    [Senate Report 119-2]
    [From the U.S. Government Publishing Office]

     119th Congress}                                          { Report
                                     SENATE
      1st Session }                                           { 119-2

    ======================================================================

                LEGISLATIVE AND OVERSIGHT ACTIVITIES DURING THE
                 118TH CONGRESS BY THE SENATE COMMITTEE ON
                              VETERANS' AFFAIRS

                                    _______

                     March 12, 2025.--Ordered to be printed

                                    _______

              Mr. Moran, from the Committee on Veterans' Affairs,
                            submitted the following

                                  R E P O R T

        Pursuant to paragraph 8 of rule XXVI of the Standing Rules
    of the Senate, the Committee on Veterans' Affairs (hereinafter,
    ``Committee'') submits its report on legislative and oversight
    activities during the 118th Congress.

                            I. HEARINGS AND MEETINGS

    A. First Session (2023)

        During the First Session of the 118th Congress, the
    Committee held 20 hearings. At those hearings, there were 115
    witness appearances.
        Two hearings (April 26 and July 12) focused exclusively on
    legislation pending before the Committee. Testimony offered at
    these hearings covered 33 bills.
        The Committee held three business meetings, including two
    meetings to discharge nominations.
        On February 16, nine measures were favorably reported out
    of Committee.
        The Committee held three joint hearings with the House
    Committee on Veterans' Affairs in order to receive legislative
    presentations from veterans service organizations. These
    hearings were held on February 28, March 1, and March 8.
        The Committee held one joint hearing with the Senate Armed
    Services Committee to examine the military to civilian
    transition. This hearing was held on October 18.

    B. Second Session (2024)

        During the Second Session of the 118th Congress, the
    Committee held 11 hearings, including one field hearing. At
    those hearings, there were 84 witness appearances.
        The Committee held one business meeting.
        On May 1, one measure was favorably reported out of
    Committee.
        The Committee held three joint hearings with the House
    Committee on Veterans' Affairs in order to receive legislative
    presentations from veterans service organizations. These
    hearings were held on March 6, March 7, and March 13.
        The Committee held one joint hearing with the Senate
    Special Committee on Aging to examine services for veterans and
    their caregivers. This hearing was held on June 5.

    C. List of Hearings and Meetings Held in the 118th Congress

        (1) Thursday, February 16, 2023
        Business Meeting: Meeting to Consider Legislation Pending
    before the Committee
               S. 10, VA Clinician Appreciation,
            Recruitment, Education, Expansion, and Retention
            Support Act of 2023 (Committee Print)
               S. 30, Fiscal Year 2023 Veterans Affairs
            Major Medical Facility Authorization Act (Committee
            Print)
               S. 106, Commitment to Veteran Support and
            Outreach Act (Committee Print)
               S. 112, A bill to amend title 38, United
            States Code, to strengthen benefits for children of
            Vietnam veterans born with spina bifida, and for other
            purposes.
               S. 132, Daniel J. Harvey Jr. and Adam
            Lambert Improving Servicemember Transition to Reduce
            Veteran Suicide Act (Committee Print)
               S. 141, Elizabeth Dole Home Care Act
            (Committee Print)
               S. 185, Native American Direct Loan
            Improvement Act of 2023
               S. 216, RESPECT Act of 2023
               S. 326, VA Medicinal Cannabis Research Act
            of 2023
        (2) Thursday, February 16, 2023
        Nomination Hearing: Pending Nomination of Joshua D. Jacobs,
    of Washington, to be Under Secretary for Benefits of the
    Department of Veterans Affairs
        (3) Tuesday, February 28, 2023
        Joint Hearing with the House of Representatives to Receive
    the Legislative Presentation of Disabled American Veterans
        (4) Wednesday, March 1, 2023
        Joint Hearing with the House of Representatives to Receive
    the Legislative Presentation of Multiple Veterans Service
    Organizations (The American Legion, Paralyzed Veterans of
    America, Student Veterans of America, Iraq and Afghanistan
    Veterans of America, National Association of State Directors of
    Veterans Affairs, Black Veterans Empowerment Council, Vietnam
    Veterans of America, Fleet Reserve Association, National
    Congress of American Indians, National Guard Association of the
    United States)
        (5) Wednesday, March 8, 2023
        Joint Hearing with the House of Representatives to Receive
    the Legislative Presentation of Multiple Veterans Service
    Organizations (Veterans of Foreign Wars of the United States,
    Jewish War Veterans of the U.S.A., Wounded Warrior Project,
    Tragedy Assistance Program for Survivors, Military Officers
    Association of America, American Veterans, Gold Star Wives of
    America, Inc., Military Order of the Purple Heart, Blinded
    Veterans Association, National Association of County Veterans
    Service Officers)
        (6) Wednesday, March 8, 2023
        Business Meeting: Meeting to Consider Pending Nomination of
    Joshua D. Jacobs, of Washington, to be Under Secretary for
    Benefits of the Department of Veterans Affairs
        (7) Wednesday, March 15, 2023
        Hearing: Examining the Future Path of VA's Electronic
    Health Record Modernization Program
        (8) Wednesday, March 22, 2023
        Hearing: Strengthening Methods of Recruitment and Retention
    for VA's Workforce
        (9) Wednesday, April 19, 2023
        Hearing: Veterans Consumer Protection: Preventing Financial
    Exploitation of Veterans and Their Benefits
        (10) Wednesday, April 26, 2023
        Legislative Hearing: Pending Legislation

               S. 280, BEST for Vets Act of 2023
               S. 291, A bill to amend title 38, United
            States Code, to establish in the Department the
            Veterans Economic Opportunity and Transition
            Administration, and for other purposes
               S. 350, Fry Scholarship Enhancement Act of
            2023
               S. 414, Caring for Survivors Act of 2023
               S. 498, Veteran Education Empowerment Act
               S. 572, Ensuring Access to VA INFO Act
               S. 656, Veteran Improvement Commercial
            Driver License Act of 2023
               S. 740, GUARD VA Benefits Act of 2023
               S. 774, Veterans Border Patrol Training Act
               S. 897, Expedited Veteran Appeals Act of
            2023
               S. 1090, A bill to direct the Secretary of
            Veterans Affairs to update the payment system of the
            Department to allow for electronic fund transfer of
            educational assistance to a foreign institution of
            higher education
               S. 1266, Love Lives On Act of 2023
               S. 1309, Student Veterans Transparency and
            Protection Act of 2023
               S. 1875, Veterans Second Amendment
            Protection Act of 2023

        (11) Wednesday, May 17, 2023
        Hearing: Review of the Fiscal Year 2024 Budget and 2025
    Advance Appropriations Requests for the Department of Veterans
    Affairs
        (12) Wednesday, May 31, 2023
        Nomination Hearing: Pending Nomination of Tanya J.
    Bradsher, of Virginia, To Be Deputy Secretary of Veterans
    Affairs
        (13) Wednesday, June 7, 2023
        Hearing: An Abiding Commitment to Those Who Served:
    Examining Veterans' Access to Long Term Care
        (14) Wednesday, June 14, 2023
        Hearing: Connections to Care: Improving Substance Use
    Disorder Care for Veterans in Rural America and Beyond
        (15) Wednesday, June 21, 2023
        Hearing: Examining the Effectiveness of the Office of
    Integrated Veteran Care
        (16) Wednesday, July 12, 2023
        Legislative Hearing: Pending Legislation

               S. 449, Veterans Patient Advocacy Act
               S. 495, Expanding Veterans' Options for Long
            Term Care Act
               S. 853, VA Zero Suicide Demonstration
            Project Act of 2023
               S. 928, Not Just a Number Act
               S. 1037, Department of Veterans Affairs EHRM
            Standardization and Accountability Act
               S. 1040, A bill to amend title 38, United
            States Code, to prohibit smoking on the premises of any
            facility of the Veterans Health Administration, and for
            other purposes.
               S. 1125, EHR Program RESET Act of 2023
               S. 1172, Removing Extraneous Loopholes
            Insuring Every Veteran Emergency (RELIEVE) Act
               S. 1315, Veterans' Health Empowerment,
            Access, Leadership, and Transparency for Our Heroes
            (HEALTH) Act of 2023
               S. 1436, Critical Health Access Resource and
            Grant Extensions (CHARGE) Act of 2023
               S. 1545, Veterans Health Care Freedom Act
               S. 1612, Reimburse Veterans for Domiciliary
            Care Act
               S. 1828, Veterans Homecare Choice Act of
            2023
               S. 1951, Department of Veterans Affairs
            Income Eligibility Standardization Act
               S. 1954, Improving Whole Health for Veterans
            With Chronic Conditions Act
               S. 2067, A bill to require the Secretary of
            Veterans Affairs to award grants to nonprofit
            organizations to assist such organizations in carrying
            out programs to provide service dogs to eligible
            veterans, and for other purposes.
               S. 2259, Leveraging Integrated Networks in
            Communities for Veterans Act
               S. 2263, Rural Vital Emergency
            Transportation Services (VETS) Act
               S. 2649, Making Community Care Work for
            Veterans Act of 2023

        (17) Thursday, July 13, 2023
        Business Meeting: Meeting to Consider Pending Nomination of
    Tanya J. Bradsher, of Virginia, To Be Deputy Secretary of
    Veterans Affairs
        (18) Wednesday, July 26, 2023
        Hearing: Implementing the PACT Act: One Year Later
        (19) Wednesday, September 20, 2023
        Hearing: Invisible Wounds of War: Improving Mental Health
    and Suicide Prevention Measures for Our Nation's Veterans
        (20) Wednesday, October 18, 2023
        Joint Hearing With the Senate Armed Services Committee:
    Military to Civilian Transition: Ensuring Success After Service
        (21) Wednesday, October 25, 2023
        Hearing: VA Accountability and Transparency: A Cornerstone
    of Quality Care and Benefits for Veterans
        (22) Wednesday, November 1, 2023
        Hearing: Foundation of Care: Examining Research at the
    Department of Veterans Affairs
        (23) Wednesday, November 15, 2023
        Hearing: VA's Fourth Mission: Supporting Our Nation's
    Emergency Preparedness and Response
        (24) Friday, January 26, 2024
        Field Hearing, Augusta, Maine: The State of Veterans' Long-
    Term Care in Maine
        (25) Wednesday, January 31, 2024
        Hearing: Vet Centers: Supporting the Mental Health Needs of
    Servicemembers, Veterans and Their Families
        (26) Wednesday, February 28, 2024
        Hearing: Sacred Mission: Honoring America's Veterans and
    Their Families at VA Cemeteries
        (27) Wednesday, March 6, 2024
        Joint Hearing with the House of Representatives To Receive
    the Legislative Presentation of Multiple Veterans Service
    Organizations (Veterans of Foreign Wars of the United States,
    Paralyzed Veterans of America, Wounded Warrior Project,
    National Association of State Directors of Veterans Affairs,
    Mission Roll Call, Blue Star Families, Iraq and Afghanistan
    Veterans of America, Blinded Veterans Association, Service
    Women's Action Network, Student Veterans of America, American
    Veterans)
        (28) Thursday, March 7, 2024
        Joint Hearing With the House of Representatives To Receive
    the Legislative Presentation of Disabled American Veterans
        (29) Wednesday, March 13, 2024
        Joint Hearing With the House of Representatives To Receive
    the Legislative Presentation of Multiple Veterans Service
    Organizations (The American Legion, Jewish War Veterans of the
    U.S.A., Tragedy Assistance Program for Survivors, National
    Coalition for Homeless Veterans, Military Officers Association
    of America, National Association of County Veterans Service
    Officers, National Congress of American Indians, Vietnam
    Veterans of America, National Guard Association of the United
    States, Fleet Reserve Association)
        (30) Wednesday, April 10, 2024
        Hearing: Caring for All Who Have Borne the Battle: Ensuring
    Equity for Women Veterans at VA
        (31) Wednesday, May 1, 2024
        Hearing: Review of the Fiscal Year 2025 Budget and 2026
    Advance Appropriations Requests for the Department of Veterans
    Affairs
        (32) Wednesday, May 1, 2024
        Business Meeting: Meeting To Consider Major Medical Lease
    Committee Resolution

               PSC-01-VA24: Charleston, SC, Research Lease;
               PTX-02-VA24: Conroe, TX, Community Living
            Center Lease;
               PTX-03-VA24: Conroe, TX, Outpatient Clinic
            Lease;
               PPA-04-VA24: Cumberland County, PA, Hospital
            Lease;
               PFL-05-VA24: Gainesville, FL, Consolidated
            Outpatient Clinic, Residential Rehabilitation Treatment
            Program, and Research Lease;
               PTX-06-VA24: Katy, TX, Community Living
            Center Lease;
               PTX-07-VA24: Katy, TX, Outpatient Clinic
            Lease;
               PFL-08-VA24: Port Saint Lucie, FL,
            Outpatient Clinic Lease;
               PNJ-09-VA24: Southern New Jersey, NJ,
            Hospital Lease; and
               PDE-10-VA24: Sussex County, DE, Hospital
            Lease

        (32) Wednesday, May 15, 2024
        Hearing: Frontier Health Care: Ensuring Veterans' Access No
    Matter Where They Live
        (33) Wednesday, June 5, 2024
        Joint Hearing With the Senate Special Committee on Aging:
    Heroes at Home: Improving Services for Veterans and Their
    Caregivers
        (34) Wednesday, September 18, 2024
        Hearing: Providing for Veterans: Addressing Current and
    Future VA Budget Challenges

                                II. LEGISLATION

    A. First Session (2023)

        During the First Session, the Committee met in open session
    on February 16, 2023, and ordered favorably reported nine
    pieces of legislation to the full Senate.

               S. 10, VA Clinician Appreciation,
            Recruitment, Education, Expansion, and Retention
            Support (CAREERS) Act of 2023 was ordered favorably
            reported with an amendment in the nature of a
            substitute by the Committee on February 16, 2023.
               S. 30, Fiscal Year 2023 Veterans Affairs
            Major Medical Facility Authorization Act passed the
            Senate on March 21, 2023, with an amendment, by
            unanimous consent. It was signed into law as Public Law
            118-8 on July 18, 2023.
               S. 106, Commitment to Veteran Support and
            Outreach Act passed the Senate on November 16, 2023,
            with an amendment, by unanimous consent on November 16,
            2023.
               S. 112, a bill to amend title 38, United
            States Code, to strengthen benefits for children of
            Vietnam veterans born with spina bifida, and for other
            purposes passed the Senate on July 13, 2023, without
            amendment, by unanimous consent. It was signed into law
            as Public Law 118-18 on October 6, 2023.
               S. 132, Daniel J. Harvey Jr. and Adam
            Lambert Improving Servicemember Transition to Reduce
            Veteran Suicide Act was ordered favorably reported,
            with an amendment in the nature of a substitute, by the
            Committee on February 16, 2023.
               S. 141, Elizabeth Dole Home Care Act was
            ordered favorably reported, with an amendment in the
            nature of a substitute, by the Committee on February
            16, 2023. It was signed into law as Public Law 118-210
            on January 2, 2025.
               S. 185, Native American Direct Loan
            Improvement Act of 2023 was ordered favorably reported,
            without amendment, by the Committee on February 16,
            2023.
               S. 216, RESPECT Act of 2023 was ordered
            favorably reported, without amendment, by the Committee
            on February 16, 2023.
               S. 326, VA Medicinal Cannabis Research Act
            of 2023, was reported, without amendment, by Senator
            Tester on March 23, 2023. A motion to proceed to
            consideration of S. 326 was made on April 20, 2023. On
            April 26, 2023, cloture was not invoked by a vote of
            57-42.

        During the First Session, the Committee discharged numerous
    bills by unanimous consent, as follows:
               S. 777, the Veterans' COLA Act of 2023, was
            discharged by the Committee on March 30, 2023, by
            unanimous consent, and passed the Senate on the same
            day without amendment, by unanimous consent. It was
            signed into law as Public Law 118-6 on June 14, 2023.
               S. 475, a bill to designate the clinic of
            the Department of Veterans Affairs in Gallup, New
            Mexico, as the Hiroshi ``Hershey'' Miyamura VA Clinic,
            was discharged by the Committee on July 13, 2023, by
            unanimous consent, and passed the Senate on the same
            day without amendment, by unanimous consent. It was
            signed into law as Public Law 118-16 on October 2,
            2023.
               S. 1096, Department of Veterans Affairs
            Office of Inspector General Training Act of 2023, was
            discharged by the Committee on July 13, 2023, by
            unanimous consent, and passed the Senate on the same
            day with an amendment, by unanimous consent.
               H.R. 3672, to designate the clinic of the
            Department of Veterans Affairs in Indian River,
            Michigan, as the ``Pfc. Justin T. Paton Department of
            Veterans Affairs Clinic'', was discharged by the
            Committee on July 13, 2023, by unanimous consent, and
            passed the Senate on the same day without amendment, by
            unanimous consent. It was signed into law as Public Law
            118-12 on July 28, 2023.
               S. 2854, A bill to require the Secretary of
            Veterans Affairs to enter into an agreement with the
            city of Fargo, North Dakota, for the conveyance of
            certain land of the Department of Veterans Affairs at
            Fargo National Cemetery, and for other purposes, was
            discharged by the Committee on October 19, 2023, by
            unanimous consent, and passed the Senate on the same
            day without amendment, by unanimous consent.
               H.R. 366, Korean American Valor Act, was
            discharged by the Committee on October 19, 2023, by
            unanimous consent, and passed the Senate on the same
            day without amendment, by unanimous consent. It was
            signed into law as Public Law 118-20 on November 13,
            2023.
               H.R. 1226, the Wounded Warrior Access Act,
            was discharged by the Committee on November 2, 2023, by
            unanimous consent, and passed the Senate on the same
            day without amendment, by unanimous consent. It was
            signed into law as Public Law 118-21 on November 13,
            2023.
               S. 656, the Veteran Improvement Commercial
            Driver License Act of 2023, was discharged by the
            Committee on November 2, 2023, by unanimous consent. It
            was signed into law as Public Law 118-95 on October 1,
            2024.

        During the First Session, the Committee also incorporated
    provisions within the Committee's jurisdiction into broader
    legislation.

    B. Second Session (2024)

        During the Second Session, the Committee met in open
    session on May 1, 2024, and ordered favorably reported a major
    medical facility lease resolution to the full Senate.
        During the Second Session, the Committee discharged
    numerous bills by unanimous consent, as follows:
               S. 2181, Keeping Military Families Together
            Act of 2023, was discharged by the Committee on May 1,
            2024, by unanimous consent, and passed the Senate on
            the same day without amendment, by unanimous consent.
            It was signed into law as Public Law 118-271 on January
            4, 2025.
               S. 3126, Mark Our Place Act, was discharged
            by the Committee on May 1, 2024, by unanimous consent,
            and passed the Senate on the same day without
            amendment, by unanimous consent. It was signed into law
            as Public Law 118-134 on November 25, 2024.
               H.R. 593, To rename the Department of
            Veterans Affairs community-based outpatient clinic in
            Hinesville, Georgia, as the ``John Gibson, Dan James,
            William Sapp, and Frankie Smiley VA Clinic'', was
            discharged by the Committee on May 2, 2024, by
            unanimous consent, and passed the Senate on the same
            day without amendment, by unanimous consent. It was
            signed into law as Public Law 118-61 on May 13, 2024.
               S. 3249, A bill to designate the outpatient
            clinic of the Department of Veterans Affairs in
            Wyandotte County, Kansas City, Kansas, as the ``Captain
            Elwin Shopteese VA Clinic'', was discharged by the
            Committee on May 2, 2024, by unanimous consent, and
            passed the Senate on the same day without amendment, by
            unanimous consent. It was signed into law as Public Law
            118-75 on July 30, 2024.
               S. 3285, A bill to rename the community-
            based outpatient clinic of the Department of Veterans
            Affairs in Butte, Montana, as the ``Charlie Dowd VA
            Clinic'', was discharged by the Committee on May 2,
            2024, by unanimous consent, and passed the Senate on
            the same day without amendment, by unanimous consent.
            It was signed into law as Public Law 118-76 on July 30,
            2024.
               S. 3938, A bill to designate the community-
            based outpatient clinic of the Department of Veterans
            Affairs in Lynchburg, Virginia, as the ``Private First
            Class Desmond T. Doss VA Clinic'', was discharged by
            the Committee on August 1, 2024, by unanimous consent,
            and passed the Senate on the same day without
            amendment, by unanimous consent. It was signed into law
            as Public Law 118-200 on December 23, 2024.
               H.R. 7333, To name the Department of
            Veterans Affairs medical center in West Palm Beach,
            Florida, as the ``Thomas H. Corey VA Medical Center','
            was discharged from Committee by unanimous consent on
            November 13, 2024, and passed the Senate the same day
            without amendment, by unanimous consent. It was signed
            into law on November 25, 2024, as Public Law 118-128.
               S. 3746, the Gold Star and Surviving Spouse
            Career Services Act, was discharged by the Committee on
            December 2, 2024, by unanimous consent, and passed the
            Senate the same day without amendment, by unanimous
            consent.
               S. 141, the Senator Elizabeth Dole 21st
            Century Veterans Healthcare and Benefits Improvement
            Act, was discharged by the Committee on December 12,
            2024, by unanimous consent, and passed the Senate the
            same day with an amendment, by unanimous consent. It
            was signed into law as Public Law 118-210 on January 2,
            2025.
               S. 1299, the Fairness for Servicemembers and
            their Families Act of 2024, was discharged by the
            Committee on December 17, 2024, by unanimous consent,
            and passed the Senate the same day with an amendment,
            by unanimous consent.
               H.R. 9124, To name the Department of
            Veterans Affairs community-based outpatient clinic in
            Auburn, California, as the ``Louis A. Conter VA
            Clinic'', was discharged by the Committee on December
            21, 2024, by unanimous consent, and passed the Senate
            the same day without amendment, by unanimous consent.
            It was signed into law as Public Law 118-259 on January
            4, 2025.
               H.R. 8667, To rename the community-based
            outpatient clinic of the Department of Veterans Affairs
            in Cadillac, Michigan, as the ``Duane E. Dewey VA
            Clinic'', was discharged by the Committee on December
            21, 2024, by unanimous consent, and passed the Senate
            the same day without amendment, by unanimous consent.
            It was signed into law as Public Law 118-251 on January
            4, 2025.
               H.R. 4955, To name the community-based
            outpatient clinic of the Department of Veterans Affairs
            in Monroeville, Pennsylvania, as the ``Henry Parham VA
            Clinic'', was discharged by the Committee on December
            21, 2024, by unanimous consent, and passed the Senate
            the same day without amendment, by unanimous consent.
            It was signed into law as Public Law 118-215 on January
            2, 2025.
               H.R. 4136, U.S. Congressman Sam Johnson
            Memorial VA Clinic Act, was discharged by the Committee
            on December 21, 2024, by unanimous consent, and passed
            the Senate the same day without amendment, by unanimous
            consent. It was signed into law as Public Law 118-214
            on January 2, 2025.
               S. 2513, the Veterans Benefits Improvement
            Act of 2024, was discharged by the Committee on
            December 12, 2024, by unanimous consent, and passed the
            Senate the same day with an amendment, by unanimous
            consent. It was signed into law as Public Law 118-196
            on December 23, 2024.

        During the Second Session, the Committee also incorporated
    provisions within the Committee's jurisdiction into broader
    legislation.

    C. Public Laws

                Senate Vehicle
        S. 30, Fiscal Year 2023 Veterans Affairs Major Medical
    Facility Authorization Act, is Public Law 118-8.
        S. 112, A bill to amend title 38, United States Code, to
    strengthen benefits for children of Vietnam veterans born with
    spina bifida, and for other purposes, is Public Law 118-18.
        S. 141, Senator Elizabeth Dole 21st Century Veterans
    Healthcare and Benefits Improvement Act, is Public Law 118-210.
        S. 475, A bill to designate the clinic of the Department of
    Veterans Affairs in Gallup, New Mexico, as the Hiroshi
    ``Hershey'' Miyamura VA Clinic, is Public Law 118-16.
        S. 656, Veteran Improvement Commercial Driver License Act
    of 2023, is Public Law 118-95.
        S. 777, Veterans' COLA Act of 2023, is Public Law 118-6.
        S. 2181, Keeping Military Families Together Act of 2023, is
    Public Law 118-271.
        S. 2513, the Veterans Benefits Improvement Act of 2024, is
    Public Law 118-196.
        S. 3126, Mark Our Place Act, is Public Law 118-134.
        S. 3249, A bill to designate the outpatient clinic of the
    Department of Veterans Affairs in Wyandotte County, Kansas
    City, Kansas, as the ``Captain Elwin Shopteese VA Clinic'', is
    Public Law 118-75.
        S. 3285, Abill to rename the community-based outpatient
    clinic of the Department of Veterans Affairs in Butte, Montana,
    as the ``Charlie Dowd VA Clinic'', is Public Law 118-76.
        S. 3938, A bill to designate the community-based outpatient
    clinic of the Department of Veterans Affairs in Lynchburg,
    Virginia, as the ``Private First Class Desmond T. Doss VA
    Clinic'', is Public Law 118-200.
                House Vehicle
        H.R. 366, Korean American VALOR Act, is Public Law 118-20.
        H.R. 593, To rename the Department of Veterans Affairs
    community-based outpatient clinic in Hinesville, Georgia, as
    the ``John Gibson, Dan James, William Sapp, and Frankie Smiley
    VA Clinic'', is Public Law 118-61.
        H.R. 1226, Wounded Warrior Access Act, is Public Law 118-
    21.
        H.R. 3672, To designate the clinic of the Department of
    Veterans Affairs in Indian River, Michigan, as the ``Pfc.
    Justin T. Paton Department of Veterans Affairs Clinic'' is
    Public Law 118-12.
        H.R. 4136, U.S. Congressman Sam Johnson Memorial VA Clinic
    Act, is Public Law 118-214.
        H.R. 4955, To name the community-based outpatient clinic of
    the Department of Veterans Affairs in Monroeville,
    Pennsylvania, as the ``Henry Parham VA Clinic'', is Public Law
    118-215.
        H.R. 7333, To name the Department of Veterans Affairs
    medical center in West Palm Beach, Florida, as the ``Thomas H.
    Corey VA Medical Center'', is Public Law 118-128.
        H.R. 8667--To rename the community-based outpatient clinic
    of the Department of Veterans Affairs in Cadillac, Michigan, as
    the ``Duane E. Dewey VA Clinic, is Public Law 118-251.
        H.R. 9124, To name the Department of Veterans Affairs
    community-based outpatient clinic in Auburn, California, as the
    ``Louis A. Conter VA Clinic'' is Public Law 118-259.

                                 III. OVERSIGHT

        In accordance with its mandate, the Committee engaged in
    oversight of VA health care facilities, VA regional offices, VA
    construction sites, State Veterans Homes, veterans cemeteries,
    and other entities within the Committee's jurisdiction.
    Summaries of various oversight activities follow.

    A. First Session (2023)

        From January 3, 2023, to January 5, 2023, Committee
    majority and minority staff traveled to Orlando, Florida, to
    attend the national conference for the Student Veterans of
    America. During this oversight visit, staff participated in a
    legislative panel regarding Congressional efforts to improve
    educational opportunities for student veterans and their
    families, and attended panels with VA leadership and
    individuals in higher education.
        From February 17, 2023, to February 25, 2023, Committee
    majority and minority staff traveled to Guam, the Commonwealth
    of the Northern Mariana Islands (Saipan), and the Philippines
    to visit VA medical facilities and veterans' cemeteries in each
    location. During these oversight visits, staff met with local
    VA staff and conducted public roundtables with local veterans
    and stakeholders to discuss the unique needs and challenges of
    the veteran populations in these areas.
        On February 18, 2023, Committee minority staff traveled to
    Russell, Kansas, to participate in the Veterans of Foreign Wars
    (VFW) Department of Kansas Veterans Round Up at the Bob Dole
    VFW Post 6240. During this oversight visit, staff met with
    leaders and service officers from Kansas VFW and with officials
    from the Veterans Benefits Administration (VBA) and the
    Veterans Health Administration (VHA). Staff also spoke directly
    with local veterans about issues related to accessing benefits,
    including health care and pension, from VA.
        From June 13, 2023, to June 14, 2023, Committee majority
    and minority staff traveled to Phoenix, Arizona, to attend the
    VA Leadership Summit. During this oversight visit, staff
    participated in a legislative panel to provide Congressional
    updates and answer questions from attendees including medical
    center directors, deputy directors, chiefs of staff, and others
    from across the country. Staff also toured the Carl T. Hayden
    Veterans' Administration Medical Center.
        From June 25, 2023, to July 2, 2023, Committee minority
    staff traveled to Kansas and Nebraska to conduct oversight
    visits of the Consolidated Mail Outpatient Pharmacy and Dwight
    D. Eisenhower VA Medical Center in Leavenworth, Kansas, the
    Omaha VA Medical Center in Omaha, Nebraska, and the Lincoln VA
    Clinic in Lincoln, Nebraska.
        On June 26, 2023, Committee majority staff visited the VISN
    6 Mid-Atlantic Office and the Durham VA Medical Center to take
    part in a VA PACT Act event and receive a tour of the Medical
    Center.
        From June 26, 2023, to June 28, 2023, Committee minority
    staff traveled to Kansas and Missouri to visit VA medical
    facilities and community partners throughout the region. During
    these oversight visits, staff toured the Colmery-O'Neil
    Veterans' Administration Medical Center in Topeka, Kansas, and
    the Community Based Outpatient Clinic (CBOC) in Lenexa, Kansas.
    Staff also met with local leaders from the Kansas Commission on
    Veterans Affairs, the Veterans of Foreign Wars, and The
    American Legion to discuss the needs of local veterans. Staff
    further met with leaders from local non-profit organizations
    that serve veterans, Horses & Heroes in Leavenworth, Kansas,
    and the Veterans Community Project in Kansas City, Missouri, to
    discuss their work and partnerships with VA.
        On July 19, 2023, Committee majority staff attended a PACT
    Act summit in Boston, Massachusetts. Staff updates on VA's
    implementation of recent toxic exposure legislation.
        From July 29, 2023, to August 3, 2023, Committee minority
    staff traveled to Los Angeles, California, and Denver, Colorado
    to visit VA facilities and attend the VA Acquisition Workforce
    Innovation Symposium. During these oversight visits, staff
    toured the West Los Angeles VA Medical Center, the Denver VA
    Medical Center, and the Denver Logistics Center.
        From August 13, 2023, to August 19, 2023, Committee
    majority staff conducted oversight of VA facilities in Montana
    and veteran services around the state. Staff met with School
    Certifying Officials at the University of Montana, Montana
    State University, Carroll College, and Great Falls College to
    discuss services and challenges for student veterans using VA
    education benefits. Staff met with faculty from the University
    of Montana Payne Family Native American Center, staff of the
    Great Plains Veterans Services Center, and the Blackfeet
    Veterans Alliance to discuss programs and services for Native
    American veterans, including coordination between VA and the
    Indian Health Service, and implementation of the Staff Sergeant
    Parker Gordon Fox Suicide Prevention Grant Program. Staff also
    conducted oversight visits at the Fort Harrison VA Medical
    Center to discuss services for veteran caregivers in the VA's
    Caregiver Support Program and services for women veterans
    including mental health care and Military Sexual Trauma
    support. Staff also visited the Cut Bank CBOC and the Southwest
    Montana Veterans Home. Staff conducted oversight visits at the
    Missoula Vet Center and the Great Falls Vet Center, to discuss
    services for women veterans, student veterans, staffing
    challenges, VA internship programs, and Mobile Vet Center
    services. Staff met with leadership from the Fort Harrison
    Regional processing center to discuss Veteran Readiness and
    Employment claims processing and staffing. Staff visited the
    Helena American Jobs Center and the Bozeman American Jobs
    Center leadership, including Department of Labor (DOL) Veterans
    Employment and Training Service (VETS) State Director Tom
    Finch, to discuss employment services for disabled veterans.
    Staff visited Malmstrom Air Force Base's Education and Training
    Center and Family Readiness Center to conduct oversight on the
    Transition Assistance Program and other services for
    transitioning servicemembers and military families.
        From August 14, 2023, to August 17, 2023, Committee
    minority staff traveled to Kansas and Missouri to visit VA and
    Department of Defense facilities and speak with local
    stakeholders. During these oversight visits, staff toured the
    Robert J. Dole VA Medical Center and the Regional Office in
    Wichita, Kansas, as well as the CBOC in Junction City, Kansas,
    and the Fort Riley Army Installation. Staff also toured the
    Kansas City VA Medical Center and Veterans Integrated Service
    Network 15 Headquarters in Kansas City, Missouri. Staff further
    met with leaders of veteran owned businesses in Wichita and
    with local employees from the VA Office of the General Counsel
    and Office of the Inspector General in Missouri.
        On August 25, 2023, Committee majority staff visited The
    American Legion's National Convention in Charlotte, North
    Carolina. Staff spoke to The American Legion's National
    Legislative Commission about the committee's legislative
    priorities.
        On August 28, 2023, Committee majority staff conducted
    oversight visits to the Baltimore and Annapolis Vet Centers.
        On September 6, 2023, Committee majority staff attended the
    DOL VETS conference on Transition in Washington, DC, to hear
    from stakeholders about the challenges that veterans and their
    family members face when leaving military service, and
    participated in a panel with a focus on military spouse
    employment.
        On September 22, 2023, Committee minority staff traveled to
    Wichita, Kansas, to speak at the opening of the Sedgwick County
    Veterans Treatment Court (VTC). During this oversight visit,
    staff spoke about legislative priorities and the importance of
    collaborative programs, as exemplified by the VTC, which is
    intended to coordinate resources across the federal, state, and
    local level to help attain positive outcomes for veterans
    involved with the justice system.
        On October 13, 2023, Committee majority staff conducted an
    oversight visit of the Richmond VA Medical Center. While there,
    staff visited the polytrauma center to talk with patients and
    staff.
        On October 24, 2023, Committee majority staff attended the
    Military Officers Association of America's Roundtable
    discussion on the Caregiver and Veteran Experience with Respite
    Care in Alexandria, VA, to hear from caregivers and veterans
    about their experiences in using VA's Respite Care programs.
        From October 25, 2023, to October 27, 2023, Committee
    majority and minority staff attended the Nurses Organization of
    Veterans Affairs Conference in Las Vegas, Nevada. While in
    Nevada, Committee majority and minority staff conducted an
    oversight visit to the North Las Vegas VA Medical Center.
        From November 1, 2023, to November 2, 2023, Committee
    majority and minority staff conducted oversight of PACT Act
    implementation and education benefit claims processing at the
    Buffalo Regional Office in New York. Staff met with executive
    leadership, frontline employees, and labor representatives to
    learn about operations and challenges with staffing and
    processing claims.
        On November 17, 2023, Committee majority staff conducted an
    oversight visit to Martinsburg, West Virginia. Committee staff
    met with staff from VHA's Office of Emergency Management to
    better understand the agency's ability to carry out its Fourth
    Mission mandate and tour assets gained with funding to address
    the COVID-19 pandemic. Staff also visited the dental clinic and
    the residential rehabilitation program on campus. In addition,
    staff also visited a local Vet Center in Martinsburg to hear
    from providers about the services offered and the ongoing
    challenges of filling open positions.
        From December 4, 2023, to December 6, 2023, Committee
    majority and minority staff conducted oversight of PACT Act
    implementation at the VBA Leadership and Partners Engagement
    Offsite in Kansas City, Missouri. Committee staff heard from
    VBA leadership, including Under Secretary for Benefits, Josh
    Jacobs, about claims automation and operation, outreach and
    engagement, production projections, and process efficiencies.
    Incorporating artificial intelligence and machine learning to
    help prepare and process claims was also discussed. Staff also
    heard from veteran service organizations and labor union
    leadership about PACT Act implementation successes and
    challenges.
        From December 7, 2023, to December 8, 2023, Committee
    minority staff conducted an oversight trip to North Chicago,
    Illinois, to visit the Captain James A. Lovell Federal Health
    Care Center. During this oversight visit, staff assessed the
    operations of this joint VA/DOD medical facility and
    preparedness for the VA new electronic health record rollout.
        From December 8, 2023, to December 9, 2023, Committee
    minority staff traveled to Topeka, Kansas, to participate in a
    PACT Act outreach event at the Colmery-O'Neill Veterans'
    Administration Medical Center. During this oversight visit,
    staff met with local leaders from VA and from the Kansas
    Commission on Veterans Affairs as well as with numerous
    veterans seeking information on, and assistance with, their VA
    benefits.
        From December 11, 2023, to December 15, 2023, the Committee
    majority staff conducted an oversight visit to Montana. In
    Butte, staff visited the new CBOC to see the facility and
    stopped by the State Veterans Home to check in on the status of
    construction delays. Staff visited the VAMC in Ft. Harrison to
    hear from acting facility leadership regarding ongoing efforts
    to improve care and services locally and across the state.
    Staff traveled to Browning to see the site chosen for the CBOC
    and better understand the remaining renovations needed to open
    the clinic. In Kalispell and Hamilton, staff visited future
    CBOC sites. Staff also toured the CBOC in Missoula, hearing
    from staff about staffing challenges, and visited with Vet
    Center staff to learn about the services offered and the
    ongoing difficulties with outreach in such a highly rural
    state.

    B. Second Session (2024)

        From January 3, 2024, to January 5, 2024, Committee
    majority and minority staff traveled to Nashville, Tennessee,
    to attend the national conference for the Student Veterans of
    America. During this oversight visit, staff spoke on a panel to
    provide a legislative update regarding the GI Bill and
    Congressional efforts to improve education benefits from VA.
    Staff also attended panels with staff from VA and DOL and met
    with student veterans individually and in focus meetings to
    discuss issues and barriers for student veterans and how
    resources could be improved to better serve student veterans.
        On January 22, 2024, Committee majority staff conducted an
    oversight visit of the Alexandria Vet Center to discuss
    staffing and veteran trends.
        On March 18, 2024, Committee majority staff conducted an
    oversight visit of the Baltimore VAMC and also visited the
    Baltimore Station, which houses homeless veterans.
        On March 21, 2024, Committee minority staff traveled to VA
    Central Office in Washington, DC to oversee the VA Operations
    Center. During this oversight visit, staff met with VA staff to
    discuss VA security and emergency operations, particularly
    procedures related to supporting local emergency response and
    VA's Fourth Mission.
        From April 1, 2024, to April 5, 2024, Committee minority
    staff traveled to Kansas to visit VA and DOD facilities. During
    this oversight visit, staff met with leaders Transition Program
    Managers at Fort Leavenworth and Fort Riley to discuss the
    transition program for servicemembers. While on base, staff
    connected with the Veterans of Foreign Wars Service Officer for
    Fort Leavenworth to discuss challenges the VFW faces when
    assisting veterans. Staff also visited the Wichita Regional
    Office, the Kansas Veterans Cemetery at Winfield, and the Fort
    Scott National Cemetery to discuss issues unique to their
    respective facilities and locations.
        On May 1, 2024, Committee majority staff attended VA's
    Veterans' Family, Caregiver, and Survivor Advisory Committee
    meeting in Washington, DC, and heard from Department officials
    about end-of-life planning for veterans, the Pension and
    Fiduciary Program, the Office of Survivors Assistance, the
    Survivor and Memorial Program, and potential recommendations by
    the Advisory Committee.
        On May 6, 2024, Committee minority staff traveled to
    Martinsburg, West Virginia to visit the VA Operations Center.
    During this oversight visit, staff discussed VA's plans for
    continuity of operations in a disaster scenario.
        On May 13, 2024, Committee majority staff attended the
    Military Officers Association of America-Quality of Life
    Foundation Roundtable in Alexandria, Virginia on VA's Caregiver
    Support Program to discuss improvements that should be made to
    the Caregiver program.
        From June 12, 2024, to June 14, 2024, Committee minority
    staff traveled to North Chicago, Illinois, to visit the Captain
    James A. Lovell Federal Health Care Center. During this
    oversight visit, which was a follow-up to the prior oversight
    visit in December 2023, staff discussed the progress of, and
    ongoing challenges associated with, the VA new electronic
    health record rollout.
        From June 24, 2024, to June 29, 2024, Committee majority
    and minority staff conducted oversight visits in St.
    Petersburg, Florida, and San Juan, Puerto Rico. Staff visited
    the St. Petersburg Regional Office, Bay Pines VA Medical
    Center, San Juan Vet Center, 156th Air National Guard Wing, San
    Juan Regional Office, Fort Buchanan, Puerto Rico National
    Cemetery, Morovis National Cemetery, San Juan VA Medical
    Center, and Endeavors--a Homeless Veterans' Reintegration
    Program grant recipient. Committee staff also participated in a
    roundtable with local veterans and VSO representatives in
    Puerto Rico.
        From June 26, 2024, to June 28, 2024, Ranking Member Moran
    and Committee minority staff traveled to Kansas to attend the
    ribbon cutting ceremony for the new VA Regional Office in
    Wichita with VA Secretary McDonough. During this oversight
    visit, Ranking Member Moran and staff met with local veterans,
    VA staff, VSO representatives and other stakeholders and toured
    the new Regional Office. While in Kansas, staff also visited
    the Robert J. Dole VA Medical Center in Wichita and met with
    the owner of Flint Hills Pain Management Clinic to discuss VA
    community partnerships and access to new and innovative pain
    management treatments for veteran patients.
        From June 26, 2024, to June 30, 2024, Committee minority
    staff traveled to Missouri and Arkansas to visit a variety of
    VA and community facilities. In St. Louis, Missouri, staff
    visited the VA Regional Office, the National Cemetery
    Administration's National Training Center, the National
    Archives and Records Administration's National Personnel
    Records Center, and a local non-profit service dog
    organization. In Little Rock, Arkansas, staff visited the VA
    Law Enforcement Training Center, the Veteran Villages of
    America, the Little Rock National Cemetery, and the Arkansas
    State Veterans Cemetery.
        On July 30, 2024, Committee minority staff traveled to
    Tennessee to VA's Military Sexual Trauma National Training
    Symposium. During this oversight visit, staff listened to
    speakers, including VA Secretary Denis McDonough, and learned
    about efforts VA is undertaking to improve training,
    transparency, and the dissemination of best practices among
    claims processers and MST coordinators.
        From August 5, 2024 to August 12, 2024, the Committee
    majority staff conducted an oversight visit to Montana to
    assess ongoing needs and improvements following significant
    leadership and operational shifts since summer 2023. They
    visited VA facilities and veteran homelessness providers, met
    with veterans, and held town halls with VA staff in Missoula,
    Kalispell, Browning, Helena, and Butte.
        On August 7, 2024, Committee majority and minority staff
    traveled to Springfield, Illinois, to attend the AMVETS 78th
    National Convention. During this oversight visit, staff took
    questions and listened to concerns from AMVETS members about VA
    health care, benefits, and funding.
        On August 12, 2024, to August 14, 2024, Committee minority
    staff traveled to Las Vegas, Nevada, to attend the summer
    conference for the National Association of State Approving
    Agencies. During this oversight visit, staff participated in a
    legislative panel on education issues facing veterans and their
    families and met with individual State Approving Agencies from
    across the country to discuss hurdles they are facing in
    current statute as well as VA policies.
        From August 23, 2024, to August 26, 2024, Committee
    minority staff traveled to Detroit, Michigan, to attend the
    National Conference of the National Guard Association of the
    United States. During this oversight visit, staff met with
    representatives from the Air Force, Army, and other defense
    equities to discuss issues unique to the National Guard and
    Reserve components. Staff also met with Guardsmen from all 54
    states and territories as well as the Acting Chief of the
    National Guard Bureau, the Chief of Staff of the Army, the
    Chief of Staff of the Air Force, the Acting Director of the Air
    National Guard, and the Air Force Assistant Secretary for
    Manpower and Reserve Affairs. Former National Guard Generals
    were also in attendance, and throughout the engagements, staff
    discussed Guard priorities, including employment, transition,
    family issues, military duty status reform, and access to
    health care.
        From August 24, 2024, to August 25, 2024, Committee
    minority staff traveled to New Orleans, Louisiana, to attend
    the National Convention of The American Legion. During the
    oversight visit, staff participated in a legislative panel and
    answered questions from Legionnaires. Staff also visited with
    veterans from across the country, and globe, to discuss
    veterans issues.
        From September 3, 2024, to September 5, 2024, Committee
    majority staff conducted oversight visits in Minneapolis,
    Minnesota, and Chicago, Illinois. Staff visited the Minneapolis
    VA Medical Center, Lovell Federal Health Care Center, and the
    VA National Acquisition Center.
        From September 3, 2024, to September 6, 2024, Committee
    minority staff traveled to Kansas to visit VA facilities. In
    Topeka, staff toured the Colmery-O'Neil VA Medical Center and
    met with representatives from the Veterans Crisis Line call
    center and the women's health center in Topeka, Kansas. Staff
    also visited the Dwight D. Eisenhower VA Medical Center and the
    Leavenworth National Cemetery in Wichita, Kansas, to engage in
    discussions about the domiciliary and Enhanced Use Lease on
    site.
        On September 6, 2024, Committee majority staff attended the
    VA's Quadrennial National Women Veterans Summit in Washington,
    DC, and attended briefings on PACT Act implementation, VHA's
    reproductive health care and services, mental health care and
    services, and also heard updates on the MST Operations Center
    and the Defense Sexual Assault Database.
        On September 17, 2024, Committee majority staff attended
    the Wounded Warrior Projects Women Warriors Panel in Arlington,
    VA, to hear from women veterans and active duty members to
    highlight the many contributions they make to national
    security.
        On September 24, 2024, Committee majority and minority
    staff traveled to Arlington, Virginia, to attend the National
    Convening of the Elizabeth Dole Foundation. During this
    oversight visit, minority staff participated in a panel with
    caregivers and representatives from non-profit organizations
    and educational institutions to discuss how to improve services
    and support for caregivers of military veterans.
        On September 25, 2024, Committee majority staff attended
    the Duke University Veteran Transitions Research Lab
    Washington, DC, summit and third annual convening to discuss
    the latest academic research related to veterans' transition
    from military service, and how to apply scientific research to
    addressing real world challenges of transition.
        From October 6 to October 8, 2024, Committee minority staff
    traveled to Dallas, Texas, to participate in meetings at the
    George W. Bush Presidential Institute. During this oversight
    visit, staff met with representatives from government, private
    sector, and nonprofit organizations that focus on serving
    veterans to discuss the current needs of American military
    veterans and how different organizations work to address
    various needs of the veteran population.
        On October 10, 2024, Committee majority and minority staff
    traveled to Virginia Beach, Virginia, to attend the annual
    meeting of the Nurses Organization of Veterans Affairs. During
    this oversight visit, staff participated in a panel to provide
    Congressional updates and answer questions from VA nurses
    across the country.
        On October 22, 2024, Committee minority staff traveled to
    Roanoke, Virginia, to visit the VA Regional Office. During this
    oversight visit, staff met with VA leaders and staff, including
    claims processors, to discuss improving the claims process for
    veterans who have experienced military sexual trauma.
        On October 28, 2024, Committee minority staff traveled to
    the Washington, DC, VA Medical Center. During this oversight
    visit, staff met with VA staff to discuss issues including
    community care, mental health care, suicide prevention,
    workforce management, homeless services, caregiver support, and
    security and emergency preparedness.
        On October 30, 2024, Committee minority staff traveled to
    Mountain Home, Tennessee, to visit the James H. Quillen VA
    Medical Center. During this oversight visit, staff met with
    local VA staff to discuss allegations of misconduct. Staff also
    met with employees from the Veterans Integrated Service
    Network, the facility, and representatives of the local
    American Federation of Government Employees union.
        On November 20, 2024, Committee majority staff attended the
    Pew Charitable Trusts ``Supporting Veterans' Transition into
    the Workforce'' Symposium in Washington, DC, with stakeholders
    including DOL VETS, VA, DOD, Syracuse Institute for Veterans
    and Military Families, and Hiring Our Heroes to facilitate
    greater information sharing and coordination across groups
    involved with support veterans' transitions from military
    service.

                                IV. NOMINATIONS

    NOMINATIONS

    ----------------------------------------------------------------------------------------------------------------
                                          Date of
           Name and position            nomination       Date of  hearing     Date  reported       Date  confirmed
    ----------------------------------------------------------------------------------------------------------------
    First Session
      Anjali Chaturvedi...........    January 3, 2023
        General Counsel of the
         Department of Veterans
         Affairs
      Joshua D. Jacobs............   January 23, 2023   February 16, 2023       March 8, 2023        April 26, 2023
        Under Secretary for
         Benefits of the
         Department of Veterans
         Affairs
      Tanya J. Bradsher...........     April 25, 2023        May 31, 2023       July 13, 2023    September 12, 2023
        Deputy Secretary of
         Veterans Affairs
    ----------------------------------------------------------------------------------------------------------------

                        V. BUDGET FOR VETERANS PROGRAMS

    A. First Session (2023)

        Pursuant to the requirements of section 301(d) of the
    Congressional Budget Act of 1974, Chairman Tester of the
    Committee submitted a letter to the Budget Committee reflecting
    the Committee's Views and Estimates on the Administration's
    proposed Fiscal Year 2024 budget for veterans' programs. The
    letter submitted is printed below in its entirety:

                                                         April 4, 2023.
    Hon. Sheldon Whitehouse, Chairman,
    Hon. Charles E. Grassley, Ranking Member,
    Committee on the Budget,
    U.S. Senate, Washington, DC.
        Dear Chairman Whitehouse and Ranking Member Grassley:
    Pursuant to Section 301(d) of the Congressional Budget Act of
    1974, I write to provide views and estimates to the Committee
    on the Budget regarding matters within the jurisdiction of the
    Committee on Veterans' Affairs (the Committee). The President's
    Budget request for Fiscal Year (FY) 2024 provides a modest
    increase for Department of Veterans Affairs' (VA) spending on
    veterans programs. The bulk of the increase is for implementing
    Public Law 117-168, the Sergeant First Class Heath Robinson
    Honoring our Promise To Address Comprehensive Toxics Act of
    2022 (the PACT Act), which was enacted in August 2022.
    Additional resources are necessary as VA works to provide
    timely, high-quality delivery of veterans' health care and
    benefits to an expanded population of veterans.
        On February 28, 2023, the Committee began a series of
    hearings where veterans service organizations (VSOs) provided
    their legislative priorities for this year as well as their
    perspectives on challenges facing VA and the veteran community.
    During my time on the Committee, these hearings have been
    invaluable in helping me better understand the legislative and
    budgeting priorities. Almost every single VSO who testified
    this year noted PACT Act implementation as the top issue of
    concern for their organization and members. As Chairman, I have
    restated my belief that Congress should be taking its cues from
    our nation's servicemembers, veterans, and their families on
    how we can best honor their service and ensure they receive the
    benefits and services they have earned.
        Accordingly, to assist in preparing these views and
    estimates, I have given careful consideration to the ``The
    Independent Budget Veterans Agenda for the 118th Congress:
    Budget for Fiscal Years 2024-2025 and Critical Issues''
    (Independent Budget or IB) prepared by three VSOs--the Disabled
    American Veterans, the Paralyzed Veterans of America, and the
    Veterans of Foreign Wars. This comprehensive budget and policy
    document created by and for veterans is also supported by many
    other organizations that care deeply about veterans and their
    families.
        The IB notes PACT Act implementation as a top issue for FY
    2024, especially as the Administration moves to expand health
    care and benefits eligibility to all eras of toxic exposed-
    veterans in a more accelerated manner than originally designed
    by the legislation. Related key priorities in the FY 2024 IB
    include improving VA health workforce recruitment and retention
    and modernizing VA infrastructure, which will help build the
    Department's capacity to deliver expanded benefits and care
    under the PACT Act. In order for VA to provide our veterans and
    their families with the world-class services and benefits they
    have been promised, PACT Act implementation and capacity-
    building measures must receive focused support in the budget
    resolution.

                            PACT Act Implementation

    Cost of War Toxic Exposures Fund

        The PACT Act represents the most significant expansion of
    VA benefits and health care in decades for veterans exposed to
    toxic substances during their service. Congress created the
    Cost of War Toxic Exposures Fund (TEF) to cover the new costs
    of health care and benefits delivery to toxic exposed-veterans
    and ensure the care of veterans already in the system was not
    disadvantaged by the costs of the new program. VA has a duty to
    deliver quality health care and timely benefits for veterans
    who were exposed to toxic substances during their service, and
    must resource VA accordingly, so the Department can continue
    PACT Act implementation and deliver on its promises to veterans
    who experienced toxic exposure.
        Funding for veterans' medical care within TEF is vital as
    more veterans become eligible for VA health care, enroll in the
    Veterans Health Administration (VHA) system, or have their
    current priority level upgraded because they are diagnosed with
    health conditions covered by the PACT Act. Veterans with toxic
    exposure may also need more costly and specialized care,
    depending on their diagnoses.
        Lastly, full funding of the TEF is critical for the
    Veterans Benefits Administration (VBA) successful
    implementation of the PACT Act. TEF funding will enable VA to
    hire 8,466 full-time equivalent (FTE) employees to process
    toxic-exposure related claims, enhance automation program to
    reduce the time veterans wait for benefits, and digitization of
    military personnel files to ease processing of PACT Act claims.
    Without this critical funding, VA could not carry out our
    nation's promise to the brave men and women who were exposed to
    toxic substances during military service. Veterans have filed
    more than 424,000 claims for benefits under the PACT Act to-
    date. In FY 2024, TEF funding would ensure VA can timely
    process the 2.4 million claims the Department is projected to
    receive, which is more than double FY 2022 actual levels due to
    the expansion of benefits by the PACT Act.

    Veterans Health Administration (VHA) Workforce

        Thanks to the PACT Act, and VA's renewed focus on
    recruitment and retention, in recent months VHA has seen its
    first net increases in hiring in nearly 20 years. In 2023,
    VHA's goal is to hire nearly 52,000 staff to account for both
    vacancies and turnover. However, VA needs additional support
    and authorities to meet this goal and maintain momentum. The
    Department needs funding to support the provisions in the PACT
    Act including expanding access to the Education Debt Reduction
    Program, which has become a highly popular retention tool;
    offering special salary rates for particularly hard-to-hire
    positions; and to hire and retain more human resources staff.
    As of February 28, 2023, Human Resources Management and Human
    Resources Assistant positions have a 25 percent vacancy rate
    across VHA. Filling these positions and offering creative
    retention support will be essential to meeting VHA's broader
    hiring goals.
        In addition to existing programs and flexibilities,
    authorizing Committees are considering further adjustments to
    pay caps, expanded access to continued professional education
    reimbursement, and recalibration of data reporting to provide a
    better view of the successes and pitfalls of VA's hiring
    process to measure success and address remaining issues. This
    pending legislation is entitled the VA Clinician Appreciation,
    Recruitment, Education, Expansion, and Retention Support
    (CAREERS) Act of 2023. The estimated cost for these provisions
    is between one and two billion dollars.

    VA Infrastructure

        Although the President's FY 2024 Budget requests an
    increase in total infrastructure funding compared to FY 2023, a
    closer examination shows unstable and inconsistent funding
    overall, particularly in the Major and Minor Construction
    accounts. With enactment of the PACT Act, it is more critical
    than ever to ensure VA is appropriately investing in new
    health, benefits, and memorial affairs facilities while also
    dedicating funds for renovations, preventative maintenance,
    seismic repair, and other safety projects. This includes
    directing funding towards improvements to ensure all VA health
    facilities are welcoming and can provide needed services to
    women veterans who account for over 30 percent of the increase
    in veterans served at VA over the past five years. As of
    January 2023, VA still has $492 million in unfulfilled women
    veteran infrastructure retrofit projects. Congress directed VA
    to prioritize this work in the Deborah Sampson Act, which was
    enacted in January 2021 as part of P.L. 116-315, Johnny Isakson
    and David P. Roe, M.D. Veterans Health Care and Benefits
    Improvement Act of 2020.
        The PACT Act expanded health care and benefits eligibility
    to millions of veterans. While the law did include $6.4 billion
    for 31 major medical clinics, research facilities, other
    facilities, and investments in enhanced-use lease projects, all
    of these funds were narrowly focused and are spread out over
    many years. These provisions are no substitute for robust
    funding in VA's two base discretionary accounts dedicated to
    new facilities or significant modernizations--the Major and
    Minor accounts. These accounts are critical to funding projects
    in every state in the country, including modernization of VBA
    regional offices which are essential for the timely processing
    of veterans' disability claims and related VBA services.
        VA's own FY 2024 budget identifies $105 to $129 billion in
    needed infrastructure projects, including up to $29 billion and
    $26 billion for Major and Minor construction, respectively,
    over ten years. The Department provided more than 500 pages of
    detail for these and other projects; however, VA only requested
    a small fraction of the needed amount in the FY 2024 budget
    request--not even reaching one-tenth of the required resources.
    Specifically, VA's FY 2024 Budget proposes a 39 percent
    decrease in base Major Construction funding--down to $881
    million from the FY 2023 enacted level of $1.4 billion. Minor
    Construction's base funding request of $680 million grew by 9
    percent, but this funding level is inadequate given a minimum
    $2.6 billion per year need.
        The President's budget supplements the Major Construction
    request through an additional investment of $600 million from
    the Recurring Expenses Transformational Fund (RETF) and a
    brand-new mandatory major and minor construction effort funded
    at $1.5 billion and $400 million respectively. While I fully
    support the use of the RETF to supplement VA's infrastructure
    budget and I am open to understanding the Administration's
    proposal for major and minor mandatory funding--neither of
    these are a substitute for base funding of these critical
    accounts.
        For a decade or more, VA's critical infrastructure accounts
    have not kept pace with the growing need to recapitalize VA's
    infrastructure, increased construction costs and inflation, and
    the demand for more services from veterans--in addition to laws
    Congress enacted adding new programs and benefits for veterans.
    VA's data indicates the average VA medical center was built
    nearly 60 years ago--compared to just 13 years ago in the
    private sector.
        Modern infrastructure is the cornerstone of VA health care
    and benefits delivery. The longer Congress waits to take
    decisive action, the more VA infrastructure upgrades will cost
    taxpayers in the long term. And more importantly, those
    existing subpar VA facilities will hamper the ability to
    deliver world-class health to veterans consistently across the
    country. It is time for Congress to make an independent
    judgement of the infrastructure investment levels needed to
    support our nation's veterans, just as we do each year in the
    Defense and Military Construction Appropriations accounts where
    Congress regularly provides funding above the President's
    request to meet the needs of our military. We must do the same
    when it comes to VA infrastructure to best serve veterans as
    part of our moral obligation and national security priorities.
    For all of the above reasons, I recommend the budget resolution
    include an increase of $1 billion for the Major and Minor
    Construction base accounts, respectively, while demanding
    improvements in VA project execution performance as directed in
    my proposed BUILD for Veterans Act. These funding increases
    should include increases in resources for the hiring of
    relevant infrastructure engineers, planners, and other
    pertinent staff that are critical to VA's infrastructure
    project execution.

                                    Closing

        I thank the Committee on the Budget for its attention to
    these views and estimates on the FY 2024 budget and FY 2025
    advance appropriations requests for VA and matters within the
    jurisdiction of the Committee on Veterans' Affairs. I look
    forward to working with you to continue to meet the needs of
    those who have served our country.
                Sincerely,
                                                    Jon Tester,
                                                              Chairman.
                                    ------

    B. Second Session (2024)

        Pursuant to the requirements of section 301(d) of the
    Congressional Budget Act of 1974, Chairman Tester submitted a
    letter to the Budget Committee reflecting the Committee's Views
    and Estimates on the Administration's proposed Fiscal Year 2025
    budget for veterans' programs. The letter submitted is printed
    below in its entirety:

                                                        April 17, 2024.
    Hon. Sheldon Whitehouse, Chairman,
    Hon. Charles E. Grassley, Ranking Member,
    Committee on the Budget,
    U.S. Senate, Washington, DC.
        Dear Chairman Whitehouse and Ranking Member Grassley:
    Pursuant to Section 301(d) of the Congressional Budget Act of
    1974, I write to provide views and estimates to the Committee
    on the Budget regarding matters within the jurisdiction of the
    Committee on Veterans' Affairs (the Committee). While the
    President's Budget request for Fiscal Year (FY) 2025 provides a
    total request of $369.3 billion for the Department of Veterans
    Affairs (VA), representing a 10% increase over FY 2024, I am
    concerned by the Department's planned cuts to its medical
    workforce in light of unprecedented enrollment growth--spurred
    by Public Law 117-168, the Sergeant First Class Heath Robinson
    Honoring our Promise to Address Comprehensive Toxics Act of
    2022 (the PACT Act).
        In 2023, VA served more veterans than ever before. This
    included providing more than 118 million clinical appointments
    and processing more than 1.9 million disability compensation
    and pension claims, breaking the previous year's record by
    nearly 16%. Much of this unprecedented growth stems from the
    continued implementation of the PACT Act. VA announced in a
    recent press release that between March 2023 and March 2024,
    enrollment had increased in its health care system by nearly
    30% thanks to authorities in the PACT Act. That same release
    also noted the PACT Act has allowed more than 746,500 veterans
    to upgrade their priority group since being signed into law.
        While the topline numbers requested in the President's
    Budget appear robust, how they are ultimately arrived at is
    concerning. For example, in the smaller accounts that make up
    Medical Care there is a growing reliance on transfers and
    unobligated balances, frequently called ``carryover,'' to
    supplement baseline requests. This is especially apparent in
    the Medical Community Care account in FY 2025. Since
    implementing Public Law 115-182, the John S. McCain III, Daniel
    K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems
    and Strengthening Integrated Outside Networks Act of 2018 (the
    MISSION Act), VA has witnessed steady double-digit growth in
    community care spending. VA's baseline request of $20.4 billion
    for FY 2025, unchanged from its previous Advance Request for
    Community Care, cannot meet demand based on past obligations.
    When transfers from other Medical Care accounts (more than $7.9
    billion), carryover ($1.5 billion), and collections ($901
    million) are factored in, the baseline request jumps closer to
    $30 billion. Additional funds from the mandatory Cost of War
    Toxic Exposure Fund or TEF cap off total obligations for the
    Medical Community Care account to a more realistic $40.9
    billion for FY 2025--more than doubling the at-first-glance
    funding for non-VA care.
        This is about more than just funding. VA's planned medical
    workforce reductions in FY 2025, coupled with its existing
    ``zero growth'' initiative, which seeks to keep the full-time
    equivalent employee (FTE) number flat between FY 2023 and FY
    2024, will directly impact the Department's ability to provide
    timely, quality care to veterans and consequently expand
    eligibility for community care. In FY 2023, nearly 40% of the
    total VA health care workload was delivered in the community
    despite having a robust workforce. When veterans can't be seen
    in a timely manner or have to drive too far for services, they
    need to be quickly connected with community care. However,
    veterans should not have their choice for VA removed because
    the Department isn't appropriately staffed to meet their needs.
    Study after study--including findings recently published in The
    Journal of General Internal Medicine--shows VA health care is
    as good as or superior to what individuals get outside of VA. A
    recent nationwide Medicare survey of patients showed VA
    outperformed non-VA hospitals in all 10 core patient
    satisfaction metrics, including overall hospital rating,
    communication with doctors, communication about medication, and
    willingness to recommend the hospital. Making sure veterans
    have access to the best care available is a no-brainer. That
    means VA needs to continue to hire and retain quality
    personnel.
        On the mandatory side of the ledger, the TEF remains a
    vital tool in VA's implementation of the PACT Act. Public Law
    118-5, the Fiscal Responsibility Act of 2023 (FRA) provided VA
    $24.5 billion for TEF in FY 2025, representing a $4 billion
    increase over the previous fiscal year. The increased TEF
    funding will cover the growing demand for health care
    associated with toxic exposure, maintain more than 6,900 FTE
    claims processing personnel, and continue expanding benefits to
    toxic-exposed veterans. Congress must maintain support for
    robust TEF funding.
        With the influx of veterans and survivors applying for PACT
    Act benefits, VA expects to significantly increase the number
    of disability compensation claim decisions it issues in FY 2025
    to 2.4 million, 400,000 more than it completed in FY 2023. In
    light of this increase in workload, it is troubling that the
    total budget requests for the Veterans Benefits Administration
    and the Board of Veterans' Appeals have decreased in FY 2025.
        I thank the Committee on the Budget for its attention to
    these views and estimates on the FY 2025 budget and FY 2026
    advance appropriations requests for VA and matters within the
    Committee on Veterans' Affairs jurisdiction. Following this
    letter is an appendix with a more expansive assessment of VA's
    budget request. I look forward to working with you to continue
    to meet the needs of those who have served our country.
                Sincerely,
                                                    Jon Tester,
                                                              Chairman.

                         COMMITTEE ON VETERANS' AFFAIRS

       JON TESTER, Montana, Chairman
    JERRY MORAN, Kansas, Ranking Member  PATTY MURRAY, Washington
    JOHN BOOZMAN, Arkansas               BERNARD SANDERS, Vermont
    BILL CASSIDY, Louisiana              SHERROD BROWN, Ohio
    MIKE ROUNDS, South Dakota            RICHARD BLUMENTHAL, Connecticut
    THOM TILLIS, North Carolina          MAZIE K. HIRONO, Hawaii
    DAN SULLIVAN, Alaska                 JOE MANCHIN III, West Virginia
    MARSHA BLACKBURN, Tennessee          KYRSTEN SINEMA, Arizona
    KEVIN CRAMER, North Dakota           MARGARET WOOD HASSAN, New
    TOMMY TUBERVILLE, Alabama            Hampshire
                                         ANGUS KING, Maine
       Tony McClain, Staff Director
     David Shearman, Republican Staff
                 Director

                                      [all]