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

                              LEGISLATIVE HEARING

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

                                    HEARING

                                   before the

                             SUBCOMMITTEE ON HEALTH

                                     of the

                         COMMITTEE ON VETERANS' AFFAIRS

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED NINETEENTH CONGRESS

                                 SECOND SESSION
                                   __________

                           TUESDAY, JANUARY 13, 2026
                                   __________

                               Serial No. 119-42
                                   __________

           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

    63-300                    WASHINGTON : 2026

                         COMMITTEE ON VETERANS' AFFAIRS

                         MIKE BOST, Illinois, Chairman

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

                           Jon Clark, Staff Director
                      Matt Reel, Democratic Staff Director

                             SUBCOMMITTEE ON HEALTH

                   MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman

    JACK BERGMAN, Michigan               JULIA BROWNLEY, California,
    GREGORY F. MURPHY, North Carolina        Ranking Member
    DERRICK VAN ORDEN, Wisconsin         SHEILA CHERFILUS-MCCORMICK,
    JEN KIGGANS, Virginia                    Florida
    ABE HAMADEH, Arizona                 MAXINE DEXTER, Oregon
    KIMBERLYN KING-HINDS, Northern       HERB CONAWAY, New Jersey
        Mariana Islands                  KELLY MORRISON, Minnesota

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

                             C  O  N  T  E  N  T  S

                                  ----------

                           TUESDAY, JANUARY 13, 2026

                                                                       Page

                               OPENING STATEMENTS

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

                             SPEAKING FROM THE DAIS

    The Honorable Kimberlyn King-Hinds, U.S. House of
      Representatives, (MP-01).......................................     4
    The Honorable Greg Landsman, U.S. House of Representatives, (OH-
      01)............................................................     5
    The Honorable Pat Fallon, U.S. House of Representatives, (TX-04).     6
    The Honorable Chris Deluzio, U.S. House of Representatives, (PA-
      17)............................................................     7
    The Honorable Ryan Mackenzie, U.S. House of Representatives, (PA-
      07)............................................................     8
    The Honorable Jack Bergman, U.S. House of Representatives, (MI-
      01)............................................................     9

                                   WITNESSES

                                    Panel I

    Dr. Mark Koeniger, Acting Assistant Under Secretary for Health
      for Patient Care Services, U.S. Department of Veterans Affairs.    10

            Accompanied by:

        Dr. Maria Llorente, Acting Assistant Under Secretary for
            Health for Integrated Veteran Care, U.S. Department of
            Veterans Affairs

                                    Panel II

    H.E. Charles Rudolph Paul, Ambassador Extraordinary &
      Plenipotentiary, Embassy of the Republic of the Marshall
      Islands........................................................    20

    Mr. James Whaley, Chief Executive Officer, Mission Roll Call.....    21

    Ms. Elizabeth McCoy, Associate Director, Government Affairs,
      Wounded Warrior Project........................................    22

    Ms. K. Conwell Smith, Deputy Chief, Military & Veterans Policy,
      American Psychological Association.............................    24

                                    APPENDIX

                        Prepared Statements Of Witnesses

    Dr. Mark Koeniger Prepared Statement.............................    39
    H.E. Charles Rudolph Paul Prepared Statement.....................    80
    Mr. James Whaley Prepared Statement..............................    81
    Ms. Elizabeth McCoy Prepared Statement...........................    82
    Ms. K. Conwell Smith Prepared Statement..........................    89

                           Statements For The Record

    Veterans of Foreign Wars of the United States Prepared Statement.    93
    Easterseals Prepared Statement...................................    98

                              APPENDIX--continued

    American Federation of Government Employees, AFL-CIO Prepared
      Statement......................................................   100
    ALS Association Prepared Statement...............................   102
    ALS United Prepared Statement....................................   103
    The Honorable Jason Crow, U.S. House of Representatives, (CO-06)
      Prepared Statement.............................................   105
    Dennis Boothe Prepared Statement.................................   107
    Endeavors Prepared Statement.....................................   110
    Fleet Reserve Association Prepared Statement.....................   111
    Jewish War Veterans Prepared Statement...........................   115
    Association of VA Nurse Anesthesiologists, Association of VA
      Psychologist Leaders, Association of VA Social Workers,
      National Association of VA Physicians and Dentists, Nurses
      Organization of Veterans Affairs, and Veterans Healthcare
      Policy Institute Prepared Statement............................   116
    Cohen Veterans Network, Inc. Prepared Statement..................   121
    Aspire Health Partners Prepared Statement........................   123
    Berry Law Prepared Statement.....................................   125
    Easterseals DC/MD/VA Prepared Statement..........................   152
    Voices for Non-Opioid Choices Prepared Statement.................   153
    Centerstone Prepared Statement...................................   156
    The Up Center Prepared Statement.................................   157
    Air Force Sergeants Association Prepared Statement...............   158
    Tragedy Assistance Program for Survivors Prepared Statement......   159
    VoteVets Prepared Statement......................................   161
    Embassy of the Federated States of Micronesia Prepared Statement.   163

                              LEGISLATIVE HEARING

                                  ----------

                           TUESDAY, JANUARY 13, 2026

                        Subcommittee on Health,
                        Committee on Veterans' Affairs,
                                 U.S. House of Representatives,
                                                        Washington, DC.
        The subcommittee met, pursuant to notice, at 2:15 p.m., in
    room 360, Cannon House Office Building, Hon. Mariannette
    Miller-Meeks [chairwoman of the subcommittee] presiding.
        Present: Representatives Miller-Meeks, Bergman, Kiggans,
    Hamadeh, King-Hinds, Brownley, Cherfilus-McCormick, Dexter,
    Conaway, and Morrison.

       OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN

        Ms. Miller-Meeks. Come to order. The chair may declare a
    recess at any point.
        I would like to welcome all the members and witnesses to
    today's hearing. Today we will discuss 12 bills designed to
    improve the lives of our Nation's veterans and the systems they
    rely on for healthcare and health-related matters. I am looking
    forward to a very productive discussion on each of these bills,
    including the many that are focused on improving access to
    mental healthcare.
        Speaking of productive, I would just like to acknowledge
    that Ranking Member Brownley has decided to retire after this
    term. I envy her, but I also want to say that she has been
    longer on the Veterans Health Committee or the Veterans'
    Affairs Committee longer than I have. This is my sixth year on
    the committee and her dedication to our veterans and her input
    has been invaluable. Thank you so much, Ranking Member Brownley
        Ms. Brownley. Thank you. Thank you. Thank you. Thank you.
        Ms. Miller-Meeks. Some of the bills that we will discuss
    today is the Recognizing in Recognizing Community Organizations
    for Veteran Engagement and Recovery (RECOVER) Act introduced by
    Chairman Bost, which would help fund programs targeted toward
    reducing nutrition and mental healthcare. Many veterans in
    areas with limited access to care still face barriers when
    seeking mental health services, especially in rural and remote
    parts of the country. Provider shortages and capacity
    constraints, for example, are but some of those many obstacles.
    We know that in all of these rural areas or even urban areas
    that telemedicine is beneficial, but still it can create
    problems and challenges if you do not have provider access.
        The RECOVER Act would require the U.S. Department of
    Veterans Affairs (VA) to carry out a 3-year pilot program under
    which nonprofit outpatient medical health providers serving
    veterans, who, for reasons outlined in the bill, may be more
    likely to discontinue care, would be eligible for grant awards.
    This bill would use existing resources more effectively while
    working with providers to do more. As I said, telemedicine
    works well in this area, so it still is an option. I am
    thankful to Chairman Bost for his thoughtful legislation on
    this matter to bridge the gap in care.
        The Veterans Mental Health and Addiction Therapy Quality of
    Care Act introduced by Representative Fallon would require VA
    to commission an independent study examining quality, access,
    and outcomes for mental health and addiction treatment provided
    both inside and outside the VA. This bill would ensure that we
    continue to provide veterans with the best possible care to
    meet their needs. I am proud to support it.
        The Veterans TBI Breakthrough Exploration of Adaptive Care
    Opportunities Nationwide (BEACON) Act, introduced by General
    Bergman, would direct VA to support research and clinical
    trials focused on chronic mild traumatic brain injury, or mild
    TBI. This would include nonpharmaceutical and community-based
    rehabilitation approaches and independent research. Many
    veterans experience long-term and sometimes debilitating
    conditions because of mTBI. Despite the prevalence of these
    injuries, work remains in research, treatment options, and
    standard of care. This bill would lay the groundwork for future
    decisions guided by evidence rather than assumptions. I thank
    General Bergman for making sure the VA delivers care that
    reflects the realities we are facing.
        I would also like to thank Representatives Mackenzie and
    Jackson for their work on legislation addressing brain injury
    and mental health issues affecting veterans. The Veterans
    Healthcare Dessert--Desert Reform Act--you can tell I have not
    had lunch yet; no, I am only kidding--the Veterans Health
    Desert Reform Act of 2025, a bill I introduced, would direct VA
    to pilot partnership with non-VA hospitals in an area where
    care is lacking. This would allow veterans to receive care
    equivalent to community care, and I have seen this in my own
    district.
        Too many veterans living in rural areas across our Nation
    face the challenge of living in a healthcare desert, an area
    without a VA facility of any type within a realistically
    accessible distance. In a health desert, basic care is
    difficult to maintain and even the most routine care presents a
    significant burden for veterans. My bill would fill geographic
    gaps in access, again recognizing the importance of
    telemedicine, ensuring that when VA facilities are not
    realistically accessible, veterans can still access care closer
    to home. This issue is a top priority for me and my bill is a
    commonsense expansion of our veterans' access to healthcare. I
    look forward to continuing this discussion and working on this
    matter.
        The Clarity on Cares Option Act introduced by Ms. Kiggans
    will would require VA to create and maintain a searchable
    directory of providers who accept the Civilian Health and
    Mental Program of the Department of Veterans Affairs, Civilian
    Health and Medical Program of the Department of Veterans
    Affairs (CHAMPVA). This would help ensure that beneficiaries
    make informed choices about their care. Often, CHAMPVA
    beneficiaries struggle to identify which healthcare providers
    will accept their coverage. This leads to delays and confusion
    for families already navigating a complex system, as we heard
    in an earlier hearing. CHAMPVA is an important healthcare
    program for dependents and survivors of our Nation's veterans.
    I appreciate Ms. Kiggans' continued efforts to make that
    coverage more usable in practice for families.
        I also want to thank Ms. King-Hinds for her diligence in
    assuring that Freely Associated States (FAS) veterans are not
    ignored. Her work on this matter is appreciated.
        This morning we are also joined by several of our
    colleagues who will speak in support of their bills. We
    appreciate their dedication to serving our Nation's veterans.
    In accordance with committee rules, I ask unanimous consent
    that the following members be permitted to participate in
    today's committee hearing: Representative Pat Fallon,
    Representative Ryan Mackenzie, Representative Greg Landsman,
    and Representative Chris Deluzio. Without objection, so
    ordered.
        I now yield to Ranking Member Brownley for any opening
    remarks she may have.

          OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER

        Ms. Brownley. Thank you, Madam Chair, and thank you to our
    witnesses today for providing your testimony on the legislation
    we are considering.
        I am excited that we are considering several of my
    Democratic colleagues' bills on today's agenda. I know the
    sponsors of these bills will be on the first panel to speak
    about the importance of those bills, so I will try to keep my
    remarks brief. I appreciate my colleagues, Congressman Landsman
    and Congressman Conaway, for introducing bills to build on VA's
    work to protect veterans from the risk of opioid overdose.
        I am also glad we will consider Congressman Crow's
    legislation to further our understanding of Amyotrophic Lateral
    Sclerosis (ALS) and the causes of veterans' increased risk of
    the disease.
        Finally, I look forward to considering Congressman
    Deluzio's bill to ensure veterans are not overly burdened by
    copays for participating in VA Whole Health Services.
        However, I must express some serious concerns about several
    of the Republican-sponsored bills on today's agenda. The
    RECOVER Act, the BEACON Act, the Health Desert Reform Act, and
    the Data Driven Suicide Prevention Act share a common theme:
    they all siphon money from existing VA programs and redirect it
    to outside organizations and providers to do the very same
    things VA is already doing, but with fewer guardrails and fewer
    requirements to ensure quality of care. Taken together, these
    bills represent a concerted effort to circumvent VA's direct
    care program and research enterprise and create no-strings-
    attached handouts of VA funding to private companies. Not only
    is this wasteful and duplicative, but it could lead to a
    further fracturing of continuity of care for are veterans.
        Worse still, the grant programs that would be created by
    the RECOVER Act and the BEACON Act lack meaningful mechanisms
    of oversight for VA to ensure that veterans are receiving the
    quality care and evidence-based standards of care through these
    grant programs.
        I am on record acknowledging that there will always be a
    place for community care in geographic regions and in
    specialties where VA cannot directly provide needed care.
    However, there is a difference between participating in the
    community care network and creating competing and duplicative
    programs through which private providers can be paid to deliver
    care with minimal requirements for veteran cultural competency,
    care coordination, and communication with VA, all the while
    avoiding rigorous oversight of care outcomes. This is what will
    happen if the RECOVER Act and the BEACON Act and the Health
    Desert Reform Act are allowed to become law.
        If private providers wish to provide care to veterans, they
    should ensure they can meet the VA Community Care Network
    requirements and enroll in that instead. I do not believe we
    should be creating carve-outs or grant programs that would
    allow private providers to avoid the requirements of the VA
    Maintaining Internal Systems and Strengthening Integrated
    Outside Networks (MISSION) Act and still financially benefit
    from VA funding.
        I would note that many organizations who have gone on the
    record supporting these bills already participate in VA's
    Community Care Network and some are already receiving grants
    from VA's Staff Sergeant Parker Gordon Fox Suicide Prevention
    Grant Program. It seems to me that creating new grant programs
    for which these organizations are uniquely eligible under the
    RECOVER Act and the BEACON Act does nothing but enable these
    organizations to double or triple dip and receive
    reimbursements for community care in addition to the new grant
    funding. That does not seem fiscally responsible to me.
        I will continue to oppose legislation that does nothing to
    ensure veterans receive quality care and instead simply siphons
    money from VA straight into the pockets of private entities
    without any guardrails. I am looking forward to hearing from
    our witnesses today and to some productive rounds of questions.
        With that, I yield back, Chairwoman Miller-Meeks.
        Ms. Miller-Meeks. We will limit the time to 3 minutes per
    bill to ensure we can move in a timely manner. General Bergman,
    if you are not ready to go, I am going to recognize Ms. King-
    Hinds. You are up unless you are not ready and I will go to Ms.
    King-Hinds.
        Okay. Ms. King-Hinds, you are recognized for 3 minutes to
    speak on your discussion draft of your bill.

                   STATEMENT OF KIMBERLYN KING-HINDS

        Ms. King-Hinds. Thank you, Chairwoman Miller-Meeks, and
    thank you to the ranking member and to my colleagues for the
    opportunity to speak today. I am proud to discuss my bill, H.R.
    6652, a bill that is about honoring a commitment Congress made
    just 2 years ago through the Compact of Free Association (COFA)
    Amendments Act and ensuring that the Department of Veterans
    Affairs follows through on that promise.
        FAS citizens serve in the U.S. military at among the
    highest rates per capita. However, the brave FAS citizens who
    have chosen to return home after their service face
    disproportionate challenges to receiving their full benefits,
    including access to medical care when residing in their Pacific
    Islands. When the COFA Act was enacted, it recognized a
    longstanding obligation to veterans and families from the
    Freely Associated States. The United States agreed to expand
    access to care and to ensure that those veterans will no longer
    be left behind because of geography or administrative
    discretion. Despite that clear intent, implementation has
    remained stalled and too many veterans are still waiting for
    those commitments to translate into real, reliable care.
        H.R. 6652 is necessary because the promise alone is not
    enough. This bill makes clear that VA must fully deliver on
    what they agreed to under the COFA Act. It ensures that
    essential components of care are not treated as optional, but
    as required parts of the services veterans receive.
        This bill does not require anything extraordinary. It
    ensures access to telehealth, mail order pharmacy services, and
    makes beneficiary travel more accessible. This legislation
    provides clarity, consistency, and accountability so that
    veterans and their families can depend on the care they were
    promised rather than navigating uncertainty or delays.
        Our veterans upheld their end of the bargain through their
    service to this country. Congress acted through COFA and now it
    is time for VA to make good on that agreement. I look forward
    to working with my colleagues in the Department of VA to ensure
    this promise is fully and finally kept.
        I yield my time.
        Ms. Miller-Meeks. Thank you, Representative King-Hinds.
        The chair now recognizes General Bergman for 3 minutes for
    any comments he may have on his bill.
        General Bergman yields.
        The chair will now recognize off-committee members to speak
    for 3 minutes on behalf of their legislation. The chair
    recognizes Representative Landsman for 3 minutes.

                       STATEMENT OF GREG LANDSMAN

        Mr. Landsman. Thank you, Madam Chair. Thank you to all the
    members, Ranking Member, for having me in today's legislative
    hearing and allowing me to talk about my bill, H.R. 4590, the
    NOPAIN for Veterans Act. I also want to thank our co-leads,
    Representatives Van Orden, Pappas, Bergman, Sewell, and
    Hamadeh, for partnering with me on this important issue.
        The opioid epidemic is a--it is a disaster, right, you
    know, across the board. It has really hit our veterans and you
    all know that. This is a really frustrating situation because
    there are all these U.S. Food and Drug Administration (FDA)-
    approved nonopioid pain treatments for veterans, for everybody.
    The VA will not provide those to veterans even though the FDA
    has approved them and they work and veterans are asking for
    pain relief that will not ruin their lives. The VA is saying
    no, no, no, it is going to require an act of Congress to update
    what we can provide to veterans.
        As such, we are trying to get this bill onto the floor or,
    you know, onto the docket and pass. There is a companion bill
    in the Senate. We can get this done. It will make a big
    difference for veterans who are asking for, looking for
    nonopioid, you know, based pain relief.
        You know, the statistics are staggering, but you all know
    just how problematic, you know, this addiction can be. Our
    veterans are going through all kinds of--you know, dealing with
    all kinds of issues that require some pain management. Again,
    this just would allow the VA to provide veterans with what
    Medicare folks and other folks in the private sector or with
    private insurance get, which is a slew of nonopioid-related or
    nonopioid-based pain relief.
        Hopefully, we can get this on the floor or on the docket. I
    appreciate your efforts in letting me speak here and encourage
    everyone to vote for it, encourage their colleagues and folks
    in the Senate to do the same so we can get this passed.
        Thank you. I yield back.
        Ms. Miller-Meeks. The gentleman yields.
        The chair now recognizes Representative Fallon for 3
    minutes to speak on his bill.

                        STATEMENT OF PAT FALLON

        Mr. Fallon. Thank you, Madam Chair, for the opportunity to
    discuss our bill, H.R. 2426, the Veterans Mental Health and
    Addiction Therapy Quality Care Act. This bill is an important
    step in ensuring that our veterans are receiving the best
    possible care across all treatment settings and to identify
    gaps and, for that matter, best practices that could inform
    future policy.
        Today, approximately 18 veterans die of suicide daily. It
    is 18 too many. This is not an abstract number. These are real
    men and women who served our Nation. Not only they return home
    and they continue fighting battles, and all too well--or all
    too often, unfortunately, they fight those alone. This bill
    arises from a longstanding concern about how to best serve
    veterans' mental health and addiction care needs, particularly
    in light of the mixed delivery systems and persistent suicide
    and treatment access challenges.
        Over the last decade, Congress has worked in a bipartisan
    way to expand access to care, including through community care
    programs that allow veterans to seek treatment outside the VA.
    That effort was necessary and well intentioned. However, access
    alone is not enough. Quality matters and outcomes matter. Lives
    matter depend on it.
        H.R. 2426 addresses an important fundamental question: are
    we truly delivering the highest quality mental health and
    addiction care to our veterans, regardless of where that care
    is provided? What we still lack is an independent, objective
    assessment of how mental health and addiction therapy delivered
    by VA providers compares with care delivered by non-VA
    providers. Competition is a good thing. This bill directs that
    such a study be undertaken by the Department of the VA, and it
    will do two things primarily. One, assess the quality of care
    across a broad set of modalities, including telehealth,
    inpatient, outpatient, intensive outpatient, and residential
    treatments. Second, perhaps most importantly, the Department
    must make the findings of that report public.
        If the outcomes of this study show strengths, we should, of
    course, build on them. If they reveal gaps in community care,
    we should fix them because we must fix them. If it reveals
    exceptional care in any facet, we need to replicate that
    success everywhere.
        Here is the bottom line. Suicide rates are unacceptably
    high. Doing nothing is not acceptable. Our veterans and their
    families are being devastated by suicide and we have the
    ability and the obligation to demand accountability and work
    toward improvements.
        I want to thank my colleagues on both sides of the aisle
    who have supported this legislation, specifically our
    Democratic co-lead, Representative Sanford Bishop. I would also
    like to thank the veterans advocates who continue to rightfully
    push us to do better.
        This is not a partisan issue. It is a national
    responsibility. I urge this esteemed subcommittee to give H.R.
    2426 thoughtful consideration and swift action. Our veterans
    have already given us so much and given so much to this
    Republic. We owe them the care that is worthy of that
    sacrifice.
        Thank you, Madam Chair. I yield back.
        Ms. Miller-Meeks. The gentleman yields.
        The chair now recognizes Representative Deluzio for 3
    minutes for any comments he may have on his bill.

                       STATEMENT OF CHRIS DELUZIO

        Mr. Deluzio. Thank you, Chairwoman Miller-Meeks, Ranking
    Member Brownley. It is great to be back in front of the Health
    Subcommittee. Thank you for having me and considering my bill,
    H.R. 6848, the Whole Health for Veterans Act.
        This bill will help more of my fellow veterans improve
    their health and well-being through access to the VA's Whole
    Health program. I know the subcommittee members know that VA
    Whole Health, it is a comprehensive program. It helps veterans
    build a personal health plan that works for them as directed by
    their care team. It does things like teach veterans to treat
    their health proactively, provides resources and oversight for
    things like strength and mobility training, and is tailor made
    to help each veteran meet their own unique goals. When veterans
    are more actively involved in their own care, it improves
    healthcare outcomes and in turns can lower healthcare cost.
        I have seen this in action in VA Pittsburgh. I have heard
    from veterans who are part of this program and they talk about
    how it saved them from surgery or other interventions that
    could be much more costly and invasive in their lives. I think
    it is something for us to build on. I think it is common sense
    that we can make this program available to all veterans.
        Unfortunately, last October, copays were introduced,
    charging Veterans Health Administration (VHA) priority groups 6
    through 8 veterans $15 per visit. Around that time I heard from
    a constituent, a veteran who loves this VA Whole Health program
    and the care he gets there, but talked about how he would be
    unable to participate due to the cost now for the program.
        My bill addresses this to fix the problem by codifying an
    already existing prohibition on copays for priority groups 1
    through 5 veterans and then caps the monthly copayments for
    other priority groups at $30 a month. Veterans who want to
    improve their health and work with their care team I think
    should be able to do it without paying a fortune. VA healthcare
    ought to be the best in the world.
        As I understand it, VA has provided some feedback on the
    bill. I looked at it. I think there are issues that we can edit
    and incorporate and update on this bill and work through. I am
    excited to work with the subcommittee. I invite support from
    both parties here, Madam Chair.
        I yield back.
        Ms. Miller-Meeks. The gentleman yields.
        The chair now recognizes Representative Mackenzie to speak
    for 3 minutes on his bill.

                      STATEMENT OF RYAN MACKENZIE

        Mr. Mackenzie. Thank you, Madam Chair. It is a pleasure to
    join the House Committee on Veterans' Affairs. Before I begin,
    I would like to extend my thanks to all of our veterans for
    their service to our country.
        Veteran suicide remains an urgent challenge facing our
    country. Despite years of effort, the overall rate has remained
    stubbornly high. Too often we learn after the fact that many of
    the warning signs were missed. One of the most troubling
    realities is that more than half of our veterans who died by
    suicide were not engaged with VA healthcare in the years before
    their death. That tells you something important, that
    traditional episodic screening, often based on self-reporting,
    is not enough to identify risk early and consistently.
        That is why I am introducing the Data Driven Suicide
    Prevention and Outreach Act of 2025. The bill directs the VA to
    establish a time-limited competitive grant program to support
    the development of predictive models that can identify risk
    factors before the crisis point. They can do that by
    responsibly integrating benefits data, service records, and
    clinical information.
        By leveraging new technologies, we have the potential to
    revolutionize how we treat and monitor the crisis of veteran
    suicide, providing more opportunities for timely intervention
    that will ultimately save lives. Importantly, this bill does
    not replace clinicians, nor does it create a black box
    algorithm. Instead, it empowers decision-makers and builds on
    the VA's knowledge of what works. Initiatives like the Recovery
    Engagement and Coordination for Health-Veterans Enhanced
    Treatment (REACH VET) program have shown that predictive
    analytics can help flag veterans at elevated risk and prompt
    earlier outreach and care engagement.
        What this legislation does differently is encourage
    innovation with guardrails. Grants are limited to organizations
    with demonstrated expertise in healthcare Artificial
    Intelligence (AI), data security, and clinical deployment.
    Models must be explainable, interoperable, and clinically
    actionable. They must comply with VA cybersecurity standards
    and any findings must be shared with the VA for systemwide
    evaluation.
        We also intentionally prioritize areas with elevated
    suicide risks and high crisis volumes with the suicide hotline.
    Also, we look at where there are long mental health wait lines
    and we can help prevent duplication of efforts or a missed
    opportunity to intervene.
        Artificial intelligence holds promise, but it is still new
    and carries real risks which we want to recognize and this bill
    takes a balanced and measured approach with a pilot program.
    Stakeholders have emphasized that these predictive schools can
    be helpful. I have seen it in my local community where health
    networks utilize AI running in the background. Again, it
    becomes a force multiplier where doctors can then go out and
    actually treat more of these situations that deserve their
    attention and should be prioritized.
        I would like to thank the chair for recognizing us and
    allowing me to be able to be with the committee today and
    appreciate the consideration of this important legislation.
        Thank you. I yield back.
        Ms. Miller-Meeks. Thank you, Representative Mackenzie.
        As is our practice, we will forego a round of questioning
    for the members. For those off-committee members, you may
    remain to ask questions later if you desire.
        Our first panel is already at the table. Excuse me. The
    chair now recognizes General Bergman to speak for 3 minutes on
    his bill.

                       STATEMENT OF JACK BERGMAN

        Mr. Bergman. Yes. Thank you, Chairwoman. There seemed to be
    a slight disconnect here when I walked in. I did not think I
    was going to be speaking on this. We will get our staffs
    together to make sure that we know when the timing is right.
    Thanks for the opportunity. This is a discussion draft of the--
    what we have titled the BEACON Act, and it is Veterans TBI
    Breakthrough Exploration of Adaptive Care Opportunities
    Nationwide Act.
        The bill would direct the Secretary of the VA to carry out
    programs awarding grants to eligible entities to study and
    conduct randomized control trials with respect to the
    neurorehabilitation treatments for chronic mild traumatic brain
    injury. Additionally, grants would be available to design those
    treatments as well as measure the effectiveness of already
    funded treatments. Nonprofits, academic institutions, and
    healthcare providers with expertise in neurorehabilitative
    therapies would be eligible.
        In the analysis of this, the randomized control trials
    measure the effectiveness of a new intervention or treatment
    and have been recognized as the gold standard for effectiveness
    research. The bill would dedicate resources to a prevalent
    issue, like lost TBIs that occur each year as mild TBIs or
    concussions.
        This is not about, as we hear so many times, privatizing
    the VA. This is enabling the Veterans Administration through
    grant process to enable other scientific entities to do more
    breakthrough therapies that are going to not only help
    veterans, but also others that suffer from mild TBI.
        With that, I yield back.
        Ms. Miller-Meeks. Thank you, General Bergman.
        Joining us today from the Department of Veterans Affairs
    are Dr. Mark Koeniger, VA's acting assistant undersecretary for
    Health for Patient Care Services. He is accompanied by Dr.
    Llorente, VA's acting assistant under secretary for Health for
    Integrated Veteran Care.
        Dr. Koeniger, you are now recognized for 5 minutes to
    present the Department's testimony.

                       STATEMENT OF MARK KOENIGER

        Dr. Koeniger. Good afternoon, Chairwoman Miller-Meeks,
    Ranking Member Brownley, and members of the subcommittee. Thank
    you for the opportunity to testify today on several bills that
    would impact VA healthcare programs and services.
        As a family practice physician, I understand the importance
    of comprehensive patient-centered care and the trust that
    veterans place in us. My nearly 37 years in uniform have
    strengthened my commitment to delivering the highest quality
    care. I had the privilege of commanding the largest U.S.
    military hospital in Iraq during 2009 to 2010, an experience
    that underscored the value of coordinated, timely care in
    saving lives. Today, as acting assistant undersecretary for
    Health for Patient Care Services, I oversee 16 national program
    offices that support a wide range of clinical professions and
    care settings, including geriatrics, rehabilitation, and whole
    health. These experiences guide my work as we strive to
    strengthen VA healthcare for all who have served.
        I am joined by Dr. Maria Llorente, acting assistant
    undersecretary for Health for Integrated Veteran Care.
        Before we begin, I would like to apologize for the delay in
    providing testimony to this committee. VA is working on process
    improvements internally as well as externally to make sure this
    is prevented in the future. While I will briefly highlight VA's
    position on several bills, my full written testimony provides
    detailed views on all 12 bills under consideration.
        Turning to the substance of the legislation, several of the
    bills on the agenda would require VA to establish new grant
    programs. VA has concerns with these bills as grants may not be
    the most appropriate means of providing the intended support.
    Grants are one way, but not the only way for providing
    financial assistance to nongovernmental agencies. VA would
    welcome the opportunity to discuss these bills further with the
    committee and to determine if a different structure might be
    more appropriate.
        First, regarding the RECOVER Act, VA strongly supports
    efforts to expand access to veteran-centric, evidence-based
    mental health. While we have concerns with certain provisions
    in the bill, we greatly value the committee's leadership in
    this issue and welcome the opportunity to work together on
    approaches that strengthen care coordination and deliver the
    greatest impact for veterans.
        Second, VA supports the Veterans Mental Health and
    Addiction Therapy Quality of Care Act, subject to amendments
    and the availability of appropriations. This bill is consistent
    with VA's current efforts to compare the quality of VA and non-
    VA mental health and addiction therapy care.
        Third, although VA appreciates the intent of the NOPAIN for
    Veterans Act, this bill would undermine VA's well-established
    evidence-based formulary process which ensures medications are
    safe, effective, and economical.
        Fourth, regarding H.R. 5999, VA supports expanding access
    to opioid antagonists subject to amendments and appropriations.
    While naloxone is already widely available at no cost to
    enrolled veterans, eliminating prescription requirements could
    increase risks of waste and fraud.
        Fifth, regarding the Veterans with ALS Reporting Act, the
    VA supports the intent, but some provisions may duplicate
    existing efforts. We welcome the opportunity to collaborate on
    strategies that advance research and care without diverting
    resources from patients.
        Similarly, the Veterans Health Desert Reform Act
    underscores the importance of improving access for rural
    veterans, a goal VA strongly supports. However, the bill as
    written appears to create no new authority to further this
    goal.
        Finally, VA appreciates the committee's focus on innovation
    through research and technology, including proposals related to
    traumatic brain injury and suicide prevention. These are
    critical areas where VA invests heavily.
        In closing, VA remains steadfast in its commitment to
    delivering world-class healthcare to veterans. We share the
    committee's goals of improving access, quality, and outcomes,
    and we look forward to working with you to refine these
    proposals so they strengthen care without unintended
    consequences.
        We are happy to answer any questions you may have.

        [The Prepared Statement Of Mark Koeniger Appears In The
    Appendix]

        Ms. Miller-Meeks. Thank you, Dr. Koeniger.
        As is my usual practice, I will reserve my time until after
    all members have had a chance to ask their questions.
        I now recognize Ranking Member Brownley for 5 minutes for
    any questions she may have.
        Ms. Brownley. Thank you, Madam Chair. I think I wanted to
    direct this question to Dr. Llorente. As I cited in my opening
    comments, and VA cited as well, significant concerns with the
    RECOVER Act. Among other things, your written testimony points
    out that grantees would be able to receive financial support
    from VA in the form of grant funds, still be able to bill the
    VA for services under the existing VA Community Care Program,
    and also be able to bill veterans' other healthcare insurance.
    I cannot see how this makes sense to me. Well, three
    opportunities to perhaps triple dip with the VA.
        VA already has a community care network. Why is it
    important to adhere to the community care eligibility and
    authorization process that was established under the MISSION
    Act?
        Dr. Llorente. As you pointed out, the Community Care
    Program does have a series of requirements to make sure that
    the providers who are delivering services to veterans have the
    needed credentials, have the privileges, and offer the quality
    of care that we expect they will deliver. That is, in fact, one
    of the concerns that we do have with the bill as written. It
    does not really specify requirements and, as written, a
    community provider could potentially get one of these grants
    and offer services through one of these grants that might not
    be eligible, might not meet the requirements under the
    Community Care Program. It is why we really do welcome an
    opportunity to work with Congress to revise the language so
    that we can address some of these concerns.
        Ms. Brownley. Thank you for that. To follow up on another
    bill, VA already administers the Staff Sergeant Parker Gordon
    Fox Suicide Prevention Grant Program, which is intended to
    address the upstream factors that contribute to suicide risk,
    such as housing and employment instability and lack of social
    support and engagement. We also have the Veterans Comprehensive
    Prevention, Access to Care, and Treatment (COMPACT) Act, which
    allows VA to cover emergency treatment for veterans
    experiencing acute suicidal crises. Both the Fox Grant Program
    and the COMPACT Act program serve veterans regardless of
    whether they are enrolled in or otherwise connected to VA
    healthcare.
        Given that, does VA think it needs the grant program that
    would be created under the RECOVER Act, or would it be
    duplicative?
        Dr. Llorente. As was described by Dr. Koeninger, one of the
    questions that we have is whether a grant process or a grant
    program is the most effective mechanism to expand access to
    especially mental health and suicide prevention care for
    veterans. VA is always looking for opportunities to expand
    access to those types of services because we recognize that
    there are areas of the country where it may be more difficult
    to access those types of services.
        Again, we would really like to work with the committee,
    first, to determine what is the most effective mechanism to be
    able to conduct a pilot program so that we can be cost-
    effective. At the same time, if there is an opportunity to
    expand services, we take that opportunity.
        Ms. Brownley. Thank you for that. Probably the last
    question that I have time for, Dr. Koeninger, is there any
    statutory or practical barrier to VA, either through its
    existing research infrastructure or through its academic
    affiliates program, being able to research, develop, and
    implement novel or alternative treatments for TBI?
        Dr. Koeniger. Ma'am, I will have to take that question back
    to look in to make sure that there are no or are statutory
    requirements. I just do not have that information offhand, but
    I can get back to the committee.
        Ms. Brownley. Okay. Let us see. I think I do not have time
    for this, so I will yield back.
        Ms. Miller-Meeks. Thank you, Ranking Member Brownley.
        The chair now recognizes Representative Hamadeh for any
    questions he may have.
        Mr. Hamadeh. Thank you, Chairwoman. President Trump has
    made veterans his priority again. He has expanded community
    care, slashed bureaucratic red tape, and put the veteran, not
    the bureaucracy, first. I am with him all the way.
        Now the Veterans Assuring Critical Care Expansions to
    Support Servicemembers (ACCESS) Act and my Coordinating and
    Aligning Records to Improve and Normalize Governance for Our
    Veterans Health (CARING) Act are built on the same foundation.
    Veterans deserve seamless access to care, whether it is inside
    the VA or in the community. Dr. Koeniger, can you explain to me
    step by step, how are you implementing the President's
    directive to ensure medical records actually follow the
    patient?
        Dr. Koeniger. I am going to defer to my colleague, Dr.
    Llorente.
        Dr. Llorente. The medical records are really bidirectional.
    When we refer veterans to community providers, we first have to
    provide them with some sort of consultation or referral. In
    some cases that referral will include information about
    laboratories, diagnostic imaging, so that the community
    provider understands what is being asked when the veteran is
    referred.
        Similarly, once the community provider completes their
    evaluation, their treatment recommendations, they send those
    records back to the VA. At the present time, unfortunately,
    there are several different ways in which those records come to
    the VA. One of the things that we are in the process of doing
    through the Request for Proposals (RFP) that is currently in
    solicitation, that has been published, is to be able to
    streamline those efforts where the Third Party Administrators
    (TPA) that received the award will create essentially a portal
    where the medical records from the community providers will now
    be centralized in order to be able to streamline that process.
        Mr. Hamadeh. Has this been attempted before?
        Dr. Llorente. To the best of my knowledge, no, but I am
    happy to take that back and get additional information.
        Mr. Hamadeh. How long until the RFP is selected?
        Dr. Llorente. We are expecting to make the awards, I
    believe in March. There is a 90-day review period and I think
    the awards--the solicitation closes at the end of this month.
        Mr. Hamadeh. How long will it take to be implemented?
        Dr. Llorente. It will take approximately a year.
        Mr. Hamadeh. You know, that is the biggest concern that
    when I go back to my district, there are a lot of veterans, you
    know, they lose their medical records, the VA does, the
    community care. I really encourage the Department to really
    prioritize this because this is a constant theme I hear.
        Can you assure us after this is implemented, hopefully when
    you have the right RFP that you select, that the veteran is not
    going to be waiting weeks for community providers' records to
    actually reach the VA.
        Dr. Llorente. You have my assurance that that is--the
    absolute goal, is that we are going to be receiving these
    records and then being able to upload them into the veteran's
    electronic health record. The specific mechanics are not
    currently in place, unfortunately, that is about the extent of
    what I can say right now.
        Mr. Hamadeh. Do you anticipate this actually cutting it,
    time, significantly?
        Dr. Llorente. Yes.
        Mr. Hamadeh. Arizona has many rural communities that are
    miles from the nearest VA facility. President Trump understands
    that the veteran in rural Arizona matters just as much as the
    one here in Washington, DC. Now, the Veterans Health Desert
    Reform Act we are considering today addresses this head-on. How
    is the VA proactively identifying these medical deserts right
    now?
        Dr. Koeniger. The VA has certain processes in place that--
    within the Office of Rural Health. That office has been up and
    running for quite some time now. They have identified a lot of
    areas in--where veterans have to travel extended periods to get
    to healthcare. They have--again, through the Office of Rural
    Health, we are engaging with those veterans on a regular basis.
        Mr. Hamadeh. Do you wait for the veteran to bring this
    issue to you or are you being proactive about it?
        Dr. Koeniger. No, the office is proactive in terms of
    outreach to veterans.
        Mr. Hamadeh. I yield back.
        Ms. Miller-Meeks. The gentleman yields.
        The chair now recognizes Dr. Conaway for 5 minutes for any
    questions he may have.
        Mr. Conaway. Thank you, Madam Chair, and thanks to Ranking
    Member Brownley for bringing us here today to discuss these
    important pieces of legislation.
        I want to discuss a particular vulnerability that veterans
    have with respect to their use of opioids. Many people in the
    service have chronic pain from service-related injuries and
    other trauma. People with chronic pain, as I am sure you are
    aware, are at higher risk of opioid reliance. Some 289,000 vets
    have used opioids in the short term and there are 162,000
    veterans who are on long-term opioid use as of data in 2023.
    Thank you.
        Would you describe, and the standard of care is that,
    particularly for people on long-term opioid use, that naloxone
    be available as a preventative for death related to opioid use.
    Would you describe the current process by which a veteran who
    has VA benefits can receive naloxone, this standard of care
    treatment to prevent preventable opioid-related deaths?
        Dr. Koeniger. Right now a veteran can walk up to a pharmacy
    and if they are high risk, there are standing orders with the
    pharmacy, so they can ask the pharmacist and the pharmacist
    uses those standing orders to provide the veteran with the
    naloxone. Again, the naloxone is provided free of charge to
    veterans. We also distribute naloxone through health fairs and
    other means.
        Mr. Conaway. That is very good. They can get the
    prescriptions--they can get their naloxone in the various forms
    without a prescription. Also, I guess in pill form because it
    does have uses in helping people that have alcohol dependence
    as a problem and preventing--or helping people to relieve
    themselves or at least get beyond alcohol dependence. It is
    free access. It mirrors a lot. You would say, the VA system is
    mirroring what many states have done in this area by providing
    easier access to this life-saving chemotherapeutic?
        Dr. Koeniger. Yes, sir.
        Mr. Conaway. Moving on, discussing another piece of
    legislation on the list today. Can you--I understand there is a
    current process through which providers and patients can submit
    formal requests for new drugs to be included in the VA National
    Formulary. Can you briefly explain what that process is and how
    long it takes on average for requested drugs to be added to the
    formulary?
        Dr. Koeniger. Veterans, of course, we have medications that
    are on the formulary and that are not. All FDA approved
    medications, veterans have access to all of them. If it is not
    on the formulary, a veteran can go to their provider, ask the
    provider for a prescription, and generally within 96 hours will
    get the medicine.
        Mr. Conaway. Now, my understanding is that the U.S.
    Department of Defense (DOD) formulary and the TRICARE formulary
    is broader than what is available to veterans receiving VA
    care. One of the pieces of legislation seeks to ensure that the
    veteran who relies on VA care for their healthcare, that they
    have the same easy access to drugs that are already approved in
    other Federal formularies. Your thoughts on that?
        Dr. Koeniger. I am not aware of the specifics of what DOD
    has on their formulary. I would have to get back to you with
    specifics.
        Mr. Conaway. Okay, thank you. That ends my questions. Thank
    you both.
        Ms. Miller-Meeks. The gentleman yields.
        The chair now recognizes Representative King-Hinds for 5
    minutes for any questions she may have.
        Ms. King-Hinds. Thank you, Madam Chairwoman. Fun little
    fact, the Northern Mariana Islands is a part of the Greater
    Micronesia. The folks from the COFA states, the Republic of the
    Marshall Islands, the Federated States of Micronesia, Palau,
    you know, we are all Micronesians. One of the commitments that
    I made was that I was going to be their champion here in
    Congress because they do not have representation, although they
    have served this country. I thank you for the opportunity to
    have this conversation today regarding my bill.
        Dr. Koeniger, you, in your testimony, you referenced the
    unique legal consideration involved in extending VA benefits to
    veterans from the Freely Associated States. You specifically
    mentioned that the Department continues to support a phased
    implementation approach to ensure durable access to care and
    continuity of services, particularly in geographically isolated
    and high-risk environments. I guess I want to understand that
    statement a little bit more and I wanted a clarification on
    what specific legal questions the VA is still working through.
        Dr. Koeniger. Ma'am, I am going to defer to Dr. Llorente on
    that question.
        Dr. Llorente. To provide some examples, let us talk about
    the medications. There are certain medications that can be
    transported based on Department of Transportation regulations
    and laws. Then there are others that are considered hazardous
    and cannot be transported or cannot be easily transported.
    There are certain medications that require certain types of
    refrigeration. Those would be logistically complicated to be
    able to send via mail order to, as you described, very--you
    know, in some cases, some fairly isolated areas over a broad
    geographic distance. I am not saying that it is impossible to
    do some of these things, but we would need to be able to figure
    out how to do it. That is on our side.
        On the FAS side, we would also need to understand what are
    their regulations, what are their restrictions, if they have
    any, with respect to the use of medications? Are there some
    medications that they do not allow? That is just an example of
    the types of things that would have to be worked out in
    agreements.
        Similarly on the provider side. We have the authority for
    U.S. providers to deliver services, for example, via
    telehealth, but those providers do not necessarily right now
    have licenses, if you will, to practice medicine in the
    Federated States. It is something that would have to be worked
    out in the agreement.
        These are just a couple of the examples of just the types
    of logistical issues that would need to be worked out. We
    welcome the opportunity not only to work with Congress, but to
    work with our interagency partners in order to see what we can
    do with respect to the options that would be available to
    deliver the services.
        Ms. King-Hinds. Are those regulatory changes that are
    required or are there specific laws which prohibits these
    agreements from being negotiated? How does that interplay with
    regards to what the commitments that we have made with the COFA
    agreement that was passed 2 years ago?
        Dr. Llorente. I would respectfully request that you allow
    me to take that back for the record because I do not know the
    answer to your question.
        Ms. King-Hinds. Okay. Well, thank you for that.
        My other question is, you know, one of the issues that were
    raised with regards to this legislation is the cost, right, and
    what has been done basically to kind of more fully vet what
    that looks like. Whenever cost comes up, it kind of aggravates
    me because we did not talk about costs when, you know, folks
    from the FAS signed up and served our country. Right? Where are
    we at with that?
        Dr. Llorente. Yes, so we have been working at trying to
    examine and evaluate what some of the potential costs would be
    based on the types of services that would be offered, the types
    of medications that are likely to be needed, and then the
    beneficiary travel component to try to come up with an
    estimate. The cost estimates also would necessarily be a result
    of what the actual utilization turns out to be. That is not
    something that we know right at this point in time. It is
    something that we are working on to try to see if we would not
    be able to obtain an estimate and a projection.
        Ms. King-Hinds. All right, thank you. I am out of time. I
    yield back.
        Ms. Miller-Meeks. Thank you very much, Representative King-
    Hinds.
        The chair now recognizes Representative Cherfilus-McCormick
    for 5 minutes for any questions she may have.
        Ms. Cherfilus-McCormick. Thank you so much. Thank you for
    our witnesses who are here.
        I have so many questions. Florida's district is--Florida
    has some of the top numbers of our veterans who we serve. I
    hear a lot from them that one of the issues they have, not just
    the distance and how long it takes them, I have some people who
    tell me it takes them a day to actually get to the VA, and so
    distance is a huge issue. Also I hear from them that cultural
    competency is also when they have to go outside. What are some
    of the safeguards that you have in place?
        We know our veterans are facing specific needs and they
    have had specific harms that are unique to their situations,
    especially when it is service-related. Are there any safeguards
    in place to make sure that they are getting similar or care
    that the VA would give them?
        Dr. Llorente. When we talk about cultural competency, it is
    important to define which culture we are talking about. In the
    VA, of course, we first and foremost start with veteran culture
    because the needs, the experiences, and the health outcomes of
    veterans are quite different than what one typically would see
    in a civilian population. There is a strong component of
    cultural competency with respect to the military culture,
    veteran health outcomes. The Sergeant First Class Heath
    Robinson Honoring our Promise to Address Comprehensive Toxics
    (PACT) Act recently mandated toxic exposure training for every
    VA provider, just as an example. I think that there is very,
    very strong training for the VA with respect to the veteran
    culture.
        There are--those same types of trainings are afforded on
    some external websites that the VA uses. The one that is most
    used by our community providers is called TRAIN. There, too, we
    offer training to community on cultural competency for military
    culture and for veteran culture.
        Beyond that, of course, one could think of being a woman as
    a subtype of culture. Being a woman veteran is also very, very
    unique. It is one of the reasons why VA has established not
    only the Women's Health Program and women's health clinics in
    our VAs, but also providers that have specific training to be
    women's healthcare primary providers.
        Ms. Cherfilus-McCormick. I wanted to pause on that because
    that is getting to the root of the issue that we have been
    finding is that there is so much uniqueness when it comes to
    our veterans, not just from the military culture, but then when
    we are looking at individuals, such as women, which are growing
    populations, and the concern really comes in because the
    training right now is voluntary. There is no real
    standardization when it comes to the community-based care that
    they are receiving.
        We submitted an amendment that would introduce that kind of
    standardization where anybody who is actually helping or
    servicing our veterans were trained the same way, so they can
    recognize burn pits or they can recognize whatever they have
    gone through, which would save our veterans a lot of time as
    they are trying to decipher what issues they have. Do you have
    anything in place that would be mandatory or do you believe
    that any kind of mandatory standardization when it comes to
    community care would actually be more advantageous to our
    veterans?
        Dr. Llorente. Thank you. That is a wonderful question. To
    the best of my knowledge, we do not have anything in place
    right now that is mandatory. It does not mean that there have
    not been many conversations and discussions about that topic. I
    think that the biggest challenge is if we started creating a
    whole host of mandatory requirements, would that then limit
    and/or restrict the availability of those community providers?
        Ms. Cherfilus-McCormick. Now, in other areas, because I
    know there is continuing education for our healthcare
    professionals all the time, have we seen any burdens before? I
    do not see any other continuing education when we actually look
    at priorities, right? The priority is to make sure our veterans
    are taken care of and to make sure if our veterans are
    presenting any kind of issue that the VA can pick up, that
    community care can pick it up just as fast, and they are not
    going through a system for years where the VA could have found
    it. Have you seen that before, that the actual training has
    caused less accessibility?
        Dr. Llorente. I would have to take that back for the record
    in order to be able to provide you with that answer.
        Ms. Cherfilus-McCormick. Thank you. I yield back.
        Ms. Miller-Meeks. The gentlewoman yields.
        The chair now recognizes General Bergman for 5 minutes for
    any questions he may have.
        Mr. Bergman. Thank you, Madam Chair.
        Dr. Koeniger, one of the biggest challenges with mild
    chronic TBI, traumatic brain injury, is that it can be hard to
    recognize and is often masked by other conditions. From the
    VA's perspective, what are the consequences of underdiagnosis
    or misdiagnosis for veterans?
        Dr. Koeniger. Well, certainly the consequences of
    underdiagnosing or misdiagnosing any medical problem would have
    a negative impact on the veteran. Whether it is mild TBI or any
    other medical condition, VA providers strive hard not to
    underdiagnose or misdiagnose.
        Mr. Bergman. Yes. You know, you are a medical professional.
    The idea, I am sure from your perspective, is you want to get
    it right as best you can the first time.
        Dr. Koeniger. Absolutely.
        Mr. Bergman. You know, I mean, that is the oath you have,
    you know, sworn to uphold, and I thank you for that. You know,
    on a different note here, but still along the same lines, Dr.
    Koeniger, many veterans struggling with mental health
    challenges never enter the VA system before engaging in self-
    destructive behaviors like suicide. They just do not--they are
    not in the system. How do we, you know, calculate the numbers?
        As such, the true scope of need is likely far greater than
    existing data would reflect. Reducing suicide risk requires
    meeting veterans where they are within their communities. The
    expectation, especially in districts like mine where it is
    rural and remote, I mean, hours of drive from any kind of
    clinician. This underscores the need for flexible, accessible
    care that engages veterans the moment they first seek help. If
    implemented, and I am being specific here, how could the
    RECOVER Act, sponsored--you know, introduced by Chairman Bost,
    change the way veterans experience mental healthcare at the
    moment they first raise their hand for help?
        Dr. Koeniger. Sir, I am going to actually defer to Dr.
    Llorente.
        Dr. Llorente. We welcome the opportunity to be able to
    identify mechanisms in which to expand just the type of access
    that you described. I think one of the advantages in the
    language as written is that the providers would be encouraging
    veterans to enroll and engage with the VA to receive VA
    healthcare services in addition to any services offered in the
    community. However, we do have some significant concerns as
    written and would like to work with the committee to best
    address those concerns.
        Mr. Bergman. Well, and I appreciate that. You know, the
    MISSION Act became the Veterans Access, Choice, and
    Accountability (CHOICE) Act and then, you know, became
    community--you know, all of those things that have morphed over
    time here over the last decade. Unfortunately, still we are in
    some ways as a committee struggling with dealing with the
    Veterans Administration to shape the environment for the
    ability to, first of all, get the first step of diagnosing the
    issue, which means contact with the veterans. I appreciate your
    willingness to take a look at different ways to make that
    initial contact because, you know, there is not a one size fits
    all, especially in those rural and remote areas.
        With that, Madam Chair, I yield back.
        Ms. Miller-Meeks. The gentleman yields.
        The chair now recognizes herself for 5 minutes for any
    questions she may have.
        Dr. Koeniger, if the pilot in my Health Deserts bill proves
    effective, how could it reshape access to care for veterans
    living in healthcare deserts nationwide and, in fact,
    worldwide?
        Dr. Koeniger. Ma'am, it is--we are--the VA is always in
    support of trying to engage veterans in health deserts or, you
    know, in very rural areas. Again, the Office of Rural Health
    has done a lot of work in those areas to identify and, again,
    define, you know, what a rural area is. Then reach out to the
    vets who live in those rural areas and try and get them, first,
    enrolled in the VA and then figure out how to best work with
    them so that they can have access on a regular basis, whether
    it be through things like ride sharing or telehealth or
    services like that.
        Ms. Miller-Meeks. Dr. Llorente, just in response to a
    comment from my colleague about standardization and mandatory
    training for individuals, whether they are within the VA
    providers, whether they are in the VA system or in a community
    care system, is it mandatory that a veteran go to community
    care or is that something they request?
        Dr. Llorente. It is, first of all, they have to meet the
    eligibility criteria for community care. Then second, we offer
    them the choice. It is the veteran's preference. If they want
    to go to community care and are eligible, then, you know, we
    will do everything that we can to facilitate. If they prefer to
    receive care from the VA, then we will honor their preference.
        Ms. Miller-Meeks. Thank you. I just wanted to emphasize
    that point, that it is voluntary and the choice of the veteran
    where they receive that care.
        Dr. Koeniger, why is it important to explore care delivery
    models that leverage existing non-VA health systems in health
    deserts?
        Dr. Koeniger. I think what the VA wants to do is to make
    sure that it provides the absolute best care to veterans as
    possible. As Dr. Llorente just said, you know, we need to
    consider all aspects of care, whether it is in the VA or
    outside of the VA and make sure that veterans have access to
    the best care.
        Ms. Miller-Meeks. Thank you. As a veteran married to a
    veteran, could not agree more. I yield back.
        On behalf of the subcommittee, I want to thank you all for
    your testimony and for joining us here today. You are now
    excused and we will wait for a moment for the second panel to
    come to the witness table.
        I welcome everyone and thank them for their participation
    today.
        On our second panel, we have Hon. Charles Rudolph Paul,
    Ambassador to the United States of the Embassy of the Republic
    of the Marshall Islands; Mr. James Whaley, chief executive
    officer for Mission Roll Call; Ms. Elizabeth McCoy, associate
    director of government affairs, Wounded Warrior Project; Ms. K.
    Conwell Smith, deputy chief of military and veterans policy at
    the American Psychological Association (APA). Thank you once
    again for attending today.
        Ambassador Paul, you are now recognized for 5 minutes.

                   STATEMENT OF CHARLES RUDOLPH PAUL

        Mr. Paul. Madam Chairwoman, ranking member, members of the
    subcommittee, thank you for the opportunity to testify on
    veterans' healthcare issues affecting the Republic of the
    Marshall Islands and the other Freely Associated States.
        The Republic of the Marshall Islands is in the closest
    relationship that the United States can have with any sovereign
    country. Under the Compacts of Free Association, which is
    enacted into U.S. law, the three Freely Associated States
    permit the United States to exercise a core element of our
    sovereignty, strategic denial of access of other nations across
    the region spanning from Hawaii to Asia. In the Marshall
    Islands, we also host a critical U.S. military installation
    that the Joint Chiefs of Staff describe as the world's premiere
    range for missile testing and space operations support.
        The United States also actively recruits in the Marshall
    Islands as if we are a U.S. State or territory. Our citizens
    enlist at some of the highest per capita rates of any U.S.
    jurisdiction. They serve honorably, deploy globally, and retire
    as U.S. veterans. Yet today, many of these veterans are
    effectively unable to return home because they cannot access
    the healthcare they earned through their service.
        The issue was central during negotiations of the Compact of
    Free Associations Amendments Act of 2024. Congress clearly
    intended that veterans' healthcare be made available in the
    Freely Associated States. That intent was reinforced in last
    year's Continuing Resolution and the National Defense
    Authorization Act.
        However, despite clear, repeated statutory direction
    authority, the Department of Veterans Affairs has not acted to
    implement this commitment on the ground. As a result, veterans
    must choose between remaining in the United States or returning
    home without access to VA healthcare. The Republic of the
    Marshall Islands strongly supports congressional action to
    resolve this gap and ensure the Compact Act commitment is
    fulfilled.
        The issue is deeply personal at the highest levels of our
    government. The Minister of Foreign Affairs and Trade of the of
    the Republic of the Marshall Islands, Hon. Kalani Kaneko, is
    himself a retired U.S. Army veteran who honorably served 20
    years, qualifying for full retirement. For more than a decade,
    he served as an Army recruiter and personally recruited
    approximately 200 Marshallese men and women to the United
    States Armed Forces, individuals who trusted the United States
    and answered its call to service.
        This issue is also personal to me. My younger brother
    medically retired from the United States Army after 13 years of
    service, including three combat tours in Iraq. He now lives in
    the Marshall Islands and cannot access the healthcare he would
    receive if he remained in the United States. My nephew is
    currently serving on Active Duty. He wants to return home after
    his service but worries whether he will be able to receive the
    care if he does. No veteran's decision to return home should
    depend on whether they can access basic medical care.
        Importantly, I am not requesting new benefits. Section
    209(a)(4) of the Compact Amendments Act explicitly directs the
    Secretary of Veterans Affairs to negotiate agreements to ensure
    the provision of veterans health services in the Freely
    Associated States. Congress has spoken clearly. The authority
    exists. The obligation is explicit.
        This is also a national security issue. Veterans living in
    the Marshall Islands strengthen local capacity, reinforce trust
    in the Republic of Marshall Islands (RMI)-U.S. relationship,
    and serve as a stabilizing force in a strategically sensitive
    region. The Republic of the Marshall Islands stands ready to
    work constructively with Congress, the Department of Veteran
    Affairs, and the Administration to implement what the Compact
    Act already promises. Our veterans honored their commitment to
    the United States. Implementing veterans' healthcare in the
    Freely Associated States is not an expansion of benefits. It is
    the fulfillment of a solemn obligation.
        Thank you and I look forward to your questions.

        [The Prepared Statement Of Charles Rudolph Paul Appears In
    The Appendix]

        Ms. Miller-Meeks. Thank you, Ambassador Paul.
        Mr. Whaley, you are now recognized for 5 minutes for your
    testimony.

                       STATEMENT OF JAMES WHALEY

        Mr. Whaley. Good afternoon, Chairwoman Miller-Meeks,
    Ranking Member Brownley, and members of the Health Committee,
    distinguished guests. Thank you for the opportunity to testify
    today on behalf of Mission Roll Call and the veteran community.
        Our mission is straightforward. We collect data from
    veterans and we make sure that that information helps inform
    decisions made in Washington. We use polling and direct
    engagement to bring real, unfiltered veteran perspectives to
    policymakers and the public. Amplifying this data on behalf of
    veterans and their families allows us to advocate for
    meaningful change that improves the lives of those who have
    served.
        The legislation under consideration today seeks to address
    and improve the lives of multiple generations of veterans
    addressing traumatic brain injury, suicide prevention, access
    to care in remote and rural areas, mental health, opioid
    addiction, and more. Mission Roll Call's survey data shows a
    strong need within the veteran community to address these
    issues in ways that place veterans first and delivers care when
    and how a veteran will benefit most.
        One area where this need is especially clear is suicide
    prevention and mental healthcare delivered outside of VA
    facilities. In Mission Roll Call's national suicide prevention
    polling in July 2025, nearly 80 percent of veterans told us
    that preventing suicide requires clinical treatment and
    community-based support working together, not in isolation.
    More than 90 percent said it is extremely or very important to
    include community-based organizations and prevention efforts,
    and an equally strong majority emphasized the importance of
    training, coordination, and accountability.
        The RECOVER Act reflects those priorities by strengthening
    evidence-based mental health capacity in the community,
    ensuring providers are trained to understand veterans' risks,
    and requiring outcome reporting so Congress and the VA can
    assess what is actually working. To veterans this is about a
    system that meets veterans where they are, especially when
    timely access to care can be the difference between stability
    and crisis.
        While suicide prevention only brings veterans into mental
    health systems, many of the underlying drivers of risk begin
    earlier and go untreated. Mission Roll Call's survey data shows
    that over 95 percent of veterans say it is extremely or very
    important to have access to specialized TBI care, including
    care delivered outside the VA. Yet among veterans seeking care
    for TBI-related symptoms, 73 percent report that assessing
    appropriate treatment is somewhat or very difficult.
        The BEACON Act responds directly to that gap by creating a
    structured evidence-based framework for evaluating innovative
    approaches for veterans with chronic TBI. Veterans are asking
    the VA to test promising therapies responsibly, publishing
    results, and expand access where evidence supports it. From the
    veterans' perspective, the BEACON Act is about restoring
    function, reducing downstream mental health risk, and giving
    clinicians better tools to intervene before injuries compound
    into lifelong disability.
        In addition, Mission Roll Call supports efforts to
    modernize veteran care by expanding evidence-based options
    while holding the system accountable for outcomes. The NOPAIN
    for Veterans Act moves VA toward broader use of effective
    nonopioid pain management therapies, while the Veterans Mental
    Health and Addiction Therapy Quality of Care Act ensures
    Congress and the VA have reliable independent data on how
    mental health and addiction care performs across VA and
    community programs. These measures reflect what veterans
    consistently ask for in our surveys: care that is grounded in
    evidence, reduces risk, and is evaluated based on real world
    results.
        Mission Roll Call has always advocated that geography
    should not determine where a veteran--if a veteran receives
    timely care, and supports legislation that addresses access
    gaps for veterans who live far from VA facilities or outside
    the Continental United States. The Veterans Health Desert
    Reform Act and the U.S. Vets of the Freely Associated States
    Act recognize this reality and seek to leverage community
    providers, telehealth, and mail order pharmacy service to close
    those gaps.
        We believe good policy starts with listening to the veteran
    community and ends with accountability. Veterans overwhelmingly
    seek better access to care in a manner that supports their life
    and family, rules that can be easily understood, and outcomes
    that can be measured and improved. The legislation before you
    reflects meaningful progress toward those goals and we
    appreciate the subcommittee's continued focus on practical
    solutions that make the veteran and family central to the
    provision of care. Thank you, Chairwoman.

        [The Prepared Statement Of James Whaley Appears In The
    Appendix]

        Ms. Miller-Meeks. Thank you, Mr. Whaley.
        Ms. McCoy, you are now recognized for 5 minutes.

                      STATEMENT OF ELIZABETH MCCOY

        Ms. McCoy. Chairwoman Miller-Meeks, Ranking Member
    Brownley, and members of the subcommittee thank you for the
    opportunity to testify. Today's agenda includes many bills that
    are aligned with Wounded Warrior Project's mission to honor and
    empower warriors, and I am pleased to speak on several that
    would have a heightened impact on the post 9-11 wounded, ill,
    and injured veterans that we serve. My remarks today focus on
    the link between mental health and brain health and why
    investment in brain health is essential.
        Military-related traumatic brain injury, a signature wound
    of post 9-11 service, can significantly increase neurological
    conditions that influence physical and psychological
    functioning, such as chronic pain, depression, and anxiety. To
    that end, a traumatic brain injury can both directly and
    indirectly elevate suicide risk. These realities underscore the
    need for continued investment and innovation. Scientific
    advancements have demonstrated that brain health must be
    treated as a long--lifelong whole health priority both during
    and after military service, just as we have learned with mental
    health. Yet much about brain function remains unknown,
    reinforcing the need for bold investment in research and
    advancement to improve outcomes.
        To address these challenges, we must move toward a
    strategic framework that integrates three pillars: prevention,
    treatment, and innovation. First, prevention and early
    identification of brain injuries are critical. Servicemembers
    in training and combat can be exposed to blast overpressure and
    repetitive head impacts that accumulate over time. We encourage
    alignment of life cycle data and standards from the Department
    of War to the Department of Veterans Affairs, shared baselines,
    common measures, and longitudinal tracking so that no veteran
    falls through the cracks during their transition.
        Legislation such as H.R. 6444, the Blast Overpressure
    Research and Mitigation Task Force Act, strengthens blast
    exposure research and seeks to translate evidence into
    standardized screening and safeguards while assuring
    assessments migrate with the veteran from their time in uniform
    to civilian life. For these reasons, we are pleased to support
    this legislation.
        Second, personalized outcome-driven treatment is essential
    because brain injury manifests differently for every veteran.
    Precision approaches, tailored neurorehabilitation,
    nonpharmacologic therapies, and integrated mental health
    support offer pathways to measurable improvements in cognition,
    mood, and functioning.
        We support H.R. 6993, the BEACON Act, which would seed
    innovation and clinical evaluation across nonprofits, academia,
    and community partners. We encourage streamlined funding so
    pilots add capacity rather than divert existing mental health
    resources.
        Third, proactive suicide prevention should take brain
    health into account. Predictive analytics can help clinicians
    identify veterans at higher risk and engage them earlier with
    safety planning, follow up, and tailored treatment. Technology
    should not be used as a shortcut. Innovation should enhance
    proven strategies, not replace them. To that end, Wounded
    Warrior Project supports the Discussion Draft Data Driven
    Suicide Prevention and Outreach Act of 2025.
        Veterans have earned care that is consistent. While public
    and private collaboration is essential to ensuring veterans
    receive the highest quality of care, VA should remain as the
    coordinator of programs and grant funding. Where shortages
    persist, especially in rural areas, we support piloting
    practical access solutions that meet veterans where they live,
    making sure data flows back to VA and measures outcomes. We are
    pleased to support the Discussion Draft Veterans Health Desert
    Reform Act of 2025.
        The legislation included in today's hearing moves beyond
    incremental fixes and strives toward a bold, integrated vision
    for brain health that supports the servicemember to veteran
    life cycle. Wounded Warrior Project stands ready to partner
    with the subcommittee, VA, the Department of War, and community
    innovators to identify and prevent injury of the brain, create
    personalized outcome-driven treatment, and build proactive
    suicide prevention programs that take brain health into
    consideration.
        Thank you for your leadership and for the opportunity to
    testify this afternoon.

        [The Prepared Statement Of Elizabeth McCoy Appears In The
    Appendix]

        Ms. Miller-Meeks. Thank you, Ms. McCoy.
        Ms. Conwell Smith, you are now recognized for 5 minutes for
    your testimony.

                     STATEMENT OF K. CONWELL SMITH

        Ms. Smith. Chairwoman Miller-Meeks, Ranking Member
    Brownley, and distinguished members of the subcommittee, thank
    you for the opportunity to testify. I am Conwell Smith, the
    deputy chief for military and veterans policy for the American
    Psychological Association.
        APA is the Nation's largest scientific and professional
    organization representing psychology with more than 190,000
    members and affiliates. Today, more than 7,000 psychologists
    work in the VA, though that number has declined by nearly 300
    since 2024. APA is proud of VA psychology's role in decades of
    mental health clinical and research advancements. My testimony
    focuses on ensuring that the legislation under consideration
    upholds the highest standards of veteran care, regardless of
    where care is delivered.
        Several bills create new delivery models, programs and
    access points operating outside the VA's Direct Care and
    Community Care program. APA's concerns that building parallel
    systems risks further fragmenting care, separating veterans
    from coordinated treatment teams, and weakening benefits of the
    VA's integrated care model. Two bills in particular, the
    RECOVER Act and the Draft Health Desert Reform Act, are well-
    intentioned efforts to expand access, but we fear risk
    unintentionally reducing the quality of veteran healthcare
    without stronger safeguards.
        APA recognizes the need to supplement VHA care. However,
    veterans should have the same expectations of quality and
    safety whether they are treated inside or outside the VA. To
    that end, our recommendations are as follows.
        Number one, APA strongly supports requiring key training
    for all community providers, including those providing care
    through separate VA-funded grant programs. The RECOVER Act
    provides 60 million in grants to mental health facilities
    serving veterans, but does not require clinicians to meet the
    training standards expected of VA providers. Notably, suicide
    prevention training is not mandated even though the bill
    targets areas with high veteran suicide risk. Veterans deserve
    clinicians who understand military culture, common service-
    related conditions, and VA medical clinical expectations.
        Number two, APA leads with psychological science and
    emphatically recommends the use of treatments scientifically
    proven to be effective for the assessment and treatment of
    mental health disorders. The RECOVER Act does not require
    provider training in evidence-based practices, leaving a
    significant gap in provider readiness to treat conditions
    disproportionately impacting veterans, such as post traumatic
    stress, depression, and substance use disorders.
        Additionally, the BEACON Act risks weakening longstanding
    VA leadership in traumatic brain injury research and treatment
    by creating a parallel research pathway outside existing
    rigorous VA processes. The VA's evidence-driven system has
    contributed to some of the most impactful TBI advances. Any new
    framework should reinforce, not bypass, that scientific rigor.
        Number three, APA supports requiring facility accreditation
    and strong quality assurance for any grantee providing mental
    health services to veterans. The RECOVER Act does not require
    accreditation by the Joint Commission or the Commission on
    Accreditation of Rehabilitation Facilities, diverging from
    accepted VA standards. Moreover, legislation should require
    standards for demonstrating improved clinical outcomes. Without
    outcome measures and enforcement, neither Congress nor the VA
    can assess impacts on veterans, positive or negative.
        Number four, effective mental healthcare relies on
    coordinated care supported by shared health records. Removing
    the VA as the coordinator of care and creating increased
    fragmentation of services could worsen continuity of care
    challenges that veterans already experience. APA recommends
    requiring all community providers to participate in timely
    medical record exchange with the VA. This ensures clinicians
    have the full health history needed to provide safe and
    consistent care.
        Number five, APA supports efforts to give veterans the
    information they need to make informed decisions about their
    care. We are encouraged by the creation of a publicly available
    directory for CHAMPVA healthcare providers as required in the
    Clarity on Care Options Act.
        We also support the intent of the Veterans Mental Health
    and Addiction Therapy Quality of Care Act. However, the bill
    falls short in enabling meaningful comparisons and quality
    assessments.
        It is an honor to represent the American Psychological
    Association and advocate for the essential work psychologists
    do for our veterans and military. As the spouse of a disabled
    Army veteran, who is with me here today and who receives his
    care through the Hampton VA Medical Center, ensuring high-
    quality care across all settings is deeply personal to me.
        Distinguished members of the subcommittee, we know that
    each of you are earnest in your commitment to improve veteran
    healthcare access and quality. The VA remains a national leader
    and we stand ready to work with you on these legislative
    endeavors. Thank you.

        [The Prepared Statement Of K. Conwell Smith Appears In The
    Appendix]

        Ms. Miller-Meeks. Thank you, Ms. Conwell Smith. Thank to
    all of our witnesses for their thoughtful input.
        Ranking Member Brownley, you are now recognized for 5
    minutes for any questions you may have.
        Ms. Brownley. Thank you, Madam Chair.
        Thank you, Ms. Smith, for your testimony. Ms. Smith, as
    written, the BEACON Act would be paid for by diverting funding
    from existing VA mental healthcare programs and from VA's
    National Center for Post-Traumatic Stress Disorder (PTSD). Can
    you expand on how diverting these funds will impact VA's
    ability to provide clinical care and continue to conduct
    research through programs?
        Ms. Smith. Thank you for that meaningful question. The VA's
    National Center for PTSD is a recognized leader across all of
    our healthcare system. I think the concern is that sidestepping
    scientific rigor of the VA and the gains made in PTSD and TBI
    research could potentially cost much more than money. It could
    cost clinical advancements. I think working how--figuring out
    how different entities work in tandem, but maintaining very
    high level of standards and not defunding the VA is a critical
    approach.
        Ms. Brownley. Thank you. Thank you for that. You know, I
    asked this question of the second panel, but I was curious to
    know if you are aware of any statutory or practical barriers to
    VA either through its existing research infrastructure or
    academic affiliations programs.
        Ms. Smith. I am not.
        Ms. Brownley. Thank you. I also noted in my opening
    statement that I have concerns about the weak oversight
    mechanisms of the grant program that would be created by the
    RECOVER Act. Ms. Smith, I would like to get your take on
    whether the RECOVER Act is robust enough from a clinical
    perspective. From your read of the bill, would it expand
    existing services or improve quality of care for veterans?
        Ms. Smith. I think as far as expanding services, my read of
    the bill is that it does not necessarily do so. It allows
    grantees to bill the VA and other insurers and also receive a
    $1.5 million grant with no require to treat higher numbers of
    veterans.
        On the quality front, unlike VA facilities, the bill does
    not impose accreditation requirements, peer review processes,
    or evidence-based treatments or training in those evidence-
    based treatments. I believe that it requires one provider to be
    trained in cultural competency. Obviously, APA feels very
    strongly that all providers of mental and behavioral healthcare
    should receive core competencies training.
        Ms. Brownley. Thank you. Are there any requirements in the
    bill that would ensure grantees engage in care coordination of
    the VA, returning medical records, or making sure veterans
    receive follow-up care from VA?
        Ms. Smith. I do not believe that the bill mentions
    transmitting records to the VA. Of course, there is not a
    requirement to join the community care program where oversight
    exist. You know, there was a recent U.S. Government
    Accountability Office (GAO) report that demonstrated that 33
    percent of VA referrals to behavioral health in the existing
    community care program were missing the initial visit record.
    This is a very serious problem and I really appreciate that
    members of the committee were addressing the importance of
    shared record exchange to quality of care.
        Ms. Brownley. Thank you. Another question. Is there any way
    that Congress would know whether the RECOVER Act grantees are
    following evidence-based practices in the provision of care for
    veterans?
        Ms. Smith. I do not believe, without a requirement, I do
    not believe that there would be an ability to know. I think
    oversight and accountability require processes that I am not
    familiar with regard to this bill.
        Ms. Brownley. What kind of clinical outcomes would you
    expect to see reported following the provision of care by a
    RECOVER Act grantee versus similar care delivered by the VA?
        Ms. Smith. Well, we are encouraged that the bill does
    mention clinical outcomes, but it is a vague word without,
    again, requirements and a building structure. Without evidence
    of grantee level effectiveness, how can Congress or the VA know
    what the positive and negative impacts are on veterans? We do
    not know that those care outcomes would be related to symptom
    improvement, for example. I think we could look to the
    congressional report on the Fox grants to demonstrate that if
    you do not have requirements and you do not have enforcement,
    there might be little there to be able to evaluate a program's
    effectiveness.
        Ms. Brownley. Thank you for that and I will yield back. I
    will just say that, you know, I certainly respect the
    intentions of this bill, but I just feel like it needs more
    accountability, more guardrails to ensure evidence based
    practices and quality of care.
        I yield back.
        Ms. Miller-Meeks. Thank you, Ranking Member Brownley.
        The chair now recognizes Representative King-Hinds for 5
    minutes for any questions she may have.
        Ms. King-Hinds. Thank you, Madam Chair.
        First of all, Mr. Whaley, great to see you again. It was
    great meeting you the other day when we had the BEACON Act
    press conference.
        Mr. Whaley. Yes, ma'am.
        Ms. King-Hinds. Honorable Charles Uwakwe. A lot of my
    questions are going to be focused on conversations about the
    RMI and my legislation that expands the--not expands, but
    actually upholds the current statutory requirements to extend
    VA benefits to our Freely Associated States citizens. Let us
    just start off by having you describe what are the most unique
    challenges that our vets face in the Freely Associated States
    and how many of them are actually returning home.
        Mr. Paul. Well, thank you. Thank you very much,
    Congresswoman, for that.
        Some of the unique challenges that our vets are
    experiencing living in the Marshall Islands, basically, as
    outlined in my statement, healthcare, I mean, a lot of them did
    not identify that they are veterans when they get healthcare
    because there is no benefit for them to do so. Also there are
    different types of, like, healthcare needs that the Islands are
    just not equipped to provide because we do not have wars or
    combat zones near anywhere around our islands. There are
    certain things like PTSD, things of that nature----
        Ms. King-Hinds. Okay.
        Mr. Paul.--that we are seeing.
        Ms. King-Hinds. That is kind of what I wanted to get into
    in terms of the types of actual physical conditions, whether it
    be PTSD or any type of visible injury. Right?
        Mr. Paul. Right. Yes. Like, visible injuries, things like,
    you know, lost limbs from being Active Duty, but also mental, a
    lot of mental issues and mental health issues where a lot of
    folks that, you know, commit suicide in veterans. Just a couple
    months ago, a veteran jumped off a ship, and there is really no
    treatment facility for--we have one psychiatrist in the
    Marshall Islands for the whole country. The veterans are not
    getting the care that they deserve.
        Ms. King-Hinds. You heard the conversation, the dialog that
    I had with the VA in the previous panel and, you know, you
    heard the challenges that they race with regards to the
    transportation of medication and whatnot. Right? The shipping
    issue and the different statutes that are required to be
    negotiated. I think it would be helpful for the panel to kind
    of hear what your healthcare system sound--what it is actually,
    what is there, because when you hear that description, it makes
    it seem as if you have zero healthcare facility and no
    medication is currently being shipped in. I mean, in your
    testimony, you pointed out that there is actual Department of
    Defense presence there, which I assume, you know, there is
    regular goods and commodities that are being brought in through
    DOD. Can you just speak on that with the very little time that
    we have?
        Mr. Paul. Sure. Thank you so much.
        Yes, so we have dispensaries and hospitals that are being
    built by compact funds for over the past 35 years. We have
    doctors that are trained and licensed from the United States in
    the Marshall Islands. In fact, if I may speak to about
    September 2024, we started engaging the VA to discuss--do
    environmental scans and what the facilities are in the Marshall
    Islands. I believe about January, February 2025, we are this
    close to starting negotiating an agreement. That was about less
    than 6 months going back and forth. We would hold monthly
    meetings with the VA. You know, we are this close to executing
    an agreement that would resolve a lot of the issues that were
    brought up today, so. I believe we can get there, we will keep
    talking and try to come up with an agreement so we can provide
    the healthcare that is needed.
        Ms. King-Hinds. Okay. Thank you for your time.
        I yield back the remainder of my time.
        Mr. Paul. Thank you.
        Ms. Miller-Meeks. Thank you. The gentlewoman yields back.
        The chair now recognizes Dr. Dexter for 5 minutes from for
    any questions she may have.
        Ms. Dexter. Thank you, Chair Miller-Meeks, and thank you to
    our ranking member for her service here. It is going to be very
    sad without you here on our subcommittee and a year we have.
        Ms. Smith, thank you so much for coming and I very much
    appreciate that your statement reflects your organization's
    commitment to high-quality, outcomes-driven, and accessible
    healthcare for our veterans. As you said, for our veterans,
    those things are often best possible when veterans have access
    to clinicians and facilities that are accredited and fully
    trained and really culturally competent.
        I also just want to shout out the outcome transparency and
    accountability that you referenced because it is really
    crucial. I am a physician, was honored to practice in a VA. It
    is crucial for making sure that what we think is science-based
    is actually driving better outcomes for our patients. Thank you
    for calling that out.
        Last thing I wanted to highlight is your statement about
    medical record exchange. Having provided care in a VA as well
    as a community care provider, I cannot list how many times we
    led to redundant care or subjected people to recurrent,
    repeated, unnecessary treatments because we did not realize
    they had already been given somewhere else.
        I want to ask some questions related to the Health Desert
    Reform Act, which I will reiterate as very well intentioned. We
    have to be able to provide community care to our veterans when
    they do not have access to a VA that can give timely care. That
    is absolutely. This is not a political issue. This is a
    priority issue that I think we all share here.
        The section of the bill on oversight, I will just note, is
    less than a page long and it includes rather vague requirements
    that the VA Secretary track access, cost, quality, and veteran
    satisfaction for each hospital that enters into an agreement
    under the bill. Ms. Smith, do you have confidence that this
    requirement will be sufficient to ensure the care delivered by
    those hospitals is of equivalent or superior quality to the
    care delivered by a VA facility?
        Ms. Smith. As it is currently written, I do not feel like
    there is the structure to give me that confidence. Am I
    encouraged that it could be? Certainly. I just think as it is
    written right now, no. I would have to say no.
        Ms. Dexter. I share that concern. Under this bill, there
    appears to be very few parameters placed on pilot program
    eligibility. It does not stipulate that for-profit or private
    equity-backed hospitals cannot take advantage of the program
    nor does it require that a hospital be located in an area with
    a demonstrated wait time or drive time issue. In your opinion,
    what risks does this pose in terms of possible exploitation,
    overutilization, or unnecessary duplication of services?
        Ms. Smith. APA has long been concerned that unfettered
    growth in the community realm without accountability could have
    a negative impact on the integrated care system of the VA. We
    do share that concern. I think there, again, I do think that
    there are structures even in the community care program that
    provide more oversight that could be applied in this case.
        Ms. Dexter. I just want to highlight an issue that I have
    raised in this committee that the VA budget, unfortunately, is
    a zero-sum game. If we take it from VA facilities to provide
    this care, it does not come back. This bill includes no cap on
    the amount of funding that can be used to furnish care through
    the arrangements that it authorizes. That means it is entirely
    possible that we could siphon large amounts of funding away
    from the VA where we know our veterans get the highest quality
    and best satisfaction. This has been documented, and for
    uncertain quality and it may or may not be necessary. Is that
    your concern as well?
        Ms. Smith. It is our concern. You know, we are down 300
    psychologists over just this past year and we know that the
    demand for mental health treatment within the VA is
    skyrocketing. I think that, you know, using funds to also
    invest in the VA's ability to meet the demand by staffing is a
    really important piece of the puzzle. If money is going from
    one place to the other, how can we reinvest there as well?
        Ms. Dexter. With my last few seconds, I just want to
    underline that because I have heard that even physicians who
    have long been practicing, at least in our Portland VA, that
    they cannot get their patients in for appointments because the
    staff who help coordinate or get them in for those appointments
    have been dismissed. It feels like right now we should be
    underlining the commitment to making sure veterans have access
    to the VA facilities that we have already funded.
        Thank you. With that, I yield back.
        Ms. Miller-Meeks. Thank you. The gentlelady yields.
        The chair now recognizes General Bergman for 5 minutes for
    any questions he may have.
        Mr. Bergman. Thank you, Madam Chair. Mr. Whaley, good to
    see you again.
        Mr. Whaley. Good to see you, sir.
        Mr. Bergman. Just like a couple of days when we are out on
    the lawn or over, you know, presenting on what you all do, and
    you do it very well.
        Mr. Whaley. Thank you.
        Mr. Bergman. In talking with veterans in my district and
    across the country, it is clear that mild chronic TBI is far
    more common than is often recognized, frequently missed and
    undiagnosed. This prevalence seems to exceed what the VA's
    current clinical footprint alone would suggest. With only five
    polytrauma centers nationwide, the current system simply does
    not have the capacity to meet the full scope of need. The
    question, why is additional targeted funding necessary? What
    kinds of community partners, nonprofits, or academic centers
    are best positioned to extend that care and innovation beyond
    the VA's walls?
        Mr. Whaley. Thank you, sir, for that question. We listen to
    veterans, we take their opinions in an unbiased, unfiltered
    way, and then we share it, of course, with all of you and with
    the media as well as our fellow veterans. It is clear when we
    speak to them that they want to be able to have the ability to
    get treatment early on in this process before it exaggerates,
    before it grows, before it affects their job, before it affects
    their family. It is a spiraling effect, right? When one thing
    goes bad, then the next and then the next, and before we know
    it, we are on a slippery slope to a bad place.
        When we can get to this early and get treated and get the
    access to healthcare in a proper way, then we can mitigate
    that. We can slow it down. We can get them the assets and the
    technology and the medication in some cases that they need.
        When I think about organizations that are doing great work
    here, I think about the Avalon Action Alliance, which has a
    number of facilities and partners across the country that right
    now are doing that, God's work for helping veterans with TBI,
    sometimes very mild, sometimes very severe. They are doing it
    in a way that is very costly to them and not sustainable long
    term for them to do without getting support.
        I think it is important for us to realize that this is a
    national issue, just not a veteran issue, and that if we cannot
    solve TBI for those that have served our country, then we are
    not going to be able to solve TBI for our citizens. I think it
    is important to invest in this. I think it is important to make
    sure we have the assets to do that. We bring the best and
    brightest organizations to take a look at this.
        Obviously, we need guardrails. Right? I mean, there has to
    be checks and balances to make sure that this is done in the
    right way. I applaud the efforts of those on this committee and
    all of you for your work.
        I think everybody has the best intentions here and we want
    the very best for our veterans and their families. I say their
    families because if you have one veteran that has this problem,
    it affects his spouse, it affects the children. When we think
    about it, there is 18 million veterans in our country. When you
    think about those dependents, you are now talking about 30 or
    40 million Americans that this impacts. Right now we are only
    having access through the VA to half of those veterans. This is
    a big problem. Thank you.
        Mr. Bergman. Yes, thank you. I noticed that at Mission Roll
    Call and I took a photo of the backdrop. It said, ``The key
    word takeaway is listening.'' In any conversation or any
    dialog, at least one entity has to be listening. Thank you for
    being a listener.
        Ms. McCoy, if this research leads to clear evidence of what
    works, how could that improve day-to-day care for veterans
    living with TBI?
        Ms. McCoy. Thank you for that question, sir. I would like
    to echo many of Mr. Whaley's points here, that it really is our
    belief that innovation can come from anywhere. We are committed
    to efforts that reduce suicide risk among veterans living with
    long-term effects of brain injury, and that is a population
    that we serve regularly.
        I believe that all of these efforts collaboratively can be
    streamlined, as you point, under the Fox grant. Ultimately, it
    is going to improve alignment, avoid duplication of care, and
    really improve medical outcomes for veterans.
        Mr. Bergman. Thank you. You know, this is not--we talk
    about in weapons system, fire and forget. What we are trying to
    do here is not a fire and forget. We just throw something out,
    create the beacon. You know, whatever it is we are trying to
    do, the therapy, it is not a fire and forget. We got to keep
    working it because things are going to change.
        With that, Madam Chair, I yield back.
        Ms. Miller-Meeks. Thank you, General Bergman.
        The chair now recognizes Dr. Morrison for 5 minutes for any
    questions she may have.
        Ms. Morrison. Thank you, Madam Chair and Ranking Member
    Brownley. I reiterate Dr. Dexter's comments. Thank you for your
    service and for your mentorship. You will be dearly missed.
    Thanks to each of the witnesses testifying before the committee
    today, grateful for your presence.
        In Minnesota, I represent Minnesota's Third District and we
    are very proud of the Minneapolis VA. It goes above and beyond
    for veterans in our State. While certainly a testament to the
    leadership and community in Minnesota, this recognition is also
    a timely reminder of how critical healthcare workers are to the
    success of VA. Intentionally tackling this burnout underscores
    how important investing in the VA workforce is and our ability
    to deliver on the promise that we have made to our veterans.
        Having myself been one of the 70-plus percent of American
    doctors who has completed part of their medical training at a
    VA hospital, it also leads me to think about the unique
    challenges that veterans face when it comes to mental health,
    substance use disorder, and overdose risk. As our country
    struggles with the opioid crisis nationwide, my heart breaks
    for our veterans that research has repeatedly shown to be at
    higher risk of death from overdose, further complicated by
    chronic pain, service-related injuries, or other service-
    related trauma.
        A major part of what compelled me to serve in Congress was
    my firsthand experience as a doctor seeing how difficult
    navigating our healthcare system can be. Helping veterans face
    unique challenges and elevated risk requires intentional work
    to break down those barriers.
        Now, as a member of this committee, I am honored to have
    the opportunity to lead policies that will help meet veterans
    where they are. That is why I am proud to have joined with
    another experienced doctor, Congressman Conaway, to introduce
    H.R. 5999, the Veteran Opioid Emergency Treatment Act. This
    bill would reduce the barriers veterans face to accessing
    naloxone, a life-saving medication that can rapidly reverse an
    opioid overdose. Medication that would be life-saving in such
    critical moments should not be out of reach to veterans as a
    result of cost or difficulty scheduling appointments. I am
    grateful for the bill's inclusion in today's hearing and I look
    forward to continuing to work with Dr. Conaway and my
    colleagues as the bill moves through the committee.
        Ms. Smith, could you elaborate on the importance of a
    consistent systemwide approach to ensuring timely access to
    naloxone? Why is this access and consistency of particular
    importance for veterans?
        Ms. Smith. Well, thank you for the question. Recognizing
    the conditions that disproportionately impact veterans is part
    of how we approach treating them. We are recognizing that there
    is definitely a sensitivity to substance use disorder and we
    must do all that we can to prevent unnecessary veteran death.
        Ms. Morrison. Thank you. In your testimony you highlight
    the importance of training an exceptional healthcare workforce.
    How does investing in VA providers protect the quality of care
    that veterans receive?
        Ms. Smith. Well, you mentioned already in your comments
    about being part of the 70 percent who receive their training
    in the VA. I have the pleasure of working with VA psychologists
    who are just tremendous public servants, but they also spend
    time training the next generation of mental health providers. I
    think a lot of times it is lost that the VA is not only
    important to our veterans, which is first and foremost, it is
    important to each and every one of us because they really are
    training the healthcare workforce.
        If I can add, because you mentioned burnout earlier, we are
    finding more and more psychologists' clinical time is being
    taken up to--you know, their entire day is filled with clinical
    scheduling and it is not leaving the time for clinical--for
    training supervision. That concerns us because I do think that
    there are training programs at certain VA facilities that are
    dying on the vine only because they do not have the time and
    the people to foster the training.
        Ms. Morrison. Thank you so much. Madam Chair, I yield back.
        Ms. Miller-Meeks. The gentlelady yields.
        The chair now recognizes Representative Kiggans for 5
    minutes for any questions she may have.
        Ms. Kiggans. Thank you, Madam Chair, for just conducting
    the hearing today to talk about important pieces of legislation
    that will improve access to care for our veterans throughout
    the VA. Included in the hearing today is my legislation, the
    Clarity on Care Option Act.
        CHAMPVA is vital for caregivers and dependents of
    permanently disabled veterans. It ensures they can continue to
    support the veteran in their lives and still receive the
    healthcare services they require. To support our veteran
    caregivers in finding providers more easily I introduced the
    Clarity on Care Options Act, which directs the VA's Community
    Care Network to create a public-facing list of all providers
    who are in-network for CHAMPVA enrollees. It is important for
    patients, for providers. There is a lot of confusion and the
    more we talk about all the other great issues we talked about
    today from mental healthcare, how we are addressing addictions,
    continuity of care issues, all the things we are working on, I
    need my veterans out there to know, to have kind of a directory
    so that they can find where the community care partners are.
    That is just what my bill does, is just establish this
    directory. We have so many and some of the great places our
    veterans live, like Hampton Roads, and just I think it would be
    a great addition to complimenting care. I just had a couple
    questions.
        First to Ms. McCoy. What barriers do you see eligible
    families most commonly facing when they are enrolling in
    CHAMPVA? What barriers do they face after having access to the
    program?
        Ms. McCoy. Thank you so much for your question,
    Representative Kiggans. Surviving families and caregivers often
    face heightened mental health risks and require consistent and
    comprehensive support. We are in support of this bill and fully
    encourage efforts to expand information on how to access
    essential healthcare information. We believe that a national
    registry provides a powerful tool for these beneficiaries to
    secure the care and support that they deserve.
        Ms. Kiggans. Great. Thank you. Are there specific
    populations such as surviving spouses, caregivers, or
    dependents with disabilities, who face disproportionate
    challenges accessing CHAMPVA?
        Ms. McCoy. Absolutely.
        Ms. Kiggans. Which would you say or what are some of the
    more challenged groups?
        Ms. McCoy. To my understanding, survivors and dependents.
        Ms. Kiggans. I would agree with that, too. Again for Ms.
    McCoy, what are the most common reasons CHAMPVA claims are
    delayed or denied?
        Ms. McCoy. Truthfully, I would have to come back to you on
    that answer.
        Ms. Kiggans. I think a lot of times our veterans probably
    access just either Google searching or, you know, look, even
    hearing from friends. They make appointments and they are seen
    and then they find out after the fact that those were not in
    the network, which is what this bill is hoping to prevent.
        Last question for Ms. McCoy, what factors contribute to
    delays in enrollment and what steps could reduce those delays?
        Ms. McCoy. At this point, I would say perhaps the Veterans
    Integrated Service Network (VISN) restructure, although yet it
    has not been implemented. We do not know what those changes
    will look like, but I am hopeful that we will see positive
    outcomes with the VISN restructuring.
        Ms. Kiggans. Good. I hope so, too. Again, I think just a
    directory and really I would like to see an overhaul of even
    just logging onto the VA system. Sometimes, you know, as a
    veteran, married to a veteran, and even daughter of veterans,
    just for me personally logging on, that log on process can be
    simplified. Even finding GI Bill, you know, health benefits, VA
    home loan, there is all the benefits that are there, but I just
    need my veterans to be able to access and understand that.
    Hopefully, this CHAMPVA piece will at least provide a little
    bit of clarity for our community care partners.
        I have a quick question then for Ms. Conwell Smith, and
    welcome. I know you are from my hometown in my district. Have
    you heard from psychologists that service CHAMPVA that are
    having trouble just servicing our beneficiaries? What is the
    most common issue that psychologists are running into?
        Ms. Smith. I have not heard this directly, but we can
    certainly go back to our membership and gather more information
    about this. I think that you highlighted challenges of
    navigation of any veteran and their family, and I think those
    of us that are in veterans families know those, oh, too well.
        Ms. Kiggans. Yes, very much so. I know just psychologists
    are important care partners for us and there is a shortage of
    mental healthcare providers and we often speak of mental
    health, but thinking of the people who provide the mental
    health, we need to do more of that and making sure that the
    providers know, too. Then the patients have a directory, but
    there is clarity kind of on both sides. That is what we hope to
    accomplish with this bill.
        Thank you so much and I yield back.
        Ms. Miller-Meeks. The gentlelady yields.
        I now recognize myself for 5 minutes to ask questions.
        This is a question both for Mr. Whaley and Ms. McCoy and
    then Ms. Conwell Smith. I realize that you are not clinicians
    per se, but as I have listened to the testimony, the questions
    today, and the bills before us, I am thinking about the blast
    injury, mild TBI, so, i.e., a wave, shockwave, but not an
    actual concussion, and how difficult that is and we do not test
    for that. Would there be some validity to either an algorithm-
    based test and/or screening prior to discharge from the
    military for those individuals who during their training,
    although they may not be in combat, but during their training
    may have exposure to a blast neurotrauma and not a TBI or
    concussion in the typical diagnosed fashion?
        Mr. Whaley. Thank you for that insight and question. We
    could not agree more. We have talked to a number of veterans,
    either in our roundtables or in our polling, and found out
    that--and find out on a systemic basis that many times someone
    does not know they have had a TBI until a number of things have
    happened. By then you are kind of picking up the pieces versus
    getting----
        Ms. Miller-Meeks. Yes. I realize the brain activity and
    connections may be very different than what you see in a TBI.
        Mr. Whaley. Right.
        Ms. Miller-Meeks. I do not have a lot of time because I
    want to ask other questions. Ms. McCoy.
        Ms. McCoy. Thank you for your question. I think it directly
    leads into H.R. 6444, which is the establishment of the task
    force, where we are able to begin to accumulate and/or leverage
    currently collected data on the DOD side of the House and allow
    that full migration of information to accompany the
    servicemember as they move into veteran status.
        Again, to your point, we know that blast overpressure has
    been kind of linked to cumulative neurological effects. How
    those build in each veteran and servicemember over time are so
    distinct that at this point, you know, we do not know what we
    do not know. Investment in research and innovation is just key.
    I think this task force will be an important infrastructural
    step to that goal.
        Ms. Miller-Meeks. Thank you. How could the pilot, and some
    of these bills that we presented today are discussion bills, so
    I appreciate all the input from all of our members and our
    witnesses, how could the pilot in the Health Deserts bill
    reduce travel burdens or delays for care and veterans?
        I can assure you in Iowa, especially northwest Iowa, but
    even in my district, veterans may have to travel 2 hours to go
    to a VA facility clinic, which has lesser services. In many
    states, including Texas, a very populated State, that drive can
    be over that. If you are talking about a visit for coordinated
    care or whatever type of care you want, that could be a 5-hour
    travel time just back and forth without including the physician
    visit. Ms. McCoy.
        Ms. McCoy. Thank you very much. I appreciate and agree with
    your point. I think that this is filling a crucial need. I
    mean, you think about a veteran that is maybe going to a
    hospital where certain providers or certain care modalities are
    covered under the community care network and others may not. An
    initial appointment may be covered, but a scan or, you know,
    some sort of Magnetic Resonance Imaging (MRI) may not be
    covered. That fragmentation of care has to be incredibly
    frustrating. It is inefficient and ultimately it is a barrier
    to care. A streamlined contractual agreement can produce
    positive outcomes for veterans.
        Ms. Miller-Meeks. Thank you. Ms. Conwell Smith, and as a
    physician and a veteran, I appreciate your focus on clinical
    outcomes. Do you consider it a favorable clinical outcome for
    17 percent of veterans to still die by suicide? Has the VA been
    successful? Is that a good clinical outcome measure?
        Ms. Smith. I would go back, thank you for the question, I
    would go back to the advances and progress within the VA when
    it comes to mental health treatment and effective treatments
    for mental health disorders, which I think have been
    extraordinary.
        Ms. Kiggans. Thank you.
        Ms. Smith. We do not want one veteran suicide.
        Ms. Kiggans. Neither do we, but that certainly is a
    clinical outcome and we have not move that needle. I think
    looking at approaches that deliver care to veterans, whether it
    is through telemedicine, community care, VA care, an algorithm-
    based care, new research, I think it is important. All of us on
    this committee want to make sure that, number one, PTSD,
    veteran suicide, that TBI veterans are getting the care that
    they need.
        Then last, let me just say, Ambassador Paul, I do not have
    a question for you, but I just wanted to thank you for coming,
    for testifying today and coming this long way to make sure
    veterans in your area in the Marianas Islands and the FAS are--
    that their needs are met as well, too. I did not want you to
    leave without my personal thank you.
        I thank the witnesses for being here today. Just in
    closing, I think we are looking at some bills, discussion
    drafts. I appreciate all of the input.
        Then Ranking Member Brownley, do you have any closing
    remarks you would like to give?
        Ms. Brownley. I do not think so, but I think, you know,
    there have been a lot of good bills here today and that, you
    know, certainly require serious consideration. I think we have
    had a good discussion on many of these bills and ways in which
    they can be improved upon so that we can move them forward.
        I yield.
        Ms. Miller-Meeks. Thank you, Ranking Member Brownley.
        On behalf of the subcommittee, I want to again thank all of
    our witnesses and members, including the VA who is on the first
    panel, Dr. Koeniger and Dr. Llorente, for being here today. I
    look forward to working with you to address the issues facing
    our veterans and also the suggestions that we have had from our
    witnesses and our members today. The complete written
    statements of today's witnesses will be entered into the
    hearing record.
        I ask unanimous consent that all members have 5 legislative
    days to revise and extend their remarks and include extraneous
    materials. Hearing no objection, so ordered.
        This hearing is now adjourned. Please, this room is being
    used immediately after this, so when the meeting is adjourned,
    please exit the hearing room. Thank you.
        [Whereupon, at 4:19 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 Mark Koeniger

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                   Prepared Statement of Charles Rudolph Paul

        Chairman, Ranking Member, and Members of the Subcommittee,
        Thank you for the opportunity to testify on the U.S. Vets of the
    FAS Act, H.R. 6652, sponsored by Delegate King-Hinds and four other
    Members of the House, including Delegate Radewagen.
        The Marshall Islands and the other FAS, Freely Associated States,
    were formerly administered by the United States as parts of a
    territory, but now are in the closest of possible relationships between
    sovereign nations with the U.S. We are the only three nations in free
    association with the U.S. Our associations are enshrined in compacts
    enacted into U.S. law.
        Under these associations, we let the U.S. exercise a fundamental
    aspect of our sovereignty: Determining whether other nations can access
    an area the size of the 48 contiguous United States from Hawaii to
    Asia.
        Our nations also host U.S. military bases. In my Marshall Islands,
    the Joint Chiefs of Staff say that the facility is the world's premiere
    range for testing ICBMs and military space operations support. Because
    of our location and the strategic rights that we let the U.S. exercise,
    our democracies are targets of aggressive efforts to weaken our
    alliances.
        The U.S. military, additionally, recruits in the Freely Associated
    States as if we were U.S. States. It enlists our citizens at rates that
    are higher than the enlistment of U.S. citizens in most U.S. States.
        Sadly, however, our U.S. military veterans are effectively
    compelled to remain in the U.S. after their service because they cannot
    receive the same healthcare if they return home.
        This was a major issue in the renegotiation of our free
    association, which culminated in the enactment of the Compact of Free
    Association Amendments Act of 2024. The law was intended to resolve the
    issue. By agreement, it included provisions to have this healthcare
    available in our islands--as this Congress emphasized in November's
    Continuing Resolution and December's National Defense Authorization
    Act.
        The Department of Veterans Affairs, however, has not acted to make
    the care available. It has acted contrary to what we negotiated, and
    Congress has said is the intent of the law.
        The Government of the Marshall Islands, therefore, strongly
    supports the enactment of legislation to ensure that our veterans can
    receive the care if they return home.
        This issue is personal at the highest levels of our government. The
    Minister of Foreign Affairs and Trade of the Republic of the Marshall
    Islands, Hon. Kalani R. Kaneko, is himself a retired United States Army
    veteran who honorably served for 20 years, qualifying him for full
    retirement under U.S. military service. During his military career, he
    served as an Army recruiter for more than a decade, actively recruiting
    across the Marshall Islands. Through that service, he recruited
    approximately 200 Marshallese men and women into the United States
    Armed Forces--individuals who answered the call because they trusted
    the United States, believed in the partnership between our nations, and
    were willing to serve wherever they were sent. Minister Kaneko has
    dedicated his life in service to the United States and its mission.
    Today, I respectfully ask the United States to stand by Minister
    Kaneko, and by the patriotic men and women he recruited, by ensuring
    access to the veterans' health care they have earned.
        This issue is also personal to me.
        My younger brother medically retired after 13 years of service in
    the United States Army, including three combat tours in Iraq. He
    retired due to injuries sustained during deployment. Today, he lives in
    the Marshall Islands,--and does not have access to health care he would
    have if he had not returned home.
        My nephew is currently serving on active duty in the United States
    Army. He wants to return to the Marshall Islands 1 day to live, to
    raise a family, and to serve his community after he retires from
    military service. But he worries about whether he will be able to
    access health care if he comes home. That concern should not be the
    deciding factor in whether a U.S. veteran can go home after their
    service.
        Importantly, access to veterans' health care in the Marshall
    Islands is not a new request, nor is it discretionary. It is explicitly
    contemplated in U.S. law and in treaty obligations.
        Section 209(a)(4)(A) of the Compact of Free Association Amendments
    Act of 2024 directs the United States to enter into agreements to
    ensure the provision of veterans' services in the Freely Associated
    States. Congress made clear that geography should not exclude veterans
    residing in the Marshall Islands, the Federated States of Micronesia,
    or the Republic of Palau from the care they have earned.
        That Compact obligation works in tandem with Section 1724(f) of
    title 38, United States Code, which authorizes the Department of
    Veterans Affairs to furnish hospital care and medical services outside
    the United States pursuant to agreements with foreign governments.
    Together, these provisions establish both clear authority and clear
    congressional intent.
        The Freely Associated States are unique. We are the only sovereign
    countries in the world where the United States is permitted--by
    international agreement--to conduct active, routine military recruiting
    nationwide, without restriction as if our nations were U.S.
    territories. If the United States can actively recruit in the islands
    as if we were U.S. territories, it is reasonable--and just--that it
    provides care in the islands as if we were U.S. territories.
        This is not only a moral obligation. It is a national security
    issue for both of our countries.
        Veterans living in the Marshall Islands are a stabilizing force.
    Their presence strengthens local institutions, reinforces trust in the
    RMI-U.S. relationship, solidifies a vital international relationship,
    and serves as a deterrent to malign influences that seek to undermine
    this partnership.
        Veterans who return home bring critical skills acquired through
    military service--engineering, logistics, health care, leadership,
    disaster response, and technical trades--that directly support national
    capacity-building in the Marshall Islands.
        From a practical standpoint, the current gap in care creates an
    excessive hardship for veterans if they come home. They must fly
    thousands of miles for routine appointments or prescriptions--at huge
    personal expense and often delaying care. Telehealth services, mail-
    order pharmacy delivery, and travel support are practical, cost-
    effective solutions.
        The Republic of the Marshall Islands stands ready to work
    constructively with Congress, the Department of Veterans Affairs, and
    the Administration to implement what the Compact Act of 2024 already
    promises.
        Our veterans kept their commitment to the United States. 2024's
    Compact Amendments reflects the United States' commitment to them.
    Implementing equal veterans' health care in the Freely Associated
    States is not an expansion of benefits--it is fulfillment of an
    obligation.
        Thank you. I look forward to your questions.

                       Prepared Statement of James Whaley

        Good afternoon, Chairwoman Miller-Meeks, Ranking Member Brownley,
    and Members of the Health Subcommittee.
        Thank you for the opportunity to testify today on behalf of Mission
    Roll Call and the veteran community. Our mission is straightforward: we
    collect data from veterans, and we make sure that data helps inform
    decisions made in Washington. We use polling and direct engagement to
    bring real, unfiltered veteran perspectives to policymakers and the
    public. Amplifying this data on behalf of veterans and their families
    allows us to advocate for meaningful change that improves the lives of
    those who have served.
        The legislation under consideration today seeks to address issues
    and improve the lives of multiple generations of veterans, addressing
    traumatic brain injury, suicide prevention, access to care in remote or
    rural areas, mental health, opioid addiction, and more. Mission Roll
    Call's survey data shows a strong need within the veteran community to
    address these issues in ways that place veterans first and delivers
    care when and how a veteran will benefit most.
        One area where that need is especially clear is suicide prevention
    and mental health care delivered outside of VA facilities. In Mission
    Roll Call's national suicide prevention polling in July 2025, nearly 80
    percent of veterans told us that preventing suicide requires clinical
    treatment and community-based support working together, not in
    isolation. More than 90 percent said it is extremely or very important
    to include community-based organizations in prevention efforts, and an
    equally strong majority emphasized the importance of training,
    coordination, and accountability.
        The RECOVER Act reflects those priorities by strengthening
    evidence-based mental health capacity in the community, ensuring
    providers are trained to understand veteran risk, and requiring outcome
    reporting so Congress and the VA can assess what is actually working.
    To veterans, this is about a system that meets veterans where they are,
    especially when timely access to care can be the difference between
    stability and crisis.
        While suicide prevention often brings veterans into the mental
    health system, many of the underlying drivers of risk begin earlier and
    go untreated. Mission Roll Call's survey data shows that over 95
    percent of veterans say it is extremely or very important to have
    access to specialized TBI care, including care delivered outside the
    VA. Yet, among veterans seeking care for TBI-related symptoms, 73
    percent report that accessing appropriate treatment is somewhat or very
    difficult.
        The BEACON Act responds directly to that gap by creating a
    structured, evidence-based framework for evaluating innovative
    neurorehabilitation approaches for veterans with chronic TBI, including
    rigorous outcome measurement and independent evaluation. Veterans are
    asking the VA to test promising therapies responsibly, publish results,
    and expand access when evidence supports it. From the veteran
    perspective, the BEACON Act is about restoring function, reducing
    downstream mental health risk, and giving clinicians better tools to
    intervene before injuries compound into lifelong disability.
        In addition, Mission Roll Call supports efforts to modernize
    veteran care by expanding evidence-based options while holding the
    system accountable for outcomes. The NOPAIN for Veterans Act moves VA
    toward broader use of effective non-opioid pain management therapies,
    while the Veterans Mental Health and Addiction Therapy Quality of Care
    Act ensures Congress and the VA have reliable, independent data on how
    mental health and addiction care performs across VA and community
    settings. These measures reflect what veterans consistently ask for in
    our surveys: care that is grounded in evidence, reduces risk, and is
    evaluated based on real-world results rather than assumptions.
        Mission Roll Call has always advocated that geography should not
    determine whether a veteran receives timely care, and supports
    legislation that addresses access gaps for veterans who live far from
    VA facilities or outside the continental United States. The Veterans
    Health Desert Reform Act and the U.S. Vets of the Freely Associated
    States Act recognize this reality and seek to leverage community
    providers, telehealth, and mail-order pharmacy services to close those
    gaps.
        We believe good policy starts with listening to the veteran
    community and ends with accountability. Veterans overwhelmingly seek
    better access to care in a manner that supports their life and family,
    rules they can easily understand, and outcomes that can be measured and
    improved. The legislation before you reflects meaningful progress
    toward those goals, and we appreciate the Subcommittee's continued
    focus on practical solutions that make the veteran and their family
    central to the provision of care.
        Mission Roll Call has submitted a Statement for the Record that
    provides additional detail and supporting veteran data on these issues.
        Chairman, Ranking Member, and Members of the Subcommittee, thank
    you, and I look forward to your questions.

                     Prepared Statement of Elizabeth McCoy

        Chairman Miller-Meeks, Ranking Member Brownley, and distinguished
    members of the House Committee on Veterans' Affairs, Subcommittee on
    Health - thank you for the opportunity to submit Wounded Warrior
    Project's views on pending legislation.
        Wounded Warrior Project (WWP) was founded to connect, serve, and
    empower our Nation's wounded, ill, and injured veterans, Service
    members, and their families and caregivers. We are fulfilling this
    mission by providing life-changing programs and services to more than
    255,000 registered post-9/11 warriors and 60,000 of their family
    support members, continually engaging with those we serve, and
    capturing an informed assessment of the challenges this community
    faces. Rooted in this experience, we are pleased to provide our
    perspective on pending legislation that would likely have a direct
    impact on many we serve.

    H.R. 2283: Recognizing Community Organizations for Veteran Engagement
    and Recovery Act (RECOVER) Act

        In response to WWP's most recent Warrior Survey, 76 percent of
    warriors reported having (or experiencing) post-traumatic stress
    disorder (PTSD), with nearly half presenting moderate to severe
    symptoms. PTSD, anxiety, and depression have continually ranked among
    the top mental health issues among warriors. Mental health and suicide
    prevention continue to be top priorities for WWP, and we support an
    approach that integrates both government as well as non-profit and
    private organizations to help increase access to timely mental health
    care that addresses these health challenges.
        The RECOVER Act would authorize grant funding for non-profit
    organizations that provide evidence-based mental health treatment
    services to veterans in outpatient facilities. Funding would aim to
    ensure that programs serve all interested veterans with care, at no
    cost. Communities that are medically underserved, have large veteran
    populations, or have large numbers of veterans at high risk of suicide
    would be key recipients. Grantees would be required to educate care
    recipients about eligibility for Department of Veterans Affairs (VA)
    healthcare and encourage enrollment.
        While WWP appreciates the need to keep VA as a coordinator of
    unfragmented clinical care, we believe that it should embrace grants to
    direct care programs. According to VA's 2024 National Veteran Suicide
    Prevention Annual Report, an average of 17.6 veterans died by suicide
    each day in 2022, and less than half (40 percent) of those had used VHA
    services in the 2-years prior to their death. These grants may help
    connect those unconnected veterans to available and VA supported mental
    health resources within their communities. Additionally, this approach
    is particularly important given the unfortunate reality that there is
    some skepticism toward VA within parts of the veteran community and
    best reflects a commitment with putting veteran's needs first.
        These figures indicate that a vast majority of veterans who die by
    suicide are not receiving mental health treatment from VA. Whether due
    to appointment hours, bad prior experiences, perceived stigma, or the
    thought that receiving care may take away an opportunity from someone
    who needs it more, many still choose not to pursue mental health care
    at VA or forego seeking help entirely. Mental health treatment works,
    but every individual has unique needs, and there is no one-size-fits-
    all solution.
        In this context, we must do everything we can to ensure that there
    is no wrong door to seeking mental health care, even if the first step
    is taken in the community. This approach has been embraced within the
    Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program (SSG
    Fox SPGP), which has been a cornerstone of VA's community-based suicide
    prevention strategy since its launch. While ``Fox Grants'' can be used
    to provide baseline mental health screenings among many other upstream
    suicide prevention services, grants cannot be used for direct mental
    health care under current law. WWP supports reauthorization of the SSG
    Fox SPGP, and we encourage consideration to adopt the RECOVER Act into
    this system and buildupon a program already committed to improving
    mental health and preventing veteran suicide through early community-
    based intervention and support.

    H.R. 2426: Veterans Mental Health and Addiction Therapy Quality of Care
    Act

        Comparative studies of VA and community-based care have drawn
    several conclusions that can inform public policy. Most recently, a
    2025 Government Accountability Office (GAO) report, Veterans' Community
    Care: VA Needs Improved Oversight of Behavioral Health Medical Records
    and Provider Training, highlighted systemic oversight gaps in the
    Veterans Community Care Program (VCCP). Nearly 225,000 veterans used
    more than 357,000 behavioral health referrals between Fiscal Year 2021
    and Fiscal Year 2023, yet 33 percent of referrals lacked initial
    medical reporting, and VA did not track final documentation, posing
    risks when veterans return for follow-up care. GAO also found that only
    2 percent of community providers completed any of VA's eight core
    trainings, including opioid safety, suicide prevention, and military
    cultural competency. These gaps can weaken care coordination and
    quality assurance.
        Unfortunately, these findings are not dissimilar to VA Office of
    Inspector General (OIG's) 2025 inspection of the Martinsburg VA Medical
    Center, which revealed fundamental breakdowns in leadership
    communication, lack of recovery-oriented programming, unclear discharge
    instructions, and non-compliance with suicide prevention and other
    trainings. These observations highlight systemic challenges in care
    coordination and lack of adherence to safety standards.
        To address key quality gaps which exist in both VA direct care, as
    well as the Community Care Network (CCN), WWP supports the Veterans
    Mental Health and Addiction Therapy Quality of Care Act. This bill
    takes a critical next step by mandating an independent, outcome-based
    study comparing VA and non-VA mental health and addiction treatment
    using metrics such as symptom improvement, suicide risk reduction, and
    adherence to evidence-based practices. The bill seeks external
    benchmarking of care quality, including assessments of military
    cultural competency, integrated care coordination, and success of
    record-sharing and outcome monitoring. This approach prioritizes
    comparative value and quality assurance, ensuring veterans receive the
    best possible care, wherever they seek it.
        Wounded Warrior Project is pleased to support this legislation.

    Discussion Draft: Veterans TBI Breakthrough Exploration of Adaptive
    Care Opportunities Nationwide Act of 2025 (BEACON Act of 2025)

        By fostering creativity and innovation in neurorehabilitation and
    treatment methodologies for TBI, VA can close critical gaps in evidence
    and practice. For example, military-related TBI significantly increases
    the risk of developing new mental health conditions and, both directly
    and indirectly, raises suicide risk. Research also consistently shows
    that TBI is a major risk factor for suicide among veterans.\1\ Findings
    like these underscore the urgent need for sustained investment in TBI
    research and care. By identifying mechanisms behind these risks and
    developing evidence-based interventions, we can improve mental health
    outcomes, accelerate recovery, and ultimately reduce suicide among
    veterans living with the long-term effects of brain injury.
    ---------------------------------------------------------------------------
        \1\ See, e.g., Lisa A. Brenner et al., Associations of Military-
    Related Traumatic Brain Injury With New-Onset Mental Health Conditions
    and Suicide Risk, JAMA NETWORK (July 2023), available at https://
    jamanetwork.com/journals/jamanetworkopen/fullarticle/2807787; Rajeev
    Ramchand & Tahina Montoya, RAND, SUICIDE AMONG VETERANS (May 2025),
    available at https://www.rand.org/pubs/perspectives/PEA1363-1-v2.html.
    ---------------------------------------------------------------------------
        One pathway to continued brain health innovation is through the
    Veterans TBI Breakthrough Exploration of Adaptive Care Opportunities
    Nationwide Act of 2025 (BEACON Act of 2025), which establishes two
    major initiatives to improve care for veterans with chronic mild
    traumatic brain injury (mTBI), a condition affecting over 400,000
    veterans since 2000.\2\ First, it establishes the TBI Innovation Grant
    Program, a 3-year, $30 million initiative that authorizes VA to award
    individual grants of up to $5 million to nonprofits, academic
    institutions, and non-VA providers. These grants would support the
    design and testing of innovative, patient-centered neurorehabilitation
    treatments, prioritizing non-pharmacological approaches. Grants would
    also fund clinical studies to measure the effectiveness of these
    approaches in improving mental health outcomes and reducing suicide
    risk. VA would be required to align the program with the Staff Sergeant
    Parker Gordon Fox Suicide Prevention Grant Program (SSG Fox SPGP),
    issue regulations within 180 days, and require annual reports and
    evaluations.
    ---------------------------------------------------------------------------
        \2\ DEF. HEALTH AGENCY, U.S. DEP'T OF DEF., https://www.health.mil/
    Military-Health-Topics/Centers-of-Excellence/Traumatic-Brain-Injury-
    Center-of-Excellence/DOD-TBI-Worldwide-Numbers (last visited Jan. 9,
    2026).
    ---------------------------------------------------------------------------
        Second, the bill would authorize a 3-year, $10 million research
    grant program to fund collaborative studies to pioneer new TBI
    treatment methodologies, including randomized controlled trials. The
    program would be overseen by an independent third party to ensure
    thorough evaluation and identification of evidence-based practices. It
    would also require annual reporting to VA and would be reviewed after
    the 3-year pilot to determine whether it should be reauthorized and/or
    expanded.
        Wounded Warrior Project is pleased to support this legislation;
    however, we believe that more clarity on funding - which current bill
    language allows to be drawn from ``amounts available [...] for general
    mental health care programs'' - would help ensure that resources will
    not be diverted away from mental health services that veterans rely on.

    H.R. 6444: Blast Overpressure Research and Mitigation Task Force Act

        Blast overpressure, a sudden spike in air pressure caused by an
    explosion or blast wave that exceeds normal atmospheric pressure, has
    been linked to cumulative neurological effects, including cognitive
    decline, neuroinflammation, and increased risk of traumatic brain
    injury (TBI) and psychiatric conditions, such as PTSD and depression.
    Studies have demonstrated that exposure to blast overpressure is linked
    to measurable brain changes, cognitive and gait deficits, and higher
    rates of TBI and mental health conditions among service members and
    veterans.\3\ These findings were highlighted during a February 28,
    2024, Senate Committee on Armed Services, Subcommittee on Personnel
    hearing where Dr. Lester Martinez-Lopez, Assistant Secretary of Defense
    for Health Affairs, emphasized the need for comprehensive research and
    insight to better understand risks, protect Service members, and
    improve brain injury treatment.
    ---------------------------------------------------------------------------
        \3\ See, e.g., Andrea Diociasi et al., Distinct Functional MRI
    Connectivity Patterns and Cortical Volume Variations Associated with
    Repetitive Blast Exposure in Special Operations Forces Members,
    RADIOLOGY (Apr. 2025), available at https://pubmed.ncbi.nlm.nih.gov/
    40167438/; Kyle Bourassa et al., Traumatic Brain Injury and Accelerated
    Epigenetic Aging Among Post-9/11 Members, J. HEAD TRAUMA REHAB. (Aug.
    2025), availble at https://pubmed.ncbi.nlm.nih.gov/40828005/.
    ---------------------------------------------------------------------------
        In this context, more comprehensive coordination between the
    Department of War (DoW) and VA can help drive progress to support
    Service members and veterans throughout and beyond the military
    lifecycle.
        Currently, VA and DoW collaborate on TBI and blast injury research
    through the Traumatic Brain Injury Center of Excellence (TBICoE).
    However, gaps remain in integrating longitudinal data, coordinating
    research infrastructure, and conducting comprehensive long-term
    studies. Ultimately, these knowledge deficits limit the provision of
    premium care for those exposed to blast overpressure, particularly as
    Service members transition from active duty to veteran status.
        H.R. 6444, the Blast Overpressure Research and Mitigation Task
    Force Act, aims to close these critical gaps through the VA-DoW Joint
    Executive Committee (JEC) and a new Blast Overpressure Task Force at
    VA. The Task Force would be required to establish physiological and
    cognitive baselines, align research agenda and acquisition strategies
    for blast-related care, and prioritize translational studies in areas
    such as cumulative mild TBI, vestibular dysfunction, autonomic
    dysregulation, as well as neuroinflammation, conditions that map
    directly onto documented blast sequelae and operational exposures in
    special-operations and weapons training cohorts.\4\
    ---------------------------------------------------------------------------
        \4\ See, e.g., Hadiyah Brendel, UNIFORMED SERVICES UNIVERSITY,
    INVICTA Study: Uncovering Blast Exposure's Impact on Special Operations
    Forces (Apr. 2025), available at https://www.dvidshub.net/news/555517/
    invicta-study-uncovering-blast-exposures-impact-special-operations-
    forces.
    ---------------------------------------------------------------------------
        By mandating annual reports, cross-agency coordination, and
    integration of mobile, longitudinal diagnostics, H.R. 6444 would create
    the infrastructure needed to translate emerging evidence into
    standardized screening, targeted mitigation strategies, and benefits
    adjudication for blast-exposed veterans. Further, the inclusion of Task
    Force recommendations related to VA claims processing and disability
    evaluations hold the promise of ensuring that veterans affected by
    blast overpressure injuries are connected to the care and support they
    have earned with their service. WWP supports H.R. 6444 and the
    objectives of the proposed Task Force. We believe the data currently
    being collected and assessed across systems represents an invaluable
    resource. Findings should be fully leveraged for robust analysis and
    research to drive evidence-based improvements.

    Discussion Draft: Data Driven Suicide Prevention and Outreach Act of
    2025

        Veterans continue to face very high risks of suicide, and current
    screening methods, rooted in self-reporting and periodic assessments,
    often fail to detect early warning signs.\5\ According to VA's 2024
    National Veteran Suicide Prevention Annual Report, more than half of
    veterans lost to suicide had not accessed VA healthcare in over 2 years
    at the time of their death. This underscores the urgent need for
    innovative approaches that integrate complex datasets and proactively
    identify risk factors before a crisis occurs.
    ---------------------------------------------------------------------------
        \5\ See, e.g., OFF. OF INSP. GEN., U.S. DEP'T OF VET. AFFAIRS,
    INADEQUATE STAFF TRAINING AND LACK OF OVERSIGHT CONTRIBUTE TO THE
    VETERANS HEALTH ADMINISTRATION'S SUICIDE RISK SCREENING AND EVALUATION
    DEFICIENCIES (Dec. 2024).
    ---------------------------------------------------------------------------
        The Data Driven Suicide Prevention and Outreach Act of 2025 would
    direct VA to establish a pilot program awarding grants to organizations
    with expertise in AI and predictive analytics to develop models that
    evaluate suicide risk among veterans. These models could help
    clinicians prioritize interventions and tailor care, improving outcomes
    and saving lives.
        This pilot program would not be VA's first attempt to incorporate
    predictive models into its suicide prevention efforts. REACH VET
    (Recovery Engagement and Coordination for Health - Veterans Enhanced
    Treatment) is a VA initiative that uses predictive analytics to
    identify veterans at the highest statistical risk for suicide and
    proactively connect them with tailored care and outreach. Research on
    VA's REACH VET program has found that veterans flagged by REACH VET
    received more proactive care, such as safety planning and outpatient
    visits, and experienced a modest reduction in nonfatal suicide
    attempts.\6\
    ---------------------------------------------------------------------------
        \6\ Kallisse Dent et al., The REACH VET Program and Mortality
    Outcomes Among Veterans at High Risk of Suicide, JAMA NETWORK (July
    2025), available at https://jamanetwork.com/journals/jamanetworkopen/
    fullarticle/2836124.
    ---------------------------------------------------------------------------
        While predictive analytics can improve engagement and care
    processes, they will not guarantee reductions in veteran suicide. As
    Congress considers new AI-driven initiatives like the Data Driven
    Suicide Prevention and Outreach Act, it is critical to build on these
    lessons, ensuring integration with existing VA models, transparency in
    algorithms, and commitment to making system improvements based on
    evidence-informed research. We also believe that innovation should
    complement, rather than replace, proven strategies for veteran suicide
    prevention.
        Wounded Warrior Project is pleased to support this legislation.

    Discussion Draft: Veterans Health Desert Reform Act of 2025

        Veterans living in rural communities encounter persistent obstacles
    to care, from long travel times and limited specialty services to
    transportation challenges that often delay treatment. While VA
    Community Care was designed to bridge these gaps, provider shortages
    and hospital closures in rural areas can leave veterans with few
    practical options, even when referrals are approved.
        Under Community Care, VA generally contracts with individual
    providers and facilities rather than enrolling an entire hospital as a
    blanket participant, though care often occurs in hospitals. Individual
    providers join VA's Community Care Network and may practice within
    hospitals, and facilities can also participate through contracts or
    agreements. However, participation is service-and provider-specific,
    not automatic for all hospital services. This structure means not every
    department or provider within a participating hospital is available to
    VA patients, and access depends on network status, contracted services,
    and referral authorization. Ultimately, Community Care operates through
    networked providers and contracted facilities, not universal hospital
    participation, which can lead to variability in access even within the
    same hospital.
        The Veterans Health Desert Reform Act of 2025 would create a VA
    pilot program to improve access to hospital care for veterans living in
    rural areas. Under this program, VA would enter agreements with at
    least three hospitals in high-need rural regions to furnish the same
    hospital care and medical services that veterans are eligible to
    receive under the Veterans Community Care Program. Participating
    hospitals would be reimbursed at rates no lower than Medicare. VA would
    review best practices from Medicare, Medicaid, and TRICARE to inform
    payment models. Throughout the pilot, VA would monitor access, cost,
    quality, and veteran satisfaction and submit a report to Congress after
    the program's authority ends in 2029.
        Wounded Warrior Project is pleased to support this legislation;
    however, we recognize that more development may be needed within the
    legislative text or Center for Innovation for Care and Payment
    implementation process to resolve issues such as conflicts with
    existing hospital-based providers.

    H.R. 6526: Clarity on Care Options Act

        Witness testimony from this Subcommittee's recent hearing,
    ``Strengthening CHAMPVA for Survivors and Dependents,'' highlighted
    that caregivers, survivors, and dependents often struggle to find
    community providers who accept Civilian Health and Medical Program of
    the Department of Veterans Affairs (CHAMPVA) coverage. Currently, there
    is no central repository for beneficiaries to look up community care
    network providers who accept CHAMPVA.
        The Clarity on Care Options Act would improve outcomes for these
    families by creating a public-facing directory of providers in the
    CHAMPVA network. The bill directs the VA to mandate Community Care
    Network (CCN) third party administrators to query their network of
    providers to confirm whether those providers accept CHAMPVA
    assignments, and then maintain an accessible, nationwide directory,
    helping families improve access to timely care. The legislation sets
    clear and intentional timelines: initial provider queries must be
    completed within 90 days of enactment, and the first public directory
    must be published within 180 days. VA would also be required to submit
    annual reports to Congress for 5 years, detailing provider
    participation rates and identifying geographic gaps (broken down by
    both State and Veteran Integrated Service Network (VISN).
        Wounded Warrior Project recognizes the critical importance of this
    effort. Surviving families often face heightened mental health risks.
    Spouses, children, and caregivers in these families are vulnerable to
    trauma and require consistent, comprehensive support. In addition,
    families of veterans rated 100 percent permanent and total; families of
    veterans in receipt of Total Disability based on Individual
    Unemployability (TDIU) and approved Primary Family Caregivers in VA's
    Program of Comprehensive Assistance for Family Caregivers (PCAFC)
    depend on reliable access to care. CHAMPVA plays a vital role in
    meeting these needs, but a lack of clarity on participating providers
    undermines its promise, and leaves too many without timely, quality
    care.
        We support H.R. 6526 and urge continued efforts to expand access to
    essential healthcare information. A national CHAMPVA provider registry
    would ensure caregivers, survivors, and dependents have a powerful tool
    to secure the care and support they deserve.

    H.R. 4509: NoPAIN for Veterans Act

        While post-9/11 service has become closely associated with
    invisible wounds like PTSD and TBI, pain management is one of the most
    critical health issues in the community we serve. Chronic pain can
    impact an individual's physical and mental well-being and quality of
    life\7\ and there is evidence to suggest veterans have higher
    prevalence of chronic pain that civilians\8\. Nearly all (95 percent)
    respondents to WWP's most recent Warrior Survey reported some pain in
    the last 3 months, and 3 in 4 (75.5 percent) provided responses
    indicating moderate to severe interference with activities and
    enjoyment of life. In addition, VA's 2024 National Veteran Suicide
    Prevention Annual Report indicates that pain in the year prior to death
    was the most common risk factor (53.8 percent) among veterans lost to
    suicide from 2020 to 2022.
    ---------------------------------------------------------------------------
        \7\ Kosuke Kawai et al., Adverse Impacts of Chronic Pain on Health-
    related Quality of Life, Work Productivity, Depression, and Anxiety in
    a Community-Based Study, FAMILY PRACTICE (Nov. 2017), available at
    https://pubmed.ncbi.nlm.nih.gov/28444208/.
        \8\ Kenneth Taylor et al., Seventeen-year National Pain Prevalence
    Trends Among U.S. Military Veterans, J. PAIN (May 2024), available at
    https://pubmed.ncbi.nlm.nih.gov/37952861/.
    ---------------------------------------------------------------------------
        Medication for pain can be part of the solution, but opioid-based
    medications carry notable risks. When prescribed after surgery or a
    severe injury (acute pain) for example, opioid treatment can increase
    the risk of addiction, especially if opioids are used for prolonged
    periods, at higher doses, or in individuals with a history of substance
    use disorders (SUD) - and nearly 14 percent (2.8 million) veterans
    struggle with SUDs.\9\
    ---------------------------------------------------------------------------
        \9\ SUBSTANCE ABUSE AND MENTAL HEALTH SERVS. ADMIN., U.S. DEP'T OF
    HEALTH & HUMAN SERVS., KEY SUBSTANCE USE AND MENTAL HEALTH INDICATORS
    IN THE UNITED STATES: RESULTS FROM THE 2023 NATIONAL SURVEY ON DRUG USE
    AND HEALTH (July 2024), available at https://www.samhsa.gov/data/sites/
    default/files/reports/rpt47095/National %20Report/National %20Report/
    2023-nsduh-annual-national.pdf.
    ---------------------------------------------------------------------------
        In this context, non-opioid medication for pain can and should be
    more easily accessible for veterans enrolled in Veterans Health
    Administration (VHA) care. Under current law, VA is not required to
    include non-opioid pain management drugs in its National Formulary,
    leaving interested patients - and their providers - to navigate a
    waiver system that requires increased effort, may result in delayed
    access, and can ultimately lead to higher costs for the veteran. The
    NOPAIN for Veterans Act would require VA to include certain non-opioid
    pain management drugs as part of the National Formulary to align with
    Medicare laws that mandate coverage of non-opioid pain drugs,
    biologics, or devices with an FDA-approved indication to reduce post-
    operative pain or produce post-surgical or regional analgesia.
        Wounded Warrior Project supports the intent of providing faster,
    easier access to non-opioid pain management drugs to veterans; however,
    distinctions between Medicare and VHA prescription drug coverage may
    require different solutions. The most notable distinction in this
    context is that VHA is a direct purchaser (and distributor) of the
    drugs included in its National Formulary whereas the Medicare system
    relies on private insurance plans offering Part D and Medicare
    Advantage plans to handle drug purchasing and network with pharmacies.
    Without deeper understanding and knowledge of how previous requests to
    cover applicable non-opioid alternatives through the VA Pharmacy
    Benefits Management (PBM) Services and VA Medical Advisory Panel-VISN
    Pharmacist Executives (MAP-VPE) have fared, we encourage this matter to
    be further explored as part of the recent majority announcement of its
    VA Reauthorization Series, which features an intent to modernize VA's
    National Formulary governance.\10\
    ---------------------------------------------------------------------------
        \10\ Press release, House Comm. Vet. Affairs, Chairman Bost, House
    Republicans Launch a Veteran First Initiative to Modernize VA
    Healthcare for the 21st Century (Dec. 10, 2025), available at https://
    veterans.house.gov/news/documentsingle.aspx?DocumentID=7810.

    H.R. 5999: To Amend Title 38, United States Code, to Direct the
    Secretary of Veterans Affairs to furnish an opioid antagonist to a
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    veteran without requiring a prescription or copayment

        Veterans living with chronic pain face a heightened risk of opioid
    overdose, as symptom management often leads to increased reliance on
    these medications.\11\ While some VA Medical Centers allow veterans to
    request opioid antagonists directly from the pharmacy, most still
    require a provider-issued prescription, placing administrative and cost
    barriers before a vulnerable population.
    ---------------------------------------------------------------------------
        \11\ See, e.g., OFF. OF RSCH. & DEV., U.S. DEP'T OF VET. AFFAIRS,
    OPIOID USE DISORDER - FACT SHEET: DATA ON VETERANS USING VA HEALTH CARE
    (Apr. 2022), available at https://www.vacsp.research.va.gov/CSPEC/
    Studies/CSPEAR/Docs/Opioid-Use-Disorder.pdf.
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        Many states already allow antagonists, such as naloxone, to be
    obtained over the counter or through standing orders, yet VA lacks a
    consistent, system-wide approach to ensure timely access. Standardizing
    protocols and expanding availability across VA facilities would
    strengthen overdose prevention and give veterans a critical,
    potentially life-saving tool.
        Providing opioid antagonists, such as naloxone, at no cost to
    veterans can save lives among a high-risk population. Community-based
    naloxone distribution programs have consistently demonstrated
    effectiveness in reversing overdoses and reducing fatalities. Evidence
    shows that jurisdictions eliminating prescription requirements and
    copayments achieve higher naloxone uptake and better outcomes in
    combating overdose deaths. RAND research further indicates that
    policies offering naloxone free of charge and without prescription
    substantially increase distribution and have the potential to reduce
    fatal overdoses. For veterans facing elevated risks due to chronic pain
    and mental health challenges, removing these barriers - as proposed -
    would align VA policy with proven public health strategies, ensuring
    immediate, cost-free access to this lifesaving medication.\12\
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        \12\ RAND, STATEWIDE FREE NALOXONE (Dec. 2023), available at
    https://www.rand.org/pubs/research_briefs/RBA3054-15.html.
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        Wounded Warrior Project is pleased to support this legislation.

    H.R. 6001: Veterans with ALS Reporting Act

        Amyotrophic Lateral Sclerosis (ALS) is a devastating
    neurodegenerative disease without a cure or effective treatment. It is
    always fatal, with most individuals tragically living only two to 5
    years after diagnosis. Veterans face an even greater risk, with studies
    showing they are twice as likely to develop ALS as the general
    population.\13\ VA recognizes ALS as a service--connected condition and
    grants a 100 percent disability rating upon diagnosis, but we still
    lack a clear picture of why veterans are disproportionately affected or
    how to reduce that risk.\14\, \15\
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        \13\ See, e.g., NAT'L ACADS. OF SCI., ENG., & MED., LIVING WITH ALS
    2024, available athttps://nap.nationalacademies.org/resource/27739/
    ALS_One_Pager_Veterans.pdf.
        \14\ I AM ALS, UNDERSTANDING VETERANS AT RISK FOR ALS, https://
    www.iamals.org/understanding-veterans-risk-for-als/ (last visited Jan.
    9, 2026).
        \15\ Hari Krishna Raju Sagiraju et al., Amyotrophic Lateral
    Sclerosis Among Veterans Deployed in Support of Post-9/11 U.S.
    Conflicts, MILITARY MED. (Mar. 2020), available at https://
    pubmed.ncbi.nlm.nih.gov/31642489/.
    ---------------------------------------------------------------------------
        The Veterans with ALS Reporting Act takes an important step toward
    answering these questions, requiring VA, in collaboration with the
    Centers for Disease Control (CDC), to report on ALS incidence and
    prevalence among veterans, identify gaps in care and support, and
    outline strategies for risk reduction. This bill also calls for better
    access to clinical trials, expanded research participation, and
    continuous tracking through the CDC's ALS registry and biorepository as
    this younger veteran cohort age. By mandating regular updates to
    Congress, this legislation ensures accountability and drives progress
    toward better understanding, prevention, and treatment of ALS in the
    veteran community.
        Wounded Warrior Project is pleased to support this legislation. To
    strengthen the bill further, we recommend adding provisions that
    require VA to develop and implement an action plan based on the
    report's findings related to gaps in care and support, rather than
    limiting the bill to data collection. Including specific outcome
    metrics and timelines for improving care access, clinical trial
    enrollment, and support services would ensure accountability. The bill
    could also mandate public reporting of corrective actions, require
    consultation with veteran advocacy and ALS organizations, and authorize
    dedicated funding for implementation so recommendations lead to real
    improvements. These enhancements would transform the bill from a
    reporting requirement into a catalyst for meaningful change in ALS care
    for veterans.

    Agenda items not addressed in this Statement for the Record

          Discussion Draft: U.S. Vets of the FAS Act

          Discussion Draft: Whole Health for Veterans Act

    Concluding Remarks

        Wounded Warrior Project once again extends our thanks to the
    Subcommittee on Health for its continued dedication to our Nation's
    veterans. Our commitment to keeping the promise by rebuilding the lives
    of warriors impacted by war and military service remains as strong as
    ever, and we are honored to contribute our voice to your discussion
    about pending legislation. As your partner in advocating for these and
    other critical issues, we stand ready to assist and look forward to our
    continued collaboration.

                     Prepared Statement of K. Conwell Smith

        Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished
    Members of the Subcommittee, on behalf of the American Psychological
    Association (APA), thank you for the opportunity to testify and provide
    comments regarding legislation being considered today. I am Conwell
    Smith, APA Deputy Chief for Military and Veterans Policy.
        The American Psychological Association and its companion
    organization APA Services, Inc. (APA/APASI) serve as the Nation's
    largest scientific and professional nonprofit organization representing
    the discipline and profession of psychology. Our organization has more
    than 190,000 members and affiliates who are clinicians, researchers,
    educators, consultants, and students. Within the Veterans Health
    Administration, there are over 7,000 psychologists serving veterans.
    That number has declined by nearly 300 psychologists since November
    2024.\1\ APA is proud of the decades of clinical and research
    advancements made in mental and behavioral health thanks to
    psychology's role within the VA since World War II. The VA has long led
    the way in establishing standards for practice, training and research
    that serve veterans and our entire healthcare system.
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        \1\ SECVA Workforce Dashboard
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        We appreciate the Committee's willingness to take on the challenges
    surrounding the critical delivery of and access to mental health care
    for our Nation's veterans. Demand for VA mental health care has
    increased steadily over the past 20 years and continues to outpace
    other care within the VA.\2\ Meeting this demand while maintaining the
    VA's high level of clinical excellence should be the priority.
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        \2\ htps://www.govinfo.gov/content/pkg/CMR-VA1-00181657/pdf/CMR-
    VA1-00181657.pdf
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        My testimony will focus primarily on ways in which legislation
    discussed today should aim to provide veterans with care of the highest
    quality, regardless of site of service - care that is on par with the
    current standards of practice that exist within the Veterans Health
    Administration. Several bills being considered today create new
    delivery models, access points, and processes separate and apart from
    VHA. APASI is concerned that the creation of new systems of care
    outside of VA direct care or the Veterans Community Care Program (VCCP)
    and without VA authorization or referral only further fragments veteran
    care, isolating veterans and compromising the benefits of an integrated
    care model. APASI is also concerned that two well intentioned bills
    focused on access to care, the Recognizing Community Organizations for
    Veteran Engagement and Recovery or RECOVER Act (H.R. 2283) and the
    draft Health Desert Reform Act, risk reducing the quality of veteran
    health care without certain safeguards put in place.
        APASI recognizes the need to supplement VHA care due to staffing,
    funding, specialty care and location considerations; however, veterans
    should expect the following when receiving mental health care outside
    of the VHA integrated health system: (1) Providers who have received
    key trainings currently required within the VA; (2) The use of
    treatments scientifically proven to be effective; (3) Quality
    assurance, oversight, and accountability; (4) Coordinated care and
    shared health records; and (5) Adequate information for informed
    choice.

    Providers Trained to Best Serve Veterans\3\
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        \3\ Veterans' Community Care: VA Needs Improved Oversight of
    Behavioral Health Medical Records and Provider Training U.S. GAO

        For years, the VA has made tremendous strides in universal suicide
    prevention risk assessments and required trainings for providers
    including training in suicide prevention, lethal means safety, military
    culture, and military sexual trauma. The RECOVER Act, which would
    provide $60 million in grants to mental health facilities serving
    veterans, fails to require that its clinicians meet the training rigor
    and responsibility of VA providers. Even suicide prevention training is
    not required, even though the legislation appropriately targets areas
    with high veteran suicide risk.
        APASI supports requiring key trainings for all VA community
    providers, including those providing mental health services through
    separate VA funded grant programs. A May 2025 Government Accountability
    Office (GAO) report recommended that VA better monitor whether
    community providers have completed any of eight core trainings,
    following findings that a mere ``two percent of the community providers
    with a behavioral health referral from fiscal years 2021 through 2023
    had completed one or more of these trainings.''

    The Use of Treatments Scientifically Proven to be Effective

        APA strongly believes in leading with psychological science and
    takes seriously the development of treatments scientifically proven to
    be effective for the assessment and treatment of mental health
    disorders.\4\ The RECOVER Act does not require provider training in
    evidence-based practices, overlooking the clear need for knowledge and
    training on common veteran conditions such as post-traumatic stress and
    traumatic brain injury.
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        \4\ Guidelines for Practitioners
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        Another bill being considered today, the Veterans TBI Breakthrough
    Exploration of Adaptive Care Opportunities Nationwide or BEACON Act of
    2025, aims to increase research on mild traumatic brain injury and
    mental health interventions outside ``the scope of traditional
    Department of Veterans Affairs pathways.'' APASI is concerned that this
    approach might also undermine the bedrock of rigorous scientific study
    that is the gold standard of existing VA traumatic brain injury
    research and treatment. APASI views this alternative pathway as
    unnecessary, likely to duplicate internal efforts, and potentially
    reducing standards necessary for evidence-based care.

    Quality Assurance, Oversight and Accountability

        APASI encourages strong quality assurance standards and facility
    accreditation for any grant recipient providing mental and behavioral
    services to veterans. The RECOVER Act currently does not require
    accreditation from either The Joint Commission or the Commission on
    Accreditation of Rehabilitation Facilities (CARF). This is a
    significant departure from quality assurance standards within the VA.
    APASI also encourages that both the RECOVER Act and the Veterans Health
    Desert Act incorporate utilization review to ensure that
    overutilization and unnecessary duplication of services are adequately
    addressed both for the quality of care for veterans and good
    stewardship of taxpayer funds. Finally, it is important that the
    RECOVER Act create a meaningful standard and process to ensure that the
    expressed intention to demonstrate improved clinical outcomes is fully
    met and enforced. We should learn from recent findings in the
    congressionally mandated final report of the Staff Sergeant Parker
    Gordon Fox Suicide Prevention Grant Program whereby, despite
    requirements for recipients to administer both baseline and follow-up
    assessments, significant numbers of grantees failed to do so. Without
    evidence of grantee level effectiveness, we fail to understand both
    positive and negative impacts on veterans.

    Care Coordination and Shared Health Records

        Known benefits of integrated health care systems include improved
    care coordination, transdisciplinary care teams, efficient resource
    utilization, prevention and early intervention, and improved patient
    experience. Perhaps this is why, in 2024, VA hospitals outperformed
    non-VA hospitals in both patient satisfaction and hospital quality
    ratings\5\ and 79.5 percent of Veterans using VA services responded in
    2025 that they trust the VA. Removing the VA as coordinator of care and
    creating increased fragmentation of VA services will further weaken
    communication and coordination among veterans' health care providers.
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        \5\ htps://news.va.gov/press-room/va-health-care-outperforms-non-
    va-care-in-two-independent-nationwide-quality-and-patient-satisfaction-
    reviews/
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        Furthermore, the same GAO report listed above\6\ found that 33
    percent of VA referrals for behavioral health services were missing
    initial visit records. The quality of care for veterans can be
    negatively impacted by the lack of shared health records. APASI
    recommends that all providers of veteran care be required to
    participate in timely medical record exchange.
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        \6\ Veterans' Community Care: VA Needs Improved Oversight of
    Behavioral Health Medical Records and Provider Training U.S. GAO

    ---------------------------------------------------------------------------
    Adequate Information for Informed Choice

        APASI lauds two bills today that aim to better inform veterans.
    APASI is encouraged by the creation of a publicly available directory
    of health care providers that accept assignments under the CHAMPVA
    program, as required in the draft Clarity on Care Options Act.
        The Veterans Mental Health and Addiction Therapy Quality of Care
    Act, H.R. 2426, also strives to provide veterans with information
    needed to make informed healthcare choices. APASI supports the intent
    of the legislation but is concerned that it falls short of intended
    goals as currently written. For example, the bill does require
    contracts with Third Party Administrators to include the expectation of
    assessing patients' treatment progress. It also does not authorize the
    VA to access VCCP health care records. Unless the bill requires VCCP
    providers to submit key uniform measurement and health care record
    information to the VA, valid comparisons cannot be made. APASI also
    suggests that wait time, provider training, and additional quality
    metrics be added.
        Finally, APASI would like to acknowledge H.R. 4509, the NOPAIN for
    Veterans Act and the draft Whole Health for Veterans Act for their
    focus on the health and well-being of veterans. By making it easier for
    veterans to access and afford non-opioid medications and whole health
    well-being services, these bills contribute to prevention and
    resiliency.

    Conclusion

        Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished
    Members of the Subcommittee, APASI thanks you for your leadership and
    for allowing us the opportunity to provide feedback on legislation. We
    know that each of you are earnest in your efforts to improve veteran
    health care access and quality. The VA has consistently led the way in
    groundbreaking mental health care research, the development of
    effective treatments, and the training of an exceptional health care
    workforce serving all Americans and we are proud of psychology's role
    within the VA. APASI believes in this high standard of care and in
    meeting the expectation of veterans to receive it.
        In closing, it is an honor to serve the American Psychological
    Association, advocating for the vital work psychologists do every day
    for our veterans and military. Importantly, I speak as the spouse of an
    Army veteran who receives his care through the Hampton VA Medical
    Center. There is nothing more important to me than ensuring he and all
    others who serve receive the best care in every setting. Thank you.

                            Statement for the Record

                                  ----------

      Prepared Statement of Veterans of Foreign Wars of the United States

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

    H.R. 2283, RECOVER Act

        The VFW supports the intent of this legislation that would
    establish a pilot program providing grants to outpatient mental health
    facilities for culturally competent, evidence-based care for veterans.
    Too many veterans, especially in rural, underserved, and high-risk
    communities, still face barriers to timely mental health and addiction
    services. This proposal offers a targeted way to expand access while
    reinforcing veteran-centered, evidence-driven care.
        The VFW is encouraged by the focus on accountability, clinical
    outcomes, and the commitment not to charge veterans for care. Removing
    cost as a barrier is essential, especially for veterans who are
    uninsured, underinsured, or concerned about finances. Prioritizing
    services in high suicide risk communities aligns this pilot with
    national suicide-prevention strategies.
        To that end, the VFW strongly urges Congress to ensure that veteran
    and military service organizations have a formal role in helping
    establish the standards for cultural competency under this program.
    Even if these organizations are not eligible for grant funding, they
    represent and serve the veteran population every day and bring an
    essential perspective on what culturally competent care should look
    like in practice. Their involvement would help ensure that standards
    reflect veterans' lived experiences rather than narrow or academic
    interpretations. The VFW urges that community-based mental health care
    must complement, not replace, Department of Veterans Affairs (VA)
    services. This pilot must strengthen the overall system, not create
    disconnected silos. Set and enforce strong standards for care
    coordination, medical record sharing, and referral paths back to VA to
    guarantee continuity of treatment, especially for veterans with
    complex, chronic, or co-occurring conditions. Do not drop coordination
    demands, remove record sharing, or weaken VA's role. Such actions would
    fragment care and jeopardize outcomes. The success of this initiative
    depends on direct action to maintain and improve integration across
    care points.
        The VFW urges Congress to take immediate action to ensure this
    pilot supplements but does not replace investment in VA's mental health
    system. Congress must fully invest in VA's own capacity and guarantee
    that expanding access through trusted partners strengthens, rather than
    undermines, VA's central role in coordinating veteran care. Do not let
    privatization weaken accountability and disrupt continuity for those
    who served.

    H.R. 2426, Veterans Mental Health and Addiction Therapy Quality of Care
    Act

        The VFW strongly supports improving the quality, safety, and
    accountability of mental health and addiction care for veterans.
    However, we cannot accept this legislation as written because it does
    not provide VA with the authority, data access, or tools needed to
    conduct the required comparison.
        The legislation requires an independent review of quality across VA
    and non-VA care. However, community providers do not collect or
    standardize data like VA does. Without comparable clinical metrics such
    as suicide-risk screenings, treatment adherence, or use of evidence-
    based practices, comparing outcomes would be flawed. Any study based on
    incomplete data risks producing misleading results.
        The VFW is also concerned that the legislation relies heavily on
    raw utilization measures, such as the number of visits, as proxies for
    quality and effectiveness. Visit counts alone do not capture changes in
    symptom severity, functional status, treatment intensity, or care
    transitions over time. Veterans' mental health and substance use needs
    often fluctuate, and meaningful evaluation must account for clinical
    trajectories, not just service volume. Without this context, the
    legislation risks reducing complex care decisions to superficial
    metrics that do not reflect real outcomes.
        This legislation also omits key tools VA would need. It does not
    guarantee access to community-provider data, reporting standards for
    non-VA providers, or risk adjustment for patient complexity and social
    factors. Without these, VA cannot make a fair or accurate comparison.
    This approach could unintentionally undermine accountability. It may
    create the appearance of oversight without the substance needed for
    improvement. Worse, incomplete or poorly contextualized findings could
    be misused to justify policy decisions that restrict access or shift
    resources based on unreliable conclusions.
        Veterans deserve real accountability, not just rhetoric. Any
    legislation claiming to measure the quality of mental health and
    addiction care must initially ensure the tools, data, and standards
    exist to make those measurements accurate, fair, and actionable.
    Without these foundations, this legislation risks creating conclusions
    that neither improve care nor serve the best interests of veterans.

    H.R. 4509, NOPAIN for Veterans Act

        The VFW does not support legislation that would amend Title 38 to
    require VA to add non-opioid pain drugs and biologicals to its
    formulary on a set timeline. These products must be FDA-approved,
    reduce certain types of pain, and not work on opioid receptors. The VFW
    has not yet issued a resolution on this matter.

        H.R. 5999, To amend title 38, United States Code, to direct the
    Secretary of Veterans Affairs to furnish an opioid antagonist to a
    veteran without requiring a prescription or copayment

        The VFW strongly supports expanding access to opioid antagonists
    through VA without prescription or copayment barriers. Overdose deaths
    are rising, including among veterans. Removing obstacles to emergency
    treatment shows commitment to prevention and harm reduction.
        Veterans face unique risks for opioid misuse, such as chronic pain,
    injuries, and mental health conditions like post-traumatic stress
    disorder. Broad, stigma-free access to overdose-reversal medication
    lets veterans, families, and communities act quickly when seconds
    count. This approach aligns with proven public health plans that
    emphasize early action and local responses.
        While the VFW supports the intent of this legislation, we believe
    safeguards are needed. Opioid antagonists are generally safe but may
    pose risks for veterans with certain health issues or medicines. If
    available without a prescription, veterans should get counseling from a
    VA pharmacist. This would ensure informed use, help find risks, and
    reinforce safe use. Informed consent and patient safety must remain
    central, even if the drug is over the counter.
        The VFW is also concerned about the fiscal implications of removing
    all copayments for these medications. VA has faced budget pressures in
    recent years despite funding increases. Congress must consider how a
    no-copay requirement would affect pharmacy budgets if demand increases.
    Expanding access should not come at the expense of sustainability or
    force VA to divert resources from other critical services.
        The VFW believes making opioid antagonists widely available through
    VA should serve as a gateway to care, not a standalone solution. When
    paired with strong referral pathways to substance use disorder
    treatment, mental health services, and peer support, this policy can
    save lives while strengthening long-term recovery.

    H.R. 6001, Veterans with ALS Reporting Act

        The VFW supports this legislation that would require the VA
    Secretary to establish a triennial amyotrophic lateral sclerosis (ALS)
    monitoring, tracking, and reporting program. Under this requirement, VA
    would assess the incidence and prevalence of ALS among veterans,
    describe the resources VA and the Centers for Disease Control and
    Prevention (CDC) provide to veterans living with ALS, identify any gaps
    in those resources, develop a strategy to evaluate risk--reduction
    therapies aimed at lowering ALS incidence and prevalence among
    veterans, establish pathways for veterans receiving VA-provided ALS
    care to participate in VA-sponsored clinical trials and research, and
    recommend legislative solutions to address barriers to reducing ALS
    incidence and prevalence in the veteran population.
        Additionally, this legislation would direct VA to track ALS
    prevalence among veterans through the VA ALS Registry and the CDC's
    biorepository. According to VA's va.gov website, studies indicate that
    veterans are approximately 1.5 times more likely to develop ALS than
    individuals with no history of military service. Establishing this
    comprehensive monitoring and reporting framework would better equip VA
    to evaluate the effectiveness of risk-reduction strategies and improve
    outcomes for veterans living with ALS.
        The VFW has long been a staunch advocate for legislation benefiting
    ALS patients and their survivors. Notably, during the 2021-2022
    timeframe, the VFW Department of Virginia authored national VFW
    resolutions calling for commonsense modifications to ALS survivors'
    benefits. These advocacy efforts helped advance the Justice for ALS
    Veterans Act of 2025, in support of which the VFW provided favorable
    testimony.

    H.R. 6444, Blast Overpressure Research and Mitigation Task Force Act

        The VFW supports this legislation that would directly advance the
    VFW's longstanding legislative priorities and active resolutions
    focused on traumatic brain injury (TBI), blast overpressure exposure,
    and related neurological and cognitive health conditions.
        Modern service members, particularly those in combat arms and high-
    exposure occupational specialties, face repeated blast exposure that
    can result in cumulative, often poorly understood injuries with
    lifelong consequences. This legislation takes an important step toward
    addressing those gaps by directing VA, in coordination with the
    Department of Defense, to establish a task force to align research,
    improve clinical care, and develop mitigation strategies for blast-
    related injuries.
        The VFW's support reflects our commitment to strengthening
    research, diagnosis, and treatment of blast overpressure injuries,
    ensuring affected veterans receive timely, evidence-based care, and
    improving long-term health outcomes for those who have borne the
    physical and cognitive costs of military service.

    H.R. 6526, Clarity on Care Options Act

        The VFW supports the intent of this legislation to improve access,
    transparency, and accountability within the Civilian Health and Medical
    Program of the Department of Veterans Affairs (CHAMPVA). Far too often,
    CHAMPVA beneficiaries--primarily surviving spouses and dependents--
    struggle to identify health care providers who accept the program,
    leading to delays in care, unexpected out-of-pocket costs, and
    unnecessary stress during difficult times.
        This legislation appears to be designed to create a more accurate
    and reliable understanding of provider participation in CHAMPVA by
    surveying current and prospective providers. If the purpose is to
    strengthen VA's internal data and build the foundation for a CHAMPVA
    provider data base, the VFW supports that goal. However, the
    legislation's wording is too vague and leaves open whether this effort
    would result in a public, searchable directory that beneficiaries could
    use.
        While the legislation's title suggests improved access for CHAMPVA
    users, the body does not clearly require VA to establish and maintain a
    public data base for beneficiaries to locate participating providers.
    If Congress intends this legislation to improve real-world access, that
    requirement must be explicitly stated with clear definitions of who can
    access the data base, how often it will be updated, and how it will be
    integrated into VA and CHAMPVA communications. Clarity between the
    title and substance is essential to ensure the policy delivers on its
    promise.
        The VFW is encouraged by the inclusion of annual reporting to
    Congress, which can help identify geographic gaps in provider
    availability and inform future reforms. However, transparency alone is
    not enough. A directory, no matter how well designed, will not solve
    the problem if providers continue to decline CHAMPVA participation due
    to reimbursement challenges and administrative burdens. Congress and VA
    must use the data from this effort not only to inform beneficiaries,
    but to drive reforms that strengthen provider participation and ensure
    CHAMPVA networks are adequate in every region.
        Families who rely on CHAMPVA have already sacrificed enough in
    service to this Nation. They deserve clear, dependable access to care,
    and this legislation is an important step toward delivering it. The VFW
    welcomes the opportunity to discuss CHAMPVA reform with the committee
    to ensure that all of VA's community care programs (Community Care
    Network, CHAMPVA, and the Foreign Medical Program) offer a similar
    structure and clarity to beneficiaries.

    H.R. 6652, U.S. Vets of the FAS Act

        The VFW supports legislation to expand access to health care for
    veterans living in the Freely Associated States (FAS), many of whom
    served honorably alongside U.S. forces yet face significant barriers to
    receiving the care they have earned. Geography should never determine
    whether a veteran can access timely, high-quality health services.
        The VFW strongly supports the legislation's requirement that VA
    establish formal agreements with FAS governments and expand the use of
    telehealth and mail-order pharmacy services. These tools offer
    practical, cost-effective solutions to improve access in remote and
    underserved regions where traditional VA facilities are unavailable.
    Providing beneficiary travel assistance for in-person care further
    strengthens this legislation's commitment to equity and fairness.
        The VFW emphasizes that expanding access must be accompanied by
    strong implementation planning and sustained funding. Delivering care
    across international borders presents logistical, technological, and
    administrative challenges that cannot be solved by statute alone.
    Congress must ensure VA has the resources and infrastructure needed to
    make these services reliable, not just available on paper.
        The VFW urges that this effort be viewed as part of a broader
    commitment to veterans in the FAS, not a limited or temporary solution.
    Telehealth and pharmacy access are critical first steps, but must be
    paired with long-term strategies to address specialty care, emergency
    services, and treatment continuity.

    Discussion Draft, BEACON Act

        The VFW supports legislation that creates grant programs within VA
    to support research and development of innovative treatments for
    traumatic brain injury, especially chronic mild TBI. It authorizes
    funding through 2028 for academic and nonprofit organizations to test
    new therapies and clinical approaches, with required oversight, annual
    evaluations, and coordination with existing mental health initiatives.
    The legislation mandates detailed reporting to Congress on research
    outcomes and recommendations to enhance TBI care for veterans. It also
    promotes the development, evaluation, and implementation of novel,
    evidence-based interventions to deliver more effective, patient-
    centered care for veterans with mild TBI.

    Discussion Draft, Data Driven Suicide Prevention and Outreach Act

        The VFW does not support this legislation that would establish a
    program to award grants for the development of predictive models to
    evaluate risk factors that contribute to the incidence of suicide among
    veterans, because it does not resolve fundamental gaps in data access
    and risks duplicating programs already in place at VA.
        VA already operates multiple suicide-prevention and predictive-
    analytics initiatives, including existing risk-stratification tools and
    outreach models designed to identify veterans at elevated risk. Rather
    than strengthening these established programs, this legislation would
    create a parallel grant structure that republishes work VA is already
    authorized and funded to do, diverting attention and resources away
    from improving and fully implementing current efforts. More critically,
    the legislation fails to address one of the most significant barriers
    to effective suicide-prevention analytics: the absence of complete,
    timely data from non-VA providers. As more veterans receive care
    through community providers under the VA MISSION Act of 2018 (Public
    Law 115-182), VA does not consistently receive behavioral health,
    substance use, and crisis intervention data in a way that allows for
    meaningful system-wide risk modeling. Without fixing this fundamental
    data-sharing gap, any new predictive model will be incomplete by
    design, limiting its accuracy and undermining its value.
        The VFW is also concerned that expanding artificial intelligence-
    driven surveillance of veterans without first resolving
    interoperability, consent, and trust issues risks creating a system
    that feels focused on monitoring rather than on care. Veterans must not
    feel that technology is used to track them rather than support them.

    Discussion Draft, Whole Health for Veterans Act

        The VFW supports legislation to reduce financial barriers to
    wellness-focused services that promote veterans' physical, mental, and
    emotional well-being. As VA continues its transformation toward a Whole
    Health System of Care, veterans must not be deterred from accessing
    preventive and supportive services because of cost, especially those
    with the greatest needs.
        Whole Health well-being services such as coaching, stress
    management education, mindfulness practices, and integrative therapies
    play an important role in helping veterans manage chronic pain, post-
    traumatic stress, and the long-term effects of military service. By
    eliminating copayments for veterans in Priority Groups 1 through 5 and
    capping monthly copayments for other enrolled veterans, this
    legislation would improve access for the most vulnerable while
    maintaining a reasonable cost-sharing structure for higher-income
    veterans.
        The VFW recognizes that Congress and VA must establish clear
    implementation guidance and oversight to ensure consistent application
    across all VA medical centers. Whole Health services should be
    delivered in a manner that is evidence-informed, veteran-centered, and
    fully integrated with clinical care, not as a substitute for needed
    medical treatment, but as a complement that strengthens overall
    outcomes.

    Discussion Draft, Veterans Health Desert Reform Act

        The VFW supports the intent of this legislation that would improve
    access to hospital care and medical services for veterans living in
    rural and medically underserved areas. Too many veterans must travel
    excessive distances or face long delays simply to receive basic
    inpatient and specialty care. No veteran should be denied timely
    treatment because of where they live.
        The VFW is encouraged by this legislation's efforts to use existing
    rural hospitals to close access gaps, while ensuring that veterans
    receive care comparable to that available through the Veterans
    Community Care Program (VCCP). Reimbursing participating hospitals at
    or above Medicare rates is a practical way to encourage provider
    participation, and the legislation's emphasis on oversight, quality
    tracking, and veteran satisfaction is essential for accountability.
    While this is a positive step, the VFW believes the language should be
    stronger and more precise. Rather than stating that rural hospitals
    should receive priority, the legislation should require the Secretary
    to select hospitals in rural and highly rural areas to ensure the
    policy reaches veterans facing the greatest access barriers.
        The VFW emphasizes that any expansion of hospital care through non-
    VA providers must remain anchored within the VA health care system.
    Veterans receiving care under this program should continue to meet VA
    enrollment requirements and qualify for care under the VCCP. Expanding
    access should not mean removing veterans from VA oversight or creating
    parallel systems that weaken accountability.
        The VFW is encouraged by the legislation efforts to leverage
    existing rural hospitals to close access gaps, while ensuring veterans
    receive care comparable to that available through the VCCP. Reimbursing
    participating hospitals at or above Medicare rates is a practical way
    to encourage provider participation, and the emphasis on oversight,
    quality tracking, and veteran satisfaction is critical to maintaining
    accountability.
        The VFW stresses that any expansion of hospital care outside the VA
    system must be paired with strong care coordination and continuity
    standards. Veterans, especially those with complex or chronic
    conditions, depend on seamless communication between providers. Without
    clear requirements for information sharing, referral management, and
    follow-up care, even well-intended access solutions risk creating
    fragmented treatment and poorer outcomes.
        The VFW cautions against policies that could unintentionally
    accelerate the privatization of veteran health care. Community
    partnerships should strengthen VA, not replace it. Expanding rural
    access must complement VA's mission and preserve its role as the
    coordinator of care, not erode it.
        Chairman Miller-Meeks and Ranking Member Brownley, this concludes
    my statement. Again, thank you for the opportunity to offer comments on
    this pending legislation.

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

    Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has
    not received any Federal grants in Fiscal Year 2026, nor has it
    received any Federal grants in the two previous Fiscal Years.

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

                       Prepared Statement of Easterseals

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    Prepared Statement of American Federation of Government Employees, AFL-
                                      CIO

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                     Prepared Statement of ALS Association

        On behalf of the more than 30,000 Americans living with amyotrophic
    lateral sclerosis (ALS) and their caregivers that we serve, The ALS
    Association thanks you for this opportunity to share our views on H.R.
    6001, the Veterans with ALS Reporting Act. In addition, we would like
    to thank the co-chairs of the congressional ALS Caucus for their
    leadership in the fight to make ALS a livable disease while we develop
    a cure for this devastating disease.
        The ALS Association is the largest philanthropic funder of ALS
    research around the world. The Association funds global research
    collaborations, supports people living with ALS and their loved ones in
    their communities, and advocates for better public policies for people
    with ALS. The ALS Association builds hope and enhances quality of life
    while urgently searching for new treatments and a cure. For more
    information about The ALS Association, visit our website at
    www.als.org.
        ALS, sometimes called Lou Gehrig's disease, is a rapidly
    progressive and always fatal neurological disease that attacks the
    nerve cells responsible for controlling voluntary muscles. The life
    expectancy of a person with ALS averages about two to 5 years from the
    time of diagnosis. The cause of ALS is not known and there is no cure.
    Annual costs associated with ALS, both direct for medical care and
    indirect costs like lost income, are over $1 billion in the US.
        For military veterans, the reality is even more sobering. Decades
    of research have confirmed that veterans, whether they serve in times
    of war or peace, are at significantly greater risk of developing ALS
    compared to their civilian counterparts. Because of ALS's connection to
    military service, the Department of Veterans Affairs has recognized ALS
    as a service-connected disease and assigns a 100 percent disability
    rating upon diagnosis. While this link is recognized, the causes and
    ways to protect military personnel defending our freedoms are still
    unclear.
        H.R. 6001, the Veterans with ALS Reporting Act, represents an
    urgent opportunity for Congress to support our veterans living with ALS
    and their loved ones. This bill is no-to low-cost for the Veterans
    Administration (VA). Even though the VA provides excellent care for our
    veterans living with ALS and their caregivers through their ALS System
    of Care, there are gaps in care that need to be addressed for this
    vulnerable population. H.R. 6001 aims to find those gaps.
        H.R. 6001 requires the Secretary of Veterans Affairs, in
    consultation with the Director of the Centers for Disease Control and
    Prevention, to submit a report to Congress on the incidence and
    prevalence of ALS in veterans. The report must include:

            1. An assessment of ALS incidence and prevalence in veterans.

            2. A description of resources and support provided to veterans
            with ALS.

            3. Identification of any deficiencies in those resources and
            support.

            4. A strategy to develop and test risk reduction strategies for
            ALS.

            5. A pathway for veterans receiving ALS care within VA clinics
            to participate in clinical trials and research.

            6. Recommendations for further legislative action to address
            the challenge of ALS among our military and veterans.

            7. Ongoing tracking of ALS prevalence in veterans using the
            CDC's National ALS Registry and Biorepository, with updates to
            Congress every 3 year.

        This bill serves not only as a report, but also as essential
    support for veterans living with ALS and their families. It represents
    a commitment to actively pursue solutions that address this serious
    disease, reinforcing efforts to promote the health and readiness of the
    military community.
        We appreciate the Committee's consideration of H.R. 6001, the
    Veterans with ALS Reporting Act. The ALS Association strongly endorses
    this legislation and urges swift advancement of this bill. Veterans
    living with ALS do not have the luxury of time. This bill is a key step
    toward ensuring veterans receive the protection, information, and care
    they deserve.

                        Prepared Statement of ALS United

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                        Prepared Statement of Jason Crow

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                      Prepared Statement of Dennis Boothe

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                        Prepared Statement of Endeavors

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                Prepared Statement of Fleet Reserve Association

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                   Prepared Statement of Jewish War Veterans

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       Prepared Statement of Association of VA Nurse Anesthesiologists,
       Association of VA Psychologist Leaders, Association of VA Social
      Workers, National Association of VA Physicians and Dentists, Nurses
       Organization of Veterans Affairs, and Veterans Healthcare Policy
                                   Institute

        Chairman Miller-Meeks, Ranking Member Brownley, and distinguished
    members of the committee:

        On behalf of our six organizations, we thank you for inviting us to
    submit a statement for the record for today's health subcommittee
    legislative hearing on improving the healthcare and services for
    veterans. Members of our organization are veterans, have family members
    who are veterans, had long careers dedicated to serving veterans,
    published papers on veterans' healthcare in peer-reviewed journals,
    presented testimony to your committee, and have served on President
    Trump's President's Roadmap to Empower Veterans and End a National
    Tragedy of Suicide (PREVENTS) task force.
        In today's statement, we wish to convey our appreciation for your
    leadership and commitment to ensuring that veterans receive the highest
    level of healthcare within the Veterans Health Administration (VHA) and
    supplementary care in the private sector when it's both needed and
    authorized by the VHA.
        We address our comments to five of the seven bills considered at
    today's hearing.

    H.R. 2283 The RECOVER Act (Recognizing Community Organizations for
    Veteran Engagement and Recovery Act)

        The RECOVER Act, a 3-year pilot reintroduced by HVAC Chairman Rep.
    Mike Bost, would provide grants of up to $1.5 million ($60 million
    total) to non-profit mental health facilities serving veterans,
    prioritizing areas with large numbers of veterans at high risk of
    suicide. It would establish a parallel care system operating outside
    of, and disjointed from, the VA and the Veterans Community Care Program
    (VCCP), severely weakening the quality of services provided to
    veterans, as we detail below.

    Undermines the Veterans Community Care Program

        The RECOVER Act creates a parallel mental healthcare system that
    fundamentally conflicts with the existing VCCP operations and erode the
    MISSION Act's intention to create a single overarching, coordinated
    program by:

            Introducing competing eligibility rules. For the past 7 years,
            veterans needing mental health care qualified for services
            through the VCCP when VA cannot provide care within 20 days or
            30 minutes of drive time. This bill would bypass the VA's
            authorization process entirely, allowing veterans to access VA-
            paid mental health care from grant recipients whenever they
            choose, ending the foundational principle of the VA as the
            authorizer and overseer of veterans' care,

            The bill subverts the VA's established system for veterans'
            priority group eligibility and co-payments. Unlike the VA and
            VCCP, no veteran would have a co-payment.

            Duplicating existing services. Unlike the Fox Grant program,
            which funds services unavailable through the VA, this bill
            duplicates mental health services delivered by the VA and VCCP.

            Removing VA as the coordinator of care. The MISSION Act
            designated VA as the overall coordinator of care that is
            furnished in the community. Mental health care delivered
            through these grants circumvents that coordinated framework.

    Reduces Quality and Evidence-Based Care Standards

        Despite its stated goal of providing culturally competent,
    evidence-based care, the bill's requirements fall far short. At each
    grant-receiving facility, only one clinician--not all--must be trained
    in ``culturally competent'' veterans mental health care. No providers
    must be trained in evidence-based practices. In sharp contrast, VA
    clinicians have recognized expertise in military-related conditions
    such as PTSD and traumatic brain injury.
        Furthermore, despite prioritizing the awarding of grants in areas
    where there are large numbers of veterans at high risk for suicide, the
    bill includes no requirement for suicide prevention training.

    Fails to Improve Timely Delivery of Services

        The bill establishes no concrete standards for timeliness of
    service. Grantees' wait times could be longer than those currently
    experienced with VA and VCCP services.

    Pays Twice for the Same Care

        The bill explicitly enables existing VCCP facilities to receive
    grant funding without any requirement to increase services--allowing
    providers to layer awards on top of the VA and insurance reimbursements
    that grant recipients already receive for delivered care.

    Eliminates Oversight, Accountability and Adherence to Standards

        The bill lacks crucial quality standards and facility accreditation
    requirements. Unlike VA facilities, grant recipients would not be
    required to obtain accreditation from The Joint Commission or the
    Commission on Accreditation of Rehabilitation Facilities.
        There is no mandate for semi-annual peer review, quality assurance
    standards integral to VA-delivered mental health care.
        There is neither utilization review nor limits to the number of
    appointments per treatment episode.
        Pre-post symptom improvement is not reported, and grants are not
    allocated based on successful outcomes.
        Unlike VCCP providers, recipient facilities face no requirement to
    share health records with VA--a fundamental breakdown in care
    coordination that could leave a veteran's treatment fragmented and
    potentially compromised.

    Undermines the network of the 300+ Vet Centers and 80 Mobile Vet
    Centers

        These options exist to serve veterans who hesitate to seek mental
    health care at VA facilities--presumably one reason for the grants that
    subsidize private sector clinics.

    Summary and Recommendation

        This legislation would severely weaken VA's healthcare model and
    further diminish the VA's ability to provide veterans with high-quality
    mental health care. Changes to the delivery of veteran mental health
    care and suicide prevention cannot come at the expense of VA's
    integrated system, which--when properly staffed and funded--
    consistently succeeds in providing comprehensive, coordinated mental
    healthcare for our Nation's veterans.
        The more effective solution would be expanding VA's mental health
    workforce while maintaining its critical role coordinating care and
    leveraging community resources, rather than creating a parallel system
    with negligible oversight and lower standards of care.
        Finally, this legislation could set a dangerous precedent, with
    veterans' mental health services being a test case for broad
    transformation of the VA from a provider of care provider to an
    insurance payer for care. That's not what the overwhelming number of
    veterans and prefer. The VA's central role in authorizing and
    coordinating veteran healthcare must be preserved while judiciously and
    effectively leveraging community resources within that framework.

    Veterans Health Desert Reform Act of 2025

        The Veterans Health Desert Reform Act of 2025 would establish a
    pilot program allowing three or more rural private sector facilities to
    provide hospital care and medical services to veterans outside of the
    Veterans Community Care Program (VCCP). Rather than protecting
    veterans, it could seriously compromise the healthcare access that most
    veterans currently depend on.
        The VA MISSION Act of 2018 created a comprehensive private sector
    network through the VCCP, guaranteeing veterans emergency medical and
    psychiatric care, as well as walk-in urgent care, anywhere in the
    country. Veterans can also access private sector outpatient care if
    they would wait more than 20 to 28 days for an appointment or must
    drive more than 30 to 60 minutes to reach a VA facility. This new bill
    creates a parallel system that fundamentally conflicts with the
    existing VCCP structure in three critical ways.
        First, it introduces competing eligibility rules that eliminate
    VA's role as authorizer of community care. Under VCCP, VA authorizes
    community care when veterans meet specific eligibility criteria. Under
    this bill, enrolled veterans could obtain VA-paid care at selected
    hospitals and their outpatient clinics simply by calling for an
    appointment or walking in, without any VA authorization.
        This represents a dangerous departure from standard practice. Prior
    authorization is a routine feature of any insurance payer that pays for
    patient care and services. It offers critical protections to veterans
    who might otherwise receive unnecessary tests or procedures, or care
    that isn't based on scientific evidence. VA oversight also protects
    taxpayers from the fraudulent billing practices that are endemic in
    America's profit-driven healthcare system.
        Second, this bill could duplicate services already available in the
    VA and VCCP--including in the same geographic locations. There's no
    stipulation that participating hospitals must be located more than a
    60-minute drive from existing VA (or VCCP) facilities. Veterans might
    end up traveling longer distances than they currently experience with
    VA and VCCP services, defeating the bill's purported purpose of
    addressing health deserts.
        Third, unlike VCCP providers, facilities face no requirement to
    share health records with VA. This represents a fundamental breakdown
    in care coordination that could leave a veteran's treatment fragmented
    and potentially compromised.
        Pilot programs are designed to start small before scaling up. This
    legislation would serve as a test case for arrangements that could
    eventually encompass far larger numbers of hospitals, representing
    another step in the accelerating privatization of VA's integrated
    healthcare system. As veterans shift their care to these facilities,
    funding follows. Declining patient volumes at VA facilities trigger
    budget cuts that force specialized programs to be scaled back or
    eliminated, ultimately depriving many veterans of the VA care they
    prefer and depend on.
        We support a provision in the legislation that aligns healthcare
    reimbursement for veterans with rates paid for non-veteran patients.
    Financial incentives should never create a system where certain
    patients receive priority based on reimbursement disparities. However,
    this worthy reform can and should be accomplished within the existing
    VCCP framework, without creating a parallel system that undermines VA
    care and abandons the safeguards veterans need.

    Recommendation

        The VA's central role in authorizing and coordinating veteran
    healthcare must be preserved while effectively leveraging community
    resources within that framework. The existing VCCP already provides the
    structure needed to address access challenges in underserved areas.
    Rather than creating a competing parallel system, the bill should
    incentivize medical facilities not currently participating in VCCP to
    join that existing program.

    Veterans Mental Health and Addiction Therapy Quality of Care Act H.R.
    2426

        The Veterans Mental Health and Addiction Therapy Quality of Care
    Act seeks to fulfill one of the VA MISSION Act of 2018's most important
    unmet promises: equipping veterans with the information they need to
    make informed healthcare choices and ensuring high-quality mental
    health care across both VHA facilities and the Veterans Community Care
    Program (VCCP). This is an inherently worthy objective. However, the
    bill as currently drafted risks undermining its own goals. Substantial
    revisions are needed to ensure it achieves its intended purpose.
        The most fundamental flaw is the absence of any requirement for VA
    to modify its contracts with Third Party Administrators. Without
    contractual obligations, community care providers will have little
    incentive to assess patients' treatment progress. This means the
    intended comparison between VA and VCCP quality will collapse into a
    one-sided evaluation of VA care alone, completely defeating the bill's
    central intent.
        Compounding this problem, the bill fails to authorize the VA or its
    designated evaluators to be able to access VCCP health care records.
    This creates a critical limitation: any comparison will be restricted
    to whatever records community providers happen to forward. Recent
    scientific studies and GAO reports reveal that only a fraction of
    initial records currently reach VA, with virtually nothing forwarded
    after initial treatment. The bill should explicitly require VCCP
    providers to submit both measurement data and veterans' complete health
    care records to VA for analysis, following the model established by the
    Fox Grant program.
        The study design itself also needs clarification. The comparison
    must specifically contrast veterans treated in VA facilities with
    veterans treated through VCCP. As written, the bill could inadvertently
    compare VA patients with non-veterans in the private sector--an apples-
    to-oranges comparison that would yield far less meaningful results.
        The bill should also specify the use of gold-standard outcome
    measurements that are widely accepted in the field. For PTSD, this
    means the PTSD Checklist. For depression, the PHQ-9. For substance use
    disorder, the Brief Addiction Monitor. These standardized instruments
    are essential for valid comparisons.
        Several additional quality indicators are conspicuously absent from
    the current bill. There is no assessment of whether mental health and
    substance use providers have completed Department-accredited or other
    recognized training specific to the conditions they treat--a
    fundamental gap in any quality evaluation. Similarly, the bill includes
    no requirement to track how many providers collect initial and follow-
    up data and enter it into the electronic health record. Provider peer
    review, another cornerstone of quality assurance, is entirely absent
    from the bill's requirements.
        Wait times to commence treatment also need to be assessed.
        Conducting a rigorous study of this complexity requires expertise
    that goes well beyond administrative capacity. The bill should
    designate that a scientific institution (such as the National Academies
    of the Sciences, Engineering, and Medicine) with demonstrated expertise
    in health outcomes evaluation oversee the study's design, methodology,
    measurement protocols, and analysis.
        Finally, when evaluating the use of evidence-based practices in
    mental health and addiction therapy, the bill should reference the
    rigorously developed VA/DOD Clinical Practice Guidelines rather than
    the American Society of Addiction Medicine criteria.
        With these revisions, the Veterans Mental Health and Addiction
    Therapy Quality of Care Act could fulfill its promise of empowering
    veterans with meaningful quality information. Without them, it risks
    creating an illusion of accountability while leaving veterans no better
    informed than they are today.

    Veterans TBI Breakthrough Exploration of Adaptive Care Opportunities
    Nationwide Act of 2025 (BEACON Act of 2025)

        The BEACON Act fundamentally undermines the VA's existing traumatic
    brain injury research and treatment infrastructure, particularly the VA
    Transitional Research Center for TBI and Stress Disorders (TRACTS).
    Rather than strengthening current programs and improving the lives of
    effected veterans, the legislation risks fragmenting and weakening the
    VA's coordinated efforts in this critical area.
        The bill's stated purpose--to ``increase research and development
    on integrated mTBI and mental health interventions outside the scope of
    traditional Department of Veterans Affairs pathways, interventions,
    programs, procedures, and pharmaceuticals''--appears designed to
    circumvent established clinical channels, potentially creating an
    alternative pathway for peer-based interventions that lack rigorous
    scientific validation.
        This approach is unnecessary and counterproductive. The VA has
    already compiled extensive research on mild traumatic brain injury and
    its treatment. Veterans with mTBI currently have access to evidence-
    based psychotherapies that have been refined and improved over two
    decades of clinical practice. Creating a parallel treatment framework
    for mTBI ignores this substantial body of ongoing work and risks
    duplicating efforts and diverting needed resources.
        Further, placing research grant administration outside the VA
    introduces organizational fragmentation and accountability gaps.

    Data Driven Suicide Prevention and Outreach Act of 2025

        The Data Driven Suicide Prevention and Outreach Act of 2025 would
    create a grant program to develop predictive models for evaluating
    suicide risk factors among veterans. While improving suicide prevention
    is undeniably critical, this legislation fundamentally duplicates the
    VA's existing big-data predictive analytics approach. Rather than
    strengthening the current program, it risks fragmenting and weakening
    the VA's efforts in this vital area.
        Over the last decade, the VA has developed and refined a
    sophisticated suicide risk prediction algorithm and implemented the
    Recovery Engagement and Coordination for Health-Veterans Enhanced
    Treatment (REACH VET) program. REACH VET identifies VA patients at
    extraordinarily high risk for suicide--specifically, the top 0.1
    percent risk tier, patients predicted to die by suicide at a rate 30
    times that of the overall VHA patient population. This risk
    identification is then provided to local REACH VET program
    coordinators, who inform the patient's clinicians so both can work
    proactively to enhance care.
        The program has demonstrated tangible results. A 2021 study found
    that REACH VET was associated with more outpatient encounters,
    increased documentation of new suicide prevention safety plans, and
    fewer inpatient mental health admissions, emergency department visits,
    and documented non-fatal suicide attempts. While the study did not
    identify differences in suicide or all-cause mortality, these process
    improvements represent meaningful enhancements to care coordination and
    crisis response.
        The bill's stated purpose--awarding grants to develop predictive
    models evaluating risk factors that contribute to veteran suicide--
    creates a parallel framework that ignores this substantial body of
    ongoing work. This approach is both unnecessary and counterproductive.
    Any algorithms developed through the grant program would be based on
    much smaller populations than the VA's comprehensive data base,
    inherently reducing their predictive value.
        Creating competing systems fragments resources and effort. Rather
    than paying twice for the same application of artificial intelligence
    and predictive analytics, Congress should invest in expanding,
    refining, and properly resourcing the existing REACH VET
    infrastructure. The VA's program already has the population-scale data,
    established clinical integration pathways, and demonstrated track
    record needed to identify at-risk veterans and connect them with
    enhanced care.
        Thank you for the opportunity to offer our input on these important
    pieces of legislation.

               Prepared Statement of Cohen Veterans Network, Inc.

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                  Prepared Statement of Aspire Health Partners

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                        Prepared Statement of Berry Law

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                   Prepared Statement of Easterseals DC/MD/VA

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              Prepared Statement of Voices for Non-Opioid Choices

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                       Prepared Statement of Centerstone

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                      Prepared Statement of The Up Center

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             Prepared Statement of Air Force Sergeants Association

        Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished
    Members of the Subcommittee:

        On behalf of the Air Force Sergeants Association (AFSA), thank you
    for the opportunity to submit this statement for the record for today's
    Health Subcommittee Legislative Hearing. We appreciate your leadership
    and sustained commitment to ensuring veterans receive timely, high-
    quality, and compassionate care.
        AFSA is the premier professional military association for enlisted
    Airmen and Guardians, representing active duty, Guard and Reserve
    members, veterans, retirees, and their families. Our mission is to
    advocate for a stronger quality of life for those who serve and have
    served--through effective legislation, informed policy engagement, and
    support to the military community. We work closely with Congress, the
    Department of Veterans Affairs, and partner organizations to advance
    commonsense reforms that strengthen readiness, improve health outcomes,
    and honor the Nation's commitment to those who wear or have worn the
    uniform.

    AFSA Strongly Supports H.R. 4509, the NOPAIN for Veterans Act

        Veterans have earned care that is not only available in theory, but
    accessible in practice. Especially when they are recovering from
    surgery or serious medical procedures. Yet too many veterans still
    describe situations where appropriate acute pain care is delayed,
    difficult to obtain, or constrained in ways that do not reflect the
    realities of individual medical need. When acute pain is not
    effectively managed, the consequences can be serious: unnecessary
    suffering, delayed recovery, avoidable complications, and increased
    risk of reliance on medications that may not be clinically optimal for
    that patient.
        This legislation is a practical, veteran-centered step toward
    ensuring the Department of Veterans Affairs can provide clinically
    appropriate, individualized post-surgical pain management, including
    non-opioid options that can reduce unnecessary exposure to opioids
    while still treating pain effectively. It reinforces a simple
    principle: decisions about acute pain control should be guided by
    medical evidence and provider judgment, not one-size-fits-all
    constraints that can unintentionally leave veterans without the right
    tools at the right time.

    Restoring Clinical Judgment While Supporting Responsible Safeguards

        AFSA supports responsible efforts to prevent misuse of controlled
    substances and to promote patient safety. However, policies designed to
    curb misuse must not inadvertently restrict access to legitimate,
    medically necessary pain treatment--especially for veterans managing
    complex injuries, surgical recoveries, or service-connected conditions.
    Veterans are not a monolith. Their injuries, comorbidities, medication
    histories, and responses to treatment vary widely. A pain management
    approach that works for one veteran may be ineffective for another.
        The NOPAIN for Veterans Act appropriately reinforces clinical
    judgment by ensuring VA providers can access a broader set of post-
    surgical pain management options, including non-opioid therapies, and
    apply them based on the needs of the individual veteran. At its core,
    this bill supports the ability of the care team to treat the whole
    patient--reducing pain, supporting mobility and rehabilitation, and
    improving recovery outcomes--without forcing unnecessary tradeoffs that
    can compromise care.

    Conclusion

        AFSA urges Congress to advance H.R. 4509 without delay. Veterans
    should never be forced to endure unmanaged pain as a consequence of
    well-intended but overly restrictive policy barriers. When a veteran
    enters a VA facility for surgery or a serious procedure, they should
    have confidence that their care team has access to a full range of
    appropriate tools to manage pain safely and effectively.
        Again, we thank the Subcommittee for its leadership and continued
    dedication to improving veterans' health outcomes. AFSA stands ready to
    work with you to move the NOPAIN for Veterans Act forward and ensure it
    is implemented in a way that strengthens patient-centered care for all
    veterans.

         Prepared Statement of Tragedy Assistance Program for Survivors

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                         Prepared Statement of VoteVets

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