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

                           PUSHING VA FORWARD: REVIEW
                           OF VA'S ADAPTIVE PROGRAMS
                             FOR DISABLED VETERANS

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

                                    HEARING

                                   BEFORE THE

                             SUBCOMMITTEE ON ECONOMIC
                                   OPPORTUNITY

                                     OF THE

                         COMMITTEE ON VETERANS' AFFAIRS

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                            WEDNESDAY, MAY 21, 2025

                                   __________

                               Serial No. 119-23

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                        Available via http://govinfo.gov

                                    __________

                       U.S. GOVERNMENT PUBLISHING OFFICE
    61-165                     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 ECONOMIC OPPORTUNITY

                     DERRICK VAN ORDEN, Wisconsin, Chairman

    JUAN CISCOMANI, Arizona              CHRIS PAPPAS, New Hampshire,
    ABE HAMADEH, Arizona                     Ranking Member
    KIMBERLYN KING-HINDS, Northern       MORGAN MCGARVEY, Kentucky
        Mariana Islands                  DELIA RAMIREZ, Illinois
    TOM BARRETT, Michigan                TIMOTHY M. KENNEDY, New York

    Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public
    hearing records of the Committee on Veterans' Affairs are also
    published in electronic form. The printed hearing record remains the
    official version. Because electronic submissions are used to prepare
    both printed and electronic versions of the hearing record, the process
    of converting between various electronic formats may introduce
    unintentional errors or omissions. Such occurrences are inherent in the
    current publication process and should diminish as the process is
    further refined.

                             C  O  N  T  E  N  T  S

                                  ----------

                            WEDNESDAY, MAY 21, 2025

                                                                       Page

                               OPENING STATEMENTS

    The Honorable Derrick Van Orden, Chairman........................     1
    The Honorable Chris Pappas, Ranking Member.......................     2

                                   WITNESSES
                                    Panel I

    Dr. Rachel McArdle, Deputy Executive Director, Rehabilitation and
      Prosthetic Services, Veterans Health Administration, U.S.
      Department of Veterans Affairs.................................     4

            Accompanied by:

        Dr. Joel Scholten, Executive Director, Physical Medicine and
            Rehabilitation Service, Veterans Health Administration,
            U.S. Department of Veterans Affairs

        Mr. Jason Latona, Assistant Director, Loan Guaranty Service,
            Veterans Benefits Administration, U.S. Department of
            Veterans Affairs

                                    Panel II

    Mr. Tom Landwermeyer, Brigadier General, USA (Ret.), President
      and Chief Executive Officer, Homes For Our Troops..............    23

    Mr. Mike Owens, Adaptive Sports Director, Wounded Warrior Project    25

    Mr. Craig Schrimsher, President of North American Manufacturing,
      BraunAbility...................................................    26

    Ms. Julie Howell, Associate Legislative Director for Government
      Relations, Paralyzed Veterans of America.......................    28

                                    APPENDIX
                        Prepared Statements Of Witnesses

    Dr. Rachel McArdle Prepared Statement............................    39
    Mr. Tom Landwermeyer Prepared Statement..........................    40
    Mr. Mike Owens Prepared Statement................................    42
    Mr. Craig Schrimsher Prepared Statement..........................    53
    Ms. Julie Howell Prepared Statement..............................    58

                           Statements For The Record

    Homes For Our Troops Prepared Statement..........................    63
    National Mobility Equipment Dealers Association Prepared
      Statement......................................................    64
    Disabled American Veterans Prepared Statement....................    64

                           PUSHING VA FORWARD: REVIEW
                           OF VA'S ADAPTIVE PROGRAMS
                             FOR DISABLED VETERANS

                                  ----------

                            WEDNESDAY, MAY 21, 2025

          Subcommittee on Economic Opportunity,
                        Committee on Veterans' Affairs,
                                 U.S. House of Representatives,
                                                        Washington, DC.
        The subcommittee met, pursuant to notice, at 10:29 a.m., in
    room 360, Cannon House Office Building, Hon. Derrick Van Orden
    (chairman of the subcommittee) presiding.
        Present: Representatives Van Orden, Ciscomani, Barrett,
    Pappas, McGarvey, and Ramirez.

            OPENING STATEMENT OF DERRICK VAN ORDEN, CHAIRMAN

        Mr. Van Orden. Good morning. In a strange twist of events
    and something that does not normally happen in the House of
    Representatives, we are going to start early. Shocking. We have
    our people here, so this subcommittee will come to order.
        I want to thank our witnesses for being here today to
    examine the U.S. Department of Veterans Affairs (VA) Specially
    Adaptive Housing, Adaptive Automobile, and Adaptive Sports
    programs to ensure these programs are effectively serving
    veterans across the country. I look forward to continuing the
    nonpartisan spirit of the subcommittee with Ranking Member
    Pappas, Chris and I were just talking here about some stuff, to
    ensure the VA's adaptive programs are modernized and work for
    the needs of today's veterans.
        The purpose of today's hearing is to examine how VA
    provides the special adaptive housing program, adaptive
    automobiles, and adaptive sports programs to our veterans. The
    Special Adaptive Housing Program, or SAH, plays an important
    role in providing customizable adaptions for severely service-
    connected disabled veterans to adapt their homes to make them
    more accessible, to lead their lives comfortably. The small but
    vital program provides these true heroes with the ability not
    only to stay and live in their home of their choice, but to
    continue to live more independently.
        Additionally, VA's Adaptive Automobile Program provides
    disabled veterans with vehicle modifications. Through this
    program, veterans can safely operate their vehicle
    independently, hopefully getting back to the workforce and live
    fulfilling lives.
        VA's Adaptive Sports Program serves thousands of veterans
    across the country and plays an important role in disabled
    veterans regaining their independence, bettering their quality
    of life and improving their overall mental health and wellness.
    This program also provides opportunities for disabled veterans
    to participate in events such as wheelchair games, golf
    clinics, and many other sporting events that promote a healthy
    lifestyle.
        This Congress, my subcommittee has championed key
    legislation regarding VA's adaptive programs. H.R. 522, the
    Deliver for Veterans Act, championed by my friend from the
    great territory of Guam, Representative Moylan, would cover the
    shipping cost of delivery--excuse me, of the delivery of an
    adaptive automobile. This legislation passed the House in
    April. Additionally, Representative Barrett is leading a bill,
    H.R. 1364, the Automotive Support Services to Improve Safe
    Transportation (ASSIST) Act, which would provide more
    flexibility for veterans to access the specific adaptive
    automobile equipment they might need. Finally, Representative
    King-Hinds will have a bill on our next legislative hearing to
    enhance the SAH program. She is from the Northern Mariana
    Islands. Absolutely beautiful part of the world.
        When President Trump and Secretary Collins stated that this
    is time to end the Biden era and make the VA put veterans
    first, these are the programs we are talking about to improve
    veterans lives. Instead of focusing on political theater, which
    we are just not going to do here, and sound bites, we, me and
    Chris, are going to lead the subcommittee to make sure that we
    accomplish the mission, and the mission is the veterans. It is
    not us and it is not the VA. It is the veterans. I know that
    Secretary Collins shares my sentiments and I am very proud that
    he is there.
        I look forward to hearing more about the VA's adaptive
    program and how the Trump administration plans to keep these
    programs moving forward.
        I now yield to my friend and ranking member, Mr. Pappas for
    his opening remarks.

           OPENING STATEMENT OF CHRIS PAPPAS, RANKING MEMBER

        Mr. Pappas. Thanks very much, Chairman Van Orden.
        The Department of Veterans Affairs offers programs for
    disabled veterans to improve their lives through housing,
    transportation, and whole health sports. These are earned
    benefits and programs designed to improve veterans' overall
    health and independence. That is why I am so pleased that the
    chairman scheduled this hearing today.
        One success story I would like to highlight is New
    Hampshire's Northeast Passage Vet Rec Program (NEP), which is a
    nationally recognized nonprofit that has served more than 300
    pre-and post-9-11 veterans and service members with
    disabilities. Through its affiliation with the University of
    New Hampshire and partnership with VA and local Veterans
    Service Organizations (VSO), it offers veterans and
    servicemembers in my State adaptive sports and recreation
    opportunities including cycling, fishing, climbing, skiing, and
    countless other activities. I have seen the equipment; it is
    endless.
        Granite Staters who participated in the NEP have reported
    improved fitness, decreased depression, help with pain
    management, and improved adjustment to disability, all of which
    supports their path to recovery. Just as important, the sense
    of community and fostering of long-term friendships have
    substantially improved their quality of life. NEP's success is
    just one example of the critical role that VA's Adaptive Sports
    Programs play in helping the physical and mental well being of
    our veterans and servicemembers.
        In addition to adaptive sports, VA offers a spectrum of
    adaptive services encompassing housing grants, vehicle
    modifications, and assistive technologies. However, further
    improvements are necessary to reduce significant barriers that
    impede many veterans' access to these critical resources,
    underscoring the urgent need for legislative solutions to
    streamline eligibility, increase funding, and optimize
    delivery.
        To this end, this committee took bipartisan action in 2022
    with the passage of the Veterans Auto and Education Improvement
    Act, which was signed into law. The this legislation offered
    disabled veterans the ability to purchase a second adaptive
    vehicle. During a full committee markup earlier this month, I
    was proud to support the ASSIST Act to build on this
    legislation, which passed the House earlier this week.
        The next step is passing Representative Sorenson's Autonomy
    for All Disabled Veterans Act to provide veterans additional
    funding for housing modifications. That legislation is
    supported by Paralyzed Veterans of America (PVA), who I know we
    will hear from later to testify on the bill.
        Funding limitations like these constrain the effectiveness
    of VA's adaptive programs. For instance, the Specially Adapted
    Housing, SAH, and Automobile Assistance Programs are subject to
    caps that often fail to align with prevailing real world costs.
    Consequently, veterans with severe disabilities may incur
    substantial out-of-pocket expenses to facilitate necessary home
    or vehicle modifications.
        I want to thank Homes For Our Troops, which is an
    organization in New Hampshire, and their fundraising efforts,
    which help bridge the gap between what an SAH grant covers and
    the actual cost of constructing a brand new adaptive home.
    However, Congress must increase these caps and implement annual
    adjustments to reflect inflation and ensure that veterans can
    take full advantage of these important programs.
        As I mentioned earlier, adaptive sports are also an
    important part for the whole health and well-being of disabled
    veterans. Sports foster physical fitness and mental well-being
    by reducing stress and isolation. They rebuild confidence and
    reintegrate veterans in their communities. Adaptive sports must
    continue to be part of rehabilitation and lifelong care plans
    for veterans.
        To improve accessibility to these programs, Congress should
    increase funding for adaptive sports programs and grants that
    directly support veteran participation. Streamlining the
    process for veterans to access adaptive equipment and
    specialized training is also crucial. Congress should support
    collaborations between VA, community-based sports
    organizations, and veterans service organizations to expand
    program reach and awareness and ensuring that all interested
    veterans and have the opportunity to participate.
        Last, VA needs to simplify the process for accessing these
    benefits. Veterans frequently encounter convoluted paperwork,
    inconsistent communication from VA offices, and ambiguous
    eligibility criteria. Congressional action could mandate a
    unified and transparent system, enabling veterans to apply for
    multiple adaptive sports via a single integrated portal
    supported by case managers with specialized expertise in
    disability-related needs.
        Insufficient outreach from VA also represents another
    critical area for improvement. Many eligible veterans remain
    unaware of available benefits, particularly in rural and
    underserved communities. Congress should prioritize investments
    in proactive outreach strategies, fostering collaborations with
    VSOs, community centers, and healthcare providers to ensure
    that targeted dissemination of information gets to the veterans
    who are eligible.
        As I said, disabled veterans have earned these benefits
    through their service. I hope our work here today will identify
    improvements that we can all agree on to allow these veterans
    and servicemembers that we represent to take full advantage of
    programs that will help them.
        Thank you very much, Mr. Chairman. I yield back.
        Mr. Van Orden. Thank you, Ranking Member Pappas. I will now
    introduce the witness panel.
        Our first witness is Dr. Rachel McArdle, deputy executive
    director, Rehabilitation and Prosthetic Services, Veterans
    Health Administration (VHA) at the Department of Veterans
    Affairs. Dr. McArdle is accompanied by Dr. Joel Scholten,
    executive director of Physical Medicine Rehabilitation
    Services, Veterans Health Administration at the Department of
    Veterans Affairs; and Mr. Jason Latona. Out of the three of
    you, you have the most easily pronounced name, sir, and you are
    a Marine, assistant director, Loan Guarantee Service, Veterans
    Benefits Administration (VBA) at the Department of Veterans
    Affairs.
        I will ask the witnesses to stand and please raise their
    right hand.
        [Witnesses sworn.]
        Mr. Van Orden. All right. The record will reflect that the
    witnesses answered in the affirmative. Please be seated.
        Dr. McArdle, you are now recognized for 5 minutes to
    deliver your testimony on behalf of the Department of Veterans
    Affairs.

                      STATEMENT OF RACHEL MCARDLE

        Dr. McArdle. Chairman Van Orden, Ranking Member Pappas, and
    other members of the subcommittee, thank you for the
    opportunity to discuss how VA fulfills the Nation's promise to
    care for veterans through the administration of adaptive
    programs. VA provides specialty adapted housing assistance,
    home improvement and structural alteration assistance,
    automobile adaptive equipment, and the Adaptive Sports Grants
    Program to maximize veteran independence.
        Joining me today, Dr. Joel Scholten, executive director of
    the Physical Medicine and Rehab Service, and Mr. Jason Latona,
    assistant director, Loan Guarantee Service, Veterans Benefits
    Administration.
        The Specialty Adapted Housing Grant Program offers various
    grants for eligible veterans and servicemembers, helping them
    acquire adapted housing necessary to service-connected
    disabilities. VA also assists if an adaptive home is destroyed
    or significantly damaged by a natural disaster. The program is
    individualized with VA agents guiding veterans through the
    process to contract with builders of their choice. The program
    staff use their expertise in home adaptations to ensure
    projects comply with applicable statutes and meet the
    individual veterans needs. The program has approved over 2,000
    grants annually for 6 of the last 7 fiscal years and
    anticipates similar or higher levels in the future.
        VA is modernizing the Specially Adapted Housing Special
    Home Adaptation System to enhance customer service. This
    multiyear project uses automation to streamline benefits
    delivery and improve oversight with enhanced monitoring from
    application to completion. The first phase of this modernized
    system is expected to begin in July 2025. Individualized
    attention to each Adaptive House grantee ensures oversight.
        In Fiscal Year 2020, VA centralized financial management
    for the Specially Adaptive Housing Grant Program disbursements,
    eliminating third party escrow agents. This change strengthened
    internal controls, improved project management, accelerated
    home adaptations' timelines, and removed a $500 escrow fee for
    veterans. The VA Home Improvement and Structural Alterations
    benefit provides financial assistance for home modifications to
    eligible veterans and servicemembers undergoing medical
    discharge due to permanent disability under certain
    circumstances. Home improvement or structural alteration
    projects are prescribed by VA clinicians based on clinical
    needs and are necessary for the provision of home health
    treatment and maximizing home accessibility.
        VA's Automobile Adaptive Equipment Program reimburses or
    pays for adaptive equipment for eligible veterans and Active-
    Duty members with certain disabilities. The equipment is
    prescribed by VA fluent physicians or certified driver
    rehabilitation specialists. VA is authorized to prescribe and
    reimburse or pay for operational and nonoperational equipment.
    VA works directly with--VA does not modify, install, repair, or
    replace such equipment. VA works directly with dealers,
    modifiers, and alterers to ensure all prescribed necessary
    adaptive equipment enable the veteran to safely drive or ride
    as a passenger in their personal vehicles. Examples of
    automobile adaptive equipment include low-effort steering,
    electronic controls, hand controls, wheelchair tie-downs,
    vehicle lifts, and voice command systems.
        VA manages an Adaptive Sports and Equine-Assisted Therapy
    Grants Program to promote the lifelong physical and mental
    health of veterans with disabilities through regular
    participation in physical activity. Through this program,
    grants are awarded to nongovernmental entities experienced in
    managing large-scale adaptive sports programs. These grants
    offer opportunities for veterans and Active-Duty servicemembers
    to engage in adaptive sports, utilizing skills taught by VA
    clinicians and apply them in their daily life in their local
    communities. During the last 9 years, VA has awarded over 119
    million in grants through the Adaptive Sports Grants Program.
    In Fiscal Year 2024, 91 grants, totaling 15.9 million were
    awarded, benefiting over 15,000 veterans and servicemembers.
        In conclusion, VA remains dedicated to providing efficient,
    effective, and meaningful adaptive programs for veterans. Thank
    you for your support and for the opportunity to speak today. We
    welcome your questions.

        [The Prepared Statement Of Rachel McArdle Appears In The
    Appendix]

        Mr. Van Orden. Thank you, Doctor. Your testimony will be
    entered, written testimony--excuse me, statement will be
    entered into the hearing record.
        We are going to proceed to questioning. Everyone knows the
    deal here. We are doing 5 minutes.
        I now recognize Ranking Member Pappas for 5 minutes to
    question the witnesses.
        Mr. Pappas. Thank you very much, Mr. Chairman. I thank you
    for the testimony. This is really an important subject here for
    veterans that I represent in New Hampshire and this is all
    about improving quality of life, giving them the best health
    outcomes, but also allowing them to live with the independence
    that they deserve.
        I want to get to you first, Mr. Latona. I want to ask about
    the Specially Adaptive Housing Grant Program. I am wondering if
    you can tell me more how veterans find out about this
    particular program.
        Mr. Latona. Yes, sir, and thank you for your question. We
    have several mechanisms by which we communicate the program. We
    have outreach efforts that cover from our internal systems.
    Veterans, once they are determined to be eligible through VA's
    compensation service, they are contacted immediately by a
    representative from the Specially Adapted Housing Program. They
    are also put it on an automated letter schedule where they will
    get annual letters notifying them of their eligibility or
    remaining entitlement.
        We also work closely with other VA programs, like my
    colleagues sitting here at the table, to make sure they have
    fact sheets and information about our grant programs in case
    they have veterans who they feel would benefit from any of
    those programs.
        Then last, we work with external partners, nonprofits,
    veteran service organizations. We meet with them regularly, as
    regularly as possible, to make sure they are aware of the
    programs, too, so they can help steer veterans toward not just
    the Specially Adapted Housing Grant Program, but any of the
    other programs that also provide the same types of features
    from VA.
        Mr. Pappas. Well, I appreciate how you are getting the word
    out. We have heard from some veterans that the process can take
    as long as 18 months because of staff turnover, losing
    paperwork, and some of the veterans who suffer from Amyotrophic
    Lateral Sclerosis (ALS) or Lou Gehrig's disease do not have the
    kind of time to get through the approval process and get the
    work done on their home. How is eligibility determined and how
    long does that process take?
        Mr. Latona. The eligibility process happens from VA's
    compensation service, and I would say on average it is probably
    3 to 6 months, depending on the complexity of the case. Every
    veteran is unique, their service-connected disabilities are
    unique. Once they are determined to be entitled and they
    receive their eligibility, that is when Specially Adapted
    Housing is contacted and that is the point at which we reach
    out to them.
        To your point as well, we also understand it can be kind of
    complex having to navigate a recent disability as well as the
    paperwork required. For veterans who have certain disabilities
    like ALS, we have an expedited process where we will focus on
    fewer serious adaptations rather than the entire project scope
    to try to speed along the grant approval process.
        Mr. Pappas. Dr. McArdle, if I could turn to you. How do
    veterans find out about Adaptive Sports Programs?
        Dr. McArdle. We have focused on outreach throughout the
    last several years. There are several reasons--several ways
    that they can find out about our Adaptive Sports Programs. At
    our national rehab events, we hold a variety of outreach
    opportunities such as health and wellness expos, informational
    tables that check in for the events, educational sessions, and
    we encourage veterans to attend to learn about not just what
    the adaptive sports portfolio offers, but also what other
    benefits and healthcare services they are entitled to.
        They can--we also use outreach through social media, VA
    news blogs. We have an adaptive sports website that is open to
    the public that we constantly update. We do emails to
    clinicians so that clinicians are aware of all of our offerings
    because the clinicians are our Ambassadors out in the field
    across the enterprise, who are letting their veterans know we
    do not just target recreation therapists or adaptive sports
    clinicians in these emails. We target all of our rehab teams so
    that all rehab providers are aware of what we have to offer.
        Mr. Pappas. Oftentimes, veterans themselves can be the best
    validators and evangelists for these Adaptive Sports Programs
    to let their peers and community know about the benefits of
    them.
        I am wondering if you can talk about staffing and whether
    you feel there is enough staffing to support all of the
    programs and special events that VA offers.
        Dr. McArdle. Currently, the VA is committed to ensuring we
    have enough staffing to have no impact on veteran care.
        Mr. Pappas. Have we seen any positions specifically related
    to Adaptive Sports Programs be impacted by any of the hiring
    freeze or any of the resignation offers to VA employees?
        Dr. McArdle. Not to my knowledge. I would have to take that
    back for the record for specifics.
        Mr. Pappas. Okay. If there is any more information there,
    we would love to hear about that. How many grants were awarded
    and what was the total amount in Fiscal Year 2024?
        Dr. McArdle. Just one moment. There were 91 grants awarded
    in 2024. The total amount was 15.9 million.
        Mr. Pappas. Okay. Are you getting annual reports back from
    all the grantees?
        Dr. McArdle. Yes, sir.
        Mr. Pappas. Okay. One recommendation that came out of a
    2021 Inspector General (IG) report was on adequate staffing,
    and we want to ensure that experienced staff are still
    providing the oversight.
        I see my time is up here, so maybe we can have a second
    round, but thanks very much. Okay.
        Mr. Van Orden. Too many buttons back here. The gentleman's
    time has expired. Chris, if you want to do a second round,
    absolutely. We are here to make sure we get all the answers we
    want.
        The chair now recognizes my friend, Mrs. Ramirez from the
    great State of Illinois, for 5 minutes. Oh, excuse me, I stand
    corrected. I now recognize Representative Barrett from the even
    greater State of Michigan for 5 minutes.
        Mr. Barrett. Not your great friend. Thank you, Mr.
    Chairman. Appreciate it. Thank you to our panelists for being
    here today. Appreciate the work that you put into this. I did
    have a few questions for you.
        Dr. McArdle, we have heard from, I have personally heard,
    too, from some of the automotive adaptive equipment providers
    that the VA has been delayed in rendering payment for already
    approved adaptive equipment for veterans that are seeking to,
    you know, certainly have that provided. I have heard it can
    even take more than 6 months to pay a provider back. Again,
    these are things that have already been approved through the
    VA, but the actual final payment to the vendors is taking a
    substantial amount of time that can really impact their ability
    to, you know, run their businesses effectively. Can you give me
    an update as to why that is taking place and what we are doing
    to correct that?
        Dr. McArdle. The Automobile Adaptive Equipment Program is a
    joint program that collaboratively VBA and VHA work together. I
    am going to defer to my colleague, Mr. Latona, to start off.
        Mr. Barrett. Sure.
        Mr. Latona.Yes. Thank you for your question, sir.
        As Dr. McArdle stated, the process begins with the veteran
    being rated. That is a VBA process, after which it turns over
    to VHA, who determines which type of equipment they
    specifically need and they are going to prescribe. Then it
    comes back to VBA for payment. As far as the payment goes, the
    payment process is not a national process currently within VBA,
    so local offices handle them themselves. We are aware of that
    there is a number of people, of vendors who have claimed the
    late payments. We have not gotten that data, but we are looking
    forward to looking at it and being able to address it at that
    point, once we have cases that we can dig into.
        Mr. Barrett. Sure. I have, you know, I have heard that VA
    is like, well, we have not seen that, and maybe it is anecdotal
    here and there, but I have had providers show me a list of
    pretty substantial delayed payments that is not a one-and two-
    off situation. I think I heard that there were a multitude of
    instances where this was happening and it was taking more than
    6 months on average to process payments, sometimes far longer
    than that, over 200 or 250 days even. That is very hard for
    those vendors to continue to offer that service. The concern
    that I have is that they are going to no longer contract with
    the VA for that. That will lead to a scarcity of available
    vendors, and veterans will have to go farther and search harder
    to find one that will accept their VA benefits. It is something
    that I think we need to fix. Is there a single point person
    that would be responsible for correcting this?
        Mr. Latona. There is currently an IPT, integrated product
    team, that is put together to actually investigate this exact
    problem.
        Mr. Barrett. Okay.
        Mr. Latona. There is leadership from VHA and from VBA
    getting together to discuss it and come up with resolutions. We
    would love to follow up with the court.
        Mr. Barrett. Yes. Who is in charge of that team, that team
    that you described?
        Mr. Latona. I am not sure who the specific point person is,
    but several leaders across both. We can provide you that
    information as well.
        Mr. Barrett. Okay. What I do not want is for this to just
    be like, you know, six people are in charge of it, and no one
    is really in charge of it. Then it kind of--everybody, you
    know, does not have ownership. If there is a specific person
    that is responsible for this, I feel like that would help work
    through some of the challenges that exist. If there is a way
    to, you know, identify whom that person or whatever role that
    is, to really figure out a way to work through this, that would
    be something that I think would be useful. I think it is fair.
        You know, we provide this for veterans as we should. It is
    an expectation that we have. Then on the other end of that,
    there is a vendor that builds that equipment, that needs to
    have that payment to make their own payroll and pay their own,
    you know, overhead as well. We are going to lose that, that
    vendor relationship with the VA and, ultimately, veterans are
    going to suffer if it goes too far that way.
        Mr. Latona. Right, sir. I agree. Yes, these are trusted
    partners of ours. They are not--we do not want to take
    advantage of them. We need to pay them for the service that
    they are providing fairly.
        Mr. Barrett. Right.
        Mr. Latona. That is the intention of the IPT, and we will
    definitely be able to provide you specific names.
        Mr. Barrett. Okay. Yes, I appreciate that. If we can meet
    with that team, I would like to just hear about their progress
    and what they are doing and really stay on top of this. Thank
    you.
        Thank you, Mr. Chairman.
        Mr. Van Orden. The gentleman yields back.
        Now I recognize my dear friend, Mrs. Ramirez from the great
    State of Illinois.
        Ms. Ramirez. The greatest, thank you. Thank you, Chairman.
        Mr. Van Orden. That is not true.
        Ms. Ramirez. I want to thank the witnesses for being here
    with us today.
        Last week, I had a chance to ask Secretary Collins about
    his commitment to serving all our veterans, not just the ones
    the administration may recognize worthy. I also asked him how
    he intended to continue providing services to veterans after
    the dismantling of offices, like the Office of Equity Assurance
    and programs that serve diverse veterans. My questions went
    mostly unanswered. In fact, on the record, he stated that the
    VA workers, many of whom are veterans, who followed his
    directives, were maliciously compliant.
        Blaming workforce, cutting services, and drastically
    limiting programs veterans can access is, to me, a page out of
    the Musk-Trump administration. I think it is really important
    to say on record, all veterans still face barriers to accessing
    housing, healthcare, and basic support. It is why this
    committee hearing is so important.
        The providers and their services are not just under strain.
    They are being actively undermined by their leader and then
    blamed on systemic shortcomings. Unfortunately, one of the
    programs at risk due to the VA's leadership and decision-making
    is the Specially Adapted Housing Program, and as you just
    mentioned, SAH. Veterans who need accessible homes, those with
    serious injuries and life-changing disabilities should not be
    facing delays or administrative confusion.
        Mr. Latona, my question is for you. Do you currently have
    enough staff in place to process SAH grants and carry out
    timely inspections? Yes or no?
        Mr. Latona. I would answer that question by saying the
    Department is following all court orders regarding staffing and
    reporting on staffing, ma'am.
        Ms. Ramirez. You would say you do have enough staff right
    now to process the grants?
        Mr. Latona. I would say that the--our mission is critical
    and we will never have enough staff, in my opinion. We always
    need more staff to perform this critical mission.
        Ms. Ramirez. Mr. Latona, is the staff training for that
    staff consistent across the board? Is it pretty much the same
    uniformity and training?
        Mr. Latona. We have national training for all agents. It is
    a very complex job. Our specially adapted housing agents need
    to be counselors and they need to be well versed in
    construction and all different kinds of elements. We spend a
    lot of time with veterans in their homes. We have to have
    sensitivity training as well. We do have national training. The
    most effective training we get is our on-the-job training with
    more senior level employees.
        Ms. Ramirez. Got it. Just follow up on that, understanding
    the comprehensive approach and spectrum and the training, can
    you tell me who in the VA is responsible for delivering the
    training itself?
        Mr. Latona. Yes, the individual operations assistant
    directors across the country deliver the training locally. Then
    we have a deputy director in Loan Guarantee Service who is in
    charge of operations, who is overall in charge.
        Ms. Ramirez. The deputy director is overall responsible for
    the training----
        Mr. Latona. For Specially Adapted Housing agents.
        Ms. Ramirez [continuing]. and then, obviously, the staff.
    Okay. We all agree that balanced budgets are important. Mr.
    Latona, I want to talk a little bit more about this. How does
    the VA calculate the amount of each SAH grant?
        Let me follow with the second question because I know I am
    limited on time. When determining grant amounts does the VA
    account for inflation?
        Mr. Latona. Yes. We have several mechanisms that we use. We
    have the cost of construction index that were authorized each
    year based upon the industry performance of construction, we
    are able to raise the grant amounts to kind of keep pace with
    the cost of construction across the industry. We also
    implemented the Ryan Kules Act recently which increased grant
    amounts and also provided a bunch of other very essential
    benefits for these veterans.
        We do track that and we are doing our best to keep up with
    it. Right now, our SAH grants, the maximum grants cover about
    20, 25 percent of the average cost to housing.
        Ms. Ramirez. Got it. What about other rising costs, like
    labor shortages or tariffs? Has the VA elevated concerns about
    how broader Federal policy, like arbitrary tariffs or rolling
    back labor regulations or immigration crackdowns, can affect
    some of the construction costs for adaptive housing?
        Mr. Latona. Well, from our role, the increased costs of
    labor and materials has a significant impact on the ability of
    the veteran to stretch their grant funds, which is really what
    we are trying to do.
        Ms. Ramirez. Got it.
        Mr. Latona. Once we identify what the veteran needs, we
    want to pay for all those, if possible. We also have the
    ability to stack different benefits. The Veteran Readiness and
    Employment (VR&E) Housing Adaptation Grant and the SAH Grant
    can be used together if needed to help stretch those dollars.
        Ms. Ramirez. I just got 30 seconds, so let me just
    transition really quickly. I want to talk to you a little bit
    about vehicle adaptation benefits, and this could be for Dr.
    McArdle or Dr. Scholten, whoever is best positioned. How many
    adaptive vehicle applications does the VA receiver receive
    annually, and how long, on average, does it take to determine
    eligibility?
        Dr. Scholten. I believe that question should be directed to
    Mr. Latona.
        Mr. Latona. Right.
        Ms. Ramirez. Mr. Latona.
        Mr. Latona. Thank you. I think it falls within the scope of
    the Veterans Benefits Administration, who determines
    eligibility.
        Ms. Ramirez. How many applications annually?
        Mr. Latona. I have to take that back and find out exactly
    how many numbers, but I do know that we delivered over 1,040
    adaptive equipment grants last year, and 620----
        Mr. Van Orden. The gentlelady's time has expired.
        Ms. Ramirez. Chairman, if I can just have it for the
    record, if I can get that information.
        Mr. Van Orden. Oh, 100 percent. We are going to do a second
    round, too.
        Ms. Ramirez. Perfect. Thank you.
        Mr. Van Orden. You are welcome. The gentlelady yields back.
        The chair now recognizes a very good friend from the great
    State of Arizona, Mr. Juan Ciscomani.
        Mr. Ciscomani. Thank you, sir. Thank you, Mr. Chairman.
    Thank you to our witnesses for coming today. Primary purpose of
    the VA is to ensure veterans are not only receiving benefits on
    healthcare when they need it, but to ensure their quality of
    everyday life can also be improved. Thank you for the work that
    you do there.
        Now, a question here, Dr. McArdle. Did I get that right?
    Okay, close enough. Please correct me on that one. I want to
    get it right. In your testimony, you mentioned the special
    Adaptive Housing Grant Program has approved more than 2,000
    grants, grant awards annually in 6 of the last 7 fiscal years.
    What do you attribute to the higher usage of this program, and
    do you think this will continue?
        Dr. McArdle. I am going to turn it over to my colleague,
    Mr. Latona.
        Mr. Ciscomani. Okay. Sir?
        Mr. Latona. Thank you for the question, sir. Yes,
    definitely it is true. Yes. In Fiscal Year 2024, we approved
    over 2,300 grants, over $150 million, 96 percent of those were
    our larger grant, called the Specially Adapted Housing Grant,
    $121,000.
        As far as the volume goes, one of the reasons, I think, is
    outreach. We have word of mouth is very popular among our
    veterans. Once they find out you can get a grant, I would say
    they will share that information. I would also say these
    partnerships that we have with our other VBA programs, like my
    colleagues here at the table and the folks who are going to be
    on this next panel, our nonprofit partners, VSO partners, they
    spend a lot of time performing outreach and helping to carry
    the water for us to our veterans.
        Mr. Ciscomani. Excellent. Thank you for that. Now, do the
    programs you oversee interact with or serve veterans
    experiencing homelessness?
        Mr. Latona. Not directly. Veterans for our program will
    usually either own a home or be residing with a family member.
        Mr. Ciscomani. Okay. Do you think there are some
    opportunities for partnership with other VA services, agencies,
    or even the private sector on this?
        Mr. Latona. Definitely. We partner with many programs
    within VA, many folks who are here today to make sure that we
    are providing comprehensive benefit. We understand that these
    are lifelines to a lot of veterans. A veteran who is coming to
    Specially Adapted Housing for a housing adaptation may not know
    about the automobile grant or may not know about another grant.
    We try to make sure we spread the word of all those, and we are
    Ambassadors for all the programs in VA when we meet with them.
        Mr. Ciscomani. Do you have any example you can give me on
    how that is working in terms of the partnerships with local
    agencies or even the private sector?
        Mr. Latona. Absolutely.
        Mr. Ciscomani. Maybe, you know, a good model that is
    working somewhere that we could replicate somewhere else.
        Mr. Latona. Absolutely. We will pull an example out of
    someone who is on the second panel. The Homes For Our Troops
    nonprofit organization provides homes for veterans who have
    been injured following 2001. In order for those veterans to be
    able to get that benefit from Homes For Our Troops, they need
    to be eligible for specially adapted housing. This requires us
    to work together. We review house plans to make sure that their
    home plans meet the requirements so we can expedite grant
    delivery.
        Mr. Ciscomani. Where is this happening?
        Mr. Latona. All across the country.
        Mr. Ciscomani. All across the country. Any Arizona good
    examples you could point me to so that I can----
        Mr. Latona. We have many grants in Arizona. I do not have
    any in front of me right now, but I can definitely provide
    examples.
        Mr. Ciscomani. Yes, I would love to get that just to know
    what is in our community, and my district specifically, in
    Congressional District 6 (CD6), and we can--love to go and pay
    more attention to that and go see it. Can you, with the time I
    have left here, can you explain what the VA is doing to
    eliminate fraud, waste, and abuse, and specifically in the SAH
    program, to ensure that severely disabled veterans are getting
    what they need and bad actors are not taking advantage of the
    program?
        Mr. Latona. Definitely, and thank you for that question.
    That is a very important area, too.
        One of the big steps we took recently was to remove third
    party escrows. What happens when a veteran receives their
    grant, a third party escrow company or the VA would hold onto
    the money and disperse the funds as the project was completed
    to make sure that we were not paying for work that was not
    completed. Rather than having third parties do this, which
    sometimes led to some funds being dispersed too quickly before
    work was done, and then we would have to try to recoup those
    funds, what we are doing now is VA holds those funds. We
    require a letter of satisfaction from the veteran and we
    perform a compliance inspection before any funds are dispersed.
        Mr. Ciscomani. That is interesting. Who were these third
    parties doing this before?
        Mr. Latona. Third parties, it was the veteran's choice.
        Mr. Ciscomani. Veteran's choice, Okay.
        Mr. Latona. Veteran was able to choose whatever attorney or
    bank they wanted to use and they would usually be charged a
    fee. This change also reduced that--eliminated that fee.
        Mr. Ciscomani. Less money flowed down to the final purpose
    with all the different steps on that. With a little time I have
    left here, 15 seconds, with the bringing this back in house,
    did that add a additional staff member within the VA network or
    how did that impact----
        Mr. Latona. No, we performed with the existing staff.
        Mr. Ciscomani. Okay. All right. Thank you, Mr. Chairman. I
    yield back.
        Mr. Van Orden. The gentleman's time has expired.
        The chair now recognizes my friend, Mr. McGarvey, from the
    great State of Kentucky.
        Mr. McGarvey. Thank you, Mr. Chairman. I want to thank you
    and I want to thank everyone who is here today for taking the
    time to dig into this really important issue. This is something
    that enables our veterans to live full lives, complete lives,
    happier, healthier lives. It gives them that sense of purpose
    that they so desperately oftentimes need, as we talk about in
    this committee.
        Dr. McArdle, I want to start with you a little bit. The VA
    is special. VA is special because its mission is to serve
    veterans. It is to make veterans lives better. It is not for
    profit. It is for our veterans. As a result of that, we get
    amazing results coming out of your office. The artificial limbs
    you all are making, the wheelchairs that are built for speed
    and for maneuverability, the tactile devices for visually
    impaired athletes, these are so important. They are not just
    meeting our veterans and our veteran athletes where they are.
    They are making their lives better. These devices provide
    purpose, they provide activity, they provide community and
    belonging. Our veterans should not lose that just because they
    lose part of what they had before they entered the service.
        Adaptive sports are so incredibly important. We got to see
    it firsthand in Louisville this year. In February, Louisville
    hosted the annual Wheelchair Rugby Invitational. There were 20
    teams all over competing in a round robin style tournament to
    get the prestigious Code of Honor Cup. This was more than a
    display of athleticism. This was determination, this was joy,
    this was happiness, this was belonging. It is something that
    our veterans need. Need. Not just something they want, it is
    something they need.
        I want to talk about this. What kind of technological
    innovations is your office investigating or investing in right
    now for the next generation of adaptive equipment to keep going
    forward, to keep our veterans having the sense of purpose and
    belonging? Are you able to partner with any outside researchers
    or manufacturers in that work?
        Dr. McArdle. Thank you for your question. It is a very
    exciting area for us as well and we feel just as passionately
    about it as you do. I am going to defer the question to my
    colleague, Dr. Scholten.
        Dr. Scholten. Yes, thank you for your question and also
    your enthusiasm. We as a rehab provider, I feel that adaptive
    sports and any efforts we can provide to help veterans
    reintegrate into their community is essential in not only their
    rehab plan, but their wellness plan. The Adaptive Sports
    Program partners very closely with our clinicians throughout
    our system of care. Relying on those clinicians to stay
    advanced or up to date with any technological advancements in
    prosthetic development, training opportunities through physical
    therapy and physiatry, and additionally pain management
    techniques that allow veterans to function at a higher level.
        We have a very robust research portfolio within VA that
    looks at a variety of musculoskeletal issues as well as
    traumatic brain injury and amputation-related research that
    help to continually push forward advancements to enhance
    veterans recovery.
        Mr. McGarvey. I think, you know, innovation is key all over
    the VA. We have to continue to innovate to find the best
    treatment and care for our veterans and we have the opportunity
    and the ability to do so.
        Are you all partnering with any outside groups really to
    kind of to help with this effort as well?
        Dr. Scholten. We are partnering with a number of academic
    institutions through our research grant portfolio to connect
    with the brightest minds across the country to further
    investigate technological advancements. In addition, we partner
    with our VSO partners to include greater participation and
    awareness of these events. Then we stay--try to stay aware and
    open for innovative ideas from our vendor--the vendor community
    throughout the country to better understand any new advances
    that might be coming down the pipeline.
        Mr. McGarvey. We want to keep working to make that
    innovation possible. Switching gears, let us talk about the
    Volunteer Transportation Network for just a second. A 2024 U.S.
    Government Accountability Office (GAO) report shows a 50
    percent decline in rides provided to medical appointments for
    veterans, partly in part because the number of volunteers is
    decreasing. What is VA doing right now to replenish its
    volunteer base and increase the use of this program, getting
    our veterans where they need to go?
        Dr. McArdle. I am going to have to take that one back for
    the record and get you some more information on that.
        Mr. McGarvey. Perfect. Got it.
        With that, I am out of time. Mr. Chairman, I yield back.
        Mr. Van Orden. The gentleman yields back.
        I now recognize myself for 5 minutes.
        Okay. I just have some real serious, like, basic rubber
    meeting road questions here. This subcommittee is also
    responsible for the Transition Assistance Program (TAP). It is
    just baffling to me that any veteran, especially someone that
    is being medically discharged, is unaware of these programs. I
    mean, that is a galactic failure. We are going to fix that.
        These programs will be introduced into the TAP program. For
    someone not to have thought of this earlier is shameful. I do
    not want anybody leaving the service and, ma'am, you said that
    people are being medically discharged and they still do not
    know about these things. Sure, it is great, peer to peer,
    veteran talking to veteran, saying, you know, these programs
    are available, but no.
        Dr. Scholten, how long have you been at the VA?
        Dr. Scholten. I have been working for the VA for 27 years.
        Mr. Van Orden. Dr. McArdle.
        Dr. McArdle. I started as a trainee 30 years ago.
        Mr. Van Orden. Mr. Latona.
        Mr. Latona. Seven years, sir.
        Mr. Van Orden. Seven. We got roughly 60 years' worth of
    experience at the VA and no one thought about talking about
    this in the TAP program? Okay. We will do better.
        Mr. Barrett brought up some very salient points about
    payment. We had one dental clinician in the Network for
    Community Care. I went there. It was an hour drive. It took the
    VA so long to pay him that they dropped out.
        Mr. Latona, we are not going to look into this anymore. We
    are not going to have meetings, we are not going to coordinate.
    We are not doing any of that. I am going to--I request
    unanimous consent to enter this into the record. Hearing no
    objection, so ordered.
        All right. I am going to give you these things, and you are
    going to take them back to the office and you are going to look
    into them, and you are going to pay these people. I am, and I
    am sure, Chris, as we have not talked about it before, we, can
    I speak for him, possibly, we are willing to accept some risk,
    because if you cannot figure out how to pay somebody, they are
    going to leave, and that what Mr. Barrett said will come to
    fruition.
        Then my Marine brother back there, who was grievously
    injured in combat outside of Balad, right? That is right, 2005,
    will not be able to get his house fixed or his vehicles fixed
    because of administrative inertia.
        I am going to give this to you. I am also going to send a
    note to the Secretary. With 60 years' of experience, you can
    figure this out. It is literally signing a check. Mr. Latona,
    that is not a question. I am just telling you what is going to
    happen.
        Mr. Latona. Yes, sir. Thank you.
        Mr. Van Orden. You said, Mr. Latona, that there is an
    expediting process for people with ALS and some other things.
    What is that process?
        Mr. Latona. Yes, sir. Thanks for the question. With most
    projects, we walk through a entire scope of a project. Veterans
    will usually have a little more time. They will want to take
    time to find a builder that they want to work with. We enable
    them to do that, and then we help facilitate that conversation
    to identify which adaptations they might need.
        Mr. Van Orden. Okay, Mr. Latona, stop it. Okay. There
    should be no expediting process. Every process should be
    expedited. Just because a veteran is not going to die within 2
    weeks does not mean you should not be running down the road at
    1,000 miles an hour to get that fixed. It is within your power,
    like it is something you can do and you need to do it.
        The average time is what from the time someone is
    discharged to their home is a place where they can live. What
    is the average time?
        Mr. Latona. Sir, I am not aware of that time, but I know
    from application to delivery could be somewhere between 6 to 12
    months for specially adapted housing projects.
        Mr. Van Orden. Right. TAP is supposed to be done 6 months
    prior and then iterative. Why did not that application process
    start while they are still in the military? Can you answer that
    question?
        Mr. Latona. Well, we do work closely, actually, with the
    services and Wounded Warrior programs when we are identified.
        Mr. Van Orden. That is a civilian organization, sir. You
    are the----
        Mr. Latona. No, no, the, I am sorry, the--within the
    service. Each service has their own Wounded Warrior Program----
        Mr. Van Orden. Yes.
        Mr. Latona [continuing]. within them. That is who we work
    with.
        Mr. Van Orden. Not the Wounded Warrior Project. Okay.
        We are going to do a second round, and I will adhere to my
    own rule. My time is about to expire, and the chair will now
    recognize Ranking Member Pappas for 5 minutes.
        Mr. Pappas. Thanks. Dr. McArdle, if I could go back to you.
    We were in the middle of a discussion when I ran out of time
    before. I just wanted to--I was highlighting this 2021 GAO
    report, which talked about adequate staffing levels, and they
    specifically cited needing more staff with grant management
    experience. I am wondering if you could speak to where we are
    today. What we have been hearing is that, based on this report,
    we were understaffed in 2021 and that we are less staffed
    today. Can you speak to that level of staffing specifically to
    people with grant management experience?
        Dr. McArdle. We have made a lot of progress on a lot of the
    recommendations that were recommended in that 2021 Office of
    Inspector General (OIG) report. Is that what we are referring
    to?
        Mr. Pappas. Yep.
        Dr. McArdle. Thank you. In terms of getting all of the
    recommendations closed, that report has been closed. We have--
    we do have a limited number of staff within the grants program,
    but the Department is committed to ensuring that there is no
    interruption in services provided to the grantees or to
    veterans who would be utilizing those grant programs.
        Mr. Pappas. Can you define better ``making progress''? I
    know you spoke about----
        Dr. McArdle. Sure.
        Mr. Pappas [continuing]. the recommendations in the report,
    but specifically as it pertains to staffing, where are we today
    versus when that report was issued?
        Dr. McArdle. I would have to take that for the record.
        Mr. Pappas. Okay. Can you give us the assurance, though,
    that VA currently has adequate staffing with respect to being
    able to properly monitor these grant programs?
        Dr. McArdle. Yes, sir.
        Mr. Pappas. Just going back to what you had told me before,
    I asked you specifically whether positions in adaptive sports
    have been impacted by the administration's hiring freeze or the
    offer for people to resign. You said you did not believe that
    any were impacted. Just talking more with staff in the
    intervening time, we have heard from groups that have told us
    that there are positions--that are people that have left their
    positions that support adaptive sports. I am wondering if you
    can provide any additional clarity now on that or if you can
    come back to us in short order with specific information about
    where we stand with staffing related to adaptive sports.
        Dr. McArdle. I would be happy to take it for the record, to
    get back to you. I do just want to clarify that adaptive sports
    clinicians are in various occupations: recreational therapists,
    physical therapists, occupational therapists. It would be a--we
    will be happy to come back.
        Mr. Pappas. Yes, but you must have an accounting of who
    is--which clinicians are connected to Adaptive Sports Programs.
    Correct?
        Dr. McArdle. They are across the enterprise and they are
    frontline field-based providers who are our coaches for our
    veterans out in the field and across the enterprise. That is
    who we rely on to assist us even with our national rehab
    events.
        Mr. Pappas. Would not you agree that is a pretty important
    element of delivering these programs to veterans?
        Dr. McArdle. Absolutely. Dr. Scholten.
        Dr. Scholten. I would just like to add that, so our
    Adaptive Sports Programs are across the enterprise, as Dr.
    McArdle mentioned. The critical piece about that is our
    rehabilitation staff stationed across every medical center are
    aware of these programs and pursuing not only their working
    with veterans to maximize their rehabilitation potential, but
    also working with community partners to provide adaptive
    sporting activities that are available in the community. This
    is an essential part of that reintegration piece that we--that
    you mentioned earlier from transitioning from the skilled
    rehabilitation part of their care after an injury toward
    reintegrating back into the community.
        We really leverage not just a specific subset of our
    rehabilitation professionals across the country, but every
    rehab individual and, in most cases, every rehab staff member
    contributes or participates part of their time into adaptive
    sporting events, whether it is through support of the actual
    event, recommending to veterans to participate in that, or to
    build onto their rehab and wellness plan.
        Mr. Pappas. Okay, I appreciate that. Just to sum up, I am
    looking for some more clarity with respect to positions that
    have been impacted by the hiring freeze within the adaptive
    sports or under the adaptive sports umbrella, anyone connected
    to that, including clinicians. I am also looking for more
    information in the wake of the IG report on staffing with grant
    management experience, making sure that we have enough and just
    kind of trying to assess what level we are at today. If you can
    follow up with us, we look forward to that information.
        I yield back.
        Mr. Van Orden. The gentleman yields back.
        The chair now recognizes Representative Barrett from the
    great State of Michigan for 5 minutes.
        Mr. Barrett. Thank you, Mr. Chairman. Appreciate the first
    round of questioning.
        Wanted to also ask, so, Dr. McArdle and for the panel, too,
    if there is someone more appropriate to answer this, I know
    that we have seen a significant rise in construction costs
    across the economy. I spoke to realtors in my district and they
    were saying, you know, you cannot buy an affordable home any
    longer and takes too much to build new and all the regulations,
    everything else, you know, tools, equipment, materials have
    skyrocketed, labor costs have gone up. Have our costs through
    the VA and the adaptive programs for living accommodations and
    everything else, have they kept pace with that ramp-up in cost
    of construction for a home? Or are veterans having to make
    decisions, you know, based upon cost overruns and things of
    that sort of.
        Mr. Latona. I can take that question, sir. Thank you very
    much. Cost of materials and labor have both been kind of
    rampant since the pandemic, and it does, as I stated before,
    impact the ability to stretch those grant funds. What we tried
    to do, utilizing the cost of construction index, which allows
    us to keep pace with the cost of construction, I think last
    year we were able to raise the amount by 4.6 percent. Year
    before that it was, I think, it was over 6 percent. We are
    maintaining about a 25 percent comparison between the overall
    average cost of housing. However, veterans, unless they are
    just adapting an existing home, they will almost always have to
    come out of pocket for other costs just because of the cost.
        However, we do have other partner programs I mentioned
    before. Home Improvement and Structural Alterations grant that
    is managed by VHA and we also have the Veteran Readiness and
    Employment Independent Living Track has a grant called the Home
    Adaptation Grant. We are actually able to leverage all those
    collectively to help reduce the amount of money that a veteran
    has to use out of their own pocket to make sure they get the
    necessary adaptations. Then, of course, we lean on nonprofit
    partners as well.
        Mr. Barrett. Sure. Thank you. Typically, if a veteran needs
    substantial account accommodations, they are not retrofitting
    the home that they may already live in. Is that generally true?
    They are usually having to build new?
        Mr. Latona. Majority of times actually they are adapting a
    home. We have several different plan types. What we call the
    plan 3 is remodeling a home that a veteran already owns. That
    is by far the one we use the most. About 85 to 90 percent of
    our projects really are that.
        Mr. Barrett. Okay. If a person, a veteran is, you know,
    substantially mobility limited and like I understand a
    wheelchair ramp for your front steps or something of that sort
    is a smaller modification, but other things for someone who may
    have much more severe mobility restrictions, that probably tips
    the scales toward a new build at that point?
        Mr. Latona. It really depends. I mean, we--a new bathroom
    will run 40-to $50,000 usually for a fully accessible bathroom.
    Those we can usually do, with a proper designer, we can do
    within the existing home. Veterans usually choose to buy a new
    home if they do not own one already or if they own an older
    home, which maybe cannot be modified. At that point, we tell
    them the property is not really suitable for the type of
    adaptations you need, and then they would try to find another
    home.
        Mr. Barrett. Okay. All right. I feel like construction
    costs have gone up by far more than the 4 or 6 percent that you
    are describing. Has that been accounted for? Is there an
    automatic adjustment? You mentioned the construction inflation
    index.
        Mr. Latona. Right.
        Mr. Barrett. Just, you know, anecdotally, you cannot go to
    Home Depot or Lowe's and find the same building materials for
    only 4 percent more than they were, you know, pre-pandemic, for
    example.
        Mr. Latona. True. We use an industry cost of construction
    index. With the authority to increase this, we had a designated
    index we would use. The one we use is currently the Turner
    cost, which actually reflects increased cost across the
    industry. That is the one we have been using.
        Mr. Barrett. Okay. All right. Is that accurate, would you
    say? Or is there work that needs to be done to make that more,
    I guess, more accurate for today's conditions?
        Mr. Latona. I think it covers most of the locations, but
    there are a lot of locations around the country where it is
    more difficult to get equipment and materials that we need to
    think about. Pacific Islands is one. Rural properties on
    Reservations land, Tribal trust lands, things like that is a
    lot harder. That is usually where we come up against projects
    that exceed the grant cost.
        Mr. Barrett. Okay. I would say even, you know, where I
    live, we are not stranded out somewhere. I mean, there are home
    improvement stores, you know, in the drivable area, but the
    costs of materials have just gone up so much. Then the building
    labor costs and then the timeline in which to find a
    contractor, it all really adds to the cost of the program.
    Thank you, appreciate it.
        Thank you, Mr. Chair.
        Mr. Van Orden. The gentleman yields back.
        The chair now recognizes Mrs. Ramirez for 5 minutes.
        Ms. Ramirez. Thank you, Chairman.
        Just wanted to follow up with you, Mr. Latona, on the
    questions around the adaptive vehicle applications. I think you
    said to me that you will go back and try to get me information
    on how many applications you get annually. Is that right? Then
    I think the only second part to that I had was how long on
    average does it take to determine eligibility once they have
    submitted the application?
        Mr. Latona. Thank you for your question, ma'am. Eligibility
    for any compensation whatsoever is performed, that
    determination is performed by the VA's Compensation Service. I
    think they have an average time. I do not have that data with
    me, but I can provide It.
        Ms. Ramirez. Yes, that would be helpful because I am trying
    to find out specifically, as it pertains to vehicle
    applications, what the average amount of time is.
        I want to pivot to another question here. We have heard
    repeated concerns from veterans and dealerships about delayed
    payments. I think it is another question for you, Mr. Latona.
    What is causing some of the backlog? Is there enough staff to
    process these applications?
        Mr. Latona. The payments are done outside of the Specially
    Adaptive Housing Program that I am--where I am here for my
    subject matter expertise for that program specifically.
    However, we can get you an answer on the staffing. I do not
    know if that impacts it currently, but I do know there are many
    variables when it comes to paying any vendors; communication
    between vendors, depending on size, depending on the way they
    invoice. There are a lot of differences in the different
    timelines specifically. I do know that once an invoice gets to
    VBA for payment, we have a time of 15 days to actually deliver
    those payments. The transaction usually takes 1 to 2 days. This
    is one of the areas that we are looking at within the IPT to
    find out where the bottlenecks are.
        Ms. Ramirez. I really appreciate that because I have heard
    repeatedly concerns with constituents about the delayed
    payments and what that means for them.
        One last question around that, and then I will get to my
    last question. Have there been any staff fired responsible for
    this work between the vendors and the processing since January
    20th?
        Mr. Latona. I am not aware. Again, that program is outside
    of my area of expertise.
        Ms. Ramirez. Okay. Can we get on the record, Chairman, that
    there is a number of questions that I do not have information
    on. I would like to be able to follow up and get it.
        Mr. Van Orden. Absolutely.
        Ms. Ramirez. Thank you, Chairman. The last one I have here
    is, how does the VA currently calculate the cost of an adaptive
    vehicle? Yes, answer that, and then I guess there is a second
    part to that.
        Mr. Latona. I am going to actually refer that to Dr.
    Scholten.
        Ms. Ramirez. Great. Someone else answering. Thank you, Dr.
    Scholten. Thank you, Mr. Latona.
        Dr. Scholten. My pleasure. Thanks for the question. That
    depends on the specific adaptation that is required, which is
    going to be uniquely customed for that individual veteran and
    their abilities. The veterans are evaluated by driver rehab
    specialists to develop a specific prescription for what
    modifications need to be placed provided for their vehicle.
    Then those line items on the invoice are processed through our
    prosthetic partners and then selected to a vendor. Once those
    modifications have been made, then Prosthetics looks at the
    line item on the prescription to ensure that each piece is
    appropriately provided on the vehicle or adapted to the vehicle
    before we can--before we sign off on completeness.
        Ms. Ramirez. Got it.
        Dr. Scholten. The payment schedule for each of those items
    is posted on our website. A payment schedule is updated every
    fiscal year. That is based on the Consumer Price Index.
        Ms. Ramirez. That is based on the Consumer Price Index as
    well?
        Dr. Scholten. Yes.
        Ms. Ramirez. Okay, got it. That was actually my follow-up
    question.
        Those are all the questions I have now, Chairman.
        Mr. Van Orden. The gentlelady yields back, and I recognize
    myself for 5 minutes.
        Okay. You just said that when the VA gets a bill, you have
    15 days to pay it, is that right?
        Mr. Latona. That is true, sir. Yes.
        Mr. Van Orden. Okay. Well, on this list that you will have,
    we got Kansas City, Missouri, 501 days; El Paso, 246; Dallas,
    Texas, 362, these are all days; Dallas, 823 days; Phoenix, 256
    days; 530 days for another thing in Phoenix; Waco, 96. I was an
    enlisted guy. You know, math is not my forte, but I am just
    going to say that I think all of those are greater than the
    number 15.
        Mr. Latona. I agree, sir.
        Mr. Van Orden. Okay. Unacceptable, sir. Can you walk me
    through the billing process? What happens?
        Mr. Latona. I can walk you through most of it. Some of it
    might be on the VHA side, but where I will pick it up from is
    once the VHA has identified the specific adaptations that were
    required, they will coordinate with the vendor to make sure the
    vendor understands what is needed and what the cost of those
    are. Once that entire package is complete, it goes to the
    vendor and then it makes its way to VA to pay it.
        Mr. Van Orden. Okay. What does that mean, sir, ``makes its
    way''?
        Mr. Latona. It is emailed. It is emailed from the local
    office. The office that is actually performing the analysis,
    determining what adaptations are required, emails it directly
    to the Support Services Division, which is an office within VA
    that handles the payments. It is a few minutes.
        Mr. Van Orden. How does a check get cut?
        Mr. Latona. The check gets cut. At that point it goes over
    to our Support Services Division who pays all vendors for all
    services.
        Mr. Van Orden. How many people are there?
        Mr. Latona. I am not aware, sir. These are not where the
    better--these are not where the bottlenecks are. Obviously
    bottlenecks are somewhere up or down the stream somewhere, not
    in those little transactions. That is----
        Mr. Van Orden. Sir, I guarantee you, I guarantee you, if we
    had open kimono with your stuff that I could figure this
    problem out in an afternoon, like line and block chart,
    disabled veteran, vendor payment. That is all we are talking
    about. This is bananas.
        I am going to say this again. The Veterans Affairs--or I am
    going to say it, the Veterans Affairs Administration is not a
    jobs program. It is not. Neither is the military. If we have
    nine bosses, Bob, you know, that is a problem. We have to look
    at the structure of the VA through the lens of getting that
    Marine what he needs, not you or you or you.
        Are individual projects capped, like a home? Is there a
    financial cap?
        Mr. Latona. Each grant program has its own maximum grant
    amount available. For specially adapted housing, it is $121,000
    this year.
        Mr. Van Orden. Per home?
        Mr. Latona. Yes.
        Mr. Van Orden. What about for a vehicle?
        Mr. Latona. I would defer to Dr. Scholten on that.
        Dr. Scholten. There is no cap on the vehicle modifications.
    It is based specifically on the required adaptations in the
    prescription from the driver rehab specialist.
        Mr. Van Orden. Okay. Riffing off Mr. Barrett's comments
    about inflation and whatnot, when was that cap of $120,000 per
    unit established?
        Mr. Latona. October 1st. Each year we have the ability to
    raise it based upon the Cost of Construction Index.
        Mr. Van Orden. What was it last October?
        Mr. Latona. A hundred and 17 thousand.
        Mr. Van Orden. You raised it 3,000 bucks.
        Mr. Latona. It is based upon an index, an industry index,
    right.
        Mr. Van Orden. Even though housing costs and construction
    costs have increased by like 30 to 40 percent in the last few
    years. Okay. We need to really look at that. Like, who said you
    are going to use the Consumer Price Index? Is that us or you?
        Dr. Scholten. For the vehicle modifications, that is in our
    regulations.
        Mr. Van Orden. You did that. What about for the homes?
        Mr. Latona. For the homes, the statute directs we use a
    Cost of Construction Index.
        Mr. Van Orden. Right.
        Mr. Latona. We selected the one that we are currently using
    because it was the most competitive.
        Mr. Van Orden. It is not tied to inflation.
        Mr. Latona. Right. It is tied to the cost of materials and
    labor across the country.
        Mr. Van Orden. Okay.
        Mr. Latona. By a third party.
        Mr. Van Orden. Check. I want to see that on paper. I want
    to see that on paper, either yours or ours or whatever. Let us
    fix this.
        Okay. Well, my time has expired. I would like to yield to
    Ranking Member Pappas if he has any closing statements, sir.
        Mr. Pappas. No, I am good. Thank you.
        Mr. Van Orden. Yes, I mean, for this panel, obviously.
        Okay. Well, here is what I am going to tell you. We got to
    do better. These things are--and listen, I am looking in the
    mirror, too. I should have figured out this TAP thing, you
    know, 2 years ago. That is a U.S. Department of Defense (DOD)
    issue. That is clear. Somebody who has been working or a group
    of people for collectively 60 years should have been like, hey,
    Congresspeople, you know, we cannot get the word out. That is
    on me, too. I am not just--I am pointing two fingers, you know,
    one at you and one at me.
        I want you just to--I want you to hyper focus on these
    issues because all of these problems are fixable. If we are
    not--the status quo is not acceptable. Our wounded veterans are
    trapped in a chair for the rest of their lives. You know what I
    mean? They cannot speak, they cannot see, they cannot walk.
    They are grotesquely disfigured, you know, by burns and they
    cannot move well, and they are having mental health issues. All
    of this is about them. I really want you guys to do some soul
    searching and figure out how to do this better, establish
    metrics. I mean, do you guys any--do you have any quantifiable
    metric at all for anything you are doing? You do?
        Mr. Latona. Yes, sir, we do.
        Mr. Van Orden. Okay. I would like to see them.
        All right. With that, thank you very much for your time. I
    appreciate it. You are excused. We are going to empanel our
    second group here.
        This committee will stand adjourned for 10 minutes.
        [Recess.]
        Mr. Van Orden. The committee will come to order.
        On our second panel, we will be hearing from our witnesses.
    The first witness is Mr. Tom Landwermeyer, president and chief
    executive officer at Homes For Our Troops. Our next witness is
    Mr. Mike Owens, Adaptive Support Sports director, Wounded
    Warrior Project. Our third witness is Mr. Craig Schrimsher,
    president of North American Manufacturing, BraunAbility. Our
    final witness is Ms. Julie Howell, my very good friend,
    associate legislative director for Government Relations,
    Paralyzed Veterans of America. I am going to ask you to stand
    and raise your right or left hand, sir.
        [Witnesses sworn.]
        Mr. Van Orden. Let the record reflect that the witnesses
    answered in the affirmative. Please be seated.
        Mr. Landwermeyer, you are now recognized for 5 minutes to
    deliver your testimony.

                     STATEMENT OF TOM LANDWERMEYER

        Mr. Landwermeyer. Thank you, Chairman Van Orden, Ranking
    Member Pappas, and distinguished members of the Veterans'
    Affairs Subcommittee on Economic Opportunity. My sincere thanks
    for granting Homes For Our Troops, or HFOT as we are known, the
    opportunity to testify before the subcommittee to review the VA
    Specially Adapted Housing, Adaptive Automobile and Adaptive
    Sports Programs to help assess how effectively these programs
    serve veterans across the country.
        To date, Homes For Our Troops has built and donated 409
    specially adapted custom homes in 45 states to the most
    severely injured post 9-11 veterans. We currently have 78
    ongoing projects with over 100 veterans in the application
    process. We use the SAH grant eligibility requirements as a
    screening criterion for our program and are quite familiar with
    the SAH program, but are less familiar with the Adaptive
    Automobile and Sports Programs.
        Over the past 20 years, HFOT has developed a close working
    relationship with the VA SAH office to better assist our
    veterans, enjoying a mutually positive and productive working
    relationship. We communicate often with the SAH office as we
    support our veterans and consistently find their personnel to
    be helpful and responsive. When the COVID pandemic restricted
    VA travel, they were open to accepting HFOT staff photos of the
    adaptations in our homes that the SAH office required for their
    approval process, expediting the SAH process for these
    deserving men and women. When Congress was considering the Ryan
    Kules and Paul Benne Specially Adapted Housing Improvement Act,
    we provided feedback from our veterans to our VA SAH contacts.
        Last month, our staff surveyed the veterans in our program
    about their familiarity and experience with the VA Specially
    Adapted Housing, Adaptive Automobile, and Adaptive Sports
    Programs. Testimony today is based on the survey results. While
    our veterans have a basic understanding of the SAH grant and
    eligibility requirements, roughly half of the veterans who
    responded say they have minimal knowledge regarding subsequent
    uses of the grant and specifically how often they can use it
    and how it actually increases annually.
        Half find the application easy to complete, but 20 percent
    find it difficult. Many veterans experience inconsistent
    procedures and approval standards between agents even in the
    same region. Working nationwide, we have found variances in
    procedures and interpretations across regions and agents and
    have provided that feedback to the SAH office.
        About 50 percent of the veterans report being familiar with
    the Adaptive Automobile Grant Program. Nearly 60 percent of our
    veterans polled struggled with the grant application process,
    finding it complex and difficult to understand. There is also
    much confusion concerning if and when a veteran can apply for a
    second grant and how this relates to the VA program that
    provides reimbursement for adaptations to an automobile.
        Nearly 80 percent of our veterans have little to no
    knowledge of the VA Adaptive Sports and Recreation Program or
    its offerings. Of those who actually compete at the national or
    Olympic level, 90 percent stated they were unfamiliar with the
    Olympic Team and Team USA monthly grant stipend. Veterans also
    noted the need for clear eligibility rules and vendor approval
    processes, as well as more flexibility for choosing adaptive
    gear based on their injuries.
        The VA offers many outstanding programs for injured
    veterans. A focus on consistency across the regions and among
    agents, more streamlined and understandable application
    procedures, and creating better awareness about these great
    programs will enhance the VA support to veterans nationwide. We
    are very grateful for our longtime partnership with the VA and
    appreciate all that they and you do for our veterans.
        Mr. Chairman and members of the committee, thank you for
    the opportunity to speak to you today and I look forward to
    your questions.

        [The Prepared Statement Of Tom Landwermeyer Appears In The
    Appendix]

        Mr. Van Orden. The gentleman yields. The chair now
    recognizes Ms. Howell. Oh, I am sorry. The chair now recognizes
    Mr. Owens for 5 minutes to deliver your testimony, sir.

                        STATEMENT OF MIKE OWENS

        Mr. Owens. Thank you. Chairman Van Orden, Ranking Member
    Pappas, and members of subcommittee, again my name is Mike
    Owens and I am the director of Adaptive Sports at Wounded
    Warrior Project and a Marine Corps veteran.
        In 2005, October, while my second deployment to Iraq, I was
    manning the 50-cal on top of a 7-ton when it rolled over. I
    obviously lost my right arm above the elbow and I also
    shattered both of my legs. As an amputee who is dependent on
    prosthetics and adaptive equipment for sport and recreation, I
    bring almost 20 years of personal and professional experience
    on the issue.
        Wounded Warrior Project was founded to serve and empower
    our Nation's heroes and we offer direct programs and services,
    including adaptive sports opportunities, to over 231,000
    registered warriors across the country. Interactions with
    warriors through our programs inform our advocacy before
    Congress here today.
        An amazing example of this is our Soldier Ride program.
    Soldier Ride is a multiday riding event where warriors never
    ride alone. They move forward together as a unit just as they
    did during their military service. We believe anyone can ride
    and we offer the use of hand cycles, recumbent trikes, road
    bikes, and hybrid bicycles. Soldier Ride empowers warriors to
    find solace, healing, and strength through movement. After
    participating in a Soldier Ride event, more than 90 percent of
    warriors report being more confident in themselves and better
    connected to other veterans.
        While a more complete list of our recommendations is
    provided in our written testimony, I would like to focus in on
    a few key areas where we believe that Congress and the VA can
    take action to expand access, promote participation, and better
    serve our veterans.
        First, we believe that Congress should increase the funding
    provided to the Adaptive Sports Grant Program. This grant
    program is vital to nonprofit organizations who provide
    adaptive support opportunities to serve veterans in their
    communities. More specifically, we feel that the amount
    appropriated for the program should be increased to offset the
    recent changes in mandatory spending related to equine-assisted
    therapy. The $16.5 million amount has not been increased since
    Fiscal Year 2016, and new requirements that approximately 30
    percent of that funding be dedicated to equine-assisted therapy
    will reduce grant funds available for organizations that
    provide all other adaptive sports programming.
        We also feel that the administrative cost allowance
    associated with these grants should be on par with other
    Federal grants in order to allow grantees to accommodate more
    veterans and provide more comprehensive adaptive sports
    programming. This change would prevent nonprofit organizations
    from being forced to use limited donor dollars to cover these
    costs.
        Second, Wounded Water Project believes strongly that the VA
    should be able to connect veterans with Adaptive Sports
    Programs regardless of where they live or the nature of their
    disability and be capable of accommodating all veterans who
    wish to attend national VA Adaptive Sports events. In order to
    meet this challenge, we recommend that VA ensure recreational
    therapists capable of accommodating veterans with all types of
    mobility challenges be accessible to all veterans and that VA
    formalize the currently ad hoc position of Adaptive Sports
    coordinator in order to ensure all veterans, regardless of
    where they live, can be connected to Adaptive Sports Programs
    as well as the six VA national events.
        Finally, we encourage Congress and VA to ensure that
    veterans who want to participate in adaptive sports have access
    to both the opportunities and the equipment needed to achieve
    their goals. Regardless of whether a warrior qualifies as a
    member of Team USA's Paralympic team or if they wish simply to
    be able to play basketball with their family in the driveway,
    VA should have the authority and ability to provide them the
    equipment that they need. Those warrior athletes who do seek
    higher levels of competition should be provided with both
    specialized equipment and the funding support to ensure they
    can reach their goals.
        Additionally, we fully support legislative efforts to allow
    participation in the DOD Warrior Games more than the 1 year
    after separation, a change that will not only benefit the
    Warrior Games, but will also provide warriors with a new chance
    to compete.
        In closing, adaptive sports and physical activity help
    veterans transition from surviving to thriving. Participation
    makes them physically stronger, more mentally resilient, and
    more connected to their peers and communities. Research has
    repeatedly shown consistent physical activity decreases stress,
    anxiety, depression, chronic pain, reduces reliance on
    prescription medication. Furthermore, positive improvements are
    seen in mobility, sleep quality, and psychological well-being.
        Adaptive Sports and Recreation for our Nation's wounded
    warriors, it is not simply a nice addition. They are a critical
    element to enhance both the length and quality of their lives.
    Wounded Warrior Project stands ready to assist on these issues
    and any others that may arise.
        Thank you and I look forward to your questions.

        [The Prepared Statement Of Mike Owens Appears In The
    Appendix]

        Mr. Van Orden. The gentleman yields. The written testimony
    of Mr. Landwermeyer and Mr. Owens will be entered into the
    record.
        Mr. Schrimsher, you are now recognized for 5 minutes.

                     STATEMENT OF CRAIG SCHRIMSHER

        Mr. Schrimsher. Thank you, Chairman Van Orden and Ranking
    Member Pappas, members of the committee, and my fellow
    panelists and the Veterans Administration for their commitment
    to work on these important issues. My name is Craig Schrimsher
    and I lead North American Manufacturing for BraunAbility, a
    global leader in wheelchair-accessible vehicles and mobility
    solutions. I oversee domestic production to ensure high
    quality, safe, and accessible products for our customers who
    are Americans with physical disabilities and their caregivers.
        At BraunAbility, we take veterans' mobility issues
    personally as they represent approximately 17 percent of our
    customers. We believe veterans have sacrificed greatly and they
    have earned these benefits. I am here to talk about three key
    issues. First being changes to the accessible vehicle trade in
    policy, which for decades allowed disabled veterans to trade in
    their vehicle every 2 years. Suddenly and without notice, the
    VA recently changed the policy to once every 4 years without
    any announcement. This has the risk of forcing veterans to pay
    significant out-of-pocket costs for mobility.
        Second issue, which we have talked about in detail today,
    are delayed VA payments to mobility dealers. According to the
    National Mobility Dealers Association, in a study of 89
    dealerships, we found $11 million in past due payments with the
    average delay being 186 days. Really encouraging to hear about
    the commitment to work that through IPT in 15 days. Sounds
    great to us.
        Third issue is around an outdated VA price schedule, so we
    appreciate the transparency. The VA for the first time
    published a price schedule listing the amounts that they will
    reimburse for conversions, equipment, and repair, which is
    great. However, it was based on 2021 data and was not published
    until 2024. We missed approximately 3 years of very real
    inflation in the automotive market, which we would anticipate
    just based on average new car prices moved somewhere from 17 to
    19 percent in that period. We urge the VA to accelerate updates
    to this. This is a significant impact to our larger dealer
    network.
        I would say an even larger problem that we would like to
    highlight beyond policy changes and payment delays is really a
    clear lack of empathy and indifference to our veteran customers
    and dealers and their experience in working with the VA.
    Bureaucratic hurdles are expected, but the dismissive attitude
    toward those who have sacrificed so much is simply
    unacceptable. Veterans and their families should not have to
    fight for fair treatment and transparency from the institution
    meant to serve them.
        I want to share a story of a gentleman I connected with
    recently. His name's John Masson. He is a Hoosier. He is from
    Lake Station, Indiana, enlisted in the U.S. Army in 1989.
    Following a family tradition of service, he served 1st Armored
    Division, 82d Airborne Division, Indiana Army National Guard,
    earning the Ranger tab, Green Beret, and Special Forces tab.
    John was deployed multiple times, including for Operations
    Iraqi Freedom, Operations Enduring Freedom, and in 2010,
    severely injured by an Improvised Explosive Device (IED) in
    Kandahar Province.
        He lost both of his legs, his dominant left hand, and
    thankfully survived, thanks to the immediate intervention from
    fellow soldiers. He underwent, like many, extensive
    rehabilitation at Walter Reed Army Medical Center. Retired in
    2012. Now advocates for accessibility with organizations like
    the Gary Sinise Foundation.
        This story we hear about frequently throughout our network.
    When I spoke with John, he was not aware of the changes to the
    trade in policy. It came as a complete surprise to him. I will
    provide a quote from John, his reaction when finding out,
    ``There's nothing like making a combat veteran feel their limbs
    and sacrifices were given in vain like stripping away their
    hard-earned benefits and making life more complicated and
    expensive. I thought leaving the VA in tears was behind me.''
        This lack of communication and transparency is a failure in
    how we support those who have sacrificed so much. Moving
    forward, we are encouraged to see reasonable reform, like House
    Bill 1364. We are here to find solutions. We believe veterans
    deserve more than bureaucracy and policy shifts. They deserve
    respect, empathy, and support. We are open to constructive
    discussions to find solutions that benefit our veterans.
        I look forward to answering any questions and working with
    the VA on meaningful change. I have submitted more detailed
    testimony. Thank you.

        [The Prepared Statement Of Craig Schrimsher Appears In The
    Appendix]

        Mr. Van Orden. Thank you, Mr. Schrimsher. The written
    testimony or statement of Mr. Schrimsher will be entered into
    the record.
        Ms. Howell, you are now recognized for 5 minutes to deliver
    your testimony.

                       STATEMENT OF JULIE HOWELL

        Ms. Howell. Chairman Van Orden, Ranking Member Pappas, and
    members of the subcommittee, Paralyzed Veterans of America is
    grateful for the opportunity to testify today about the
    critical role that VA's adaptive programs play in the lives of
    PVA members.
        For almost 80 years, PVA has been a voice for veterans who
    have experienced catastrophic injury or illness. We regularly
    engage with many of the VA programs being discussed today.
    These programs help deliver veterans with catastrophic
    disability--excuse me. These programs help veterans with
    catastrophic disabilities modify their homes, receive adapted
    vehicles, and find camaraderie through adaptive sports, which
    supports them on their journey to find a renewed sense of
    purpose and hope.
        Jason, a Marine Corps veteran and PVA member, recently
    affirmed the role adaptive fitness plays when he said, being
    able to push barriers, that helps people know that there is
    more to life. Adaptive fitness can help save a life. It gives
    you a great sense of purpose.
        Now, I would like to discuss some of the specific VA
    programs that help PVA members and other disabled veterans
    regain their independence. First, VA's home modification
    programs are crucial for veterans with catastrophic
    disabilities. They provide essential support to help them adapt
    their homes to better accommodate their needs. While we
    appreciate the significant improvements Congress has made in
    recent years to the Specially Adapted Housing Grant, we are
    concerned with recent changes to the program's administration
    and that it will make it more difficult to navigate as VA is
    less able to provide veterans with direct support throughout
    the modification process.
        Another essential program is VA's Home Improvements and
    Structural Alterations, or HISA grant. Unfortunately, HISA
    rates have not increased since 2010 despite the cost of
    construction increasing around 50 percent in the same
    timeframe. H.R. 2245, the Autonomy for Disabled Veterans Act,
    and H.R. 3309, the Autonomy for All Disabled Veterans Act, both
    seek to increase the amount available to veterans through the
    HISA grant, while also tying the grant to an inflationary
    index. PVA strongly supports improving this benefit so that it
    more closely aligns with the needs of eligible veterans.
        Second, the Automobile Adaptive Equipment, or AAE, Program
    exists to increase access to safe and reliable transportation
    for service-connected, catastrophically disabled veterans.
    Recent regulatory and policy changes made by VA have created
    barriers for some PVA members. As an example, current law
    states that adaptive equipment includes but is not limited to
    power steering, power brakes, air conditioning, and other
    features. However, in 2024, VA issued a final rule which
    basically ignores the statutory requirements enlist these items
    at a reimbursement rate of $0. The Department has effectively
    made it impossible for veterans to be reimbursed for these
    necessary features, creating significant roadblocks and
    increasing the financial burden faced by disabled veterans.
        VA lacks the authority to implement a final rule that is
    counter to the statutory requirement for the delivery of this
    benefit, and veterans often appeal these decisions, which are
    consistently reversed by the Board of Veteran Appeals. It is a
    waste of taxpayer dollars to deny veterans their earned
    benefits, which then requires them to file an appeal.
        Finally, many of our members find camaraderie and community
    thanks to adaptive sports. For example, the VA's Adaptive Sport
    Grant helps allow PVA to host more than 60 free year-round
    Adaptive Sport and Recreation events across the country, which
    provide an opportunity for PVA members to explore adaptive
    sports and find new path passions. For many veterans, their
    introduction to adaptive sports is a direct result of VA--
    excuse me, of VA rehabilitation programs facilitated by
    recreational therapists. VA rec therapists provide direct care
    to veterans and help them bridge the gap between clinical
    rehabilitation and community reintegration, which le which
    leads to decreased suicidal ideation and improved clinical
    outcomes. VA must prioritize and protect recreational
    therapists as they have done with other direct care provide
    providers.
        Funding for adaptive sports as well as ensuring access to
    recreational therapists are essential in upholding the promise
    made to our Nation's veterans that we will care for them after
    their service and their sacrifice. More than 50 years ago, a
    PVA president testified before the Senate Veteran Affairs
    Committee on the importance of adaptive sports and rec
    therapists. He said, for the average person this is of no
    consequence, but to a man who has recently suffered an injury
    is to make him question the value of life, the result can be
    more crippling than their paralysis.
        It is a proven fact that the greatest number of failures in
    rehabilitating a person occur in the evening hours and on
    weekends when they are away from work. It seems senseless to
    throw away the efforts, money and most important, that
    individual's life because of the failure to teach that person
    how to cope with their leisure time. This statement remains as
    true today as it was then. Catastrophically disabled veterans
    deserve no less.
        Thank you for allowing PVA to testify at today's hearing
    and I welcome any questions you may have.

        [The Prepared Statement Of Julie Howell Appears In The
    Appendix]

        Mr. Van Orden. Thank you, Ms. Howell. Ms. Howell's written
    statement will be entered into the record.
        We are going to proceed to questioning now. I recognize
    Ranking Member Pappas for 5 minutes.
        Mr. Pappas. Thanks very much. I appreciate all of your
    testimony and the way that you and your organizations stand up
    for veterans each and every day. I am really grateful for the
    work that you do and I think you gave us a good roadmap of how
    we can help make sure that our veterans and their service are
    honored and that we are improving the kind of coordination that
    sometimes sees a breakdown over at VA in terms of
    communication, transparency and some of the other ideas that
    you all put on the table.
        Ms. Howell, if I can start with you. I appreciate you
    highlighting sports at the end of your testimony. I have got an
    organization in my State, Northeast Passage, that does a great
    job offering veterans and servicemembers access to sports and
    recreation. You talked a little bit about barriers. I am
    wondering if you can highlight those as they pertain to sports.
    What are some ways that we can encourage and identify this as
    an opportunity for more veterans to pursue?
        Ms. Howell. Thank you for that question, sir. I think as
    has been highlighted by several people today, a big barrier is
    understanding and even knowing about a program. Most of PVA's
    events are in partnership with chapters, so they are within or
    near hubs where we have a high member population. Many of our
    members were introduced to adaptive sports through their rec
    therapist, which is a direct provider in their delivery of care
    team through a spinal cord injury center.
        I think as many efforts are made from the top down, there
    is going to be breakdowns in that communication flow. I think
    VA can do better to engage with all of the grant recipients for
    the sport grant program. I think earlier today it was mentioned
    that there is 15,000 organizations that are dedicated to this
    type of work. It is just going to require greater community,
    greater engagement, reaching across maybe more local lines and
    just creating that network so that that awareness and that
    information can be shared.
        Mr. Pappas. Maybe I can open that up to the panel. Whether
    it is sports or other adaptive programs through VA, I am
    wondering if you could give me some observations in terms of
    how VA is doing with outreach and communication, giving
    veterans the information and knowledge that they need about the
    opportunities that are available to them. Mr. Owens.
        Mr. Owens. Yes, sir. Thank you for the question. First of
    all, I will add down in San Antonio area, you know, we are
    definitely blessed. The VA has done an amazing job. As they
    say, if you have been to one VA, you have been to one VA. We
    have great benefits there in Military City, USA, for example,
    access to local parks. We have over 100 miles of concrete path
    that is being built just for people to have access and be--have
    recreation outside.
        There, the benefits that we see are not always the case,
    especially for those individuals that End of Active Service
    (EAS) and get out of the service and go back home to the middle
    of nowhere. Maybe they are 3, 4 hours away from the closest VA
    and that means they have almost no resources available in their
    local area. We have seen that many times.
        Additionally, in the program that I mentioned within
    Soldier Ride, we have seen on multiple occasions almost every
    event, at least one veteran that attends that would benefit
    from the adaptive equipment and it could definitely be used to
    improve their mobility, their pain, reduce pain, all of that,
    but they do not meet the eligibility requirements to receive
    that equipment through the VA.
        Mr. Pappas. Thank you. Anyone else? Mr. Schrimsher.
        Mr. Schrimsher. Thank you. I would just highlight that we
    have a decades-long precedent for a trade-in policy that is
    written pretty plainly in policy that changed suddenly. You
    know, when I think of communication, and we are hearing this
    frequently, we have Vietnam veterans that have been in the
    trade cycle every 2 years for decades, finding out from their
    dealerships that they no longer qualify. I want to underline,
    there are a lot of great people in the VA that mean well and
    are doing great things. Right? This is an example of some
    recent changes that are really, really impacting and surprising
    veterans, and we just do not think that should be the case.
        Mr. Pappas. Thank you. Mr. Landwermeyer.
        Mr. Landwermeyer. Thank you, sir. Sir, about 70 percent of
    the veterans that come to us annually already have their SAH
    grant eligibility figured out. They have already applied, been
    approved. About 30 percent have either been denied or do not
    know how to do it, and we will help them. Again, quite a few
    already know about it when they come to us.
        Mr. Pappas. Thank you. Ms. Howell, maybe in the time I have
    left, you mentioned need to protect recreational therapists.
    Could you expound on that a little bit?
        Ms. Howell. Yes, sir. Thank you. As far as we are aware,
    recreational therapists are not on the exempt list for
    retaining VA staff. We believe that as a direct care provider
    and as a critical component of a care team for a
    catastrophically disabled veteran that they should be added to
    that exempt list.
        Mr. Pappas. Thank you. I yield back.
        Mr. Van Orden. The gentleman yields back.
        The chair now recognizes Mr. Barrett for 5 minutes.
        Mr. Barrett. Thank you, Mr. Chairman. Appreciate it and
    appreciate each of you and the work that you are doing to move
    forward with our veterans in a really meaningful way. Thank you
    all for being here.
        Ms. Howell, special appreciation for you. I know you were
    very helpful in the ASSIST Act, and we were able to get that
    through the House earlier this week. Genuinely appreciate your
    work in crafting that bill and adding improvements to it along
    the way. Thank you for that.
        Mr. Schrimsher, had a question for you. I know you have
    brought the issue before the committee about payment and prompt
    payment from the VA and what that has looked like and how that
    has affected local dealers and others that are, you know,
    rendering these vehicles for veterans and how that can affect
    them. I looked at the list that you provided of past due
    payments, and, you know, many of--frankly, all of them are
    concerning and some of them are deeply concerning with the
    amount of time, more than a year in some instances, more than 2
    years in other instances.
        Can you help me understand what is the industry standards?
    Outside of the VA, I am sure your company provides vehicles for
    others in a lack of mobility condition as well, what is the
    current, you know, kind of industry standard for payment?
        Mr. Schrimsher. Thank you, Congressman Barrett, for the
    question. The industry standard for payment, typically in
    private pay is upon delivery.
        Mr. Barrett. Okay.
        Mr. Schrimsher. That is through banking, you know, finance
    typically, or, you know, a check in some cases. Yes.
        Mr. Barrett. Mm-hmm. Let us say a person's insurance,
    whether that is medical or automobile insurance, you know, they
    were catastrophically injured in an automotive accident maybe,
    and their insurance covered that as a benefit. How long would
    that typically take if the person purchasing was not the
    ultimate payer?
        Mr. Schrimsher. I do not have a data point on that handy. I
    could follow up on that, would be glad to. I know that that
    does vary significantly across geographies.
        Mr. Barrett. Okay. Then payments for adaptive vehicles are,
    I guess, done at the local VA level, not a--there is not like a
    centralized clearinghouse for this. It appears that some
    process quicker. I do not know if they are on the list because
    they have had more adaptive vehicles approved and that is why
    they are on the list or if just some local VAs are quicker than
    others. What is kind of your experience with that?
        Mr. Schrimsher. We would like to understand that as well.
    You know, what we know is that there is consistent variability
    within our dealer network. It is typically known which VAs are
    habitual offenders on late payment.
        Mr. Barrett. Yes.
        Mr. Schrimsher. Right? Yes, lack of consistency across the
    network is a major concern.
        Mr. Barrett. What percent of your business, if you are
    willing to share with us, is VA-related, would you say?
        Mr. Schrimsher. BraunAbility, approximately 17 percent.
    However, I would say within our dealer network it can range
    from 20 to 40 percent, you know, depending on the geography. So
    significant.
        Mr. Barrett. So substantial. Then do you believe it would
    be better or more useful if we did have a centralized, you
    know, processing for rendering payment for these vehicles?
        Mr. Schrimsher. I know that we cut cars in half and put
    them back together in 3 days. You know, anything that would
    drive an improvement from this 189-day average would be
    welcomed. Consistency across the network would be appreciated.
        Mr. Barrett. Sure, yes. If you can make the car in a few
    days, we should not take, you know, 100 times that amount to
    get the payment through to you. Okay, I do appreciate that. As
    I know you can tell from the committee testimony today, this is
    something we want to really genuinely work on, so.
        Mr. Schrimsher. Thank you
        Mr. Barrett. Again, appreciate each of you for being here
    and the work that you are doing.
        With that, Mr. Chairman, I yield back.
        Mr. Van Orden. The gentleman yields back. I recognize
    myself for 5 minutes.
        I tell you what, I have been getting progressively angrier
    as these hearings are going on because this is just completely
    unacceptable. There is no other way to describe this. It is
    unacceptable. You are never getting your arm back, Marine. For
    a bureaucrat to, you know, blow that off is not okay.
        My veterans are not beggars and they will not be treated as
    such. Hey, Dutch, that is--Schrimsher, that is my personal cell
    phone number. You give it to that Green Beret, tell him to call
    me. If he ever has another issue with the VA, I swear to God, I
    will go down there and strangle somebody.
        Mr. Schrimsher. Thank you.
        Mr. Van Orden. You are welcome.
        Good. On that note, Mr. Owens, when is this next Soldiers
    Ride, and where is it?
        Mr. Owens. Actually, we have them all over the Nation. The
    next one would--I think they just had DC and the next one that
    they will be having is Chicago.
        Mr. Van Orden. Okay. Well, I know the vice chairman of the
    congressional Motorcycle Caucus. His name is Van Orden. I do
    not know why I have not got an invite yet, buddy, but that
    better happen. Is that clear?
        Mr. Owens. Yes, sir.
        Mr. Van Orden. Okay. I got a bike here. I do not have a car
    in DC, man. I will go real heavy with you cats. That is really
    important.
        You have been involved in the VA system for quite a while,
    since 2005. Got blown up outside of Balad, you know, rolled
    over and stuff. Have you seen an increase--I would like to have
    some positive things here. Have you seen an increase in the
    VA's delivery of services, availability of services?
        Mr. Owens. Yes, 100 percent. They have done an amazing job
    over the years to improve the care, access to care, and the
    opportunities or options available. I will say, I am in
    Military City, USA. There is a lot of resources in that area,
    so----
        Mr. Van Orden. Right.
        Mr. Owens [continuing]. it is definitely not the same
    across the board.
        Mr. Van Orden. Okay. Ms. Howell, you said recent changes to
    policy or recent policy changes, 2024, in reference to the
    ability to deliver care through the VA, is that correct?
        Ms. Howell. Sir, the policy change that I mentioned was an
    internal policy decision made by VA when it comes to what the
    reimbursement rate is when it comes to certain features of a
    vehicle.
        Mr. Van Orden. Okay. The Board of Veterans Appeals, where
    do they reside?
        Ms. Howell. Down the street.
        Mr. Van Orden. What is that?
        Ms. Howell. Down the street.
        Mr. Van Orden. Okay. I would like to maybe pay him a visit
    and see what their rate of refusing claims is.
        Ms. Howell. Sir, if I may.
        Mr. Van Orden. Yes.
        Ms. Howell. No. The VA denies the reimbursement rate, at
    which point the veteran files the appeal to the Board. The
    Board overturns that denial.
        Mr. Van Orden. They are a force for good or a force for
    bad?
        Ms. Howell. When it comes to the reimbursement schedule
    rating, they are a force for good.
        Mr. Van Orden. Well, then I would like to go see him and
    bring them a cup of coffee then. That would be wonderful, too.
    Good news story. Thank you for that.
        Mr. Landwermeyer, you said that you provide feedback to the
    SAH office. How responsive have they been to you?
        Mr. Landwermeyer. Thank you, sir. Actually, pretty
    responsive, sir. As I mentioned, COVID, they were not able to
    travel. The agents were not able to travel, go out and inspect
    our homes.
        Mr. Van Orden. Yes.
        Mr. Landwermeyer. We offered to take photos and ship those
    back in, and they took those. Then we also were able to call
    them up at any time. We have, usually probably twice a year,
    Zoom calls with the leadership of the SAH branch. We can give
    them the pluses and minuses, good, bad, and ugly that we have
    been running up against as we go through the process. Some
    regions do really well, others are not quite as fast. Then
    sometimes within regions, you have fast ones and slow ones. We
    do provide them all that feedback.
        Mr. Van Orden. Okay. That is another good news story.
        Mr. Schrimsher, so for a domestic powered side-entry in-
    floor vehicles, $39,498, it should be $46,212. Structurally
    modified pickup truck, $38,601. It should be $45,163.
    Wheelchair back-lift, 6,819 bucks, would be $7,980.
        Hey, so check it out. What you guys witnessed without
    knowing it was bipartisanship taking place because me and Chris
    just hatched a plan to fix this. We are going to write some
    legislation to catch you guys up. That will be--we will
    introduce it together. It will be a bipartisan effort because
    this, again, is wholly unacceptable.
        Last thing, my time has expired, so I am going to recognize
    the ranking member for any closing statements he may have.
        Mr. Pappas. Well, thank you, Mr. Chairman, for holding this
    session. I want to thank our panel for their contributions to
    this conversation. Clearly, we have got a lot of work to do on
    the legislative front to make sure that we are improving
    eligibility, that we are increasing funding, that we are
    ultimately optimizing the delivery of programs that serve our
    veteran communities. Really grateful for the feedback that you
    have presented us with today. I think we have got some good,
    clear action items that are going to come out of this hearing.
        I yield back.
        Mr. Van Orden. The gentleman yields back.
        I just want to say a couple things before we are out of
    here. Look, I get letters from the VA all the time. I am 100
    percent service-connected disabled vet. You can sign up for
    emails, they call you. Right? Why in the hell do our disabled
    veterans not know about these programs? We know where they all
    are, sir and ma'am. Sitting in the third row back there, we
    know where they are. We know their names, we know their
    addresses. We know their email addresses. We know their phone
    numbers. For a single disabled veteran to not know that these
    programs exist or that you can get reimbursed, you can do
    trade-in, and stuff like that is just stupid.
        It is 2025. We know where all of these people are. We
    literally can assign a geographic point to their house. I am
    making the strongest recommendation possible to fix this
    problem. Fix it. Email them, write them, and call them. You
    know what their disability rating is. You know where they live.
        No more we are going to talk about this. We are excited
    about that. We are having a planning session on this. We are
    going to write their moms and--call them. Stop it. I guarantee
    you the Secretary is either unaware of this or he does not
    understand how large this problem is. We operate on scale. The
    scale for a veteran not knowing about this is one, it is not
    two, it is not five, it is one. If one of my veterans who got
    blown up overseas or, God forbid, something else happened to
    him does not know about this, it is your fault. It is. Fix it.
        I want to thank you all for coming. I do, all of you. I
    want to thank you, Mr. Owens, for your continued sacrifice to
    our country. I want to thank--are you married?
        Mr. Owens. Yes, sir.
        Mr. Van Orden. How is she doing?
        Mr. Owens. Oh, she is doing great.
        Mr. Van Orden. All right.
        Mr. Owens. Been with me through everything.
        Mr. Van Orden. All right, that is cool. That is wonderful
    to hear. Well, we are going to keep working together. You just
    figured out. I mean, we literally just hatched a plan to help
    fix this. That is what we are going to do. We will continue to
    consult with the Veterans Affairs Administration. I am glad we
    got some really good, good news stories out of the VA because I
    love the VA. I mean, I love the VA. It is very simple.
        With that, I would like to ask unanimous consent that all
    members only have 5 days, legislative days, to revise and
    extend the remarks and include any extraneous materials.
    Without objection, so ordered.
        This hearing is adjourned.
        [Whereupon, at 12:23 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 Rachel McArdle

        Chairman Van Orden, Ranking Member Pappas, and other members of the
    Subcommittee, thank you for the opportunity to appear before you today
    to discuss how VA fulfills the Nation's promise to care for Veterans
    through the administration of adaptive programs. To maximize Veteran
    independence when performing daily tasks or participating in
    therapeutic activities, VA provides Specially Adapted Housing (SAH)
    assistance, Home Improvements and Structural Alterations (HISA)
    benefits, Automobile Adaptive Equipment (AAE), and the Adaptive Sports
    Grant Program (ASGP). Joining me today is Dr. Joel Scholten, Executive
    Director, Physical Medicine and Rehabilitation Service, and Jason
    Latona, Assistant Director, Loan Guaranty Service, Veterans Benefits
    Administration.

    SAH Grant Program

        The SAH grant program administers several types of grants for
    eligible Veterans and Service members under 38 U.S.C. Ch. 21. The
    program assists eligible individuals in acquiring adapted housing made
    necessary by their service-connected disability. VA also provides SAH
    assistance if an adapted home has been destroyed or significantly
    damaged by a natural disaster.
        VA's approach to the SAH grant program is individualized. Congress
    set the maximum aggregate amount of assistance for each grant type and
    directed VA to adjust these amounts annually in accordance with
    increases in the residential home cost-of-construction index. An
    assigned VA SAH agent guides the eligible individual and their family
    through the home adaptation process to meet the individual's unique
    needs. The individual ultimately contracts with the builders of their
    choice, and SAH grant program staff use their expertise in home
    adaptations to ensure the-project is completed and is consistent with
    applicable statutes and the individual's adaptive housing needs.
        The SAH grant program has approved more than 2,000 grant awards
    annually for 6 of the last 7 fiscal years (FY). VA anticipates similar
    or higher usage levels in the future. As of the end of March, 1,643 SAH
    grants have been approved $ 85 million in Fiscal Year 2025.

    Improving Benefits Delivery through Modernization

        To continue delivering world-class customer service to Veterans and
    Service members, VA has initiated a multi-year project to modernize the
    SAH case management system. The modernized system will use automation
    to streamline the delivery of benefits to eligible individuals. The
    upgraded tool will also improve VA oversight by allowing for enhanced
    monitoring of the grant process from initial application to compliance
    inspection upon completion of work. The implementation of the
    modernized SAHSHA system will be conducted in phases; the first phase
    is expected to begin in July 2025.

    Eliminating Fraud, Waste, and Abuse

        The individualized attention given to each SAH grantee ensures
    there is a high degree of oversight on each award. In Fiscal Year 2020,
    VA implemented a new financial process to manage SAH grant program
    disbursements using centralized VA financial staff, rather than third-
    party escrow agents. This change strengthened VA's internal controls
    and improved overall project management capabilities for SAH grant
    program staff. These oversight measures resulted in improved home
    adaptation delivery and payment timelines, reducing overall project
    timelines by days or weeks, and eased Veteran financial burdens by
    eliminating a third-party escrow fee of approximately $500 per project.

    Home Improvements and Structural Alterations

        The VA HISA benefit, under 38 U.S.C. Sec.  1717, provides financial
    assistance to disabled Veterans eligible for medical services under 38
    U.S.C. Sec.  1710(a) who require modifications to their primary
    residence. Service members undergoing medical discharge from the Armed
    Forces for a permanent disability that was incurred or aggravated in
    the line of duty in the active military, naval, air, or space service
    are also eligible for the HISA benefit. HISA projects are prescribed by
    a VHA clinician and medically justified based on the Veteran or Service
    member's clinical needs that support the type of home improvement or
    structural alterations being prescribed. These medically necessary
    improvements or structural alterations allow for continued home health
    treatment of the Veteran or Service member's disability and maximize
    the Veteran's or Service member's access to the home and independence
    while performing daily tasks within their homes. HISA benefits and
    lifetime payments are approved and processed in accordance with 38
    C.F.R. Sec. Sec.  17.3100 through 17.3130.

    Automobile Adaptive Equipment Benefit

        The VA AAE program, under the authority of 38 U.S.C. Sec. Sec.
    3901-3903 and 38 C.F.R. Sec. Sec.  17.155-17.159, reimburses or pays
    for adaptive equipment for eligible Veterans and active-duty members of
    the Armed Forces who have certain disabilities. AAE is prescribed by a
    VHA physician or Certified Drivers Rehabilitation Specialist. VA is
    authorized to prescribe and reimburse or pay for operational and non-
    operational equipment, but VA does not modify, install, repair, or
    replace the AAE. VA works directly with AAE dealers, modifiers, and
    alterers to ensure all prescribed, necessary adaptive equipment enable
    the Veteran to safely drive or ride as a passenger in their personal
    vehicles. Examples of AAE include low-effort or sensitized steering;
    electronic accelerator and brakes; mechanical hand controls for
    accelerator and brakes; wheelchair tie downs; vehicle lifts; tilt
    steering wheels; voice command systems; raised roofs and doors; and
    tinted windows for burn injury disabilities. In Fiscal Year 2025
    through March 31, 2025, VA has provided AAE to 1,181 Veterans. The
    total value of that benefit is $31,928,405, and the average award is
    $27,035.

    ASGP

        VA also manages the ASGP, which provides Veterans and members of
    the Armed Forces with disabilities access to sports and equine therapy
    to encourage a healthy and active lifestyle. As provided by 38 C.F.R.
    Part 77, VA awards grants to non-Federal Government entities with
    significant experience in managing a large-scale adaptive sport
    program. In Fiscal Year 2024, VA's ASGP awarded 91 individual grants,
    totaling $15.9 million in awarded funds. Organizations funded through
    VA's ASGP currently provide resources for more than 15,000 Veterans and
    members of the Armed Forces.

    Conclusion

        In conclusion, VA will continue to provide the Nation's Veterans
    with efficient, effective, and meaningful programs centered on meeting
    their adaptive needs. Thank you for your continued support of our
    programs and for this opportunity to speak today. This concludes my
    testimony, and we welcome any questions that you or other Members of
    the Subcommittee may have.

                     Prepared Statement of Tom Landwermeyer

        Chairman Van Orden, Ranking Member Pappas, and distinguished
    members of the Veterans' Affairs Subcommittee on Economic Opportunity,
    my sincere thanks for granting Homes For Our Troops, or HFOT, the
    opportunity to testify before the subcommittee to review the VA's
    Specially Adapted Housing, Adaptive Automobile, and Adaptive Sports
    Programs, to help assess how effectively these programs serve Veterans
    across the country.
        To date, Homes For Our Troops has built and donated 409 specially
    adapted custom homes in 45 states to the most severely injured post-9/
    11 Veterans. We currently have 78 ongoing projects, with over 100
    Veterans in the application process. We use the SAH grant eligibility
    requirements as a screening criterion for our program, and are quite
    familiar with the VA's SAH grant program, but are less familiar with
    the adaptive automobile and sports programs.
        Over the past 20 years, HFOT has developed a close working
    relationship with the VA SAH office to better assist our Veterans,
    enjoying a mutually positive and productive working relationship. We
    communicate often with the SAH office as we support our Veterans and
    consistently find their personnel to be helpful and responsive. When
    the COVID pandemic restricted VA travel, they were open to accepting
    HFOT staff photos of the adaptations in our homes that the SAH office
    required for their approval process, expediting the SAH process for
    these deserving men and women. When Congress was considering the Ryan
    Kules and Paul Benne Specially Adaptive Housing Improvement Act, we
    provided feedback from our Veterans to our VA SAH points of contact.
        Last month, our staff surveyed the veterans in our program about
    their familiarity and experience with the VA's Specially Adapted
    Housing, Adaptive Automobile, and Adaptive Sports Programs. Our
    testimony today is based on these survey results.
        While our Veterans have a basic understanding of the SAH grant and
    eligibility requirements, roughly half of the Veterans who responded
    say they have minimal knowledge regarding subsequent uses, and
    specifically how often they can use it and how it increases annually.
    Half find the application easy to complete, with 20 percent finding it
    difficult. Many Veterans experienced inconsistent procedures and
    approval standards between agents, even in the same Region. Working
    nationwide, HFOT has found variances in procedures and interpretations
    across regions and agents, and has provided that feedback to the SAH
    office.
        About 50 percent of the Veterans report being familiar with the
    Adaptive Automobile grant program. Nearly 60 percent of Veterans polled
    struggled with the vehicle-grant application process, finding it
    complex and difficult to understand. There is also much confusion
    concerning if and when a Veteran can apply for a second grant, and how
    this relates to the VA program that provides reimbursement for
    adaptations to an automobile.
        Nearly 80 percent of our veterans have little to no knowledge of
    the VA Adaptive Sports and Recreation program or its offerings. Of
    those who actually compete at the national or Olympic level, 90 percent
    stated they were unfamiliar with the Olympic Team and Team USA monthly
    grant stipend. Veterans also noted the need for clearer eligibility
    rules and vendor approval processes, as well as more flexibility for
    choosing adaptive gear based on their injuries.
        The VA offers many outstanding programs for injured veterans. A
    focus on consistency across the regions and among agents, more
    streamlined and understandable application procedures, and creating
    better awareness about these great programs will enhance the VA's
    support to veterans nationwide.
        We are grateful for our long-time partnership with the VA, and
    appreciate all that they and you do for our veterans. Mr. Chairman and
    members of the committee, thank you for the opportunity to speak to you
    today, and I look forward to your questions.

                        Prepared Statement of Mike Owens
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                     Prepared Statement of Craig Schrimsher

    Introduction

        On behalf of BraunAbility, I would like to thank Chair Van Orden,
    Ranking Member Pappas, and all the members of the House of
    Representatives Veterans' Affairs Subcommittee on Economic Opportunity
    for the opportunity to testify today. My name is Craig Schrimsher, and
    I lead North American Manufacturing at BraunAbility, the global leader
    in wheelchair-accessible vehicles and mobility solutions, overseeing
    domestic production to ensure top-tier product quality, safety, and
    accessibility for our customers, Americans with physical disabilities
    and those who care for them.

    Supporting VA's Mission to Serve Veterans

        BraunAbility seeks to support the United States Department of
    Veterans Affairs' (``VA'') mission to care for those who have served in
    our Nation's military and for their families, caregivers, and
    survivors. BraunAbility and our network of mobility dealers bring
    independence and mobility freedom to people with physical disabilities
    and their caregivers. The Adaptive Automobile Equipment (``AAE'')
    program, which BraunAbility actively supports, provides disabled
    veterans and their caregivers with the adaptive equipment necessary for
    a veteran to access and operate a vehicle, or to have someone operate
    the vehicle for them.
        Larry Dodson, a Vietnam War veteran, sustained a spinal cord injury
    in 1974 that drastically changed his life. When he finally purchased
    his first accessible van, he said, ``Getting that freedom of
    transportation was invaluable.'' It restored a sense of independence
    and dignity during a period in his life marked by despair and
    hopelessness. He went on to own six more BraunAbility vans. He later
    dedicated his career to the Paralyzed Veterans of America (``PVA''),
    advocating for fellow veterans, helping them reclaim their mobility,
    and ensuring they receive the care and benefits they deserve. Of his
    career with the PVA he said, ``As long as I can, I will help.''
        A core part of BraunAbility's mission is to help VA do the same for
    our Nation's veterans. In Mr. Dodson's case and others, our products
    and services keep veterans connected to their families, their careers,
    and their communities. However, recent policy changes and ongoing
    challenges within VA threaten disabled veterans' independence and sense
    of purpose by imposing undue financial and personal hardship. This
    document outlines the challenges presented by certain VA policies and
    calls for necessary reforms, including the restoration of fair trade-in
    policies, timely reimbursements, and updated adaptive equipment
    pricing. By surfacing these issues, BraunAbility seeks to protect
    veterans' mobility rights and advocate for sustainable solutions that
    uphold their dignity and autonomy. Before discussing the AAE program in
    greater depth, I would like to provide some background on BraunAbility.

    Ralph Braun: A Legacy of Innovation and Independence

        BraunAbility was built on a commitment to reliable, accessible
    transportation for people with mobility challenges. That mission
    started with our founder, Ralph Braun, who was diagnosed with muscular
    dystrophy as a child. Determined to navigate a world not built for him,
    with his father's help, he created the first battery-powered
    wheelchair--an innovation that launched a lifetime of mobility
    solutions. Eventually, he made a massive breakthrough, designing and
    producing the first wheelchair-accessible vehicle, which changed the
    future for people with physical disabilities. Ralph's vision led to the
    creation of The Braun Corporation. Veterans have been an essential part
    of BraunAbility's story since the beginning. Among Ralph's first
    customers were Vietnam War veterans facing an uncertain road ahead and
    significant mobility challenges resulting from their service.
    Understanding their struggles firsthand, Ralph focused on solutions
    that restored their independence, revolutionizing the adaptive vehicle
    industry and establishing BraunAbility as a global leader in
    accessibility.
        BraunAbility continues Ralph Braun's mission of expanding mobility
    access. For over 50 years, his legacy has fueled the development of
    wheelchair-accessible vans, SUVs, lifts, and adaptive seating,
    transforming the lives of more than a million customers. Today,
    BraunAbility supports over 2,000 American jobs, with its products
    available in more than 50 countries across six continents. Veterans
    remain central to BraunAbility's mission, making up approximately 17
    percent of its customers. In 2024 alone, thousands of veterans regained
    mobility by using BraunAbility's accessible vehicles. These veterans
    deserve policies that respect their service and ensure they have access
    to the mobility products they need to preserve their independence.

    Addressing Adaptive Equipment Policy

    `Two in Four' Adaptive Equipment Trade-In Policy

        The Automobile Adaptive Equipment policy, encoded at section
    3902(b) of Title 38, United States Code (U.S.C.), requires VA to
    provide eligible veterans with ``the adaptive equipment deemed
    necessary to insure [sic] that the eligible person will be able to
    operate [an] automobile or other conveyance.'' VA implements this
    policy at 38 CFR sections 17.155-17.159. The term `adaptive equipment'
    can cover a wide range of medically necessary vehicle modifications,
    including lowered vehicle floors, mobility device lifts, ramps, and
    kneeling systems, among other modifications. Adaptive equipment
    modifications can increase the cost of a vehicle by thousands or tens
    of thousands of dollars. Without VA covering this cost, it would be
    impossible for many veterans to afford this life-altering equipment.
        Under the AAE program, VA reimburses the eligible veteran or
    registered provider for a sizable portion of the veteran's first
    vehicle and any adaptive equipment required for the veteran to operate
    the vehicle. VA also reimburses the eligible veteran or registered
    provider for adaptive equipment for not more than ``two automobiles or
    other conveyances at any one time or during any 4-year period.''
        Until recently, VA interpreted this `two in four' language to mean
    that an eligible veteran could trade in their older vehicle and be
    reimbursed for new adaptive equipment every 2 years. Commonly, VA would
    reimburse a veteran for a new base vehicle and adaptive equipment, the
    veteran would use the vehicle for 2 years, the veteran would trade the
    vehicle in to cover the cost of a new base vehicle, and VA would
    reimburse the veteran for new adaptive equipment for that vehicle.
    After two more years, the veteran would trade in the vehicle again and
    the cycle would repeat.
        This system meant VA reimbursed veterans for new adaptive equipment
    on two automobiles every 4 years, as regulation and statute suggest is
    appropriate. The system created a virtuous cycle. Because (besides the
    first vehicle) VA only covers the cost of new adaptive equipment, not
    the cost of the base vehicle, veterans are on the hook for the cost of
    new vehicles. However, a veteran could trade in their used vehicle
    after 2 years and the trade-in value would offset the cost of a new
    base vehicle while VA would pay for the cost of adaptive equipment.
    This system protected veterans' mobility independence by providing
    access to adapted vehicles for low or no cost.
        Recently, VA changed its interpretation of this policy, resulting
    in significant hardship for veterans. To our knowledge, this change in
    interpretation occurred without any public comment process or public
    notice in the Federal Register. Under the new interpretation, the
    veteran cannot trade in the adapted vehicle until after 4 years, rather
    than after 2 years like before. Because adapted vehicles depreciate
    significantly more quickly than standard vehicles, this policy change
    means that vehicle trade-ins no longer cover the cost of a new vehicle.
    As a result, to access the VA benefit of new adaptive equipment,
    disabled veterans must spend thousands of dollars out of pocket every 4
    years to cover the cost of the base vehicle. Moreover, because the
    warranty on these vehicles is 36 months and adaptive equipment is
    subject to significant wear and tear, veterans often have to pay out of
    pocket to repair their own vehicles. This is a problem that, by
    statute, VA is supposed to resolve.

          Uncertainty in VA Process Blocks Mobility Access--For
    veterans seeking a modified vehicle, securing one isn't just about
    finding the right fit--it's about waiting for VA's approval, a process
    riddled with delays and uncertainty. Without that approval, out-of-
    pocket costs remain unknown, leaving veterans stuck in financial limbo.
    Planning becomes nearly impossible. Should they move forward with
    purchasing a vehicle? Can they afford both the conversion and the car
    itself? With no clear answers until the VA's decision arrives,
    everything grinds to a halt. Veterans are forced to navigate layers of
    bureaucracy before they can even begin the process of regaining
    mobility. The recent change in trade-in policy has only exacerbated
    this issue, and the inefficiencies don't stop there. VA's sluggish
    approach to approving quotes creates additional obstacles: veterans
    must wait to see not just what will be approved, but how much they'll
    be expected to cover themselves. Meanwhile, they can't secure financing
    or even hold a vehicle because approved amounts remain in limbo.
    Instead of streamlining the process to support those who need mobility
    solutions, the VA's current system forces veterans into an endless
    waiting game--one that delays independence and leaves them stranded in
    uncertainty.

        Nothing in statute or regulation suggests that there should be a
    requirement to own a vehicle for 4 years before trade-in, yet VA made
    this change that directly harms disabled veterans. The decrease in
    trade-ins also results in fewer used adapted vehicles on the market for
    other non--veteran disabled Americans who cannot afford the cost of a
    new vehicle. VA's policy is putting true mobility and accessibility out
    of reach for tens of thousands of Americans, particularly veterans who
    were wounded in service of their country.
        VA's altered interpretation of the adaptive equipment allowance is
    in direct contradiction with the doctrine of Gardner deference, also
    known as veterans canon. Gardner deference, rooted in the 1994 Supreme
    Court case Brown v. Gardner, holds that in cases of interpretive doubt
    of a statute or regulation, benefits should be resolved in favor of the
    veteran. Applied to adaptive equipment trade-in policy, even if there
    is interpretive doubt in the phrase from 38 USC 3903, ``An eligible
    person shall not be entitled to adaptive equipment under this chapter
    for more than two automobiles or other conveyances at any one time...
    during any 4-year period,'' that doubt should be resolved in favor of
    the veteran.
        VA's new requirement to have owned a vehicle for 4 years before
    being eligible for a trade-in appears nowhere in statute or regulation.
    VA is interpreting this policy in a way that directly harms disabled
    veterans. VA should reinstate its prior policy of allowing trade-ins
    and providing new adaptive equipment after 2 years, as intended in
    statute.

    Prompt Payment

        As discussed above, the adaptive equipment allowance policy
    provides veterans with the vehicles and adaptive equipment they need to
    secure mobility independence. In most instances, veterans receive
    adapted vehicles from government-registered dealers. Dealers are then
    reimbursed by VA upon submission of VA Form 10-1394, an itemized
    estimate before work, and an itemized invoice upon completion of work.
    However, according to the National Mobility Equipment Dealers
    Association (NMEDA), there are almost $11 million in payments to
    dealers that are more than 90 days overdue. Many accounts are over 6
    months overdue with some exceeding a year overdue. This is a
    longstanding, persistent problem with no obvious cause----some VA
    locations make regular on-time payments while others have dozens of
    overdue invoices worth hundreds of thousands of dollars.
        These overdue payments cause disabled veterans and mobility dealers
    significant hardship. At any given dealer, roughly 20 to 40 percent of
    their business is with VA. For these dealers, especially small dealers,
    these delays make it difficult to manage operations, invest in new
    technology, or plan for the future. For veterans directly reimbursed by
    VA, these delays mean that they can be out of pocket tens of thousands
    of dollars for months.
        The Prompt Payment Act states at (31 USC Sec.  3903(a)(1)) that the
    required payment date is ``30 days after a proper invoice for the
    amount due is received if a specific payment date is not established by
    contract.'' The Prompt Payment Act also states at (31 USC Sec.
    3903(7)(B)) that ``any invoice determined not to be such a proper
    invoice suitable for payment shall be returned as soon as practicable,
    but not later than 7 days, after receipt, specifying the reasons that
    the invoice is not a proper invoice.'' Taken together, these provisions
    mean that VA is required to pay dealers within 30 days of receiving a
    completed invoice and, in the case of an unsuitable invoice, inform
    dealers of the unsuitable invoice and how to correct it within 7 days
    of receipt.
        BraunAbility's trade association, NMEDA, is currently tracking just
    under $11 million in payments to dealers that are averaging 187 days
    overdue. It should be noted that this data is submitted from 89 of the
    302 NMEDA member locations and is counted once the payments are 60 days
    past due. Submission of the data to NMEDA by its members is voluntary
    so the actual past due total is most likely much higher. This total
    includes not just wheelchair accessible vehicles but adaptive equipment
    and repairs as well. Moreover, to our knowledge, dealers rarely, if
    ever, receive notice from VA within 7 days that an invoice is
    unsuitable. Recently, VA reported that it had only two invoices over 90
    days overdue. We believe that there is a systemic lack of communication
    within VA that results in the agency processing dealers' reimbursement
    invoices with considerable delay. We ask VA to honor its commitment to
    disabled veterans and prioritize prompt reimbursements to veterans and
    dealers for adaptive automotive equipment.

    Adaptive Equipment Schedule

        Under VA's recent Adaptive Equipment Allowance rule (RIN: 2900-
    AP39), finalized July 17, 2024, VA established the Adaptive Equipment
    Schedule for Automobiles and Other Conveyances (``Schedule''). The
    Schedule is intended to calculate ``the amount of the monetary
    allowance for adaptive equipment based on industry standards and our
    experience administering this program.'' In its rulemaking, VA
    committed to increasing the reimbursement amounts in the Schedule based
    on the Consumer Price Index (CPI) expenditure category for ``motor
    vehicle parts and equipment''.
        In concept, the Schedule should standardize payment and provide a
    fair valuation for adaptive equipment for the future. However, the
    Schedule--published in July 2024--relies on data from 2021, meaning
    that it significantly undervalues the cost of adaptive equipment.
    Adaptive equipment dealers are currently being reimbursed for
    significantly less than fair market value.
        On average, the CPI for ``motor vehicle parts and equipment''
    suggests that the prices in the Schedule need to be increased by 17
    percent to reflect the true cost of adaptive equipment in 2025. We
    request that VA rely on CPI data to increase the prices reflected in
    the Schedule for every year since 2021, the year data was collected.
    This will ensure that veterans and dealers are properly reimbursed for
    the real cost of adaptive equipment.

          Essential Mobility Upgrades Denied by VA--Some critical
    mobility modifications never make it into VA's Schedule, meaning they
    simply can't be included for financial assistance--regardless of
    necessity. Essential equipment, like reduced effort steering and
    braking, often falls into this gap, forcing veterans to cover
    unexpected costs out-of-pocket. In one case, VA reviewed a conversion
    quote and arbitrarily cut more than half of the proposed expenses. With
    the remaining costs too high to absorb, the mobility dealer couldn't
    bridge the gap, leaving the veteran without crucial modifications. As a
    result, mobility and independence were put on hold--another example of
    how vague policies place veterans in an impossible position between
    what's required and what's approved. One veteran, relying on a 17-year-
    old vehicle, required a new rack and pinion system, but VA refused to
    cover backup braking or steering because they weren't listed on the
    initial evaluation form. With costs totaling $21,000, VA only approved
    $6,000, expecting the dealer and veteran to absorb the remaining
    $15,000--an unsustainable request. VA is frequently unwilling to
    accommodate necessary modifications, leaving veterans and providers to
    shoulder unexpected expenses with little regard for their financial
    realities.

        We are deeply concerned with VA's negligence in delivering prompt
    payment and failure to properly account for inflation in the adaptive
    equipment Schedule. Moreover, we disapprove of VA overturning its
    longstanding policy that veterans may trade in their adapted vehicles
    after 2 years and receive new adaptive equipment, a change made without
    any public comment process or official notice. We call on VA to honor
    its commitment to our Nation's wounded heroes: deliver prompt payment
    to adaptive equipment dealers, update the adaptive equipment Schedule
    to ensure proper pricing, and reverse the harmful change to adaptive
    equipment allowance interpretation.

    Call to Action: Protect Veterans' Mobility Access

    Addressing Key Policy Challenges

        Mobility equipment manufacturers like BraunAbility play a vital
    role in ensuring veterans and individuals with disabilities maintain
    their independence. Similarly, mobility equipment dealers provide the
    link between manufacturers and disabled veterans. However, current VA
    policies threaten the ability of these businesses to operate and serve
    veterans. Without action, veterans risk losing access to essential
    mobility solutions.
        To strengthen accessibility for veterans, we respectfully request
    the VA take the following steps:

          Restore the previous vehicle trade-in policy, allowing
    disabled veterans to exchange vehicles every 2 years, as originally
    intended in statute. This will ensure access to updated adaptive
    equipment without undue financial hardship.

          Ensure timely reimbursements for adaptive equipment
    dealers by addressing overdue payments and implementing a system for
    prompt future payments.

          Update pricing schedules for adaptive equipment using
    current Consumer Price Index (CPI) data to reflect 2025 costs. Existing
    rates, based on outdated 2021 data, no longer cover actual expenses.

    Partnering to Protect Veterans' Mobility Independence

        These actions are necessary to ensure businesses can continue
    providing essential mobility solutions to disabled veterans.
    BraunAbility encourages VA to work with industry partners to address
    these challenges and implement reforms that protect veterans' access to
    independence and mobility.
    ADDENDUM / CASE EXAMPLES

        New Conversion, Old Classification--A veteran diagnosed with ALS
    made the decision to--purchase a pre-owned accessible van, which was
    considered a new conversion on a used vehicle. Given the progressive
    nature of ALS, a pre-owned van was a more practical and economical
    option. However, VA classified the entire vehicle as used, even though
    the conversion and modifications were brand new, making them ineligible
    for necessary financial support. As a result, the only options were
    selling the veteran a new van or nothing at all--creating an
    unnecessary financial hurdle for a veteran in need.

        VA Error Leaves Veteran with $70K Bill--A 78-year-old Vietnam
    veteran received a signed 4502 form from the VA, approving mobility
    modifications. The dealer followed every required step--submitting
    quotes, securing authorization, ordering parts, and delivering the
    vehicle. Yet after final paperwork was submitted, the VA suddenly
    reversed its stance, claiming the veteran was ineligible, despite its
    own signed approval. This error led to a denial of payment, leaving the
    veteran burdened with a $70,340.02 bill. To make matters worse, VA
    instructed the dealer to repossess the vehicle, placing the veteran in
    an impossible financial position. Even after admitting the mistake, the
    regional office still refuses to correct it, insisting on repossession.
    This situation exposes serious flaws in VA's approval process, forcing
    veterans and providers to either second-guess every decision or risk
    devastating financial consequences--all because someone checked the
    wrong box.

        New Upgrades, Old Rules--A modified van should provide freedom and
    mobility, but bureaucratic regulations often create unexpected
    barriers. In this case, a veteran purchased a 2022 van for conversion,
    expecting essential modifications to be covered. However, because VA
    classified the vehicle as 3 years old--despite the conversion and
    customizations being brand new--they only agreed to cover 40 percent of
    the quoted cost. With a remaining balance of $60,000, neither the
    veteran nor the dealer could absorb the expense. Previously, the
    veteran had worked through VA to receive a fully covered vehicle. Now,
    needing electronic mobility control (``EMC'') equipment to drive, he
    followed the same process, believing he was taking the right steps. But
    VA policy dictates that when additional equipment is required, the van
    may be categorized as ``used,'' disqualifying the owner from new
    vehicle assistance under the 4-year rule. Even though the modifications
    are brand new, the depreciation rate applied to used conversions often
    makes the final cost unaffordable. The result? A frustrating situation
    where rigid policy trumps practical necessity, leaving veterans and
    dealers to bear the burden with little flexibility or willingness to
    reconsider the individual needs of those affected.

        Red Tape Stalls Veterans' Driving Evaluations--Navigating the VA
    system for a driving evaluation has become an increasingly time-
    consuming and frustrating process. Today's process requires an annual
    driver evaluation--but appointment times continue to stretch months
    into the future due to a shortage of evaluators. Once the evaluation is
    completed, a new obstacle arises: the evaluator's report often doesn't
    align with VA's Schedule, triggering a cascade of administrative
    hurdles. Veterans and dealers find themselves stuck in a cycle of
    revision requests, back-and-forth calls with evaluators, appeals to the
    Prosthetics department, and waiting for the Regional Office to reject
    the evaluation--just to start the process over. What once took just 24
    hours for approval can now drag on for weeks, leaving veterans without
    the mobility solutions they need. Further complicating matters, some VA
    offices prohibit dealers from speaking directly to evaluators, instead
    requiring them to go through the Prosthetics department, adding yet
    another layer of delay. This bureaucratic tangle not only postpones
    essential mobility modifications but also forces veterans into an
    exhausting loop where paperwork precision is prioritized over their
    actual needs. The result? Untold delays that keep veterans waiting for
    the independence they deserve.
        Solutions, Not Indifference: A Path for Partnership to Help
    Veterans--Navigating VA's vehicle policies is difficult enough, but the
    real issue is the lack of compassion veterans feel when problems arise.
    Instead of working toward solutions, VA's default response is often
    repossession--forcing the financial burden onto the veteran rather than
    addressing mistakes collaboratively. If a veteran cannot afford a
    necessary expense, the reaction is often dismissive: ``It's not the
    VA's problem.'' Rather than seeking alternative options or helping, the
    solution is simply to deny the sale, leaving veterans stranded without
    mobility or support. When policy takes precedence over people, and
    problem-solving is replaced with indifference, veterans are left
    without the help they need. For many, the VA no longer feels like an
    ally, but an obstacle. As one veteran put it: ``I used to feel like the
    VA took care of their veterans, and now they simply don't care.'' And
    when the VA won't step up, mobility dealers are left scrambling to fill
    the gap, absorbing costs that should never have fallen on their
    shoulders in the first place. Instead, we call on VA to partner with
    BraunAbility, other manufacturers, and adaptive equipment dealers to
    help veterans in need. BraunAbility believes strongly in VA's mission
    to care for former servicemembers, and we believe that with the right
    reforms, we can ensure that every disabled veteran secures mobility
    freedom.

                       Prepared Statement of Julie Howell

        Chairman Van Orden, Ranking Member Pappas, and members of the
    subcommittee, Paralyzed Veterans of America (PVA) appreciates the
    opportunity to testify on VA's adaptive programs, which are critical
    for disabled veterans, especially PVA members - veterans who have
    acquired a spinal cord injury or disorder (SCI/D). For almost 80 years,
    PVA has been a voice for thousands of veterans who experienced
    catastrophic injury or illness, ensuring that the Department of Veteran
    Affairs (VA) was prepared to care for our Nation's most vulnerable
    veterans. The VA offers health care and benefits for millions of
    veterans but rarely discussed are ancillary programs like the ones
    being examined today.
        PVA's programs and departments allow our organization to
    collaborate in unique ways with many of the VA programs being discussed
    in this hearing. For example, we have a team of architects on staff who
    review all VA SCI/D construction projects, ensuring new facilities are
    fully accessible to SCI/D and other disabled veterans. We also work on
    VA's design guides for SCI/D health care facilities. In addition to
    working with VA on ensuring that building projects are barrier free for
    disabled veterans, our architects also work with individual disabled
    veterans on accessible home design.
        Our Veterans Benefits Department is staffed with national service
    officers (NSO) around the country who are experts at complex claims
    work and are well versed in the intricacies of applying for programs
    like the Specially Adapted Housing (SAH) grant, the Automobile
    Allowance, the Automobile Adaptive Equipment (AAE) program, and other
    ancillary benefits our members rely on.
        PVA's Sports and Recreation Department offers over 60 free, year-
    round adaptive sporting and recreational opportunities in partnership
    with the VA and our 33 chapters across the country. These include
    adaptive cycling, trapshooting, boccia ball, bass fishing, wheelchair
    basketball, wheelchair rugby, and many other events that promote a
    healthy and active lifestyle, all while fostering community and
    independence. Each year, PVA partners with the VA to host the National
    Veterans Wheelchair Games (NVWG), the largest gathering of veteran
    wheelchair athletes in the country. The opportunities made available to
    PVA members because of adaptive sports are endless. Not only does our
    sports programing offer camaraderie, but it also improves the physical
    and mental health of thousands of veterans across the country.

    VA's Housing Adaptation Programs

        For catastrophically ill and injured veterans, housing adaptations
    are critical to living a safe and independent life. Although important,
    an adapted home is more than just a wheelchair ramp through the front
    door. Without housing adaptations, veterans with SCI/D may be forced to
    live in homes that don't meet their needs and greatly inhibit their
    ability to travel within them or use the kitchen or bathroom with any
    level of independence.
        VA's SAH grant program provides crucial funding to allow veterans
    with specific catastrophic disabilities to adapt their homes to allow
    them to live independently with their families in their communities.
    The SAH grant can be used to purchase, build, or remodel an existing
    house to an adapted home for veterans who have experienced blindness,
    who have experienced loss of use in their hands or a lower extremity,
    or who have severe burns or respiratory injuries. For Fiscal Year 2024,
    an eligible veteran can qualify for up to $117,014 through the SAH
    grant. Qualified veterans can return to their SAH allowance up to six
    times or until the amount available has been exhausted.\1\
    ---------------------------------------------------------------------------
        \1\ VA's Handbook for Design: A Guide for Specially Adapted Housing
    (SAH) and Special Housing Adaptation (SAH) Projects, September 2021.
    ---------------------------------------------------------------------------
        When a veteran acquires a catastrophic injury or illness, they are
    often experiencing a sense of tremendous loss and are navigating
    complex feelings like grief and depression. These veterans generally
    feel like they've lost their independence, yet trained SAH agents are
    experts at having these sensitive conversations. Historically, an SAH
    agent would meet with the veteran and their family, in their home to
    assess their needs and determine which adaptations would best serve the
    veteran. These face-to-face meetings are critical in ensuring that VA
    funds are properly applied to medically necessary adaptations and that
    the work needed is completed by a reputable contractor.
        PVA has heard from many of our members and NSOs across the country
    that there are new barriers in receiving support from SAH agents. Due
    to recent staffing reforms, SAH agents are now expected to cover a
    larger catchment area, they are prohibited from travel on toll roads
    which increases the time it takes to travel to a veteran's home and are
    expected to conduct many inspections virtually. It is highly unlikely
    that an SAH agent is going to be able to perform a virtual home
    inspection with the same level of detail and understanding as an in-
    person inspection. This leaves a lot of room for errors and mistakes,
    and therefore begs the question, ``Who will be responsible for subpar
    construction or inappropriate materials, when remote inspections are
    the only option?'' SAH agents have learned the most effective way to
    deliver this benefit is with in-person home inspections that not only
    safeguard taxpayer dollars from misuse but provide an expert on the
    ground to help veterans and their families receive appropriate
    modifications for their homes.
        Recently, PVA's National Treasurer received an email from his SAH
    agent informing him of his early retirement. He wanted to make sure
    that all the veterans he worked with knew he was leaving, and that
    another agent would be in touch soon, but couldn't provide a timeline
    for his replacement. Our members are experiencing this across the
    country, and we fear that without robust staffing of the SAH program,
    as well as administrative support to process all the necessary
    documents, service-connected catastrophically disabled veterans will
    not be able to receive the dedicated attention they need for their
    individual situations. In general, SAH agents are dedicated to
    delivering these benefits in a timely manner, but the high quality of
    service the program is known for may diminish if they experience
    continued staffing decreases.
        Another critical adaptive housing program is the Home Improvements
    and Structural Alterations (HISA) grant. Designed to be nimbler than
    the SAH grant, HISA is often used to make modifications to a home such
    as adding a wheelchair ramp or improving bathroom accessibility.
    Unfortunately, this program is no longer meeting the needs of veterans
    because the grant amounts have not increased since 2010 despite
    construction and material costs rising more than 50 percent over the
    past 15 years. H.R. 2245, the Autonomy for Disabled Veterans Act, and
    H.R. 3309, the Autonomy for All Disabled Veterans Act, would raise the
    HISA amount to better meet the needs of veterans and tie the grant to
    an inflation index, enabling the grant to automatically keep up with
    future needs.
        While PVA members and other disabled veterans rely on these home
    modification grants for their independence, the need for increased
    efficiency around the program is critical. One of our NSOs shared that
    a veteran can submit their VA Form 26-4555, Application in Acquiring
    Specially Adapted Housing or Special Home Adaptation Grant, directly to
    the VA, but it can take months before that veteran receives a response.
    Modernizing the application process for this critical benefit would
    improve the experience for veterans, while minimizing the
    administrative burden for VA staff. Veterans who are eligible for the
    SAH grant and are experiencing barriers and limitations in their homes
    must be able to access these resources in a timely manner for their
    health and well-being.

    Vehicle Modifications and the Auto Grant

        Access to safe and reliable transportation is essential to the
    mobility, health, and independence of catastrophically disabled
    veterans. Improving transportation access is a top priority for PVA and
    we were proud to advocate for the Veterans AUTO and Education
    Improvement Act (P.L. 117-333). This life changing legislation
    authorized the VA to issue a second auto grant to an eligible veteran
    starting initially with veterans who received their grant more than 30
    years ago.
        To receive a VA auto grant, a veteran must receive a rating
    decision issued by the Veterans Benefits Administration (VBA) which
    establishes eligibility for the Auto Grant and Adaptive Equipment. A
    veteran must then complete VA Form 21-4502 (application for the Auto
    Grant) and submit it to VBA. Once VBA processes the 4502 and certifies
    it, they send it back to the veteran with an Award Letter letting the
    veteran know their grant has been approved, and with instructions to
    bring the form to the dealer where they intend to purchase a vehicle.
    The dealer and veteran work with the Prosthetics Department at their
    local VA medical center on authorized adaptive equipment, and once the
    vehicle is ready for delivery and a veteran accepts delivery, they sign
    the 4502 indicating they received the vehicle, and the dealer sends the
    4502 to the local VA regional office for payment.
        This process may seem reasonable for able-bodied individuals, but
    it is time-consuming and cumbersome for veterans with catastrophic
    disabilities. There is ample room for the VA to make improvements to
    this process and increase efficiency. For example, the VA should
    dedicate additional resources focused on modernization of this
    application process by evolving to a digital application which can be
    accessed remotely, allowing for e-signatures to reduce the burden
    placed on veterans.
        We have heard several stories from PVA members and NSOs of veterans
    needing to wait months for approval or for VBA to issue grant payments
    at which point the dealership has already sold the vehicle the veteran
    planned to purchase. VA bureaucracy should never impede the delivery of
    benefits for eligible veterans, particularly for something as critical
    as transportation. This process becomes more complicated when a
    dealership has no experience in dealing with the VA or this program.
        The Veterans AUTO and Education Improvement Act not only authorized
    an additional auto grant for eligible veterans, but it also amended the
    definition of ``medical services'' to include certain vehicle
    modifications (e.g., van lifts) offered through VA's medical benefits
    package. Specifically, it amended the definition of ``medical
    services'' under 38 U.S.C. Sec.  1701(6) to include the provision of
    medically necessary van lifts, raised doors, raised roofs, air
    conditioning, and wheelchair tiedowns for passenger use. The change was
    intended to codify VA's existing practice of furnishing certain items,
    like van lifts and wheelchair tiedowns, to catastrophically disabled
    veterans. However, where the Veterans Health Administration (VHA) has
    used these items as examples, the statute defines them as the only
    types of modifications that are permissible. Remember, this is for
    adaptive equipment through the VA's medical benefits package and is
    different from the Automobile Adaptive Equipment (AAE) program for
    eligible service-connected veterans.
        Like the VA, we agree that a technical amendment to 38 U.S.C. Sec.
    1701(6) is needed to give the department greater flexibility in making
    the necessary modifications to veterans' vehicles to ensure they can
    safely enter or exit the vehicle and transport needed equipment,
    including power wheelchairs. The statutory language inadvertently
    limits the scope of an existing benefit. As a result, PVA strongly
    supports H.R. 1364, the Automotive Support Services to Improve Safe
    Transportation Act of 2025, which addresses this oversight to ensure
    that seriously disabled veterans are getting the equipment and
    modifications needed to travel safely. We urge swift passage of this
    legislation.
        Reforms are also needed to the AAE program. The necessary
    adaptations approved by VA through the AAE program are in some cases
    adaptations that the veteran pays for directly and is then reimbursed
    by VBA. Some medically necessary features of a vehicle can be things
    like air conditioning, automatic transmissions, power brakes, and power
    windows. When vehicle manufacturers stopped itemizing these features
    there was no way to determine what kind of reimbursement should be
    issued to the veteran, other than VHA Directive 2011-046 which VA
    Prosthetics and Sensory Aid Services (PSAS) now states has been
    rescinded. The cost for these types of features is now included in the
    base price of the vehicle. Since the items aren't itemized, veterans'
    ability to prove the cost to them has effectively disappeared. The
    applicable statute, 38 U.S.C. Sec.  3901(2), provides in part that the
    term ``adaptive equipment'' includes, but is not limited to, power
    steering, power brakes, power window lifts, power seats,'' and (A) air-
    conditioning equipment when such equipment is necessary to the health
    and safety of the veteran and to the safety of others.'' \2\
    ---------------------------------------------------------------------------
        \2\ 38 U.S. Code Sec.  3901--Definitions U.S. Code US Law LII /
    Legal Information Institute.
    ---------------------------------------------------------------------------
        In July 2024, VA issued a final rule titled, ``Adaptive Equipment
    Allowance.'' This new rule effectively ignores the statutory
    requirement to reimburse veterans for these items. VA's new form 10-
    1394, Application for Adaptive Equipment, does not list items like
    power windows, brakes, and other statutorily listed items. Also, the
    new AAE reimbursement schedule lists these items with a reimbursement
    rate of $0. So, although the new regulation says VA will pay for this
    equipment, VA is making it impossible for veterans to be reimbursed by
    implementing significant roadblocks to this statutory benefit. Even
    prior to changing the rule, VA would deny veterans reimbursement and
    force them to appeal denials. The Board of Veterans' Appeals has
    reversed these denials. It is inefficient and a waste of taxpayer
    dollars to deny veterans' statutorily earned benefits and require them
    to file appeals to receive them.
        In addition, VA's PSAS now maintains that a veteran cannot trade-in
    a vehicle VA paid to adapt until that vehicle has been on a veteran's
    record for 4 years. PVA maintains that this interpretation is not based
    on law. PSAS has cited 38 CFR 17.158(a) to support their new
    ``policy,'' but VA did not change the regulation prior to changing its
    policy. This interpretation is quite burdensome for catastrophically
    disabled veterans and has resulted in requests for equitable relief for
    veterans who were in the process of receiving a new vehicle when VA's
    interpretation changed. We believe that VA must end this new policy.
        Finally, we understand that many of the businesses that adapt
    vehicles for use by disabled veterans are waiting on past due invoices
    pending with VA. We are concerned that these businesses may be unable
    to continue to provide services to veterans using VA benefits because
    of the financial burden placed on them as they wait for payment. This
    would cause great harm to catastrophically disabled veterans. Our goal
    is to make sure veterans have access to critical vehicle adaptations
    when needed.

    Adaptive Sports Grant Program and Recreation Opportunities

        As previously mentioned, our signature adaptive sports event is the
    NVWG. This event, which PVA hosts in partnership with the VA, brings
    hundreds of veterans together each year fostering team building,
    camaraderie, and independence. For many novice wheelchair athletes, the
    NVWG is the first time they've flown, or stayed in a hotel, or been to
    such a large event since their injury or diagnosis. A separate program,
    the VA's Adaptive Sports Grant Program, is a well-established and
    meticulously administered program for organizations like PVA to offer
    opportunities to improve independence, well-being, and quality of life
    through adaptive sports.
        Adaptive sports are much more than just recreation; they are a
    critical component of healing, rehabilitation, and community
    reintegration. They provide supportive opportunities for veterans to
    regain their confidence and independence while discovering a community
    that understands the complications and challenges faced by wheelchair
    users. Eliminating grants or reducing necessary VA staff, specifically
    recreational therapists, would reduce the number of opportunities for
    veterans and exacerbate barriers to participation and rehabilitation.
        It is difficult to describe how impactful adaptive sports can be on
    an individual veteran's life. PVA members who participate in adaptive
    sport programs improve their cardiovascular health, increase their
    strength, stability, and endurance, all of which lead to a longer and
    healthier life. The benefits of accessible adaptive sports go beyond
    just improved physical health; they can also have a profound impact on
    veteran mental health. James, an Air Force veteran, told PVA, ``I love
    adaptive sports; they saved my life. [They] got me off drugs and
    alcohol and my suicidal ideations stopped. When I first came in 2018, I
    was depressed and suicidal and didn't really want to be here. Another
    veteran I met schooled me, talked to me about the competition and the
    games, and what it's like to have like-minded people being here. I went
    home with three gold medals and a bronze that year.'' Similarly, Jason,
    a Marine Corps veteran, spoke of the power of adaptive sports by
    saying, ``Living in the darkness, living with depression, keeping
    yourself in dark places, you eat yourself away. But being able to push
    barriers, that helps people know there is more to life. Adaptive
    fitness can help save a life; it gives you a great sense of purpose.''
        The VA's Adaptive Sports Grant, and adaptive sports more broadly,
    help change the lives of disabled veterans for the better. It's
    important to note that VA staff are the facilitators of these
    transformational programs. Occupational therapists, physical
    therapists, and recreational therapists work in coordination with each
    other and other providers to offer evidence-based treatment and
    rehabilitation, improve wellness and lifestyle, and ultimately improve
    a veteran's quality of life. Recreational therapists are professionals
    who assist veterans in finding a reason to reengage with the world
    around them post injury or diagnosis in a holistic way. They offer
    individualized care that impacts a veteran's social, cognitive, and
    physical health and help to bridge the gap between their clinical
    rehabilitation and community reintegration.
        The profound impact of recreation and recreational therapists has
    long been debated, as demonstrated in the testimony of PVA Past
    President, Donald H. Broderick, before the Senate Veterans' Affairs
    Committee in 1975. In his testimony, Past President Broderick testified
    that:

            ``Patients are left to their own devices resulting in rampant
            deviant behavior. Instead of scheduled recreational and
            cultural activities in the evening hours and on weekends, the
            patient is forced to seek diversionary interests for himself.
            For the average person this is of no consequence, but to a man
            who has recently suffered such an injury as to make him
            question the value of life, the results can be more crippling
            that his paralysis. Rather than have young men turn to drugs
            and alcohol, suffer unnecessary emotional strain, and devoid
            themselves of motivation and expectations needed to recover
            from the catastrophic disabilities of paraplegia, blindness, or
            multiple amputation, we can assist them. Through stimulating
            severely disabled patients to use their leisure time
            constructively, as much can be done to guarantee their
            rehabilitation as by providing educational or vocational
            training. It is a proven fact that the greatest number of
            failures in rehabilitating a person, occur in the evening hours
            and on weekends when they are away from work. It seems
            senseless to throw away the efforts, money, and most important,
            individuals' lives, because of the failure to teach that person
            how to cope with his leisure time. Money and specific programs
            must be directed in this area, or we shall lose many valuable
            men to a life of failure, and ultimately, confinement in VA
            hospitals. You must prod the VA to take action and begin an
            active and effective program of recreation.''

        Congress and the VA heeded these suggestions and over the years
    have developed robust adaptive sports and recreation programs that
    promote physical and mental health, which offer opportunities for
    collaboration and increased engagement between the VA and veteran
    organizations and ultimately has had a lasting impact on the lives of
    thousands of individual veterans. Several PVA members who discovered
    adaptive sports at the VA, and who participated in the NVWG, have gone
    on to be Paralympians representing Team USA this past year in Paris.
    Marco, a Marine Corps Veteran, was a second time Paralympian, Mason
    competed on the USA Wheelchair Rugby team where they took the Silver
    Metal, and Jason competed in para-archery where he took home the Gold
    for Team USA.
        We urge Congress to reauthorize the VA's Adaptive Sports Grant
    program which is set to expire at the end of the year. When it comes to
    Federal funding having a direct impact on veterans, there are very few
    other opportunities, if any, that have such a positive impact on the
    quality of someone's life. The resources spent on these amazing
    programs and opportunities have a profound impact on veterans, their
    families, their caregivers, and their communities.
        In closing, adaptive programs and benefits are essential in the
    life and well-being of PVA members. Before any of these were available
    to disabled veterans, it was common practice for veterans to languish
    in long-term care facilities or other institutional settings rather
    than living independent lives that allowed them to thrive. Now,
    disabled veterans can live meaningful lives within their communities.
    They can drive themselves to work, their VA appointments, or other
    activities in their local communities. Every one of them is a living
    example how support from the VA can transform the lives of
    catastrophically disabled veterans in a meaningful and lasting way.
        Thank you for the opportunity to share our views on adaptive
    programs offered by the VA. We look forward to working with the
    subcommittee and the VA to ensure the longevity of the programs
    discussed at the hearing today.

      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.

                           Statements for the Record

                                  ----------

                   Prepared Statement of Homes For Our Troops
    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

     Prepared Statement of National Mobility Equipment Dealers Association

        The National Mobility Equipment Dealers Association (NMEDA), a non-
    profit trade association representing over 300 members across the
    mobility industry, strongly supports the testimony submitted by
    BraunAbility to Chair Van Orden, Ranking Member Pappas, and all members
    of the House Veterans' Affairs Subcommittee on Economic Opportunity.
        For more than 35 years, NMEDA has championed safe, reliable, and
    customized transportation solutions for individuals with disabilities--
    including our Nation's disabled veterans. Our membership includes
    mobility equipment manufacturers, dealers, driver rehabilitation
    specialists, and other professionals committed to enhancing the
    independence and quality of life of those we serve.
        NMEDA supports BraunAbility's testimony because it highlights three
    key priorities that are critical to the success and sustainability of
    the VA's adaptive automotive program:

            1. Updating the Adaptive Equipment Schedule: An accurate,
            modernized equipment schedule is essential to ensuring veterans
            receive the appropriate mobility solutions they need--
            reflecting current technologies, safety standards, and real-
            world costs.

            2. Prompt Payment: Timely reimbursement to providers is crucial
            to maintaining uninterrupted access to adaptive equipment and
            services for veterans. Delays jeopardize both the viability of
            providers and the continuity of care for those who rely on
            these solutions for daily independence.

            3. Two-in-Four's Adaptive Equipment Trade-In Policy: The VA's
            sudden change in the interpretations of the two-in-four
            regulations significantly burdens our veterans.

        As a long-standing advocate for veterans' mobility needs, NMEDA
    urges the Subcommittee to take these recommendations seriously.
    Ensuring veterans have access to updated equipment and prompt provider
    payments directly supports their freedom, dignity, and mobility.

                Prepared Statement of Disabled American Veterans

        Chairman Van Orden, Ranking Member Pappas and Members of the
    Subcommittee:

        DAV (Disabled American Veterans) appreciates the opportunity to
    provide testimony for this oversight hearing titled, ``Pushing VA
    Forward: Review of VA's Adaptive Programs for Disabled Veterans''.
        DAV is a congressionally chartered non-profit veterans service
    organization composed of nearly one million wartime service-disabled
    veterans. Our single purpose is to empower veterans to lead high-
    quality lives with respect and dignity.
        VA adaptive programs play a crucial role in enhancing the quality
    of life for service-disabled veterans. These programs provide financial
    assistance for essential modifications and specialized equipment,
    enabling veterans to live more independently and safely by enhancing
    their mobility, accessibility, and overall well-being. These programs
    foster veterans' independence while enhancing their mental, emotional,
    and physical health, allowing them to engage more fully in daily
    activities and social interactions. Adaptive sports initiatives
    complement these efforts by promoting physical activity, building
    confidence, and helping veterans lead meaningful and fulfilling lives.
        In partnership with the VA, DAV is proud to co-host two events each
    year focused on adaptive sports initiatives for service-disabled
    veterans. One of these events is the Winter Sports Clinic in Snowmass,
    Colorado, which brings together nearly 400 veterans from across the
    country with spinal cord injuries, amputations, traumatic brain
    injuries, and near blindness. These veterans are introduced to adaptive
    skiing, sled hockey, scuba diving, rock wall climbing, educational
    sessions, and other activities. Various types of adaptive equipment are
    used based on the severity of each veteran's injury, and hundreds of
    ski instructors volunteer their time to support the event. The success
    of this clinic is heavily reliant on the dedication of these
    volunteers. We could not conduct these events without the invaluable
    support of the VA and corporate sponsors. Their contributions are
    essential to making this life-changing event possible for our Nation's
    service-disabled veterans.
        DAV and VA also co-host the National Disabled Veterans Golf Clinic,
    which introduces veterans to the therapeutic benefits of golf and other
    activities, including kayaking, bicycling, bowling and shooting. Each
    year, this event brings together over 200 veterans from across the
    United States to Riverside, Iowa. These veterans, who have serious
    disabilities such as spinal cord injuries, traumatic amputations, and
    significant visual impairments, receive intensive instruction from over
    75 PGA (Professional Golfer's Association) professionals. This event is
    life-changing for both veterans and their caregivers, as they learn
    together how to engage in these activities upon returning home.
        VA Health Systems Research, Management Briefs eBrief-no154, and
    Therapeutic Recreation Journal reviewed the benefits and barriers to
    participation in adaptive sports programs for disabled veterans. The
    reviews found that adaptive sports significantly improve veterans'
    independence, well-being, and quality of life. The results indicate
    veterans make significant improvements in their psychological health,
    and reductions in mood disturbances such as depression and anger. These
    studies highlight the need to expand existing adaptive sports equipment
    programs and create new initiatives.
        In addition to the positive impact of adaptive sports programs, it
    is important to recognize the comprehensive support provided by the
    VA's adaptive equipment programs. The VA administers a range of
    adaptive programs, each with distinct requirements, designed to address
    the diverse needs of different veteran populations. These programs
    encompass both residential modifications and automotive adaptations,
    ensuring comprehensive support for veterans across various aspects of
    daily living.
        The Home Improvements and Structural Alterations (HISA) grant
    program is an initiative that provides veterans with financial
    assistance to make necessary modifications to their homes. These
    modifications, such as installing ramps, widening doorways, and adding
    accessible bathrooms, significantly enhance the safety and
    accessibility of veterans' living environments. By addressing physical
    barriers within the home, this program empowers veterans to live more
    independently and comfortably, reducing the risk of injuries and
    improving their overall quality of life and well-being.
        The Specially Adapted Housing (SAH) grant program is another
    essential initiative that supports veterans with severe disabilities by
    providing housing adaptions to create barrier-free environments for
    veterans with severe disabilities. These adaptations include
    constructing wheelchair-accessible homes, installing specialized
    fixtures, and structural changes to accommodate mobility devices. This
    program's emphasis on creating tailored living environments for
    veterans with significant physical challenges ensures they can live
    safely and independently. By offering substantial financial support for
    these specialized adaptations, the program helps veterans achieve a
    higher level of comfort and functionality in their daily lives.
        The Special Home Adaptation (SHA) grant program helps veterans with
    certain service-connected disabilities to modify or purchase a home. It
    provides allowances for adaptations to accommodate specific
    disabilities with the goal of enabling service-disabled veterans to
    live independently in a home that meets their specific needs. While
    both the SAH and SHA initiatives target improved living conditions for
    veterans, their respective services and financial support vary.
        The Automotive Adaptive Equipment program focuses on providing
    veterans with the modifications to their vehicles, enabling them to
    drive safely and comfortably. These upgrades include hand controls,
    wheelchair lifts, and other assistive devices addressing the needs of
    disabled veterans to ensure that they can maintain their independence
    and engage in community activities without limitations.
        Although the benefits these adaptive programs bring to veterans are
    invaluable, our members have identified several concerns, particularly
    the complexity of the eligibility requirements. Each program has
    similar yet distinct eligibility criteria, which can make it difficult
    for veterans to distinguish between them or they may not be aware of
    their eligibility for more than one program. This lack of clarity can
    hinder veterans from accessing the full range of benefits available to
    them. In some cases, eligibility requires approval from both the
    Veterans Benefits Administration (VBA) and the Veterans Health
    Administration (VHA), further complicating the process and potentially
    delaying access to necessary modifications and equipment. In addition,
    when VA does not verify eligibility properly, it can create an
    overpayment of benefits.
        A significant issue for housing grants is the conflict between
    building code enforcement and the specific needs of veterans. For
    instance, if a veteran requires a larger opening to a room to
    accommodate a wheelchair or other mobility device, an electrical outlet
    may need to be removed. Should the building code mandate a certain
    number of outlets in the room, this modification could render the room
    non-compliant, resulting in serious delays and substantial hardship for
    the veteran. Similarly, modifications such as lowering countertops for
    accessibility may not align with existing building codes, causing
    further delays and complications. These conflicts highlight the urgent
    need for better coordination between VA and local contractors to ensure
    that necessary modifications are implemented as required and in a
    timely manner.
        There are also instances where communication lapses have led to
    significant delays in project completion. For the SAH and SHA programs,
    the failure of VA to maintain regular communication with veterans and
    builders has led to delays and disputes. Similarly, veterans have
    reported challenges with understanding the eligibility criteria and
    navigating the application process for Home Improvements and Structural
    Alterations grants, often stemming from inadequate communication and
    support from VA representatives. These examples underscore the need for
    improved communication and support from the VA to ensure veterans can
    effectively access the benefits from these programs. The VA should
    implement a centralized case management system, assign dedicated
    liaison officers, enhance digital communication tools, improve staff
    training, coordinate with local authorities, and expand outreach
    efforts to ensure veterans receive timely and effective support in
    accessing adaptive equipment and housing programs.
        Improving IT systems for eligibility reviews could also speed up
    the process and reduce unnecessary overpayments. It is essential for VA
    staff to be well-versed in the specifics of each program to reduce
    errors. The VA should collaborate more closely with state and local
    officials to request exceptions to building codes, without compromising
    safety, when applying any of the housing modification programs.
    Training for VA personnel should emphasize the timeliness of
    communication throughout the process. Ensuring that veterans understand
    what is needed from them will help mitigate delays and confusion,
    ultimately improving the efficiency and effectiveness of these vital
    programs.
        Finally, funding shortages present significant challenges for VA
    adaptive equipment programs. Allocated funds often fall short of
    meeting the growing demand and rising costs associated with these
    adaptations. For instance, the maximum grant amounts have remained
    unchanged for years, despite inflation and increasing construction
    costs.
        By addressing both physical and psychological needs, adaptive
    equipment and sports programs empower service-disabled veterans to live
    more independently, engage in their communities, and enjoy a higher
    quality of life. To sustain these efforts, Congress must collaborate
    with the VA to secure increased funding, raise grant maximums, improve
    communication, upgrade IT systems, and enhance VA staff training--
    ensuring these programs continue to meet the evolving needs of veterans
    with disabilities and provide the resources and opportunities they
    deserve.
        Mr. Chairman, this concludes my testimony. I would be pleased to
    answer questions you or members of the Subcommittee may have.

                                     [all]