[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.
[all]