Oversight: Beyond the City Limits: Delivering for Rural Veterans

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                        BEYOND THE CITY LIMITS:56                     DELIVERING FOR RURAL VETERANS78=======================================================================910                                HEARING1112                               before the1314                SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION1516                                 of the1718                     COMMITTEE ON VETERANS' AFFAIRS1920                     U.S. HOUSE OF REPRESENTATIVES2122                    ONE HUNDRED NINETEENTH CONGRESS2324                             FIRST SESSION2526                               __________2728                         FRIDAY, JULY 25, 20252930                               __________3132                           Serial No. 119-333334                               __________3536       Printed for the use of the Committee on Veterans' Affairs3738  [GRAPHIC(S) NOT AVAILANLE IN TIFF FORMAT3940                    Available via http://govinfo.gov4142                 U.S. GOVERNMENT PUBLISHING OFFICE4361-507                  WASHINGTON : 20254445                     COMMITTEE ON VETERANS' AFFAIRS4647                     MIKE BOST, Illinois, Chairman4849AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking50    American Samoa, Vice-Chairwoman      Member51JACK BERGMAN, Michigan               JULIA BROWNLEY, California52NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire53MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,54GREGORY F. MURPHY, North Carolina        Florida55DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky56MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois57JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois58KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York59JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon60ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey61KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota62    Mariana Islands63TOM BARRETT, Michigan6465                       Jon Clark, Staff Director66                  Matt Reel, Democratic Staff Director6768                SUBCOMMITTEE ON TECHNOLOGY MODERNIZATION6970                    TOM BARRETT, Michigan, Chairman7172NANCY MACE, South Carolina           NIKKI BUDZINSKI, Illinois, Ranking73MORGAN LUTTRELL, Texas                   Member74                                     SHEILA CHERFILUS-MCCORMICK,75                                         Florida7677Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public78hearing records of the Committee on Veterans' Affairs are also79published in electronic form. The printed hearing record remains the80official version. Because electronic submissions are used to prepare81both printed and electronic versions of the hearing record, the process82of converting between various electronic formats may introduce83unintentional errors or omissions. Such occurrences are inherent in the84current publication process and should diminish as the process is85further refined.86                         C  O  N  T  E  N  T  S8788                              ----------8990                         FRIDAY, JULY 25, 20259192                                                                   Page9394                           OPENING STATEMENTS9596The Honorable Tom Barrett, Chairman..............................     197The Honorable Nikki Budzinski, Ranking Member....................     49899                               WITNESSES100                                Panel I101102Dr. Daniel Zomchek, Ph.D, Director, Veteran Integrated Service103  Network 12, Veterans Health Administration, U.S. Department of104  Veterans Affairs...............................................     6105106        Accompanied by:107108    Dr. Staci Williams, PharmD, RPh, Executive Director, VA109        Illiana Healthcare System, Veterans Health110        Administration, U.S. Department of Veterans Affairs111112    Dr. Peter Kaboli, MD, MS, Executive Director, Office of Rural113        Health, Veterans Health Administration, U.S. Department114        of Veterans Affairs115116Mr. John Lawson, Superintendent, Veterans Assistance Commission117  of St. Clair County............................................     7118119Ms. Hillary Rains, Community Engagement Manager, Illinois Office120  of Broadband, Illinois Department of Commerce and Economic121  Opportunity....................................................     9122123Mr. Kim Kirchner, Veteran, United States Air Force, Illinois Air124  National Guard.................................................    11125126Ms. Christina Schauer, President & Co-Founder, Tri-State Women127  Warriors.......................................................    12128129                                APPENDIX130                    Prepared Statements Of Witnesses131132Dr. Daniel Zomchek, Ph.D Prepared Statement......................    33133Mr. John Lawson Prepared Statement...............................    35134Ms. Hillary Rains Prepared Statement.............................    37135Mr. Kim Kirchner Prepared Statement..............................    40136Ms. Christina Schauer Prepared Statement.........................    41137138                        BEYOND THE CITY LIMITS:139140                     DELIVERING FOR RURAL VETERANS141142                              ----------143144                         FRIDAY, JULY 25, 2025145146  Subcommittee on Technology Modernization,147                    Committee on Veterans' Affairs,148                             U.S. House of Representatives,149                                                    Washington, DC.150    The subcommittee met, pursuant to notice, at 10:10 a.m., at151Chez Veterans Center, 908 West Nevada Street, Urbana, Illinois,152Hon. Tom Barrett (chairman of the subcommittee) presiding.153    Present: Representatives Barrett and Budzinski.154155           OPENING STATEMENT OF TOM BARRETT, CHAIRMAN156157    Mr. Barrett. Good morning, everyone. How are you?158    Thank you so much and thank you for the opportunity to join159you today.160    The Subcommittee on Technology Modernization will come to161order. I want to start by thanking our ranking member and the162host today in your district, Ranking Member Budzinski, for163welcoming us to Illinois' 13th District. I appreciate the164hospitality and the welcome, and everyone, and really just the165warmth that I can feel for how you care for veterans and how166you have welcomed us on the committee here today, and I really167deeply appreciate all of that.168    I would also like to thank the University of Illinois and169the Chez Veterans Center for hosting us, and for all of the170staff at the university that helped make this hearing possible.171I know many of you went out of your way to put this together.172Colonel, I appreciate your willingness to help pull this173together and everything that you did. Even though you were174voluntold, I appreciate your willingness to step up and do175that.176    I appreciate our conversation earlier, really about that177transition from military back into civilian life, and the178challenges that some of our veterans face, whether they are on179campus or not, and how we can do a better job of really making180that transition easier for our veterans.181    I also want to thank Garrett Anderson who is here. Where is182Garrett? Very good. Garrett, thank you so much for taking me on183the tour this morning. Really appreciate all of your very, very184clear commitment to veterans and making sure that they are185welcomed home and treated with the dignity that they need and186really transition as effectively as possible. I can tell that187you take a great deal of pride in that, and we appreciate your188work in that regard, so thank you.189    The mission of the Technology Modernization Subcommittee is190to make sure that U.S. Department of Veterans Affairs (VA) is191buying, using, and developing the right information technology192(IT) in order to deliver the best care and services for our193veterans. That is the task that we have on this subcommittee194and plays into why we are here today.195    Technology plays a huge role in delivering VA care to rural196veterans because VA simply cannot give all the care and197services they need at traditional brick and mortar facilities198that are often too far for veterans to reach or might not be as199convenient to them because of their limitations for travel.200    This topic is also personal to me. I served 22 years in the201United States Army, and I am now building a family in a rural202part of Michigan myself. I also represent Michigan State203University in my district, so I do have to say a ``Go Green''204while I am here.205    I know firsthand the frustration that veterans feel when206the care they have earned is out of reach simply because of207where they live. I actually do not have a VA hospital facility208in the district that I represent. The 800,000 or so residents209of my district and the veterans there have to travel outside of210my congressional district if they go to a VA hospital.211    That is what today is about, making sure rural veterans are212not left behind. The reality is veterans in rural communities213face serious barriers to accessing VA care. Nearly one third of214VA-enrolled veterans live in rural communities. They drive215longer distances. They wait longer for appointments, have fewer216providers to choose from, and deal with limited broadband and217transportation options. However each community is different,218and rural veterans do not all have the same experience with the219VA. I am glad the ranking member and I were able to take our220subcommittee on the road and talk to you all where you live and221learn about the specific challenges that you face.222    In Washington, we hear a lot of experiences from people. I223think we all benefit from going directly to the source for224where things are happening. That is a good reason why we are225here today.226    One of the most important tools that exists for rural227veterans is the Community Care Program. Community care allows228veterans, especially those in rural and underserved areas to229see outside providers when brick and mortar VA facilities230cannot meet their needs. Community care is VA care, and231millions of veterans rely on it every single year.232    Having used community care personally, I know there is room233for improvement. I want to ensure every veteran watching this234hearing knows they only need to meet one of the several235criteria to qualify for community care. One is if the VA does236not offer the service that is needed. Another is if the VA237facility is not in the area in which they are located. If the238VA cannot schedule an appointment quickly enough or close239enough to them. Or if community care is in the veteran's best240medical interest.241    Under the leadership of Chairman Mike Bost, chairman of242this committee, whose district is not too far south of here,243this committee is working hard to ensure that rural veterans244are able to make their own choice on whether community care is245the right option for them, if they are eligible.246    In addition to community care, VA has many other resources247that are important for rural veterans, including telehealth,248mobile medical units, and much more that we will hear about249today. Technology has a big role to play here, and that is250where this subcommittee comes in.251    There are a lot of exciting opportunities for technology to252drive better VA care and services in rural communities. A great253example is the External Provider Scheduling (EPS) System, which254allows VA staff to see realtime appointment availability and255book directly with community providers or within the VA system,256depending on which is available first and closer to home. While257it is only active at around 50 VA medical centers currently, it258has empowered staff to schedule up to four times more259appointments per day by eliminating delays, confusion, and260honestly a game of telephone that goes back and forth.261    Another great example is telemedicine. When it comes to262mental health, where isolation is a real risk, tools like tele-263mental health and remote monitoring are essential lifelines for264veterans who otherwise might fall through the cracks. I want to265say I am very impressed by the services that you have here that266allow veterans to access those services around other veterans267who may have had a shared experience to them. I think that is268another important community aspect of this.269    Even with these tools, there is room for improvement.270Reports from Government Accountability Office (GAO) and the VA271Inspector General have shown that rural health programs lack272clear performance goals, outreach strategies that are273inconsistent at the Veterans Integrated Service Network (VISN)274level, and community care referrals still take too long,275especially in high-need areas like mental health and women's276care that we are still trying to make strides in.277    Provider participation in VA's cellular networks is also278lagging, with some rural providers walking away due to red279tape, poor communication, or late payments. We cannot let280bureaucracy or outdated processes get in the way of quality and281timely health care.282    This subcommittee is committed to ensuring that VA's rural283health programs are well managed, accountable, and truly284reaching the veterans they are meant to serve. That means285cutting the red tape, improving access to care, ensuring every286veteran understands their options for quality care, and that we287leave no veteran behind to figure this out for themselves. It288also means ensuring the resources are there to sustain proven289services and tools, like the external provider scheduling290system, telehealth, transportation services, and others.291    My goal is to ensure every program is driven by measurable292outcomes that validate better health outcomes, not just good293intentions. In fact, we talked about that today earlier. There294are so many veteran organizations out there, each with good295intentions, sometimes duplicating services, sometimes296duplicating intentions. Having a real drive to find out where297we can get that done in the best way is really important.298    The bottom line is this-Geography should never be a barrier299to care. If a veteran qualifies for VA health care, it is our300job to make sure they can get it without delays, without301confusion, without frustration, and without giving up. We hear302too many stories about veterans who have simply abandoned the303benefits that they have earned because they cannot untangle the304confusion.305    I look forward to hearing from you all about how we can306accomplish this today.307    Before I turn it over to the ranking member, I just want to308remind everyone here that this is not an open forum but is a309oversight hearing for Members of Congress and the witnesses310that are before us today. They will be testifying under oath.311This is not a forum for individuals to participate. I know,312seeing as how we are in the ranking member's district, if you313do have questions of your own, I am sure she is available to314work with you on those.315    With that, I will yield to the ranking member for her316opening statement. Thank you again for having us.317318      OPENING STATEMENT OF NIKKI BUDZINSKI, RANKING MEMBER319320    Ms. Budzinski. Thank you very much, Chairman Barrett, for321coming to the 13th District. Welcome to Urbana. It is really322great to have you here. I appreciate you making that trip.323    I also want to just echo a sincere thank you to the Chez324Veterans Center and the leadership. I have had the privilege of325visiting the center and I know the important work that you are326doing for veterans, student veterans on campus, and just want327to say it is so special to be here, having you host us for this328field hearing. I want to say a sincere thank you. Thank you to329the University of Illinois.330    You know, Chairman Barrett's district and mine are probably331very similar. He mentioned Michigan State, so I have to say,332``Go Illini.''333    Very similar in a lot of different ways. I think that this334forum, this panel is going to be, I think, really important to335both of us and we will take all of this information back with336us to Washington. I look forward to a robust conversation about337the experiences specifically for our rural veterans, gaps in338access to care and benefits, and resources that are available339to bridge them.340    I want to also welcome our diverse panel of witnesses341representing VA leadership, veterans service organizations,342county and State programs, and most importantly veterans. I am343grateful to all of you for being here, and I know that many of344you traveled long distances to participate. Please know that I345appreciate those efforts, and this conversation would not be as346productive without you. Thank you.347    For the rural veterans in the room, this type of travel is348nothing new. Whether it is driving hours to the closest VA349medical center, or even farther for a compensation and pension350exam, rural veterans are unfortunately used to traveling to351access the care and benefits they have earned through their352service to our Nation. I think something the chairman mentioned353I share in common, Danville, Illinois is actually outside of my354district, about 45 minutes from here, but is the closest VA355hospital. The 13th District is serviced by VA hospitals, but356just outside of it.357    This is the biggest reason that I believe that community358care, though, has to remain available to rural veterans.359Unfortunately, community care access in rural America is not360guaranteed. Due to financial issues and national provider and361nursing shortages, rural health care is dying. Changes to362Medicaid will only make it worse.363    According to the Center for Health Care Quality and Payment364Reform, 700 rural hospitals, a third of all rural hospitals in365the country, are at risk of closing in the near future. Almost366half of those are deemed at immediate risk of closing. In fact,367Illinois has already lost three community hospitals in recent368years, and nine more have been deemed at immediate risk. We369cannot have a conversation about community care without370addressing the fact that it may not be there to take care of371our veterans.372    I hope to hear from VA regarding its plans to ensure that373veterans continue to have access to care. The work that374Chairman Barrett and I do on the Technology Modernization375Subcommittee seeks to help VA bridge some of these gaps through376the use of technology. VA has long been a pioneer of377telehealth, and during the COVID-19 pandemic, the Department378quickly pivoted to expand telehealth, which allowed many379veterans to continue to receive much of their care.380Unfortunately, telehealth is only a solution for veterans who381have access to sufficient internet and the technical knowledge382to use it.383    It is sad that in 2025, there are still parts of Illinois384and the country that do not have access to broadband internet.385Sadly, it is not just a rural America issue, either. Even in386places where broadband internet is available, it can be387prohibitively expensive, especially for veterans living on a388fixed income.389    I am looking forward to hearing about our efforts to390address the access and cost to make internet available to391veterans so that they can access their care and benefits.392    I hope that we can have a fruitful conversation about these393issues and possible solutions.394    Thank you again, Mr. Chairman, for being here, and I will395yield back.396    Mr. Barrett. Thank you, Ranking Member Budzinski. I will397now introduce our witnesses.398    From the Department of Veterans Affairs, we have Mr. Daniel399Zomchek, the Executive Director of VISN 12 for this region.400Thank you for being here.401    Accompanying Mr. Zomchek is Dr. Staci Williams, the402Executive Director of the Illiana Healthcare System--did I say403that right? Illiana, sorry. My apologies. They even spelled it404phonetically for me. Yes. I am an Army grunt, so--I was in the405artillery. We just got to get close.406    [Laughter.]407    Mr. Barrett. Dr. Peter Kaboli, Executive Director of the408Office of Rural Health. Thank you.409    We also have Mr. John Lawson, Army veteran and410Superintendent of the St. Clair County Veterans Assistance411Commission. Thank you.412    Ms. Hillary Rains from the Illinois Department of Commerce413and Economic Opportunity. We met back in the coffee room414earlier. Thank you. I think you told me you traveled a bit of a415distance to get here today, so appreciate it. Thank you for416being here.417    Finally, we have Mr. Kim Kirchner, an Air Force veteran418from Girard, Illinois, and Ms. Christina Schauer, an Army419veteran and co-founder of Tri-State Women Warriors. Thank you420both for being here as well.421    At this time, we will ask the witnesses to please stand and422raise your right hand.423    [Witnesses sworn.]424    Mr. Barrett. Very good, thank you. Let the record reflect425that all witnesses have answered in the affirmative.426    Mr. Zomchek, you are now recognized for 5 minutes to427deliver your opening statement on behalf of VA.428429                  STATEMENT OF DANIEL ZOMCHEK430431    Dr. Zomchek. Well, thank you very much. Good morning,432Chairman Barrett, Ranking Member Budzinski, and our433distinguished guests. Thank you for this opportunity to discuss434VA's efforts to enhance the well-being of our rural veterans,435especially within the VA Illiana Healthcare System.436    As you announced, my name is Dan Zomchek. I am the network437director of VISN 12. Joining me today are Dr. Staci Williams,438from the VA Illiana Healthcare System, and Dr. Peter Kaboli439from the Office of Rural Health in Veterans Health440Administration (VHA).441    I would like to take some time to share some highlights442about the work that we are doing within VA, VISN 12, and443specifically the VA Illiana Healthcare System in providing444essential care to our rural veterans. Having been with the VA445for over 20 years and serving as the network director of VISN44612 for almost 3 years, I am deeply committed to our veterans447and to our mission. We strive to ensure that veterans, no448matter where they live, receive the top notch care that they449have earned and deserve.450    I will start with the health care services provided by the451VA Illiana Healthcare System. This system has been a452cornerstone within the Danville community for over 125 years,453with a dedicated team of over 1,500 health care professionals454taking care of about 30,000 veterans in the community. Covering45534 counties in east-central Illinois and west-central Indiana,456we reach vets in both urban and rural areas.457    Over two dozen of our sites across VISN 12 serve a458population where more than half of those veterans are enrolled459from rural areas. Given that 4.2 million of the 16.5 million460U.S. veterans live in rural areas, our services play a crucial461role in ensuring these veterans have access to the health care462that they have earned and deserve.463    It is also important to note that veterans in rural areas464enroll in VHA care at higher rates, that is 65 percent,465compared to 47 percent for their urban counterparts.466    I would like to touch on a few key initiatives that support467rural veterans, starting with community care as you mentioned.468Through the Veterans Community Care Program, we ensure timely469care closer to home via a network of over 1.4 million non-VA470providers. The network here is vital for delivering hospital471care, medical services, and specialty care, especially for472those vets that need to travel long distances. We have473streamlined referrals and improved care coordination to ensure474quality and continuity.475    Next, telehealth, which was also mentioned earlier, and476virtual mental health services have truly been a game changer477for our veterans in rural and remote areas. VA has invested in478telehealth infrastructure, enabling veterans to connect with479primary care providers and specialists through platforms like480VA Video Connect, that we call VVC, reducing travel and481improving health outcomes. We have also ramped up on virtual482mental health services, including therapy, medication483management, and crisis intervention, all critical for484addressing mental health needs of our veterans. As a former VA485psychologist and intern, this is a particular area that is of486importance to me, is mental health.487    Last, on beneficiary travel, we recognize that getting to488appointments can be challenging for our veterans in rural489areas. VA's Veterans Transportation Service, or VTS, provides490door-to-door rides for eligible veterans. Our Highly Rural491Transportation Grants Program helps vets to travel to VA492medical centers. The Volunteer Transportation Network, backed493primarily by the Disabled American Veterans Organization, which494is a fantastic partner for us and our veterans, offers free495rides through volunteers.496    That is it, Chairman Barrett and Ranking Member Budzinski.497I want to thank you for allowing me and us to share our efforts498in assisting our rural veterans. With your backing, VA499continues to expand its reach, ensuring more veterans receive500the care that they have earned and deserve. We appreciate your501commitment, and we look forward to discussing these points502further during today's field hearing.503504    [The Prepared Statement Of Daniel Zomchek Appears In The505Appendix]506507    Mr. Barrett. Thank you. The written statement of Mr.508Zomchek will be entered into the hearing record, and appreciate509your testimony.510    Mr. Lawson, you are now recognized for 5 minutes to deliver511your opening statement.512513                    STATEMENT OF JOHN LAWSON514515    Mr. Lawson. Chairman Barrett, Ranking Member Budzinski and516the members of the subcommittee, on behalf of the Veterans of517St. Clair County, thank you for the opportunity to provide518remarks on challenges faced by veterans residing in rural519America and, in our opinion, the best State for veterans, the520Land of Lincoln, the great State of Illinois.521    My name is John Lawson. I am the superintendent of the522Veterans Assistance Commission of St. Clair County, Illinois. I523am a VA-accredited government veterans service officer (VSO)524through the National Association of County Veterans Service525Officers (NACVSO). I am also a life member of the Veterans of526Foreign Wars of the United States (VFW) Post 1739 in527Belleville, Illinois, and currently serving as the VFW State of528Illinois legislative co-chairman, and a life member of the529Disabled American Veterans Chapter 24 in Freeburg, Illinois.530    I lead a small team of five other full-time veterans531service officers who are fully invested in ensuring our532veterans receive the benefits that they have earned, and533safeguarding them from predatory, unaccredited claims534consultants.535    St. Clair County is unique in that, while we do have a536suburban feel and a significant active military presence at537Scott Air Force Base, much of our veteran population exists in538the small towns that dot rural Illinois. We consider ourselves539very fortunate to have our VA community-based outpatient540clinic, the CBOC, in Shiloh, Illinois, and one more forecasted541to open on Scott Air Force Base.542    Even with these two facilities, our population of veterans543from St. Clair County and surrounding counties have eclipsed544the safe patient load of our great care providers at the CBOC.545Many veterans cannot use this facility due to these patient546load caps. Coupling this limiting factor is the limited scope547of care available at the CBOC that nearly always leads to a548veteran being referred to a VA medical center for specialty or549advanced care needs. Our veterans are served by the St. Louis550Veterans Administration Medical Center (VAMC) that also serves551over 110,000 eligible veterans on the Missouri side of the552river.553    Although we understand that full-service VAMC on the554Illinois side of the St. Louis metro may not necessarily be in555the cards for the nearly 104,000 eligible veterans of the556Illinois 12th and 13th congressional Districts, we do need a557much larger footprint and improved service capacity for our558veterans by way of a higher level of care facility that is able559to accommodate our needs beyond routine physicals and blood560draws.561    At my last count, we had five patient-aligned care teams562(PACT) at the St. Clair County CBOC with a max patient load of5636,000 veterans, with two additional patient-aligned care teams564forecasted for the future Scott Air Force Base CBOC. This565combined maximum patient load of 8,400 only represents about 33566percent of the eligible veteran population of St. Clair County,567according to the 2023 VA Georgraphic Distribution of VA568Expenditures (GDX) and roughly 8 percent of the eligible569veterans of the 12th and 13th congressional Districts.570    The non-forecasted number is even more disappointing at571approximately 24 percent for St. Clair County and 5 percent for572the combined congressional districts without inclusion of the573forecasted Scott Air Force Base CBOC.574    We do believe that H.R. 740, the Veterans' Assuring575Critical Care Expansions to Support Servicemembers (ACCESS) Act576of 2025 will be a good start for St. Clair County veterans,577especially as our CBOC in Shiloh sits directly between two578full-service hospitals less than two miles to the east or west,579much closer than the nearest VAMC in St. Louis, Missouri, at 45580minutes to an hour away.581    We look forward to the subcommittee's help to help our582veterans by working with the VA to direct the development of583automated approvals of community care applications to reduce584the time to approval, reduce travel, reduce the delays in585receiving care, and also supporting the local community by586veterans utilizing their earned VA compensation where it was587intended, in that veteran's local community, not in another588State.589    Additionally, we would like to ensure that the veterans do590not receive bills for this care when applicable. Negotiated591reimbursements and payment submission portals for providers592should be developed to ensure clarity of responsibility of593payment for the provider and patient.594    Last, ensuring our VA electronic health records (EHR) are595two way accessible to the VA primary care providers and the596community care providers is essential in ensuring the best597possible outcomes for our veteran patients. In situations598involving advanced or specialty care, miscommunication between599providers can cause irreparable harm to the veteran.600    I wish to emphasize that our support for the Veterans'601ACCESS Act of 2025 is not to be an indication that we support602substitution or privatization for direct VA care for our603veterans. To be straightforward, we do not. Our support of this604proposal is as a supplemental partnership with the community605medical providers to ensure timely access to care and the best606possible health outcomes for our veterans.607    It is important to remember that providing resources for608care only in the community and not also for VA direct care can609lead to a less capable VA, which is a detriment to our veteran610care. In military terms, community care is a force multiplier611when leveraged correctly, not a substitution.612    Chairman Barrett, Ranking Member Budzinski, this concludes613my testimony. I have also submitted written testimony on other614pending legislation matters for your review.615    I welcome any questions from you or members of the616subcommittee.617618    [The Prepared Statement Of John Lawson Appears In The619Appendix]620621    Mr. Barrett. With 2 seconds to spare, we appreciate your622testimony today. Did you time that out?623    Mr. Lawson. Yes, sir, I did. I am a slow talker from the624Ozarks; I am surprised I got it out that fast.625    Mr. Barrett. Thank you for your testimony. Thank you for626being here. The written statement of Mr. Lawson will be entered627into the hearing record. Thank you.628    Ms. Rains, you are now recognized for 5 minutes to deliver629your opening statement.630631                   STATEMENT OF HILLARY RAINS632633    Ms. Rains. Thank you so much, Mr. Chairman. Chairman634Barrett, Ranking Member Budzinski, and distinguished guests,635thank you for the opportunity to testify today on behalf of the636Illinois Department of Commerce and Economic Opportunity, and637the Illinois Office of Broadband. I am here to talk about the638critical intersection of telehealth access for rural veterans639and the impact of the digital divide on their health and well-640being.641    When we talk about the digital divide in 2025, we are642talking about a disparity in access to fast, affordable, and643robust internet, as well as to the devices, tools, and skills644that allow people to connect to critical supports throughout645their lives. Vulnerable populations often find themselves on646the wrong side of this divide, and veterans, of course, are one647of them, with only about 67 percent of Illinois veterans having648and using broadband access.649    Veterans are often also part of more than one vulnerable650population, as 56 percent are over the age of 60 and 26 percent651nationwide, over 4 million people, live in rural areas. Rural652residents have their own challenges where internet connectivity653is concerned. The Federal Communications Commission (FCC)654estimates that 28 percent, almost a third, of rural residents655lack broadband access.656    Fifty-seven percent of rural locations in Illinois alone657are entirely unserved or underserved, receiving internet speeds658below the FCC's minimum recommendation of 100 by 20 megabits659per second. This recommendation is indeed the bare minimum, as660it is only often adequate for one user at a time to do everyday661tasks like videoconferencing, streaming, and emailing. The662inability to complete these tasks from home disadvantages rural663veterans, especially when trying to access telemedicine664resources.665    The VA obviously provides vital care centers and hospitals666across the country. When we look at veterans who live in rural667areas, they live an average of 45 miles--and that is an668average--to be seen in person at a VA center. As veterans are669twice as likely as nonveterans to suffer from two or more670chronic health conditions, frequent checkups and appointments671are especially important.672    Telehealth resources began to be promoted heavily just673before the pandemic to alleviate those challenges with674transportation and provider availability. Adoption rates in675rural areas suffered because of the lack of broadband access.676When considering additional complications such as subscription677affordability, device ownership, and varying degrees of digital678literacy and skill, especially in the more than half of679veterans over 60, the problem is laid out in stark relief.680    Illinois has already worked diligently to increase681broadband access for rural residents through the Connect682Illinois broadband infrastructure grant. Connect Illinois683allows internet service providers to build high-speed fiber684infrastructure in rural areas that often have low population or685subscriber density and are isolated from middle mile686infrastructure.687    As of today, three State and federally funded rounds of688this program have connected approximately 7,500 households,689with 46,000 total more to be connected over the next 3 years.690The fourth round is currently being funded by the Federal691Broadband Access Equity and Deployment Act, you might have692heard BAED, Program, and stands to connect over 165,000693Illinois residents and almost 5 million other households across694the country without adequate connectivity.695    While the BAED program is in progress, there is another696program that can fund veteran-serving organizations on the697ground and helped to provide rural residents with device698access, digital skill building, one-on-one troubleshooting699support, and more. That program is the Digital Equity Act. This700program was poised to provide $2.75 billion to states to701support programming and sub-grants to direct service702organizations with veterans being targeted as one of the703vulnerable populations most affected by the digital divide.704Illinois was to receive more than $23 million to equip705households and residents with the skills, resources, and tools706needed to use the high-speed internet.707    Illinois received over 260 sub-grant applications708throughout the State, with the full ask over $100 million, far709outstripping the available funds, showing the need. Some of the710programs proposed were to support telehealth and resource711access for recently separated women veterans in the rural712southwest central region, veteran-focused digital literacy713classes, mobile skill-building hubs, and secure community714telehealth rooms. Unfortunately, the Digital Equity Act and its715$2.75 billion of appropriated funding were terminated by716executive order, leaving these programs unfunded.717    Expanding access is the key to health and well-being of718rural veterans. Thank you so much and thank you for having us719today.720721    [The Prepared Statement Of Hillary Rains Appears In The722Appendix]723724    Mr. Barrett. Thank you for your testimony. Thank you for725being here.726    The written statement of Ms. Rains will be entered into the727hearing record.728    Mr. Kirchner, you are now recognized for 5 minutes to729deliver your opening statement.730731                   STATEMENT OF KIM KIRCHNER732733    Mr. Kirchner. Good morning. Thank you everyone for taking734the time out of your day to listen to my testimony. My name is735Kim Kirchner, and I am a proud veteran who served in the United736States Air Force, Illinois Air National Guard, and served in737Operation Iraqi Freedom and Operation Enduring Freedom (OIF/738OEF). I am currently a sergeant with the Macoupin County739Sheriff's Department.740    I am writing the testimony in regard to the care that I741have received at a compensation and pension exam. I drove over74230 minutes to an exam that the VA scheduled for me with a743contract provider. When I arrived, the medical provider744informed me that I was not on her schedule and that she could745not find my medical records. I told her that the VA had called746me and asked me to come in at an earlier date due to an747opening. She finally found my records, but had an attitude748through the entire exam, which lasted a total of 3 minutes. At749no time did she conduct a medical exam on me. She only reviewed750my medical record. Based on that exam, VA denied my claim. In751order to finally get my claim awarded, I had to do a whole752other medical exam. This was a massive waste of my time and753taxpayers' money.754    I firmly believe that I am not the only veteran this has755happened to, and the outsourcing of these exams definitely756needs to be looked into. When a veteran goes for an exam, they757should be treated with the utmost respect they deserved,758especially for putting their lives on the line for our country.759When I walked out of that exam that did not last approximately7603 minutes, I have never felt so disrespected in my life. It was761very frustrating to get treated this way, especially having to762drive 30 minutes to the exam due to living in a small town and763nowhere close to a VA clinic.764    I firmly believe that the VA need to pay more attention to765the care we are receiving from them outsourcing their766compensation and pension exams.767    Thank you everyone, and I am happy to answer any questions768that you may have.769770    [The Prepared Statement Of Kim Kirchner Appears In The771Appendix]772773    Mr. Barrett. Thank you, Mr. Kirchner, and thank you for774your service then and your service now. I have heard from other775veterans with similar experiences to yours with that776compensation and pension, so I want to make sure that we777correct that. I hope your experience since then has been far778better and far more respectful. If not, I know the ranking779member and I would be very interested in ensuring that that780happens for you going forward.781    Your written statement will be entered into the hearing782record, and again I appreciate your willingness to come and783testify today.784    Ms. Schauer, you are now recognized for 5 minutes to785deliver your opening statement.786787                 STATEMENT OF CHRISTINA SCHAUER788789    Ms. Schauer. Chairman Barrett, Ranking Member Budzinski,790and members of the subcommittee, thank you for the opportunity791to speak today. My name is Christina Schauer. I am a U.S. Army792Iraq War veteran and president of the Tri-State Women Warriors,793a nonprofit with a mission to provide connection and advocacy794for the unique needs of women veterans and service members.795    Today, I will focus on three key areas of impact for rural796veterans: Enhanced community outreach, coordinated and797purposeful community care utilization, and a strong rural VA798presence.799    Community outreach is vital to ensure veterans understand800their benefits, how to access them, and why they matter,801especially in isolated rural areas. The VA's community802engagement and partnerships for suicide prevention program has803been essential in supporting local coalitions like ours working804to prevent veteran suicide.805    Our local engagement coordinator has been a behind-the-806scenes champion of the Tri-State Women Warriors, which has now807served over 100 local women through live events and helped many808access VA care for the first time. Some, for trauma experienced809decades ago. These outreach programs serve a vital role in810ensuring rural communities stay informed and engaged with the811VA.812    While many of our members prefer VA care, almost all of us813have relied on VA community care at some point, due to814specialty care needs, wait times, or distance. Despite its815necessity, community care is not optimized. Research shows that816community care clinicians often report learning about policy817and workflow changes only through error notifications and818request denials, which is consistent with reports we hear from819veterans in our community.820    Any policy change that impacts community care partners,821such as the Veterans Comprehensive Prevention, Access to Care,822and Treatment (COMPACT) Act, should follow an effective823standardized communication process that includes clinical824services as well as billing departments to safeguard veteran825care and prevent them from receiving medical bills in error.826    Care continuity is also an ongoing issue. Successful827implementation of a comprehensive EHR is paramount to ensure828the seamless flow of communication across care teams.829    Lack of cultural competency has also been a pain point for830community care. Unfortunately initiatives to improve this are831resource intensive. With 48 percent of rural hospitals832operating at a financial loss in 2023, and the recent passing833of H.R. 1, most rural hospitals are strategizing ways to ensure834their doors stay open and would struggle to absorb any835additional financial strain.836    With health care viability in mind, it is also important to837acknowledge that 92 rural hospitals have closed or have been838unable to continue providing inpatient services in the last839decade. A recent study showed that even in major cities,840average wait times across specialties are increasing, and841nearly 62 percent of mental health provider shortage areas in842the United States are rural. Expanding community care without843addressing provider shortages could exacerbate current access844issues if VA resources are lost within these communities.845    Our local CBOC is a trusted anchor, and this committee's846greatest focus should be ensuring rural veterans have access to847VHA's veteran-centered patient care. Research shows rural848veterans report higher satisfaction with VA care than community849care, and that VA facilities often outperform or match non-VA850providers in quality and safety.851    When a permanent, physical VA presence is not possible,852strategic telehealth can extend resources and build853connections. Evaluating when face-to-face interactions are most854critical to building trust, and supplementing with telehealth855can broaden the meaningful--sorry.856    Evaluating when face-to-face interactions are most critical857to building trust, and supplementing with telehealth, can858broaden the meaningful reach of these CBOCs.859    Finally, we must protect the psychological safety of the VA860workforce, many of whom are veterans themselves. Successful861deployment of a modernized EHR will rely heavily on a strong,862confident workforce, which is only possible when employees feel863valued and supported.864    This subcommittee is uniquely positioned to lead in865expanding VA access to rural veterans through technology.866Community care is vital, but history shows that even well-867intended privatization can lead to inequitable services for868rural communities, as resources naturally shift to more869profitable urban areas. As we see this disparity in the broader870health care system today, the VA remains a vital equalizer. A871balanced, bipartisan approach can strengthen both VA and872community care to ensure our most vulnerable veterans are not873forgotten.874    The VA I returned to in 2004 after my deployment to Iraq as875a student on this campus, where I was told by the VA in876Danville that my new breathing issues were likely from anxiety,877is not the VA we have today. The progress we have made has been878intentional and remarkable. Let us continue investing in this879transformation and use modern tools to bring care and benefits880closer to rural veterans who have earned them. Thank you.881882    [The Prepared Statement Of Christina Schauer Appears In The883Appendix]884885    Mr. Barrett. Thank you, Ms. Schauer. I appreciate your886testimony, and your written statement will be also entered into887the hearing record.888    We will now proceed to questioning, and I will recognize889myself for 5 minutes. I forgot to advise you ahead of time, but890we have a light system here in front of you, green, yellow, and891red. Pretty self-explanatory. Yellow is you are getting close892and red is you are out of time. We will begin questioning.893    We genuinely appreciate each of you that are here today and894the testimony that you offered today.895    Ms. Schauer, you say you were deployed in Iraq, 2003, 2004896sometime? Where were you operating out of there?897    Ms. Schauer. Baghdad International Airport.898    Mr. Barrett. Okay, and what was your job?899    Ms. Schauer. I was a combat medic.900    Mr. Barrett. Oh, very good. Well, thank you. I was there a901few years after you and certainly appreciate your service902there. Thank you.903    Ms. Schauer. Thank you.904    Mr. Barrett. Mr. Kirchner, you say you were Army as well?905    Mr. Kirchner. No, sir. Air Force.906    Mr. Barrett. Air Force, okay. Where were you deployed when907you were in service?908    Mr. Kirchner. Incirlik, Turkey.909    Mr. Barrett. Okay. I did kind of a layover there one time.910I was in Guantanamo Bay, on my way to Afghanistan. It was911great, because they had a Taco Bell there, so it was good for912morale.913    Ms. Rains, I wanted to ask you, I know you mentioned a lot914of the access to telemedicine and some of the extension of915broadband. You mentioned access to fiber for rural residents. I916live in a pretty rural part of Michigan. In fact, I am not917joking, my neighbors across the street from me are Amish. They918are not so into the broadband. Nonetheless, in the community919that I live in, we have folks like me that need access to920internet and broadband.921    Do you know, you said you had connected about 7,500 homes922that way. Do you know what the cost for that 7,500 homes was?923    Ms. Rains. That 7,500 with the 46,000 altogether will be924about $350 million, and most of that is--I believe all of that925has been fiber, yes. We were with the United States Department926of Agriculture (USDA) Rural Development Opportunity Fund, which927is in Illinois mostly wireless.928    Mr. Barrett. How many millions again?929    Ms. Rains. Three hundred and fifty million dollars, about,930for those were State and Federal funds in the first three931rounds of the Connect Illinois program.932    Mr. Barrett. $350 million for how many homes are going to933be connected for that?934    Ms. Rains. It is just over 50,000.935    Mr. Barrett. Okay. That would be a substantial cost per936home with fiber.937    Ms. Rains. Yes.938    Mr. Barrett. I guess Dr. Kaboli, maybe you could help me939answer this. Is there any opportunity, perhaps, or we could940just outfit veterans who are accessing telehealth with a fixed941wireless connection? I have one of those in my home. It works942pretty well, actually. It allows me to use, you know, if I were943using telehealth, I can use Zoom. My wife works from home and944is able to do her work that way.945    I feel like for $350 million, we could buy a lot of people946a home internet, you know, fixed wireless provider type of947thing and pay $50 a month for them and not hit $350 million for948a great long time.949    Either one of you.950    Ms. Rains. Wireless internet is an excellent stopgap, yes.951In areas in Illinois, especially where I am from down in952Crawford County, Robbins, Illinois, there is no cell signal in953a lot of the county. Even if you had a hotspot, you are not954able to access it. Wireless internet is coming but wireless is955slower speeds, it is interrupted by any kind of weather,956rainstorm or thunderstorms, which are very common on the957prairie, as you know.958    It is an opportunity to get people connected faster.959    Mr. Barrett. I actually found--I mean, I had cable, copper,960it was not fiber, but it was like a lower speed, but it was961into the home through the phone line--I do not know. I have962actually had more reliable service through the Verizon--not963just a little hockey puck hot spot that you would take while964you are traveling, but like the fixed, plug-into-the-wall kind965of service that comes over the air. I feel like delivering to966those folks you talk about that are the most stranded, I mean,967it is going to be a huge expense to run fiber to them, and I968almost wonder if we would be better served putting more of that969into some of the more accessible already options available.970    Ms. Rains. Yes. The wireless tower that provides the971Verizon service is served by fiber middle mile infrastructure.972Middle mile infrastructure still needs to go out to provide973that wireless service. Fiberoptic, of course, is more expensive974at the installation. It is also what we call kind of future975proof. It is 50 years is its serviceable life in the ground,976and it is still being tested, so it could be even longer than977that.978    As speeds increase over time and technology improvement,979the cable does not need to be upgraded, just the data centers980on either side, because it carries information at the speed of981light.982    Mr. Barrett. Sure. Not to cut you off, I just wanted to get983Dr. Kaboli's thoughts really quick----984    Ms. Rains. Oh, of course.985    Mr. Barrett.--before I yield to the ranking member. Then we986can come back after that. Go ahead.987    Dr. Kaboli. Yes, real quickly, I think the other thing to988think about is low Earth orbit satellite internet. We looked989into this the last couple years to see if we could, the Office990of Rural Health, could provide that service for veterans.991Unfortunately, there is no legislative mandate to allow us, or992authority to allow us to actually pay for it. You are right,993the cost per month would be much less if we could just994subsidize it, but we cannot.995    Mr. Barrett. Okay.996    Dr. Kaboli. We do have a pilot with a company to sort of997identify sort of what the challenges are. One of the challenges998in rural areas is actually the installation. You know, you have999to get somebody to come in, drive in, set up the satellite and1000all that kind of thing. I will stop there, but I think there is1001a lot of other options out there.1002    Mr. Barrett. Thank you. Thank you.1003    Ms. Rains. Just to finish, in Illinois and across the1004country, we are using a mix of technologies. Of course, we are1005looking toward the future. That is why we prioritize fiber, but1006it is definitely going to be a mix of all these things, as well1007as low Earth orbit, to deliver service.1008    Mr. Barrett. Sure, thank you.1009    I am going to yield to the ranking member for 5 minutes for1010her questions.1011    Ms. Budzinski. Thank you, Mr. Chairman.1012    My first kind of set of questions is really just to the1013panelists from the VA directly. I would love to hear from each1014of your perspectives just a general question about gaps in1015care, access to care, that you see within the VA and what those1016barriers are that exist in filling those gaps, especially in1017our rural communities, obviously, with the topic today. Then1018just to ask you in addition what kind of feedback you get from1019veterans as it relates to these gaps and filling them.1020    Dr. Zomchek. Well, thank you, Congresswoman. I would say1021there are certainly less opportunities for rural veterans,1022especially the more specialized the services that they are.1023Throughout VISN 12, we have a fair amount of rural areas, not1024only in VA Illiana but in Iron Mountain, particularly, where it1025is literally a four and a half hour drive from Sault Ste.1026Marie, the CBOC, to the main campus.1027    I think--I think when it comes to primary care and mental1028health treatment, both virtual and face to face is where we1029have really been able to close the gap more so. We are1030continuing to expand our CBOCs, not only growing them and doing1031construction, but also trying to create new specialty services1032there.1033    Certainly across the board, that is why I think community1034care, as was stated, is so critical. We can do a lot in the VA.1035We have a lot of opportunities that we can offer for our vets.1036There are some things that we cannot. Having that partnership1037of community care can really help us.1038    There is a lot of mobile opportunities that we do, too. I1039think maybe Dr. Kaboli could talk a bit more about that.1040    Dr. Williams. Here at VA Illiana, and I actually have spent1041over 30 years in health care specifically relating to providing1042services to individuals in rural areas, so rural health care is1043a passion for me. At VA Illiana, we have actually implemented a1044screening program titled ACORN, which stands for Assessing1045Circumstances and Offering Resources for Needs.1046    To speak to some of the testimony that we have already1047heard, when we have done this screening through our social work1048team, it really addresses some of the social determinants of1049health like food, housing, utilities, transportation,1050education, employment, digital needs and the like. We have1051actually found that 19 percent of our veterans are positive for1052digital needs, and another 65 percent positive for social1053isolation and loneliness.1054    Since we are a rural Department of Veterans Affairs1055hospital, we do have CBOCs spread throughout this area. We1056certainly recognize the needs of our veterans to try to remain1057connected with not only health care but with one another.1058    Dr. Kaboli. I just want to say to start out, though, I am1059actually from Iowa City, Iowa. I grew up across the river from1060Illinois in southeast Iowa, so ``Go Hawks.'' We have the Big 101061covered here. I did wear my Illini colors today because I knew1062where I was.1063    No, I think to answer your question about access and gaps,1064I think it comes down to sort of, kind of like Ms. Rains said,1065about you just--you use every possible thing you have. You1066know, what do we have that we can get veterans access to care?1067It is face-to-face care with us, face-to-face care in the1068community, telemedicine, instant messaging, you know, we have1069all these things offered out there. The thing is not every1070veteran wants telemedicine. Of veterans that have used1071telemedicine, 80 percent say, yes, I want this. Twenty percent1072say, you know, I tried it, it is not for me. Pretty much all of1073us had some form of telemedicine during the pandemic, so we1074have had experiences with it. Really, veterans want more1075telemedicine.1076    Again, what do they want? Let us either bring them to care1077or bring the care to them.1078    Ms. Budzinski. Could I ask just one follow-up question? One1079thing I have noticed within the district just within health1080care in general, just even beyond providing care to veterans,1081is we lack the ability to attract specialty care, health care1082professionals, doctors, nurses. We have a shortage of health1083care professionals just within our hospital systems.1084    Is that reflected as well at the VA in Danville that you1085have those shortages or a hard time kind of attracting those1086professionals?1087    Dr. Williams. We have very similar challenges to what are1088experienced in the private sector in the community care1089network, yes.1090    Dr. Kaboli. If I can add to that, we think one of the1091things that we do have is because we are a national network of1092providers, we actually do not have a shortage, say, of primary1093care providers. Even though there are shortages everywhere. We1094just do not have them all in the right places at the right1095time.1096    Like you were talking about PACT teams and how many1097providers they have. You know, we can supplement that through1098the clinical resource hub program, so we can supplement primary1099care, mental health, specialty care. A nephrologist in Boston1100who has extra effort to give can provide care in rural1101Illinois, and that is----1102    Ms. Budzinski. By telehealth.1103    Dr. Kaboli. By telehealth, yes.1104    Ms. Budzinski. Telehealth is key to that, yes. Okay.1105    I will go ahead and yield back.1106    Mr. Barrett. Sure, thank you.1107    I will now recognize myself for 5 minutes.1108    I know a couple of you, I think Mr. Lawson and Ms. Schauer,1109you mentioned the electronic health record upgrades that are1110necessary to kind of integrate that community care and VA care1111together, because oftentimes veterans will, even if they are1112using community care, will also have a segment of their health1113care through VA. That has been a major subject of consideration1114by our subcommittee. I feel like it has taken up 80 percent of1115my life these days.1116    If you can give us any of your perspective as to your1117expectations for that? I know Cerner has now been acquired by1118Oracle. The VISN that I live in specifically in Michigan is the1119next region to receive this update and, you know, it has1120frankly not gone well in the places it has been rolled out in1121the past, minus the exception here in Illinois. I am curious if1122you have any thoughts on how that will take place and what1123would be things we ought to look for on this committee to make1124sure that it is done appropriately?1125    Mr. Lawson. Yes. When we think about, you know, those1126electronic health records, even speaking from the private1127sector experience in my previous life before the1128superintendency here, the systems do not talk with one another.1129You might have one health care facility using--I do not want to1130endorse any places here--but Epic and then one may be on1131Cerner. Those two hospitals might even be owned by the same1132ownership group but do not communicate with one another with1133those records because they do not intermix.1134    I think what we would be looking here is, you know, we look1135to like software as service type of mechanisms, to where maybe1136providers might be provided login access, something along those1137lines, to direct access those records from the VA.1138    On that software rollout from Oracle and Cerner, we did get1139an update about that last week at the NACVSO annual conference.1140When we think about those records coming in from the active1141duty component of the U.S. Armed Forces, it is happening. It1142seems or appears or we have been told that those bugs have been1143worked out. Time will tell. However, we are looking at 181144months to 24 months of full rollout, you know. Illinois is not1145among the next states, by the way. We would like to see that1146happen.1147    That really kind of covers that active duty component. I1148think what we really need to really focus on is how do we make1149access for those community care providers, either through a1150software service platform or some other type of agreement with1151those providers.1152    Mr. Barrett. You are saying instead of like sending the1153file back and forth, having an access portal for the community1154care providers to access your VA record?1155    Mr. Lawson. Yes.1156    Mr. Barrett. Make maybe even some edit privileges to that1157for the community care work that is being done?1158    Mr. Lawson. Correct. Very similar to how a VSO has Veterans1159Benefits Management System (VBMS) access. I can get in there1160and I can kind of see what is going on with a case file. I1161think something very similar to that but with a bit more1162privilege, you know, from a provider end, to add to and edit.1163    Mr. Barrett. Sure. Very good.1164    Ms. Schauer, I do not know if you have any thoughts on that1165yourself?1166    Ms. Schauer. My background is nursing and not IT, so I want1167to give that caveat. As a clinician, just being able to access1168the records you need when you need them is especially helpful.1169It goes two ways. It is the VA EHR, but then also figuring out1170with the community care, as you mentioned. Everybody is working1171on different systems. Making sure it works with a variety of1172systems.1173    Another additional thing just to point out, I know up until1174recently, we did have an EHR change in my organization. When1175that interoperability is not there, sometimes it does rely on1176actually making a phone call to the CBOC or to the primary care1177team, which that relies on that CBOC being open. Weekends,1178holidays, nights, you do not always have that ability to access1179those records.1180    If this was ever a possibility, I would love to see a1181future where not only do we ensure that any veteran that is1182eligible for community care receives the information about what1183they are eligible for and where they can go, but alternatively1184we have a lot of veterans that are not using their VA care;1185they are using the community on their private insurance. They1186may not have any awareness. I would love to see some way for1187some sort of integration that would allow community providers1188to easily screen and then refer to VA when somebody meets those1189criteria.1190    Mr. Barrett. Yes, I do not disagree with you. One of the1191bills that I introduced was the Veterans Community Care1192Scheduling Improvement Act to allow for that integration with1193community care providers within the VA, so they could see that1194matrix of what is available. One of the revisions we made to1195that bill was a requirement that if a veteran called for a1196scheduled appointment, they would be advised of both options1197available to them, so that they would know what is available,1198so that they would then be able to choose between I am willing1199to travel a little bit further to get an appointment maybe1200sooner, or I am going to stay closer for an appointment a1201little bit later. Or just that entire decision matrix that they1202may have. Or maybe they are like a lot of folks in my district1203who travel to Florida in the wintertime, and they spend part of1204their time there, part of their time in Michigan, and having,1205you know, other options available to them is really something1206that is important. We are working through a lot of this1207electronic health record, you know, tangled issue right now.1208    I know, Mr. Lawson, you pointed out in your testimony just1209that certainty that if you have, for example, a referral for a1210critical need, that it is not getting lost in that gap,1211perhaps, before this is fully integrated. That we know if you1212send a referral for a test or a service, it is going to be1213received on the other end and actioned appropriately in a1214timely way to make sure that it is not falling through the1215cracks. I appreciate that.1216    I want to yield to the ranking member for 5 minutes.1217    Ms. Budzinski. Great, thank you. Thank you again.1218    My next question, Mr. Lawson, actually, we could spend1219probably this entire hearing talking about health care. I do1220want to talk about access to benefits. I just was curious if1221you could speak a little bit to that, and what you are hearing1222from your fellow service members just about access to benefits,1223barriers to that, challenges with it in our more rural1224communities, obviously.1225    Mr. Lawson. Sure. I think the first priority is ensuring1226that we have got access to accredited veterans service officers1227for these veterans in rural areas. In my office, we are going1228through quite a bit of a transformation to make ourselves1229available to veterans wherever they may be. We even service1230veterans outside of our county. We have got clients as far away1231as Ireland that we are able to do remotely, work through the1232claims process with them.1233    Part of what we do, you know, is educating veterans on1234that. They have to be into the system first. If you have not1235entered the VA system, meaning that you have not applied for a1236VA home loan, if you have not entered VA care, if you have not1237used education benefits, you are not counted and you are not in1238the system.1239    We need to make sure that you are enrolled and counted in1240the system. One, it gives our VA administrative staff and1241planning staff some better head count of numbers so we know1242where to center our care and where to look to build facilities1243or expand out options. You know, but for us, the challenge is,1244especially as we stand up here in Illinois are veterans1245assistance commissions, making sure that we have got an1246accredited veterans service officer in every county. These1247veterans service offices are free for the veteran to use. They1248should use free veterans services officers at all times and1249never pay for the service. That is a benefit that they have1250earned, and they should not be charged to access it. That is1251that.1252    Ms. Budzinski. Thank you. Yes, one of the things we have1253tried to do in my office is host resource center, you know,1254resource fairs, connecting veterans to the VA, to services. It1255is challenging. It is challenging. We did it at one of our1256community colleges not far from here. We had light attendance.1257Any observations or kind of suggestions you might have on how1258we can better connect?1259    Mr. Lawson. Yes, that is one thing we have been wrestling1260with. We attended one of your resource fairs as well at the1261Legion in Edwardsville. We have noticed that as well, that the1262resource fairs--the face of the veteran is changing. We have to1263look at the demographics of these veterans, how they access1264care, how they consume information.1265    Resource fairs used to work back when the internet did not1266exist. Now that veteran has more access to information through1267their handheld computer on their phone than they ever will at a1268resource fair.1269    There is so much, as Congressman Barrett mentioned, so many1270groups out there that are trying to do good things. It is just1271not a very coordinated effort in my opinion. That we need to,1272you know, figure out what that next generation of outreach is.1273Is it through social media? Is it through other platforms? It1274is just it takes money, quite honestly, to commit to those1275types of things.1276    We are looking and exploring how do we offer these things1277or these services or education opportunities in a more modern1278setting to appeal to the OIF/OEF generation, which is ours, and1279currently in the most need for care at this point.1280    Ms. Budzinski. I would love to keep working with you,1281working with you on that to figure that out, for sure.1282    Mr. Lawson. I would be happy to.1283    Ms. Budzinski. Thank you.1284    Dr. Williams, I wanted to ask, I know you are currently the1285medical center director up in Chicago at the Jesse Brown VAMC.1286I was just wondering if you could maybe, since we are talking1287about rural health care, obviously Chicago not being rural, if1288you could kind of just talk to us a little bit about, you know,1289as you are practicing working up north, kind of the comparison1290between resources, any things you see different between what1291can be offered in a community that is more rural, the1292challenges or the lesser of the resources that might be down1293here, or maybe we have adequate, you know, same amount of1294resources than Chicago. I was just curious if you could reflect1295on that?1296    Dr. Williams. Actually, what is very interesting about my1297time at Chicago is that the Jesse Brown VA actually hosts the1298clinical resource hub for VISN 12. Some of the rural health1299care that Dr. Kaboli was mentioning being provided through the1300clinical resource hub, I see the opposite end of that care. I1301see those providers and those specialists in my role as the1302medical center director at Jesse Brown. Then I see my home1303site, VA Illiana, as a consumer of those services. That1304partnership with the clinical resource hub is critical.1305    There are some, you know, obviously, differences between1306urban and rural health care. One other noticeable difference is1307the relationship or affiliations with the educational1308institutions in the different communities. Because a larger VA1309medical center obviously has typically a broader range of1310services, including specialties, there is a much tighter1311relationship with their academic affiliate.1312    We do have a great partnership down here at VA Illiana with1313the University of Illinois Urbana-Champaign, so we are very1314fortunate to that. It is a different relationship than what I1315see in Chicago.1316    Ms. Budzinski. Okay, thank you. I will yield back.1317    Mr. Barrett. Sure, thank you. I wanted to follow up a1318little bit more, Dr. Zomchek, about the EPS scheduling and how1319that has been integrated. I know it is not fully at every1320facility yet. I am curious in your VISN where it is being used1321and how it is being utilized, and if you have any feedback for1322us as to how that is going in its real application sense now.1323    Dr. Zomchek. Yes, thanks for that question. EPS, I am well1324aware of it. Part of being the governance board that has been1325discussed for a number of months now, and so I have been1326involved in those discussions and in the rollout, kind of input1327about the planning. At this point, we do not have any of our1328eight facilities in VISN 12 that are in the pilot, as you had1329mentioned. However, I think it is a great thing. I think it is1330a wonderful opportunity to provide more resources and access1331for our vets, and timeliness. I mean, literally it is moving1332appointment scheduling from days or weeks in some cases to the1333period of minutes.1334    I am encouraged about it. I do think it is a--it is a1335double-side-coin idea in terms of implementation, right? You1336really need the local medical center to be engaged in opening1337up those clinic slots. You also need the community partner, and1338a connection like Chief Executive Officer (CEO) to CEO, to open1339up those grids and then kind of get proof of concept so that it1340can be expanded.1341    Mr. Barrett. Sure. For those that may be here today1342unfamiliar, basically when you call to schedule an appointment,1343often in community care, I had this example happen to me. I was1344at an audiology appointment, and they had to first call me and1345get my availability, then call these other providers that were1346available, then call me back. They scheduled it at a time I1347told them I was not available. Then they told me, well, when1348that happens, we just schedule you for the next appointment if1349we cannot meet your timeline that you are available.1350    I am like, I am literally going to be out of the State. You1351know, I am going to be in Washington, DC, and you scheduled me1352an appointment in Michigan at the same time. It was a very1353significant hassle. I think having that realtime awareness so1354you are not going through that game of telephone is really1355critically important.1356    I think you are right, though. You need both the VA1357scheduler as well as the community care provider to opt into1358that, that meshing of information, so that that scheduling is1359going to be available for people and they can know what is1360close to home, what is available, and what am I willing to1361travel farther for or what is nearby and timely and everything1362else. Think that is, you know, an important thing that we have1363got to kind of pull together, basically.1364    Dr. Kaboli, on that piece of it, and maybe I am not sure if1365you have awareness of this, do you feel like there is that1366awareness and buy-in by potential community care partners when1367we offer this to them that they have this willingness to1368participate?1369    Dr. Kaboli. Absolutely. Our office has kind of followed the1370external scheduling program for the last 3 years. You know, we1371have worked, for example, with the Nebraska Rural Health1372Association, because they are really tied into the rural1373communities and saying, we will partner with you to make sure1374that they are on the grids.1375    Like you said, if the scheduler has access to both grids at1376that exact moment in time when they are on the phone with the1377veteran, they can say, we can get you into the VA in 32 days or1378we can get you into this other clinic in 47 days. Which would1379you rather have?1380    I think if it works half as well as we hope it does, it1381will still be good. You know, I think they are up to, what,1382there were 4,000 appointments made last month in June. It is1383ramping up quickly. I think it will prove to be mutually1384beneficial, and that is where it will work.1385    Mr. Barrett. Yes. I am not sure if this is the best1386question for you or not. The community care partners, do you1387feel that they feel like they are getting a--everybody always1388wants a greater reimbursement. Do you feel it at least is a1389market reimbursement rate that is something that will draw in1390community care partnerships?1391    Dr. Kaboli. Yes, so we have gone around and met with1392community partners. I still practice in Iowa, and I talk to1393these other providers all the time. They are happy with the1394rates that we provide. It is just you have to make it easy.1395    Mr. Barrett. Right.1396    Dr. Kaboli. The harder you make it, especially, you know,1397with record exchange, the harder we make it, it just becomes a1398hassle. I think they are really committed to the veterans in1399their community, and I have never heard anybody in the1400community ever say, you know what? Taking care of veterans is1401not a priority for us. They always want to care for veterans.1402    Mr. Barrett. We want to draw in the best that we can by1403having a reimbursement rate that is reflective of the service1404that is provided, that does that to really strengthen those1405particularly rural community partners that we have. Thank you.1406    I can yield to the ranking member. Do you have other1407questions? Go ahead.1408    Ms. Budzinski. I was just going to follow up on telehealth,1409actually, and maybe ask Dr. Zomchek, when you are talking about1410telehealth and using it specifically for mental health1411challenges, do you find that there are still a lot of barriers1412around stigma related to seeking this care? Barriers to, you1413know, a veteran coming in in person or utilizing telehealth? Is1414telehealth making it more easily accessible for a veteran that1415might be trying to get over a stigma about seeking that care?1416    Dr. Zomchek. Well, I think, first of all, VA care and1417mental health is second to none. I think the plethora of1418services that we offer and modalities that we offer mitigates1419stigma that historically was there.1420    I think it is still there, certainly. I think candidly, I1421think it is part of the disease process to some extent for1422people to be reluctant to seek care when they really need it. I1423think we will never stop in terms of that outreach and finding1424connectivity for our vets, whether it is through VVC or coming1425to a local CBOC and using telehealth.1426    One of the programs that we have related to this broadband1427discussion we have been having is what we call the digital1428divide program. That is where we have literally issued VA-1429loaned iPads, tablets that have internet connectivity for1430veterans that are in rural areas who cannot afford it. Then1431that gives them the ability to connect with their clinician at1432their kitchen table.1433    Ms. Budzinski. Right.1434    Dr. Zomchek. We have distributed thousands of those across1435the network.1436    Ms. Budzinski. That is great. Yes, that is great.1437    Can I open the question up to--I know we have a number of1438veterans, obviously, on the panel--specifically around1439barriers. Anything you could speak to as far as barriers that1440we could help overcome in helping connect veterans to1441telehealth services, mental health services?1442    Mr. Lawson. I think, when we think about the telehealth1443services, I used telehealth, telehealth mental health, even. I1444am not ashamed to admit it. It was wonderful. It worked. I am1445at work. I am a working adult. I am still in the workforce. I1446think sometimes there is this misconception that, you know, oh,1447you can just take off work to go to an appointment.1448    Here in Illinois, we have got legislation pushing forward1449to kind of help those veterans take some extra time off,1450compensated, to go to these appointments for service-related1451conditions. A lot of this is going to come on educating,1452especially for some of our older veterans who are just not1453quite at the technology level maybe some of us are.1454    You know, we are still seeing Vietnam-era veterans that are1455now coming in for the first time for Post-Traumatic Stress1456Disorder (PTSD). You know, it breaks your heart to see them1457dealing with that for so long. We have got to figure out ways1458to also, as we issue out those iPads and pieces of technology,1459how do we educate them to use it?1460    You know, one of the things we do in our office is, you1461know, when they come to see us for claims, do you have VA.gov1462app on your phone? Most veterans do have phones at this point,1463even the older ones. How do we educate them to use that VA app?1464They can communicate with their primary care provider on there.1465They can retrieve records, letters, medical records, decision1466notices. They get notices for appointments coming up on their1467app. It is really a great tool, and we really do love that app.1468It is just, again, how do we educate those veterans on using1469it?1470    Making sure that we have got access, critical. Also1471education on how to use the tool.1472    Ms. Budzinski. Any others? Yes.1473    Ms. Schauer. One of the biggest barriers I see is just a1474lack of awareness of eligibility. I think that the veterans1475that are within the VA somehow or have ever been connected with1476VA will get some information. You can access so much1477information on the internet. It is almost too much, it is hard1478to digest, you do not know what is worth going after. Not1479everybody even realizes that it is something that they should1480pursue.1481    I think again that outreach is so important. Going to where1482the veterans are. We find a lot of luck meeting women veterans1483in places like the farmers market. You know, like places just1484that veterans are, versus having a fair where they come to you.1485If I do not believe--we have a lot of veterans that do not even1486understand that they are a veteran, they do not identify as a1487veteran. That resource fair for them is not for them.1488    Finding ways to meet the veterans where they are and make1489sure that you have those conversations about what you are1490eligible for. Most of our women, that is why they have now1491gotten VA care is because they learned that they could. They1492did not even know that it was a possibility before.1493    Ms. Budzinski. Okay, thank you. I will go ahead and yield1494back.1495    Mr. Barrett. Sure, thank you. Thank you for that. I think1496you are right. I think it speaks to a thing--when I, prior to1497coming to Congress, I was in the State legislature in Michigan.1498We would always model our outreach and instead of asking, are1499you a veteran, because you are right, because people will self-1500select out of that definition, you ask, did you ever serve in1501the military, and then you can kind of explore that from there.1502    It is hard to hold a resource fair and advertise it as a1503did-you-ever-serve-in-the-military fair. It is a little bit1504harder to package. I think it is part of that, going where1505people are instead of expecting them to come to us. I think1506there is a lot of--part of this is an inertia thing. You begin1507unpacking this and then you work through the process and maybe1508obtain the benefits that you have kind of had on the back1509burner. Life comes at you, you are transitioning to civilian1510life. Things are difficult. It is like being in a batting cage1511and you are figuring out how to get stood up again. Then you1512think you will worry about it later. Then life comes in and you1513have a lot of other priorities.1514    Even for our Vietnam generation coming home, they were1515treated so poorly when they came back that many of them just1516kind of packed it away and then life took over. Then they moved1517to a different phase of life and those things they had tried to1518pack away come to kind of percolate back out.1519    I really hope, and I think we are making the strident1520effort of making up the lost ground that we had with that1521generation. They truly did suffer unnecessarily.1522    I will say, I am grateful that that generation made sure1523that our generation was welcomed back respectfully and with the1524dignity that all veterans deserve. I think that each of our1525Vietnam veterans are owed a great deal of appreciation for1526that.1527    Mr. Kirchner, I wanted to ask you a question. Since your1528really tragic experience with that provider, have you found or1529have you gone back into any community care services? What have1530your experiences been like more recently, and can you give us1531any insight into how that may or may not have improved, and1532where you think those improvements ought to go?1533    Mr. Kirchner. Sure. First of all, community care,1534excellent. Excellent. Every time they call about the1535appointment, like you said, we will get back with you, 24 or 481536hours. It is within 10 minutes they are calling. You know, they1537are bringing their A game.1538    Where I see that could be a benefit for the veterans and1539the VA is if I am going to an audiology appointment, I want my1540records to be reviewed by an audiologist, not a heart doctor or1541a person that is had the training. I do not believe the people1542that are doing these exams are the right people doing the1543exams. I think that is where the----1544    Mr. Barrett. You are talking for the compensation, pension?1545    Mr. Kirchner. Correct.1546    Mr. Barrett. Okay. Not the community care ongoing medical--1547--1548    Mr. Kirchner. No, the community care, they are doing1549everything to get you there.1550    Mr. Barrett. Sure. Sure.1551    Mr. Kirchner. You know, that is where community care is on1552top of their game. I think that is where it is falling apart,1553is whenever community care is done, that is where it is falling1554off the board.1555    Mr. Barrett. We will take that back, because I am not sure,1556sitting here, what the qualifications for those delegated1557outsourced, you know, compensation and benefit exams, what a1558requirement is for that person to be. I am sure they have to be1559a medical doctor, but I am not sure in which specialty or what1560that would involve. We will take that back for consideration,1561for some questions to VA about that. I appreciate your insight1562there.1563    Dr. Zomchek, one thing, I know you have talked about1564outreach with mental health and that being important, and I1565think that is a continuing effort we have to keep working1566toward. One population that we found some success in Michigan1567was actually reaching out to spouses of veterans as well,1568because oftentimes they are observing the behavioral challenges1569that veterans may have in a more, you know, intimate setting1570back home that they are not displaying out in public at their1571job, or they are, you know, taking that hardship back home with1572them. I think that that outreach to the spouses of saying, hey,1573here are some benefits that may be available to your loved one,1574may be that soft encouragement that they need to, you know,1575make the decision to come in to receive the help that they1576should have and that certainly have earned. I do not know if1577that is anything you have explored at all or if it is worthy of1578your consideration or not.1579    Dr. Zomchek. Yes, that is a great point. We know the1580connectivity with our veterans is often with family members,1581often children. Could be a neighbor. I think, as I hear this1582discussion about outreach and connectivity with our veterans,1583of course we have telehealth coordinators, we have people to1584talk and to train and to teach our veterans and family members.1585I really think that a multifaceted approach is what is needed.1586    There can be some of these standardized approaches that we1587are doing. What I have seen in my network is I have very rural1588and very urban centers, and even some of the hospitals that are1589very urban have very rural CBOCs. Having a group--each of the1590facilities does, I think, a great job of even with town hall1591meetings in reaching out and opening up our connections.1592Sometimes it is in person, sometimes it is with Facebook.1593    Whenever possible, we certainly invite spouses and family1594members to be involved in the care, so long as it is, you know,1595it is okay from a health information standpoint.1596    Mr. Barrett. Do you know of any way that we kind of tried1597to do the direct outreach to the spouses or near close family1598members of veterans, you know, with resources from the VA, to1599encourage them to try and encourage their veteran loved one to1600explore their benefits?1601    Dr. Zomchek. I would have to take that back.1602    Mr. Barrett. Okay.1603    Dr. Zomchek. I would be happy to follow up with you about1604any specific program or initiative about that.1605    Mr. Barrett. Sure.1606    Dr. Zomchek. I think mostly what we do, it is all1607encompassing, so all of the outreach that we do, we do not turn1608down if someone is asking about their father or mother or a1609sibling.1610    Mr. Barrett. I just think it might be a useful inroad with1611veterans. As it turns out, I have a wife, and she thinks I am1612rather stubborn. Maybe I am the only one, I do not know. Thank1613you. Appreciate it.1614    Dr. Zomchek. Thank you.1615    Mr. Barrett. Ranking Member Budzinski, go ahead.1616    Ms. Budzinski. Sure, I just had a final question for Ms.1617Schauer. I was wondering if you could speak about specifically1618women veterans? We have had a lot of conversation, obviously,1619focused on rural health care. I think that those challenges to1620access for women is probably greater. I was wondering if you1621could speak a little bit to that experience?1622    Ms. Schauer. Yes, our women veteran population, of course,1623we have a lot of unique needs. Military sexual trauma is1624probably one of the most prominent, though not isolated to1625women veterans, a higher percentage of women veterans. What I1626find in our community is hesitance toward using the VA because1627of experiences they had 10, 20 years ago, you know, when you1628dig into it. Just trying to encourage them that today's VA is1629different and you are in a place where you will be welcomed.1630    Once they try it again, they see and they believe, and they1631socialize it with each other. I think it is getting them in1632that door.1633    I think the social isolation that you are talking about, I1634love--I want to learn more about that program, because that is1635really why our community was created, and hearing about the1636high suicide rates for women veterans which, as a nurse, having1637been a nurse for 15 years at that point, I was completely1638unaware of.1639    When we started our group, we had immediate energy behind1640it. It just keeps growing and it just shows that need for1641people. Often, it does take asking them two, three, four times1642to come. Once they come, they are like so excited for the next1643meetup.1644    I do think women have unique needs that have gone a little1645bit unnoticed and unrecognized for a while. I am really happy1646that today's VA is seeing that and addressing that.1647    Ms. Budzinski. Thank you very much. I will yield back, Mr.1648Chairman.1649    Mr. Barrett. Sure, thank you. I appreciate that insight as1650well. I think maybe doing some public service outreach to women1651to really--like having firsthand testimonials of women who have1652come back and now received care at the VA to advocate for other1653women to, hey, this is not--number one, this is not the1654military. Whatever trauma you may have experienced there is1655not--I get that this is still the U.S. Government and there is1656a hill we have to climb to reestablish trust in many ways. This1657is not the same VA that may have been unprepared during those1658early days of the War on Terror and the war in Iraq and coming1659back home, and a lack of capacity and understanding and, you1660know, kind of a little bit of a legacy VA that has since1661transformed, and through a lot of work that was done and paths1662that were forged by women like yourself and other veterans1663coming back home, and advocates like many of you here and folks1664that work within the VA. We appreciate your work doing that.1665    I now want to yield to the ranking member for your closing1666statement.1667    Ms. Budzinski. Yes, thank you, Mr. Chairman. I just want to1668say again, thank you for coming to the 13th District. I really1669appreciate that.1670    Thank you to all the panelists. This was very informative1671on the work that we have ahead of us back in Washington. I1672really appreciate all of your time in making the trip here.1673    As the ranking member on the subcommittee with Chairman1674Barrett on Tech and Modernization, it was great to hear some of1675that conversation and how that is integrated into the rural1676experience for our veterans. I think we both know we have a1677long way to go, and we are a partner in that work because it is1678just so critical, whether it is scheduling or the electronic1679health records system, getting that fully operational within1680the VA is something that is critically important and will be to1681the benefit of the services that the veterans so well deserve.1682    Thank you again for being here. To the veterans, thank you1683for your service. I will yield back to the chairman.1684    Mr. Barrett. Thank you. Thank you, Ranking Member1685Budzinski, for hosting us today and for allowing me to see a1686little bit of a glimpse of your district, and appreciate both1687similarities and some of the differences between communities1688that we represent and how things are done. I really cannot say1689enough about how impressed I am by this facility, the outreach1690that is done, and the success stories that you have all had and1691the work that is ongoing that you are doing.1692    Kind of like we talked about earlier, Colonel, allowing1693veterans to find that next sense of real purpose, and I1694appreciate the work that you are doing here to make that1695happen.1696    One thing that I think can give us some really focused1697motivation for this is there are statistics around this. Of1698course, during that 20-year-long span of the War on Terror, we1699had just over 7,000 troops die on the battlefield. Every single1700one of them is an absolute tragedy. I have friends, and many of1701us who served have friends that were lost in that effort. We1702lost 35,000 more to suicide during the same period of time.1703    That really to me speaks about that total--the real total1704human cost of war that we have yet to fully appreciate. We have1705a lot further to go in that and how we can prevent those, each1706of which are preventable with the right intervention and the1707right outreach and the right care and treatment. That is a real1708mission of what we on this committee are focused on. A piece of1709that is this technology aspect of how we deliver benefits to1710veterans and how we really do a better job of making sure that1711they have the adequate access that they have all earned, to1712really head off at the pass the next veteran who may be going1713down that path.1714    Then also looking at veterans who are not contemplating1715suicide, but still need help for, you know, the back injury1716they sustained or the other service-connected conditions they1717may be facing or dealing with. What education benefits do they1718have that are available to them? What compensation and benefits1719are available for that continuation? All of the other services1720that VA provides that are really truly important and fall under1721this rather broad umbrella of the subcommittee and the work1722that we do.1723    I cannot tell you how much we appreciate each of you being,1724you know, really on-the-ground advocates, and with the1725firsthand knowledge and experience that you have of how we go1726about that.1727    You know, Washington, DC, is an 11-hour drive from here. We1728almost had to drive because of the weather with the flights1729yesterday. It is a long ways away from here, and it is a long1730ways away from everyday America. These are the communities that1731we represent.1732    I say this in my own district. It is my job to be my1733district's representative in Washington, DC, not Washington's1734representative back home in my district. That should really be1735a one-way street where we take our voices of our constituents1736and the folks that we represent and go advocate for them in our1737Nation's capital, and not come back here and tell you, well,1738you know, this is how it really works, and you have just got to1739get on board with it. That is not the role of Congress and that1740is never going to be what we do on this subcommittee.1741    This field hearing today really allows us to gather that1742insight from all of you here and take this with us back to our1743Nation's capital to really do our best and strive to make the1744best public policy that we can on behalf of our veterans and on1745behalf of the communities that we represent.1746    I thank you again for hosting us today, and we look forward1747to welcoming you to Michigan in the future to do another1748hearing in my district. Certainly for those of you that have1749further insight or thoughts for us, we welcome your insight. If1750you make it to Washington, we would love to have you in our1751hearing there as well.1752    Thank you again to everyone. Thank you to the staff, both1753committee staff on both sides, as well as the staff for1754arranging all of this, for those that were here providing other1755services, for hosting us today. I really do appreciate each and1756every one of you.1757    With that, I will ask unanimous consent that all members1758have five legislative days to revise and extend the remarks and1759include extraneous material. Without objection, it is so1760ordered.1761    And this hearing is adjourned.1762    [Whereupon, at 11:37 a.m., the subcommittee was adjourned.]17631764?17651766=======================================================================17671768                         A  P  P  E  N  D  I  X17691770=======================================================================17711772                    Prepared Statements of Witnesses17731774                              ----------17751776                  Prepared Statement of Daniel Zomchek17771778    Good morning, Chairman Barrett, Ranking Member Budzinski, and1779distinguished guests, thank you for the opportunity to discuss the1780Department of Veterans Affairs' (VA) extensive efforts to enhance the1781well-being of Veterans living in rural areas broadly as well as in the1782VA Illiana Healthcare System service area. My name is Daniel Zomchek,1783and I am the Network Director of Veterans Integrated Service Network1784(VISN) 12. I am accompanied today by Dr. Staci Williams, Executive1785Director of VA Illiana Healthcare System, and Dr. Peter Kaboli,1786Executive Director, Office of Rural Health (ORH), VHA.1787    Today, I will discuss key initiatives within the VA Illiana1788Healthcare System, VISN 12, and VA that exemplify our commitment to1789Veterans living in rural areas. From implementing advanced telehealth1790services to expanding our reach through community collaborations, VA,1791VISN 12, and the VA Illiana Healthcare System continually strive to1792bridge the gap in health care access faced by Veterans living in rural1793areas.1794    Our goal across VA, and certainly here in VISN 12, is to ensure1795that Veterans residing in rural areas have the same access to high-1796quality care as those in urban centers. ORH is instrumental in1797addressing the challenges faced by Veterans living in rural areas. VA1798is dedicated to putting Veterans first, prioritizing their needs, and1799continually improving access to care - especially for Veterans in rural1800areas. ORH supports 34 innovative enterprise-wide initiatives (EWI),1801which are field-based solutions that have been tested in multiple1802locations - including here in VISN 12 - and shown to be effective and1803efficient methods for standardized care delivery.1804    We understand the unique circumstances and needs of Veterans living1805in rural areas and are dedicated to developing sustainable and1806impactful solutions to meet those needs. By sharing our experiences and1807strategies, we hope to provide a clearer understanding of both the1808challenges faced and the progress made in delivering high-quality1809health care to Veterans living in rural areas.18101811Status of Rural Health in the VA Illiana Healthcare System18121813    We are proud of the comprehensive range of health care services we1814provide to Veterans through the VA Illiana Healthcare System. VA1815Illiana Healthcare System has been serving the Danville community for1816over 125 years. We employ over 1,500 health care professionals across1817our service area and deliver care to 30,000 Veterans annually. We are1818committed to expanding rural health access across our 34-county service1819area, reaching Veterans in both urban and rural areas in east-central1820Illinois and west-central Indiana.1821    Of the estimated 18 million Veterans living in the United States1822and its territories, approximately 4.7 million Veterans reside in rural1823areas. We also know that Veterans in rural areas enroll in VHA health1824care at a higher rate (65 percent) than their urban counterparts (471825percent). Out of the 62 VHA facilities in VISN 12, 43.5 percent (271826facilities) serve a population where 50 percent or more of enrolled1827Veterans are from rural areas. We understand the unique challenges they1828face, including difficulties accessing VA care due to geographical1829isolation.1830    I would like to highlight several areas of particular importance to1831us as we continue to put Veterans first and to enhance our outreach and1832capacity to reach Veterans living in rural areas: community care,1833telehealth to include virtual mental health care, and beneficiary1834travel.18351836Community Care18371838    VA continues to enhance the Veterans Community Care Program (VCCP)1839to ensure Veterans - especially those in rural or underserved areas--1840receive timely, high-quality care closer to home. Through VCCP, VA uses1841a network of more than 1.4 million non-VA providers to deliver1842essential hospital care and medical services (including mental health1843and specialty care), as well as extended care services, to eligible1844Veterans when they elect to receive care from such providers. This1845network is particularly vital for Veterans living in rural areas, who1846often face geographic and transportation barriers to care. VA has taken1847steps to streamline referrals, improve care coordination, and enhance1848oversight of community providers to ensure continuity and quality of1849care. The integration of community care with VA care reflects VA's1850commitment to meeting Veterans where they are and offering them more1851options while upholding the same high standards of Veteran-centered1852care.18531854Telehealth and Virtual Mental Health Services18551856    Telehealth has become a lifeline for Veterans living in rural and1857remote areas, where distance and limited local health care options can1858make it difficult to access timely care. VA has invested significantly1859in the telehealth infrastructure, enabling Veterans and other1860beneficiaries in rural areas to connect with primary care providers,1861specialists, and care teams through platforms like VA Video Connect.1862This technology eliminates the need for long travel times, supports1863continuity of care, and improves the management of chronic conditions.1864By leveraging telehealth, VA is not only expanding access but also1865improving health outcomes for Veterans in rural areas, ensuring they1866receive high-quality care regardless of where they live.1867    An essential aspect of telehealth and virtual health services is1868its pivotal role in addressing the mental health needs of Veterans.1869Access to mental health care remains a critical need for Veterans1870living in rural areas, where provider shortages and geographic1871isolation can create significant barriers to timely treatment.1872Recognizing this, VA has significantly expanded its virtual mental1873health services, ensuring that such Veterans can connect with1874psychologists, psychiatrists, and counselors from the privacy and1875convenience of their homes. Through VA Video Connect, Veterans receive1876care ranging from therapy and medication management to crisis1877intervention, all while avoiding long travel times. This digital1878infrastructure is helping to close care gaps, reduce stigma, and1879provide continuous support for Veterans who might otherwise go without1880essential mental health services.1881    To further meet Veterans' needs, VA has launched several telehealth1882initiatives including the VA Clinical Resource Hub program; Accessing1883Telehealth through Local Area Stations, Digital Divide Consult, Mobile1884Connectivity Program, clinic-to-clinic telehealth links, and the My VA1885Images app. These initiatives help increase clinical capacity and1886enhance health care delivery in rural areas.18871888Beneficiary Travel18891890    Veterans in rural areas can face significant barriers in accessing1891health care services due to longer travel distances. Recognizing these1892challenges, VA has developed a range of robust programs to facilitate1893transportation for Veterans designed to meet the diverse needs of1894Veterans and ensure that no Veteran - especially those living in rural1895areas - is left without options. VA operates several programs designed1896to meet the transportation needs of Veterans, including:18971898      Veterans Transportation Service (VTS): Through VTS, VA1899transports eligible persons to or from a VA or VA-authorized facility1900or other place for the purpose of examination, treatment, or care. VTS1901offers safe, reliable door-to-door transportation for Veterans,1902particularly those with disabilities, through a fleet of vehicles at1903many VA medical centers.19041905      Highly Rural Transportation Grants (HRTG): VA's HRTG1906program provides grants to eligible entities to assist Veterans in1907highly rural areas through innovative transportation services to travel1908to VA medical centers and to otherwise assist in providing1909transportation services in connection with the provision of VA medical1910care to these Veterans.19111912      Volunteer Transportation Network (VTN): VTN, principally1913supported by the Veterans Service Organization, Disabled American1914Veterans, provides free transportation for Veterans through volunteers1915using personal or VA vehicles to ensure access to appointments.19161917    VA's beneficiary travel program offers payments or allowances for1918eligible individuals. This includes both mileage reimbursement and1919special mode transportation, and beneficiaries can receive assistance1920when traveling for various examinations and care. This program helps1921reduce travel expenses, especially for those living in rural or remote1922areas.19231924Conclusion19251926    Chairman Barrett and Ranking Member Budzinski, thank you for the1927opportunity to discuss VA's efforts to serve Veterans in rural areas1928and to highlight the work of VA broadly and here in the Urbana,1929Illinois area. Thanks to Congress' support, VA has expanded its reach,1930delivering more care to a greater number of Veterans than ever before.1931We value your ongoing efforts as we strive to better serve those who1932have served.19331934                   Prepared Statement of John Lawson19351936H.R. 3132, CHOICE for Veterans Act of 202519371938    We adamantly oppose H.R. 3132, CHOICE for Veterans Act of 2025 as1939written. We do not view this proposal as a compromise contrary to some1940commentary being published and will continue to oppose any legislation1941that charges veterans for initial claims assistance based on their1942future benefits. This proposal has the likely outcome of putting1943veterans into debt before even receiving a single penny in their earned1944benefit. The companies engaging in this currently illegal activity1945should be punished, not rewarded with a disabled veterans compensation1946benefit. Congress' inaction on this matter has forced veterans to seek1947remedy at the statehouse, namely here in Illinois with the passage of1948SB3479 codified in Public Act 103-0783 under the Consumer Fraud and1949Deceptive Business Practices Act. Free VA accredited veterans service1950officers all over the country are ready to assist our fellow veterans1951without taking any part of their earned disability benefit. We expect1952our elected representatives to work with us to help serve the veterans1953in their districts and not to line pockets of claim sharks with money1954the taxpayers set aside to provide for the disabled veterans of the1955United States Armed Forces. We are extremely disappointed we must1956continue to have dialog on this topic, year after year after year. This1957legislation is also strongly opposed by the Veterans of Foreign Wars1958and Disabled American Veterans.19591960Veterans Benefits Improvement Act: Enhancing Communication19611962    With regard to the implementation of the Veterans Benefits1963Improvement Act: Enhancing Communication, Veterans Service Officers are1964still not experiencing the mandated communication in Section 3 between1965Claims and Pension (C&P) Examiners and veteran's representatives. It is1966essential to the timely adjudication of a veteran's claim that when1967issues arise or clarity is needed, an examiner attempts to resolve the1968issue directly with the veteran's representative, not by sending more1969letters or kicking the can to another work queue. Additionally, Section19704 of the same Act mandates that the VA provides regular reports on how1971it can improve communication with veterans' representatives. This1972includes assigning veteran liaisons to local facilities and enhancing1973access to VA systems, all aimed at fostering better coordination and1974ensuring veterans have the support they deserve throughout their1975benefits process. To date, this has not occurred in any meaningful way1976with our accrediting body, the National Association of County Veterans1977Service Officers (NACVSO).19781979H.R. 3951, Rural Veterans' Improved Access to Benefits Act of 202519801981    We encourage support of this legislation to extend the license1982portability for contracted health care professionals to perform VA1983disability examinations to January 2031. The disability examination1984system has evolved and expanded over many years. In 1996, as part of a1985pilot program, VA granted temporary license portability to allow1986contracted physicians to assist with disability examinations. Since the1987fall of 2016, VA has transitioned from VA-conducted examinations in VA1988settings to contracted examinations in non-VA settings for nearly all1989disability examinations. Exceptions are examinations that VA personnel1990must specifically perform by law. By increasing the number of eligible1991providers, this legislation would accelerate the initial stage of the1992disability claims process, particularly for rural and tribal veterans1993who often have few examination options near their homes.19941995S. 784, Rural Veterans Transportation to Care Act19961997    We encourage support of this legislation that would expand1998eligibility for the Highly Rural Transportation Grant (HRTG) program.1999It would also grant as much as $80,000 to State and county veterans2000service agencies, such as the Veterans Assistance Commission of St.2001Clair County and its Veterans Service Organization members to purchase2002vehicles, including those compliant with the Americans with2003Disabilities Act of 1990 (Public Law 101-336) to provide innovative2004transportation options for veterans in rural or highly rural areas2005traveling to and from medical treatment.2006    Unique to the HRTG program is the definition of ``highly rural'' as2007a location that contains no more than seven persons per square mile,2008which is a highly restrictive criterion. Other VA rural programs use2009the Rural-Urban Commuting Areas (RUCA) coding system to assess2010rurality. This bill would expand eligibility by including veterans who2011reside in either rural as defined by RUCA, or highly rural areas as2012defined by HRTG. This uniformity in standard will simplify processes2013and be more a more realistic approach to solving transportation issues2014in rural communities such as St. Clair County.2015    Our Public transportation options, taxis, and ridesharing companies2016that urban dwellers take for granted are virtually non-existent in2017rural St. Clair County, severely disadvantaging ill or injured veterans2018or those who do not drive or own a vehicle. This expanded program would2019satisfy a pressing need and ensure veterans could use their earned2020benefits regardless of where they live.20212022                  Prepared Statement of Hillary Rains2023[GRAPHIC(S) NOT AVAILANLE IN TIFF FORMAT20242025                   Prepared Statement of Kim Kirchner20262027    Good morning and thank you everyone for taking the time out of your2028day to listen to my testimony. My name is Kim Kirchner and I am a proud2029veteran who served in the United States Air Force/Illinois Air National2030Guard and served in Operation Iraqi Freedom and Operation Enduring2031Freedom. I'm currently a Sergeant with the Macoupin County Sheriff's2032Department.2033    I am writing the testimony in regard to the care that I have2034received at a compensation and pension exam. I drove over thirty2035minutes to an exam that VA scheduled for me with a contract provider.2036When I arrived, the medical provider informed me that I was not on her2037schedule and that she couldn't find my medical records. I told her that2038VA called me and asked me to come at an earlier date due to an opening.2039She finally found my records but had an attitude through the entire2040exam, which lasted a total of 3 minutes.At no time did she conduct a2041medical exam on me, she only reviewed my medical record. Based on that2042exam VA denied my claim. In order to finally get my claim awarded, I2043had to do a whole other medical exam. This was a massive waste of my2044time and taxpayer money.2045    I firmly believe that I am not the only veteran this has happened2046to and the outsourcing of these exams definitely needs to be looked2047into. When a veteran goes for an exam they should be treated with the2048upmost respect they deserve especially for putting their lives on the2049line for our country. When I walked out of the exam that didn't last2050approximately 3 minutes I have never felt so disrespected in my life.2051It is very frustrating to get treated this way especially having to2052drive 30 minutes to the exam due to living in a small town and nowhere2053close to a VA Clinic. I firmly believe that the VA needs to pay more2054attention to the care we are receiving from them outsourcing their2055compensation and pension exams.2056    Thank you and I am happy to answer any questions you may have.20572058                Prepared Statement of Christina Schauer20592060[GRAPHIC(S) NOT AVAILANLE IN TIFF FORMAT