[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
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of converting between various electronic formats may introduce
unintentional errors or omissions. Such occurrences are inherent in the
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further refined.
C O N T E N T S
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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
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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
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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.
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\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.
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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.
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\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).
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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.
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\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/.
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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\
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\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.
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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.
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\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).
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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\
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\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.
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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.
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\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/.
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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\
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\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.
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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\
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\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.
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\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/.
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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
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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
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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
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of American Federation of Government Employees, AFL-
CIO
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Jason Crow
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Dennis Boothe
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Endeavors
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Fleet Reserve Association
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Prepared Statement of Jewish War Veterans
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
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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Prepared Statement of Embassy of the Federated States of Micronesia
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