[Congressional Record Volume 168, Number 128 (Monday, August 1, 2022)]
[Senate]
[Pages S3797-S3799]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                            Democratic Party

  Mrs. BLACKBURN. Madam President, Joe Biden and the Democrats have 
ushered us into what will be remembered as one of the most cynical and 
dangerous periods in our Nation's history. For 18 months, they have 
wreaked havoc on the economy, welcomed drugs and crime into their own 
backyards, and enabled the rise of the new axis of evil, which is my 
term for Russia, China, Iran, and North Korea.
  Last week was really a particularly bad week for the Biden-Harris 
administration, but it was even worse for the people watching it play 
out, sitting at home in their communities. Inflation hit a 41-year 
high, consumer confidence hit a historic low, and we confirmed that the 
American economy is indeed in a recession.
  But rather than taking responsibility, my Democratic friends decided 
they would go on an all-out campaign and redefine the word 
``recession,'' and they insisted that the economic ruin that they have 
rained down on us all is in our imaginations. The economy is in great 
shape, they say. It is better than ever, they say. But Tennesseans 
sitting at their kitchen table, trying to figure out how to make ends 
meet, they know different.
  If ever there were a time to listen to what the American people are 
telling each and every one of us, it is now. Yet here we are facing now 
what is possibly the Democratic Party's most cynical and dangerous move 
to date: a trillion-plus--a trillion-plus-dollar spending spree. It is 
full of tax increases and policies so unpopular that its negotiators 
had to hide its existence from our own colleagues.
  Chuck Schumer and Joe Manchin have dubbed this secret plan--I guess 
is what it was--they have dubbed it the Inflation Reduction Act, which 
immediately brings to mind one simple question: How out of step can you 
possibly be with where the American people are? You are so out of step. 
And do you truly think that the American people are so stupid that they 
think raising taxes is going to bring a reduction in inflation?
  If the situation weren't so dire for people back in Tennessee, I 
would assume this was some sort of joke, but it is not. The American 
people are drowning, and Chuck Schumer and Joe Manchin have thrown them 
a cinder block instead of a life preserver. People cannot believe this. 
They absolutely cannot believe this.
  This bill represents the worst elements of a radical socialist agenda 
that Americans have already rejected: a multihundred-billion-dollar tax 
hike that will kill tens of thousands of jobs, sabotage energy 
producers, and make it even more expensive to heat homes and fill gas 
tanks; a multihundred-billion-dollar payday for climate activists and 
the environmental lobby; innovation-killing price controls on 
prescription drugs; and tax breaks, but only for the wealthiest 
Americans.
  Nothing in this bill will make life easier. Nothing in this bill will 
lower gas prices or reduce inflation. But it is exactly what 
Tennesseans were afraid would happen if Joe Biden and the Democrats 
took control of the Federal Government.
  This week, every Member of this body has a choice to make: Will you 
stand with the American people, or will you make their life harder 
every day because of more spending, more tax increases, and more Green 
New Deal? Will you ease their pain, or will you make their pain worse 
by supporting this bloated, foolish spending spree?
  I hope that my colleagues will come to their senses because this is a 
breaking point between Congress and the American people.
  I cannot tell you how many times I heard that very statement this 
weekend from Tennesseans. They cannot even believe another trillion 
dollars in spending--another trillion. Money does not grow on trees.
  If you, as an individual who has a vote on this bill, if you choose 
to support this bill and tax and spend this country into oblivion, that 
is a road that you are going to have to go down alone because the 
American people cannot afford to go down this road with you.


                            PACT Act of 2022

  Madam President, the Democratic press machine has done a great job 
framing the debate over much needed changes to the PACT Act as an 
attack on our most vulnerable veterans. This framing ignores reality.
  I supported the PACT Act. I voted for final passage last time around. 
I have worked for years on the issue of toxic exposure. I intend to 
vote for the bill again, so do many of my colleagues who have joined me 
in still pushing for critical improvements to this bill.
  Before we vote on final passage this week, I would ask my colleagues 
one question: Why wait to fix the problems we all know will hamper the 
effectiveness of this bill? Why not fix the PACT Act now and ensure 
that veterans actually have access to the care they deserve once this 
bill leaves the President's desk with his signature? That is the real 
choice here.
  Now, I know my Democratic colleagues are on a tight timeline. They 
want this thing done. They want it done before the elections. They want 
this signed. They want to get out there and campaign on this. They want 
us just to move on and not have to fix it until later.

  But it is not my job to make Chuck Schumer's life easier or those 
running for election, to make their lives easier. It is my job to be 
certain that I represent these veterans in Tennessee who have given 
their commitment to defend this Nation. They have done it honorably. 
They have done it expecting care from the VA for harms that have come 
their way. And we should make certain that they have access to the care 
that they need.
  The PACT Act in its current form is not the best that we can do, but 
we can get it there in a few more hours with a few amendments that 
would make sure this bill can help veterans suffering from the effects 
of toxic exposure and help them get the care that they deserve.
  And I want to make it clear that Senator Schumer and Chairman Tester 
know this. The majority of my colleagues who sit with me on the 
Veterans' Affairs Committee support a vote on these amendments, so much 
so that, at one point, we had all agreed to give these amendments a 
vote because we all know that the VA is not capable of implementing 
this bill as it is currently written.
  The VA cannot deliver on the promise that is in this bill. In fact, 
it will do the exact opposite. Right now, the claims backlog at the VA 
sits at 168,000 cases. You heard me right on that--168,000 cases. That 
is the current backlog.
  The PACT Act, as written, will increase that backlog by more than--
get this--1 million cases--1 million. That is not according to me. That 
is according

[[Page S3798]]

to the Biden-nominated, Senate-confirmed VA Secretary Denis McDonough.
  Here is what he told us in testimony delivered to the committee on 
March 29, 2022:

       Estimates from VA's initial technical assistance . . . 
     demonstrated a potential backlog increase to 1.5 . . . 
     million claims by the end of fiscal year . . . 2023.

  Madam President, I ask unanimous consent to have Secretary 
McDonough's testimony printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

              Title II: Toxic Exposure Presumption Process


                                summary

       Title II, called the Fairly Assessing Service-related Toxic 
     Exposure Residuals Presumptions Act, or the FASTER 
     Presumptions Act, would create new provisions in chapter 11 
     of title 38, U.S.C., regarding determinations relating to 
     presumptions of service connection based on toxic exposure.
       The new 38 U.S.C. Sec. 1171 would establish the process by 
     which VA could establish or modify presumptions of service 
     connection based on toxic exposures.
       The new 38 U.S.C. Sec. 1172 would establish a Formal 
     Advisory Committee on Toxic Exposure.
       VA could consult with, and seek the advice of, the 
     Committee with respect to cases in which Veterans are 
     suspected of having experienced a toxic exposure during 
     active service or dependents of such Veterans.
       The Committee would have to assess cases of toxic exposures 
     of Veterans and their dependents by conducting ongoing 
     surveillance and reviewing scientific literature, media 
     reports, information from Veterans and information from 
     Congress. These assessments would cover suspected and known 
     toxic exposures.
       The Committee also would be responsible for periodically 
     assessing the accuracy of the Individual Longitudinal 
     Exposure Record (ILER) and the data collected.
       The Committee could develop a recommendation for formal 
     evaluation under the new 38 U.S.C. Sec. 1173 to conduct a 
     review of the health effects related to an exposure if the 
     Committee determines that the research may change the current 
     understanding of the relationship between an exposure to an 
     environmental hazard and adverse health outcomes in humans. 
     Based upon evidence regarding the periods and locations of 
     exposure covered by an existing presumption, the Committee 
     could nominate for formal evaluation under new 38 U.S.C. 
     Sec. 1173 modifications of the periods and locations for 
     eligibility for benefits.
       The new 38 U.S.C. Sec. 1173 would require VA to establish a 
     process to conduct a formal evaluation for each 
     recommendation of the Committee established under proposed 
     Sec. 1172.
       Under this process, VA would have to conduct research 
     regarding the health effects related to a case of toxic 
     exposure or to evaluate evidence regarding the periods and 
     locations of exposure covered by an existing presumption of 
     service connection.
       Each formal evaluation would have to cover scientific 
     evidence, claims data and other factors as VA determined 
     appropriate.
       The formal evaluations would have to evaluate the 
     likelihood that a positive association existed between an 
     illness and a toxic exposure while serving in active service 
     and assess toxic exposures and illnesses to determine whether 
     the evidence supported a finding of a positive association 
     between the toxic exposure and the illness.
       Not later than 120 days after a formal evaluation is 
     commenced, the element of VA that conducts the evaluation 
     would have to submit to the Secretary a recommendation with 
     respect to establishing a presumption of service connection 
     for the toxic exposure and illness, or modifying an existing 
     presumption of service connection, covered by the evaluation.
       The new 38 U.S.C. Sec. 1174 would require VA to commence 
     issuing regulations if the Secretary determines, based on a 
     recommendation under Sec. 1173, that the presumption or 
     modification is warranted or to notify the public that the 
     presumption or modification is not warranted. If VA removed a 
     presumption, Veterans and other beneficiaries who were 
     receiving benefits based on that presumption would continue 
     to receive such benefits.
       The new 38 U.S.C. Sec. 1175 would allow VA to modify the 
     process under which it conducts formal evaluations under 
     Sec. 1173 and issues regulations under Sec. 1174.
       VA would have to ensure the new evaluations cover the 
     evidence, data and factors required by Sec. 1173(b).
       VA would have to notify Congress and wait 180 days before 
     implementing such changes.
       VA also would have to seek to enter into an agreement with 
     a nongovernmental entity or a Federally funded research and 
     development center to conduct a review of the implementation 
     of this subchapter.
       The new 38 U.S.C. Sec. 1167 would require VA, whenever a 
     law, regulation or Federal court decision established or 
     modified a presumption of service connection, to identify all 
     previously denied claims that were submitted to VA that might 
     have been decided differently had the presumption been in 
     effect at the time of the application.
       VA would have to allow for the re-evaluation of such claims 
     at the election of the Veteran.
       Notwithstanding 38 U.S.C. Sec. 5110, VA would have to 
     provide compensation with respect to claims approved pursuant 
     to such reevaluation based on the date of the submission of 
     the original claim.
       VA also would have to conduct outreach to inform relevant 
     Veterans they may elect to have a claim re-evaluated under 
     this authority.
       This section would apply to presumptions of service-
     connection established or modified on or after the date of 
     enactment.
       Title II also would amend 38 U.S.C. Sec. 1116 to require VA 
     to ensure that any determination made on or after the date of 
     enactment regarding a presumption of service connection based 
     on exposure to an herbicide agent under this section would 
     be made pursuant to the new authorities described 
     previously.
       In addition, title II would require VA to submit to 
     Congress:
       Not less frequently than annually, a publicly available 
     report on recommendations for research and any 
     recommendations for legislative or administrative action from 
     the Committee established under Sec. 1172; VA would have to 
     submit a publicly available report on the findings and 
     opinions of VA with respect to the Committee's report.
       Within 2 years of enactment, a report on the implementation 
     of, and recommendations for, the new Sec. Sec. 1171-1175. On 
     a quarterly basis during the 2-year period beginning on the 
     date of enactment, VA would have to provide to Congress a 
     briefing on the implementation of these provisions.
       Within 540 days of enactment, a report containing the 
     review by the nongovernmental entity or Federally funded 
     research and development center on the implementation of the 
     new Sec. Sec. 1171-1175.


                      impact on care and benefits

       As the President said in the State of the Union earlier 
     this month, VA already is pioneering new ways of linking 
     toxic exposures to diseases, thus helping more Veterans 
     receive their benefits. Based on a focused review of 
     scientific and medical evidence related to exposure to fine 
     particulate matter and the subsequent development of rare 
     respiratory cancers, VA recently announced its intention to 
     initiate rulemaking that would consider adding presumptions 
     of service connection for several rare respiratory cancers 
     for certain Veterans. This announcement follows VA's 
     rulemaking action last year establishing a presumption of 
     service connection for three chronic respiratory conditions, 
     including asthma, rhinitis and sinusitis.
       We appreciate that the bill, as passed, includes changes 
     made in collaboration between VA and the House Committee on 
     Veterans' Affairs. For example, removal of the Science Review 
     Board and Working Group on presumptions of service connection 
     would allow VA to implement an efficient, science-driven 
     process. We are concerned, though, that the creation of a new 
     Committee, particularly one subject to the Federal Advisory 
     Committee Act, would likely slow existing mechanisms for 
     proposing and conducting research.
       Rather than using an advisory committee that would create 
     significant administrative burdens and slow down the 
     presumptive decision-making process, we recommend Congress 
     consider requiring VA to publish in the Federal Register an 
     annual list of conditions the Department plans to evaluate 
     under VA's presumptive decision model, explain why the 
     conditions were chosen for evaluation and seek input from the 
     public on that list. This approach would enable transparency, 
     intentionality and allow for public participation. It also 
     would allow for a timelier decision-making process. We 
     further recommend that Congress establish clear effective 
     dates indicating when the proposed changes would take effect. 
     VA recommends that sufficient time be given to allow it to 
     implement this authority based on a variety of factors, 
     including the regulatory development and public comment 
     process, as well as the significant implementation 
     requirements and dependencies (such as staffing and 
     resources) associated with the bill as a whole.
       We also are concerned that the current bill text is 
     ambiguous, notwithstanding the four ``strength of evidence'' 
     categories listed in proposed Sec. 1173, as to when a 
     presumption is warranted. It remains unclear whether Congress 
     intends for the Secretary to adopt the recommendations from 
     the bill's proposed process as a matter of course. If 
     Congress intends to allow VA to determine the applicable 
     standards for creating a presumption, it would be helpful to 
     make that clear and to provide specific guidelines for when 
     VA must create or modify these presumptions. For example, if 
     the strength of evidence for a particular condition falls in 
     the category of ``equipoise and above,'' it is unclear 
     whether the Secretary would be required to establish a 
     presumption or if the Secretary would have discretion in 
     those instances. If Congress intends any specific, triggering 
     standards governing these determinations, it would be helpful 
     to clarify such standards in the bill. The court orders in 
     the long-standing, complex class action litigation in Nehmer 
     v. U.S. Dep't of Veterans Affairs (Nehmer) were based on a 
     finding that, in creating presumptions based on herbicide 
     agent exposure, VA applied standards inconsistent with 
     Congressional intent. It would be helpful for the Committee 
     to clarify Congressional intent on this point to avoid 
     similar consequences with respect to this bill.

[[Page S3799]]

       The new Sec. 1167 would impose a Nehmer-type effective date 
     mechanism for new presumptions. We want to be clear to the 
     Committee, though, that applying a Nehmer-like retroactive 
     effective date provision in this instance would create a 
     significant exception to the legal structure governing 
     Veterans' benefits. Applying this standard makes it difficult 
     to predict the consequences of this type of effective date 
     provision. VA would be required to apply the provision in 
     this new authority not only to the presumptions created in 
     this bill but also to any future presumptions created by 
     regulation, statute or court order. This requirement would 
     present extraordinary workload challenges to the agency and 
     unprecedented delays in the delivery of benefits to Veterans. 
     For example, every previously denied claim for any of the 
     presumptive conditions identified in or contemplated by this 
     bill (out of the nearly 3.5 million Gulf War-deployed 
     Veterans) would now be subject to a retroactive effective 
     date as far back as 1991 for Gulf War I Veterans and 2001 for 
     Global War on Terrorism Veterans.
       We would welcome the opportunity to work with Congress to 
     ensure that new authorities in this area support our ongoing 
     work to help us make informed decisions as quickly as 
     possible.


                          costs and resources

       VA is concerned that an extremely large and unprecedented 
     disability claims backlog would be created if the Nehmer-like 
     provisions in this bill are retained. Based on VA's previous 
     experience in implementing similar retroactive effective date 
     provisions, we understand this provision would result in 
     complex and time-intensive claims processing procedures. In 
     this case, claims processors would be required to review 20 
     to 30 years of evidence for a single issue. Considering that 
     more than 1.9 million Gulf War-era deployed Veterans have 
     filed disability claims in the past 30 years (over 900,000 of 
     whom filed claims for respiratory issues), VA is very 
     concerned about the impact of this provision. VA claims 
     processors would be required to re-adjudicate hundreds of 
     thousands of previously denied claims for earlier effective 
     dates. Estimates from VA's initial technical assistance, 
     without this provision, demonstrated a potential backlog 
     increase to 1.5 and 1.8 million claims by the end of fiscal 
     year (FY) 2023. Any further application of retroactive 
     presumptions would drive further benefit delivery delays for 
     all Veterans.


                                research

       Title II would establish a new Committee and institute new 
     processes related to the identification of and support for 
     research related to toxic exposures. As noted previously, we 
     are concerned some of the specific provisions in this title 
     would prove more onerous and less nimble than our current 
     approach.

  Mrs. BLACKBURN. Now, the reason I have paid so much attention to this 
backlog is because every single week the team that works with me in 
Tennessee handling these issues with our VSOs--our veterans service 
officers--keeps track of what we hear from the veterans.
  Right now in Tennessee, I have veterans telling me they are waiting 
almost 100 days for a primary care appointment at the VA. Now, for many 
vets, this is just step 1. So once they contact the VA, it is 100 days. 
Think about that: 100 days before they get that primary care 
appointment, and that is if the appointment doesn't get canceled or it 
has to be rescheduled. So that is an average to get to step 1--first 
step.
  Across Tennessee, veterans are waiting yet another 39 days to get 
mental healthcare. Now, if they are needing dental appointments, dental 
surgery, or dental care, that is 44 days. If they go for that primary 
care appointment and they need to go see a cardiologist, that is 33 
days; 28 days to see a gynecologist; 30 days to go talk to someone 
about chronic pain.
  Look at what is happening. The VA cannot meet the load in front of 
them. Our veterans--our veterans who have defended our Nation's 
freedom--cannot get the care they need in a timely manner.
  Now, we have done a lot of work over the years to help the VA help 
itself. We have given them support for hiring. We have given them 
support for retention. But, Madam President, it takes 90 days for this 
Agency, the VA, to hire one person--90 days. And think of the number of 
caseworkers they would have to hire to implement this. Throwing money 
at the problem isn't going to make these wait times and backlogs 
disappear.
  It is imperative that we fix the PACT Act so it is not a false 
promise, so it is not false hope. If the PACT Act is going to work for 
our veterans, then the VA needs to embrace community care.
  I proposed an amendment to the bill that would have eliminated 
arbitrary bureaucratic hurdles for toxic-exposed veterans who will 
inevitably face these long wait times. It would allow them to seek care 
in the community right there where they live if they could get it 
faster than they could from the VA.
  I offered this amendment based on my conversations with Tennessee 
veterans who are chronically ill but cannot get in to the VA to see a 
doctor and get that primary care appointment so they can move on to 
specialty care. Many of them are deteriorating at an alarming rate, and 
they deserve access to care as soon as they can get it. The only way 
that access to care for them is going to happen is if we allow them 
community care. They have fought for this country. They deserve to have 
access to that care, but right now, they cannot get it.
  Madam President, I know you more than most understand how imperative 
it is for veterans to have access to the care they need, that this 
government make good on its promise to our veterans, that we stop these 
long wait times, that we stop the delays, and that we allow them that 
access that they have earned and that they deserve.
  There is a way to fix this bill. I know there are some who say: Well, 
we are afraid this will privatize the VA. That is their fear, and I 
understand that. But at some point, veterans want us to take that 
action to put them first--not the bureaucracy first, put the veterans 
first--allow the veterans to make that choice if they cannot get to the 
VA in a timely manner. If the VA can't get them in for an appointment, 
let's open this up and let the veterans out into community care so 
their needs can be met in a timely manner.
  A promise in a piece of legislation ought not to end up as a false 
hope when it comes to our Nation's veterans. The best way we can 
fulfill our promise to toxic-exposed veterans is to give this bill the 
time it needs for an amendment that will allow our veterans to access 
the care they need without having to wait on the VA to figure out how 
to implement this bill.
  Surely, surely, we can do this. Let's have a vote on these amendments 
and fix this bill before it is signed into law.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The senior assistant legislative clerk proceeded to call the roll.
  Mr. SULLIVAN. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.