Legislative Hearing on: H.R. 785, The Representing Our Seniors at VA Act of 2025, H.R. 2068, The Veterans Patient Advocacy Act, H.R. 2605, The Service Dogs Assisting Veterans (SAVES) Act, H.R. 3400, The Territorial Response and Access to Veterans’ Essential Lifecare (TRAVEL) Act of 2025, Discussion Draft: To amend title 38, United States Code, to prohibit smoking on the premises of any facility of the Veterans Health Administration, and for other purposes, Discussion Draft: The VA Data Transparency and Trust Act, Discussion Draft: To direct the Secretary of Veterans Affairs to conduct a study to determine whether RNA sequencing can be used to effectively diagnose PTSD in veterans, Discussion Draft: The Health Professionals Scholarship Program Improvement Act of 2025, Discussion Draft: The Fisher House Availability Act of 2025, H.R. 1404, The CHAMPVA Children’s Care Protection Act of 2025, H.R. 2148, The Veteran Caregiver Reeducation, Reemployment, and Retirement Act, Discussion Draft: The VA Mental Health Outreach and Engagement Act

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                          LEGISLATIVE HEARING5=======================================================================67                                HEARING89                               BEFORE THE1011                         SUBCOMMITTEE ON HEALTH1213                                 OF THE1415                     COMMITTEE ON VETERANS' AFFAIRS1617                     U.S. HOUSE OF REPRESENTATIVES1819                    ONE HUNDRED NINETEENTH CONGRESS2021                             FIRST SESSION2223                               __________2425                        THURSDAY, JUNE 12, 20252627                               __________2829                           Serial No. 119-263031                               __________3233       Printed for the use of the Committee on Veterans' Affairs3435[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]3637                    Available via http://govinfo.gov3839                                __________4041                   U.S. GOVERNMENT PUBLISHING OFFICE4261-124                     WASHINGTON : 20254344-----------------------------------------------------------------------------------4546                     COMMITTEE ON VETERANS' AFFAIRS4748                     MIKE BOST, Illinois, Chairman4950AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking51    American Samoa, Vice-Chairwoman      Member52JACK BERGMAN, Michigan               JULIA BROWNLEY, California53NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire54MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,55GREGORY F. MURPHY, North Carolina        Florida56DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky57MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois58JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois59KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York60JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon61ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey62KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota63    Mariana Islands64TOM BARRETT, Michigan6566                       Jon Clark, Staff Director67                  Matt Reel, Democratic Staff Director6869                         SUBCOMMITTEE ON HEALTH7071               MARIANNETTE MILLER-MEEKS, Iowa, Chairwoman7273JACK BERGMAN, Michigan               JULIA BROWNLEY, California,74GREGORY F. MURPHY, North Carolina        Ranking Member75DERRICK VAN ORDEN, Wisconsin         SHEILA CHERFILUS-MCCORMICK,76JEN KIGGANS, Virginia                    Florida77ABE HAMADEH, Arizona                 MAXINE DEXTER, Oregon78KIMBERLYN KING-HINDS, Northern       HERB CONAWAY, New Jersey79    Mariana Islands                  KELLY MORRISON, Minnesota8081Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public82hearing records of the Committee on Veterans' Affairs are also83published in electronic form. The printed hearing record remains the84official version. Because electronic submissions are used to prepare85both printed and electronic versions of the hearing record, the process86of converting between various electronic formats may introduce87unintentional errors or omissions. Such occurrences are inherent in the88current publication process and should diminish as the process is89further refined.9091                         C  O  N  T  E  N  T  S9293                              ----------9495                        THURSDAY, JUNE 12, 20259697                                                                   Page9899                           OPENING STATEMENTS100101The Honorable Mariannette Miller-Meeks, Chairwoman...............     1102The Honorable Julia Brownley, Ranking Member.....................     3103104                         SPEAKING FROM THE DAIS105106The Honorable Greg Murphy, U.S. House of Representatives, (NC-3).     4107The Honorable Nikki Budzinski, U.S. House of Representatives,108  (IL-13)........................................................     5109The Honorable Kimberlyn King-Hinds, U.S. House of110  Representatives, Northern Mariana Island's at-large111  Congressional District.........................................     6112The Honorable Morgan Luttrell, U.S. House of Representatives,113  (TX-8).........................................................     6114The Honorable John McGuire, U.S. House of Representatives, (VA-5)     7115116                               WITNESSES117                                Panel I118119Dr. Antoinette V. Shappell, M.D., Deputy Assistant Under120  Secretary for Health for Patient Care Services, Veterans Health121  Administration, U.S. Department of Veterans Affairs............     8122123        Accompanied by:124125    Dr. Ilse Wiechers, Deputy Executive Director, Office of126        Mental Health, Veterans Health Administration, U.S.127        Department of Veterans Affairs128129                                Panel II130131Mr. David Coker, President, Fisher House Foundation..............    17132133Mr. Randy Johnson, Constituent, Rep. King-Hinds of the134  Commonwealth of the Northern Mariana Islands...................    18135136Mr. Cole Lyle, Director, Veterans Affairs and Rehabilitation137  Division, The American Legion..................................    20138139Mr. John Schmitt, Chief Executive Officer, iXpressGenes, Inc.....    22140141Ms. Caira Benson, Caregiver Fellow, Elizabeth Dole Foundation....    23142143                                APPENDIX144                    Prepared Statements Of Witnesses145146Dr. Antoinette V. Shappell, M.D. Prepared Statement..............    33147Mr. David Coker Prepared Statement...............................    50148Mr. Randy Johnson Prepared Statement.............................    51149Mr. Cole Lyle Prepared Statement.................................    53150Mr. John Schmitt Prepared Statement..............................    71151Ms. Caira Benson Prepared Statement..............................    78152153                          APPENDIX--continued154                       Statements For The Record155156The Honorable Joseph Morelle, U.S. House of Representatives, (NY-157  25) Prepared Statement.........................................    83158Paralyzed Veterans of America Prepared Statement.................    83159Gold Star Spouses of America, Inc. Prepared Statement............    87160National Association of Veterans' Research and Education161  Foundations Prepared Statement.................................    88162National Association of State Veterans Homes Prepared Statement..    88163Quality of Life Foundation Prepared Statement....................    90164United Services Automobile Association Prepared Statement........    92165The Veterans of Foreign Wars of the United States Prepared166  Statement......................................................    93167American Academy of Physician Associates Prepared Statement......    95168Concerned Veterans of America Prepared Statement.................    97169Military Officers Association of America Prepared Statement......   101170Student Veterans of America Prepared Statement...................   105171K9s For Warriors Prepared Statement..............................   108172173                          LEGISLATIVE HEARING174175                              ----------176177                        THURSDAY, JUNE 12, 2025178179                    Subcommittee on Health,180                    Committee on Veterans' Affairs,181                             U.S. House of Representatives,182                                                    Washington, DC.183    The subcommittee met, pursuant to notice, at 2:15 p.m., in184room 360, Cannon House Office Building, Hon. Mariannette185Miller-Meek [chairwoman of the subcommittee] presiding.186    Present: Representatives Miller-Meek, Bergman, Murphy, Van187Orden, Kiggans, Hamadah, King-Hinds, Brownley, Cherfilus-188McCormick, Dexter, Conaway, and Morrison.189190   OPENING STATEMENT OF MARIANNETTE MILLER-MEEKS, CHAIRWOMAN191192    Ms. Miller-Meeks. This legislative hearing of the193Subcommittee on Health will now come to order. Without194objection, the Chair may declare a recess at any time. Given195that votes have been moved to 3 o'clock, we will, in all196likelihood, declare a recess. I would like to welcome all197members and witnesses to today's hearing. We have 12 important198legislative proposals to consider here today. It is important199to note that not all of the proposals will move forward in the200legislative process, but many will. Congress is responsible for201ensuring U.S. Department of Veterans Affairs (VA) stewards its202resources effectively. Many of my colleague's bills would203optimize the VA's funding, talent, and capital. Other bills204reinforce VA's mission to care for veterans in mental and205physical health.206    I am grateful to Representative Hamadeh for introducing the207Health Professional Scholarship Program (HPSP) Improvement Act.208One of the greatest resource drains at the VA is the broken209student-to-employee pipeline. The VA loses untold investments210in student clinicians by offering scholarships in exchange for211employment commitments only for the VA not to keep its end of212the deal. Students are consistently unemployed for months213before the VA gives them a position. These students have been214driven to the point where they cut their losses with the VA and215seek jobs elsewhere at great financial cost to them and an216opportunity cost to the VA. Representative Hamadeh's bill would217help end this unacceptable dilemma.218    The Representing Our Seniors at VA Act by Representative219Kiggins would improve the Geriatric and Gerontology Advisory220Committee. Under current law, there is no requirement for input221from State veterans homes, even though these homes are key222partners in serving aging veterans. Representative Kiggins's223bill would fix this oversight by making sure these homes have a224seat at the committee table.225    The Veterans Patient Advocacy Act by Representative226Moolenaar would increase the rural footprint for VA patient227advocates. I know all too well how veterans in rural areas228struggle to obtain care from the VA. I firmly support the229bill's goal to have patient advocates accessible to rural230veterans. I think we can all agree that we can always do more231to ensure that VA's resources must keep evolving to reach232veterans where they live.233    The Territorial Response and Access to Veterans Essential234Life Care (TRAVEL) Act by Representative King-Hinds would also235help our veterans living in remote areas. This bill would236require a 1-year billet for VA physicians at U.S. territories237like the Northern Mariana Islands. Health care is not easy to238come by in these remote parts of the world. This bill would239place VA practitioners in the right places at the right times.240    Representative McGuire's bill, the VA Data Transparency and241Trust Act, tackles the unending reporting requirements at the242VA and replaces them with a comprehensive and unified report on243outcomes and metrics to improve VA programs. The laws today244incentivize a system where consultants can create a cottage245industry to broker reports, which diverts precious time and246money away from VA's mission and only makes oversight more247difficult. Congress has gained little from the manner in which248it has received information from the numerous current VA249reporting requirements. Representative McGuire's bill would250pull in the reins and improve outcomes for veterans.251    My bill, the Fisher House Availability Act, would make252lodging in Fisher Houses more accessible for service members253and their families. Fisher House Foundation is a nonprofit254dedicated to providing lodging for veterans and service members255in need. The VA owns most Fisher Houses. We know that service256members and their families can stay at Fisher Houses whenever257they get care from the VA. However, a recent agency258interpretation prohibits them from using VA-owned Fisher House259when receiving non-VA care, even though we all know there is260more than enough room to house them. This bill does not261displace veterans or veterans' families. It is important to262know it would simply ensure that service members have access to263available lodging. I am thankful to the Fisher House Foundation264for supporting this bill, and I am proud to sponsor it.265    Representative Luttrell's bill, the Service Dogs Assisting266Veterans (SAVES) Act, picks up where the popular Puppies267Assisting Wounded Servicemembers for Veterans Therapy (PAWS)268Act left off. This bill covers the cost for service dogs that269provide veterans with mental and physical assistance. The270therapeutic benefits of service dogs are well established. I271thank Representative Luttrell for his efforts to improve the272availability of service dogs for veterans in need.273    Representative Dunn's bill would align nonsmoking policies274at Veterans Health Administration (VHA) with most medical275facilities in America. Currently, there is no protection in law276against smoking at VHA facilities. As a physician, I know how277important it is to make sure that patients breathe clean air278when they receive care at the VHA facility. This bill would279ensure that.280    Finally, a bill introduced by Dr. Murphy would create a281pilot program to build on existing research into Post-Traumatic282Stress Disorder (PTSD)-related inflammation and cellular283stress. The continued prevalence of PTSD in our veteran284population requires us to continue finding new and innovative285ways of screening and diagnosing PTSD. The research from this286pilot program could help equip VA with the tools for preventive287rather than reactive care for PTSD.288    Again, these bills optimize VA and reinforce its mission to289care for veterans' mental and physical health in exchange for290their service in uniform. I now yield to Ranking Member291Brownley for any opening remarks you may have.292293      OPENING STATEMENT OF JULIA BROWNLEY, RANKING MEMBER294295    Ms. Brownley. Thank you, Madam Chair, and thank you to our296witnesses for making the time to be here. I understand we will297have votes, as the Chairwoman said, that could interrupt us298this afternoon. I will keep my remarks brief to allow us to get299to everyone's testimony. While Committee Democrats appreciate300and are not opposed to the intent of many of the Republican301bills on today's agenda, we would like to see some changes and302improvements on some of these bills. I hope we will be able to303work together collaboratively with our majority colleagues to304make these improvements through the committee markup process305and put forth the best possible legislation to support our306veterans.307    I am pleased we are considering three Democratic bills308today, including my bill, the Civilian Health and Medical309Program of the Department of Veterans Affairs (CHAMPVA)310Children's Care Protection Act. I first introduced this bill in3112019, and it has long been a priority for numerous veteran312service organizations and organizations serving caregivers and313survivors. CHAMPVA provides health care coverage for spouses314and dependent children of veterans with permanent and total315service-connected disabilities and for the surviving spouses316and children of veterans who have died from service-connected317disabilities.318    When the Affordable Care Act (ACA) was signed into law in3192010, it required private-sector health plans to allow children320to stay on their parent's insurance until they are 26 years321old. However, this ACA mandate was not extended to military or322veteran health coverage. This inequity was addressed for323TRICARE in 2011, but to date, we have not extended parity to324the CHAMPVA program. It is long past time to right this wrong.325I am glad we will have a chance to hear directly from a326caregiver, Ms. Caira Benson, about what this legislation would327mean for her and her family. I look forward to working with the328VA to learn how we can address the department's concerns and329ensure that caregivers and their families have the support that330they deserve.331    To that end, I also appreciate that we are considering332Representative Morelle's bill, H.R. 2148, The Veteran Caregiver333Reeducation, Reemployment, and Retirement Act. This legislation334will provide VA and other agencies additional authorities to335support veteran caregivers as they transition out of VA's336program of comprehensive assistance for family caregivers. The337sacrifices caregivers make, including for their own earning338potential and financial security, are immense, and we must339support them by ensuring they have the tools and the resources340they need. I know Ms. Benson will also provide powerful341testimony in support of Representative Morelle's bill.342    Finally, I know Congresswoman Budzinski will be here to343discuss her own legislation, the VA Mental Health Outreach and344Engagement Act, so I will briefly just say that I also support345her bill. This legislation will ensure that VA conducts regular346outreach and offers consultations to assess the needs of347veterans with service-connected disability ratings for mental348health conditions. We know that veterans who are connected with349VA care have better health outcomes and lower risk of suicide350than veterans who are not connected. I am glad Congresswoman351Budzinski's bill will allow more eligible veterans to engage352with VA care.353    I look forward to hearing from all of our witnesses today.354With that, Madam Chair, I will yield back.355    Ms. Miller-Meeks. Thank you, Ranking Member Brownley. We356have a full agenda today, so I will be holding everyone to 3357minutes per bill to ensure we can move in a timely manner. In358accordance with Committee Rule 5(e), I ask unanimous consent359that Representative Luttrell from Texas be permitted to360participate in today's subcommittee hearing. Without objection,361so ordered.362    I now recognize Representative Murphy for 3 minutes to363speak on his bill.364365                     STATEMENT GREG MURPHY366367    Mr. Murphy. Thank you, Chairwoman Miller-Meeks and Ranking368Member Brownley, for holding this meeting today. My bill, H.R.3693886, the Veterans PTSD Screening Act, is being discussed at370today's hearing. You know, we talk a lot about mental health371with our veterans, especially with PTSD and Traumatic Brain372Injury (TBI), and anything that we can do to move the needle. I373have been obviously a big fan of hyperbaric oxygen therapy, but374any other thing that we can do to move the needle is critical375in how we are trying to help the veterans who have kept us376free.377    I am going to talk a little bit about something called378Ribonucleic Acid (RNA), RNA sequencing. Deoxyribonucleic Acid379(DNA) is in our body, and DNA is a constant thing in our body.380RNA rather changes with different experiences, with different381memories, et cetera, in our brain. What we have found and has382been well documented is the ability to measure RNA sequencing,383either microRNA or something called long digital RNA, in384different assays. These have become a predicting point to385determine levels of stress within the body. Where compared to386controls, those who have experienced PTSD have a markedly387different pattern of RNA. What this bill is going to do is388going to direct the VA to study this RNA sequencing in five389separate veterans' VINs. I think it is going to be critical as390we put our armamentarium, as our toolbox gets bigger and bigger391as technology advances, that this will be a great tool.392    Now, caveats. We do not want to ever deny care based upon393what is found with RNA sequencing. We also do not want to make394this as a single modality. We have to have a holistic approach395to PTSD. Being able to monitor just this one single variable396really helps us, but it is not going to be the sole object for397doing this.398    The science is growing. We are actually using this in some399VAs right now, as been modeled in some VAs right now and is400being modeled in other places, trauma centers, et cetera. I401think we are seeing as technology increases, especially with402AI, that we are going to be able to use all these new different403tools to help our veterans, those who have experienced PTSD,404and hopefully come up with a cure 1 day. If not, be able to405monitor, to diagnose, and to monitor treatment as we treat our406veterans.407    I will ask for appreciation and I would love us to bring408the vote to committee. Thank you, Madam Chairwoman. I yield409back.410    Ms. Miller-Meeks. Thank you, Representative Murphy. The411Chair now recognizes Representative Budzinski for 3 minutes to412speak on her bill.413414                  STATEMENT OF NIKKI BUDZINSKI415416    Ms. Budzinski. Thank you, Chairwoman Miller-Meeks, and417thank you to Ranking Member Brownley. I appreciate this for418giving me the opportunity to speak on my bill, H.R. 3863, the419VA Mental Health Outreach and Engagement Act, which would420expand VA's outreach to veterans about mental health services.421I also want to thank my Republican colleague, Mr. Edwards, for422co-leading this bipartisan bill.423    As a member of the Veterans Affairs Committee, I have heard424from veterans unaware of where to turn for support and care for425the invisible wounds of war. We must support our veterans and426provide them with the knowledge and resources to prosper427following their service to our Nation. My bill would ensure we428are proactively reaching out to veterans with mental health-429related service-connected disabilities and connecting them with430the care that they need. Navigating the VA should never be a431burden, and this bipartisan legislation would help to make it432easier for veterans to get the mental health care that they433have earned.434    I am also here today to speak in support of H.R. 3767, the435Health Professional Scholarship Program Improvement Act. I want436to thank my colleague on the committee, Congressman Hamadeh,437for his leadership and bipartisan collaboration on this bill.438VA's Health Professional Scholarship Program supports the439students pursuing healthcare careers while connecting VA with440talented staff. When program participants graduate, they are441often met with delays in receiving a contract. Amid Veteran442Health Administration staffing shortages, we need solutions to443address this inefficiency. This legislation would streamline444the path for HPSP participants to start working full-time,445making it easier for veterans to get the care that they need.446    For both of these bipartisan bills, I am committed to447working with my colleagues on both sides of the aisle, the VA448and Veterans Service Organizations (VSO), to ensure we are449continuing to improve healthcare for our Nation's veterans.450Thank you very much for the time, and I yield back.451    Ms. Miller-Meeks. Thank you, Representative Budzinski. The452Chair now recognizes Representative King-Hinds for 3 minutes to453address her bill.454455               STATEMENT OF KIMBERLYN KING-HINDS456457    Ms. King-Hinds. Thank you, Chairwoman Miller-Meeks and458Ranking Member Brownley, for the opportunity to speak on my459bill, H.R. 3400, The Territorial Response and Access to460Veterans Essential Life Care Act, or the TRAVEL Act of 2025 for461short, which aims to provide much-needed medical care to the462United States territories.463    My home, the Northern Mariana Islands, has one contracted464part-time doctors who sees and cares for hundreds of veterans465who are spread across three islands. Which means if a veteran466needs specialized medical care, he or she must travel to Guam,467Hawaii, or the continental United States for health care. This468is not only acceptable, it is offensive to the people who have469served our country. Veterans should not have to pay upfront for470air travel, book appointments across the globe, or forego471medical care entirely because there are no nearby accessible472doctors.473    Our Nation's heroes have worked hard and sacrificed so much474to provide for us. We owe medical care to our veterans. We are475indebted for their service. The very least we can do is to476ensure they can go to a cardiologist or a neurologist when they477need it. It is my hope that the TRAVEL Act will begin to478address the medical desert that veterans face every day in the479Northern Mariana Islands and all across the territories.480    This bill, once passed, will create a program similar to481Doctors Without Borders. Veterans' Affairs, who supports this482bill, will send doctors to the territories for periods of up to4831 year so they can practice specialized medical care on Island.484It will not bring the status of medical care for veterans in my485district up to par with care available in the continental486United States, but every little bit, any sort of improvement487will help, and this bill does that.488    I ask and urge all of my colleagues in the House of489Representatives to stand behind me as I advocate for our heroes490across our territories. Thank you, Madam Chair. I yield my time491back.492    Ms. Miller-Meeks. Thank you very much, Representative King-493Hinds. The Chair now recognizes Representative Luttrell for 3494minutes to speak on his bill.495496                  STATEMENT OF MORGAN LUTTRELL497498    Mr. Luttrell. Thank you, Madam Chairwoman and Ranking499Member Brownley, for inviting me to speak on the Service Dogs500Assisting Veterans Act. This legislation is an important step501forward toward improving access to service dogs for our502veterans. This pilot program gives the Secretary the authority503to award competitive grants to nonprofits that provide service504dogs to assist veterans who need them most.505    We are talking about men and women who have borne the506weight of war, many of them returning from a theater of combat507with invisible wounds. Nearly one in five veterans from those508conflicts live with post-traumatic stress, post-traumatic509stress disorder, or other cognitive issues. Over 450,000510veterans have suffered at least one traumatic brain injury over511the past two decades. These are not just numbers. These are512warriors now battling depression, anxiety, addiction,513joblessness, and homelessness. Right now, we are losing an514estimated 17 to 22 veterans a day to suicide. This is515absolutely a national crisis.516    Service dogs are more than companions. They are a life517changing--they are life changing. They assist veterans. They518assist veterans in regaining a sense of normalcy and control.519They support those living with post-traumatic stress and520traumatic brain injury and also assist vets dealing with521mobility issues, vision loss, and hearing impairments. These522dogs help our veterans live independently and stay active and523re-engage with their families and their communities. This524program is about giving back to those who never hesitated to525serve. It is a step toward healing and toward honoring the526promise we made to our veterans.527    Cost is one of the biggest hurdles veterans must jump over528when it comes to service dogs. I am pleased that this529legislation would enable veterans to gain access to highly530trained service dogs at no cost. Ensuring our veterans have531access to the biggest resources is a team sport. The SAVES Act532team is comprised of dedicated members from across the533political spectrum working to make this bill a reality. We also534count numerous veterans organizations who are ready to execute535and provide our veterans with highly trained service dogs who536will make their life better.537    I would like to thank this committee and Ranking Member538McGarvey for their assistance. Thank you, and I yield back.539    Ms. Miller-Meeks. Thank you, Representative Luttrell. The540Chair asked--in accordance with Committee Rule 5(e), I asked541unanimous consent that Representative McGuire from Virginia be542permitted to participate in today's committee subcommittee543hearing. Without objection, so ordered. The Chair now544recognizes Representative McGuire for 3 minutes to speak on his545bill.546547                   STATEMENT OF JOHN MCGUIRE548549    Mr. McGuire. I need a little teammate teamwork for my SEAL550brother. Thank you, Madam Chair. We would not have a country551without our men and women who risk their life or give their552life. For all of our men and women, our veterans, thank you.553Ranking Member Brownley, thank you as well. For the opportunity554to speak on my bill, H.R. 3643, the Virginia Data Transparency555and Trust Act, which I was proud to introduce with my good556friend, the chairman of the full committee, Chairman Mike Bost557of Illinois. Information and access to reliable and accurate558data are necessary to all industries and government agencies.559Nowhere is this need more apparent or more important than the560Department of Veterans Affairs.561    Over the past 10 years, the VA's budget has increased by562nearly 220 percent while the daily suicide rate has remained563flat, with 18 veterans committing suicide each day, with some564experts believing that number might be higher. We also cannot565forget that last November, the Department of Veterans Affairs566made egregious mistakes and its accountant and budgeting567practices, and they came to Congress last summer asking for568additional funds or else veterans would lose their benefits.569This resulted in a $3 billion stopgap spending bill that was570rushed through Congress to ensure veteran benefits could571continue, only for us to learn months later that there was no572shortfall at all. Clearly, Congress needs to have better573oversight of how the VA spends taxpayer funds and where they574spend it.575    Currently, the department provides Congress with a wide576range of reports but falls short of providing timely and577accurate reports conducted by other agencies, such as the578Department of Defense (DOD), with regard to TRICARE and the579Center for Medicare and Medicaid Services. My bill would580require that the VA provide an annual comprehensive report that581would provide Congress and congressional support agencies with582the necessary information to provide proper and clear oversight583while allowing for greater visibility of veterans needs and the584usage of certain programs. Without comprehensive and useful585data, Congress cannot make informed decisions about veterans'586healthcare, disability compensation or program funding. This587bill modernizes the way the VA handles data, bringing it in588line with other major Federal agencies' best practices.589    I would like to thank Chairwoman Miller-Meeks for allowing590me the time to speak and be impart on this important591legislation today. I will yield back the balance of my time.592    Ms. Miller-Meeks. Thank you, Representative McGuire. Seeing593no other members here to speak on their bills, as is our594practice, we will forego a round of questioning for the595members. For those off committee members who are here, you may596remain to ask questions of our witnesses if you have time.597    I now invite our first panel to the table. Thank you.598Joining us today is Dr. Antoinette Shappell with support from599Dr. Ilse Wiechers. Dr. Shappell is Deputy Assistant600Undersecretary for Health and Patient Care Services at VHA. Dr.601Wiechers is Deputy Executive Director of the Office of Mental602Health and Suicide Prevention at VHA.603    Dr. Shappell, you are now recognized for 5 minutes to604prevent the department's testimony.605606                STATEMENT OF ANTOINETTE SHAPPELL607608    Dr. Shappell. Thank you. Chairwoman Miller-Meeks, Ranking609Member Brownley, and members of the subcommittee thank you for610inviting us to discuss several bills affecting Veterans Affairs611programs and services. My name is Dr. Antoinette Shappell, and612I currently serve as the Deputy Assistant Undersecretary for613Health for Patient Care Services. I am joined today by Dr. Ilsa614Wiechers, Deputy Executive Director for the Office of Mental615Health.616    While VA's detailed views on each of the bills are included617in my written statement, I will briefly highlight some of the618bills. First, H.R. 785, the Representing Our Seniors at VA Act.619VA supports the intent and has already appointed a member of620the National Association for State Veteran Homes to the621Gerontology Advisory Committee in 2024. We have some concerns622with the legislation as written.623    Next is H.R. 1404, the CHAMPVA Children's Care Protection624Act of 2025, which would extend CHAMPVA benefits for children625until age 26. CHAMPVA is a medical care benefit for dependents626of certain veterans similar to DoD's TRICARE. However, VA does627not support this bill because we believe this coverage up to628age 23 is sufficient for our beneficiary population. VA is629concerned that the bill would require resources that could630otherwise be used to support patient care.631    VA agrees with the intent of H.R. 2068, the Veterans632Patient Advocacy Act. The bill aims to ensure rural veterans633can access patient advocates. VA has expanded advocacy options634for veterans, such as local advocates, online platforms, and635the VA Hotline to meet veterans' needs. VA has concerns with636some of the bill's provisions.637    The Veteran Caregiver Reeducation, Reemployment, and638Retirement Act, H.R. 2148, proposes several changes. It extends639CHAMPVA benefits for 180 days for primary family caregivers640after their designation ends, offering a necessary transition641time for seeking alternative health care coverage. The bill642also suggests employment assistance and compensation, including643training for caregivers. VA supports Section II of the bill,644subject to appropriations. We generally support Section III of645the bill, subject to appropriations. However, we do have some646concerns with the certain provisions and would appreciate the647opportunity to discuss these concerns with the committee.648    The Service Dogs Assisting Veterans ACT, or the SAVES Act,649H.R. 2605, requires the VA to establish a pilot program to650provide service dogs to eligible veterans. VA supports this but651recommends clarifying the bill's language for effective use of652funds. We also propose aligning terminology with existing VA653definitions. We do have concerns about including traumatic654brain injury and post-traumatic stress disorder in the655criteria, given insufficient evidence of service dogs'656effectiveness for PTSD.657    Additionally, H.R. 3400, the TRAVEL Act, proposes assigning658traveling VA physicians to territories and possessions in the659U.S. VA supports this with amendments to clarify the bonus660eligibility and coordination of care, ensuring physicians661provide care where it is needed. We agree with the intent to662expedite the employment process for healthcare professions.663However, we do not support the bill seeking to expedite VA664employment for health professional scholarship program665participants within 90 days.666    VA supports the VA Data Transparency and Trust Act, which667requires VA to submit detailed reports and create a data-668sharing system for researchers. However, we recommend669amendments to focus on desired topic areas to avoid complex and670resource intensive implementation.671    The Fisher House Availability Act of 2025 aims to extend672lodging benefits at Fisher Houses. VA supports this, provided673amendments to clarify eligibility for service members and674dependents, ensuring the bill's language aligns with current675practices.676    We strongly support the bill banning smoking in all VHA677facilities.678    VA supports the intent of the draft bill, directing VA to679conduct a study on RNA sequencing to diagnose PTSD. We do have680concerns with several of the bill's provisions and would681appreciate the opportunity to discuss our concerns with the682committee.683    VA supports the VA Mental Health Outreach and Engagement684Act. Support is subject to amendments and the availability of685appropriations. We would appreciate the opportunity to discuss686amendments with the committee and provide technical assistance.687    This concludes my statement. We are happy to answer any688questions you or other members of the subcommittee may have.689Thank you.690691    [The Prepared Statement Of Antoinette Shappell Appears In692The Appendix]693694    Ms. Miller-Meeks. Thank you for your testimony, Dr.695Shappell. Your full written statement will be entered into the696record.697    As is my typical practice, I will reserve my time until all698of the members have had a chance to ask their questions,699especially with pending votes coming. I now recognize Ranking700Member Brownley for 5 minutes for any questions she may have.701    Ms. Brownley. Thank you, Madam Chair. Dr. Shappell, thank702you for being here. In your testimony, your written testimony,703anyway, you say that the--that VA opposes the CHAMPVA because704it is not an insurance plan. Is that correct?705    Dr. Shappell. Yes.706    Ms. Brownley. If you could answer just a couple of707questions for me, just yes--yes or no. The first one, does708CHAMPVA have cost-sharing requirements like deductibles and co-709pays?710    Dr. Shappell. I would need to that for the record.711    Ms. Brownley. Well, I can say that it does for the record.712Are there any limitations to the services and supplies covered713by CHAMPVA?714    Dr. Shappell. I would also take that one for the record.715    Ms. Brownley. It does. Does CHAMPVA use a formulary?716    Dr. Shappell. I believe so, but I can get specifics for the717record.718    Ms. Brownley. Well, I can tell you that it does. Does719CHAMPVA have any prior authorization requirements for services720like mental health and substance use treatment?721    Dr. Shappell. I believe so, but I can--I can----722    Ms. Brownley. I can tell you--say that it does. Is CHAMPVA723considered credible coverage for the purposes of the ACA's724mandate that individuals have health insurance coverage?725    Dr. Shappell. CHAMPVA is a benefit, but it is not an726insurance policy per se.727    Ms. Brownley. Well, the point that I am trying to make here728is that all the questions that I just asked you, the answers729are yes. Then, of course, you say that it is not a health730insurance policy, but it certainly sounds like one. It has, you731know, the questions that I just asked you were sort of almost732like a checklist for insurance policies. It just seems to me733that CHAMPVA--you say it is not a health insurance policy. I734say it certainly appears to be one. As the old saying goes, if735it walks like a duck and swims like a duck and quacks like a736duck, it is probably a duck.737    DoD's TRICARE program was not affected by the ACA either.738However, Congress created the TRICARE Young Adult program in7392011 to provide health care for qualified young adults ages 21740to 26 who are unmarried and not eligible for an employer-741sponsored health plan. Why is VA advocating for the dependents742and survivors of service-disabled veterans to be treated743differently and less than TRICARE beneficiaries? This744legislation would create that long-standing inequity.745    In her testimony on behalf of the Elizabeth Dole746Foundation, Mrs. Benson suggests that our committee should use747its oversight authority to improve the administration of the748CHAMPVA program. I certainly agree. She recounts the incredible749number of hurdles she has to overcome in getting services750covered, getting claims paid, and even simply getting VA to751process the paperwork to recertify her child's status as a752college student. Yes, I mean paperwork because CHAMPVA is still753operating, in my most humble opinion, in the dark ages with754paper-based forms and a month's long backlog in processing the755mail.756    Dr. Shappell, 7 weeks ago today, committee staff submitted757a few simple questions to VHA regarding academic enrollment758recertification requirements for CHAMPVA beneficiaries. We have759yet to receive a response despite our attempts to follow up.760Can I have your assurance that we will receive answers to these761questions within the next week, which will make it more than 2762months since we requested the information?763    Dr. Shappell. Thank you. I do not have a timeline right764now, but I can assure you that I will work with my colleagues765in our Office of congressional Legislative Affairs to ensure766you have a response.767    Ms. Brownley. You cannot state at a timeline? Not a week,768not 2 weeks, not a month, not 3 months?769    Dr. Shappell. Not at this time.770    Ms. Brownley. I yield back.771    Dr. Shappell. Thank you.772    Ms. Miller-Meeks. Thank you, Representative Brownley. The773Chair now recognizes representative Dr. Murphy for 5 minutes774for any questions he may have.775    Mr. Murphy. I am going to hold off and pass on questions. I776will come back later. Thank you.777    Ms. Miller-Meeks. The Chair now recognizes Representative778King-Hinds for any questions she may have.779    Ms. King-Hinds. just have a couple of questions. I was780reading over your comments on the proposed TRAVEL Act, and781first of all, thank you for the support. Section, the proposed782section 7415B proposes to require traveling physicians to783coordinate with non-departmental medical providers to the784extent necessary to ensure high-quality and coordinated care.785How do you foresee the VHA implementing this program?786    Dr. Shappell. Thank you. I am going to pass that to Dr.787Wiechers.788    Dr. Wiechers. We would actually like to work with the789committee to better understand what the intent is in that790section so that we can have some clarity on what care791coordination entails.792    Ms. King-Hinds. Okay, great.793    Dr. Wiechers. That we could make a plan together.794    Ms. King-Hinds. I would love to have that conversation with795you. Just one other quick question. There was some objections796with regards to, I think I want to say, section--the pay,797section 7415. I know that there are some concerns about the798budget and the language with regards to the retention bonus,799which is included in the legislation. I just wanted to bring800this up for situational awareness.801    Right now, the Commonwealth of the Northern Mariana Islands802(CNMI), in general, is having a hard time recruiting healthcare803professionals just for regular care. I think that is a direct804result of, you know, just the difference in the quality of life805that is here on the mainland as it relates to back in the806territories. I will give you an example. I am really excited807that he is introducing the SAVES Act, which would, you know,808allow for the VA to provide service care or service animals. We809do not have a vet. That is one of the biggest challenges is810that you do have these professionals who want to relocate811there. Transporting your pets to the CNMI right row costs812around $10,000. You know, it is cost-prohibitive, right? We do813not have a mall, we do not have a shopping center, any type of814major shopping center. Our only movie theater has just recently815closed down. I would like to have a conversation with you with816regards to the challenges as it relates to recruitment and817retention for people coming out to the territories.818    Dr. Wiechers. Absolutely. We would be happy to engage in a819conversation with you about that. I think the technical820amendment suggestion is just to ensure that the language and821the authorities that we have related to bonus eligibility line822up appropriately. Absolutely understand the importance of being823able to recruit high quality providers to be able to come to824the islands and to help with the health care for our veterans825there.826    Ms. King-Hinds. All right, thank you. I yield my time.827    Ms. Miller-Meeks. Thank you. If I can, I will remind our828witnesses to speak a little louder. The Chair now recognizes829Representative Bergman, General Bergman, for any questions he830may have.831    Mr. Bergman. Thank you, Madam Chair, and thank you to832everybody who is here because we are all trying to do the right833thing for the right reasons. The question is, how do we figure834out what the right reasons really are and what the priorities835are? We are in an oversight position here. You are the, you836know, we are the higher headquarters that send you money and837resources to do the mission. We want to know how the mission is838going, okay? I appreciate the honesty in your testimony.839    One specific question here as it relates to H.R. 3767, as840it relates to the Health Professional Scholarship program. I am841not going to go into details of what each--whether you are a842psychiatrist, a nurse practitioner, pharmacist, how many of843those scholarships, so the Health Professional Scholarship844program, are providing scholarships for certain specialties. I845will just say if you do not have the answer, you can take it846for the record. Why is the VHA plan for Fiscal Year 2026847eliminating the PA, Physician's Assistance, Health Professional848Scholarship Program for returning veteran medics and corpsmen?849Do we have any detail of that? I do not want--I do not want to850play gotcha here, but I want to give you the opportunity to851answer the question based upon what you know.852    Dr. Shappell. Thank you. I will pass that to Dr. Wiechers.853    Dr. Wiechers. I am going to have to take that for the854record, sir. I do not have an answer for you today, but I will855get an answer for you.856    Mr. Bergman. Well, the reality is here we need all857different medical special, you know, proficiencies,858specialties. It would seem to me that when we have veteran859medics and corpsmen that are already, for lack of a better860term, in most cases, battle-tested, we would want to make sure861that we continue to develop their expertise and their ability862to serve other veterans. This is a medical specialty that we863need to continue to move forward. This cannot be, you know,864the--not that I would get specific, but there is an ongoing865discussion between nurse anesthetists and anesthesiologists.866That is--we have been dealing with that for a very, very long867time, and there is room for both. The question is, who868supervises who, who has charge of patient care, et cetera, et869cetera. As we continue to look at the healthcare system of the870future and physician's assistance, as they might migrate into871the VA system, and maybe they go out into community care, which872the vast majority of veterans are looking for care in the873community. Physician assistant in the world in which we live is874a great step forward.875    With that, Madam Chair, I yield back.876    Ms. Miller-Meeks. Thank you, General Bergman. The Chair now877recognizes Dr. Conaway for any questions he may have for 5878minutes.879    Mr. Conaway. Hi. Thank you, Madam Chair, for recognizing me880for a few moments to make a statement and answer some881questions. We are, I am assuming I just walked in, we are on8823643, right? No. Oh. What is that? Okay. I just wanted to take883a moment to discuss H.R. 3643, the VA Data Transparency and884Trust Act. It aims to reauthorize a congressionally mandated885report that expired in 2022 and significantly expands the886number of elements that the VA is required to report. Dr.887Shappell, does the VA have the personnel and resources888necessary to compile, calculate, and report this data?889    Dr. Shappell. Thank you. VA does support this bill, subject890to amendments. Right now, as written, the report is very broad891and would require a significant amount of time and resources to892fully understand what is desired. We would appreciate the893opportunity to meet with the committee to narrow the focus of894the specific topics.895    Mr. Conaway. I agree with the importance of transparency in896this bill and strongly believe data points from the VA are897essential for Congress to effectively conduct its oversight898responsibilities. I would. You have just said that you have899some concern about the breadth of the report, but I must say900that I am concerned about what is lacking, specifically how901many staff are retiring, resigning or leaving the VA, along902with their specific job titles. I am also concerned about what903is going on with new hires and what their titles are. It sounds904like you would not be able to provide--you do not believe the905VA, excuse me, is in a position to provide this data. We think,906I think, and I think, I hope, I am joined by everyone here,907believes it is important to understand what is going on with908the staffing levels in the VA and that it has the appropriate909personnel and adequate numbers of personnel to complete its910very important mission. Certainly, what is going on with hiring911and staffing, et cetera, would be important to our oversight912function. What are your thoughts on--on the things I suggest913needed to go into the bill?914    Dr. Shappell. Thank you. Thank you for the question. That915the resources that would be needed to collect and report on916this data could potentially divert from health care and917benefits delivery, but we do not have a cost estimate at this918time. We would really appreciate the opportunity to meet with919the committee to fully understand what is really desired and920needed so that we can come up with a better plan to move921forward.922    Mr. Conaway. Well, then I would ask then, do you know why--923and of course, you are supposed to know the answer to these924questions before we ask them. You know, it is, my notes say, of925course, this report ceased a couple of years ago. Do you have926an explanation for why that happened?927    Dr. Shappell. I do not know. I was not in my current928position at that time. I would be happy to take that for the929record and provide a response for you.930    Mr. Conaway. Well, I would just say that we know that931staffing and the ability to fully staff the various departments932within the VA plays an enormous role in the quality of care933that is delivered to our veterans. Gathering these data points934would allow us to better understand how we can support the VA935and ensuring they provide the high-quality care that veterans936deserve. Do you agree? Or that staffing levels have an937important impact on the. On the outcomes that we expect from938the VA and that our veterans need the VA to produce for them939and their care?940    Dr. Shappell. Yes, I do believe that the veterans need the941VA. However, I can assure you that the VA has worked with the942White House and the Office of Personnel Management to exempt943more than 300,000 positions from the hiring freeze and early944retirement incentives or deferred resignation program. We, the945Department, is committed to ensuring that we have the best946employees in place to serve our veterans and the services that947they need.948    Mr. Conaway. Thank you, Doctor. Madam Chair, I yield back.949    Ms. Miller-Meeks. Thank you, Dr. Coleman. The Chair now950recognizes Representative Luttrell for 5 minutes for any951questions you may have.952    Mr. Luttrell. Thank you, Madam Chairwoman. Dr. Shappell,953H.R. 2605, the SAVE Act, I think I heard you say that the954Department of Veterans Affairs does not support a portion of955that because of the given service--it says that the service956dogs do not provide effectiveness for post-traumatic stress957disorder?958    Dr. Shappell. Yes.959    Mr. Luttrell. I want you to read that statement out of your960notes. Make sure that I heard it right.961    Dr. Shappell. The Service Dogs Assisting Veterans Act, or962the SAVES Act, H.R. 2605, requires the VA to establish a pilot963program to provide service dogs for eligible veterans. VA964supports this but recommends clarifying the bill's language for965effective use of funds. We also propose aligning terminology966with existing VA definitions. We do have concerns about967including traumatic brain injury and post-traumatic stress968disorder criteria in the--in the criteria given insufficient969evidence of service dogs' effectiveness.970    Mr. Luttrell. Insufficient evidence that service animals971assist veterans with post-traumatic stress disorder. That is972the opinion of the Department of Veterans Affairs?973    Dr. Shappell. Yes, and I am going to pass this over to Dr.974Wiechers.975    Mr. Luttrell. Have at it.976    Dr. Wiechers. All right. Thank you, sir, for the question.977The evidence does not support any----978    Mr. Luttrell. What evidence?979    Dr. Wiechers. There is a study that was conducted.980    Mr. Luttrell. One study. One study.981    Dr. Wiechers. That is----982    Mr. Luttrell. The VA is basing that claim that you just983threw at me off of one study.984    Dr. Wiechers. I would like----985    Mr. Luttrell. I would be very careful in the waters that986you are going to swim in with me right now----987    Dr. Wiechers. I am, sir.988    Mr. Luttrell [continuing]. because I have been studying989this for an extremely long period of time. One thing that I do990know, and I talked to hundreds of veterans that have post-991traumatic stress disorder and post-traumatic stress and992traumatic brain injury with service animals, and they say this993is a life-changing event for them. It is the opinion off of one994study in the Department of Veterans Affairs to say that that is995ineffective?996    Dr. Wiechers. We have a method in the existing regulations997that we have around access to service dogs for mental health998mobility dogs for veterans with PTSD and TBI. That is what we999are speaking to.1000    Mr. Luttrell. You are differentiating between a service1001animal and a therapy animal?1002    Dr. Wiechers. I am speaking to a mental health mobility1003dog. Mental health mobility service dog, which can be provided1004for patients with PTSD and TBI. It is a--sir, I agree with you.1005    Mr. Luttrell. In the language----1006    Dr. Wiechers. I agree with you.1007    Mr. Luttrell [continuing]. in front of you, I need to add1008that subtext in there to make this thing?1009    Dr. Wiechers. I would like to work with you to make sure we1010have language that aligns with the definitions we have that1011allow for the access when it is appropriate clinically for1012veterans with PTSD or TBI who have a mental health mobility1013disability. We have a method we need to align language, sir.1014    Mr. Luttrell. Well, I can assure you, if it does not happen1015today, within the next couple of days, you need to be in my1016office and make sure that it is absolutely the way that it1017needs to be because this is something I am not walking away1018from because I adamantly disagree with what you are saying.1019Since you are speaking for the VA, you do not want to go to war1020with me over this.1021    Dr. Wiechers. I do not.1022    Mr. Luttrell. There is a room full of veterans sitting1023behind you that I am sure going to be on my side.1024    Dr. Wiechers. I understand. I am committed to working with1025you and making sure we get the language that works so that we1026can ensure access to the service dogs through this pilot1027program.1028    Mr. Luttrell. This is the conversation that most likely1029should have happened before you are sitting in front of the1030committee in an open hearing.1031    The VA has expressed concerns that the Fisher House1032Availability Act will create an adverse interference that1033providing lodging to some service members is prohibited by law.1034On what legal authority does VA base its concern? If these1035concerns were alleviated, would VA support allowing DoD use of1036excess capacity in VA Fisher House residences?1037    Dr. Shappell. Thank you. Yes, so VA does support this1038proposed bill. We would like to work with the committee on some1039technical assistance. We do want to support service members and1040their beneficiaries.1041    Mr. Luttrell. Madam Chairwoman, I yield back.1042    Ms. Miller-Meeks. Thank you, Representative Luttrell. The1043Chair now recognizes, again, Dr. Murphy for any questions you1044may have. Okay. The chair now recognizes herself for any1045questions she may have. They are calling for votes, so I am1046going to be very, very brief so we can try to complete this1047panel before we recess and then come back for the next panel.1048    Dr. Shappell, in your testimony, you state that due to the1049ambiguity of current law, active-duty service members, and I1050think this is getting to the point Mr. Luttrell was making, and1051their beneficiaries are being turned away even though the1052Fisher House Foundation is willing and able to support them if1053there is availability. Can you explain why my bill is necessary1054to clarify congressional intent and correct this error?1055    Dr. Shappell. Currently, the current law does not allow for1056TRICARE beneficiaries to stay in the Fisher home. VA does1057support this and does want to provide equitable access for our1058military families, but we do need to have it codified in law.1059    Ms. Miller-Meeks. Dr. Shappell, Congress often encounters1060difficulty getting timely information on performance outcomes1061and spending. I know that the VA spends countless hours1062preparing numerous and disparate reports for Congress. Would1063the VA support a centralized, publicly accessible data1064platform, as Congressman McGuire's bill proposes, to streamline1065oversight and increase public trust?1066    Dr. Shappell. Thank you for your question. I would have to1067take that back for the record, ma'am.1068    Ms. Miller-Meeks. Thank you very much. The other questions1069I will have, I will submit for the record in order for time.1070There is still 421 votes, so I think we have a few minutes. On1071behalf of this subcommittee, I want to thank you for your1072testimony and for joining us here today. You are now excused.1073We are going to wait a moment for the second panel to come to1074the witness table.1075    Thank you very much. Welcome, everyone, and thank you for1076your participation today. The staff and I are watching votes1077very carefully. I am hoping to push through to get through at1078least one of our testimoneys, and we can at least introduce the1079panel.1080    On our second panel today, we have Dave Coker, President of1081the Fisher House Foundation, Randy Johnson, Marine Corps1082veteran, member of The Veterans of Foreign Wars of the U.S.1083(VFW) Post 3457, and constituent of Representative King-Hinds.1084Cole Lyle, Director of the Veterans Affairs and Rehabilitation1085Division at the American Legion. John Schmitt, Chief Executive1086Officer (CEO) of iExpressGenes. Caira Benson, a caregiver1087fellow, testifying on behalf of the Elizabeth Dole Foundation.1088Mr. Coker, you are now recognized for 5 minutes.10891090                    STATEMENT OF DAVID COKER10911092    Mr. Coker. Thank you, Chairwoman Miller-Meeks, and good1093afternoon to the members of the committee. My name is David1094Coker, and I have the privilege of serving as President of1095Fisher House Foundation.1096    The Fisher House Program was founded in 1990 by Zachary1097Fisher, a private citizen and patriotic philanthropist who1098believed that no military family should ever struggle to be by1099their loved one's side during a medical crisis. He built the1100first Fisher Houses at the National Naval Medical Center and1101Walter Reed Army Medical Center. The vision was simple but1102powerful: to create a home away from home for families1103traveling to be with a loved one receiving care.1104    The Fisher House program has now grown into a network of1105100 Fisher Houses located at Department of Defense hospitals1106and VA medical centers across the country and overseas. Because1107of the special mission of supporting both military and veteran1108families, it is fitting that the 100th Fisher House, to be1109dedicated next month, is located at the James A. Lovell Federal1110Health Care Center, the only fully integrated DoD and VA1111Medical center in the country.1112    Each home is now built through the generous support of the1113American public and donated to the Veterans Affairs or the1114military service it serves. To date, Fisher Houses have offered1115more than 12 million nights of lodging and saved families more1116than $650 million in out-of-pocket costs. When we gift a Fisher1117House to the Army, Navy, Air Force, or Veterans Affairs, our1118goal is to support these families in their time of greatest1119need. We know that having a loved one present improves1120recovery. Family members serve as caregivers and advocates and1121are a tremendous source of strength. We believe they are1122essential to the healing process and that every veteran and1123service member deserves to have their loved one by their side.1124    Of the 100 Fisher Houses, more than half support VA medical1125centers. In 2024, the VA Fisher Houses served more than 24,0001126veteran families spanning all eras and generations.1127    Last fall, guidance was published which changed the way VA1128Houses operate. It directed that only families of veterans1129receiving VA-directed care were eligible for the support Fisher1130Houses provide. Even when rooms are available, families that1131have historically been welcomed must now be turned away. Last1132year, the occupancy rate at the VA Fisher Houses across the1133country was 53 percent. We would ask that if a room was1134available, consideration should be given to support the family1135of an eligible DoD beneficiary.1136    The Fisher House supporting the Washington DC VA Medical1137Center is on the same campus as the Children's National1138Hospital, the National Rehabilitation Hospital, and the1139Washington Hospital Center. Last year, occupancy at that house1140was 22 percent and could have easily accommodated families1141receiving care at one of those facilities.1142    The world-renowned Paley Orthopedic and Spine Institute is1143located near the Fisher House, supporting the Thomas H. Corey1144VA Medical Center in West Palm Beach, Florida. 27 military1145children were referred to them for life-changing care last1146year. Today, their families are no longer eligible to stay in1147the Fisher House.1148    There are three Fisher Houses at the DeBakey VA Medical1149Center in Houston, adjacent to the Texas Medical Center and MD1150Anderson. Last year, the occupancy rate was 63 percent. Again,1151because of this guidance, military families will be turned1152away.1153    The bipartisan Fisher House Availability Act of 2025 would1154restore the flexibility that the VA Fisher House Managers once1155had, allowing the families of active-duty service members and1156other eligible beneficiaries to stay on a space-available basis1157while preserving the priority access for veterans. This change1158will not reduce access for veterans. It simply allows these1159homes already built, already staffed, and already serving, to1160do what they were intended to do: keep families of our Nation's1161heroes together in the hardest moments of their lives.1162    This bill is consistent with the Memorandum of1163Understanding between the Secretary of Defense and Secretary of1164Veterans Affairs titled, Strengthening Our Partnership and1165Service to Those Who We Serve, and it will provide one more way1166for the two departments to work together to support both the1167military and veterans' communities.1168    On behalf of the Fisher House Foundation and the tens of1169thousands of families we have the privilege of serving each1170year, I want to thank the sponsors of this bill and all of you1171for your support of our Nation's service members, veterans, and1172their loved ones. Thank you for the opportunity to speak today.1173I welcome any questions.11741175    [The Prepared Statement Of David Coker Appears In The1176Appendix]11771178    Ms. Miller-Meeks. Thank you, Mr. Coker. Mr. Johnson, you1179are now recognized for 5 minutes.11801181                   STATEMENT OF RANDY JOHNSON11821183    Mr. Johnson. Thank you. Chairwoman Miller-Meeks, Ranking1184Member Brownley, and members of this committee. My name is1185Randy Johnson. I am a resident of the Northern Mariana Islands,1186a veteran of the United States Marine Corps. For the past1187decade, I have had the privilege of assisting fellow veterans1188in the Northern Marianas, helping them navigate the VA system1189and access the benefits they earn through their service. I have1190traveled nearly 8,000 miles to be here today to speak in1191support of H.R. 3400, The Territorial Response and Access to1192Veterans' Essential Lifecare, known as the TRAVEL Act,1193introduced by our delegate, Congresswoman Kimberlyn King-Hinds.1194This is a good bill.1195    In the Northern Marianas, we do not have a VA medical1196center. We do not have consistent access to specialty care or1197mental health services. When veterans need more than basic1198care, we are often told to leave the island, traveling1199thousands of miles, paying out of pocket, and spending weeks1200away from our families. The TRAVEL Act helps to change that. It1201allows the Department of Veterans Affairs to send traveling VA1202physicians into remote communities like ours. Instead of1203forcing the veteran to chase care across oceans, this bill1204brings care to the veteran. That is the right direction.1205    I am here to voice my support for the TRAVEL Act, but I1206also came this distance to give voice to the hundreds of1207veterans who could not be here. Veterans who serve this country1208with honor, who, like me, are not asking for special treatment.1209We are asking for what we would have received if we lived1210anywhere else in the United States.1211    We are the only place in the Nation where a veteran can1212call home but have no access to community-based outpatient1213clinicians (CBOC). No CBOC at all. Veterans from every1214conflict, past and present, have been told that if they want1215the full range of care they have earned, they cannot live at1216home. Veterans seeking care at home see one doctor on Tuesdays1217and Thursdays. Dr. Ada has done a great job, but only--but1218there is only one such--only so much one person can do. Her1219office has one VA registered nurse, a veteran herself, but if1220she needs care or takes a much-needed vacation, there is no one1221left to keep pace.1222    Decisions on care, travel, and benefits happen in Guam or1223Hawaii. Resources come from Guam or Hawaii. When those places1224are struggling or overloaded, we cannot reasonably expect them1225to prioritize our needs.1226    What we want, and what I believe we have earned, is the1227right to live in the country that we fought for, in the1228community we fought for, and to have our services speak for1229itself. We should not have to choose between access to care and1230being with home with our families. We stood the watch. We1231answered the call. That should be enough.1232    I served in Iraq. I saw combat. I received a Purple Heart1233for it. I traveled here by choice. Many veterans are forced to1234travel simply to receive the care they need. That should not be1235the case.1236    In the Northern Marianas, I have served alongside and1237advocated for generations of veterans, those who fought in1238Vietnam, Panama, Iraq, and Afghanistan. All of them returned1239home to a system still not built to meet their needs.1240    As I made my way here, I thought the--thought of the1241Vietnam veterans in their 70's and 80's who served our Nation1242even before our islands were formally part of this country.1243They have spent a lifetime fighting for benefits that only1244trickled in slowly over decades. Now, even in their later1245years, they are still being asked to travel off island for1246basic, sometimes life-sustaining care. I think of how difficult1247this travel is for them. I thought of the Gulf War veterans who1248opened a new chapter in America's military history but returned1249to the same old gaps in care and support. I thought of my1250generation, those who served in Operation Iraqi Freedom and1251Enduring Freedom. We served with commitment. We returned home1252with hope. We still face the same cycle of delay, denial, and1253distance.1254    Of this generation of new veterans, I am proud to be part1255of a group that is organizing to support one another directly.1256Project Buddy Check 670 is an example of that effort. It1257reflects our belief that care for veterans does not always come1258in the form of a pill or prescription, but sometimes it comes1259from another veteran picking up the phone, checking in, and1260listening. Project Buddy Check is a reminder that veterans1261seeking care that treats us as people, not just patients. When1262even ordinary care is far to reach, how can we expect a system1263to provide the mental health and holistic support for our1264veterans who truly need?1265    Generations of veterans have answered the call from our1266islands. I know the challenges we face are difficult to1267address, but again, we stood the watch. We bore the burden.1268That should be enough. It is time the system answered back.1269    H.R. 3400 is a strong start. I respectfully ask this1270committee to support it and continue advancing policies that1271bring real access, real dignity to every veteran, no matter1272where they live. Thank you for your time and for your1273unwavering commitment to those who serve.12741275    [The Prepared Statement Of Randy Johnson Appears In The1276Appendix]12771278    Ms. Miller-Meeks. Thank you, Mr. Johnson, and thank you for1279your long duration of travel to get here. Mr. Lyle, you are now1280recognized for 5 minutes.1281    Mr. Luttrell. Madam Chairwoman, they called votes. I do not1282know if you, just----1283    Ms. Miller-Meeks. Yes, sir. There is 327 people left to1284vote.1285    Mr. Luttrell. I have never missed a vote time.1286    Ms. Miller-Meeks. Sir, you may be excused if you want to be1287excused. I am sorry. Mr. Lyle.12881289                     STATEMENT OF COLE LYLE12901291    Mr. Lyle. Well, thank you, Chairwoman Miller-Meeks, Ranking1292Member Brownley, distinguished members of the subcommittee, on1293behalf of National Commander James A. LaCoursiere Jr., and the12941.5 million dues-paying members of the American Legion, thank1295you for the opportunity to testify today discussing pending1296legislation that directly impacts the lives and well-being of1297American veterans.1298    Today, the American Legion supports nearly all the bills1299under consideration because they reflect a bipartisan1300commitment to improving mental health outcomes, suicide1301prevention, addressing provider shortages, and safeguarding the1302dignity of those who have worn the uniform.1303    First, H.R. 785, the Representing Our Seniors at VA Act.1304This bill appropriately recognizes the vital role that State1305veterans homes play in long-term care. As the average age of1306our veteran population reaches 75 this year, this legislation1307would add a representative from the National Association of1308State Veterans Homes (NASVH) to the Geriatrics and Gerontology1309Advisory Committee. With over 169 homes now operating under1310NASVH, this change is both timely and necessary.1311    Second, the VA Data and Transparency and Trust Act is a1312good step toward improving VA reporting on health care and1313benefits. By expanding access to underlying data and requiring1314disaggregation by gender, age, geography, and condition, this1315legislation enhances oversight, fosters collaboration, and1316enables evidence-based improvements in care delivery. We1317support the bill with amendments to clarify definitions like1318``reliance'' on VA care and minimize administrative burden1319while urging the inclusion of data on caregivers, survivors,1320and emerging chronic conditions.1321    We also offer strong support for H.R. 3400, the TRAVEL Act,1322which would authorize temporary VA physician assignments to1323U.S. territories like Puerto Rico and Guam. With physician1324shortages reaching crisis levels in these areas, this1325legislation brings us closer to healthcare equity for veterans,1326no matter where they live.1327    Further, we commend the draft legislation directing VA to1328study RNA sequencing as a diagnostic tool for post-traumatic1329stress. While this technology should never be used as the sole1330basis for compensation decisions, it holds promise for1331advancing diagnostic precision and developing targeted1332therapies. We must embrace science without losing sight of the1333holistic nature of invisible wounds.1334    Workforce development also remains a priority. That is why1335we support the bill establishing employment timeframes for1336Health Professional Scholarship Program participants, a1337commonsense measure to address critical shortages and ensure VA1338retains its pipeline of trained professionals.1339    On caregiver support, H.R. 2148 expands transitional health1340care and provides stipends for career re-licensure, recognizing1341the sacrifices caregivers make. These steps help veterans1342remain in-home settings at a fraction of the cost of1343institutional care and ensure caregivers can reenter the1344workforce with dignity and purpose.1345    Finally, H.R. 2605, the SAVES Act, would establish a grant1346program to expand access to service dogs through accredited1347nonprofits. VA's own research continues to confirm that1348veterans paired with service dogs experience reduced post-1349traumatic stress symptoms, decreased suicidal ideation, and1350improved quality of life. The VA itself offered a FOX Grant to1351a service dog organization.1352    Anyone who owns a dog will tell you they can be1353therapeutic. You do not need research. When fingers meet fur,1354magic happens. I know from personal experience, having1355previously benefited from a service dog named Kaya (phonetic),1356the profound power a specially trained dog can have in a1357veteran's life. This is why I helped author the original PAWS1358Act of 2016, and Kaya and I spent years advocating for its1359passage before she passed. The compromised version passed in13602021. The SAVES Act builds on this effort and more closely1361aligns to the text of the original PAWS Act than the1362compromised version that ultimately passed.1363    I cannot overstate the power passage and implementation of1364this bill would have on veteran suicide prevention and improved1365mental health outcomes. Because of Kaya, I earned a bachelor's1366and a master's degree. I have a beautiful 2-year-old son. I sit1367here today, as a veteran advocate in the largest division for1368the largest veterans service organization in the country1369because of my service dog.1370    Chairwoman Miller-Meeks, Ranking Member Brownley, thank you1371for the opportunity to testify, and I stand ready to answer1372your questions.13731374    [The Prepared Statement Of Cole Lyle Appears In The1375Appendix]13761377    Ms. Miller-Meeks. Thank you very much, Mr. Lyle. My1378apologies to the witnesses and those who are here. Due to the1379vote that has already been called in the House, the1380subcommittee will stand in recess subject to the call of the1381chair. I expect to reconvene 10 minutes after the start of the1382last vote. There are 5 votes.1383    [Recess]1384    Ms. Miller-Meeks. Welcome back. I am sorry. Mr. Schmitt.13851386                   STATEMENT OF JOHN SCHMITT13871388    Mr. Schmitt. Good afternoon, Chairwoman Miller-Meeks and1389Ranking Member Brownley and members of the subcommittee. Thank1390you for the opportunity to testify today.1391    I want to begin not with the science, but with the1392intention behind the science. Because when it comes to the1393lives of veterans, as one myself, I believe that intention1394matters.1395    In 2010, the founder of iXpressGenes, Dr. Joe Ng, molecular1396biologist and professor at the University of Alabama,1397Huntsville, was at a routine faculty meeting. Tragedy struck1398when a colleague pulled a handgun out of her purse and murdered1399three people in front of him. Joe fortunately survived, but in1400the aftermath, he watched this spectrum of resilience occur1401among his peers. Joe asked the question that would change1402everything, could trauma have an immunological component? That1403question set us on a path to transform trauma care forever.1404    I met Dr. Ng in 2018. I am John Schmitt. I am a CEO of1405iXpressGenes and a two tour Iraq combat veteran, having served1406over 20 years in the Army. When Joe and I crossed paths, I was1407still in uniform. I was trapped in a culture of silence. Like1408many of my peers and contemporaries, because of the risk to my1409career, I could not admit I was unraveling, depressed, anxious,1410and increasingly suicidal. That journey for me has turned into1411a mission. Today I testify not just as a veteran and a CEO, but1412as a survivor advocating for the science to help me heal, and I1413hope will help millions of others.1414    While in uniform, I earned a degree in microbiology and1415immunology from Vanderbilt University School of Medicine. It1416was a fateful step, one that quietly equipped me to understand1417the science and the application of the technology that I stand1418before you advocating for.1419    Together, our team at iXpressGenes has developed1420groundbreaking blood tests using the power of RNA transcriptome1421analysis, the Trauma Autoimmune Indicator, or TAI as we call1422it. It identifies inflammation caused by trauma, detectable1423before symptoms even surface, to empower prevention, enable1424early intervention, and inform effective treatments for best1425possible outcomes.1426    The TAI test reads RNA transcription, how the body's genes1427are responding right now in real time, creating potential for1428limitless therapeutic strategies never before possible. Unlike1429genetics, which only tell us what might happen, RNA tells us1430what is happening and this matters. This matters because it is1431the kind of inflammation that we detect, is the root cause for1432the oxidative stress and the neuroinflammation that crosses the1433blood-brain barrier and contributes to the anxiety, depression,1434and other hallmarks of PTSD. This lab developed test is already1435available commercially through our lab in Huntsville, Alabama.1436It is low cost, it is scalable, and it is incredibly precise.1437    With the VA, we are not starting from scratch. With our1438partnerships at VA Birmingham over the last 2 years, we have1439already demonstrated powerful results. In fact, as our key1440clinical research collaborators put it, ``Its high sensitivity,1441specificity, and translational relevance position it as an1442exceptional tool for clinical use. Given the clarity and1443consistency of the data it provides, I strongly advocate for1444its broader adoption and urge that it be rapidly prioritized1445for clinical validation to support improved patient outcomes.''1446    PTSD and trauma-related illness have long been treated1447based on symptoms and subjective reporting. Now with RNA1448transcriptome analysis, we can assess it objectively for the1449first time, offering a novel approach for diagnosing, treating,1450and even preventing trauma-induced disease.1451    Today there is a promising patchwork of powerful therapies:1452mindfulness, contrast therapy, Eye Movement Desensitization and1453Reprocessing (EMDR), neurofeedback, ketamine-assisted1454psychotherapy, and even psychedelics. It is a choose-your-own1455adventure landscape for our veterans because we have lacked an1456objective compass. TAI is that objective compass and we can use1457it to validate the effectiveness of all of these modalities and1458track clinical progress in real time. We are not starting from1459scratch here either. We have already partnered with1460groundbreaking technology companies using hyperbaric oxygen to1461virtual reality with exceptionally promising early results.1462    The VA has long pioneered technologies that went on to1463change the world. Let this be the next chapter, ushering in a1464new standard of precision mental health that is proactive, data1465driven, and lifesaving. iXpressGenes is a company born out of1466tragedy, led by those who have lived the realities of trauma1467and built for a world finally ready to confront it. Let us lead1468the transformation of trauma care. Our veterans deserve it, and1469so does every other American still waiting for their suffering1470to be seen, understood, and treated with precision. The1471opportunity is massive and, as you know, the need is urgent and1472only growing. Now the science is ready. Let us transform trauma1473care together forever.1474    Thank you for your time and I welcome your questions.14751476    [The Prepared Statement Of John Schmitt Appears In The1477Appendix]14781479    Ms. KING-HINDS. [Presiding.] Thank you, Mr. Schmitt. I now1480recognize Ms. Benson for 5 minutes.14811482                   STATEMENT OF CAIRA BENSON14831484    Ms. Benson. Members of the committee, thank you for1485inviting me to testify today. As the wife and caregiver of a1486severely injured and ill combat veteran, it is my honor to1487speak to some proposed legislation that could lessen the burden1488of each of our caregiving families face every day. I care for1489my husband Eric, who deployed twice to Iraq as a combat1490engineer. My husband suffered multiple traumatic brain injuries1491during his years in service and is considered by VA to be1492permanently and totally disabled and unable to work. He is1493wheelchair-dependent, struggles cognitively, suffers from1494migraines and blackouts, and is visually impaired.1495    I am also mom to five amazing kids, three of whom have1496needed specialized care over the years. The day my husband was1497awarded permanent and total status, my children and I became1498eligible for CHAMPVA. I breathed a sigh of relief knowing that1499we, too, would have appropriate healthcare.1500    In 2021, one of my children began attending college and1501needed monthly medications. We mailed the required1502certification paperwork, but when we went to fill the1503prescriptions, we found CHAMPVA was inactive. I called, sat on1504hold for 4 hours, and learned CHAMPVA's central mail facility1505was 6 months behind on opening mail. Horrifyingly, CHAMPVA1506began requiring semester certifications in 2023 with no option1507to expedite activation for medical best interest.1508    Since 2023, my child has suffered from lapsed coverage1509between semesters due to the certification process in CHAMPVA's1510archaic mail system. Winter and summer break became a mix of1511timing medication pickups prior to coverage loss, and paying1512out of pocket for any therapies or doctors' visits. This1513outdated system ensured my child was without insurance from1514November 2024 to May 2025. Caregivers need CHAMPVA fixed1515beginning with ensuring our children who have already given up1516so much do not have to worry over the loss of coverage upon1517their 18th birthday or due to an archaic certification process.1518    H.R. 1404, the CHAMPVA Children's Care Protection Act,1519would allow coverage until age 26, eliminating these egregious1520situations. It would align coverage with civilian insurers and1521the age at which dependents must begin to use their VA Chapter152235 education benefits. It also recognizes the true nature and1523sacrifice of youth caregivers by allowing them to support the1524need--or support their needs as they transition from caregiving1525into adulthood.1526    I understand at VA's recent testimony VA indicated they1527oppose this bill due to the nature of CHAMPVA, arguing that it1528is a medical service and not an insurance product. CHAMPVA1529provides explanation of benefits, approves or denies diagnostic1530and medical treatment codes, and remits payment for enrollees1531to providers for services. CHAMPVA even has out-of-pocket1532maximums, deductibles, co-pays, and a medication formulary with1533tiered pricing.1534    Every year, enrollees receive a 1095B attesting to the fact1535that CHAMPVA counts as minimum essential coverage under the1536Affordable Care Act. I admit I am a layperson, but this feels1537like every other insurance product I have ever received through1538an employer. While I am here to support extending CHAMPVA1539coverage to age 26, I implore this committee to use its1540oversight authority to improve the system itself so our1541families can use it to find appropriate care. To help you1542understand the challenges, let me explain what using CHAMPVA is1543like.1544    In 2019, one of our children was hospitalized and needed a1545residential facility. I was told to find a facility that would1546take CHAMPVA without the guidance of a provider network. I1547called over 20 facilities that were TRICARE approved to see if1548they had a bed available or could add my child to their wait1549list. All but one turned me down immediately. The reason? Prior1550authorization under CHAMPVA since January of that year was1551taking upward of 6 to 9 months. The one residential facility1552that did agree to treat our child had a stipulation. We were to1553sign $110,000 promissory note upon admission and the chance1554CHAMPVA refused authorization and payment.1555    Another of my children needed specialized therapy which was1556completed in 2021. In 2023, the provider called me to let me1557know they had finally received payment from CHAMPVA, almost 271558months later. Unlike its TRICARE counterpart, CHAMPVA has no1559contracted network of providers and no published fee schedule.1560CHAMPVA processes the majority of provider and enrollee claims1561using a single traditional mail center, lengthening the time1562between claim submission, processing, and reimbursement.1563    Filing and retaining providers willing to file it in my1564area--I am sorry, filing and retaining pay for services has1565become so cumbersome that the number of providers willing to1566file it in my area dropped to two practices, neither containing1567a pediatrician.1568    Once again, I am paying out of pocket for basic routine and1569pediatric care. I have stopped filing for reimbursement myself1570due to the burden of the process. It is one more bureaucratic1571fight caregivers like me do not need. Yet I know another fight1572looms on the horizon.1573    Not long ago, I firmly realized, like so many other1574caregivers, I would likely become a survivor. Having given over1575a decade to being a caregiver, I was situated to outlive my1576veteran with no retirement, no active work credits, and almost1577no life insurance for my family's financial security. I am not1578alone. Mozella Richardson Kamara, a 2025 Dole caregiver fellow1579from Delaware, studied for many years to become a civil1580engineer, but left her job to care for her veteran husband.1581Like myself, Mozella made this choice to ensure immediate well-1582being of her husband and sacrifice their own long-term1583professional goals and retirement potential for the benefit of1584the veteran.1585    According to a recent Research and Development (RAND)1586report, military connected caregivers saved this Nation in1587healthcare costs by providing a minimum of $119 billion in1588unpaid care. In exchange, we face this harsh reality: when our1589caregiving ends, many of us will be financially destitute.1590Caregivers like Mozella and me, we need you to pass H.R. 2148,1591the Veteran Caregiver Reeducation, Reemployment, and Retirement1592Act. This bill will not fix the entirety of the problem, but it1593is a valuable first step in ensuring caregivers can begin to1594plan for retirement and establish safety nets of their own.1595More immediately, it will provide caregivers financial security1596by allowing for reentry--work reentry programs and paying for1597relicensure in careers like teaching and engineering.1598    Again, I am honored to be here at the request of the1599Committee and the Elizabeth Dole Foundation. To truly support1600the veteran, we must support the caregivers, survivors, and1601families who bear the burden of the war that continues to rage1602at home.1603    I thank you for your time and attention and I look forward1604to your questions.16051606    [The Prepared Statement Of Caira Benson Appears In The1607Appendix]16081609    Ms. King-Hinds. Thank you very much, Ms. Benson. Thank you1610to all of you for your very insightful testimony.1611    I now recognize Ranking Member Brownley for 5 minutes.1612    Ms. Brownley. Thank you, Madam Chair.1613    Ms. Benson, thank you for being here. I think you and I1614think alike when it comes to the CHAMPVA bill and you certainly1615have my commitment to continue to work hard on this. You know,1616I introduced this back in 2019, so it has been something that I1617have been trying to work on for a long time. I can tell you1618before I even got to Congress there were a couple of members1619who have carried this bill. For a very long time we have been1620trying to fight for some kind of parity and healthcare. We will1621continue that fight.1622    I agree with you that we need more committee oversight of1623the program. Again, I commit to you to make sure that that1624happens. Hopefully, you can join us again in another hearing1625and I certainly would encourage Dr. Miller-Meeks to help me in1626that process. I think we should try very hard to encourage the1627VA Office of Inspector General and the Government1628Accountability Office to assist us in this effort to drill1629down.1630    About 18 months ago, VA's Office of Integrated Veteran Care1631began an initiative to modernize what it calls the Family1632Member Programs, which included CHAMPVA. You are smiling. They1633planned to implement additional Information Technology (IT)1634systems to administer the program and move away from a paper-1635based process. Have you noticed any improvements in the last 181636months as far as hold times when you call the CHAMPVA call1637center or processing times when you submit paperwork?1638    Ms. Benson. I want to thank you for your commitment and the1639question. I actually called this morning and when I called at1640opening, the hold time was an hour and a half, which is not1641bad. They did now offer----1642    Ms. Brownley. Which is not bad?1643    Ms. Benson. I am used to 4 to 6 hours with CHAMPVA. They1644did offer callback service now, which was new. I called May 21.1645I was here in town and spoke with another caregiver who was1646having similar recertification issues and she was able to get1647through. They told her they were opening mail from January.1648    Ms. Brownley. Tell me about the paper process.1649    Ms. Benson. The paper process, I understand that there is--1650I actually just spoke with another caregiver whose wife is1651pregnant and diabetic. They are trying--well, I am sorry, the1652veteran, his wife is pregnant, diabetic. They are trying to get1653her CHAMPVA turned on. They went to go submit through the1654online portal, which is down. There is a fax number which has1655been disconnected.1656    Ms. Brownley. A fax number?1657    Ms. Benson. Yes, ma'am, a fax number. That was the1658expedition process that we had always used in the past.1659    Ms. Brownley. I have not seen a fax machine in a long time.1660I guess I should go over to the VA perhaps to see one.1661    Ms. Benson. Yes. I can tell you that the way we were able1662to turn on my daughter's insurance was that I called, I1663instituted a VHA executive inquiry. That executive inquiry1664allowed us to upload the documentation and bypass the mail1665system. The ability to turn it on once that is uploaded is1666instantaneous.1667    Ms. Brownley. Is what?1668    Ms. Benson. Instantaneous.1669    Ms. Brownley. Instantaneous.1670    Ms. Benson. I do not understand why we are on a mail paper1671system when no other provider, including other government1672medical benefits are. That is the best answer I have is that,1673no, I have not seen an improvement at all.1674    Ms. Brownley. I had a feeling that that was going to be1675your answer, but I wanted it for the record, so thank you for1676that. You know, in addition to the Children's Care Protection1677Act, what should we prioritize in terms of oversight or1678legislation to improve the CHAMPVA program for your family and1679for other families?1680    Ms. Benson. My belief is, again, wonderful question, my1681belief is the statute is outdated.1682    Ms. Brownley. Yes.1683    Ms. Benson. The statute is very outdated. We have been a1684very small constituency, 737,000, of those only about 408,000,1685according to the congressional Report that was done in October1686of last year, are actually users. We have to at least bring it1687up to the standard that is TRICARE, who has a contract, who has1688providers. It is impossible for me to go to a provider and say,1689you may or may not be paid Medicaid rates. Would you please1690accept this? The only mandated acceptors are hospitals and1691urgent cares.1692    Ms. Brownley. Hospitals and what?1693    Ms. Benson. Urgent cares.1694    Ms. Brownley. Oh, and urgent cares.1695    Ms. Benson. To the VA's point today that they are worried1696that the money that this would cost would take away from1697healthcare of the veteran, I argue we are healthcare. Every1698caregiver, every youth caregiver, we provide billions in1699healthcare for our veterans. We save lives every day. We are1700the front lines. We are providing that. In exchange, we are1701left without our own care for ourselves because caregiving is1702stressful and destroys our own health. Our children, who are1703higher special needs rates, are left without coverage and it is1704impossible to find coverage. We are, as you said earlier, we1705are so behind even TRICARE, and it is egregious.1706    Ms. Brownley. It is egregious. I agree with you.1707    My time is up. I also hope that the VA begins the process1708of instituting the Elizabeth Dole Bill, because that, too--1709well, I should not say that, too, but that will be helpful and1710supportive of you as a caregiver to your husband and certainly1711to your children as well. I really enjoyed working with the1712Elizabeth Dole Foundation to have that section in the bill that1713takes care of our caregivers.1714    Thank you for your husband's service. Thank you for your1715service and helping him.1716    With that, I yield back.1717    Ms. Miller-Meeks. [Presiding.] Thank you, Ranking Member1718Brown.1719    The chair now recognizes Representative King-Hinds for any1720questions you may have.1721    Ms. King-Hinds. First of all, I want to say thank you to1722each and every one of you for coming here and providing your1723testimony and sharing your insights with regards to different1724legislations that are before us. Time is money and traveling is1725very costly, so I definitely appreciate it.1726    I want to start off first by saying thank you to TSL1727Foundation for supporting my very own constituent, Mr. Randy1728Johnson, who has made the 8,000-mile trek here to Washington,1729DC, to amplify the voices of the veterans across the territory,1730specifically the Commonwealth of the Northern Mariana Islands.1731I want to focus my questions today to further flesh out some of1732the challenges that the veterans in the CNMI face by asking a1733couple of questions to Mr. Johnson.1734    Just for the record, prior to a few--up to about 3 months1735ago, you were employed by the district office by my predecessor1736and then the first couple months during my tenure serving as a1737community caseworker, basically serving our veterans. In your1738experience there, what are the three areas of concerns that are1739frequently raised by the vets who come and seek help at the1740office?1741    Mr. Johnson. Thank you for your questions. The veterans1742seek travel. They have difficulty with travel, mainly, to their1743appointments. A lot of times the veterans have to pay out of1744pocket. The veteran from Tinian and Rota traveling to Saipan1745have to pay out of pocket to travel to go see the VA doctor on1746Saipan. If they have to get further care, they have to go1747through BeniTravel, which is on Guam, and a lot of times1748BeniTravel will not issue the tickets immediately for them and1749sometimes it may take up to a couple of days, right, even1750before their appointment schedule. At that point, sometimes the1751veteran is stressed and was worried if they have to cancel or1752postpone their appointments and seek alternative care or1753alternative means by either fundraising for the necessary funds1754to travel or taking up personal loans. A lot of veterans on1755those islands are on fixed incomes and so filing for1756reimbursement with the VA sometimes can be difficult.1757    I know a lot of our veterans are old school, so they would1758rather talk to somebody in person. Communicating with the VA is1759difficult on Guam because they are also working with their VA1760veterans on Guam. Our veterans are stuck with having to wait on1761calls sometimes or not get through and that poses a difficult1762challenge for them as well.1763    Ms. King-Hinds. All right. Tell us just a little bit, just1764so that the committee has an idea, what the cost of travel is1765for vets, for example, from Rota or Tinian----1766    Mr. Johnson. Yes. The travel----1767    Ms. King-Hinds [continuing]. and what all that entails.1768    Mr. Johnson. Yes. The travel between the interislands can1769run up a couple hundred dollars round trip, and that is just1770the veteran him-or herself. Oftentimes veterans are1771uncomfortable traveling by themselves so they would pay for1772their spouse or caregiver and that comes out of pocket, and1773then they would have to file for reimbursement. Fortunately, I1774have not heard of delay in that reimbursement. I would have to1775assume that there has been delays because that was an issue1776during my employment during my--the last delegate-under1777Delegate Sablan. That was something that we had tried to close1778gaps with the reimbursement because a lot of these veterans do1779not just have a single appointment on Guam or Hawaii, they have1780multiple appointments. While they are waiting for the1781reimbursement, they have to push back their next appointment at1782times.1783    Ms. King-Hinds. In terms of specialized care, what are the1784areas of needs do you foresee being something that will fulfill1785some of the medical requirements that are needed on the ground?1786    Mr. Johnson. Yes. The one thing that been highlighted1787during discussions recently is the chiropractic care. I do know1788some veterans that do travel to Guam for chiropractic care,1789including myself in the past. Those tickets can, round trip,1790run between $300 to $580 through United Airlines and that is1791just the airline itself. Then, also, you are considering the1792overnight stay because there is only one flight leaving to Guam1793daily. Those can add up significantly for a veteran.1794    Ms. King-Hinds. All right, thank you.1795    I yield back the balance of my time. Thank you, Chair.1796    Ms. Miller-Meeks. Thank you, Representative King-Hinds.1797    I now recognize myself for 5 minutes for questions.1798    Mr. Lyle, can you share with us how veterans around the1799country would benefit from Congressman Luttrell's SAVES Act?1800    Mr. Lyle. Thank you for the question, Chairwoman Miller-1801Meeks. Obviously, in my opening statement, I testified that I1802have a large, extensive personal experience with this as an end1803user of a service dog.1804    As somebody who has advocated and heard from other veterans1805for years, you know, I think there is a misconception that1806service dogs, at least at the VA, service dogs should be viewed1807simply as clinical tools. I think they also serve as a powerful1808backstop to veteran suicide because when you are in that point,1809that critical crisis point, you feel unloved, you feel alone,1810and you look down at the dog and you say, I cannot leave the1811dog, and the dog would miss me. Right? It provides a sense of1812purpose that pills and therapy simply just will not ever do.1813    I was a little upset to hear the study that the VA cited,1814which I am very familiar with. The study, in my mind, was set1815up to fail because the control group was emotional support1816animals, not somebody that did not have a service dog1817altogether. The study, even though I feel it was set up to1818fail, still showed positive results for reduced post-traumatic1819stress symptoms, depression, anxiety, any number of different1820things.1821    In my long history of advocating for this, the amount of1822veterans that have reached out to me and said, you know, I saw1823your story and it prompted me to get my own dog, and if I had1824not had the dog, I would have killed myself, is just super1825powerful testimony to that end.1826    Ms. Miller-Meeks. Thank you. Mr. Coker, would you mind1827sharing firsthand accounts of servicemembers and their1828families' inability to access your facilities due to the1829current policy and how my legislation would help prevent this1830from occurring again?1831    Mr. Coker. You know, the VA medical centers have such a1832tremendous affiliation with academic medical centers, and so1833often we believe that both within the DOD health system and VA1834health system, you have world-class healthcare. Sometimes the1835treatments need to be so specialized, and when you do not have1836a safe, comfortable environment for your family to be there,1837you worry about do I max out the credit cards? Or you decide I1838am going to accept what time I have left, and I will just1839forego treatment so that we can be together. That is not a1840decision that a military member should have to make.1841    Ms. Miller-Meeks. Thank you very much. Ranking Member1842Brownley, would you like to make any closing remarks?1843    Ms. Brownley. I have no closing remarks, but I thank you1844for bringing the witnesses here today and reviewing all of1845these bills and look forward to continuing to mark them up and1846move them forward.1847    Ms. Miller-Meeks. I want to also thank our witnesses and1848then again apologize for the 90-minute delay on recess as we1849had to go vote.1850    On behalf of the subcommittee, I want to again thank all of1851you, the witnesses and the members, for being here today. I1852look forward to working with you and the Ranking Member to1853address the issues facing our veterans.1854    The complete written statements of today's witnesses will1855be entered into the hearing record. I ask unanimous consent1856that all members have 5 legislative days to revise and extend1857their remarks and include extraneous material.1858    Hearing no objection, so ordered.1859    This hearing is now adjourned.1860    [Whereupon, at 4:44 p.m., the subcommittee was adjourned.]18611862=======================================================================18631864                         A  P  P  E  N  D  I  X18651866=======================================================================18671868                    Prepared Statements of Witnesses18691870                              ----------18711872               Prepared Statement of Antoinette Shappell1873[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]18741875                   Prepared Statement of David Coker18761877    Thank you, Chairwoman Miller-Meeks, and good afternoon to the1878members of the Committee.1879    My name is David Coker, and I have the privilege of serving as1880President of Fisher House Foundation.1881    The Fisher House program was founded in 1990 by Zachary Fisher, a1882private citizen and patriotic philanthropist who believed that no1883military family should ever struggle to be by their loved one's side1884during a medical crisis. He built the first Fisher Houses at the1885National Naval Medical Center and Walter Reed Army Medical Center. The1886vision was simple but powerful: to create a home away from home for1887families traveling to be with a loved one receiving care.1888    The Fisher House program has now grown into a network of 100 Fisher1889Houses located at Department of Defense hospitals and VA medical1890centers across the country and overseas. Because of the special mission1891of supporting both military and veteran families, it is fitting that1892the 100th Fisher House, to be dedicated next month, is located at the1893Captain James A. Lovell Federal Health Care Center--the only fully1894integrated DoD and VA medical center in the country.1895    Each home is now built through the generous support of the American1896public and donated to the VA or the military service it serves. To1897date, Fisher Houses have offered more than 12 million nights of lodging1898and saved families more than $650 million in out-of-pocket costs.1899    When we gift a Fisher House to the Army, Navy, Air Force, or VA,1900our goal is to support families in their time of greatest need. We know1901that having a loved one present improves recovery. Family members serve1902as caregivers, advocates, and a tremendous source of strength. We1903believe they are essential to the healing process--and that every1904veteran and service member deserves to have their loved one at their1905side.1906    Of the 100 Fisher Houses, more than half support VA medical1907centers. In 2024, VA Fisher Houses served more than 24,000 veteran1908families--spanning all eras and every generation.1909    Last fall, guidance was published which changed the way VA houses1910operate. It directed that only families of veterans receiving VA-1911directed care were eligible for the support Fisher Houses provide. Even1912when rooms are available, families that have historically been welcomed1913must now be turned away.1914    Last year, the occupancy rate at VA Fisher Houses across the1915country was 53 percent. We would ask if a room was available;1916consideration should be given to support the family of an eligible DoD1917beneficiary.1918    The Fisher House supporting the Washington DC VA Medical Center is1919on the same campus as the Children's National Hospital, the National1920Rehabilitation Hospital, and Washington Hospital Center. Last year,1921occupancy at that house was 22 percent and could easily accommodate1922families receiving care at one of the other hospitals.1923    The world-renowned Paley Orthopedic and Spine Institute is located1924near the Fisher House supporting the Thomas H. Corey VA Medical Center1925in West Palm Beach, Florida. 27 military children were referred to them1926for life-changing care last year, but today their families are no1927longer eligible to stay in the Fisher House.1928    There are three Fisher Houses at the DeBakey VA Medical Center in1929Houston, Texas adjacent to the Texas Medical Center and MD Anderson.1930Last year, the occupancy rate was 63 percent, and again, because of1931this guidance, military families will be turned away.1932    The bipartisan Fisher House Availability Act of 2025 would restore1933the flexibility that VA Fisher House managers once had, allowing1934families of active-duty service members and other eligible1935beneficiaries to stay on a space-available basis, while preserving the1936priority access for veterans.1937    This change will not reduce access for veterans. It simply allows1938these homes--already built, already staffed, already serving--to do1939what they were intended to do: keep families of our Nation's heroes1940together in the hardest moments of their lives.1941    This bill is consistent with the Memorandum of Understanding1942between the Secretary of Defense and the Secretary of the VA--1943Strengthening our Partnership in Service to those we Serve, and it will1944provide one more way for the two departments to work together to1945support both the military and the veteran communities.1946    On behalf of Fisher House Foundation and the tens of thousands of1947families we have the privilege of serving each year, I want to thank1948the sponsors of this bill and all of you for your support for our1949Nation's service members, veterans, and their loved ones. Thank you for1950the opportunity to speak today. I welcome your questions.19511952                  Prepared Statement of Randy Johnson19531954    Thank you, Chairman Bost, Ranking Member Takano, and members of1955this Committee.1956    My name is Randy Johnson. I am a resident of the Northern Mariana1957Islands, a veteran of the United States Marine Corps, and for the past1958decade I have had the privilege of assisting fellow veterans in the1959Northern Marianas, helping them navigate the VA system, and access the1960benefits they earned through their service.1961    I have traveled nearly 8,000 miles to be here today to speak in1962support of H.R. 3400, the Territorial Response and Access to Veterans'1963Essential Lifecare Act, known as the TRAVEL Act, introduced by our1964delegate, Congresswoman Kimberlyn King-Hinds.1965    This is a good bill. In the Northern Marianas, we do not have a VA1966medical center. We do not have consistent access to specialty care or1967mental health services. When veterans need more than basic care, we are1968often told to leave the island, traveling thousands of miles, paying1969out of pocket, and spending weeks away from our families.1970    The TRAVEL Act helps to change that. It allows the Department of1971Veterans Affairs to send traveling VA physicians into remote1972communities like ours. Instead of forcing the veteran to chase care1973across oceans, this bill brings care to the veteran. That is the right1974direction.1975    I am here to voice my support for the TRAVEL Act. But I also came1976this distance to give voice to the hundreds of veterans who could not1977be here. Veterans who served this country with honor, who, like me, are1978not asking for special treatment. We are asking for what we would1979receive if we lived anywhere else in the United States.1980    We are the only place in the Nation where a veteran can call home1981but have no access to a Community Based Outpatient Clinic. No CBOC at1982all. Veterans from every conflict, past and present, have been told1983that if they want the full range of care they have earned, they cannot1984live at home.1985    Veterans seeking care at home see one doctor, on Tuesdays and1986Thursdays. Dr. Ada has done a good job, but there is only so much one1987person can do. Her office has one VA Registered Nurse, a veteran1988herself. But if she needs care, or takes a much-needed vacation, there1989is no one left to keep pace.1990    Decisions on care, travel, and benefits happen in Guam or Hawaii.1991Resources come from Guam or Hawaii. And when those places are1992struggling or overloaded, we cannot reasonably expect them to1993prioritize our needs.1994    But what we want, and what I believe we have earned, is the right1995to live in the country we fought for, in the community we fought for,1996and to have our service speak for itself. We should not have to choose1997between access to care and being home with our families. We stood the1998watch. We answered the call. That should be enough.1999    I served in Iraq. I saw combat. And I received the Purple Heart for2000it. I traveled here by choice, but many veterans are forced to travel2001simply to receive the care they need. That should not be the case.2002    In the Northern Marianas, I have served alongside and advocated for2003generations of veterans, those who fought in Vietnam, Panama, Iraq, and2004Afghanistan. All of them returned home to a system still not built to2005meet their needs.2006    As I made my way here, I thought of the Vietnam veterans in their200770's and 80's who served our Nation even before our islands were2008formally part of this country. They have spent a lifetime fighting for2009benefits that only trickled in, slowly, over decades. Now, even in2010their later years, they are still being asked to travel off-island for2011basic, sometimes life-sustaining care. I think of how difficult this2012travel is for them.2013    I thought of the Gulf War veterans who opened a new chapter in2014America's military history, but returned to the same old gaps in care2015and support.2016    And I thought of my own generation, those who served in Operation2017Iraqi Freedom and Enduring freedom. We served with commitment. We2018returned home with hope. But we still face the same cycle of delay,2019denial, and distance.2020    Of this new generation of veterans, I am proud to be part of a2021group that is organizing to support one another directly. Project Buddy2022Check 670 is an example of that effort. It reflects our belief that2023care for veterans does not always come in the form of a pill or a2024prescription. Sometimes, it comes from another veteran picking up the2025phone, checking in, and listening.2026    Project Buddy Check is a reminder that veterans seeking care that2027treats us as people, not just patients. But when even ordinary medical2028care is so far out of reach, how can we expect the system to provide2029the mental health and holistic support our veterans truly need?2030    Generations of veterans have answered the call from our islands. I2031know the challenges we face are difficult to address. But again, we2032stood the watch. We bore the burden. That should be enough. It is time2033the system answered back.2034    H.R. 3400 is a strong start. I respectfully ask this committee to2035support it and to continue advancing policies that bring real access2036and real dignity to every veteran, no matter where they live. Thank you2037for your time, and for your unwavering commitment to those who served.20382039                    Prepared Statement of Cole Lyle2040[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]20412042                   Prepared Statement of John Schmitt2043[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]20442045                   Prepared Statement of Caira Benson20462047    Chairwoman Miller-Meeks, Ranking Member Brownley, Members of the2048House Committee on Veterans' Affairs, thank you for inviting me to2049testify today. As the wife and caregiver of a severely injured and ill2050combat veteran, it is my honor to speak to some proposed legislation2051that could lessen the burden each of our caregiving families face every2052day.2053    Veteran family caregivers are a group of people who have been2054tempered in the fires of a war many will never see and even fewer will2055understand. We are forged stronger every day we fight for appropriate2056care for our loved ones.2057    I care for my husband, Eric, deployed twice to Iraq between 2003-20582006, spending roughly over 20 months in combat zones. I immediately2059noticed things were off upon his return home, but I was told not to2060worry. It was only ``expected reintegration stress.'' By 2007, my2061husband's ``reintegration stress'' would ensure he couldn't feel his2062legs when he ran. He was quickly put on a permanent profile, meaning he2063was unable to carry out a mission due to medical conditions that had2064not stabilized, and, due to deployment readiness policies at the time,2065my husband was separated from the Army with no medical board and no2066financial security.2067    We would spend the next decade fighting for understanding of his2068injuries as well as proper diagnosis and treatment while often facing2069the worst-case scenario. Initial screens for Traumatic Brain Injury2070(TBI) were non-existent or misunderstood; the Veterans Health2071Administration (VHA) originally told me my husband's IQ was too high to2072have suffered TBI, despite all evidence to the contrary. By 2010, my2073husband needed full-time care, and I would have to step down from my2074position as an executive director at a non-profit. It would take us2075until 2018 to formally diagnose my husband's multiple TBIs, despite a2076clear record of evidence. It would take another year to figure out his2077case was complicated by toxic encephalopathic process, most likely due2078to chemical exposures. The two conditions, mingling together, started a2079path of neurological degeneration that cannot be stopped.2080    Today, Eric is considered by the Department of Veteran Affairs (VA)2081to be permanently and totally disabled and unable to work. He is2082wheelchair dependent, struggles cognitively, suffers from migraines and2083blackouts, and is visually impaired. I care for him full-time and am2084enrolled in the VA's Program for Comprehensive Assistance for2085Caregivers (PCAFC). His TBI care is considered complex enough it is2086managed by a university specialty neurological team.2087    You should know I am also mom to five amazing children, three of2088whom have needed specialized care over the years. The day my husband2089was awarded permanent and total status, my children and I became2090eligible for the Civilian Health and Medical Program of the Department2091of Veteran Affairs (CHAMPVA). CHAMPVA is medical coverage offered to2092dependents and survivors of eligible veterans, mainly those with 1002093percent permanent and total disabilities. CHAMPVA is also offered to2094caregivers through PCAFC. I breathed a sigh of relief knowing that we,2095too, would have appropriate health care for our needs.2096    However, in 2021, one of my children began attending college prior2097to their 18th birthday and needed monthly medications. We mailed the2098certification paperwork, but, when I went to fill prescriptions, I2099found out CHAMPVA was inactive. I called CHAMPVA, sat on hold for 42100hours, and was told that CHAMPVA's central mail facility was 6 months2101behind opening mail. Because my child was on medications that would2102cause permanent damage if terminated without tapering, I was offered an2103expedited process to certify and activate the CHAMPVA coverage within 72104days via fax. We used the same method to certify coverage in 2022.2105However, in the fall of 2023, coverage lapsed again when certifications2106began to be required on a semester basis instead of a yearly basis,2107compounding the mail-in timeframe dilemma. Horrifyingly, CHAMPVA agents2108relayed to me that CHAMPVA had terminated the ability to expedite2109certifications in the fall of 2024.2110    My child, who is in therapies and on daily medications, suffered2111from lapsed coverage between semesters--even over Christmas break--due2112to the way certification was completed. CHAMPVA's archaic mail system,2113often months behind in opening mail, complicated the ability to2114maintain coverage. Winter break and summer break became a mix of timing2115medication pickups prior to coverage loss and paying out of pocket for2116any therapies or doctor's visits. Indeed, until last month, my child,2117who was enrolled in school, had been without insurance since November21182025, had been paying out of pocket for meds and therapies, and had an2119unpaid ER bill sent to collections. However, it wasn't a miracle in the2120mail room that finally activated the CHAMPVA coverage; it was an2121executive inquiry within VHA.2122    I have another child who graduated high school this past May. With2123licenses and certificates in hand, my child desires to work instead of2124going to college. However, this child knows that within the next 62125months, their CHAMPVA coverage will disappear unless they enroll in2126college or trade school. Can you imagine the pressure on this 17-year-2127old who worked day in and day out to finish high school and attain a2128drone pilot's license within 3 years to meet their goals? This child2129who has given up so much to aid me in the care of their father, who has2130suffered the trauma of watching their father's degeneration, and who2131has been devastated over the lack of appropriate care for both their2132father and their siblings--tell me, how do I tell my child that the2133system meant to help us has spectacularly failed once more?2134    Caregivers like myself and our families need CHAMPVA fixed and that2135begins with ensuring our children, who have already given so much,2136don't have to worry over loss of coverage upon their 18th birthday or2137suffer from lapse of coverage due to an archaic certification process2138by passing H.R. 1404, The CHAMPVA Children's Care Protection Act. This2139legislation would help alleviate these egregious situations by2140authorizing CHAMPVA eligibility automatically through age 26, allowing2141us to forgo the constant bureaucracy, which makes using the benefit a2142challenge. It also recognizes the true nature and sacrifice of these2143young caregivers by allowing them the support they need to transition2144from caregiving into adulthood while having their medical and mental2145health needs supported during key years. Allowing the younger2146dependents coverage until age 26 is crucial and aligns with not only2147private, civilian insurers but also the age limit CHAMPVA eligible2148dependents CHAMPVA must begin to use their VA Chapter 35 Dependent's2149Education Assistance.2150    I understand in VA's testimony to the Senate Veteran Affairs2151Committee on May 21, 2025, VA indicated they opposed this bill due to2152the nature of CHAMPVA, arguing that it is a medical service and not an2153insurance product.2154    However, the industry, the Federal Government, and, more often than2155not, VA treat CHAMPVA as an insurance product. For instance, like those2156covered by Medicaid, Medicare, or TRICARE, my family may not take part2157in the drug cost reduction programs offered to patients on fixed or low2158incomes due to our eligibility for CHAMPVA. If we choose to shop for2159insurance through the Health Care Marketplace, CHAMPVA enrollees are2160not eligible for either financial assistance nor advance premium tax2161credits. Every year, CHAMPVA enrollees receive a 1095-B attesting to2162the fact that CHAMPVA counts as minimum essential coverage under the2163Affordable Care Act. Finally, even VHA states that CHAMPVA is only2164available to caregivers enrolled in PCAFC when they have no other2165health insurance.2166    CHAMPVA provides explanations of benefits (EOB), approves and2167denies diagnostic codes, approves and denies medical treatment codes,2168and remits payment for enrollees to providers for approved services2169rendered by the medical community. CHAMPVA even has out-of-pocket2170maximums, deductibles, copays, and a medication formulary with tiered2171pricing. I admit I am a lay person, but this feels like every other2172insurance product I have ever received through an employer.2173    While I'm here to support extending CHAMPVA coverage to age 26, I2174also ask that this Committee use its oversight authority to improve the2175system itself so our families can find appropriate medical care.2176    To help you understand the challenges, let me explain what using2177CHAMPVA is like. In 2019, when one of our children was hospitalized and2178needed movement to a residential facility, I was told to find a2179facility that would take CHAMPVA, as there was no facility nor provider2180network available under CHAMPVA. I called over 20 TRICARE approved2181facilities to see if they had a bed available or could add my child to2182their waitlist. All but one turned me down immediately. The reason -2183prior authorizations under CHAMPVA since January of that year were2184taking upwards of 6-9 months. The one residential facility that did2185agree to treat our child had a stipulation - we were to sign a $110,0002186promissory note upon admission in the chance CHAMPVA refused2187authorization and payment. Later during treatment, I would be told that2188CHAMPVA had ordered a discharge within 24 hours, even though our child2189had not completed their treatments. Only intervention by a VHA2190executive, finding the preauthorization form in the mail room, enabled2191necessary continued hospitalization approval.2192    Another of my children needed specialized therapy during 2020 and21932021. The physician didn't routinely take CHAMPVA, but, wanting to help2194us, agreed to see us and bill CHAMPVA. Our child completed her therapy2195in 2021. In 2023, I received a call from the physician's office. They2196had finally received payment from CHAMPVA with the exception of one2197therapy session, which I would have to pay for myself. I gladly paid2198and asked about the delay; the account manager relayed that she'd had2199to mail-in everything and simply wait. Because CHAMPVA has no provider2200contracts or a published fee schedule, the provider only had a ballpark2201estimate of what their payment would be until the claim was returned.2202Due to the mail-in claims system, lack of automation, and lack of2203published fee schedule, providers must wait inordinately long periods2204of time for payment, and that payment is a relative unknown until it is2205received. I can't think of a better scenario to discourage provider2206participation.2207    As I mentioned above, CHAMPVA has no contracted network of2208providers or facilities. It has no published fee schedule to share with2209potential providers. It processes the majority of claims using paper2210sent through a mail-in center, lengthening the time between physician2211or enrollee submission, claim processing, and enrollee reimbursement.2212CHAMPVA processes certifications, coverage additions, and changes of2213information through mail - using a single mail center in Colorado for2214all 737,000 enrollees. While an online portal currently exists for2215initial applications only, its functionality varies.2216    Providers who have agreed to take CHAMPVA often have mixed2217messaging - hospitals can file electronically, but most providers I've2218spoken to must file by mail. Some are told to file with the mail-in2219center in Colorado, while others are told to file directly with the2220local VAMC Community Care Network (CCN). Filing and retaining pay for2221services has become so cumbersome that the number of providers willing2222to file it in my area, which is last year's fastest growing county in2223the United States, dropped to 2 practices outside hospitals and urgent2224cares. Neither practice willing to file CHAMPVA contains a2225pediatrician.2226    Once again, I'm paying out-of-pocket for basic, routine, and2227pediatric care. I've stopped filing for reimbursement myself due to the2228burden of the process, including diagnostic codes which may or may not2229be covered and long pay times.2230    My understanding is that CHAMPVA falls under VHA's Office for2231Integrated Veteran Care (IVC), which also runs VHA's CCN. If that is2232true, why could VA not use the existing CCN structure to provide for2233network providers, a published fee schedule, and electronic claims2234submissions? It seems that it would be far more efficient, reduce the2235burden on VA and providers, and better meet the medical best interest2236of our veterans' dependents and caregivers.2237    As a wife and caregiver, I have fought every day for appropriate2238care for my husband and for my children. Yet, I know another fight2239looms on the horizon.2240    Not long ago, I firmly realized, like so many other caregivers, I2241would eventually become a survivor. Having given over a decade to being2242a sandwich caregiver, I am situated to outlive my veteran with almost2243no retirement, no active work credits, and almost no life insurance for2244my and my family's financial security.2245    Because we have fought so long for appropriate care and ratings, my2246family has financially suffered. I left my growing career in non-profit2247administration at the age of 30. What I had saved in retirement until2248that point was cashed out to pay for emergent medical care for my2249family. We have struggled, but survived, for over a decade on only2250disability income. The severity of my husband's injuries, like so many2251others, makes him uninsurable for life insurance.2252    I am not alone. Mozella Richardson Kamara, a 2025 Dole Caregiver2253Fellow from Delaware, studied for many years to become a civil2254engineer, but left her job to care for her veteran husband who suffers2255from many service-connected disabilities, both neurological and2256physical. Like myself, Mozella made this choice to ensure the immediate2257well-being of her husband, and, out of love, sacrificed her own long-2258term professional goals and retirement potential for the benefit of her2259family and service-connected veteran husband.2260    According to a recent RAND report, commissioned by the Elizabeth2261Dole Foundation and released in September of last year, military-2262connected caregivers save this Nation billions in healthcare costs by2263providing a minimum of $119 billion in unpaid care. In exchange, we2264face this harsh reality--when our caregiving ends, most of us will be2265financially destitute.2266    As this harsh reality was revealed, I started planning what I2267could. I used my Chapter 35 Dependents Educations Assistance to finish2268a terminal degree remotely, all while caring for both my husband and2269our children. Once I graduated, I overhauled my resume and began2270seeking any kind of contract work so that I had some earned income.2271That earned income allowed me to finally contribute some small amount2272to a retirement plan. It's too little, too late, but it is something2273more than 0.2274    With the growth of remote work, I eventually began searching for2275full-time work so that I could once again have work credits to pay2276toward Social Security and pay toward student loans. Employers are not2277designed to be caregiver friendly, even with their remote employees. I2278found an employer willing to be flexible with me, and I excelled at my2279job. Unfortunately, I had to resign recently because my salary would2280not entirely cover the cost of care for my husband while I worked. I2281loved my work, I had stellar performance reviews, but I was working at2282a net negative after expenses.2283    Like Mozella, I have once again put aside my own personal and2284professional goals to care for those who need me. But caregivers like2285Mozella and me, we need you to pass H.R. 2148, The Veteran Caregiver2286Reeducation, Reemployment, and Retirement Act.2287    This bill won't fix the entirety of the problem, but it is a2288valuable first step in ensuring caregivers can begin to establish2289safety-nets of their own. It will begin the process and hopefully2290eventually allow caregivers like Mozella and me to contribute to a2291retirement fund. More immediately, it will provide caregivers financial2292security by allowing for returnships, or other possible work-rentry2293program, and paying for re-licensure in careers like teaching and2294engineering, ensuring caregivers like Mozella experience fewer2295obstacles to returning to work.2296    It is a truth that 1 day, every caregiver will stop caregiving,2297either through the veteran's improvement or their passing. As a2298thankful nation, we should ensure veteran caregivers do not end up in2299poverty simply because they ensured their veteran had appropriate care2300due to the wounds, illnesses, and injuries sustained while serving2301their nation.2302    Again, I am honored to be here at the request of the Committee and2303the Elizabeth Dole Foundation. I am ever thankful that Senator2304Elizabeth Dole led the charge to build a remarkable non-profit that2305ensures caregivers like me are seen, accepted, supported, and2306encouraged. Senator Dole gave caregivers a voice so we are heard in2307places such as this Committee room. Every day, caregivers carry out the2308work of caring for, as President Lincoln said, those who have borne the2309battle. To support the veteran, we must also support the caregivers,2310survivors, and families who bear the burden of the war that continues2311to rage at home.2312    I thank you for your time and attention, and I look forward to your2313questions.23142315                       Statements for the Record23162317                              ----------23182319                  Prepared Statement of Joseph Morelle23202321    Chairwoman Miller-Meeks, Ranking Member Brownley, thank you for the2322opportunity to submit this statement for the record in support of H.R.23232148, the Veteran Caregiver Reeducation, Reemployment, and Retirement2324Act. I also want to express my deep appreciation to my colleague and2325co-lead, Representative Juan Ciscomani, for his partnership on this2326vital bipartisan legislation.2327    Every day, thousands of family caregivers across the country make2328extraordinary sacrifices to care for our Nation's veterans. They put2329their careers on hold, deplete savings, and forgo personal goals to2330ensure their loved ones receive the care and dignity they deserve. When2331those caregiving duties come to an end--whether through recovery,2332transition to other care, or the passing of a veteran--these caregivers2333are often left to navigate a difficult and uncertain path forward,2334without the tools or support they need to rebuild their lives.2335    H.R. 2148 seeks to change that. This legislation would require the2336Department of Veterans Affairs to provide family caregivers with2337practical and meaningful support as they transition into the next2338chapter of their lives. This includes employment assistance, retirement2339planning, bereavement counseling, and reimbursement for professional2340certification or re-licensure fees. It would also require VA to study2341the barriers caregivers face when reentering the workforce, grant2342access to existing employment services, and evaluate the feasibility of2343establishing a retirement savings mechanism tailored to their unique2344circumstances.2345    These are not luxuries--they are long overdue acknowledgments of2346the economic and emotional toll that caregiving can take. This2347legislation will empower caregivers to regain their footing and reclaim2348their futures. It is a step toward honoring the quiet service they2349provide behind the scenes and recognizing that their well-being is2350essential to our broader commitment to veterans and their families.2351    Finally, I want to extend my heartfelt thanks to the many2352caregivers across America whose strength and selflessness make this2353bill necessary. Your stories, your sacrifices, and your advocacy have2354shaped this legislation. It is my hope that H.R. 2148 is just the2355beginning of a broader national effort to support you in the same way2356you have supported our veterans.2357    Thank you.23582359          Prepared Statement of Paralyzed Veterans of America23602361    Chairwoman Miller-Meeks, Ranking Member Brownley, and members of2362the subcommittee, Paralyzed Veterans of America (PVA) appreciates this2363opportunity to share our views on some of the legislation before the2364subcommittee today. PVA members, veterans who have acquired a spinal2365cord injury or disorder (SCI/D), experience the breadth of VA care and2366benefits in unique ways due to their injuries and illnesses. We welcome2367the chance to share how some of these bills might impact our members.23682369H.R. 1404, the CHAMPVA Children's Care Protection Act23702371    The Civilian Health and Medical Program of the Department of2372Veterans Affairs (CHAMPVA) is a comprehensive healthcare program for2373the spouse or widow(er) and children of an eligible veteran. Through2374CHAMPVA, VA shares the cost of certain healthcare services and supplies2375with eligible beneficiaries. It may also provide benefits to the2376Primary Family Caregiver through the Program of Comprehensive2377Assistance for Family Caregivers (PCAFC). Coverage for children under2378CHAMPVA currently expires when they turn 18 unless they are full-time2379students. In this case, they continue to receive coverage until they2380turn 23, stop attending school full-time, or get married. However, for2381most Americans with health insurance, their adult children can remain2382on their plan until age 26 with no separate premium, as mandated in the2383Patient Protection and Affordable Care Act (ACA) (P.L. 111-148).2384CHAMPVA and the military's TRICARE programs were not affected by the2385ACA, so they required separate congressional action to extend these2386benefits to children up to age 26. This discrepancy was addressed for2387TRICARE in 2011 and the CHAMPVA Children's Care Protection Act would2388fix this for VA's CHAMPVA program.2389    The delay in making this change to CHAMPVA has adversely impacted2390several of our members. Take PVA member Amy and her husband for2391example. She served honorably in the U.S. Marine Corps before an SCI/D2392cut her military service short. Her husband served in the Marine Corps2393as well, but injuries he sustained in Operation Desert Storm curtailed2394his military career, too. Both have 100 percent disability ratings from2395the VA. Their two boys have severe immune deficiencies that were caused2396by their parents' exposure to hazards during their military service. As2397a result, the boys require weekly plasma infusions to keep them alive.2398These infusions cost thousands per month, and they cannot afford to pay2399for them out of pocket. They rely on CHAMPVA to provide this life-2400saving care and suffered tremendous angst when their oldest child2401turned 18. Fortunately, he became well enough with the infusions that2402they were able to keep him in school and CHAMPVA until he turns 23 in2403March 2026. The younger child is currently 17 but he has additional2404comorbidities that may not allow him to do the same. The family is2405straining under the pressure that the lack of action from Congress has2406put on them and unless legislation like this is passed, there is a very2407real possibility that both children will age out of the program next2408year.2409    The VA testified in opposition to the companion measure to this2410bill at a May 1, 2025, Senate Veterans' Affairs Committee hearing. The2411witness correctly stated that CHAMPVA was not affected by the ACA, but2412we disagree with VA's assertion that it is not health insurance because2413it clearly functions like it. For example, certain types of care and2414services require preauthorization. This approval is extremely2415important, and the failure to obtain it may result in denial of the2416claim. Also, providers must be properly licensed in their State to2417receive payment from CHAMPVA, and they cannot be on the Medicare2418exclusion list. To be reimbursed, providers must file a claim, using2419diagnosis and procedure codes that all other healthcare plans follow.2420    The Congressional Research Service (CRS) which advises Congress on2421programs like this seems to agree. In its October report to Congress on2422VA healthcare programs for dependents and survivors, CRS stated,2423``CHAMPVA is primarily a health insurance program where certain2424eligible dependents and survivors of veterans receive care from private2425sector healthcare providers. The program is administered by the2426Veterans Health Administration (VHA), Assistant Under Secretary for2427Health (AUSH) for Integrated Veteran Care, Office of Integrated Veteran2428Care (IVC). The law (38 U.S.C. Sec. of veterans, 1781) requires CHAMPVA2429to provide for medical care in the same or similar manner and subject2430to the same or similar limitations as medical care is furnished to2431certain dependents and survivors of active duty and retired members of2432the Armed Forces under [the Department of Defense (DOD) TRICARE2433program].'' \1\2434---------------------------------------------------------------------------2435    \1\ Health Care for Dependents and Survivors of Veterans, October243616, 20242437---------------------------------------------------------------------------2438    DOD's TRICARE program wasn't affected by the ACA either, but2439Congress created the TRICARE Young Adult program in 2011 which provides2440health care for qualified young adults aged 21 to 26 who are unmarried2441and not eligible for an employer-sponsored health plan. Our government2442should not deem veterans' dependents and survivors less worthy than2443civilians for support. Those who are eligible for CHAMPVA should be2444able to retain their healthcare coverage until their 26th birthday just2445like those in private and Federal healthcare plans. We urge Congress to2446correct this inequity as soon as possible.24472448H.R. 2148, the Veteran Caregiver Reeducation, Reemployment, and2449Retirement Act24502451    The VA's PCAFC was established by Congress in 2010 to support2452family caregivers who play a critical role in caring for and supporting2453veterans severely injured in the line of duty following 9/11.2454Occasionally, changes have been made to improve the program's support2455of veterans. Such changes include those in the VA MISSION Act of 2018,2456which authorized VA to offer PCAFC to caregivers for veterans of all2457eras.2458    Still, the program does not consider that many caregivers are2459forced to reduce their work hours, take unpaid leave, or leave the2460workforce entirely to provide care. They sacrifice wages, retirement2461savings, and financial stability to care for those they love. The time2462away from their jobs creates gaps in their resumes and many lose the2463employment certifications they previously held. When their loved one2464either passes away or returns to independent functioning, caregivers2465need to return to the workplace and must face these issues. Also, those2466who were relying on CHAMPVA for their health care lose this coverage2467within 90 days of leaving PCAFC through the death or discharge of the2468veteran. Members in other insurance programs have 180 days to2469transition their health insurance benefits.2470    This bill seeks to strengthen the PCAFC by addressing these, and2471other common problems that many caregivers face. Provisions in the bill2472would provide former caregivers with bereavement counseling, funding to2473renew their professional certifications, and the ability to participate2474in employment assistance programs like Military OneSource or the2475Department of Labor's, Veterans' Employment and Training Service. It2476also directs studies on the possibility of allowing caregivers to make2477contributions to Social Security and other types of existing retirement2478accounts, the feasibility of caregivers being allowed to participate in2479a Department of Labor returnship program, and the possibility of the VA2480incorporating former caregivers into the VA workforce as personal care2481attendants, enabling the VA to lessen staff shortages. Last, it gives2482caregivers who are not Medicare eligible the option to keep their2483CHAMPVA coverage for 180 days, if they need it.2484    Caregivers are often the most important component of rehabilitation2485and maintenance for veterans with catastrophic disabilities. As a2486result, their welfare directly affects the quality-of-care veterans2487receive. We strongly support this bill and urge Congress to pass it2488quickly.24892490Discussion Draft, the Fisher House Availability Act of 202524912492    Beneficiaries of active-duty service members often travel far from2493home to receive care through DOD's TRICARE program. Often their2494appointments don't end until late in the day which then requires them2495to drive extended distances home at night. This bill would allow VA to2496provide temporary lodging to a covered beneficiary or a family member2497of a covered beneficiary on a space available basis. If VA has2498available space and there is no cost to the department, PVA can support2499this legislation.25002501Discussion Draft, to provide for a timeframe for the employment in the2502Department of Veterans Affairs of participants in the Health2503Professionals Scholarship Program25042505    The Health Professionals Scholarship Program (HPSP) provides2506financial assistance to students in various healthcare disciplines,2507aiming to meet VA workforce needs. Participants must complete their2508education and meet qualification requirements before employment, with2509the program requiring an 18-month service obligation for each year of2510support. The current law does not have a provision guaranteeing2511graduates of the HPSP a job at the VA following completion of their2512training. PVA supports this draft bill which requires VA to offer each2513participant a contract for full-time employment at the VA facility with2514the greatest need for their specialty within 90 days of their course2515completion date.25162517Discussion Draft, the VA Mental Health Outreach and Engagement Act25182519    PVA supports passage of the VA Mental Health Outreach and2520Engagement Act. The VA suicide report clearly states that veterans who2521are not enrolled and engaged with the VHA are more likely to die by2522suicide. As we work to reduce the number of veteran suicides, the most2523common sense first step is to conduct proactive outreach to veterans2524receiving compensation for a service-connected mental health condition2525who are not accessing VA mental health services. By conducting2526intentional outreach to a vulnerable population, the department could2527not only increase enrollment in VA mental health programs, but2528ultimately, it may move the needle on curbing the number of veteran2529suicides.25302531Discussion Draft, the VA Data Transparency and Trust Act25322533    The House and Senate Veterans' Affairs Committees are responsible2534for moving legislation expanding, curtailing, or fine-tuning existing2535laws relating to health care and benefits for veterans, certain2536dependents, and eligible survivors. The committees also have oversight2537responsibility of the department, which means monitoring and evaluating2538the operations of the VA. So, if the committees find that VA is not2539administering laws as Congress intended, or if emerging needs of2540veterans are identified, it is addressed through the hearing process2541and legislation. To fulfil this role, the committees need timely and2542accurate information, but in recent years, VA has been unable to2543provide either. We strongly believe that VA should be able to produce2544timely and accurate reports to Congress and respective oversight bodies2545so the committees can ensure the department is providing the benefits2546and services that veterans have earned and deserve.2547    We support the VA Data Transparency and Trust Act which requires2548the department to provide Congress with annual reports detailing how VA2549benefits are delivered, who is using them, and how well the system is2550performing while still safeguarding veterans' privacy. This would help2551the committees ensure VA programs are properly funded, operating2552efficiently, and most importantly, meeting the needs of the veterans2553they were intended to serve.25542555H.R. 2605, the Service Dogs Assisting Veterans (``SAVES'') Act25562557    Service dogs provide invaluable assistance to disabled veterans2558with the greatest support needs, allowing them to live more independent2559lives in their communities. PVA supports the SAVES Act, which requires2560the VA to establish a competitive grant program to fund nonprofit2561organizations that provide service dogs to veterans with a variety of2562disabilities, such as mobility or vision impairments or PTSD. Nonprofit2563organizations would be required to submit an application to the2564Secretary that includes a description of the training that will be2565provided by the organization to eligible veterans; the training of dogs2566that will serve as service dogs; the aftercare services that the2567organization will provide for the service dog and eligible veteran; the2568plan for publicizing the availability of service dogs through a2569marketing campaign; and the commitment of the organization to have2570humane standards for animals. Passage of this legislation will increase2571veterans' access to service dogs and their independence.25722573Discussion Draft, the Territorial Response and Access to Veterans'2574Essential Lifecare Act or the TRAVEL Act of 202525752576    Thousands of veterans who are residents of U.S. territories or2577reside on islands in the Pacific face significant challenges in seeking2578medical care. In May 2024, the Government Accountability Office issued2579a report that found these veterans often experienced ``unique and2580substantial barriers'' that veterans in the United States do not2581encounter when seeking medical services from the VA.\2\ PVA supports2582this proposed legislation, which authorizes the department to utilize2583traveling physicians to provide needed health care to veterans residing2584in these areas.2585---------------------------------------------------------------------------2586    \2\ GAO-24-106364, VETERANS AFFAIRS: Actions Needed to Improve2587Access to Care in the U.S. Territories and Freely Associated States25882589---------------------------------------------------------------------------2590Discussion Draft, the Representing our Seniors at VA Act of 202525912592    State Veterans Homes play a crucial role in providing care and2593support for those who have served this Nation in uniform. These2594facilities are designed to meet the unique needs of veterans, offering2595a range of services tailored to their medical and emotional well-being.2596For many veterans and their families, these homes represent a vital2597resource for long-term care, rehabilitation, and companionship. They2598play an outsized role in VA's ability to provide skilled nursing and2599long-term care for veterans. PVA supports including a representative of2600the National Association of State Veterans Homes on the VA's Geriatrics2601and Gerontology Advisory Committee.26022603H.R. 2068, the Veterans Patient Advocacy Act26042605    PVA supports the Veterans Patient Advocacy Act, which seeks to2606ensure there are an adequate number of patient advocates at VA medical2607facilities. Patient advocates are highly trained professionals who can2608help resolve veterans' concerns about any aspect of their healthcare2609experience, particularly those concerns that cannot be resolved at the2610point of care. They help to ensure access to care by listening to any2611questions, problems, or special needs that a veteran has and working to2612resolve them. PVA supports passage of the Veterans Patient Advocacy Act2613with the understanding that VA may need additional resources to assign2614patient advocates to rural community-based outpatient clinics.2615    PVA would once again like to thank the subcommittee for the2616opportunity to submit our views on some of the bills being considered2617today. We look forward to working with you on this legislation and2618would be happy to take any questions for the record.26192620  Information Required by Rule XI 2(g) of the House of Representatives26212622Pursuant to Rule XI 2(g) of the House of Representatives, the following2623information is provided regarding Federal grants and contracts.26242625                            Fiscal Year 202526262627Department of Veterans Affairs, Office of National Veterans Sports2628Programs & Special Events---- Grant to support rehabilitation sports2629activities--$502,000.26302631                            Fiscal Year 202326322633Department of Veterans Affairs, Office of National Veterans Sports2634Programs & Special Events----Grant to support rehabilitation sports2635activities--$479,000.26362637                            Fiscal Year 202226382639Department of Veterans Affairs, Office of National Veterans Sports2640Programs & Special Events----Grant to support rehabilitation sports2641activities--$ 437,745.26422643                     Disclosure of Foreign Payments26442645Paralyzed Veterans of America is largely supported by donations from2646the general public. However, in some very rare cases we receive direct2647donations from foreign nationals. In addition, we receive funding from2648corporations and foundations which in some cases are U.S. subsidiaries2649of non-U.S. companies.26502651        Prepared Statement of Gold Star Spouses of America, Inc.26522653    Chairwoman Miller-Meeks, Ranking Member Brownley, and distinguished2654members of the House Committee on Veterans Affairs, Subcommittee on2655Health,26562657    Gold Star Spouses of America, Inc. appreciates the opportunity to2658submit this statement for the record as the Committee considers several2659important legislative proposals aimed at improving the lives of2660veterans and their families. As an organization dedicated to advocating2661for the needs, dignity, and recognition of surviving military spouses2662and their families, we are encouraged by the Committee's ongoing2663commitment to addressing inequities and modernizing policies that2664directly affect our community.2665    We write today to express our strong support for the CHAMPVA2666Children's Care Protection Act (H.R. 1404), introduced by Ranking2667Member Julia Brownley. This legislation would extend eligibility for2668health care coverage under the Civilian Health and Medical Program of2669the Department of Veterans Affairs (CHAMPVA) to children of disabled2670veterans up to age 26, aligning CHAMPVA with current standards2671established by the Affordable Care Act and the Department of Defense's2672TRICARE program.2673    Currently, children enrolled in CHAMPVA lose eligibility at age 18,2674or at 23 if enrolled in school. This is in stark contrast to families2675covered under private insurance or TRICARE, who benefit from dependent2676coverage through age 26. As a result, children of disabled or fallen2677veterans are too often forced off health coverage at a critical stage,2678while pursuing higher education or beginning their professional lives.2679This disparity is not only unjust; it places unnecessary financial and2680emotional strain on families who have already endured great sacrifice2681in service to our country.2682    Surviving families deserve the same respect, stability, and support2683afforded to others across the Federal health care system. By extending2684CHAMPVA eligibility, this legislation honors the full scope of a2685veteran's service and ensures their children are not treated as second-2686class dependents under Federal policy. We urge the Committee to advance2687this bill and address this longstanding inequity.2688    Gold Star Spouses of America stands ready to work alongside2689Congress to strengthen the systems that support surviving families. We2690remain committed to ensuring the promise made to those who serve, that2691their families will not be forgotten, is fully upheld.2692    Thank you for your consideration of this statement and for your2693steadfast dedication to veterans and their loved ones.26942695Gold Star Spouses of America, Inc.26962697    Gold Star Spouses of America is a national nonprofit organization2698dedicated to supporting the surviving spouses of military service2699members and veterans who have made the ultimate sacrifice in defense of2700our country. Our mission is to provide meaningful support, advocacy,2701education, and a sense of community for Gold Star families. Through our2702programs, we work to ensure that the needs of these spouses and their2703families are heard, addressed, and prioritized by policymakers at the2704Federal, State, and local levels.2705    GSSA is listed as an approved resource in the National Resource2706Directory (NRD.gov) and has been approved by the Department of Defense2707as a resource on Military OneSource and in the ``Days Ahead'' binder2708for all active-duty losses.2709    GSSA is also recognized by the Department of Veterans Affairs for2710volunteer opportunities within the department's Center for Development2711and Civic Engagement.27122713 Prepared Statement of National Association of Veterans' Research and2714                         Education Foundations27152716    The National Association of Veterans' Research and Education2717Foundations (NAVREF) is the national nonprofit organization2718representing over 75 VA-affiliated nonprofit research and education2719corporations (NPCs), established by Congress [38 U.S.C. Sec. Sec. 7361-27207366] to support the VA's medical and scientific research enterprise.2721Since 1992, our community has facilitated clinical trials, engaged2722private sector and academic partners, and advanced groundbreaking2723discoveries that improve the health and lives of veterans.27242725VA Data Transparency and Trust Act27262727    We commend the intent behind the VA Data Transparency and Trust Act2728to improve transparency and trust in VA data. However, we have concerns2729about the scope and quality of data that would be accessed and reported2730if the legislation were enacted. Specifically, the bill calls for2731medical services data as defined by 38 U.S.C. Sec. 1701, which may not2732fully capture the complexity of veteran care and research activities at2733VA. For example, a veteran receiving medical care for diabetes at VA2734could also be enrolled in an industry-sponsored diabetes study at the2735same VA medical center, but those treatment protocols are not2736traditionally accounted for the same way as a ``medical service'' is.2737This segmentation risks incomplete or skewed reporting, limiting the2738full picture of veteran care and research. We urge Congress and VA2739stakeholders to carefully consider these nuances to ensure transparency2740efforts accurately reflect the scope of veteran care and research and2741ultimately, keep VA accountable on all aspects of the integrated health2742care system.27432744RNA Sequencing to Diagnose PTSD Bill27452746    NAVREF fully supports the direction of the proposed legislation2747directing the VA to study whether RNA sequencing can effectively2748diagnose inflammation or cellular stress symptoms related to PTSD in2749veterans. This initiative aligns with ongoing VA research efforts to2750explore innovative molecular diagnostics and precision medicine2751approaches that could improve mental health diagnosis and treatment.2752Several VA-affiliated nonprofits are actively engaged in PTSD research,2753and NAVREF's membership stands ready to collaborate with the VA and2754congressional committees by sharing expertise, supporting study2755implementation, and facilitating connections with research programs. We2756also encourage the legislation to be inclusive of the VA Million2757Veteran Program and direct it to use its resources and data to engage2758in this initiative.2759    NAVREF appreciates the opportunity to provide input on these2760important legislative efforts. We look forward to working closely with2761Congress and VA leaders to help refine policies and support research2762that advances veterans' health and well-being.27632764   Prepared Statement of National Association of State Veterans Homes27652766    Chairwoman Miller-Meeks and Ranking Member Brownley:27672768    As President of the National Association of State Veterans Homes2769(NASVH), I'm pleased to offer our strong support for H.R. 785, the2770Representing our Seniors at VA Act of 2025, legislation to include a2771member of NASVH on VA's Geriatrics and Gerontology Advisory Committee2772(GGAC). This legislation is a commonsense effort to ensure that the2773experience and expertise of a State Veteran Home (SVH) leader is a part2774of VA's long term care planning.2775    As you may know, NASVH is an all-volunteer organization dedicated2776to promoting and enhancing the quality of care and life for the2777veterans and families in our Homes through education, networking, and2778advocacy. Today there are 172 VA-recognized State Veterans Homes across2779the Nation operating 166 skilled nursing care programs, 47 domiciliary2780care programs, and 3 adult day health care (ADHC) programs. NASVH is2781the only organization representing their collective interests, and our2782membership continues to grow as new Homes seek VA recognition.2783    With over 30,000 authorized State Home beds providing a mix of2784skilled nursing and domiciliary care, SVHs provide approximately half2785of all federally supported institutional long-term care for veterans2786yet consume less than 20 percent of VA's total budget for veterans'2787long term nursing home care. Having a permanent seat for a NASVH member2788would add a critical voice commensurate with the leading role that2789State Veterans Homes play in meeting veterans long term care needs.27902791    The GGAC was first authorized by Public Law 102-40 in 1991 to2792advise VA on all matters pertaining to geriatrics and gerontology, and2793was charged with three specific tasks:27942795        1. Evaluate the operation and effectiveness of VA's Geriatric2796        Research Education and Clinical Centers (GRECCs);27972798        2. Assess the demand for long term care by veterans and VA's2799        capability to provide high quality geriatric and extended care2800        services; and28012802        3. Assess the current and projected needs for veterans' long2803        term care services and VA's activities and plans to meet such2804        needs.28052806    H.R. 785 would require the appointed NASVH member to be a licensed2807nursing home administrator, which would provide a different perspective2808from the clinicians, researchers, and academics on the GGAC.2809Historically, there have been few, if any, GGAC members with direct2810experience leading or overseeing nursing homes, and particularly not2811ones focused on the care of aging and disabled veterans.2812    For more than a decade, NASVH had proposed a number of highly2813qualified leaders for membership on the GGAC, however none had been2814chosen until last year. Among the arguments that some VA officials had2815made against a NASVH member was that State Home administrators were not2816``experts'' and that the GGAC already had sufficient expertise.2817However, the vast majority of GGAC members have never run a nursing2818home, nor worked directly on issues related to aging and disabled2819military veterans and their unique medical and social challenges.2820    We were pleased last fall when then-VA Secretary McDonough and2821Under Secretary Elnahal agreed to add a NASVH member, however we were2822disappointed to learn that the NASVH member would be a ``non-voting''2823member of the GGAC. We were told that a NASVH member would have a2824conflict of interest, since State Veterans Homes receive funding from2825VA, even though many current and past members of the GGAC have worked2826for organizations or companies that have an interest in Federal2827policies related to long term care.2828    For example, the GGAC's immediate past Chairman, David Gifford, was2829the Chief Medical Officer for the American Health Care Association2830(AHCA), which lobbies on behalf of thousands of nursing homes,2831overwhelmingly private ones. Most of these nursing homes receive2832significant Federal funding through the Center for Medicare and2833Medicaid Services (CMS), and many also have contracts with VA for the2834care of veterans. Yet, Dr. Gifford was able to successfully lead the2835GGAC and manage his dual roles in conformity with Federal ethics rules.2836    While NASVH receives no funding from VA or any Federal agency, if a2837member of NASVH appointed to the GGAC also works for a State Veteran2838Home, then that member would certainly recuse themselves appropriately,2839in the same manner as other GGAC members whose jobs, organizations, and2840companies are impacted by Federal funding, grants, and policies.2841    Madame Chairwoman, State Veterans Homes can and must play a greater2842role in meeting the needs of aging veterans and their caregivers in2843partnership with VA and other Federal agencies. One way to strengthen2844that partnership is to ensure that NASVH and its members are engaged2845when VA is discussing, evaluating and making plans to improve the2846access to and quality of long-term care for our Nation's aging and2847disabled veterans.2848    NASVH fully endorses H.R. 785 and looks forward to continuing to2849work with Congress and VA to ensure that veterans have greater access2850to a full spectrum of long-term care options, whether at home or in2851nursing homes. Adding the experience and expertise of a NASVH member2852will not only benefit the GGAC but will also improve the lives of2853America's heroes.28542855            Prepared Statement of Quality of Life Foundation28562857    Thank you Chairman Miller-Meeks, Ranking Member Brownley, and2858distinguished members of the Committee for allowing us to emphasize and2859advocate for H.R. 2148, the Veteran Caregiver Re-education, Re-2860employment and Retirement Act (Veteran Caregiver 3R Act). This bill is2861deeply personal to my organization, Quality of Life Foundation, and to2862me personally as a caregiver to a veteran who withdrew from the VA's2863Program of Comprehensive Assistance for Family Caregivers (PCAFC). I'd2864like to thank Congressmen Ciscomani and Morelle, as well as Senator2865Moran, and former Senator Sinema for taking my words in the SVAC2866hearing in March 2022 to heart when I said VA's family caregivers,2867without the safety nets in this bill, will fall into poverty upon2868leaving their caregiving roles. I will leave the facts and statistics2869of caregivers' financial contributions and lost income to others.2870Today, I want to tell you why this legislation is personal to me and2871why I feel it necessary to advocate so strongly for it.2872    In 2009, Wounded Warrior Project invited myself and 19 other Post28739/11 military veteran caregivers to the Hill, to tell our stories to2874lawmakers about why Congress should create the VA's Caregiver Support2875Program, a component of which, the Program for Comprehensive Assistance2876for Family Caregivers (PCAFC), would provide a stipend for those2877caregivers whose role prevented us from maintaining a position in the2878workforce. When I arrived in DC in July 2009, my husband was on his2879third hospitalization since returning from Iraq in February 2007.2880During those years, I had tried to maintain my 13 year teaching career2881while raising two young children and caring for him, but it was2882impossible to simultaneously teach well and to caregive well. And,2883honestly, there is no room in either role, teacher or caregiver, for2884anything less than well.2885    In May 2009, I made the decision to give up my financial2886independence and professional identity in order to become ``just a2887caregiver.'' At the time, not only did I hold teaching licenses in two2888states, but I also held my National Board Of Professional Teaching2889Standards certificate. This certificate offered me a substantial salary2890boost to my teacher salary and is something only 141,000 teachers2891nationwide have achieved. The last day of that school year in June 20092892saw me shifting from providing the majority of my family's income to2893providing none of it.2894    That shift was substantial and provided the reason it was so2895important for me to advocate for family caregivers in the summer of28962009. I gave up my job voluntarily to care for my husband, but, in2897doing so, I lost my professional identity, my financial independence2898which contributed to my family's financial well-being, and my long-term2899retirement savings' stability. Additionally, I had no idea how long I2900would have to support my veteran through caregiving nor the long-2901lasting effects that it would have on my retirement savings.2902    In 2009, I came to the Hill with high hopes for the creation of a2903program that would provide me, a caregiver, an income, allowing me to2904make a monetary contribution to my family and relieve the financial2905pressure we felt after losing my teaching income. I also had hopes of2906having my role as caregiver validated as an important part of my2907husband's recovery, not just another role that was expected of me. When2908the Caregivers and Veterans Omnibus Health Services Act of 2010 was2909signed into law on May 5, 2010, I was excited to see a program that I2910had supported through legislation come into fruition.2911    However, as the years have gone by, PCAFC has become a reality2912along with regulations and a few oversights. As a person who worked on2913helping PCAFC come into existence, I find it imperative that I, as2914Advocacy Director of Quality of Life Foundation's Wounded Veteran2915Family Care Program, and a caregiver, lead the efforts in fixing those2916oversights, for the caregivers that advocated for that original2917legislation and all the caregivers that have come before and will come2918after us.2919    As a teacher, I had to renew my licenses with continuing education2920credits, some of which can be earned by teaching in the classroom and2921others through taking classes or going to conferences. I held on to my2922State licenses for 15 years, but did eventually give them up. It made2923little sense to keep them, when there was no end in sight to my2924caregiving. In addition to my regular State teaching licenses, The2925National Board of Professional Teaching Standards certification that I2926had taken such pains to earn in addition to my State licenses was lost2927as it could only be renewed by actually being in the classroom.2928    Had I chosen to return to the classroom, here's what would have2929happened: I would have needed to renew my license. Depending on the2930State, I would be teaching on daily substitute pay until my full2931license was restored by earning enough continuing education credits.2932Not only would that path mean teaching days be paid with extremely low2933wages on which to support myself, it also meant I would have to bear2934the cost of the renewal of my licenses which could add up to thousands2935of dollars depending on the State requirements, including any college2936classes or seminars. That is not a cost caregivers can support if they2937have lost their income from caregiving, nor will that cost be2938realistically covered by the 3-months of stipend paid when the2939caregiver exits PCAFC.2940    H.R. 2148, the Veteran Caregiver Re-education, Re-employment, and2941Retirement Act would grant $1000 per caregiver for those who wish to2942renew licenses or certifications upon leaving the Caregiver Program and2943returning to the workplace. H.R. 2148 would institute a program which2944is a mirror of a program that already exists in DOD for military2945spouses that must relocate due to their spouses receiving orders. In2946reality, many of our caregivers will never return to the workplace,2947either because their veterans never recover fully enough for them to do2948so or because they will end caregiving well past retirement age. But2949for those caregivers who must return to the workforce due to the death2950of their care recipients during their pre-retirement years, this money2951would be essential.2952    The bill would study expanding returnships to caregivers.2953Returnship programs are already supported by the Department of Labor.2954Returnships are opportunities for companies to hire Americans returning2955to work after being out of the workplace for a period of at least 22956years. The best way to think about returnships are to think of Robert2957De Niro's character in the movie The Intern. Technically he wasn't an2958intern; he was a return. This type of returnship program would allow2959caregivers to become current on workplace skills while using the vast2960knowledge they have from their prior careers and leveraging the skills2961they have learned from caregiving, such as superb organizational skills2962and ability to prioritize multiple tasks. Some companies, i.e. Goldman2963Sachs and Wells Fargo, and State governments, such as Utah and Vermont,2964have returnship programs already established.2965    The VA remains in a shortage of workers to meet demand, and the2966Veteran Caregiver 3R Act would study whether caregivers discharged from2967PCAFC could be used to fill gaps within the VA workforce, either2968through roles leveraging prior professional skillsets or as non-medical2969attendants. Either way, leveraging the wealth of experience, knowledge,2970and skill sets of caregivers exiting PCAFC could be a way to fill2971apparent gaps in VA's workforce while also providing economic stability2972to caregivers having to return to the workforce.2973    Another component of this bill offers transition assistance to2974caregivers who are either transitioning from caregiving back to the2975workforce or into caregiver ``retirement,'' the later stages of life2976where it is no longer beneficial for caregivers or their care recipient2977to have care from the person designated as the family caregiver.2978    But what future exists for caregivers without retirement income2979options? Truly, this is the most important component of this bill to2980me. It solves a crisis that currently keeps me up at night. For many2981years, I was not able to contribute to a retirement fund due to lack of2982earned income in my home. Any year that I worked part time, I made a2983contribution to my personal individual retirement account, though there2984were many years it was not funded or underfunded due to limited income2985and the inability to contribute. At 51, I have about one-third of the2986retirement savings that I should have at this time, and I am running2987out of time to catch up on those contributions.2988    I am one of the lucky ones. I was old enough to have made some2989retirement contributions, and I have been able to return to work in a2990job that uses all of my teaching experience and my knowledge of caring2991for an injured veteran.2992    Unfortunately, that is not the case for many of the caregivers I2993advocated with on the Hill in 2009. Many of them have been caregivers2994since 2005. They are looking at 20 years with no contributions to2995Social Security or individual retirement accounts. There is no safety2996net for them if they are injured while providing care for their loved2997one. If their spouses pass away now, with them in their early 40's to2998mid 50's, they will have to go back into the workplace after more than299920 years out of the workforce. They will have no retirement savings,3000and they will have to move into jobs that are at a lower pay level than3001their peers of the same age due to their lack of work experience. This3002severely limits their ability to save for retirement in their personal3003retirement accounts and their income from Social Security. In addition,3004the Social Security spousal benefit will not be an option for them3005because their spouses stopped contributing to Social Security at an3006extremely young age; meaning the potential spousal benefit would be3007extremely low, if it existed at all. These caregivers should not be3008forced into a low retirement income because they chose to care for3009their loved one and save the VA and taxpayers money.3010    As caregivers, we simply want to be able to have a way to3011contribute to and fund our own retirement savings and income so that we3012do not to fall into poverty because we chose to care for our veterans3013at home. Please allow us the pathway to do this. Such a pathway could3014be created by creating special caregiver IRA's which would allow3015taxation at the withdrawal period and not at the contribution period.3016Other options are Thrift Savings Plans like those offered to troops.3017    While I am extremely grateful that I was able to be a part of the3018creation of the VA's PCAFC, I would also like to be a part of the3019fixing issues that were not even considered when the legislation3020creating the program was drafted. None of us knew this would be a3021potential lifelong role. We did not think about returning to the3022workforce if our care recipient passed away. None of us thought about3023retirement at the ages of 20 or 30, and none of us thought about having3024to transition from caregiving for our veteran to possibly needing to3025``retire'' from caregiving and ourselves be cared for and how that3026would be funded. But today, at 40 and 50 years of age, we are thinking3027of that. And what we see is frightening--we don't have easy pathways to3028returning to the workforce or retiring. Some of us have no pathway to3029return to the workforce or retire.3030    Veteran Caregiver Re-education, Re-employment, and Retirement Act3031is our plea to Congress to help us address these issues. It allows us3032to create our own long-term safety nets through re-employment or3033funding retirement. As a caregiver for a veteran, and as an advocate3034for caregivers of veterans, I would ask you to please pass H.R. 2148,3035the Veteran Caregiver Re-education, Re-employment, and Retirement Act.30363037      Prepared Statement of United Services Automobile Association30383039    On behalf of the United Services Automobile Association (USAA) and3040our nearly 14 million members of the U.S. military, veterans who have3041honorably served, and their families, thank you for convening today's3042hearing on legislative proposals to care for our Nation's veterans and3043their families. We appreciate the opportunity to provide this statement3044of support for H.R. 2148, the Veteran Caregiver Reeducation,3045Reemployment, and Retirement Act.3046    USAA is a membership association that serves members of the3047military community, including active duty, Guard, Reserve, veterans,3048and their families. Since our founding in 1922 by 25 U.S. Army3049officers, USAA has facilitated the financial security of our members,3050associates, and their families by providing a full range of highly3051competitive financial products and services. In our second century of3052service, we remain focused on meeting our members' needs through every3053stage of life--from joining the military to buying a home to retiring.30543055H.R. 2148, the Veteran Caregiver Reeducation, Reemployment, and3056Retirement Act30573058    In September 2024, RAND published a report commissioned by the3059Elizabeth Dole Foundation titled, ``America's Military and Veteran3060Caregivers: Hidden Heroes Emerging from the Shadows.'' There are3061approximately 14.3 million military and veteran caregivers today,3062representing 5.5 percent of the U.S. adult population. According to3063RAND, these caregivers on average incur over $8,500 in annual out of3064pocket costs, while forgoing over $4,500 in annual household income.3065More than one-third of these caregivers live below 130 percent of the3066Federal poverty level. Serving as a caregiver can also compound future3067financial challenges. Military and veteran caregivers often have3068employment gaps in their resume, which can impact their future3069employment and earnings prospects, and many lack retirement savings3070vehicles to invest in their own financial security.3071    This bipartisan bill will expand support available to veteran3072caregivers enrolled in the Department of Veterans Affairs (VA) Program3073of Comprehensive Assistance for Family Caregivers (PCAFC). It would3074provide employment assistance to eligible caregivers, including fee3075reimbursement associated with professional certifications or licenses.3076Caregivers would also be granted access to existing employment3077assistance programs through the VA, the Department of Defense, and the3078Department of Labor. In recognition of the fact that caregivers are at3079higher risk of depression and suicidality, the bill expands caregiver3080access to bereavement counseling and support. The bill also directs the3081VA to study the feasibility of establishing a retirement plan or3082alternate pathway to retirement savings for veteran caregivers.3083    USAA thanks Representatives Joseph Morelle (D-NY) and Juan3084Ciscomani (R-AZ) for their leadership on this important proposal to3085better support the caregivers who selflessly serve our Nation. We urge3086the Committee to support the bill when considered during a future3087markup.30883089Prepared Statement of The Veterans of Foreign Wars of the United States30903091    Chairwoman Miller-Meeks, Ranking Member Brownley, and members of3092the subcommittee, on behalf of the men and women of the Veterans of3093Foreign Wars of the United States (VFW) and its Auxiliary, thank you3094for the opportunity to provide our remarks on this pending legislation.30953096H.R. 785, Representing our Seniors at VA Act of 202530973098    The VFW supports this legislation to include a representative from3099the National Association of State Veterans Homes on the Department of3100Veterans Affairs (VA) Geriatrics and Gerontology Advisory Committee.3101This inclusion would give state-run veterans homes a voice in Federal3102VA policymaking on elder care, and facilitate collaboration between VA3103and State Veterans Homes (SVHs) as the veteran population continues to3104age.3105    SVHs originated in the pre-Civil War era and were initially3106established to care for injured and aging soldiers. These homes are3107operated by State governments and provide nursing, assisted living, or3108domiciliary care specifically for veterans. They offer long-term care3109services tailored to meet their unique needs.3110    Living in SVHs offers several benefits, including subsidized care,3111VA per diem grants that help reduce out-of-pocket expenses, and a3112supportive environment where veterans can connect with one another and3113build camaraderie. VA provides general oversight for all 153 SVHs,3114which care for approximately 14,500 veterans.31153116H.R. 2068, Veterans Patient Advocacy Act31173118    The VFW supports this legislation to provide veterans living in3119highly rural areas with better access to patient advocate services. For3120the past 11 years, the VFW has partnered with Student Veterans of3121America (SVA) to select student veterans from across the country to3122research and advocate for improvements on issues that matter to3123veterans. Past VFW-SVA Fellow and Grand Valley State University3124graduate Cameron Zbikowski focused his semester-long research proposal3125on enhancing the patient advocate program at VA. He proposed3126improvements to ensure that each facility had an adequate number of3127patient advocates. In that spirit, the VFW continues to support this3128legislation.31293130H.R. 2605, Service Dogs Assisting Veterans (SAVES) Act31313132    The VFW strongly supports this legislation to create a 5-year pilot3133program in which VA would provide up to $2 million in grants to3134nonprofit organizations to provide service dogs to eligible veterans.3135It would also provide commercially available veterinary insurance for3136them. Service dogs assist with various physical, auditory, and trauma-3137related disabilities. They help empower veterans to regain their3138independence, pride, and hope. While they are typically provided free3139of charge, the medical care involved can be costly. This legislation3140would enable more veterans to receive support animals with less of a3141financial burden.3142    The VFW thanks Representative Luttrell for introducing this3143legislation and for inviting VFW Post 4709 Commander Marcy Phillips3144from his Post in Conroe, Texas, to speak at the Congressman's press3145conference for this legislation. The VFW was honored to have her talk3146about her service dog and how it has had a positive impact on her life.31473148H.R. 3400, Territorial Response and Access to Veterans' Essential3149Lifecare (TRAVEL) Act of 202531503151    The VFW supports this legislation to authorize VA physicians to3152temporarily serve as traveling physicians for up to 1 year in American3153Samoa, Northern Mariana Islands, Guam, Puerto Rico, the Virgin Islands,3154and other U.S. territories. It would improve support for veterans3155living in these areas or medically underserved regions by offering3156providers incentives like relocation or retention bonuses. This would3157allow VA to address gaps in health care in U.S. territories and provide3158a continuity of care through coordinated integration with local3159providers.31603161H.R. 3643, VA Data Transparency and Trust Act31623163    The VFW supports the intent of this legislation, but we have3164questions about the scope of the information to be collected. This3165proposal would establish certain VA annual reports to Congress from the3166Veterans Benefits Administration and the Veterans Health3167Administration. The reports would span 5 years, focusing on areas such3168as hospital care, medical services, nursing home care, and the3169management of these services. It includes a set of metrics designed to3170provide insights into veterans' demographic profiles, health3171conditions, service utilization, and benefits usage over time. While3172the VFW has advocated for improved data reporting by VA, we also want3173the intent of these reports to be made clear. The VFW also cautions3174against collecting income and other financial information of veterans3175that could be used to reduce benefits or prevent veterans from3176accessing their earned benefits.31773178Discussion Draft: To direct the Secretary of Veterans Affairs to3179conduct a study to determine whether RNA sequencing can be used to3180effectively diagnose PTSD in veterans31813182    As a resolutions-based organization, the VFW does not have a3183position on this proposal at this time, however, we do have some3184concerns. This legislation would direct the Secretary of Veterans3185Affairs to conduct a study on whether ribonucleic acid (RNA) sequencing3186can effectively diagnose post-traumatic stress disorder (PTSD) in3187veterans. Although this idea is innovative, focusing solely on3188biological markers may oversimplify the complexity of the disorder.3189Trauma, environment, genetics, and psychology are all factors in PTSD.3190While a biomarker-based diagnostic tool could aid in the early3191detection of PTSD, it also raises several scientific, practical, and3192ethical concerns.31933194Discussion Draft: Health Professionals Scholarship Program Improvement3195Act of 202531963197    The VFW supports this legislation to improve the hiring of3198participants in the VA Health Professional Scholarship Program that3199provides scholarships to students pursuing health care degrees in3200exchange for service at VA facilities. It enables VA to provide3201incentives to qualified health care professionals to work at VA medical3202centers, particularly in areas where recruitment and retention are3203difficult.3204    This legislation would create a more efficient process of placing3205scholarship recipients into clinical roles, which is particularly3206important given VA's critical medical staff shortages. It would do this3207by requiring VA to provide employment contracts within 90 days of3208students completing their coursework. It would also assign providers to3209VA facilities with the highest need, and offer competitive salaries and3210benefits aligned with VA standards.32113212H.R. 3726, Fisher House Availability Act of 202532133214    The VFW supports this legislation to allow veterans, service3215members, and their families to stay at temporary lodging facilities,3216such as Fisher Houses, when having to travel significant distances for3217medical care. For more than 30 years, Fisher Houses have been available3218free of charge. The Fisher House Foundation provided 57 homes to VA and321942 to the Department of Defense. A VA policy change in 2023 restricted3220these homes to only those receiving VA-directed care, greatly3221restricting service members with TRICARE from using this option. In32222024, Fisher Houses were operating at only 53 percent capacity, mainly3223housing the families of hospitalized veterans. This proposal would3224codify the previous practice of allowing service members who receive3225non-VA care and their families to stay at temporary lodging facilities3226on a space-available basis. The priority access would continue to be3227for veterans and their families. The VFW sees this as a reasonable3228expansion for TRICARE beneficiaries and their families. Broadening3229eligibility would help alleviate financial and logistical burdens when3230a loved one needs to be hospitalized or receive medical care far from3231home.32323233H.R. 1404, CHAMPVA Children's Care Protection Act of 202532343235    The VFW supports this legislation that extends the age limit for3236children eligible for medical coverage under the Civilian Health and3237Medical Program of the Department of Veterans Affairs (CHAMPVA). This3238legislation aims to enhance health care access for young adult children3239of veterans, ensuring they receive continuous care during a critical3240phase of life and minimizing coverage gaps for military families. This3241initiative is a key legislative priority for the VFW, and it aligns3242with other Federal health care programs such as the Affordable Care Act3243that allows dependent coverage until age 26.32443245H.R. 2148, Veteran Caregiver Reeducation, Reemployment, and Retirement3246Act32473248    The VFW supports this legislation to expand medical coverage,3249counseling, and employment services to individuals who have3250participated in VA's caregiver programs. These dedicated individuals3251spend a significant amount of time providing in-home care. When someone3252leaves the program, typically because the veteran loved one has passed3253away, the caregiver often faces challenges when attempting to reenter3254the workforce. Proper training, counseling, and support for3255reintegration are essential for those who have left their careers to3256become full-time caregivers.3257    This proposal would provide employment assistance to former3258caregivers through reimbursement of certification fees, access to VA3259training modules, and support through Military OneSource and the3260Veterans' Employment and Training Service. It would also expand3261available retirement planning and workforce transition assistance for3262these individuals; extend CHAMPVA medical coverage to former caregivers3263for 180 days after their designation ends as long as they were not3264dismissed for fraud, abuse, or mistreatment; and provide bereavement3265counseling following the death of the veteran. The VFW sees all of3266these initiatives as beneficial to the dedicated caregivers who provide3267long-term care for veterans who need it.32683269Discussion Draft: VA Mental Health Outreach and Engagement Act32703271    The VFW appreciates the intent of this legislation, but we have3272certain recommendations for improvement. Currently, VA is required to3273offer a mental health consultation to veterans within 30 days after3274submitting a claim for disability compensation for mental health3275conditions. Offering veterans mental health consultations every year3276may be a deterrent that creates concerns that their benefits could be3277reduced, or cause retraumatization when asked to discuss their mental3278health needs.3279    The VFW recommends instead that VA conduct regular outreach to3280veterans who have filed VA claims (regardless of the outcome of these3281claims) and who do not utilize VA health care services, so they can3282receive information about services they may need now or in the future.3283Effective outreach to those within the VA health care system and to3284those who have not yet enrolled would encourage veterans to consider3285these services and utilize them when needed.3286    Chairwoman Miller-Meeks, Ranking Member Brownley, this concludes my3287statement. Again, thank you for the opportunity to offer our comments3288on these issues.32893290Information Required by Rule XI2(g)(4) of the House of Representatives32913292Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has3293not received any Federal grants in Fiscal Year 2025, nor has it3294received any Federal grants in the two previous Fiscal Years.32953296The VFW has not received payments or contracts from any foreign3297governments in the current year or preceding two calendar years.32983299     Prepared Statement of American Academy of Physician Associates33003301    Subcommittee Chairman Miller-Meeks, Subcommittee Ranking Member3302Brownley, and Members of the Committee on Veterans' Affairs:33033304    On behalf of the approximately 190,000 physician associates/3305physician assistants (PAs) throughout the United States, including more3306than 2,500 PAs employed by the Veterans' Health Administration to serve3307veterans, the American Academy of Physician Associates (AAPA) thanks3308the Subcommittee on Health for its continued leadership on veterans'3309health issues. We appreciate the opportunity to comment on H.R. 3767,3310the Health Professionals Scholarship Program Improvement Act of 20253311(HPSP Improvement Act of 2025), which was introduced by Reps. Abraham3312Hamadeh (R-AZ) and Nikki Budzinski (D-IL).3313    The PA profession proudly maintains a close connection to the VA,3314as the founding class of PA students in 1965 were veterans. These first3315PA students were former Navy hospital corpsmen and Army combat medics3316with considerable medical training from their military service. The VA3317was the first employer of PAs in 1967 and today is the largest single3318employer of PAs in the Nation. Eleven percent of all practicing PAs and331924 percent of PAs employed by the VA are veterans, active-duty3320military, or serve in the National Guard and Reserves. PAs maintain a3321strong, personal desire and dedication to serve veterans and AAPA fully3322supports efforts, such as the law enacted in 2018 that provided funding3323for HPSP scholarships for PAs, to strengthen the workforce at the VA3324and expand access to care for veterans.3325    Last year, AAPA commented on a proposed rule to implement3326requirements in the Consolidated Appropriations Act of 2023 for the VA3327to ``specifically award scholarships to applicants pursuing degrees or3328training in mental health disciplines, including advanced practice3329nursing (with a focus on mental health or substance use disorder),3330psychology, and social work,'' and to provide no fewer than 503331additional awards to such applicants beginning in academic year 2022.3332In its comments, AAPA noted that while it appreciated the VA specifying3333that PAs should be eligible for the additional HPSP scholarships, it3334also formally requested that the VA specifically list PAs in the Code3335of Federal Regulations as well to minimize any future confusion.\1\ In3336its final rule, the VA responded that ``PAs are eligible to apply for3337and receive HPSP scholarships for mental health disciplines under3338proposed Sec.  17.603(b)(2),'' but that it would not be making changes3339based on AAPA's comments because, ``the list of mental health3340disciplines in proposed Sec.  17.603(b)(2) is not an exhaustive list''3341and ``VA determined that it should maintain a non-exhaustive list in3342the regulation to permit flexibility so that new mental health3343professions can be included without the need to amend the3344regulations.'' \2\ AAPA continues to support efforts that encourage and3345support PAs to practice in mental or behavioral health and psychiatry3346to help address national provider shortages.3347---------------------------------------------------------------------------3348    \1\ American Academy of Physician Associates. Comments on Proposed3349Rule-VA Health Professional Scholarship Program. October, 2023.3350    \2\ Federal Register. 38 CFR Part 17, RIN 2900-AR98, VA Health3351Professional Scholarship Program. June, 2024.3352---------------------------------------------------------------------------3353    AAPA has heard from some PAs working for the VA that even after3354completing the HPSP, there are many problems with communication and3355administrative delays that have prevented HPSP beneficiary PAs from3356being able to treat veterans. Some PAs have faced delays as long as 63357months from the time of their interview until they began work at a VA3358facility. These unnecessary delays impose the burden of an income gap3359on PAs and other health care providers who would like to care for3360veterans, while also compounding the problem of student debt. The HPSP3361Improvement Act of 2025 would address this problem by requiring the3362Secretary of the VA to ensure that HPSP participants receive a contract3363for full-time employment withing 90 days of the completion of their3364training.3365    The HPSP Improvement Act of 2025 is an important step toward3366ensuring that the VA is able to hire qualified health care3367professionals for which recruitment or retention is difficult. However,3368as the VA and Congress work to strengthen the Veterans Health3369Administration workforce, it is essential that PAs are included in3370these efforts. Despite previous inclusion in VA's HPSP, and despite the3371most recent OIG Determination of Veterans Health Administration's3372Severe Occupational Staffing Shortages listing numerous severe3373shortages of PAs, mental health care providers, and primary care3374providers,\3\ the VA has not made PAs eligible for the current round of3375HPSP.\4\ It is important for VA recruitment and retention efforts and3376for veterans' access to care that PAs be eligible for HPSP, and we3377believe it is critical to ensure that PAs and other health care3378providers for which there are severe shortages at VA facilities are3379included in HPSP.3380---------------------------------------------------------------------------3381    \3\ Veterans Health Administration. OIG Determination of Veterans3382Health Administration's Severe Occupational Staffing Shortages Fiscal3383Year 2024. August, 2024.3384    \4\ Department of Veterans Affairs. HPSP. Retrieved June 17, 2025.3385---------------------------------------------------------------------------3386    With clinical expertise, medical training, the initiative to help,3387and unique connection to our veteran population, PAs are on the ground3388in local communities and especially positioned to increase access to3389care in areas of health care in which VA has acute shortages.3390    AAPA thanks the Subcommittee for this opportunity to provide3391comments on H.R. 3767, the HPSP Improvement Act of 2025, and welcome3392any comments or questions you may have for us. Please contact AAPA Vice3393President of Federal Advocacy Tate Heuer at theuer@aapa.org.33943395          Prepared Statement of Concerned Veterans of America3396[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]33973398     Prepared Statement of Military Officers Association of America3399[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]34003401           Prepared Statement of Student Veterans of America3402[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]34033404                 Prepared Statement of K9s For Warriors3405[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]34063407                                 [all]