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

                              LEGISLATIVE HEARING
    =======================================================================

                                    HEARING

                                   BEFORE THE

                             SUBCOMMITTEE ON HEALTH

                                     OF THE

                         COMMITTEE ON VETERANS' AFFAIRS

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                            THURSDAY, JUNE 12, 2025

                                   __________

                               Serial No. 119-26

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                        Available via http://govinfo.gov

                                    __________

                       U.S. GOVERNMENT PUBLISHING OFFICE
    61-124                     WASHINGTON : 2025

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

                         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

                                  ----------

                            THURSDAY, JUNE 12, 2025

                                                                       Page

                               OPENING STATEMENTS

    The Honorable Mariannette Miller-Meeks, Chairwoman...............     1
    The Honorable Julia Brownley, Ranking Member.....................     3

                             SPEAKING FROM THE DAIS

    The Honorable Greg Murphy, U.S. House of Representatives, (NC-3).     4
    The Honorable Nikki Budzinski, U.S. House of Representatives,
      (IL-13)........................................................     5
    The Honorable Kimberlyn King-Hinds, U.S. House of
      Representatives, Northern Mariana Island's at-large
      Congressional District.........................................     6
    The Honorable Morgan Luttrell, U.S. House of Representatives,
      (TX-8).........................................................     6
    The Honorable John McGuire, U.S. House of Representatives, (VA-5)     7

                                   WITNESSES
                                    Panel I

    Dr. Antoinette V. Shappell, M.D., Deputy Assistant Under
      Secretary for Health for Patient Care Services, Veterans Health
      Administration, U.S. Department of Veterans Affairs............     8

            Accompanied by:

        Dr. Ilse Wiechers, Deputy Executive Director, Office of
            Mental Health, Veterans Health Administration, U.S.
            Department of Veterans Affairs

                                    Panel II

    Mr. David Coker, President, Fisher House Foundation..............    17

    Mr. Randy Johnson, Constituent, Rep. King-Hinds of the
      Commonwealth of the Northern Mariana Islands...................    18

    Mr. Cole Lyle, Director, Veterans Affairs and Rehabilitation
      Division, The American Legion..................................    20

    Mr. John Schmitt, Chief Executive Officer, iXpressGenes, Inc.....    22

    Ms. Caira Benson, Caregiver Fellow, Elizabeth Dole Foundation....    23

                                    APPENDIX
                        Prepared Statements Of Witnesses

    Dr. Antoinette V. Shappell, M.D. Prepared Statement..............    33
    Mr. David Coker Prepared Statement...............................    50
    Mr. Randy Johnson Prepared Statement.............................    51
    Mr. Cole Lyle Prepared Statement.................................    53
    Mr. John Schmitt Prepared Statement..............................    71
    Ms. Caira Benson Prepared Statement..............................    78

                              APPENDIX--continued
                           Statements For The Record

    The Honorable Joseph Morelle, U.S. House of Representatives, (NY-
      25) Prepared Statement.........................................    83
    Paralyzed Veterans of America Prepared Statement.................    83
    Gold Star Spouses of America, Inc. Prepared Statement............    87
    National Association of Veterans' Research and Education
      Foundations Prepared Statement.................................    88
    National Association of State Veterans Homes Prepared Statement..    88
    Quality of Life Foundation Prepared Statement....................    90
    United Services Automobile Association Prepared Statement........    92
    The Veterans of Foreign Wars of the United States Prepared
      Statement......................................................    93
    American Academy of Physician Associates Prepared Statement......    95
    Concerned Veterans of America Prepared Statement.................    97
    Military Officers Association of America Prepared Statement......   101
    Student Veterans of America Prepared Statement...................   105
    K9s For Warriors Prepared Statement..............................   108

                              LEGISLATIVE HEARING

                                  ----------

                            THURSDAY, JUNE 12, 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, Bergman, Murphy, Van
    Orden, Kiggans, Hamadah, King-Hinds, Brownley, Cherfilus-
    McCormick, Dexter, Conaway, and Morrison.

       OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN

        Ms. Miller-Meeks. This legislative hearing of the
    Subcommittee on Health will now come to order. Without
    objection, the Chair may declare a recess at any time. Given
    that votes have been moved to 3 o'clock, we will, in all
    likelihood, declare a recess. I would like to welcome all
    members and witnesses to today's hearing. We have 12 important
    legislative proposals to consider here today. It is important
    to note that not all of the proposals will move forward in the
    legislative process, but many will. Congress is responsible for
    ensuring U.S. Department of Veterans Affairs (VA) stewards its
    resources effectively. Many of my colleague's bills would
    optimize the VA's funding, talent, and capital. Other bills
    reinforce VA's mission to care for veterans in mental and
    physical health.
        I am grateful to Representative Hamadeh for introducing the
    Health Professional Scholarship Program (HPSP) Improvement Act.
    One of the greatest resource drains at the VA is the broken
    student-to-employee pipeline. The VA loses untold investments
    in student clinicians by offering scholarships in exchange for
    employment commitments only for the VA not to keep its end of
    the deal. Students are consistently unemployed for months
    before the VA gives them a position. These students have been
    driven to the point where they cut their losses with the VA and
    seek jobs elsewhere at great financial cost to them and an
    opportunity cost to the VA. Representative Hamadeh's bill would
    help end this unacceptable dilemma.
        The Representing Our Seniors at VA Act by Representative
    Kiggins would improve the Geriatric and Gerontology Advisory
    Committee. Under current law, there is no requirement for input
    from State veterans homes, even though these homes are key
    partners in serving aging veterans. Representative Kiggins's
    bill would fix this oversight by making sure these homes have a
    seat at the committee table.
        The Veterans Patient Advocacy Act by Representative
    Moolenaar would increase the rural footprint for VA patient
    advocates. I know all too well how veterans in rural areas
    struggle to obtain care from the VA. I firmly support the
    bill's goal to have patient advocates accessible to rural
    veterans. I think we can all agree that we can always do more
    to ensure that VA's resources must keep evolving to reach
    veterans where they live.
        The Territorial Response and Access to Veterans Essential
    Life Care (TRAVEL) Act by Representative King-Hinds would also
    help our veterans living in remote areas. This bill would
    require a 1-year billet for VA physicians at U.S. territories
    like the Northern Mariana Islands. Health care is not easy to
    come by in these remote parts of the world. This bill would
    place VA practitioners in the right places at the right times.
        Representative McGuire's bill, the VA Data Transparency and
    Trust Act, tackles the unending reporting requirements at the
    VA and replaces them with a comprehensive and unified report on
    outcomes and metrics to improve VA programs. The laws today
    incentivize a system where consultants can create a cottage
    industry to broker reports, which diverts precious time and
    money away from VA's mission and only makes oversight more
    difficult. Congress has gained little from the manner in which
    it has received information from the numerous current VA
    reporting requirements. Representative McGuire's bill would
    pull in the reins and improve outcomes for veterans.
        My bill, the Fisher House Availability Act, would make
    lodging in Fisher Houses more accessible for service members
    and their families. Fisher House Foundation is a nonprofit
    dedicated to providing lodging for veterans and service members
    in need. The VA owns most Fisher Houses. We know that service
    members and their families can stay at Fisher Houses whenever
    they get care from the VA. However, a recent agency
    interpretation prohibits them from using VA-owned Fisher House
    when receiving non-VA care, even though we all know there is
    more than enough room to house them. This bill does not
    displace veterans or veterans' families. It is important to
    know it would simply ensure that service members have access to
    available lodging. I am thankful to the Fisher House Foundation
    for supporting this bill, and I am proud to sponsor it.
        Representative Luttrell's bill, the Service Dogs Assisting
    Veterans (SAVES) Act, picks up where the popular Puppies
    Assisting Wounded Servicemembers for Veterans Therapy (PAWS)
    Act left off. This bill covers the cost for service dogs that
    provide veterans with mental and physical assistance. The
    therapeutic benefits of service dogs are well established. I
    thank Representative Luttrell for his efforts to improve the
    availability of service dogs for veterans in need.
        Representative Dunn's bill would align nonsmoking policies
    at Veterans Health Administration (VHA) with most medical
    facilities in America. Currently, there is no protection in law
    against smoking at VHA facilities. As a physician, I know how
    important it is to make sure that patients breathe clean air
    when they receive care at the VHA facility. This bill would
    ensure that.
        Finally, a bill introduced by Dr. Murphy would create a
    pilot program to build on existing research into Post-Traumatic
    Stress Disorder (PTSD)-related inflammation and cellular
    stress. The continued prevalence of PTSD in our veteran
    population requires us to continue finding new and innovative
    ways of screening and diagnosing PTSD. The research from this
    pilot program could help equip VA with the tools for preventive
    rather than reactive care for PTSD.
        Again, these bills optimize VA and reinforce its mission to
    care for veterans' mental and physical health in exchange for
    their service in uniform. I now yield to Ranking Member
    Brownley for any opening remarks you may have.

          OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER

        Ms. Brownley. Thank you, Madam Chair, and thank you to our
    witnesses for making the time to be here. I understand we will
    have votes, as the Chairwoman said, that could interrupt us
    this afternoon. I will keep my remarks brief to allow us to get
    to everyone's testimony. While Committee Democrats appreciate
    and are not opposed to the intent of many of the Republican
    bills on today's agenda, we would like to see some changes and
    improvements on some of these bills. I hope we will be able to
    work together collaboratively with our majority colleagues to
    make these improvements through the committee markup process
    and put forth the best possible legislation to support our
    veterans.
        I am pleased we are considering three Democratic bills
    today, including my bill, the Civilian Health and Medical
    Program of the Department of Veterans Affairs (CHAMPVA)
    Children's Care Protection Act. I first introduced this bill in
    2019, and it has long been a priority for numerous veteran
    service organizations and organizations serving caregivers and
    survivors. CHAMPVA provides health care coverage for spouses
    and dependent children of veterans with permanent and total
    service-connected disabilities and for the surviving spouses
    and children of veterans who have died from service-connected
    disabilities.
        When the Affordable Care Act (ACA) was signed into law in
    2010, it required private-sector health plans to allow children
    to stay on their parent's insurance until they are 26 years
    old. However, this ACA mandate was not extended to military or
    veteran health coverage. This inequity was addressed for
    TRICARE in 2011, but to date, we have not extended parity to
    the CHAMPVA program. It is long past time to right this wrong.
    I am glad we will have a chance to hear directly from a
    caregiver, Ms. Caira Benson, about what this legislation would
    mean for her and her family. I look forward to working with the
    VA to learn how we can address the department's concerns and
    ensure that caregivers and their families have the support that
    they deserve.
        To that end, I also appreciate that we are considering
    Representative Morelle's bill, H.R. 2148, The Veteran Caregiver
    Reeducation, Reemployment, and Retirement Act. This legislation
    will provide VA and other agencies additional authorities to
    support veteran caregivers as they transition out of VA's
    program of comprehensive assistance for family caregivers. The
    sacrifices caregivers make, including for their own earning
    potential and financial security, are immense, and we must
    support them by ensuring they have the tools and the resources
    they need. I know Ms. Benson will also provide powerful
    testimony in support of Representative Morelle's bill.
        Finally, I know Congresswoman Budzinski will be here to
    discuss her own legislation, the VA Mental Health Outreach and
    Engagement Act, so I will briefly just say that I also support
    her bill. This legislation will ensure that VA conducts regular
    outreach and offers consultations to assess the needs of
    veterans with service-connected disability ratings for mental
    health conditions. We know that veterans who are connected with
    VA care have better health outcomes and lower risk of suicide
    than veterans who are not connected. I am glad Congresswoman
    Budzinski's bill will allow more eligible veterans to engage
    with VA care.
        I look forward to hearing from all of our witnesses today.
    With that, Madam Chair, I will yield back.
        Ms. Miller-Meeks. Thank you, 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. In
    accordance with Committee Rule 5(e), I ask unanimous consent
    that Representative Luttrell from Texas be permitted to
    participate in today's subcommittee hearing. Without objection,
    so ordered.
        I now recognize Representative Murphy for 3 minutes to
    speak on his bill.

                         STATEMENT GREG MURPHY

        Mr. Murphy. Thank you, Chairwoman Miller-Meeks and Ranking
    Member Brownley, for holding this meeting today. My bill, H.R.
    3886, the Veterans PTSD Screening Act, is being discussed at
    today's hearing. You know, we talk a lot about mental health
    with our veterans, especially with PTSD and Traumatic Brain
    Injury (TBI), and anything that we can do to move the needle. I
    have been obviously a big fan of hyperbaric oxygen therapy, but
    any other thing that we can do to move the needle is critical
    in how we are trying to help the veterans who have kept us
    free.
        I am going to talk a little bit about something called
    Ribonucleic Acid (RNA), RNA sequencing. Deoxyribonucleic Acid
    (DNA) is in our body, and DNA is a constant thing in our body.
    RNA rather changes with different experiences, with different
    memories, et cetera, in our brain. What we have found and has
    been well documented is the ability to measure RNA sequencing,
    either microRNA or something called long digital RNA, in
    different assays. These have become a predicting point to
    determine levels of stress within the body. Where compared to
    controls, those who have experienced PTSD have a markedly
    different pattern of RNA. What this bill is going to do is
    going to direct the VA to study this RNA sequencing in five
    separate veterans' VINs. I think it is going to be critical as
    we put our armamentarium, as our toolbox gets bigger and bigger
    as technology advances, that this will be a great tool.
        Now, caveats. We do not want to ever deny care based upon
    what is found with RNA sequencing. We also do not want to make
    this as a single modality. We have to have a holistic approach
    to PTSD. Being able to monitor just this one single variable
    really helps us, but it is not going to be the sole object for
    doing this.
        The science is growing. We are actually using this in some
    VAs right now, as been modeled in some VAs right now and is
    being modeled in other places, trauma centers, et cetera. I
    think we are seeing as technology increases, especially with
    AI, that we are going to be able to use all these new different
    tools to help our veterans, those who have experienced PTSD,
    and hopefully come up with a cure 1 day. If not, be able to
    monitor, to diagnose, and to monitor treatment as we treat our
    veterans.
        I will ask for appreciation and I would love us to bring
    the vote to committee. Thank you, Madam Chairwoman. I yield
    back.
        Ms. Miller-Meeks. Thank you, Representative Murphy. The
    Chair now recognizes Representative Budzinski for 3 minutes to
    speak on her bill.

                      STATEMENT OF NIKKI BUDZINSKI

        Ms. Budzinski. Thank you, Chairwoman Miller-Meeks, and
    thank you to Ranking Member Brownley. I appreciate this for
    giving me the opportunity to speak on my bill, H.R. 3863, the
    VA Mental Health Outreach and Engagement Act, which would
    expand VA's outreach to veterans about mental health services.
    I also want to thank my Republican colleague, Mr. Edwards, for
    co-leading this bipartisan bill.
        As a member of the Veterans Affairs Committee, I have heard
    from veterans unaware of where to turn for support and care for
    the invisible wounds of war. We must support our veterans and
    provide them with the knowledge and resources to prosper
    following their service to our Nation. My bill would ensure we
    are proactively reaching out to veterans with mental health-
    related service-connected disabilities and connecting them with
    the care that they need. Navigating the VA should never be a
    burden, and this bipartisan legislation would help to make it
    easier for veterans to get the mental health care that they
    have earned.
        I am also here today to speak in support of H.R. 3767, the
    Health Professional Scholarship Program Improvement Act. I want
    to thank my colleague on the committee, Congressman Hamadeh,
    for his leadership and bipartisan collaboration on this bill.
    VA's Health Professional Scholarship Program supports the
    students pursuing healthcare careers while connecting VA with
    talented staff. When program participants graduate, they are
    often met with delays in receiving a contract. Amid Veteran
    Health Administration staffing shortages, we need solutions to
    address this inefficiency. This legislation would streamline
    the path for HPSP participants to start working full-time,
    making it easier for veterans to get the care that they need.
        For both of these bipartisan bills, I am committed to
    working with my colleagues on both sides of the aisle, the VA
    and Veterans Service Organizations (VSO), to ensure we are
    continuing to improve healthcare for our Nation's veterans.
    Thank you very much for the time, and I yield back.
        Ms. Miller-Meeks. Thank you, Representative Budzinski. The
    Chair now recognizes Representative King-Hinds for 3 minutes to
    address her bill.

                   STATEMENT OF KIMBERLYN KING-HINDS

        Ms. King-Hinds. Thank you, Chairwoman Miller-Meeks and
    Ranking Member Brownley, for the opportunity to speak on my
    bill, H.R. 3400, The Territorial Response and Access to
    Veterans Essential Life Care Act, or the TRAVEL Act of 2025 for
    short, which aims to provide much-needed medical care to the
    United States territories.
        My home, the Northern Mariana Islands, has one contracted
    part-time doctors who sees and cares for hundreds of veterans
    who are spread across three islands. Which means if a veteran
    needs specialized medical care, he or she must travel to Guam,
    Hawaii, or the continental United States for health care. This
    is not only acceptable, it is offensive to the people who have
    served our country. Veterans should not have to pay upfront for
    air travel, book appointments across the globe, or forego
    medical care entirely because there are no nearby accessible
    doctors.
        Our Nation's heroes have worked hard and sacrificed so much
    to provide for us. We owe medical care to our veterans. We are
    indebted for their service. The very least we can do is to
    ensure they can go to a cardiologist or a neurologist when they
    need it. It is my hope that the TRAVEL Act will begin to
    address the medical desert that veterans face every day in the
    Northern Mariana Islands and all across the territories.
        This bill, once passed, will create a program similar to
    Doctors Without Borders. Veterans' Affairs, who supports this
    bill, will send doctors to the territories for periods of up to
    1 year so they can practice specialized medical care on Island.
    It will not bring the status of medical care for veterans in my
    district up to par with care available in the continental
    United States, but every little bit, any sort of improvement
    will help, and this bill does that.
        I ask and urge all of my colleagues in the House of
    Representatives to stand behind me as I advocate for our heroes
    across our territories. Thank you, Madam Chair. I yield my time
    back.
        Ms. Miller-Meeks. Thank you very much, Representative King-
    Hinds. The Chair now recognizes Representative Luttrell for 3
    minutes to speak on his bill.

                      STATEMENT OF MORGAN LUTTRELL

        Mr. Luttrell. Thank you, Madam Chairwoman and Ranking
    Member Brownley, for inviting me to speak on the Service Dogs
    Assisting Veterans Act. This legislation is an important step
    forward toward improving access to service dogs for our
    veterans. This pilot program gives the Secretary the authority
    to award competitive grants to nonprofits that provide service
    dogs to assist veterans who need them most.
        We are talking about men and women who have borne the
    weight of war, many of them returning from a theater of combat
    with invisible wounds. Nearly one in five veterans from those
    conflicts live with post-traumatic stress, post-traumatic
    stress disorder, or other cognitive issues. Over 450,000
    veterans have suffered at least one traumatic brain injury over
    the past two decades. These are not just numbers. These are
    warriors now battling depression, anxiety, addiction,
    joblessness, and homelessness. Right now, we are losing an
    estimated 17 to 22 veterans a day to suicide. This is
    absolutely a national crisis.
        Service dogs are more than companions. They are a life
    changing--they are life changing. They assist veterans. They
    assist veterans in regaining a sense of normalcy and control.
    They support those living with post-traumatic stress and
    traumatic brain injury and also assist vets dealing with
    mobility issues, vision loss, and hearing impairments. These
    dogs help our veterans live independently and stay active and
    re-engage with their families and their communities. This
    program is about giving back to those who never hesitated to
    serve. It is a step toward healing and toward honoring the
    promise we made to our veterans.
        Cost is one of the biggest hurdles veterans must jump over
    when it comes to service dogs. I am pleased that this
    legislation would enable veterans to gain access to highly
    trained service dogs at no cost. Ensuring our veterans have
    access to the biggest resources is a team sport. The SAVES Act
    team is comprised of dedicated members from across the
    political spectrum working to make this bill a reality. We also
    count numerous veterans organizations who are ready to execute
    and provide our veterans with highly trained service dogs who
    will make their life better.
        I would like to thank this committee and Ranking Member
    McGarvey for their assistance. Thank you, and I yield back.
        Ms. Miller-Meeks. Thank you, Representative Luttrell. The
    Chair asked--in accordance with Committee Rule 5(e), I asked
    unanimous consent that Representative McGuire from Virginia be
    permitted to participate in today's committee subcommittee
    hearing. Without objection, so ordered. The Chair now
    recognizes Representative McGuire for 3 minutes to speak on his
    bill.

                       STATEMENT OF JOHN MCGUIRE

        Mr. McGuire. I need a little teammate teamwork for my SEAL
    brother. Thank you, Madam Chair. We would not have a country
    without our men and women who risk their life or give their
    life. For all of our men and women, our veterans, thank you.
    Ranking Member Brownley, thank you as well. For the opportunity
    to speak on my bill, H.R. 3643, the Virginia Data Transparency
    and Trust Act, which I was proud to introduce with my good
    friend, the chairman of the full committee, Chairman Mike Bost
    of Illinois. Information and access to reliable and accurate
    data are necessary to all industries and government agencies.
    Nowhere is this need more apparent or more important than the
    Department of Veterans Affairs.
        Over the past 10 years, the VA's budget has increased by
    nearly 220 percent while the daily suicide rate has remained
    flat, with 18 veterans committing suicide each day, with some
    experts believing that number might be higher. We also cannot
    forget that last November, the Department of Veterans Affairs
    made egregious mistakes and its accountant and budgeting
    practices, and they came to Congress last summer asking for
    additional funds or else veterans would lose their benefits.
    This resulted in a $3 billion stopgap spending bill that was
    rushed through Congress to ensure veteran benefits could
    continue, only for us to learn months later that there was no
    shortfall at all. Clearly, Congress needs to have better
    oversight of how the VA spends taxpayer funds and where they
    spend it.
        Currently, the department provides Congress with a wide
    range of reports but falls short of providing timely and
    accurate reports conducted by other agencies, such as the
    Department of Defense (DOD), with regard to TRICARE and the
    Center for Medicare and Medicaid Services. My bill would
    require that the VA provide an annual comprehensive report that
    would provide Congress and congressional support agencies with
    the necessary information to provide proper and clear oversight
    while allowing for greater visibility of veterans needs and the
    usage of certain programs. Without comprehensive and useful
    data, Congress cannot make informed decisions about veterans'
    healthcare, disability compensation or program funding. This
    bill modernizes the way the VA handles data, bringing it in
    line with other major Federal agencies' best practices.
        I would like to thank Chairwoman Miller-Meeks for allowing
    me the time to speak and be impart on this important
    legislation today. I will yield back the balance of my time.
        Ms. Miller-Meeks. Thank you, Representative McGuire. Seeing
    no other members here to speak on their bills, as is our
    practice, we will forego a round of questioning for the
    members. For those off committee members who are here, you may
    remain to ask questions of our witnesses if you have time.
        I now invite our first panel to the table. Thank you.
    Joining us today is Dr. Antoinette Shappell with support from
    Dr. Ilse Wiechers. Dr. Shappell is Deputy Assistant
    Undersecretary for Health and Patient Care Services at VHA. Dr.
    Wiechers is Deputy Executive Director of the Office of Mental
    Health and Suicide Prevention at VHA.
        Dr. Shappell, you are now recognized for 5 minutes to
    prevent the department's testimony.

                    STATEMENT OF ANTOINETTE SHAPPELL

        Dr. Shappell. Thank you. Chairwoman Miller-Meeks, Ranking
    Member Brownley, and members of the subcommittee thank you for
    inviting us to discuss several bills affecting Veterans Affairs
    programs and services. My name is Dr. Antoinette Shappell, and
    I currently serve as the Deputy Assistant Undersecretary for
    Health for Patient Care Services. I am joined today by Dr. Ilsa
    Wiechers, Deputy Executive Director for the Office of Mental
    Health.
        While VA's detailed views on each of the bills are included
    in my written statement, I will briefly highlight some of the
    bills. First, H.R. 785, the Representing Our Seniors at VA Act.
    VA supports the intent and has already appointed a member of
    the National Association for State Veteran Homes to the
    Gerontology Advisory Committee in 2024. We have some concerns
    with the legislation as written.
        Next is H.R. 1404, the CHAMPVA Children's Care Protection
    Act of 2025, which would extend CHAMPVA benefits for children
    until age 26. CHAMPVA is a medical care benefit for dependents
    of certain veterans similar to DoD's TRICARE. However, VA does
    not support this bill because we believe this coverage up to
    age 23 is sufficient for our beneficiary population. VA is
    concerned that the bill would require resources that could
    otherwise be used to support patient care.
        VA agrees with the intent of H.R. 2068, the Veterans
    Patient Advocacy Act. The bill aims to ensure rural veterans
    can access patient advocates. VA has expanded advocacy options
    for veterans, such as local advocates, online platforms, and
    the VA Hotline to meet veterans' needs. VA has concerns with
    some of the bill's provisions.
        The Veteran Caregiver Reeducation, Reemployment, and
    Retirement Act, H.R. 2148, proposes several changes. It extends
    CHAMPVA benefits for 180 days for primary family caregivers
    after their designation ends, offering a necessary transition
    time for seeking alternative health care coverage. The bill
    also suggests employment assistance and compensation, including
    training for caregivers. VA supports Section II of the bill,
    subject to appropriations. We generally support Section III of
    the bill, subject to appropriations. However, we do have some
    concerns with the certain provisions and would appreciate the
    opportunity to discuss these concerns with the committee.
        The Service Dogs Assisting Veterans ACT, or the SAVES Act,
    H.R. 2605, requires the VA to establish a pilot program to
    provide service dogs to eligible veterans. VA supports this but
    recommends clarifying the bill's language for effective use of
    funds. We also propose aligning terminology with existing VA
    definitions. We do have concerns about including traumatic
    brain injury and post-traumatic stress disorder in the
    criteria, given insufficient evidence of service dogs'
    effectiveness for PTSD.
        Additionally, H.R. 3400, the TRAVEL Act, proposes assigning
    traveling VA physicians to territories and possessions in the
    U.S. VA supports this with amendments to clarify the bonus
    eligibility and coordination of care, ensuring physicians
    provide care where it is needed. We agree with the intent to
    expedite the employment process for healthcare professions.
    However, we do not support the bill seeking to expedite VA
    employment for health professional scholarship program
    participants within 90 days.
        VA supports the VA Data Transparency and Trust Act, which
    requires VA to submit detailed reports and create a data-
    sharing system for researchers. However, we recommend
    amendments to focus on desired topic areas to avoid complex and
    resource intensive implementation.
        The Fisher House Availability Act of 2025 aims to extend
    lodging benefits at Fisher Houses. VA supports this, provided
    amendments to clarify eligibility for service members and
    dependents, ensuring the bill's language aligns with current
    practices.
        We strongly support the bill banning smoking in all VHA
    facilities.
        VA supports the intent of the draft bill, directing VA to
    conduct a study on RNA sequencing to diagnose PTSD. We do have
    concerns with several of the bill's provisions and would
    appreciate the opportunity to discuss our concerns with the
    committee.
        VA supports the VA Mental Health Outreach and Engagement
    Act. Support is subject to amendments and the availability of
    appropriations. We would appreciate the opportunity to discuss
    amendments with the committee and provide technical assistance.
        This concludes my statement. We are happy to answer any
    questions you or other members of the subcommittee may have.
    Thank you.

        [The Prepared Statement Of Antoinette Shappell Appears In
    The Appendix]

        Ms. Miller-Meeks. Thank you for your testimony, Dr.
    Shappell. Your full written statement will be entered into the
    record.
        As is my typical practice, I will reserve my time until all
    of the members have had a chance to ask their questions,
    especially with pending votes coming. I now recognize Ranking
    Member Brownley for 5 minutes for any questions she may have.
        Ms. Brownley. Thank you, Madam Chair. Dr. Shappell, thank
    you for being here. In your testimony, your written testimony,
    anyway, you say that the--that VA opposes the CHAMPVA because
    it is not an insurance plan. Is that correct?
        Dr. Shappell. Yes.
        Ms. Brownley. If you could answer just a couple of
    questions for me, just yes--yes or no. The first one, does
    CHAMPVA have cost-sharing requirements like deductibles and co-
    pays?
        Dr. Shappell. I would need to that for the record.
        Ms. Brownley. Well, I can say that it does for the record.
    Are there any limitations to the services and supplies covered
    by CHAMPVA?
        Dr. Shappell. I would also take that one for the record.
        Ms. Brownley. It does. Does CHAMPVA use a formulary?
        Dr. Shappell. I believe so, but I can get specifics for the
    record.
        Ms. Brownley. Well, I can tell you that it does. Does
    CHAMPVA have any prior authorization requirements for services
    like mental health and substance use treatment?
        Dr. Shappell. I believe so, but I can--I can----
        Ms. Brownley. I can tell you--say that it does. Is CHAMPVA
    considered credible coverage for the purposes of the ACA's
    mandate that individuals have health insurance coverage?
        Dr. Shappell. CHAMPVA is a benefit, but it is not an
    insurance policy per se.
        Ms. Brownley. Well, the point that I am trying to make here
    is that all the questions that I just asked you, the answers
    are yes. Then, of course, you say that it is not a health
    insurance policy, but it certainly sounds like one. It has, you
    know, the questions that I just asked you were sort of almost
    like a checklist for insurance policies. It just seems to me
    that CHAMPVA--you say it is not a health insurance policy. I
    say it certainly appears to be one. As the old saying goes, if
    it walks like a duck and swims like a duck and quacks like a
    duck, it is probably a duck.
        DoD's TRICARE program was not affected by the ACA either.
    However, Congress created the TRICARE Young Adult program in
    2011 to provide health care for qualified young adults ages 21
    to 26 who are unmarried and not eligible for an employer-
    sponsored health plan. Why is VA advocating for the dependents
    and survivors of service-disabled veterans to be treated
    differently and less than TRICARE beneficiaries? This
    legislation would create that long-standing inequity.
        In her testimony on behalf of the Elizabeth Dole
    Foundation, Mrs. Benson suggests that our committee should use
    its oversight authority to improve the administration of the
    CHAMPVA program. I certainly agree. She recounts the incredible
    number of hurdles she has to overcome in getting services
    covered, getting claims paid, and even simply getting VA to
    process the paperwork to recertify her child's status as a
    college student. Yes, I mean paperwork because CHAMPVA is still
    operating, in my most humble opinion, in the dark ages with
    paper-based forms and a month's long backlog in processing the
    mail.
        Dr. Shappell, 7 weeks ago today, committee staff submitted
    a few simple questions to VHA regarding academic enrollment
    recertification requirements for CHAMPVA beneficiaries. We have
    yet to receive a response despite our attempts to follow up.
    Can I have your assurance that we will receive answers to these
    questions within the next week, which will make it more than 2
    months since we requested the information?
        Dr. Shappell. Thank you. I do not have a timeline right
    now, but I can assure you that I will work with my colleagues
    in our Office of congressional Legislative Affairs to ensure
    you have a response.
        Ms. Brownley. You cannot state at a timeline? Not a week,
    not 2 weeks, not a month, not 3 months?
        Dr. Shappell. Not at this time.
        Ms. Brownley. I yield back.
        Dr. Shappell. Thank you.
        Ms. Miller-Meeks. Thank you, Representative Brownley. The
    Chair now recognizes representative Dr. Murphy for 5 minutes
    for any questions he may have.
        Mr. Murphy. I am going to hold off and pass on questions. I
    will come back later. Thank you.
        Ms. Miller-Meeks. The Chair now recognizes Representative
    King-Hinds for any questions she may have.
        Ms. King-Hinds. just have a couple of questions. I was
    reading over your comments on the proposed TRAVEL Act, and
    first of all, thank you for the support. Section, the proposed
    section 7415B proposes to require traveling physicians to
    coordinate with non-departmental medical providers to the
    extent necessary to ensure high-quality and coordinated care.
    How do you foresee the VHA implementing this program?
        Dr. Shappell. Thank you. I am going to pass that to Dr.
    Wiechers.
        Dr. Wiechers. We would actually like to work with the
    committee to better understand what the intent is in that
    section so that we can have some clarity on what care
    coordination entails.
        Ms. King-Hinds. Okay, great.
        Dr. Wiechers. That we could make a plan together.
        Ms. King-Hinds. I would love to have that conversation with
    you. Just one other quick question. There was some objections
    with regards to, I think I want to say, section--the pay,
    section 7415. I know that there are some concerns about the
    budget and the language with regards to the retention bonus,
    which is included in the legislation. I just wanted to bring
    this up for situational awareness.
        Right now, the Commonwealth of the Northern Mariana Islands
    (CNMI), in general, is having a hard time recruiting healthcare
    professionals just for regular care. I think that is a direct
    result of, you know, just the difference in the quality of life
    that is here on the mainland as it relates to back in the
    territories. I will give you an example. I am really excited
    that he is introducing the SAVES Act, which would, you know,
    allow for the VA to provide service care or service animals. We
    do not have a vet. That is one of the biggest challenges is
    that you do have these professionals who want to relocate
    there. Transporting your pets to the CNMI right row costs
    around $10,000. You know, it is cost-prohibitive, right? We do
    not have a mall, we do not have a shopping center, any type of
    major shopping center. Our only movie theater has just recently
    closed down. I would like to have a conversation with you with
    regards to the challenges as it relates to recruitment and
    retention for people coming out to the territories.
        Dr. Wiechers. Absolutely. We would be happy to engage in a
    conversation with you about that. I think the technical
    amendment suggestion is just to ensure that the language and
    the authorities that we have related to bonus eligibility line
    up appropriately. Absolutely understand the importance of being
    able to recruit high quality providers to be able to come to
    the islands and to help with the health care for our veterans
    there.
        Ms. King-Hinds. All right, thank you. I yield my time.
        Ms. Miller-Meeks. Thank you. If I can, I will remind our
    witnesses to speak a little louder. The Chair now recognizes
    Representative Bergman, General Bergman, for any questions he
    may have.
        Mr. Bergman. Thank you, Madam Chair, and thank you to
    everybody who is here because we are all trying to do the right
    thing for the right reasons. The question is, how do we figure
    out what the right reasons really are and what the priorities
    are? We are in an oversight position here. You are the, you
    know, we are the higher headquarters that send you money and
    resources to do the mission. We want to know how the mission is
    going, okay? I appreciate the honesty in your testimony.
        One specific question here as it relates to H.R. 3767, as
    it relates to the Health Professional Scholarship program. I am
    not going to go into details of what each--whether you are a
    psychiatrist, a nurse practitioner, pharmacist, how many of
    those scholarships, so the Health Professional Scholarship
    program, are providing scholarships for certain specialties. I
    will just say if you do not have the answer, you can take it
    for the record. Why is the VHA plan for Fiscal Year 2026
    eliminating the PA, Physician's Assistance, Health Professional
    Scholarship Program for returning veteran medics and corpsmen?
    Do we have any detail of that? I do not want--I do not want to
    play gotcha here, but I want to give you the opportunity to
    answer the question based upon what you know.
        Dr. Shappell. Thank you. I will pass that to Dr. Wiechers.
        Dr. Wiechers. I am going to have to take that for the
    record, sir. I do not have an answer for you today, but I will
    get an answer for you.
        Mr. Bergman. Well, the reality is here we need all
    different medical special, you know, proficiencies,
    specialties. It would seem to me that when we have veteran
    medics and corpsmen that are already, for lack of a better
    term, in most cases, battle-tested, we would want to make sure
    that we continue to develop their expertise and their ability
    to serve other veterans. This is a medical specialty that we
    need to continue to move forward. This cannot be, you know,
    the--not that I would get specific, but there is an ongoing
    discussion between nurse anesthetists and anesthesiologists.
    That is--we have been dealing with that for a very, very long
    time, and there is room for both. The question is, who
    supervises who, who has charge of patient care, et cetera, et
    cetera. As we continue to look at the healthcare system of the
    future and physician's assistance, as they might migrate into
    the VA system, and maybe they go out into community care, which
    the vast majority of veterans are looking for care in the
    community. Physician assistant in the world in which we live is
    a great step forward.
        With that, Madam Chair, I yield back.
        Ms. Miller-Meeks. Thank you, General Bergman. The Chair now
    recognizes Dr. Conaway for any questions he may have for 5
    minutes.
        Mr. Conaway. Hi. Thank you, Madam Chair, for recognizing me
    for a few moments to make a statement and answer some
    questions. We are, I am assuming I just walked in, we are on
    3643, right? No. Oh. What is that? Okay. I just wanted to take
    a moment to discuss H.R. 3643, the VA Data Transparency and
    Trust Act. It aims to reauthorize a congressionally mandated
    report that expired in 2022 and significantly expands the
    number of elements that the VA is required to report. Dr.
    Shappell, does the VA have the personnel and resources
    necessary to compile, calculate, and report this data?
        Dr. Shappell. Thank you. VA does support this bill, subject
    to amendments. Right now, as written, the report is very broad
    and would require a significant amount of time and resources to
    fully understand what is desired. We would appreciate the
    opportunity to meet with the committee to narrow the focus of
    the specific topics.
        Mr. Conaway. I agree with the importance of transparency in
    this bill and strongly believe data points from the VA are
    essential for Congress to effectively conduct its oversight
    responsibilities. I would. You have just said that you have
    some concern about the breadth of the report, but I must say
    that I am concerned about what is lacking, specifically how
    many staff are retiring, resigning or leaving the VA, along
    with their specific job titles. I am also concerned about what
    is going on with new hires and what their titles are. It sounds
    like you would not be able to provide--you do not believe the
    VA, excuse me, is in a position to provide this data. We think,
    I think, and I think, I hope, I am joined by everyone here,
    believes it is important to understand what is going on with
    the staffing levels in the VA and that it has the appropriate
    personnel and adequate numbers of personnel to complete its
    very important mission. Certainly, what is going on with hiring
    and staffing, et cetera, would be important to our oversight
    function. What are your thoughts on--on the things I suggest
    needed to go into the bill?
        Dr. Shappell. Thank you. Thank you for the question. That
    the resources that would be needed to collect and report on
    this data could potentially divert from health care and
    benefits delivery, but we do not have a cost estimate at this
    time. We would really appreciate the opportunity to meet with
    the committee to fully understand what is really desired and
    needed so that we can come up with a better plan to move
    forward.
        Mr. Conaway. Well, then I would ask then, do you know why--
    and of course, you are supposed to know the answer to these
    questions before we ask them. You know, it is, my notes say, of
    course, this report ceased a couple of years ago. Do you have
    an explanation for why that happened?
        Dr. Shappell. I do not know. I was not in my current
    position at that time. I would be happy to take that for the
    record and provide a response for you.
        Mr. Conaway. Well, I would just say that we know that
    staffing and the ability to fully staff the various departments
    within the VA plays an enormous role in the quality of care
    that is delivered to our veterans. Gathering these data points
    would allow us to better understand how we can support the VA
    and ensuring they provide the high-quality care that veterans
    deserve. Do you agree? Or that staffing levels have an
    important impact on the. On the outcomes that we expect from
    the VA and that our veterans need the VA to produce for them
    and their care?
        Dr. Shappell. Yes, I do believe that the veterans need the
    VA. However, I can assure you that the VA has worked with the
    White House and the Office of Personnel Management to exempt
    more than 300,000 positions from the hiring freeze and early
    retirement incentives or deferred resignation program. We, the
    Department, is committed to ensuring that we have the best
    employees in place to serve our veterans and the services that
    they need.
        Mr. Conaway. Thank you, Doctor. Madam Chair, I yield back.
        Ms. Miller-Meeks. Thank you, Dr. Coleman. The Chair now
    recognizes Representative Luttrell for 5 minutes for any
    questions you may have.
        Mr. Luttrell. Thank you, Madam Chairwoman. Dr. Shappell,
    H.R. 2605, the SAVE Act, I think I heard you say that the
    Department of Veterans Affairs does not support a portion of
    that because of the given service--it says that the service
    dogs do not provide effectiveness for post-traumatic stress
    disorder?
        Dr. Shappell. Yes.
        Mr. Luttrell. I want you to read that statement out of your
    notes. Make sure that I heard it right.
        Dr. Shappell. The Service Dogs Assisting Veterans Act, or
    the SAVES Act, H.R. 2605, requires the VA to establish a pilot
    program to provide service dogs for eligible veterans. VA
    supports this but recommends clarifying the bill's language for
    effective use of funds. We also propose aligning terminology
    with existing VA definitions. We do have concerns about
    including traumatic brain injury and post-traumatic stress
    disorder criteria in the--in the criteria given insufficient
    evidence of service dogs' effectiveness.
        Mr. Luttrell. Insufficient evidence that service animals
    assist veterans with post-traumatic stress disorder. That is
    the opinion of the Department of Veterans Affairs?
        Dr. Shappell. Yes, and I am going to pass this over to Dr.
    Wiechers.
        Mr. Luttrell. Have at it.
        Dr. Wiechers. All right. Thank you, sir, for the question.
    The evidence does not support any----
        Mr. Luttrell. What evidence?
        Dr. Wiechers. There is a study that was conducted.
        Mr. Luttrell. One study. One study.
        Dr. Wiechers. That is----
        Mr. Luttrell. The VA is basing that claim that you just
    threw at me off of one study.
        Dr. Wiechers. I would like----
        Mr. Luttrell. I would be very careful in the waters that
    you are going to swim in with me right now----
        Dr. Wiechers. I am, sir.
        Mr. Luttrell [continuing]. because I have been studying
    this for an extremely long period of time. One thing that I do
    know, and I talked to hundreds of veterans that have post-
    traumatic stress disorder and post-traumatic stress and
    traumatic brain injury with service animals, and they say this
    is a life-changing event for them. It is the opinion off of one
    study in the Department of Veterans Affairs to say that that is
    ineffective?
        Dr. Wiechers. We have a method in the existing regulations
    that we have around access to service dogs for mental health
    mobility dogs for veterans with PTSD and TBI. That is what we
    are speaking to.
        Mr. Luttrell. You are differentiating between a service
    animal and a therapy animal?
        Dr. Wiechers. I am speaking to a mental health mobility
    dog. Mental health mobility service dog, which can be provided
    for patients with PTSD and TBI. It is a--sir, I agree with you.
        Mr. Luttrell. In the language----
        Dr. Wiechers. I agree with you.
        Mr. Luttrell [continuing]. in front of you, I need to add
    that subtext in there to make this thing?
        Dr. Wiechers. I would like to work with you to make sure we
    have language that aligns with the definitions we have that
    allow for the access when it is appropriate clinically for
    veterans with PTSD or TBI who have a mental health mobility
    disability. We have a method we need to align language, sir.
        Mr. Luttrell. Well, I can assure you, if it does not happen
    today, within the next couple of days, you need to be in my
    office and make sure that it is absolutely the way that it
    needs to be because this is something I am not walking away
    from because I adamantly disagree with what you are saying.
    Since you are speaking for the VA, you do not want to go to war
    with me over this.
        Dr. Wiechers. I do not.
        Mr. Luttrell. There is a room full of veterans sitting
    behind you that I am sure going to be on my side.
        Dr. Wiechers. I understand. I am committed to working with
    you and making sure we get the language that works so that we
    can ensure access to the service dogs through this pilot
    program.
        Mr. Luttrell. This is the conversation that most likely
    should have happened before you are sitting in front of the
    committee in an open hearing.
        The VA has expressed concerns that the Fisher House
    Availability Act will create an adverse interference that
    providing lodging to some service members is prohibited by law.
    On what legal authority does VA base its concern? If these
    concerns were alleviated, would VA support allowing DoD use of
    excess capacity in VA Fisher House residences?
        Dr. Shappell. Thank you. Yes, so VA does support this
    proposed bill. We would like to work with the committee on some
    technical assistance. We do want to support service members and
    their beneficiaries.
        Mr. Luttrell. Madam Chairwoman, I yield back.
        Ms. Miller-Meeks. Thank you, Representative Luttrell. The
    Chair now recognizes, again, Dr. Murphy for any questions you
    may have. Okay. The chair now recognizes herself for any
    questions she may have. They are calling for votes, so I am
    going to be very, very brief so we can try to complete this
    panel before we recess and then come back for the next panel.
        Dr. Shappell, in your testimony, you state that due to the
    ambiguity of current law, active-duty service members, and I
    think this is getting to the point Mr. Luttrell was making, and
    their beneficiaries are being turned away even though the
    Fisher House Foundation is willing and able to support them if
    there is availability. Can you explain why my bill is necessary
    to clarify congressional intent and correct this error?
        Dr. Shappell. Currently, the current law does not allow for
    TRICARE beneficiaries to stay in the Fisher home. VA does
    support this and does want to provide equitable access for our
    military families, but we do need to have it codified in law.
        Ms. Miller-Meeks. Dr. Shappell, Congress often encounters
    difficulty getting timely information on performance outcomes
    and spending. I know that the VA spends countless hours
    preparing numerous and disparate reports for Congress. Would
    the VA support a centralized, publicly accessible data
    platform, as Congressman McGuire's bill proposes, to streamline
    oversight and increase public trust?
        Dr. Shappell. Thank you for your question. I would have to
    take that back for the record, ma'am.
        Ms. Miller-Meeks. Thank you very much. The other questions
    I will have, I will submit for the record in order for time.
    There is still 421 votes, so I think we have a few minutes. On
    behalf of this subcommittee, I want to thank you for your
    testimony and for joining us here today. You are now excused.
    We are going to wait a moment for the second panel to come to
    the witness table.
        Thank you very much. Welcome, everyone, and thank you for
    your participation today. The staff and I are watching votes
    very carefully. I am hoping to push through to get through at
    least one of our testimoneys, and we can at least introduce the
    panel.
        On our second panel today, we have Dave Coker, President of
    the Fisher House Foundation, Randy Johnson, Marine Corps
    veteran, member of The Veterans of Foreign Wars of the U.S.
    (VFW) Post 3457, and constituent of Representative King-Hinds.
    Cole Lyle, Director of the Veterans Affairs and Rehabilitation
    Division at the American Legion. John Schmitt, Chief Executive
    Officer (CEO) of iExpressGenes. Caira Benson, a caregiver
    fellow, testifying on behalf of the Elizabeth Dole Foundation.
    Mr. Coker, you are now recognized for 5 minutes.

                        STATEMENT OF DAVID COKER

        Mr. Coker. Thank you, Chairwoman Miller-Meeks, and good
    afternoon to the members of the committee. My name is David
    Coker, and I have the privilege of serving as President of
    Fisher House Foundation.
        The Fisher House Program was founded in 1990 by Zachary
    Fisher, a private citizen and patriotic philanthropist who
    believed that no military family should ever struggle to be by
    their loved one's side during a medical crisis. He built the
    first Fisher Houses at the National Naval Medical Center and
    Walter Reed Army Medical Center. The vision was simple but
    powerful: to create a home away from home for families
    traveling to be with a loved one receiving care.
        The Fisher House program has now grown into a network of
    100 Fisher Houses located at Department of Defense hospitals
    and VA medical centers across the country and overseas. Because
    of the special mission of supporting both military and veteran
    families, it is fitting that the 100th Fisher House, to be
    dedicated next month, is located at the James A. Lovell Federal
    Health Care Center, the only fully integrated DoD and VA
    Medical center in the country.
        Each home is now built through the generous support of the
    American public and donated to the Veterans Affairs or the
    military service it serves. To date, Fisher Houses have offered
    more than 12 million nights of lodging and saved families more
    than $650 million in out-of-pocket costs. When we gift a Fisher
    House to the Army, Navy, Air Force, or Veterans Affairs, our
    goal is to support these families in their time of greatest
    need. We know that having a loved one present improves
    recovery. Family members serve as caregivers and advocates and
    are a tremendous source of strength. We believe they are
    essential to the healing process and that every veteran and
    service member deserves to have their loved one by their side.
        Of the 100 Fisher Houses, more than half support VA medical
    centers. In 2024, the VA Fisher Houses served more than 24,000
    veteran families spanning all eras and generations.
        Last fall, guidance was published which changed the way VA
    Houses operate. It directed that only families of veterans
    receiving VA-directed care were eligible for the support Fisher
    Houses provide. Even when rooms are available, families that
    have historically been welcomed must now be turned away. Last
    year, the occupancy rate at the VA Fisher Houses across the
    country was 53 percent. We would ask that if a room was
    available, consideration should be given to support the family
    of an eligible DoD beneficiary.
        The Fisher House supporting the Washington DC VA Medical
    Center is on the same campus as the Children's National
    Hospital, the National Rehabilitation Hospital, and the
    Washington Hospital Center. Last year, occupancy at that house
    was 22 percent and could have easily accommodated families
    receiving care at one of those facilities.
        The world-renowned Paley Orthopedic and Spine Institute is
    located near the Fisher House, supporting the Thomas H. Corey
    VA Medical Center in West Palm Beach, Florida. 27 military
    children were referred to them for life-changing care last
    year. Today, their families are no longer eligible to stay in
    the Fisher House.
        There are three Fisher Houses at the DeBakey VA Medical
    Center in Houston, adjacent to the Texas Medical Center and MD
    Anderson. Last year, the occupancy rate was 63 percent. Again,
    because of this guidance, military families will be turned
    away.
        The bipartisan Fisher House Availability Act of 2025 would
    restore the flexibility that the VA Fisher House Managers once
    had, allowing the families of active-duty service members and
    other eligible beneficiaries to stay on a space-available basis
    while preserving the priority access for veterans. This change
    will not reduce access for veterans. It simply allows these
    homes already built, already staffed, and already serving, to
    do what they were intended to do: keep families of our Nation's
    heroes together in the hardest moments of their lives.
        This bill is consistent with the Memorandum of
    Understanding between the Secretary of Defense and Secretary of
    Veterans Affairs titled, Strengthening Our Partnership and
    Service to Those Who We Serve, and it will provide one more way
    for the two departments to work together to support both the
    military and veterans' communities.
        On behalf of the Fisher House Foundation and the tens of
    thousands of families we have the privilege of serving each
    year, I want to thank the sponsors of this bill and all of you
    for your support of our Nation's service members, veterans, and
    their loved ones. Thank you for the opportunity to speak today.
    I welcome any questions.

        [The Prepared Statement Of David Coker Appears In The
    Appendix]

        Ms. Miller-Meeks. Thank you, Mr. Coker. Mr. Johnson, you
    are now recognized for 5 minutes.

                       STATEMENT OF RANDY JOHNSON

        Mr. Johnson. Thank you. Chairwoman Miller-Meeks, Ranking
    Member Brownley, and members of this committee. My name is
    Randy Johnson. I am a resident of the Northern Mariana Islands,
    a veteran of the United States Marine Corps. For the past
    decade, I have had the privilege of assisting fellow veterans
    in the Northern Marianas, helping them navigate the VA system
    and access the benefits they earn through their service. I have
    traveled nearly 8,000 miles to be here today to speak in
    support of H.R. 3400, The Territorial Response and Access to
    Veterans' Essential Lifecare, known as the TRAVEL Act,
    introduced by our delegate, Congresswoman Kimberlyn King-Hinds.
    This is a good bill.
        In the Northern Marianas, we do not have a VA medical
    center. We do not have consistent access to specialty care or
    mental health services. When veterans need more than basic
    care, we are often told to leave the island, traveling
    thousands of miles, paying out of pocket, and spending weeks
    away from our families. The TRAVEL Act helps to change that. It
    allows the Department of Veterans Affairs to send traveling VA
    physicians into remote communities like ours. Instead of
    forcing the veteran to chase care across oceans, this bill
    brings care to the veteran. That is the right direction.
        I am here to voice my support for the TRAVEL Act, but I
    also came this distance to give voice to the hundreds of
    veterans who could not be here. Veterans who serve this country
    with honor, who, like me, are not asking for special treatment.
    We are asking for what we would have received if we lived
    anywhere else in the United States.
        We are the only place in the Nation where a veteran can
    call home but have no access to community-based outpatient
    clinicians (CBOC). No CBOC at all. Veterans from every
    conflict, past and present, have been told that if they want
    the full range of care they have earned, they cannot live at
    home. Veterans seeking care at home see one doctor on Tuesdays
    and Thursdays. Dr. Ada has done a great job, but only--but
    there is only one such--only so much one person can do. Her
    office has one VA registered nurse, a veteran herself, but if
    she needs care or takes a much-needed vacation, there is no one
    left to keep pace.
        Decisions on care, travel, and benefits happen in Guam or
    Hawaii. Resources come from Guam or Hawaii. When those places
    are struggling or overloaded, we cannot reasonably expect them
    to prioritize our needs.
        What we want, and what I believe we have earned, is the
    right to live in the country that we fought for, in the
    community we fought for, and to have our services speak for
    itself. We should not have to choose between access to care and
    being with home with our families. We stood the watch. We
    answered the call. That should be enough.
        I served in Iraq. I saw combat. I received a Purple Heart
    for it. I traveled here by choice. Many veterans are forced to
    travel simply to receive the care they need. That should not be
    the case.
        In the Northern Marianas, I have served alongside and
    advocated for generations of veterans, those who fought in
    Vietnam, Panama, Iraq, and Afghanistan. All of them returned
    home to a system still not built to meet their needs.
        As I made my way here, I thought the--thought of the
    Vietnam veterans in their 70's and 80's who served our Nation
    even before our islands were formally part of this country.
    They have spent a lifetime fighting for benefits that only
    trickled in slowly over decades. Now, even in their later
    years, they are still being asked to travel off island for
    basic, sometimes life-sustaining care. I think of how difficult
    this travel is for them. I thought of the Gulf War veterans who
    opened a new chapter in America's military history but returned
    to the same old gaps in care and support. I thought of my
    generation, those who served in Operation Iraqi Freedom and
    Enduring Freedom. We served with commitment. We returned home
    with hope. We still face the same cycle of delay, denial, and
    distance.
        Of this generation of new veterans, I am proud to be part
    of a group that is organizing to support one another directly.
    Project Buddy Check 670 is an example of that effort. It
    reflects our belief that care for veterans does not always come
    in the form of a pill or prescription, but sometimes it comes
    from another veteran picking up the phone, checking in, and
    listening. Project Buddy Check is a reminder that veterans
    seeking care that treats us as people, not just patients. When
    even ordinary care is far to reach, how can we expect a system
    to provide the mental health and holistic support for our
    veterans who truly need?
        Generations of veterans have answered the call from our
    islands. I know the challenges we face are difficult to
    address, but again, we stood the watch. We bore the burden.
    That should be enough. It is time the system answered back.
        H.R. 3400 is a strong start. I respectfully ask this
    committee to support it and continue advancing policies that
    bring real access, real dignity to every veteran, no matter
    where they live. Thank you for your time and for your
    unwavering commitment to those who serve.

        [The Prepared Statement Of Randy Johnson Appears In The
    Appendix]

        Ms. Miller-Meeks. Thank you, Mr. Johnson, and thank you for
    your long duration of travel to get here. Mr. Lyle, you are now
    recognized for 5 minutes.
        Mr. Luttrell. Madam Chairwoman, they called votes. I do not
    know if you, just----
        Ms. Miller-Meeks. Yes, sir. There is 327 people left to
    vote.
        Mr. Luttrell. I have never missed a vote time.
        Ms. Miller-Meeks. Sir, you may be excused if you want to be
    excused. I am sorry. Mr. Lyle.

                         STATEMENT OF COLE LYLE

        Mr. Lyle. Well, thank you, Chairwoman Miller-Meeks, Ranking
    Member Brownley, distinguished members of the subcommittee, on
    behalf of National Commander James A. LaCoursiere Jr., and the
    1.5 million dues-paying members of the American Legion, thank
    you for the opportunity to testify today discussing pending
    legislation that directly impacts the lives and well-being of
    American veterans.
        Today, the American Legion supports nearly all the bills
    under consideration because they reflect a bipartisan
    commitment to improving mental health outcomes, suicide
    prevention, addressing provider shortages, and safeguarding the
    dignity of those who have worn the uniform.
        First, H.R. 785, the Representing Our Seniors at VA Act.
    This bill appropriately recognizes the vital role that State
    veterans homes play in long-term care. As the average age of
    our veteran population reaches 75 this year, this legislation
    would add a representative from the National Association of
    State Veterans Homes (NASVH) to the Geriatrics and Gerontology
    Advisory Committee. With over 169 homes now operating under
    NASVH, this change is both timely and necessary.
        Second, the VA Data and Transparency and Trust Act is a
    good step toward improving VA reporting on health care and
    benefits. By expanding access to underlying data and requiring
    disaggregation by gender, age, geography, and condition, this
    legislation enhances oversight, fosters collaboration, and
    enables evidence-based improvements in care delivery. We
    support the bill with amendments to clarify definitions like
    ``reliance'' on VA care and minimize administrative burden
    while urging the inclusion of data on caregivers, survivors,
    and emerging chronic conditions.
        We also offer strong support for H.R. 3400, the TRAVEL Act,
    which would authorize temporary VA physician assignments to
    U.S. territories like Puerto Rico and Guam. With physician
    shortages reaching crisis levels in these areas, this
    legislation brings us closer to healthcare equity for veterans,
    no matter where they live.
        Further, we commend the draft legislation directing VA to
    study RNA sequencing as a diagnostic tool for post-traumatic
    stress. While this technology should never be used as the sole
    basis for compensation decisions, it holds promise for
    advancing diagnostic precision and developing targeted
    therapies. We must embrace science without losing sight of the
    holistic nature of invisible wounds.
        Workforce development also remains a priority. That is why
    we support the bill establishing employment timeframes for
    Health Professional Scholarship Program participants, a
    commonsense measure to address critical shortages and ensure VA
    retains its pipeline of trained professionals.
        On caregiver support, H.R. 2148 expands transitional health
    care and provides stipends for career re-licensure, recognizing
    the sacrifices caregivers make. These steps help veterans
    remain in-home settings at a fraction of the cost of
    institutional care and ensure caregivers can reenter the
    workforce with dignity and purpose.
        Finally, H.R. 2605, the SAVES Act, would establish a grant
    program to expand access to service dogs through accredited
    nonprofits. VA's own research continues to confirm that
    veterans paired with service dogs experience reduced post-
    traumatic stress symptoms, decreased suicidal ideation, and
    improved quality of life. The VA itself offered a FOX Grant to
    a service dog organization.
        Anyone who owns a dog will tell you they can be
    therapeutic. You do not need research. When fingers meet fur,
    magic happens. I know from personal experience, having
    previously benefited from a service dog named Kaya (phonetic),
    the profound power a specially trained dog can have in a
    veteran's life. This is why I helped author the original PAWS
    Act of 2016, and Kaya and I spent years advocating for its
    passage before she passed. The compromised version passed in
    2021. The SAVES Act builds on this effort and more closely
    aligns to the text of the original PAWS Act than the
    compromised version that ultimately passed.
        I cannot overstate the power passage and implementation of
    this bill would have on veteran suicide prevention and improved
    mental health outcomes. Because of Kaya, I earned a bachelor's
    and a master's degree. I have a beautiful 2-year-old son. I sit
    here today, as a veteran advocate in the largest division for
    the largest veterans service organization in the country
    because of my service dog.
        Chairwoman Miller-Meeks, Ranking Member Brownley, thank you
    for the opportunity to testify, and I stand ready to answer
    your questions.

        [The Prepared Statement Of Cole Lyle Appears In The
    Appendix]

        Ms. Miller-Meeks. Thank you very much, Mr. Lyle. My
    apologies to the witnesses and those who are here. Due to the
    vote that has already been called in the House, the
    subcommittee will stand in recess subject to the call of the
    chair. I expect to reconvene 10 minutes after the start of the
    last vote. There are 5 votes.
        [Recess]
        Ms. Miller-Meeks. Welcome back. I am sorry. Mr. Schmitt.

                       STATEMENT OF JOHN SCHMITT

        Mr. Schmitt. Good afternoon, Chairwoman Miller-Meeks and
    Ranking Member Brownley and members of the subcommittee. Thank
    you for the opportunity to testify today.
        I want to begin not with the science, but with the
    intention behind the science. Because when it comes to the
    lives of veterans, as one myself, I believe that intention
    matters.
        In 2010, the founder of iXpressGenes, Dr. Joe Ng, molecular
    biologist and professor at the University of Alabama,
    Huntsville, was at a routine faculty meeting. Tragedy struck
    when a colleague pulled a handgun out of her purse and murdered
    three people in front of him. Joe fortunately survived, but in
    the aftermath, he watched this spectrum of resilience occur
    among his peers. Joe asked the question that would change
    everything, could trauma have an immunological component? That
    question set us on a path to transform trauma care forever.
        I met Dr. Ng in 2018. I am John Schmitt. I am a CEO of
    iXpressGenes and a two tour Iraq combat veteran, having served
    over 20 years in the Army. When Joe and I crossed paths, I was
    still in uniform. I was trapped in a culture of silence. Like
    many of my peers and contemporaries, because of the risk to my
    career, I could not admit I was unraveling, depressed, anxious,
    and increasingly suicidal. That journey for me has turned into
    a mission. Today I testify not just as a veteran and a CEO, but
    as a survivor advocating for the science to help me heal, and I
    hope will help millions of others.
        While in uniform, I earned a degree in microbiology and
    immunology from Vanderbilt University School of Medicine. It
    was a fateful step, one that quietly equipped me to understand
    the science and the application of the technology that I stand
    before you advocating for.
        Together, our team at iXpressGenes has developed
    groundbreaking blood tests using the power of RNA transcriptome
    analysis, the Trauma Autoimmune Indicator, or TAI as we call
    it. It identifies inflammation caused by trauma, detectable
    before symptoms even surface, to empower prevention, enable
    early intervention, and inform effective treatments for best
    possible outcomes.
        The TAI test reads RNA transcription, how the body's genes
    are responding right now in real time, creating potential for
    limitless therapeutic strategies never before possible. Unlike
    genetics, which only tell us what might happen, RNA tells us
    what is happening and this matters. This matters because it is
    the kind of inflammation that we detect, is the root cause for
    the oxidative stress and the neuroinflammation that crosses the
    blood-brain barrier and contributes to the anxiety, depression,
    and other hallmarks of PTSD. This lab developed test is already
    available commercially through our lab in Huntsville, Alabama.
    It is low cost, it is scalable, and it is incredibly precise.
        With the VA, we are not starting from scratch. With our
    partnerships at VA Birmingham over the last 2 years, we have
    already demonstrated powerful results. In fact, as our key
    clinical research collaborators put it, ``Its high sensitivity,
    specificity, and translational relevance position it as an
    exceptional tool for clinical use. Given the clarity and
    consistency of the data it provides, I strongly advocate for
    its broader adoption and urge that it be rapidly prioritized
    for clinical validation to support improved patient outcomes.''
        PTSD and trauma-related illness have long been treated
    based on symptoms and subjective reporting. Now with RNA
    transcriptome analysis, we can assess it objectively for the
    first time, offering a novel approach for diagnosing, treating,
    and even preventing trauma-induced disease.
        Today there is a promising patchwork of powerful therapies:
    mindfulness, contrast therapy, Eye Movement Desensitization and
    Reprocessing (EMDR), neurofeedback, ketamine-assisted
    psychotherapy, and even psychedelics. It is a choose-your-own
    adventure landscape for our veterans because we have lacked an
    objective compass. TAI is that objective compass and we can use
    it to validate the effectiveness of all of these modalities and
    track clinical progress in real time. We are not starting from
    scratch here either. We have already partnered with
    groundbreaking technology companies using hyperbaric oxygen to
    virtual reality with exceptionally promising early results.
        The VA has long pioneered technologies that went on to
    change the world. Let this be the next chapter, ushering in a
    new standard of precision mental health that is proactive, data
    driven, and lifesaving. iXpressGenes is a company born out of
    tragedy, led by those who have lived the realities of trauma
    and built for a world finally ready to confront it. Let us lead
    the transformation of trauma care. Our veterans deserve it, and
    so does every other American still waiting for their suffering
    to be seen, understood, and treated with precision. The
    opportunity is massive and, as you know, the need is urgent and
    only growing. Now the science is ready. Let us transform trauma
    care together forever.
        Thank you for your time and I welcome your questions.

        [The Prepared Statement Of John Schmitt Appears In The
    Appendix]

        Ms. KING-HINDS. [Presiding.] Thank you, Mr. Schmitt. I now
    recognize Ms. Benson for 5 minutes.

                       STATEMENT OF CAIRA BENSON

        Ms. Benson. Members of the committee, thank you for
    inviting me to testify today. As the wife and caregiver of a
    severely injured and ill combat veteran, it is my honor to
    speak to some proposed legislation that could lessen the burden
    of each of our caregiving families face every day. I care for
    my husband Eric, who deployed twice to Iraq as a combat
    engineer. My husband suffered multiple traumatic brain injuries
    during his years in service and is considered by VA to be
    permanently and totally disabled and unable to work. He is
    wheelchair-dependent, struggles cognitively, suffers from
    migraines and blackouts, and is visually impaired.
        I am also mom to five amazing kids, three of whom have
    needed specialized care over the years. The day my husband was
    awarded permanent and total status, my children and I became
    eligible for CHAMPVA. I breathed a sigh of relief knowing that
    we, too, would have appropriate healthcare.
        In 2021, one of my children began attending college and
    needed monthly medications. We mailed the required
    certification paperwork, but when we went to fill the
    prescriptions, we found CHAMPVA was inactive. I called, sat on
    hold for 4 hours, and learned CHAMPVA's central mail facility
    was 6 months behind on opening mail. Horrifyingly, CHAMPVA
    began requiring semester certifications in 2023 with no option
    to expedite activation for medical best interest.
        Since 2023, my child has suffered from lapsed coverage
    between semesters due to the certification process in CHAMPVA's
    archaic mail system. Winter and summer break became a mix of
    timing medication pickups prior to coverage loss, and paying
    out of pocket for any therapies or doctors' visits. This
    outdated system ensured my child was without insurance from
    November 2024 to May 2025. Caregivers need CHAMPVA fixed
    beginning with ensuring our children who have already given up
    so much do not have to worry over the loss of coverage upon
    their 18th birthday or due to an archaic certification process.
        H.R. 1404, the CHAMPVA Children's Care Protection Act,
    would allow coverage until age 26, eliminating these egregious
    situations. It would align coverage with civilian insurers and
    the age at which dependents must begin to use their VA Chapter
    35 education benefits. It also recognizes the true nature and
    sacrifice of youth caregivers by allowing them to support the
    need--or support their needs as they transition from caregiving
    into adulthood.
        I understand at VA's recent testimony VA indicated they
    oppose this bill due to the nature of CHAMPVA, arguing that it
    is a medical service and not an insurance product. CHAMPVA
    provides explanation of benefits, approves or denies diagnostic
    and medical treatment codes, and remits payment for enrollees
    to providers for services. CHAMPVA even has out-of-pocket
    maximums, deductibles, co-pays, and a medication formulary with
    tiered pricing.
        Every year, enrollees receive a 1095B attesting to the fact
    that CHAMPVA counts as minimum essential coverage under the
    Affordable Care Act. I admit I am a layperson, but this feels
    like every other insurance product I have ever received through
    an employer. While I am here to support extending CHAMPVA
    coverage to age 26, I implore this committee to use its
    oversight authority to improve the system itself so our
    families can use it to find appropriate care. To help you
    understand the challenges, let me explain what using CHAMPVA is
    like.
        In 2019, one of our children was hospitalized and needed a
    residential facility. I was told to find a facility that would
    take CHAMPVA without the guidance of a provider network. I
    called over 20 facilities that were TRICARE approved to see if
    they had a bed available or could add my child to their wait
    list. All but one turned me down immediately. The reason? Prior
    authorization under CHAMPVA since January of that year was
    taking upward of 6 to 9 months. The one residential facility
    that did agree to treat our child had a stipulation. We were to
    sign $110,000 promissory note upon admission and the chance
    CHAMPVA refused authorization and payment.
        Another of my children needed specialized therapy which was
    completed in 2021. In 2023, the provider called me to let me
    know they had finally received payment from CHAMPVA, almost 27
    months later. Unlike its TRICARE counterpart, CHAMPVA has no
    contracted network of providers and no published fee schedule.
    CHAMPVA processes the majority of provider and enrollee claims
    using a single traditional mail center, lengthening the time
    between claim submission, processing, and reimbursement.
        Filing and retaining providers willing to file it in my
    area--I am sorry, filing and retaining pay for services has
    become so cumbersome that the number of providers willing to
    file it in my area dropped to two practices, neither containing
    a pediatrician.
        Once again, I am paying out of pocket for basic routine and
    pediatric care. I have stopped filing for reimbursement myself
    due to the burden of the process. It is one more bureaucratic
    fight caregivers like me do not need. Yet I know another fight
    looms on the horizon.
        Not long ago, I firmly realized, like so many other
    caregivers, I would likely become a survivor. Having given over
    a decade to being a caregiver, I was situated to outlive my
    veteran with no retirement, no active work credits, and almost
    no life insurance for my family's financial security. I am not
    alone. Mozella Richardson Kamara, a 2025 Dole caregiver fellow
    from Delaware, studied for many years to become a civil
    engineer, but left her job to care for her veteran husband.
    Like myself, Mozella made this choice to ensure immediate well-
    being of her husband and sacrifice their own long-term
    professional goals and retirement potential for the benefit of
    the veteran.
        According to a recent Research and Development (RAND)
    report, military connected caregivers saved this Nation in
    healthcare costs by providing a minimum of $119 billion in
    unpaid care. In exchange, we face this harsh reality: when our
    caregiving ends, many of us will be financially destitute.
    Caregivers like Mozella and me, we need you to pass H.R. 2148,
    the Veteran Caregiver Reeducation, Reemployment, and Retirement
    Act. This bill will not fix the entirety of the problem, but it
    is a valuable first step in ensuring caregivers can begin to
    plan for retirement and establish safety nets of their own.
    More immediately, it will provide caregivers financial security
    by allowing for reentry--work reentry programs and paying for
    relicensure in careers like teaching and engineering.
        Again, I am honored to be here at the request of the
    Committee and the Elizabeth Dole Foundation. To truly support
    the veteran, we must support the caregivers, survivors, and
    families who bear the burden of the war that continues to rage
    at home.
        I thank you for your time and attention and I look forward
    to your questions.

        [The Prepared Statement Of Caira Benson Appears In The
    Appendix]

        Ms. King-Hinds. Thank you very much, Ms. Benson. Thank you
    to all of you for your very insightful testimony.
        I now recognize Ranking Member Brownley for 5 minutes.
        Ms. Brownley. Thank you, Madam Chair.
        Ms. Benson, thank you for being here. I think you and I
    think alike when it comes to the CHAMPVA bill and you certainly
    have my commitment to continue to work hard on this. You know,
    I introduced this back in 2019, so it has been something that I
    have been trying to work on for a long time. I can tell you
    before I even got to Congress there were a couple of members
    who have carried this bill. For a very long time we have been
    trying to fight for some kind of parity and healthcare. We will
    continue that fight.
        I agree with you that we need more committee oversight of
    the program. Again, I commit to you to make sure that that
    happens. Hopefully, you can join us again in another hearing
    and I certainly would encourage Dr. Miller-Meeks to help me in
    that process. I think we should try very hard to encourage the
    VA Office of Inspector General and the Government
    Accountability Office to assist us in this effort to drill
    down.
        About 18 months ago, VA's Office of Integrated Veteran Care
    began an initiative to modernize what it calls the Family
    Member Programs, which included CHAMPVA. You are smiling. They
    planned to implement additional Information Technology (IT)
    systems to administer the program and move away from a paper-
    based process. Have you noticed any improvements in the last 18
    months as far as hold times when you call the CHAMPVA call
    center or processing times when you submit paperwork?
        Ms. Benson. I want to thank you for your commitment and the
    question. I actually called this morning and when I called at
    opening, the hold time was an hour and a half, which is not
    bad. They did now offer----
        Ms. Brownley. Which is not bad?
        Ms. Benson. I am used to 4 to 6 hours with CHAMPVA. They
    did offer callback service now, which was new. I called May 21.
    I was here in town and spoke with another caregiver who was
    having similar recertification issues and she was able to get
    through. They told her they were opening mail from January.
        Ms. Brownley. Tell me about the paper process.
        Ms. Benson. The paper process, I understand that there is--
    I actually just spoke with another caregiver whose wife is
    pregnant and diabetic. They are trying--well, I am sorry, the
    veteran, his wife is pregnant, diabetic. They are trying to get
    her CHAMPVA turned on. They went to go submit through the
    online portal, which is down. There is a fax number which has
    been disconnected.
        Ms. Brownley. A fax number?
        Ms. Benson. Yes, ma'am, a fax number. That was the
    expedition process that we had always used in the past.
        Ms. Brownley. I have not seen a fax machine in a long time.
    I guess I should go over to the VA perhaps to see one.
        Ms. Benson. Yes. I can tell you that the way we were able
    to turn on my daughter's insurance was that I called, I
    instituted a VHA executive inquiry. That executive inquiry
    allowed us to upload the documentation and bypass the mail
    system. The ability to turn it on once that is uploaded is
    instantaneous.
        Ms. Brownley. Is what?
        Ms. Benson. Instantaneous.
        Ms. Brownley. Instantaneous.
        Ms. Benson. I do not understand why we are on a mail paper
    system when no other provider, including other government
    medical benefits are. That is the best answer I have is that,
    no, I have not seen an improvement at all.
        Ms. Brownley. I had a feeling that that was going to be
    your answer, but I wanted it for the record, so thank you for
    that. You know, in addition to the Children's Care Protection
    Act, what should we prioritize in terms of oversight or
    legislation to improve the CHAMPVA program for your family and
    for other families?
        Ms. Benson. My belief is, again, wonderful question, my
    belief is the statute is outdated.
        Ms. Brownley. Yes.
        Ms. Benson. The statute is very outdated. We have been a
    very small constituency, 737,000, of those only about 408,000,
    according to the congressional Report that was done in October
    of last year, are actually users. We have to at least bring it
    up to the standard that is TRICARE, who has a contract, who has
    providers. It is impossible for me to go to a provider and say,
    you may or may not be paid Medicaid rates. Would you please
    accept this? The only mandated acceptors are hospitals and
    urgent cares.
        Ms. Brownley. Hospitals and what?
        Ms. Benson. Urgent cares.
        Ms. Brownley. Oh, and urgent cares.
        Ms. Benson. To the VA's point today that they are worried
    that the money that this would cost would take away from
    healthcare of the veteran, I argue we are healthcare. Every
    caregiver, every youth caregiver, we provide billions in
    healthcare for our veterans. We save lives every day. We are
    the front lines. We are providing that. In exchange, we are
    left without our own care for ourselves because caregiving is
    stressful and destroys our own health. Our children, who are
    higher special needs rates, are left without coverage and it is
    impossible to find coverage. We are, as you said earlier, we
    are so behind even TRICARE, and it is egregious.
        Ms. Brownley. It is egregious. I agree with you.
        My time is up. I also hope that the VA begins the process
    of instituting the Elizabeth Dole Bill, because that, too--
    well, I should not say that, too, but that will be helpful and
    supportive of you as a caregiver to your husband and certainly
    to your children as well. I really enjoyed working with the
    Elizabeth Dole Foundation to have that section in the bill that
    takes care of our caregivers.
        Thank you for your husband's service. Thank you for your
    service and helping him.
        With that, I yield back.
        Ms. Miller-Meeks. [Presiding.] Thank you, Ranking Member
    Brown.
        The chair now recognizes Representative King-Hinds for any
    questions you may have.
        Ms. King-Hinds. First of all, I want to say thank you to
    each and every one of you for coming here and providing your
    testimony and sharing your insights with regards to different
    legislations that are before us. Time is money and traveling is
    very costly, so I definitely appreciate it.
        I want to start off first by saying thank you to TSL
    Foundation for supporting my very own constituent, Mr. Randy
    Johnson, who has made the 8,000-mile trek here to Washington,
    DC, to amplify the voices of the veterans across the territory,
    specifically the Commonwealth of the Northern Mariana Islands.
    I want to focus my questions today to further flesh out some of
    the challenges that the veterans in the CNMI face by asking a
    couple of questions to Mr. Johnson.
        Just for the record, prior to a few--up to about 3 months
    ago, you were employed by the district office by my predecessor
    and then the first couple months during my tenure serving as a
    community caseworker, basically serving our veterans. In your
    experience there, what are the three areas of concerns that are
    frequently raised by the vets who come and seek help at the
    office?
        Mr. Johnson. Thank you for your questions. The veterans
    seek travel. They have difficulty with travel, mainly, to their
    appointments. A lot of times the veterans have to pay out of
    pocket. The veteran from Tinian and Rota traveling to Saipan
    have to pay out of pocket to travel to go see the VA doctor on
    Saipan. If they have to get further care, they have to go
    through BeniTravel, which is on Guam, and a lot of times
    BeniTravel will not issue the tickets immediately for them and
    sometimes it may take up to a couple of days, right, even
    before their appointment schedule. At that point, sometimes the
    veteran is stressed and was worried if they have to cancel or
    postpone their appointments and seek alternative care or
    alternative means by either fundraising for the necessary funds
    to travel or taking up personal loans. A lot of veterans on
    those islands are on fixed incomes and so filing for
    reimbursement with the VA sometimes can be difficult.
        I know a lot of our veterans are old school, so they would
    rather talk to somebody in person. Communicating with the VA is
    difficult on Guam because they are also working with their VA
    veterans on Guam. Our veterans are stuck with having to wait on
    calls sometimes or not get through and that poses a difficult
    challenge for them as well.
        Ms. King-Hinds. All right. Tell us just a little bit, just
    so that the committee has an idea, what the cost of travel is
    for vets, for example, from Rota or Tinian----
        Mr. Johnson. Yes. The travel----
        Ms. King-Hinds [continuing]. and what all that entails.
        Mr. Johnson. Yes. The travel between the interislands can
    run up a couple hundred dollars round trip, and that is just
    the veteran him-or herself. Oftentimes veterans are
    uncomfortable traveling by themselves so they would pay for
    their spouse or caregiver and that comes out of pocket, and
    then they would have to file for reimbursement. Fortunately, I
    have not heard of delay in that reimbursement. I would have to
    assume that there has been delays because that was an issue
    during my employment during my--the last delegate-under
    Delegate Sablan. That was something that we had tried to close
    gaps with the reimbursement because a lot of these veterans do
    not just have a single appointment on Guam or Hawaii, they have
    multiple appointments. While they are waiting for the
    reimbursement, they have to push back their next appointment at
    times.
        Ms. King-Hinds. In terms of specialized care, what are the
    areas of needs do you foresee being something that will fulfill
    some of the medical requirements that are needed on the ground?
        Mr. Johnson. Yes. The one thing that been highlighted
    during discussions recently is the chiropractic care. I do know
    some veterans that do travel to Guam for chiropractic care,
    including myself in the past. Those tickets can, round trip,
    run between $300 to $580 through United Airlines and that is
    just the airline itself. Then, also, you are considering the
    overnight stay because there is only one flight leaving to Guam
    daily. Those can add up significantly for a veteran.
        Ms. King-Hinds. All right, thank you.
        I yield back the balance of my time. Thank you, Chair.
        Ms. Miller-Meeks. Thank you, Representative King-Hinds.
        I now recognize myself for 5 minutes for questions.
        Mr. Lyle, can you share with us how veterans around the
    country would benefit from Congressman Luttrell's SAVES Act?
        Mr. Lyle. Thank you for the question, Chairwoman Miller-
    Meeks. Obviously, in my opening statement, I testified that I
    have a large, extensive personal experience with this as an end
    user of a service dog.
        As somebody who has advocated and heard from other veterans
    for years, you know, I think there is a misconception that
    service dogs, at least at the VA, service dogs should be viewed
    simply as clinical tools. I think they also serve as a powerful
    backstop to veteran suicide because when you are in that point,
    that critical crisis point, you feel unloved, you feel alone,
    and you look down at the dog and you say, I cannot leave the
    dog, and the dog would miss me. Right? It provides a sense of
    purpose that pills and therapy simply just will not ever do.
        I was a little upset to hear the study that the VA cited,
    which I am very familiar with. The study, in my mind, was set
    up to fail because the control group was emotional support
    animals, not somebody that did not have a service dog
    altogether. The study, even though I feel it was set up to
    fail, still showed positive results for reduced post-traumatic
    stress symptoms, depression, anxiety, any number of different
    things.
        In my long history of advocating for this, the amount of
    veterans that have reached out to me and said, you know, I saw
    your story and it prompted me to get my own dog, and if I had
    not had the dog, I would have killed myself, is just super
    powerful testimony to that end.
        Ms. Miller-Meeks. Thank you. Mr. Coker, would you mind
    sharing firsthand accounts of servicemembers and their
    families' inability to access your facilities due to the
    current policy and how my legislation would help prevent this
    from occurring again?
        Mr. Coker. You know, the VA medical centers have such a
    tremendous affiliation with academic medical centers, and so
    often we believe that both within the DOD health system and VA
    health system, you have world-class healthcare. Sometimes the
    treatments need to be so specialized, and when you do not have
    a safe, comfortable environment for your family to be there,
    you worry about do I max out the credit cards? Or you decide I
    am going to accept what time I have left, and I will just
    forego treatment so that we can be together. That is not a
    decision that a military member should have to make.
        Ms. Miller-Meeks. Thank you very much. Ranking Member
    Brownley, would you like to make any closing remarks?
        Ms. Brownley. I have no closing remarks, but I thank you
    for bringing the witnesses here today and reviewing all of
    these bills and look forward to continuing to mark them up and
    move them forward.
        Ms. Miller-Meeks. I want to also thank our witnesses and
    then again apologize for the 90-minute delay on recess as we
    had to go vote.
        On behalf of the subcommittee, I want to again thank all of
    you, the witnesses and the members, for being here today. I
    look forward to working with you and the Ranking Member to
    address the issues facing our veterans.
        The complete written statements 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 4:44 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

                                  ----------

                   Prepared Statement of Antoinette Shappell
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                       Prepared Statement of David Coker

        Thank you, Chairwoman Miller-Meeks, and good afternoon to the
    members of the Committee.
        My name is David Coker, and I have the privilege of serving as
    President of Fisher House Foundation.
        The Fisher House program was founded in 1990 by Zachary Fisher, a
    private citizen and patriotic philanthropist who believed that no
    military family should ever struggle to be by their loved one's side
    during a medical crisis. He built the first Fisher Houses at the
    National Naval Medical Center and Walter Reed Army Medical Center. The
    vision was simple but powerful: to create a home away from home for
    families traveling to be with a loved one receiving care.
        The Fisher House program has now grown into a network of 100 Fisher
    Houses located at Department of Defense hospitals and VA medical
    centers across the country and overseas. Because of the special mission
    of supporting both military and veteran families, it is fitting that
    the 100th Fisher House, to be dedicated next month, is located at the
    Captain James A. Lovell Federal Health Care Center--the only fully
    integrated DoD and VA medical center in the country.
        Each home is now built through the generous support of the American
    public and donated to the VA or the military service it serves. To
    date, Fisher Houses have offered more than 12 million nights of lodging
    and saved families more than $650 million in out-of-pocket costs.
        When we gift a Fisher House to the Army, Navy, Air Force, or VA,
    our goal is to support families in their time of greatest need. We know
    that having a loved one present improves recovery. Family members serve
    as caregivers, advocates, and a tremendous source of strength. We
    believe they are essential to the healing process--and that every
    veteran and service member deserves to have their loved one at their
    side.
        Of the 100 Fisher Houses, more than half support VA medical
    centers. In 2024, VA Fisher Houses served more than 24,000 veteran
    families--spanning all eras and every generation.
        Last fall, guidance was published which changed the way VA houses
    operate. It directed that only families of veterans receiving VA-
    directed care were eligible for the support Fisher Houses provide. Even
    when rooms are available, families that have historically been welcomed
    must now be turned away.
        Last year, the occupancy rate at VA Fisher Houses across the
    country was 53 percent. We would ask if a room was available;
    consideration should be given to support the family of an eligible DoD
    beneficiary.
        The Fisher House supporting the Washington DC VA Medical Center is
    on the same campus as the Children's National Hospital, the National
    Rehabilitation Hospital, and Washington Hospital Center. Last year,
    occupancy at that house was 22 percent and could easily accommodate
    families receiving care at one of the other hospitals.
        The world-renowned Paley Orthopedic and Spine Institute is located
    near the Fisher House supporting the Thomas H. Corey VA Medical Center
    in West Palm Beach, Florida. 27 military children were referred to them
    for life-changing care last year, but today their families are no
    longer eligible to stay in the Fisher House.
        There are three Fisher Houses at the DeBakey VA Medical Center in
    Houston, Texas adjacent to the Texas Medical Center and MD Anderson.
    Last year, the occupancy rate was 63 percent, and again, because of
    this guidance, military families will be turned away.
        The bipartisan Fisher House Availability Act of 2025 would restore
    the flexibility that VA Fisher House managers once had, allowing
    families of active-duty service members and other eligible
    beneficiaries to stay on a space-available basis, while preserving the
    priority access for veterans.
        This change will not reduce access for veterans. It simply allows
    these homes--already built, already staffed, already serving--to do
    what they were intended to do: keep families of our Nation's heroes
    together in the hardest moments of their lives.
        This bill is consistent with the Memorandum of Understanding
    between the Secretary of Defense and the Secretary of the VA--
    Strengthening our Partnership in Service to those we Serve, and it will
    provide one more way for the two departments to work together to
    support both the military and the veteran communities.
        On behalf of Fisher House Foundation and the tens of thousands of
    families we have the privilege of serving each year, I want to thank
    the sponsors of this bill and all of you for your support for our
    Nation's service members, veterans, and their loved ones. Thank you for
    the opportunity to speak today. I welcome your questions.

                      Prepared Statement of Randy Johnson

        Thank you, Chairman Bost, Ranking Member Takano, and members of
    this Committee.
        My name is Randy Johnson. I am a resident of the Northern Mariana
    Islands, a veteran of the United States Marine Corps, and for the past
    decade I have had the privilege of assisting fellow veterans in the
    Northern Marianas, helping them navigate the VA system, and access the
    benefits they earned through their service.
        I have traveled nearly 8,000 miles to be here today to speak in
    support of H.R. 3400, the Territorial Response and Access to Veterans'
    Essential Lifecare Act, known as the TRAVEL Act, introduced by our
    delegate, Congresswoman Kimberlyn King-Hinds.
        This is a good bill. In the Northern Marianas, we do not have a VA
    medical center. We do not have consistent access to specialty care or
    mental health services. When veterans need more than basic care, we are
    often told to leave the island, traveling thousands of miles, paying
    out of pocket, and spending weeks away from our families.
        The TRAVEL Act helps to change that. It allows the Department of
    Veterans Affairs to send traveling VA physicians into remote
    communities like ours. Instead of forcing the veteran to chase care
    across oceans, this bill brings care to the veteran. That is the right
    direction.
        I am here to voice my support for the TRAVEL Act. But I also came
    this distance to give voice to the hundreds of veterans who could not
    be here. Veterans who served this country with honor, who, like me, are
    not asking for special treatment. We are asking for what we would
    receive if we lived anywhere else in the United States.
        We are the only place in the Nation where a veteran can call home
    but have no access to a Community Based Outpatient Clinic. No CBOC at
    all. Veterans from every conflict, past and present, have been told
    that if they want the full range of care they have earned, they cannot
    live at home.
        Veterans seeking care at home see one doctor, on Tuesdays and
    Thursdays. Dr. Ada has done a good job, but there is only so much one
    person can do. Her office has one VA Registered Nurse, a veteran
    herself. But if she needs care, or takes a much-needed vacation, there
    is no one left to keep pace.
        Decisions on care, travel, and benefits happen in Guam or Hawaii.
    Resources come from Guam or Hawaii. And when those places are
    struggling or overloaded, we cannot reasonably expect them to
    prioritize our needs.
        But what we want, and what I believe we have earned, is the right
    to live in the country we fought for, in the community we fought for,
    and to have our service speak for itself. We should not have to choose
    between access to care and being home with our families. We stood the
    watch. We answered the call. That should be enough.
        I served in Iraq. I saw combat. And I received the Purple Heart for
    it. I traveled here by choice, but many veterans are forced to travel
    simply to receive the care they need. That should not be the case.
        In the Northern Marianas, I have served alongside and advocated for
    generations of veterans, those who fought in Vietnam, Panama, Iraq, and
    Afghanistan. All of them returned home to a system still not built to
    meet their needs.
        As I made my way here, I thought of the Vietnam veterans in their
    70's and 80's who served our Nation even before our islands were
    formally part of this country. They have spent a lifetime fighting for
    benefits that only trickled in, slowly, over decades. Now, even in
    their later years, they are still being asked to travel off-island for
    basic, sometimes life-sustaining care. I think of how difficult this
    travel is for them.
        I thought of the Gulf War veterans who opened a new chapter in
    America's military history, but returned to the same old gaps in care
    and support.
        And I thought of my own generation, those who served in Operation
    Iraqi Freedom and Enduring freedom. We served with commitment. We
    returned home with hope. But we still face the same cycle of delay,
    denial, and distance.
        Of this new generation of veterans, I am proud to be part of a
    group that is organizing to support one another directly. Project Buddy
    Check 670 is an example of that effort. It reflects our belief that
    care for veterans does not always come in the form of a pill or a
    prescription. Sometimes, it comes from another veteran picking up the
    phone, checking in, and listening.
        Project Buddy Check is a reminder that veterans seeking care that
    treats us as people, not just patients. But when even ordinary medical
    care is so far out of reach, how can we expect the system to provide
    the mental health and holistic support our veterans truly need?
        Generations of veterans have answered the call from our islands. I
    know the challenges we face are difficult to address. But again, we
    stood the watch. We bore the burden. That should be enough. It is time
    the system answered back.
        H.R. 3400 is a strong start. I respectfully ask this committee to
    support it and to continue advancing policies that bring real access
    and real dignity to every veteran, no matter where they live. Thank you
    for your time, and for your unwavering commitment to those who served.

                        Prepared Statement of Cole Lyle
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                       Prepared Statement of John Schmitt
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                       Prepared Statement of Caira Benson

        Chairwoman Miller-Meeks, Ranking Member Brownley, Members of the
    House Committee on Veterans' Affairs, thank you for inviting me to
    testify today. As the wife and caregiver of a severely injured and ill
    combat veteran, it is my honor to speak to some proposed legislation
    that could lessen the burden each of our caregiving families face every
    day.
        Veteran family caregivers are a group of people who have been
    tempered in the fires of a war many will never see and even fewer will
    understand. We are forged stronger every day we fight for appropriate
    care for our loved ones.
        I care for my husband, Eric, deployed twice to Iraq between 2003-
    2006, spending roughly over 20 months in combat zones. I immediately
    noticed things were off upon his return home, but I was told not to
    worry. It was only ``expected reintegration stress.'' By 2007, my
    husband's ``reintegration stress'' would ensure he couldn't feel his
    legs when he ran. He was quickly put on a permanent profile, meaning he
    was unable to carry out a mission due to medical conditions that had
    not stabilized, and, due to deployment readiness policies at the time,
    my husband was separated from the Army with no medical board and no
    financial security.
        We would spend the next decade fighting for understanding of his
    injuries as well as proper diagnosis and treatment while often facing
    the worst-case scenario. Initial screens for Traumatic Brain Injury
    (TBI) were non-existent or misunderstood; the Veterans Health
    Administration (VHA) originally told me my husband's IQ was too high to
    have suffered TBI, despite all evidence to the contrary. By 2010, my
    husband needed full-time care, and I would have to step down from my
    position as an executive director at a non-profit. It would take us
    until 2018 to formally diagnose my husband's multiple TBIs, despite a
    clear record of evidence. It would take another year to figure out his
    case was complicated by toxic encephalopathic process, most likely due
    to chemical exposures. The two conditions, mingling together, started a
    path of neurological degeneration that cannot be stopped.
        Today, Eric is considered by the Department of Veteran Affairs (VA)
    to be permanently and totally disabled and unable to work. He is
    wheelchair dependent, struggles cognitively, suffers from migraines and
    blackouts, and is visually impaired. I care for him full-time and am
    enrolled in the VA's Program for Comprehensive Assistance for
    Caregivers (PCAFC). His TBI care is considered complex enough it is
    managed by a university specialty neurological team.
        You should know I am also mom to five amazing children, three of
    whom have needed specialized care over the years. The day my husband
    was awarded permanent and total status, my children and I became
    eligible for the Civilian Health and Medical Program of the Department
    of Veteran Affairs (CHAMPVA). CHAMPVA is medical coverage offered to
    dependents and survivors of eligible veterans, mainly those with 100
    percent permanent and total disabilities. CHAMPVA is also offered to
    caregivers through PCAFC. I breathed a sigh of relief knowing that we,
    too, would have appropriate health care for our needs.
        However, in 2021, one of my children began attending college prior
    to their 18th birthday and needed monthly medications. We mailed the
    certification paperwork, but, when I went to fill prescriptions, I
    found out CHAMPVA was inactive. I called CHAMPVA, sat on hold for 4
    hours, and was told that CHAMPVA's central mail facility was 6 months
    behind opening mail. Because my child was on medications that would
    cause permanent damage if terminated without tapering, I was offered an
    expedited process to certify and activate the CHAMPVA coverage within 7
    days via fax. We used the same method to certify coverage in 2022.
    However, in the fall of 2023, coverage lapsed again when certifications
    began to be required on a semester basis instead of a yearly basis,
    compounding the mail-in timeframe dilemma. Horrifyingly, CHAMPVA agents
    relayed to me that CHAMPVA had terminated the ability to expedite
    certifications in the fall of 2024.
        My child, who is in therapies and on daily medications, suffered
    from lapsed coverage between semesters--even over Christmas break--due
    to the way certification was completed. CHAMPVA's archaic mail system,
    often months behind in opening mail, complicated the ability to
    maintain coverage. Winter break and summer break became a mix of timing
    medication pickups prior to coverage loss and paying out of pocket for
    any therapies or doctor's visits. Indeed, until last month, my child,
    who was enrolled in school, had been without insurance since November
    2025, had been paying out of pocket for meds and therapies, and had an
    unpaid ER bill sent to collections. However, it wasn't a miracle in the
    mail room that finally activated the CHAMPVA coverage; it was an
    executive inquiry within VHA.
        I have another child who graduated high school this past May. With
    licenses and certificates in hand, my child desires to work instead of
    going to college. However, this child knows that within the next 6
    months, their CHAMPVA coverage will disappear unless they enroll in
    college or trade school. Can you imagine the pressure on this 17-year-
    old who worked day in and day out to finish high school and attain a
    drone pilot's license within 3 years to meet their goals? This child
    who has given up so much to aid me in the care of their father, who has
    suffered the trauma of watching their father's degeneration, and who
    has been devastated over the lack of appropriate care for both their
    father and their siblings--tell me, how do I tell my child that the
    system meant to help us has spectacularly failed once more?
        Caregivers like myself and our families need CHAMPVA fixed and that
    begins with ensuring our children, who have already given so much,
    don't have to worry over loss of coverage upon their 18th birthday or
    suffer from lapse of coverage due to an archaic certification process
    by passing H.R. 1404, The CHAMPVA Children's Care Protection Act. This
    legislation would help alleviate these egregious situations by
    authorizing CHAMPVA eligibility automatically through age 26, allowing
    us to forgo the constant bureaucracy, which makes using the benefit a
    challenge. It also recognizes the true nature and sacrifice of these
    young caregivers by allowing them the support they need to transition
    from caregiving into adulthood while having their medical and mental
    health needs supported during key years. Allowing the younger
    dependents coverage until age 26 is crucial and aligns with not only
    private, civilian insurers but also the age limit CHAMPVA eligible
    dependents CHAMPVA must begin to use their VA Chapter 35 Dependent's
    Education Assistance.
        I understand in VA's testimony to the Senate Veteran Affairs
    Committee on May 21, 2025, VA indicated they opposed this bill due to
    the nature of CHAMPVA, arguing that it is a medical service and not an
    insurance product.
        However, the industry, the Federal Government, and, more often than
    not, VA treat CHAMPVA as an insurance product. For instance, like those
    covered by Medicaid, Medicare, or TRICARE, my family may not take part
    in the drug cost reduction programs offered to patients on fixed or low
    incomes due to our eligibility for CHAMPVA. If we choose to shop for
    insurance through the Health Care Marketplace, CHAMPVA enrollees are
    not eligible for either financial assistance nor advance premium tax
    credits. Every year, CHAMPVA enrollees receive a 1095-B attesting to
    the fact that CHAMPVA counts as minimum essential coverage under the
    Affordable Care Act. Finally, even VHA states that CHAMPVA is only
    available to caregivers enrolled in PCAFC when they have no other
    health insurance.
        CHAMPVA provides explanations of benefits (EOB), approves and
    denies diagnostic codes, approves and denies medical treatment codes,
    and remits payment for enrollees to providers for approved services
    rendered by the medical community. CHAMPVA even has out-of-pocket
    maximums, deductibles, copays, and a medication formulary with tiered
    pricing. I admit I am a lay person, but this feels like every other
    insurance product I have ever received through an employer.
        While I'm here to support extending CHAMPVA coverage to age 26, I
    also ask that this Committee use its oversight authority to improve the
    system itself so our families can find appropriate medical care.
        To help you understand the challenges, let me explain what using
    CHAMPVA is like. In 2019, when one of our children was hospitalized and
    needed movement to a residential facility, I was told to find a
    facility that would take CHAMPVA, as there was no facility nor provider
    network available under CHAMPVA. I called over 20 TRICARE approved
    facilities to see if they had a bed available or could add my child to
    their waitlist. All but one turned me down immediately. The reason -
    prior authorizations under CHAMPVA since January of that year were
    taking upwards of 6-9 months. The one residential facility that did
    agree to treat our child had a stipulation - we were to sign a $110,000
    promissory note upon admission in the chance CHAMPVA refused
    authorization and payment. Later during treatment, I would be told that
    CHAMPVA had ordered a discharge within 24 hours, even though our child
    had not completed their treatments. Only intervention by a VHA
    executive, finding the preauthorization form in the mail room, enabled
    necessary continued hospitalization approval.
        Another of my children needed specialized therapy during 2020 and
    2021. The physician didn't routinely take CHAMPVA, but, wanting to help
    us, agreed to see us and bill CHAMPVA. Our child completed her therapy
    in 2021. In 2023, I received a call from the physician's office. They
    had finally received payment from CHAMPVA with the exception of one
    therapy session, which I would have to pay for myself. I gladly paid
    and asked about the delay; the account manager relayed that she'd had
    to mail-in everything and simply wait. Because CHAMPVA has no provider
    contracts or a published fee schedule, the provider only had a ballpark
    estimate of what their payment would be until the claim was returned.
    Due to the mail-in claims system, lack of automation, and lack of
    published fee schedule, providers must wait inordinately long periods
    of time for payment, and that payment is a relative unknown until it is
    received. I can't think of a better scenario to discourage provider
    participation.
        As I mentioned above, CHAMPVA has no contracted network of
    providers or facilities. It has no published fee schedule to share with
    potential providers. It processes the majority of claims using paper
    sent through a mail-in center, lengthening the time between physician
    or enrollee submission, claim processing, and enrollee reimbursement.
    CHAMPVA processes certifications, coverage additions, and changes of
    information through mail - using a single mail center in Colorado for
    all 737,000 enrollees. While an online portal currently exists for
    initial applications only, its functionality varies.
        Providers who have agreed to take CHAMPVA often have mixed
    messaging - hospitals can file electronically, but most providers I've
    spoken to must file by mail. Some are told to file with the mail-in
    center in Colorado, while others are told to file directly with the
    local VAMC Community Care Network (CCN). Filing and retaining pay for
    services has become so cumbersome that the number of providers willing
    to file it in my area, which is last year's fastest growing county in
    the United States, dropped to 2 practices outside hospitals and urgent
    cares. Neither practice willing to file CHAMPVA contains a
    pediatrician.
        Once again, I'm paying out-of-pocket for basic, routine, and
    pediatric care. I've stopped filing for reimbursement myself due to the
    burden of the process, including diagnostic codes which may or may not
    be covered and long pay times.
        My understanding is that CHAMPVA falls under VHA's Office for
    Integrated Veteran Care (IVC), which also runs VHA's CCN. If that is
    true, why could VA not use the existing CCN structure to provide for
    network providers, a published fee schedule, and electronic claims
    submissions? It seems that it would be far more efficient, reduce the
    burden on VA and providers, and better meet the medical best interest
    of our veterans' dependents and caregivers.
        As a wife and caregiver, I have fought every day for appropriate
    care for my husband and for my children. Yet, I know another fight
    looms on the horizon.
        Not long ago, I firmly realized, like so many other caregivers, I
    would eventually become a survivor. Having given over a decade to being
    a sandwich caregiver, I am situated to outlive my veteran with almost
    no retirement, no active work credits, and almost no life insurance for
    my and my family's financial security.
        Because we have fought so long for appropriate care and ratings, my
    family has financially suffered. I left my growing career in non-profit
    administration at the age of 30. What I had saved in retirement until
    that point was cashed out to pay for emergent medical care for my
    family. We have struggled, but survived, for over a decade on only
    disability income. The severity of my husband's injuries, like so many
    others, makes him uninsurable for life insurance.
        I am not alone. Mozella Richardson Kamara, a 2025 Dole Caregiver
    Fellow from Delaware, studied for many years to become a civil
    engineer, but left her job to care for her veteran husband who suffers
    from many service-connected disabilities, both neurological and
    physical. Like myself, Mozella made this choice to ensure the immediate
    well-being of her husband, and, out of love, sacrificed her own long-
    term professional goals and retirement potential for the benefit of her
    family and service-connected veteran husband.
        According to a recent RAND report, commissioned by the Elizabeth
    Dole Foundation and released in September of last year, military-
    connected caregivers save this Nation billions in healthcare costs by
    providing a minimum of $119 billion in unpaid care. In exchange, we
    face this harsh reality--when our caregiving ends, most of us will be
    financially destitute.
        As this harsh reality was revealed, I started planning what I
    could. I used my Chapter 35 Dependents Educations Assistance to finish
    a terminal degree remotely, all while caring for both my husband and
    our children. Once I graduated, I overhauled my resume and began
    seeking any kind of contract work so that I had some earned income.
    That earned income allowed me to finally contribute some small amount
    to a retirement plan. It's too little, too late, but it is something
    more than 0.
        With the growth of remote work, I eventually began searching for
    full-time work so that I could once again have work credits to pay
    toward Social Security and pay toward student loans. Employers are not
    designed to be caregiver friendly, even with their remote employees. I
    found an employer willing to be flexible with me, and I excelled at my
    job. Unfortunately, I had to resign recently because my salary would
    not entirely cover the cost of care for my husband while I worked. I
    loved my work, I had stellar performance reviews, but I was working at
    a net negative after expenses.
        Like Mozella, I have once again put aside my own personal and
    professional goals to care for those who need me. But caregivers like
    Mozella and me, we need you to pass H.R. 2148, The Veteran Caregiver
    Reeducation, Reemployment, and Retirement Act.
        This bill won't fix the entirety of the problem, but it is a
    valuable first step in ensuring caregivers can begin to establish
    safety-nets of their own. It will begin the process and hopefully
    eventually allow caregivers like Mozella and me to contribute to a
    retirement fund. More immediately, it will provide caregivers financial
    security by allowing for returnships, or other possible work-rentry
    program, and paying for re-licensure in careers like teaching and
    engineering, ensuring caregivers like Mozella experience fewer
    obstacles to returning to work.
        It is a truth that 1 day, every caregiver will stop caregiving,
    either through the veteran's improvement or their passing. As a
    thankful nation, we should ensure veteran caregivers do not end up in
    poverty simply because they ensured their veteran had appropriate care
    due to the wounds, illnesses, and injuries sustained while serving
    their nation.
        Again, I am honored to be here at the request of the Committee and
    the Elizabeth Dole Foundation. I am ever thankful that Senator
    Elizabeth Dole led the charge to build a remarkable non-profit that
    ensures caregivers like me are seen, accepted, supported, and
    encouraged. Senator Dole gave caregivers a voice so we are heard in
    places such as this Committee room. Every day, caregivers carry out the
    work of caring for, as President Lincoln said, those who have borne the
    battle. To support the veteran, we must also support the caregivers,
    survivors, and families who bear the burden of the war that continues
    to rage at home.
        I thank you for your time and attention, and I look forward to your
    questions.

                           Statements for the Record

                                  ----------

                      Prepared Statement of Joseph Morelle

        Chairwoman Miller-Meeks, Ranking Member Brownley, thank you for the
    opportunity to submit this statement for the record in support of H.R.
    2148, the Veteran Caregiver Reeducation, Reemployment, and Retirement
    Act. I also want to express my deep appreciation to my colleague and
    co-lead, Representative Juan Ciscomani, for his partnership on this
    vital bipartisan legislation.
        Every day, thousands of family caregivers across the country make
    extraordinary sacrifices to care for our Nation's veterans. They put
    their careers on hold, deplete savings, and forgo personal goals to
    ensure their loved ones receive the care and dignity they deserve. When
    those caregiving duties come to an end--whether through recovery,
    transition to other care, or the passing of a veteran--these caregivers
    are often left to navigate a difficult and uncertain path forward,
    without the tools or support they need to rebuild their lives.
        H.R. 2148 seeks to change that. This legislation would require the
    Department of Veterans Affairs to provide family caregivers with
    practical and meaningful support as they transition into the next
    chapter of their lives. This includes employment assistance, retirement
    planning, bereavement counseling, and reimbursement for professional
    certification or re-licensure fees. It would also require VA to study
    the barriers caregivers face when reentering the workforce, grant
    access to existing employment services, and evaluate the feasibility of
    establishing a retirement savings mechanism tailored to their unique
    circumstances.
        These are not luxuries--they are long overdue acknowledgments of
    the economic and emotional toll that caregiving can take. This
    legislation will empower caregivers to regain their footing and reclaim
    their futures. It is a step toward honoring the quiet service they
    provide behind the scenes and recognizing that their well-being is
    essential to our broader commitment to veterans and their families.
        Finally, I want to extend my heartfelt thanks to the many
    caregivers across America whose strength and selflessness make this
    bill necessary. Your stories, your sacrifices, and your advocacy have
    shaped this legislation. It is my hope that H.R. 2148 is just the
    beginning of a broader national effort to support you in the same way
    you have supported our veterans.
        Thank you.

              Prepared Statement of Paralyzed Veterans of America

        Chairwoman Miller-Meeks, Ranking Member Brownley, and members of
    the subcommittee, Paralyzed Veterans of America (PVA) appreciates this
    opportunity to share our views on some of the legislation before the
    subcommittee today. PVA members, veterans who have acquired a spinal
    cord injury or disorder (SCI/D), experience the breadth of VA care and
    benefits in unique ways due to their injuries and illnesses. We welcome
    the chance to share how some of these bills might impact our members.

    H.R. 1404, the CHAMPVA Children's Care Protection Act

        The Civilian Health and Medical Program of the Department of
    Veterans Affairs (CHAMPVA) is a comprehensive healthcare program for
    the spouse or widow(er) and children of an eligible veteran. Through
    CHAMPVA, VA shares the cost of certain healthcare services and supplies
    with eligible beneficiaries. It may also provide benefits to the
    Primary Family Caregiver through the Program of Comprehensive
    Assistance for Family Caregivers (PCAFC). Coverage for children under
    CHAMPVA currently expires when they turn 18 unless they are full-time
    students. In this case, they continue to receive coverage until they
    turn 23, stop attending school full-time, or get married. However, for
    most Americans with health insurance, their adult children can remain
    on their plan until age 26 with no separate premium, as mandated in the
    Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).
    CHAMPVA and the military's TRICARE programs were not affected by the
    ACA, so they required separate congressional action to extend these
    benefits to children up to age 26. This discrepancy was addressed for
    TRICARE in 2011 and the CHAMPVA Children's Care Protection Act would
    fix this for VA's CHAMPVA program.
        The delay in making this change to CHAMPVA has adversely impacted
    several of our members. Take PVA member Amy and her husband for
    example. She served honorably in the U.S. Marine Corps before an SCI/D
    cut her military service short. Her husband served in the Marine Corps
    as well, but injuries he sustained in Operation Desert Storm curtailed
    his military career, too. Both have 100 percent disability ratings from
    the VA. Their two boys have severe immune deficiencies that were caused
    by their parents' exposure to hazards during their military service. As
    a result, the boys require weekly plasma infusions to keep them alive.
    These infusions cost thousands per month, and they cannot afford to pay
    for them out of pocket. They rely on CHAMPVA to provide this life-
    saving care and suffered tremendous angst when their oldest child
    turned 18. Fortunately, he became well enough with the infusions that
    they were able to keep him in school and CHAMPVA until he turns 23 in
    March 2026. The younger child is currently 17 but he has additional
    comorbidities that may not allow him to do the same. The family is
    straining under the pressure that the lack of action from Congress has
    put on them and unless legislation like this is passed, there is a very
    real possibility that both children will age out of the program next
    year.
        The VA testified in opposition to the companion measure to this
    bill at a May 1, 2025, Senate Veterans' Affairs Committee hearing. The
    witness correctly stated that CHAMPVA was not affected by the ACA, but
    we disagree with VA's assertion that it is not health insurance because
    it clearly functions like it. For example, certain types of care and
    services require preauthorization. This approval is extremely
    important, and the failure to obtain it may result in denial of the
    claim. Also, providers must be properly licensed in their State to
    receive payment from CHAMPVA, and they cannot be on the Medicare
    exclusion list. To be reimbursed, providers must file a claim, using
    diagnosis and procedure codes that all other healthcare plans follow.
        The Congressional Research Service (CRS) which advises Congress on
    programs like this seems to agree. In its October report to Congress on
    VA healthcare programs for dependents and survivors, CRS stated,
    ``CHAMPVA is primarily a health insurance program where certain
    eligible dependents and survivors of veterans receive care from private
    sector healthcare providers. The program is administered by the
    Veterans Health Administration (VHA), Assistant Under Secretary for
    Health (AUSH) for Integrated Veteran Care, Office of Integrated Veteran
    Care (IVC). The law (38 U.S.C. Sec. of veterans, 1781) requires CHAMPVA
    to provide for medical care in the same or similar manner and subject
    to the same or similar limitations as medical care is furnished to
    certain dependents and survivors of active duty and retired members of
    the Armed Forces under [the Department of Defense (DOD) TRICARE
    program].'' \1\
    ---------------------------------------------------------------------------
        \1\ Health Care for Dependents and Survivors of Veterans, October
    16, 2024
    ---------------------------------------------------------------------------
        DOD's TRICARE program wasn't affected by the ACA either, but
    Congress created the TRICARE Young Adult program in 2011 which provides
    health care for qualified young adults aged 21 to 26 who are unmarried
    and not eligible for an employer-sponsored health plan. Our government
    should not deem veterans' dependents and survivors less worthy than
    civilians for support. Those who are eligible for CHAMPVA should be
    able to retain their healthcare coverage until their 26th birthday just
    like those in private and Federal healthcare plans. We urge Congress to
    correct this inequity as soon as possible.

    H.R. 2148, the Veteran Caregiver Reeducation, Reemployment, and
    Retirement Act

        The VA's PCAFC was established by Congress in 2010 to support
    family caregivers who play a critical role in caring for and supporting
    veterans severely injured in the line of duty following 9/11.
    Occasionally, changes have been made to improve the program's support
    of veterans. Such changes include those in the VA MISSION Act of 2018,
    which authorized VA to offer PCAFC to caregivers for veterans of all
    eras.
        Still, the program does not consider that many caregivers are
    forced to reduce their work hours, take unpaid leave, or leave the
    workforce entirely to provide care. They sacrifice wages, retirement
    savings, and financial stability to care for those they love. The time
    away from their jobs creates gaps in their resumes and many lose the
    employment certifications they previously held. When their loved one
    either passes away or returns to independent functioning, caregivers
    need to return to the workplace and must face these issues. Also, those
    who were relying on CHAMPVA for their health care lose this coverage
    within 90 days of leaving PCAFC through the death or discharge of the
    veteran. Members in other insurance programs have 180 days to
    transition their health insurance benefits.
        This bill seeks to strengthen the PCAFC by addressing these, and
    other common problems that many caregivers face. Provisions in the bill
    would provide former caregivers with bereavement counseling, funding to
    renew their professional certifications, and the ability to participate
    in employment assistance programs like Military OneSource or the
    Department of Labor's, Veterans' Employment and Training Service. It
    also directs studies on the possibility of allowing caregivers to make
    contributions to Social Security and other types of existing retirement
    accounts, the feasibility of caregivers being allowed to participate in
    a Department of Labor returnship program, and the possibility of the VA
    incorporating former caregivers into the VA workforce as personal care
    attendants, enabling the VA to lessen staff shortages. Last, it gives
    caregivers who are not Medicare eligible the option to keep their
    CHAMPVA coverage for 180 days, if they need it.
        Caregivers are often the most important component of rehabilitation
    and maintenance for veterans with catastrophic disabilities. As a
    result, their welfare directly affects the quality-of-care veterans
    receive. We strongly support this bill and urge Congress to pass it
    quickly.

    Discussion Draft, the Fisher House Availability Act of 2025

        Beneficiaries of active-duty service members often travel far from
    home to receive care through DOD's TRICARE program. Often their
    appointments don't end until late in the day which then requires them
    to drive extended distances home at night. This bill would allow VA to
    provide temporary lodging to a covered beneficiary or a family member
    of a covered beneficiary on a space available basis. If VA has
    available space and there is no cost to the department, PVA can support
    this legislation.

    Discussion Draft, to provide for a timeframe for the employment in the
    Department of Veterans Affairs of participants in the Health
    Professionals Scholarship Program

        The Health Professionals Scholarship Program (HPSP) provides
    financial assistance to students in various healthcare disciplines,
    aiming to meet VA workforce needs. Participants must complete their
    education and meet qualification requirements before employment, with
    the program requiring an 18-month service obligation for each year of
    support. The current law does not have a provision guaranteeing
    graduates of the HPSP a job at the VA following completion of their
    training. PVA supports this draft bill which requires VA to offer each
    participant a contract for full-time employment at the VA facility with
    the greatest need for their specialty within 90 days of their course
    completion date.

    Discussion Draft, the VA Mental Health Outreach and Engagement Act

        PVA supports passage of the VA Mental Health Outreach and
    Engagement Act. The VA suicide report clearly states that veterans who
    are not enrolled and engaged with the VHA are more likely to die by
    suicide. As we work to reduce the number of veteran suicides, the most
    common sense first step is to conduct proactive outreach to veterans
    receiving compensation for a service-connected mental health condition
    who are not accessing VA mental health services. By conducting
    intentional outreach to a vulnerable population, the department could
    not only increase enrollment in VA mental health programs, but
    ultimately, it may move the needle on curbing the number of veteran
    suicides.

    Discussion Draft, the VA Data Transparency and Trust Act

        The House and Senate Veterans' Affairs Committees are responsible
    for moving legislation expanding, curtailing, or fine-tuning existing
    laws relating to health care and benefits for veterans, certain
    dependents, and eligible survivors. The committees also have oversight
    responsibility of the department, which means monitoring and evaluating
    the operations of the VA. So, if the committees find that VA is not
    administering laws as Congress intended, or if emerging needs of
    veterans are identified, it is addressed through the hearing process
    and legislation. To fulfil this role, the committees need timely and
    accurate information, but in recent years, VA has been unable to
    provide either. We strongly believe that VA should be able to produce
    timely and accurate reports to Congress and respective oversight bodies
    so the committees can ensure the department is providing the benefits
    and services that veterans have earned and deserve.
        We support the VA Data Transparency and Trust Act which requires
    the department to provide Congress with annual reports detailing how VA
    benefits are delivered, who is using them, and how well the system is
    performing while still safeguarding veterans' privacy. This would help
    the committees ensure VA programs are properly funded, operating
    efficiently, and most importantly, meeting the needs of the veterans
    they were intended to serve.

    H.R. 2605, the Service Dogs Assisting Veterans (``SAVES'') Act

        Service dogs provide invaluable assistance to disabled veterans
    with the greatest support needs, allowing them to live more independent
    lives in their communities. PVA supports the SAVES Act, which requires
    the VA to establish a competitive grant program to fund nonprofit
    organizations that provide service dogs to veterans with a variety of
    disabilities, such as mobility or vision impairments or PTSD. Nonprofit
    organizations would be required to submit an application to the
    Secretary that includes a description of the training that will be
    provided by the organization to eligible veterans; the training of dogs
    that will serve as service dogs; the aftercare services that the
    organization will provide for the service dog and eligible veteran; the
    plan for publicizing the availability of service dogs through a
    marketing campaign; and the commitment of the organization to have
    humane standards for animals. Passage of this legislation will increase
    veterans' access to service dogs and their independence.

    Discussion Draft, the Territorial Response and Access to Veterans'
    Essential Lifecare Act or the TRAVEL Act of 2025

        Thousands of veterans who are residents of U.S. territories or
    reside on islands in the Pacific face significant challenges in seeking
    medical care. In May 2024, the Government Accountability Office issued
    a report that found these veterans often experienced ``unique and
    substantial barriers'' that veterans in the United States do not
    encounter when seeking medical services from the VA.\2\ PVA supports
    this proposed legislation, which authorizes the department to utilize
    traveling physicians to provide needed health care to veterans residing
    in these areas.
    ---------------------------------------------------------------------------
        \2\ GAO-24-106364, VETERANS AFFAIRS: Actions Needed to Improve
    Access to Care in the U.S. Territories and Freely Associated States

    ---------------------------------------------------------------------------
    Discussion Draft, the Representing our Seniors at VA Act of 2025

        State Veterans Homes play a crucial role in providing care and
    support for those who have served this Nation in uniform. These
    facilities are designed to meet the unique needs of veterans, offering
    a range of services tailored to their medical and emotional well-being.
    For many veterans and their families, these homes represent a vital
    resource for long-term care, rehabilitation, and companionship. They
    play an outsized role in VA's ability to provide skilled nursing and
    long-term care for veterans. PVA supports including a representative of
    the National Association of State Veterans Homes on the VA's Geriatrics
    and Gerontology Advisory Committee.

    H.R. 2068, the Veterans Patient Advocacy Act

        PVA supports the Veterans Patient Advocacy Act, which seeks to
    ensure there are an adequate number of patient advocates at VA medical
    facilities. Patient advocates are highly trained professionals who can
    help resolve veterans' concerns about any aspect of their healthcare
    experience, particularly those concerns that cannot be resolved at the
    point of care. They help to ensure access to care by listening to any
    questions, problems, or special needs that a veteran has and working to
    resolve them. PVA supports passage of the Veterans Patient Advocacy Act
    with the understanding that VA may need additional resources to assign
    patient advocates to rural community-based outpatient clinics.
        PVA would once again like to thank the subcommittee 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 Gold Star Spouses of America, Inc.

        Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished
    members of the House Committee on Veterans Affairs, Subcommittee on
    Health,

        Gold Star Spouses of America, Inc. appreciates the opportunity to
    submit this statement for the record as the Committee considers several
    important legislative proposals aimed at improving the lives of
    veterans and their families. As an organization dedicated to advocating
    for the needs, dignity, and recognition of surviving military spouses
    and their families, we are encouraged by the Committee's ongoing
    commitment to addressing inequities and modernizing policies that
    directly affect our community.
        We write today to express our strong support for the CHAMPVA
    Children's Care Protection Act (H.R. 1404), introduced by Ranking
    Member Julia Brownley. This legislation would extend eligibility for
    health care coverage under the Civilian Health and Medical Program of
    the Department of Veterans Affairs (CHAMPVA) to children of disabled
    veterans up to age 26, aligning CHAMPVA with current standards
    established by the Affordable Care Act and the Department of Defense's
    TRICARE program.
        Currently, children enrolled in CHAMPVA lose eligibility at age 18,
    or at 23 if enrolled in school. This is in stark contrast to families
    covered under private insurance or TRICARE, who benefit from dependent
    coverage through age 26. As a result, children of disabled or fallen
    veterans are too often forced off health coverage at a critical stage,
    while pursuing higher education or beginning their professional lives.
    This disparity is not only unjust; it places unnecessary financial and
    emotional strain on families who have already endured great sacrifice
    in service to our country.
        Surviving families deserve the same respect, stability, and support
    afforded to others across the Federal health care system. By extending
    CHAMPVA eligibility, this legislation honors the full scope of a
    veteran's service and ensures their children are not treated as second-
    class dependents under Federal policy. We urge the Committee to advance
    this bill and address this longstanding inequity.
        Gold Star Spouses of America stands ready to work alongside
    Congress to strengthen the systems that support surviving families. We
    remain committed to ensuring the promise made to those who serve, that
    their families will not be forgotten, is fully upheld.
        Thank you for your consideration of this statement and for your
    steadfast dedication to veterans and their loved ones.

    Gold Star Spouses of America, Inc.

        Gold Star Spouses of America is a national nonprofit organization
    dedicated to supporting the surviving spouses of military service
    members and veterans who have made the ultimate sacrifice in defense of
    our country. Our mission is to provide meaningful support, advocacy,
    education, and a sense of community for Gold Star families. Through our
    programs, we work to ensure that the needs of these spouses and their
    families are heard, addressed, and prioritized by policymakers at the
    Federal, State, and local levels.
        GSSA is listed as an approved resource in the National Resource
    Directory (NRD.gov) and has been approved by the Department of Defense
    as a resource on Military OneSource and in the ``Days Ahead'' binder
    for all active-duty losses.
        GSSA is also recognized by the Department of Veterans Affairs for
    volunteer opportunities within the department's Center for Development
    and Civic Engagement.

     Prepared Statement of National Association of Veterans' Research and
                             Education Foundations

        The National Association of Veterans' Research and Education
    Foundations (NAVREF) is the national nonprofit organization
    representing over 75 VA-affiliated nonprofit research and education
    corporations (NPCs), established by Congress [38 U.S.C. Sec. Sec. 7361-
    7366] to support the VA's medical and scientific research enterprise.
    Since 1992, our community has facilitated clinical trials, engaged
    private sector and academic partners, and advanced groundbreaking
    discoveries that improve the health and lives of veterans.

    VA Data Transparency and Trust Act

        We commend the intent behind the VA Data Transparency and Trust Act
    to improve transparency and trust in VA data. However, we have concerns
    about the scope and quality of data that would be accessed and reported
    if the legislation were enacted. Specifically, the bill calls for
    medical services data as defined by 38 U.S.C. Sec. 1701, which may not
    fully capture the complexity of veteran care and research activities at
    VA. For example, a veteran receiving medical care for diabetes at VA
    could also be enrolled in an industry-sponsored diabetes study at the
    same VA medical center, but those treatment protocols are not
    traditionally accounted for the same way as a ``medical service'' is.
    This segmentation risks incomplete or skewed reporting, limiting the
    full picture of veteran care and research. We urge Congress and VA
    stakeholders to carefully consider these nuances to ensure transparency
    efforts accurately reflect the scope of veteran care and research and
    ultimately, keep VA accountable on all aspects of the integrated health
    care system.

    RNA Sequencing to Diagnose PTSD Bill

        NAVREF fully supports the direction of the proposed legislation
    directing the VA to study whether RNA sequencing can effectively
    diagnose inflammation or cellular stress symptoms related to PTSD in
    veterans. This initiative aligns with ongoing VA research efforts to
    explore innovative molecular diagnostics and precision medicine
    approaches that could improve mental health diagnosis and treatment.
    Several VA-affiliated nonprofits are actively engaged in PTSD research,
    and NAVREF's membership stands ready to collaborate with the VA and
    congressional committees by sharing expertise, supporting study
    implementation, and facilitating connections with research programs. We
    also encourage the legislation to be inclusive of the VA Million
    Veteran Program and direct it to use its resources and data to engage
    in this initiative.
        NAVREF appreciates the opportunity to provide input on these
    important legislative efforts. We look forward to working closely with
    Congress and VA leaders to help refine policies and support research
    that advances veterans' health and well-being.

       Prepared Statement of National Association of State Veterans Homes

        Chairwoman Miller-Meeks and Ranking Member Brownley:

        As President of the National Association of State Veterans Homes
    (NASVH), I'm pleased to offer our strong support for H.R. 785, the
    Representing our Seniors at VA Act of 2025, legislation to include a
    member of NASVH on VA's Geriatrics and Gerontology Advisory Committee
    (GGAC). This legislation is a commonsense effort to ensure that the
    experience and expertise of a State Veteran Home (SVH) leader is a part
    of VA's long term care planning.
        As you may know, NASVH is an all-volunteer organization dedicated
    to promoting and enhancing the quality of care and life for the
    veterans and families in our Homes through education, networking, and
    advocacy. Today there are 172 VA-recognized State Veterans Homes across
    the Nation operating 166 skilled nursing care programs, 47 domiciliary
    care programs, and 3 adult day health care (ADHC) programs. NASVH is
    the only organization representing their collective interests, and our
    membership continues to grow as new Homes seek VA recognition.
        With over 30,000 authorized State Home beds providing a mix of
    skilled nursing and domiciliary care, SVHs provide approximately half
    of all federally supported institutional long-term care for veterans
    yet consume less than 20 percent of VA's total budget for veterans'
    long term nursing home care. Having a permanent seat for a NASVH member
    would add a critical voice commensurate with the leading role that
    State Veterans Homes play in meeting veterans long term care needs.

        The GGAC was first authorized by Public Law 102-40 in 1991 to
    advise VA on all matters pertaining to geriatrics and gerontology, and
    was charged with three specific tasks:

            1. Evaluate the operation and effectiveness of VA's Geriatric
            Research Education and Clinical Centers (GRECCs);

            2. Assess the demand for long term care by veterans and VA's
            capability to provide high quality geriatric and extended care
            services; and

            3. Assess the current and projected needs for veterans' long
            term care services and VA's activities and plans to meet such
            needs.

        H.R. 785 would require the appointed NASVH member to be a licensed
    nursing home administrator, which would provide a different perspective
    from the clinicians, researchers, and academics on the GGAC.
    Historically, there have been few, if any, GGAC members with direct
    experience leading or overseeing nursing homes, and particularly not
    ones focused on the care of aging and disabled veterans.
        For more than a decade, NASVH had proposed a number of highly
    qualified leaders for membership on the GGAC, however none had been
    chosen until last year. Among the arguments that some VA officials had
    made against a NASVH member was that State Home administrators were not
    ``experts'' and that the GGAC already had sufficient expertise.
    However, the vast majority of GGAC members have never run a nursing
    home, nor worked directly on issues related to aging and disabled
    military veterans and their unique medical and social challenges.
        We were pleased last fall when then-VA Secretary McDonough and
    Under Secretary Elnahal agreed to add a NASVH member, however we were
    disappointed to learn that the NASVH member would be a ``non-voting''
    member of the GGAC. We were told that a NASVH member would have a
    conflict of interest, since State Veterans Homes receive funding from
    VA, even though many current and past members of the GGAC have worked
    for organizations or companies that have an interest in Federal
    policies related to long term care.
        For example, the GGAC's immediate past Chairman, David Gifford, was
    the Chief Medical Officer for the American Health Care Association
    (AHCA), which lobbies on behalf of thousands of nursing homes,
    overwhelmingly private ones. Most of these nursing homes receive
    significant Federal funding through the Center for Medicare and
    Medicaid Services (CMS), and many also have contracts with VA for the
    care of veterans. Yet, Dr. Gifford was able to successfully lead the
    GGAC and manage his dual roles in conformity with Federal ethics rules.
        While NASVH receives no funding from VA or any Federal agency, if a
    member of NASVH appointed to the GGAC also works for a State Veteran
    Home, then that member would certainly recuse themselves appropriately,
    in the same manner as other GGAC members whose jobs, organizations, and
    companies are impacted by Federal funding, grants, and policies.
        Madame Chairwoman, State Veterans Homes can and must play a greater
    role in meeting the needs of aging veterans and their caregivers in
    partnership with VA and other Federal agencies. One way to strengthen
    that partnership is to ensure that NASVH and its members are engaged
    when VA is discussing, evaluating and making plans to improve the
    access to and quality of long-term care for our Nation's aging and
    disabled veterans.
        NASVH fully endorses H.R. 785 and looks forward to continuing to
    work with Congress and VA to ensure that veterans have greater access
    to a full spectrum of long-term care options, whether at home or in
    nursing homes. Adding the experience and expertise of a NASVH member
    will not only benefit the GGAC but will also improve the lives of
    America's heroes.

                Prepared Statement of Quality of Life Foundation

        Thank you Chairman Miller-Meeks, Ranking Member Brownley, and
    distinguished members of the Committee for allowing us to emphasize and
    advocate for H.R. 2148, the Veteran Caregiver Re-education, Re-
    employment and Retirement Act (Veteran Caregiver 3R Act). This bill is
    deeply personal to my organization, Quality of Life Foundation, and to
    me personally as a caregiver to a veteran who withdrew from the VA's
    Program of Comprehensive Assistance for Family Caregivers (PCAFC). I'd
    like to thank Congressmen Ciscomani and Morelle, as well as Senator
    Moran, and former Senator Sinema for taking my words in the SVAC
    hearing in March 2022 to heart when I said VA's family caregivers,
    without the safety nets in this bill, will fall into poverty upon
    leaving their caregiving roles. I will leave the facts and statistics
    of caregivers' financial contributions and lost income to others.
    Today, I want to tell you why this legislation is personal to me and
    why I feel it necessary to advocate so strongly for it.
        In 2009, Wounded Warrior Project invited myself and 19 other Post
    9/11 military veteran caregivers to the Hill, to tell our stories to
    lawmakers about why Congress should create the VA's Caregiver Support
    Program, a component of which, the Program for Comprehensive Assistance
    for Family Caregivers (PCAFC), would provide a stipend for those
    caregivers whose role prevented us from maintaining a position in the
    workforce. When I arrived in DC in July 2009, my husband was on his
    third hospitalization since returning from Iraq in February 2007.
    During those years, I had tried to maintain my 13 year teaching career
    while raising two young children and caring for him, but it was
    impossible to simultaneously teach well and to caregive well. And,
    honestly, there is no room in either role, teacher or caregiver, for
    anything less than well.
        In May 2009, I made the decision to give up my financial
    independence and professional identity in order to become ``just a
    caregiver.'' At the time, not only did I hold teaching licenses in two
    states, but I also held my National Board Of Professional Teaching
    Standards certificate. This certificate offered me a substantial salary
    boost to my teacher salary and is something only 141,000 teachers
    nationwide have achieved. The last day of that school year in June 2009
    saw me shifting from providing the majority of my family's income to
    providing none of it.
        That shift was substantial and provided the reason it was so
    important for me to advocate for family caregivers in the summer of
    2009. I gave up my job voluntarily to care for my husband, but, in
    doing so, I lost my professional identity, my financial independence
    which contributed to my family's financial well-being, and my long-term
    retirement savings' stability. Additionally, I had no idea how long I
    would have to support my veteran through caregiving nor the long-
    lasting effects that it would have on my retirement savings.
        In 2009, I came to the Hill with high hopes for the creation of a
    program that would provide me, a caregiver, an income, allowing me to
    make a monetary contribution to my family and relieve the financial
    pressure we felt after losing my teaching income. I also had hopes of
    having my role as caregiver validated as an important part of my
    husband's recovery, not just another role that was expected of me. When
    the Caregivers and Veterans Omnibus Health Services Act of 2010 was
    signed into law on May 5, 2010, I was excited to see a program that I
    had supported through legislation come into fruition.
        However, as the years have gone by, PCAFC has become a reality
    along with regulations and a few oversights. As a person who worked on
    helping PCAFC come into existence, I find it imperative that I, as
    Advocacy Director of Quality of Life Foundation's Wounded Veteran
    Family Care Program, and a caregiver, lead the efforts in fixing those
    oversights, for the caregivers that advocated for that original
    legislation and all the caregivers that have come before and will come
    after us.
        As a teacher, I had to renew my licenses with continuing education
    credits, some of which can be earned by teaching in the classroom and
    others through taking classes or going to conferences. I held on to my
    State licenses for 15 years, but did eventually give them up. It made
    little sense to keep them, when there was no end in sight to my
    caregiving. In addition to my regular State teaching licenses, The
    National Board of Professional Teaching Standards certification that I
    had taken such pains to earn in addition to my State licenses was lost
    as it could only be renewed by actually being in the classroom.
        Had I chosen to return to the classroom, here's what would have
    happened: I would have needed to renew my license. Depending on the
    State, I would be teaching on daily substitute pay until my full
    license was restored by earning enough continuing education credits.
    Not only would that path mean teaching days be paid with extremely low
    wages on which to support myself, it also meant I would have to bear
    the cost of the renewal of my licenses which could add up to thousands
    of dollars depending on the State requirements, including any college
    classes or seminars. That is not a cost caregivers can support if they
    have lost their income from caregiving, nor will that cost be
    realistically covered by the 3-months of stipend paid when the
    caregiver exits PCAFC.
        H.R. 2148, the Veteran Caregiver Re-education, Re-employment, and
    Retirement Act would grant $1000 per caregiver for those who wish to
    renew licenses or certifications upon leaving the Caregiver Program and
    returning to the workplace. H.R. 2148 would institute a program which
    is a mirror of a program that already exists in DOD for military
    spouses that must relocate due to their spouses receiving orders. In
    reality, many of our caregivers will never return to the workplace,
    either because their veterans never recover fully enough for them to do
    so or because they will end caregiving well past retirement age. But
    for those caregivers who must return to the workforce due to the death
    of their care recipients during their pre-retirement years, this money
    would be essential.
        The bill would study expanding returnships to caregivers.
    Returnship programs are already supported by the Department of Labor.
    Returnships are opportunities for companies to hire Americans returning
    to work after being out of the workplace for a period of at least 2
    years. The best way to think about returnships are to think of Robert
    De Niro's character in the movie The Intern. Technically he wasn't an
    intern; he was a return. This type of returnship program would allow
    caregivers to become current on workplace skills while using the vast
    knowledge they have from their prior careers and leveraging the skills
    they have learned from caregiving, such as superb organizational skills
    and ability to prioritize multiple tasks. Some companies, i.e. Goldman
    Sachs and Wells Fargo, and State governments, such as Utah and Vermont,
    have returnship programs already established.
        The VA remains in a shortage of workers to meet demand, and the
    Veteran Caregiver 3R Act would study whether caregivers discharged from
    PCAFC could be used to fill gaps within the VA workforce, either
    through roles leveraging prior professional skillsets or as non-medical
    attendants. Either way, leveraging the wealth of experience, knowledge,
    and skill sets of caregivers exiting PCAFC could be a way to fill
    apparent gaps in VA's workforce while also providing economic stability
    to caregivers having to return to the workforce.
        Another component of this bill offers transition assistance to
    caregivers who are either transitioning from caregiving back to the
    workforce or into caregiver ``retirement,'' the later stages of life
    where it is no longer beneficial for caregivers or their care recipient
    to have care from the person designated as the family caregiver.
        But what future exists for caregivers without retirement income
    options? Truly, this is the most important component of this bill to
    me. It solves a crisis that currently keeps me up at night. For many
    years, I was not able to contribute to a retirement fund due to lack of
    earned income in my home. Any year that I worked part time, I made a
    contribution to my personal individual retirement account, though there
    were many years it was not funded or underfunded due to limited income
    and the inability to contribute. At 51, I have about one-third of the
    retirement savings that I should have at this time, and I am running
    out of time to catch up on those contributions.
        I am one of the lucky ones. I was old enough to have made some
    retirement contributions, and I have been able to return to work in a
    job that uses all of my teaching experience and my knowledge of caring
    for an injured veteran.
        Unfortunately, that is not the case for many of the caregivers I
    advocated with on the Hill in 2009. Many of them have been caregivers
    since 2005. They are looking at 20 years with no contributions to
    Social Security or individual retirement accounts. There is no safety
    net for them if they are injured while providing care for their loved
    one. If their spouses pass away now, with them in their early 40's to
    mid 50's, they will have to go back into the workplace after more than
    20 years out of the workforce. They will have no retirement savings,
    and they will have to move into jobs that are at a lower pay level than
    their peers of the same age due to their lack of work experience. This
    severely limits their ability to save for retirement in their personal
    retirement accounts and their income from Social Security. In addition,
    the Social Security spousal benefit will not be an option for them
    because their spouses stopped contributing to Social Security at an
    extremely young age; meaning the potential spousal benefit would be
    extremely low, if it existed at all. These caregivers should not be
    forced into a low retirement income because they chose to care for
    their loved one and save the VA and taxpayers money.
        As caregivers, we simply want to be able to have a way to
    contribute to and fund our own retirement savings and income so that we
    do not to fall into poverty because we chose to care for our veterans
    at home. Please allow us the pathway to do this. Such a pathway could
    be created by creating special caregiver IRA's which would allow
    taxation at the withdrawal period and not at the contribution period.
    Other options are Thrift Savings Plans like those offered to troops.
        While I am extremely grateful that I was able to be a part of the
    creation of the VA's PCAFC, I would also like to be a part of the
    fixing issues that were not even considered when the legislation
    creating the program was drafted. None of us knew this would be a
    potential lifelong role. We did not think about returning to the
    workforce if our care recipient passed away. None of us thought about
    retirement at the ages of 20 or 30, and none of us thought about having
    to transition from caregiving for our veteran to possibly needing to
    ``retire'' from caregiving and ourselves be cared for and how that
    would be funded. But today, at 40 and 50 years of age, we are thinking
    of that. And what we see is frightening--we don't have easy pathways to
    returning to the workforce or retiring. Some of us have no pathway to
    return to the workforce or retire.
        Veteran Caregiver Re-education, Re-employment, and Retirement Act
    is our plea to Congress to help us address these issues. It allows us
    to create our own long-term safety nets through re-employment or
    funding retirement. As a caregiver for a veteran, and as an advocate
    for caregivers of veterans, I would ask you to please pass H.R. 2148,
    the Veteran Caregiver Re-education, Re-employment, and Retirement Act.

          Prepared Statement of United Services Automobile Association

        On behalf of the United Services Automobile Association (USAA) and
    our nearly 14 million members of the U.S. military, veterans who have
    honorably served, and their families, thank you for convening today's
    hearing on legislative proposals to care for our Nation's veterans and
    their families. We appreciate the opportunity to provide this statement
    of support for H.R. 2148, the Veteran Caregiver Reeducation,
    Reemployment, and Retirement Act.
        USAA is a membership association that serves members of the
    military community, including active duty, Guard, Reserve, veterans,
    and their families. Since our founding in 1922 by 25 U.S. Army
    officers, USAA has facilitated the financial security of our members,
    associates, and their families by providing a full range of highly
    competitive financial products and services. In our second century of
    service, we remain focused on meeting our members' needs through every
    stage of life--from joining the military to buying a home to retiring.

    H.R. 2148, the Veteran Caregiver Reeducation, Reemployment, and
    Retirement Act

        In September 2024, RAND published a report commissioned by the
    Elizabeth Dole Foundation titled, ``America's Military and Veteran
    Caregivers: Hidden Heroes Emerging from the Shadows.'' There are
    approximately 14.3 million military and veteran caregivers today,
    representing 5.5 percent of the U.S. adult population. According to
    RAND, these caregivers on average incur over $8,500 in annual out of
    pocket costs, while forgoing over $4,500 in annual household income.
    More than one-third of these caregivers live below 130 percent of the
    Federal poverty level. Serving as a caregiver can also compound future
    financial challenges. Military and veteran caregivers often have
    employment gaps in their resume, which can impact their future
    employment and earnings prospects, and many lack retirement savings
    vehicles to invest in their own financial security.
        This bipartisan bill will expand support available to veteran
    caregivers enrolled in the Department of Veterans Affairs (VA) Program
    of Comprehensive Assistance for Family Caregivers (PCAFC). It would
    provide employment assistance to eligible caregivers, including fee
    reimbursement associated with professional certifications or licenses.
    Caregivers would also be granted access to existing employment
    assistance programs through the VA, the Department of Defense, and the
    Department of Labor. In recognition of the fact that caregivers are at
    higher risk of depression and suicidality, the bill expands caregiver
    access to bereavement counseling and support. The bill also directs the
    VA to study the feasibility of establishing a retirement plan or
    alternate pathway to retirement savings for veteran caregivers.
        USAA thanks Representatives Joseph Morelle (D-NY) and Juan
    Ciscomani (R-AZ) for their leadership on this important proposal to
    better support the caregivers who selflessly serve our Nation. We urge
    the Committee to support the bill when considered during a future
    markup.

    Prepared Statement of The Veterans of Foreign Wars of the United States

        Chairwoman Miller-Meeks, Ranking Member Brownley, and members of
    the subcommittee, on behalf of the men and women of the Veterans of
    Foreign Wars of the United States (VFW) and its Auxiliary, thank you
    for the opportunity to provide our remarks on this pending legislation.

    H.R. 785, Representing our Seniors at VA Act of 2025

        The VFW supports this legislation to include a representative from
    the National Association of State Veterans Homes on the Department of
    Veterans Affairs (VA) Geriatrics and Gerontology Advisory Committee.
    This inclusion would give state-run veterans homes a voice in Federal
    VA policymaking on elder care, and facilitate collaboration between VA
    and State Veterans Homes (SVHs) as the veteran population continues to
    age.
        SVHs originated in the pre-Civil War era and were initially
    established to care for injured and aging soldiers. These homes are
    operated by State governments and provide nursing, assisted living, or
    domiciliary care specifically for veterans. They offer long-term care
    services tailored to meet their unique needs.
        Living in SVHs offers several benefits, including subsidized care,
    VA per diem grants that help reduce out-of-pocket expenses, and a
    supportive environment where veterans can connect with one another and
    build camaraderie. VA provides general oversight for all 153 SVHs,
    which care for approximately 14,500 veterans.

    H.R. 2068, Veterans Patient Advocacy Act

        The VFW supports this legislation to provide veterans living in
    highly rural areas with better access to patient advocate services. For
    the past 11 years, the VFW has partnered with Student Veterans of
    America (SVA) to select student veterans from across the country to
    research and advocate for improvements on issues that matter to
    veterans. Past VFW-SVA Fellow and Grand Valley State University
    graduate Cameron Zbikowski focused his semester-long research proposal
    on enhancing the patient advocate program at VA. He proposed
    improvements to ensure that each facility had an adequate number of
    patient advocates. In that spirit, the VFW continues to support this
    legislation.

    H.R. 2605, Service Dogs Assisting Veterans (SAVES) Act

        The VFW strongly supports this legislation to create a 5-year pilot
    program in which VA would provide up to $2 million in grants to
    nonprofit organizations to provide service dogs to eligible veterans.
    It would also provide commercially available veterinary insurance for
    them. Service dogs assist with various physical, auditory, and trauma-
    related disabilities. They help empower veterans to regain their
    independence, pride, and hope. While they are typically provided free
    of charge, the medical care involved can be costly. This legislation
    would enable more veterans to receive support animals with less of a
    financial burden.
        The VFW thanks Representative Luttrell for introducing this
    legislation and for inviting VFW Post 4709 Commander Marcy Phillips
    from his Post in Conroe, Texas, to speak at the Congressman's press
    conference for this legislation. The VFW was honored to have her talk
    about her service dog and how it has had a positive impact on her life.

    H.R. 3400, Territorial Response and Access to Veterans' Essential
    Lifecare (TRAVEL) Act of 2025

        The VFW supports this legislation to authorize VA physicians to
    temporarily serve as traveling physicians for up to 1 year in American
    Samoa, Northern Mariana Islands, Guam, Puerto Rico, the Virgin Islands,
    and other U.S. territories. It would improve support for veterans
    living in these areas or medically underserved regions by offering
    providers incentives like relocation or retention bonuses. This would
    allow VA to address gaps in health care in U.S. territories and provide
    a continuity of care through coordinated integration with local
    providers.

    H.R. 3643, VA Data Transparency and Trust Act

        The VFW supports the intent of this legislation, but we have
    questions about the scope of the information to be collected. This
    proposal would establish certain VA annual reports to Congress from the
    Veterans Benefits Administration and the Veterans Health
    Administration. The reports would span 5 years, focusing on areas such
    as hospital care, medical services, nursing home care, and the
    management of these services. It includes a set of metrics designed to
    provide insights into veterans' demographic profiles, health
    conditions, service utilization, and benefits usage over time. While
    the VFW has advocated for improved data reporting by VA, we also want
    the intent of these reports to be made clear. The VFW also cautions
    against collecting income and other financial information of veterans
    that could be used to reduce benefits or prevent veterans from
    accessing their earned benefits.

    Discussion Draft: To direct the Secretary of Veterans Affairs to
    conduct a study to determine whether RNA sequencing can be used to
    effectively diagnose PTSD in veterans

        As a resolutions-based organization, the VFW does not have a
    position on this proposal at this time, however, we do have some
    concerns. This legislation would direct the Secretary of Veterans
    Affairs to conduct a study on whether ribonucleic acid (RNA) sequencing
    can effectively diagnose post-traumatic stress disorder (PTSD) in
    veterans. Although this idea is innovative, focusing solely on
    biological markers may oversimplify the complexity of the disorder.
    Trauma, environment, genetics, and psychology are all factors in PTSD.
    While a biomarker-based diagnostic tool could aid in the early
    detection of PTSD, it also raises several scientific, practical, and
    ethical concerns.

    Discussion Draft: Health Professionals Scholarship Program Improvement
    Act of 2025

        The VFW supports this legislation to improve the hiring of
    participants in the VA Health Professional Scholarship Program that
    provides scholarships to students pursuing health care degrees in
    exchange for service at VA facilities. It enables VA to provide
    incentives to qualified health care professionals to work at VA medical
    centers, particularly in areas where recruitment and retention are
    difficult.
        This legislation would create a more efficient process of placing
    scholarship recipients into clinical roles, which is particularly
    important given VA's critical medical staff shortages. It would do this
    by requiring VA to provide employment contracts within 90 days of
    students completing their coursework. It would also assign providers to
    VA facilities with the highest need, and offer competitive salaries and
    benefits aligned with VA standards.

    H.R. 3726, Fisher House Availability Act of 2025

        The VFW supports this legislation to allow veterans, service
    members, and their families to stay at temporary lodging facilities,
    such as Fisher Houses, when having to travel significant distances for
    medical care. For more than 30 years, Fisher Houses have been available
    free of charge. The Fisher House Foundation provided 57 homes to VA and
    42 to the Department of Defense. A VA policy change in 2023 restricted
    these homes to only those receiving VA-directed care, greatly
    restricting service members with TRICARE from using this option. In
    2024, Fisher Houses were operating at only 53 percent capacity, mainly
    housing the families of hospitalized veterans. This proposal would
    codify the previous practice of allowing service members who receive
    non-VA care and their families to stay at temporary lodging facilities
    on a space-available basis. The priority access would continue to be
    for veterans and their families. The VFW sees this as a reasonable
    expansion for TRICARE beneficiaries and their families. Broadening
    eligibility would help alleviate financial and logistical burdens when
    a loved one needs to be hospitalized or receive medical care far from
    home.

    H.R. 1404, CHAMPVA Children's Care Protection Act of 2025

        The VFW supports this legislation that extends the age limit for
    children eligible for medical coverage under the Civilian Health and
    Medical Program of the Department of Veterans Affairs (CHAMPVA). This
    legislation aims to enhance health care access for young adult children
    of veterans, ensuring they receive continuous care during a critical
    phase of life and minimizing coverage gaps for military families. This
    initiative is a key legislative priority for the VFW, and it aligns
    with other Federal health care programs such as the Affordable Care Act
    that allows dependent coverage until age 26.

    H.R. 2148, Veteran Caregiver Reeducation, Reemployment, and Retirement
    Act

        The VFW supports this legislation to expand medical coverage,
    counseling, and employment services to individuals who have
    participated in VA's caregiver programs. These dedicated individuals
    spend a significant amount of time providing in-home care. When someone
    leaves the program, typically because the veteran loved one has passed
    away, the caregiver often faces challenges when attempting to reenter
    the workforce. Proper training, counseling, and support for
    reintegration are essential for those who have left their careers to
    become full-time caregivers.
        This proposal would provide employment assistance to former
    caregivers through reimbursement of certification fees, access to VA
    training modules, and support through Military OneSource and the
    Veterans' Employment and Training Service. It would also expand
    available retirement planning and workforce transition assistance for
    these individuals; extend CHAMPVA medical coverage to former caregivers
    for 180 days after their designation ends as long as they were not
    dismissed for fraud, abuse, or mistreatment; and provide bereavement
    counseling following the death of the veteran. The VFW sees all of
    these initiatives as beneficial to the dedicated caregivers who provide
    long-term care for veterans who need it.

    Discussion Draft: VA Mental Health Outreach and Engagement Act

        The VFW appreciates the intent of this legislation, but we have
    certain recommendations for improvement. Currently, VA is required to
    offer a mental health consultation to veterans within 30 days after
    submitting a claim for disability compensation for mental health
    conditions. Offering veterans mental health consultations every year
    may be a deterrent that creates concerns that their benefits could be
    reduced, or cause retraumatization when asked to discuss their mental
    health needs.
        The VFW recommends instead that VA conduct regular outreach to
    veterans who have filed VA claims (regardless of the outcome of these
    claims) and who do not utilize VA health care services, so they can
    receive information about services they may need now or in the future.
    Effective outreach to those within the VA health care system and to
    those who have not yet enrolled would encourage veterans to consider
    these services and utilize them when needed.
        Chairwoman Miller-Meeks, Ranking Member Brownley, this concludes my
    statement. Again, thank you for the opportunity to offer our comments
    on these issues.

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

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

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

         Prepared Statement of American Academy of Physician Associates

        Subcommittee Chairman Miller-Meeks, Subcommittee Ranking Member
    Brownley, and Members of the Committee on Veterans' Affairs:

        On behalf of the approximately 190,000 physician associates/
    physician assistants (PAs) throughout the United States, including more
    than 2,500 PAs employed by the Veterans' Health Administration to serve
    veterans, the American Academy of Physician Associates (AAPA) thanks
    the Subcommittee on Health for its continued leadership on veterans'
    health issues. We appreciate the opportunity to comment on H.R. 3767,
    the Health Professionals Scholarship Program Improvement Act of 2025
    (HPSP Improvement Act of 2025), which was introduced by Reps. Abraham
    Hamadeh (R-AZ) and Nikki Budzinski (D-IL).
        The PA profession proudly maintains a close connection to the VA,
    as the founding class of PA students in 1965 were veterans. These first
    PA students were former Navy hospital corpsmen and Army combat medics
    with considerable medical training from their military service. The VA
    was the first employer of PAs in 1967 and today is the largest single
    employer of PAs in the Nation. Eleven percent of all practicing PAs and
    24 percent of PAs employed by the VA are veterans, active-duty
    military, or serve in the National Guard and Reserves. PAs maintain a
    strong, personal desire and dedication to serve veterans and AAPA fully
    supports efforts, such as the law enacted in 2018 that provided funding
    for HPSP scholarships for PAs, to strengthen the workforce at the VA
    and expand access to care for veterans.
        Last year, AAPA commented on a proposed rule to implement
    requirements in the Consolidated Appropriations Act of 2023 for the VA
    to ``specifically award scholarships to applicants pursuing degrees or
    training in mental health disciplines, including advanced practice
    nursing (with a focus on mental health or substance use disorder),
    psychology, and social work,'' and to provide no fewer than 50
    additional awards to such applicants beginning in academic year 2022.
    In its comments, AAPA noted that while it appreciated the VA specifying
    that PAs should be eligible for the additional HPSP scholarships, it
    also formally requested that the VA specifically list PAs in the Code
    of Federal Regulations as well to minimize any future confusion.\1\ In
    its final rule, the VA responded that ``PAs are eligible to apply for
    and receive HPSP scholarships for mental health disciplines under
    proposed Sec.  17.603(b)(2),'' but that it would not be making changes
    based on AAPA's comments because, ``the list of mental health
    disciplines in proposed Sec.  17.603(b)(2) is not an exhaustive list''
    and ``VA determined that it should maintain a non-exhaustive list in
    the regulation to permit flexibility so that new mental health
    professions can be included without the need to amend the
    regulations.'' \2\ AAPA continues to support efforts that encourage and
    support PAs to practice in mental or behavioral health and psychiatry
    to help address national provider shortages.
    ---------------------------------------------------------------------------
        \1\ American Academy of Physician Associates. Comments on Proposed
    Rule-VA Health Professional Scholarship Program. October, 2023.
        \2\ Federal Register. 38 CFR Part 17, RIN 2900-AR98, VA Health
    Professional Scholarship Program. June, 2024.
    ---------------------------------------------------------------------------
        AAPA has heard from some PAs working for the VA that even after
    completing the HPSP, there are many problems with communication and
    administrative delays that have prevented HPSP beneficiary PAs from
    being able to treat veterans. Some PAs have faced delays as long as 6
    months from the time of their interview until they began work at a VA
    facility. These unnecessary delays impose the burden of an income gap
    on PAs and other health care providers who would like to care for
    veterans, while also compounding the problem of student debt. The HPSP
    Improvement Act of 2025 would address this problem by requiring the
    Secretary of the VA to ensure that HPSP participants receive a contract
    for full-time employment withing 90 days of the completion of their
    training.
        The HPSP Improvement Act of 2025 is an important step toward
    ensuring that the VA is able to hire qualified health care
    professionals for which recruitment or retention is difficult. However,
    as the VA and Congress work to strengthen the Veterans Health
    Administration workforce, it is essential that PAs are included in
    these efforts. Despite previous inclusion in VA's HPSP, and despite the
    most recent OIG Determination of Veterans Health Administration's
    Severe Occupational Staffing Shortages listing numerous severe
    shortages of PAs, mental health care providers, and primary care
    providers,\3\ the VA has not made PAs eligible for the current round of
    HPSP.\4\ It is important for VA recruitment and retention efforts and
    for veterans' access to care that PAs be eligible for HPSP, and we
    believe it is critical to ensure that PAs and other health care
    providers for which there are severe shortages at VA facilities are
    included in HPSP.
    ---------------------------------------------------------------------------
        \3\ Veterans Health Administration. OIG Determination of Veterans
    Health Administration's Severe Occupational Staffing Shortages Fiscal
    Year 2024. August, 2024.
        \4\ Department of Veterans Affairs. HPSP. Retrieved June 17, 2025.
    ---------------------------------------------------------------------------
        With clinical expertise, medical training, the initiative to help,
    and unique connection to our veteran population, PAs are on the ground
    in local communities and especially positioned to increase access to
    care in areas of health care in which VA has acute shortages.
        AAPA thanks the Subcommittee for this opportunity to provide
    comments on H.R. 3767, the HPSP Improvement Act of 2025, and welcome
    any comments or questions you may have for us. Please contact AAPA Vice
    President of Federal Advocacy Tate Heuer at theuer@aapa.org.

              Prepared Statement of Concerned Veterans of America
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

         Prepared Statement of Military Officers Association of America
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

               Prepared Statement of Student Veterans of America
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                     Prepared Statement of K9s For Warriors
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

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