S.Hrg.119-86

1[Senate Hearing 119-86]2[From the U.S. Government Publishing Office]34                                                         S. Hrg. 119-8656                HEARING TO CONSIDER PENDING LEGISLATION7=======================================================================89                                HEARING1011                               BEFORE THE1213                     COMMITTEE ON VETERANS' AFFAIRS14                          UNITED STATES SENATE1516                    ONE HUNDRED NINETEENTH CONGRESS1718                             FIRST SESSION1920                               __________2122                              MAY 21, 20252324                               __________2526       Printed for the use of the Committee on Veterans' Affairs2728[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]2930        Available via the World Wide Web: http://www.govinfo.gov3132                                __________3334                   U.S. GOVERNMENT PUBLISHING OFFICE3560-595 PDF                  WASHINGTON : 20263637-----------------------------------------------------------------------------------38                 SENATE COMMITTEE ON VETERANS' AFFAIRS3940                     Jerry Moran, Kansas, Chairman41John Boozman, Arkansas               Richard Blumenthal, Connecticut,42Bill Cassidy, Louisiana                  Ranking Member43Thom Tillis, North Carolina          Patty Murray, Washington44Dan Sullivan, Alaska                 Bernard Sanders, Vermont45Marsha Blackburn, Tennessee          Mazie K. Hirono, Hawaii46Kevin Cramer, North Dakota           Margaret Wood Hassan, New47Tommy Tuberville, Alabama                Hampshire48Jim Banks, Indiana                   Angus S. King, Jr., Maine49Tim Sheehy, Montana                  Tammy Duckworth, Illinois50                                     Ruben Gallego, Arizona51                                     Elissa Slotkin, Michigan5253                     David Shearman, Staff Director54                Tony McClain, Democratic Staff Director5556                           C O N T E N T S5758                              ----------5960                              May 21, 20256162                                SENATORS6364                                                                   Page65Hon. Jerry Moran, Chairman, U.S. Senator from Kansas.............     166Hon. Angus S. King, Jr., U.S. Senator from Maine.................     467Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......     468Hon. Richard Blumenthal, Ranking Member, U.S. Senator from69  Connecticut....................................................     670Hon. Tim Sheehy, U.S. Senator from Montana.......................     771Hon. Patty Murray, U.S. Senator from Washington..................     87273                               WITNESSES74                                Panel I7576Thomas O'Toole, MD, Acting Assistant Under Secretary for Health77  for Clinical Services, Veterans Health Administration, U.S.78  Department of Veterans Affairs accompanied by Kenneth Smith,79  Assistant Deputy Under Secretary, Operations Management, Office80  of Field Operations, Acting Executive Director of Education81  Services, Veterans Benefits Administration, U.S. Department of82  Veterans Affairs; and Phillip W. Christy, Acting Principal83  Executive Director and Chief Acquisition Officer, U.S.84  Department of Veterans Affairs.................................     28586                                Panel II8788Morgan Brown, National Legislative Director, Paralyzed Veterans89  of America.....................................................    109091Brian Dempsey, Director of Government Affairs, Wounded Warrior92  Project........................................................    129394Jon Retzer, Deputy National Legislative Director for Health,95  Disabled American Veterans.....................................    149697                                APPENDIX98                             Hearing Agenda99100List of Pending Bills............................................    25101102                           Opening Statement103104Hon. Richard Blumenthal..........................................    29105106                          Prepared Statements107108Thomas O'Toole, MD, Acting Assistant Under Secretary for Health109  for Clinical Services, Veterans Health Administration, U.S.110  Department of Veterans Affairs.................................    33111112Morgan Brown, National Legislative Director, Paralyzed Veterans113  of America.....................................................    74114115Brian Dempsey, Director of Government Affairs, Wounded Warrior116  Project........................................................    84117118Jon Retzer, Deputy National Legislative Director for Health,119  Disabled American Veterans.....................................    99120121                       Submissions for the Record122123The New York Times article ``Trump's Push to Defund Harvard124  Prompts Clash Over Veteran Suicide Research''..................   113125126American Gold Star Mothers, Inc., Patti Elliott, 2024-2025127  National President.............................................   117128129The American Legion, James A. LaCoursiere, National Commander....   118130131Gold Star Spouses of America, Inc., Tamra Sipes, President.......   119132133Jewish Community Relations Bureau/American Jewish Committee134  (JCRB/AJC), Neta Meltzer, Executive Director, Bert Berkley135  Chair for Community Relations..................................   121136137Non Commissioned Officers Association of the United States of138  America, Levi H. Sadr, Director of Government Affairs..........   122139140Republican Jewish Coalition, Norm Coleman, National Chairman and141  Matthew Brooks, Chief Executive Officer........................   123142143Tragedy Assistance Program for Survivors (TAPS), Bonnie Carroll,144  President and Founder..........................................   124145146Veterans of Foreign Wars of the United States, Kristina Keenan,147  Director, VFW National Legislative Service.....................   125148149Vietnam Veterans of America, Jack McManus, National President....   126150151                        Questions for the Record152153Department of Veterans Affairs response to questions submitted154  by:155156  Hon. Margaret Wood Hassan......................................   129157158  Hon. Dan Sullivan..............................................   130159160  Hon. Tommy Tuberville..........................................   132161162                       Statements for the Record163164American Battle Monuments Commission.............................   137165166American Federation of Government Employees (AFGE), AFL-CIO,167  Daniel M. Horowitz, Director of Legislation....................   140168169The American Legion, Matthew Cardenas, Policy Analyst............   143170171Coalition for Common Sense in Government Procurement, Roger D.172  Waldron, President.............................................   163173174Concerned Veterans for America, John Vick, Executive Director....   167175176Congressional Medal of Honor Society, Britt Slabinski, President.   173177178Elizabeth Dole Foundation........................................   175179180K9s For Warriors, Daniel Bean, Chief Executive Officer...........   180181182Military Officers Association of America (MOAA)..................   182183184Medal of Honor Foundation, David J. McIntyre, Jr., Chairman of185  the Board of Directors.........................................   188186187National Guard Association of the United States..................   190188189Quality of Life Foundation.......................................   193190191Reserve Organization of America, Jake Fales, Senior Policy Fellow192  for Veterans' Affairs; and Peter Donlon, Senior Policy Fellow193  for Defense and Acquisitions...................................   197194195Student Veterans of America......................................   205196197Veterans of Foreign Wars of the United States, Kristina Keenan,198  Director, VFW National Legislative Service.....................   210199200Veterans Healthcare Policy Institute.............................   216201202                      HEARING TO CONSIDER PENDING203                              LEGISLATION204205                              ----------206207                        WEDNESDAY, MAY 21, 2025208209                                       U.S. Senate,210                            Committee on Veterans' Affairs,211                                                    Washington, DC.212    The Committee met, pursuant to notice, at 4 p.m., in Room213SR-418, Russell Senate Office Building, Hon. Jerry Moran,214Chairman of the Committee, presiding.215216    Present: Senators Moran, Sheehy, Blumenthal, Murray,217Hassan, and King.218219             OPENING STATEMENT OF HON. JERRY MORAN,220               CHAIRMAN, U.S. SENATOR FROM KANSAS221222    Chairman Moran. Nice to see that works. We have significant223time constraints in our hearing today, and we are going to move224it as expeditiously but as effectively as we can to go through225our agenda. I have not checked with Senator Blumenthal's staff226but I assume he is on his way. I am going to make my opening227statement, and we have cut it in half, maybe the witnesses have228done the same, and we will proceed with our hearing as members229join us.230    I call the meeting to order. Welcome. Welcome to our231witnesses and to those in the audience. We are going to hear232from witnesses from the VA, from the Paralyzed Veterans of233America, the Wounded Warrior Project, and Disabled American234Veterans about 20 pieces of legislation on today's agenda.235These bills reflect a wide range of issues facing military and236veteran communities as well as the Department tasked with237serving them. I am grateful for the sponsors of these bills and238will work with them to make certain that they improve services239for veterans, and I look forward to hearing from our witnesses240today about these proposals.241    So recognizing that schedules for many of us, myself242included, are particularly constrained this afternoon, in the243interest of time I will withhold further comment. I will244recognize the Ranking Member when he arrives, and I will now245introduce our first panel.246    Testifying today from the Department of Veterans Affairs is247Dr. Thomas O'Toole, not an unfamiliar face to us, the VA's248Acting Assistant Under Secretary for Health for Clinical249Services. He is accompanied by Kenneth Smith, the VA's250Assistant Deputy Under Secretary for Operations Management, and251Acting Executive Director of Education Services, and Phillip252Christy, VA's Acting Principal Executive Director and Chief253Acquisition Officer.254    Again, thank you all for being here, and Dr. O'Toole, I255recognize you for your statement.256257                               PANEL I258259                              ----------260261    STATEMENT OF THOMAS O'TOOLE, MD, ACTING ASSISTANT UNDER262  SECRETARY FOR HEALTH FOR CLINICAL SERVICES, VETERANS HEALTH263ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS ACCOMPANIED264BY KENNETH SMITH, ASSISTANT DEPUTY UNDER SECRETARY, OPERATIONS265   MANAGEMENT, OFFICE OF FIELD OPERATIONS, ACTING EXECUTIVE266       DIRECTOR OF EDUCATION SERVICES, VETERANS BENEFITS267   ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND268  PHILLIP W. CHRISTY, ACTING PRINCIPAL EXECUTIVE DIRECTOR AND269 CHIEF ACQUISITION OFFICER, U.S. DEPARTMENT OF VETERANS AFFAIRS270271    Dr. O'Toole. Thank you, Senator, and before I begin I want272to apologize for the delay in getting the testimony before the273Committee.274    Chairman Moran. Dr. O'Toole, that was part of my opening275statement, critiquing that fact, which I left out.276    Dr. O'Toole. Well, now we are covered.277    Chairman Moran. Yes, sir.278    Dr. O'Toole. While the Department has provided detailed279views in my written statement, I would like to highlight280several of the bills we will be discussing today.281    VA supports the intent of S. 1591, Acquisition Reform and282Cost Assessment Act of 2025, but recommends amendments to283ensure effective implementation. VA does not support Section 6284of the bill, which would require VA to establish a cost285assessment and program evaluation office.286    VA supports S. 214, the MEDAL Act of 2025, subject to287amendments and the availability of appropriations.288    VA strongly supports the goal of S. 1533. We do recommend289amendments to certain provisions and are happy to work with the290Committee.291    Regarding S. 649, Guard and Reserve GI Bill Parity Act of2922025, the Department is still examining the bill and is unable293to provide comprehensive views at this time.294    The Department supports the principles behind expanding295access and simplifying eligibility for community care as it296appears to be the intent in S. 219, the Veterans Health Care297Freedom Act. However, VA believes enacting the Veterans' ACCESS298Act of 2025 would be a better way of ensuring veterans can299receive care from community providers.300    We support the intent of S. 506, to improve care301coordination for veterans dual eligible for Medicare and VA302health care. However, VA has concerns with certain provisions.303    Similarly, VA supports the intent of S. 800, which aims to304advance critical research in brain health, blast exposure, and305a potential treatment for veterans adversely impacted by their306military service. We would appreciate the opportunity to work307with the Committee to discuss any concerns we have with this,308and also to discuss our research efforts.309    VA supports S. 585, S. 635, S. 778, and S. 1441. Regarding310S. 605, the CHAMPVA Children's Care Protection Act of 2025, VA311does not support extending CHAMPVA benefits to children up to312age 26.313    We support the intent of certain provisions in both S. 784314and S. 827, which would expand grant programs aiding315transportation to rural veterans. And we are happy to work with316the Committee on technical assistance toward those bills.317    We do not support S. 599, the DRIVE Act.318    This concludes my testimony. Thank you, and we are prepared319to answer and respond to any questions you or other members of320the Committee may have.321322    [The prepared statement of Dr. O'Toole appears on page 33323of the Appendix.]324325    Chairman Moran. Dr. O'Toole, thank you very much for your326testimony. I appreciate the VA's support for one of the bills327on the agenda that I introduced, the Coordinating Care for328Senior Veterans and Wounded Warriors Act, and your willingness329to work with me to make certain we are facilitating timely and330efficient information sharing between the VA and CMS and331avoiding duplication.332    In the interim, between now and potential enactment of this333legislation, what is the VA doing to accomplish these outcomes?334    Dr. O'Toole. Thank you, Senator. The concerns we have with335this bill are primarily related to the fact that it addresses336many of the things that we are already doing. One of the337primary concerns is related to--we currently provide care338coordination, and care coordination through the primary care339group at the VA. The added provision of having additional care340coordination runs the risk, in our view, that we could have341redundancy in that care and redundancy in those services.342    A significant provision to the bill is the information343sharing between CMS and between the Medicare providers to CMS344and VA care. This is a long-standing challenge and issue, one345that we have currently in the community care effort. We are in346the process, particularly through our EHRM efforts and347expansion in Oracle Health, developing a health exchange that348does provide a more timely way for sharing medical records, and349we expect with more rapid transition of implementation of that350EHR, we will have a better system in place for the record351sharing we are discussing.352    Chairman Moran. Thank you. Let me ask Mr. Smith this353question. As VBA continues to tackle the claims backlog as well354as remands from the Board of Veterans' Appeals, timely and355high-quality medical disability exams are important. My bill,356the VA License Portability Act, would permanently authorize the357VA License Portability Pilot Program for contract medical358disability examiners.359    Would you speak to why this is important and what the360current hindrance is for veterans receiving medical disability361exams in a timely manner, absent expanded license portability362for contract examiners?363    Mr. Smith. Thank you for the question, Senator. We strongly364support this. Of course, we are operating under a pilot program365that has been in existence since 1996, and we are eager to move366to a more permanent structure.367    We do have a couple of concerns, just with the designation368of physicians in the bill. We would prefer to use health care369providers because 86 percent of our exams are currently370conducted by non-physician health care providers. And last, I371would say we have concerns with the submission of evidence to372the contract examiners. We would prefer that those records come373directly to VA, because we do not have contractual privity with374the actual providers. They are all subcontractors to the four375main contract vendors.376    Chairman Moran. Thank you. I am going to cut my questions377short. Senator King and Senator Hassan, there has not been a378coup. I expect Senator Blumenthal to arrive. And there is379almost no member of this Committee who could remain here past3805, so we are trying to be very timely.381    And I now recognize Senator King for his questions.382383                    HON. ANGUS S. KING, JR.,384                    U.S. SENATOR FROM MAINE385386    Senator King. I have no questions because I believe that387the testimony is that this witness supports all of the bills388that I have introduced. So I commend you for your insight and389the deep intelligence.390    [Laughter.]391    Chairman Moran. I think I am going to make sure you are a392co-sponsor of every bill that I introduce.393    [Laughter.]394    Senator King. But I do note that there are reservations395about some amendments that you want to discuss. I am happy to396work with you on those, because there are some very important397provisions here. So thank you.398    Thank you, Mr. Chairman.399    Chairman Moran. You're welcome. While Senator Blumenthal400gets settled, I will recognize Senator Hassan.401402                   HON. MARGARET WOOD HASSAN,403                U.S. SENATOR FROM NEW HAMPSHIRE404405    Senator Hassan. Thanks very much, Mr. Chair. Dr. O'Toole,406it is good to see you again. A few weeks ago we discussed VA's407plan to fire 80,000 workers. You testified then that despite408being the Acting Chief Medical Officer at the VA, you had not409been consulted about how this plan would affect care for410veterans.411    Two weeks ago, I asked Secretary Collins about this, and I412alerted him to the fact that the top doctor at the VA had not413been consulted about how this plan might help or harm veterans'414health care.415    Since we last spoke Dr. O'Toole, has anyone at VA asked for416your input or analysis or asked you to oversee any analysis417done by the VA's Clinical Services Department regarding how418firing 80,000 VA employees would affect veterans' care?419    Dr. O'Toole. Thank you, Senator, and I appreciate the420opportunity to respond. I will note two things. One is that421there is a larger process. I appreciate the title of ``Top422Doc,'' but there are several clinicians, physicians senior to423me who are actively involved in this. It is very much pre-424decisional. The specifics to the questions you have asked, I do425not know. I am not aware of. But that does not mean that these426analyses are not ongoing. I would have to take it for the427record and respond to you on that. But I am happy to speak to428the legislation we have.429    Senator Hassan. Well, that would be excellent. Can you tell430me who the doctors senior to you, or the clinicians senior to431you are, who are involved in this analysis?432    Dr. O'Toole. I would like to get back to you on the433specific names on that if I can, ma'am.434    Senator Hassan. Okay. You know, part of our job is435oversight, and there have been bipartisan concerns, obviously,436about what Secretary Collins says is a plan or a goal to fire437this many workers. And it is really important that we438understand what kind of analysis is being done before they go439forward with the decision. I expect them to do analysis. I440expect them to measure. I expect them to consult with you and441other clinicians to understand what the interplay between the442clinician is and, let's say, somebody who orders supplies at443the VA. And I think we are running out of time here, and I keep444kind of getting these answers, either they have not consulted445you or you cannot tell me who they are consulting.446    So we will certainly submit a question for the record, but447I hope you will take back to the Secretary and his whole team448our expectation that they really lay out who is doing this449analysis.450    Now, the President recently signed an Executive order that451requires the Secretary of the VA to commission a feasibility452study and an action plan to expand services to support a full-453service medical service in New Hampshire. This is a really good454first step. We have needed that full-service medical center in455New Hampshire for a long time. We are the only state in the456contiguous United States that does not have its own full-457service medical center.458    But I want to make sure that this problem gets the459attention it deserves and that Granite Staters get the best460possible care. It is critically important that the VA and the461Administration engage with New Hampshire veterans, VSOs, and462other Granite Staters on the ground to get their input and463feedback. As you know, my colleagues and I have been advocating464for this full-service VA for a long time, but we want to make465sure that as plans are going forward, veteran care is not466disrupted at our current facility, and I want to make sure that467the Administration is reaching out to get input from folks on468the ground in New Hampshire.469    So Dr. O'Toole, how will the VA decide what new clinical470services to provide to veterans in New Hampshire at the471hospital, and how will the VA engage with Granite Staters to472make sure the new facility meets the unmet clinical needs of473our veterans, and what will the timeline be for this kind of474decision?475    Dr. O'Toole. Thank you, Senator, and first, fully476acknowledge and agree with all the points you are making, and477that would be the process I would expect would be underway. I478do not know, and I am not prepared to be able to speak to the479specifics to that. I would have to take it for the record, in480terms of where we are with that planning and what the process481will be.482    Senator Hassan. Well, I appreciate that. From what I am483hearing on the ground, nobody has heard anything from the VA,484from the White House since the President's Executive order,485which makes us wonder how much of this is window dressing and486how much of this is real, right. So we really would appreciate487outreach, and again, if you all will take that back to the488Secretary's office that would be very helpful.489    I have more questions. I will submit them for the record.490Thank you, Mr. Chair.491    Chairman Moran. I now recognize the Ranking Member, Senator492Blumenthal.493494                  HON. RICHARD BLUMENTHAL,\1\495         RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT496---------------------------------------------------------------------------497498    \1\ The opening statement for Senator Blumenthal appears on page 29499of the Appendix.500---------------------------------------------------------------------------501    Senator Blumenthal. Thank you, Mr. Chairman, and I502apologize. I have another subcommittee, the Subcommittee on503Permanent Investigations, which is ongoing, as Senator Hassan504knows, because she is also a member of that subcommittee, and505it is still ongoing. So I do apologize.506    Before I begin, I want to ask consent to enter into the507record a recent New York Times article entitled ``Trump's Push508to Defund Harvard Prompts Clash Over Veteran Suicide509Research.''510    Chairman Moran. Without objection.511512    [The article referred to appears on page 113 of the513Appendix.]514515    Senator Blumenthal. Thank you. This article, I do not know516whether you are familiar with it, Dr. O'Toole, shows that there517are multiple contracts between the VA and Harvard University518that are planned to be canceled, including contracts involving519VA suicide prevention efforts and contracts ensuring veterans520have adequate access to clinical trials.521    VA officials are quoted in the article saying that522canceling these contracts would result in, quote, ``more523veteran suicides that could have been prevented,'' end quote.524They are raising the alarm and pleading with VA leadership not525to cancel these highly critical contracts.526    Dr. O'Toole, are you aware of this situation?527    Dr. O'Toole. I have seen the article, sir, and I have528heard, obviously I have heard it as you have as well, and the529concerns. I would have to take for the record any specifics on530the status of those deliberations.531    Senator Blumenthal. Well those research contracts are532important to prevent veteran suicide, are they not?533    Dr. O'Toole. Absolutely, sir. I am not, by any means,534disputing the nature of the research nor the importance of it.535    Senator Blumenthal. Do you agree with their cancellation?536    Dr. O'Toole. Sir, I am not here to discuss the specifics of537that. I am not prepared to be able to discuss that from a538departmental perspective, but happy to take for the record what539the status of those considerations are.540    Senator Blumenthal. Well, I do not mean to be541disrespectful, but veterans may be dying as a result of these542contracts being canceled. You have been involved in the VA for543some time. I am disappointed that you will not express perhaps544a more critical view of what is happening here.545    Dr. O'Toole. Well, thank you, sir, and as somebody who has546done research in the VA, I can fully appreciate that. I just do547not want to get ahead of my skis here in speaking for the548Department on this, so I do need to take it for the record.549    Senator Blumenthal. Well you are here on behalf of the VA.550And I am just going to be really direct. We have been asking551the VA about these contracts, including the Harvard contracts,552for more than a month, and we have received no response. So553that when people come to me and say, ``Why are you holding554these nominations?'' and I say, ``It is because the VA is555denying us essential information that is necessary for our556oversight and we want accountability. Here is Exhibit A, saving557lives.''558    The VA has no more foundational and essential purpose than559stopping veteran suicide, and it has denied us and refused to560provide information, purposefully. It cannot be an accident,561but purposefully. And I know you are on the receiving line of562this complaint, and make no mistake, I know you are not the one563responsible.564    So, when you take this message back, and you get back to565us, and I am not going to berate you further, you should make566clear that here is the reason why we are putting a hold on567these nominees and why we are extremely disappointed, I will568put it euphemistically, with the response so far.569    And just so we also understand why we are here today, a lot570of great legislation. The Children's Care Protection Act, other571measures that are important to advance the authority of the VA.572    We still do not know the number of fired VA employees, as573well as the canceled VA contracts. We have no idea when, if574ever, we will have the VA lift its freeze on rulemaking.575Remember, rulemaking is important to legislation. Legislation576cannot be implemented until the rules are in place. And we have577no idea when that freeze will be lifted so laws can be578implemented.579    Here we are talking about new laws. Laws are dead letter if580there are no rules and regulation. Laws are also dead letter if581there is no workforce to implement them. If people cannot582enforce them and carry them out, they have no meaning. And the583VA is planning, it's the stated goal of the VA Secretary, to584cut 83,000 employees who are important to carry out those laws.585    So, the laws we have passed already, the PACT Act and the586Elizabeth Dole Act, great bipartisan measures. They are going587to be dead letter if we do not provide the resources for them588to be implemented and if the slash-and-trash approach is589carried forward.590    My time has expired. Mr. Chairman, thank you.591    Chairman Moran. You are welcome. Thank you, Senator592Blumenthal. Senator Sheehy.593594                        HON. TIM SHEEHY,595                   U.S. SENATOR FROM MONTANA596597    Senator Sheehy. No questions at this time.598    Chairman Moran. Thank you, Senator. Senator Murray.599600                       HON. PATTY MURRAY,601                  U.S. SENATOR FROM WASHINGTON602603    Senator Murray. Thank you, Mr. Chairman. Dr. O'Toole, thank604you for being here. You know, women veterans, particularly605those who have suffered from PTSD or sexual assault, tend to606experience menopause much earlier than women who did not serve607in the military. One VA study found that 15 percent of women608veterans experience menopause before the age of 40. That is 10609years earlier than most women. It is really important that we610strengthen menopause research at the VA and DoD so we can611provide better care for women servicemembers and our veterans.612    That is why I was very proud to join Representative613Houlahan and Senator Ernst in introducing the Servicewomen and614Veterans Menopause Research Act last month to do that. Can you615tell me today what resources are available right now, at the616VA, for women veterans who are experiencing menopause? Are617there any plans to expand that, and what do you have right now?618    Dr. O'Toole. Thank you, Senator, and first I acknowledge619and fully appreciate and agree with what you are saying there.620I do not have that information readily available in terms of621what resources are currently being dedicated. I would have to622get it for the record.623    Senator Murray. Okay. How long will that take you to get to624me?625    Dr. O'Toole. We will get it as quickly as we can.626    Senator Murray. Okay.627    Senator King. But do you support the bill?628    Dr. O'Toole. Yes. Yes, we strongly support the bill.629    Senator Murray. Thank you. During a hearing earlier this630month I actually asked Secretary Collins about the Trump631administration's 90-day pause on VA clinical trials, which is632right now delaying planned trials and putting a halt to ongoing633clinical trials at VA, everything from predicting stroke risks634to addressing substance abuse. Now, Secretary Collins said at635the time, there was no decision regarding what would happen to636VA researchers and trials when that pause ended.637    Do you have an answer to that question I asked a few weeks638ago? What will happen after this 90-day pause ends? Where will639you direct these patients whose clinical trials were canceled640or delayed?641    Dr. O'Toole. Thank you, Senator. Unfortunately, as noted642earlier, I do not have that information available to me. I have643to take it for the record.644    Senator Murray. You do not have any idea?645    Dr. O'Toole. I do not. No, ma'am.646    Senator Murray. Can you provide my office with a list of647clinical trials that were canceled?648    Dr. O'Toole. Again, I do not have that available but we can649get that information to you. Yes, ma'am.650    Senator Murray. Well, the VA has to have this information.651Certainly if you care about transparency, which we keep652hearing, I see no reason why this information would be secret.653When can you get that information to us? These are people who654are in trials. These are researchers. Just for the next 10655years they are not supposed to know? When are you going to get656that to us?657    Dr. O'Toole. We will get it to you as soon as we can,658ma'am.659    Senator Murray. What does that mean? I have heard that from660so many people in the last couple of weeks.661    Dr. O'Toole. I would obviously defer to our legislative662team and our research office on those specifics, but I would663imagine we would be able to get----664    Senator Murray. It is a disappointing response, I have to665tell you.666    Dr. O'Toole. Okay. I would imagine we would be able to get667it to you within the next few weeks, 1 to 2 weeks hopefully.668    Senator Murray. Okay. Well, let me try one more. Women are669the fastest-growing demographic within the veteran population.670You know that. VA was not initially built for women. It is our671collective responsibility to honor women who have bravely672served our country by taking action to remove barriers that for673too long have restricted their access to the benefits that they674earned and the health care that they earned. And I really675believe the goal should be a VA system that offers women676comprehensive at every stage of life post-service.677    Actually, in my home State of Washington, Puget Sound VA678saw a 7 percent increase in women veterans utilizing their679service over the past few years.680    I am appreciative of the mobile mammography centers that681were made available for our Puget Sound veterans, but it is a682temporary fix. Can you provide me any update today on the683progress in establishing a permanent in-house mammography684service for veterans in VISN 20, or a timeline?685    Dr. O'Toole. I do not have the specifics, but I am happy to686track those down, and we can get back to you on it.687    Senator Murray. Okay. I would appreciate answers to those688questions as soon as you can. This is critical information that689we need. Thank you.690    Chairman Moran. Thank you, Senator Murray. Senator691Blumenthal.692    Senator Blumenthal. Thank you, Mr. Chairman. I have one693more question. And by the way, I strongly support Senator694Murray's Servicewomen and Veterans Menopause Research Act. It695is a great piece of legislation, another example of how a696hiring freeze and firings are chipping away at VA research, and697we should have the answers to the questions that she asked.698    Let me turn to the Elizabeth Dole Act. Earlier this week,699the VA announced it will be implementing Section 101 of the700Elizabeth Dole Act, which would definitively give a veteran and701their referring VA clinician the final decision regarding702eligibility for community care. Our Committee is still waiting703to learn or hear how or when the VA will implement dozens of704other critical sections of the bill. This is what I am talking705about--implementation, rulemaking, time-sensitive provisions706such as raising the grant and per diem rate for homeless707veterans and expanding home and community-based care for708veterans with ALS or spinal cord injuries, provisions that709directly impact the most vulnerable veterans we serve. They710were top of mind when, in a bipartisan way, our Committee and711our Senate passed this measure, overwhelmingly.712    If the VA is stalling implementation of the Dole Act and713planning to fire tens of thousands of staff, how can the714Department adequately implement this additional legislation715that we are considering today?716    Dr. O'Toole. Well, Senator, thank you, and I would first717acknowledge that the provisions in the Dole Act are ones that718we fully endorse and are actively working to implement, and719being personally involved in several of the sections, it is720something that we are working on, and I am hoping that we will721have results shortly. And I am happy to be reporting back to722your staff on those updates.723    Senator Blumenthal. Thank you. Mr. Chairman, in the724interest of time, I am going to submit my other questions for725the record, and we can go on to our next panel.726    Chairman Moran. Thank you, sir. Senator King, in quick727summary of the bills I have introduced that are being728considered today, at least half of the bills that I have729introduced, you are the primary co-sponsor. So I look forward730to seeing great success in my efforts [laughter.] The other731ones are with Senator Blumenthal. We will see how you compare.732    [Laughter.]733    Chairman Moran. They loved every one of his bills.734    Thank you all very much for your presence here today. As735you can see, the Committee has lots of questions that are736broader than the scope of this hearing, and we would continue737to encourage the Department of Veterans Affairs to provide the738information requested by any member of this Committee, any side739of this Committee, and to forthrightly provide us with the740information our staffs have asked for.741    Thank you, Dr. O'Toole, and your team.742    I welcome our second panel, and I will go ahead and743introduce you, even though you cannot quite get there yet.744Testifying with us today is Morgan Brown, the National745Legislative Director for the Paralyzed Veterans of America;746Brian Dempsey, the Director of Government Affairs for Wounded747Warrior Project; and Jon Retzer, the Deputy National748Legislative Director for the Disabled American Veterans.749    I thank all three of you for being here. Thank you for the750work that you do for veterans, and thank you for your751organizations that you represent who take such care and concern752for those who served our country.753    Mr. Brown, we will recognize you first.754755                               PANEL II756757                              ----------758759   STATEMENT OF MORGAN BROWN, NATIONAL LEGISLATIVE DIRECTOR,760                 PARALYZED VETERANS OF AMERICA761762    Mr. Brown. All right. Thank you, Mr. Chairman and Ranking763Member Blumenthal, Members of the Committee. PVA certainly764appreciates the opportunity to appear before you today to765discuss some of the bills that you are looking at.766    First, though, I would like to just take a moment and767recognize the fellows that are here from the Elizabeth Dole768Foundation. We have had the privilege of spending some time769with them the past couple of days, and I know that they have770been out visiting some of the congressional offices, and771hopefully you had an opportunity to speak with some of them.772    PVA supports the overwhelming majority of the bills that773are on the agenda today. I would be remiss if I did not774publicly acknowledge our support of the Rural Transportation775bills, the 3R Caregiver bill, the SAVES Act, and the Fourth776Administration bill. So I am just going to limit real brief777comments on three of the others.778    The first is the Veterans Accessibility Advisory Committee779Act. Over the last five decades, Congress has spent a780considerable amount of time passing legislation to improve781disability access to both Federal facilities, especially the782VA, and, in some cases, into the private sector. These laws783provide critical protections to people with disabilities when784they interact with all levels of the government and many785everyday accommodations like medical offices, grocery stores,786and hotels.787    Despite all of this effort and these legal requirements,788our members routinely face disability access barriers when it789comes to accessing VA care within VA facilities and within the790community. We have appeared before the Committee before. We791have discussed some of the problems that we have encountered.792Senator Murray mentioned the fact that a lot of VA facilities793were not originally fitted for women veteran health care.794    I recall one instance where a woman veteran clinic was795established for VA but it did not have like the outdoor796controls, the handicapped controls, so that one of our members797could enter that facility. And unfortunately, the office staff798were positioned within the facility in such a manner that they799were not able to see anybody at the door, and our member was800stuck outside of the door until somebody came to the door and801was able to let them in. Those are the types of barriers that802we are talking about.803    Because of the complex nature of injuries and illnesses804that our members face, we tend to access VA care much more so805than the average veteran, and we believe that VA should lead806the way in accessibility for disabled veterans, so we are807strongly supporting this bill, which directs VA to create an808advisory committee on issues relating to the accessibility of809VA benefits, services, and facilities, but not just within VA,810granted the push toward the private sector. We need to make811sure that there is greater emphasis on the accessibility of the812primary care facilities, as well.813    Next, you are familiar that VA pays eligible veterans and814caregivers mileage and other travel expenses to and from815approved health care appointments, but the current816reimbursement rate is too low. Fifteen years ago, Congress set817the rate at 41 cents per mile. That was based on the Federal818rate at the time. Since then, the Federal rate has increased819significantly, but VA has remained stagnant, even though the820cost of gas and vehicle maintenance and car insurance has821increased dramatically. We support this bill, which ties the822veteran's mileage rate to the GSA rate, and we believe that823this will help improve veterans' access to their health care824services and reduce their financial burden.825    Senator King. Which bill is that, please?826    Mr. Brown. That is S. 599.827    Finally, we support the CHAMPVA Children's Care Protection828Act. This is the bill that would allow the surviving spouses,829family members using the CHAMPVA program to remain in the830program until age 26. Back in 2011, after the ACA extended this831health care to all of the other Federal programs and health832insurance programs, DoD made the change. VA did not. And so833these family members of veterans are forced out of the program,834the latest at age 23, and we believe that this program should835allow them to remain in until age 26. Thank you.836837    [The prepared statement of Mr. Brown appears on page 74 of838the Appendix.]839840    Chairman Moran. Thank you very much, Mr. Brown.841    Senator Blumenthal. Mr. Chairman, if I could just----842    Chairman Moran. Senator Blumenthal.843    Senator Blumenthal [continuing]. Apologize to the panel. I844am obligated to go to the floor of the Senate. I would have845asked you a question about how the cutbacks in staff might846affect your view of how the Department is functioning. I will847submit that question for the record. I appreciate the Chairman848giving me this opportunity to apologize and explain the reasons849for my absence. It is not out of lack of interest. And I know850Senator King will be here. I yield to him my time. And since851the Chairman seems to regard him as a favorite anyway----852    [Laughter.]853    Senator Blumenthal [continuing]. I know I will not be854missed.855    Chairman Moran. Just because you are associating with856Senator King does not mean you can get your way on everything.857    [Laughter.]858    Senator Blumenthal. Thank you.859    Chairman Moran. Senator Blumenthal, thank you. Senator860Blumenthal and I both had nothing on our schedules whenever the861point in time is we chose this date and time for this hearing,862and it just has not worked to remain that clear today. We are863still trying to figure out--I am still trying to figure out864what time of the day and what day of the week is our best865opportunity to be most available to most members so that we can866hear the most amount of testimony and interact with those who867come before us.868    Mr. Dempsey, you are recognized.869870              STATEMENT OF BRIAN DEMPSEY, DIRECTOR871         OF GOVERNMENT AFFAIRS, WOUNDED WARRIOR PROJECT872873    Mr. Dempsey. Chairman Moran, Ranking Member Blumenthal, and874distinguished Committee members, thank you for inviting Wounded875Warrior Project to testify on legislation intended to improve876access to care and benefits for our Nation's veterans.877    Today's agenda includes many bills that are aligned with878our mission to honor and empower wounded warriors, and I am879pleased to speak on several that would have a heightened impact880on the post-9/11 wounded, ill, and injured veterans we serve.881    To help those struggling with invisible wounds we strongly882support the Precision Brain Health Research Act as the next883step in Federal action to address the service injuries caused884by blast exposure. Low-level blast injuries have received885increased attention thanks to recent reporting from The New886York Times and 60 Minutes, but they have also been the subject887of congressional action on the prevention side. The Precision888Brain Health Research Act would bring focus to veterans' health889care.890    The bill would leverage VA's biomarker research891capabilities and precision medicine initiative to learn more892about the long-term health effects of blast injuries and893translate those findings into better and more personalized894treatment plans. Over time, the bill will help transform the895way we care for those affected by brain injury and ultimately896help many veterans lead longer, healthier, and more productive897lives.898    On a similar note, we support the Coordinating Care for899Senior Veterans and Wounded Warriors Act. With clear900acknowledgement in its title, this bill speaks to the fact that901many veterans are relying on Medicare and VA's geriatrics and902extended care programs earlier in life after being903catastrophically wounded in service.904    Five percent of VHA-enrolled veterans under the age of 45905have Medicare coverage, along with another 15 percent of those906between the ages of 45 and 60. For many in these categories,907the bill would help address their priorities like better care908coordination and patient advocacy through a 3-year pilot909program aimed at improving care, lowering costs and eliminating910gaps in care and duplication of services. There is clearly much911that can be learned from this pilot, so we strongly advocate912for the bill's passage as a key for systemic improvements.913    To help care for women veterans, we are proud to endorse914the Servicewomen and Women Veteran Menopause Research Act,915which would require VA and DoD to evaluate and conduct research916on menopause, perimenopause, and midlife women's health. This917legislation represents a long-overdue recognition of the unique918and evolving health care needs of servicewomen and women919veterans as they age.920    To help the hidden heroes who have supported the most921severely injured warriors in our community, we are pleased to922endorse the Veteran Caregiver Reeducation, Reemployment, and923Retirement Act. By passing this legislation, Congress can924invest in the well-being of caregivers, ensuring they have the925resources needed to reclaim their careers, stabilize their926financial futures, and transition out of their caregiving roles927with dignity.928    Finally, I want to highlight our support for the Veterans929Accessibility Advisory Committee Act of 2025, which has930companion legislation that was passed by the House yesterday.931Establishing an advisory committee on equal access will help932ensure that accessibility is built into every aspect of VA's933operations, from facilities and medical equipment to digital934platforms and communication tools, all of which are critical935parts of a system that should provide accessibility groups with936a seat at the table.937    Thank you again for the opportunity to testify at today's938hearing. Like I said, we support many of the bills on today's939agenda. But this concludes my testimony, and I look forward to940your questions. Thank you.941942    [The prepared statement of Mr. Dempsey appears on page 84943of the Appendix.]944945    Chairman Moran. Thank you, Mr. Dempsey. Mr. Retzer, you are946now recognized.947948 STATEMENT OF JON RETZER, DEPUTY NATIONAL LEGISLATIVE DIRECTOR949             FOR HEALTH, DISABLED AMERICAN VETERANS950951    Mr. Retzer. Thank you, Chairman Moran, Ranking Member952Blumenthal, and Members of the Committee. Thank you for the953opportunity to testify today, and in respect of your time, that954you are all busy, I just want to highlight that DAV, out of all955the 20 bills, we support 20 of them with some recommendations,956and 5 we have no concerns. However, we urge the Committee to957carefully review the following legislation.958    S. 506 aims to enhance the care coordination for veterans959enrolled in both VA and Medicare, but it lacks clarity on case960management and oversight and training standards. Without strong961VA oversight, veterans face fragmented care and inadequate962coordination between providers, especially since many private963sector providers lack specialized expertise in service-964connected conditions. DAV urges the Committee to prioritize VA-965led case management and provide necessary training to ensure966seamless, high-quality care for the dual-enrolled veterans.967    S. 635 expands homecare access through nurse registries968within the Veterans Community Care Network. While increasing969homecare options is critical, the inclusion of non-medical970roles, such as companions and homemakers, raises oversight971concerns and liability issues tied to the nurse registry.972Regulatory changes vary across states, potentially limiting973veterans' access to reliable home-based care. DAV recommends974refining the bill's language to clearly define the nurse975registry's functions within existing VA homecare initiatives,976ensuring consistency and quality of services.977    Finally, S. 219, the Veterans Health Care Freedom Act,978proposes expanding private sector options, but DAV strongly979opposes this measure. While community care is vital for980veterans facing excessive wait times or travel burdens, a981balanced approach is necessary. Diverting resources from VA982without additional funding would weaken specialized care983designed for service-disabled veterans. Private sector984providers often lack the expertise adequate to address985conditions related to military service, leading to fragmented986and inconsistent care. DAV urges Congress to increase in the VA987staffing infrastructure and research to strengthen the VA988system and maintain VA as the primary provider while989integrating an effective Community Care Network.990    DAV members who rely heavily on the VA health care system991believe it remains the best choice because it provides the992comprehensive, whole-health model of care tailored to veterans'993unique needs. Our nation's veterans deserve nothing less.994    This concludes my testimony, and I am pleased to answer any995questions you or the Committee may have.996997    [The prepared statement of Mr. Retzer appears on page 99 of998the Appendix.]9991000    Chairman Moran. Thank you for your testimony. Senator King?1001    Senator King. I am comfortable with the testimony. I look1002forward to working with all of you as we refine these bills. I1003appreciate the comments today, and we will continue to be in1004touch as we move forward with these bills. But thank you. Very1005helpful testimony. Thank you, Mr. Chairman.1006    Chairman Moran. Thank you, Senator King. Mr. Brown, your1007testimony was very compelling or catching to me about the VA1008and its incapacity, its lack of capability of meeting the needs1009of veterans with disabilities. It seems like one of the last1010places we would expect to find that to be a problem, and it is1011legislation that I am introducing that you are talking about.1012But until you gave your testimony it was not that evident to me1013that there would be such a significant challenge at the1014Department of Veterans Affairs in meeting the needs of all1015veterans.1016    What impediments does the VA have in fixing this problem,1017and what efforts are they undertaking to, I don't want to say1018whittle away, but to solve this problem even over a period of1019time?1020    Mr. Brown. Well, in truth, I mean, VA has made great1021strides in trying to improve accessibility.1022    You know, one area I did not have a chance, because we were1023attempting to try to shorten things up here, but is probably a1024good example of an area maybe for the Committee to look at is1025the accessibility of diagnostic equipment. We are talking about1026mammograms, the x-ray machines, dental chairs, weight scales,1027even x-ray machines themselves.1028    In 2017, the U.S. Access Board published new accessibility1029standards for medical diagnostic equipment, and shortly after1030that VA jumped on board, very proactively, so that they would1031adopt those standards to ensure the needs of disabled veterans1032were met. But since that time we have no updates. We do hear1033from our members who have been unable to receive dental care at1034VA facilities because the chairs cannot accommodate them, they1035cannot get their x-rays or their mammograms because the1036equipment could not access them.1037    So clearly there is a problem there, and I would encourage1038the Committee, maybe, this should be an area to do some1039additional oversight on, and not only see how far VA has come1040toward adopting these standards but what else needs to be done.1041    Chairman Moran. Mr. Brown, thank you. What you are doing is1042again causing me to recognize it is not necessarily the1043automatic door or the curb cut, things that I might think of as1044being an impediment, but it is the actual equipment and the1045access to that equipment.1046    Mr. Brown. You know, sometimes I think--if I may, sir--it1047may be because some of these changes are being made, or they1048are not being made with the view of the veteran in mind. And1049case in point, we had a veteran that went into the chapel1050between appointments, and was stuck in the chapel because the1051door did not have the push bar or the automatic door opener for1052them to get out, so they were stuck in the chapel until1053somebody came along to let them out.1054    Had you had an advisory committee like this legislation is1055proposing, you would have veterans on that committee that would1056serve as advisors to the Department and then offer suggestions1057coming specifically from the perspective of a veteran with a1058complex illness or injury.1059    Chairman Moran. Senator King?1060    Senator King. I want to follow up on exactly that point. It1061strikes me that you have members all over the country, as all1062of you do. Perhaps you could have a project of examining the1063accessibility of various VA facilities and letting the VA know.1064In other words, give them an inventory--the back door at the1065Veterans Hospital in Knoxville is not accessible. Do you see1066what I mean, to use your membership and other veterans and VSOs1067to kind of survey the veterans facilities and advise the VA and1068us about where accessibility needs to be. Because often1069individuals who are not wheelchair-bound do not really1070appreciate the height of the button, for example. I think you1071could be very helpful in that.1072    Mr. Brown. So I thank you for the recommendation. I know in1073many cases once a problem is identified, working through our1074service officers we do notify the facility, and then we work1075with the Department to get those corrected. But sometimes--and1076I am just putting on my old IG hat from my time in military1077service--a problem may be identified in one facility and1078actually exists in other facilities. So there needs to be a1079system internally to where a problem has been identified, look1080throughout the Department, does this problem exist elsewhere,1081and here is how to correct it.1082    But I will take that back to my leadership and we will see1083what we can do.1084    Senator King. I am thinking of a nationwide audit.1085    Mr. Brown. Okay.1086    Chairman Moran. Thank you, Senator King. My thoughts are1087just, personally, I visit lots of VA facilities. I ought to ask1088the question and be observant myself. So thank you for1089highlighting that.1090    Mr. Dempsey, the Veterans Caregiver Reeducation,1091Reemployment, and Retirement Act, tell me, and tell the1092Committee, why it is important to assist family caregivers1093transitioning back into the workforce or into retirement once1094they are no longer needed as full-time caregivers.1095    Mr. Dempsey. Thank you for the question, Chairman. A recent1096report that RAND had published, and again, Wounded Warrior1097Project is often focused on the post-9/11 wounded, ill, and1098injured community, that RAND report had found that about 361099percent of post-9/11 caregivers had reported income below 1301100percent of Federal poverty levels, and that many were lacking1101basic health insurance or emergency savings. And particularly1102for those who are leaving the program of Comprehensive1103Assistance for Family Caregivers there can be additional1104challenges when those caregiving responsibilities conclude, as1105many of the benefits are not portable or inclusive of1106retirement benefits.1107    So what the Veteran Caregiver Reeducation, Reemployment,1108and Retirement Act would do essentially is bundle all of those,1109I think, elements that are essential to whether it be1110reclaiming your career, entering retirement on a comfortable1111level, and making sure that your financial security is future1112and that you can enter the world post-caregiving1113responsibilities with more confidence and security.1114    Chairman Moran. Thank you. Mr. Retzer, you mentioned dual1115enrollees, and this is perhaps a question for any and all.1116Would you put into the record and educate me and perhaps others1117on what challenges dual-enrollees face, and how do you think1118this pilot program could establish the ways to address those1119challenges?1120    Mr. Retzer. Thank you for that question, and if VA had a1121system of interoperability, an EHRM that was in place, so let's1122put that up front, saying it is there for us, and to have the1123providers, between VA and Medicare, to be able to understand1124the priority of the veterans. The veteran's complexity is they1125are at the VA medical center under eight priorities. We know1126that Priority Group 8 is a grandfathered-in priority, but when1127we look at the various priorities, they have service1128connections, Medal of Honor, Purple Heart requirements that1129fill in broad spectrum, plus their income.1130    So then we look at the aging population, which we know1131right now that 49 percent of the veteran population that are1132enrolled in the VA health care system is 65 or older, so they1133are meeting the requirements of Medicare. They have to enroll1134into at least Medicare B.1135    We would have to have training on the VA side, where the1136care coordinator has the expertise and the knowledge of both1137hemispheres, and to be able to understand what the priority1138groups are within the VA system to identify first their service1139connections that can be dealt with within the VA system,1140identifying also their demographics on where they live, because1141that is where the challenge comes. Like for your constituents1142in Kansas, they are mostly rural. So aging population in a1143rural community, they have to also be trained in the cultural1144competency, the understanding of the social dynamics of their1145own state, so that they can best facilitate when it is best to1146leverage Medicare when the costs can actually be saved on the1147veteran by providing care directly from VA, or in the veteran1148community program.1149    So there is going to have to be a very robust training1150program and oversight ensuring continuity of that care is not1151broken. It is really a big component of training and rule bases1152established.1153    Chairman Moran. Senator King.1154    Senator King. Mr. Retzer, I wanted to follow up on your1155testimony and just thank you for your strong testimony about1156community care not encroaching on the underlying mission of VA-1157provided care. I think that is something that we just have to1158keep our eyes on. There are those, I think, who would like to1159move further and further in that direction, but I believe that1160preserving the fundamental veterans' health care system is1161critically important. I take it you agree.1162    Mr. Retzer. Yes, Senator King, thank you for that. I think1163it is very important to look at what the veterans' needs are1164right now. We have heard concerns surrounding the veteran1165population of enrollment has stayed plateaued and the access to1166health care that veterans are enrolled in has also plateaued.1167    One thing that we have noticed in the VA dashboard reports1168and the annual budget is this trend that is not being spoken1169about, but it is reported, and that is the episodes of care. In11702019 to 2023, what we saw was that there was an estimate of 1201171million veteran episodes of care annually that was provided in11722019, and then in 2023, it was roughly about 130 million1173estimated episodes of care. That is a very important number1174because, like Senator Murray, one of the things that she is1175really sponsoring is our women veterans. There are now nearly 11176million enrolled in the VA health care system. We have an1177upward trajectory. And just like I said previously to Senator1178Moran's question is our veteran population of 49 percent at 651179and older, so they are needing more care.1180    Let alone, statistics also show us that 70 percent and1181higher ratings are being given more, so that means younger1182veterans have more catastrophic ratings from VA that is going1183to require medical assistance and services, to include long-1184term care.1185    So I think it is really important that we look at the needs1186of our veterans, and to even address the rural complications,1187remote areas, but also look at the specialized care that is1188really challenging our women veterans, our minority, LGBTQ+. So1189it is so important that we do some good research, and that is1190why DAV also says research is important.1191    Senator King. Do those episodes of care, does that data1192break out community care versus Veterans Administration health1193care?1194    Mr. Retzer. I would have to go back and look. I do know1195that there are----1196    Senator King. See if you could look to see if there are any1197trends in that data.1198    Mr. Retzer. Yes, there are some trends that indicate where1199community care is and how many they are having and also with1200rural veterans care. So we know that out of the 2.7 rural1201veterans, how much of their care is in what direction.1202    Senator King. Thank you, Mr. Chairman.1203    Chairman Moran. I am sorry you caused me to think of1204another question that you may or may not have an answer to, any1205of you. The veterans who are not enrolled in the VA, or not1206receiving health benefits, some may be just utilizing Medicare.1207Do we know the characteristics of the population that the VA1208does not serve? You started down a path of statistics about1209who, you mentioned women, Senator Murray's issue. What is the1210typical veteran who is not utilizing the VA? Do we know that?1211This may not be the panel.1212    Mr. Retzer. That is an interesting question, Senator, and1213with the data that we----1214    Chairman Moran. That is what I say when I do not know the1215answer.1216    [Laughter.]1217    Mr. Retzer. And actually, the interesting thing is this may1218spell out for you where we are at. We know that we have talked1219about 9 million enrolled veterans. And we know currently that1220as we look at the trajectory and the reports estimating that1221the numbers are coming down in the veteran population, and we1222are sitting at about 18 million. So that is kind of indicating1223to us that in the general population, half of them are enrolled1224in the VA health care system. Where are the rest going then? So1225they must be in the private sector, is what we look at, and we1226would anticipate that, if they are not enrolled in the VA1227health care system.1228    But we are looking further into that to see where the1229implications are.1230    Chairman Moran. I would be interested. This is a question1231for the VA, as well, and they may know these numbers. But is it1232young veterans who are not taking advantage of services from1233the Department of Veterans Affairs? People in rural America?1234People with disabilities? Women? Maybe there is no pattern to1235this, but I am going to try to find out in my own capacity who1236is not being served, and then look for ways that we can meet1237that particular segment of our veteran population. Make sense?1238I guess I am not supposed to be asking you to confirm that what1239I am asking is a good question.1240    I have one more thing. Senator King, do you have anything?1241    Senator King. I am all set. Thank you.1242    Chairman Moran. Okay. And that is--just one moment. I have1243a bill not with Senator King but with Senator Rosen, Fallen1244Servicemembers Religious Heritage Restoration Act, that is1245included in today's hearing. It would make certain that1246veterans buried overseas in cemeteries under the care of the1247American Battle Monuments Commission have grave markers that1248are accurately representing their religious faith.1249    I saw an episode on television about this topic, and it was1250compelling, and I am grateful for the support of today's1251witnesses. I want to just ask for unanimous consent that we put1252into the record comments on this legislation from the Jewish1253Community Relations Bureau of Kansas City, the American Gold1254Star Mothers, Inc., the Republican Jewish Coalition, Veterans1255of Foreign Wars, Gold Star Spouses of America, the American1256Legion, Vietnam Veterans of America, Non Commissioned Officers1257Association, and TAPS, the Tragedy Assistance Program for1258Survivors.1259    With no objection, it is so ordered.12601261    [The information referred to appears on pages 117-126 of1262the Appendix.]12631264    Chairman Moran. Would any of the three of you like to1265conclude? I always try to give my witnesses, our witnesses, the1266chance to add anything to the record or correct anything that1267you feel needs to be corrected. Any additional comments?1268    [No response.]1269    Chairman Moran. Thank you very much for your testimony.1270    [Pause.]1271    Chairman Moran. I look forward to working with all of you1272and your organizations, as this Committee does, to improve the1273circumstances and honor of those who serve.1274    The hearing record will remain open for five legislative1275days, and should any Committee member wish to submit additional1276statements or questions for the record, you may use that time1277to do so. I ask that today's witnesses respond to any questions1278for the record that you may receive following today's hearing,1279Doctor, in a timely manner.1280    And with that the hearing is adjourned.1281    [Whereupon, at 4:55 p.m., the hearing was adjourned.]12821283                            A P P E N D I X12841285                             Hearing Agenda12861287    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]12881289                           Opening Statement12901291[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]12921293                          Prepared Statements12941295    [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]12961297                       Statements for the Record12981299   [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]13001301                                  [all]