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


                                                         S. Hrg. 119-86

                HEARING TO CONSIDER PENDING LEGISLATION
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                                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                  
          
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                 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.]

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