Hearings to examine putting veterans first, focusing on the current VA disability system.

1[Senate Hearing 119-189]2[From the U.S. Government Publishing Office]34                                                        S. Hrg. 119-18956                 PUTTING VETERANS FIRST: IS THE CURRENT7               VA DISABILITY SYSTEM KEEPING ITS PROMISE?89=======================================================================1011                                HEARING1213                               BEFORE THE1415                     COMMITTEE ON VETERANS' AFFAIRS16                          UNITED STATES SENATE1718                    ONE HUNDRED NINETEENTH CONGRESS1920                             FIRST SESSION2122                               __________2324                            OCTOBER 29, 20252526                               __________2728       Printed for the use of the Committee on Veterans' Affairs2930[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3132        Available via the World Wide Web: http://www.govinfo.gov3334                                __________3536                   U.S. GOVERNMENT PUBLISHING OFFICE3761-878 PDF                  WASHINGTON : 20253839-----------------------------------------------------------------------------------4041                 SENATE COMMITTEE ON VETERANS' AFFAIRS4243                     Jerry Moran, Kansas, Chairman44John Boozman, Arkansas               Richard Blumenthal, Connecticut,45Bill Cassidy, Louisiana                  Ranking Member46Thom Tillis, North Carolina          Patty Murray, Washington47Dan Sullivan, Alaska                 Bernard Sanders, Vermont48Marsha Blackburn, Tennessee          Mazie K. Hirono, Hawaii49Kevin Cramer, North Dakota           Margaret Wood Hassan, New50Tommy Tuberville, Alabama                Hampshire51Jim Banks, Indiana                   Angus S. King, Jr., Maine52Tim Sheehy, Montana                  Tammy Duckworth, Illinois53                                     Ruben Gallego, Arizona54                                     Elissa Slotkin, Michigan5556                     David Shearman, Staff Director57                Tony McClain, Democratic Staff Director5859                           C O N T E N T S6061                              ----------6263                            October 29, 20256465                                SENATORS6667                                                                   Page68Hon. Jerry Moran, Chairman, U.S. Senator from Kansas.............     169Hon. Richard Blumenthal, Ranking Member, U.S. Senator from70  Connecticut....................................................     271Hon. Tommy Tuberville, U.S. Senator from Alabama.................    1472Hon. Mazie K. Hirono, U.S. Senator from Hawaii...................    1773Hon. Marsha Blackburn, U.S. Senator from Tennessee...............    1974Hon. John Boozman, U.S. Senator from Arkansas....................    2075Hon. Tim Sheehy, U.S. Senator from Montana.......................    2276Hon. Tammy Duckworth, U.S. Senator from Illinois.................    2477Hon. Jim Banks, U.S. Senator from Indiana........................    297879                               WITNESSES8081Hon. Cheryl Mason, Inspector General, U.S. Department of Veterans82  Affairs........................................................     48384Jeremy Villanueva, Associate Legislative Director, Paralyzed85  Veterans of America............................................     58687Jon Retzer, Deputy National Legislative Director, Disabled88  American Veterans..............................................     78990Ryan Gallucci, Executive Director, Veterans of Foreign Wars of91  the United States..............................................     89293Daniel M. Gade, Ph.D., Lieutenant Colonel, U.S. Army (Retired)...    109495Elizabeth H. Curda, Director, Education, Workforce and Income96  Security, Government Accountability Office.....................    129798                                APPENDIX99                          Prepared Statements100101Hon. Cheryl Mason, Inspector General, U.S. Department of Veterans102  Affairs........................................................    37103104Jeremy Villanueva, Associate Legislative Director, Paralyzed105  Veterans of America............................................    46106107Jon Retzer, Deputy National Legislative Director, Disabled108  American Veterans..............................................    54109110Ryan Gallucci, Executive Director, Veterans of Foreign Wars of111  the United States..............................................    61112113Daniel M. Gade, Ph.D., Lieutenant Colonel, U.S. Army (Retired)...    71114115  Attachment--Independence Project Sixth Interim Report..........    75116117  Attachment--``Wounding Warriors: How Bad Policy is Making118    Veterans Sicker and Poorer''.................................    83119120Elizabeth H. Curda, Director, Education, Workforce and Income121  Security, Government Accountability Office.....................    93122123                        Questions for the Record124125Government Accountability Office response to questions submitted126  by:127128  Hon. Bill Cassidy..............................................   109129130                       Statements for the Record131132American Federation of Government Employees (AFGE), AFL-CIO......   117133134The American Legion, Martin Callaghan, Veterans Disability Claims135  Specialist.....................................................   131136137Common Defense, John Kamin, Deputy Director for Government138  Relations......................................................   141139140Iraq and Afghanistan Veterans of America (IAVA), Devin Wozniak,141  Zach McIlwain Leadership Fellow................................   148142143National Association of County Veterans Service Officers144  (NACVSO), Andrew Tangen, President.............................   160145146National Organization of Veterans' Advocates, Inc. (NOVA), Diane147  Boyd Rauber, Esq., Executive Director..........................   166148149                        PUTTING VETERANS FIRST:150                  IS THE CURRENT VA DISABILITY SYSTEM151                          KEEPING ITS PROMISE?152153                              ----------154155                      WEDNESDAY, OCTOBER 29, 2025156157                                       U.S. Senate,158                            Committee on Veterans' Affairs,159                                                    Washington, DC.160    The Committee met, pursuant to notice, at 4 p.m., in Room161SD-G50, Dirksen Senate Office Building, Hon. Jerry Moran,162Chairman of the Committee, presiding.163164    Present: Senators Moran, Boozman, Cassidy, Blackburn,165Tuberville, Banks, Sheehy, Blumenthal, Hirono, Hassan, King,166and Duckworth.167168             OPENING STATEMENT OF HON. JERRY MORAN,169               CHAIRMAN, U.S. SENATOR FROM KANSAS170171    Chairman Moran. The Committee will come to order. Good172afternoon and welcome. It is nice to walk through the halls of173Dirksen and see kids trick-or-treating, it made me smile, and174then it made me sad that I wasn't home so I could be with my175kids, now my grandkids, on this occasion. But we have important176work here, and I am delighted to have the opportunity to bring177our Committee together and take a look at disability issues,178and I thank our witnesses for your presence here today.179    Senator Blumenthal is on his way. We have a 5:00 vote. I am180going to try to get us started, and that means I should stop181doing intro and begin the hearing. But I want to say a few182things first.183    Again, I appreciate the witnesses that are here. We want184your insight and perspective on this issue, and know it will185benefit us as legislators, and it will be helpful to veterans186and their families that we certainly aim to serve. Our nation187owes those who have served in uniform not only gratitude but a188steadfast commitment to provide health care, benefits, and189support they have earned through their service. It is our190collective duty to make certain we are doing everything191possible to help veterans to lead successful and fulfilling192lives after their military service. This obligation forms the193foundation of this Committee's work and the focus of today's194hearing.195    The disability claims process is intended to make certain196that those who have a lasting injury, visible or invisible,197from their service, receive the care and compensation they198deserve. Recent articles published by The Washington Post have199raised concerns and frustration within the veteran community. I200have heard from numerous veterans and groups who are frustrated201that these articles have left an impression that the veterans202are engaging in widespread fraud in the disability claims203space. The cases of fraud highlighted in these articles do not204reflect the reality of who veterans are, the vast majority of205veteran population, or the values veterans embody. Veterans put206country before self, from their decision to serve, to the oath207they swore.208    The attention that these stories have received provides us209with an opportunity to have an important discussion about210whether this system we have built is serving the needs of211veterans today and how we can reform it to better serve those212who it is designed to help.213    We have an obligation to the men and women who have214injuries or illnesses connected with their service in uniform215to make certain they are provided the tools and resources they216need to succeed in life after the military. Our goal today is217to examine the facts. Is the system ensuring timely, accurate,218and fair outcomes? Is it empowering veterans to thrive or219inadvertently creating barriers to their success and220opportunities after service?221    Today we will hear from the VA Inspector General, Cheryl222Mason, whose office is responsible for helping to root out223fraud and abuse in the VA system and who has extensive224experience in the disability claims system as the former225Chairwoman of the Board of Veterans Appeals; representatives226from three of our Nation's largest, most active veterans227service organizations, who represent various veteran228constituencies day in and day out in the disability claims229process; a representative from the Government Accountability230Office, who has published numerous reports and made numerous231recommendations on how to improve oversight and management of232the disability claims process; and Daniel Gade, who is a233service-connected disabled veteran and a vocal advocate for234changing the current disability system to better serve veterans235and support their long-term well-being.236    This is not the first, and will not be the last,237conversation we have in exploring how to better serve business238and improve the disability system to compensate veterans for239their service-connected conditions and help them live lives--240strong, successful, fulfilling lives, after their military241service.242    I look forward to the constructive discussion that I243anticipate will take place here, and we will give Chairman--244Ranking Member Blumenthal, no promotion intended--Ranking245Member Blumenthal the opportunity to offer his opening246statement as soon as he sits down.247    You must have heard me call you Chairman and you248immediately arrived.249    [Laughter.]250251         OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,252         RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT253254    Senator Blumenthal. Thank you, Mr. Chairman, and thank you255to all of our witnesses. We have more than the usual number,256and we welcome you here. We appreciate your public service as257veterans and afterwards as advocates of our veterans.258    And today's hearing is really focused on our Nation's259obligation to the men and women in uniform, and the system we260use to compensate any of them who become ill or injured due to261their service. We all know that the system inherited by262Secretary Collins was not perfect, but it was providing263historic levels of benefits to toxic-exposed veterans, thanks264to the bipartisan PACT Act, which all of us on this Committee,265I think, supported in a very bipartisan way.266    That same system is being dismantled through a series of267really reckless policies, in my view, that have pushed hard-268working civil servants who process disability claims to the269brink of what they can do. In fact, the Administration's270draconian deferred resignation program, return-to-office271policy, hiring freeze, arbitrary contract cancellation, and272other morale-crushing initiatives have driven out more than2731,800 mission-critical VBA employees. The result has been a274demoralized VBA workforce who is consistently pushed to275sacrifice quality for the sake of quantity.276    There simply are not enough people doing these jobs for the277work to be performed capably at a level that our veterans278deserve. It has created more work for claims processors, and279today we are going to hear from our VSO witnesses on how this280abdication in the name of modernization is impacting the281veterans you represent. I also want to hear your response to282those who believe that VA disability compensation is too283generous--not my view. That is how the system has been284portrayed by some opponents of the system in past years.285    The articles fail to understand or capture the purpose of286the benefit. Instead, they cherry-pick anecdotes to wrongly287claim that disability benefits is fraught with widespread288fraud. There is, in fact, some wrongdoing and fraud. We need to289root it out, investigate, and prosecute it, but not abandon a290system of compensation that is deserved and needed by veterans,291our heroes who serve and sacrifice for our country.292    I want to say finally that the current VA leadership has293repeatedly violated the Hatch Act by blurring the lines between294governance and political campaigning. That is unacceptable. And295there used to be bipartisan pushback to such behavior, and I296hope there will be again. Veterans deserve a VA that works for297them, whether they are Democrats or Republicans, and avoids298pushing partisan messages. I will continue to fight for the299improvement and expansion of earned VA benefits, and I300appreciate all of you here who are advocating for that cause.301Thank you, Mr. Chairman.302    Chairman Moran. Senator Blumenthal, thank you.303    Testifying on today's witness panel is Hon. Cheryl Mason,304the VA's Inspector General; Mr. Jeremy Villanueva, Associate305Legislative Director for Paralyzed Veterans of America; Mr. Jon306Retzer, Deputy National Legislative Director for Disabled307American Veterans; Ryan Gallucci, Executive Director for the308Veterans of Foreign Wars, and I know each and every one of you;309Retired Colonel Dr. Daniel Gade, who is a retired United States310Army Lieutenant Colonel; Ms. Elizabeth Curda, who is the311Director of Education, Whistleblower, and Income Security312Issues at the Government Accountability Office.313    Thank you all again for being here. Ms. Mason, you are now314recognized for 5 minutes.315316    STATEMENT OF HON. CHERYL MASON, INSPECTOR GENERAL, U.S.317                 DEPARTMENT OF VETERANS AFFAIRS318319    Ms. Mason. Thank you, Chairman Moran. Chairman Moran,320Ranking Member Blumenthal, and Members of this Committee, I am321pleased to be here today to discuss this important topic.322Having been on the job as VA IG for just over three months, I323am impressed by the dedication and significant oversight that324my OIG team provides to combat fraud, waste, and abuse, and to325improve the effectiveness and efficiencies of VA programs and326operations in service to our veterans, their families,327caregivers, and survivors.328    The veterans who served this country have made sacrifices329to do so, some with their lives, others through the challenges330of their individual service. Members of this Committee have led331efforts in passing legislation to expand benefits for veterans332over many years, such as the PACT Act. You know how important333it is for the government to keep its promise to our veterans334and their families. Most deserve, and have earned, the benefits335and services the VA provides to them.336    As the daughter and spouse of veterans and someone who has337made it her lifelong commitment to champion veterans, I find it338reprehensible for any person or entity to suggest that many339veterans are hustling or scamming to get benefits. Furthermore,340using OIG investigative evidence collected over several years341to make it appear like there is mass fraud by veterans,342misleads the public and maligns veterans.343    While, yes, there are some bad actor veterans who do commit344fraud against VA in both benefits and health care, they are few345in comparison to the 6.9 million veterans and beneficiaries who346receive VA benefits. Our OIG's investigative metrics indicate347that approximately 3.7 percent of our active fraud348investigations are veterans suspected of fraud in VA's349compensation benefits programs. My special agents'350investigative portfolios include violent crimes, threats,351ethics violations, and theft, as well as allegations of fraud352schemes related to a wide variety of VA programs, comprised of353education, fiduciary, compensation, loan guarantee, contracts,354and health care, just to name a few.355    The largest percentage of fraud in VA programs and356operations is perpetrated against VA and veterans, and my team357investigates these allegations to the full extent of the law,358and prosecutes them to the full extent of the law with the help359of DOJ.360    But VA OIG is not one dimensional. We are here not just to361stop fraud but also to prevent it. And one of the ways we do so362is through the collaboration of our accomplished staff in our363Disability Fraud Workgroup, sharing information and data across364the organization to ensure that veterans who have earned their365benefits receive them, and that people who defraud VA programs366are held accountable. My Office of Audits and Evaluations367conducts reviews of VA programs and operations, including all368of VBA's business lines, and makes recommendations for369improvement.370    These recommendations include ensuring that claims raters371consistently apply the correct laws and policies; the leaders372strengthen contracts for better, more accurate medical373disability exams; monitor and review fiduciaries' actions;374establish guardrails and procedures for educational programs;375and test existing automation methods and outcomes. Weakness in376guidance, application of the law, implementation of policy, and377lack of controls and oversight increase the probability of378fraud against VA and our veterans.379    Additionally, OIG provides fraud alerts about potential380fraudulent actions, from pension poaching to entities offering381fake documentation and promises and guarantees regarding382outcomes in VA benefits. We provide training and information on383how to recognize and report fraud to the OIG.384    As the VA IG, I take my duty to be impartial and385independent very seriously. Our work at OIG is based on the386facts and circumstances and evidence of each situation, and as387IG, I can assure you that VA OIG is committed to fighting fraud388and recommending efficiencies in VA's management of programs389and operations. In the past three months, we have increased our390efforts to work across all directorates so that our subject391matter experts can be force multipliers and share their392knowledge to protect the benefits and services that our393veterans have earned.394    Mr. Chairman, this concludes my statement. I look forward395to answering the questions the Committee may have and working396with you, your staff, and this Committee to improve oversight397of VA and the lives of veterans by ensuring they receive and398retain the benefits they earned. Thank you.399400    [The prepared statement of Ms. Mason appears on page 37 of401the Appendix.]402403    Chairman Moran. Thank you very much. Mr. Villanueva.404405STATEMENT OF JEREMY VILLANUEVA, ASSOCIATE LEGISLATIVE DIRECTOR,406                 PARALYZED VETERANS OF AMERICA407408    Mr. Villanueva. Thank you. Chairman Moran, Ranking Member409Blumenthal, Members of the Committee, I appreciate the410opportunity to speak with you today on behalf of Paralyzed411Veterans of America about the importance of VA disability412compensation to veterans with spinal cord injuries and413disorders.414    Due to the nature of their injuries and illnesses, our415members require a wide range of services and benefits,416including health care, specially adapted housing, adaptive417equipment for their vehicles, and financial compensation that418are tailored to their needs.419    It is disgraceful when disabled veterans are portrayed as420fraudsters and cheats simply for accessing earned benefits. To421be fair, PVA acknowledges that there are some veterans who422attempt to defraud the VA. However, these instances are few and423far between.424    It is a disservice to the sacrifices of the many men and425women who have served this Nation to suggest that large sums of426money are being wasted simply because veterans receive earned427benefits for service-connected conditions. In truth, many428veterans find it difficult to file even a basic claim for429disability. This is why PVA has service officers throughout the430country to help veterans navigate the VA's complex disability431process.432    We have gone on record numerous times to discuss ways to433make the disability compensation system less vulnerable to434fraud and waste while ensuring that veterans are fairly435compensated for their conditions. Today, I would like to focus436on two of those ways: insurance C&P exams and reviewing DBQs437for quality assurance.438    First, VA must ensure proper C&P exams. When a veteran439files a claim for disability compensation, a thorough440examination is crucial to an accurate outcome. The alternative441could mean years of appeals for the veterans to receive their442earned benefits. We have heard from our service officers, they443routinely see a lack of expertise in specific medical444specialties among contracted C&P examiners, which delays the445adjudication of veterans' claims.446    PVA strongly believes medical examinations for complex447service-related conditions such as SCI/D and TBI should be448conducted by VA doctors. Regardless, the VA must ensure that449any contracted C&P examiners are qualified to conduct necessary450exams, and any legislative proposals supporting contract exams451should include such provisions.452    Equally important to the qualifications of the provider is453an accessible, barrier-free facility to conduct C&P exams. Our454members have seen exam rooms that are physically inaccessible455and/or lack overhead patient ceiling lifts, causing members to456pause and wonder why the VA is sending them to facilities that457are ill-equipped to accommodate them.458    Another barrier encountered by SCI/D veterans is getting to459the contract facility. Several of our members have been460expected to travel more than 100 miles to reach the contracted461facility, even while the veteran is critically ill. VA and462third-party vendors' policies regarding these situations need463to be examined, and greater use of telehealth exams and464traveling examiners should be made.465    Second, VA must properly review DBQs for quality assurance.466PVA believes that the VA could improve the quality control467review of incoming DBQs to help ensure that exams are proper468and any fraud is caught early in the claims process. Currently,469VA claims processors have the authority to weigh the value of470DBQs provided by the veteran if they believe there might be471fraud. VA has roughly 20 quality analysts who review DBQs from472VA contractors. However, these examiners only review a sample473size for contractual compliance. Additionally, they only have474access to these DBQs once they are uploaded to VBMS, so often475they are reviewing them after a final decision. These examiners476should be given greater oversight authority, be allowed to477review all DBQs that are submitted, and have access to them478prior to uploading them to VBMS.479    In conclusion, PVA strongly believes that addressing areas480where VA can be more efficient would benefit veterans and481ensure the integrity of the benefits system.482    Thank you once again for the opportunity to present our483views on VA's disability claims process, and we look forward to484continuing our work with you to ensure that veterans get timely485access to all the benefits that they have earned and deserve.486And I would be happy to answer any questions you may have.487488    [The prepared statement of Mr. Villanueva appears on page48946 of the Appendix.]490491    Chairman Moran. Jeremy, thank you. Mr. Retzer.492493STATEMENT OF JON RETZER, DEPUTY NATIONAL LEGISLATIVE DIRECTOR,494                   DISABLED AMERICAN VETERANS495496    Mr. Retzer. Chairman Moran, Ranking Member Blumenthal, and497Members of the Committee, thank you for inviting DAV to testify498today on the VA disability compensation program, its vital role499in supporting veterans, their families, caregivers, and their500survivors, and the challenges VA faces in delivering timely and501accurate decisions.502    Last year alone, DAV assisted over 1.1 million veterans and503survivors. We filed more than 560,000 claims and took over 3.1504million actions on their behalf, at no cost. These numbers are505staggering, but they are not just statistics. They represent506veterans living with life-altering injuries, chronic illnesses,507and visible wounds such as PTSD. Many face barriers with508employment, health care, and activities of daily living. Behind509every claim is a personal sacrifice and a genuine need.510    Before I turn to recommendations, I must address the recent511article of The Washington Post that grossly misrepresented512disabled veterans and the VA disability compensation system.513The Post claimed veterans are swamping the VA with fraudulent514or dubious claims. According to the VA Office of Inspector515General, fewer than 200 fraud convictions occur each year. With516nearly 3 million claims processed annually, that is a fraud517rate of 1/100th of 1 percent. The article also labeled518conditions such as tinnitus, eczema, chronic pain,519hypertension, diabetes, depression, and even PTSD as dubious.520These are conditions Congress and VA have long recognized as521service-connectable conditions.522    Furthermore, The Post mischaracterized the PACT Act--the523Appeals Modernization Act is a loophole to abuse--when these524laws exist to deliver long-overdue justice.525    The VA disability adjudication process is legally binding,526highly regulated, and evidence-based. Service-connection527generally requires current diagnosed disability, an in-service528event or exposure, and medical nexus linking the two. However,529presumptive service-connection has an exception that allows VA530to grant benefits when scientific and historical evidence shows531veterans in certain places and locations were exposed. Claims532undergo a multilayered review by rating specialists and533compensation and pension examiners to ensure accuracy and534compliance. Fraud is an exception. It is not systemic.535    Now let me turn to our recommendations.536    First, VA must have resources to maintain claims accuracy537and timeliness. Backlogs surged from 150,000 in 2022 to over538400,000 in 2024, due to the PACT Act and also the outreach for539veterans crisis. Thanks to the increasing staffing, the number540is now about 135,000. Continued progress depends on sustaining541VBA funding, strategic use of overtime, and close monitoring of542staffing needs.543    Second, we must simplify the claims process. Veterans544should be able to file a claim by telephone. VA claims process545is well recognized as non-adversarial, and claims processors546should construe claims to maximize benefits. VA's requirements547that veterans specify a single benefit on a VA Intent to File548form can unfairly delay and reduce payments. If a veteran549checks only one box but later qualifies for another benefit,550they lose retroactive entitlement. This rule should be removed.551    Third, VBA must optimize technology. Artificial552intelligence, document digitization, and data mining can553transform claims processing. But accuracy, oversight, and staff554support are essential. VBA and its contractors must develop IT555systems that integrate with accredited veterans service556organizations for filing claims and appeals. The new Accredited557Representative Portal was developed without consulting DAV or558other major accredited veterans service organizations. It is559advisable that VBA and its contractors seek input and560collaboration with DAV and other major accredited veterans561service organizations on future enhancements and new system562builds to ensure usable, accuracy, and alignment with veterans'563needs.564    Finally, improve the presumptive-making process for toxic-565exposed veterans. Expanding research, creating independent566scientific review processes, and establishing stakeholder567oversight will help end decades-long wait for toxic-exposed568veterans. Presumptive rules not only deliver justice, they569allow VBA to adjudicate large cohorts efficiently, reducing570delays and appeals.571    Mr. Chairman, the veterans we represent are counting on572this Committee to ensure the system works for them, not against573them, to every veteran, so that every veteran has an574opportunity to have success after their service.575    Thank you, and I am happy to answer any questions.576577    [The prepared statement of Mr. Retzer appears on page 54 of578the Appendix.]579580    Chairman Moran. Mr. Gallucci.581582  STATEMENT OF RYAN GALLUCCI, EXECUTIVE DIRECTOR, VETERANS OF583               FOREIGN WARS OF THE UNITED STATES584585    Mr. Gallucci. Thank you. Chairman Moran, Ranking Member586Blumenthal, Members of the Committee, thank you for the587opportunity to testify on behalf of the VFW.588    When Americans raise their right hand, they sign a binding589contract to surrender freedoms, obey orders, and if called,590march into combat. In return, our Nation promises care and591benefits. That promise is not charity. It is a contract. For592our enlistees, it is enshrined in DD Form 4.593    Every veteran who served honorably has kept their end of594that contract, yet lately headlines question whether our595veterans really deserve it. The Washington Post, The Economist,596and others have said that benefits are absurdly generous, that597fraud is rampant, or suggest that a disability industrial598complex of VSOs profits off the system.599    We have heard it before. In 1930s, when the Economy Act600slashed benefits at the recommendation of Archibald Roosevelt,601and in the 1950s, when Omar Bradley chaired a commission that602tried to strip benefits from the less disabled and questioned603toxic exposure. We buried those bad ideas then, and it is our604duty to bury those bad ideas today.605    Fraud exists in large systems--Medicare, Social Security,606and yes, VA. But it is rare and it is prosecuted when it is607found. What is not rare are the invisible wounds of war--PTSD,608traumatic brain injury, chronic pain, or cancers caused by609toxic exposure. To claim these wounds are embellished or fake610is either ignorant or cruel. Invisible does not mean imaginary.611    Reporting like The Post's misrepresents key facts. They612tell readers that more than half a million veterans are613service-connected for seemingly minor skin conditions, failing614to note that 76 percent of these veterans are rated at 0615percent. If you add in 10 percent ratings, which often do not616affect compensation, that number jumps to nearly 94 percent.617The dataset does not support rampant exaggeration and fraud.618Plus The Post conveniently ignores the unique occupational619hazards of military service and why skin and foot conditions620are so common. There is a reason it is called ``trench foot.''621    It is easier to claim benefits in 2025, but this is a622feature, not a flaw. Reforms like the PACT Act leveled the623playing field for those poisoned by burn pits and other toxins.624We fought deliberately to improve access because past625generations suffered in silence. PTSD claims have drastically626risen in recent years, but it is naive to think PTSD is new.627Past conflicts labeled it ``soldier's heart'' or ``shell628shock,'' and it was a condition we tried to hide. Today,629veterans talk about mental health because it is okay to have630PTSD, and it is okay to claim your benefits. Because we talk631about it, veterans are fighting stigma for all Americans.632    The costs may seem jarring, but this is the sobering true633cost of two wars many households could afford to overlook.634Disability compensation is the settlement of a debt for the635social and occupational losses associated with the real and636persistent hazards of military service. A paycheck does not637erase a missing limb, and a steady job does not cure a damaged638lung.639    The all-volunteer force understands that military service640is dangerous. We choose to serve because service is authentic641and necessary, and in our contracts the United States committed642to make us whole when we were ordered to combat or other643hazardous situations.644    Unfortunately, perverse incentives exist, such as645concurrent receipt kicking in at 50 percent disability, or646family care that kicks in at 100 percent. Bad policy can drive647bad behavior, but Congress should fix the policy and not blame648the veteran.649    On fraud, let's talk about claim sharks, who often promise650benefit increases by submitting questionable evidence for a651hefty and illegal cut of the action. The VFW has led the fight652against this scourge, not to profit but to support veterans and653protect the non-adversarial benefit process. The VFW has654testified before Congress 15 times over the last three years655raising this alarm. We have had countless conversations with656the Committee seeking to stop the fleecing of veterans and657taxpayers. But our calls have gone unheeded, and we are now658targets of The Washington Post, accusing VSOs of embellishing.659    Our accredited representatives are bound by strict ethics660regulations in 38 CFR. We tell veterans what they need to know,661not what they want to hear. And we invited the VA general662counsel to audit our training in 2021, an offer that still663stands four years later.664    Its costs VFW and our partners tens of millions of dollars665each year to provide this service because every veteran666deserves an honest advocate, not a profiteer. Our veterans did667not ask what was in the air they breathed or the water they668drank, and unlike many other public servants, they cannot just669walk away if they do not want to do it anymore. We serve in670accordance with the contract we signed, and many now live with671the illnesses that steal their sleep, breath, and ability to672work. Suggesting they embellished their suffering for some673money is insulting.674    The VA system must work better. Simpler forms, improved675access to exams, and reliable technology. But veterans and676their VSOs are not the problem. We appear before Congress677dozens of times every year, asking for some nuanced reforms678that sometimes come to fruition, other times don't. And as we679speak, the government shutdown disrupts our work as critical680deadlines approach. Veterans cannot afford to wait. We must681reopen the government to avoid unnecessary pain and hardship682for our defenders.683    Members of the Committee, the all-volunteer force has684carried this Nation through the last quarter century of war. We685kept our promise, now the Nation must keep its word. It is time686for all of us to honor the contract.687    Thank you, and I look forward to answering any questions688the Committee may have.689690    [The prepared statement of Mr. Gallucci appears on page 61691of the Appendix.]692693    Chairman Moran. Thank you. Dr. Gade.694695              STATEMENT OF DANIEL M. GADE, PH.D.,696            LIEUTENANT COLONEL, U.S. ARMY (RETIRED)697698    Colonel Gade. Ladies and gentlemen, thank you for the699opportunity to testify on VA disability compensation system. My700testimony will differ from most you have heard. I am a member701of no veterans service organization and have no motive other702than to help restore the lives and dignity of millions of703veterans.704    For too long you have been told that the best way to care705for veterans is to shovel billions of taxpayer dollars into706their pockets. This approach has resulted in a veteran class707that is sicker, more marginally employed, and more suicidal708than ever. By paying veterans to be sick, we create more sick709veterans, separated from meaningful lives and purpose, and we710deepen our suicide crisis.711    I developed this perspective through hard experience and712long study. I was wounded in combat twice, losing my right leg713and spending a year at Walter Reed. After recovery, I earned a714master's degree and joined the White House Domestic Policy715Council, where my previously acquired user-level experience was716bolstered by my work alongside both the Dole Shalala Commission717and the Scott Commission.718    I later completed a Ph.D. in public policy, focused on the719VA claims process, and while teaching at West Point, co-led the720Independence Project, a randomized control trial demonstrating721the powerful link between employment and health. In 2021, I722published, ``Wounding Warriors: How Bad Policy is Making723Veterans Sicker and Poorer,'' and recently served two years as724Virginia's Commissioner of Veterans Services.725    The surge in disability claims is not due to combat726injuries but to a culture that rewards illness. Last year727alone, over 450,000 new compensation recipients entered the728system, while total combat-wounded from the Global War on729Terror (GWOT) numbered around 50,000. Last year, more than730270,000 veterans began receiving compensation for tinnitus,731which is 100 times the number of GWOT amputees over a 20 year732period. Blessedly high survival rates from combat wounds are733not the cause of the growth. This lie allows advocates to tuck734every veteran disability claim under the cloak of virtue.735    Instead, the avalanche of claims is driven by non-profits736and pay-to-play claims companies that encourage veterans to737selectively exaggerate or falsify symptoms to ``grab all they738can.'' Aging, genetic, and lifestyle conditions are739increasingly labeled ``service-connected,'' resulting in tens740or hundreds of thousands of veterans rated as 100 percent741disabled who have no true incapacity, or whose incapacity would742have eventuated regardless of service status.743    I propose two principles of reform. One, meaningful744employment is powerful medicine. A 2020 paper called745``Employment is a critical mental health intervention.''746Unfortunately, veteran participation in the labor market,747especially among men in prime working years, is markedly lower748than their civilian counterparts, and has been steadily749declining over the past 20 years. Disability compensation750discourages work by rewarding inactivity; some programs, like751IU, create a direct barrier to work. Any separation from the752labor force causes isolation, malaise, and reduced income753coupled with a demand for ever-higher ``disability'' payments.754    We should shift dollars from paying veterans to be sick755toward meaningful incentives for gaining and maintaining756productive employment. Early positive incentives can have a757long-lasting positive effect, as demonstrated by the758Independence Project.759    Two, disability compensation is a destructive goal.760``Disability'' is a negative word. In Latin, ``dis'' means761``not,'' ``opposite of'' or ``apart.'' The disability762compensation system pulls veterans into a destructive identity763as ``disabled veteran'' rather than helping create a positive,764forward-looking life and career. This system is anti-thriving,765anti-productivity, and ultimately anti-veteran. Further, it766discourages future generations serving by painting veterans as767a troubled, problem class.768    The compensation system traps veterans in a disability769identity, teaching them to chase a 100 percent rating as proof770of honor or source of validation. Nine of the top 10 conditions771for newly rated veterans are easily exaggerated or totally772unverifiable. We need a system that affirms veterans' capacity773to thrive, not their presumed fragility.774    Here are several steps that would protect the integrity of775the system. One, treat but do not compensate for non-disabling776conditions and eliminate conditions caused by genetics, aging,777or lifestyle from the compensation rolls. Sleep apnea is one778obvious example; there are hundreds of others.779    Two, require active treatment for compensated mental health780conditions. If compensation is warranted, so is care.781    Three, extend VA medical eligibility for all service-782related conditions without tying it to disability ratings,783removing incentives for false claims.784    The current disability system robs veterans of purpose and785dignity, trapping them in idleness and despair. Further, the786isolation brought on by separation from the labor market can787and does send many veterans into a morass of tragic788consequences.789    Reform will be difficult--entrenched interests protect the790status quo--but it is essential. A close look at past changes791shows that what survives the legislative and rulemaking process792are usually additions to existing programs or the creation of793new programs. The VA budget grows inexorably despite the system794causing immense ongoing harm. Deep structural reform will save795lives and restore what veterans truly need: meaning, work, and796hope.797    And to Senator Tuberville I say, ``War Eagle.''798799    [The prepared statement of Lieutenant Colonel Gade appears800on page 71 of the Appendix.]801802    Chairman Moran. Ms. Curda.803804STATEMENT OF ELIZABETH H. CURDA, DIRECTOR, EDUCATION, WORKFORCE805     AND INCOME SECURITY, GOVERNMENT ACCOUNTABILITY OFFICE806807    Ms. Curda. Good afternoon, Chairman Moran, Ranking Member808Blumenthal, and Members of the Committee. I am pleased to809discuss GAO's work on VA's management and modernization of its810disability compensation program.811    VA has taken various steps to improve this program.812However, VA is a large, decentralized organization where813efforts to bring about positive change can face strong814headwinds.815    As a result of this situation, we put VA's disability816compensation program on our High-Risk List. This is a list of817programs GAO considers to be high risk because there is818significant waste, mismanagement, or a need for broad-based819transformation. In the case of disability compensation, VA has820been trying to update and modernize the program for years, with821limited success.822    Underpinning many of these problems are VA leaders and823managers not fully leveraging leading practices to manage the824disability compensation program. These are practices like825setting goals, developing plans to achieve the goals,826collecting data, and assessing results. These practices set up827organizations for success. Here, that means providing accurate828and equitable decisions on compensation claims for veterans829with service-connected disabilities.830    To some, talk like this of management practices may seem831quite dry and technical. However, effective management of the832disability compensation program can help VA meet veterans'833needs by providing timely and accurate decisions. It can also834save taxpayer dollars by reducing mistakes and costly rework.835    My testimony today discusses, first, VA's longstanding836challenges with managing changes to the disability compensation837program; second, challenges to ensuring the quality of838disability compensation decisions; and third, policy approaches839that disability commissions and others have raised for840modernizing VA's disability benefits structure.841    For the first area, on managing changes to the program, one842key example of a longstanding challenge is VA's efforts to843update its rating schedule. VA continues to rely on outdated844medical and earnings loss information in the rating schedule to845determine whether veterans qualify for disability benefits.846VA's updates of the medical information in the rating schedule847have been slow. VA is 10 years behind its goal. While VA848officials have updated many of the body system, several systems849remain outdated.850    Moreover, the rating schedule has not been comprehensively851adjusted since its creation in 1945. Past studies found that852given all the changes in the labor market, veterans were not853being equitably compensated under this 1940s model.854    For the second area on ensuring the quality of decisions,855our prior work has identified challenges to VA providing high856quality disability exams for veterans and training for claims857processors. These exams and training are key for accurately858processing veterans' claims and preventing fraud, costly859delays, and rework.860    For example, we recently made five recommendations to861strengthen VA's oversight of contracted medical exam quality.862Our recommendations generally focused on three areas:863identifying and correcting the most frequent or complex864problems with contracted exams; incorrect financial incentive865payments to contractors; and third, a gap in feedback from866those who perform disability medical exams.867    VA generally agreed with these recommendations. As of868today, none of the five have been fully implemented.869    In addition, our 2021 report highlighted numerous870shortfalls in VA's management of its training for new and871experienced claims processors. To address these shortfalls, we872made ten recommendations. As of today, four recommendations873remain open, including ones to enhance VA's planning and874evaluation of its training program.875    For the final area on program modernization, our prior work876has identified various policy options proposed by others for877rethinking VA's existing disability benefits structure. For878example, our 2012 report examined opportunities and challenges879of several policy options. These options included things like880integrating vocational services with cash assistance rather881than focusing on compensation alone.882    In summary, addressing the longstanding challenges we have883identified requires sustained leadership over the use of884leading management practices. Ultimately, this would help885ensure veterans receive accurate and timely decisions on their886disability compensation claims while also safeguarding taxpayer887dollars.888    This concludes my statement, and I am happy to address your889questions.890891    [The prepared statement of Ms. Curda appears on page 93 of892the Appendix.]893894    Chairman Moran. Thank you very much. Senator Tuberville.895896                     HON. TOMMY TUBERVILLE,897                   U.S. SENATOR FROM ALABAMA898899    Senator Tuberville. Thank you, Mr. Chairman. Thank you for900your passion. This is a great panel. Thanks for doing this. We901have spent a lot of time doing things to help our veterans. I902come from a military family and it has been very passionate to903me. Right benefits for the right veterans. I think that is what904our title is here today.905    I would like for anybody to answer this. I do not know who906to ask this question to. Many will remember that under the907Veterans Access Choice and Accountability Act of 2014, a908commission on care was established to develop recommendations909to improve the VHA. The call for this commission came after a910scandal at the VHA. Don't each of you think that it is time a911commission was established to develop recommendations to912improve the VBA, and don't our veterans deserve a system like913this with a commission?914    Does anybody want to answer this? Push your button and have915at it.916    Ms. Mason. I guess I am going to jump in.917    Senator Tuberville. You are first. Go ahead.918    Ms. Mason. Yes. I think a commission would be very well919placed. I think it is needed to look at the VBA process, like920it is supposed to do at VHA.921    Senator Tuberville. Anybody else? Go ahead, Ryan.922    Mr. Gallucci. Thank you, Senator. I get nervous about the923prospect of a commission, and there is a reason why.924    Senator Tuberville. Well, we all do. We all do.925    Mr. Gallucci. I remember with the AIR Commission we, as an926organization, were a bit of champions of that, and it could not927make it past the first marker. And now we are seeing the928repercussions of that. I know we are talking about the Benefits929Administration, but now with Veterans Health Administration it930has become glaringly obvious that the infrastructure is in the931wrong place, and it has resulted in a higher cost for care.932    I would argue that a forum like this is certainly a good933start to have these discussions. I know that Dr. Gade and I do934not agree on everything, but there are a few things that he935said that I know are very--I think we would agree on, as far as936how we reform the system and incentivizing the right behavior937by veterans, who are only seeking the benefits that they have938earned through their service contract.939    Senator Tuberville. Thank you. You know, with the passage940and fast-tracked implementation of the PACT Act, it has put a941strain on disability claim processes. How can we simplify that?942How can we make sure they both work? A lot of money has been943put into this. Anybody?944    Colonel Gade. Senator, I would like to just briefly point945out that there are several things in the PACT Act that are not946only problematic from a sort of overloading the system point of947view but also problematic from a moral point of view. So here948is an example.949    The PACT Act makes hypertension a presumptive condition for950all Vietnam veterans who were exposed to Agent Orange. What is951not mentioned in the PACT Act, or any of the discussion around952that, is that when you norm for age, sex, and race, non-953veterans of those age groups have the same exact hypertension954rates as veterans do in those age groups. So we are955compensating for something that is--forgive the expression--956old, fat people get hypertension. That is going to happen to957sort of all of us at some point.958    But what the PACT Act did was allowed people to shift the959responsibility for those lifestyle conditions from themselves960to the government and blame the government for problems that961are not the fault of the government, and therefore taxpayers962are taking a bath on that.963    Senator Tuberville. Thank you. So, anybody, what simple964changes do we need to make to make sure disability claims go to965the right people? Go ahead, Ryan.966    Mr. Gallucci. Senator, I would say that we need to speed up967the science. I think the issue that we see, for example, with968Karshi-Khanabad in Uzbekistan, there is a stark difference969between what servicemembers who developed rare cancers and rare970health care conditions while they were still in active duty,971gaining those benefits, and then those who, the uniform came972off but the condition did not develop until 15 months after973they came off of active duty, and they have been struggling974ever since.975    I think one of the greatest detriments that we have is the976time it takes to identify when a toxic exposure has happened977and then make that veteran whole. I think because of the978framework set forth in the PACT Act, there needs to be some979urgency, especially for people like those who served on K2.980    Senator Tuberville. Urgency does not work up here, in the981Federal Government. I will tell you that. We wish it did.982    Thank you, Mr. Chairman. My time is up.983    Chairman Moran. Senator Blumenthal.984    Senator Blumenthal. Thank you, Mr. Chairman. Thank you all985for being here and for your testimony.986    Let me ask you, Ms. Curda, as you know substantial numbers987of VA employees have been cut, and as many as 30,000 will be988cut. The original number was 83,000. The uproar and reaction to989Secretary Collins' announcement caused it to be reduced. But990doesn't that kind of cut in workforce have an impact on the991quality of work in processing disability claims?992    Ms. Curda. Well, one of the issues on our High-Risk List is993the ability of VA to process disability claims and manage the994workloads. As we have been discussing, there have been many995changes to what is eligible, and that has increased claims996substantially, and over time VA has had extensive backlogs that997they have not been able to keep up with. And so they have been998in kind of a pattern of recently hiring more staff to be able999to process those claims, and they have most recently been1000somewhat successful in bringing the backlogs down and improving1001timeliness.1002    I do not know how many of those people that you mentioned1003were actually processing disability claims. I would expect VA1004to conduct analysis, workforce planning analysis, to see what1005would the cuts to staff in the disability claims processing1006area, what effect would that have on productivity and on these1007backlogs. Because they were making progress, and I do not know1008that these particular cuts are affecting that or not.1009    Senator Blumenthal. But basically, if you cut the number of1010people doing the work and the work increases, it is going to1011take longer and possibly be more error prone.1012    Ms. Curda. That is a logical conclusion, yes.1013    Senator Blumenthal. Thank you. Mr. Gallucci, I was struck1014by your comment that if there are problems in the programs we1015should fix the programs, not blame the veterans. The veterans1016are not the problem, and I am struck by statements from the1017Administration, including the top levels of the Office of1018Management and Budget, Russell Vought, that means testing maybe1019is a reform that should be adopted. He has suggested that the1020Administration should, quote, ``target significant cost savings1021from revising disability rating awards.'' I have not heard the1022Secretary criticize or refute that potential course of action.1023What do you think of it?1024    Mr. Gallucci. Senator, the idea to restrict benefits1025payments to service-disabled veterans at a lower percentage,1026that dates back to the Bradley Commission in the 1950s. It was1027a recommendation that came out of there at the time, and there1028was nothing really to substantiate that at the time.1029    One of the things that we often talk about is that we are1030talking about social and occupational impairment here and loss1031average earnings potential. And it really should be a dead1032conversation on means testing for a service-connected1033disability. That is a very different rate. I mean, there is1034means testing for pension, but we are talking about service-1035incurred disability. It is a very different scenario. We see1036nothing in Title 38 that would allow for that without a change1037from Congress that we would vocally oppose.1038    There is a philosophy there that when you sign that1039contract, and it is the clause in the contract that says, ``you1040will be ordered to deploy to combat or other hazardous1041situations.'' And I worry sometimes we lose the focus on that1042``other hazardous situations'' point. The Washington Post did1043that in their article, talked about what they presumed to be1044non-service-related conditions or common conditions. And that1045could probably be a whole other hearing, to break down how1046those are service-related because of the unique nature of1047military service. And then when you are talking about those1048lower percentages, the occupational impairment that comes with1049that--time off for medical appointments, underemployment. Those1050are real issues for veterans that face chronic health1051conditions that require consistent care.1052    Senator Blumenthal. We do not need a commission to tell us1053that we ought to sustain disability benefits for injured1054veterans, do we?1055    Mr. Gallucci. I think it is an obligation of our country to1056honor the enlistment contract, the contract that we all signed,1057and provide the care and benefits that we have earned.1058    Senator Blumenthal. Exactly. Just one last question for Mr.1059Retzer. You told me that VSOs have been excluded from the space1060that they have at regional offices. Could you tell the1061Committee about that fact?1062    Mr. Retzer. Yes, thank you for that question. Yes,1063unfortunately our national service officers around the country1064who have been co-located within the VA Regional Offices are not1065allowed to conduct normal business to be able to assist the1066veterans. Even though the VA Regional Offices are closed, we1067were only allowed 30 minutes. And an example is in North1068Carolina. We unfortunately went there one morning and we had1069over 180 pieces of mail. And when you look at that, those are1070time-sensitive issues, with the effective dates to file initial1071claims and evidence to support pending claims, and so on. And1072it makes it very difficult for us, even though our team is1073ready to provide services at home, doing telework. We have been1074ready because the pandemic prepared us to do that.1075    But what we are seeing is that our service officers,1076unfortunately, now have to deal with the PII, taking the1077information out of the Regional Office and to do that work, and1078be responsible, and they are. But the thing is, it really1079drives a wedge in our process, because within the VA Regional1080Office, we have the capacity of technology and the resources to1081do secure work. And we are very disappointed, and we hope that1082the VA will open back up for all organizations that are1083accredited in there, because this is the first time in any1084shutdown that we are actually not allowed to stay in.1085    Senator Blumenthal. Thank you. And I have spoken to others1086about it. I do not know whether that is the experience of other1087VSOs as well. Is that true of VFW, Mr. Gallucci? It is. Okay.1088    Mr. Gallucci. Yes. It is the common experience for those of1089us who utilize space in those federal facilities. And this1090morning we were also notified by general counsel that the1091processing of accreditations is not considered an excepted1092activity.1093    Senator Blumenthal. I might ask, and I have mentioned it to1094Inspector General Mason, and perhaps she can look into it.1095Thank you all. Thanks Mr. Chairman.1096    Chairman Moran. You're welcome. Senator Hirono.10971098                     HON. MAZIE K. HIRONO,1099                    U.S. SENATOR FROM HAWAII11001101    Senator Hirono. Thank you. I think when you read The1102Washington Post's article, recent article, it really gives the1103impression that the whole system of ratings and disability1104payments and all of that are fraught with peril and fraud. So1105as Mr. Gallucci said, a system as large as that, well, there1106will be fraud.1107    So what I would like to ask Inspector General Mason is, a1108system like this, a program like this system is going to have1109fraud, my concern would be that do we have the capacity within1110the VA to investigate fraud? And I am not sure who prosecutes1111the fraud, whether the VA has lawyers that do that, or whether1112that has to go to the Attorney General's Office? But really, I1113would like to know what kind of capacity is in the VA to1114investigate fraud, meaning that has the entity that would, I1115guess it would be your office, Ms. Mason, that would1116investigate fraud?1117    Ms. Mason. Yes.1118    Senator Hirono. Have you seen reductions in the number of1119people in your office?1120    Ms. Mason. Senator Hirono, let me answer that question. It1121is our office that is charged with that duty, to investigate,1122and work with DOJ, primarily the Assistant U.S. Attorneys, as1123well as local law enforcement to go after the fraud, and we do1124that. To go after fraud there does have to be a threshold,1125though, of intent. So there has to be corroborating evidence1126and facts. So our office does that.1127    As far as the number of people we have, we do have that, my1128investigators are working.1129    Senator Hirono. Excuse me. Why don't we go to--I would like1130to ask the question relating to pre-shutdown. The last IG had1131over 1,000 staff. Is that what you have? Do you have 1,0001132staff people?1133    Ms. Mason. Currently we have approximately 1,000 staff1134prior to shutdown. OPM did authorize me, through exemptions, to1135hire 35 additional staff across the OIG, which included two1136investigators. And we were proceeding to do that but the1137shutdown got in the way.1138    Senator Hirono. You know, we can end the shutdown if a1139certain party decides to restore health care to the American1140people, but we will not get into that right now.1141    So you have the same number of people then that your1142predecessor had, and you have authority to hire 35 more people.1143Do you consider that enough of a staff, enough capacity to deal1144with the millions and millions of veterans that you are dealing1145with? And I do not know how many hundreds of thousands of1146claims that you are being asked to review.1147    Ms. Mason. Well, let me clarify that real quick, Senator.1148At the beginning of FY 2025 we had 1,175 people. We lost about1149175 people due to DRP and VERA and normal attrition. We are at1150about 1,000 right now. My budget, as presumed, we think, is1151going to be able to allow me to hire an additional 70 people.1152OPM is giving me authorization for 35. However, we do not1153process the claims. We do not adjudicate the claims. We1154investigate fraud, and we do oversight of VBA. That VBA does1155all the claims actions. But we have the people to do oversight.1156    Senator Hirono. Okay. So there is another office within the1157VA that has oversight over the claimants, and you have all1158these people who have to determine ratings and the extent of1159disability, et cetera, that leads to certain amounts being1160paid. So let me ask you this, then. Do you think that you have1161enough capacity to investigate all of the fraud that you think1162is out there?1163    Ms. Mason. We do. The majority of our work, Senator, is in1164education and health care and fiduciary fraud, as well as some1165compensation. But as I testified earlier----1166    Senator Hirono. So you--I am running out of time--so you1167would take issue with The Washington Post's article----1168    Ms. Mason. Absolutely.1169    Senator Hirono [continuing]. That indicates there is1170massive fraud going on.1171    Ms. Mason. There is no massive fraud going on. I take1172issue, yes.1173    Senator Hirono. I want to thank the other people who have1174testified from the VSOs, because you are right there, on the1175ground, and you are dealing with the veterans. And I know from1176the veterans that I hear from that there are delays in getting1177their ratings. There are any number of ways that the system can1178be improved. And we heard from Ms. Curda, from GAO, about a1179number of recommendations that could improve the system, and1180the indications seem to be that the VA has not made the kind of1181changes that were recommended.1182    Would those of you who represent VSOs, would you agree that1183these recommendations have not been complied with or met?1184Anybody want to weigh in, briefly, because my time is already1185up?1186    Mr. Gallucci. I would agree that oversight and quality1187controls need to be there. When we are talking about fraud or1188questionable claims, I point to one of the examples in The1189Washington Post story, where they talked about a veteran who1190received benefits for an accident related to a DUI. I believe1191that is a quality control thing. And there are things that are1192supposed to be considered willful misconduct that do not1193qualify for benefits. And when something like that is found,1194that VA has the quality controls in place to make sure that1195they are not awarding benefits in a situation that they should1196not.1197    Senator Hirono. And do you think they do have those quality1198controls in place?1199    Mr. Gallucci. I think they need to improve on those quality1200controls, ma'am, yes.1201    Senator Hirono. Thank you.1202    Chairman Moran. Senator Blackburn.12031204                     HON. MARSHA BLACKBURN,1205                  U.S. SENATOR FROM TENNESSEE12061207    Senator Blackburn. Thank you, Mr. Chairman. I have got just1208a couple of questions. But before I start, I do want to correct1209the record. Republicans are not denying health care to anyone.1210There is a discussion over the Biden bonus credits that were1211given during COVID. And our colleagues across the aisle could1212end the shutdown today by voting for a clean CR, which these1213are numbers they have voted for many times----1214    Senator Hirono. Mr. Chairman, I was good enough not to get1215into it, and I would ask the same from my colleague.1216    Senator Blackburn. And then also I would note that the1217claims backlog that was referenced happened during the last1218administration, and we discussed this at length in hearing1219after hearing, with the fact that workers were working1220remotely, and of course, and Ms. Mason, I want to come to you1221on this. Because the PACT Act implementation caused a lot of1222confusion, and there was the warning of we had a $3 billion1223shortfall, and it was going to require emergency spending. And1224then, of course, we found out later that this was just a1225budgeting boondoggle, and the implementation of the PACT Act,1226the VA systems could not handle it, and there was no shortfall,1227but this frightened a lot of our veterans and their families.1228And the good news is we have got some leadership at the VA now1229that is straightening this out, and we are grateful for that.1230    And what I would like to hear from you is what your sense1231of how well the VA leadership is following through on your1232recommendations to tighten oversight and prevent that kind of1233misstep from taking place again.1234    Ms. Mason. Senator Blackburn, to answer your question, we1235have done a series of reports in the OIG's office to point out1236the lack of controls and oversight within VBA around1237particularly PACT Act, especially with the fact that they have1238scattered guidance all over the place and their manual is not1239in compliance with the law.1240    Right now they tell us they have a plan. We have not seen1241anything. They are partially shut down. They are doing claims.1242We have not seen anything yet, but we are following up, and we1243have further evaluations to look at and audits to do once we1244get back in business.1245    Senator Blackburn. Okay. And Mr. Gade, thank you for your1246testimony. And I noted in there that you made a strong case1247that the disability system sometimes will trap veterans. So1248what is the first couple of things that you think Congress1249could change that would help clean this system up?1250    Colonel Gade. Yes, ma'am. Thank you for that question. The1251very first thing that I think ought to be changed is how we1252talk about the word ``disability.'' So only in the VA system1253are flat feet a disability. Only in the VA system is tinnitus a1254disability. Because what we have is an over-broad definition of1255the word. If we went to the ACS, American Community Survey,1256definition, or we went to any other publicly available1257definition, like the Social Security disability definition,1258what we would have is the ability then to put more money to1259things that matter, things like employment, things like1260rehabilitation, things like medical care, and less money in1261transfer payments that we know are causing people to be sicker1262and to be trapped in this cycle of malaise. So that is the very1263first thing I would say.1264    Senator Blackburn. And Ms. Curda, would you agree with1265that, because you have weighed in some on this system.1266    Ms. Curda. Yes. In our testimony we did work some years ago1267where we looked at all the commissions that have looked at1268reform options for the disability system, and summarized those1269positions, the advantages, the disadvantages. I do not know1270that there is a clear one right answer there. It is a policy1271call. There are no changes that do not come without some kind1272of a cost. You know, one way or another, there will be winners,1273there will be losers, there will be costs to administer more1274complex systems. I mean, it has to be looked at very carefully.1275    Senator Blackburn. But you had referenced the high-risk1276areas for mismanagement, and that being one of them.1277    Ms. Curda. Well, for sure they have not updated the1278schedule for how they decide those compensation levels within1279existing law.1280    Senator Blackburn. Excellent. Thank you. Thank you, Mr.1281Chairman.1282    Chairman Moran. Senator Boozman.12831284                       HON. JOHN BOOZMAN,1285                   U.S. SENATOR FROM ARKANSAS12861287    Senator Boozman. Thank you, Senator Moran and Senator1288Blumenthal, for really bringing kind of the who's who of1289experts on this issue. We appreciate you all being here, and1290again, on such an important topic.1291    While we have recently seen progress ensuring veterans are1292receiving claims decisions in a timely manner and provided1293adequate benefits that align with their service, there is still1294more work to do. As evidence, I have veterans in my state1295waiting on decisions for years and years, some perishing before1296they can get a final ruling after years of waiting. I am1297confident in the VA's disability system, but that confidence1298comes not without the desire to continue pushing forward to1299best serve our Nation's heroes.1300    Mr. Gade, I am interested in the principle, ``meaningful1301employment is a powerful medicine,'' you outlined in your1302testimony. Like you, I believe active participation in the1303workforce and larger society serves as a powerful remedy to1304some of the issues our veterans face.1305    What ideas do you have for this Committee and the VA on how1306we could support that principle through the compensation system1307without creating fear or hesitation among veterans about losing1308their benefits?1309    Colonel Gade. Thank you, sir. In my written testimony that1310I submitted for the Committee, there is a report of something1311called the Independence Project that I also referred to in my1312oral testimony. The Independence Project was a randomized1313control trial where we took two groups of veterans and we gave1314one certain benefits and we did not give anything to the other.1315We just monitored them. And the veterans who were given the1316incentives up-front to thrive were able to do so, and those1317gains in employment, not only in the percent of them who were1318employed but also in their salaries, and their gains in1319physical and mental health sustained far after the incentive1320payments ended.1321    So what you have is the ability right there, the scientific1322basis exists, to put incentives in place to get the kind of1323positive outcomes that we want and to not get the negative1324outcomes that we want.1325    Senator Boozman. Very good. Ms. Curda, GAO has laid out the1326need for VA to follow leading management practices when it1327undertakes reforms of the disability compensation program.1328Would you elaborate on the downsides of having to do this?1329    Ms. Curda. Sure. Thank you for that question. When we set1330out to look at how they manage reforms at VA, the first1331question we asked was how many initiatives do you have ongoing,1332and they could not tell us. We had to assemble that list. And1333these were significant initiatives. There were 23 of them over1334a three-year period that we looked at. We pulled a sample of1335five of those randomly and compared them to how are they being1336managed for success, and found lots of issues. We made a lot of1337recommendations to improve those initiatives, because they were1338not setting goals, they were not involving key stakeholders,1339they were not monitoring progress.1340    In particular, one of them was looking at creating1341specialized teams to evaluate military sexual trauma claims,1342which are very complex and very different from other kinds of1343claims. And we found that across the board they did not have1344clear goals with measurable outcomes. They did not have clear1345leadership oversight. There were recommendations from the IG1346that did not get implemented. They were making changes to how1347things got done, but it was never clear that anything was1348improved as a result of that.1349    So that is the kind of thing. It is important to have1350goals. It is important to know where you are headed before you1351start down the path, and that ability then to be able to tell1352the Congress and the public that this investment had a payoff.1353    Senator Boozman. So is that a cultural thing or poor1354leadership? With it being so broad in the group that you1355studied, it is like it was a one-off----1356    Ms. Curda. I think there is, perhaps, a culture. There are1357lots of fires to put out all the time at VA, and there is a1358culture of, oh, let's put together a tiger team and fix this1359right away and be in a hurry. And I think sometimes they do not1360have a good system in place to ensure that when they get1361started they have that kind of good plan in place. And that was1362one of our high priority recommendations for the Secretary is,1363put in place a policy that if you are going to start a major1364reform initiative, that it have these elements in place before1365you start so that you will know where they are headed.1366    Senator Boozman. Thank you, Mr. Chairman.1367    Chairman Moran. Senator Sheehy.13681369                        HON. TIM SHEEHY,1370                   U.S. SENATOR FROM MONTANA13711372    Senator Sheehy. Thank you, Chairman. Thank you all for1373being here today. As a fellow combat veteran of multiple tours,1374married to a combat veteran, I take these issues very1375seriously. And I want to echo some comments made from our VFW1376partners about some poisonous and disgusting rhetoric from The1377Washington Post recently, that accused our veteran community1378and our broader veterans service organization community of1379fraud, of taking advantage of the American people. When this1380group of people, this body of veterans, raised their hands and1381swore an oath to defend this country, the system is not1382perfect. There is no question, the VA is not perfect, veterans1383are not perfect, and there is fraud, no doubt.1384    But the byline of that rhetoric should not be attacking the1385people that chose to defend this Nation. It should be an1386internal examination of how we do things better in this1387government and how we make the VA focused on veteran outcomes1388and patient outcomes and not process. We have been lost in the1389bureaucracy for too long in the VA, and it is about time we1390have a customer service-oriented organization that is focused1391on optimal outcomes for veterans.1392    Outcomes for veterans. ``Veterans not victims'' is my1393favorite saying. We are not victims. We do not come back sorry,1394asking for handouts. We come back wanting a new mission in1395life, and wanting to be empowered to continue to serve our1396country, in law enforcement, in government service, even as1397entrepreneurs. We want our veterans to come home and be1398empowered, not treated like victims. But sometimes they need1399that help to do so.1400    And I would welcome your thoughts, specifically, I think,1401Dr. Cade, related to, specifically, how does our incentive1402system within disability claims, how does our incentive system1403within the transition process, are we incentivizing veterans to1404succeed at the end of that process or instead are we driving1405them into a cul-de-sac of dependence? Because ultimately we1406want to help them as a bridge to another successful chapter in1407life. We do not want them to be professional veterans when they1408are done. We want them to be done and be proud of their1409service, but then open a new chapter for their life and succeed1410there.1411    Colonel Gade. Sir, thanks for that question. When I went1412through the Transition Assistance Program when I was leaving1413the military, we spent about half a day on employment stuff and1414about a day and a half on how to file disability claims. And1415the proverbial little old lady in tennis shoes stood up there1416and said, ``Claim everything you can. It is free money. All1417you've got to do is go get it. And if you have these conditions1418you get this, but if you look at a DBQ carefully,'' and she1419like stomped on the floor and said, ``If you look at the DBQ1420carefully, you can see that if you have these conditions you1421can get to 70 percent, and if you have these conditions you can1422get to 100 percent.'' And so it was right there in front of1423people that all you have to do is exaggerate and you can get1424paid more.1425    That is not actually my main problem. My main problem is1426what happens then. Because if a veteran is separated from the1427labor market, they do not work anymore, they are sitting at1428home, they are sitting on the couch, their wife is going to1429work, if it is a male veteran, the children are going to1430school, and what happens when those people come back home is1431the veteran is still sitting there. And that is a life of1432disempowerment, not empowerment. And men get so much identity1433from their work that we ought to be putting all of our effort1434into positive, meaningful, gainful employment and get away from1435saying to everybody, ``Hey, get everything you can from the1436government. All you've got to do is fill out this little form1437and we'll give you disability payments.'' Thank you.1438    Senator Sheehy. That is exactly right, and disability is1439too often times confused, that if you are able to work you do1440not deserve that disability. And the truth is that disability1441is a recognition that you are going to carry that injury, that1442condition for the rest of your life, and you can never heal1443from that because of what you did for this country.1444    What do we think about alternatives to how the disability1445system is currently structured? And this is open to anybody.1446How can we better structure this so that after our veterans1447leave, take the uniform off, we are incentivizing them to find1448new careers and succeed in those careers, but still recognizing1449they have conditions they have to live with?1450    Colonel Gade. Sir, if I may really quick, the way that we1451talk about disability is different than any other program talks1452about disability. The bar is much lower. The conditions are1453much broader. If--and I am not making this proposal1454necessarily--but if we were to take the people 60 percent and1455below in 2024 Annual Benefits Report, and we were to say, you1456know what, those are conditions that we are going to treat for,1457but we are not going to compensate for those because they are1458not a disability by any other definition of the word, what you1459would do is you would save $20 billion a year that you could1460then put toward meaningful job programs. You could put it1461toward internships and externships and education and even1462higher benefits for the triple amputee and the person with a1463traumatic brain injury.1464    There is a way to do this that is smart and that1465incentivizes the right things, and that is what I am just1466begging folks to focus on.1467    Senator Sheehy. We are at the end of my 5 minutes. I am1468sorry, but did you want to wrap up quick?1469    Mr. Retzer. Yes, Senator. I just wanted to say it is very1470important that we understand, yes, we know about the injuries1471and illnesses. But the thing is we have questions with regards1472to integration and to rehabilitation. And then there is1473compensation. We need to understand that it is complementary.1474And we need to ensure that when we look at the VA's ability of1475it, that VA's integrated care links the issues really, that is1476health care, vocational programs, and education. That is the1477struggle that we are having here, and so VA needs to continue1478to expand programs like the Veteran Readiness and Employment1479(VR&E) system while they ensure that the veterans are getting1480their compensation. As you said, they have earned these1481benefits. So we want to make sure that they strengthen the1482partnerships that are out there to employees and workforces to1483ensure that they are hiring and recruiting veterans, and really1484emphasize that there is a difference between the integration1485back into employment versus compensation.1486    Senator Sheehy. Well, thank you for being here. We are at1487the end of our Nation's longest war, and we may potentially be1488seeing the start of another war soon. So the work you are doing1489is going to be absolutely critical. Veterans not victims.1490Outcomes over process. Patients over bureaucracy. Thank you.1491    Chairman Moran. Senator Sheehy, thank you. Senator1492Duckworth.14931494                     HON. TAMMY DUCKWORTH,1495                   U.S. SENATOR FROM ILLINOIS14961497    Senator Duckworth. Thank you, Mr. Chairman. I have to say I1498must express disappointment in the decision to convene a1499legislative hearing that amplifies The Washington Post1500misleading and flawed attack against the VA disability benefits1501system, especially by inviting a witness who supports those1502sentiments. And adding insult to injury, this effort to falsely1503depict our Nation's disabled veterans as a group of dishonest1504fraudsters and cheaters originates from a paper that is owned1505by a multi-billionaire whose net worth exceed, by tens of1506billions of dollars, the total amount that the U.S. Government1507spends on disability compensation to over 6 million disabled1508veterans in any given year.1509    Look, nobody is denying the unfortunate reality that a1510small number of veterans exists who will dishonor their own1511service and that of their fellow veterans by defrauding the VA.1512These individuals can and should be prosecuted to the fullest1513extent of the law. If we want to enhance deterrence we should1514strengthen enforcement resources to increase the rates of1515criminal investigations, prosecutions, and convictions of these1516fraudsters.1517    The mistake we must avoid is allowing a minority of1518criminals to dictate the redesign of the VA disability benefits1519system into a bureaucratic black box that is more frustrating1520and less fair and will leave more veterans waiting and dying,1521waiting to get their benefits that they have earned.1522    Since we met many years ago at Walter Reed, I have been1523disappointed, Colonel Gade, in watching your journey. You and I1524were there together. We suffered together. We recovered1525together. But I have to say, I have been disappointed in1526watching your journey to becoming one of the leading critics of1527the entire concept of disability compensation for disabled1528veterans. And I do feel that you believe that you are simply1529offering our fellow disabled veterans some tough love that1530everyone else is too afraid to give, to inspire them to achieve1531the success that you have been so very fortunate to earn.1532    However, your rhetoric, particularly in downplaying the1533severity of the reality of the invisible wounds of war runs the1534real risk of doing more harm than good. Portraying disabled1535veterans as a group of takers who will happily never work again1536for $3,100 per month is incredibly condescending and1537disrespectful to these heroic Americans.1538    Disabled veterans, like any American, want to work for more1539than just money. They are driven by a sense of mission,1540purpose, and meaning. And your characterization of disabled1541veterans who accept disability compensation as being moochers1542who are trapped by the system, advances a very damaging1543stereotype that shames many veterans into foregoing VA benefits1544at a cost to themselves and their loved ones.1545    So there is an irony that the VA is being accused of being1546too generous, too trusting, and too focused on enhancing1547efficiency for disabled veterans by a paper whose owner is1548famous for accumulating a vast fortune by adopting a core1549management principle, obsessive customer focus.1550    So my question for the VSO leaders on the panel is simple.1551Do our disabled veterans deserve worse treatment from the1552United States Government?1553    Mr. Villanueva. No, they don't.1554    Mr. Retzer. No, they do not.1555    Senator Duckworth. Should Congress require VA to presume1556that every disabled veteran applying for benefits is guilty of1557fraud?1558    Mr. Villanueva. They should not because they are not.1559    Senator Duckworth. Should VA force every disabled veteran1560to fight through copious amounts of paperwork and push through1561layer upon layer of cold, harsh bureaucracy to prove, beyond a1562reasonable doubt, to obtain what are often quite modest1563disability compensation benefits?1564    Mr. Retzer. Senator, no.1565    Senator Duckworth. We must never forget that Congress and1566VA have worked hard for many decades to end an unacceptable1567status quo where the VA benefit system was hostile, combative,1568and stunningly inefficient. My larger fear is that our1569Committee, indulging in efforts to demonize the VA disability1570benefit system, will lead us to creating harmful guardrails1571that reduce improper payments, but at the cost of scores of1572eligible disabled veterans giving up and abandoning efforts to1573secure the benefits they earned when they served our country in1574uniform.1575    Would any of the witnesses testifying on behalf of VSOs1576like to elaborate on that threat and why criticism of VA trying1577to instill a culture that seeks ``let's get to yes'' is1578preferable to a culture that seeks to ``get to no'' ?1579    Mr. Gallucci. Senator, I will happily take that question,1580if I may. As I said in my remarks and in our submission for the1581record, we have deliberately worked to make it easier for1582veterans to access the benefits that they have earned. Those of1583us who have worn the uniform have seen it, where peers of our1584struggle for the care for the diseases or the health conditions1585that they are suffering with.1586    In addition to Karshi-Khanabad, our organization is1587advocating for air crews. Congress just passed a study to make1588sure that air crews, and signed into law, that we study their1589toxic exposures. There is a group of veterans, submariners, in1590the Veterans of Foreign Wars who are speaking very vocally1591about the unique challenges of submarine service and the1592exposures that they have.1593    Now make no mistake, we all knew that military service was1594dangerous, but as we have focused on, when we say ``honor the1595contract,'' it was in our enlistment contracts. It is in there,1596required to order--ordered to serve in combat or other1597hazardous situations, and then entitled to receive pay1598allowances and other benefits as provided by law in regulation.1599    So to have a discussion where it is portraying veterans1600accessing that system as if we are somehow exploiting1601loopholes, and it is an honor system, look, it is trying to pit1602veterans against Americans, other Americans. And it is1603something that we should not tolerate, especially when such a1604small percentage of the population volunteered for that1605dangerous job that has occupational hazards that others can1606just walk away from.1607    Senator Duckworth. The data is clear. It is not just data1608coming from the VA but from other not-for-profits that the vast1609majority of veterans' claims of benefits are truthful and1610accurate, not that they are fraudulent and false. And I think1611we need to keep that in mind.1612    Thank you, Mr. Chairman.1613    Chairman Moran. Senator Duckworth, thank you. I thank all1614of our witnesses, and I would just highlight for the Committee,1615and perhaps for my own satisfaction, there is no doubt about1616the controversy that arises from this Washington Post article.1617But I have great faith in the witnesses that we have here, the1618veterans who have talked to us, the information that we1619received, to suggest that this Committee is capable of hearing1620from veterans and responding to the thought that is expressed1621in The Washington Post article. I also have sufficient faith in1622the colleagues here, many who have served, some who have served1623and earned disability, that we have the capability as Members1624of this Committee to sort out and have the opportunity also to1625hear from somebody who has a different point of view, so that1626we can come to a conclusion, probably more than one,1627conclusions over time about how we improve the system, and we1628make certain that veterans who served and those who are1629disabled by that service receive the compensation, as well as1630care, that they are entitled to.1631    So I am pleased we have had this hearing, are having this1632hearing, and I think it has value as we try to sort out how we1633make things sufficiently better for those who served our1634country.1635    I want to ask a couple of questions and then a vote has1636been called and we will bring this hearing to a conclusion.1637First of all, Ms. Mason, Senator Blackburn asked you about1638inspector general's report. Are there any particular reports1639that are pending on this topic of disability that you would1640like to highlight that would be important for the VA to come1641into compliance or explain why they are not pursuing the1642inspector general's recommendations?1643    Ms. Mason. Well, we have about 30.1644    Chairman Moran. All of them equal importance and all of1645them on this topic?1646    Ms. Mason. All of them equal importance. But I think we1647have two or three particularly that are pending on disability1648issues. But we have some audit work that we are getting ready1649to start, primarily around quality review, and around1650automation, particularly in concerns we have around whether the1651right information is in the automation system.1652    And then, again, to the reports we have already discussed1653today on PACT Act and a couple of the other areas in1654disability, our fraud teams and our audit teams work very1655closely together. So where they see gaps on either side they1656trade information, and the fraud teams goes and investigates1657and the audit team does their audit work.1658    So we do have some others teed up. We only have a couple of1659reports, though, that are pending, and they are primarily on1660the quality aspect as well as the application of overall1661disability review.1662    Chairman Moran. In your previous life and previous work at1663the Department of Veterans Affairs, anything that you learned1664in that capacity that would be important for us to hear today?1665    Ms. Mason. Well, Chairman Moran, you know, in my current1666seat I look at everything through the eyes of the IG. But what1667I can tell you in looking at those through the eyes of IG, I1668can look back over the 30 years, from starting as a young1669attorney in 1990, going forward to my time as judge and1670chairman, where I can see many of the things that VA put in1671place, that the Congress has put in place, and I see the1672impacts and effects of that on our veterans. And what I see is1673the lack of controls and the lack of oversight within all of1674VA, but for this hearing, particularly in VBA, in areas from1675compensation to education to pension to fiduciary. We can go1676down the whole list.1677    Chairman Moran. I want to highlight, at least from my view,1678a great level of respect for the role of the inspector general,1679the role of the Government Accountability Office, in this1680Committee and this Congress, being able to do its work. I am1681developing a good working relationship with you, Ms. Mason, and1682I had a really good working relationship with your predecessor.1683And my view is that the efforts by both of these agencies are1684hugely valuable to the well-being of veterans that we all try1685to serve.1686    Ms. Mason. And we do talk to each other often, Chairman1687Moran, both you and I and Ms. Curda and her team.1688    Chairman Moran. Thank you both.1689    Mr. Gallucci, you did something just a moment ago that I1690was going to ask you to do. I wanted to know what a member of1691the service believes when they enlist, their contract is, with1692the United States Government, with the Department of Veterans1693Affairs, with the American people, with our country, with our1694government. When someone raises their hand and takes the oath1695and enters the service, what is it that they expect in return?1696    Mr. Gallucci. To put it in the simplest terms, that if we1697are going to live up to these other requirements to obey all1698lawful orders, subject to the military justice system, serving1699in combat and other hazardous situations, that we will be taken1700care of if something goes wrong on the government's time and on1701the government's dime.1702    I point, in The Washington Post story, and we have talked1703about this a lot, about them talking about toenail fungus,1704right. That was in there designed to really bait people into1705thinking, well, that is common. That happens to a lot of1706Americans. You go to a gym, you get athlete's foot, you treat1707it with some Tinactin. I don't know.1708    But the issue is we are talking about military service,1709especially ground forces, Army, Marine Corps, that focus so1710heavily on foot health and hygiene. Because when I was deployed1711to Iraq, OIF-1, living out of a Humvee for the first couple of1712months, personal hygiene was sparse and difficult. And I talked1713to a veteran before coming into this hearing who has dealt with1714a systemic fungal infection since he served in the Marine1715Corps. This is very real. It is an occupational hazard. It may1716sound odd to someone who has never served, a reader of The1717Washington Post or a reporter who never raised their right1718hand. But this is why it is service-connected. A veteran who is1719on a medication that causes liver damage because it started out1720as a foot fungal infection--it started as toenail fungus--yes,1721that is service-connected. It is related to service, and it is1722a clear occupational hazard of military service.1723    Chairman Moran. Thank you. And do those individuals, they1724recognize, know that at the moment they enlist and raise their1725right hand?1726    Mr. Gallucci. You do not know all of them, but I will tell1727you this--we know the military is dangerous, right. It is a1728job, as our Secretary of War says, is to destroy our enemies. I1729mean, we know it is dangerous going in, but we believe that1730with the contract that we signed, if something goes wrong that1731we will be taken care of.1732    Chairman Moran. Dr. Gade raised this topic of work, and I1733certainly share a view that work is important to the well-being1734of every human being. It is the way we earn a living and get1735satisfaction, hopefully, from what we do. I always think it is1736something that is within us that gives us purpose in life,1737soul, a sense of meaning and value.1738    What is it that we can do? Dr. Gade indicates that there is1739seemingly a disincentive from the disability system to work.1740But aside from that suggestion, that connection, there are a1741lot of things that the Department of Veterans Affairs is1742entrusted to do and should be doing to help veterans find1743meaningful employment. And I know, I mean I saw, where a group1744of Fort Riley soldiers who were about to end their time in the1745military service spent time in Wichita, Kansas, at the aviation1746and aircraft companies, learning about opportunities for their1747future.1748    There is a significant demand for the skill set and1749integrity, the moral values of a soldier, of a member of our1750military. There is demand for that work. And yet we may not be1751taking sufficient advantage of the opportunity that a person1752who is leaving military service can provide value to a company.1753We have got a program in Kansas to interest soldiers as they1754depart in agriculture, to become farmers. There is a demand for1755those kinds of employment opportunities. What are we missing in1756trying to make certain that work is honored, aside from the1757suggestions of Dr. Gade? Mr. Villanueva?1758    Mr. Villanueva. Thank you, Mr. Chairman.1759    Chairman Moran. I was worried you were being ignored until1760Senator Duckworth captured you.1761    Mr. Villanueva. No, I appreciate it. There are a lot of1762good panelists here, and I definitely do not want to step on1763anybody's toes when it comes to how much we all agree with each1764other. But the one thing I think everybody on this panel can1765agree with is that every veteran who wants to work and is1766inhibited by a disability, that they have every incentive and1767opportunity to get to work.1768    And again, I guess I have to be 100 percent for all the1769hearings I ever testify at, to bring up VR&E, but VR&E should1770definitely be pushed, more so than most any other program that1771they have out there for veterans who want to get back out to1772work. And that includes doing things like removing delimiting1773dates. That goes for education by the VA to all veterans to1774say, hey, especially those who are being medically discharged1775or medically retired, to push that program, and to say if you1776want to get back out to work, it is available to you. And we1777have been on record about this.1778    So we would love to work with yourself, your office, the1779rest of the Members of the Committee to see how we can do that.1780    Chairman Moran. Remind me. Are there opportunities that are1781presented to veterans who have a disability beyond the normal1782programs to provide education, workforce training to veterans1783generally?1784    Mr. Villanueva. There are. But again, I mean, not a lot of1785the veterans who, when they leave the service, know that there1786is a disability with them. It comes up years and years later.1787Myself, I went out and, despite some of my disabilities, I1788decided to take up blue-collar work for the first five years1789post-service, and it caught up to me. Only after that time did1790I ever find out, or ever attempt to use my GI Bill, and never1791once, until many years later, did I even hear about VR&E. So1792again, this should be pushed by the VA.1793    Chairman Moran. Thank you. I look forward to working with1794you and PVA. Senator Banks.17951796                        HON. JIM BANKS,1797                   U.S. SENATOR FROM INDIANA17981799    Senator Banks. Thank you, Mr. Chairman. Ms. Curda, the VA1800disability claims process is dysfunctional and antiquated, no1801doubt. An initial claim decision takes about 100 days, on1802average, but appeals stretch on for years. My office worked on1803one case, for example, a claim that took eight years to be1804decided.1805    How are VA's efforts to improve that process coming along?1806    Ms. Curda. Well, as I mentioned earlier, one of our issues1807that places VA on the High-Risk List is their challenges with1808managing their workloads, and that includes appeals. You know,1809this has been going on for decades, where various surges come1810along on the initial claims side. Veterans who are denied1811appeal those claims. That creates additional pressure on the1812appeals side. And when veterans choose to go before a judge,1813that is the longest amount of time that a veteran will1814experience. There are other choices, but that one, in1815particular, can take a really long time. And currently, VA is1816not meeting its timeliness goals for various appeals options,1817they are exceeding them.1818    I think what they are doing is, we have been engaging with1819them on this high-risk issue for a number of years now, and1820most recently they have developed a better ability to predict1821their workloads through more sophisticated modeling. That is1822certainly true on the initial claims side. I think they are1823trying to kind of do a little bit more on the appeals side, to1824be able to better predict what is coming in. And when you can1825predict, you can plan, and you can get the resources that you1826need to get the work done.1827    So they are moving along. They still are somewhat lacking1828in their, I think, capacity to really fix the problems. But we1829were close to moving up their rating in the high-risk issue1830last year, and then that budget issue came along and we had to1831kind of rethink that. But they have made progress in terms of1832just their ability to plan for workloads, so that when things1833change--and they will change--they are in a position to address1834them.1835    Senator Banks. The key tool in the claims process, the VA1836rating schedule for disabilities, was created in the 1940s.1837Some elements of the schedule have never been updated. The VA1838has been trying to update it for years. Which conditions and1839body parts rating schedules are the most outdated, and what1840problems does that cause, Ms. Curda?1841    Ms. Curda. Sure. I would say the issue is that they have1842not all been comprehensively updated. There have been small1843changes over the years, here and there, but they have not taken1844a comprehensive look at--there are 15 body systems. All the1845conditions are organized in different body systems. Of the 15,1846they have updated, comprehensively, 11 of them, and there are1847still four that remain, and they are in various states of1848regulatory development. The four that are remaining are mental1849disorders, respiratory illnesses, ear and auditory issues, and1850neurological conditions.1851    The problem that creates, and I think you can see a little1852bit of this in The Washington Post article, where you might see1853inequities, or there might appear to be an inequity in how1854different conditions are compensated. I think, in particular,1855when this was studied, mental conditions have been--because if1856you think about in the 1940s, people had not even heard of1857PTSD. So that may be compensated differently than, say, someone1858with an amputation. So it is thinking through what that level1859of compensation should be.1860    The other issue is earnings loss. That is the medical side1861I was talking about. The earnings part of it has never been1862comprehensively updated, so that is another component of this.1863    Senator Banks. I want to move on. Colonel Gade, good to see1864you. I am glad the OIG investigates disability compensation1865fraud, but the examples in The Washington Post article are not1866subtle. They are glaring. A Vietnam veteran who pretended to be1867blind for 29 years while he continued to drive. A bodybuilder1868who pretended to walk with a cane and wore a diaper. A veteran1869who claimed paralyzing anxiety and an inability to work while1870he was running a bar in Costa Rica. A VA claims representative1871who claimed to be homebound and bilked the agency out of1872benefits for five years while he was working there.1873    These fraud cases should not take years to crack, and it1874makes me wonder how widespread that problem really is. How1875prevalent do you think outright disability compensation fraud1876really is?1877    Colonel Gade. Sir, I think outright disability fraud is1878actually quite rare, as Ms. Mason pointed out earlier. A bigger1879problem is the problem of lax oversight and easily exaggerated1880conditions and no follow-up.1881    I went on Reddit yesterday and I typed in, ``How do I get a1882100 percent disability? I only have 10 percent now,'' which is1883false. So here is what Reddit said: ``Go to your C&P exam with1884a DBQ that you filled out yourself. Look up what you will1885qualify for, 100 percent, and check the boxes, and write the1886explanations that apply to you. Submit that to your examiner at1887the beginning of the appointment and have a copy in front of1888you. Throughout the exam, answer the questions based on the1889answers you gave on the DBQ.''1890    So it is widespread that people know that the DBQ exists.1891They know that if they claim this severity, they get this1892disability. If they claim this severity, they get this. And if1893they claim this, then they get this. It is widespread1894knowledge. So that is a kind of quiet thing that The Washington1895Post article never even discussed.1896    Senator Banks. Got it. Thank you. My time has expired.1897    Chairman Moran. Let me see if anyone, before we conclude1898this hearing, does anybody have the sense that they wanted to1899say something that they did not get the chance to say, or1900correct anything that you said that you wish you had not have1901said?1902    Ms. Mason. Chairman, I would like to jump in here real1903quick.1904    Chairman Moran. Please.1905    Ms. Mason. The VA OIG looks at pretty much everything, from1906soup to nuts, from fraud as well as the oversight, as we have1907discussed today. But one particular area that I think Senator1908Banks just touched on, and Colonel Gade touched on, are the1909DBQs. And let me be clear, the DBQs are a problem both publicly1910and internally. Because of the lack of controls, and we have1911specific reports to this as to issues, that VBA is not1912following up on within their internal contracts and their DBQs,1913they are the pot calling the kettle black. So there are issues1914with public-facing DBQs. There have been since they were1915engaged and brought forward. And those continue, both1916internally and externally.1917    So our recommendation is that we look at and recommend that1918the Committee consider looking at all DBQs and setting some1919standards at your level. Thank you.1920    Chairman Moran. Thank you. Anyone else? Mr. Gade?1921    Colonel Gade. And, Senator, just briefly, and I am sorry1922that she departed earlier, Senator Duckworth and I were in the1923hospital together. She was wounded two months before I was. And1924so I wish that we had been able to have that conversation that1925she directed to me in a two-way direction, but unfortunately I1926had to sit here.1927    What I believe about mental health reform is that the1928system should better address invisible wounds like PTSD, but1929without incentivizing long-term disability. PTSD is curable.1930PTSD is possible to recover from and lead a full and thriving1931life. But a veteran who is labeled 100 percent, permanent and1932total, before the efforts have been made to get better, is one1933whose life is made worse by that system. And that has been my1934argument for the last 20 years, and will be my argument until1935my dying day. And I am sorry that Senator Duckworth missed1936that.1937    Chairman Moran. Anyone else? I did not expect anyone to1938take advantage of my suggestion. You cannot allow me to miss my1939vote.1940    Mr. Villanueva. I will make this quick, Mr. Chairman. The1941most worrying thing about The Washington Post article, and as a1942person, like many people who are on this panel today, we1943remember the history. And the history goes back a ways. But1944when you look at the Civil War pension program that these folks1945came back to, after a while the articles in the news and the1946public opinion shifted away from that it is the government's1947fault that is making it too hard and they put a glaring light1948on the veterans and the doctors and the lawyers, and they1949scrapped the program. And as we all know, it went from that to1950the Spanish-American War pension program, which preceded the1951bonus marches of the 1930s. And we are less than a half mile1952away from where thousands of veterans camped out for days, and1953some of them lost their lives for their benefits.1954    Now, as we move forward, and this discussion moves forward,1955we should always keep that in mind, so that it never, ever1956happens again. If there is a program that can be improved, that1957is here already, we should all work together to make those1958improvements.1959    Chairman Moran. Thank you. It is a good place to end the1960hearing. Thank you.1961    I want to again thank you. Each member of the Committee now1962has 5 legislative days to submit any written statements or1963questions for the record. Any Senator who would like to submit1964a question for the record to today's--I did not say that quite1965right. Let's do it over.1966    Each member has 5 legislative days in which to submit1967statements or questions for the record. Any Senator who would1968like to submit a question for the record for today's witnesses,1969please do so in a timely manner. Likewise, I ask our witnesses1970to respond to any questions for the record following today's1971hearing in a timely manner as well.1972    And with that this hearing is adjourned.1973    [Whereupon, at 5:43 p.m., the hearing was adjourned.]19741975                            A P P E N D I X19761977                          Prepared Statements19781979    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]19801981                              [all]