[Senate Hearing 119-172]
[From the U.S. Government Publishing Office]
S. Hrg. 119-172
STRENGTHENING SERVICES FOR VETERANS
WITH SPINAL CORD INJURY AND DISORDER
=======================================================================
HEARING
BEFORE THE
COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
SEPTEMBER 17, 2025
__________
Printed for the use of the Committee on Veterans' Affairs
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
______
U.S. GOVERNMENT PUBLISHING OFFICE
61-681 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
----------
September 17, 2025
SENATORS
Page
Hon. Jerry Moran, Chairman, U.S. Senator from Kansas............. 1
Hon. Richard Blumenthal, Ranking Member, U.S. Senator from
Connecticut.................................................... 2
Hon. Thom Tillis, U.S. Senator from North Carolina............... 13
Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire....... 14
Hon. Angus S. King, Jr., U.S. Senator from Maine................. 17
Hon. Tammy Duckworth, U.S. Senator from Illinois................. 18
WITNESSES
Panel I
Shelly Hoover, EdD, Navy Veteran................................. 3
Mandi Bailey, Veteran ALS Action Committee....................... 5
Mary Ward, Veteran Spouse/Caregiver and Fellow, Elizabeth Dole
Foundation..................................................... 6
Robert L. Thomas Jr., National President and Chairman of the
Board, Paralyzed Veterans of America........................... 9
Panel II
Erica Scavella, MD, FACP, FACHE, Assistant Under Secretary for
Health for Clinical Services, U.S. Department of Veterans
Affairs accompanied by Manosha Wickremasinghe, MD, Executive
Director, VA's Spinal Cord Injuries and Disorders (SCI/D)
System of Care................................................. 22
APPENDIX
Prepared Statements
Shelly Hoover, EdD, Navy Veteran................................. 37
Mandi Bailey, Veteran ALS Action Committee....................... 39
Mary Ward, Veteran Spouse/Caregiver and Fellow, Elizabeth Dole
Foundation..................................................... 41
Robert L. Thomas Jr., National President and Chairman of the
Board, Paralyzed Veterans of America........................... 48
Erica Scavella, MD, FACP, FACHE, Assistant Under Secretary for
Health for Clinical Services, U.S. Department of Veterans
Affairs........................................................ 58
Questions for the Record
Department of Veterans Affairs response to questions submitted
by:
Hon. Richard Blumenthal........................................ 65
Hon. Angus S. King, Jr......................................... 66
Hon. Marsha Blackburn.......................................... 67
Questions for the Record (cont.)
Shelly Hoover response to questions submitted by:
Hon. Richard Blumenthal........................................ 69
Paralyzed Veterans of America response to questions submitted by:
Hon. Margaret Wood Hassan...................................... 70
Attachments for response to questions:
SCI/D Long-Term Care Centers Priorities.................... 72
SCI/D Project Delays....................................... 75
Statement for the Record
Veterans Multiple Sclerosis Alliance (VMSA)...................... 81
STRENGTHENING SERVICES FOR VETERANS WITH SPINAL CORD INJURY AND
DISORDER
----------
WEDNESDAY, SEPTEMBER 17, 2025
U.S. Senate,
Committee on Veterans' Affairs,
Washington, DC.
The Committee met, pursuant to notice, at 4 p.m., in Room
SD-106, Dirksen Senate Office Building, Hon. Jerry Moran,
Chairman of the Committee, presiding.
Present: Senators Moran, Cassidy, Tillis, Blumenthal,
Hassan, King, and Duckworth.
OPENING STATEMENT OF HON. JERRY MORAN,
CHAIRMAN, U.S. SENATOR FROM KANSAS
Chairman Moran. Good afternoon. I need to end the silence
in this room. We should be warm and welcoming, and we are glad
you are here. I want to extend a particular welcome to all of
our witnesses. Your presence and testimony are valuable as we
work to fulfill our Nation's promise to care for those who
served.
Veterans, particularly those with spinal cord injuries and
disorders, are a testament to courage and resilience. The
challenges they face are immense and often lifelong. For many,
a new and different journey begins the moment they return home
or receive their life-changing diagnosis, one marked by
physical and emotional hurdles that require specialized care,
innovative technology, and a dedicated support system. The VA's
Spinal Cord Injury and Disorder System of Care is a critical
lifeline for these veterans, making certain they receive
quality care when needed.
During this hearing, we will examine the current state of
the VA's SCI/D System of Care, identify where the VA is
succeeding, and pinpoint areas where the VA should do better.
We must make certain that the access to care and benefits is
timely and efficient, that the VA is at the forefront of
medical research and technology, and that veterans and their
caregivers have the necessary resources and support they
deserve.
I look forward to hearing from our witnesses this morning--
I guess it is this afternoon--which include Shelly Hoover, a
Navy veteran who has been living with ALS since 2013, and who
will testify today using a speech generation device with eye-
gaze technology.
Mandi Bailey, an ALS advocate who lost her Army veteran
stepfather to ALS, and has since dedicated her efforts to
supporting veterans with ALS and their caregivers.
Mary Ward, a spouse and caregiver to her Marine Corps
veteran husband, who has been living with ALS for 15 years.
And Robert Thomas, an Army veteran and the National
President of Paralyzed Veterans of America, which is the only
veteran service organization dedicated to the veteran SCI/D
community.
These witnesses will provide firsthand accounts of the
needs and challenges of living with spinal cord injuries and
disorders and how the VA and this Committee can best support
these veterans and their families. I thank you all for being
here, for your service to our country, and for their continued
advocacy on behalf of others.
With that, I yield to the Ranking Member, Senator
Blumenthal, for his opening remarks.
OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,
RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT
Senator Blumenthal. I join Senator Moran in thanking you
for being here. I know that as caregivers and veterans of very
deep and immediate experience with spinal cord injuries and
disorders, the challenge of being here is probably even more
difficult than for many of our other witnesses. And so, your
being here has special meaning.
I am glad we are focusing on a part of the veteran
population that relies, probably more than any other group, on
the VA. And that is a testament to the quality of the care that
the VA provides. The employees who provide this kind of care
are unmatched in the private sector, making these services
extremely valuable but also vulnerable to the type of cuts and
cancellations that we are seeing throughout the VA.
And, as VA continues to bleed employees due to this
Secretary's harmful policies, the services provided to people
who are directly involved in SCI/D are particularly at risk.
So, I think today's hearing is very, very timely and important.
Veterans who receive these services from VA cannot easily
transfer their care to community providers, where facilities
are often inaccessible and providers rarely receive specialized
SCI/D training. And the training is not a luxury; it is
essential. It is dealing with severe, life-threatening
complications that can arise from seeing a provider who is not
sufficiently trained. And I am very disturbed at how Secretary
Collins has failed to provide any credible assurances that he
will fight to preserve access to SCI/D care at the VA, which,
even before these cuts, needed bolstering and expanding.
The Administration has left many veterans with SCI/D and
their loved ones in limbo by failing to publish a rule to
extend eligibility for participants in the Caregivers Program.
And I think that is an immediate need that needs to be
addressed. He has been slow-rolling implementation of the
Elizabeth Dole Act, which would improve access to long-term
care services for veterans with SCI/D. He is delaying
implementation of critical funding increases for organizations
that serve veterans experiencing homelessness. Congress
intended these funds to help providers to keep their doors open
and continue supporting veterans.
On both of these provisions, we have been given a lot of
assurances that immediate implementation was not only possible,
but also a priority for the VA. We are here, months later, with
no concrete implementation timeline for either authority. I
wish we could be using today's hearing to discuss expanding
SCI/D care at the Department of Veterans Affairs rather than
just fighting to keep the status quo and asking the VA to
implement laws Congress has already passed. We approved those
laws. We worked hard on them. And the VA is failing to
implement them because of the leadership, not because the
dedicated, hardworking VA workforce has any reluctance to do
so. They want to serve.
So, I thank the Chairman for having this hearing and I look
forward to hearing from you.
Chairman Moran. Senator Blumenthal, thank you. Ms. Hoover,
you are now recognized for your testimony. Thank you. Thank you
for joining us, and thank you for communicating with us.
PANEL I
----------
STATEMENT OF SHELLY HOOVER, EDD, NAVY VETERAN
Ms. Hoover. Chairman Moran, Ranking Member Blumenthal, and
distinguished Members of the Senate Committee, thank you for
the opportunity to appear before you today. My name is Dr.
Shelly Hoover, and I am a veteran of the United States Navy.
For 12 years, I have been part of the Spinal Cord Injury and
Disorder System of Care, and I stand here today as a testament
to the lifesaving care provided by the Veterans Health
Administration. This testimony is the culmination of a decade
spent advocating for the more than 4,000 veterans currently
living with ALS.
My journey with ALS began in 2013. Initially, the VA's
support felt focused on end-of-life care, a system designed to
manage my death rather than empower my life. But I had a
different plan. I proactively sought out an ALS multi-
disciplinary clinic and worked to redefine my path. That
experience drove me to seek a seat at the table with the VA ALS
Executive Committee, ALSEC.
Working alongside a team of fellow advocates, we built a
relationship of trust with the ALSEC. We urged them to make the
ALS System of Care more user-friendly for veterans and their
caregivers, and they listened. Under the visionary leadership
of Drs. Ileana Howard and Sharyl Martini, the committee
achieved significant improvements without any additional
compensation for their work.
Their dedication led to the creation of a network of ALS
Coordinators, including nearly all of the 170 VA medical
centers; a comprehensive website to help veterans and
caregivers navigate their care; and an internal training
program for new coordinators and other departments.
This model, which integrates feedback from those with
``boots on the ground'' experience, demonstrates the power of
collaboration and mutual trust. It is a gold standard for
enhancing the veteran experience and improving morale for VA
employees who care so deeply for those they serve.
Based on my lived experience, I offer two recommendations
for continued improvement and future success:
Recommendation 1: Empower Stakeholders. All departments and
workgroups within the Spinal Cord Injury and Disorder system
must develop trusting relationships with both internal and
external stakeholders. As the ALSEC has demonstrated, this
approach enhances employee morale, empowers stakeholders, and,
most importantly, improves the quality of care and the overall
experience for veterans.
Recommendation 2: Ensure Full Funding. Congress must ensure
the Veterans Health Administration is fully funded. In addition
to budget cuts, congressionally allocated funds for special
diagnoses, like ALS, cannot be spent due to VA-imposed hiring
freezes and caps. Can that be corrected?
These funding shortfalls have had a direct and devastating
impact on my health and safety. I recently experienced severe
complications after a VA pharmacy, due to budget cuts, was
unable to provide the liquid form of a prescribed chemotherapy
drug. I suffered severe burns across my chest and pelvic
region, an extreme and avoidable outcome. Delays are now a
constant risk. For example, my replacement mic-key button, used
for feeding and medications, is over a month late. How long
before my current one breaks down and my stoma becomes
infected?
Life-sustaining breathing and nutrition supplies that were
once readily available now face delays of weeks or even months.
For a person with my condition, this is not just an
inconvenience, it is a grave threat. I will not die from ALS. I
will likely die from infection, a risk dramatically increased
by these supply delays.
Some may suggest that private Community Care is the
solution, noting its budget was recently doubled. However, with
one exception, my personal experience has been a disaster. I
have endured 6-month delays and lost referrals, forcing my
husband to spend countless hours on the phone. In one instance,
a private medical office initially refused to treat me due to
my tracheostomy, a clear violation of my rights.
By contrast, I have never experienced a delay or faced
discrimination from the Durham VA Medical Center. It is clear
to me that the VA is the best choice for veterans.
My family's legacy is deeply tied to military service, with
eight of my immediate family members having served in the Army,
Navy, and Marines. I am profoundly grateful for the exceptional
care the VA provides, and my grandchildren are thankful that I
am still here because of it.
To continue this gold standard of care, the Spinal Cord
Injury and Disorder system must actively seek input from
external stakeholders. And, above all, Congress must fully fund
the VA to protect the health and lives of current and future
veterans. Thank you.
[The prepared statement of Ms. Hoover appears on pages 37-
38 of the Appendix.]
Chairman Moran. Thank you. Thank you very much for your
testimony and your service.
I now recognize Ms. Bailey.
STATEMENT OF MANDI BAILEY,
VETERAN ALS ACTION COMMITTEE
Ms. Bailey. Hello and thank you for the opportunity to
speak before you today. My name is Mandi Bailey, and I am the
team lead of the ALS Hope Foundation's Veteran ALS Action
Committee, a volunteer group of veterans and caregivers that
have been impacted by ALS.
ALS is a 100 percent fatal disease with no known cure. And
for reasons not yet fully understood, our veterans are at a
significantly higher risk of developing ALS. My family got a
crash course in ALS and VA care when my stepdad, a proud
veteran, was diagnosed in 2017. Our local VA in Pensacola,
Florida, is under-resourced and understaffed, but they did
everything they could to ensure my stepdad was able to live his
life with dignity until his passing on February 2, 2018.
Because of the lack of services and resources at our VA, we
had to use community care in addition to the services we
received at the VA. In our opinion, the care we received inside
the walls of our local VA Medical Center was far superior to
the community care we received.
I soon learned that we are not alone in that opinion. In
2024, a survey was conducted by the VA's Veteran Experience
Office, and that revealed the highest trust levels in years.
Our veterans know that by receiving care at the VA, they will
be treated with the dignity and the respect they deserve as
U.S. veterans.
But it was not always this way. The VA has worked very hard
to improve the care that they provide, and the ALS System of
Care, much of the progress has come from allowing the
stakeholders, like myself, to give feedback and being open to
the input and ideas from the community. Dr. Ileana Howard,
Director of Neurology for ALS, has done a tremendous job of
listening, and has made considerable improvements by doing so.
She has brought the voice of the veteran to the table, and it
has made an immeasurable difference.
While it is important to recognize how far the VA has come
in its care for veterans, we know that there is still room for
growth. In 2021, the VA issued a VHA Directive, 1101.07,
Amyotrophic Lateral Sclerosis System of Care, and recently a
comprehensive ALS Handbook. The problem is that, one VA is one
VA. The services and resources at one VA are not the same as
the services and resources at another.
For example, my team co-lead, Jill Brattain's husband,
Dave, received top-notch care at the Richard Roudebush VA in
Indianapolis during his ALS journey. Their team was proactive,
knowledgeable, and responsive to their needs. The care that
Jill and Dave experienced is why the VA was called the ``Gold
Standard'' in a recent report from the National Academies of
Science, Engineering, and Medicine.
In contrast, our care was held up by red tape, lack of
knowledge, and scarce resources. Our team did what they could,
and we are grateful, but there was so much we missed out on
because of our ZIP Code. Consistency of care cannot happen
without proper funding and support. Veterans and their families
deserve uniformly high care throughout the VA.
Additionally, that same National Academies report that
praised the care provided by the VA should also serve as a
wake-up call. We need to fund research that will give us
answers as to what is causing our military veterans to be
diagnosed at higher rates, and what we can do to prevent and
possibly cure this disease.
When you are diagnosed with ALS you quickly learn that the
treatment options are few, and the options that are there might
only buy you a few months. Many times the focus shifts to
finding ways to remain engaged in life. Veterans are fortunate
that the VA provides many of the tools they need to do this.
Eye gaze computers, home modifications, and wheelchairs are
just a few of the ways that the VA helps our veterans continue
to have the best quality of life.
VA providers go above and beyond to help our veterans
living with ALS find ways to do things they love, and are a
critical part of caring for our veterans, not just for their
physical health, but for their mental and emotional well-being.
Veterans already carry a higher risk of suicidal ideation, but
a veteran that was diagnosed with ALS, their risk goes up
almost four times.
Staying engaged in the world has a big impact on the mental
health of a veteran. I have seen the impact firsthand. My dear
friend and veteran living with ALS, Dr. Mary Porter, was
feeling the weight of her diagnosis. Life was difficult, and
she was bracing for the inevitable until she was encouraged to
try her hand at art. That lifted her spirits, and she decided
to see what else she could do. Fast forward to February of this
year when she not only participated in the Invictus games, but
she earned a gold medal. Now she is still active, finding new
adaptive sports to try, and encouraging other veterans to do
the same.
Protecting the services provided to our veterans can and
will save lives. We strongly suggest exemptions from hiring
caps for these positions funded by congressionally mandated
programs.
I would like to leave you with the words of Brigadier
General Thomas Mikolajcik from his congressional testimony on
ALS in 2007. ``If these soldiers were dying on the field rather
than at home as a result of their service, we would leave no
stone unturned. We would use the best existing resources and
programs to make sure they had whatever they needed to survive,
to ensure that no man or woman is left behind.'' Thank you.
[The prepared statement of Ms. Bailey appears on pages 39-
40 of the Appendix.]
Chairman Moran. Thank you, Ms. Bailey.
And now, Ms. Ward, you are recognized for your testimony.
STATEMENT OF MARY WARD, VETERAN SPOUSE/CAREGIVER AND FELLOW,
ELIZABETH DOLE FOUNDATION
Ms. Ward. Thank you for inviting me to testify today. My
name is Mary Ward, and I am the wife and full-time caregiver
for my husband, Tom----
Chairman Moran. Pull the microphone closer to you. Thank
you.
Ms. Ward. I am the wife and full-time caregiver for my
husband, Tom, a Marine Corps veteran diagnosed with service-
connected ALS over 15 years ago. I am also a 2016 Elizabeth
Dole Foundation Fellow.
I would like you to pause and think of a simple pleasure
you enjoy. For me, it has long been a Starbucks Vanilla Bean
Frappuccino--three pumps of vanilla, fat-free milk, and whipped
cream. For years, I thought the joy was in the ritual. But this
past July, I realized I had redefined what it means to me. Now,
it comes when I drink that Frappuccino, knowing there is a
nurse at home with my veteran husband, ensuring he is safe and
supported. In that moment, I am not a caregiver. I am me, doing
something normal. That is the gift of respite. And it only took
us eight years to get there.
To understand the importance of long-term care support, it
helps to know our journey. In 2010, Tom was diagnosed with ALS,
and in 2013, with Type 2 diabetes. He is rated 100 percent
permanently and totally disabled. A typical day includes
helping him from his bed to his wheelchair, checking his blood
glucose frequently, responding to alarms, getting him showered
and dressed, administering medications, assisting him with
eating, and doing cough assist to help him clear mucus from his
lungs.
Over the years we have experienced numerous struggles and
small victories. For example, shortly after his diagnosis, the
VA denied the Specially Adaptive Housing (SAH) grant and
adaptive vehicle grant because Tom was not yet rated 100
percent. Despite having been diagnosed with a progressive
terminal disease, it took two years before a policy change
shifted that rated him to 100 percent.
During that same period, the VA did give him a power
wheelchair, but it stayed in the garage because we didn't have
a handicap accessible home or vehicle that could accommodate
it. Finally, after the wheelchair was delivered, the VA
approved this vehicle grant.
Knowing the destructive nature of ALS, we got busy
developing a plan for my future as a widow. In 2010, we moved
from Durham to Wilmington to downsize and save money, and I
accepted a virtual teaching position. And when I did that I
left my State retirement behind. Finally, in 2013, the VA
approved Tom for the SAH grant, but that didn't mean our wait
was over. From start to finish, it took 27 months to make the
house accessible. It is not a process I would want to repeat.
In 2016, we enrolled in the VA's Home-Based Primary Care
Program (HBPC). However, because we no longer lived in the
catchment area for Durham services, we would only have access
through the Wilmington CBOC. If we chose Wilmington, we could
no longer directly access the superior ALS care available at
the Durham VA. We had to choose. After a series of mishaps due
to the situation, including the inability to address a
malfunction with Tom's non-invasive ventilator, we made the
difficult choice to give up HBPC and move all care to Durham.
After learning about Veteran-Directed Care (VDC), I decided
to apply for Tom. VDC is an innovative program that offers the
veteran a budget for personal care services and allows more
flexibility and control for his or her care. And even though I
knew another veteran enrolled in the VDC through the Durham VA,
I was repeatedly told by a social worker that it simply did not
exist there, and I let it go. I didn't have the energy to take
on another battle while caring for Tom and dealing with his
increasing health complications.
I eventually tried again, but my attempts to access VDC
were foiled until last year, when we were enrolled.
Unfortunately, this still does not mean we received any
services. When I asked for a timeline regarding funding, the
response was, ``30 days, 60 days, 90 days, I just don't know.''
With that lack of certainty and seemingly zero sense of
urgency, we reluctantly withdrew from the program.
Recently, I realized I couldn't do it alone anymore. His
ALS progression was more pronounced, his diabetes grew more
complex, and I didn't realize how exhausted I was from the last
few years of 24/7 caregiving. Together with the Elizabeth Dole
Foundation, we pursued skilled nursing care as a possible
alternative. At first I doubted Tom would qualify. He has
multiple complex diagnoses, but he is not ventilator-dependent,
which seems to be the criteria.
Finally, after the intervention of leadership, the VA
approved skilled nursing care. A long time ago, someone asked
Tom about me as his caregiver, and he said, ``She is my wife
first and caregiver second.'' That had insidiously changed over
the last few years. The benefit of respite for me is clear.
Because of it, the care I provide Tom is exponentially better.
My sense of humor and joy has returned. At the end of the
nurse's shift, I look forward to seeing him.
Just last week, one of our nurses discovered Tom's blood
pressure was running high, despite medication. This finding
likely prevented a crisis.
I share our story because while we have finally found the
proper support, it should not have taken eight years,
relentless advocacy, and national-level intervention to get
here. Too many caregivers give up before they reach this point.
They go unseen, unsupported, and burned out. Simply put,
veterans suffer when their caregivers suffer.
I hope you will note the recommendations I outlined in my
written testimony, especially the need to promote effective,
proactive, and comprehensive care coordination.
For those with devastating injuries and illnesses, long-
term care support, especially respite, is not a luxury. It is
essential--for caregivers, for families, and for the veterans
who depend on us.
I am grateful for the nurses who now come into our home,
for the Elizabeth Dole Foundation's relentless advocacy, and
for the VA staff who have stood by us. But the care we now
receive should not be the exception reached only after years of
struggle. It should be the standard. For every Frappuccino
moment I now enjoy, there are thousands of caregivers still
waiting for that moment to take a breath. Please make it
possible for them to find joy again, and to see and feel that
they matter, too. Their veterans' care, and sometimes their
lives, depend on it. Thank you.
[The prepared statement of Ms. Ward appears on pages 41-47
of the Appendix.]
Chairman Moran. Thank you, Ms. Ward.
And now, Mr. Thomas. Thank you.
STATEMENT OF ROBERT L. THOMAS JR., NATIONAL PRESIDENT AND
CHAIRMAN OF THE BOARD, PARALYZED VETERANS OF AMERICA
Mr. Thomas. Chairman Moran, Ranking Member Blumenthal, and
Members of the Committee, I appreciate the opportunity to speak
to you today on behalf of Paralyzed Veterans of America about
the strengths and weaknesses of the VA care for veterans with
Spinal Cord Injuries or Disorders, or SCI/D.
When I testified before the Committee in March, I expressed
our frustration with the existing state of the SCI/D system and
concerns about its future. We have relayed some of our biggest
concerns to Secretary Collins, and he has signaled to us that
the VA's specialized services and the care of catastrophically
disabled veterans are a priority in this Administration. But
they can't do it alone. Your leadership and support are needed
to preserve and strengthen the SCI/D System of Care, and all VA
care for catastrophically disabled veterans.
PVA firmly believes VA is the best health care provider for
disabled veterans, particularly those with catastrophic
disabilities. More importantly, our members consistently choose
VA.
Recently, a PVA member expressed this sentiment when he
relayed that while has had surgery in the community, the VA
doctors he sees at the Dwight D. Eisenhower VA Medical Center
in Leavenworth, Kansas, understand the full nature of his
trauma, and they provide the tailored support with post-surgery
rehab and long-term support that increase his quality of life.
Another PVA member in Colorado shared his contrasting
experience between VA and community emergency room visits
following a severe flare-up of MS. VA published his story, and
I strongly encourage you to read it.
PVA has three primary concerns about the ability of VA's
SCI/D System of Care to continue serving veterans both now and
in the future. These concerns are ongoing staffing vacancies,
delayed infrastructure improvements, and the continued shortage
of specialty, long-term care beds.
Staffing levels for the SCI/D System of Care are detailed
in VHA Directive 1176. The requirements outlined in this
directive are based on the level of care needed to maintain the
health and well-being of veterans with SCI/D. Unfortunately, VA
leaders have long treated these as optional rather than
directives based on best care standards. As a result, VA can
only staff a nominal number of beds in some locations.
The impact of such practice is profound, causing severe
delays in critically needed routine care, including annual
exams and respite, as well as acute care needs. Such delays
have real consequences for veterans who need care now. The VA
must be able to staff to the level needed to serve veterans
with SCI/D.
We also need new approaches to recruiting medical
professionals in hard-to-recruit locations. Furthermore, the
bureaucratic hiring process must be streamlined to allow
professionals to be identified and onboarded as quickly as
possible.
Secondly, we are concerned about delayed infrastructure
improvements. VA's SCI/D System of Care is comprised of 25
acute care centers and 6 long-term care centers, with an
average age of nearly 40 years old. Many of the older centers
have only had minor cosmetic renovations. More than a dozen
SCI/D-related construction projects on the SCIP list continue
to go unfunded year after year.
In reviewing VA infrastructure, decision-makers must
remember that VA's SCI/D System of Care is unique, and not
replicated outside the VA. We believe VA should return to the
practice of placing greater emphasis on funding facilities that
support the types of services like SCI/D care, which the
Department uniquely provides. Investment in these areas would
greatly strengthen VA's specialty care services and ensure
their future availability.
Finally, our Nation's lack of adequate long-term care
options is an enormous problem for people with catastrophic
disabilities. There are very few long-term care facilities that
are capable of appropriately serving veterans with SCI/D. With
less than 180 beds, VA's six existing SCI/D long-term care
facilities are not enough for the tens of thousands of veterans
with SCI/D. Expanding projects, provide additional beds would
be a good first step to ensuring quality care.
Many PVA members also depend on VA home and community-based
services throughout their lives. We are very appreciative of
Congress' passage last year of the Senator Elizabeth Dole Act.
We need you to exercise your oversight authority to ensure the
measure is implemented as Congress intended.
Thank you for the opportunity to present our views this
afternoon. I will be happy to answer any questions.
[The prepared statement of Mr. Thomas appears on pages 48-
57 of the Appendix.]
Chairman Moran. Thank you, Mr. Thomas. Let me ask you, just
that last sentence you indicated. Is the implementation far
enough along, of the Elizabeth Dole Act, that you know of
instances where we need to be exercising our oversight
authority to get something on the right track that seems to be
on the wrong track?
Mr. Thomas. Thank you. That is a great question. So there
are some limitations to the Veteran-Directed Care that come up
through the Elizabeth Dole Act that we hear it is implemented
all throughout the VA but individual members and all, that try
and get on the program, are not able to get on the program
because it is not at their VA facility.
Chairman Moran. That is really important for us to know.
The Elizabeth Dole Act, I think, is, again, one of the more and
most significant pieces of legislation this Committee has
enacted, but implementation is hugely important, and we will
continue to work with you and PVA to make certain that that,
and other instances, are brought to the VA's attention for
correction. Make sense?
Mr. Thomas. Yes, sir.
Chairman Moran. Let me ask you, Ms. Ward, caregivers,
especially for those with spinal cord injuries or disorders, as
you indicated face major physical, emotional, and financial
strain. You talked about respite care programs and they fall
short. What reforms, changes would you suggest need to be
pursued to make certain that caregivers receive adequate
support without compromising their own health and well-being?
Ms. Ward. Well, I think that is where I think about the
coordination of care. Personally, I am in the PCAFC program,
and I access my caregiver support coordinator for respite care,
to come here today, to get approval for that. And I only know
that I have approval for that, that I could get approval for
that, because the Elizabeth Dole Foundation worked with me to
get the nursing care that my husband needed.
But I did not know who to ask to get that done, and that is
a problem. And I should know. We are 15 years into this
disease. I should know. And believe me, I know a lot about the
VA and the bureaucracy and the challenges. But there is a point
at which I am busy being a caregiver. I am busy trying to keep
this guy alive, and I can't do all that.
So I need somebody at the VA who I can say, hey, I need
this help. Do you understand what this program is? Can you get
Veteran-Directed Care? Can you get long-term care for us? What
can we do? How can you help me do the job that I need to do?
Chairman Moran. You are actively engaged in the Elizabeth
Dole Foundation. Tell me what services are offered that others
ought to know about, someone in the same position you have been
in. Where should they turn for help?
Ms. Ward. Well, if they are not in PCAFC, I do not have an
answer for that. I do not know who they would go to. If you are
in the Veteran ALS lane--let's call it that--in the VA, there
is an ALS Coordinator at many of the VAs, and think Mandi
Bailey probably can speak about that a little bit better than
me. I do not access the ALS Coordinator because I actually knew
more than our ALS Coordinator at first. So I could do her job
or still be Tom's caregiver.
Chairman Moran. Well, let me ask Ms. Bailey that question.
I recognize--I think we recognize that the VA--let me just put
it this way, many veterans do not know what services they are
entitled to, do not know what is available. Obviously,
communication is important, but particularly for caregivers.
Tell me how you think we can help provide the information
necessary to get people to the resources that they need?
Ms. Bailey. In my opinion, a lot of it is going to come
down to funding and support. In our area, we are a very
underserved, under-resourced area. So everything that we did
pretty much felt like it was sent out to the community care.
The ALS Coordinator position is a fairly new thing that has
been brought about. I believe that came in with the VHA
Directive 1101.07. It was not around when my stepdad was going
through ALS. For us it was calling our caseworker. And because
of the understaffed nature of the VA where we live, sometimes
it was hard to get a call back because she was busy herself,
taking care of the many, many, many other families and veterans
that she had to contend with.
So honestly, I think a lot of that is going to come down to
funding and support. Our VA, last I heard, was 140 percent of
capacity. They are wildly, wildly understaffed for what they
are dealing with. They do not have the resources and time
available while they are in those walls, doing their job, to be
able to answer all those phone calls and get people connected
with the resources that they need, and do the research to find
out where they need to be sent.
So again, funding and support. Our VAs desperately need
that funding and support to do their jobs the way that our
veterans deserve.
Chairman Moran. With that, let me call on the Ranking
Member.
Senator Blumenthal. Thank you. Again, thank you all for
being here and for your excellent testimony. We have heard
about community care providers outside the VA presenting
accessibility challenges when SCI/D veterans or others who are
non-ambulatory, disabled, or have complex health needs, try to
get access to those private, non-VA facilities. I wonder if you
could talk a little bit, from your experience, what you have
seen or heard, Ms. Bailey, and others on the panel.
Ms. Bailey. We were sent to the community to get our care,
first to see a neurologist. At that point, there was not an on-
staff neurologist at our local VA. Thank goodness there are
now. We have a fantastic neurologist at our local VA.
Unfortunately, they were not there for us.
It did take some time to get put into the schedule to see
the neurologist, and we were his first people that he had dealt
with ALS. When you are dealing with ALS, you want somebody who
has knowledge, not somebody who says, ``You know, this is the
first time I've dealt with that.'' That was really, really
difficult for us. It is scary. It is so scary.
We are grateful that he was willing to learn, but the care
that was in the community was nothing like the care that we
received at the VA. They at least knew what ALS was, and
although it was held up by red tape and all of the limitations
that they had, it was still far superior to the care that we
received. We even had to go out of our VA when he needed his
feeding tube done. We had to go to Biloxi, which is several
hours away. That is a really difficult drive when you are
taking care of somebody living with ALS who cannot move their
arms and legs. You are the only person who is able to do that
for them. And then you have to turn around and drive home the
same day.
I cannot say that the community care in our area would have
been much better. Again, lack of knowledge is a huge, huge
problem. They do not understand the complex needs of ALS like
the VA providers would.
Senator Blumenthal. Others?
Mr. Thomas. Yes. In addition to what Ms. Bailey just said,
a lot of the community facilities do not have the adequate
amount of wheelchair space when you go in there, or the proper
equipment to move an individual in a wheelchair over to the
exam tables or even give them a good X-ray. So we run into that
issue all the time.
Senator Blumenthal. I want to ask about mental health. I
have a bill that is called the BRAVE Act, which includes a
provision requiring the VA to establish a pilot program to
ensure VA residential rehabilitation treatment programs. These
are, in effect, inpatient, residential treatment, including for
mental health. Maybe you can comment on the need for both
inpatient and other kinds of mental health treatment programs.
Ms. Bailey. As I mentioned in my testimony, when you are
diagnosed with ALS, as a veteran, your suicidal ideation risk
goes up tremendously. Mental health, while it is addressed--
typically there is a questionnaire or they are asking several
questions to kind of assess how you are doing--I think there is
a bigger need to address the mental health needs of veterans
with spinal cord injury and disorder, especially in ALS. When
you are given a terminal diagnosis it changes your entire
outlook on the world.
My stepdad wanted to take his life because it became too
much for him, and he did not, and I am thankful for that. But I
wish that there had been more of a focus on mental health. I
wish that he had had somebody like my friend, Dr. Mary Porter
had, that would have encouraged him to try new things and to
see that he could live with ALS, and you are not dying of ALS.
I think that is a really important thing that needs to be
addressed in the mental health area for ALS.
Senator Blumenthal. Thank you. Any others? Thank you. Thank
you, Mr. Chairman.
Chairman Moran. Senator Tillis.
HON. THOM TILLIS,
U.S. SENATOR FROM NORTH CAROLINA
Senator Tillis. Thank you, Mr. Chairman. Ms. Ward, welcome
to the Committee. You may not know that I am actually sitting
in the seat that was occupied by Senator Dole back in the day,
and I am very proud of the work that she continues to do in
this and so many other areas. So welcome to the Committee.
Before I ask a few questions, first, Dr. Hoover, we are
going to be submitting for the record some questions that I
would like to get from you, in terms of, sort of the fabric
that has to come together to provide a network and supporting
people suffering from this horrible disease.
And before I start there though, a couple of weeks ago I
was walking down the hallway--I grew up in a family of six kids
so I know how to like hear a lot of voices at once. I heard a
Capitol Police officer say he was going to have to file an
appeal or try to figure out a way to get care himself, not in
this space. But I went up to him and asked him, I said, ``Have
you contacted your Congressman?'' He is not from North
Carolina. I said, ``But look, I want to help you out. But make
sure that you are using every available resource before you
start spending money.'' Which is why in the last Congress, I
proposed the Patriot Bill of Rights, which is to make
absolutely certain that any veteran knows that before you spend
a dime on an attorney or even other support organizations, you
put a call in to your U.S. Senator, put a call in to your
Congressman.
What I wanted to do, and I have run into a little bit of
pushback, mainly from people who benefit from patriots not
knowing this, is to make sure before you sign an agreement with
somebody who is going to act on your behalf and charge you for
that fee, that you know what options are available that are not
subject to a charge, like a U.S. Senator who is hell-bent on
trying to clear cases, before you have to go anywhere else.
That is what I do in North Carolina.
So we are going to reintroduce the Patriot Bill of Rights.
It is pretty straightforward. If you are going after Camp
Lejeune toxics, or you are trying to help somebody, I want a
piece of paper down there that says these options were
available to you. If you have not used them, you may want to,
before some of the benefits that you have worked hard for and
deserve go to somebody else representing on your behalf.
We cannot close all cases. Some of them have to be
adjudicated, and there is an appropriate place. But I do think
that there are some organizations out there that hope they get
a good outcome for the veteran they are representing, but
frankly, they also want a good outcome for their pocketbook.
So in the remaining time I have here, Ms. Ward, spread the
word in North Carolina. I have 473 days before I retire, and I
am not counting those days because I am counting the days to
get out of here, that is how much more time I have to help.
Ms. Bailey, and to everyone, I have a personal story on
caregiving. I know how hard it can be. Even that coffee break,
your testimony was very compelling. I believe everybody in the
VA wants to do the right thing, but we are doing things
inconsistently, and we are doing things on an uninformed basis.
We do not need somebody providing care to a very specific
disease that has very specific protocols for trying to provide
the best care. We do not want somebody doing on-the-job
training, to your point, Ms. Bailey.
There are good stories to be told, even in North Carolina.
But the variation between just facilities within our State, and
the variation across the country is unacceptable. I worked in
management consulting for my entire career before I got into
public service. There is such a thing as best practices. And
what I would like you all to think about, from your respective
organizations, let's shine some light on best practices that
are going on in the VA, and then put pressure, that is
oftentimes a resource issue.
But let's put pressure on everybody measuring up to what
that best practice looks like, and let's make sure that the
Secretary, who I have great confidence in, and everybody in the
VA--I mean, people are working hard, but it is all about
resource, connections, and setting high expectations and
measuring the results.
So I am not going to ask you any questions here in the
Committee, but we will be submitting some questions for the
record to say how do we do it? How do we find one in every
State, if there is a best practice, to say that every VISN
should have a best practice model, and if they do not, we need
to have one, in this case, and several others.
And count me in, in my remaining time to do everything I
can to help. And in the meantime, count me in to make sure that
every veteran knows, if they cannot even get a good response
from a Congressman or a Senator from their State, we will work
with those Senators first. We will do the casework in North
Carolina for anybody. Thank you.
Chairman Moran. Senator Tillis, thank you. You took me by
surprise claiming the Dole seat because I thought, no, that is
me.
[Laughter.]
Chairman Moran. Wrong Dole. Senator Hassan.
HON. MARGARET WOOD HASSAN,
U.S. SENATOR FROM NEW HAMPSHIRE
Senator Hassan. Thank you very much, Mr. Chair, and I
appreciate you and the Ranking Member having this hearing
today. To our witnesses, thank you so much for testifying
before us today and for your service to our country and to our
veterans.
Ms. Bailey, I want to start with a question for you. First,
my condolences for your family's loss. I did not know your
stepfather but I am confident that he would be proud of your
advocacy for veterans.
Your testimony touched upon an issue that I think is really
important which is, access to high-quality care when you need
it and where you need it. And in response to questions from
Senator Blumenthal, you mentioned that after your stepfather's
ALS diagnosis he had to use community care in addition to the
care he received at the VA because of the lack of resources
available. And you talked about the impact, you know, the lack
of experience of that community care provider.
But this is beyond an individual profile of a particular
condition or disease. My concern, because I am from New
Hampshire, which does not have a full-service VA hospital, and
also has a very high rural population of veterans who live far
away from the nearest VA facility. Can you just expand on how
veterans are affected when they cannot get all of the care that
they need through a VA that is practically accessible to them?
Ms. Bailey. There are a lot of things that can happen.
First and foremost, I think there is kind of a mental aspect to
it. At the VA, it is a culture. Our veterans like being at the
VA. They prefer it, because those people understand them. Many
of the VA providers and employees are veterans themselves, and
there is a unique bond that veterans have and that trust that
they have. So I think that is a big thing right there to look
at.
You know, the lack of knowledge in these conditions like
ALS, that is very, very important to address. And I think that
having that in our family, and being sent to the community to
get the care, it was frustrating. Our family questioned, should
we even go back to this doctor? And that is dangerous when you
are dealing with ALS. There are a lot of things that you need
to consider--feeding tubes, breathing options, PT, OT,
respiratory care. You need to make sure you are taking all of
those things into account. And if you are sent to a community
care physician or provider that does not really understand your
condition, you are not as likely to go back and continue that
care. And you have a problem with, well, is this going to go
downhill a lot faster? What is this going to do?
So I think that making sure, even at those VAs that are not
a full service, they are knowledgeable enough in the community
to know--where should I send these people that know about ALS,
that are going to treat my veterans the way they deserve to be
treated; that are going to treat them like I would? So that is
something to really kind of think about when we are using the
community care.
It is an option, and I do think that it should stay an
option. But I do not think it should be our go-to option for
our veterans.
Senator Hassan. I appreciate that very much. And a quick
personal aside, my son has a feeding tube, and it was a
neurologist who treats a whole lot of children with feeding
tubes who figured out how we could get capsulated medication
into the feeding tube without clogging it. She also happened to
be a mother, and I happened to think that that played something
into it. But it really does make a huge difference.
Mrs. Ward, in your written testimony you discussed the need
to fully implement provisions of the Dole Act, which President
Biden signed into law at the start of this year. And I share
your concern about the delayed implementation of the bill.
Senator Moran asked you about oversight, but as someone who
has such personal knowledge about the challenges that veterans
and caregivers face, can you please tell us a little more about
how full implementation of the Dole Act would support
caregivers and how its continued delay might affect you, your
family, and our other veterans?
Ms. Ward. Yes. Thank you for the question. I think that the
full implementation of the Dole Act would eliminate the sense
that all these beautiful programs that we have at the VA, they
are so siloed----
Senator Hassan. Right.
Ms. Ward [continuing]. Is what it feels like. Like, how can
I get home-based primary care, because I live in an area where
I am too far from the main Durham VA. But why can't
Fayetteville, which is where the Wilmington CBOC falls under,
why can't they communicate well with Durham? Why can't I have
that? Why is it so hard to get Veteran-Directed Care? I
remember we did get it. We finally got it. But then we got
skilled care, and we are not going to use services we do not
actually need right now, just because we can get them. So
nursing care really fits for our situation.
But then what about palliative care? How do we get that?
Does my PCAFC Coordinator know about how to get palliative
care? What about hospice, and how can we set it up so that this
man, that I love so much, can stay at home for the rest of his
life? And it should not take so much work.
And my sense of working with some of the people at the VA,
they want to do the right thing. We have had pretty much a good
experience with everybody that we have worked with the VA. But
they do not know this program from that program. And my
understanding of the Dole bill is that that is not there
anymore. Those barriers are not there. There are so many
barriers, that somebody like me, who is well educated and
experienced with the VA, I sometimes cannot get access to these
programs. And it is so tiring to fight them. I just want to go
drink a Frappuccino somewhere.
Senator Hassan. Yes, yes, yes. I hear you.
Ms. Ward. I am not even asking for a lot. I am not asking
to go to Hawaii or Italy or something. I just want to have a
little bit of peace, and I want to be able to take care of him
at home. And whether my veteran has ALS or another spinal cord
injury or traumatic brain injury, it does not matter. We all
should be able to access this care so that we can keep doing
what we do. It should not be siloed like it feels like.
Senator Hassan. I appreciate that. I appreciate your
indulgence, Mr. Chair, with the time. Mr. Thomas, I will submit
a question for the record for you. Again, I appreciate all of
you very much being here. We really value your care, your
service, and your expertise. Thank you.
Chairman Moran. Thank you. Senator King.
HON. ANGUS S. KING, JR.,
U.S. SENATOR FROM MAINE
Senator King. Thank you, Mr. Chairman. Before I ask my
questions I have to acknowledge that in the last five years I
have lost two of my best friends to ALS. One was one of my
oldest friends from high school football, and one was one of my
very best friends in Maine, George Smith, who battled this
disease, this awful disease, with such courage. And I can't not
acknowledge these two guys that played such an important role
in my life.
Ms. Bailey, you said something, you just touched on it
briefly, that I find very potentially important, and that is
that veterans seem to contract ALS at something like twice the
level of the population at large. And I will ask this of our
second panel. Are there any theories on that? Because I have
always viewed ALS as almost like being struck by lightning. But
that suggests that there may be environmental causes that
contribute to the contraction of this disease. Are there
theories on this?
Ms. Bailey. There are theories, anything from traumatic
head injury, environmental exposures when they are overseas.
There are a lot of different theories, but there is nothing
concrete, which is why we need to support research that is
going to dig into this a little bit deeper. There have been
even studies that show some specific occupations inside the
military are up to 10 times as likely to be diagnosed, and that
is terrifying.
My husband served in the Army. My nephew just joined the
Army. I want to make sure that, God forbid, if something
happens to them that they are able to get the best care
possible. And the research that can come from learning more
about the veteran impact, it can go a long way in the civilian
population, too.
Senator King. I agree. Mr. Chairman, I think that is some
research that we should really encourage. The VA is the likely
place to conduct that research.
Ms. Bailey. Absolutely.
Senator King. Mr. Thomas, accessibility to long-term care.
You touched on this in your testimony. My understanding is that
this is one of the greatest problems facing our veteran
community. Is that true?
Mr. Thomas. Yes, it is.
Senator King. And you mentioned a number. You said
thousands. Do you have any idea how many SCI/D patients,
veterans there are, in round numbers?
Mr. Thomas. Well, Senator, I will have to get back to you
with the exact number. But I would say it is more around
60,000.
Senator King. But it is safe to say that it grossly exceeds
the availability of resources, particularly for long-term care.
Is that correct?
Mr. Thomas. Yes.
Senator King. We have talked a bit about the Elizabeth Dole
Act, and I think I will join my colleagues and ask for you to
give us your thoughts, perhaps in writing after this hearing,
on how it is being implemented and not being implemented, and
where the gaps are. Because one of our roles here--often in our
business we pass the law and it is sort of, okay, we have done
our thing. But I do not believe that. I think part of our
responsibility is to oversee the implementation and execution
of these laws.
So it would be very helpful to us to sort of survey your
colleagues, your contacts, your circle of friends in the
community to tell us how this law is working and how we can
improve it, and what we must do to improve it.
The other thing that bothers me, Mr. Thomas, you mentioned
onboarding, and unfortunately at the VA now there is a hiring
freeze. And there is hiring going on in certain areas, but the
VA, as of the end of this month, I think, is going to be 30,000
people less than it was at the beginning of this year.
Do any of you see the staffing reductions as affecting the
level of care and the responsiveness of the various VA
facilities with which you engage? Mr. Thomas?
Mr. Thomas. There has been a lot of lack of staffing on the
SCI/D centers, you know, for a while, but we do see that the
quality of care is still trying to be maintained. But we do
need those nurses. We do need that team effect to make sure
that our members get the quality care that they need.
Senator King. And I think one of you mentioned burnout. I
mean, we have got to maintain the good quality people that we
have and not burn them out because of understaffing. Would you
agree?
Mr. Thomas. I would agree.
Senator King. And finally, Dr. Hoover, I want to commend
you for being here and providing your very compelling
testimony. And we will look forward to your response to some of
the questions after the hearing.
Thank you all. This has been very powerful testimony. And
again, we cannot fix problems we do not know about. So the
invitation is for you to tell us what needs fixing, whether it
is administrative or whether it is a matter of the law. Take
advantage of the fact that you have a group of U.S. Senators
here who are totally committed to this issue and its
amelioration and mitigation.
So thank you all for your testimony. Thank you, Mr.
Chairman.
Chairman Moran. Senator King, thanks for that summary. And
I recognize now Senator Duckworth.
HON. TAMMY DUCKWORTH,
U.S. SENATOR FROM ILLINOIS
Senator Duckworth. Thank you, Mr. Chairman, and thank you
to all the witnesses who are here today. As you know, Mr.
Chairman, this Committee has earned a longstanding reputation
for prioritizing pragmatic bipartisanship. In my view, it is a
commitment that all committees should strive to achieve.
Preserving the bipartisan nature of our work is especially
critical amid this Administration's attacks on America's
cities, and while Immigration and Customs Enforcement is
actively stealing U.S. Department of Defense and U.S.
Department of Veterans Affairs resources away from their core
mission to support its invasion of Chicago.
Specifically, at Hines VA Hospital, my VA home where I get
my care, it already suffers from limited parking that is
inadequate for the level of patient demand. I think any veteran
that goes to a VA hospital shares the frustration across the
country of the inadequate parking.
ICE has taken over 12 parking spots for operations at Hines
VA, that have nothing to do with providing veterans with care,
and this is causing anxiety and confusion among staff and
patients. Diverting VA resources for ICE's reckless
paramilitary immigration enforcement operations, not only does
nothing to enhance veteran care, but it likely will harm care
delivery.
Veterans should be able to safely access their health care
services without fear of intimidation, harassment, or even
detainment, and it is absurd to believe that allowing ICE to
operate in any capacity on any VA campus will not adversely
impact delivery of care for their patients. This is especially
true at Hines.
The VA must establish a clear, strong policy against
capitulation to ICE. Veterans and their family members that
receive care at VA medical facilities across the country need
to be protected. Otherwise, I am deeply concerned that patients
will delay or cancel their appointments due to well-documented
risks that they will be aggressively accosted by an out-of-
control, secretive paramilitary force, and whisked away in
unmarked vans, solely because of the color of their skin, what
they look like, race, or the language that they speak.
If VA fails to stop ICE's theft of its resources, the
Department will validate the veteran community's worst
suspicions about the Trump administration, namely that
President Trump is sabotaging VA's ability to carry out its
mission and actively working to manufacture crisis that would
justify privatization of the VA.
Earlier this year, VA cut 80,000 jobs, including doctors
and nurses. A recent ProPublica article reported on the
consequences of this massive disruption, noting, and I quote,
``the VA this year is down more than 600 doctors and about
1,900 nurses. The number of doctors on staff has declined each
month since President Donald Trump took office. The agency also
lost twice as many nurses as it hired, between January and
June.''
The VA said it is working to address this, including by
referring veterans to private providers and telehealth
appointments. Meanwhile, waiting times for new patients seeking
primary and specialized care are increasing, and I am gravely
concerned that the Trump administration's dismantling of VA's
capabilities and capacity is intended to create chaos that will
achieve two of their main goals. First, they want to accelerate
VA dependence on private sector providers, and second, they
want to degrade VA's quality of care to justify privatizing our
Nation's largest integrated health care system.
Dating back to President Trump's first term, we know he is
surrounded by wealthy donors who would love nothing more than
to dismantle VA and force all veterans, particularly veterans
who need specialized care, into the often more expensive, yet
less effective private sector health care system. After all, VA
providers are trained so they can address the unique needs of
veterans, and this is just not true for most non-VA providers.
A non-VA provider may look at a veteran and see that they have
prostate cancer, but not check them for ischemic heart disease
or Leukemia B, two other conditions that are tied to Agent
Orange exposure, for example.
Instead of siphoning resources away from the VA to a
civilian health system that is already under duress, due to the
Republicans' biggest Medicaid cut in history, we should be
investing in VA civil servants while upgrading facilities and
technologies to strengthen VA delivery of care.
To all of the panelists, what specific steps should the VA
take to ensure there are enough providers and accessible
facilities for treating veterans with SCI/D in a timely manner
and with the dignity and respect that they deserve? Would any
of you like to answer that? Do you have any steps that you
think the VA should be taking to support spinal cord injury
patients, also through providing providers as well as access to
facilities?
Ms. Bailey. Shelly and I mentioned in our testimonies stop
any hiring freezes or hiring caps, support and fund additional
positions. Those, I think, are going to be the biggest steps
you can make. It is hard to serve our veterans with their hands
tied behind their backs right now, and it feels like that is
what a lot of them are doing.
Senator Duckworth. Thank you. Thank you, Mr. Chairman.
Chairman Moran. Senator Duckworth, thank you. I do not
anticipate having a second round, but having said that I would
like to ask a couple of questions myself, unless there is
concern about being left out, anybody else? I just want to
capitalize on just a couple of things.
First of all, community care. Is there ALS and these
circumstances in which it makes sense, in your minds, to refer
to a program, a hospital, a set of physicians that have
expertise in this area, and it makes sense for the VA to allow
for referral to that community care? Ms. Ward?
Ms. Ward. Yes, I would like to speak to that. We have an
excellent ALS Center at the Duke, the Duke Center for ALS Care
Clinic, a clinic experience for somebody with ALS. They
fortunately do have clinic rooms that are large enough to
support not just somebody who is in a wheelchair but family
members that come along with them. And they stay in that room
for hours. Every specialty comes to see them--respiratory care,
pulmonary, social workers come through, the ALS Association
will come through, your neurologist comes through. It is an
exhausting experience. It is a great experience, though,
because you get soup to nuts there.
But to try to get a community care referral, you have to
get one for each specialty that is there, right. That is hard
work, to get a community care specialty, for all to come
together, so that you have a referral for every specialty care
health care provider that comes to that room.
For us personally, we use Medicare, because it is easier. I
mean, you know, is it the right thing to do? Probably not. We
probably really should go through the VA to make that happen.
But it is hard to do, though, too. I mean, I personally do not
want to go through all that.
Chairman Moran. I appreciate knowing that, and it seems to
me that that is not a damning thing about referral to community
care. It is a damning thing about the way we refer it to
community care.
Ms. Ward. Yes.
Chairman Moran. If we could get the referral fixed, that
would be an improvement, and you would have, in this instance,
the level of expertise, a combination of all the services in
one location, that might make sense for a particular veteran or
a veteran's family member. Because the standard in community
care is what is in the best interest of the veteran, to be
determined by the veteran and his or her provider. And in some
instances there may be a program, as I say, a facility, a set
of doctors, a continuum of care, that might make sense. And I
want to make sure that is the case, in the best interest, that
that is a possibility.
Mr. Thomas, let me conclude my questions with just a
follow-up to something that has been said in response to my
colleagues' questions. The issue of the ACCESS Act, one of the
things that occurred, and the PVA supports the ACCESS Act, but
one of the reasons that is true is because we addressed the
concerns regarding the VA's referrals to community providers
who are ill-equipped. We heard testimony today about maybe--not
maybe--we heard testimony about this being a new thing, to a
neurologist not treating an ALS patient. And the PVA advocated
for provisions in the ACCESS Act to address this issue of
referral to people who are ill-equipped to handle a referral.
Is that true, and do you have anything to say about that?
Mr. Thomas. So I would say that is true. And, you know, it
is hard, when you get a referral and brought there into the
community, as was stated, that individuals need to be able to
choose who they want to choose, and we understand that and we
are on board and agree with that.
But we need to be referred to doctors that truly understand
the aspect of what SCI/D entails on the body. And a lot of
times when we are referred out there to the community, they do
not understand that. So that is why most of our members choose
the VA.
Chairman Moran. That makes sense to me, but I do want to
highlight, at least it is my understanding the ACCESS Act
includes language that veteran organizations, and I think
including the PVA, encouraged be included in the ACCESS Act
that deals with the concerns about referrals to someone who
should not be referred to because it is a new experience for
them, it is a new field for them--same field, I guess, a
different kind of patient and a different kind of circumstance.
And we want to make sure that the referral is actually to a
provider that provides the expertise and experience that is
actually helpful to the veteran. So we will continue to work on
that, but I think that is part of our efforts in this ACCESS
Act, to improve that circumstance.
Thank you all very much. Senator King summed it up very
well. Thank you for being such advocates. Thank you, I
recognize that in instances here it is very difficult for you
to be away, difficult to be here, and we are grateful that you
take the time. It demonstrates that you care about your loved
ones, you care about people you do not even know because you
want the system to work, you want the VA to work, and the
process to care for those who served our country, and we are
all grateful for that, and I thank you for your presence.
We are going to call up the second panel in just a moment.
Thank you all for being here.
[Recess.]
Chairman Moran. Let me call to the table the second panel.
Testifying today, this afternoon, and almost this evening, on
the second panel is Dr. Erica Scavella, and she is the
Assistant Under Secretary for Health for Clinical Services at
the U.S. Department of Veterans Affairs. I am going to use my
prerogative and ask you to introduce who you are accompanied
by.
Dr. Scavella. Thank you----
Chairman Moran. ----If you would do that. Thank you,
Doctor.
Dr. Scavella. Yes, sir. Thank you so much.
PANEL II
----------
STATEMENT OF ERICA SCAVELLA, MD, FACP, FACHE, ASSISTANT UNDER
SECRETARY FOR HEALTH FOR CLINICAL SERVICE, U.S. DEPARTMENT OF
VETERANS AFFAIRS ACCOMPANIED BY MANOSHA WICKREMASINGHE, MD,
EXECUTIVE DIRECTOR, VA'S SPINAL CORD INJURIES AND DISORDERS
(SCI/D) SYSTEM OF CARE
Dr. Scavella. Good afternoon, Chairman Moran, Ranking
Member Blumenthal, and Members of the Committee. Thank you for
the opportunity to testify today. Joining me today is Dr.
Manosha Wickremasinghe. She is the Executive Director of VA's
Spinal Cord Injuries and Disorders System of Care. Together,
our mission is to address, not just the immediate needs, but
also the long-term challenges and opportunities facing the
veteran community affected by spinal cord injuries and
disorders, also known as SCI/D.
As we recognize the unique and evolving needs of veterans
living with SCI/D, our response continues to center on
specialized comprehensive care. These complex conditions
require individualized approaches, and our commitment is to
leverage the full depth of VA resources and compassionate
expertise to optimize the quality of life for all veterans.
VA's SCI/D System of Care is the Nation's largest, most
comprehensive integrated health care system dedicated to
treating individuals with spinal cord injuries and disorders.
Our Hub and Spoke System enhances health, well-being,
functionality, and quality of life for over 24,000 veterans.
The veteran is central to all that we do and we strive to
provide care that considers the whole person. We work as
interdisciplinary teams to provide acute rehabilitation,
specialized medical management, primary and preventive care,
respite care, and long-term support. Annual comprehensive
evaluations focus on health promotion, complication prevention,
and early intervention, addressing the evolving needs related
to SCI/D at any age.
To support veterans in their communities, our SCI/D System
of Care includes the SCI/D Home Care Program. Members of
interdisciplinary teams are available to support the transition
and health care needs of veterans with SCI/D in the home or
community. In addition to the SCI/D Home Care Program, the VA
SCI/D System of Care leverages home- and community-based
services such as Skilled Home Health Care, Homemaker/Home
Health Aide, and/or Veteran-Directed Care to ensure eligible
veterans receive care comfortably within their home or the
community.
Recent legislative progress has enabled VA to expand
support for veterans facing complex medical conditions. For
example, Section 120 of the Senator Elizabeth Dole 21st Century
Veterans Healthcare and Benefits Improvement Act, raises the
maximum per-veteran expenditure cap for home- and community-
based services from 65 percent to 100 percent of Community
Living Center costs, while allowing exception for diagnoses
such as SCI/D. These changes directly translate into expanded
options for home-based care and greater financial flexibility.
As the Vietnam-era veteran cohort continues to age, the
complexity of their needs increases. In response, VA is working
to expand SCI/D long-term care capacity with two funded
construction projects in North Texas, which is Dallas, and the
VA San Diego Healthcare System. Both have had existing SCI/D
acute and sustaining centers. Once completed, this will bring
the total number of VA SCI/D long-term care centers to eight.
Ensuring the availability of high-quality, long-term care for
veterans with SCI/D is a prominent challenge and one that
remains central to our resolution, our resource allocation, and
planning.
Removing barriers for veterans with SCI/D requires ongoing
investments in adaptive equipment and technology. In fiscal
year 2024, VA processed more than 5,000 claims for vehicle
conversions, hand controls, and entry/exit ramps, empowering
safe and independent mobility for eligible veterans with
service-connected disabilities.
Additionally, VA's SCI/D System of Care and Office of
Advanced Manufacturing have partnered to ensure veterans have
access to cutting-edge manufacturing technologies such as 3D
printing, in health care. These technologies allow for the
faster innovation and improved access to personalized health
care solutions for veterans.
VA's SCI/D System of Care maintains a strong tradition of
continuous quality improvement and performance measurement.
Recent initiatives have modernized outcome measurement and
reporting. For example, VA has developed standardized
documentation for the Functional Mobility Assessment. This
measure allows VA to evaluate veteran satisfaction with wheeled
mobility access.
Chairman Moran, Ranking Member Blumenthal, this concludes
my testimony. VA's SCI/D System of Care is committed to
delivering high-quality care, ensuring veterans receive the
care and support they deserve. My colleague and I are prepared
to answer your questions.
[The prepared statement of Dr. Scavella appears on pages
58-61 of the Appendix.]
Chairman Moran. Thank you very much. I am going to call on
Senator King to begin the questioning.
Senator King. Thank you, Mr. Chairman. I appreciate the
courtesy. I want to thank both of you for being here. I hope
you listened. There was a lot of praise for the VA in the last
panel. There were some questions, but I think the consensus was
that the veterans that have these SCI/D afflictions prefer the
VA treatment system, and I hope you will take that back to your
colleagues.
I do want to follow up on the comment that Ms. Bailey made
about ALS affecting veterans in a greater proportion than in
the general population. I hope that is something that will
provoke some serious research. It strikes me that could be a
very promising area of research and also, if something is
dangerous for our veterans, we should know it. Dr. Scavella, is
that something you are planning to pursue?
Dr. Scavella. Yes, thank you for that question. We are
aware of the increased propensity of veterans to develop ALS,
and that is included in our ongoing research, to determine both
presumed and causative agents. We have some suspicions and some
thoughts on that, and there is ongoing research into that. But
we do know that there is a correlation between having served
and developing ALS. That is something that is in the
literature, something that our Office of Research and
Development is looking at.
Senator King. I hope that is pursued on an urgent basis.
That could have enormous benefits. If we can nail down a
possible cause, that would be a huge breakthrough for thousands
and thousands of people.
Second question, and I apologize having to leave. I have
got an appointment in my office that has already been waiting
for me. Last fall, the VA indicated an interest in fall
prevention, which, of course, contributes to these kinds of
spinal cords injuries as well as traumatic brain injuries. You
were going to establish, I heard, a Fall Prevention Program. I
have not heard much lately. Is that still in the works? I
certainly hope it is.
Dr. Scavella. Thank you for that question, Senator King.
Fall Prevention, I have been a clinician with VA since 1999.
Fall Prevention has been an ongoing effort. There may be some
renewed attention to that. We want to make sure that veterans
are not falling both in our facilities and in their homes, so
that is something that is ongoing. I would be happy to take
that back for the record to get you details on anything that is
new.
Senator King. I would appreciate that. One out of 4 people
over 65 suffer a serious fall. It costs the economy $80 billion
a year, two-thirds of which comes from Medicare. So this
strikes me as low-hanging fruit in terms of health care costs,
let alone the trauma to families and individuals that are
afflicted by, as I say, traumatic brain injuries, spinal
injuries, and others. So I hope you will take that back, and
let's up the emphasis. Thank you.
And Ms. Wickremasinghe--how did I do?
Dr. Wickremasinghe. Very well.
Senator King. Very well.
Chairman Moran. You are more courageous than I was.
Senator King. I noticed, Mr. Chairman. I did not want to
call attention to that. But you heard the testimony, and please
describe the strategy for dealing with these serious injuries,
SCI/D afflictions.
Dr. Wickremasinghe. Thank you for that question, Senator.
As mentioned before, the VA SCI/D System of Care has 25
dedicated SCI/D centers and over 120 spoke sites. These are
located within facilities which do not have our SCI/D centers.
These spoke sites provide local primary care and SCI/D informed
care.
Within our centers, we have large interdisciplinary teams
that manage the complex care needs of our veterans, ranging
from acute rehabilitation to ongoing care of secondary medical
complications. We provide respite care. We have outpatient
clinics. We have dedicated SCI/D home care programs, and we
have dedicated SCI/D long-term care centers unique to VA.
Senator King. Thank you very much. And I appreciate the
outline and appreciate the work that you are doing, and I hope
you were taking notes during the prior testimony. There are
places where we can shore up the system.
Thank you very much, Mr. Chairman. I appreciate the
courtesy.
Chairman Moran. You are welcome, Senator King. Dr.
Scavella, you heard, to follow up on Senator King's closing
comment, you heard the testimony that occurred just moments
ago. What is your takeaway? We heard correctly that there is
lots of praise and appreciation for the VA and its capabilities
of dealing with veterans and their caregivers. But what did you
learn that you and the VA should be doing differently or
better, and was there something that you want to highlight for
this Committee that we ought to be doing to help you accomplish
that?
Dr. Scavella. Thank you for that question, Chairman Moran.
I will say that we are very proud that we are partnering with
each of the folks on your first panel. We worked extensively
with Dr. Hoover to improve the care that is being provided for
patients with ALS, based upon her direct input. She, in her
testimony, did name one of the two physicians that we were able
to assign to assist with ensuring that her voice and other
voices are known. Mrs. Ward, Ms. Bailey, and Mr. Thomas also
talked about the extensive partnership that we have had.
So I am very pleased to hear their testimony today, and we
look forward to continuing to work with them to learn about
what is not working, what we can improve upon, and anything new
that comes up, as health care evolves and innovates and
improves.
Chairman Moran. Well, let me raise a couple of topics then.
The Congress, Dr. Scavella, has allocated the full amount of
funding that the VA has requested for medical services. Has
there been any hindrance in making certain that SCI/D System of
Care receives the necessary funding to provide the complex
level care needed for these veterans? In other words, the VA
asked Congress, in their budget, for this amount of money. We
have appropriated this amount of money. The VA has that. Is it
getting to the care and treatment programs, the care programs
for these veterans that were described today?
Dr. Scavella. Yes, thank you for that question. We are not
aware of any challenges. I know that there was a focus in the
previous panel about staffing. It has been made clear. We have
communicated it that we have an exemption for the caregivers
that are providing direct patient care in our system. That
includes our clinicians, our nurses, our physicians. That
includes our social workers, but it also includes those folks
that make sure that the space is clean and safe for veterans to
receive care. So in my understanding, we have adequate funding
and are able to use those funds appropriately.
When looking at our staffing from September 2025 and
comparing it to a year ago, it appears as if we have the same
exact number of staff assigned to spinal cord injuries and
disorders. Where there may be some differences perhaps with the
differences in the categories, and we would be happy to take
that back to make sure that we are still meeting the intent.
Chairman Moran. It has been brought to our attention that,
at least in commentary, I would say, is the way that I would
describe this, that the VA's Spinal Cord Injury and Disorder
system is understaffed, and it is the challenge of hiring and
retaining highly skilled providers, particularly in rural
areas. I think you just testified that the same amount of staff
in this arena within the VA, it is the same as it was a year
ago. Are there different challenges depending upon where those
programs are located or where the veteran resides and needs
care?
Dr. Scavella. Yes, so I will highlight that a bit. We know
that there can be some challenges, but with health care in
general, not just within VA, for both attracting, recruiting,
and retaining the talent that we need to provide this skilled
care. We do have a number of modalities, I will let Dr.
Wickremasinghe outline, related to how we can address those
care needs in a rural setting.
Chairman Moran. Thank you very much. Doctor?
Dr. Wickremasinghe. Thank you very much for the question,
Mr. Chairman. You know, we recognize that providing care to our
veterans located in rural areas is critical. We rely on
transportation and telehealth, in addition to our spoke
clinics, which really enhance our outreach. Our spoke clinics
are located in areas closest to where our veterans live, many
times, and that, in combination with telehealth and
transportation, really, you know, are where, for us, the money
is, you know, when trying to reach our rural veterans.
So for example, with telehealth, we have the VA Eastern
Colorado Health Care System. That has expanded rural health
care to VA Black Hills Health Care System. So we have SCI/D
specialists who can participate in appointments with veterans
who are served at Fort Meade in South Dakota. So this is
occurring in many VAs.
In addition, we have telemental health. We have dedicated
mental health providers within our interdisciplinary teams
within our centers. So we have psychologists specialized in the
care of veterans with SCI/D participating through telemental
health, to reach our veterans.
A third example would be our tele-wound programs. Our
veterans with spinal cord injuries many times have skin
conditions resulting in pressure injuries. And instead of
having our veterans drive in for follow-up appointments, we are
able to use 3D imaging and cameras to see the wounds in real
time and have our clinicians monitor progress. Sometimes, it
also allows us to bring our veterans into our centers, sooner
than later, when we see any changes in wounds.
Chairman Moran. Thank you. I am going to ask another
question and then turn to Senator Blumenthal, and I will
continue with you, Doctor. We heard the circumstance described
by our first panel about lack of knowledge of programs, where
to go, and then the silos within the VA that make continuum of
care a challenge, or the length for the necessary components of
care to be coordinated. What would you tell me about that,
whether it is a problem, a challenge? How is it being
addressed? What would you tell the first panel about that
circumstance?
Dr. Wickremasinghe. Thank you for that question. I am not
able to speak for the ALS System of Care. Within the SCI/D
System of Care, however, we provide an interdisciplinary,
comprehensive, lifelong continuum, that I mentioned earlier,
with our Senator. And I can take that back for the record and
get that information to you, through the subject matter
experts.
Chairman Moran. Thank you. What does the VA do to educate
and help connect veterans with opportunities to participate in
clinical research trials?
Dr. Wickremasinghe. VA is a nation's leader in health care
research, Senator, and we currently have about 27 VA-funded
trials and projects focused on veterans with spinal cord
injuries and disorders. We have, for example, the
Rehabilitation Research and Development Gordon Mansfield Spinal
Cord Consortium, located in California, works with many VAs in
the UCLA branches to focus on stem cell research.
We also, for example, in West Haven, Connecticut, we have a
Rehabilitation Research and Development Center focused on
addressing neuropathic or nerve pain, the chronic pain that
affects many veterans with SCI/D, and so on and so forth. I
could provide you much more detailed information for the
record, as well.
Chairman Moran. Thank you. Let me turn to Senator
Blumenthal.
Senator Blumenthal. Thank you. Thank you both for your
service. Let me ask you, how have the cuts in numbers of
workforce affected the work that you do? What number have you
lost?
Dr. Scavella. Thank you for that question, Ranking Member
Blumenthal. I do not actually have the current data on our
attrition rates. I can tell you and reassure you that within
our direct patient care that there are exemptions in place to
make sure that we are not affecting the ability to provide care
in our facilities.
Senator Blumenthal. So you have been affected, or not? I am
not sure I understand your answer.
Dr. Scavella. I am not aware of any effects related to
staffing and the----
Senator Blumenthal. Well, have you lost staff?
Dr. Scavella. I am sure that we have lost staff and gained
staff.
Senator Blumenthal. You have lost staff, but you do not
know how many?
Dr. Scavella. I do not have that data in front of me to
provide you with an accurate number, but we would be happy to
take it back for the record.
Senator Blumenthal. Well, do you have an estimate?
Dr. Scavella. I do not have an estimate, sir.
Senator Blumenthal. You have no idea.
Dr. Scavella. I have heard numbers bandied about, but I
would rather not give a number that is inaccurate in front of
this Committee.
Senator Blumenthal. Well, I have to say, you know, I am
disappointed that you do not have at least an estimate, given
that you are responsible for this whole department. Do you have
an estimate, Dr. Wickremasinghe?
Dr. Wickremasinghe. Thank you for the question. I would
have to take that back for the record. I do not have the data
on hand.
Senator Blumenthal. How many nurse vacancies in SCI/D are
there right now? How many nurse vacancies?
Dr. Scavella. We do not have that data, sir.
Senator Blumenthal. I am stunned. You do not have an
answer, how many vacancies there are?
Dr. Scavella. We would be happy to take that back for the
record. I do not have that data in front of me. I do not want
to give you an inaccurate number.
Senator Blumenthal. How many recreational therapist
vacancies are there?
Dr. Scavella. I do not have that data in front of me, sir.
Senator Blumenthal. How many doctor vacancies?
Dr. Scavella. I do not have any data related to whether we
are actually above or below the recommended staffing for any of
the specialties.
Senator Blumenthal. Are there more vacancies now for
nurses----
Dr. Scavella. I do not have----
Senator Blumenthal [continuing]. Than there were in January
of this year?
Dr. Scavella. I do not have that data in front of me, sir.
Senator Blumenthal. Let me posit, let me assume that staff
are necessary to deliver services. Correct?
Dr. Scavella. Correct.
Senator Blumenthal. So the number of staff would seem to be
related to the quality of your service. Correct?
Dr. Scavella. So perhaps I can explain a bit. We have over
400,000 employees in Veterans Administration, the Department of
Veterans Affairs. I do not have data on those fluctuations----
Senator Blumenthal. I am talking about dealing with SCI/D.
I am not talking about the whole Veterans Administration.
Dr. Scavella. Okay.
Senator Blumenthal. I am talking about dealing with those
issues.
Dr. Scavella. So as I testified a few minutes ago, it
appears as if our staffing within SCI/D remains flat compared
between September 2025 and September 2024. I do not have
information about potential fluctuations in the types of staff
that may have composed that number.
Senator Blumenthal. You do not kind of monthly or quarterly
assessment of what the recommended numbers are and how close
you are to those numbers? You do not do a monthly report or any
regular reporting?
Dr. Scavella. We do monitor our staffing. I do not have
that data in front of me today. I just had the flat number in
that SCI/D----
Senator Blumenthal. Well, what I am going to ask you to do
is to provide me those numbers, vacancies for SCI/D nurses,
recreational therapists, doctors, and other staff, month by
month, to the present, over the past year.
Dr. Scavella. Thank you for that. We will do that, sir.
Thank you.
Senator Blumenthal. When do you think you can have it?
Dr. Scavella. I think we need to confer to make sure we
have got the data available and how soon that will be. I am not
sure what the normal turnaround will be, but we will commit to
getting that information back to you.
Senator Blumenthal. Did you discuss with anyone at the VA
the possibility that you would be asked about these numbers?
Dr. Scavella. Again, I had focused on the total numbers
within the system. I did not focus on the breakdown.
Senator Blumenthal. But did you talk to anybody at the VA
in preparing to come here today about questions relating to
staffing?
Dr. Scavella. Correct, and that is why I had that number of
being the same as September 2024 and September 2025.
Senator Blumenthal. So you did talk to people. Did anyone
say that you should not have the most current numbers on
vacancies?
Dr. Scavella. Nobody gave me that instruction, sir.
Senator Blumenthal. Are people still leaving the VA, in
your department?
Dr. Scavella. So again, I speak for thousands of employees
that do not just include SCI/D, so there is attrition and there
is recruitment. So there is fluctuation every day in our
staffing.
Senator Blumenthal. Are you hiring?
Dr. Scavella. We are hiring.
Senator Blumenthal. Are you hiring more than you are
losing?
Dr. Scavella. Again, I do not have those gains and losses
data in front of me, sir.
Senator Blumenthal. Okay. How about cancellation of
contracts? Do you have contracts with companies outside the VA?
Dr. Scavella. I am going to defer to Dr. Wickremasinghe
about any contracts related to SCI/D.
Dr. Wickremasinghe. Thank you for the question. At the
national level we do not have contracts affecting our SCI/D
System of Care, but I cannot speak for each of our facilities,
so I would need to take that back for the record, please.
Senator Blumenthal. How about the Hubs and Centers? They
have contracts, right?
Dr. Wickremasinghe. I do not want to misspeak, so I would
need to take that back for the record to find out more.
Senator Blumenthal. You do not know whether the Hubs--do
the Hubs and Centers report to you?
Dr. Wickremasinghe. At the national level I oversee policy,
and the more detailed operational involvement, including
contracts, many times is at the local level, at the facility
level. And some of those contracts are national contracts, as
well, but I do not have that information. I would need to take
that back for the record, to make sure that we are providing
the most accurate information.
Senator Blumenthal. Well, my understanding is that you
provide services through Hubs around the country. Correct?
There are about 25 of them, or centers around the country, Hubs
and Spokes?
Dr. Wickremasinghe. Yes. That is correct. We have 25
dedicated SCI/D centers, which are in our VA medical centers.
Senator Blumenthal. And did they have contracts with
private entities?
Dr. Wickremasinghe. I am not able to answer that question
because that is not something that I am directly tracking or
involved with. So I would need to take that back for the
record.
Senator Blumenthal. Well, I am perplexed. You are in charge
of policy, which means meeting basic needs of individuals
served by those 25 SCI/D centers, and you are saying you do not
know whether they have contracts with service providers outside
of their entities, and you do not know whether at the national
level there are contracts?
Dr. Wickremasinghe. That is correct. Senator, because
contracts do not fall directly under my office, we have----
Senator Blumenthal. But you would know--you got a center.
What is the nearest one to Connecticut? Boston?
Dr. Wickremasinghe. Yes.
Senator Blumenthal. Okay. So you would know, in Boston, we
have a certain kind of rehabilitation service that is provided
by a contractor.
Dr. Wickremasinghe. For example, in Boston we have an SCI/D
center, and that center operates under the national guidelines
and standards set forward by VA. We have Directive 1176(2),
which provides the standards for care of veterans with spinal
cord injuries and disorders.
Senator Blumenthal. Alright. Well, I hope maybe you can
provide some more information.
I have been unhappy with the delays in implementing the
Dole Act, as I expressed. Earlier, I have repeated those
concerns. The VA touts its implementation of the Dole Act as a
success. Do you regard it as a success?
Dr. Scavella. Thank you for that question. We are happy to
have the provisions set forth in the Dole Act, which will
address several concerns that were raised here during this
particular hearing. We are grateful for Section 120, which will
help us with some very challenging situations that our patients
have been facing. So we are happy for the provision.
Senator Blumenthal. Don't you need more people to implement
it properly and successfully, more staff?
Dr. Scavella. I cannot comment on needing more staff if I
do not know what the current staffing is capable of providing.
So again, I would like to get back to you with accuracy of what
has been implemented, how it has been implemented, as well as
whether or not we do have any staffing challenges within the
fact that we appear to have a flat staffing.
Senator Blumenthal. Forgive me, but what I am hearing you
say to me is you do not know whether you have enough staff to
implement it successfully.
Dr. Scavella. That is not what I meant to say, sir. What I
am saying is----
Senator Blumenthal. I am sorry. I apologize.
Dr. Scavella [continuing]. I would like to make sure that
as I am answering a question about a new provision and
legislation that we are currently implementing----
Senator Blumenthal. So you are not prepared to answer.
Dr. Scavella. Correct. I want to make sure that I am
providing accurate information pertaining to the new
legislation.
Senator Blumenthal. What is your opinion, Doctor?
Dr. Wickremasinghe. Thank you for the question, Senator.
What I know is that VA is pursuing value-based care to address
the Elizabeth Dole Act.
Senator Blumenthal. I am going to finish my questions at
this point. You know, it is not a failing to say, ``We would
like to have more staff.'' The reason I am asking these
questions is, the VA has lost thousands of dedicated,
hardworking members of its workforce. And my educated guess is
that that has happened in your departments, and that it has
affected performance. And it is not your fault. It is not your
fault. It is the result of decisions made by Elon Musk, DOGE,
tech bros, Secretary Collins, and the Trump administration,
that has taken a chainsaw. It is the chainsaw that Elon Musk
touted as he paraded on that stage, and it has affected your
workers, but even more so, the brave veterans who are
struggling with ALS and other spinal cord injuries. And that is
a tragedy for our country.
So I hope maybe you can provide more information to me,
because it will enable us to do better oversight. Thank you,
Mr. Chairman.
Chairman Moran. Thank you, Senator Blumenthal. There are no
other questions, and therefore I want to again thank our
witnesses, from the first panel and now from the second, for
their testimony, and our Committee members and the audience for
being here this afternoon.
The hearing record will remain open for five legislative
days, should any Committee members want to submit additional
statements for the record. And I ask our witnesses to respond
to any questions that are provided for the record, once they
are received that they are answered in a timely manner. I think
we are done. We will adjourn the meeting, and thank you very
much.
[Whereupon, at 5:45 p.m., the hearing was adjourned.]
A P P E N D I X
Prepared Statements
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Questions for the Record
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Statement for the Record
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
[all]