S.Hrg.119-247

1[Senate Hearing 119-247]2[From the U.S. Government Publishing Office]34                                                        S. Hrg. 119-24756                HEARING TO CONSIDER PENDING LEGISLATION7=======================================================================89                                HEARING1011                               BEFORE THE1213                     COMMITTEE ON VETERANS' AFFAIRS14                          UNITED STATES SENATE1516                    ONE HUNDRED NINETEENTH CONGRESS1718                             FIRST SESSION1920                               __________2122                           DECEMBER 10, 20252324                               __________2526       Printed for the use of the Committee on Veterans' Affairs2728[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]2930        Available via the World Wide Web: http://www.govinfo.gov3132                               __________3334                     U.S. GOVERNMENT PUBLISHING OFFICE3562-272 PDF                   WASHINGTON : 202636=======================================================================3738                 SENATE COMMITTEE ON VETERANS' AFFAIRS3940                     Jerry Moran, Kansas, Chairman41John Boozman, Arkansas               Richard Blumenthal, Connecticut,42Bill Cassidy, Louisiana                  Ranking Member43Thom Tillis, North Carolina          Patty Murray, Washington44Dan Sullivan, Alaska                 Bernard Sanders, Vermont45Marsha Blackburn, Tennessee          Mazie K. Hirono, Hawaii46Kevin Cramer, North Dakota           Margaret Wood Hassan, New47Tommy Tuberville, Alabama                Hampshire48Jim Banks, Indiana                   Angus S. King, Jr., Maine49Tim Sheehy, Montana                  Tammy Duckworth, Illinois50                                     Ruben Gallego, Arizona51                                     Elissa Slotkin, Michigan5253                     David Shearman, Staff Director54                Tony McClain, Democratic Staff Director5556                            C O N T E N T S5758                              ----------5960                           December 10, 20256162                                SENATORS6364                                                                   Page65Hon. Jerry Moran, Chairman, U.S. Senator from Kansas.............     166Hon. Richard Blumenthal, Ranking Member, U.S. Senator from67  Connecticut....................................................     268Hon. Thom Tillis, U.S. Senator from North Carolina...............     769Hon. Patty Murray, U.S. Senator from Washington..................     970Hon. Kevin Cramer, U.S. Senator from North Dakota................    1071Hon. Margaret Wood Hassan, U.S. Senator from New Hampshire.......    1272Hon. John Boozman, U.S. Senator from Arkansas....................    1373Hon. Angus S. King, Jr., U.S. Senator from Maine.................    1574Hon. Elissa Slotkin, U.S. Senator from Michigan..................    177576                               WITNESSES77                                Panel I7879Margarita Devlin, MA, CRC, Principal Deputy Under Secretary for80  Benefits, U.S. Department of Veterans Affairs accompanied by81  Thomas O'Toole, MD, Acting Assistant Under Secretary for Health82  for Clinical Services, Veterans Health Administration..........     38384                                Panel II8586Morgan Brown, National Legislative Director, Paralyzed Veterans87  of America.....................................................    208889Nancy A. Springer, Acting Director, National Legislative Service,90  Veterans of Foreign Wars of the United States..................    219192Barton Stichman, Co-Founder and Special Counsel, National93  Veterans Legal Services Program................................    239495                                APPENDIX96                             Hearing Agenda9798List of Pending Bills............................................    3399100                          Prepared Statements101102Margarita Devlin, MA, CRC, Principal Deputy Under Secretary for103  Benefits, U.S. Department of Veterans Affairs..................    37104105Morgan Brown, National Legislative Director, Paralyzed Veterans106  of America.....................................................    97107108Nancy A. Springer, Acting Director, National Legislative Service,109  Veterans of Foreign Wars of the United States..................   106110111Barton Stichman, Co-Founder and Special Counsel, National112  Veterans Legal Services Program................................   118113114                       Submissions for the Record115116Senator Cramer117118  American Hospital Association, Rick Pollack, President and119    Chief Executive Officer......................................   129120121  First Care Health Center in Park River North Dakota, Marcus R.122    Lewis, Chief Executive Officer...............................   131123124  North Dakota Rural Health Association (NDRHA), Kylie Nissen,125    Executive Director...........................................   133126127  Unity Medical Center, Alan O'Neil, Chief Executive Officer;128    First Care Health Center, Marcus Lewis, Chief Executive129    Officer; and other organizations.............................   135130131Senator King132133  American Academy of Pediatrics, Susan J. Kressly, MD, FAAP,134    President....................................................   137135136  American Association for Marriage and Family Therapy, and other137    organizations................................................   139138139  American Psychiatric Association...............................   141140141  Association of VA Hematology/Oncology, and other organizations.   144142143  End Family Fire-Brady, Colleen Creighton, Senior Director......   154144145  Everytown for Gun Safety, Monisha Henley, Senior Vice President146    for Government Affairs.......................................   156147148  GIFFORDS, Vanessa Gonzalez, Director of Government and149    Political Affairs............................................   158150151  Sandy Hook Promise, Mark Barden, Co-Founder; and Nicole152    Hockley, Co-Founder and Chief Executive Officer..............   160153154  United Steelworkers (USW), Roy Houseman Jr., Legislative155    Director, Assistant to the International President...........   162156157  Walk the Talk America (WTTA), Michael Sodini, Founder and158    President....................................................   164159160Senator Blumenthal161162  Urban Institute, Matthew Buettgens; Jennifer M. Haley; and163    Michael Simpson..............................................   167164165                       Statements for the Record166167The American Legion, Cole T. Lyle, Director, Veterans' Affairs168  and Rehabilitation Division....................................   171169170American Psychological Association Services, Inc., and other171  organizations..................................................   196172173Anoka County Board of Commissioners, Mike Gamache, Chair,174  District 5; and Districts 1-4, 6 and 7.........................   206175176Disabled American Veterans (DAV), Jon Retzer, Deputy National177  Legislative Director...........................................   208178179Military-Veterans Advocacy, Cmdr. John B. Wells, USN (Ret.),180  Chairman.......................................................   224181182Military, Veteran and Family Center of Excellence................   228183184National Organization of Veterans' Advocates, Inc. (NOVA), Diane185  Boyd Rauber, Esq., Executive Director..........................   231186187Student Veterans of America (SVA)................................   237188189Tragedy Assistance Program for Survivors (TAPS)..................   241190191Veterans' Survivor Coalition.....................................   253192193                               HEARING TO194                      CONSIDER PENDING LEGISLATION195196                              ----------197198                      WEDNESDAY, DECEMBER 10, 2025199200                                       U.S. Senate,201                            Committee on Veterans' Affairs,202                                                    Washington, DC.203    The Committee met, pursuant to notice, at 4:01 p.m., in204Room SR-418, Russell Senate Office Building, Hon. Jerry Moran,205Chairman of the Committee, presiding.206207    Present: Senators Moran, Boozman, Tillis, Cramer, Sheehy,208Blumenthal, Murray, Hassan, King, and Slotkin.209210             OPENING STATEMENT OF HON. JERRY MORAN,211               CHAIRMAN, U.S. SENATOR FROM KANSAS212213    Chairman Moran. Good afternoon. Our Committee will come to214order. I express my gratitude to our witnesses for joining us215today. We're going to consider 24 pieces of legislation216sponsored by me, the Ranking Member, and Senators from both217sides of the aisle.218    That includes two bills that I introduced; the Fisher House219Availability Act would allow families of service members to220stay at VA Fisher Houses if the service member is being treated221at a nearby VA Fisher House--I'm sorry, I didn't say that222right--is being treated near a VA Fisher House while still223prioritizing space for family members of VA patients; and the224SERVE Act, which would improve relationships between the VA225medical centers and military treatment facilities to improve226access to care for service members and veterans, and increase227training opportunities for the VA and DoD healthcare providers.228    I appreciate the support of this legislation, that it's229received from my colleagues and across Capitol Hill, as well as230from veterans service organizations community, and I'm pleased231to see its inclusion in fiscal year 2026 NDAA. I look forward232to it being enacted into law, and seeing how it will benefit233the veteran and military communities moving forward.234    And turning back to today's hearing, as we move away a235moment from NDAA, the bills on the agenda today represent a236number of bipartisan priorities that would build on the237successes Congress has achieved in expanding access to care and238benefits for veteran survivors and their families. A notion239that all of us on this Committee share.240    I'm grateful to the sponsors of all of these bills for241their work on these pieces of legislation. I'm grateful to the242VA for providing technical assistance on the legislation, and243to our veterans service organizations partners for working well244with us to improve and advance the bills.245    With that, I yield to the Ranking Member, Senator246Blumenthal.247248         OPENING STATEMENT OF HON. RICHARD BLUMENTHAL,249         RANKING MEMBER, U.S. SENATOR FROM CONNECTICUT250251    Senator Blumenthal. Thanks, Mr. Chairman. I appreciate the252opportunity to hear testimony on some very important bipartisan253legislation today. But before we begin, I think we have to254recognize the importance of votes that we will take tomorrow,255one of them to extend the healthcare tax credits under the256Affordable Care Act (ACA) that will affect literally 267,000257veterans who rely on the ACA enhanced premium tax credits to258afford health insurance.259    And whether you support the ACA, whether you have other260views on what might be a perfect system in the long run, if we261had tons of time; the simple fact is we face a deadline of the262end of the year when these tax credits will expire, and 267,000263veterans will no longer be able to afford ACA coverage if these264credits are not extended. These are primarily veterans who are265not eligible for Medicaid, TRICARE, or Medicare, and often not266eligible to get their care through the VA, leaving them with267the ACA Marketplace plans as the only option for healthcare268coverage.269    The ACA isn't perfect. We need to lower the costs of270healthcare generally. We need to work on reforms, and we need271to eliminate any fraud that exists in these programs. But the272fact of the matter is, the consequences of failing to extend273these tax credits will be devastating for veterans and their274families. Veterans will be forced to navigate a perfect storm,275an understaffed VA healthcare system, increased wait times for276VA healthcare, Medicaid cuts, and the loss of affordable health277insurance. They deserve better. So, do millions of Americans278who will be impacted by the potential failure to extend these279tax credits. I hope that we approve them to the benefit of280those veterans and countless other Americans affected.281    On the legislation today, I want to particularly thank Mr.282Stichman for his work alongside the Yale Veterans Legal283Services Clinic to improve how a federal appellate court's284process VA appeals. I've worked with the Yale Veterans Legal285Services Clinic over the years, and I know how important their286work is.287    Generally, the Veterans Appeals Efficiency Act, which I co-288led with Senator Banks, is one of the many bills that we're289here to discuss. And I will be supporting many, if not all of290them, for example, the Molly Loomis Act, which would build on291the promise of the PACT Act by exploring health conditions292prevalent among descendants of veterans who were exposed to293toxic substances during their service.294    And we have to confront as well the painful legacy of295discrimination. The Commission on Equity and Reconciliation in296the Uniformed Services Act would investigate the harm done to297LGBTQ+ service members and veterans, many of whom received298punitive discharges, and were forced to hide their identities,299and ultimately, denied benefits.300    These measures are not partisan. This Committee generally301is not partisan. And I welcome the support of my Republican302colleagues for many of these important measures that we303hopefully will advance after today's hearing. Thank you.304    Chairman Moran. Thank you, Ranking Member. I'll introduce305our first panel. Testifying today from the Department of306Veterans Affairs is Margarita Devlin, the Principal Deputy307Under Secretary for Benefits. And she's accompanied by Thomas308O'Toole, the Acting Assistant Under Secretary for Health for309Clinical Services, Veterans Health Administration.310    Thank you both for being here. And Ms. Devlin, I now311recognize you for your opening statement.312313                            PANEL I314315                              ----------316317STATEMENT OF MARGARITA DEVLIN, MA, CRC, PRINCIPAL DEPUTY UNDER318  SECRETARY FOR BENEFITS, U.S. DEPARTMENT OF VETERANS AFFAIRS319   ACCOMPANIED BY THOMAS O'TOOLE, MD, ACTING ASSISTANT UNDER320  SECRETARY FOR HEALTH FOR CLINICAL SERVICES, VETERANS HEALTH321                         ADMINISTRATION322323    Ms. Devlin. Good afternoon, Chairman Moran, and Ranking324Member Blumenthal. Thank you for inviting us to speak on VA's325views on the legislation before us today. I am joined by Dr.326Thomas O'Toole, Deputy Assistant Under Secretary for Health327from the Veterans Administration.328    Before we begin, I'd like to apologize for the delay in329providing testimony to this Committee. VA is working on process330improvements, internally as well as externally, to ensure that331this is prevented in the future.332    Chairman Moran. Thank you for your regrets and apologies,333and we'll consider this probably most likely external334challenges. Thank you very much.335    Ms. Devlin. Thank you. There are 24 bills on today's336agenda, and while I won't be able to address each one of them337in my opening remarks, I welcome the opportunity to answer your338questions and provide any additional information the Committee339may need.340    VA's full views on the bills are submitted for the record341in written testimony. VA has noted in our official views where342important amendments would be needed to ensure feasibility of343implementation. I will highlight several bills where VA either344supports or supports the intent.345    VA supports the Fisher House Availability Act of 2025,346introduced by Chairman Moran. This bill would expand access to347temporary lodging in Fisher Houses or other appropriate348facilities for veterans and their families, not only when the349veteran is receiving care, but also when a family member is350receiving care. We appreciate the Chairman's leadership on this351compassionate and practical proposal, and support the bill352subject to availability of appropriations.353    VA also supports the intent of the SERVE Act, also354introduced by Chairman Moran, which seeks to improve access to355care for veterans by leveraging the Department of War356facilities and providers. While VA does not support the bill as357currently drafted, we value our longstanding partnership with358the Department of War, and are confident that our cooperative359relationship will continue to ensure veterans receive high360quality care. We welcome the opportunity to work with the361Committee to refine the bill's language, and ensure clarity362around provider roles, veteran choice, and coordination of363care.364    Suicide prevention remains one of Secretary Collins' top365priorities, and VA appreciates the intent behind the Saving Our366Veterans Lives Act, introduced by Senator King. While we do not367support the bill as drafted due to concerns about scope and368cost, particularly the $5 million annual authorization, we are369proud to report that VA has already launched a lockbox370distribution program for enrolled veterans at medium to high371risk of suicide who have access to firearms. This program372includes provider ordering, tracking, and distribution, and is373supported by VA's mandatory suicide prevention training, VA374S.A.V.E., which continues to be updated and expanded.375    VA appreciates the intent of the Molly R. Loomis Act, which376would mandate research on health conditions in descendants of377veterans exposed to toxic substances. While we support the goal378of better understanding long-term impacts, we believe our379existing programs, particularly those conducted in partnership380with the National Academies of Sciences, already provides a381robust framework for this research.382    VA supports the intent of the Purple Heart Veterans383Education Act, introduced by Senator Murray, which would allow384Purple Heart recipients to transfer Post-9/11 GI Bill benefits385to dependents. However, we recommend amending the bill to386clarify the role of the Secretary of War in the transfer387process, as current law requires coordination with the388Department of War for approval and management of transferred389benefits.390    The VA appreciates the intent of the Obligations to391Aberdeen's Trusted Heroes or OATH Act of 2025, introduced by392Ranking Member Blumenthal. While VA cites concerns regarding393various sections as written, and subject to appropriations, we394welcome the opportunity to continue working with you and your395staff to amend the language.396    VA also appreciates the goals of the Veterans Appeals397Efficiency Act, introduced by Senator Banks and Ranking Member398Blumenthal. We support efforts to improve transparency in the399appeals process, but recommend amendments to ensure400feasibility. For example, we suggest reporting legacy and AMA401appeals remand separately, which would allow VA a sunset402reporting on legacy remand once they are completed.403    We also recommend against the requirement to track and404report when VBA adjudicators do not follow board remand405instructions. Implementing this would require building a new406review system for all post-remand decisions, demanding407significant staff and IT resources. Even with system upgrades,408VA anticipates several challenges in accurately tracking non-409compliance. For instance, if the agency of original410jurisdiction grants a claim without following the board's411instructions, it's unclear whether that outcome would be412considered non-compliance under the bill's language.413    Furthermore, under the Appeals Modernization Act, post-414remand decisions are not automatically returned to the board.415As a result, VA cannot confirm compliance with remand416instructions unless the veteran chooses to appeal.417    Mr. Chairman, that concludes my statement. Thank you again418for the opportunity to discuss these important legislative419proposals to improve benefits for veterans, service members and420their families. While I was unable to cover all the bills in my421opening remarks, my colleague and I will be happy to answer any422questions the Committee may have.423424    [The prepared statement of Ms. Devlin appears on pages 37-42596 of the Appendix.]426427    Chairman Moran. Thank you, Ms. Devlin. And I thank you and428the VA for providing technical assistance in support of the429SERVE Act, which I have indicated earlier, is now included in430this year's NDAA.431    Ms. Devlin and Dr. O'Toole, besides the mandates that are432included in the SERVE Act to improve healthcare resource433sharing between the VA and DoD, how else do you think the VA,434DoD, and Congress could work together to improve access to care435for service members and veterans in both of these federal436healthcare programs? What do we do to make this a better437broader system?438    Ms. Devlin. I'll ask my colleague from VHA to answer that.439    Dr. O'Toole. Thank you, Senator. And I think the question440speaks to, I think, an opportunity for us. Both systems have a441long history of collaborating together. Both systems have a442shared mission, and clearly, we want to also ultimately improve443the transition from active duty to civilian life, and444hopefully, VA care.445    I think there are several things that we, I think the SERVE446Act is a great step forward for us, and I appreciate the447opportunity for us to continue to work with you and your staff448on some of the concerns that we have. I think as we move449forward, issues of the processes of credentialing, and450privileging, and potentially working together with clinicians451in military treatment facilities in a more seamless capacity is452an opportunity.453    I look at models that we have, for instance, with the454Lovell FHCC and Chicago health system as a strong collaborative455model for us to continue to develop. But you know, I think this456is an important and prioritized area for us.457    Chairman Moran. Thank you for those suggestions and those458comments. I want to speak just a moment about Fisher House, and459express my gratitude to those involved in Fisher House for the460tremendous service they provide to veterans and to service461members. The issue that's addressed in this legislation was in462part a result from the VA continuing a practice that they had463previously due to lack of clarity in the law.464    This bill is designed to make clarity, and I want to make465sure that you agree to support this legislation. But there's no466question, what that clarity is now. Let me say it this way,467that ambiguity is no longer going to necessitate any decline of468the opportunity to serve service members' families.469    Dr. O'Toole. Happy to speak to that. And that is exactly470what we have heard from our facilities, is they've also looked471at the bill that this provides that level of clarity. So, thank472you.473    Chairman Moran. And then, finally, let me turn to Senator474Blumenthal--Senator Blumenthal.475    Senator Blumenthal. Thanks, Mr. Chairman. I want to focus476on the ACA tax credits. I've seen an estimate that a 1-percent477increase in reliance by veterans on VA healthcare produces $2.6478billion in additional costs. So, if 267,000 veterans are denied479the ACA tax credits and they are not extended, presumably some480major number will go to the VA healthcare system, significantly481raising the cost to the VA. Have you done an analysis on the482impact on the VA healthcare system of 267,000 veterans losing483their ACA health insurance coverage?484    Dr. O'Toole. Yes, I'm not aware of an analysis. I would485definitely--I take your word in terms of that transition, but I486can't speak to any specific analyses or numbers and would have487to take it for the record, sir.488    Senator Blumenthal. So, it would be fair to say that the489additional cost of VA healthcare system is going to be in the490billions of dollars if we fail, that is, if the United States491Senate failed to vote tomorrow to extend these healthcare492subsidies?493    Dr. O'Toole. Based on what you're describing in terms of494the numbers and your analyses, yes, sir.495    Senator Blumenthal. And you don't dispute them?496    Dr. O'Toole. No reason to dispute them. But I also, again,497want to be clear that I we have not done the analysis. I have498not done the analysis to be able to----499    Senator Blumenthal. Well, you'd be in a position to dispute500them if they sounded wildly wrong.501    Dr. O'Toole. Yes, if they sounded wildly, yes, I would.502    Senator Blumenthal. You know there have been recent reports503about the apparent demise of the DOGE program, but the VA still504has yet to share, by the way, despite bipartisan requests; a505full list of the thousands of contracts that have been cut by506Secretary Collins in connection with the DOGE Elon Musk507program.508    The VA has yet to respond to my May 19th letter demanding a509full accounting of these haphazard cuts. And despite promises510from multiple VA leaders to brief this Committee on the cuts,511we have yet to receive a briefing within the VBA and the VHA.512Do you have a full list of all the contracts canceled as a513consequence of DOGE, or because of the slashing cuts made by514the VA Secretary?515    Ms. Devlin. Senator, thank you for the question. I rejoined516VBA in May of this year, so I wasn't there for the DOGE517activities. However, I can tell you that we have the contracts518that we need to support our mission.519    Senator Blumenthal. Well, do you have a list of all the520contracts that have been canceled?521    Ms. Devlin. I don't personally have that list, no.522    Senator Blumenthal. Does anyone?523    Ms. Devlin. I'd have to get back to you on that, sir.524    Senator Blumenthal. Do you know, Dr. O'Toole?525    Dr. O'Toole. I don't, and again, I'd have to--we'd have to526get back to you on that.527    Senator Blumenthal. I can't speak for the Committee, but I528can for myself. I have no clue as to what excuse there could be529for failing to provide us with that list after so many months,530so many communications in hearings, and the letter that I did.531So, if you could take that message back, I would appreciate it.532    Dr. O'Toole, the last time you were here was in May. My533office sent a request to the VA immediately preceding that534hearing for data that we used to receive from the department.535Some of it was publicly available, regarding VA and community536care wait times, VA wait times, and community care wait times.537200 days later since I made that request, I have not received538any of the information that I asked for.539    As the Deputy Assistant Under Secretary for Health for540Clinical Services, you oversee VHA field operations. When was541the last time you received updates on wait times at the VA or542for community care?543    Dr. O'Toole. Well, sir, we track IC data related to VA wait544times on a frequent basis. And we do track that. I would have545to defer to my colleagues in the IVC office in terms of what546the community wait times are.547    Senator Blumenthal. Can you give us an update?548    Dr. O'Toole. Off the top of my head, no, but I'm happy to,549you know----550    Senator Blumenthal. Can you give us an update before we551leave for the holiday break?552    Dr. O'Toole. I will definitely try to, sir. Yes.553    Senator Blumenthal. Thank you. my time has expired. That554completes my questions. Thank you.555    Chairman Moran. Thank you, Senator Blumenthal. Senator556Tillis.557558                       HON. THOM TILLIS,559                U.S. SENATOR FROM NORTH CAROLINA560561    Senator Tillis. Thank you, Mr. Chair. Dr. O'Toole, Senator562Blumenthal asked you about the 250,000 or so people who may be563on ACA subsidized care. Do we know whether or not--I mean, can564you try and identify--frankly, if they're VA-eligible, I would565prefer for them to be getting care from the VA. I understand566the fiscal impact, but this may represent an opportunity to567find a swathe of people who are going out to the exchange568buying healthcare coverage when we can give them the569extraordinary coverage that they could get within the VA.570    The concern I have with that is it's kind of like calling571roll by asking people who are absent to raise their hand? How572would we find those people and what was the basis for the573analytics? I mean, it's one thing to estimate, but how can we574get to a level of granularity where we know who they are, and575we can reach out to them and say there is an alternative576whether or not the subsidies get extended?577    Dr. O'Toole. Yes, it's a great question, sir. And, you578know, having been practicing in the VA for 20 years, I'm always579an advocate of the care that we provide in that system. I don't580know, and we'd have to get back to you in terms of what type581of----582    Senator Tillis. And clearly, if we have an influx and583covered veterans, then we're going to have to deal with584funding. But if they're not getting the subsidy on the585exchange, there may be a source of funding there that we should586talk about. So, I think it would be helpful for us to get that587regardless of what occurs, because I'm always looking for588veterans to get the best care that they can. And I believe589that's through the VA when given the option, if they're590eligible for it.591    Ms. Devlin, you covered, I think, about 8 or 10 of the592bills on the list that I have before me. Do you have a formal593position that you've communicated to us on the other pending594bills, the longer list?595    Ms. Devlin. Yes, sir. We submitted testimony for the record596on all bills.597    Senator Tillis. Okay. I haven't seen it. Are there any hard598nos? Not only do you not agree with the intent, you think it's599a bad idea?600    Ms. Devlin. We did have some opposition.601    Senator Tillis. Like, as in ``No, we don't want this policy602to be passed,'' and that's in the record?603    Ms. Devlin. Yes.604    Senator Tillis. Thank you. Then the only other question I605had specifically--actually, let me see if I can find the bill.606Oh, yes, 2807, Restoring Eligibility Standards for Placement in607Eligible Cemeteries. What's your position on that?608    Ms. Devlin. Thank you for the question. Our NCA partners609are not here to testify on that bill. We----610    Senator Tillis. But was that submitted to the record?611    Ms. Devlin. It was, sir.612    Senator Tillis. And what was the position in the record?613    Ms. Devlin. If you can give just one moment, I will look it614up in the testimony [turns pages in notebook]. If you'd like to615ask me another question while I look it up?616    Senator Tillis. No, that's the last one.617    Ms. Devlin. Oh, okay.618    Senator Tillis. Sooner you get that one, sooner you get rid619of me.620    Ms. Devlin. Trying to avoid the awkwardness of going621through the----622    Senator Tillis. That's okay. Appreciate your preparation.623    Ms. Devlin. Absolutely, yes, sir. Thankfully, they're in624numerical order.625    Senator Tillis. Yes. If staff have feedback, y'all can626whisper in my ear, too.627    Ms. Devlin. I wanted to give you the exact language just so628that I don't go on the record with the wrong language.629    Senator Tillis. Well, the only reason out this entire list,630I think I'm only co-sponsor on the Purple Heart Veterans631Education Act. But that one gets out to me. It stands out in632that I think that we have to have pretty significant633consultation with the DOJ.634    It sounds like, directionally, you are supportive. I've had635the staff provide me something, but we really need to get that636right. There are clearly instances where I can think of a637tragic event in North Carolina where it would be appropriate638for this, I believe, my personal opinion, appropriate.639    The circumstances at face value would not justify maybe640making an exception. But I do think we need to look at it, but641we need to have a very tight set of standards, and I think642strong consultation with DOJ before I'd be willing to support643it. Thank you, Mr. Chair.644    Chairman Moran. Thank you, Senator Tillis. Senator Murray.645646                       HON. PATTY MURRAY,647                  U.S. SENATOR FROM WASHINGTON648649    Senator Murray. Thank you, Mr. Chairman. You know,650President Trump came into office saying that he would make IVF651free. Instead, not only has the President not done a thing to652lower the cost of IVF, he stood by as Speaker Johnson cut a653very straightforward provision to make IVF more affordable for654service members as part of this year's NDAA. And on that note,655I'm really disappointed to see that my Veteran Families Health656Services Act was left off of the agenda today. That bill would657give more service members and veterans the opportunity to grow658their families, including through IVF, by expanding the659fertility services that are covered under VA and DoD660healthcare.661    It just seems like Republicans in this Administration662really talk a big game about IVF, but when it comes to actual663policy, it's pretty clear who's in the driver's seat; anti-664abortion extremists like Speaker Johnson. So, I just want to665make it clear, I think it's pretty outrageous that Republicans666won't lift a finger to help our service members, or anyone for667that matter, to access IVF. And I think it is really important668everybody here understands that.669    Dr. O'Toole, are you aware that service members face a670higher rate of infertility compared to the rest of the671population?672    Dr. O'Toole. I am not directly familiar with it, ma'am, but673I take your word on it.674    Senator Murray. Well, it is true. And our service members,675as we all know, they lay their lives on the line for our676country. And I really believe, and I think many people do, that677the least we can do is help them start their families when they678come home. So, again, I'm registering my deep disappointment679and hope that that can change.680    Let me move on. As the daughter of a Purple Heart veteran,681I know how much they sacrifice for our country. I take682seriously our responsibility to be there for them when they683need it the most. And unfortunately, right now, not all Purple684Heart veterans are treated equally when it comes to their685benefits. For example, post-9/11 veterans can transfer their GI686benefits to their descendants while they're still in service.687    However, one of my constituents reached out to tell me688about a problem he was facing because he received his Purple689Heart after his service and was unable to transfer his GI Bill690benefits to his daughter when she was looking to go to college.691So, the bill that I'm offering, which I'm glad to see on the692agenda today, would fix that loophole.693    Ms. Devlin, you mentioned you wanted to see some changes,694but let me just ask you, are you supportive of this695legislation?696    Ms. Devlin. We do support the intent of this, and it's697really technical amendments to ensure Department of War is698involved in the process as they're responsible for the process699of transferring eligibility.700    Senator Murray. Well, I'm happy to talk with you about what701your recommendations are, but I think this is a really702important piece of legislation. I hope we can move on it.703    And let me ask about the Molly R. Loomis Research for704Descendants of Toxic Exposed Veterans Act. This is a bill705that's really near and dear to me. Molly is a Washington State706resident. She was born with spina bifida and it's believed to707be caused by her father's exposure to Agent Orange when he708served in Vietnam. And despite research showing descendants of709toxic-exposed veterans experience lifelong medical issues,710there is yet to be a comprehensive government-led study of this711issue.712    So, my bill simply takes a very critical step forward by713requiring research on health conditions that are prevalent in714the descendants of veterans who were exposed to toxic715substances during their service. Ms. Devlin, talk a little bit716first about how this research would prepare VA to help future717generations of veterans who've been affected by toxic exposure.718    Ms. Devlin. Thank you for the question. We take research719objectives very seriously. And of course, for individuals with720spina bifida whose parents were exposed to toxic substances,721there is the Chapter 18 program which supports them. And that722program continues today to support those dependents.723    There has been no significant association that we've seen724through the National Academy of Sciences research to indicate725that there are generational impacts based on toxic exposures,726but we do have the infrastructure in place. And in fact, with727the PACT Act, we have the infrastructure in place to determine728which research objectives to take on with the working groups729that exist already.730    Senator Murray. Well, it's my understanding that there is731research showing that descendants of toxic-exposed veterans do732experience lifelong medical issues. I think it is really733important for us to look at this to make sure they are getting734the support they need. So, I thank you for your inclusion of735this bill on the agenda today.736    Chairman Moran. Senator Murray, thank you. I have taken an737interest a long time ago in regard to next generation affecting738the next generation by service of their parents or their739grandparents. And look forward to working with you on this and740other pieces of legislation.741    Senator Murray. Thank you.742    Chairman Moran. Senator Cramer.743744                       HON. KEVIN CRAMER,745                 U.S. SENATOR FROM NORTH DAKOTA746747    Senator Cramer. Thank you, Mr. Chairman. And thank you both748for being here today. I want to talk a little bit about and get749some feedback on my legislation that I introduced with Senator750Sheehy from Montana, an even larger and more rural state than751North Dakota. It's called the Critical Access for Veterans Care752Act.753    I believe you're familiar with it. I mean, the VA did754testify to it, I know. I'm going to just read a little bit of755it. It reads a little bit like the girls I used to ask out in756high school, and they'd say, well, we like you a lot and you757have a good personality. Says, ``The VA strongly agrees with758the intent to improve the quality and availability of care to759veterans in highly rural areas like Montana and North Dakota.760We support the goal of improving access for rural veterans and761want to work with the Committee to clarify how this new762authority would integrate with existing VA care processes.''763    You know, in states as rural as North Dakota and Montana,764we have very limited VA providers and facilities. In North765Dakota, we have one hospital in Fargo, which is the very766eastern edge of the state, we have, I think, eight CBOCs, and767the community care program literally can be a lifeline. And I768say can be because the thing that prevents it from being a769lifeline as often as it ought to be, is of course, are all the770roadblocks that get put up; all the fine print, all the771exceptions, all the slow walking and administrative hurdles for772the veterans and the providers themselves to participate.773    So, we've seen some administrations, prior administrations,774intentionally put up some of these roadblocks and to deter775veterans from using these options, even though it's the law and776an option that we've all told veterans many times it's777available to them.778    After hearing from veterans and rural healthcare providers779and leaders across North Dakota, I proposed the solution, as I780said, with Senator Sheehy. And it was to simplify access to the781critical access network, whether it's critical access hospitals782rural health clinics, and the model.783    And as a point of emphasis, you guys, critical access is a784designation specific to healthcare providers where they're the785only hospital or the only provider in an entire region many786miles between the providers. Our system, our VA system,787effectively discriminates against our veterans compared to788their neighbors, their non-veteran neighbors and friends and789family, by giving them less access to care that's readily790available than they have currently.791    And so, I mean, we just have so much opportunity here.792Obviously, I'm always willing to work to improve the details of793legislation. We want to get it right. But parts of the794testimony seem to indicate that the VA wants to maintain the795control, and that's always the deal. All the good language in796the world. However, you know, as long as we agree that that's797not really a culture change that's maintaining of control.798    So, the goal is to give rural veterans access to local799critical access hospitals without the strings attached. I mean,800we talk about wait lines in the waiting room that Senator801Blumenthal talked about. That is one thing. But the wait lines802we're talking about are days, and weeks, and months to get803permission to get the care that they need across the street,804rather than across the state. So, I understand, and again, want805to make the language clear.806    You probably hear it quite a bit, I know I do, that prior807authorization process for veterans is a nightmare. It not only808takes a long time, and oftentimes gets the wrong result, but809it's just awful to do. So, anyway, I worry that if the bill's810watered down, quite honestly, that we turn this authority back811over to the bureaucracy to decide.812    I want to say I've got a lot of support, Mr. Chairman, and813I have several letters here, including from the American814Hospital Association supporting the legislation as it is, other815leaders, rural healthcare leaders from across North Dakota. And816I would like to submit them all for the record, if it's okay.817    Chairman Moran. Without objection, so ordered.818819    [The information referred to appears on pages 129-136 of820the Appendix.]821822    Senator Cramer. All right. Anyway, with whatever time823remain, which is now 25 seconds, Dr. O'Toole, maybe you could824just elaborate a little bit on my rant.825    Dr. O'Toole. Sure. I thank you, Senator. And let me say,826you know, first we strongly support definitely the intent and827the need for this legislation as it relates to rural veterans.828I think the sticking point, which you noted, is really how do829we create some clarity in language and direction as it relates830to prior authorization versus clinical necessity. That can be831achievable, and we're very much looking forward to working with832you and how we get appropriate language to make that work.833    Senator Cramer. Thank you.834    Chairman Cramer. Senator Hassan.835836                   HON. MARGARET WOOD HASSAN,837                U.S. SENATOR FROM NEW HAMPSHIRE838839    Senator Hassan. Well, thanks, Mr. Chairman, and Ranking840Member Blumenthal for the hearing. To both Ms. Devlin and Dr.841O'Toole, thank you for your service to our Nation's veterans.842    Ms. Devlin, this may actually be a question that Dr.843O'Toole is better positioned to answer, but as you both know,844in May, President Trump signed an Executive order that required845the Secretary of the VA to direct a feasibility study and846create an action plan regarding bringing a full service VA847hospital to New Hampshire. This action plan was due to the848President last month.849    A few weeks ago, my New Hampshire colleagues and I wrote a850letter to the Secretary asking him to make that action plan851publicly available so that Granite Staters can see it, have852input, provide feedback. So, can you, whichever one of you is853in a better position to respond, can you please tell me when854this action plan will be made available for my constituents to855review and comment on?856    Dr. O'Toole. Senator, I'll take that one on. I don't have857the specific information. I will say that this is a priority of858the Secretary. It is something that I know a lot of people are859working on, and we will take it for the record to get that860information for you.861    Senator Hassan. I would appreciate that. We liked having862the Secretary come in person to Manchester a little bit ago. It863was a really good visit, but we really need to see the action864on this. And we've been asking for a while.865    Ms. Devlin, I want to change gears a bit now and discuss866how scammers are targeting veterans. I bet everybody here has867gotten a text, email, phone call and been the target of a scam.868According to the Federal Trade Commission, veterans and869military retirees reported nearly $420 million lost to fraud870just last year. And when you include active military members,871reservists, and their families, that number climbs to more than872$580 million.873    According to the FTC, the top type of fraud affecting our874military and veterans was imposter scams. Those types of scams875alone add up to almost $200 million. Ms. Devlin, can you please876discuss how scams and financial losses can affect veterans and877their families, and what the VA is doing about it?878    Ms. Devlin. Thank you for the question. We take this very879seriously, and we have multiple efforts underway to prevent880fraud from even happening, from even affecting a veteran. But881it does affect veterans. And so, what I'd like to share with882you is that we have in the last couple years prevented $9.6883million from being stolen from veterans' accounts. The bad guys884are always changing their approaches, and we're always evolving885to make sure we're one step ahead of them as much as we can.886    So, a lot of what happens is really the redirect, the887attempt to redirect finances from a veteran's account to888another account. And those are the--that's the $9.6 million889that we prevented from happening. And when it does happen, we890provide one-on-one remediation support.891    So, if a veteran or a service member or family member is892subject to or victim of fraud, we'll provide remediation893support one-on-one through our fraud team. And we do extensive894outreach and communications, even with the latest fraud scheme895where veterans are getting a message saying they have a VA896overpayment, and it's not true. And we've sent out897communications and reached millions of veterans with that898information.899    Senator Hassan. Well, I appreciate that very much. And you900mentioned your fraud prevention or your fraud remediation901teams. One of the things I'd like to continue to do is work902with you to address this issue and find ways to strengthen our903support and prevent even more losses. One way we can do that is904to make sure that the VA's efforts on scam prevention and905education are fully supported.906    Senator Cornyn and I introduced the bipartisan VSAFE Act,907which would require that the VA have a scam and fraud evasion908officer, ensuring that such a position is codified and909congressionally supported so that there's a specific person in910office to lead the VA scam profession efforts across911administrations. And so, I'd love to work with you on that912legislation, and also, interested on what additional ways you913think that Congress and the VA can work together to address914scam--scams and fraud.915    Ms. Devlin. Happy to work with you on that. Absolutely.916    Senator Hassan. Yes. Just for my colleagues' knowledge, if917they don't know, that the overall cost of these scams now918economy-wide around the world is over a $1 trillion in losses a919year. It is now outpacing the illicit drug trade. So, it's just920something we all got to really take on together. Thanks so921much.922    Chairman Moran. Senator Hassan, thank you. Senator Boozman923is recognized.924925                       HON. JOHN BOOZMAN,926                   U.S. SENATOR FROM ARKANSAS927928    Senator Boozman. Thank you for being here, and we929appreciate you and Senator Blumenthal for calling the meeting.930And this is really good stuff that we're discussing.931    I want to start with discussing the Veteran Burial932Timeliness and Death Certificate Accountability Act. Families933of veterans have suffered delays in certifying their loved ones934passing as long as eight weeks. This creates difficulties for935the families to receive death benefits received with burial936honors, and forces local government to maintain possession of937the veteran's body.938    Mr. O'Toole, does VA policy allow a physician assistant to939certify a death certificate in states that require a physician940or coroner to certify?941    Dr. O'Toole. Thank you, Senator. And specifically related942to this bill, I want to note that the VA supports it943absolutely, although there are some amendments that we would944recommend.945    The first is that physician assistants who are practicing946as independent providers in primary care specifically, we feel947should be included in those clinicians able to sign a death948certificate, which is standard practice in many states already.949    Our other request is that we go for--instead of 48 hours,950to two business days, which is our current practice, and also951reflects the challenges with 95 percent of the deaths occurring952outside of a VA facility, some of the logistic requirements953dealing with holidays, weekends, and so forth.954    Senator Boozman. Very good. Can you explain the processes a955VA physician must go through to sign a death certificate, and956compare that process for when a veteran passes away outside of957a VA facility?958    Dr. O'Toole. I can tell you from my own experience.959Usually, it's a notification by the medical examiner or a960mortician's office about a death, and then, and requesting the961certification be completed in a certain time. Obviously, it is962greatly facilitated if that patient has been seen recently. And963records are appreciated for natural causes.964    Again, it's a little bit trickier if the patient has not965been seen recently or the death occurred in a circumstance that966might not be consistent. And that's pretty usual, whether it's967within the VA or outside the VA system.968    We recently stood up in office and put out a directive as969well as training for all of our VA clinicians that's intended970to clarify and codify those processes internally for us.971    Senator Boozman. Very good. Ms. Devlin, can you speak to972the importance of death benefits for the families of veterans,973and the consequences of delaying their delivery?974    Ms. Devlin. Absolutely. We work with many sources of975information for first notice of death because we want to make976sure that the survivors receive their benefits in the most977timely manner. We've reduced our inventory of dependency and978indemnity compensation claims dramatically working on getting979those timely benefits to survivors.980    Senator Boozman. Very good. I'm proud to be an original co-981sponsor of the VSAFE Act of 2025. Veterans are uniquely982targeted by scammers to exploit their access to benefits. Ms.983Devlin, can you talk about the legal difficulties in recovery984from a scam?985    Ms. Devlin. I'm not an expert in legal recovery from scams,986but I can tell you we take very seriously protecting our987veterans from fraudsters. We have many efforts underway, and as988I mentioned earlier, the bad guys are always changing their989techniques, which means we have to be sharp and continually990evolving our practices.991    We saved veterans from multiple fraud attempts based on our992efforts. And I can tell you that identity theft and other types993of fraud can be very catastrophic for families. Financial loss994of credit, all sorts of problems can result. And that's why we995provide one-on-one remediation to our veterans and their996families if that does happen to them.997    Senator Boozman. What does the VA lack in ability the scam998and fraud officer could provide?999    Ms. Devlin. I'm sorry, can you repeat the question?1000    Senator Boozman. What does the VA lack in ability that a1001scam and fraud officer could provide?1002    Ms. Devlin. I think we have the capability now creating a1003fraud officer. We did support the bill. Having that position1004codified in law would strengthen our capabilities just for the1005mere fact of that position being a permanent position. And that1006put, that individual would work with all of the1007administrations, because we have unique situations in VBA, and1008VHA, and NCA that are uniquely different in terms of how fraud1009can affect our veterans that we serve.1010    Senator Boozman. Very good. We appreciate it. These not1011little things. There are things that really do affect people a1012great deal, and both with inconvenience, and as you pointed1013out, Ms. Devlin, just the adverse things that can happen as a1014result of the scams. And then, two, not being able to get a1015death certificate in a timely fashion. And we can argue about1016what timely is, but in some cases, it's not timely. We do need1017to correct that because it really does put people in difficult1018situations. So, thank you, Mr. Chairman.1019    Chairman Moran. Senator Boozman, thank you. Senator King.10201021                    HON. ANGUS S. KING, JR.,1022                    U.S. SENATOR FROM MAINE10231024    Senator King. Thank you, Mr. Chairman. I wanted to talk a1025bit about S. 926, a bill that Senator Sheehy and I have1026introduced. Senator Gallego and Collins have also joined in1027support.1028    It involves falls prevention. I'm sorry, that's next. It1029involves a lockbox for firearms. I don't have to talk to you1030about the grave history of suicides among our veterans. 751031percent of which involve firearms. I did a calculation; about1032one veteran every two hours takes their own life with a1033firearm. And what we're proposing here is based on a successful1034program in Utah where it's basically a free lockbox for1035veterans that apply. There's no Second Amendment issues, purely1036voluntary. And the research, as I'm sure you know, Doctor, if1037you can lengthen the time between ideation and action, you're1038going to save lives.1039    I know that the department has a kind of pilot program and1040they're worried about the cost, but I hate to think that cost1041is going to be the barrier to saving a life. I mean, what's the1042value of one veteran's life saved? So, I hope you'll take a1043closer look at this bill. I don't think it's the--we estimate1044$5 million a year. That would be 33,000 lockboxes, and that's a1045pretty good uptake rate. So, Doctor, your thoughts, and I hope1046I can move you a bit on this.1047    Dr. O'Toole. Well, thank you, Senator. And first thank you1048for introducing this bill. And I know we've talked about it1049previously, and this is obviously a priority for the Secretary.1050It's a priority for the VA. Any suicide is one too many. And1051you're absolutely right. Anything that creates some space1052between that impulse and that action, whether it's in securing1053medications or securing firearms, critically important and1054it'll save lives.1055    We need to work with you on this. I think our concerns1056about the recommended appropriated amount of $5 million is1057something that I'm hoping we can work through to be able to1058hopefully create some comfort in terms of what is the right1059amount.1060    Our efforts to date have been focused on providing1061lockboxes to those veterans identified as having moderate or1062severe risk, and clearly coupling that with the wraparound1063services, and mental health services, and social support1064services that hopefully will help.1065    Senator King. And that's a very limited uptake.1066    Dr. O'Toole. Absolutely. We need to do more. And I was1067going to add also, we have the gun cables that are more1068generally available. But the technology and the capacities with1069lockboxes is preferable to the cables.1070    Senator King. Let's continue our discussion----1071    Dr. O'Toole. Yes.1072    Senator King [continuing]. Because I think this is, like I1073say, every two hours, a veteran dies by firearm suicide, and we1074ought to be doing whatever we can. And Mr. Chairman, I'd like1075to submit for the record, I think it's communications from 241076different groups supporting this bill. So, if I can submit that1077for the record.1078    Chairman Moran. Without objection.10791080    [The information referred to appears on pages 137-166 of1081the Appendix.]10821083    Senator King. The second issue I want to talk about briefly1084is falls. One out of every four people over 65 have a1085debilitating fall. The cost of one fractured hip is between1086$40,000 and $50,000. Falls prevention to me is the low hanging1087fruit of lowering the cost of healthcare. It's an epidemic in1088this country. And Senator Rounds, and I, and Senator Blumenthal1089have a bill that basically puts a focus on this issue within1090the department by creating an Office of Falls Prevention.1091    And my philosophy of management is you need somebody in1092charge who's responsible for a particular program, otherwise it1093just falls away. The way I used to put it in business was ``one1094throat to choke.'' And what I'm talking about is somebody who's1095responsible every day when they get up, saying, ``How can we1096prevent falls among veterans?''1097    So, again, I think you've been somewhat negative about this1098bill, but seriously, this is something, as I say, it's the low1099hanging fruit of prevention not only a financial cause, but of1100the terrible toll that it takes on our veterans and their1101families.1102    Dr. O'Toole. No. And you're absolutely right. I mean, falls1103are a preventable cause of significant morbidity and mortality,1104and we obviously, with our aging veteran population need to1105have that focus.1106    Our concern or basis for objection is that much of the work1107is underway. We launched a falls office within the National1108Office of Patient Safety this past year. And we are doing a lot1109of the things that the legislation calls for. And our concern1110is that creating or enacting the legislation, we don't want1111that to be taken from the momentum of what we are currently1112doing. But, again, let me please extend the offer for us to be1113able to work with your office to be able to find some common1114ground to be able to move this forward.1115    Senator King. I appreciate that. And it may be just some1116modifications to what you're already doing and sort of beefing1117it up, because again, this is a real opportunity to relieve a1118lot of pain and suffering for our veterans, but also pain and1119suffering for the taxpayers. Thank you. Thank you, Mr.1120Chairman.1121    Chairman Moran. Thank you. Senator Slotkin.11221123                      HON. ELISSA SLOTKIN,1124                   U.S. SENATOR FROM MICHIGAN11251126    Senator Slotkin. Thank you, Chairman. Thanks for having1127this hearing. And you're coming to the end because I'm at the1128end of the dais, so it's almost over. And I appreciate you1129really have had, like, the grab bag of issues. So, it's not1130like a hearing on one issue. Thank you for taking all of our1131particular questions.1132    I want to follow-up on an issue I feel very strongly about,1133which is toxic exposure for our veterans, particularly burn1134pits. You know, I was a CIA officer, not a veteran, but lived1135in Iraq for many years of my life. And the burn pit exposure, I1136mean, you didn't have to be a doctor to understand that it's1137pretty crazy to live close to a place where you burn all kinds1138of trash. And we passed the PACT Act, which I think was a1139really important lesson that we weren't going to let the 9/111140veterans have to fight for 30 years the way that the Agent1141Orange exposure folks in Vietnam had to fight.1142    And so, you know, we got a bunch of new veterans into VA1143care who had served in places where we burn our trash. And I1144was proud to play a really small part of that. But the bill1145that I'm interested now is kind of like the next set of--the1146next part of that story which is the Molly R. Loomis Research1147for Descendants of Toxic Exposed Veterans Act. It's basically1148this question that I think is unknown right now is, if you are1149exposed to toxic exposure burn pits and you've served for a1150long time, what, if anything, do you pass on to your kids? And1151I think there's like a--a lot of open questions here about1152that.1153    And so, the bill is just basically, can we research that?1154Can we get some data behind that? But I understand the VA is1155against it. Can you walk me through your sort of feeling on the1156bill, but then just what's the next step the VA is looking at1157for toxic exposure, particularly for the 9/11-era veteran?1158    Ms. Devlin. Yes. Thank you so much for that question. We1159believe that we have the infrastructure in place. Part of it1160was put in place by the PACT Act to research conditions,1161exposures that we believe have science behind them. And we do1162some preliminary research, and then we determine which ones we1163need to delve into and do the more extensive research.1164    We work with the National Academy of Science and Medicine1165and Engineering on these. There's not been a significant1166association shown at this point that shows any descendants1167impact of toxic exposures. We are researching some other1168exposures, and I'm happy to share those with you, but they're1169not----1170    Senator Slotkin. But you have some sort of program that's1171been funded by the VA or sponsored by the VA that looks at the1172descendant piece, not other--because certainly, we had a long1173debate in the PACT Act about which conditions would qualify. Do1174we actually have science to link to the toxic exposure, which I1175get, but is there actually a funded project looking at the1176descendant piece, the children?1177    Ms. Devlin. It's not specifically looking at descendants.1178We determine, as I mentioned, which exposures, which locations,1179particles, specific items that veterans are exposed to during1180service and determine which ones require further research. As I1181indicated, the last research on toxic exposures for1182descendants, which was in 2018, did not show a significant1183association.1184    Senator Slotkin. Well, maybe I'd just like to see it.1185Because we hear this, and again, you know, I understand we need1186the science behind it, but we certainly hear from veterans,1187that era of folks many of them have had children and they feel1188like there's similarities across what they're seeing in their1189own children. So, I just think it's important that we1190understand and have done the work. But I'll look at the 20181191stuff, but I certainly think the demand signal is there.1192    Ms. Devlin. Happy to share it with you.1193    Senator Slotkin. Thank you. And then the other issue I just1194wanted to talk about was on this kind of communication when1195veterans leave the VA system and go out on the open market for1196their care. It's something that has been much discussed here.1197We keep hearing that there's problems when someone goes out1198into community care in like their records coming back to the1199VA. That there's this drop off.1200    And so, again, there is a bill, a bipartisan bill, the1201Caring for our Veterans Health Act, which would just improve1202information sharing between the VA and these normal providers1203out on the market. Can I get your thoughts on that? Because we1204want them to get the care, but then it shouldn't be up to the1205veteran to have to slog and get the records back to the VA.1206    Dr. O'Toole. No, absolutely. And I appreciate you bringing1207it up. It's a concern and a challenge for us. And we, the OIG,1208has investigated, looked at it, identified issues and problems1209as well. Much of the efforts involved are going to be captured1210in the next gen contract with an enhanced role for the TPAs,1211the third-party administrators, in terms of collecting and1212managing those records.1213    And our position on this bill is that we are better served1214working through a contractual and business arrangement, rather1215than having to legislate for the outcomes that we're trying to1216achieve. But absolutely, we share your same concerns with this,1217and it's more of a strategy issue.1218    Senator Slotkin. Great. Happy to keep talking about it.1219Thank you, Chairman. I yield back.1220    Chairman Moran. Senator Slotkin, thank you. I was just1221expressing to Senator Blumenthal that I think he and I, to my1222knowledge, were the first to introduce legislation and it1223became law. It was the Toxic Exposure Research Act of 2015 that1224looked at the consequences to the next generation of toxically1225exposed veterans.1226    My awareness of this issue came from the Vietnam Veterans1227of America Forum conference they had in Wichita, Kansas that I1228attended. And it's why I indicated to Senator Murray that I'm1229interested in continuing--she asked similar questions to1230yours--interested in working with you and others to see that1231the answer I was going to ask Ms. Devlin--what I think I heard1232her say, and I think that research was done, according to that1233Toxic Exposure Act of 2015, and the conclusion of that research1234was what?1235    Ms. Devlin. So, the conclusion of that research from 20181236was that there was no significant association between toxic1237exposures in the Asia areas were related to children,1238descendants of those veterans.1239    Chairman Moran. What did that research consist of? How was1240that research conducted?1241    Ms. Devlin. It was conducted in collaboration with the1242National Academy of Sciences, Engineering, and Medicine. So, we1243can provide the report to you.1244    Chairman Moran. I've seen it, but it has been a while.1245    Ms. Devlin. Okay. Sorry. It has been a while.1246    Chairman Moran. And then, did you also indicate that,1247perhaps as a result of that conclusion, the research1248conclusion, that there is no research currently ongoing at the1249VA related to this topic with the next generation, or their1250veteran parent, or grandparent?1251    Ms. Devlin. Not to my awareness, unless Dr. O'Toole is1252familiar. No, not to my awareness. Not on descendants1253specifically.1254    Chairman Moran. Senator Slotkin, again, I have an interest1255in this topic, Senator Blumenthal.1256    Senator Blumenthal. Just to clarify, are you aware of other1257research outside the VA that's ongoing with respect to this1258issue?1259    Ms. Devlin. I'm not aware of any research on descendants.1260Are you, Dr. O'Toole?1261    Dr. O'Toole. Yes, I'm not aware, but I will also say I1262haven't been actively tracking. We do track it actively as part1263of the PACT Act of current veterans. But as far as descendants1264go, I don't know. And, you know, 2018 was a while back.1265    Chairman Moran. Well, and 10 years ago, what I recall from1266the conference I attended, it was very vivid. It sticks with me126710 years later about a significant circumstances I heard about1268and saw related to veterans and their next generation. Senator1269Slotkin.1270    Senator Slotkin. Yes. I just will say briefly and while1271again we certainly have heard from Vietnam veterans their1272perception that things can be passed on to their kids but would1273just offer, and I'm not a scientist, but Agent Orange exposure1274can't be exactly the same as burn pit exposure. And I just1275think, you know, it at a minimum, if you have a bipartisan1276interest in supporting that kind of research, I think it's sort1277of part of what we owe to folks if there's a possibility that1278it affects their children, I'd be happy to see this Committee1279push it forward.1280    Senator Blumenthal. I think that, if I may, Mr. Chairman--1281--1282    Chairman Moran. Senator Blumenthal.1283    Senator Blumenthal. I think Senator Slotkin is absolutely1284right that this area really cries out for some bipartisan1285action. And I'm struck by the stories that I have heard from1286veterans about children bearing the diseases and afflictions1287that are attributed by medical experts to the exposure to the1288burn pits and other kinds of toxic substances, including in1289this country at Camp Lejeune, parents having children who may1290be affected by the contamination of that water there. So, thank1291you, Mr. Chairman, and thank you Senator Slotkin.1292    Chairman Moran. Good. Thank you, Ms. Devlin, and you, Dr.1293O'Toole, for joining us today. And now we dismiss you. It1294sounds like a harsh word. We'll now ask the next panel to1295approach the desk and join us. Thank you.1296    Testifying on the second panel is Morgan Brown, the1297National Legislative Director for the Paralyzed Veterans of1298America; Nancy Springer, the Associate Director of the National1299Legislative Service for the Veterans of Foreign Wars; and1300Barton Stichman, the Co-founder and Special Counsel for the1301National Veterans Legal Service Program.1302    Thank all three of you for being here. And with that, Mr.1303Brown, I'll recognize you first.13041305                            PANEL II13061307                              ----------13081309   STATEMENT OF MORGAN BROWN, NATIONAL LEGISLATIVE DIRECTOR,1310                 PARALYZED VETERANS OF AMERICA13111312    Mr. Brown. Well, thank you, Mr. Chairman, and Ranking1313Member Blumenthal, and Members of the Committee. Paralyzed1314Veterans of America would like to thank you for the opportunity1315to testify on some of the pending legislation impacting VA that1316the community or the Committee is reviewing today.1317    Obviously, there are many bills on the docket, so I'm going1318to limit my comments to just three of them that we feel most1319closely impact our members. First, PVA supports the Review1320Every Veteran's Claim Act, which seeks to limit VA's authority1321to deny a veteran's claim solely on the veteran's failure to1322appear for medical examination that's associated with the1323claim.1324    Thousands of veterans claim for service-connection, claims1325for increase and for other benefits like total disability,1326individual unemployability, and aid in attendance, have been1327denied solely because of missing an examination. There are many1328legitimate reasons why a veteran may not be able to attend a1329scheduled exam. We are also aware of numerous instances where1330VA contractors erroneously recorded the veteran as a no-show.1331    Veterans with SCI/D often encounter multiple barriers in1332travel when compared to other veterans and are apt to miss some1333of these appointments. We believe that passage of this1334legislation will ensure that a missed exam isn't the only basis1335for denying the veteran's claim. VA should also carefully1336consider whether an examination is needed since many veterans1337with SCI/D already received most of their care through the1338department's SCI/D system of care. Therefore, their records1339have adequate information to provide an accurate picture of1340their disabilities.1341    We also support the Veterans Appeals Efficiency Act, which1342would establish additional reporting and tracking requirements1343for the Veterans Benefits Administration and the Board of1344Veterans Appeals, such as information on higher level reviews,1345supplemental claims, and notices of disagreement.1346    It also requires the tracking of claims pending in the1347national work queue not assigned to an adjudicator, cases that1348are remanded by the Board, Veterans Appeals Improvement and1349Modernization Act cases pending a hearing, and when a decision-1350maker did not comply with the board's decision.1351    We recognize the value of and support efforts to track1352meaningful data to improve the effectiveness and accuracy of1353the claims process. However, the data sought by this1354legislation will be meaningless unless the department addresses1355the problems that hinder their ability to obtain proper medical1356opinions since this continues to result in remandable errors.1357    This act would also give the board the authority to1358aggregate certain claims. And while PVA does not oppose1359allowing the board to aggregate appeals involving common1360questions of law or fact, we believe that before that can be1361done, a feasibility study should be conducted and the findings1362reviewed, then legislation based on those findings should be1363brought forth.1364    And then, finally, in times of fiscal constraint, joint use1365agreements between DoD and VA should be highly prized for their1366ability to increase access to care for service members and1367veterans while reducing overall federal spending.1368    Such agreements allow for the sharing of medical personnel,1369facilities, and resources, which can lead to faster access to1370high quality care and improved medical outcomes. They also1371reduce bureaucracy and improve the efficiency of the system.1372DoD and VA have had the authority to execute these types of1373agreements for decades, but have never really used them to1374achieve their full potential.1375    PVA supports the SERVE Act, which reinforces some of these1376existing authorities and will improve access to healthcare by1377improving collaboration and increasing the use of these1378agreements between the two departments.1379    I thank you again for the opportunity to share our views on1380some of the bills, and I'll be happy to answer any questions1381you may have.13821383    [The prepared statement of Mr. Brown appears on pages 97-1384105 of the Appendix.]13851386    Chairman Moran. Mr. Brown, thank you so much. Ms. Springer,1387your testimony please.13881389   STATEMENT OF NANCY A. SPRINGER, ACTING DIRECTOR, NATIONAL1390  LEGISLATIVE SERVICE, VETERANS OF FOREIGN WARS OF THE UNITED1391                             STATES13921393    Ms. Springer. Good afternoon, Chairman Moran Ranking Member1394Blumenthal, and Members of the Committee. On behalf of the men1395and women of the Veterans of Foreign Wars of the United States1396and its auxiliary, thank you for the opportunity to provide our1397remarks on the legislation pending before this Committee. My1398written testimony includes the VFW's positions on all the bills1399under consideration. This afternoon, I'll highlight three.1400    First, the VFW supports S. 1657, Review Every Veteran's1401Claim Act of 2025, legislation we have championed for the last1402few years. This bill would amend Title 38 to ensure that VA may1403not deny a disability claim solely because of veteran missed a1404compensation pension or CMP examination.1405    We believe this bill would move VA toward a more flexible1406and veteran-centered claims process as scheduling conflicts do1407arise and veterans should not be penalized when unavailable. We1408understand that veterans miss CMP appointments for many reasons1409such as illness, lack of transportation, work conflicts, or1410just simple misunderstandings. They should not be forced to1411restart their entire claim because of a single missed1412appointment.1413    The VFW has assisted many veterans who had to reopen claims1414for this reason alone. Starting a claim from the beginning is1415unnecessarily burdensome and can be mentally exhausting.1416Instead, we recommend that VA return the claim to the work1417queue with a missed medical examination flag so the process can1418resume exactly where it stopped.1419    We also recommend that when the evidence already in the1420file clearly establishes both the existence and severity of the1421disability, it would lead to a favorable outcome, VA should1422adjudicate the claim based on that evidence alone. Conversely,1423when the record is insufficient, a CMP examination should1424remain mandatory to ensure a fully informed decision.1425    Next, the VFW supports S. 1992, Veterans Appeals Efficiency1426Act of 2025, which would give the Board of Veterans Appeals or1427BVA, and the Court of Appeals for Veterans Claims, additional1428tools to improve the efficiency of the appeals process, reduce1429the backlog of appeals at BVA, and allow appellants to receive1430quicker decisions.1431    Specifically, it would allow BVA to aggregate similar1432claims and decide multiple appeals simultaneously. It will1433grant BVA Presidential authority, if feasible, that would1434reduce repetitive litigation and promote greater decisional1435uniformity. It would clarify evidentiary support for an1436advancement on-the-docket request, and the typical timeline for1437a decision. For a Court of Appeals for Veterans Claims, the1438ability to expand the court's ability to certify class actions,1439helping resolve systemic issues that affect many veterans1440similarly at once and would codify the court's authority to1441issue limited remands, which would allow BVA to correct a1442specific error without reopening an entire multi-issue appeal.1443Although limited remands would enhance efficiency, they're1444rarely used because no clear criteria currently exists. This1445legislation would change that.1446    Today, many veterans wait up to two years for a BVA1447decision, longer if they request a hearing. With the number of1448pending and projected appeals, BVA cannot likely make1449meaningful progress using its current processes. These tools1450will provide an opportunity to break that paradigm and1451streamline the appeals process.1452    Finally, we support the bill's enhanced reporting and data1453tracking requirements. However, we recommend two additions to1454increase accuracy. First, track the impact of natural disasters1455on docket advancement as they can significantly delay case1456movement, and track cases in which an eligible survivor1457requests substitution for deceased claimant for purpose of1458pursuing the claim to completion.1459    Lastly, the VFW supports the discussion draft entitled1460Sharing Essential Resources for Veterans Everywhere or SERVE1461Act. Its proposal would strengthen collaboration and resource1462sharing between VA and Department of Defense for DoD to expand1463healthcare access for veterans, especially those who live near1464military medical treatment facilities.1465    Allowing veterans, particularly those in rural or1466underserved areas to utilize nearby military hospitals and1467clinics, would reduce travel burdens, shorten wait times, make1468better use of federal medical capacity that might otherwise go1469unused. Increased resource sharing would also promote better1470systems integration between DoD and VA, support cross1471credentialing of staff and facilitate joint training, all of1472which would contribute to better continuity of care, both1473active-duty service members and veterans.1474    While successful implementation would require attention to1475funding, staffing, and data integration, this proposal would1476represent a significant opportunity to better leverage existing1477federal healthcare resources for veterans.1478    Chairman Moran, Ranking Member Blumenthal, thank you again1479for the opportunity to share the VFWs remarks. I look forward1480to answering your questions.14811482    [The prepared statement of Ms. Springer appears on pages1483106-117 of the Appendix.]14841485    Chairman Moran. Thank you very much. Mr. Stichman.14861487 STATEMENT OF BARTON STICHMAN, CO-FOUNDER AND SPECIAL COUNSEL,1488            NATIONAL VETERANS LEGAL SERVICES PROGRAM14891490    Mr. Stichman. I'd like to thank Chairman Moran, Ranking1491Member Blumenthal, and the Members of this Committee for the1492opportunity for NVLSP to present our views regarding the1493pending legislation before the Committee.1494    NVLSP firmly supports, as do my colleagues on this panel,1495the Veterans Appeals Efficiency Act, S. 1992, which contains1496several reforms that would meaningfully improve speed,1497accuracy, and efficiency in the adjudication of benefit claims1498at the VA and at the Veterans Court.1499    First, the Veterans Appeals Efficiency Act would restore1500the supplemental jurisdiction the Veterans Court used to have1501in cases in which a veteran denied benefits by the BVA, seek1502certification of his appeal to the Veterans Court as a class1503action. S. 1992 would overrule the recent decision of the1504Federal Circuit in Skaar v. McDonough. The rule announced in1505Skaar bars the large majority of similarly situated veterans1506with pending claims at the BVA or RO from being included in the1507class and counting toward the numerosity requirement of there1508being at least 40 putative class members.1509    S. 1992 would require the Veterans Court to use the same1510approach used by all other Article III courts who handle class1511actions, namely counting toward the numerosity requirement1512similarly situated veterans with appeals of pending before the1513BVA or on supplemental claims before the regional offices. This1514would ensure the continued viability of class actions, which1515for years have helped streamline the VA benefit system.1516    Second, section 2(e) of S. 1992 would encourage the court1517to exercise its existing authority to issue limited remands.1518Currently, when the Veterans Court encounters a defect that1519requires agency action on one issue in an appeal involving1520multiple issues, the court typically remands the entire case1521back to the BVA for correction of one error without addressing1522any of the other issues. This piecemeal approach adds years to1523the adjudication process and results in substantial delays for1524veterans.1525    Although the court possesses the ability to issue limited1526remands while retaining jurisdiction over the rest of the case,1527it rarely does so because its authority is not well-defined,1528and current precedent confines its use to exceptional1529circumstances.1530    The Veterans Appeals Efficiency Act codifies the court's1531existing authority to order limited remands and instructs the1532Veterans Court to develop guidelines governing their use,1533including authority to require the BVA to act within a1534specified timeframe so that the case may expeditiously return1535to the court for a final court decision that disposes of the1536entire appeal.1537    By directing the court to articulate standards for when and1538how limited remands may be used, this bill will enable all1539participants in the system to understand when limited remands1540are available and the proper process for requesting them. This1541reform turns an underused mechanism into a practical accessible1542means of reducing delay and expediting relief.1543    In addition, NVLSP supports section 2(d)(i) of the Veterans1544Appeals Efficiency Act, which aims to reduce the backlog of1545veterans' benefits appeals by confirming the BVA's authority to1546aggregate appeals. While more than 70 other federal agencies1547have rules that facilitate aggregation of administrative1548appeals, the BVA is an outlier and insisting it lacks power1549ever to group together appeals raising the same question of law1550or fact for efficient adjudication.1551    The bill would codify the authority of the BVA to aggregate1552claims in appropriate cases after a federally funded research1553and development center does an assessment with VSO input of the1554feasibility of BVA aggravation and Presidential decision-1555making. I'd be happy to answer any questions you may have.1556Thank you.15571558    [The prepared statement of Mr. Stichman appears on pages1559118-125 of the Appendix.]15601561    Chairman Moran. Strictly back to my practice of law or law1562school, I'm not sure which, but something sounded familiar in1563your testimony. Senator Blumenthal.1564    Senator Blumenthal. I just want to apologize. I have1565another commitment that I have to go to, but I actually think1566this testimony has been very important, and I have really no1567substantive questions. If I think of any, I will pose them in1568writing to you. But I want to thank every one of you for your1569service, and we hopefully, will move forward. Thank you.1570    And I thank the Chairman for his courtesy. I also want to1571put in the record, if I may, Mr. Chairman, an analysis from the1572Urban Institute, I believe I referred to it earlier, that1573provides the basis for the number 267,000 veterans that I1574mentioned earlier as the number who would lose their insurance1575if the subsidies are not extended.1576    Chairman Moran. There's no objection. It's to be entered.1577    Senator Blumenthal. Thank you.15781579    [The information referred to appears on pages 167-168 of1580the Appendix.]15811582    Chairman Moran. Senator King. Is it helpful if you go1583before I do?1584    Senator King. I'm fine, you go ahead.1585    Chairman Moran. Well, now that I've offered, you could1586accept.1587    [Laughter.]1588    Chairman Moran. Senator King's bill along with Senator1589Banks', S. 1657. And I consider its passage a priority. It1590seems odd to me that it's necessary, and I was wondering if any1591of you have the statistics that demonstrate how often someone1592is denied their opportunity for a claim because of missing a1593physician's appointment? Is it a significant problem, or it's a1594rarity? I'll check with my caseworkers and I'll find out.1595    Mr. Brown. Mr. Chairman, I don't think it's a data point1596that we actually track per se. But we are aware from time to1597time talking with our service officers that they're having to1598go back after the fact and attempt to get a--one of our members1599back into the system.1600    Chairman Moran. Well, certainly if the VA cannot--I mean,1601encourage the VA to fix the problem itself immediately. In the1602absence of that, or maybe even in with that occurring, I look1603forward to the passage of this piece of legislation.1604    I want to ask about the SERVE Act, really, for each of you1605or any of you who have a thought that you'd like to share. From1606your vantage points working directly with service members and1607veterans, where do you see the biggest gap in health services1608during transition from DoD to VA? And do you believe this1609legislation can be a part of the solutions to those problems1610and desire to improve the continuity of care? Mr. Brown, you1611seemed perhaps the most anxious.1612    Mr. Brown. So, I was going to say, I was just thinking,1613what would be the greatest area for me. And if you don't mind,1614I'll share like my personal experience.1615    Chairman Moran. Please do.1616    Mr. Brown. Currently, I'm fortunate that my primary care1617manager for VA is a provider that I saw while I was serving on1618active duty. And I think that one of the bigger advantages in1619terms of transition, if we were to expand access for veterans1620to be seen in the DoD system, certainly being able to see a1621provider that already knows your history so you don't have to1622repeat it would be a clear advantage.1623    Chairman Moran. You had heads nodding behind you, so you've1624hit upon a point that apparently needed to be made. And I1625assume that the availability of that opportunity is going to be1626geographic. It depends on where that provider is and where that1627veteran is.1628    Mr. Brown. That is quite true, as I just happen to live1629outside of Andrews Air Force Base, and she works at the CBOC on1630Allentown Road. So, most fortunate.1631    Chairman Moran. Anyone else? Ms. Springer?1632    Ms. Springer. And Mr. Chairman, I would go along with Mr.1633Brown's comments, and I'll use a personal story as well. I1634don't use VA care, I'm a TRICARE beneficiary, but very similar1635in some cases. And I think transitioning from active duty to a1636veteran status, there's a lack of familiarity in the process.1637    I use a military clinic on board of Fort Myer, which is1638very close to my house, and that is just like being on active1639duty. I go there. I have a primary care manager, they get me in1640for appointments. If they can't do it, they send me to another1641clinic in the military treatment facility realm, or they send1642me out in town.1643    But it's very familiar, and I think that would help1644transitioning service members to keep up with their medical,1645get signed up and go to a place that's familiar, which is a1646military treatment facility.1647    Chairman Moran. You know, part of my interest in this1648legislation revolves around Fort Riley, and Irwin Army1649Hospital, and then the VA in Topeka, in particular, but VA1650hospitals in Kansas. And as you described that, I was thinking,1651well, that'd be a rare thing in Kansas because we live so far1652from Fort Riley and the Irwin Army Hospital, for example.1653    But that's for a lot of veterans, for a lot of service1654members who retire near the last place they served or the place1655they served and want to retire to. There is a military hospital1656that would be of great benefit that you just described to me.1657So, I appreciate both of those stories. Mr. Stichman, anything1658you want to add?1659    Mr. Stichman. No, I have nothing further to add to that.1660    Chairman Moran. Thank you. And one more question, and1661that's on the Fisher House, just for my help. I think this is a1662piece of legislation that we will be able to pass and it will1663be coming into law, but I'll be visiting or speaking about it1664with my colleagues, either in person or on the floor of the1665Senate.1666    And based upon your members' experiences, how significant1667is the unmet demand for lodging today? And do you believe1668expanding eligibility will improve access to care? Why or why1669not? What role does housing play in access to care, and is it a1670challenge in many places? Ms. Springer, you seem the most1671interested.1672    Ms. Springer. I'll take a stab at it, Mr. Chairman. This1673hasn't been brought to my attention as a huge problem. But1674anytime you go get care, you have to think about the logistics,1675and you have to think about where am I going to house my family1676members? How much is it going to cost, and how is that going to1677affect my willingness to go?1678    And if there is an unused space in these Fisher Houses,1679which are wonderful institutions, if there's unused space, I1680think that's a very positive thing to do. Rather than have it1681sit empty, have people fill it up, active-duty members and1682families on a space available basis, I think is a very good1683thing. And we support this proposal.1684    Chairman Moran. Thank you. And I, again, would use the1685opportunity to thank Fisher House and what great work they do1686across the Nation. Senator King.1687    Senator King. I'd like to join you in the thanks to the1688Fisher Foundation for the work they do. It's amazing. On the1689issue of transition, we had a bill before our hearing, I think1690it'll be at our next markup, that would allow active-duty1691service members to pre-enroll in the VA healthcare before they1692transition out so there's no gap. Mr. Brown, do you have any1693views on that idea?1694    Mr. Brown. I believe we would support that legislation.1695    Senator King. Good. That's what I was hoping you would say.1696Let the record show Mr. Brown, you heard me in my exchange with1697the doctor about falls and we have a bill in to deal with the--1698to try to focus the attention of the VA on falls. Give me your1699thoughts on that, please.1700    Mr. Brown. So, PVA supports your legislation. I listened, I1701think you've mentioned it twice now. One out of four veterans1702over the age of 60--was it, or was 65?1703    Senator King. 65.1704    Mr. Brown. So, I don't meet the second criteria yet, but I1705did meet the first criteria. And I was thinking that, well, you1706got to count me twice, because I've had two major falls that1707have resulted in a significant health issue. One that not only1708incapacitated me for several months, but it also required my1709wife to take off time off work to like get me to my1710appointments, and back and forth extensive physical therapy and1711the like.1712    So, I personally understand the value of fall prevention.1713And we know that every major area, service area within VHA,1714certainly has their individual fall prevention programs. It's1715extremely important for veterans with SCI, MS and ALS. But I do1716agree with you that I think that VA would benefit from having1717like that one single point of contact.1718    And from the sounds of things from Mr. O'Toole's testimony,1719it sounds like they're already headed in that direction. And1720I'm sure you'll look into that with them and verify that. But1721otherwise, we think that your legislation is appropriate.1722    Senator King. Thank you. Any other comments on that? Ms.1723Springer?1724    Ms. Springer. Yes. Senator, we would actually propose that1725the existing structures the VA already has be strengthened.1726There are already offices that deal with falls prevention1727instead of--we're not really in favor of creating a separate1728office for that, but instead, take those offices that are1729already doing this and strengthen them. Codify what they're1730doing, and ensure that some kind of discussion about falls is1731at every medical appointment, not just an annual physical, but1732every time that veteran comes in for care. Somebody's asking1733about falls because I agree it's a very significant problem and1734it can lead to other more serious health problems.1735    Senator King. We'll look forward to working with Dr.1736O'Toole and the agency to focus how to strengthen, as you say,1737the current structure, and give it a focus that will increase1738the effectiveness.1739    Second issue I wanted to talk about was the bill that I1740mentioned, with Senator Sheehy, on safe gun storage. Ms.1741Springer, do you have any thoughts about that issue?1742    Ms. Springer. Yes, we support that bill. We are very aware1743of the problem with suicides in our veteran population. And we1744do think that that would help decrease those incidents.1745Anything we can do to separate a person who may be having an1746impulsive thought and lethal means is something that we would1747support. And I think that you can easily roll this out and get1748it up and running. We do support this bill.1749    Senator King. Mr. Brown, did you have a comment?1750    Mr. Brown. PVA shares the same view.1751    Senator King. Thank you. Thank you, Mr. Chairman. Thank you1752for this hearing.1753    Chairman Moran. Thank you, Senator King. Let me ask this1754panel. You heard the testimony of the VA, Ms. Devlin, and Dr.1755O'Toole. Anything you heard that you want me to ask them in a1756written question? Is there something that they said or didn't1757say that you'd like me to further explore? Apparently, Dr.1758O'Toole and Ms. Devlin passed the test.1759    Okay. I think we are going to conclude the hearing. And I1760want to, again, thank the second panel for their testimony as1761well as the first. And I thank our members of the audience and1762the Members of our Committee for being here today.1763    Senators who would like to submit written questions for the1764record to today's witnesses or additional statements have a1765week to do so, and ask our witnesses to respond any questions1766for the record they receive following today's hearing in a1767timely manner.1768    Chairman Moran. And we've had conversations this afternoon1769about how we want to have a markup on these bills and move1770forward. And I've asked the staff to try to schedule that as1771expeditiously as we can accomplish. So, we intend to move1772forward.1773    Senator King. Is that expeditiously Senate time or real-1774world time?1775    Chairman Moran. Well, I can tell you the Senate time has1776something to do with whether or not we will be expeditious.1777    Senator King. Yes, sir.1778    Chairman Moran. They're related.1779    Senator King. I do have one piece of advice for you. If St.1780Peter ever comes to you and says, ``You have 10 minutes to1781live,'' your response would be, ``Could it be during a 10-1782minute Senate vote?''1783    [Laughter.]1784    Senator King. Because you'll have about an hour.1785    Chairman Moran. Well said.1786    [Laughter.]1787    Chairman Moran. With that, our hearing is adjourned.1788    [Whereupon, at 5:30 p.m., the hearing was adjourned.]17891790                            A P P E N D I X17911792                             Hearing Agenda17931794    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]17951796                          Prepared Statements17971798    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]17991800                       Submissions for the Record18011802    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]18031804                       Statements for the Record18051806    [GRAPHICS NOT AVAILABLE IN TIFF FORMAT]18071808                                  [all]