    [Senate Hearing 119-247]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 119-247

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

                                    HEARING

                                   BEFORE THE

                         COMMITTEE ON VETERANS' AFFAIRS
                              UNITED STATES SENATE

                        ONE HUNDRED NINETEENTH CONGRESS

                                 FIRST SESSION

                                   __________

                               DECEMBER 10, 2025

                                   __________

           Printed for the use of the Committee on Veterans' Affairs

    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

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

                                   __________

                         U.S. GOVERNMENT PUBLISHING OFFICE
    62-272 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

                                  ----------

                               December 10, 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...............     7
    Hon. Patty Murray, U.S. Senator from Washington..................     9
    Hon. Kevin Cramer, U.S. Senator from North Dakota................    10
    Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......    12
    Hon. John Boozman, U.S. Senator from Arkansas....................    13
    Hon. Angus S. King, Jr., U.S. Senator from Maine.................    15
    Hon. Elissa Slotkin, U.S. Senator from Michigan..................    17

                                   WITNESSES
                                    Panel I

    Margarita Devlin, MA, CRC, Principal Deputy Under Secretary for
      Benefits, U.S. Department of Veterans Affairs accompanied by
      Thomas O'Toole, MD, Acting Assistant Under Secretary for Health
      for Clinical Services, Veterans Health Administration..........     3

                                    Panel II

    Morgan Brown, National Legislative Director, Paralyzed Veterans
      of America.....................................................    20

    Nancy A. Springer, Acting Director, National Legislative Service,
      Veterans of Foreign Wars of the United States..................    21

    Barton Stichman, Co-Founder and Special Counsel, National
      Veterans Legal Services Program................................    23

                                    APPENDIX
                                 Hearing Agenda

    List of Pending Bills............................................    33

                              Prepared Statements

    Margarita Devlin, MA, CRC, Principal Deputy Under Secretary for
      Benefits, U.S. Department of Veterans Affairs..................    37

    Morgan Brown, National Legislative Director, Paralyzed Veterans
      of America.....................................................    97

    Nancy A. Springer, Acting Director, National Legislative Service,
      Veterans of Foreign Wars of the United States..................   106

    Barton Stichman, Co-Founder and Special Counsel, National
      Veterans Legal Services Program................................   118

                           Submissions for the Record

    Senator Cramer

      American Hospital Association, Rick Pollack, President and
        Chief Executive Officer......................................   129

      First Care Health Center in Park River North Dakota, Marcus R.
        Lewis, Chief Executive Officer...............................   131

      North Dakota Rural Health Association (NDRHA), Kylie Nissen,
        Executive Director...........................................   133

      Unity Medical Center, Alan O'Neil, Chief Executive Officer;
        First Care Health Center, Marcus Lewis, Chief Executive
        Officer; and other organizations.............................   135

    Senator King

      American Academy of Pediatrics, Susan J. Kressly, MD, FAAP,
        President....................................................   137

      American Association for Marriage and Family Therapy, and other
        organizations................................................   139

      American Psychiatric Association...............................   141

      Association of VA Hematology/Oncology, and other organizations.   144

      End Family Fire-Brady, Colleen Creighton, Senior Director......   154

      Everytown for Gun Safety, Monisha Henley, Senior Vice President
        for Government Affairs.......................................   156

      GIFFORDS, Vanessa Gonzalez, Director of Government and
        Political Affairs............................................   158

      Sandy Hook Promise, Mark Barden, Co-Founder; and Nicole
        Hockley, Co-Founder and Chief Executive Officer..............   160

      United Steelworkers (USW), Roy Houseman Jr., Legislative
        Director, Assistant to the International President...........   162

      Walk the Talk America (WTTA), Michael Sodini, Founder and
        President....................................................   164

    Senator Blumenthal

      Urban Institute, Matthew Buettgens; Jennifer M. Haley; and
        Michael Simpson..............................................   167

                           Statements for the Record

    The American Legion, Cole T. Lyle, Director, Veterans' Affairs
      and Rehabilitation Division....................................   171

    American Psychological Association Services, Inc., and other
      organizations..................................................   196

    Anoka County Board of Commissioners, Mike Gamache, Chair,
      District 5; and Districts 1-4, 6 and 7.........................   206

    Disabled American Veterans (DAV), Jon Retzer, Deputy National
      Legislative Director...........................................   208

    Military-Veterans Advocacy, Cmdr. John B. Wells, USN (Ret.),
      Chairman.......................................................   224

    Military, Veteran and Family Center of Excellence................   228

    National Organization of Veterans' Advocates, Inc. (NOVA), Diane
      Boyd Rauber, Esq., Executive Director..........................   231

    Student Veterans of America (SVA)................................   237

    Tragedy Assistance Program for Survivors (TAPS)..................   241

    Veterans' Survivor Coalition.....................................   253

                                   HEARING TO
                          CONSIDER PENDING LEGISLATION

                                  ----------

                          WEDNESDAY, DECEMBER 10, 2025

                                           U.S. Senate,
                                Committee on Veterans' Affairs,
                                                        Washington, DC.
        The Committee met, pursuant to notice, at 4:01 p.m., in
    Room SR-418, Russell Senate Office Building, Hon. Jerry Moran,
    Chairman of the Committee, presiding.

        Present: Senators Moran, Boozman, Tillis, Cramer, Sheehy,
    Blumenthal, Murray, Hassan, King, and Slotkin.

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

        Chairman Moran. Good afternoon. Our Committee will come to
    order. I express my gratitude to our witnesses for joining us
    today. We're going to consider 24 pieces of legislation
    sponsored by me, the Ranking Member, and Senators from both
    sides of the aisle.
        That includes two bills that I introduced; the Fisher House
    Availability Act would allow families of service members to
    stay at VA Fisher Houses if the service member is being treated
    at a nearby VA Fisher House--I'm sorry, I didn't say that
    right--is being treated near a VA Fisher House while still
    prioritizing space for family members of VA patients; and the
    SERVE Act, which would improve relationships between the VA
    medical centers and military treatment facilities to improve
    access to care for service members and veterans, and increase
    training opportunities for the VA and DoD healthcare providers.
        I appreciate the support of this legislation, that it's
    received from my colleagues and across Capitol Hill, as well as
    from veterans service organizations community, and I'm pleased
    to see its inclusion in fiscal year 2026 NDAA. I look forward
    to it being enacted into law, and seeing how it will benefit
    the veteran and military communities moving forward.
        And turning back to today's hearing, as we move away a
    moment from NDAA, the bills on the agenda today represent a
    number of bipartisan priorities that would build on the
    successes Congress has achieved in expanding access to care and
    benefits for veteran survivors and their families. A notion
    that all of us on this Committee share.
        I'm grateful to the sponsors of all of these bills for
    their work on these pieces of legislation. I'm grateful to the
    VA for providing technical assistance on the legislation, and
    to our veterans service organizations partners for working well
    with us to improve and advance the bills.
        With that, I yield to the Ranking Member, Senator
    Blumenthal.

             OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,
             RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT

        Senator Blumenthal. Thanks, Mr. Chairman. I appreciate the
    opportunity to hear testimony on some very important bipartisan
    legislation today. But before we begin, I think we have to
    recognize the importance of votes that we will take tomorrow,
    one of them to extend the healthcare tax credits under the
    Affordable Care Act (ACA) that will affect literally 267,000
    veterans who rely on the ACA enhanced premium tax credits to
    afford health insurance.
        And whether you support the ACA, whether you have other
    views on what might be a perfect system in the long run, if we
    had tons of time; the simple fact is we face a deadline of the
    end of the year when these tax credits will expire, and 267,000
    veterans will no longer be able to afford ACA coverage if these
    credits are not extended. These are primarily veterans who are
    not eligible for Medicaid, TRICARE, or Medicare, and often not
    eligible to get their care through the VA, leaving them with
    the ACA Marketplace plans as the only option for healthcare
    coverage.
        The ACA isn't perfect. We need to lower the costs of
    healthcare generally. We need to work on reforms, and we need
    to eliminate any fraud that exists in these programs. But the
    fact of the matter is, the consequences of failing to extend
    these tax credits will be devastating for veterans and their
    families. Veterans will be forced to navigate a perfect storm,
    an understaffed VA healthcare system, increased wait times for
    VA healthcare, Medicaid cuts, and the loss of affordable health
    insurance. They deserve better. So, do millions of Americans
    who will be impacted by the potential failure to extend these
    tax credits. I hope that we approve them to the benefit of
    those veterans and countless other Americans affected.
        On the legislation today, I want to particularly thank Mr.
    Stichman for his work alongside the Yale Veterans Legal
    Services Clinic to improve how a federal appellate court's
    process VA appeals. I've worked with the Yale Veterans Legal
    Services Clinic over the years, and I know how important their
    work is.
        Generally, the Veterans Appeals Efficiency Act, which I co-
    led with Senator Banks, is one of the many bills that we're
    here to discuss. And I will be supporting many, if not all of
    them, for example, the Molly Loomis Act, which would build on
    the promise of the PACT Act by exploring health conditions
    prevalent among descendants of veterans who were exposed to
    toxic substances during their service.
        And we have to confront as well the painful legacy of
    discrimination. The Commission on Equity and Reconciliation in
    the Uniformed Services Act would investigate the harm done to
    LGBTQ+ service members and veterans, many of whom received
    punitive discharges, and were forced to hide their identities,
    and ultimately, denied benefits.
        These measures are not partisan. This Committee generally
    is not partisan. And I welcome the support of my Republican
    colleagues for many of these important measures that we
    hopefully will advance after today's hearing. Thank you.
        Chairman Moran. Thank you, Ranking Member. I'll introduce
    our first panel. Testifying today from the Department of
    Veterans Affairs is Margarita Devlin, the Principal Deputy
    Under Secretary for Benefits. And she's accompanied by Thomas
    O'Toole, the Acting Assistant Under Secretary for Health for
    Clinical Services, Veterans Health Administration.
        Thank you both for being here. And Ms. Devlin, I now
    recognize you for your opening statement.

                                PANEL I

                                  ----------

    STATEMENT OF MARGARITA DEVLIN, MA, CRC, PRINCIPAL DEPUTY UNDER
      SECRETARY FOR BENEFITS, U.S. DEPARTMENT OF VETERANS AFFAIRS
       ACCOMPANIED BY THOMAS O'TOOLE, MD, ACTING ASSISTANT UNDER
      SECRETARY FOR HEALTH FOR CLINICAL SERVICES, VETERANS HEALTH
                             ADMINISTRATION

        Ms. Devlin. Good afternoon, Chairman Moran, and Ranking
    Member Blumenthal. Thank you for inviting us to speak on VA's
    views on the legislation before us today. I am joined by Dr.
    Thomas O'Toole, Deputy Assistant Under Secretary for Health
    from the Veterans Administration.
        Before we begin, I'd like to apologize for the delay in
    providing testimony to this Committee. VA is working on process
    improvements, internally as well as externally, to ensure that
    this is prevented in the future.
        Chairman Moran. Thank you for your regrets and apologies,
    and we'll consider this probably most likely external
    challenges. Thank you very much.
        Ms. Devlin. Thank you. There are 24 bills on today's
    agenda, and while I won't be able to address each one of them
    in my opening remarks, I welcome the opportunity to answer your
    questions and provide any additional information the Committee
    may need.
        VA's full views on the bills are submitted for the record
    in written testimony. VA has noted in our official views where
    important amendments would be needed to ensure feasibility of
    implementation. I will highlight several bills where VA either
    supports or supports the intent.
        VA supports the Fisher House Availability Act of 2025,
    introduced by Chairman Moran. This bill would expand access to
    temporary lodging in Fisher Houses or other appropriate
    facilities for veterans and their families, not only when the
    veteran is receiving care, but also when a family member is
    receiving care. We appreciate the Chairman's leadership on this
    compassionate and practical proposal, and support the bill
    subject to availability of appropriations.
        VA also supports the intent of the SERVE Act, also
    introduced by Chairman Moran, which seeks to improve access to
    care for veterans by leveraging the Department of War
    facilities and providers. While VA does not support the bill as
    currently drafted, we value our longstanding partnership with
    the Department of War, and are confident that our cooperative
    relationship will continue to ensure veterans receive high
    quality care. We welcome the opportunity to work with the
    Committee to refine the bill's language, and ensure clarity
    around provider roles, veteran choice, and coordination of
    care.
        Suicide prevention remains one of Secretary Collins' top
    priorities, and VA appreciates the intent behind the Saving Our
    Veterans Lives Act, introduced by Senator King. While we do not
    support the bill as drafted due to concerns about scope and
    cost, particularly the $5 million annual authorization, we are
    proud to report that VA has already launched a lockbox
    distribution program for enrolled veterans at medium to high
    risk of suicide who have access to firearms. This program
    includes provider ordering, tracking, and distribution, and is
    supported by VA's mandatory suicide prevention training, VA
    S.A.V.E., which continues to be updated and expanded.
        VA appreciates the intent of the Molly R. Loomis Act, which
    would mandate research on health conditions in descendants of
    veterans exposed to toxic substances. While we support the goal
    of better understanding long-term impacts, we believe our
    existing programs, particularly those conducted in partnership
    with the National Academies of Sciences, already provides a
    robust framework for this research.
        VA supports the intent of the Purple Heart Veterans
    Education Act, introduced by Senator Murray, which would allow
    Purple Heart recipients to transfer Post-9/11 GI Bill benefits
    to dependents. However, we recommend amending the bill to
    clarify the role of the Secretary of War in the transfer
    process, as current law requires coordination with the
    Department of War for approval and management of transferred
    benefits.
        The VA appreciates the intent of the Obligations to
    Aberdeen's Trusted Heroes or OATH Act of 2025, introduced by
    Ranking Member Blumenthal. While VA cites concerns regarding
    various sections as written, and subject to appropriations, we
    welcome the opportunity to continue working with you and your
    staff to amend the language.
        VA also appreciates the goals of the Veterans Appeals
    Efficiency Act, introduced by Senator Banks and Ranking Member
    Blumenthal. We support efforts to improve transparency in the
    appeals process, but recommend amendments to ensure
    feasibility. For example, we suggest reporting legacy and AMA
    appeals remand separately, which would allow VA a sunset
    reporting on legacy remand once they are completed.
        We also recommend against the requirement to track and
    report when VBA adjudicators do not follow board remand
    instructions. Implementing this would require building a new
    review system for all post-remand decisions, demanding
    significant staff and IT resources. Even with system upgrades,
    VA anticipates several challenges in accurately tracking non-
    compliance. For instance, if the agency of original
    jurisdiction grants a claim without following the board's
    instructions, it's unclear whether that outcome would be
    considered non-compliance under the bill's language.
        Furthermore, under the Appeals Modernization Act, post-
    remand decisions are not automatically returned to the board.
    As a result, VA cannot confirm compliance with remand
    instructions unless the veteran chooses to appeal.
        Mr. Chairman, that concludes my statement. Thank you again
    for the opportunity to discuss these important legislative
    proposals to improve benefits for veterans, service members and
    their families. While I was unable to cover all the bills in my
    opening remarks, my colleague and I will be happy to answer any
    questions the Committee may have.

        [The prepared statement of Ms. Devlin appears on pages 37-
    96 of the Appendix.]

        Chairman Moran. Thank you, Ms. Devlin. And I thank you and
    the VA for providing technical assistance in support of the
    SERVE Act, which I have indicated earlier, is now included in
    this year's NDAA.
        Ms. Devlin and Dr. O'Toole, besides the mandates that are
    included in the SERVE Act to improve healthcare resource
    sharing between the VA and DoD, how else do you think the VA,
    DoD, and Congress could work together to improve access to care
    for service members and veterans in both of these federal
    healthcare programs? What do we do to make this a better
    broader system?
        Ms. Devlin. I'll ask my colleague from VHA to answer that.
        Dr. O'Toole. Thank you, Senator. And I think the question
    speaks to, I think, an opportunity for us. Both systems have a
    long history of collaborating together. Both systems have a
    shared mission, and clearly, we want to also ultimately improve
    the transition from active duty to civilian life, and
    hopefully, VA care.
        I think there are several things that we, I think the SERVE
    Act is a great step forward for us, and I appreciate the
    opportunity for us to continue to work with you and your staff
    on some of the concerns that we have. I think as we move
    forward, issues of the processes of credentialing, and
    privileging, and potentially working together with clinicians
    in military treatment facilities in a more seamless capacity is
    an opportunity.
        I look at models that we have, for instance, with the
    Lovell FHCC and Chicago health system as a strong collaborative
    model for us to continue to develop. But you know, I think this
    is an important and prioritized area for us.
        Chairman Moran. Thank you for those suggestions and those
    comments. I want to speak just a moment about Fisher House, and
    express my gratitude to those involved in Fisher House for the
    tremendous service they provide to veterans and to service
    members. The issue that's addressed in this legislation was in
    part a result from the VA continuing a practice that they had
    previously due to lack of clarity in the law.
        This bill is designed to make clarity, and I want to make
    sure that you agree to support this legislation. But there's no
    question, what that clarity is now. Let me say it this way,
    that ambiguity is no longer going to necessitate any decline of
    the opportunity to serve service members' families.
        Dr. O'Toole. Happy to speak to that. And that is exactly
    what we have heard from our facilities, is they've also looked
    at the bill that this provides that level of clarity. So, thank
    you.
        Chairman Moran. And then, finally, let me turn to Senator
    Blumenthal--Senator Blumenthal.
        Senator Blumenthal. Thanks, Mr. Chairman. I want to focus
    on the ACA tax credits. I've seen an estimate that a 1-percent
    increase in reliance by veterans on VA healthcare produces $2.6
    billion in additional costs. So, if 267,000 veterans are denied
    the ACA tax credits and they are not extended, presumably some
    major number will go to the VA healthcare system, significantly
    raising the cost to the VA. Have you done an analysis on the
    impact on the VA healthcare system of 267,000 veterans losing
    their ACA health insurance coverage?
        Dr. O'Toole. Yes, I'm not aware of an analysis. I would
    definitely--I take your word in terms of that transition, but I
    can't speak to any specific analyses or numbers and would have
    to take it for the record, sir.
        Senator Blumenthal. So, it would be fair to say that the
    additional cost of VA healthcare system is going to be in the
    billions of dollars if we fail, that is, if the United States
    Senate failed to vote tomorrow to extend these healthcare
    subsidies?
        Dr. O'Toole. Based on what you're describing in terms of
    the numbers and your analyses, yes, sir.
        Senator Blumenthal. And you don't dispute them?
        Dr. O'Toole. No reason to dispute them. But I also, again,
    want to be clear that I we have not done the analysis. I have
    not done the analysis to be able to----
        Senator Blumenthal. Well, you'd be in a position to dispute
    them if they sounded wildly wrong.
        Dr. O'Toole. Yes, if they sounded wildly, yes, I would.
        Senator Blumenthal. You know there have been recent reports
    about the apparent demise of the DOGE program, but the VA still
    has yet to share, by the way, despite bipartisan requests; a
    full list of the thousands of contracts that have been cut by
    Secretary Collins in connection with the DOGE Elon Musk
    program.
        The VA has yet to respond to my May 19th letter demanding a
    full accounting of these haphazard cuts. And despite promises
    from multiple VA leaders to brief this Committee on the cuts,
    we have yet to receive a briefing within the VBA and the VHA.
    Do you have a full list of all the contracts canceled as a
    consequence of DOGE, or because of the slashing cuts made by
    the VA Secretary?
        Ms. Devlin. Senator, thank you for the question. I rejoined
    VBA in May of this year, so I wasn't there for the DOGE
    activities. However, I can tell you that we have the contracts
    that we need to support our mission.
        Senator Blumenthal. Well, do you have a list of all the
    contracts that have been canceled?
        Ms. Devlin. I don't personally have that list, no.
        Senator Blumenthal. Does anyone?
        Ms. Devlin. I'd have to get back to you on that, sir.
        Senator Blumenthal. Do you know, Dr. O'Toole?
        Dr. O'Toole. I don't, and again, I'd have to--we'd have to
    get back to you on that.
        Senator Blumenthal. I can't speak for the Committee, but I
    can for myself. I have no clue as to what excuse there could be
    for failing to provide us with that list after so many months,
    so many communications in hearings, and the letter that I did.
    So, if you could take that message back, I would appreciate it.
        Dr. O'Toole, the last time you were here was in May. My
    office sent a request to the VA immediately preceding that
    hearing for data that we used to receive from the department.
    Some of it was publicly available, regarding VA and community
    care wait times, VA wait times, and community care wait times.
    200 days later since I made that request, I have not received
    any of the information that I asked for.
        As the Deputy Assistant Under Secretary for Health for
    Clinical Services, you oversee VHA field operations. When was
    the last time you received updates on wait times at the VA or
    for community care?
        Dr. O'Toole. Well, sir, we track IC data related to VA wait
    times on a frequent basis. And we do track that. I would have
    to defer to my colleagues in the IVC office in terms of what
    the community wait times are.
        Senator Blumenthal. Can you give us an update?
        Dr. O'Toole. Off the top of my head, no, but I'm happy to,
    you know----
        Senator Blumenthal. Can you give us an update before we
    leave for the holiday break?
        Dr. O'Toole. I will definitely try to, sir. Yes.
        Senator Blumenthal. Thank you. my time has expired. That
    completes my questions. Thank you.
        Chairman Moran. Thank you, Senator Blumenthal. Senator
    Tillis.

                           HON. THOM TILLIS,
                    U.S. SENATOR FROM NORTH CAROLINA

        Senator Tillis. Thank you, Mr. Chair. Dr. O'Toole, Senator
    Blumenthal asked you about the 250,000 or so people who may be
    on ACA subsidized care. Do we know whether or not--I mean, can
    you try and identify--frankly, if they're VA-eligible, I would
    prefer for them to be getting care from the VA. I understand
    the fiscal impact, but this may represent an opportunity to
    find a swathe of people who are going out to the exchange
    buying healthcare coverage when we can give them the
    extraordinary coverage that they could get within the VA.
        The concern I have with that is it's kind of like calling
    roll by asking people who are absent to raise their hand? How
    would we find those people and what was the basis for the
    analytics? I mean, it's one thing to estimate, but how can we
    get to a level of granularity where we know who they are, and
    we can reach out to them and say there is an alternative
    whether or not the subsidies get extended?
        Dr. O'Toole. Yes, it's a great question, sir. And, you
    know, having been practicing in the VA for 20 years, I'm always
    an advocate of the care that we provide in that system. I don't
    know, and we'd have to get back to you in terms of what type
    of----
        Senator Tillis. And clearly, if we have an influx and
    covered veterans, then we're going to have to deal with
    funding. But if they're not getting the subsidy on the
    exchange, there may be a source of funding there that we should
    talk about. So, I think it would be helpful for us to get that
    regardless of what occurs, because I'm always looking for
    veterans to get the best care that they can. And I believe
    that's through the VA when given the option, if they're
    eligible for it.
        Ms. Devlin, you covered, I think, about 8 or 10 of the
    bills on the list that I have before me. Do you have a formal
    position that you've communicated to us on the other pending
    bills, the longer list?
        Ms. Devlin. Yes, sir. We submitted testimony for the record
    on all bills.
        Senator Tillis. Okay. I haven't seen it. Are there any hard
    nos? Not only do you not agree with the intent, you think it's
    a bad idea?
        Ms. Devlin. We did have some opposition.
        Senator Tillis. Like, as in ``No, we don't want this policy
    to be passed,'' and that's in the record?
        Ms. Devlin. Yes.
        Senator Tillis. Thank you. Then the only other question I
    had specifically--actually, let me see if I can find the bill.
    Oh, yes, 2807, Restoring Eligibility Standards for Placement in
    Eligible Cemeteries. What's your position on that?
        Ms. Devlin. Thank you for the question. Our NCA partners
    are not here to testify on that bill. We----
        Senator Tillis. But was that submitted to the record?
        Ms. Devlin. It was, sir.
        Senator Tillis. And what was the position in the record?
        Ms. Devlin. If you can give just one moment, I will look it
    up in the testimony [turns pages in notebook]. If you'd like to
    ask me another question while I look it up?
        Senator Tillis. No, that's the last one.
        Ms. Devlin. Oh, okay.
        Senator Tillis. Sooner you get that one, sooner you get rid
    of me.
        Ms. Devlin. Trying to avoid the awkwardness of going
    through the----
        Senator Tillis. That's okay. Appreciate your preparation.
        Ms. Devlin. Absolutely, yes, sir. Thankfully, they're in
    numerical order.
        Senator Tillis. Yes. If staff have feedback, y'all can
    whisper in my ear, too.
        Ms. Devlin. I wanted to give you the exact language just so
    that I don't go on the record with the wrong language.
        Senator Tillis. Well, the only reason out this entire list,
    I think I'm only co-sponsor on the Purple Heart Veterans
    Education Act. But that one gets out to me. It stands out in
    that I think that we have to have pretty significant
    consultation with the DOJ.
        It sounds like, directionally, you are supportive. I've had
    the staff provide me something, but we really need to get that
    right. There are clearly instances where I can think of a
    tragic event in North Carolina where it would be appropriate
    for this, I believe, my personal opinion, appropriate.
        The circumstances at face value would not justify maybe
    making an exception. But I do think we need to look at it, but
    we need to have a very tight set of standards, and I think
    strong consultation with DOJ before I'd be willing to support
    it. Thank you, Mr. Chair.
        Chairman Moran. Thank you, Senator Tillis. Senator Murray.

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

        Senator Murray. Thank you, Mr. Chairman. You know,
    President Trump came into office saying that he would make IVF
    free. Instead, not only has the President not done a thing to
    lower the cost of IVF, he stood by as Speaker Johnson cut a
    very straightforward provision to make IVF more affordable for
    service members as part of this year's NDAA. And on that note,
    I'm really disappointed to see that my Veteran Families Health
    Services Act was left off of the agenda today. That bill would
    give more service members and veterans the opportunity to grow
    their families, including through IVF, by expanding the
    fertility services that are covered under VA and DoD
    healthcare.
        It just seems like Republicans in this Administration
    really talk a big game about IVF, but when it comes to actual
    policy, it's pretty clear who's in the driver's seat; anti-
    abortion extremists like Speaker Johnson. So, I just want to
    make it clear, I think it's pretty outrageous that Republicans
    won't lift a finger to help our service members, or anyone for
    that matter, to access IVF. And I think it is really important
    everybody here understands that.
        Dr. O'Toole, are you aware that service members face a
    higher rate of infertility compared to the rest of the
    population?
        Dr. O'Toole. I am not directly familiar with it, ma'am, but
    I take your word on it.
        Senator Murray. Well, it is true. And our service members,
    as we all know, they lay their lives on the line for our
    country. And I really believe, and I think many people do, that
    the least we can do is help them start their families when they
    come home. So, again, I'm registering my deep disappointment
    and hope that that can change.
        Let me move on. As the daughter of a Purple Heart veteran,
    I know how much they sacrifice for our country. I take
    seriously our responsibility to be there for them when they
    need it the most. And unfortunately, right now, not all Purple
    Heart veterans are treated equally when it comes to their
    benefits. For example, post-9/11 veterans can transfer their GI
    benefits to their descendants while they're still in service.
        However, one of my constituents reached out to tell me
    about a problem he was facing because he received his Purple
    Heart after his service and was unable to transfer his GI Bill
    benefits to his daughter when she was looking to go to college.
    So, the bill that I'm offering, which I'm glad to see on the
    agenda today, would fix that loophole.
        Ms. Devlin, you mentioned you wanted to see some changes,
    but let me just ask you, are you supportive of this
    legislation?
        Ms. Devlin. We do support the intent of this, and it's
    really technical amendments to ensure Department of War is
    involved in the process as they're responsible for the process
    of transferring eligibility.
        Senator Murray. Well, I'm happy to talk with you about what
    your recommendations are, but I think this is a really
    important piece of legislation. I hope we can move on it.
        And let me ask about the Molly R. Loomis Research for
    Descendants of Toxic Exposed Veterans Act. This is a bill
    that's really near and dear to me. Molly is a Washington State
    resident. She was born with spina bifida and it's believed to
    be caused by her father's exposure to Agent Orange when he
    served in Vietnam. And despite research showing descendants of
    toxic-exposed veterans experience lifelong medical issues,
    there is yet to be a comprehensive government-led study of this
    issue.
        So, my bill simply takes a very critical step forward by
    requiring research on health conditions that are prevalent in
    the descendants of veterans who were exposed to toxic
    substances during their service. Ms. Devlin, talk a little bit
    first about how this research would prepare VA to help future
    generations of veterans who've been affected by toxic exposure.
        Ms. Devlin. Thank you for the question. We take research
    objectives very seriously. And of course, for individuals with
    spina bifida whose parents were exposed to toxic substances,
    there is the Chapter 18 program which supports them. And that
    program continues today to support those dependents.
        There has been no significant association that we've seen
    through the National Academy of Sciences research to indicate
    that there are generational impacts based on toxic exposures,
    but we do have the infrastructure in place. And in fact, with
    the PACT Act, we have the infrastructure in place to determine
    which research objectives to take on with the working groups
    that exist already.
        Senator Murray. Well, it's my understanding that there is
    research showing that descendants of toxic-exposed veterans do
    experience lifelong medical issues. I think it is really
    important for us to look at this to make sure they are getting
    the support they need. So, I thank you for your inclusion of
    this bill on the agenda today.
        Chairman Moran. Senator Murray, thank you. I have taken an
    interest a long time ago in regard to next generation affecting
    the next generation by service of their parents or their
    grandparents. And look forward to working with you on this and
    other pieces of legislation.
        Senator Murray. Thank you.
        Chairman Moran. Senator Cramer.

                           HON. KEVIN CRAMER,
                     U.S. SENATOR FROM NORTH DAKOTA

        Senator Cramer. Thank you, Mr. Chairman. And thank you both
    for being here today. I want to talk a little bit about and get
    some feedback on my legislation that I introduced with Senator
    Sheehy from Montana, an even larger and more rural state than
    North Dakota. It's called the Critical Access for Veterans Care
    Act.
        I believe you're familiar with it. I mean, the VA did
    testify to it, I know. I'm going to just read a little bit of
    it. It reads a little bit like the girls I used to ask out in
    high school, and they'd say, well, we like you a lot and you
    have a good personality. Says, ``The VA strongly agrees with
    the intent to improve the quality and availability of care to
    veterans in highly rural areas like Montana and North Dakota.
    We support the goal of improving access for rural veterans and
    want to work with the Committee to clarify how this new
    authority would integrate with existing VA care processes.''
        You know, in states as rural as North Dakota and Montana,
    we have very limited VA providers and facilities. In North
    Dakota, we have one hospital in Fargo, which is the very
    eastern edge of the state, we have, I think, eight CBOCs, and
    the community care program literally can be a lifeline. And I
    say can be because the thing that prevents it from being a
    lifeline as often as it ought to be, is of course, are all the
    roadblocks that get put up; all the fine print, all the
    exceptions, all the slow walking and administrative hurdles for
    the veterans and the providers themselves to participate.
        So, we've seen some administrations, prior administrations,
    intentionally put up some of these roadblocks and to deter
    veterans from using these options, even though it's the law and
    an option that we've all told veterans many times it's
    available to them.
        After hearing from veterans and rural healthcare providers
    and leaders across North Dakota, I proposed the solution, as I
    said, with Senator Sheehy. And it was to simplify access to the
    critical access network, whether it's critical access hospitals
    rural health clinics, and the model.
        And as a point of emphasis, you guys, critical access is a
    designation specific to healthcare providers where they're the
    only hospital or the only provider in an entire region many
    miles between the providers. Our system, our VA system,
    effectively discriminates against our veterans compared to
    their neighbors, their non-veteran neighbors and friends and
    family, by giving them less access to care that's readily
    available than they have currently.
        And so, I mean, we just have so much opportunity here.
    Obviously, I'm always willing to work to improve the details of
    legislation. We want to get it right. But parts of the
    testimony seem to indicate that the VA wants to maintain the
    control, and that's always the deal. All the good language in
    the world. However, you know, as long as we agree that that's
    not really a culture change that's maintaining of control.
        So, the goal is to give rural veterans access to local
    critical access hospitals without the strings attached. I mean,
    we talk about wait lines in the waiting room that Senator
    Blumenthal talked about. That is one thing. But the wait lines
    we're talking about are days, and weeks, and months to get
    permission to get the care that they need across the street,
    rather than across the state. So, I understand, and again, want
    to make the language clear.
        You probably hear it quite a bit, I know I do, that prior
    authorization process for veterans is a nightmare. It not only
    takes a long time, and oftentimes gets the wrong result, but
    it's just awful to do. So, anyway, I worry that if the bill's
    watered down, quite honestly, that we turn this authority back
    over to the bureaucracy to decide.
        I want to say I've got a lot of support, Mr. Chairman, and
    I have several letters here, including from the American
    Hospital Association supporting the legislation as it is, other
    leaders, rural healthcare leaders from across North Dakota. And
    I would like to submit them all for the record, if it's okay.
        Chairman Moran. Without objection, so ordered.

        [The information referred to appears on pages 129-136 of
    the Appendix.]

        Senator Cramer. All right. Anyway, with whatever time
    remain, which is now 25 seconds, Dr. O'Toole, maybe you could
    just elaborate a little bit on my rant.
        Dr. O'Toole. Sure. I thank you, Senator. And let me say,
    you know, first we strongly support definitely the intent and
    the need for this legislation as it relates to rural veterans.
    I think the sticking point, which you noted, is really how do
    we create some clarity in language and direction as it relates
    to prior authorization versus clinical necessity. That can be
    achievable, and we're very much looking forward to working with
    you and how we get appropriate language to make that work.
        Senator Cramer. Thank you.
        Chairman Cramer. Senator Hassan.

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

        Senator Hassan. Well, thanks, Mr. Chairman, and Ranking
    Member Blumenthal for the hearing. To both Ms. Devlin and Dr.
    O'Toole, thank you for your service to our Nation's veterans.
        Ms. Devlin, this may actually be a question that Dr.
    O'Toole is better positioned to answer, but as you both know,
    in May, President Trump signed an Executive order that required
    the Secretary of the VA to direct a feasibility study and
    create an action plan regarding bringing a full service VA
    hospital to New Hampshire. This action plan was due to the
    President last month.
        A few weeks ago, my New Hampshire colleagues and I wrote a
    letter to the Secretary asking him to make that action plan
    publicly available so that Granite Staters can see it, have
    input, provide feedback. So, can you, whichever one of you is
    in a better position to respond, can you please tell me when
    this action plan will be made available for my constituents to
    review and comment on?
        Dr. O'Toole. Senator, I'll take that one on. I don't have
    the specific information. I will say that this is a priority of
    the Secretary. It is something that I know a lot of people are
    working on, and we will take it for the record to get that
    information for you.
        Senator Hassan. I would appreciate that. We liked having
    the Secretary come in person to Manchester a little bit ago. It
    was a really good visit, but we really need to see the action
    on this. And we've been asking for a while.
        Ms. Devlin, I want to change gears a bit now and discuss
    how scammers are targeting veterans. I bet everybody here has
    gotten a text, email, phone call and been the target of a scam.
    According to the Federal Trade Commission, veterans and
    military retirees reported nearly $420 million lost to fraud
    just last year. And when you include active military members,
    reservists, and their families, that number climbs to more than
    $580 million.
        According to the FTC, the top type of fraud affecting our
    military and veterans was imposter scams. Those types of scams
    alone add up to almost $200 million. Ms. Devlin, can you please
    discuss how scams and financial losses can affect veterans and
    their families, and what the VA is doing about it?
        Ms. Devlin. Thank you for the question. We take this very
    seriously, and we have multiple efforts underway to prevent
    fraud from even happening, from even affecting a veteran. But
    it does affect veterans. And so, what I'd like to share with
    you is that we have in the last couple years prevented $9.6
    million from being stolen from veterans' accounts. The bad guys
    are always changing their approaches, and we're always evolving
    to make sure we're one step ahead of them as much as we can.
        So, a lot of what happens is really the redirect, the
    attempt to redirect finances from a veteran's account to
    another account. And those are the--that's the $9.6 million
    that we prevented from happening. And when it does happen, we
    provide one-on-one remediation support.
        So, if a veteran or a service member or family member is
    subject to or victim of fraud, we'll provide remediation
    support one-on-one through our fraud team. And we do extensive
    outreach and communications, even with the latest fraud scheme
    where veterans are getting a message saying they have a VA
    overpayment, and it's not true. And we've sent out
    communications and reached millions of veterans with that
    information.
        Senator Hassan. Well, I appreciate that very much. And you
    mentioned your fraud prevention or your fraud remediation
    teams. One of the things I'd like to continue to do is work
    with you to address this issue and find ways to strengthen our
    support and prevent even more losses. One way we can do that is
    to make sure that the VA's efforts on scam prevention and
    education are fully supported.
        Senator Cornyn and I introduced the bipartisan VSAFE Act,
    which would require that the VA have a scam and fraud evasion
    officer, ensuring that such a position is codified and
    congressionally supported so that there's a specific person in
    office to lead the VA scam profession efforts across
    administrations. And so, I'd love to work with you on that
    legislation, and also, interested on what additional ways you
    think that Congress and the VA can work together to address
    scam--scams and fraud.
        Ms. Devlin. Happy to work with you on that. Absolutely.
        Senator Hassan. Yes. Just for my colleagues' knowledge, if
    they don't know, that the overall cost of these scams now
    economy-wide around the world is over a $1 trillion in losses a
    year. It is now outpacing the illicit drug trade. So, it's just
    something we all got to really take on together. Thanks so
    much.
        Chairman Moran. Senator Hassan, thank you. Senator Boozman
    is recognized.

                           HON. JOHN BOOZMAN,
                       U.S. SENATOR FROM ARKANSAS

        Senator Boozman. Thank you for being here, and we
    appreciate you and Senator Blumenthal for calling the meeting.
    And this is really good stuff that we're discussing.
        I want to start with discussing the Veteran Burial
    Timeliness and Death Certificate Accountability Act. Families
    of veterans have suffered delays in certifying their loved ones
    passing as long as eight weeks. This creates difficulties for
    the families to receive death benefits received with burial
    honors, and forces local government to maintain possession of
    the veteran's body.
        Mr. O'Toole, does VA policy allow a physician assistant to
    certify a death certificate in states that require a physician
    or coroner to certify?
        Dr. O'Toole. Thank you, Senator. And specifically related
    to this bill, I want to note that the VA supports it
    absolutely, although there are some amendments that we would
    recommend.
        The first is that physician assistants who are practicing
    as independent providers in primary care specifically, we feel
    should be included in those clinicians able to sign a death
    certificate, which is standard practice in many states already.
        Our other request is that we go for--instead of 48 hours,
    to two business days, which is our current practice, and also
    reflects the challenges with 95 percent of the deaths occurring
    outside of a VA facility, some of the logistic requirements
    dealing with holidays, weekends, and so forth.
        Senator Boozman. Very good. Can you explain the processes a
    VA physician must go through to sign a death certificate, and
    compare that process for when a veteran passes away outside of
    a VA facility?
        Dr. O'Toole. I can tell you from my own experience.
    Usually, it's a notification by the medical examiner or a
    mortician's office about a death, and then, and requesting the
    certification be completed in a certain time. Obviously, it is
    greatly facilitated if that patient has been seen recently. And
    records are appreciated for natural causes.
        Again, it's a little bit trickier if the patient has not
    been seen recently or the death occurred in a circumstance that
    might not be consistent. And that's pretty usual, whether it's
    within the VA or outside the VA system.
        We recently stood up in office and put out a directive as
    well as training for all of our VA clinicians that's intended
    to clarify and codify those processes internally for us.
        Senator Boozman. Very good. Ms. Devlin, can you speak to
    the importance of death benefits for the families of veterans,
    and the consequences of delaying their delivery?
        Ms. Devlin. Absolutely. We work with many sources of
    information for first notice of death because we want to make
    sure that the survivors receive their benefits in the most
    timely manner. We've reduced our inventory of dependency and
    indemnity compensation claims dramatically working on getting
    those timely benefits to survivors.
        Senator Boozman. Very good. I'm proud to be an original co-
    sponsor of the VSAFE Act of 2025. Veterans are uniquely
    targeted by scammers to exploit their access to benefits. Ms.
    Devlin, can you talk about the legal difficulties in recovery
    from a scam?
        Ms. Devlin. I'm not an expert in legal recovery from scams,
    but I can tell you we take very seriously protecting our
    veterans from fraudsters. We have many efforts underway, and as
    I mentioned earlier, the bad guys are always changing their
    techniques, which means we have to be sharp and continually
    evolving our practices.
        We saved veterans from multiple fraud attempts based on our
    efforts. And I can tell you that identity theft and other types
    of fraud can be very catastrophic for families. Financial loss
    of credit, all sorts of problems can result. And that's why we
    provide one-on-one remediation to our veterans and their
    families if that does happen to them.
        Senator Boozman. What does the VA lack in ability the scam
    and fraud officer could provide?
        Ms. Devlin. I'm sorry, can you repeat the question?
        Senator Boozman. What does the VA lack in ability that a
    scam and fraud officer could provide?
        Ms. Devlin. I think we have the capability now creating a
    fraud officer. We did support the bill. Having that position
    codified in law would strengthen our capabilities just for the
    mere fact of that position being a permanent position. And that
    put, that individual would work with all of the
    administrations, because we have unique situations in VBA, and
    VHA, and NCA that are uniquely different in terms of how fraud
    can affect our veterans that we serve.
        Senator Boozman. Very good. We appreciate it. These not
    little things. There are things that really do affect people a
    great deal, and both with inconvenience, and as you pointed
    out, Ms. Devlin, just the adverse things that can happen as a
    result of the scams. And then, two, not being able to get a
    death certificate in a timely fashion. And we can argue about
    what timely is, but in some cases, it's not timely. We do need
    to correct that because it really does put people in difficult
    situations. So, thank you, Mr. Chairman.
        Chairman Moran. Senator Boozman, thank you. Senator King.

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

        Senator King. Thank you, Mr. Chairman. I wanted to talk a
    bit about S. 926, a bill that Senator Sheehy and I have
    introduced. Senator Gallego and Collins have also joined in
    support.
        It involves falls prevention. I'm sorry, that's next. It
    involves a lockbox for firearms. I don't have to talk to you
    about the grave history of suicides among our veterans. 75
    percent of which involve firearms. I did a calculation; about
    one veteran every two hours takes their own life with a
    firearm. And what we're proposing here is based on a successful
    program in Utah where it's basically a free lockbox for
    veterans that apply. There's no Second Amendment issues, purely
    voluntary. And the research, as I'm sure you know, Doctor, if
    you can lengthen the time between ideation and action, you're
    going to save lives.
        I know that the department has a kind of pilot program and
    they're worried about the cost, but I hate to think that cost
    is going to be the barrier to saving a life. I mean, what's the
    value of one veteran's life saved? So, I hope you'll take a
    closer look at this bill. I don't think it's the--we estimate
    $5 million a year. That would be 33,000 lockboxes, and that's a
    pretty good uptake rate. So, Doctor, your thoughts, and I hope
    I can move you a bit on this.
        Dr. O'Toole. Well, thank you, Senator. And first thank you
    for introducing this bill. And I know we've talked about it
    previously, and this is obviously a priority for the Secretary.
    It's a priority for the VA. Any suicide is one too many. And
    you're absolutely right. Anything that creates some space
    between that impulse and that action, whether it's in securing
    medications or securing firearms, critically important and
    it'll save lives.
        We need to work with you on this. I think our concerns
    about the recommended appropriated amount of $5 million is
    something that I'm hoping we can work through to be able to
    hopefully create some comfort in terms of what is the right
    amount.
        Our efforts to date have been focused on providing
    lockboxes to those veterans identified as having moderate or
    severe risk, and clearly coupling that with the wraparound
    services, and mental health services, and social support
    services that hopefully will help.
        Senator King. And that's a very limited uptake.
        Dr. O'Toole. Absolutely. We need to do more. And I was
    going to add also, we have the gun cables that are more
    generally available. But the technology and the capacities with
    lockboxes is preferable to the cables.
        Senator King. Let's continue our discussion----
        Dr. O'Toole. Yes.
        Senator King [continuing]. Because I think this is, like I
    say, every two hours, a veteran dies by firearm suicide, and we
    ought to be doing whatever we can. And Mr. Chairman, I'd like
    to submit for the record, I think it's communications from 24
    different groups supporting this bill. So, if I can submit that
    for the record.
        Chairman Moran. Without objection.

        [The information referred to appears on pages 137-166 of
    the Appendix.]

        Senator King. The second issue I want to talk about briefly
    is falls. One out of every four people over 65 have a
    debilitating fall. The cost of one fractured hip is between
    $40,000 and $50,000. Falls prevention to me is the low hanging
    fruit of lowering the cost of healthcare. It's an epidemic in
    this country. And Senator Rounds, and I, and Senator Blumenthal
    have a bill that basically puts a focus on this issue within
    the department by creating an Office of Falls Prevention.
        And my philosophy of management is you need somebody in
    charge who's responsible for a particular program, otherwise it
    just falls away. The way I used to put it in business was ``one
    throat to choke.'' And what I'm talking about is somebody who's
    responsible every day when they get up, saying, ``How can we
    prevent falls among veterans?''
        So, again, I think you've been somewhat negative about this
    bill, but seriously, this is something, as I say, it's the low
    hanging fruit of prevention not only a financial cause, but of
    the terrible toll that it takes on our veterans and their
    families.
        Dr. O'Toole. No. And you're absolutely right. I mean, falls
    are a preventable cause of significant morbidity and mortality,
    and we obviously, with our aging veteran population need to
    have that focus.
        Our concern or basis for objection is that much of the work
    is underway. We launched a falls office within the National
    Office of Patient Safety this past year. And we are doing a lot
    of the things that the legislation calls for. And our concern
    is that creating or enacting the legislation, we don't want
    that to be taken from the momentum of what we are currently
    doing. But, again, let me please extend the offer for us to be
    able to work with your office to be able to find some common
    ground to be able to move this forward.
        Senator King. I appreciate that. And it may be just some
    modifications to what you're already doing and sort of beefing
    it up, because again, this is a real opportunity to relieve a
    lot of pain and suffering for our veterans, but also pain and
    suffering for the taxpayers. Thank you. Thank you, Mr.
    Chairman.
        Chairman Moran. Thank you. Senator Slotkin.

                          HON. ELISSA SLOTKIN,
                       U.S. SENATOR FROM MICHIGAN

        Senator Slotkin. Thank you, Chairman. Thanks for having
    this hearing. And you're coming to the end because I'm at the
    end of the dais, so it's almost over. And I appreciate you
    really have had, like, the grab bag of issues. So, it's not
    like a hearing on one issue. Thank you for taking all of our
    particular questions.
        I want to follow-up on an issue I feel very strongly about,
    which is toxic exposure for our veterans, particularly burn
    pits. You know, I was a CIA officer, not a veteran, but lived
    in Iraq for many years of my life. And the burn pit exposure, I
    mean, you didn't have to be a doctor to understand that it's
    pretty crazy to live close to a place where you burn all kinds
    of trash. And we passed the PACT Act, which I think was a
    really important lesson that we weren't going to let the 9/11
    veterans have to fight for 30 years the way that the Agent
    Orange exposure folks in Vietnam had to fight.
        And so, you know, we got a bunch of new veterans into VA
    care who had served in places where we burn our trash. And I
    was proud to play a really small part of that. But the bill
    that I'm interested now is kind of like the next set of--the
    next part of that story which is the Molly R. Loomis Research
    for Descendants of Toxic Exposed Veterans Act. It's basically
    this question that I think is unknown right now is, if you are
    exposed to toxic exposure burn pits and you've served for a
    long time, what, if anything, do you pass on to your kids? And
    I think there's like a--a lot of open questions here about
    that.
        And so, the bill is just basically, can we research that?
    Can we get some data behind that? But I understand the VA is
    against it. Can you walk me through your sort of feeling on the
    bill, but then just what's the next step the VA is looking at
    for toxic exposure, particularly for the 9/11-era veteran?
        Ms. Devlin. Yes. Thank you so much for that question. We
    believe that we have the infrastructure in place. Part of it
    was put in place by the PACT Act to research conditions,
    exposures that we believe have science behind them. And we do
    some preliminary research, and then we determine which ones we
    need to delve into and do the more extensive research.
        We work with the National Academy of Science and Medicine
    and Engineering on these. There's not been a significant
    association shown at this point that shows any descendants
    impact of toxic exposures. We are researching some other
    exposures, and I'm happy to share those with you, but they're
    not----
        Senator Slotkin. But you have some sort of program that's
    been funded by the VA or sponsored by the VA that looks at the
    descendant piece, not other--because certainly, we had a long
    debate in the PACT Act about which conditions would qualify. Do
    we actually have science to link to the toxic exposure, which I
    get, but is there actually a funded project looking at the
    descendant piece, the children?
        Ms. Devlin. It's not specifically looking at descendants.
    We determine, as I mentioned, which exposures, which locations,
    particles, specific items that veterans are exposed to during
    service and determine which ones require further research. As I
    indicated, the last research on toxic exposures for
    descendants, which was in 2018, did not show a significant
    association.
        Senator Slotkin. Well, maybe I'd just like to see it.
    Because we hear this, and again, you know, I understand we need
    the science behind it, but we certainly hear from veterans,
    that era of folks many of them have had children and they feel
    like there's similarities across what they're seeing in their
    own children. So, I just think it's important that we
    understand and have done the work. But I'll look at the 2018
    stuff, but I certainly think the demand signal is there.
        Ms. Devlin. Happy to share it with you.
        Senator Slotkin. Thank you. And then the other issue I just
    wanted to talk about was on this kind of communication when
    veterans leave the VA system and go out on the open market for
    their care. It's something that has been much discussed here.
    We keep hearing that there's problems when someone goes out
    into community care in like their records coming back to the
    VA. That there's this drop off.
        And so, again, there is a bill, a bipartisan bill, the
    Caring for our Veterans Health Act, which would just improve
    information sharing between the VA and these normal providers
    out on the market. Can I get your thoughts on that? Because we
    want them to get the care, but then it shouldn't be up to the
    veteran to have to slog and get the records back to the VA.
        Dr. O'Toole. No, absolutely. And I appreciate you bringing
    it up. It's a concern and a challenge for us. And we, the OIG,
    has investigated, looked at it, identified issues and problems
    as well. Much of the efforts involved are going to be captured
    in the next gen contract with an enhanced role for the TPAs,
    the third-party administrators, in terms of collecting and
    managing those records.
        And our position on this bill is that we are better served
    working through a contractual and business arrangement, rather
    than having to legislate for the outcomes that we're trying to
    achieve. But absolutely, we share your same concerns with this,
    and it's more of a strategy issue.
        Senator Slotkin. Great. Happy to keep talking about it.
    Thank you, Chairman. I yield back.
        Chairman Moran. Senator Slotkin, thank you. I was just
    expressing to Senator Blumenthal that I think he and I, to my
    knowledge, were the first to introduce legislation and it
    became law. It was the Toxic Exposure Research Act of 2015 that
    looked at the consequences to the next generation of toxically
    exposed veterans.
        My awareness of this issue came from the Vietnam Veterans
    of America Forum conference they had in Wichita, Kansas that I
    attended. And it's why I indicated to Senator Murray that I'm
    interested in continuing--she asked similar questions to
    yours--interested in working with you and others to see that
    the answer I was going to ask Ms. Devlin--what I think I heard
    her say, and I think that research was done, according to that
    Toxic Exposure Act of 2015, and the conclusion of that research
    was what?
        Ms. Devlin. So, the conclusion of that research from 2018
    was that there was no significant association between toxic
    exposures in the Asia areas were related to children,
    descendants of those veterans.
        Chairman Moran. What did that research consist of? How was
    that research conducted?
        Ms. Devlin. It was conducted in collaboration with the
    National Academy of Sciences, Engineering, and Medicine. So, we
    can provide the report to you.
        Chairman Moran. I've seen it, but it has been a while.
        Ms. Devlin. Okay. Sorry. It has been a while.
        Chairman Moran. And then, did you also indicate that,
    perhaps as a result of that conclusion, the research
    conclusion, that there is no research currently ongoing at the
    VA related to this topic with the next generation, or their
    veteran parent, or grandparent?
        Ms. Devlin. Not to my awareness, unless Dr. O'Toole is
    familiar. No, not to my awareness. Not on descendants
    specifically.
        Chairman Moran. Senator Slotkin, again, I have an interest
    in this topic, Senator Blumenthal.
        Senator Blumenthal. Just to clarify, are you aware of other
    research outside the VA that's ongoing with respect to this
    issue?
        Ms. Devlin. I'm not aware of any research on descendants.
    Are you, Dr. O'Toole?
        Dr. O'Toole. Yes, I'm not aware, but I will also say I
    haven't been actively tracking. We do track it actively as part
    of the PACT Act of current veterans. But as far as descendants
    go, I don't know. And, you know, 2018 was a while back.
        Chairman Moran. Well, and 10 years ago, what I recall from
    the conference I attended, it was very vivid. It sticks with me
    10 years later about a significant circumstances I heard about
    and saw related to veterans and their next generation. Senator
    Slotkin.
        Senator Slotkin. Yes. I just will say briefly and while
    again we certainly have heard from Vietnam veterans their
    perception that things can be passed on to their kids but would
    just offer, and I'm not a scientist, but Agent Orange exposure
    can't be exactly the same as burn pit exposure. And I just
    think, you know, it at a minimum, if you have a bipartisan
    interest in supporting that kind of research, I think it's sort
    of part of what we owe to folks if there's a possibility that
    it affects their children, I'd be happy to see this Committee
    push it forward.
        Senator Blumenthal. I think that, if I may, Mr. Chairman--
    --
        Chairman Moran. Senator Blumenthal.
        Senator Blumenthal. I think Senator Slotkin is absolutely
    right that this area really cries out for some bipartisan
    action. And I'm struck by the stories that I have heard from
    veterans about children bearing the diseases and afflictions
    that are attributed by medical experts to the exposure to the
    burn pits and other kinds of toxic substances, including in
    this country at Camp Lejeune, parents having children who may
    be affected by the contamination of that water there. So, thank
    you, Mr. Chairman, and thank you Senator Slotkin.
        Chairman Moran. Good. Thank you, Ms. Devlin, and you, Dr.
    O'Toole, for joining us today. And now we dismiss you. It
    sounds like a harsh word. We'll now ask the next panel to
    approach the desk and join us. Thank you.
        Testifying on the second panel is Morgan Brown, the
    National Legislative Director for the Paralyzed Veterans of
    America; Nancy Springer, the Associate Director of the National
    Legislative Service for the Veterans of Foreign Wars; and
    Barton Stichman, the Co-founder and Special Counsel for the
    National Veterans Legal Service Program.
        Thank all three of you for being here. And with that, Mr.
    Brown, I'll recognize you first.

                                PANEL II

                                  ----------

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

        Mr. Brown. Well, thank you, Mr. Chairman, and Ranking
    Member Blumenthal, and Members of the Committee. Paralyzed
    Veterans of America would like to thank you for the opportunity
    to testify on some of the pending legislation impacting VA that
    the community or the Committee is reviewing today.
        Obviously, there are many bills on the docket, so I'm going
    to limit my comments to just three of them that we feel most
    closely impact our members. First, PVA supports the Review
    Every Veteran's Claim Act, which seeks to limit VA's authority
    to deny a veteran's claim solely on the veteran's failure to
    appear for medical examination that's associated with the
    claim.
        Thousands of veterans claim for service-connection, claims
    for increase and for other benefits like total disability,
    individual unemployability, and aid in attendance, have been
    denied solely because of missing an examination. There are many
    legitimate reasons why a veteran may not be able to attend a
    scheduled exam. We are also aware of numerous instances where
    VA contractors erroneously recorded the veteran as a no-show.
        Veterans with SCI/D often encounter multiple barriers in
    travel when compared to other veterans and are apt to miss some
    of these appointments. We believe that passage of this
    legislation will ensure that a missed exam isn't the only basis
    for denying the veteran's claim. VA should also carefully
    consider whether an examination is needed since many veterans
    with SCI/D already received most of their care through the
    department's SCI/D system of care. Therefore, their records
    have adequate information to provide an accurate picture of
    their disabilities.
        We also support the Veterans Appeals Efficiency Act, which
    would establish additional reporting and tracking requirements
    for the Veterans Benefits Administration and the Board of
    Veterans Appeals, such as information on higher level reviews,
    supplemental claims, and notices of disagreement.
        It also requires the tracking of claims pending in the
    national work queue not assigned to an adjudicator, cases that
    are remanded by the Board, Veterans Appeals Improvement and
    Modernization Act cases pending a hearing, and when a decision-
    maker did not comply with the board's decision.
        We recognize the value of and support efforts to track
    meaningful data to improve the effectiveness and accuracy of
    the claims process. However, the data sought by this
    legislation will be meaningless unless the department addresses
    the problems that hinder their ability to obtain proper medical
    opinions since this continues to result in remandable errors.
        This act would also give the board the authority to
    aggregate certain claims. And while PVA does not oppose
    allowing the board to aggregate appeals involving common
    questions of law or fact, we believe that before that can be
    done, a feasibility study should be conducted and the findings
    reviewed, then legislation based on those findings should be
    brought forth.
        And then, finally, in times of fiscal constraint, joint use
    agreements between DoD and VA should be highly prized for their
    ability to increase access to care for service members and
    veterans while reducing overall federal spending.
        Such agreements allow for the sharing of medical personnel,
    facilities, and resources, which can lead to faster access to
    high quality care and improved medical outcomes. They also
    reduce bureaucracy and improve the efficiency of the system.
    DoD and VA have had the authority to execute these types of
    agreements for decades, but have never really used them to
    achieve their full potential.
        PVA supports the SERVE Act, which reinforces some of these
    existing authorities and will improve access to healthcare by
    improving collaboration and increasing the use of these
    agreements between the two departments.
        I thank you again for the opportunity to share our views on
    some of the bills, and I'll be happy to answer any questions
    you may have.

        [The prepared statement of Mr. Brown appears on pages 97-
    105 of the Appendix.]

        Chairman Moran. Mr. Brown, thank you so much. Ms. Springer,
    your testimony please.

       STATEMENT OF NANCY A. SPRINGER, ACTING DIRECTOR, NATIONAL
      LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED
                                 STATES

        Ms. Springer. Good afternoon, Chairman Moran Ranking Member
    Blumenthal, and Members of the Committee. On behalf of the men
    and women of the Veterans of Foreign Wars of the United States
    and its auxiliary, thank you for the opportunity to provide our
    remarks on the legislation pending before this Committee. My
    written testimony includes the VFW's positions on all the bills
    under consideration. This afternoon, I'll highlight three.
        First, the VFW supports S. 1657, Review Every Veteran's
    Claim Act of 2025, legislation we have championed for the last
    few years. This bill would amend Title 38 to ensure that VA may
    not deny a disability claim solely because of veteran missed a
    compensation pension or CMP examination.
        We believe this bill would move VA toward a more flexible
    and veteran-centered claims process as scheduling conflicts do
    arise and veterans should not be penalized when unavailable. We
    understand that veterans miss CMP appointments for many reasons
    such as illness, lack of transportation, work conflicts, or
    just simple misunderstandings. They should not be forced to
    restart their entire claim because of a single missed
    appointment.
        The VFW has assisted many veterans who had to reopen claims
    for this reason alone. Starting a claim from the beginning is
    unnecessarily burdensome and can be mentally exhausting.
    Instead, we recommend that VA return the claim to the work
    queue with a missed medical examination flag so the process can
    resume exactly where it stopped.
        We also recommend that when the evidence already in the
    file clearly establishes both the existence and severity of the
    disability, it would lead to a favorable outcome, VA should
    adjudicate the claim based on that evidence alone. Conversely,
    when the record is insufficient, a CMP examination should
    remain mandatory to ensure a fully informed decision.
        Next, the VFW supports S. 1992, Veterans Appeals Efficiency
    Act of 2025, which would give the Board of Veterans Appeals or
    BVA, and the Court of Appeals for Veterans Claims, additional
    tools to improve the efficiency of the appeals process, reduce
    the backlog of appeals at BVA, and allow appellants to receive
    quicker decisions.
        Specifically, it would allow BVA to aggregate similar
    claims and decide multiple appeals simultaneously. It will
    grant BVA Presidential authority, if feasible, that would
    reduce repetitive litigation and promote greater decisional
    uniformity. It would clarify evidentiary support for an
    advancement on-the-docket request, and the typical timeline for
    a decision. For a Court of Appeals for Veterans Claims, the
    ability to expand the court's ability to certify class actions,
    helping resolve systemic issues that affect many veterans
    similarly at once and would codify the court's authority to
    issue limited remands, which would allow BVA to correct a
    specific error without reopening an entire multi-issue appeal.
    Although limited remands would enhance efficiency, they're
    rarely used because no clear criteria currently exists. This
    legislation would change that.
        Today, many veterans wait up to two years for a BVA
    decision, longer if they request a hearing. With the number of
    pending and projected appeals, BVA cannot likely make
    meaningful progress using its current processes. These tools
    will provide an opportunity to break that paradigm and
    streamline the appeals process.
        Finally, we support the bill's enhanced reporting and data
    tracking requirements. However, we recommend two additions to
    increase accuracy. First, track the impact of natural disasters
    on docket advancement as they can significantly delay case
    movement, and track cases in which an eligible survivor
    requests substitution for deceased claimant for purpose of
    pursuing the claim to completion.
        Lastly, the VFW supports the discussion draft entitled
    Sharing Essential Resources for Veterans Everywhere or SERVE
    Act. Its proposal would strengthen collaboration and resource
    sharing between VA and Department of Defense for DoD to expand
    healthcare access for veterans, especially those who live near
    military medical treatment facilities.
        Allowing veterans, particularly those in rural or
    underserved areas to utilize nearby military hospitals and
    clinics, would reduce travel burdens, shorten wait times, make
    better use of federal medical capacity that might otherwise go
    unused. Increased resource sharing would also promote better
    systems integration between DoD and VA, support cross
    credentialing of staff and facilitate joint training, all of
    which would contribute to better continuity of care, both
    active-duty service members and veterans.
        While successful implementation would require attention to
    funding, staffing, and data integration, this proposal would
    represent a significant opportunity to better leverage existing
    federal healthcare resources for veterans.
        Chairman Moran, Ranking Member Blumenthal, thank you again
    for the opportunity to share the VFWs remarks. I look forward
    to answering your questions.

        [The prepared statement of Ms. Springer appears on pages
    106-117 of the Appendix.]

        Chairman Moran. Thank you very much. Mr. Stichman.

     STATEMENT OF BARTON STICHMAN, CO-FOUNDER AND SPECIAL COUNSEL,
                NATIONAL VETERANS LEGAL SERVICES PROGRAM

        Mr. Stichman. I'd like to thank Chairman Moran, Ranking
    Member Blumenthal, and the Members of this Committee for the
    opportunity for NVLSP to present our views regarding the
    pending legislation before the Committee.
        NVLSP firmly supports, as do my colleagues on this panel,
    the Veterans Appeals Efficiency Act, S. 1992, which contains
    several reforms that would meaningfully improve speed,
    accuracy, and efficiency in the adjudication of benefit claims
    at the VA and at the Veterans Court.
        First, the Veterans Appeals Efficiency Act would restore
    the supplemental jurisdiction the Veterans Court used to have
    in cases in which a veteran denied benefits by the BVA, seek
    certification of his appeal to the Veterans Court as a class
    action. S. 1992 would overrule the recent decision of the
    Federal Circuit in Skaar v. McDonough. The rule announced in
    Skaar bars the large majority of similarly situated veterans
    with pending claims at the BVA or RO from being included in the
    class and counting toward the numerosity requirement of there
    being at least 40 putative class members.
        S. 1992 would require the Veterans Court to use the same
    approach used by all other Article III courts who handle class
    actions, namely counting toward the numerosity requirement
    similarly situated veterans with appeals of pending before the
    BVA or on supplemental claims before the regional offices. This
    would ensure the continued viability of class actions, which
    for years have helped streamline the VA benefit system.
        Second, section 2(e) of S. 1992 would encourage the court
    to exercise its existing authority to issue limited remands.
    Currently, when the Veterans Court encounters a defect that
    requires agency action on one issue in an appeal involving
    multiple issues, the court typically remands the entire case
    back to the BVA for correction of one error without addressing
    any of the other issues. This piecemeal approach adds years to
    the adjudication process and results in substantial delays for
    veterans.
        Although the court possesses the ability to issue limited
    remands while retaining jurisdiction over the rest of the case,
    it rarely does so because its authority is not well-defined,
    and current precedent confines its use to exceptional
    circumstances.
        The Veterans Appeals Efficiency Act codifies the court's
    existing authority to order limited remands and instructs the
    Veterans Court to develop guidelines governing their use,
    including authority to require the BVA to act within a
    specified timeframe so that the case may expeditiously return
    to the court for a final court decision that disposes of the
    entire appeal.
        By directing the court to articulate standards for when and
    how limited remands may be used, this bill will enable all
    participants in the system to understand when limited remands
    are available and the proper process for requesting them. This
    reform turns an underused mechanism into a practical accessible
    means of reducing delay and expediting relief.
        In addition, NVLSP supports section 2(d)(i) of the Veterans
    Appeals Efficiency Act, which aims to reduce the backlog of
    veterans' benefits appeals by confirming the BVA's authority to
    aggregate appeals. While more than 70 other federal agencies
    have rules that facilitate aggregation of administrative
    appeals, the BVA is an outlier and insisting it lacks power
    ever to group together appeals raising the same question of law
    or fact for efficient adjudication.
        The bill would codify the authority of the BVA to aggregate
    claims in appropriate cases after a federally funded research
    and development center does an assessment with VSO input of the
    feasibility of BVA aggravation and Presidential decision-
    making. I'd be happy to answer any questions you may have.
    Thank you.

        [The prepared statement of Mr. Stichman appears on pages
    118-125 of the Appendix.]

        Chairman Moran. Strictly back to my practice of law or law
    school, I'm not sure which, but something sounded familiar in
    your testimony. Senator Blumenthal.
        Senator Blumenthal. I just want to apologize. I have
    another commitment that I have to go to, but I actually think
    this testimony has been very important, and I have really no
    substantive questions. If I think of any, I will pose them in
    writing to you. But I want to thank every one of you for your
    service, and we hopefully, will move forward. Thank you.
        And I thank the Chairman for his courtesy. I also want to
    put in the record, if I may, Mr. Chairman, an analysis from the
    Urban Institute, I believe I referred to it earlier, that
    provides the basis for the number 267,000 veterans that I
    mentioned earlier as the number who would lose their insurance
    if the subsidies are not extended.
        Chairman Moran. There's no objection. It's to be entered.
        Senator Blumenthal. Thank you.

        [The information referred to appears on pages 167-168 of
    the Appendix.]

        Chairman Moran. Senator King. Is it helpful if you go
    before I do?
        Senator King. I'm fine, you go ahead.
        Chairman Moran. Well, now that I've offered, you could
    accept.
        [Laughter.]
        Chairman Moran. Senator King's bill along with Senator
    Banks', S. 1657. And I consider its passage a priority. It
    seems odd to me that it's necessary, and I was wondering if any
    of you have the statistics that demonstrate how often someone
    is denied their opportunity for a claim because of missing a
    physician's appointment? Is it a significant problem, or it's a
    rarity? I'll check with my caseworkers and I'll find out.
        Mr. Brown. Mr. Chairman, I don't think it's a data point
    that we actually track per se. But we are aware from time to
    time talking with our service officers that they're having to
    go back after the fact and attempt to get a--one of our members
    back into the system.
        Chairman Moran. Well, certainly if the VA cannot--I mean,
    encourage the VA to fix the problem itself immediately. In the
    absence of that, or maybe even in with that occurring, I look
    forward to the passage of this piece of legislation.
        I want to ask about the SERVE Act, really, for each of you
    or any of you who have a thought that you'd like to share. From
    your vantage points working directly with service members and
    veterans, where do you see the biggest gap in health services
    during transition from DoD to VA? And do you believe this
    legislation can be a part of the solutions to those problems
    and desire to improve the continuity of care? Mr. Brown, you
    seemed perhaps the most anxious.
        Mr. Brown. So, I was going to say, I was just thinking,
    what would be the greatest area for me. And if you don't mind,
    I'll share like my personal experience.
        Chairman Moran. Please do.
        Mr. Brown. Currently, I'm fortunate that my primary care
    manager for VA is a provider that I saw while I was serving on
    active duty. And I think that one of the bigger advantages in
    terms of transition, if we were to expand access for veterans
    to be seen in the DoD system, certainly being able to see a
    provider that already knows your history so you don't have to
    repeat it would be a clear advantage.
        Chairman Moran. You had heads nodding behind you, so you've
    hit upon a point that apparently needed to be made. And I
    assume that the availability of that opportunity is going to be
    geographic. It depends on where that provider is and where that
    veteran is.
        Mr. Brown. That is quite true, as I just happen to live
    outside of Andrews Air Force Base, and she works at the CBOC on
    Allentown Road. So, most fortunate.
        Chairman Moran. Anyone else? Ms. Springer?
        Ms. Springer. And Mr. Chairman, I would go along with Mr.
    Brown's comments, and I'll use a personal story as well. I
    don't use VA care, I'm a TRICARE beneficiary, but very similar
    in some cases. And I think transitioning from active duty to a
    veteran status, there's a lack of familiarity in the process.
        I use a military clinic on board of Fort Myer, which is
    very close to my house, and that is just like being on active
    duty. I go there. I have a primary care manager, they get me in
    for appointments. If they can't do it, they send me to another
    clinic in the military treatment facility realm, or they send
    me out in town.
        But it's very familiar, and I think that would help
    transitioning service members to keep up with their medical,
    get signed up and go to a place that's familiar, which is a
    military treatment facility.
        Chairman Moran. You know, part of my interest in this
    legislation revolves around Fort Riley, and Irwin Army
    Hospital, and then the VA in Topeka, in particular, but VA
    hospitals in Kansas. And as you described that, I was thinking,
    well, that'd be a rare thing in Kansas because we live so far
    from Fort Riley and the Irwin Army Hospital, for example.
        But that's for a lot of veterans, for a lot of service
    members who retire near the last place they served or the place
    they served and want to retire to. There is a military hospital
    that would be of great benefit that you just described to me.
    So, I appreciate both of those stories. Mr. Stichman, anything
    you want to add?
        Mr. Stichman. No, I have nothing further to add to that.
        Chairman Moran. Thank you. And one more question, and
    that's on the Fisher House, just for my help. I think this is a
    piece of legislation that we will be able to pass and it will
    be coming into law, but I'll be visiting or speaking about it
    with my colleagues, either in person or on the floor of the
    Senate.
        And based upon your members' experiences, how significant
    is the unmet demand for lodging today? And do you believe
    expanding eligibility will improve access to care? Why or why
    not? What role does housing play in access to care, and is it a
    challenge in many places? Ms. Springer, you seem the most
    interested.
        Ms. Springer. I'll take a stab at it, Mr. Chairman. This
    hasn't been brought to my attention as a huge problem. But
    anytime you go get care, you have to think about the logistics,
    and you have to think about where am I going to house my family
    members? How much is it going to cost, and how is that going to
    affect my willingness to go?
        And if there is an unused space in these Fisher Houses,
    which are wonderful institutions, if there's unused space, I
    think that's a very positive thing to do. Rather than have it
    sit empty, have people fill it up, active-duty members and
    families on a space available basis, I think is a very good
    thing. And we support this proposal.
        Chairman Moran. Thank you. And I, again, would use the
    opportunity to thank Fisher House and what great work they do
    across the Nation. Senator King.
        Senator King. I'd like to join you in the thanks to the
    Fisher Foundation for the work they do. It's amazing. On the
    issue of transition, we had a bill before our hearing, I think
    it'll be at our next markup, that would allow active-duty
    service members to pre-enroll in the VA healthcare before they
    transition out so there's no gap. Mr. Brown, do you have any
    views on that idea?
        Mr. Brown. I believe we would support that legislation.
        Senator King. Good. That's what I was hoping you would say.
    Let the record show Mr. Brown, you heard me in my exchange with
    the doctor about falls and we have a bill in to deal with the--
    to try to focus the attention of the VA on falls. Give me your
    thoughts on that, please.
        Mr. Brown. So, PVA supports your legislation. I listened, I
    think you've mentioned it twice now. One out of four veterans
    over the age of 60--was it, or was 65?
        Senator King. 65.
        Mr. Brown. So, I don't meet the second criteria yet, but I
    did meet the first criteria. And I was thinking that, well, you
    got to count me twice, because I've had two major falls that
    have resulted in a significant health issue. One that not only
    incapacitated me for several months, but it also required my
    wife to take off time off work to like get me to my
    appointments, and back and forth extensive physical therapy and
    the like.
        So, I personally understand the value of fall prevention.
    And we know that every major area, service area within VHA,
    certainly has their individual fall prevention programs. It's
    extremely important for veterans with SCI, MS and ALS. But I do
    agree with you that I think that VA would benefit from having
    like that one single point of contact.
        And from the sounds of things from Mr. O'Toole's testimony,
    it sounds like they're already headed in that direction. And
    I'm sure you'll look into that with them and verify that. But
    otherwise, we think that your legislation is appropriate.
        Senator King. Thank you. Any other comments on that? Ms.
    Springer?
        Ms. Springer. Yes. Senator, we would actually propose that
    the existing structures the VA already has be strengthened.
    There are already offices that deal with falls prevention
    instead of--we're not really in favor of creating a separate
    office for that, but instead, take those offices that are
    already doing this and strengthen them. Codify what they're
    doing, and ensure that some kind of discussion about falls is
    at every medical appointment, not just an annual physical, but
    every time that veteran comes in for care. Somebody's asking
    about falls because I agree it's a very significant problem and
    it can lead to other more serious health problems.
        Senator King. We'll look forward to working with Dr.
    O'Toole and the agency to focus how to strengthen, as you say,
    the current structure, and give it a focus that will increase
    the effectiveness.
        Second issue I wanted to talk about was the bill that I
    mentioned, with Senator Sheehy, on safe gun storage. Ms.
    Springer, do you have any thoughts about that issue?
        Ms. Springer. Yes, we support that bill. We are very aware
    of the problem with suicides in our veteran population. And we
    do think that that would help decrease those incidents.
    Anything we can do to separate a person who may be having an
    impulsive thought and lethal means is something that we would
    support. And I think that you can easily roll this out and get
    it up and running. We do support this bill.
        Senator King. Mr. Brown, did you have a comment?
        Mr. Brown. PVA shares the same view.
        Senator King. Thank you. Thank you, Mr. Chairman. Thank you
    for this hearing.
        Chairman Moran. Thank you, Senator King. Let me ask this
    panel. You heard the testimony of the VA, Ms. Devlin, and Dr.
    O'Toole. Anything you heard that you want me to ask them in a
    written question? Is there something that they said or didn't
    say that you'd like me to further explore? Apparently, Dr.
    O'Toole and Ms. Devlin passed the test.
        Okay. I think we are going to conclude the hearing. And I
    want to, again, thank the second panel for their testimony as
    well as the first. And I thank our members of the audience and
    the Members of our Committee for being here today.
        Senators who would like to submit written questions for the
    record to today's witnesses or additional statements have a
    week to do so, and ask our witnesses to respond any questions
    for the record they receive following today's hearing in a
    timely manner.
        Chairman Moran. And we've had conversations this afternoon
    about how we want to have a markup on these bills and move
    forward. And I've asked the staff to try to schedule that as
    expeditiously as we can accomplish. So, we intend to move
    forward.
        Senator King. Is that expeditiously Senate time or real-
    world time?
        Chairman Moran. Well, I can tell you the Senate time has
    something to do with whether or not we will be expeditious.
        Senator King. Yes, sir.
        Chairman Moran. They're related.
        Senator King. I do have one piece of advice for you. If St.
    Peter ever comes to you and says, ``You have 10 minutes to
    live,'' your response would be, ``Could it be during a 10-
    minute Senate vote?''
        [Laughter.]
        Senator King. Because you'll have about an hour.
        Chairman Moran. Well said.
        [Laughter.]
        Chairman Moran. With that, our hearing is adjourned.
        [Whereupon, at 5:30 p.m., the hearing was adjourned.]

                                A P P E N D I X

                                 Hearing Agenda

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                              Prepared Statements

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                           Submissions for the Record

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                           Statements for the Record

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