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

                        REEVALUATING THE RATING SCHEDULE:
                       EXAMINING VA'S EFFORT TO MODERNIZE
                              DISABILITY BENEFITS

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

                                    HEARING

                                   before the

           SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS

                                     of the

                         COMMITTEE ON VETERANS' AFFAIRS

                         U.S. HOUSE OF REPRESENTATIVES

                        ONE HUNDRED NINETEENTH CONGRESS

                                 SECOND SESSION

                                   __________

                          WEDNESDAY, JANUARY 14, 2026

                                   __________

                               Serial No. 119-43

                                   __________

           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

    63-301                    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 DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS

                        MORGAN LUTTRELL, Texas, Chairman

    AUMUA AMATA COLEMAN RADEWAGEN,       MORGAN MCGARVEY, Kentucky, Ranking
        American Samoa                       Member
    JACK BERGMAN, Michigan               CHRIS PAPPAS, New Hampshire
    NANCY MACE, South Carolina           MAXINE DEXTER, Oregon
    KEITH SELF, Texas                    KELLY MORRISON, Minnesota

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

                             C  O  N  T  E  N  T  S

                                  ----------

                          WEDNESDAY, JANUARY 14, 2026

                                                                       Page

                               OPENING STATEMENTS

    The Honorable Morgan Luttrell, Chairman..........................     1
    The Honorable Morgan McGarvey, Ranking Member....................     3

                                   WITNESSES
                                    Panel I

    Ms. Nina Tann, Executive Director, Compensation Service, Veterans
      Benefits Administration, U.S. Department of Veterans Affairs...     4

            Accompanied by:

        Dr. Ulia Sokol, Medical Officer, Compensation Service,
            Veterans Benefits Administration, U.S. Department of
            Veterans Affairs

                                    Panel II

    Ms. Elizabeth Curda, Director, Education, Workforce, and Income
      Security, U.S. Government Accountability Office................    14

    Mr. Philip Armour, Senior Economist, Director of Ph.D. Program,
      Professor of Policy Analysis, RAND.............................    16

    Dr. Kyleanne Hunter, Chief Executive Officer, Iraq and
      Afghanistan Veterans of America................................    18

                                    APPENDIX
                        Prepared Statements Of Witnesses

    Ms. Nina Tann Prepared Statement.................................    37
    Ms. Elizabeth Curda Prepared Statement...........................    39
    Mr. Philip Armour Prepared Statement.............................    53
    Dr. Kyleanne Hunter Prepared Statement...........................    63

                           Statements For The Record

    Disabled American Veterans Prepared Statement....................    71
    Berry Law Prepared Statement.....................................    75
    Veterans of Foreign Wars of the United States Prepared Statement.    95

                        REEVALUATING THE RATING SCHEDULE:
                       EXAMINING VA'S EFFORT TO MODERNIZE
                              DISABILITY BENEFITS

                                  ----------

                          WEDNESDAY, JANUARY 14, 2026

       Subcommittee on Disability Assistance &
                              Memorial Affairs,
                        Committee on Veterans' Affairs,
                                 U.S. House of Representatives,
                                                        Washington, DC.
        The subcommittee met, pursuant to notice, at 2:16 p.m., in
    room 360, Cannon House Office Building, Hon. Morgan Luttrell
    (chairman of the subcommittee) presiding.
        Present: Representatives Luttrell, Radewagen, Bergman,
    Self, McGarvey, Dexter, and Morrison.

             OPENING STATEMENT OF MORGAN LUTTRELL, CHAIRMAN

        Mr. Luttrell. Right. Good afternoon. Thank you for coming
    today. Everyone in the audience thank you for attending the
    committee hearing today and Disability Assistance and Memorial
    Affairs. The chair may declare recess at any time. The
    subcommittee hearing will come to order. Good afternoon. Again,
    thank you to our witnesses for being here today.
        This afternoon the subcommittee is examining the U.S.
    Department of Veterans Affairs (VA) Schedule for Rating
    Disabilities, otherwise known as the VASRD, and the Department
    efforts modernizing this system. The VASRD is the scale that
    determines how the veteran's service-connected conditions are
    evaluated, which then determine a veteran's eligibility for
    benefits, overall disability ratings, and, ultimately, the
    amount of tax-free money they receive each month.
        While the VASRD is incredibly is incredibly overly over
    complicated, it is important to step back and know that the
    schedule affects real lives. It allows VA to deliver
    compensation to veterans for their service-connected
    disabilities and ensure all veterans are evaluated at the same
    standard.
        Congress created the VASRD with a clear purpose to
    compensate veterans for the average impairment caused by their
    service-connected disabilities to their earnings capacity. The
    rating schedule was created in 1945. While parts of it have
    been updated over time, the overall framework remains
    unchanged.
        In 2007, VA Advisory Committee on Disability Compensation
    concluded that the rating schedule was outdated and recommended
    a full review of all 15 body systems. VA formally began the
    effort in 2009, with a plan to complete this work by 2016. Ten
    years later, VA has only completed a review of 11 body systems
    out of the total 15. According to the testimony provided in a
    Senate hearing last year, VA has now extended its timeline to
    2026. Again, this is more than 10 years beyond the original
    goal.
        VA has made progress, but it is inconsistent thus far. In
    my personal opinion, the veterans of today deserve a system
    that evaluates their disabilities based on the medical evidence
    of today's medical practices. The respiratory, endocrine,
    musculoskeletal, and digestive systems have been updated in the
    past 10 years, but several important systems remain unfinished.
    The neurological, cardiovascular, and hematologic systems are
    still in various stages of review despite many of these
    conditions being common and often complex.
        Mental health remains the most concerning. VA proposed
    updates to the mental health rating criteria in 2022, but those
    changes have not been finalized. As a result, one of the most
    heavily relied upon portions of the rating schedule continues
    to operate under criteria that many believe no longer reflects
    modern clinical understanding or the full scope of functional
    impairment that veterans experience.
        Just as important, VA has not undertaken a comprehensive
    review of the economic component of the rating schedule. That
    component is supposed to connect medical findings to loss of
    earning capacity. Without updating this, the system risks
    drifting further away from its statutory purpose of benefiting
    veterans.
        This uneven modernization has real consequences on the
    veterans community and their families. When rating criteria are
    outdated, inconsistent examiners and raters are left actually
    just to fill in the gaps. That increases the likelihood that
    similar claims are handled differently. Recent U.S. Government
    Accountability Office (GAO) reporting has highlighted
    inconsistent outcomes for similar conditions, outdated medical
    and occupational criteria, and quality review processes that
    are not strong enough to catch errors before they affect
    veterans.
        VA's current quality assurance approach relies on limited
    samplings that often fail to identify broader area of twins--
    trends, excuse me, and too often problems are discovered only
    after decisions have already been issued, leading to rework
    appeals and additional delays. Systems matter, standards
    matter, and today oversight obviously matters.
        I will close with this. For veterans, the disability rating
    process is not an abstract policy exercise. It is often the
    moment when they sit across from the system and ask for help,
    sometimes years after they left the military. When the process
    feels outdated, inconsistent or confusing, veterans do not lose
    confidence in a form or regulation. They lose confidence when
    they ask for help. Where will it be? Modernizing the rating
    schedule is not just about updating language or revising
    criteria. It is about trust. It is about ensuring that when a
    veteran raises their right hand and serves, a system they
    return to is worthy of that commitment.
        With that, I will yield to the ranking member.

          OPENING STATEMENT OF MORGAN MCGARVEY, RANKING MEMBER

        Mr. McGarvey. Thank you, Chairman Luttrell, and good
    afternoon, everyone. Appreciate you all being here today. Mr.
    Chairman, I am grateful for you holding this hearing.
        The VA Schedule for Rating Disabilities, or VASRD, is a
    massive program. It is big in size, it is big in impact, and it
    is absolutely central to how we support our veterans.
    Everything we do on this committee starts with one simple idea,
    that when a service member raises her right hand and serves
    this country, we owe her a system that works. If she is injured
    or becomes ill because of her service, she has earned care,
    benefits, and services, full stop. The process to get those
    benefits should not be so confusing or slow that she feels lost
    before the process even begins.
        This hearing should not be about cutting those services. It
    should be about cutting red tape. Veterans should not need a
    law degree or a medical degree and a decade of patience just to
    get what they have earned by serving our country.
        We also should not be afraid of change. I, for one, think
    the VA's Schedule for Rating Disabilities is outdated. Medicine
    has changed. Diagnostics have changed. The nature of military
    service itself has changed. The injuries and illnesses our
    servicemembers face today look very different to what they did
    80 years ago. Yes, the schedule needs to be updated, but the
    goal has to be clear, and that is to modernize the system
    without harming the veterans. That is the line we cannot cross.
    That is the mission that is central to this committee.
        I have a few questions that I think we can begin to answer
    today. If we are trying to figure out whether the current
    schedule actually works, we have got a real challenge. There is
    almost no up-to-date, publicly available research on how VA's
    compensation system is performing. How do we fill that gap?
    What additional data do we need? How do we get it? How do we
    use it?
        If today's hearing is about understanding the methodology
    VA is using to update this disability rating schedule, then I
    welcome that. Across multiple administrations, VA's work on
    VASRD has been a black box. Veterans deserve transparency.
    Congress deserves transparency so that we can help our
    veterans.
        Mr. Chairman, I also want to address something that we have
    been hearing in the media a little bit, that there is a growing
    narrative that disability compensation is somehow too generous
    or that it is arbitrary and there is encouragement for veterans
    to game the system. I want full transparency. I want to know
    everything that is going on. I resent that characterization of
    our veterans. Our veterans, it is not who they are, and it is
    not what this program is.
        These benefits are not handouts. They are not freebies.
    They are a recognition of service and sacrifice. For many
    veterans, they are the only support they have when service-
    connected conditions make work difficult or impossible.
        Mr. Chairman, you know better than I do about the risks
    that military service carries and that most civilians will
    never fully understand. Those risks do not end when someone
    takes off their uniform. They can follow a veteran for the rest
    of their life, and they cannot be reduced to a simple earnings
    loss formula.
        We also have to remember that health relates to the whole
    person. A diagnosis that sounds minor to you or to me might be
    a sign of something much bigger. A veteran who has cystic acne
    that is linked to Agent Orange exposure is not just dealing
    with acne. They are living with the consequence of toxic
    exposure, and that context matters.
        We also have to remember what these programs are. No matter
    how big they are or how big they get, the heart of these
    programs are our veterans, human beings. Our brothers, sisters,
    moms, dads, sons, and daughters who put on a uniform willing to
    serve us, people who deserve the dignity and care they have
    earned in exchange for that service.
        Which brings me to the last point I will raise, Mr.
    Chairman. My concern today that we only have one veteran
    service organization testifying. Veterans are not monoliths.
    They go into different branches of the service with different
    experiences at different times. Their voices should be central
    to this conversation. I hope that we can have more
    conversations with the Veterans Service Organizations (VSO) on
    this topic as we move forward. Their voices are important, the
    most important ones in this discussion.
        Mr. Chairman, I am looking forward to a productive and
    honest discussion today. I hope this is just the beginning of
    our oversight into this issue. There is a lot more work to do,
    and I yield back.
        Mr. Luttrell. Thank you, Mr. McGarvey.
        I would like to introduce our witnesses. Our lead witness
    from VA is Ms. Nina Tann. Ms. Tann is the executive director of
    Compensation Service at the Veterans Benefits Administration
    (VBA). Good afternoon. She is joined with Dr. Sokol, correctly
    pronounced, is a medical officer in Compensation Services at
    the Veterans Benefits Administration. Thank you both for being
    here today. I ask that you please stand. Raise your right hand.
        [Witnesses sworn.]
        Mr. Luttrell. Let the record reflect that the witnesses
    have answered in the affirmative. You may be seated.
        Ms. Tann, at any moment if you need to--okay. Ms. Tann, you
    are now recognized for 5 minutes for your opening statement.

                         STATEMENT OF NINA TANN

        Ms. Tann. Good afternoon, Chairman Luttrell, Ranking Member
    McGarvey, and members of the subcommittee. I appreciate the
    opportunity to appear before you today.
        Mr. Luttrell. Ms. Tann, is your mic on?
        Ms. Tann. Yes, sir.
        Mr. Luttrell. Okay. Thank you.
        Ms. Tann. Good afternoon, Chairman Luttrell, Ranking Member
    McGarvey, and members of the subcommittee. I appreciate the
    opportunity to appear before you today to discuss VA's efforts
    to modernize disability benefits. I am accompanied today by Dr.
    Ulia Sokol, medical officer with the Veterans Benefits
    Administration.
        For disability compensation or pension purposes, a
    veteran's disabilities are evaluated using the guidance in the
    VA Schedule for Rating Disability, or VASRD, also known as the
    rating schedule. Under the authority established by 38 U.S.C.
    1155, the VA Secretary shall adopt and apply a schedule of
    ratings of reductions in earning capacity from specific
    injuries or combination of injuries. This rating shall be
    based, as far as practicable, upon the average impairments of
    earning capacity resulting from such injuries in civil
    occupations. The Secretary shall, from time to time, readjust
    this schedule of ratings in accordance with experience.
        VA is committed to updating its disability rating criteria
    to accurately reflect medical science advancements and improved
    technology and current terminology. These updates allow VA to
    ensure its disability evaluations more accurately compensate
    veterans based on impairments and average earning ability.
    While VA has made numerous changes to the VASRD, it has not
    completed a holistic comprehensive update since 1945.
        In 2003, the Government Accountability Office, or GAO,
    deemed VA's disability program high-risk because VA had not
    systematically updated the VASRD. In response, VA developed a
    modernization plan in 2009, with the goal of comprehensively
    updating all 15 body systems of the VASRD. VA established work
    groups that included medical and VA policy Subject Matter
    Experts (SME) and used the analysis following its thorough
    review of established medical research to begin the rulemaking
    process, which involves drafting and publishing a proposed and
    final rule for each body system.
        To date, VA has completed updates on 11 of the 15 body
    systems. Any updates made to the VASRD are point forward in
    that they do not impact veterans currently service-connected
    for that particular condition or veterans who filed their
    claims prior to the implementation date of new rules. VA
    anticipates publishing the final rules for all four body
    systems in three rulemakings by the end of Fiscal Year 2026,
    which will complete the first holistic comprehensive update
    since 1945.
        In 2019, VA established the VASRD Program Management Office
    with a mission of revising the VASRD through rulemaking, body
    system by body system in staggered cycles of recurring reviews
    as well as in response to GAO's high-risk recommendations. VA
    has successfully met three of the five high-risk categories
    identified by GAO and have partially met the remaining two as
    we continue the iterative process of ensuring alignment of the
    VASRD evaluation criteria with medical, scientific, and
    technological advancements.
        The rulemaking process generally takes 2 to 5 years to
    complete, but can take longer due to the length and medical
    complexity of the VASRD proposed updates. Updates to the VASRD
    require coordination to implement required claims processing
    changes and to provide training and guidance to clinicians on
    the disability benefits questionnaires and to claims processors
    charged with correctly applying current disability evaluation
    criteria.
        Following the completion of the first holistic and
    comprehensive update to the VASRD since 1945, VA will actively
    pursue opportunities to update the VASRD. In our next phase VA
    plans to continue updating the VASRD with the evolution of
    medical science, technology, and treatment modalities. While VA
    aims to update the schedule to simplify the claims process for
    veterans and to promote a fair, objective, and efficient
    process, VA will also standardize rating terminology,
    incorporate the effects of court decisions, and address
    contemporary claims processing issues to assist claims
    processors charged with delivering fair, efficient, and timely
    benefit decisions to veterans. VA is focused on completing the
    first holistic change and anticipate starting the next phase of
    this iterative process at the end of this fiscal year.
        In closing, VA remains committed to modernizing disability
    benefits by making continuous updates to the VASRD. We thank
    the committee for your continued support of programs that serve
    the Nation's veterans and look forward to working together to
    further enhance delivery of benefits and service to veterans.
        Mr. Chairman, this concludes my statement. My colleague and
    I are prepared to respond to any questions that you or other
    members of the subcommittee may have.

        [The Prepared Statement Of Nina Tann Appears In The
    Appendix]

        Mr. Luttrell. Thank you, Ms. Tann. The written statement of
    Ms. Tann will be entered into the record. We will now move to
    questioning.
        I am going to ask some clarification questions. By the end
    of 2026, all body systems will be complete and this program
    will be completely buttoned up?
        Ms. Tann. This first holistic comprehensive review of the
    body systems.
        Mr. Luttrell. All 15 body systems?
        Ms. Tann. All 15 body systems.
        Mr. Luttrell. By the--in the Fiscal Year 2026?
        Ms. Tann. By the end of this fiscal year.
        Mr. Luttrell. Okay. That is great news. Good to hear that.
        Can you explain to me, and I can appreciate the
    complexities of this, why has this taken so long? I do not want
    to have to ask you this question at the end of 2026 of why we
    have not completed it. Can you explain to me? I understand when
    we are diving into the mental health issue, and I know that is
    almost impossible to figure out. Right? Can you explain to me
    why the last three have taken so long considering--and I will
    not put 1945 in there, just from the late 2019s to now.
        Ms. Tann. Sure. We have actually been updating all along.
    We have focused in, primarily, some of the most recent updates
    have been from 2017, but we have updates all the way back to
    1994. Some of the----
        Mr. Luttrell. What is an update?
        Ms. Tann. Update is through a final rule in which we are
    using updated medical evidence, science, technology to look at
    each of the body systems, as you mentioned, and we are looking
    at each of the diagnostic criteria that goes along with it.
        Mr. Luttrell. Where are we aggregating our data from?
        Ms. Tann. We have a series of processes through our work
    groups and the development where we look at all sorts of data
    from the medical community, and Dr. Sokol can speak more
    about----
        Mr. Luttrell. Our medical community or outside the VA?
        Ms. Tann. We use a combination. We look at published
    literature. We use resources from things like all the
    American--also American Heart Association, for example. We look
    at peer-reviewed literature, all sorts of data and information.
        Mr. Luttrell. We are bringing that internal to the VA
    system? Aggregated data outside and internal to the VA is all
    aggregated internal to the VA, correct?
        Ms. Tann. When we establish a working group, we have a
    number of SMEs and clinical advisors, both in VA and outside of
    VA, and they look at current medical literature from those
    types of associations and things of that nature. They are
    bringing all of that data in. We do have clinicians, not only
    in VBA, in Compensation Service and our Medical Disability
    Examination Office (MDO) office, which you are familiar with,
    at Veterans Health Administration (VHA). Those are some of the
    sources who then look at the available data and evidence and
    they pull that into the process.
        Mr. Luttrell. Where do we currently sit with the
    advancements of Machine Learning (ML) and Artificial
    Intelligence (AI)?
        Ms. Tann. We are open to exploring how we can bring
    technology into this process. I think we have a unique
    opportunity now.
        Mr. Luttrell. We have not done that yet?
        Ms. Tann. Not in the process of VASRD modernization.
        Mr. Luttrell. Why not? The world around us is.
        Ms. Tann. Sure.
        Mr. Luttrell. You may not be able to answer that question,
    but I know somebody in your Department who I am going to call
    as soon as this hearing is over with to ask why implementation
    of AI and ML is not in this rating discussion, because it makes
    absolute sense for it to be.
        Ms. Tann. I think as our focus has been on this first
    holistic update as we move into our next iteration, that is
    something that we are absolutely welcome to explore. I think
    there is opportunity for that, sir, and I can take that back or
    as--if you----
        Mr. Luttrell. Please do. I would actually like to have an
    answer to that. It makes more sense to me now and an
    understanding of how machine learning is effectively changing
    the dynamics of how we interpret medicine. I can assure you our
    veterans will be very pleased to know that we can do this in a
    matter of milliseconds, not a matter of months and years, and
    these platforms can do that for us. Implementation is where we
    seem to be hung up.
        Not to beat up on the VA too much, but the VA can be very
    siloed at times. I think that might be a missed opportunity if
    we just continue down the kind of the railway that we are on
    with--and by all means, I know that everyone that touches this
    information is brilliant, but when you can process information
    at petaflop speeds, that is a game-changer. Thank you.
        Ranking Member.
        Mr. McGarvey. Thank you, Mr. Chairman. I will build on that
    point for just a second. I do not want to speak for you at all,
    but, you know, we do not want to hear something is too
    complicated, especially if that means 5 and 10 years from now
    it is really a lot more complicated because we did not do
    something today that we should be doing. I just want to build
    on that a second.
        Ms. Tann, I will start with you. As I said at the
    beginning, veterans are at the heart of every single thing we
    do. That is what this committee is about. It is about serving
    our veterans. I would like to start by asking the Department's
    process for including veteran and VSO feedback into your
    methodology.
        Ms. Tann. So----
        Mr. McGarvey. Waiting until the notice and comment period
    for proposed rules, to me that is too late. I want to know to
    what extent and through what process do you ask stakeholders
    for their input before you get into the rule drafting phase?
        Ms. Tann. We do follow the American Procedures Act (APA)
    and within that we do have limited opportunities with which we
    can have what is considered ex parte conversations so that we
    are not being unduly influenced or having more weight or access
    to more information for any group of stakeholders and others so
    that we maintain transparency. We do invite, through that
    required 60-day public comment period as--we invite anyone to
    provide input into that process. We do not actually currently
    have processes in which we are doing it because we are bound by
    those requirements of the APA.
        Mr. McGarvey. I appreciate you being clear and at the end
    there getting to the point: it does not happen. To take this
    out of government-speak, when you said there is limited
    opportunities for ex parte conversation, what that really means
    is we are not talking to veterans before you all come up with a
    rule. To me that needs to change.
        You said unduly influenced. I do not view this as undue
    influence. I think talking to the end user of this service is
    of paramount importance, particularly because this is all about
    helping our veterans and we know this. Sometimes something can
    look good on paper and then it gets into practice and it does
    not work the way you intended, even if you had the best
    intentions. Getting that feedback from our veterans is really
    important.
        I understand that Disability Compensation Advisory
    Committee exists, but their work is infrequent and it is
    increasingly sidelined by this administration. Can you commit
    to doubling down on efforts to get more veteran input into this
    process at an earlier stage?
        Ms. Tann. I will identify ways that we can do that, sir.
        Mr. McGarvey. Thank you. We would love that.
        As I understand it, VA is working on a new loss-earnings
    study given how old the previous one is. When do you expect to
    complete that study? Will you commit to making both the data
    supporting that study and its results public?
        Ms. Tann. We are evaluating the deliverables from that
    study. We actually had contractor support that ended at the end
    of Fiscal Year 2025. My team is actually in the process of
    evaluating that information from those studies, which was a
    test program and a proof of concept to kind of see where we go
    next from that.
        Mr. McGarvey. Can we see the data supporting the study and
    the results when it is all finished?
        Ms. Tann. I will take that back, sir.
        Mr. McGarvey. Yes. I am going to press you a little bit on
    that because I think we deserve better than that and I know our
    veterans deserve better than that.
        This is not a gotcha moment. This is asking for the data
    used in conducting a study and the results that impacts our
    veterans. We want to understand how we are coming up with these
    calculations that our veterans oftentimes depend on when they
    have been injured because of their military service and what
    that means for them. It is really important for anyone to have
    that and for it to be a transparent, inclusive process so we
    know what is going on.
        We are going to keep following up with you on that. It
    needs to be more than an answer, a throwaway answer in a
    committee of we will take that back to somebody. I know our
    veterans are entitled to that information and I want to make
    sure they get it.
        As I understand it, the VA has historically provided
    updates to GAO on your ongoing work around revising VASRD. When
    was the last time VA met with them? Have you shared your
    methodology with them recently?
        Ms. Tann. We do meet with GAO regularly. The last status
    update, I cannot give you the exact date when we did that. I do
    know in Fiscal Year 2025 that is when we had the increase and
    moved to partially met for the monitoring stage of the high-
    risk list criteria. We do have ongoing communications with GAO
    and others and provide status updates as required.
        Mr. McGarvey. Have you shared it with any outside
    researchers at all?
        Ms. Tann. Not to my knowledge, sir.
        Mr. McGarvey. I think it would, also--this is another
    thing. I just think it is helpful to have a second set of eyes
    on this type of thing to validate the methodology, to make sure
    we are coming up with the best system to help our veterans.
    Especially these are our veterans who have been injured in
    their service or are disabled because of their service.
    Appreciate that.
        Mr. Chairman, my time is expired. I yield back.
        Mr. Luttrell. Thank you, sir.
        Mr. Bergman, General, you are recognized, sir.
        Mr. Bergman. Thank you, Mr. Chairman.
        I had a chance here the last 20 minutes or so just kind of
    reflect on what everybody was saying. Couple of thoughts.
        1945, my dad was just mustering out of the Navy after World
    War II. Okay. I think about his last endeavor before he passed
    some 40-some years ago, was he was a volunteer driver for the
    county VSO to get the veterans to the VA hospital over by the
    Minneapolis airport. I, you know, I think about my parents,
    what they went through in the Depression and then World War II.
    We are using the date here, 1945, in current data. Scares the
    hell out of me in some ways because it means we did not change.
        Someone said a couple of different ways, it is complicated.
    Yes. Life is tough, but it is tougher when you are not exactly,
    you know, embracing it every day. It gets more complicated. It
    is like a ball of bureaucratic string that was built over time.
    Nobody knows where it starts, where it ends. All they know is
    it is this big ball of string, and it is a reason to say no.
        Having said that, let me just ask just--and a sense of
    urgency would be extremely helpful and desired within the
    Veterans Administration, as well as everybody involved in this,
    whether it is the VSOs, the veterans, but especially the
    bureaucracy of the Veterans Administration. If it is
    complicated, it is up to those of us in charge of what we are
    doing right now to uncomplicate it as best we can. When you
    heard about AI and ML, that is a way to begin the unraveling
    and the uncomplication of it.
        To what extent do outdated portions of the VASRD--you can
    use that in a pronunciation and an acronym, VASRD?
        Ms. Tann. ``VASR-D.''
        Mr. Bergman. Yes, boy. ``Varsity,'' VASRD, huh? As opposed
    to the junior varsity? Okay, got it.
        Ms. Tann. You can say rating schedule, sir.
        Mr. Bergman. All right. To what extent does the outdated
    portions of it make it harder for the VA to consistently and
    accurately evaluate modern, complex conditions among younger
    veterans? We know, based on the nature of war, the injuries
    that were received in World War I, World War II, Korea,
    Vietnam, Desert Shield, Desert Storm, Operation Iraqi Freedom
    (OIF), Operation Enduring Freedom (OEF) have changed because of
    the nature of the fight, the survivability, et cetera, et
    cetera. Are we getting rid of the outdated stuff? I mean,
    regardless of timelines, do you really think when all is said
    and done, this will really be reflective of the types of
    injuries that our veterans are receiving in conflicts today?
        Ms. Tann. Yes, sir, I do. As part of our updates, and
    again, to be clear, it is not that we have not updated since
    1945. The systemic and holistic update has not been completed,
    but we have updated body systems, diagnostic codes, and we do
    remove outdated terminology. We remove outdated testing and
    things that are not accepted in the medical and clinical
    community. We remove instances where there may be subjective
    criteria.
        I will use for an example in the proposed rule for the
    neurological body system where some nerve paralysis could be
    rated by mild, moderate, or severe. Well, that is not really
    great objective criteria then for someone to use. We are adding
    testing and objective and measurable components that help
    reflect the current disability picture, like you mentioned, of
    what our veterans are experiencing today. We add new diagnostic
    codes. We--like for mental health, for example, we are
    proposing updates that adapt to the DSM-4.
        Mr. Bergman. I mean, I know you could--okay. Is there a
    sense of urgency?
        Ms. Tann. Absolutely.
        Mr. Bergman. I guess it would be helpful if you could, you
    know, not today, but give us something that shows a sense of
    urgency, that actually shows that. We hear it, but I can be
    honest with you, I do not see it. Okay?
        Ms. Tann. Yes, sir.
        Mr. Bergman. I will just leave it at that and I will yield
    back, Mr. Chairman.
        Mr. Luttrell. Mrs. Radewagen, you are recognized for 5
    minutes.
        Ms. Radewagen. Thank you, Mr. Chairman, for holding this
    important hearing today. Thank you to the witnesses.
        Ms. Tann, what is VA's plan for future updates of the VASRD
    and what criteria is VA using to prioritize future updates?
        Ms. Tann. Thank you for that question. We are using the
    lessons learned from this first iteration and best practices.
    We are looking at ways to be more strategic in that. We do not
    just necessarily want to take a look body system by body
    system, but where we have evidence and data that supports that
    we need to take another look. Some of that may come from
    studies and things such as our earnings loss studies, if we are
    able to use that. We will use areas where we know in medical
    science that have changed and updated through technology and
    treatment modalities. We will look at the body systems.
        We will also look at individual diagnostic codes and, based
    off the available evidence, we will prioritize those remaining
    updates or the next phase of updates with all of that
    information in mind. Trying to take a much more strategic
    approach, project management focused approach to it, I think,
    because we do have this experience and lessons learned from
    this first holistic update that will be completed by the end of
    this fiscal year.
        Ms. Radewagen. Ms. Tann, does VA have a project management
    plan or other document that outlines goals, objectives, or a
    schedule for future updates? If not, is there a timeline for VA
    to develop such a plan?
        Ms. Tann. We do have a plan for the first iteration, which
    is coming to a close, as I mentioned before, and we are working
    on what that project management plan for the next iteration
    will look like so that we do have schedules, milestones, and
    things like that to measure our progress and to make sure that
    we are following good project management principles for our
    future updates.
        Ms. Radewagen. Thank you, Mr. Chairman. I yield back the
    balance of my time.
        Mr. Luttrell. Thank you, ma'am.
        Mr. Self, sir, you are recognized for 5 minutes.
        Mr. Self. Thank you, Mr. Chairman. I have just got some
    probably easy questions to answer. Why sleep apnea? Is that
    military related?
        Ms. Tann. It can be. For VA disability purposes, we look at
    disabilities that were incurred in or caused by or aggravated
    by military service. If something started during military
    service, then we have a responsibility according to the law to
    service-connect sleep apnea for any residual disability based
    upon that.
        Mr. Self. Really? Okay. How much of this, and I realize
    this is not Veterans Integrated Service Network (VISN) driven,
    but how much of this is customization that is allowed amongst
    the different contractors? How much of that? We see that, I see
    that often, we allow too much customization across the VA.
        Ms. Tann. So are you referring to our Disability Benefits
    Commission?
        Mr. Self. Yes, yes, the----
        Ms. Tann. We have criteria which must be supported by
    clinical findings and medical evidence. That is one----
        Mr. Self. How much of that is customizable?
        Ms. Tann. We do cut down on areas of free text, but we do
    need the doctor's observations. We do--but we use testing, we
    use clinical criteria, and we look at the entire disability
    record and we do not rest anything on just one single piece of
    evidence.
        Mr. Self. There is a statement in here that more veterans
    are relying on disability. Is that actually true or is that--do
    we see a growth in this?
        Ms. Tann. I do not have any evidence to support that. More
    evidence--excuse me, more veterans are relying on this benefit.
    We do have veterans that are employed. Most veterans that we
    serve are actually employed in some part and gainfully employed
    in many situations.
        Mr. Self. Would you just give me, and you may have already
    covered this and you probably have, and I apologize if you
    have, give me a short dissertation on impairment disability
    versus financial inability to earn? Why that distinction and
    how is that working in all of this review that you are doing?
    This seems to me to be part of the crux of what we are asking
    here.
        Ms. Tann. Part of our evaluations, we look at occupational
    impairment and functional loss. I think when, in VA terms, when
    we look at things like TDIU, which I am sure you are familiar
    with, when we find veterans who are unemployable because of
    service-connected disabilities, if they do not meet that
    criteria otherwise, then we have benefits in store for that.
    You could very easily have a 100 percent service-connected
    disabled veteran who is able to work, For us, a disability and
    100 percent evaluation does not mean unable to work in many
    situations.
        Disability compensation does not mean that a veteran cannot
    earn wages, that they are unemployable. It means that based off
    the residual impairment, the VA finds them to be 100 percent
    disabled because of the severity of their disabilities.
        Mr. Self. Right. How are you going to apply either one of
    those really to mental health, which is a growth industry? As
    we know, mental health amongst veterans is rampant. How is that
    working with mental health? It is a little bit different than
    physical impairment.
        Ms. Tann. Certainly. I am going to ask----
        Mr. Self. How are you going to apply that?
        Ms. Tann. I am going to ask Dr. Sokol to address that
    because she has done a lot of the work in that area.
        Dr. Sokol. Good afternoon. Currently, the portion of the
    rating schedule which addresses mental disorders is in the
    final stages of its publication as a final rule. We did publish
    the proposed rule several years ago, which received
    overwhelmingly positive feedback from the veterans community,
    from clinicians. That is because we adhered to the latest
    approach to assessing the functional impairment due to mental
    disorders, which is outlined in great detail in DSM-5, which is
    the governing document for all psychiatrists and clinical
    psychologists to assess the level of functional impairment due
    to mental disorders. In this new portion of the rating
    schedule, we will be able to adequately address the level of
    functional impairment and corresponding occupationally
    significant disability. We are looking forward to publishing it
    by the end of the Fiscal Year 2026.
        Mr. Self. Okay. Real quickly, what has the toxic exposure
    law done to this examination, this review of your disability
    criteria?
        Dr. Sokol. I will ask Ms. Tann to weigh in on this
    question, please.
        Mr. Self. Just quickly. I am out of time.
        Ms. Tann. Sorry, sir. We have a process by which we look at
    toxic exposures through our military. I am sorry, it is called
    the Military Environmental Exposures Sub-Council (MEESC) for--
    it escapes me right now what that group looks at, but that is a
    separate group that looks for things based off our presumptive
    conditions----
        Mr. Self. Right.
        Ms. Tann [continuing]. based off the codified requirement
    for that disease process. We look at those slightly differently
    based off exposures and what the science and evidence shows
    based off that exposure.
        Mr. Self. You have made my point, more complexity. I yield,
    Chairman.
        Mr. Luttrell. Thank you, Mr. Self.
        If we are using DSM-5, what data--can you give me, Dr.
    Sokol, can you give me kind of a timeframe of the data that we
    are currently using to define mental health for the VASR
    system, VASRD system? Let me give you a little bit more depth
    to this because----
        Dr. Sokol. Yes. Will you please----
        Mr. Luttrell. Yes, absolutely.
        Dr. Sokol [continuing]. expand a little bit on the data
    portion?
        Mr. Luttrell. Before I showed up to this wonderful place,
    my focus was in neuroscience. One thing my professors told me
    when I was in grad school is that what you are going to learn
    today will not be correct in 5 years. How were they right. It
    is not more or less a concern because research is research, but
    are we about to do an implementation of information that is
    already outdated?
        Dr. Sokol. Well, let me revisit DSM-5. DSM-5 is updated on
    average every 16 to 18 years.
        Mr. Luttrell. Great. I mean, that is a home run.
        Dr. Sokol. There is a great big committee which gathers all
    the data between the Diagnostic and Statistical Manual of
    Mental Disorders (DSM) publications. The current DSM, DSM-5,
    was published in 2013, and it had introduced a lot of changes
    to the way we look at the functional impairment due to mental
    disorders.
        Mr. Luttrell. In 2013, a severe traumatic brain--there were
    three levels of traumatic brain injury in 2013: mild, medium,
    and severe.
        Dr. Sokol. Well----
        Mr. Luttrell. That is it.
        Dr. Sokol. Actually the biggest introduction was the
    multidimensional approach to the way we look at their mental
    health and mental disability. Those multidimensional approach
    means that all of us are built the same way and there are
    certain number of domains of function, such as ability to
    interact with others, cognition, self care, and so on and so
    forth. That multidimensional approach, which was introduced
    based on a great deal of data by DSM-5, is the basis of our
    review of the VASRD Rating Schedule for disability mental
    disorders portion.
        Mr. Luttrell. That will not be updated until the DSM-5
    comes out with the DSM-6 version?
        Dr. Sokol. It will be updated by the end of Fiscal Year
    2026. It is updated already. It will be published. This final
    rule----
        Mr. Luttrell. Off of the DSM-5?
        Dr. Sokol. Yes. It is based on DSM-5 multidimensional
    approach.
        Mr. Luttrell. Fifteen years ago. Somebody do the math.
        Dr. Sokol. No, it was----
        Mr. Luttrell. 2013?
        Dr. Sokol. 2013.
        Mr. Luttrell. 23 is 10 plus--that is concerning because how
    much more we know today will not be near as much as we know
    tomorrow when we are dealing with the beautiful mind that sits
    between our ears, which every single human being is different,
    which I am sure you absolutely know.
        Ms. Tann, the end of 2020, give me a--do you have a date? I
    am big on dates. The day after this thing goes out, I would
    like you and Dr. Sokol sitting in front of us and assuring us
    that we are--we got a green light and we are good to go. Do you
    have----
        Ms. Tann. We anticipate our remaining final rules to be
    published around the summer of 2026.
        Mr. Luttrell. Summer of 2026.
        Ms. Tann. Then we will have time for implementation and an
    effective date, sir, beyond that.
        Mr. Luttrell. Summer of 2026. Interesting. Okay.
        Mr. McGarvey, you good? General? Mrs. Radewagen, do you
    have a question? You are good? Mr. Self? Good to go?
        Okay. Thank you very much for your testimony today. Thank
    you. Again, thank you for everything that you are doing for our
    veterans and the Department of Veterans Affairs. I like to say
    this every single time we have a hearing. The VA is one--is a
    big machine. Everybody plays their role. Every morning that we
    wake up, every morning that you wake up, we absolutely know
    that who we are serving is our veterans, and we are here
    because of them. Thank you and have a very blessed day.
        Ms. Tann. Yes, sir. Thank you. Thank you for this.
        Dr. Sokol. Thank you for this opportunity.
        Mr. Luttrell. Yes, ma'am.
        Once the first panel is up, panel number two may be seated.
        Our first witness on this panel will be Ms. Elizabeth
    Curda. Ms. Curda is the director of Education, Workforce, and
    Income Security at the Government Accountability Office. Second
    witness on the panel is Mr. Philip Armour. Mr. Armour is the
    director of the RAND School of Public Policy Ph.D. program and
    a senior economist at RAND. Our third witness is Dr. Kyleanne
    Hunter. Dr. Hunter is the Chief Executive Officer (CEO) of Iraq
    and Afghanistan Veterans of America (IAVA). What branch?
        Dr. Hunter. Marine Corps. Best one.
        Mr. Luttrell. I feel like as a Navy guy, I should say
    something. Okay. Thank you for your service. I would like to
    welcome the witnesses to our second panel. The witnesses, I
    please ask that you stand and raise your right hand.
        [Witnesses sworn.]
        Mr. Luttrell. Let the record reflect that the witnesses
    have answered in the affirmative.
        Ms. Curda, you are now recognized for 5 minutes to deliver
    your opening testimony.

                      STATEMENT OF ELIZABETH CURDA

        Ms. Curda. Good afternoon, Chairman Luttrell, Ranking
    Member McGarvey, and members of the subcommittee. I am pleased
    to discuss GAO's work on VA's efforts to update its disability
    rating schedule.
        When veterans file claims for disability compensation, VBA
    claims processors use the rating schedule to determine monthly
    compensation. VA's Disability Compensation Program provides
    billions of dollars in benefits to millions of veterans and
    their families. VA must be able to make accurate decisions
    about the amount of compensation a veteran receives as a matter
    of fairness to veterans and to ensure the program is achieving
    its intended results.
        VA has struggled to stay current with needed updates to the
    rating schedule. In 2003, we designated VA's Disability
    Compensation Program high-risk, in part because its rating
    schedule did not fully reflect advances in medicine and
    technology and changes in the labor market that have occurred
    since 1945. VA is required to base its compensation decisions
    on the average loss in civilian earnings resulting from a
    veteran's service-connected disability, but it has never
    updated this information based on data-driven analysis. My
    testimony today discusses VA's progress on updating the medical
    and earnings loss information in the rating schedule as well as
    remaining challenges.
        Medical information includes the types of disabling
    conditions that veterans may have organized into the 15 body
    systems. Earnings loss information is the average decrease in
    expected earnings caused by those disabilities. VA has taken
    positive steps to improve the process for updating medical
    information.
        In terms of progress, between 1945 and 2009, VA mainly
    focused on updating the rating schedule with new medical terms
    and criteria for determining a condition's severity. In 2009,
    VA embarked upon an ambitious effort to comprehensively update
    both medical and earnings loss information. These changes
    included establishing an office to plan and oversee these
    efforts. VA has also begun making plans for a 10-year cycle for
    updating the medical information to more systematically
    consider advances in the evaluation and treatment of medical
    conditions.
        Since 2009, VA has completed updates to the medical
    information for 11 of 15 body systems. After years of fits and
    starts, VA has also begun testing its own earnings loss
    studies. VA is testing how the Department could produce
    earnings loss data and update the rating schedule with this
    information.
        However, VA still faces challenges keeping its rating
    schedule up to date. It has yet to complete comprehensive
    revisions for four body systems. VA's attempts to revise some
    of these systems have been going on for years. In addition,
    information about how veterans' disabilities affect earnings
    loss remain a major gap. It is uncertain whether or when VA
    will complete these studies and use the information to update
    the rating schedule.
        Going back decades, VA and external studies have evaluated
    the average loss of earnings for veterans with service-
    connected disabilities and suggested that not all veterans were
    being equitably compensated. For example, certain external
    studies suggested that veterans with mental health conditions
    were being undercompensated. As of today, VA has not updated
    its rating schedule with earnings loss information.
    Consequently, ratings determinations for all earnings loss
    calculations remain based on information from over eight
    decades ago.
        We have been monitoring VA's efforts to fix these problems
    through the lens of our high-risk list. As of 2025, VA has met
    three of the five criteria for removal from the list. It has
    shown leadership, commitment, developed an action plan to
    address root causes of its problems, and has been monitoring
    its progress. To have this area removed from the high-risk
    list, VA must continue to meet these three criteria and fully
    meet two more: capacity and demonstrated progress. Capacity
    involves things like identifying and applying the resources
    needed to implement its plans, and demonstrated progress means
    VA is accomplishing its goals and objectives for updating the
    rating schedule.
        Ultimately, without a rating schedule that fully reflects
    present day medicine and changes in the labor market since
    1945, VA may overcompensate some veterans while
    undercompensating others.
        This concludes my prepared statement and I am happy to
    address your questions.

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

        Mr. Luttrell. The written statement from Ms. Curda will be
    entered into the record.
        Mr. Armour, you are now recognized for 5 minutes.

                       STATEMENT OF PHILIP ARMOUR

        Mr. Armour. Chairman Luttrell, Ranking Member McGarvey, and
    members of the committee, thank you for your invitation to
    testify.
        As a labor economist, I research how health conditions
    impact individuals' ability to earn income and on the design of
    disability programs. Today I will focus on four points related
    to the economic effects of disability and describe implications
    for VA Disability Compensation (VADC).
        By statute, VADC benefits consider veterans' earning losses
    from service-connected disabilities, not just a medical rating
    of impairment severity. The most recently published VA
    commissioned earning loss study was in 2008. Although there
    have been more recent studies, none of these studies have
    incorporated modern disability research findings, specifically
    how different elements of disability programs can independently
    impact earnings. Evidence from other programs shows that cash
    and noncash disability benefits do directly affect earnings,
    but no research exists on how VA's programs impact today's
    veterans' earnings.
        Updated earnings loss studies that incorporate research on
    today's veterans would inform more accurate disability ratings.
    Alternatively, a move toward individualized disability
    determinations could also increase accuracy and eliminate the
    need for detailed earnings loss studies, but would require
    statutory changes.
        To zoom out, in disability studies, there is a distinction
    between impairment and disability. Physical or mental
    conditions can lead to impairment, a reduction in the
    functioning of a body system or structure which can be
    diagnosed by medical professionals. Disability, however,
    relates to how these conditions lead to limitations to societal
    participation. For many disability programs in the U.S., there
    is a focus on how impairments lead to work disability,
    specifically reduced earnings capacity. Unlike with
    impairments, evaluating work disability requires consideration
    of the economic consequences of health conditions and thus
    requires collaboration between medical and labor force experts.
        VA disability compensation is aptly named. By statute, a
    veteran with a service-connected health condition receives a
    rating that, quoting here, ``shall be based upon the average
    impairments of earning capacity resulting from such injuries in
    civil occupations.'' Given the statutory requirements, VA has
    commissioned studies to estimate how service-connected health
    conditions translate into average earnings losses. In general,
    these studies compare earnings of veterans with service-
    connected ratings with earnings of otherwise similar
    nonveterans or veterans without ratings. There are two issues
    facing the state of VA earnings loss studies.
        First, to be relevant, earnings loss studies need to
    reflect the current employment environment. However, the last
    published study relied on data from at least 20 years ago.
    Since then, there have been substantial changes in medical
    treatments, veteran disability evaluation, and the labor
    market, such as, for example, substantial increases in remote
    work.
        Furthermore, a rated health condition is rated because of
    its impact on earnings capacity, but the rating then
    facilitates access to VADC benefits and additional VA programs.
    How participation in VA programs affects the earnings of
    veterans is largely unknown. Yet, since the publication of the
    last earnings loss study, research on the causal impacts of
    other disability programs has proliferated. Specifically, there
    is now strong evidence on how the benefits in those programs
    have direct effects on earnings.
        For example, recent evidence indicates that low cost-
    sharing healthcare access and targeted vocational
    rehabilitation benefits similar to benefits offered by the VA
    can facilitate return to work and higher earnings. Not
    accounting for these program-induced earnings increases would
    make average earnings losses appear less severe, but only due
    to the success of the programs.
        Other programs are different than VAs and serve different
    populations, and the field of disability research also tells us
    the program details matter and that different populations
    respond differently. These other findings are suggestive of
    potential VA effects, but are not conclusive.
        Because we do not have a clear understanding of the
    relationship among VADC, other VA programs, and veterans'
    earnings, we have limited ability to evaluate these programs'
    effectiveness and thus limited ability to estimate earnings
    losses from service-connected work disability.
        Other disability programs also offer potential alternatives
    to the average earnings loss approach. The VADC statute
    reflects a concept known as disability-based average justice,
    or the notion that individuals with similar levels of
    disability should receive the same rating and the same
    compensation. Most other disability systems take an individual
    justice approach to at least disability determination, where an
    applicant's disability is rated based on the impacts of their
    health condition on their own earnings capacity, not on the
    average work disability.
        Regardless of the conceptual framework, recent research
    from Social Security and Workers' Compensation programs can
    provide insight into how the impact of VA programs on earnings
    could be incorporated into the current average justice
    framework or on how VADC could implement an individual justice
    framework. Yet these other programs serve distinct populations,
    so additional research with and insights from today's veterans
    are essential to ensure an accurately implemented VADC program.
        Thank you for your time and I look forward to your
    questions.

        [The Prepared Statement Of Philip Armour Appears In The
    Appendix]

        Mr. Luttrell. The written statement for Mr. Armour will be
    entered into the hearing record.
        Dr. Hunter, you are now recognized for 5 minutes.

                      STATEMENT OF KYLEANNE HUNTER

        Dr. Hunter. Chairman Luttrell, Ranking Member McGarvey,
    members of the subcommittee, thank you for the opportunity to
    testify today. Iraq and Afghanistan Veterans of America is
    dedicated to improving the lives of post 9-11 veterans and it
    is an honor to speak on their behalf today.
        It is also concerning that at today's hearing there is only
    one veteran organization represented. This despite the fact
    that veterans who engage with the VASRD are not a monolith and
    there are several voices not in this room, including those that
    have directly worked with veterans to navigate the benefit
    process, and I hope in future conversations we can include more
    veteran voices. Modernization should be done with us, not
    merely on our behalf.
        Veterans Affairs is currently undertaking a process of
    modernizing the VASRD, attempting to reflect both the realities
    of injuries experienced by servicemembers and advancement in
    medical science. The modern veteran population faces conditions
    and occupational realities that were not examined in many of
    the previous efforts. For example, traumatic brain injuries,
    toxic exposure, military sexual trauma, and complex mental
    health disorders are central to the post 9-11 veteran
    experience and have a significant impact on veteran quality of
    life and long-term employment outcomes.
        Current modernization efforts to be undertaken by the VA
    include earning-loss studies to incorporate data on how
    service-connected conditions affect veterans' earning capacity
    and to align compensation with functional impairment and labor
    market realities. However, there remains virtually no
    transparency into how these studies are being conducted and
    whether or not they truly reflect the complete reality of the
    veteran experience.
        Earnings loss studies may provide us useful data, but are
    in an incomplete lens to view the problem. For example, the
    Congressional Budget Office study on disability compensation
    focused only on male veterans, despite the fact that when this
    study was conducted, women made up the fastest growing group of
    veterans. We do have significant evidence to show that women
    veterans, even when fully employed, have different earnings
    than their male peers. As a representative of the generation
    that has seen the largest increase in women's service, this
    shows why it is critical that veteran voices are included at
    the table to ensure fulsome and essential studies.
        While the VASRD shares some similarities to other
    disability compensation programs, there are fundamental
    differences between veteran and civilian populations. Military
    service impacts the human body physically and mentally in ways
    that few civilian occupations ever will. From high physical
    risk occupations to repeated exposures to toxic substances, to
    increased risks for interpersonal harmful behaviors, and to
    having little control over where one lives, military service
    comes with inherent health risks. VASRD is one way that the
    country recognizes and compensates the individuals who
    volunteered and accepted these risks on behalf of the American
    people.
        This system also exists in a unique legal framework shaped
    by the Ferris Doctrine, which prevents servicemembers from
    suing the Federal Government for injuries incurred during
    military services. Because veterans cannot legally seek tort
    damages for pain and suffering or loss of quality of life,
    disability compensation often also serves as not just income
    replacement, but redress for harms incurred while choosing to
    serve one's country.
        Many service-connected conditions, such as chronic pain,
    migraines, Post-Traumatic Stress Disorder (PTSD), sleep
    disorders, may not immediately remove a veteran from the
    workforce, but still impose real lifelong impairments that
    merit compensation. Veterans service organizations for decades
    have been advocating to include lagging quality of life
    indicators in disability compensation calculations and that
    total compensation should look not just at the ability of
    veterans to be employed, but the compound and long-term medical
    impacts of service-connected illnesses and injuries. New
    research is also showing that quality of life indicators may be
    uniquely impactful to veterans and may exacerbate existing
    employment challenges.
        VASRD as a program is also not just an investment in those
    that served, but an investment in our long-term national
    security. Veteran care after service is still a strong
    recruitment tool for military service, which requires the
    public trust. Veterans' participation in the modernization
    process will increase the confidence that these reforms are
    justified, fair, and aligned with modern veterans needs. It
    maintains the buy-in of one of the country's best recruiting
    assets: those of us who have already served.
        Like many other veterans organizations, IAVA stands ready
    to support the VA in these modernization efforts and our
    members are eager to engage. In our most recent polity priority
    survey, over 50 percent of IAVA members cited modernizing the
    process as their top area that they would like to be involved
    in. Additionally, of our members that have a disability raising
    over 65 percent report that their disability payments are
    essential to their overall financial well being.
        Thank you for your commitment to America's veterans and I
    look forward to your questions.

        [The Prepared Statement Of Kyleanne Hunter Appears In The
    Appendix]

        Mr. Luttrell. The written statement of Dr. Hunter will be
    entered into the hearing record. Well said, Dr. Hunter.
        All right. Mr. Armour, I was trying to pick your opening
    statement apart as best I could, but what I took from it is I
    think we are in trouble. Now I am going to ask you to talk to
    me. I consider myself a highly educated guy, but if you would
    not mind putting it in crayon for me. What you just said is do
    we have the capability to get there from here with compensation
    levels through this rating system? It did not sound like it.
    You were doing a comparative analysis to the civilian
    population and the veteran population, and Dr. Hunter most
    eloquently defined both, which, again, good job. Can we do this
    or is this an uphill battle that we will constantly have VA in
    front of us saying it will be next year?
        Mr. Armour. I can speak for the analytic question.
        Mr. Luttrell. I am going to beat on you. You got a Ph.D.
    That means you are way smarter than me.
        Mr. Armour. We can do the earnings loss. We can do modern
    earnings loss studies. That is right. I think transparency
    about the methods that are used in it, pretty much all the
    methods used so far from the work cited in my testimony and the
    other panelists, it is outdated or it is using estimation
    techniques that are just not actually getting action.
        Mr. Luttrell. It will always be outdated.
        Mr. Armour. Not always 20 years outdated.
        Mr. Luttrell. We have to land somewhere, this panel right
    here and subcommittee, the full committee, all the way to where
    it needs to go. It will always be outdated. Where is the
    landing zone for us? We are going to have this conversation
    with VA and the fact that the other veteran organizations--Dr.
    Hunter, as you stated, this is an--anyone is welcome to sit in
    front of this committee at any time. I welcome it. We welcome
    that.
        Mr. Armour. We have done these, this kind of research for
    other programs. They do differ in these ways, but modern
    techniques can do it and they can do it relatively quickly in
    terms of, you know, months and years instead of decades.
        Mr. Luttrell. Define ``relatively quickly'' for the Federal
    Government.
        Mr. Armour. Months and years instead of decades.
        Mr. Luttrell. Okay. Dr. Curda, is the VA in a position to
    get this thing completed and pushed across the finish line in
    summer of 2026, in your personal opinion?
        Ms. Curda. I cannot tell you that they will be done in
    2026. We----
        Mr. Luttrell. From the information that you have gathered
    and the research that you have done, what are we looking at?
        Ms. Curda. They are in the final stages.
        Mr. Luttrell. Final stage. Man, I tell you what, you would
    be surprised how many people are in final stages in the U.S.
    Government. I mean, we are like there.
        Ms. Curda. That is what I--that is all I know.
        Mr. Luttrell. I mean, the electronic healthcare record has
    been in the final stages for the past 10 years and we are about
    50 billion into it and it is still not done. Matter of fact, we
    are shutting it down.
        Ms. Curda. Yes. Meaning they are just before the Office of
    Management and Budget (OMB) phase, I guess----
        Mr. Luttrell. Right.
        Ms. Curda [continuing]. with the final rule. It is possible
    that they can be done this year and we are hopeful. We would
    love them to be done this year. I cannot be sure they will. We
    have not seen an update on their progress since June of last
    year, and we have not had a substantive update on their action
    plans since August 2024.
        Mr. Luttrell. I would be interested to know how, once the
    15 body systems rescheduling is complete and we have the 15
    body systems that we consider, okay, how do we continue to
    update that at a pace that stays relevant to science and
    medicine? Mr. Armour, you got something for that? You are a
    doctor, are you not?
        Mr. Armour. Ph.D. Again, I think we can do these analyses
    much faster. We have the capacity.
        Mr. Luttrell. Can I will tell you what?
        Mr. Armour. That access is the biggest issue, I think,
    right now.
        Mr. Luttrell. Analysis to application is the death of this
    place. You know how--looking around at the walls, everybody
    wants to write about something. We have to touch human bodies.
    I mean, I am so sick and tired of that. I am not beating up on
    you. I am talking out loud for the world to hear this.
        How do we stay relevant in your personal and professional
    opinion once this thing goes nuclear? Is that a possibility or,
    Ms. Curda, are we going to be having this conversation 5 years
    from now that we are still using the DSM-5 and the information
    that we have on traumatic brain injuries date from 2013? I am
    sure Dr. Dexter is going to clack off on this one in a hurry
    when it is her turn.
        Ms. Curda. Yes, I am not a medical doctor either. I think
    it is possible for VA to stay up to date and I think they need
    to stay up to date, but they will have to continue to have
    really rigorous and realistic planning. They need to address
    some of the root causes of the issues. For example, the
    internal review process. I took a look at all the stakeholders
    internally to VA and there is something like 18 different--8
    parts of VA that have to look at the draft rule and 16,
    according to them, 16 levels of review. Then once you are done
    with that, there is external parties, there is something like
    11 external parties that they review it.
        Mr. Luttrell. I mean, the complexities are mind-numbing,
    but it is so important for us to figure this out, us, we, the
    Department of Veterans Affairs, figure this out because it is
    the veterans that are feeling the pressures.
        Mr. McGarvey, you are recognized, sir.
        Mr. McGarvey. Thanks, Mr. Chairman. I am just going to pick
    up on what you were just saying, Dr. Armour. I used to work
    with a lawyer who would say, had an old expression, he said,
    you can get it fast, good, and cheap. Pick any two of three.
    Right. What is the best and fastest way we keep up to date?
        Mr. Armour. I think it is facilitating access to data for
    researchers. There is a paper that Dr. Hunter cited forthcoming
    by David Silver and Jonathan Zhang, looking at the impacts of
    ratings for mental conditions on quality of life outcomes and
    on healthcare utilization. That was--it is a phenomenal
    project. I think that represents the current state of what
    research can do in this field. It is entirely limited to
    outcomes that the Veterans Health Administration has access to.
        Mr. McGarvey. Where is the lag in data coming from?
        Mr. Armour. I cannot speak to specifically the internals of
    that study. I think, in general, getting linkages between VBA
    and VHA to occur is pretty much impossible to have happen, let
    alone the other aspect of this, which is the earnings loss
    studies. Those data generally need to come from the Social
    Security Administration, which has--they will not export
    individual data, but will allow for some Memorandum of
    Understandings (MOU) to understand it. Setting those up,
    facilitating that, that enables research to be done, the good
    research, and--yes.
        Ms. Curda. Can I comment on--just comment on that?
        Mr. McGarvey. Yes.
        Ms. Curda. VA actually has in place agreements now with the
    Social Security Administration and the Internal Revenue Service
    (IRS) and some other entities to do that kind of data exchange.
    They have made progress in that area. I just wanted to point
    that out.
        Mr. McGarvey. It sounds like we still need to have some
    progress in that area. One thing we need you all is help on and
    I can tell you on this committee, we are not going to accept
    the idea that we cannot do this because I think we can.
        Dr. Hunter, do you want to say something?
        Dr. Hunter. Yes. I will just add to the conversation and I
    will disclose Phil and I were colleagues until just a little
    while ago here. There is also a big issue in the transparency
    of these studies being done. We hear a lot that VA is making
    these--like having these MOUs, doing all of these data, but
    they are doing it in a black box, which does not allow for
    either organizations like RAND and other Federally Funded
    Research and Development Centers (FFRDC) to actually do
    reproduction surveys or you do the data or do the studies
    faster, often through tools, or for VSOs to validate and
    understand. Like are you actually representative of this
    hierarchy of the population? We end up with studies like the
    U.S. Congressional Budget Office (CBO) does that excludes the
    fastest growing part of our population. Data transparency
    coming out of the VA is one of the biggest blockers to being
    able to do these fast and accurately.
        Mr. McGarvey. That should be something we should be able to
    help fix a little bit, I would think, Mr. Chairman.
        Dr. Hunter, I am going to go over to you. Thank you for
    your service. Appreciate that. I want to get away from--we have
    been out of government-speak now for a solid 3 minutes. I hope
    we can stay in this zone. I am just going to ask you point
    blank, do you think the VA disability is overly generous right
    now?
        Dr. Hunter. No.
        Mr. McGarvey. Have you spoken with anybody who does?
        Dr. Hunter. No.
        Mr. McGarvey. Okay, good. What would you say to someone who
    thinks that veterans who receive VA disability are somehow
    taking advantage of taxpayers, they are scamming the system?
        Dr. Hunter. I would first say that when you raise your
    right hand to serve, you make a contract with the United
    States, and that is that we put our lives on the line 24/7, and
    as a result, we are to be taken care of for the time when we
    are done.
        Mr. McGarvey. I think that contract you make when you raise
    your right hand and give yourself to service is both a legal
    and a moral obligation that we have as a country.
        I want to ask you about the statutory mandate for the basis
    of disability ratings. The law says, quote, ``The rating shall
    be based upon the average impairments of earning capacity
    resulting from such injuries in civil occupations,'' which is
    wonderful statutory language to say you get injured in the
    service. We are going to look at your disability rating based
    off a civilian counterpart. It is that ``civil occupations''
    part that concerns me because military occupations do not
    always line up with civilian occupations.
        You yourself, Dr. Hunter, you were an attack pilot on a
    helicopter. I am not sure there is a civilian equivalent for
    that type of job.
        Dr. Hunter. I have not found it. I was looking for it for a
    long time. I have not found it.
        Mr. McGarvey. I do not think it is there. You know, and
    whether it is a Navy SEAL, whether it is an artillery crewman,
    we are going to have trouble lining this up.
        Dr. Hunter, how do you compare injuries and illnesses that
    happen in military service with civilians?
        Dr. Hunter. They are not comparable. The military service,
    as I stated, there are physical risks that are unique. There
    are mental and psychological risks that are unique. There are
    environmental risks that are unique. One of the biggest areas
    of sort of divergence between the civilian and military
    occupations is that military servicemembers have very little to
    no control over where they spend their time, what environmental
    factors might be around them, what they are exposed to, the
    types of injuries they may receive.
        A lot of the research that is done on the civilian side
    also include some opt in, right, some buy in to whatever career
    path they choose to be in in terms of how those calculations
    are done. The military, that is also removed, which goes back
    to some of this contract, that there is a volunteer to do
    whatever the country asks of you to do. Both the type of
    injuries and the environment in which those injuries might take
    place are divergent in medical aspects as well as the moral
    contract that we have made with the country.
        Mr. McGarvey. Thank you very much. I do think that how,
    when, and where the injuries occur are often important in
    military service, just as the injury itself.
        Mr. Chairman, I am out of time. I yield back.
        Mr. Luttrell. Thank you, sir.
        General Bergman, sir, you are recognized for 5 minutes.
        Mr. Bergman. Thank you, Mr. Chairman. It is really
    fascinating to sit here and listen to the discussion back and
    forth because I sense everybody here is--no matter what role
    you are playing, even if you are sitting out there in a crowd,
    we are all here for the betterment for veterans outcomes, which
    is a good thing. Not necessarily in Washington, DC, can that be
    said in every hearing room. I will just leave that for a
    discussion of a different time.
        I would like--and this is a generic--it is not a generic
    question. It is a specific question for any of you to respond
    to. To what extent do silos currently exist that inhibit the
    breakthrough results and the speed at which we need--the change
    that we know needs to occur occurs? Would anyone like to
    address the--however you want to address silos?
        Ms. Curda. Yes, there are silos that exist that prevent the
    speed of things getting done.
        Mr. Bergman. Okay. In that case, so we agree that there are
    silos. I think that is not a surprise. Is the level of
    understanding that those silos exist, let us say within the
    Veterans Administration, to acknowledge they exist and then
    deal with the fact that do they need to exist? Do we need--is
    it additive in a positive way for the outcomes? Sometimes we
    have to work to get things done. If we work too long in a silo,
    we do not share the information.
        As the Veterans Administration looks at their
    reorganization of the business, which was just announced, you
    know, in the last month or so, do you believe that a part of
    being able to speed up the process here toward positive
    results, it would be a positive effect to, however it is done,
    break down, rewicker, whatever you want to call the silos?
        Dr. Hunter. Sir, I will answer that one and I will answer
    it both from now as a CEO of a veteran organization and someone
    who was a public policy researcher before coming into this
    role. Absolutely, and particularly breaking down the silo
    between the VA and veterans in this research.
        One of the things I learned very early on doing public
    policy research is that numbers are all great and fine in the
    spreadsheet, but the rubber meets the road when you engage the
    population that whatever you are researching is going to be
    impacting. Breaking down that silo, A, it will allow
    information to get to the VA faster about the reality of what
    is happening to veterans rather than waiting 10 years of the
    study. Talk to us, ask us. We can tell you that very quickly,
    as well as allow for a more, you know, robust and rapid
    updating of the system to meet the realities.
        We talk a lot and we hear in the news all the time that
    warfare and the type of, like, modern warfare is expanding at
    this exponential rate. We have--whether it is advancements in
    technologies or the change in the type of enemies that we have,
    and if the VA remains siloed and cutoff, doing their research
    and not interacting with those who most recently served, there
    is always going to be this lag. We are always going to be
    playing catch-up and saying, oh, yes, well, next time we will
    deal with this injury. Next time we will look into this body
    system. Next time we will figure this out.
        From where we sit, absolutely, we are here and ready and
    want to break down those silos and work to ensure that our
    veterans are taken care of.
        Mr. Bergman. Anybody else want to comment? Okay, that is
    all right. Silence is you do not want to comment.
        Okay. Along with the silos, what can we do, from your
    perspective, as a committee to advance the decrease--or, excuse
    me, the increase in transparency? Once you have got the silos
    broken down, how do you set the environment where now if you
    are working on this project--we are all working, you know, but
    there is that transparency of data exchange? Any thoughts?
        Ms. Curda. Well, I think certainly hearings like this are a
    great way to make situations at VA more transparent and having
    testimony. I think, encouraging the agency to be forthcoming
    and transparent with information with GAO, for example. We have
    had a good dialog with them in the past number of years as we
    have been monitoring their progress on the high-risk issue.
    Sometimes the information has to go through extensive levels of
    clearance and takes a lot of time to get to us. We just would
    prefer to have a more give-and-take kind of relationship on
    these things because we think that would help give us an
    opportunity to respond to them sooner and it may help things--
    keep things from going off track.
        Mr. Bergman. Okay, thank you.
        Mr. Chairman, thank you. I see I am over my time. I yield
    back.
        Mr. Luttrell. Thank you, General. Dr. Morrison, you are
    recognized for 5 minutes.
        Ms. Morrison. Thank you, Mr. Chair. I want to thank you and
    the ranking member for holding this hearing today. I want to
    thank our witnesses for being here to testify, too.
        I am also glad there is bipartisan agreement that the VA
    Schedule for Rating Disability should be modernized and it is
    essential that we get this right. We need to require
    transparency from VA and a process that incorporates feedback
    from medical experts, economists, and, of course, the veterans
    themselves.
        My late father-in-law was an Army Ranger and received
    disability compensation for the injuries he sustained in
    combat. We know that so much has changed since veterans like my
    father-in-law served, both in terms of the nature of military
    service as well as significant advances in medical research and
    treatment. We know more than ever we have the--we know more
    about the effects of military service on veterans' physical and
    mental health. It is critical that we put this data as well as
    veterans' experience to use as we tackle this important issue.
        Dr. Hunter, I want to begin with you. As you noted, women
    are the fastest growing group of veterans. According to VA,
    women made up about 4 percent of the veteran population in
    2000. By 2040, VA expects that number to increase to 18
    percent. What should VA be doing to incorporate data that
    accurately accounts for the increasing population of women
    veterans?
        Dr. Hunter. When we look at women veterans, and
    particularly for this topic in particular, there are two areas
    that need to be done. One is ensuring that when we are looking
    at the actual impacts of certain injuries, illnesses, and
    exposures, that women are part of the clinical studies to
    understand what the impairments actually are. There is a long
    history of medical research excluding women and so we are
    basing women's conditions off of what men have experienced. We
    know that women are not just little men in this regard.
    Actually doing the clinical studies to understand the impact on
    women is essential.
        When we are looking at earnings loss statements as well,
    women need to be considered in the workforce aspect of this.
    You know, we look at a lot of conditions that may, you know,
    triple or almost quadruple impact women if we look at things
    like reproductive healthcare issues that are connected to
    service-related conditions and what that does to workforce
    engagement. We also have a whole like a host of new issues
    since women have been involved in ground combat of the
    musculoskeletal systems that have not been studied. We cannot
    make accurate determinations without knowing that. Which is
    why, again, the veteran community stands here willing and
    wanting to be involved.
        Ms. Morrison. I appreciate that and thank you for bringing
    reproductive healthcare and its impacts into it. As an
    Obstetrics and Gynecologist (OB/GYN) myself, I think that is
    critically important.
        Dr. Hunter, in your testimony you mentioned that post 9-11
    veterans are more likely than previous generations to endure
    exposure experiences that contribute to diagnosed mental health
    disorders, both from the psychological and physiological
    perspective. Traumatic brain injury, toxic exposure, and
    military sexual trauma are all factors that have to be
    considered to meet the needs of the modern day veteran
    population. As we continue to learn more about these various
    forms of trauma--how these various forms of trauma affect a
    veteran's quality of life and economic prospects, what role do
    veteran service organizations have to play in ensuring the
    needs of the veteran are reflected in any proposed changes to
    the rating schedule?
        Dr. Hunter. Thank you so much for bringing up the mental
    health side of this, too. I think VSOs have three or four big
    areas that we play.
        One is we are the frontline touch points with veterans. As
    IAVA, we conduct multiple surveys a year to understand the
    experiences in closer to real time than any of these VA studies
    can be done. If we want to know how this is impacting people,
    we can tell you. We actually have that data. When we talk about
    data sharing and transparency, we can get it to you in a much
    faster way.
        Additionally, one of the big parts of this is that VSOs
    engage with veterans who may not be in the VA system. When VA
    is doing their studies, they have a huge bias that we have not
    even talked about, the fact that when they are looking at
    outcomes, they are looking most often at people who are already
    part of the VHA system. Part of what we want to do is catch
    that wherever it is, between 20 and 50 percent, depending on
    what study you read, of veterans who are outside of the system.
    We are the conduit to those people. We are the conduit to the
    people that is actually the hardest to get the data on, which
    is important.
        Then third, we are a trusted agent. There has been
    historic--through all of the scandals and all of the reporting,
    the VA has been all over the place in how much the veteran
    community actually trusts them. VSOs are often more trusted
    organizations, and we can serve a role in helping the VA build
    that trust back in the veteran population through collaborative
    work.
        Ms. Morrison. Thank you so much. Many more questions, but I
    see my time has expired. One more? Thank you, Mr. Chair.
        Mr. Luttrell. Mrs. Radewagen.
        Ms. Radewagen. Thank you, Mr. Chairman. I want to thank the
    witnesses for appearing today.
        Ms. Curda, does GAO believe that VA is still treating this
    rating schedule updating, overhaul as a project instead of a
    program?
        Ms. Curda. I am not sure I understood your question.
        Ms. Radewagen. Does GAO believe that VA is still treating
    this rating schedule updating, overhaul as a project instead of
    a program?
        Ms. Curda. No, they have--they are treating it like a
    program. They have a program office which they have
    established. They have staffed it mostly. Those staff have
    been, you know, developing, promulgating the regulations to
    provide the medical updates. They have also been working on the
    earnings loss studies.
        Ms. Radewagen. How does the schedule influence the claims
    processing workload? Do you believe that the lack of updates is
    causing issues within VBA when it comes to claims processing?
        Ms. Curda. No, I do not think it really affects the claims
    processing. You know, down the road, if they change the
    regulations, it will have an impact. They will have to make
    updates to a lot of the training and all the inputs that go
    into the process so that it is up to date and in line with the
    regulations.
        I think the impact is more along the lines of the equity
    issues we have been discussing today, where outdated
    information might lead some veterans to be overcompensated and
    others to be undercompensated. I mean, if you are just strictly
    on an earnings loss basis.
        Ms. Radewagen. Yes. Mr. Armour, when researchers evaluate
    the impact of veterans' benefits, what challenges exist in
    isolating the effects of a single benefit when many veterans
    are accessing multiple programs at the same time?
        Mr. Armour. There is a lot of challenges with that. That is
    actually a fundamental concern here, is that we do not have a
    sense of why some veterans access certain programs at different
    times and thus the impacts that those program--participation in
    those programs has. It is very difficult to tease apart for
    these earnings losses. You know, was it vocational
    rehabilitation, the Veterans Readiness and Employment (VR&E)
    services that went into it? Was it kind of the access to VA
    healthcare being priority group 1 through 3 that had an impact
    or is it just fundamentally the health condition itself
    improved? These are all things that are from the data alone are
    quite challenging because we just do not have an evidence base
    on the impacts of these programs or also like how benefits
    themselves sort into using them. Yes, so I guess I would leave
    it at that.
        Ms. Radewagen. Thank you, Mr. Chairman. I yield back the
    balance of my time.
        Mr. Luttrell. Thank you, ma'am.
        Dr. Dexter, you are recognized for 5 minutes.
        Ms. Dexter. Thank you, Mr. Chair. Thank you both, our
    ranking member as well as you, for your leadership in this. I
    think this is a really important topic and I am grateful for
    this today. I appreciate the committee being engaged and
    bipartisan as well. This is unique in Congress to have folks
    who are aligned, so thanks. To our witnesses, thank you, also,
    for your service as well as being here today.
        As a physician, I strongly believe that disability rating
    schedules must be data-driven, medically sound, comprehensive,
    and centered on veterans' lived experiences, so certainly need
    to include women in those studies as well as many other
    conditions. I will just share, as a medical student and then as
    a medical resident in the early 2000's, 30 years after the
    Vietnam War, I cared for patients in the VA system with complex
    and poorly understood symptoms. Over time, research made clear
    that many of these conditions were linked to Agent Orange
    exposure, something that many of the veterans expressed
    suspicion of, but felt very, we will say, gaslit these days. We
    were not saying that then, but not trusted. The frustration,
    the betrayal, the despair I saw so many veterans experience
    left an impression. It also showed how long it can take for
    science to catch up to exposure impacts and why ongoing
    monitoring and research are essential.
        As a pulmonologist, the lungs in particular are uniquely
    vulnerable. They are the only organ continuously exposed to the
    outside world without any protective barrier unless we put
    something on. Toxic exposures are constantly evolving, as we
    know on this committee, which means our understanding of their
    long-term health impacts must evolve as well.
        First for Mr. Armour, you noted--or Dr. Armour, sorry, you
    noted that the last VA Commission's RAND studies were conducted
    more than 20 years ago before much of our current understanding
    of toxic exposure, PTSD, and traumatic brain injury were
    available. From your perspective, what are the most important
    next steps to ensure veterans are benefiting from the most up-
    to-date science when disability rating schedules are reviewed
    and updated?
        Mr. Armour. I mean, just updating those earnings loss
    studies and in particular like bringing in the issues that we
    have observed from other disability programs to address, like
    those modern techniques.
        Ms. Dexter. Just to follow up on that, that is sufficient,
    you think, for the science to catch up as well?
        Mr. Armour. I will speak as an economist on what the
    economic angle would be.
        Ms. Dexter. Okay.
        Mr. Armour. I think that would check that box, but I am not
    a physician.
        Ms. Dexter. No, of course. Obviously, it is an unfair
    question for many of you. I will just state that we need to
    have ongoing evaluation and iterative evaluation of our medical
    information in the same way that I hear you arguing for
    economic information.
        The second question, I am proud that my bipartisan bill to
    strengthen the Veterans Readiness and Employment Program, the
    VR&E Act, with a lot of support from people here passed both
    the House and Senate, and I am continuing to work to better
    support VR&E counselors. Mr. Armour, can you speak to the role
    of rigorous research in evaluating and strengthening VR&E and
    what this program can tell us about earnings losses associated
    with service-connected disabilities?
        Mr. Armour. I can tell you I think there is tremendous
    potential to learn those things. I think the current state of
    research on it is such that it is very difficult to identify
    the causal impact of those services. There are--the VR&E
    longitudinal study is one sort of study that has been going on
    for a stretch of time. Again, it is sort of a study that does
    not use modern methods in comparing people who did get services
    versus those who did not and the subsequent outcomes.
        I think that there are ways in which we could--there is a
    lot of potential to find out for whom it is working and what
    those impacts are. We just do not have that evidence base right
    now.
        Ms. Dexter. Very good. Not good, but obviously you have
    expressed the need for implementing change to how we collect
    data.
        Dr. Hunter, disability rating decisions must be grounded in
    sound medical evidence. Proposals to lower disability ratings
    based on whether a condition is treated raise serious concerns
    for me. Take obstructive sleep apnea as an example. When
    untreated, it can worsen hypertension, heart failure, and
    significantly increase risk of heart attack and stroke. Trying
    to lower ratings to treatment could discourage veterans from
    seeking care, which puts their health at risk and may
    ultimately cost more for the VA as well as cost of productive
    life here for those veterans. Dr. Hunter, from a veteran's
    perspective, can you speak to the concerns around lowering
    disability ratings based on treatment status?
        Dr. Hunter. In addition to what you mentioned about it
    potentially discouraging veterans from getting care, there is
    also the very real thing that we need to look at about
    treatment for veterans who may not live close to VA symptoms.
    Like, I am out in the West, as are you, and for me, I get all
    of my care at the VA and I often have to travel 3-1/2 to 5
    hours, depending on the weather conditions, to get some
    specialized care. If we say, well, you are getting care, you
    are not getting compensation, the other thing that we have to
    look at is how does that remove people from the workplace? What
    is the added stress and time and, you know, hardship that is
    put on it, on an individual? Which is something that needs to
    be looked at as the total overall compensation. We do not want
    to say we are correcting one issue and making a bigger problem,
    which is why these updated studies need to be done.
        Additionally, what it does not take into effect is the
    long-term impact in quality of life issues that arise. Even if
    a condition is considered treated, there still is often a
    lagging quality of defect of life indicator. I actually
    encourage the committee to encourage the VA to look at studies
    coming out of Australia and Canada and Israel where they
    actually include like verified quality of life measures into
    their veterans' disability compensation programs that have had
    results of actually improving workplace outcomes through
    addressing the fact that there were initial quality of life
    concerns. Just through the redress payments from those, you end
    up having much better long-term economic outcomes as well.
        Ms. Dexter. Thank you. I appreciate your patience.
        Mr. Luttrell. Yes, ma'am.
        Mr. Self, you are recognized for 5 minutes, sir.
        Mr. Self. Thank you, Mr. Chairman.
        Ms. Curda, I was very curious that the management of
    disability compensation claims has been on your high-risk list
    since 2003. Yet you said that August of 2024, January,
    February, and June of 2025, you got a lot of input. Can you
    estimate how much of the advances they have made happened since
    August of 2024? Just a rough estimate.
        Ms. Curda. That I cannot tell you much. I would say it is
    not true that is the first time we have heard from them. We
    actually have been talking to them pretty frequently since
    about 2019, but we saw progress more in more recent years.
        It took a while. We went through a process of deciding,
    okay, what are the root causes of these issues? VA came up with
    root causes. They developed an action plan to address those
    root causes. The first version was more like a list of stuff we
    have done. It was not a plan. Then they had to go back to the
    drawing board and come up with a plan that had milestones and
    goals and, you know, ended up being something we were--we
    thought was an actionable plan and they had something they
    could monitor their progress against. It just--it is been a
    multiyear effort and it has not all been since 2024.
        Mr. Self. Well, I would ask you what can Congress do to
    help GAO? Not just in VA, but across the government, you have
    hundreds and hundreds of reports that have not been acted on by
    many of the departments. I think Congress ought to be looking
    at GAO, how we help you to get things implemented.
        Now, let us go back to your five criteria for removing them
    from the GAO high-risk list. They have met leadership
    commitment, action plan, and monitoring, less so in capacity,
    which is basically resources. It is not capacity, it is
    resources, and demonstrated progress. We have got a saying in
    Texas, when you look at the three that they have met, they are
    still fixing to do something.
        Ms. Curda. Yes.
        Mr. Self. They have not done--I mean, logistics is
    everything. If they have not provided the resources for the
    capacity to do it, then they are not going to demonstrate
    progress. I think this is very telling chart that you have
    given us, that they really need to do something now that they
    have made the commitment, apparently.
        Then, Dr. Armour, you talked about individual versus
    average justice. You spent a lot of time on that with the
    Social Security. Now, Social Security Administration supposedly
    has outdated computers, old coding, and yet you basically said
    that the Social Security Administration does a far better job
    individualizing plans. Can you kind of talk to that?
        Mr. Armour. I will say historically, Social Security has
    been very welcoming to the research community in allowing us to
    conduct research on how the disability determination process
    works and at sort of which stage. They do contract with--they
    contract with states to actually administer the first stage of
    it. For each kind of level of that. They have shared a lot of
    their earnings data, their benefit data, and we have provided
    over the years a lot of strong results on kind of the--every
    stage of their determination process, sort of how it works.
    That has allowed them to make various policy decisions to
    provide that feedback back to that determination process. They
    have also engaged in a lot of National Academies of Science,
    Engineering, and Medicine panels to update their own listings.
        Mr. Self. Well, that is not really my question because you
    get a very individualized plan from Social Security
    Administration. These are your earnings, this is your
    disability. This is--I mean, it is pretty detailed and it is
    individualized. Yet you say that VA uses an average justice
    sort of model. Yet we spend a lot of time individually, and
    part of that is the problem. We have 66 percent of claims have
    errors and 44 percent of all--I have forgotten the data, but, I
    mean, we have a tremendous error rating. Why is that if we are
    using average justice as opposed to individualized? It looks to
    us as though we spend a lot of time with the individual. Can
    you explain that?
        Mr. Armour. I can speak to how Social Security does this--
    --
        Mr. Self. All right.
        Mr. Armour [continuing]. and how they separate the
    determination process into two steps. One is a listing of
    impairments. These are conditions that are sort of severe
    enough that through medical evidence alone can determine that
    there is a disability. There is that. They have an all or
    nothing determination as well, is another thing that makes that
    makes Social Security a little clearer.
        Then if there is not that listing of that level of
    severity, then it is an individualized assessment that they
    have, and it is a residual--it is trying to estimate functional
    capacity at that individual level. They have done a, you know,
    spelling things out for the things that can be easily spelled
    out and then having an individual assessment where they see
    people's earnings leading up to it. You know, they have
    physicians comment not just on the medical component, but on
    the functional capacity component, and then they have a lot of
    oversight of that particular process. They have split apart
    that decision instead of trying to schedule everything.
        Mr. Self. Thank you very much. I think that is something we
    might do a deeper dive on.
        Chairman, I yield back.
        Mr. Luttrell. Thank you, Mr. Self.
        Go ahead.
        Mr. McGarvey. Thank you, Mr. Chairman. I just want a couple
    of quick follow-up questions.
        Ms. Curda, earlier I asked VA if they would commit to
    sharing their methodology with you. Would you be receptive to
    that?
        Ms. Curda. Absolutely.
        Mr. McGarvey. Perfect. Beyond sharing methods and data, is
    there anything more that you would ask the VA to better provide
    oversight, accountability, and quality assurance in this rating
    schedule?
        Ms. Curda. Just quicker turnarounds on things. When we ask
    for information, just instead of having to wait a long time for
    clearances and stuff, you know, just get it to us. If it
    exists, they should be able to provide it.
        Mr. McGarvey. Thank you. One common theme between the first
    panel and between you all seem to be these silos of
    information. These silos are terrible things that I think are
    hurting our veterans. They are holding information and keeping
    it from people who need it when it should be shared, it should
    be transparent.
        Dr. Armour, you talked a little bit about this and we seem
    to be dealing with several information gaps, in part caused by
    some of these silos, which leads to nonexistent research, out-
    of-date data sets. What other sorts of basic research need to
    happen and does it make sense to have that before people start
    talking about radically changing the VA compensation system?
        Mr. Armour. I think given the state of knowledge on the
    economic consequences of VA benefits, yes, we just do not have
    a lot of publicly available research on, right, today's
    veterans and today's system. I think, yes, kind of more
    research. I particular, I think it is not wildly complicated. I
    think it is sharing the existing data that Social Security has
    that the VBA, the VHA has, together could provide if that were
    more widely available, if more research could be conducted on
    that in a way in which there is transparency and comment so
    that modern techniques could be used. I think that would answer
    a lot of questions very quickly, again, if things moved.
        Mr. McGarvey. Transparency and sharing of information, I
    like it.
        Mr. Chairman, I yield back to you.
        Mr. Luttrell. Mr. McGarvey, I have--since my time in
    academia to the time I am sitting next to you today, trying to
    convince--I do not care which institute of higher learning you
    are talking about and that famous catchphrase of silos, how do
    you sew the seams between the two? Who will have the
    willingness to open--like in my personal opinion, the VA should
    be the premier institute of research on the planet, amount of
    information that is inside of the VA system. They have always
    been, since I have had the opportunity to work alongside the VA
    or with the VA, very protective of us, the veteran community.
    That information is some of the most cherished data on the
    planet. Everyone is knocking on the door saying, please let us
    engage with you to share this information so we can move any
    side, any kind of information forward. VA has always been very
    reluctant of that because who is going to fall on the sword?
    Who is going to take responsibility if there is a breach and
    the information is gone or lost or taken or worst case
    scenario?
        Conversations on the committee and with secretaries, deputy
    secretary, who you are talking to, and this kind of goes to
    what you are talking about, Dr. Hunter and Mr. Armour, is, yes,
    if other institutions, whether that is VSO or any institute of
    higher learning, had the opportunity to do that, where would we
    be now? I have been having this conversation for 12, 15 years,
    so I can only imagine how long you guys have been having it. I
    speak to the broader research base. You guys look like you are
    in your 20's. How do we break that down? We do. It is a fair
    question.
        I can understand and I really appreciate where we are in
    the protection mechanism, especially in the branches of
    artificial intelligence, machine learning, and the bad actors
    that are pushing that out to take from us that we cannot defend
    against. As we incorporate machine learning language models
    into this data to find these answers, at what point, this is a
    fair question to ask, at what point do we find the answers to
    solve the issues of the brain?
        If we have the ability to get rid of sleep apnea or
    tinnitus or the varying degrees of heart disease and exposures
    from being in combat, where do we sit then? Do we ask the
    veterans, like, hey, we are going to give you this and
    everything is going to be okay? Or do we grandfather it in and
    we move forward into the next generation? These are discussions
    we are going to have to have. You would be pleasantly surprised
    how challenging those discussions are going to be. It lends
    itself to what Mr. Self was saying, is that what point do we
    say, hey, look, we can fix these things? How do we engage with
    the veterans so they will receive it? How does the VA implement
    it? Then how do we move forward to make sure that we do not
    talk about 1945 infrastructure, which I still find moderately
    entertaining?
        I will never say we are moving fast enough because of all
    the veterans in my district that walk up to me and say we are
    not. I am listening. As a veteran myself, I have that same
    response. I do understand how complicated the VA system is just
    from this side. I have never actually been inside the VA, but
    having offline afterschool conversations of how challenging it
    could be, it is. I just hope and pray every single day they
    keep moving forward. We will do everything that we can on this
    committee to make sure that they have what they need.
        As problem sets continue to increase and it seems like we
    always have to talk about dollar bills. Well, I am going to be
    quite honest. You know what? Dollar bills is something that is
    extremely hard to find even in the VA considering how far in
    debt we are as a country. We beg, borrow, and steal and kick a
    lot of butt to get the money for our veterans because we would
    not be sitting there having this conversation if it was not for
    you all. We are willing to do that, but we make sure we have to
    do it right. It has to be done right.
        I want to thank all of our witnesses for joining us today
    to discuss how the Department can address the longstanding
    delays in updating the rating schedule and, more importantly,
    how we ensure this does not remain a recurring problem for the
    future and for our veterans. When the rating schedule is
    outdated or applied inconsistently, it just creates confusion,
    frustration, and delay. That is something that we do not want.
        Updating the system is necessary. I am excited about the
    opportunity. This will be closed up and we will complete this
    at the summer of this year. This committee will be on standby
    to see if that actually happens.
        Ranking Member, do you have closing remarks? We good to go?
        Mr. McGarvey. Thank you, Mr. Chairman.
        Mr. Luttrell. Yep. I ask unanimous consent that all members
    may have 5 legislative days to revise and extend their remarks
    and include extraneous material. Without objection, so ordered.
        We are adjourned.
        [Whereupon, at 4 p.m., the subcommittee was adjourned.]

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

                             A  P  P  E  N  D  I  X

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

                        Prepared Statements of Witnesses

                                  ----------

                        Prepared Statement of Nina Tann

        Good afternoon, Chairman Luttrell, Ranking Member McGarvey, and
    distinguished Members of the Subcommittee. I appreciate the opportunity
    to appear before you today to discuss the Department of Veterans
    Affairs' (VA) efforts to modernize disability benefits. Joining me
    today is Dr. Ulia Sokol, a Medical Officer with the Veterans Benefits
    Administration.
        For disability compensation or pension purposes, a Veteran's
    disabilities are evaluated using the VA Schedule for Rating
    Disabilities (VASRD), also known as the ``rating schedule.'' The
    statute giving VA authority to establish and maintain the rating
    schedule, 38 U.S.C. section 1155, states: ``The Secretary shall adopt
    and apply a schedule of ratings of reductions in earning capacity from
    specific injuries or combination of injuries. The ratings shall be
    based, as far as practicable, upon the average impairments of earning
    capacity resulting from such injuries in civil occupations...The
    Secretary shall from time to time readjust this schedule of ratings in
    accordance with experience.''
        VA is committed to updating its disability compensation rating
    criteria to accurately reflect medical science, advancements and
    improvements in technology, and current terminology. These updates
    allow VA to ensure its disability evaluations accurately compensate
    Veterans based on average impairments in earning capacity.
        While VA has made numerous changes to the VASRD over time,\1\ it
    has not completed a holistic and comprehensive update since 1945,
    despite notable progress during that time period. In 2003, the
    Government Accountability Office (GAO) deemed VA's disability program
    high-risk because VA had not systematically updated the VASRD. In
    response, VA developed a Modernization Plan in 2009 with the goal of
    comprehensively updating all 15 body systems of the VASRD. VA
    established workgroups that included medical and VA policy subject
    matter experts. VA used the groups' analyses of established medical
    research to begin the rulemaking process, which involves drafting and
    publishing a proposed and final rule for each body system. To date, VA
    has completed updates on 11 of the 15 body systems. Specifically, VA
    completed: Dental and Oral Conditions in Fiscal Year (FY) 2017;
    Endocrine, Gynecological Conditions and Disorders of the Breast, Organs
    of Special Sense (Eyes), and Skin in Fiscal Year 2018; Hematologic and
    Lymphatic and Infectious Diseases, Immune Disorders, and Nutritional
    Deficiencies in Fiscal Year 2019; Musculoskeletal, Cardiovascular, and
    Genitourinary in Fiscal Year 2021; and Digestive in Fiscal Year 2024.
    Updates made to the VASRD are generally applied prospectively and
    therefore, do not impact current beneficiaries in receipt of disability
    compensation. In circumstances where a change to the rating schedule
    lowers the rating assigned to a particular disability, Veterans enjoy
    numerous protections. Most notable of these protections is that a
    readjustment in the rating schedule cannot cause a rating in effect at
    the time of the change to be reduced unless an improvement in the
    Veteran's disability is shown to have occurred.
    ---------------------------------------------------------------------------
        \1\ Genitourinary, effective 02/17/1994. Dental/Oral, effective 02/
    17/1994. Gynecological Conditions/Breast Disorders, effective 05/22/
    1995. Hemic and Lymphatic, effective 10/23/1995. Endocrine, effective
    06/06/1996. Infectious Diseases, effective 08/30/1996. Respiratory,
    effective 10/07/1996. Mental Disorders, effective 11/07/1996. Muscle
    Injuries, effective 07/03/1997. Cardiovascular System, effective 01/12/
    1998. Ear, effective 05/11/1999. Skin, effective 08/30/2002. Eye,
    effective 11/10/2008.
    ---------------------------------------------------------------------------
        VA published proposed rules for the remaining four body systems,
    Mental Disorders (AQ82), Respiratory, and Ear (AQ72) in Fiscal Year
    2022 and Neurological Conditions and Convulsive Disorders (AQ73) in
    Fiscal Year 2025. VA anticipates publishing the final rules for all
    four body systems in three rulemakings by the end of Fiscal Year 2026,
    which will complete the first holistic and comprehensive update since
    1945.
        In 2019, VA established the VASRD Program Management Office with a
    mission of revising the VASRD through rulemaking--body system by body
    system, in staggered cycles of recurring reviews, in response to GAO's
    high-risk recommendations. This iterative process ensures continuing
    alignment of the VASRD evaluation criteria with medical, scientific,
    and technological advancements. As with the initial iteration, VA will
    apply lessons learned from previous efforts and begin future iterations
    by establishing workgroups prior to developing proposed and final
    rules, which undergo a thorough medical, legal, and policy review prior
    to publication in the Federal Register. The rulemaking process
    generally takes 2 to 5 years to complete but can take longer due to the
    length and medical complexity of the VASRD updates. Updates to the
    VASRD require coordination to implement required claims processing
    system changes and to provide training and guidance to clinicians on
    disability benefits questionnaires and to claims processors charged
    with correctly applying current disability evaluation criteria.
        Following the completion of the first holistic and comprehensive
    update to the VASRD, VA plans to continue updating the VASRD with the
    evolution of medical science and treatment modalities. While VA aims to
    update the rating schedule to simplify the claims process for Veterans
    and promote a fair and efficient process, VA will also standardize
    rating terminology and address contemporary claims processing issues to
    assist claims processors charged with delivering fair, efficient, and
    timely benefits decisions to Veterans.
        In closing, VA remains committed to modernizing disability benefits
    by making continuous updates to the VASRD. We thank the Committee for
    your continued support of programs that serve the Nation's Veterans and
    look forward to working together to further enhance delivery of
    benefits and services to Veterans.
        Mr. Chairman, this concludes my statement. We look forward to
    answering any questions you may have.

                     Prepared Statement of Elizabeth Curda

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                      Prepared Statement of Philip Armour

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                     Prepared Statement of Kyleanne Hunter

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                           Statements for the Record

                                  ----------

                Prepared Statement of Disabled American Veterans

        Chairman Luttrell, Ranking Member McGarvey and members of the
    Subcommittee:

        On behalf of DAV (Disabled American Veterans) and our nearly 1
    million members, I am pleased to offer this statement outlining our
    views of the Department of Veterans Affairs (VA) disability
    compensation schedule of rating disabilities (VASRD) and how well it
    fulfills the purposes for which it was created. As you know, DAV is a
    congressionally chartered, VA-accredited, nonprofit veterans service
    organization (VSO) with nearly a million members, all of whom are
    wartime service-disabled veterans. We are dedicated to a single
    purpose: empowering veterans to lead high-quality lives with respect
    and dignity.
        To fulfill DAV's service mission assisting veterans, their
    families, caregivers and survivors seeking benefits earned as a result
    of their military service, we have over 4,200 chapter, department,
    transition and national service officers (NSO) nationwide; including
    DAV accredited county veterans service officers. Today there are over
    1.1 million veterans and their survivors who have chosen DAV to be
    their representative before the VA and last year we helped them file
    over 560,000 claims for benefits to the Veterans Benefits
    Administration (VBA), taking over 3.1 million actions to support them.
    This assistance, like all of DAV's charitable services, was provided at
    no charge to veterans and their families, and DAV receives no
    compensation of any kind from the government for providing these
    services. Our comments are informed by the collective experience and
    expertise of our benefits experts.
        The Subcommittee's hearing comes in the wake of a series of
    outrageously misleading and highly inaccurate stories that The
    Washington Post published last fall. Frankly, DAV was shocked and
    disgusted to read the Post stories and deeply disappointed with certain
    so-called veterans advocates who have been repeating and amplifying
    these falsehoods. To assess how well the VASRD has served and can
    continue to serve as an instrument to provide justice and compensation
    to veterans injured, disabled, and made ill from their service, it is
    necessary to first debunk several myths about VA disability
    compensation.
        For example, the Post alleged that disabled veterans are
    ``swamping'' the VA with ``false'', ``fraudulent'' and ``dubious''
    disability claims for injuries and illnesses because the Post considers
    them illegitimate. Nothing could be farther from the truth. According
    to the VA Office of Inspector General, there have been fewer than 200
    fraud convictions annually in recent years. With VBA processing almost
    3 million claims in the most recent fiscal year, that equates to a
    fraud rate of less than 1/100th of 1 percent. To justify their
    conclusion that VA is ``swamped'' with illegitimate claims, the Post
    argued that common claims for conditions such as depression, PTSD,
    hypertension, diabetes, eczema, tinnitus, and pain were ``dubious'' and
    ``exaggeration''. With veteran suicide still slowly rising, it is
    outrageous to assert that depression and PTSD are not real
    disabilities, just as it is absurd to argue that hypertension and
    diabetes are exaggerations. Moreover, severe eczema, tinnitus and pain
    can be highly disruptive and disabling to a veterans life.
        The Post also advanced the myth that ``Congress and VA have made it
    easier to cheat and take advantage of the system,'' referring to the
    Sergeant First Class Heath Robinson Honoring our Promise to Address
    Comprehensive Toxics (PACT) Act of 2022 (P.L. 117-168) and the Veterans
    Appeals Improvement and Modernization Act (AMA) (P.L. 115-55). These
    landmark laws were expressly designed by Congress to make it easier for
    veterans to receive earned benefits because millions of them have faced
    unnecessary obstacles that delayed or too often denied their legitimate
    claims for benefits. It is a gross mischaracterization to imply that
    these laws made it easier for criminal veterans to steal taxpayer
    dollars, rather than recognize how the laws have fundamentally improved
    the ability of millions of veterans to receive long overdue justice and
    compensation.
        Another misunderstanding the Post and others continue to promote is
    that VA disability compensation should only go to veterans unable to
    work. According to the Post story, ``The current [VA] disability
    program was designed 80 years ago to provide a safety net for
    unemployable [emphasis added] veterans wounded or injured during World
    War II.'' That statement demonstrates ignorance about the history and
    purpose of VA's disability compensation system, how it has evolved over
    the years, and how it operates today. It is important to recognize that
    the VA disability compensation system is fundamentally different than
    Social Security Disability Insurance and workmen's compensation
    programs that are only concerned with a person's ability to work. This
    is because military service is a uniquely dangerous type of work for
    the men and women who wear the uniform. Further, unlike other hazardous
    occupations, service members are not able to quit their jobs whenever
    they choose, since they are under orders. They are also not able to sue
    the Federal Government if they are injured, regardless of the
    circumstances, due to the Feres Doctrine\1\.
    ---------------------------------------------------------------------------
        \1\ Feres v. United States, 340 U.S. 135 (1950)
    ---------------------------------------------------------------------------
        The VA disability compensation was not created only to assist
    ``unemployable'', veterans, nor was it designed to compensate for
    veterans' lost earnings, a common misunderstanding. Instead, beginning
    after World War I, Congress created and over the course of many years
    evolved a system centered on providing compensation to disabled
    veterans based on ``...the average impairments in earnings
    capacity...'', a legal phrase that may sound like economic loss, but in
    reality, measures functional loss. Under this standard, a blind or
    paralyzed veteran who through perseverance is able to overcome their
    disabilities and work is still recognized as having suffered a loss of
    functional capacity and deserving of compensation. The fact that they
    have been able to overcome their disability does not alleviate our
    Nation's obligation to compensate them for the price they paid and will
    continue to pay for the rest of their lives.
        For these reasons, VA disability compensation uses an ``average
    person'' standard rather than an ``individual'' one that would require
    VA to evaluate the unique characteristics and circumstances of each of
    the millions of veterans who are wounded, injured, or made ill in
    service. Creating such a system based on each individual veteran's
    actual loss of earnings would not only be impractical - since most
    service members leaving the military have never had a full-time
    civilian job - but would also be dramatically more complicated, time-
    consuming, and expensive to implement. What this also means in practice
    is that disabled veterans are strongly incentivized to seek meaningful
    work since doing so will not result in a reduction in their disability
    compensation.
        In fact, this is one of the most important but often overlooked
    strengths of the current VA disability compensation system: disabled
    veterans are incentivized to continually improve their health and well-
    being in order to pursue meaningful employment and entrepreneurship.
    The Post apparently believes that even severely disabled veterans -
    those who have lost limbs, are blind or paralyzed - only merit
    disability compensation when they are unable to work. This view fails
    to recognize all the time and effort it may take for these men and
    women to overcome such disabilities, the impact on the families and the
    other parts of their lives, including how it often shortens their
    lives. Providing disability compensation is just one way that our
    government helps to keep the promise to the men and women who served.
        Another common myth is the false belief that VA's disability rating
    system, and specifically the VASRD, has not been updated or modernized
    since 1945. While there was a major overhaul of the rating schedule
    following World War II, particularly to add new psychological
    conditions, there have been literally hundreds of changes and updates
    to the VASRD since then, as can be seen in the Code of Federal
    Regulations (CFR) Appendix A to Subpart B of Part 4. More recently,
    since September 2017, VA has comprehensively reviewed and updated the
    rating schedule for at least eight of the 15 body systems, and is
    actively working on the others.
        Mr. Chairman, almost two decades ago, after Congress created the
    Veterans Disability Benefits Commission to explore whether major
    changes were needed to VA's benefit programs, one of my DAV
    predecessors testified that the disability compensation system was:

        ``...fundamentally sound and the most practical approach to the
    complex task of fairly compensating a large number of veterans for whom
    the effect of disability is as diverse as the demographic and
    socioeconomic characteristics of the members of the military force and
    the citizens of our Nation from which those members come.'' \2\
    ---------------------------------------------------------------------------
        \2\ Testimony of Rick Surratt, DAV Deputy National Legislative
    Director, before the Committee on Medical Evaluation of Veterans for
    Disability Compensation of the Institute of Medicine, July 7, 2006.

        This statement echoes a famous quote attributed to Winston
    Churchill, who observed that, ``democracy is the worst form of
    government except for all those other forms that have been tried...''
    While the VA rating system and the VASRD is not perfect, DAV continues
    to believe that is the most effective and efficient way to fairly and
    equitably compensate veterans for the disabilities, injuries, and
    illnesses they have suffered in service to the Nation.
        We also believe that some of the questions being raised about
    whether the VA disability compensation system is properly structured
    are the result of persistent problems with the claims processing
    system. If veterans were able to receive fast, accurate, and
    transparent decisions on their claims for benefits, confidence in the
    system could be significantly improved. To help accomplish that, DAV
    offers the following recommendations to make the claims processing
    system work better for veterans.

              Allow veterans to file claims by phone
            VA allows a veteran to submit an Intent to File (ITF) form by
            phone, but not a formal claim, such as for an increased
            evaluation or secondary condition. We believe a veteran should
            be able to contact the VA by phone and file a claim for any
            condition at any time, just as they can for an ITF.

              Amend VA's policy on incorrect forms
            Currently, the VA treats claims filed on an incorrect form
            merely as a request for a claims application, which can result
            in a veteran receiving a delayed effective date and potential
            loss of tens of thousands of dollars in benefits. To remedy
            this situation, VA should accept any filing made by a veteran
            for benefits as a clear statement of the veteran's ``intent to
            file'' a claim and protect that effective date.

              Allow veterans to certify their symptom statements
            during examinations
            When veterans receive VA disability examinations, they are
            often required to describe symptoms of conditions they are
            claiming to be used in making a rating decision. However, when
            they receive their claims decisions, many times the symptoms
            they reported during the exam are different from what was
            recorded by the examiner. To alleviate this problem, VA should
            add a step in the exam process that allows veterans to review
            and certify that the symptoms they reported have been
            accurately recorded.

              Strengthen presumptive decision-making processes for
            toxic exposure claims
            Presumptive service connection is used to improve the process
            and outcomes for veterans filing benefit claims related
            primarily to military toxic exposures and environmental
            hazards. The historic PACT Act created new presumptives for
            burn pits and other airborne hazards, however, it did not cover
            all affected veterans and all toxic substances. The DAV and
            MOAA report, Ending the Wait for Toxic-Exposed Veterans,
            includes a number of recommendations to build on the PACT Act
            and create a more effective presumptive decision-making process
            to improve the accuracy and timeliness of toxic-exposed
            veterans claims for disability compensation.

              Optimize the use of technology, particularly AI
            In order to improve both productivity and accuracy, VBA must
            continue to maximize and optimize the use of advanced
            technology, including artificial intelligence (AI), which can
            significantly increase processing speed and reduce errors.
            However, its application must be carefully implemented and
            continuously monitored to ensure essential expertise and
            decision-making authority is retained by human employees.

              Ensure VA has the resources to improve accuracy and
            timeliness of claims
            Due to the enactment of the PACT Act in August 2022, along with
            expanded outreach efforts to veterans in crisis or at risk of
            suicide, VBA has seen a tremendous influx of new benefit claims
            and a larger claims backlog. Thanks to staffing increases in
            2023 and 2024, the rising backlog was stemmed early in 2025 and
            has since declined. However, we urge the Committee to closely
            monitor staffing levels at VBA, and particularly VA's 30,000
            FTE force reduction last year, to ensure there are adequate
            resources to process veterans claims quickly and accurately.

        Mr. Chairman, we appreciate the Committee's interest in reviewing
    the VA rating schedule and how well it serves disabled veterans. While
    it is not perfect, we believe it is a proven and reliable methodology
    to fairly compensate the men and women who have served, suffered, and
    sacrificed for the country. We look forward to working with the
    Committee and VA to continually review, and when appropriate, update
    the VASRD and other aspects of VA's disability compensation to keep the
    promise to the men and women who served.

                        Prepared Statement of Berry Law

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

      Prepared Statement of Veterans of Foreign Wars of the United States

        Chairman Luttrell, Ranking Member McGarvey, 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 testify on the Department of Veterans Affairs (VA)
    ongoing modernization of the Veterans Affairs Schedule for Rating
    Disabilities (VASRD), which is a critical component of VA's disability
    compensation system.
        The VFW considers this review as essential to ensuring the accuracy
    of disability compensation ratings while also providing equitable
    financial relief to veterans whose service-connected injuries or
    illnesses have caused, or may cause, undue economic hardship. As we
    begin this most important discussion publicly, we must note no
    witnesses appearing before the subcommittee for this hearing represent
    national VA-accredited organizations that routinely interact with VA
    and the rating schedule on behalf of claimants. Notably absent are
    organizations such as the VFW, Disabled American Veterans, the American
    Legion, the National Association of County Veterans Service Officers,
    any accredited agents or attorneys, or their representative trade
    associations that collectively hold power of attorney for millions of
    VA beneficiaries, and possess decades of direct, practical experience
    navigating the complexities and nuance of the VASRD in real-world
    adjudication.
        Moreover, anyone who is accredited through VA has a regulatory
    requirement under 38 CFR Part 14 to understand the intricacies of the
    VASRD. Without witnesses who routinely train on and apply the VASRD for
    claimants seeking benefits, this hearing risks trusting academic or
    theoretical assessments rather than current, veteran-centered
    perspectives grounded in daily practice. This may unintentionally shape
    the subcommittee's understanding of the VASRD in ways that do not fully
    reflect its operational realities.
        The VFW is particularly concerned that mischaracterizations or
    misunderstandings about the VASRD may go unchallenged, including
    assertions that it is inherently flawed due to its perceived age, that
    the combined ratings table philosophy is incoherent, or that disability
    compensation should be tied to employability. These arguments, while
    often presented as justification for radical reforms, carry serious
    implications for veterans and their families. Absent testimony from
    accredited advocates who can explain these principles in practical
    terms, the VFW believes the subcommittee may accept these positions
    without sufficient scrutiny or rebuttal from those most familiar with
    how these standards protect veterans from economic harm resulting from
    service-connected disabilities.
        If these issues are not fully and publicly examined in the hearing
    room, the conversation risks moving in directions that undermine long-
    standing principles of veteran disability compensation. This
    compensation is first and foremost recognition of diminished earning
    capacity caused by injuries or illnesses incurred in service. Likewise,
    the combined ratings table reflects deliberate calculations intended to
    balance equity, consistency, and sustainability. These are complex
    matters that demand input from experienced practitioners who represent
    veterans every day, not just abstract policy discussions.
        For these reasons, we believe the subcommittee has a responsibility
    to convene an additional future hearing that includes testimony from
    accredited Veterans Service Organizations, agents, and attorneys with
    experience applying the VASRD on behalf of claimants. Committee members
    deserve to hear directly from those who understand the downstream
    consequences of proposed changes. Similarly, we recognize that our
    perspective is not the only perspective on this matter, and we invite
    public dialog and scrutiny of our perspective from members of the
    subcommittee to reach the best possible outcome for our veterans.
    Veterans deserve nothing less than a complete, balanced, and fully
    informed record before the subcommittee contemplates any legislative
    reforms to this critical system.
        The current VA disability rating framework has been in existence
    since April 1, 1945. For more than 80 years, this framework has
    undergone continued modernization to ensure veterans receive fair and
    accurate compensation based on current medical science and labor market
    realities. The basis of the current system is centered on the ``whole
    person'' formula, establishing a mathematical calculation that assesses
    each disability as independent of one another.
        This structure works hand in hand with a veteran's ``average
    impairment'' and the claimant's current disability picture. Previous to
    this implementation, a veteran who was fortunate enough to be granted a
    disability rating received payments based on ``occupational variants''
    that were grounded in the veteran's pre-war occupation. The current
    structure offers a more objective evaluation based on the ``average
    impairment of earnings capacity'' more reflective of the typical person
    in civil occupations. The justification for this structure is grounded
    in tort law, as the VFW has noted in its recent discussions over The
    Washington Post's misrepresentation of the current VA disability
    system. This fact was recently reinforced in a Military.com editorial
    by contributor and Marine Corps veteran Haley Fuller, reminding readers
    that service-connected disability payments ``were not designed as a
    safety net for those unable to function in civilian life. They were
    designed as a liability mechanism.''
        Any deliberation on changes to the VASRD must respect this legal
    fact. Proposals like eliminating compensation for so-called minor
    disabilities or means testing the receipt of compensation must be
    stopped before ever coming before Congress. The VFW invites discussion
    with the subcommittee on these principles to ensure that there is
    consensus that ``average impairment'' and ``lost earning potential''
    mean that veterans drawing service-connected compensation can both work
    and thrive financially, but that these factors do not absolve the U.S.
    Government of its responsibility to resolve the tort.
        Every American who volunteers for military service understands that
    service is dangerous. Every enlistment contract obligates the service
    member to upon order report to ``combat or other hazardous
    situations.'' Understanding this contractual obligation, veterans
    cannot sue the military for resolution of occupational illnesses or
    injuries under the well-established Feres doctrine. Eroding this
    paradigm would compromise the good order and discipline of the military
    and undermine the willingness of Americans to volunteer for this
    inherently dangerous profession. This is why the VFW has vocally
    opposed anyone who whispers the notion of eroding this benefit system,
    scaling back compensation systems, or radically manipulating the rating
    schedule.
        While some view providing benefits to veterans as a sacred
    obligation, it is in fact much simpler than that. It is fulfilling a
    contract. Honor the contract.
        At the time of its implementation, the schedule categorized
    approximately 1,600 medical conditions into broad body systems. The
    criteria were heavily designed to evaluate the physical trauma more
    common to World War II such as shrapnel and gunshot wounds,
    amputations, and infectious diseases. In the present day, there are
    more than 1,100 specific diagnostic codes, organized into 15 body
    systems that may qualify a veteran for disability compensation.
        This is clearly indicative of the changes in how medicine has
    advanced, but it also indicates that VA has been receptive to changing
    with the times. We know that on today's modern battlefield, troops are
    more likely to survive catastrophic injuries or diseases that may have
    been fatal in past conflicts. The current rating system is reflective
    of these advances that have been adjusted as medicine and other
    technologies continue to evolve.

    MODERNIZATION

        The VA's modernization plan is centered on a phased revision of all
    15 body systems in the VASRD. This effort involves updating outdated
    diagnostic criteria, incorporating modern medical terminology, and
    aligning evaluation criteria with contemporary clinical and functional
    evidence. Part of this modernization includes Earnings Loss Studies
    (ELS) that use data from multiple Federal sources to better understand
    how disabilities impact veterans' earning capacity, which is a critical
    data source for setting compensation levels. Organizationally, the VFW
    has asked for updates to any available ELS data on multiple occasions
    but has yet to receive any useful information. This data is critical to
    ensure that veterans are fairly compensated for injuries during service
    that impact their financial well-being. Additionally, this critical
    information will help show more clearly the long-term effects of
    illness or injury incurred in service in a way that is often overlooked
    in the civilian sector, and especially in recent news articles that
    have painted veterans as undeserving and even criminal.
        Many veterans who have rightfully been awarded a disability payment
    end up unemployed or underemployed because of long-term or unseen
    effects of their service. This is particularly true in veterans who
    experience the consequences of mental health or traumatic brain
    injuries. Previous occupations may trigger symptoms or cause
    disruptions in their daily employment. Employers may not be aware of
    these injuries and do not understand why the veteran needs to be absent
    from work for treatment or the side effects of medications. This can
    result in veterans taking jobs that do not require exposure to loud
    noises, interactions with the public, or other stressors that may have
    a negative result. The rating system, whether in its current form or
    future state, is critical to acknowledge and be sympathetic to the
    symptoms they may suffer and provide the necessary compensation to make
    up for lost wages.
        To date, VA has made measurable but nominal progress. Several body
    systems, such as digestive, dental, endocrine, gynecological, and
    others, have recently been revised or updated with new criteria.
    Updates to the digestive system, which added or refined evaluation
    criteria for conditions like celiac disease and irritable bowel
    syndrome, became effective in 2024. Additional proposed updates for
    respiratory, auditory, and mental disorders are underway, with public
    commentary periods concluded and rulemaking in progress.
        Despite these efforts, implementation has been slower than expected
    and extended far beyond initial timelines. According to the Government
    Accountability Office (GAO), the comprehensive update has been delayed
    by lengthy internal reviews and lack of clear metrics. As a result,
    full completion is now projected for Fiscal Year 2026, far behind VA's
    original intent. The VFW provided comments to the Federal Register as
    far back as April 2022 for proposed changes to mental disorders among
    others. Through the last two Administrations, we have asked for
    progress reports as to the remaining proposed changes and final rules.
    We have been consistently told that the regulations are still under
    review.
        We are happy to note that over the past 3 years limited progress
    has taken place. However, it has been inconsistent and, at times,
    obscure. While VA has published updated criteria for some body systems,
    major areas still await final rulemaking and implementation. Several
    proposed changes have been delayed multiple times, leaving veterans and
    stakeholders uncertain about timing and the potential effects of the
    proposed changes. This prolonged uncertainty undermines confidence
    among veterans, family members, and survivors.
        There are considerable advantages to the modernization plan.
    Updated criteria reflect contemporary medical understanding, removing
    archaic language and measurement concepts, and enabling adjudicators to
    make clearer, more consistent decisions. By continuing to evaluate and
    incorporate earnings loss data, there will be a closer tie between
    disability evaluation and real-world economic impact. This can lead to
    fairer and more equitable compensation among veterans. It will also
    encourage those who may have shied away from seeking benefits and
    health care treatment to pursue the benefits their service has earned
    them.

    CHALLENGES

        However, this modernization effort also faces substantial
    challenges. The slow pace of rulemaking and implementation frustrates
    veterans who have waited years for meaningful updates. The lack of
    transparency, clearly defined metrics, and organizational leadership as
    noted in GAO reports, makes it difficult to assess where bottlenecks
    persist and how they will be resolved.
        As VA moves forward with modernizing the rating schedule, it must
    also continue to invest in its IT infrastructure. This has long been a
    concern of the VFW and our partner organizations. The constant changing
    of platforms and systems may be an operational necessity, but it also
    has unintended consequences. If VA were to complete its review today,
    it is more than likely that the underlying systems VA depends on to
    process claims still would not be up to date to manage these vast and
    complex changes. This will lead to continued delays in benefits and an
    excess workload.
        The VFW has long held that we support the use of AI and analytics
    to assist in the claims development and review process. It has the
    potential to increase the efficiency of evidence gathering, improve
    accuracy, and promote consistency in benefit decisions. We agree that
    changes to the rating schedule and its underlying support system are
    necessary to support objective review and decision-making. However, we
    remain steadfast in our position that VA must balance technology and
    human discernment. An overreliance on underdeveloped technology may
    lead to poor quality in decisions, especially when considering the
    unique human factors of each disability claim. While AI is a powerful
    tool to promote efficiency, the VFW maintains that claims must include
    human review prior to issuing any final decisions. VA should ensure
    that regulatory changes and the use of technological platforms enhance
    the process but do not replace the human element of supporting
    veterans.

    CONCLUSION

        In closing, the modernization of the VA Schedule for Rating
    Disabilities represents a potential vital step toward a more just and
    contemporary disability compensation system for our Nation's veterans,
    if it is conducted with the needs of the veteran as its central
    obligation. While the current plan has yielded some updates and
    demonstrates a commitment to consistent, evidence-based revisions, its
    execution has been hampered by delays and management challenges.
        VA's advisory mechanisms, such as the Advisory Committee on
    Disability Compensation, provide important stakeholder input, but they
    too have consistently highlighted the complexity of this reform. These
    committees are designed to guide periodic review and revision of the
    VASRD, yet their outputs must be integrated into a larger regulatory
    process that has proven slow and administratively heavy.
        The VFW is ready to work with VA and this subcommittee to overcome
    these persistent obstacles. VA must continue to honor the selfless
    service of veterans, family members, and survivors. We look forward to
    working together to ensure equitable benefits for all entitled
    claimants. The VFW urges VA to accelerate progress, provide clear
    updates to stakeholders and this subcommittee, establish clear
    milestones, and maintain transparent communication with veterans and
    Congress.
        Chairman Luttrell, Ranking Member McGarvey, this concludes our
    testimony. We are happy to answer any questions you may have.

    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.

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