    [Senate Hearing 119-86]
    [From the U.S. Government Publishing Office]

                                                             S. Hrg. 119-86

                    HEARING TO CONSIDER PENDING LEGISLATION
    =======================================================================

                                    HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS
                              UNITED STATES SENATE

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                                  MAY 21, 2025

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

            Available via the World Wide Web: http://www.govinfo.gov

                                    __________

                       U.S. GOVERNMENT PUBLISHING OFFICE
    60-595 PDF                  WASHINGTON : 2026

    -----------------------------------------------------------------------------------
                     SENATE COMMITTEE ON VETERANS' AFFAIRS

                         Jerry Moran, Kansas, Chairman
    John Boozman, Arkansas               Richard Blumenthal, Connecticut,
    Bill Cassidy, Louisiana                  Ranking Member
    Thom Tillis, North Carolina          Patty Murray, Washington
    Dan Sullivan, Alaska                 Bernard Sanders, Vermont
    Marsha Blackburn, Tennessee          Mazie K. Hirono, Hawaii
    Kevin Cramer, North Dakota           Margaret Wood Hassan, New
    Tommy Tuberville, Alabama                Hampshire
    Jim Banks, Indiana                   Angus S. King, Jr., Maine
    Tim Sheehy, Montana                  Tammy Duckworth, Illinois
                                         Ruben Gallego, Arizona
                                         Elissa Slotkin, Michigan

                         David Shearman, Staff Director
                    Tony McClain, Democratic Staff Director

                               C O N T E N T S

                                  ----------

                                  May 21, 2025

                                    SENATORS

                                                                       Page
    Hon. Jerry Moran, Chairman, U.S. Senator from Kansas.............     1
    Hon. Angus S. King, Jr., U.S. Senator from Maine.................     4
    Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......     4
    Hon. Richard Blumenthal, Ranking Member, U.S. Senator from
      Connecticut....................................................     6
    Hon. Tim Sheehy, U.S. Senator from Montana.......................     7
    Hon. Patty Murray, U.S. Senator from Washington..................     8

                                   WITNESSES
                                    Panel I

    Thomas O'Toole, MD, Acting Assistant Under Secretary for Health
      for Clinical Services, Veterans Health Administration, U.S.
      Department of Veterans Affairs accompanied by Kenneth Smith,
      Assistant Deputy Under Secretary, Operations Management, Office
      of Field Operations, Acting Executive Director of Education
      Services, Veterans Benefits Administration, U.S. Department of
      Veterans Affairs; and Phillip W. Christy, Acting Principal
      Executive Director and Chief Acquisition Officer, U.S.
      Department of Veterans Affairs.................................     2

                                    Panel II

    Morgan Brown, National Legislative Director, Paralyzed Veterans
      of America.....................................................    10

    Brian Dempsey, Director of Government Affairs, Wounded Warrior
      Project........................................................    12

    Jon Retzer, Deputy National Legislative Director for Health,
      Disabled American Veterans.....................................    14

                                    APPENDIX
                                 Hearing Agenda

    List of Pending Bills............................................    25

                               Opening Statement

    Hon. Richard Blumenthal..........................................    29

                              Prepared Statements

    Thomas O'Toole, MD, Acting Assistant Under Secretary for Health
      for Clinical Services, Veterans Health Administration, U.S.
      Department of Veterans Affairs.................................    33

    Morgan Brown, National Legislative Director, Paralyzed Veterans
      of America.....................................................    74

    Brian Dempsey, Director of Government Affairs, Wounded Warrior
      Project........................................................    84

    Jon Retzer, Deputy National Legislative Director for Health,
      Disabled American Veterans.....................................    99

                           Submissions for the Record

    The New York Times article ``Trump's Push to Defund Harvard
      Prompts Clash Over Veteran Suicide Research''..................   113

    American Gold Star Mothers, Inc., Patti Elliott, 2024-2025
      National President.............................................   117

    The American Legion, James A. LaCoursiere, National Commander....   118

    Gold Star Spouses of America, Inc., Tamra Sipes, President.......   119

    Jewish Community Relations Bureau/American Jewish Committee
      (JCRB/AJC), Neta Meltzer, Executive Director, Bert Berkley
      Chair for Community Relations..................................   121

    Non Commissioned Officers Association of the United States of
      America, Levi H. Sadr, Director of Government Affairs..........   122

    Republican Jewish Coalition, Norm Coleman, National Chairman and
      Matthew Brooks, Chief Executive Officer........................   123

    Tragedy Assistance Program for Survivors (TAPS), Bonnie Carroll,
      President and Founder..........................................   124

    Veterans of Foreign Wars of the United States, Kristina Keenan,
      Director, VFW National Legislative Service.....................   125

    Vietnam Veterans of America, Jack McManus, National President....   126

                            Questions for the Record

    Department of Veterans Affairs response to questions submitted
      by:

      Hon. Margaret Wood Hassan......................................   129

      Hon. Dan Sullivan..............................................   130

      Hon. Tommy Tuberville..........................................   132

                           Statements for the Record

    American Battle Monuments Commission.............................   137

    American Federation of Government Employees (AFGE), AFL-CIO,
      Daniel M. Horowitz, Director of Legislation....................   140

    The American Legion, Matthew Cardenas, Policy Analyst............   143

    Coalition for Common Sense in Government Procurement, Roger D.
      Waldron, President.............................................   163

    Concerned Veterans for America, John Vick, Executive Director....   167

    Congressional Medal of Honor Society, Britt Slabinski, President.   173

    Elizabeth Dole Foundation........................................   175

    K9s For Warriors, Daniel Bean, Chief Executive Officer...........   180

    Military Officers Association of America (MOAA)..................   182

    Medal of Honor Foundation, David J. McIntyre, Jr., Chairman of
      the Board of Directors.........................................   188

    National Guard Association of the United States..................   190

    Quality of Life Foundation.......................................   193

    Reserve Organization of America, Jake Fales, Senior Policy Fellow
      for Veterans' Affairs; and Peter Donlon, Senior Policy Fellow
      for Defense and Acquisitions...................................   197

    Student Veterans of America......................................   205

    Veterans of Foreign Wars of the United States, Kristina Keenan,
      Director, VFW National Legislative Service.....................   210

    Veterans Healthcare Policy Institute.............................   216

                          HEARING TO CONSIDER PENDING
                                  LEGISLATION

                                  ----------

                            WEDNESDAY, MAY 21, 2025

                                           U.S. Senate,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 4 p.m., in Room
    SR-418, Russell Senate Office Building, Hon. Jerry Moran,
    Chairman of the Committee, presiding.

        Present: Senators Moran, Sheehy, Blumenthal, Murray,
    Hassan, and King.

                 OPENING STATEMENT OF HON. JERRY MORAN,
                   CHAIRMAN, U.S. SENATOR FROM KANSAS

        Chairman Moran. Nice to see that works. We have significant
    time constraints in our hearing today, and we are going to move
    it as expeditiously but as effectively as we can to go through
    our agenda. I have not checked with Senator Blumenthal's staff
    but I assume he is on his way. I am going to make my opening
    statement, and we have cut it in half, maybe the witnesses have
    done the same, and we will proceed with our hearing as members
    join us.
        I call the meeting to order. Welcome. Welcome to our
    witnesses and to those in the audience. We are going to hear
    from witnesses from the VA, from the Paralyzed Veterans of
    America, the Wounded Warrior Project, and Disabled American
    Veterans about 20 pieces of legislation on today's agenda.
    These bills reflect a wide range of issues facing military and
    veteran communities as well as the Department tasked with
    serving them. I am grateful for the sponsors of these bills and
    will work with them to make certain that they improve services
    for veterans, and I look forward to hearing from our witnesses
    today about these proposals.
        So recognizing that schedules for many of us, myself
    included, are particularly constrained this afternoon, in the
    interest of time I will withhold further comment. I will
    recognize the Ranking Member when he arrives, and I will now
    introduce our first panel.
        Testifying today from the Department of Veterans Affairs is
    Dr. Thomas O'Toole, not an unfamiliar face to us, the VA's
    Acting Assistant Under Secretary for Health for Clinical
    Services. He is accompanied by Kenneth Smith, the VA's
    Assistant Deputy Under Secretary for Operations Management, and
    Acting Executive Director of Education Services, and Phillip
    Christy, VA's Acting Principal Executive Director and Chief
    Acquisition Officer.
        Again, thank you all for being here, and Dr. O'Toole, I
    recognize you for your statement.

                                   PANEL I

                                  ----------

        STATEMENT OF THOMAS O'TOOLE, MD, ACTING ASSISTANT UNDER
      SECRETARY FOR HEALTH FOR CLINICAL SERVICES, VETERANS HEALTH
    ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS ACCOMPANIED
    BY KENNETH SMITH, ASSISTANT DEPUTY UNDER SECRETARY, OPERATIONS
       MANAGEMENT, OFFICE OF FIELD OPERATIONS, ACTING EXECUTIVE
           DIRECTOR OF EDUCATION SERVICES, VETERANS BENEFITS
       ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND
      PHILLIP W. CHRISTY, ACTING PRINCIPAL EXECUTIVE DIRECTOR AND
     CHIEF ACQUISITION OFFICER, U.S. DEPARTMENT OF VETERANS AFFAIRS

        Dr. O'Toole. Thank you, Senator, and before I begin I want
    to apologize for the delay in getting the testimony before the
    Committee.
        Chairman Moran. Dr. O'Toole, that was part of my opening
    statement, critiquing that fact, which I left out.
        Dr. O'Toole. Well, now we are covered.
        Chairman Moran. Yes, sir.
        Dr. O'Toole. While the Department has provided detailed
    views in my written statement, I would like to highlight
    several of the bills we will be discussing today.
        VA supports the intent of S. 1591, Acquisition Reform and
    Cost Assessment Act of 2025, but recommends amendments to
    ensure effective implementation. VA does not support Section 6
    of the bill, which would require VA to establish a cost
    assessment and program evaluation office.
        VA supports S. 214, the MEDAL Act of 2025, subject to
    amendments and the availability of appropriations.
        VA strongly supports the goal of S. 1533. We do recommend
    amendments to certain provisions and are happy to work with the
    Committee.
        Regarding S. 649, Guard and Reserve GI Bill Parity Act of
    2025, the Department is still examining the bill and is unable
    to provide comprehensive views at this time.
        The Department supports the principles behind expanding
    access and simplifying eligibility for community care as it
    appears to be the intent in S. 219, the Veterans Health Care
    Freedom Act. However, VA believes enacting the Veterans' ACCESS
    Act of 2025 would be a better way of ensuring veterans can
    receive care from community providers.
        We support the intent of S. 506, to improve care
    coordination for veterans dual eligible for Medicare and VA
    health care. However, VA has concerns with certain provisions.
        Similarly, VA supports the intent of S. 800, which aims to
    advance critical research in brain health, blast exposure, and
    a potential treatment for veterans adversely impacted by their
    military service. We would appreciate the opportunity to work
    with the Committee to discuss any concerns we have with this,
    and also to discuss our research efforts.
        VA supports S. 585, S. 635, S. 778, and S. 1441. Regarding
    S. 605, the CHAMPVA Children's Care Protection Act of 2025, VA
    does not support extending CHAMPVA benefits to children up to
    age 26.
        We support the intent of certain provisions in both S. 784
    and S. 827, which would expand grant programs aiding
    transportation to rural veterans. And we are happy to work with
    the Committee on technical assistance toward those bills.
        We do not support S. 599, the DRIVE Act.
        This concludes my testimony. Thank you, and we are prepared
    to answer and respond to any questions you or other members of
    the Committee may have.

        [The prepared statement of Dr. O'Toole appears on page 33
    of the Appendix.]

        Chairman Moran. Dr. O'Toole, thank you very much for your
    testimony. I appreciate the VA's support for one of the bills
    on the agenda that I introduced, the Coordinating Care for
    Senior Veterans and Wounded Warriors Act, and your willingness
    to work with me to make certain we are facilitating timely and
    efficient information sharing between the VA and CMS and
    avoiding duplication.
        In the interim, between now and potential enactment of this
    legislation, what is the VA doing to accomplish these outcomes?
        Dr. O'Toole. Thank you, Senator. The concerns we have with
    this bill are primarily related to the fact that it addresses
    many of the things that we are already doing. One of the
    primary concerns is related to--we currently provide care
    coordination, and care coordination through the primary care
    group at the VA. The added provision of having additional care
    coordination runs the risk, in our view, that we could have
    redundancy in that care and redundancy in those services.
        A significant provision to the bill is the information
    sharing between CMS and between the Medicare providers to CMS
    and VA care. This is a long-standing challenge and issue, one
    that we have currently in the community care effort. We are in
    the process, particularly through our EHRM efforts and
    expansion in Oracle Health, developing a health exchange that
    does provide a more timely way for sharing medical records, and
    we expect with more rapid transition of implementation of that
    EHR, we will have a better system in place for the record
    sharing we are discussing.
        Chairman Moran. Thank you. Let me ask Mr. Smith this
    question. As VBA continues to tackle the claims backlog as well
    as remands from the Board of Veterans' Appeals, timely and
    high-quality medical disability exams are important. My bill,
    the VA License Portability Act, would permanently authorize the
    VA License Portability Pilot Program for contract medical
    disability examiners.
        Would you speak to why this is important and what the
    current hindrance is for veterans receiving medical disability
    exams in a timely manner, absent expanded license portability
    for contract examiners?
        Mr. Smith. Thank you for the question, Senator. We strongly
    support this. Of course, we are operating under a pilot program
    that has been in existence since 1996, and we are eager to move
    to a more permanent structure.
        We do have a couple of concerns, just with the designation
    of physicians in the bill. We would prefer to use health care
    providers because 86 percent of our exams are currently
    conducted by non-physician health care providers. And last, I
    would say we have concerns with the submission of evidence to
    the contract examiners. We would prefer that those records come
    directly to VA, because we do not have contractual privity with
    the actual providers. They are all subcontractors to the four
    main contract vendors.
        Chairman Moran. Thank you. I am going to cut my questions
    short. Senator King and Senator Hassan, there has not been a
    coup. I expect Senator Blumenthal to arrive. And there is
    almost no member of this Committee who could remain here past
    5, so we are trying to be very timely.
        And I now recognize Senator King for his questions.

                        HON. ANGUS S. KING, JR.,
                        U.S. SENATOR FROM MAINE

        Senator King. I have no questions because I believe that
    the testimony is that this witness supports all of the bills
    that I have introduced. So I commend you for your insight and
    the deep intelligence.
        [Laughter.]
        Chairman Moran. I think I am going to make sure you are a
    co-sponsor of every bill that I introduce.
        [Laughter.]
        Senator King. But I do note that there are reservations
    about some amendments that you want to discuss. I am happy to
    work with you on those, because there are some very important
    provisions here. So thank you.
        Thank you, Mr. Chairman.
        Chairman Moran. You're welcome. While Senator Blumenthal
    gets settled, I will recognize Senator Hassan.

                       HON. MARGARET WOOD HASSAN,
                    U.S. SENATOR FROM NEW HAMPSHIRE

        Senator Hassan. Thanks very much, Mr. Chair. Dr. O'Toole,
    it is good to see you again. A few weeks ago we discussed VA's
    plan to fire 80,000 workers. You testified then that despite
    being the Acting Chief Medical Officer at the VA, you had not
    been consulted about how this plan would affect care for
    veterans.
        Two weeks ago, I asked Secretary Collins about this, and I
    alerted him to the fact that the top doctor at the VA had not
    been consulted about how this plan might help or harm veterans'
    health care.
        Since we last spoke Dr. O'Toole, has anyone at VA asked for
    your input or analysis or asked you to oversee any analysis
    done by the VA's Clinical Services Department regarding how
    firing 80,000 VA employees would affect veterans' care?
        Dr. O'Toole. Thank you, Senator, and I appreciate the
    opportunity to respond. I will note two things. One is that
    there is a larger process. I appreciate the title of ``Top
    Doc,'' but there are several clinicians, physicians senior to
    me who are actively involved in this. It is very much pre-
    decisional. The specifics to the questions you have asked, I do
    not know. I am not aware of. But that does not mean that these
    analyses are not ongoing. I would have to take it for the
    record and respond to you on that. But I am happy to speak to
    the legislation we have.
        Senator Hassan. Well, that would be excellent. Can you tell
    me who the doctors senior to you, or the clinicians senior to
    you are, who are involved in this analysis?
        Dr. O'Toole. I would like to get back to you on the
    specific names on that if I can, ma'am.
        Senator Hassan. Okay. You know, part of our job is
    oversight, and there have been bipartisan concerns, obviously,
    about what Secretary Collins says is a plan or a goal to fire
    this many workers. And it is really important that we
    understand what kind of analysis is being done before they go
    forward with the decision. I expect them to do analysis. I
    expect them to measure. I expect them to consult with you and
    other clinicians to understand what the interplay between the
    clinician is and, let's say, somebody who orders supplies at
    the VA. And I think we are running out of time here, and I keep
    kind of getting these answers, either they have not consulted
    you or you cannot tell me who they are consulting.
        So we will certainly submit a question for the record, but
    I hope you will take back to the Secretary and his whole team
    our expectation that they really lay out who is doing this
    analysis.
        Now, the President recently signed an Executive order that
    requires the Secretary of the VA to commission a feasibility
    study and an action plan to expand services to support a full-
    service medical service in New Hampshire. This is a really good
    first step. We have needed that full-service medical center in
    New Hampshire for a long time. We are the only state in the
    contiguous United States that does not have its own full-
    service medical center.
        But I want to make sure that this problem gets the
    attention it deserves and that Granite Staters get the best
    possible care. It is critically important that the VA and the
    Administration engage with New Hampshire veterans, VSOs, and
    other Granite Staters on the ground to get their input and
    feedback. As you know, my colleagues and I have been advocating
    for this full-service VA for a long time, but we want to make
    sure that as plans are going forward, veteran care is not
    disrupted at our current facility, and I want to make sure that
    the Administration is reaching out to get input from folks on
    the ground in New Hampshire.
        So Dr. O'Toole, how will the VA decide what new clinical
    services to provide to veterans in New Hampshire at the
    hospital, and how will the VA engage with Granite Staters to
    make sure the new facility meets the unmet clinical needs of
    our veterans, and what will the timeline be for this kind of
    decision?
        Dr. O'Toole. Thank you, Senator, and first, fully
    acknowledge and agree with all the points you are making, and
    that would be the process I would expect would be underway. I
    do not know, and I am not prepared to be able to speak to the
    specifics to that. I would have to take it for the record, in
    terms of where we are with that planning and what the process
    will be.
        Senator Hassan. Well, I appreciate that. From what I am
    hearing on the ground, nobody has heard anything from the VA,
    from the White House since the President's Executive order,
    which makes us wonder how much of this is window dressing and
    how much of this is real, right. So we really would appreciate
    outreach, and again, if you all will take that back to the
    Secretary's office that would be very helpful.
        I have more questions. I will submit them for the record.
    Thank you, Mr. Chair.
        Chairman Moran. I now recognize the Ranking Member, Senator
    Blumenthal.

                      HON. RICHARD BLUMENTHAL,\1\
             RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT
    ---------------------------------------------------------------------------

        \1\ The opening statement for Senator Blumenthal appears on page 29
    of the Appendix.
    ---------------------------------------------------------------------------
        Senator Blumenthal. Thank you, Mr. Chairman, and I
    apologize. I have another subcommittee, the Subcommittee on
    Permanent Investigations, which is ongoing, as Senator Hassan
    knows, because she is also a member of that subcommittee, and
    it is still ongoing. So I do apologize.
        Before I begin, I want to ask consent to enter into the
    record a recent New York Times article entitled ``Trump's Push
    to Defund Harvard Prompts Clash Over Veteran Suicide
    Research.''
        Chairman Moran. Without objection.

        [The article referred to appears on page 113 of the
    Appendix.]

        Senator Blumenthal. Thank you. This article, I do not know
    whether you are familiar with it, Dr. O'Toole, shows that there
    are multiple contracts between the VA and Harvard University
    that are planned to be canceled, including contracts involving
    VA suicide prevention efforts and contracts ensuring veterans
    have adequate access to clinical trials.
        VA officials are quoted in the article saying that
    canceling these contracts would result in, quote, ``more
    veteran suicides that could have been prevented,'' end quote.
    They are raising the alarm and pleading with VA leadership not
    to cancel these highly critical contracts.
        Dr. O'Toole, are you aware of this situation?
        Dr. O'Toole. I have seen the article, sir, and I have
    heard, obviously I have heard it as you have as well, and the
    concerns. I would have to take for the record any specifics on
    the status of those deliberations.
        Senator Blumenthal. Well those research contracts are
    important to prevent veteran suicide, are they not?
        Dr. O'Toole. Absolutely, sir. I am not, by any means,
    disputing the nature of the research nor the importance of it.
        Senator Blumenthal. Do you agree with their cancellation?
        Dr. O'Toole. Sir, I am not here to discuss the specifics of
    that. I am not prepared to be able to discuss that from a
    departmental perspective, but happy to take for the record what
    the status of those considerations are.
        Senator Blumenthal. Well, I do not mean to be
    disrespectful, but veterans may be dying as a result of these
    contracts being canceled. You have been involved in the VA for
    some time. I am disappointed that you will not express perhaps
    a more critical view of what is happening here.
        Dr. O'Toole. Well, thank you, sir, and as somebody who has
    done research in the VA, I can fully appreciate that. I just do
    not want to get ahead of my skis here in speaking for the
    Department on this, so I do need to take it for the record.
        Senator Blumenthal. Well you are here on behalf of the VA.
    And I am just going to be really direct. We have been asking
    the VA about these contracts, including the Harvard contracts,
    for more than a month, and we have received no response. So
    that when people come to me and say, ``Why are you holding
    these nominations?'' and I say, ``It is because the VA is
    denying us essential information that is necessary for our
    oversight and we want accountability. Here is Exhibit A, saving
    lives.''
        The VA has no more foundational and essential purpose than
    stopping veteran suicide, and it has denied us and refused to
    provide information, purposefully. It cannot be an accident,
    but purposefully. And I know you are on the receiving line of
    this complaint, and make no mistake, I know you are not the one
    responsible.
        So, when you take this message back, and you get back to
    us, and I am not going to berate you further, you should make
    clear that here is the reason why we are putting a hold on
    these nominees and why we are extremely disappointed, I will
    put it euphemistically, with the response so far.
        And just so we also understand why we are here today, a lot
    of great legislation. The Children's Care Protection Act, other
    measures that are important to advance the authority of the VA.
        We still do not know the number of fired VA employees, as
    well as the canceled VA contracts. We have no idea when, if
    ever, we will have the VA lift its freeze on rulemaking.
    Remember, rulemaking is important to legislation. Legislation
    cannot be implemented until the rules are in place. And we have
    no idea when that freeze will be lifted so laws can be
    implemented.
        Here we are talking about new laws. Laws are dead letter if
    there are no rules and regulation. Laws are also dead letter if
    there is no workforce to implement them. If people cannot
    enforce them and carry them out, they have no meaning. And the
    VA is planning, it's the stated goal of the VA Secretary, to
    cut 83,000 employees who are important to carry out those laws.
        So, the laws we have passed already, the PACT Act and the
    Elizabeth Dole Act, great bipartisan measures. They are going
    to be dead letter if we do not provide the resources for them
    to be implemented and if the slash-and-trash approach is
    carried forward.
        My time has expired. Mr. Chairman, thank you.
        Chairman Moran. You are welcome. Thank you, Senator
    Blumenthal. Senator Sheehy.

                            HON. TIM SHEEHY,
                       U.S. SENATOR FROM MONTANA

        Senator Sheehy. No questions at this time.
        Chairman Moran. Thank you, Senator. Senator Murray.

                           HON. PATTY MURRAY,
                      U.S. SENATOR FROM WASHINGTON

        Senator Murray. Thank you, Mr. Chairman. Dr. O'Toole, thank
    you for being here. You know, women veterans, particularly
    those who have suffered from PTSD or sexual assault, tend to
    experience menopause much earlier than women who did not serve
    in the military. One VA study found that 15 percent of women
    veterans experience menopause before the age of 40. That is 10
    years earlier than most women. It is really important that we
    strengthen menopause research at the VA and DoD so we can
    provide better care for women servicemembers and our veterans.
        That is why I was very proud to join Representative
    Houlahan and Senator Ernst in introducing the Servicewomen and
    Veterans Menopause Research Act last month to do that. Can you
    tell me today what resources are available right now, at the
    VA, for women veterans who are experiencing menopause? Are
    there any plans to expand that, and what do you have right now?
        Dr. O'Toole. Thank you, Senator, and first I acknowledge
    and fully appreciate and agree with what you are saying there.
    I do not have that information readily available in terms of
    what resources are currently being dedicated. I would have to
    get it for the record.
        Senator Murray. Okay. How long will that take you to get to
    me?
        Dr. O'Toole. We will get it as quickly as we can.
        Senator Murray. Okay.
        Senator King. But do you support the bill?
        Dr. O'Toole. Yes. Yes, we strongly support the bill.
        Senator Murray. Thank you. During a hearing earlier this
    month I actually asked Secretary Collins about the Trump
    administration's 90-day pause on VA clinical trials, which is
    right now delaying planned trials and putting a halt to ongoing
    clinical trials at VA, everything from predicting stroke risks
    to addressing substance abuse. Now, Secretary Collins said at
    the time, there was no decision regarding what would happen to
    VA researchers and trials when that pause ended.
        Do you have an answer to that question I asked a few weeks
    ago? What will happen after this 90-day pause ends? Where will
    you direct these patients whose clinical trials were canceled
    or delayed?
        Dr. O'Toole. Thank you, Senator. Unfortunately, as noted
    earlier, I do not have that information available to me. I have
    to take it for the record.
        Senator Murray. You do not have any idea?
        Dr. O'Toole. I do not. No, ma'am.
        Senator Murray. Can you provide my office with a list of
    clinical trials that were canceled?
        Dr. O'Toole. Again, I do not have that available but we can
    get that information to you. Yes, ma'am.
        Senator Murray. Well, the VA has to have this information.
    Certainly if you care about transparency, which we keep
    hearing, I see no reason why this information would be secret.
    When can you get that information to us? These are people who
    are in trials. These are researchers. Just for the next 10
    years they are not supposed to know? When are you going to get
    that to us?
        Dr. O'Toole. We will get it to you as soon as we can,
    ma'am.
        Senator Murray. What does that mean? I have heard that from
    so many people in the last couple of weeks.
        Dr. O'Toole. I would obviously defer to our legislative
    team and our research office on those specifics, but I would
    imagine we would be able to get----
        Senator Murray. It is a disappointing response, I have to
    tell you.
        Dr. O'Toole. Okay. I would imagine we would be able to get
    it to you within the next few weeks, 1 to 2 weeks hopefully.
        Senator Murray. Okay. Well, let me try one more. Women are
    the fastest-growing demographic within the veteran population.
    You know that. VA was not initially built for women. It is our
    collective responsibility to honor women who have bravely
    served our country by taking action to remove barriers that for
    too long have restricted their access to the benefits that they
    earned and the health care that they earned. And I really
    believe the goal should be a VA system that offers women
    comprehensive at every stage of life post-service.
        Actually, in my home State of Washington, Puget Sound VA
    saw a 7 percent increase in women veterans utilizing their
    service over the past few years.
        I am appreciative of the mobile mammography centers that
    were made available for our Puget Sound veterans, but it is a
    temporary fix. Can you provide me any update today on the
    progress in establishing a permanent in-house mammography
    service for veterans in VISN 20, or a timeline?
        Dr. O'Toole. I do not have the specifics, but I am happy to
    track those down, and we can get back to you on it.
        Senator Murray. Okay. I would appreciate answers to those
    questions as soon as you can. This is critical information that
    we need. Thank you.
        Chairman Moran. Thank you, Senator Murray. Senator
    Blumenthal.
        Senator Blumenthal. Thank you, Mr. Chairman. I have one
    more question. And by the way, I strongly support Senator
    Murray's Servicewomen and Veterans Menopause Research Act. It
    is a great piece of legislation, another example of how a
    hiring freeze and firings are chipping away at VA research, and
    we should have the answers to the questions that she asked.
        Let me turn to the Elizabeth Dole Act. Earlier this week,
    the VA announced it will be implementing Section 101 of the
    Elizabeth Dole Act, which would definitively give a veteran and
    their referring VA clinician the final decision regarding
    eligibility for community care. Our Committee is still waiting
    to learn or hear how or when the VA will implement dozens of
    other critical sections of the bill. This is what I am talking
    about--implementation, rulemaking, time-sensitive provisions
    such as raising the grant and per diem rate for homeless
    veterans and expanding home and community-based care for
    veterans with ALS or spinal cord injuries, provisions that
    directly impact the most vulnerable veterans we serve. They
    were top of mind when, in a bipartisan way, our Committee and
    our Senate passed this measure, overwhelmingly.
        If the VA is stalling implementation of the Dole Act and
    planning to fire tens of thousands of staff, how can the
    Department adequately implement this additional legislation
    that we are considering today?
        Dr. O'Toole. Well, Senator, thank you, and I would first
    acknowledge that the provisions in the Dole Act are ones that
    we fully endorse and are actively working to implement, and
    being personally involved in several of the sections, it is
    something that we are working on, and I am hoping that we will
    have results shortly. And I am happy to be reporting back to
    your staff on those updates.
        Senator Blumenthal. Thank you. Mr. Chairman, in the
    interest of time, I am going to submit my other questions for
    the record, and we can go on to our next panel.
        Chairman Moran. Thank you, sir. Senator King, in quick
    summary of the bills I have introduced that are being
    considered today, at least half of the bills that I have
    introduced, you are the primary co-sponsor. So I look forward
    to seeing great success in my efforts [laughter.] The other
    ones are with Senator Blumenthal. We will see how you compare.
        [Laughter.]
        Chairman Moran. They loved every one of his bills.
        Thank you all very much for your presence here today. As
    you can see, the Committee has lots of questions that are
    broader than the scope of this hearing, and we would continue
    to encourage the Department of Veterans Affairs to provide the
    information requested by any member of this Committee, any side
    of this Committee, and to forthrightly provide us with the
    information our staffs have asked for.
        Thank you, Dr. O'Toole, and your team.
        I welcome our second panel, and I will go ahead and
    introduce you, even though you cannot quite get there yet.
    Testifying with us today is Morgan Brown, the National
    Legislative Director for the Paralyzed Veterans of America;
    Brian Dempsey, the Director of Government Affairs for Wounded
    Warrior Project; and Jon Retzer, the Deputy National
    Legislative Director for the Disabled American Veterans.
        I thank all three of you for being here. Thank you for the
    work that you do for veterans, and thank you for your
    organizations that you represent who take such care and concern
    for those who served our country.
        Mr. Brown, we will recognize you first.

                                   PANEL II

                                  ----------

       STATEMENT OF MORGAN BROWN, NATIONAL LEGISLATIVE DIRECTOR,
                     PARALYZED VETERANS OF AMERICA

        Mr. Brown. All right. Thank you, Mr. Chairman and Ranking
    Member Blumenthal, Members of the Committee. PVA certainly
    appreciates the opportunity to appear before you today to
    discuss some of the bills that you are looking at.
        First, though, I would like to just take a moment and
    recognize the fellows that are here from the Elizabeth Dole
    Foundation. We have had the privilege of spending some time
    with them the past couple of days, and I know that they have
    been out visiting some of the congressional offices, and
    hopefully you had an opportunity to speak with some of them.
        PVA supports the overwhelming majority of the bills that
    are on the agenda today. I would be remiss if I did not
    publicly acknowledge our support of the Rural Transportation
    bills, the 3R Caregiver bill, the SAVES Act, and the Fourth
    Administration bill. So I am just going to limit real brief
    comments on three of the others.
        The first is the Veterans Accessibility Advisory Committee
    Act. Over the last five decades, Congress has spent a
    considerable amount of time passing legislation to improve
    disability access to both Federal facilities, especially the
    VA, and, in some cases, into the private sector. These laws
    provide critical protections to people with disabilities when
    they interact with all levels of the government and many
    everyday accommodations like medical offices, grocery stores,
    and hotels.
        Despite all of this effort and these legal requirements,
    our members routinely face disability access barriers when it
    comes to accessing VA care within VA facilities and within the
    community. We have appeared before the Committee before. We
    have discussed some of the problems that we have encountered.
    Senator Murray mentioned the fact that a lot of VA facilities
    were not originally fitted for women veteran health care.
        I recall one instance where a woman veteran clinic was
    established for VA but it did not have like the outdoor
    controls, the handicapped controls, so that one of our members
    could enter that facility. And unfortunately, the office staff
    were positioned within the facility in such a manner that they
    were not able to see anybody at the door, and our member was
    stuck outside of the door until somebody came to the door and
    was able to let them in. Those are the types of barriers that
    we are talking about.
        Because of the complex nature of injuries and illnesses
    that our members face, we tend to access VA care much more so
    than the average veteran, and we believe that VA should lead
    the way in accessibility for disabled veterans, so we are
    strongly supporting this bill, which directs VA to create an
    advisory committee on issues relating to the accessibility of
    VA benefits, services, and facilities, but not just within VA,
    granted the push toward the private sector. We need to make
    sure that there is greater emphasis on the accessibility of the
    primary care facilities, as well.
        Next, you are familiar that VA pays eligible veterans and
    caregivers mileage and other travel expenses to and from
    approved health care appointments, but the current
    reimbursement rate is too low. Fifteen years ago, Congress set
    the rate at 41 cents per mile. That was based on the Federal
    rate at the time. Since then, the Federal rate has increased
    significantly, but VA has remained stagnant, even though the
    cost of gas and vehicle maintenance and car insurance has
    increased dramatically. We support this bill, which ties the
    veteran's mileage rate to the GSA rate, and we believe that
    this will help improve veterans' access to their health care
    services and reduce their financial burden.
        Senator King. Which bill is that, please?
        Mr. Brown. That is S. 599.
        Finally, we support the CHAMPVA Children's Care Protection
    Act. This is the bill that would allow the surviving spouses,
    family members using the CHAMPVA program to remain in the
    program until age 26. Back in 2011, after the ACA extended this
    health care to all of the other Federal programs and health
    insurance programs, DoD made the change. VA did not. And so
    these family members of veterans are forced out of the program,
    the latest at age 23, and we believe that this program should
    allow them to remain in until age 26. Thank you.

        [The prepared statement of Mr. Brown appears on page 74 of
    the Appendix.]

        Chairman Moran. Thank you very much, Mr. Brown.
        Senator Blumenthal. Mr. Chairman, if I could just----
        Chairman Moran. Senator Blumenthal.
        Senator Blumenthal [continuing]. Apologize to the panel. I
    am obligated to go to the floor of the Senate. I would have
    asked you a question about how the cutbacks in staff might
    affect your view of how the Department is functioning. I will
    submit that question for the record. I appreciate the Chairman
    giving me this opportunity to apologize and explain the reasons
    for my absence. It is not out of lack of interest. And I know
    Senator King will be here. I yield to him my time. And since
    the Chairman seems to regard him as a favorite anyway----
        [Laughter.]
        Senator Blumenthal [continuing]. I know I will not be
    missed.
        Chairman Moran. Just because you are associating with
    Senator King does not mean you can get your way on everything.
        [Laughter.]
        Senator Blumenthal. Thank you.
        Chairman Moran. Senator Blumenthal, thank you. Senator
    Blumenthal and I both had nothing on our schedules whenever the
    point in time is we chose this date and time for this hearing,
    and it just has not worked to remain that clear today. We are
    still trying to figure out--I am still trying to figure out
    what time of the day and what day of the week is our best
    opportunity to be most available to most members so that we can
    hear the most amount of testimony and interact with those who
    come before us.
        Mr. Dempsey, you are recognized.

                  STATEMENT OF BRIAN DEMPSEY, DIRECTOR
             OF GOVERNMENT AFFAIRS, WOUNDED WARRIOR PROJECT

        Mr. Dempsey. Chairman Moran, Ranking Member Blumenthal, and
    distinguished Committee members, thank you for inviting Wounded
    Warrior Project to testify on legislation intended to improve
    access to care and benefits for our Nation's veterans.
        Today's agenda includes many bills that are aligned with
    our mission to honor and empower wounded warriors, and I am
    pleased to speak on several that would have a heightened impact
    on the post-9/11 wounded, ill, and injured veterans we serve.
        To help those struggling with invisible wounds we strongly
    support the Precision Brain Health Research Act as the next
    step in Federal action to address the service injuries caused
    by blast exposure. Low-level blast injuries have received
    increased attention thanks to recent reporting from The New
    York Times and 60 Minutes, but they have also been the subject
    of congressional action on the prevention side. The Precision
    Brain Health Research Act would bring focus to veterans' health
    care.
        The bill would leverage VA's biomarker research
    capabilities and precision medicine initiative to learn more
    about the long-term health effects of blast injuries and
    translate those findings into better and more personalized
    treatment plans. Over time, the bill will help transform the
    way we care for those affected by brain injury and ultimately
    help many veterans lead longer, healthier, and more productive
    lives.
        On a similar note, we support the Coordinating Care for
    Senior Veterans and Wounded Warriors Act. With clear
    acknowledgement in its title, this bill speaks to the fact that
    many veterans are relying on Medicare and VA's geriatrics and
    extended care programs earlier in life after being
    catastrophically wounded in service.
        Five percent of VHA-enrolled veterans under the age of 45
    have Medicare coverage, along with another 15 percent of those
    between the ages of 45 and 60. For many in these categories,
    the bill would help address their priorities like better care
    coordination and patient advocacy through a 3-year pilot
    program aimed at improving care, lowering costs and eliminating
    gaps in care and duplication of services. There is clearly much
    that can be learned from this pilot, so we strongly advocate
    for the bill's passage as a key for systemic improvements.
        To help care for women veterans, we are proud to endorse
    the Servicewomen and Women Veteran Menopause Research Act,
    which would require VA and DoD to evaluate and conduct research
    on menopause, perimenopause, and midlife women's health. This
    legislation represents a long-overdue recognition of the unique
    and evolving health care needs of servicewomen and women
    veterans as they age.
        To help the hidden heroes who have supported the most
    severely injured warriors in our community, we are pleased to
    endorse the Veteran Caregiver Reeducation, Reemployment, and
    Retirement Act. By passing this legislation, Congress can
    invest in the well-being of caregivers, ensuring they have the
    resources needed to reclaim their careers, stabilize their
    financial futures, and transition out of their caregiving roles
    with dignity.
        Finally, I want to highlight our support for the Veterans
    Accessibility Advisory Committee Act of 2025, which has
    companion legislation that was passed by the House yesterday.
    Establishing an advisory committee on equal access will help
    ensure that accessibility is built into every aspect of VA's
    operations, from facilities and medical equipment to digital
    platforms and communication tools, all of which are critical
    parts of a system that should provide accessibility groups with
    a seat at the table.
        Thank you again for the opportunity to testify at today's
    hearing. Like I said, we support many of the bills on today's
    agenda. But this concludes my testimony, and I look forward to
    your questions. Thank you.

        [The prepared statement of Mr. Dempsey appears on page 84
    of the Appendix.]

        Chairman Moran. Thank you, Mr. Dempsey. Mr. Retzer, you are
    now recognized.

     STATEMENT OF JON RETZER, DEPUTY NATIONAL LEGISLATIVE DIRECTOR
                 FOR HEALTH, DISABLED AMERICAN VETERANS

        Mr. Retzer. Thank you, Chairman Moran, Ranking Member
    Blumenthal, and Members of the Committee. Thank you for the
    opportunity to testify today, and in respect of your time, that
    you are all busy, I just want to highlight that DAV, out of all
    the 20 bills, we support 20 of them with some recommendations,
    and 5 we have no concerns. However, we urge the Committee to
    carefully review the following legislation.
        S. 506 aims to enhance the care coordination for veterans
    enrolled in both VA and Medicare, but it lacks clarity on case
    management and oversight and training standards. Without strong
    VA oversight, veterans face fragmented care and inadequate
    coordination between providers, especially since many private
    sector providers lack specialized expertise in service-
    connected conditions. DAV urges the Committee to prioritize VA-
    led case management and provide necessary training to ensure
    seamless, high-quality care for the dual-enrolled veterans.
        S. 635 expands homecare access through nurse registries
    within the Veterans Community Care Network. While increasing
    homecare options is critical, the inclusion of non-medical
    roles, such as companions and homemakers, raises oversight
    concerns and liability issues tied to the nurse registry.
    Regulatory changes vary across states, potentially limiting
    veterans' access to reliable home-based care. DAV recommends
    refining the bill's language to clearly define the nurse
    registry's functions within existing VA homecare initiatives,
    ensuring consistency and quality of services.
        Finally, S. 219, the Veterans Health Care Freedom Act,
    proposes expanding private sector options, but DAV strongly
    opposes this measure. While community care is vital for
    veterans facing excessive wait times or travel burdens, a
    balanced approach is necessary. Diverting resources from VA
    without additional funding would weaken specialized care
    designed for service-disabled veterans. Private sector
    providers often lack the expertise adequate to address
    conditions related to military service, leading to fragmented
    and inconsistent care. DAV urges Congress to increase in the VA
    staffing infrastructure and research to strengthen the VA
    system and maintain VA as the primary provider while
    integrating an effective Community Care Network.
        DAV members who rely heavily on the VA health care system
    believe it remains the best choice because it provides the
    comprehensive, whole-health model of care tailored to veterans'
    unique needs. Our nation's veterans deserve nothing less.
        This concludes my testimony, and I am pleased to answer any
    questions you or the Committee may have.

        [The prepared statement of Mr. Retzer appears on page 99 of
    the Appendix.]

        Chairman Moran. Thank you for your testimony. Senator King?
        Senator King. I am comfortable with the testimony. I look
    forward to working with all of you as we refine these bills. I
    appreciate the comments today, and we will continue to be in
    touch as we move forward with these bills. But thank you. Very
    helpful testimony. Thank you, Mr. Chairman.
        Chairman Moran. Thank you, Senator King. Mr. Brown, your
    testimony was very compelling or catching to me about the VA
    and its incapacity, its lack of capability of meeting the needs
    of veterans with disabilities. It seems like one of the last
    places we would expect to find that to be a problem, and it is
    legislation that I am introducing that you are talking about.
    But until you gave your testimony it was not that evident to me
    that there would be such a significant challenge at the
    Department of Veterans Affairs in meeting the needs of all
    veterans.
        What impediments does the VA have in fixing this problem,
    and what efforts are they undertaking to, I don't want to say
    whittle away, but to solve this problem even over a period of
    time?
        Mr. Brown. Well, in truth, I mean, VA has made great
    strides in trying to improve accessibility.
        You know, one area I did not have a chance, because we were
    attempting to try to shorten things up here, but is probably a
    good example of an area maybe for the Committee to look at is
    the accessibility of diagnostic equipment. We are talking about
    mammograms, the x-ray machines, dental chairs, weight scales,
    even x-ray machines themselves.
        In 2017, the U.S. Access Board published new accessibility
    standards for medical diagnostic equipment, and shortly after
    that VA jumped on board, very proactively, so that they would
    adopt those standards to ensure the needs of disabled veterans
    were met. But since that time we have no updates. We do hear
    from our members who have been unable to receive dental care at
    VA facilities because the chairs cannot accommodate them, they
    cannot get their x-rays or their mammograms because the
    equipment could not access them.
        So clearly there is a problem there, and I would encourage
    the Committee, maybe, this should be an area to do some
    additional oversight on, and not only see how far VA has come
    toward adopting these standards but what else needs to be done.
        Chairman Moran. Mr. Brown, thank you. What you are doing is
    again causing me to recognize it is not necessarily the
    automatic door or the curb cut, things that I might think of as
    being an impediment, but it is the actual equipment and the
    access to that equipment.
        Mr. Brown. You know, sometimes I think--if I may, sir--it
    may be because some of these changes are being made, or they
    are not being made with the view of the veteran in mind. And
    case in point, we had a veteran that went into the chapel
    between appointments, and was stuck in the chapel because the
    door did not have the push bar or the automatic door opener for
    them to get out, so they were stuck in the chapel until
    somebody came along to let them out.
        Had you had an advisory committee like this legislation is
    proposing, you would have veterans on that committee that would
    serve as advisors to the Department and then offer suggestions
    coming specifically from the perspective of a veteran with a
    complex illness or injury.
        Chairman Moran. Senator King?
        Senator King. I want to follow up on exactly that point. It
    strikes me that you have members all over the country, as all
    of you do. Perhaps you could have a project of examining the
    accessibility of various VA facilities and letting the VA know.
    In other words, give them an inventory--the back door at the
    Veterans Hospital in Knoxville is not accessible. Do you see
    what I mean, to use your membership and other veterans and VSOs
    to kind of survey the veterans facilities and advise the VA and
    us about where accessibility needs to be. Because often
    individuals who are not wheelchair-bound do not really
    appreciate the height of the button, for example. I think you
    could be very helpful in that.
        Mr. Brown. So I thank you for the recommendation. I know in
    many cases once a problem is identified, working through our
    service officers we do notify the facility, and then we work
    with the Department to get those corrected. But sometimes--and
    I am just putting on my old IG hat from my time in military
    service--a problem may be identified in one facility and
    actually exists in other facilities. So there needs to be a
    system internally to where a problem has been identified, look
    throughout the Department, does this problem exist elsewhere,
    and here is how to correct it.
        But I will take that back to my leadership and we will see
    what we can do.
        Senator King. I am thinking of a nationwide audit.
        Mr. Brown. Okay.
        Chairman Moran. Thank you, Senator King. My thoughts are
    just, personally, I visit lots of VA facilities. I ought to ask
    the question and be observant myself. So thank you for
    highlighting that.
        Mr. Dempsey, the Veterans Caregiver Reeducation,
    Reemployment, and Retirement Act, tell me, and tell the
    Committee, why it is important to assist family caregivers
    transitioning back into the workforce or into retirement once
    they are no longer needed as full-time caregivers.
        Mr. Dempsey. Thank you for the question, Chairman. A recent
    report that RAND had published, and again, Wounded Warrior
    Project is often focused on the post-9/11 wounded, ill, and
    injured community, that RAND report had found that about 36
    percent of post-9/11 caregivers had reported income below 130
    percent of Federal poverty levels, and that many were lacking
    basic health insurance or emergency savings. And particularly
    for those who are leaving the program of Comprehensive
    Assistance for Family Caregivers there can be additional
    challenges when those caregiving responsibilities conclude, as
    many of the benefits are not portable or inclusive of
    retirement benefits.
        So what the Veteran Caregiver Reeducation, Reemployment,
    and Retirement Act would do essentially is bundle all of those,
    I think, elements that are essential to whether it be
    reclaiming your career, entering retirement on a comfortable
    level, and making sure that your financial security is future
    and that you can enter the world post-caregiving
    responsibilities with more confidence and security.
        Chairman Moran. Thank you. Mr. Retzer, you mentioned dual
    enrollees, and this is perhaps a question for any and all.
    Would you put into the record and educate me and perhaps others
    on what challenges dual-enrollees face, and how do you think
    this pilot program could establish the ways to address those
    challenges?
        Mr. Retzer. Thank you for that question, and if VA had a
    system of interoperability, an EHRM that was in place, so let's
    put that up front, saying it is there for us, and to have the
    providers, between VA and Medicare, to be able to understand
    the priority of the veterans. The veteran's complexity is they
    are at the VA medical center under eight priorities. We know
    that Priority Group 8 is a grandfathered-in priority, but when
    we look at the various priorities, they have service
    connections, Medal of Honor, Purple Heart requirements that
    fill in broad spectrum, plus their income.
        So then we look at the aging population, which we know
    right now that 49 percent of the veteran population that are
    enrolled in the VA health care system is 65 or older, so they
    are meeting the requirements of Medicare. They have to enroll
    into at least Medicare B.
        We would have to have training on the VA side, where the
    care coordinator has the expertise and the knowledge of both
    hemispheres, and to be able to understand what the priority
    groups are within the VA system to identify first their service
    connections that can be dealt with within the VA system,
    identifying also their demographics on where they live, because
    that is where the challenge comes. Like for your constituents
    in Kansas, they are mostly rural. So aging population in a
    rural community, they have to also be trained in the cultural
    competency, the understanding of the social dynamics of their
    own state, so that they can best facilitate when it is best to
    leverage Medicare when the costs can actually be saved on the
    veteran by providing care directly from VA, or in the veteran
    community program.
        So there is going to have to be a very robust training
    program and oversight ensuring continuity of that care is not
    broken. It is really a big component of training and rule bases
    established.
        Chairman Moran. Senator King.
        Senator King. Mr. Retzer, I wanted to follow up on your
    testimony and just thank you for your strong testimony about
    community care not encroaching on the underlying mission of VA-
    provided care. I think that is something that we just have to
    keep our eyes on. There are those, I think, who would like to
    move further and further in that direction, but I believe that
    preserving the fundamental veterans' health care system is
    critically important. I take it you agree.
        Mr. Retzer. Yes, Senator King, thank you for that. I think
    it is very important to look at what the veterans' needs are
    right now. We have heard concerns surrounding the veteran
    population of enrollment has stayed plateaued and the access to
    health care that veterans are enrolled in has also plateaued.
        One thing that we have noticed in the VA dashboard reports
    and the annual budget is this trend that is not being spoken
    about, but it is reported, and that is the episodes of care. In
    2019 to 2023, what we saw was that there was an estimate of 120
    million veteran episodes of care annually that was provided in
    2019, and then in 2023, it was roughly about 130 million
    estimated episodes of care. That is a very important number
    because, like Senator Murray, one of the things that she is
    really sponsoring is our women veterans. There are now nearly 1
    million enrolled in the VA health care system. We have an
    upward trajectory. And just like I said previously to Senator
    Moran's question is our veteran population of 49 percent at 65
    and older, so they are needing more care.
        Let alone, statistics also show us that 70 percent and
    higher ratings are being given more, so that means younger
    veterans have more catastrophic ratings from VA that is going
    to require medical assistance and services, to include long-
    term care.
        So I think it is really important that we look at the needs
    of our veterans, and to even address the rural complications,
    remote areas, but also look at the specialized care that is
    really challenging our women veterans, our minority, LGBTQ+. So
    it is so important that we do some good research, and that is
    why DAV also says research is important.
        Senator King. Do those episodes of care, does that data
    break out community care versus Veterans Administration health
    care?
        Mr. Retzer. I would have to go back and look. I do know
    that there are----
        Senator King. See if you could look to see if there are any
    trends in that data.
        Mr. Retzer. Yes, there are some trends that indicate where
    community care is and how many they are having and also with
    rural veterans care. So we know that out of the 2.7 rural
    veterans, how much of their care is in what direction.
        Senator King. Thank you, Mr. Chairman.
        Chairman Moran. I am sorry you caused me to think of
    another question that you may or may not have an answer to, any
    of you. The veterans who are not enrolled in the VA, or not
    receiving health benefits, some may be just utilizing Medicare.
    Do we know the characteristics of the population that the VA
    does not serve? You started down a path of statistics about
    who, you mentioned women, Senator Murray's issue. What is the
    typical veteran who is not utilizing the VA? Do we know that?
    This may not be the panel.
        Mr. Retzer. That is an interesting question, Senator, and
    with the data that we----
        Chairman Moran. That is what I say when I do not know the
    answer.
        [Laughter.]
        Mr. Retzer. And actually, the interesting thing is this may
    spell out for you where we are at. We know that we have talked
    about 9 million enrolled veterans. And we know currently that
    as we look at the trajectory and the reports estimating that
    the numbers are coming down in the veteran population, and we
    are sitting at about 18 million. So that is kind of indicating
    to us that in the general population, half of them are enrolled
    in the VA health care system. Where are the rest going then? So
    they must be in the private sector, is what we look at, and we
    would anticipate that, if they are not enrolled in the VA
    health care system.
        But we are looking further into that to see where the
    implications are.
        Chairman Moran. I would be interested. This is a question
    for the VA, as well, and they may know these numbers. But is it
    young veterans who are not taking advantage of services from
    the Department of Veterans Affairs? People in rural America?
    People with disabilities? Women? Maybe there is no pattern to
    this, but I am going to try to find out in my own capacity who
    is not being served, and then look for ways that we can meet
    that particular segment of our veteran population. Make sense?
    I guess I am not supposed to be asking you to confirm that what
    I am asking is a good question.
        I have one more thing. Senator King, do you have anything?
        Senator King. I am all set. Thank you.
        Chairman Moran. Okay. And that is--just one moment. I have
    a bill not with Senator King but with Senator Rosen, Fallen
    Servicemembers Religious Heritage Restoration Act, that is
    included in today's hearing. It would make certain that
    veterans buried overseas in cemeteries under the care of the
    American Battle Monuments Commission have grave markers that
    are accurately representing their religious faith.
        I saw an episode on television about this topic, and it was
    compelling, and I am grateful for the support of today's
    witnesses. I want to just ask for unanimous consent that we put
    into the record comments on this legislation from the Jewish
    Community Relations Bureau of Kansas City, the American Gold
    Star Mothers, Inc., the Republican Jewish Coalition, Veterans
    of Foreign Wars, Gold Star Spouses of America, the American
    Legion, Vietnam Veterans of America, Non Commissioned Officers
    Association, and TAPS, the Tragedy Assistance Program for
    Survivors.
        With no objection, it is so ordered.

        [The information referred to appears on pages 117-126 of
    the Appendix.]

        Chairman Moran. Would any of the three of you like to
    conclude? I always try to give my witnesses, our witnesses, the
    chance to add anything to the record or correct anything that
    you feel needs to be corrected. Any additional comments?
        [No response.]
        Chairman Moran. Thank you very much for your testimony.
        [Pause.]
        Chairman Moran. I look forward to working with all of you
    and your organizations, as this Committee does, to improve the
    circumstances and honor of those who serve.
        The hearing record will remain open for five legislative
    days, and should any Committee member wish to submit additional
    statements or questions for the record, you may use that time
    to do so. I ask that today's witnesses respond to any questions
    for the record that you may receive following today's hearing,
    Doctor, in a timely manner.
        And with that the hearing is adjourned.
        [Whereupon, at 4:55 p.m., the hearing was adjourned.]

                                A P P E N D I X

                                 Hearing Agenda

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                               Opening Statement

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                              Prepared Statements

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                           Statements for the Record

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