Veterans
Health Administration (VHA). The bill aims to enhance mental health
services for veterans and maintain consistent care across VHA
facilities by ensuring that MFTs are highly qualified and recognized by
reputable organizations like the American Association for Marriage and
Family Therapy.
Veterans face numerous mental health challenges, including post-
traumatic stress disorder (PTSD), depression, anxiety, substance use
disorders, and traumatic brain injuries (TBI). Qualified MFTs can
significantly improve mental health outcomes by providing effective
supervision and promoting better therapeutic practices, potentially
reducing the incidence of suicide among veterans. Including family and
relationships in mental health treatment is crucial for the holistic
well-being of veterans. Many veterans have found that involving their
loved ones in therapy sessions helps create a better support system,
and fosters improved understanding and communication. This approach can
lead to more effective treatment, as the support from family members
can reinforce coping strategies and provide a sense of belonging and
stability.
We support this bill in accordance with DAV Resolution No. 224,
which calls for program improvements, sufficient staffing, and enhanced
resources for VA mental health services.
H.R. 1107, the Protecting Veteran Access to Telemedicine Services Act
of 2025
The Protecting Veteran Access to Telemedicine Services Act is a
crucial step toward ensuring that veterans receive the high-quality,
accessible health care they earned. Many veterans face challenges in
accessing timely and consistent medical care, particularly in rural and
underserved areas. This legislation addresses these challenges by
leveraging the power of telemedicine to provide controlled medications
to veterans without the need for in-person medical visits.
Telemedicine bridges the gap for veterans living in remote
locations, allowing them to receive necessary medications and
consultations from home. This convenience is particularly beneficial
for those with mobility issues or limited transportation options.
Additionally, the flexibility of telemedicine allows veterans to
schedule appointments that fit their busy lives, leading to better
adherence to treatment plans and improved health outcomes. The bill
would ensure that health care providers can maintain regular contact
with patients, providing continuous care and preventing interruptions
in treatment, which is vital for managing chronic conditions.
Telemedicine is also a game-changer for mental health services, helping
to reduce the stigma and barriers often associated with seeking help by
providing therapy and support remotely. Finally, the bill includes
robust guidelines and processes to ensure that the delivery and
dispensing of controlled substances via telemedicine is safe and legal,
maintains integrity of the health care system and patient safety while
expanding access to care for veteran patients.
We support this bill in accordance with DAV Resolution No. 342,
which urges the VA to enhance its national pain management program
using patient-centered, interdisciplinary, and holistic approaches,
ensuring timely medication delivery and humane alternatives to
controlled substances. It also encourages the VA to regularly update
its clinical guidance and policies to comply with Federal law and best
practices for prescribing and dispensing controlled substances. By
harnessing the power of telemedicine, we can provide veterans with the
accessible, efficient, and high-quality care they deserve.
H.R. 1336, the Veterans National Traumatic Brain Injury Treatment Act
The Veterans National Traumatic Brain Injury Treatment Act would
require the VA to establish a pilot program to provide hyperbaric
oxygen therapy (HBOT) to veterans suffering from TBI or PTSD.
Veterans with TBI and PTSD face significant challenges, and
traditional treatments have proven ineffective for some. Studies have
shown that HBOT, which involves breathing pure oxygen in a pressurized
chamber, can enhance the body's natural healing processes. This
therapy, traditionally used for treating severe wounds that won't heal,
has been found to promote the growth of new blood vessels, reduce
inflammation, and improve oxygen delivery to injured tissues. One small
clinical trial, published in the Journal of Clinical Psychiatry (JCP)
in 2024, has also demonstrated improvements in PTSD symptoms and brain
function among veterans undergoing HBOT.
However, despite these promising findings, more comprehensive
research is necessary to fully understand the efficacy and safety of
HBOT for patients with TBI and PTSD. According to the VA, the
scientific evidence is currently mixed, and rigorous, larger-scale
studies are recommended to validate the initial positive outcomes noted
in the 2024 JCP study and to address any potential risks. A 2018 report
by the VA's Evidence Synthesis Program found that large treatment
benefits demonstrated in uncontrolled case series have not been easily
replicated in well-controlled randomized controlled trials (RCTs). The
report suggests that the potential benefits of HBOT may be subtle and
require larger RCTs to demonstrate significant effects.
Currently, the VA offers HBOT as a treatment option for a small
number of veterans with persistent PTSD symptoms that are resistant to
standard treatments. This treatment is provided through partnerships
with HBOT providers at select VA health care systems and medical
centers. The VA is also conducting a multisite research study to
examine the use of HBOT for patients diagnosed with PTSD.
While HBOT shows promise, we must remain committed to a
comprehensive and evidence-based approach. By supporting further
research and careful evaluation, we can better ensure that our veterans
receive the best possible and most effective care for TBI and PTSD. We
therefore recommend the Subcommittee include provisions in this bill to
prioritize rigorous research alongside providing veterans access to
HBOT. It is important to thoroughly validate and understand the
efficacy and risks of this therapy as an alternative treatment option
for PTSD and TBI before it is more broadly implemented.
H.R. 1644, the Copay Fairness for Veterans Act
The Copay Fairness for Veterans Act aims to eliminate copayments
for medications and preventive health services provided by the VA. It
would enhance access to these services by removing financial barriers
that can discourage veterans from seeking essential care. Preventive
services are critical for early detection and management of certain
health issues, leading to improved health outcomes. The bill also
includes provisions for women veterans to ensure they receive
preventative care services, screenings and contraceptives as outlined
in the Health Resources and Services Administration Preventative
Services Guidelines.
By removing financial barriers, the bill encourages routine check-
ups, vaccinations and critical screenings, leading to better overall
health management and fewer emergency medical situations. Many
veterans, especially those on fixed incomes, struggle with copayments
for health services and medication. By removing required copayments,
the bill provides much-needed financial relief, ensuring that veterans
can access the care they need without worrying about additional costs.
Moreover, promoting preventive care can lead to long-term cost savings
for both veterans and the health care system by reducing the need for
more expensive treatments and hospitalizations. Preventive services
with an ``A'' or ``B'' rating from the United States Preventive
Services Task Force and immunizations recommended by the Advisory
Committee on Immunization Practices are essential components of this
approach.
We support this bill in accordance with DAV Resolution No. 246,
which calls for legislation to eliminate or reduce VA and DOD health
care out-of-pocket costs for service-connected disabled veterans to
improve health care access, provide financial relief, enhance health
equity and encourage routine care. This bill reflects our Nation's
commitment to supporting our veterans and ensuring they receive the
care they earned.
H.R. 1823, to direct the VA Secretary and the Comptroller General of
the United States to report on certain funding shortfalls in the VA
This bill seeks to address funding shortfalls in the VA by
directing the VA Secretary and the Comptroller General of the United
States to conduct thorough reviews and report on funding shortfalls.
The bill specifically mandates a review by the Comptroller General
to investigate the circumstances and causes of funding shortfalls in
the Veterans Benefits Administration (VBA) for Fiscal Year 2024 and the
VHA for Fiscal Year 2025. The review must include a comparison of
monthly obligations and expenditures against the spending plan, an
analysis of any transfers between accounts, an evaluation of reasons
for significant diversions from the spending plan, an assessment of the
accuracy of projections and estimates, and recommendations for remedial
actions to improve accuracy and prevent future shortfalls. The
Comptroller General would be required to submit a report to the VA
Secretary, who will then submit the report to the specified
congressional committees.
By identifying and addressing funding shortfalls, the bill aims to
improve the financial management of the VBA and VHA and establish more
efficient use of resources and better allocation of funds to critical
services. The goal of the bill is to improve financial management,
enhance accountability, establish preventive measures, and ensure more
timely reporting of projected budget shortfalls. The bill also requires
thorough reviews and reports aimed at increasing accountability within
the VA and promoting more transparent and responsible budget management
practices. The identification of remedial actions may help prevent
future funding shortfalls, ensuring uninterrupted services for
veterans.
We support this bill in accordance with DAV Resolutions Nos. 23 and
403, advocating for consistent VA funding, full implementation of
existing laws, and protection of veterans' services and health care
from budget caps.
H.R. 1860, the Women Veterans Cancer Care Coordination Act
The Women Veterans Cancer Care Coordination Act seeks to
revolutionize cancer care for women veterans by establishing a
comprehensive support system. The bill mandates the designation of
Regional Breast and Gynecologic Cancer Care Coordinators within each
Veteran Integrated Services Network (VISN). These coordinators would be
tasked with ensuring seamless communication and coordination between VA
clinicians and community cancer care providers.
Eligibility for care coordination would be extended to veterans
diagnosed with breast or gynecologic cancer or those identified with
precancerous conditions, provided they qualify for health care through
the Veterans Community Care Program (VCCP). Additionally, the bill
would require the establishment of regions for care coordination, to
determine the specific needs of veterans in different areas, including
rural communities. This regional approach aims to provide tailored
support, ensuring that veterans receive timely and appropriate care
regardless of their location.
The prescribed duties of the Regional Breast and Gynecologic Cancer
Care Coordinators are multifaceted. They would facilitate the
coordination of care between VA clinicians and community care
providers, ensuring that veterans receive consistent and comprehensive
treatment. They would be responsible for monitoring the services
provided, tracking health outcomes, and maintaining data on cancer
care. This data--driven approach will help identify trends, measure
effectiveness, and guide future improvements in care delivery.
A significant component of the bill is the requirement for the VA
Secretary to submit a detailed report to Congress within 3 years of
enactment. This report would compare health outcomes between veterans
treated at VA facilities and those treated by community providers. It
would assess the timeliness, safety, and quality of care, and identify
any necessary changes or additional resources needed to enhance cancer
care for women veterans. By establishing dedicated coordinators,
focusing on data-driven care, and providing essential information and
support, the bill strives to improve health outcomes and quality of
life for these veterans and to ensure they receive coordinated,
comprehensive, and compassionate care.
The bill would also help to ensure that male veterans who suffer
from breast cancer due to toxic exposures receive the same specialized
care as their female counterparts. The Honoring our PACT Act, signed
into law in August 2022 (P.L. 117-168), expands and extends eligibility
for VA health care for veterans with toxic exposures. This includes
male veterans who have been diagnosed with breast cancer.
The VA has recognized the need to address the health effects of
toxic exposures and has included male breast cancer in the list of
conditions presumed to be caused by military service. Male veterans who
have been exposed to toxic substances during their service and have
developed breast cancer are eligible for the same benefits and
specialized care as female veterans.
We support this bill in accordance with DAV Resolution 39, which
calls for ensuring that the VA provides health care services and
specialized programs, including gender-specific services, to eligible
women veterans at the same degree and extent as services provided to
male veterans. It also emphasizes improving women's health programs and
finding innovative methods to address care barriers, ensuring women
veterans receive quality treatment and specialized services.
Draft Bill, the Saving Our Veterans Lives Act of 2025
The Saving Our Veterans Lives Act of 2025 aims to prevent veteran
suicide by providing eligible veterans with secure firearm storage
items upon request. The alarming rate of veteran suicide is a stark
reminder of the urgent need for comprehensive measures to protect those
who have sacrificed so much for our country. According to the VA 2024
National Veteran Suicide Prevention Annual Report, there were 6,407
suicides among veterans in 2022, with firearms being involved in 72
percent of these cases. Firearms are the primary method of suicide
among veterans, and by providing secure storage options for firearms--
such as a lockbox or safe, this Act aims to reduce access to lethal
means during moments of crisis, potentially saving countless lives.
Creating time and space is a critical component of this Act's
strategy to reduce veteran suicides. Providing veterans with secure
firearm storage can create a critical time delay, allowing them to
reconsider their actions and seek help during moments of crisis. This
additional time can be a lifesaving interval, as it provides a window
of opportunity for the veteran to reach out for support, contact the
crisis hotline, or have a moment of reflection. The VA's 2024 suicide
prevention report highlighted a reduction in suicide rates among
veterans with VHA mental health diagnoses, underscoring the
effectiveness of targeted suicide prevention efforts. By delaying
access to firearms during a crisis period, the Act empowers veterans to
make safer choices and access the help they need.
The Act includes an educational component that would help inform
veterans about the benefits of secure firearm lock box storage with a
goal of more responsible firearm handling and storage practices. The
development of informational videos would help ensure that veterans
receive the necessary guidance on secure storage as a suicide
prevention strategy. Proper firearm storage not only protects veterans
but also their families, reducing the risk of accidental discharges and
unauthorized access by children or other household members. This
program aims to promote a culture of safety within the veteran's
community, fostering a secure environment for all.
We support this bill in accordance with DAV Resolution No. 224,
which calls for mental health and suicide prevention program
improvements to include suicide rate data collection and reporting,
improved outreach for stigma reduction, sufficient mental health
staffing, and enhanced resources for VA mental health programs.
Draft Bill, the No Wrong Door for Veterans Act
The No Wrong Door for Veterans Act would reauthorize and extend the
Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program
through September 30, 2028, ensuring that community-based suicide
prevention initiatives and mental health services will continue to be
available to veterans.
By adjusting the grant amount and clarifying the criteria for
eligible entities, the bill promotes equitable distribution of funds
and aims to ensure that qualified organizations can provide high-
quality mental health services to veterans. Moreover, the bill's
emphasis on improved coordination and communication between grantees
and VA medical centers is a significant enhancement. Quarterly
briefings for local VA medical center personnel will help facilitate
better collaboration and information sharing, hopefully leading to more
efficient and effective delivery of mental health services. This
improved coordination is crucial for creating a seamless support
network for veterans in crisis.
Another critical provision in the legislation is the bill's
requirement that grantees notify eligible individuals about emergent
suicide care options and report requests for such care to the VA.
Increased awareness and utilization of suicide prevention resources can
lead to more timely intervention and potentially save lives. By
requiring the use of screening protocols selected by the Secretary, the
bill also ensures that veterans receive consistent and standardized
care, further enhancing the quality of mental health services.
While the intent of extending the Fox Suicide Prevention Grant
Program is commendable, DAV recommends strengthening the proposed
legislation to ensure it meets its primary objective--reducing risk of
suicide in this population. We recommend the bill reiterate the
standard of baseline mental health screening that all grantees must
provide or coordinate the provision of a baseline mental health
screening to all eligible individuals they serve at the time those
services begin. This mental health screening must be provided using a
validated screening tool that assesses suicide risk and mental and
behavioral health conditions. Applicants or partner organizations must
measure the effectiveness of suicide prevention services provided to
eligible individuals and their families using pre-and post-evaluations
that employ validated measures of suicide risk and mood-related
symptoms.
Additionally, funding criteria in the bill is associated with the
number of participants served rather than prioritizing demonstrated
improvements in veterans' well-being (i.e., reduction in suicide risk
factors). We want to ensure that resources are directed to programs
that achieve measurable outcomes. Finally, we suggest the payment
structure be more clearly defined to prevent overcompensation for
minimal services.
Given that the funding renewal for this initiative was supposed to
be based on demonstrated improvements in veterans evaluation measures,
we recommend a cautious, annual renewal process until comprehensive
data confirms the program's overall efficacy and specifically, which
services are most effective in reducing suicide risk in the veteran
population. These changes are essential to maximize the program's
potential and truly support at-risk veterans.
Draft Bill, the Providing Veterans Essential Medications Act
The Providing Veterans Essential Medications Act would amend title
38, United States Code, to ensure that veterans receiving nursing home
care in State homes have access to necessary, yet costly, medications.
Under this bill, the VA Secretary is directed to either reimburse
State homes for these high-cost medications or furnish them directly,
at the election of the State home. The bill defines ``costly
medication'' as any drug or medicine whose average wholesale price for
a 1-month supply, plus a transaction fee, exceeds 8.5 percent of the
payment made by the Secretary for the veteran's care. This amendment
seeks to alleviate the financial burden on State homes and ensure that
veterans continue to receive appropriate and comprehensive care without
the added stress of high medication costs.
The cost of high-cost medications, such as revolutionary cancer
drugs, can often exceed $1,000 a day. This bill will ensure that State
homes are not financially strained by these costs. VA providing these
types of medications also incentivizes more State homes to provide care
for severely disabled veterans and increases the availability of high-
quality long-term care services across the country. The PACT Act has
led to an increase in veterans adjudicated as severely disabled due to
toxic exposure. This rise will more likely than not necessitate State
Veterans Homes to provide high-cost medications to more veterans. As
the number of veterans requiring specialized and expensive medications
grows, State Veterans Homes will face increased financial strain. It is
essential to ensure that these homes receive adequate funding and
support to meet the rising demand for care. This bill will help address
the growing demand for high-cost medications in State homes and ensure
that all veterans receive the health care they earned.
We support this bill in accordance with DAV Resolution No. 227,
which calls on Congress and the VA to provide sufficient funding to
support State Veterans Homes, including adequate per diem payments for
skilled nursing care, domiciliary care and adult day health care, which
properly support different levels of care within each program.
Draft Bill, to establish the period during which the referral of a
veteran, made by a health care provider of the Department of Veterans
Affairs, to a non-Department provider, for care under the VA Community
Care Program, remains valid.
This bill seeks to streamline the referral process for community
services, reduce administrative barriers, and improve access to care.
The bill's primary objective is to establish the period during which a
referral of a veteran, made by a health care provider of the VA, to a
non-Department provider remains valid under the VCCP. The bill
specifies that this period begins on the day the covered veteran has
their first appointment with the non-Department provider. This
provision would ensure veterans referred to non-Department providers
have a clear referral validity period, facilitating smoother
transitions.
We support this bill in accordance to DAV Resolution No. 18, which
supports legislation that establishes clearly defined VA health care
services for enrolled veterans.
Draft Bill, the Veterans Supporting Prosthetics Opportunities and
Recreational Therapy or SPORT Act
The DAV has long recognized the importance of adaptive sports in
the rehabilitation and well-being of veterans through our involvement
with events like the National Disabled Veterans Winter Sports Clinic,
and the National Disabled Veterans Golf Clinic. These recreational
therapy programs help veterans improve their physical and mental health
through sports and activities tailored to their abilities, while
connecting them with other veterans and a community to help overcome
limitations and challenge their perceived disabilities.
The Veterans SPORT Act seeks to include adaptive prostheses and
terminal devices, for participation in sports and other recreational
activities, in the medical services provided by VA to eligible
veterans. Including adaptive sports devices is congruent with VA's
holistic approach to veteran care, which includes the physical,
psychological and social aspects of rehabilitation. This legislation
aims to enhance the quality of life for our Nation's ill and injured
veterans by providing them with the necessary adaptive devices to
participate in various sports and recreational activities, which plays
a vital role in their overall physical and mental well-being. These
devices enable service-disabled veterans to engage in a wide range of
activities, including Paralympic sports like track and field, swimming,
and wheelchair basketball; archery with adaptive equipment; cycling
with hand cycles and adaptive bicycles; skiing with adaptive equipment;
hunting with specialized devices; rock climbing with modified safety
equipment; skydiving with adaptive gear; golf with adaptive golf
equipment; and various water sports like paddle boarding, kayaking,
pedal boating, and canoeing.
We support this bill in accordance with DAV Resolution No. 429,
which urges the VA to keep centralized funding for Prosthetics and
Sensory Aids Service to provide high-quality prosthetic items and train
veterans on their use and care. By supporting this bill, we honor the
sacrifices of our most severely disabled veterans and promote their
overall well-being by providing them with the necessary adaptive
devices to once again engage in sports and recreational activities.
In closing, the proposed bills under consideration by the
Subcommittee today represent a comprehensive and multifaceted approach
to addressing the urgent needs of our veterans. By prioritizing timely
access to care, effective care coordination, and comprehensive,
individualized health care options, these bills aim to enhance the
quality of life for our veterans, who have bravely served our Nation.
This concludes my testimony on behalf of DAV. I am pleased to
answer questions you or members of the Subcommittee may have.
Statements for the Record
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Veterans Healthcare Policy Institute
Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished
members of the subcommittee:
On behalf of the Veterans Healthcare Policy Institute, we thank you
for inviting us to submit a statement for the record for today's
hearing on improving the health care and services for veterans. Many
members of our organization are veterans or have family members who are
veterans. Many of us have had long careers serving veterans, published
papers on veterans' healthcare in peer-reviewed journals, or presented
congressional testimony. In today's statement, we wish to convey our
appreciation for your leadership and 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.
While today's hearing considers 12 bills, we limit our comments to
only one of them--The No Wrong Door for Veterans Act.
Background
The No Wrong Door for Veterans Act proposes to renew and modify the
Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program. This
pilot initiative allocated $174 million over 3 years to a diverse array
of private and government community entities to supplement VA efforts,
including veterans' associations, social service agencies, and tribal
nations that partnered with the VHA at the local level.
Under the Fox Grant Program, 80 grantees receive up to $750,000
annually. Their primary role is to identify and engage veterans
exhibiting one or more of 14 defined suicide risk factors. Once
identified, these at-risk veterans and their families are provided with
peer support, case management, benefits navigation assistance and/or
other targeted services aimed at reducing suicide risk factors before
they escalate into crises.
The Importance of the Fox Grant Program's Use of Outcome Measurement
The original Fox Grant law vastly improved the use of comprehensive
outcome data to be able to discern which community programs effectively
enhanced veterans' lives and reduced long-term suicide risk. As
Congressman Jack Bergman, the bill's co-author, emphasized: ``This bill
would develop measurement tools to track the effectiveness of these
community-level programs in order to address the suicide crisis and its
impact on Veterans.''
The law authorized the VA to establish and apply a comprehensive
baseline mental health screening for outcome metrics. Five well-
validated measures were identified for grantees to administer at the
beginning and end of participants' involvement. These additional
measures are crucial, given that the programs are not clinical and are
expected to impact suicidality downstream. The VA was expected to
analyze changes in these scores to direct renewal funding to the
interventions that demonstrated improvement in these instrument scores.
Senator John Boozman (R-AR) hailed the Fox Grant Program for
establishing ``a common tool to measure the effectiveness of our
programs and promote better information sharing, data collection, and
continual feedback in order to identify what services are having the
most impact.''
Concerns with the No Wrong Door for Veterans Act
As the 3-year pilot comes up for reauthorization, the proposed ``No
Wrong Door for Veterans Act'' contains several concerning elements that
significantly undermine the Fox Grant program. Amendments are needed to
remedy these shortcomings.
1. Eliminating Demonstrated Effectiveness as a Criterion for Continued
Funding
The bill explicitly states that previously funded entities need
only demonstrate ``serving a significant number of veterans'' to
qualify for continued funding. That eliminates the core feature of the
Fox Grant program to utilize participants' pre-post changes for
decisions about continued funding. Grant recipients would only need to
demonstrate throughput, not a track record of any successful
improvements, leaving open the strong possibility that taxpayer funds
would be misdirected into programs without proven effectiveness.
2. Ambiguous Language About Screening Requirements
As noted above, the original Fox program required grantees to
screen for acute suicide risk and collect pre/post measurements of five
psychosocial suicide risk factors.
The language in the No Wrong Door legislation is unclear whether
both types of screening remain mandatory. At a HVAC hearing last
December, testimony suggested the new bill might eliminate pre/post
screening requirements. Without these crucial evaluation metrics, it
will be challenging to accurately assess any program's success in
addressing the issues surrounding veteran suicide prevention.
The bill also explicitly permits grantees to use their own
protocols to screen for risk, undermining the ability to make apples-
to-apples comparisons or aggregate data reporting, which require
uniform protocols.
3. Insufficient Safeguards on Overpayment to Grantees
The bill provides $500,000 per grantee ``plus $10,000 per eligible
individual who receives suicide prevention services provided or
coordinated by such grantee.'' This ambiguous wording could allow a
grantee to be reimbursed $10,000 for nominal activities. For example, a
grantee could be reimbursed for:
Providing services to an individual that another funder
is already fully covering
Conducting a screening with no follow-up services
Giving a pamphlet to an individual at an outreach event
There needs to be far more explicit definitions for what
constitutes reimbursable ``suicide prevention services provided or
coordinated by such grantee.''
4. Premature Extension of an Unproven Program
The bill calls for a 3-year extension through 2028 despite the lack
of a proven track record. Yet, the Interim Report on the Fox Suicide
Prevention Grant Program revealed extremely significant gaps:
Of the 80 grantees, 55 failed to report any post-service
outcome measurements
The remaining 25 grantees had only 196 participants total
who completed services and underwent some degree of pre/post
measurement
27 percent of eligible participants did not complete even
one instrument upon entering their program
23 percent of grantees served fewer than ten veterans/
family members in their first year
80 percent of grantees had less than fifty participants
Thus, as of today, grantee effectiveness has been impossible to
ascertain--either at the disaggregated grantee level or even at the Fox
Grant program level--as required by law. The purpose of requiring both
internal VA and external MITRE program evaluations of the pilot is to
determine whether the Fox Grant program is effective for its intended
purpose of reducing suicide risk factors. The program should not be
extended carte blanche for three more years until its effectiveness is,
as Bergman and Boozman intended, identified by data.
Recommendations:
1. Tie funding to demonstrated effectiveness: Add language
specifying that reauthorizing an entity's funds is based on it
serving a significant number of veterans and demonstrated
improvements in participant outcomes on the mandated well-being
measures.
2. Strengthen outcome measurement requirements: The Act must
explicitly reinforce the requirement that Fox Grant recipients
conduct pre-and post-intervention assessments across all
relevant metrics. This ensures robust data collection that
shows how veterans' scores on the five key measures improve
after participating in each grantee's services. All grantees
should use the identical measures.
3. Clarify payment structure: Tighten language to ensure that
entities are paid $10,000 per enrollee only for a defined and
substantial amount of provided services, not nominal
interventions.
4. Implement a 1-year renewal before blindly funding a long-
term commitment: Until there is concrete proof of the Fox Grant
program's effectiveness, and until the congressionally mandated
MITRE Corporation 18-month and 3-year evaluations show
systematic success, renewal should proceed on a year-to-year
basis rather than a multi-year extension.
While leveraging non-clinical community organizations is a crucial
component of an effective upstream public health approach to suicide
prevention, rigorous evaluation must be maintained to ensure these
programs truly benefit veterans and represent good stewardship of
taxpayer dollars.
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 American Association for Marriage and Family
Therapy and California Association of Marriage and Family Therapists
Dear Chairwoman Miller-Meeks and Ranking Member Brownley:
We are writing on behalf of the American Association for Marriage
and Family Therapy (``AAMFT'') and the California Association of
Marriage and Family Therapists (``CAMFT''), organizations that
represent the professional interests of more than 81,000 licensed
marriage and family therapists (``MFTs'') who provide individual,
family, and group psychotherapy services throughout the United States.
Thank you for providing AAMFT and CAMFT with an opportunity to comment
in response to legislation considered on March 11, 2025 by the
Committee on Veterans' Affairs Subcommittee on Health.
We are commenting in support of H.R. 658, legislation introduced by
Ranking Member Julia Brownley to correct a problem that impacts care
and treatment for Veterans. AAMFT and CAMFT would like to thank Ranking
Member Brownley for sponsoring this legislation. H.R. 658 seeks to
expand access to licensed MFTs for Veterans and their families by
removing unnecessary guidelines and policies that currently restrict
the promotion of many VA MFT employees to supervisory positions,
resulting in barriers to a qualified mental health workforce and
barriers to timely access to care. H.R 658 would allow MFTs in the VA
who are authorized to provide clinical supervision under State law to
be eligible to provide clinical supervision in the VA.
Background
In 2006, the Veterans Benefits, Health Care, and Information
Technology Act of 2006 (P.L. 109-461) was signed into law. This
legislation established MFTs as recognized professionals within the VA.
The VA started hiring MFTs in 2010 after the adoption of the first
qualification standard for MFTs.\1\ In 2018, the VA issued its second
and current qualification standard for MFTs.\2\ This 2018 standard
added a new requirement that all MFTs in the VA who are supervising or
who want to serve at a supervisory or managerial level and above
designation must first have obtained the AAMFT Approved Supervisor
designation in order to supervise.\3\ This requirement prevents well-
trained and highly qualified MFTs who are serving in the VA at the GS-
11 full performance level from advancing within the VA into a
supervisory role. In addition, no such requirement exists in almost all
other employment settings, and a similar requirement in the VA does not
exist for psychologists, clinical social workers, or professional
mental health counselors.
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\1\ VA Handbook 5005/41, Part II, Appendix G42
\2\ VA Handbook 5005/101, Part II, Appendix G44
\3\ The VA does allow MFTs to are working to obtain the AAMFT
Approved Supervisor designation to serve as supervisors in the VA.
These providers have 2 years from the date of placement to obtain the
AAMFT Approved Supervisor designation.
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Currently, the VA requires that MFTs must hold the AAMFT Approved
Supervisor designation to be promoted to supervisory positions. While
AAMFT is proud of its high caliber supervisory designation, the AAMFT
Approved Supervisor designation is not intended to be the only pathway
for an MFT to become a clinical supervisor in the VA or in other
settings. The VA does not require that licensed professional mental
health counselors (``LPMHCs''), licensed clinical social workers
(``LCSWs'') or other clinicians obtain a designation from a private
organization in order to serve as a clinical supervisor in the VA.
The Current MFT Supervisor Requirement is an Unnecessary Barrier
The current MFT supervisor requirement is not necessary, and serves
as a barrier for providers and Veterans. This requirement places MFTs
at a disadvantage when it comes to the retention and promotion of MFTs
within the VA. There are thousands of MFTs who are recognized as state-
approved supervisors, yet they are not able to supervise within the VA
because they do not have the AAMFT Approved Supervisor designation. We
are aware of MFTs who have left VA employment because of this
restriction, including MFTs that are Veterans themselves. We have heard
that some hiring authorities within the VA are reluctant to hire MFTs
for entry level positions due to the shortage of MFTs eligible to
supervise in the VA, thus unnecessarily increasing workforce shortages
and hampering Veteran's timely access to care.
The Current MFT Supervisor Requirement Does Not Align with State
Requirements
The VA's current MFT supervisor requirement is not in alignment
with State law. All 50 states and the District of Columbia license
MFTs. States require that in order to become a licensed MFT, an
applicant must hold a master's degree or doctoral degree in marriage
and family therapy or a related field, have 2 years of clinical
supervised experience, and pass a clinical exam. All states have
requirements for MFTs who want to provide clinical supervision.
Based upon a review of the licensure laws governing MFTs in all 50
states and the District of Columbia, only two states--North Carolina
and Tennessee--require that clinical supervisors providing supervision
for MFT licensure must be AAMFT Approved Supervisors. In all 48 other
states, a clinical supervisor of a candidate for licensure as an MFT
does not need to be an AAMFT Approved Supervisor. Instead, these 48
states allow MFTs who have experience and/or training in supervision to
obtain a State MFT supervisor designation or otherwise legally provide
supervision to supervisees in those states. For example, under Texas
law, a person can become a Texas MFT supervisor if have either
successfully completed a 3-semester hour course in MFT supervision,
completed a 40-hour continuing education course in clinical
supervision, or completed a supervision course approved by AAMFT.\4\
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\4\ 22 TX Admin Code Sec. 801.143. In addition, all candidates for
the MFT supervisor status in Texas must document the completion of
3,000 hours of MFT practice over a minimum of 3 years.
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In many states, the supervisor requirements for MFTs are identical
to, or closely similar to, the State supervisor requirements for other
mental health professionals. For example, in Iowa, the requirements to
be an eligible supervisor for MFTs and LPMHCs are identical: hold an
active license, have a minimum of 3 years of independent practice
experience, complete at least a 6-hour continuing education course in
supervisor or one graduate-level course in supervision, and knowledge
of the law and ethics rules governing supervisees in Iowa.\5\
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\5\ Iowa Admin Code r. 481.891.7
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The VA's current additional MFT supervisor requirement does not
align with the VA's own clinical supervisor requirements for other
healthcare professionals. The VA generally recognizes clinical
providers in the VA as eligible to supervise if State law allows them
to supervise. For example, within the mental health professions, LPMHCs
and LCSWs can provide clinical supervision if they are licensed to
provide clinical supervision under State law or otherwise can legally
provide supervision for licensure under State law.\6\ Instead of
following clinical supervisor requirements under State law, the VA MFT
supervisor requirement is unique in requiring those applying for a
supervisory position or having the ability to supervise trainees to
obtain a supervision designation from a nongovernmental organization.
Since the VA generally defers to State law pertaining to the minimum
standards necessary to work in the VA, such as meeting a state's
requirements for licensure in a recognized healthcare profession, the
VA should allow MFTs who are authorized to provide clinical supervision
under State law to be eligible to provide clinical supervision in the
VA.
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\6\ VA Handbook 5005/106, Part II, Appendix G43 (LPMHCs) & VA
Handbook 5005/120, Part II, Appendix G39 (LCSWs)
HR 658 Would Increase the Number of MFT Supervisors While Providing the
---------------------------------------------------------------------------
Best Quality of Care to Veterans
HR 658 would expand access to licensed MFTs for Veterans and their
families by removing unnecessary regulations that currently prohibit
many MFTs employed by the VA from being promoted to supervisory
positions. This legislation would significantly increase the number of
current MFTs in the VA who would be eligible to provide clinical
supervision. By increasing the pool of MFTs eligible to become clinical
supervisors and be promoted within the VA, this bill would increase the
retention of MFTs within the VA. Increasing the number of supervisors
and improving retention of MFTs within the VA will also improve access
to care in a timely manner for Veterans. H.R 658 protects Veterans by
requiring that all MFT supervisors must be an AAMFT Approved Supervisor
or authorized by a State to provide clinical supervisor. As with all
clinical supervisors of any profession within the VA, under this bill,
the VA would still retain the ability to manage VA employees,
investigate supervisors, and take any action against employees who are
not providing the best care for Veterans.
We would like to thank the Committee for the opportunity to submit
comments in support of H.R. 658. AAMFT and CAMFT look forward to
working with the Committee on this legislation.
Prepared Statement of Paralyzed Veterans of America
Chairman Bost, Ranking Member Takano, and members of the committee,
Paralyzed Veterans of America (PVA) would like to thank you for the
opportunity to submit our views on some of the pending legislation
impacting the Department of Veterans Affairs (VA) that is before the
committee. No group of veterans understand the full scope of benefits
and care provided by the VA better than PVA members--veterans who have
incurred a spinal cord injury or disorder (SCI/D). We appreciate the
opportunity to offer our observations on some of the bills being
discussed during today's hearing.
H.R. 217, the Communities Helping Invest through Property and
Improvements Needed or CHIP IN for Veterans Act
The Communities Helping Invest through Property and Improvements
Needed for Veterans Act of 2016 (P.L. 114-294), often referred to as
the ``CHIP IN'' Act, authorized the VA to carry out a pilot program
under which it may accept up to five donations from nonfederal entities
of existing facilities, land, or a facility to be constructed by the
donor on real property of the VA. Increasing investment in VA's
infrastructure, particularly facilities that support specialized health
care services, is a crucial priority for veterans with SCI/D. PVA
supports this bill, which would make the CHIP IN pilot program
permanent, thus, increasing the availability of health care services to
veterans.
H.R. 658, to establish qualifications for the appointment of a person
as a marriage and family therapist, qualified to provide clinical
supervision, in the Veterans Health Administration
PVA supports this legislation, which would establish qualifications
for the appointment of a person as a marriage and family therapist,
qualified to provide clinical supervision in the Veterans Health
Administration (VHA). Veterans who have developed mental health issues
often find it difficult to resume daily activities, which creates
stress and anxiety. Well trained marriage and family therapists have
helped thousands of veterans become productive citizens and improve
their family relationships. Removing current restrictions that limit
the growth potential for marriage and family therapists within the VA
will increase retention of these professionals and improve access to
the care they provide.
H.R. 1107, the Protecting Veteran Access to Telemedicine Services Act
of 2025
PVA supports this legislation, which would permanently extend a
pandemic-related exemption that allows VA health care providers to
prescribe certain medications via telemedicine to their veteran
patients. Specifically, it would authorize a covered health care
professional to use telemedicine to deliver, distribute, or dispense to
veterans certain controlled medications via telemedicine under specific
conditions as determined under the Federal Food, Drug, and Cosmetic Act
(21 U.S.C. 301 et seq.). Veterans who live in rural communities often
do not have easy access to a VA health care facility, and telemedicine
is often the most convenient way to provide essential care. Using
technology to increase access to care within VA is an important way to
provide care to better meet veterans' needs, ensuring they receive
their medications without interruption.
H.R. 1336, the Veterans National Traumatic Brain Injury Treatment Act
Hyperbaric Oxygen Therapy (HBOT) is a well-established treatment
for a variety of conditions, including decompression illness, carbon
monoxide poisoning, or compromised skin grafts and flaps. However, its
safety and efficacy to treat Traumatic Brain Injury or Post Traumatic
Stress Disorder is unclear. PVA has no objections to this legislation,
which seeks to establish a pilot program at the VA to furnish HBOT to
veterans with these conditions.
H.R. 1644, the Copay Fairness for Veterans Act
PVA supports this legislation, which would eliminate copayments for
medications and preventive health services provided by the VA. While
the VA charges copays to certain veterans for hospital and medical
care, veterans should not be subject to copays for preventive services.
These services are essential for management and early detection of
health issues, that if left untreated, could lead to more serious
illnesses or conditions. Ending copays for preventative care will also
ensure parity for veterans with most other Americans who have no copays
when accessing this type of care.
H.R. 1823, to direct the VA Secretary and the Comptroller General of
the United States to report on certain funding shortfalls in the VA.
In July 2024, the Veterans Benefits Administration (VBA) projected
a $2.88 billion budget shortfall for the remainder of Fiscal Year (FY)
2024 and VHA projected a $12 billion shortfall for Fiscal Year 2025.
Toward the end of September 2024, Congress approved H.R. 9468, the
Veterans Benefits Continuity and Accountability Supplemental
Appropriations Act of 2024 (P.L. 118-82), which gave VBA an additional
$2.9 billion to pay veterans' pension and disability benefits for
Fiscal Year 2024.
On November 1, 2024, VBA revealed that it carried over
approximately $5.1 billion from Fiscal Year 2024 to Fiscal Year 2025,
meaning it did not need the additional funding approved by Congress.
Also, at the end of November, the VA announced that it only needed $6.6
billion, not $12 billion, to cover existing shortfalls in the VHA
budget for Fiscal Year 2025. The lack of clarity on what VA's true
financial needs are has been a concern for all interested parties, and
to date, sparse details have been provided about VA's inability to
track and project its funding. PVA strongly supports this legislation,
which requires the Comptroller General to investigate the circumstances
surrounding the reported funding shortfalls for the VHA and VBA in
Fiscal Year 2024 and Fiscal Year 2025.
Discussion Draft, to establish the period during which the referral of
a veteran, made by a health care provider of the Department of Veterans
Affairs, to a non-Department provider, for care or services under the
Community Care Program of such Department, remains valid.
PVA supports this draft legislation, which would establish the
valid time frame for a referral from a VA health care provider to a
non-VA Community provider under the Community Care Program. As written,
``valid time'' begins the day a covered veteran has their first
appointment with the community care provider. This would ensure
veterans referred to community care providers meet all of VA's
authorization requirements, allowing the provider to focus on
delivering appropriate care to a veteran without delay.
Discussion Draft, the Providing Veterans Essential Medications Act
PVA supports this draft bill, which would ensure that veterans
receiving nursing home care in State Veterans Homes have access to
high-cost medications, as needed. Currently, the VA does not pay State
homes for high-cost medications for veterans. This bill would require
the VA Secretary to either reimburse State homes for costly medications
or furnish them directly, which would eliminate financial burdens on
these long-term care facilities and increase veterans' access to care.
Discussion Draft, The Veterans Supporting Prosthetics Opportunities and
Recreational Therapy (``SPORT'') Act.
PVA strongly supports this draft bill, which would provide VA
coverage of prosthetic limbs that veterans with limb loss use to
participate in sports and other recreational activities. Specifically,
this bill would add ``adaptive prostheses and terminal devices for
sports and other recreational activities'' to the statute governing
which equipment and aids that the VA is allowed to grant veterans.
Adaptive equipment is intended to promote and support holistic healthy
lifestyles for amputees. But occasionally, VA's own internal policies
create unnecessary barriers for veterans with disabilities. For this
reason, we highly recommend that VA provide these kinds of adaptive
equipment for amputees without requiring that the veteran be enrolled
in a VA rehabilitative program.
Discussion Draft, the Saving Our Veterans Lives Act
Firearms are the most common method of suicide in the US, with
veterans representing slightly more than 69 percent of cases.\1\ More
than 70 percent of male veteran suicide deaths and 50 percent of female
veteran suicide deaths are the result of firearms, and these rates
greatly exceed those of non-veterans. Fifty-one percent of veterans
report owning one or more personal firearms, and of those, over half
report storing firearms that are loaded and/or unsecured. Many of the
veterans who store their firearms loaded and unlocked don't even own a
lockbox or safe. PVA supports this effort to make it easier for
veterans to access secure firearm storage devices and raise awareness
about the importance of lethal means safety to help prevent firearm
suicide among veterans and their families.
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\1\ Firearm suicide risk and prevention in service members--
ScienceDirect
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Discussion Draft, the Women Veterans Cancer Care Coordination Act
The Women Veterans Cancer Care Coordination Act would require the
VA to hire or designate a Regional Breast Cancer and Gynecologic Cancer
Care Coordinator at each Veterans Integrated Services Network (VISN).
While PVA supports the intent of this draft bill, some changes are
needed to make it stronger. The National Women Veterans Oncology System
of Excellence was established in 2020 to offer increased attention and
collaborative treatment plans for women experiencing breast or
gynecological cancers. Their work has led to improved early detection,
coordinated treatment of cancers, and provided increased trust in VA
among women veterans. However, the National Women Veterans Oncology
System of Excellence is not protected in statute. PVA recommends adding
a provision within the legislation that secures the National Women
Veterans Oncology System of Excellence to ensure the great work VA is
doing on behalf of women veterans living with cancer. Additionally,
cancer care coordination is disparate across the system, and while PVA
supports additional focus and attention on the needs of women veterans,
we believe having someone within each VISN to focus on all cancers,
regardless of gender, should be prioritized.
PVA would once again like to thank the committee for the
opportunity to submit our views on some of the bills being considered
today. We look forward to working with you on this legislation and
would be happy to take any questions for the record.
Information Required by Rule XI 2(g) of the House of Representatives
Pursuant to Rule XI 2(g) of the House of Representatives, the following
information is provided regarding Federal grants and contracts.
Fiscal Year 2025
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events----Grant to support rehabilitation sports
activities--$502,000.
Fiscal Year 2023
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events----Grant to support rehabilitation sports
activities--$479,000.
Fiscal Year 2022
Department of Veterans Affairs, Office of National Veterans Sports
Programs & Special Events----Grant to support rehabilitation sports
activities--$ 437,745.
Disclosure of Foreign Payments
Paralyzed Veterans of America is largely supported by donations from
the general public. However, in some very rare cases we receive direct
donations from foreign nationals. In addition, we receive funding from
corporations and foundations which in some cases are U.S. subsidiaries
of non-U.S. companies.
Prepared Statement of American Federation of Government Employees, AFL-
CIO
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Trajector Medical
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Document for the Record Submitted by Greg Murphy
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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