Reevaluating the Rating Schedule: Examining VA’s Efforts to Modernize Disability Benefits

1[House Hearing, 119 Congress]2[From the U.S. Government Publishing Office]34                    REEVALUATING THE RATING SCHEDULE:5                   EXAMINING VA'S EFFORT TO MODERNIZE6                          DISABILITY BENEFITS78=======================================================================910                                HEARING1112                               before the1314       SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS1516                                 of the1718                     COMMITTEE ON VETERANS' AFFAIRS1920                     U.S. HOUSE OF REPRESENTATIVES2122                    ONE HUNDRED NINETEENTH CONGRESS2324                             SECOND SESSION2526                               __________2728                      WEDNESDAY, JANUARY 14, 20262930                               __________3132                           Serial No. 119-433334                               __________3536       Printed for the use of the Committee on Veterans' Affairs3738                [GRAPHIC NOT AVAILABLE IN TIFF FORMAT]3940                    Available via http://govinfo.gov4142                               ______4344                 U.S. GOVERNMENT PUBLISHING OFFICE454663-301                    WASHINGTON : 20264748                     COMMITTEE ON VETERANS' AFFAIRS4950                     MIKE BOST, Illinois, Chairman5152AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking53    American Samoa, Vice-Chairwoman      Member54JACK BERGMAN, Michigan               JULIA BROWNLEY, California55NANCY MACE, South Carolina           CHRIS PAPPAS, New Hampshire56MARIANNETTE MILLER-MEEKS, Iowa       SHEILA CHERFILUS-MCCORMICK,57GREGORY F. MURPHY, North Carolina        Florida58DERRICK VAN ORDEN, Wisconsin         MORGAN MCGARVEY, Kentucky59MORGAN LUTTRELL, Texas               DELIA RAMIREZ, Illinois60JUAN CISCOMANI, Arizona              NIKKI BUDZINSKI, Illinois61KEITH SELF, Texas                    TIMOTHY M. KENNEDY, New York62JEN KIGGANS, Virginia                MAXINE DEXTER, Oregon63ABE HAMADEH, Arizona                 HERB CONAWAY, New Jersey64KIMBERLYN KING-HINDS, Northern       KELLY MORRISON, Minnesota65    Mariana Islands66TOM BARRETT, Michigan6768                       Jon Clark, Staff Director69                  Matt Reel, Democratic Staff Director7071       SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS7273                    MORGAN LUTTRELL, Texas, Chairman7475AUMUA AMATA COLEMAN RADEWAGEN,       MORGAN MCGARVEY, Kentucky, Ranking76    American Samoa                       Member77JACK BERGMAN, Michigan               CHRIS PAPPAS, New Hampshire78NANCY MACE, South Carolina           MAXINE DEXTER, Oregon79KEITH SELF, Texas                    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                      WEDNESDAY, JANUARY 14, 20269697                                                                   Page9899                           OPENING STATEMENTS100101The Honorable Morgan Luttrell, Chairman..........................     1102The Honorable Morgan McGarvey, Ranking Member....................     3103104                               WITNESSES105                                Panel I106107Ms. Nina Tann, Executive Director, Compensation Service, Veterans108  Benefits Administration, U.S. Department of Veterans Affairs...     4109110        Accompanied by:111112    Dr. Ulia Sokol, Medical Officer, Compensation Service,113        Veterans Benefits Administration, U.S. Department of114        Veterans Affairs115116                                Panel II117118Ms. Elizabeth Curda, Director, Education, Workforce, and Income119  Security, U.S. Government Accountability Office................    14120121Mr. Philip Armour, Senior Economist, Director of Ph.D. Program,122  Professor of Policy Analysis, RAND.............................    16123124Dr. Kyleanne Hunter, Chief Executive Officer, Iraq and125  Afghanistan Veterans of America................................    18126127                                APPENDIX128                    Prepared Statements Of Witnesses129130Ms. Nina Tann Prepared Statement.................................    37131Ms. Elizabeth Curda Prepared Statement...........................    39132Mr. Philip Armour Prepared Statement.............................    53133Dr. Kyleanne Hunter Prepared Statement...........................    63134135                       Statements For The Record136137Disabled American Veterans Prepared Statement....................    71138Berry Law Prepared Statement.....................................    75139Veterans of Foreign Wars of the United States Prepared Statement.    95140141                    REEVALUATING THE RATING SCHEDULE:142                   EXAMINING VA'S EFFORT TO MODERNIZE143                          DISABILITY BENEFITS144145                              ----------146147                      WEDNESDAY, JANUARY 14, 2026148149   Subcommittee on Disability Assistance &150                          Memorial Affairs,151                    Committee on Veterans' Affairs,152                             U.S. House of Representatives,153                                                    Washington, DC.154    The subcommittee met, pursuant to notice, at 2:16 p.m., in155room 360, Cannon House Office Building, Hon. Morgan Luttrell156(chairman of the subcommittee) presiding.157    Present: Representatives Luttrell, Radewagen, Bergman,158Self, McGarvey, Dexter, and Morrison.159160         OPENING STATEMENT OF MORGAN LUTTRELL, CHAIRMAN161162    Mr. Luttrell. Right. Good afternoon. Thank you for coming163today. Everyone in the audience thank you for attending the164committee hearing today and Disability Assistance and Memorial165Affairs. The chair may declare recess at any time. The166subcommittee hearing will come to order. Good afternoon. Again,167thank you to our witnesses for being here today.168    This afternoon the subcommittee is examining the U.S.169Department of Veterans Affairs (VA) Schedule for Rating170Disabilities, otherwise known as the VASRD, and the Department171efforts modernizing this system. The VASRD is the scale that172determines how the veteran's service-connected conditions are173evaluated, which then determine a veteran's eligibility for174benefits, overall disability ratings, and, ultimately, the175amount of tax-free money they receive each month.176    While the VASRD is incredibly is incredibly overly over177complicated, it is important to step back and know that the178schedule affects real lives. It allows VA to deliver179compensation to veterans for their service-connected180disabilities and ensure all veterans are evaluated at the same181standard.182    Congress created the VASRD with a clear purpose to183compensate veterans for the average impairment caused by their184service-connected disabilities to their earnings capacity. The185rating schedule was created in 1945. While parts of it have186been updated over time, the overall framework remains187unchanged.188    In 2007, VA Advisory Committee on Disability Compensation189concluded that the rating schedule was outdated and recommended190a full review of all 15 body systems. VA formally began the191effort in 2009, with a plan to complete this work by 2016. Ten192years later, VA has only completed a review of 11 body systems193out of the total 15. According to the testimony provided in a194Senate hearing last year, VA has now extended its timeline to1952026. Again, this is more than 10 years beyond the original196goal.197    VA has made progress, but it is inconsistent thus far. In198my personal opinion, the veterans of today deserve a system199that evaluates their disabilities based on the medical evidence200of today's medical practices. The respiratory, endocrine,201musculoskeletal, and digestive systems have been updated in the202past 10 years, but several important systems remain unfinished.203The neurological, cardiovascular, and hematologic systems are204still in various stages of review despite many of these205conditions being common and often complex.206    Mental health remains the most concerning. VA proposed207updates to the mental health rating criteria in 2022, but those208changes have not been finalized. As a result, one of the most209heavily relied upon portions of the rating schedule continues210to operate under criteria that many believe no longer reflects211modern clinical understanding or the full scope of functional212impairment that veterans experience.213    Just as important, VA has not undertaken a comprehensive214review of the economic component of the rating schedule. That215component is supposed to connect medical findings to loss of216earning capacity. Without updating this, the system risks217drifting further away from its statutory purpose of benefiting218veterans.219    This uneven modernization has real consequences on the220veterans community and their families. When rating criteria are221outdated, inconsistent examiners and raters are left actually222just to fill in the gaps. That increases the likelihood that223similar claims are handled differently. Recent U.S. Government224Accountability Office (GAO) reporting has highlighted225inconsistent outcomes for similar conditions, outdated medical226and occupational criteria, and quality review processes that227are not strong enough to catch errors before they affect228veterans.229    VA's current quality assurance approach relies on limited230samplings that often fail to identify broader area of twins--231trends, excuse me, and too often problems are discovered only232after decisions have already been issued, leading to rework233appeals and additional delays. Systems matter, standards234matter, and today oversight obviously matters.235    I will close with this. For veterans, the disability rating236process is not an abstract policy exercise. It is often the237moment when they sit across from the system and ask for help,238sometimes years after they left the military. When the process239feels outdated, inconsistent or confusing, veterans do not lose240confidence in a form or regulation. They lose confidence when241they ask for help. Where will it be? Modernizing the rating242schedule is not just about updating language or revising243criteria. It is about trust. It is about ensuring that when a244veteran raises their right hand and serves, a system they245return to is worthy of that commitment.246    With that, I will yield to the ranking member.247248      OPENING STATEMENT OF MORGAN MCGARVEY, RANKING MEMBER249250    Mr. McGarvey. Thank you, Chairman Luttrell, and good251afternoon, everyone. Appreciate you all being here today. Mr.252Chairman, I am grateful for you holding this hearing.253    The VA Schedule for Rating Disabilities, or VASRD, is a254massive program. It is big in size, it is big in impact, and it255is absolutely central to how we support our veterans.256Everything we do on this committee starts with one simple idea,257that when a service member raises her right hand and serves258this country, we owe her a system that works. If she is injured259or becomes ill because of her service, she has earned care,260benefits, and services, full stop. The process to get those261benefits should not be so confusing or slow that she feels lost262before the process even begins.263    This hearing should not be about cutting those services. It264should be about cutting red tape. Veterans should not need a265law degree or a medical degree and a decade of patience just to266get what they have earned by serving our country.267    We also should not be afraid of change. I, for one, think268the VA's Schedule for Rating Disabilities is outdated. Medicine269has changed. Diagnostics have changed. The nature of military270service itself has changed. The injuries and illnesses our271servicemembers face today look very different to what they did27280 years ago. Yes, the schedule needs to be updated, but the273goal has to be clear, and that is to modernize the system274without harming the veterans. That is the line we cannot cross.275That is the mission that is central to this committee.276    I have a few questions that I think we can begin to answer277today. If we are trying to figure out whether the current278schedule actually works, we have got a real challenge. There is279almost no up-to-date, publicly available research on how VA's280compensation system is performing. How do we fill that gap?281What additional data do we need? How do we get it? How do we282use it?283    If today's hearing is about understanding the methodology284VA is using to update this disability rating schedule, then I285welcome that. Across multiple administrations, VA's work on286VASRD has been a black box. Veterans deserve transparency.287Congress deserves transparency so that we can help our288veterans.289    Mr. Chairman, I also want to address something that we have290been hearing in the media a little bit, that there is a growing291narrative that disability compensation is somehow too generous292or that it is arbitrary and there is encouragement for veterans293to game the system. I want full transparency. I want to know294everything that is going on. I resent that characterization of295our veterans. Our veterans, it is not who they are, and it is296not what this program is.297    These benefits are not handouts. They are not freebies.298They are a recognition of service and sacrifice. For many299veterans, they are the only support they have when service-300connected conditions make work difficult or impossible.301    Mr. Chairman, you know better than I do about the risks302that military service carries and that most civilians will303never fully understand. Those risks do not end when someone304takes off their uniform. They can follow a veteran for the rest305of their life, and they cannot be reduced to a simple earnings306loss formula.307    We also have to remember that health relates to the whole308person. A diagnosis that sounds minor to you or to me might be309a sign of something much bigger. A veteran who has cystic acne310that is linked to Agent Orange exposure is not just dealing311with acne. They are living with the consequence of toxic312exposure, and that context matters.313    We also have to remember what these programs are. No matter314how big they are or how big they get, the heart of these315programs are our veterans, human beings. Our brothers, sisters,316moms, dads, sons, and daughters who put on a uniform willing to317serve us, people who deserve the dignity and care they have318earned in exchange for that service.319    Which brings me to the last point I will raise, Mr.320Chairman. My concern today that we only have one veteran321service organization testifying. Veterans are not monoliths.322They go into different branches of the service with different323experiences at different times. Their voices should be central324to this conversation. I hope that we can have more325conversations with the Veterans Service Organizations (VSO) on326this topic as we move forward. Their voices are important, the327most important ones in this discussion.328    Mr. Chairman, I am looking forward to a productive and329honest discussion today. I hope this is just the beginning of330our oversight into this issue. There is a lot more work to do,331and I yield back.332    Mr. Luttrell. Thank you, Mr. McGarvey.333    I would like to introduce our witnesses. Our lead witness334from VA is Ms. Nina Tann. Ms. Tann is the executive director of335Compensation Service at the Veterans Benefits Administration336(VBA). Good afternoon. She is joined with Dr. Sokol, correctly337pronounced, is a medical officer in Compensation Services at338the Veterans Benefits Administration. Thank you both for being339here today. I ask that you please stand. Raise your right hand.340    [Witnesses sworn.]341    Mr. Luttrell. Let the record reflect that the witnesses342have answered in the affirmative. You may be seated.343    Ms. Tann, at any moment if you need to--okay. Ms. Tann, you344are now recognized for 5 minutes for your opening statement.345346                     STATEMENT OF NINA TANN347348    Ms. Tann. Good afternoon, Chairman Luttrell, Ranking Member349McGarvey, and members of the subcommittee. I appreciate the350opportunity to appear before you today.351    Mr. Luttrell. Ms. Tann, is your mic on?352    Ms. Tann. Yes, sir.353    Mr. Luttrell. Okay. Thank you.354    Ms. Tann. Good afternoon, Chairman Luttrell, Ranking Member355McGarvey, and members of the subcommittee. I appreciate the356opportunity to appear before you today to discuss VA's efforts357to modernize disability benefits. I am accompanied today by Dr.358Ulia Sokol, medical officer with the Veterans Benefits359Administration.360    For disability compensation or pension purposes, a361veteran's disabilities are evaluated using the guidance in the362VA Schedule for Rating Disability, or VASRD, also known as the363rating schedule. Under the authority established by 38 U.S.C.3641155, the VA Secretary shall adopt and apply a schedule of365ratings of reductions in earning capacity from specific366injuries or combination of injuries. This rating shall be367based, as far as practicable, upon the average impairments of368earning capacity resulting from such injuries in civil369occupations. The Secretary shall, from time to time, readjust370this schedule of ratings in accordance with experience.371    VA is committed to updating its disability rating criteria372to accurately reflect medical science advancements and improved373technology and current terminology. These updates allow VA to374ensure its disability evaluations more accurately compensate375veterans based on impairments and average earning ability.376While VA has made numerous changes to the VASRD, it has not377completed a holistic comprehensive update since 1945.378    In 2003, the Government Accountability Office, or GAO,379deemed VA's disability program high-risk because VA had not380systematically updated the VASRD. In response, VA developed a381modernization plan in 2009, with the goal of comprehensively382updating all 15 body systems of the VASRD. VA established work383groups that included medical and VA policy Subject Matter384Experts (SME) and used the analysis following its thorough385review of established medical research to begin the rulemaking386process, which involves drafting and publishing a proposed and387final rule for each body system.388    To date, VA has completed updates on 11 of the 15 body389systems. Any updates made to the VASRD are point forward in390that they do not impact veterans currently service-connected391for that particular condition or veterans who filed their392claims prior to the implementation date of new rules. VA393anticipates publishing the final rules for all four body394systems in three rulemakings by the end of Fiscal Year 2026,395which will complete the first holistic comprehensive update396since 1945.397    In 2019, VA established the VASRD Program Management Office398with a mission of revising the VASRD through rulemaking, body399system by body system in staggered cycles of recurring reviews400as well as in response to GAO's high-risk recommendations. VA401has successfully met three of the five high-risk categories402identified by GAO and have partially met the remaining two as403we continue the iterative process of ensuring alignment of the404VASRD evaluation criteria with medical, scientific, and405technological advancements.406    The rulemaking process generally takes 2 to 5 years to407complete, but can take longer due to the length and medical408complexity of the VASRD proposed updates. Updates to the VASRD409require coordination to implement required claims processing410changes and to provide training and guidance to clinicians on411the disability benefits questionnaires and to claims processors412charged with correctly applying current disability evaluation413criteria.414    Following the completion of the first holistic and415comprehensive update to the VASRD since 1945, VA will actively416pursue opportunities to update the VASRD. In our next phase VA417plans to continue updating the VASRD with the evolution of418medical science, technology, and treatment modalities. While VA419aims to update the schedule to simplify the claims process for420veterans and to promote a fair, objective, and efficient421process, VA will also standardize rating terminology,422incorporate the effects of court decisions, and address423contemporary claims processing issues to assist claims424processors charged with delivering fair, efficient, and timely425benefit decisions to veterans. VA is focused on completing the426first holistic change and anticipate starting the next phase of427this iterative process at the end of this fiscal year.428    In closing, VA remains committed to modernizing disability429benefits by making continuous updates to the VASRD. We thank430the committee for your continued support of programs that serve431the Nation's veterans and look forward to working together to432further enhance delivery of benefits and service to veterans.433    Mr. Chairman, this concludes my statement. My colleague and434I are prepared to respond to any questions that you or other435members of the subcommittee may have.436437    [The Prepared Statement Of Nina Tann Appears In The438Appendix]439440    Mr. Luttrell. Thank you, Ms. Tann. The written statement of441Ms. Tann will be entered into the record. We will now move to442questioning.443    I am going to ask some clarification questions. By the end444of 2026, all body systems will be complete and this program445will be completely buttoned up?446    Ms. Tann. This first holistic comprehensive review of the447body systems.448    Mr. Luttrell. All 15 body systems?449    Ms. Tann. All 15 body systems.450    Mr. Luttrell. By the--in the Fiscal Year 2026?451    Ms. Tann. By the end of this fiscal year.452    Mr. Luttrell. Okay. That is great news. Good to hear that.453    Can you explain to me, and I can appreciate the454complexities of this, why has this taken so long? I do not want455to have to ask you this question at the end of 2026 of why we456have not completed it. Can you explain to me? I understand when457we are diving into the mental health issue, and I know that is458almost impossible to figure out. Right? Can you explain to me459why the last three have taken so long considering--and I will460not put 1945 in there, just from the late 2019s to now.461    Ms. Tann. Sure. We have actually been updating all along.462We have focused in, primarily, some of the most recent updates463have been from 2017, but we have updates all the way back to4641994. Some of the----465    Mr. Luttrell. What is an update?466    Ms. Tann. Update is through a final rule in which we are467using updated medical evidence, science, technology to look at468each of the body systems, as you mentioned, and we are looking469at each of the diagnostic criteria that goes along with it.470    Mr. Luttrell. Where are we aggregating our data from?471    Ms. Tann. We have a series of processes through our work472groups and the development where we look at all sorts of data473from the medical community, and Dr. Sokol can speak more474about----475    Mr. Luttrell. Our medical community or outside the VA?476    Ms. Tann. We use a combination. We look at published477literature. We use resources from things like all the478American--also American Heart Association, for example. We look479at peer-reviewed literature, all sorts of data and information.480    Mr. Luttrell. We are bringing that internal to the VA481system? Aggregated data outside and internal to the VA is all482aggregated internal to the VA, correct?483    Ms. Tann. When we establish a working group, we have a484number of SMEs and clinical advisors, both in VA and outside of485VA, and they look at current medical literature from those486types of associations and things of that nature. They are487bringing all of that data in. We do have clinicians, not only488in VBA, in Compensation Service and our Medical Disability489Examination Office (MDO) office, which you are familiar with,490at Veterans Health Administration (VHA). Those are some of the491sources who then look at the available data and evidence and492they pull that into the process.493    Mr. Luttrell. Where do we currently sit with the494advancements of Machine Learning (ML) and Artificial495Intelligence (AI)?496    Ms. Tann. We are open to exploring how we can bring497technology into this process. I think we have a unique498opportunity now.499    Mr. Luttrell. We have not done that yet?500    Ms. Tann. Not in the process of VASRD modernization.501    Mr. Luttrell. Why not? The world around us is.502    Ms. Tann. Sure.503    Mr. Luttrell. You may not be able to answer that question,504but I know somebody in your Department who I am going to call505as soon as this hearing is over with to ask why implementation506of AI and ML is not in this rating discussion, because it makes507absolute sense for it to be.508    Ms. Tann. I think as our focus has been on this first509holistic update as we move into our next iteration, that is510something that we are absolutely welcome to explore. I think511there is opportunity for that, sir, and I can take that back or512as--if you----513    Mr. Luttrell. Please do. I would actually like to have an514answer to that. It makes more sense to me now and an515understanding of how machine learning is effectively changing516the dynamics of how we interpret medicine. I can assure you our517veterans will be very pleased to know that we can do this in a518matter of milliseconds, not a matter of months and years, and519these platforms can do that for us. Implementation is where we520seem to be hung up.521    Not to beat up on the VA too much, but the VA can be very522siloed at times. I think that might be a missed opportunity if523we just continue down the kind of the railway that we are on524with--and by all means, I know that everyone that touches this525information is brilliant, but when you can process information526at petaflop speeds, that is a game-changer. Thank you.527    Ranking Member.528    Mr. McGarvey. Thank you, Mr. Chairman. I will build on that529point for just a second. I do not want to speak for you at all,530but, you know, we do not want to hear something is too531complicated, especially if that means 5 and 10 years from now532it is really a lot more complicated because we did not do533something today that we should be doing. I just want to build534on that a second.535    Ms. Tann, I will start with you. As I said at the536beginning, veterans are at the heart of every single thing we537do. That is what this committee is about. It is about serving538our veterans. I would like to start by asking the Department's539process for including veteran and VSO feedback into your540methodology.541    Ms. Tann. So----542    Mr. McGarvey. Waiting until the notice and comment period543for proposed rules, to me that is too late. I want to know to544what extent and through what process do you ask stakeholders545for their input before you get into the rule drafting phase?546    Ms. Tann. We do follow the American Procedures Act (APA)547and within that we do have limited opportunities with which we548can have what is considered ex parte conversations so that we549are not being unduly influenced or having more weight or access550to more information for any group of stakeholders and others so551that we maintain transparency. We do invite, through that552required 60-day public comment period as--we invite anyone to553provide input into that process. We do not actually currently554have processes in which we are doing it because we are bound by555those requirements of the APA.556    Mr. McGarvey. I appreciate you being clear and at the end557there getting to the point: it does not happen. To take this558out of government-speak, when you said there is limited559opportunities for ex parte conversation, what that really means560is we are not talking to veterans before you all come up with a561rule. To me that needs to change.562    You said unduly influenced. I do not view this as undue563influence. I think talking to the end user of this service is564of paramount importance, particularly because this is all about565helping our veterans and we know this. Sometimes something can566look good on paper and then it gets into practice and it does567not work the way you intended, even if you had the best568intentions. Getting that feedback from our veterans is really569important.570    I understand that Disability Compensation Advisory571Committee exists, but their work is infrequent and it is572increasingly sidelined by this administration. Can you commit573to doubling down on efforts to get more veteran input into this574process at an earlier stage?575    Ms. Tann. I will identify ways that we can do that, sir.576    Mr. McGarvey. Thank you. We would love that.577    As I understand it, VA is working on a new loss-earnings578study given how old the previous one is. When do you expect to579complete that study? Will you commit to making both the data580supporting that study and its results public?581    Ms. Tann. We are evaluating the deliverables from that582study. We actually had contractor support that ended at the end583of Fiscal Year 2025. My team is actually in the process of584evaluating that information from those studies, which was a585test program and a proof of concept to kind of see where we go586next from that.587    Mr. McGarvey. Can we see the data supporting the study and588the results when it is all finished?589    Ms. Tann. I will take that back, sir.590    Mr. McGarvey. Yes. I am going to press you a little bit on591that because I think we deserve better than that and I know our592veterans deserve better than that.593    This is not a gotcha moment. This is asking for the data594used in conducting a study and the results that impacts our595veterans. We want to understand how we are coming up with these596calculations that our veterans oftentimes depend on when they597have been injured because of their military service and what598that means for them. It is really important for anyone to have599that and for it to be a transparent, inclusive process so we600know what is going on.601    We are going to keep following up with you on that. It602needs to be more than an answer, a throwaway answer in a603committee of we will take that back to somebody. I know our604veterans are entitled to that information and I want to make605sure they get it.606    As I understand it, the VA has historically provided607updates to GAO on your ongoing work around revising VASRD. When608was the last time VA met with them? Have you shared your609methodology with them recently?610    Ms. Tann. We do meet with GAO regularly. The last status611update, I cannot give you the exact date when we did that. I do612know in Fiscal Year 2025 that is when we had the increase and613moved to partially met for the monitoring stage of the high-614risk list criteria. We do have ongoing communications with GAO615and others and provide status updates as required.616    Mr. McGarvey. Have you shared it with any outside617researchers at all?618    Ms. Tann. Not to my knowledge, sir.619    Mr. McGarvey. I think it would, also--this is another620thing. I just think it is helpful to have a second set of eyes621on this type of thing to validate the methodology, to make sure622we are coming up with the best system to help our veterans.623Especially these are our veterans who have been injured in624their service or are disabled because of their service.625Appreciate that.626    Mr. Chairman, my time is expired. I yield back.627    Mr. Luttrell. Thank you, sir.628    Mr. Bergman, General, you are recognized, sir.629    Mr. Bergman. Thank you, Mr. Chairman.630    I had a chance here the last 20 minutes or so just kind of631reflect on what everybody was saying. Couple of thoughts.632    1945, my dad was just mustering out of the Navy after World633War II. Okay. I think about his last endeavor before he passed634some 40-some years ago, was he was a volunteer driver for the635county VSO to get the veterans to the VA hospital over by the636Minneapolis airport. I, you know, I think about my parents,637what they went through in the Depression and then World War II.638We are using the date here, 1945, in current data. Scares the639hell out of me in some ways because it means we did not change.640    Someone said a couple of different ways, it is complicated.641Yes. Life is tough, but it is tougher when you are not exactly,642you know, embracing it every day. It gets more complicated. It643is like a ball of bureaucratic string that was built over time.644Nobody knows where it starts, where it ends. All they know is645it is this big ball of string, and it is a reason to say no.646    Having said that, let me just ask just--and a sense of647urgency would be extremely helpful and desired within the648Veterans Administration, as well as everybody involved in this,649whether it is the VSOs, the veterans, but especially the650bureaucracy of the Veterans Administration. If it is651complicated, it is up to those of us in charge of what we are652doing right now to uncomplicate it as best we can. When you653heard about AI and ML, that is a way to begin the unraveling654and the uncomplication of it.655    To what extent do outdated portions of the VASRD--you can656use that in a pronunciation and an acronym, VASRD?657    Ms. Tann. ``VASR-D.''658    Mr. Bergman. Yes, boy. ``Varsity,'' VASRD, huh? As opposed659to the junior varsity? Okay, got it.660    Ms. Tann. You can say rating schedule, sir.661    Mr. Bergman. All right. To what extent does the outdated662portions of it make it harder for the VA to consistently and663accurately evaluate modern, complex conditions among younger664veterans? We know, based on the nature of war, the injuries665that were received in World War I, World War II, Korea,666Vietnam, Desert Shield, Desert Storm, Operation Iraqi Freedom667(OIF), Operation Enduring Freedom (OEF) have changed because of668the nature of the fight, the survivability, et cetera, et669cetera. Are we getting rid of the outdated stuff? I mean,670regardless of timelines, do you really think when all is said671and done, this will really be reflective of the types of672injuries that our veterans are receiving in conflicts today?673    Ms. Tann. Yes, sir, I do. As part of our updates, and674again, to be clear, it is not that we have not updated since6751945. The systemic and holistic update has not been completed,676but we have updated body systems, diagnostic codes, and we do677remove outdated terminology. We remove outdated testing and678things that are not accepted in the medical and clinical679community. We remove instances where there may be subjective680criteria.681    I will use for an example in the proposed rule for the682neurological body system where some nerve paralysis could be683rated by mild, moderate, or severe. Well, that is not really684great objective criteria then for someone to use. We are adding685testing and objective and measurable components that help686reflect the current disability picture, like you mentioned, of687what our veterans are experiencing today. We add new diagnostic688codes. We--like for mental health, for example, we are689proposing updates that adapt to the DSM-4.690    Mr. Bergman. I mean, I know you could--okay. Is there a691sense of urgency?692    Ms. Tann. Absolutely.693    Mr. Bergman. I guess it would be helpful if you could, you694know, not today, but give us something that shows a sense of695urgency, that actually shows that. We hear it, but I can be696honest with you, I do not see it. Okay?697    Ms. Tann. Yes, sir.698    Mr. Bergman. I will just leave it at that and I will yield699back, Mr. Chairman.700    Mr. Luttrell. Mrs. Radewagen, you are recognized for 5701minutes.702    Ms. Radewagen. Thank you, Mr. Chairman, for holding this703important hearing today. Thank you to the witnesses.704    Ms. Tann, what is VA's plan for future updates of the VASRD705and what criteria is VA using to prioritize future updates?706    Ms. Tann. Thank you for that question. We are using the707lessons learned from this first iteration and best practices.708We are looking at ways to be more strategic in that. We do not709just necessarily want to take a look body system by body710system, but where we have evidence and data that supports that711we need to take another look. Some of that may come from712studies and things such as our earnings loss studies, if we are713able to use that. We will use areas where we know in medical714science that have changed and updated through technology and715treatment modalities. We will look at the body systems.716    We will also look at individual diagnostic codes and, based717off the available evidence, we will prioritize those remaining718updates or the next phase of updates with all of that719information in mind. Trying to take a much more strategic720approach, project management focused approach to it, I think,721because we do have this experience and lessons learned from722this first holistic update that will be completed by the end of723this fiscal year.724    Ms. Radewagen. Ms. Tann, does VA have a project management725plan or other document that outlines goals, objectives, or a726schedule for future updates? If not, is there a timeline for VA727to develop such a plan?728    Ms. Tann. We do have a plan for the first iteration, which729is coming to a close, as I mentioned before, and we are working730on what that project management plan for the next iteration731will look like so that we do have schedules, milestones, and732things like that to measure our progress and to make sure that733we are following good project management principles for our734future updates.735    Ms. Radewagen. Thank you, Mr. Chairman. I yield back the736balance of my time.737    Mr. Luttrell. Thank you, ma'am.738    Mr. Self, sir, you are recognized for 5 minutes.739    Mr. Self. Thank you, Mr. Chairman. I have just got some740probably easy questions to answer. Why sleep apnea? Is that741military related?742    Ms. Tann. It can be. For VA disability purposes, we look at743disabilities that were incurred in or caused by or aggravated744by military service. If something started during military745service, then we have a responsibility according to the law to746service-connect sleep apnea for any residual disability based747upon that.748    Mr. Self. Really? Okay. How much of this, and I realize749this is not Veterans Integrated Service Network (VISN) driven,750but how much of this is customization that is allowed amongst751the different contractors? How much of that? We see that, I see752that often, we allow too much customization across the VA.753    Ms. Tann. So are you referring to our Disability Benefits754Commission?755    Mr. Self. Yes, yes, the----756    Ms. Tann. We have criteria which must be supported by757clinical findings and medical evidence. That is one----758    Mr. Self. How much of that is customizable?759    Ms. Tann. We do cut down on areas of free text, but we do760need the doctor's observations. We do--but we use testing, we761use clinical criteria, and we look at the entire disability762record and we do not rest anything on just one single piece of763evidence.764    Mr. Self. There is a statement in here that more veterans765are relying on disability. Is that actually true or is that--do766we see a growth in this?767    Ms. Tann. I do not have any evidence to support that. More768evidence--excuse me, more veterans are relying on this benefit.769We do have veterans that are employed. Most veterans that we770serve are actually employed in some part and gainfully employed771in many situations.772    Mr. Self. Would you just give me, and you may have already773covered this and you probably have, and I apologize if you774have, give me a short dissertation on impairment disability775versus financial inability to earn? Why that distinction and776how is that working in all of this review that you are doing?777This seems to me to be part of the crux of what we are asking778here.779    Ms. Tann. Part of our evaluations, we look at occupational780impairment and functional loss. I think when, in VA terms, when781we look at things like TDIU, which I am sure you are familiar782with, when we find veterans who are unemployable because of783service-connected disabilities, if they do not meet that784criteria otherwise, then we have benefits in store for that.785You could very easily have a 100 percent service-connected786disabled veteran who is able to work, For us, a disability and787100 percent evaluation does not mean unable to work in many788situations.789    Disability compensation does not mean that a veteran cannot790earn wages, that they are unemployable. It means that based off791the residual impairment, the VA finds them to be 100 percent792disabled because of the severity of their disabilities.793    Mr. Self. Right. How are you going to apply either one of794those really to mental health, which is a growth industry? As795we know, mental health amongst veterans is rampant. How is that796working with mental health? It is a little bit different than797physical impairment.798    Ms. Tann. Certainly. I am going to ask----799    Mr. Self. How are you going to apply that?800    Ms. Tann. I am going to ask Dr. Sokol to address that801because she has done a lot of the work in that area.802    Dr. Sokol. Good afternoon. Currently, the portion of the803rating schedule which addresses mental disorders is in the804final stages of its publication as a final rule. We did publish805the proposed rule several years ago, which received806overwhelmingly positive feedback from the veterans community,807from clinicians. That is because we adhered to the latest808approach to assessing the functional impairment due to mental809disorders, which is outlined in great detail in DSM-5, which is810the governing document for all psychiatrists and clinical811psychologists to assess the level of functional impairment due812to mental disorders. In this new portion of the rating813schedule, we will be able to adequately address the level of814functional impairment and corresponding occupationally815significant disability. We are looking forward to publishing it816by the end of the Fiscal Year 2026.817    Mr. Self. Okay. Real quickly, what has the toxic exposure818law done to this examination, this review of your disability819criteria?820    Dr. Sokol. I will ask Ms. Tann to weigh in on this821question, please.822    Mr. Self. Just quickly. I am out of time.823    Ms. Tann. Sorry, sir. We have a process by which we look at824toxic exposures through our military. I am sorry, it is called825the Military Environmental Exposures Sub-Council (MEESC) for--826it escapes me right now what that group looks at, but that is a827separate group that looks for things based off our presumptive828conditions----829    Mr. Self. Right.830    Ms. Tann [continuing]. based off the codified requirement831for that disease process. We look at those slightly differently832based off exposures and what the science and evidence shows833based off that exposure.834    Mr. Self. You have made my point, more complexity. I yield,835Chairman.836    Mr. Luttrell. Thank you, Mr. Self.837    If we are using DSM-5, what data--can you give me, Dr.838Sokol, can you give me kind of a timeframe of the data that we839are currently using to define mental health for the VASR840system, VASRD system? Let me give you a little bit more depth841to this because----842    Dr. Sokol. Yes. Will you please----843    Mr. Luttrell. Yes, absolutely.844    Dr. Sokol [continuing]. expand a little bit on the data845portion?846    Mr. Luttrell. Before I showed up to this wonderful place,847my focus was in neuroscience. One thing my professors told me848when I was in grad school is that what you are going to learn849today will not be correct in 5 years. How were they right. It850is not more or less a concern because research is research, but851are we about to do an implementation of information that is852already outdated?853    Dr. Sokol. Well, let me revisit DSM-5. DSM-5 is updated on854average every 16 to 18 years.855    Mr. Luttrell. Great. I mean, that is a home run.856    Dr. Sokol. There is a great big committee which gathers all857the data between the Diagnostic and Statistical Manual of858Mental Disorders (DSM) publications. The current DSM, DSM-5,859was published in 2013, and it had introduced a lot of changes860to the way we look at the functional impairment due to mental861disorders.862    Mr. Luttrell. In 2013, a severe traumatic brain--there were863three levels of traumatic brain injury in 2013: mild, medium,864and severe.865    Dr. Sokol. Well----866    Mr. Luttrell. That is it.867    Dr. Sokol. Actually the biggest introduction was the868multidimensional approach to the way we look at their mental869health and mental disability. Those multidimensional approach870means that all of us are built the same way and there are871certain number of domains of function, such as ability to872interact with others, cognition, self care, and so on and so873forth. That multidimensional approach, which was introduced874based on a great deal of data by DSM-5, is the basis of our875review of the VASRD Rating Schedule for disability mental876disorders portion.877    Mr. Luttrell. That will not be updated until the DSM-5878comes out with the DSM-6 version?879    Dr. Sokol. It will be updated by the end of Fiscal Year8802026. It is updated already. It will be published. This final881rule----882    Mr. Luttrell. Off of the DSM-5?883    Dr. Sokol. Yes. It is based on DSM-5 multidimensional884approach.885    Mr. Luttrell. Fifteen years ago. Somebody do the math.886    Dr. Sokol. No, it was----887    Mr. Luttrell. 2013?888    Dr. Sokol. 2013.889    Mr. Luttrell. 23 is 10 plus--that is concerning because how890much more we know today will not be near as much as we know891tomorrow when we are dealing with the beautiful mind that sits892between our ears, which every single human being is different,893which I am sure you absolutely know.894    Ms. Tann, the end of 2020, give me a--do you have a date? I895am big on dates. The day after this thing goes out, I would896like you and Dr. Sokol sitting in front of us and assuring us897that we are--we got a green light and we are good to go. Do you898have----899    Ms. Tann. We anticipate our remaining final rules to be900published around the summer of 2026.901    Mr. Luttrell. Summer of 2026.902    Ms. Tann. Then we will have time for implementation and an903effective date, sir, beyond that.904    Mr. Luttrell. Summer of 2026. Interesting. Okay.905    Mr. McGarvey, you good? General? Mrs. Radewagen, do you906have a question? You are good? Mr. Self? Good to go?907    Okay. Thank you very much for your testimony today. Thank908you. Again, thank you for everything that you are doing for our909veterans and the Department of Veterans Affairs. I like to say910this every single time we have a hearing. The VA is one--is a911big machine. Everybody plays their role. Every morning that we912wake up, every morning that you wake up, we absolutely know913that who we are serving is our veterans, and we are here914because of them. Thank you and have a very blessed day.915    Ms. Tann. Yes, sir. Thank you. Thank you for this.916    Dr. Sokol. Thank you for this opportunity.917    Mr. Luttrell. Yes, ma'am.918    Once the first panel is up, panel number two may be seated.919    Our first witness on this panel will be Ms. Elizabeth920Curda. Ms. Curda is the director of Education, Workforce, and921Income Security at the Government Accountability Office. Second922witness on the panel is Mr. Philip Armour. Mr. Armour is the923director of the RAND School of Public Policy Ph.D. program and924a senior economist at RAND. Our third witness is Dr. Kyleanne925Hunter. Dr. Hunter is the Chief Executive Officer (CEO) of Iraq926and Afghanistan Veterans of America (IAVA). What branch?927    Dr. Hunter. Marine Corps. Best one.928    Mr. Luttrell. I feel like as a Navy guy, I should say929something. Okay. Thank you for your service. I would like to930welcome the witnesses to our second panel. The witnesses, I931please ask that you stand and raise your right hand.932    [Witnesses sworn.]933    Mr. Luttrell. Let the record reflect that the witnesses934have answered in the affirmative.935    Ms. Curda, you are now recognized for 5 minutes to deliver936your opening testimony.937938                  STATEMENT OF ELIZABETH CURDA939940    Ms. Curda. Good afternoon, Chairman Luttrell, Ranking941Member McGarvey, and members of the subcommittee. I am pleased942to discuss GAO's work on VA's efforts to update its disability943rating schedule.944    When veterans file claims for disability compensation, VBA945claims processors use the rating schedule to determine monthly946compensation. VA's Disability Compensation Program provides947billions of dollars in benefits to millions of veterans and948their families. VA must be able to make accurate decisions949about the amount of compensation a veteran receives as a matter950of fairness to veterans and to ensure the program is achieving951its intended results.952    VA has struggled to stay current with needed updates to the953rating schedule. In 2003, we designated VA's Disability954Compensation Program high-risk, in part because its rating955schedule did not fully reflect advances in medicine and956technology and changes in the labor market that have occurred957since 1945. VA is required to base its compensation decisions958on the average loss in civilian earnings resulting from a959veteran's service-connected disability, but it has never960updated this information based on data-driven analysis. My961testimony today discusses VA's progress on updating the medical962and earnings loss information in the rating schedule as well as963remaining challenges.964    Medical information includes the types of disabling965conditions that veterans may have organized into the 15 body966systems. Earnings loss information is the average decrease in967expected earnings caused by those disabilities. VA has taken968positive steps to improve the process for updating medical969information.970    In terms of progress, between 1945 and 2009, VA mainly971focused on updating the rating schedule with new medical terms972and criteria for determining a condition's severity. In 2009,973VA embarked upon an ambitious effort to comprehensively update974both medical and earnings loss information. These changes975included establishing an office to plan and oversee these976efforts. VA has also begun making plans for a 10-year cycle for977updating the medical information to more systematically978consider advances in the evaluation and treatment of medical979conditions.980    Since 2009, VA has completed updates to the medical981information for 11 of 15 body systems. After years of fits and982starts, VA has also begun testing its own earnings loss983studies. VA is testing how the Department could produce984earnings loss data and update the rating schedule with this985information.986    However, VA still faces challenges keeping its rating987schedule up to date. It has yet to complete comprehensive988revisions for four body systems. VA's attempts to revise some989of these systems have been going on for years. In addition,990information about how veterans' disabilities affect earnings991loss remain a major gap. It is uncertain whether or when VA992will complete these studies and use the information to update993the rating schedule.994    Going back decades, VA and external studies have evaluated995the average loss of earnings for veterans with service-996connected disabilities and suggested that not all veterans were997being equitably compensated. For example, certain external998studies suggested that veterans with mental health conditions999were being undercompensated. As of today, VA has not updated1000its rating schedule with earnings loss information.1001Consequently, ratings determinations for all earnings loss1002calculations remain based on information from over eight1003decades ago.1004    We have been monitoring VA's efforts to fix these problems1005through the lens of our high-risk list. As of 2025, VA has met1006three of the five criteria for removal from the list. It has1007shown leadership, commitment, developed an action plan to1008address root causes of its problems, and has been monitoring1009its progress. To have this area removed from the high-risk1010list, VA must continue to meet these three criteria and fully1011meet two more: capacity and demonstrated progress. Capacity1012involves things like identifying and applying the resources1013needed to implement its plans, and demonstrated progress means1014VA is accomplishing its goals and objectives for updating the1015rating schedule.1016    Ultimately, without a rating schedule that fully reflects1017present day medicine and changes in the labor market since10181945, VA may overcompensate some veterans while1019undercompensating others.1020    This concludes my prepared statement and I am happy to1021address your questions.10221023    [The Prepared Statement Of Elizabeth Curda Appears In The1024Appendix]10251026    Mr. Luttrell. The written statement from Ms. Curda will be1027entered into the record.1028    Mr. Armour, you are now recognized for 5 minutes.10291030                   STATEMENT OF PHILIP ARMOUR10311032    Mr. Armour. Chairman Luttrell, Ranking Member McGarvey, and1033members of the committee, thank you for your invitation to1034testify.1035    As a labor economist, I research how health conditions1036impact individuals' ability to earn income and on the design of1037disability programs. Today I will focus on four points related1038to the economic effects of disability and describe implications1039for VA Disability Compensation (VADC).1040    By statute, VADC benefits consider veterans' earning losses1041from service-connected disabilities, not just a medical rating1042of impairment severity. The most recently published VA1043commissioned earning loss study was in 2008. Although there1044have been more recent studies, none of these studies have1045incorporated modern disability research findings, specifically1046how different elements of disability programs can independently1047impact earnings. Evidence from other programs shows that cash1048and noncash disability benefits do directly affect earnings,1049but no research exists on how VA's programs impact today's1050veterans' earnings.1051    Updated earnings loss studies that incorporate research on1052today's veterans would inform more accurate disability ratings.1053Alternatively, a move toward individualized disability1054determinations could also increase accuracy and eliminate the1055need for detailed earnings loss studies, but would require1056statutory changes.1057    To zoom out, in disability studies, there is a distinction1058between impairment and disability. Physical or mental1059conditions can lead to impairment, a reduction in the1060functioning of a body system or structure which can be1061diagnosed by medical professionals. Disability, however,1062relates to how these conditions lead to limitations to societal1063participation. For many disability programs in the U.S., there1064is a focus on how impairments lead to work disability,1065specifically reduced earnings capacity. Unlike with1066impairments, evaluating work disability requires consideration1067of the economic consequences of health conditions and thus1068requires collaboration between medical and labor force experts.1069    VA disability compensation is aptly named. By statute, a1070veteran with a service-connected health condition receives a1071rating that, quoting here, ``shall be based upon the average1072impairments of earning capacity resulting from such injuries in1073civil occupations.'' Given the statutory requirements, VA has1074commissioned studies to estimate how service-connected health1075conditions translate into average earnings losses. In general,1076these studies compare earnings of veterans with service-1077connected ratings with earnings of otherwise similar1078nonveterans or veterans without ratings. There are two issues1079facing the state of VA earnings loss studies.1080    First, to be relevant, earnings loss studies need to1081reflect the current employment environment. However, the last1082published study relied on data from at least 20 years ago.1083Since then, there have been substantial changes in medical1084treatments, veteran disability evaluation, and the labor1085market, such as, for example, substantial increases in remote1086work.1087    Furthermore, a rated health condition is rated because of1088its impact on earnings capacity, but the rating then1089facilitates access to VADC benefits and additional VA programs.1090How participation in VA programs affects the earnings of1091veterans is largely unknown. Yet, since the publication of the1092last earnings loss study, research on the causal impacts of1093other disability programs has proliferated. Specifically, there1094is now strong evidence on how the benefits in those programs1095have direct effects on earnings.1096    For example, recent evidence indicates that low cost-1097sharing healthcare access and targeted vocational1098rehabilitation benefits similar to benefits offered by the VA1099can facilitate return to work and higher earnings. Not1100accounting for these program-induced earnings increases would1101make average earnings losses appear less severe, but only due1102to the success of the programs.1103    Other programs are different than VAs and serve different1104populations, and the field of disability research also tells us1105the program details matter and that different populations1106respond differently. These other findings are suggestive of1107potential VA effects, but are not conclusive.1108    Because we do not have a clear understanding of the1109relationship among VADC, other VA programs, and veterans'1110earnings, we have limited ability to evaluate these programs'1111effectiveness and thus limited ability to estimate earnings1112losses from service-connected work disability.1113    Other disability programs also offer potential alternatives1114to the average earnings loss approach. The VADC statute1115reflects a concept known as disability-based average justice,1116or the notion that individuals with similar levels of1117disability should receive the same rating and the same1118compensation. Most other disability systems take an individual1119justice approach to at least disability determination, where an1120applicant's disability is rated based on the impacts of their1121health condition on their own earnings capacity, not on the1122average work disability.1123    Regardless of the conceptual framework, recent research1124from Social Security and Workers' Compensation programs can1125provide insight into how the impact of VA programs on earnings1126could be incorporated into the current average justice1127framework or on how VADC could implement an individual justice1128framework. Yet these other programs serve distinct populations,1129so additional research with and insights from today's veterans1130are essential to ensure an accurately implemented VADC program.1131    Thank you for your time and I look forward to your1132questions.11331134    [The Prepared Statement Of Philip Armour Appears In The1135Appendix]11361137    Mr. Luttrell. The written statement for Mr. Armour will be1138entered into the hearing record.1139    Dr. Hunter, you are now recognized for 5 minutes.11401141                  STATEMENT OF KYLEANNE HUNTER11421143    Dr. Hunter. Chairman Luttrell, Ranking Member McGarvey,1144members of the subcommittee, thank you for the opportunity to1145testify today. Iraq and Afghanistan Veterans of America is1146dedicated to improving the lives of post 9-11 veterans and it1147is an honor to speak on their behalf today.1148    It is also concerning that at today's hearing there is only1149one veteran organization represented. This despite the fact1150that veterans who engage with the VASRD are not a monolith and1151there are several voices not in this room, including those that1152have directly worked with veterans to navigate the benefit1153process, and I hope in future conversations we can include more1154veteran voices. Modernization should be done with us, not1155merely on our behalf.1156    Veterans Affairs is currently undertaking a process of1157modernizing the VASRD, attempting to reflect both the realities1158of injuries experienced by servicemembers and advancement in1159medical science. The modern veteran population faces conditions1160and occupational realities that were not examined in many of1161the previous efforts. For example, traumatic brain injuries,1162toxic exposure, military sexual trauma, and complex mental1163health disorders are central to the post 9-11 veteran1164experience and have a significant impact on veteran quality of1165life and long-term employment outcomes.1166    Current modernization efforts to be undertaken by the VA1167include earning-loss studies to incorporate data on how1168service-connected conditions affect veterans' earning capacity1169and to align compensation with functional impairment and labor1170market realities. However, there remains virtually no1171transparency into how these studies are being conducted and1172whether or not they truly reflect the complete reality of the1173veteran experience.1174    Earnings loss studies may provide us useful data, but are1175in an incomplete lens to view the problem. For example, the1176Congressional Budget Office study on disability compensation1177focused only on male veterans, despite the fact that when this1178study was conducted, women made up the fastest growing group of1179veterans. We do have significant evidence to show that women1180veterans, even when fully employed, have different earnings1181than their male peers. As a representative of the generation1182that has seen the largest increase in women's service, this1183shows why it is critical that veteran voices are included at1184the table to ensure fulsome and essential studies.1185    While the VASRD shares some similarities to other1186disability compensation programs, there are fundamental1187differences between veteran and civilian populations. Military1188service impacts the human body physically and mentally in ways1189that few civilian occupations ever will. From high physical1190risk occupations to repeated exposures to toxic substances, to1191increased risks for interpersonal harmful behaviors, and to1192having little control over where one lives, military service1193comes with inherent health risks. VASRD is one way that the1194country recognizes and compensates the individuals who1195volunteered and accepted these risks on behalf of the American1196people.1197    This system also exists in a unique legal framework shaped1198by the Ferris Doctrine, which prevents servicemembers from1199suing the Federal Government for injuries incurred during1200military services. Because veterans cannot legally seek tort1201damages for pain and suffering or loss of quality of life,1202disability compensation often also serves as not just income1203replacement, but redress for harms incurred while choosing to1204serve one's country.1205    Many service-connected conditions, such as chronic pain,1206migraines, Post-Traumatic Stress Disorder (PTSD), sleep1207disorders, may not immediately remove a veteran from the1208workforce, but still impose real lifelong impairments that1209merit compensation. Veterans service organizations for decades1210have been advocating to include lagging quality of life1211indicators in disability compensation calculations and that1212total compensation should look not just at the ability of1213veterans to be employed, but the compound and long-term medical1214impacts of service-connected illnesses and injuries. New1215research is also showing that quality of life indicators may be1216uniquely impactful to veterans and may exacerbate existing1217employment challenges.1218    VASRD as a program is also not just an investment in those1219that served, but an investment in our long-term national1220security. Veteran care after service is still a strong1221recruitment tool for military service, which requires the1222public trust. Veterans' participation in the modernization1223process will increase the confidence that these reforms are1224justified, fair, and aligned with modern veterans needs. It1225maintains the buy-in of one of the country's best recruiting1226assets: those of us who have already served.1227    Like many other veterans organizations, IAVA stands ready1228to support the VA in these modernization efforts and our1229members are eager to engage. In our most recent polity priority1230survey, over 50 percent of IAVA members cited modernizing the1231process as their top area that they would like to be involved1232in. Additionally, of our members that have a disability raising1233over 65 percent report that their disability payments are1234essential to their overall financial well being.1235    Thank you for your commitment to America's veterans and I1236look forward to your questions.12371238    [The Prepared Statement Of Kyleanne Hunter Appears In The1239Appendix]12401241    Mr. Luttrell. The written statement of Dr. Hunter will be1242entered into the hearing record. Well said, Dr. Hunter.1243    All right. Mr. Armour, I was trying to pick your opening1244statement apart as best I could, but what I took from it is I1245think we are in trouble. Now I am going to ask you to talk to1246me. I consider myself a highly educated guy, but if you would1247not mind putting it in crayon for me. What you just said is do1248we have the capability to get there from here with compensation1249levels through this rating system? It did not sound like it.1250You were doing a comparative analysis to the civilian1251population and the veteran population, and Dr. Hunter most1252eloquently defined both, which, again, good job. Can we do this1253or is this an uphill battle that we will constantly have VA in1254front of us saying it will be next year?1255    Mr. Armour. I can speak for the analytic question.1256    Mr. Luttrell. I am going to beat on you. You got a Ph.D.1257That means you are way smarter than me.1258    Mr. Armour. We can do the earnings loss. We can do modern1259earnings loss studies. That is right. I think transparency1260about the methods that are used in it, pretty much all the1261methods used so far from the work cited in my testimony and the1262other panelists, it is outdated or it is using estimation1263techniques that are just not actually getting action.1264    Mr. Luttrell. It will always be outdated.1265    Mr. Armour. Not always 20 years outdated.1266    Mr. Luttrell. We have to land somewhere, this panel right1267here and subcommittee, the full committee, all the way to where1268it needs to go. It will always be outdated. Where is the1269landing zone for us? We are going to have this conversation1270with VA and the fact that the other veteran organizations--Dr.1271Hunter, as you stated, this is an--anyone is welcome to sit in1272front of this committee at any time. I welcome it. We welcome1273that.1274    Mr. Armour. We have done these, this kind of research for1275other programs. They do differ in these ways, but modern1276techniques can do it and they can do it relatively quickly in1277terms of, you know, months and years instead of decades.1278    Mr. Luttrell. Define ``relatively quickly'' for the Federal1279Government.1280    Mr. Armour. Months and years instead of decades.1281    Mr. Luttrell. Okay. Dr. Curda, is the VA in a position to1282get this thing completed and pushed across the finish line in1283summer of 2026, in your personal opinion?1284    Ms. Curda. I cannot tell you that they will be done in12852026. We----1286    Mr. Luttrell. From the information that you have gathered1287and the research that you have done, what are we looking at?1288    Ms. Curda. They are in the final stages.1289    Mr. Luttrell. Final stage. Man, I tell you what, you would1290be surprised how many people are in final stages in the U.S.1291Government. I mean, we are like there.1292    Ms. Curda. That is what I--that is all I know.1293    Mr. Luttrell. I mean, the electronic healthcare record has1294been in the final stages for the past 10 years and we are about129550 billion into it and it is still not done. Matter of fact, we1296are shutting it down.1297    Ms. Curda. Yes. Meaning they are just before the Office of1298Management and Budget (OMB) phase, I guess----1299    Mr. Luttrell. Right.1300    Ms. Curda [continuing]. with the final rule. It is possible1301that they can be done this year and we are hopeful. We would1302love them to be done this year. I cannot be sure they will. We1303have not seen an update on their progress since June of last1304year, and we have not had a substantive update on their action1305plans since August 2024.1306    Mr. Luttrell. I would be interested to know how, once the130715 body systems rescheduling is complete and we have the 151308body systems that we consider, okay, how do we continue to1309update that at a pace that stays relevant to science and1310medicine? Mr. Armour, you got something for that? You are a1311doctor, are you not?1312    Mr. Armour. Ph.D. Again, I think we can do these analyses1313much faster. We have the capacity.1314    Mr. Luttrell. Can I will tell you what?1315    Mr. Armour. That access is the biggest issue, I think,1316right now.1317    Mr. Luttrell. Analysis to application is the death of this1318place. You know how--looking around at the walls, everybody1319wants to write about something. We have to touch human bodies.1320I mean, I am so sick and tired of that. I am not beating up on1321you. I am talking out loud for the world to hear this.1322    How do we stay relevant in your personal and professional1323opinion once this thing goes nuclear? Is that a possibility or,1324Ms. Curda, are we going to be having this conversation 5 years1325from now that we are still using the DSM-5 and the information1326that we have on traumatic brain injuries date from 2013? I am1327sure Dr. Dexter is going to clack off on this one in a hurry1328when it is her turn.1329    Ms. Curda. Yes, I am not a medical doctor either. I think1330it is possible for VA to stay up to date and I think they need1331to stay up to date, but they will have to continue to have1332really rigorous and realistic planning. They need to address1333some of the root causes of the issues. For example, the1334internal review process. I took a look at all the stakeholders1335internally to VA and there is something like 18 different--81336parts of VA that have to look at the draft rule and 16,1337according to them, 16 levels of review. Then once you are done1338with that, there is external parties, there is something like133911 external parties that they review it.1340    Mr. Luttrell. I mean, the complexities are mind-numbing,1341but it is so important for us to figure this out, us, we, the1342Department of Veterans Affairs, figure this out because it is1343the veterans that are feeling the pressures.1344    Mr. McGarvey, you are recognized, sir.1345    Mr. McGarvey. Thanks, Mr. Chairman. I am just going to pick1346up on what you were just saying, Dr. Armour. I used to work1347with a lawyer who would say, had an old expression, he said,1348you can get it fast, good, and cheap. Pick any two of three.1349Right. What is the best and fastest way we keep up to date?1350    Mr. Armour. I think it is facilitating access to data for1351researchers. There is a paper that Dr. Hunter cited forthcoming1352by David Silver and Jonathan Zhang, looking at the impacts of1353ratings for mental conditions on quality of life outcomes and1354on healthcare utilization. That was--it is a phenomenal1355project. I think that represents the current state of what1356research can do in this field. It is entirely limited to1357outcomes that the Veterans Health Administration has access to.1358    Mr. McGarvey. Where is the lag in data coming from?1359    Mr. Armour. I cannot speak to specifically the internals of1360that study. I think, in general, getting linkages between VBA1361and VHA to occur is pretty much impossible to have happen, let1362alone the other aspect of this, which is the earnings loss1363studies. Those data generally need to come from the Social1364Security Administration, which has--they will not export1365individual data, but will allow for some Memorandum of1366Understandings (MOU) to understand it. Setting those up,1367facilitating that, that enables research to be done, the good1368research, and--yes.1369    Ms. Curda. Can I comment on--just comment on that?1370    Mr. McGarvey. Yes.1371    Ms. Curda. VA actually has in place agreements now with the1372Social Security Administration and the Internal Revenue Service1373(IRS) and some other entities to do that kind of data exchange.1374They have made progress in that area. I just wanted to point1375that out.1376    Mr. McGarvey. It sounds like we still need to have some1377progress in that area. One thing we need you all is help on and1378I can tell you on this committee, we are not going to accept1379the idea that we cannot do this because I think we can.1380    Dr. Hunter, do you want to say something?1381    Dr. Hunter. Yes. I will just add to the conversation and I1382will disclose Phil and I were colleagues until just a little1383while ago here. There is also a big issue in the transparency1384of these studies being done. We hear a lot that VA is making1385these--like having these MOUs, doing all of these data, but1386they are doing it in a black box, which does not allow for1387either organizations like RAND and other Federally Funded1388Research and Development Centers (FFRDC) to actually do1389reproduction surveys or you do the data or do the studies1390faster, often through tools, or for VSOs to validate and1391understand. Like are you actually representative of this1392hierarchy of the population? We end up with studies like the1393U.S. Congressional Budget Office (CBO) does that excludes the1394fastest growing part of our population. Data transparency1395coming out of the VA is one of the biggest blockers to being1396able to do these fast and accurately.1397    Mr. McGarvey. That should be something we should be able to1398help fix a little bit, I would think, Mr. Chairman.1399    Dr. Hunter, I am going to go over to you. Thank you for1400your service. Appreciate that. I want to get away from--we have1401been out of government-speak now for a solid 3 minutes. I hope1402we can stay in this zone. I am just going to ask you point1403blank, do you think the VA disability is overly generous right1404now?1405    Dr. Hunter. No.1406    Mr. McGarvey. Have you spoken with anybody who does?1407    Dr. Hunter. No.1408    Mr. McGarvey. Okay, good. What would you say to someone who1409thinks that veterans who receive VA disability are somehow1410taking advantage of taxpayers, they are scamming the system?1411    Dr. Hunter. I would first say that when you raise your1412right hand to serve, you make a contract with the United1413States, and that is that we put our lives on the line 24/7, and1414as a result, we are to be taken care of for the time when we1415are done.1416    Mr. McGarvey. I think that contract you make when you raise1417your right hand and give yourself to service is both a legal1418and a moral obligation that we have as a country.1419    I want to ask you about the statutory mandate for the basis1420of disability ratings. The law says, quote, ``The rating shall1421be based upon the average impairments of earning capacity1422resulting from such injuries in civil occupations,'' which is1423wonderful statutory language to say you get injured in the1424service. We are going to look at your disability rating based1425off a civilian counterpart. It is that ``civil occupations''1426part that concerns me because military occupations do not1427always line up with civilian occupations.1428    You yourself, Dr. Hunter, you were an attack pilot on a1429helicopter. I am not sure there is a civilian equivalent for1430that type of job.1431    Dr. Hunter. I have not found it. I was looking for it for a1432long time. I have not found it.1433    Mr. McGarvey. I do not think it is there. You know, and1434whether it is a Navy SEAL, whether it is an artillery crewman,1435we are going to have trouble lining this up.1436    Dr. Hunter, how do you compare injuries and illnesses that1437happen in military service with civilians?1438    Dr. Hunter. They are not comparable. The military service,1439as I stated, there are physical risks that are unique. There1440are mental and psychological risks that are unique. There are1441environmental risks that are unique. One of the biggest areas1442of sort of divergence between the civilian and military1443occupations is that military servicemembers have very little to1444no control over where they spend their time, what environmental1445factors might be around them, what they are exposed to, the1446types of injuries they may receive.1447    A lot of the research that is done on the civilian side1448also include some opt in, right, some buy in to whatever career1449path they choose to be in in terms of how those calculations1450are done. The military, that is also removed, which goes back1451to some of this contract, that there is a volunteer to do1452whatever the country asks of you to do. Both the type of1453injuries and the environment in which those injuries might take1454place are divergent in medical aspects as well as the moral1455contract that we have made with the country.1456    Mr. McGarvey. Thank you very much. I do think that how,1457when, and where the injuries occur are often important in1458military service, just as the injury itself.1459    Mr. Chairman, I am out of time. I yield back.1460    Mr. Luttrell. Thank you, sir.1461    General Bergman, sir, you are recognized for 5 minutes.1462    Mr. Bergman. Thank you, Mr. Chairman. It is really1463fascinating to sit here and listen to the discussion back and1464forth because I sense everybody here is--no matter what role1465you are playing, even if you are sitting out there in a crowd,1466we are all here for the betterment for veterans outcomes, which1467is a good thing. Not necessarily in Washington, DC, can that be1468said in every hearing room. I will just leave that for a1469discussion of a different time.1470    I would like--and this is a generic--it is not a generic1471question. It is a specific question for any of you to respond1472to. To what extent do silos currently exist that inhibit the1473breakthrough results and the speed at which we need--the change1474that we know needs to occur occurs? Would anyone like to1475address the--however you want to address silos?1476    Ms. Curda. Yes, there are silos that exist that prevent the1477speed of things getting done.1478    Mr. Bergman. Okay. In that case, so we agree that there are1479silos. I think that is not a surprise. Is the level of1480understanding that those silos exist, let us say within the1481Veterans Administration, to acknowledge they exist and then1482deal with the fact that do they need to exist? Do we need--is1483it additive in a positive way for the outcomes? Sometimes we1484have to work to get things done. If we work too long in a silo,1485we do not share the information.1486    As the Veterans Administration looks at their1487reorganization of the business, which was just announced, you1488know, in the last month or so, do you believe that a part of1489being able to speed up the process here toward positive1490results, it would be a positive effect to, however it is done,1491break down, rewicker, whatever you want to call the silos?1492    Dr. Hunter. Sir, I will answer that one and I will answer1493it both from now as a CEO of a veteran organization and someone1494who was a public policy researcher before coming into this1495role. Absolutely, and particularly breaking down the silo1496between the VA and veterans in this research.1497    One of the things I learned very early on doing public1498policy research is that numbers are all great and fine in the1499spreadsheet, but the rubber meets the road when you engage the1500population that whatever you are researching is going to be1501impacting. Breaking down that silo, A, it will allow1502information to get to the VA faster about the reality of what1503is happening to veterans rather than waiting 10 years of the1504study. Talk to us, ask us. We can tell you that very quickly,1505as well as allow for a more, you know, robust and rapid1506updating of the system to meet the realities.1507    We talk a lot and we hear in the news all the time that1508warfare and the type of, like, modern warfare is expanding at1509this exponential rate. We have--whether it is advancements in1510technologies or the change in the type of enemies that we have,1511and if the VA remains siloed and cutoff, doing their research1512and not interacting with those who most recently served, there1513is always going to be this lag. We are always going to be1514playing catch-up and saying, oh, yes, well, next time we will1515deal with this injury. Next time we will look into this body1516system. Next time we will figure this out.1517    From where we sit, absolutely, we are here and ready and1518want to break down those silos and work to ensure that our1519veterans are taken care of.1520    Mr. Bergman. Anybody else want to comment? Okay, that is1521all right. Silence is you do not want to comment.1522    Okay. Along with the silos, what can we do, from your1523perspective, as a committee to advance the decrease--or, excuse1524me, the increase in transparency? Once you have got the silos1525broken down, how do you set the environment where now if you1526are working on this project--we are all working, you know, but1527there is that transparency of data exchange? Any thoughts?1528    Ms. Curda. Well, I think certainly hearings like this are a1529great way to make situations at VA more transparent and having1530testimony. I think, encouraging the agency to be forthcoming1531and transparent with information with GAO, for example. We have1532had a good dialog with them in the past number of years as we1533have been monitoring their progress on the high-risk issue.1534Sometimes the information has to go through extensive levels of1535clearance and takes a lot of time to get to us. We just would1536prefer to have a more give-and-take kind of relationship on1537these things because we think that would help give us an1538opportunity to respond to them sooner and it may help things--1539keep things from going off track.1540    Mr. Bergman. Okay, thank you.1541    Mr. Chairman, thank you. I see I am over my time. I yield1542back.1543    Mr. Luttrell. Thank you, General. Dr. Morrison, you are1544recognized for 5 minutes.1545    Ms. Morrison. Thank you, Mr. Chair. I want to thank you and1546the ranking member for holding this hearing today. I want to1547thank our witnesses for being here to testify, too.1548    I am also glad there is bipartisan agreement that the VA1549Schedule for Rating Disability should be modernized and it is1550essential that we get this right. We need to require1551transparency from VA and a process that incorporates feedback1552from medical experts, economists, and, of course, the veterans1553themselves.1554    My late father-in-law was an Army Ranger and received1555disability compensation for the injuries he sustained in1556combat. We know that so much has changed since veterans like my1557father-in-law served, both in terms of the nature of military1558service as well as significant advances in medical research and1559treatment. We know more than ever we have the--we know more1560about the effects of military service on veterans' physical and1561mental health. It is critical that we put this data as well as1562veterans' experience to use as we tackle this important issue.1563    Dr. Hunter, I want to begin with you. As you noted, women1564are the fastest growing group of veterans. According to VA,1565women made up about 4 percent of the veteran population in15662000. By 2040, VA expects that number to increase to 181567percent. What should VA be doing to incorporate data that1568accurately accounts for the increasing population of women1569veterans?1570    Dr. Hunter. When we look at women veterans, and1571particularly for this topic in particular, there are two areas1572that need to be done. One is ensuring that when we are looking1573at the actual impacts of certain injuries, illnesses, and1574exposures, that women are part of the clinical studies to1575understand what the impairments actually are. There is a long1576history of medical research excluding women and so we are1577basing women's conditions off of what men have experienced. We1578know that women are not just little men in this regard.1579Actually doing the clinical studies to understand the impact on1580women is essential.1581    When we are looking at earnings loss statements as well,1582women need to be considered in the workforce aspect of this.1583You know, we look at a lot of conditions that may, you know,1584triple or almost quadruple impact women if we look at things1585like reproductive healthcare issues that are connected to1586service-related conditions and what that does to workforce1587engagement. We also have a whole like a host of new issues1588since women have been involved in ground combat of the1589musculoskeletal systems that have not been studied. We cannot1590make accurate determinations without knowing that. Which is1591why, again, the veteran community stands here willing and1592wanting to be involved.1593    Ms. Morrison. I appreciate that and thank you for bringing1594reproductive healthcare and its impacts into it. As an1595Obstetrics and Gynecologist (OB/GYN) myself, I think that is1596critically important.1597    Dr. Hunter, in your testimony you mentioned that post 9-111598veterans are more likely than previous generations to endure1599exposure experiences that contribute to diagnosed mental health1600disorders, both from the psychological and physiological1601perspective. Traumatic brain injury, toxic exposure, and1602military sexual trauma are all factors that have to be1603considered to meet the needs of the modern day veteran1604population. As we continue to learn more about these various1605forms of trauma--how these various forms of trauma affect a1606veteran's quality of life and economic prospects, what role do1607veteran service organizations have to play in ensuring the1608needs of the veteran are reflected in any proposed changes to1609the rating schedule?1610    Dr. Hunter. Thank you so much for bringing up the mental1611health side of this, too. I think VSOs have three or four big1612areas that we play.1613    One is we are the frontline touch points with veterans. As1614IAVA, we conduct multiple surveys a year to understand the1615experiences in closer to real time than any of these VA studies1616can be done. If we want to know how this is impacting people,1617we can tell you. We actually have that data. When we talk about1618data sharing and transparency, we can get it to you in a much1619faster way.1620    Additionally, one of the big parts of this is that VSOs1621engage with veterans who may not be in the VA system. When VA1622is doing their studies, they have a huge bias that we have not1623even talked about, the fact that when they are looking at1624outcomes, they are looking most often at people who are already1625part of the VHA system. Part of what we want to do is catch1626that wherever it is, between 20 and 50 percent, depending on1627what study you read, of veterans who are outside of the system.1628We are the conduit to those people. We are the conduit to the1629people that is actually the hardest to get the data on, which1630is important.1631    Then third, we are a trusted agent. There has been1632historic--through all of the scandals and all of the reporting,1633the VA has been all over the place in how much the veteran1634community actually trusts them. VSOs are often more trusted1635organizations, and we can serve a role in helping the VA build1636that trust back in the veteran population through collaborative1637work.1638    Ms. Morrison. Thank you so much. Many more questions, but I1639see my time has expired. One more? Thank you, Mr. Chair.1640    Mr. Luttrell. Mrs. Radewagen.1641    Ms. Radewagen. Thank you, Mr. Chairman. I want to thank the1642witnesses for appearing today.1643    Ms. Curda, does GAO believe that VA is still treating this1644rating schedule updating, overhaul as a project instead of a1645program?1646    Ms. Curda. I am not sure I understood your question.1647    Ms. Radewagen. Does GAO believe that VA is still treating1648this rating schedule updating, overhaul as a project instead of1649a program?1650    Ms. Curda. No, they have--they are treating it like a1651program. They have a program office which they have1652established. They have staffed it mostly. Those staff have1653been, you know, developing, promulgating the regulations to1654provide the medical updates. They have also been working on the1655earnings loss studies.1656    Ms. Radewagen. How does the schedule influence the claims1657processing workload? Do you believe that the lack of updates is1658causing issues within VBA when it comes to claims processing?1659    Ms. Curda. No, I do not think it really affects the claims1660processing. You know, down the road, if they change the1661regulations, it will have an impact. They will have to make1662updates to a lot of the training and all the inputs that go1663into the process so that it is up to date and in line with the1664regulations.1665    I think the impact is more along the lines of the equity1666issues we have been discussing today, where outdated1667information might lead some veterans to be overcompensated and1668others to be undercompensated. I mean, if you are just strictly1669on an earnings loss basis.1670    Ms. Radewagen. Yes. Mr. Armour, when researchers evaluate1671the impact of veterans' benefits, what challenges exist in1672isolating the effects of a single benefit when many veterans1673are accessing multiple programs at the same time?1674    Mr. Armour. There is a lot of challenges with that. That is1675actually a fundamental concern here, is that we do not have a1676sense of why some veterans access certain programs at different1677times and thus the impacts that those program--participation in1678those programs has. It is very difficult to tease apart for1679these earnings losses. You know, was it vocational1680rehabilitation, the Veterans Readiness and Employment (VR&E)1681services that went into it? Was it kind of the access to VA1682healthcare being priority group 1 through 3 that had an impact1683or is it just fundamentally the health condition itself1684improved? These are all things that are from the data alone are1685quite challenging because we just do not have an evidence base1686on the impacts of these programs or also like how benefits1687themselves sort into using them. Yes, so I guess I would leave1688it at that.1689    Ms. Radewagen. Thank you, Mr. Chairman. I yield back the1690balance of my time.1691    Mr. Luttrell. Thank you, ma'am.1692    Dr. Dexter, you are recognized for 5 minutes.1693    Ms. Dexter. Thank you, Mr. Chair. Thank you both, our1694ranking member as well as you, for your leadership in this. I1695think this is a really important topic and I am grateful for1696this today. I appreciate the committee being engaged and1697bipartisan as well. This is unique in Congress to have folks1698who are aligned, so thanks. To our witnesses, thank you, also,1699for your service as well as being here today.1700    As a physician, I strongly believe that disability rating1701schedules must be data-driven, medically sound, comprehensive,1702and centered on veterans' lived experiences, so certainly need1703to include women in those studies as well as many other1704conditions. I will just share, as a medical student and then as1705a medical resident in the early 2000's, 30 years after the1706Vietnam War, I cared for patients in the VA system with complex1707and poorly understood symptoms. Over time, research made clear1708that many of these conditions were linked to Agent Orange1709exposure, something that many of the veterans expressed1710suspicion of, but felt very, we will say, gaslit these days. We1711were not saying that then, but not trusted. The frustration,1712the betrayal, the despair I saw so many veterans experience1713left an impression. It also showed how long it can take for1714science to catch up to exposure impacts and why ongoing1715monitoring and research are essential.1716    As a pulmonologist, the lungs in particular are uniquely1717vulnerable. They are the only organ continuously exposed to the1718outside world without any protective barrier unless we put1719something on. Toxic exposures are constantly evolving, as we1720know on this committee, which means our understanding of their1721long-term health impacts must evolve as well.1722    First for Mr. Armour, you noted--or Dr. Armour, sorry, you1723noted that the last VA Commission's RAND studies were conducted1724more than 20 years ago before much of our current understanding1725of toxic exposure, PTSD, and traumatic brain injury were1726available. From your perspective, what are the most important1727next steps to ensure veterans are benefiting from the most up-1728to-date science when disability rating schedules are reviewed1729and updated?1730    Mr. Armour. I mean, just updating those earnings loss1731studies and in particular like bringing in the issues that we1732have observed from other disability programs to address, like1733those modern techniques.1734    Ms. Dexter. Just to follow up on that, that is sufficient,1735you think, for the science to catch up as well?1736    Mr. Armour. I will speak as an economist on what the1737economic angle would be.1738    Ms. Dexter. Okay.1739    Mr. Armour. I think that would check that box, but I am not1740a physician.1741    Ms. Dexter. No, of course. Obviously, it is an unfair1742question for many of you. I will just state that we need to1743have ongoing evaluation and iterative evaluation of our medical1744information in the same way that I hear you arguing for1745economic information.1746    The second question, I am proud that my bipartisan bill to1747strengthen the Veterans Readiness and Employment Program, the1748VR&E Act, with a lot of support from people here passed both1749the House and Senate, and I am continuing to work to better1750support VR&E counselors. Mr. Armour, can you speak to the role1751of rigorous research in evaluating and strengthening VR&E and1752what this program can tell us about earnings losses associated1753with service-connected disabilities?1754    Mr. Armour. I can tell you I think there is tremendous1755potential to learn those things. I think the current state of1756research on it is such that it is very difficult to identify1757the causal impact of those services. There are--the VR&E1758longitudinal study is one sort of study that has been going on1759for a stretch of time. Again, it is sort of a study that does1760not use modern methods in comparing people who did get services1761versus those who did not and the subsequent outcomes.1762    I think that there are ways in which we could--there is a1763lot of potential to find out for whom it is working and what1764those impacts are. We just do not have that evidence base right1765now.1766    Ms. Dexter. Very good. Not good, but obviously you have1767expressed the need for implementing change to how we collect1768data.1769    Dr. Hunter, disability rating decisions must be grounded in1770sound medical evidence. Proposals to lower disability ratings1771based on whether a condition is treated raise serious concerns1772for me. Take obstructive sleep apnea as an example. When1773untreated, it can worsen hypertension, heart failure, and1774significantly increase risk of heart attack and stroke. Trying1775to lower ratings to treatment could discourage veterans from1776seeking care, which puts their health at risk and may1777ultimately cost more for the VA as well as cost of productive1778life here for those veterans. Dr. Hunter, from a veteran's1779perspective, can you speak to the concerns around lowering1780disability ratings based on treatment status?1781    Dr. Hunter. In addition to what you mentioned about it1782potentially discouraging veterans from getting care, there is1783also the very real thing that we need to look at about1784treatment for veterans who may not live close to VA symptoms.1785Like, I am out in the West, as are you, and for me, I get all1786of my care at the VA and I often have to travel 3-1/2 to 51787hours, depending on the weather conditions, to get some1788specialized care. If we say, well, you are getting care, you1789are not getting compensation, the other thing that we have to1790look at is how does that remove people from the workplace? What1791is the added stress and time and, you know, hardship that is1792put on it, on an individual? Which is something that needs to1793be looked at as the total overall compensation. We do not want1794to say we are correcting one issue and making a bigger problem,1795which is why these updated studies need to be done.1796    Additionally, what it does not take into effect is the1797long-term impact in quality of life issues that arise. Even if1798a condition is considered treated, there still is often a1799lagging quality of defect of life indicator. I actually1800encourage the committee to encourage the VA to look at studies1801coming out of Australia and Canada and Israel where they1802actually include like verified quality of life measures into1803their veterans' disability compensation programs that have had1804results of actually improving workplace outcomes through1805addressing the fact that there were initial quality of life1806concerns. Just through the redress payments from those, you end1807up having much better long-term economic outcomes as well.1808    Ms. Dexter. Thank you. I appreciate your patience.1809    Mr. Luttrell. Yes, ma'am.1810    Mr. Self, you are recognized for 5 minutes, sir.1811    Mr. Self. Thank you, Mr. Chairman.1812    Ms. Curda, I was very curious that the management of1813disability compensation claims has been on your high-risk list1814since 2003. Yet you said that August of 2024, January,1815February, and June of 2025, you got a lot of input. Can you1816estimate how much of the advances they have made happened since1817August of 2024? Just a rough estimate.1818    Ms. Curda. That I cannot tell you much. I would say it is1819not true that is the first time we have heard from them. We1820actually have been talking to them pretty frequently since1821about 2019, but we saw progress more in more recent years.1822    It took a while. We went through a process of deciding,1823okay, what are the root causes of these issues? VA came up with1824root causes. They developed an action plan to address those1825root causes. The first version was more like a list of stuff we1826have done. It was not a plan. Then they had to go back to the1827drawing board and come up with a plan that had milestones and1828goals and, you know, ended up being something we were--we1829thought was an actionable plan and they had something they1830could monitor their progress against. It just--it is been a1831multiyear effort and it has not all been since 2024.1832    Mr. Self. Well, I would ask you what can Congress do to1833help GAO? Not just in VA, but across the government, you have1834hundreds and hundreds of reports that have not been acted on by1835many of the departments. I think Congress ought to be looking1836at GAO, how we help you to get things implemented.1837    Now, let us go back to your five criteria for removing them1838from the GAO high-risk list. They have met leadership1839commitment, action plan, and monitoring, less so in capacity,1840which is basically resources. It is not capacity, it is1841resources, and demonstrated progress. We have got a saying in1842Texas, when you look at the three that they have met, they are1843still fixing to do something.1844    Ms. Curda. Yes.1845    Mr. Self. They have not done--I mean, logistics is1846everything. If they have not provided the resources for the1847capacity to do it, then they are not going to demonstrate1848progress. I think this is very telling chart that you have1849given us, that they really need to do something now that they1850have made the commitment, apparently.1851    Then, Dr. Armour, you talked about individual versus1852average justice. You spent a lot of time on that with the1853Social Security. Now, Social Security Administration supposedly1854has outdated computers, old coding, and yet you basically said1855that the Social Security Administration does a far better job1856individualizing plans. Can you kind of talk to that?1857    Mr. Armour. I will say historically, Social Security has1858been very welcoming to the research community in allowing us to1859conduct research on how the disability determination process1860works and at sort of which stage. They do contract with--they1861contract with states to actually administer the first stage of1862it. For each kind of level of that. They have shared a lot of1863their earnings data, their benefit data, and we have provided1864over the years a lot of strong results on kind of the--every1865stage of their determination process, sort of how it works.1866That has allowed them to make various policy decisions to1867provide that feedback back to that determination process. They1868have also engaged in a lot of National Academies of Science,1869Engineering, and Medicine panels to update their own listings.1870    Mr. Self. Well, that is not really my question because you1871get a very individualized plan from Social Security1872Administration. These are your earnings, this is your1873disability. This is--I mean, it is pretty detailed and it is1874individualized. Yet you say that VA uses an average justice1875sort of model. Yet we spend a lot of time individually, and1876part of that is the problem. We have 66 percent of claims have1877errors and 44 percent of all--I have forgotten the data, but, I1878mean, we have a tremendous error rating. Why is that if we are1879using average justice as opposed to individualized? It looks to1880us as though we spend a lot of time with the individual. Can1881you explain that?1882    Mr. Armour. I can speak to how Social Security does this--1883--1884    Mr. Self. All right.1885    Mr. Armour [continuing]. and how they separate the1886determination process into two steps. One is a listing of1887impairments. These are conditions that are sort of severe1888enough that through medical evidence alone can determine that1889there is a disability. There is that. They have an all or1890nothing determination as well, is another thing that makes that1891makes Social Security a little clearer.1892    Then if there is not that listing of that level of1893severity, then it is an individualized assessment that they1894have, and it is a residual--it is trying to estimate functional1895capacity at that individual level. They have done a, you know,1896spelling things out for the things that can be easily spelled1897out and then having an individual assessment where they see1898people's earnings leading up to it. You know, they have1899physicians comment not just on the medical component, but on1900the functional capacity component, and then they have a lot of1901oversight of that particular process. They have split apart1902that decision instead of trying to schedule everything.1903    Mr. Self. Thank you very much. I think that is something we1904might do a deeper dive on.1905    Chairman, I yield back.1906    Mr. Luttrell. Thank you, Mr. Self.1907    Go ahead.1908    Mr. McGarvey. Thank you, Mr. Chairman. I just want a couple1909of quick follow-up questions.1910    Ms. Curda, earlier I asked VA if they would commit to1911sharing their methodology with you. Would you be receptive to1912that?1913    Ms. Curda. Absolutely.1914    Mr. McGarvey. Perfect. Beyond sharing methods and data, is1915there anything more that you would ask the VA to better provide1916oversight, accountability, and quality assurance in this rating1917schedule?1918    Ms. Curda. Just quicker turnarounds on things. When we ask1919for information, just instead of having to wait a long time for1920clearances and stuff, you know, just get it to us. If it1921exists, they should be able to provide it.1922    Mr. McGarvey. Thank you. One common theme between the first1923panel and between you all seem to be these silos of1924information. These silos are terrible things that I think are1925hurting our veterans. They are holding information and keeping1926it from people who need it when it should be shared, it should1927be transparent.1928    Dr. Armour, you talked a little bit about this and we seem1929to be dealing with several information gaps, in part caused by1930some of these silos, which leads to nonexistent research, out-1931of-date data sets. What other sorts of basic research need to1932happen and does it make sense to have that before people start1933talking about radically changing the VA compensation system?1934    Mr. Armour. I think given the state of knowledge on the1935economic consequences of VA benefits, yes, we just do not have1936a lot of publicly available research on, right, today's1937veterans and today's system. I think, yes, kind of more1938research. I particular, I think it is not wildly complicated. I1939think it is sharing the existing data that Social Security has1940that the VBA, the VHA has, together could provide if that were1941more widely available, if more research could be conducted on1942that in a way in which there is transparency and comment so1943that modern techniques could be used. I think that would answer1944a lot of questions very quickly, again, if things moved.1945    Mr. McGarvey. Transparency and sharing of information, I1946like it.1947    Mr. Chairman, I yield back to you.1948    Mr. Luttrell. Mr. McGarvey, I have--since my time in1949academia to the time I am sitting next to you today, trying to1950convince--I do not care which institute of higher learning you1951are talking about and that famous catchphrase of silos, how do1952you sew the seams between the two? Who will have the1953willingness to open--like in my personal opinion, the VA should1954be the premier institute of research on the planet, amount of1955information that is inside of the VA system. They have always1956been, since I have had the opportunity to work alongside the VA1957or with the VA, very protective of us, the veteran community.1958That information is some of the most cherished data on the1959planet. Everyone is knocking on the door saying, please let us1960engage with you to share this information so we can move any1961side, any kind of information forward. VA has always been very1962reluctant of that because who is going to fall on the sword?1963Who is going to take responsibility if there is a breach and1964the information is gone or lost or taken or worst case1965scenario?1966    Conversations on the committee and with secretaries, deputy1967secretary, who you are talking to, and this kind of goes to1968what you are talking about, Dr. Hunter and Mr. Armour, is, yes,1969if other institutions, whether that is VSO or any institute of1970higher learning, had the opportunity to do that, where would we1971be now? I have been having this conversation for 12, 15 years,1972so I can only imagine how long you guys have been having it. I1973speak to the broader research base. You guys look like you are1974in your 20's. How do we break that down? We do. It is a fair1975question.1976    I can understand and I really appreciate where we are in1977the protection mechanism, especially in the branches of1978artificial intelligence, machine learning, and the bad actors1979that are pushing that out to take from us that we cannot defend1980against. As we incorporate machine learning language models1981into this data to find these answers, at what point, this is a1982fair question to ask, at what point do we find the answers to1983solve the issues of the brain?1984    If we have the ability to get rid of sleep apnea or1985tinnitus or the varying degrees of heart disease and exposures1986from being in combat, where do we sit then? Do we ask the1987veterans, like, hey, we are going to give you this and1988everything is going to be okay? Or do we grandfather it in and1989we move forward into the next generation? These are discussions1990we are going to have to have. You would be pleasantly surprised1991how challenging those discussions are going to be. It lends1992itself to what Mr. Self was saying, is that what point do we1993say, hey, look, we can fix these things? How do we engage with1994the veterans so they will receive it? How does the VA implement1995it? Then how do we move forward to make sure that we do not1996talk about 1945 infrastructure, which I still find moderately1997entertaining?1998    I will never say we are moving fast enough because of all1999the veterans in my district that walk up to me and say we are2000not. I am listening. As a veteran myself, I have that same2001response. I do understand how complicated the VA system is just2002from this side. I have never actually been inside the VA, but2003having offline afterschool conversations of how challenging it2004could be, it is. I just hope and pray every single day they2005keep moving forward. We will do everything that we can on this2006committee to make sure that they have what they need.2007    As problem sets continue to increase and it seems like we2008always have to talk about dollar bills. Well, I am going to be2009quite honest. You know what? Dollar bills is something that is2010extremely hard to find even in the VA considering how far in2011debt we are as a country. We beg, borrow, and steal and kick a2012lot of butt to get the money for our veterans because we would2013not be sitting there having this conversation if it was not for2014you all. We are willing to do that, but we make sure we have to2015do it right. It has to be done right.2016    I want to thank all of our witnesses for joining us today2017to discuss how the Department can address the longstanding2018delays in updating the rating schedule and, more importantly,2019how we ensure this does not remain a recurring problem for the2020future and for our veterans. When the rating schedule is2021outdated or applied inconsistently, it just creates confusion,2022frustration, and delay. That is something that we do not want.2023    Updating the system is necessary. I am excited about the2024opportunity. This will be closed up and we will complete this2025at the summer of this year. This committee will be on standby2026to see if that actually happens.2027    Ranking Member, do you have closing remarks? We good to go?2028    Mr. McGarvey. Thank you, Mr. Chairman.2029    Mr. Luttrell. Yep. I ask unanimous consent that all members2030may have 5 legislative days to revise and extend their remarks2031and include extraneous material. Without objection, so ordered.2032    We are adjourned.2033    [Whereupon, at 4 p.m., the subcommittee was adjourned.]20342035=======================================================================20362037                         A  P  P  E  N  D  I  X20382039=======================================================================20402041                    Prepared Statements of Witnesses20422043                              ----------20442045                    Prepared Statement of Nina Tann20462047    Good afternoon, Chairman Luttrell, Ranking Member McGarvey, and2048distinguished Members of the Subcommittee. I appreciate the opportunity2049to appear before you today to discuss the Department of Veterans2050Affairs' (VA) efforts to modernize disability benefits. Joining me2051today is Dr. Ulia Sokol, a Medical Officer with the Veterans Benefits2052Administration.2053    For disability compensation or pension purposes, a Veteran's2054disabilities are evaluated using the VA Schedule for Rating2055Disabilities (VASRD), also known as the ``rating schedule.'' The2056statute giving VA authority to establish and maintain the rating2057schedule, 38 U.S.C. section 1155, states: ``The Secretary shall adopt2058and apply a schedule of ratings of reductions in earning capacity from2059specific injuries or combination of injuries. The ratings shall be2060based, as far as practicable, upon the average impairments of earning2061capacity resulting from such injuries in civil occupations...The2062Secretary shall from time to time readjust this schedule of ratings in2063accordance with experience.''2064    VA is committed to updating its disability compensation rating2065criteria to accurately reflect medical science, advancements and2066improvements in technology, and current terminology. These updates2067allow VA to ensure its disability evaluations accurately compensate2068Veterans based on average impairments in earning capacity.2069    While VA has made numerous changes to the VASRD over time,\1\ it2070has not completed a holistic and comprehensive update since 1945,2071despite notable progress during that time period. In 2003, the2072Government Accountability Office (GAO) deemed VA's disability program2073high-risk because VA had not systematically updated the VASRD. In2074response, VA developed a Modernization Plan in 2009 with the goal of2075comprehensively updating all 15 body systems of the VASRD. VA2076established workgroups that included medical and VA policy subject2077matter experts. VA used the groups' analyses of established medical2078research to begin the rulemaking process, which involves drafting and2079publishing a proposed and final rule for each body system. To date, VA2080has completed updates on 11 of the 15 body systems. Specifically, VA2081completed: Dental and Oral Conditions in Fiscal Year (FY) 2017;2082Endocrine, Gynecological Conditions and Disorders of the Breast, Organs2083of Special Sense (Eyes), and Skin in Fiscal Year 2018; Hematologic and2084Lymphatic and Infectious Diseases, Immune Disorders, and Nutritional2085Deficiencies in Fiscal Year 2019; Musculoskeletal, Cardiovascular, and2086Genitourinary in Fiscal Year 2021; and Digestive in Fiscal Year 2024.2087Updates made to the VASRD are generally applied prospectively and2088therefore, do not impact current beneficiaries in receipt of disability2089compensation. In circumstances where a change to the rating schedule2090lowers the rating assigned to a particular disability, Veterans enjoy2091numerous protections. Most notable of these protections is that a2092readjustment in the rating schedule cannot cause a rating in effect at2093the time of the change to be reduced unless an improvement in the2094Veteran's disability is shown to have occurred.2095---------------------------------------------------------------------------2096    \1\ Genitourinary, effective 02/17/1994. Dental/Oral, effective 02/209717/1994. Gynecological Conditions/Breast Disorders, effective 05/22/20981995. Hemic and Lymphatic, effective 10/23/1995. Endocrine, effective209906/06/1996. Infectious Diseases, effective 08/30/1996. Respiratory,2100effective 10/07/1996. Mental Disorders, effective 11/07/1996. Muscle2101Injuries, effective 07/03/1997. Cardiovascular System, effective 01/12/21021998. Ear, effective 05/11/1999. Skin, effective 08/30/2002. Eye,2103effective 11/10/2008.2104---------------------------------------------------------------------------2105    VA published proposed rules for the remaining four body systems,2106Mental Disorders (AQ82), Respiratory, and Ear (AQ72) in Fiscal Year21072022 and Neurological Conditions and Convulsive Disorders (AQ73) in2108Fiscal Year 2025. VA anticipates publishing the final rules for all2109four body systems in three rulemakings by the end of Fiscal Year 2026,2110which will complete the first holistic and comprehensive update since21111945.2112    In 2019, VA established the VASRD Program Management Office with a2113mission of revising the VASRD through rulemaking--body system by body2114system, in staggered cycles of recurring reviews, in response to GAO's2115high-risk recommendations. This iterative process ensures continuing2116alignment of the VASRD evaluation criteria with medical, scientific,2117and technological advancements. As with the initial iteration, VA will2118apply lessons learned from previous efforts and begin future iterations2119by establishing workgroups prior to developing proposed and final2120rules, which undergo a thorough medical, legal, and policy review prior2121to publication in the Federal Register. The rulemaking process2122generally takes 2 to 5 years to complete but can take longer due to the2123length and medical complexity of the VASRD updates. Updates to the2124VASRD require coordination to implement required claims processing2125system changes and to provide training and guidance to clinicians on2126disability benefits questionnaires and to claims processors charged2127with correctly applying current disability evaluation criteria.2128    Following the completion of the first holistic and comprehensive2129update to the VASRD, VA plans to continue updating the VASRD with the2130evolution of medical science and treatment modalities. While VA aims to2131update the rating schedule to simplify the claims process for Veterans2132and promote a fair and efficient process, VA will also standardize2133rating terminology and address contemporary claims processing issues to2134assist claims processors charged with delivering fair, efficient, and2135timely benefits decisions to Veterans.2136    In closing, VA remains committed to modernizing disability benefits2137by making continuous updates to the VASRD. We thank the Committee for2138your continued support of programs that serve the Nation's Veterans and2139look forward to working together to further enhance delivery of2140benefits and services to Veterans.2141    Mr. Chairman, this concludes my statement. We look forward to2142answering any questions you may have.21432144                 Prepared Statement of Elizabeth Curda21452146[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]21472148                  Prepared Statement of Philip Armour21492150[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]21512152                 Prepared Statement of Kyleanne Hunter21532154[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]21552156                       Statements for the Record21572158                              ----------21592160            Prepared Statement of Disabled American Veterans21612162    Chairman Luttrell, Ranking Member McGarvey and members of the2163Subcommittee:21642165    On behalf of DAV (Disabled American Veterans) and our nearly 12166million members, I am pleased to offer this statement outlining our2167views of the Department of Veterans Affairs (VA) disability2168compensation schedule of rating disabilities (VASRD) and how well it2169fulfills the purposes for which it was created. As you know, DAV is a2170congressionally chartered, VA-accredited, nonprofit veterans service2171organization (VSO) with nearly a million members, all of whom are2172wartime service-disabled veterans. We are dedicated to a single2173purpose: empowering veterans to lead high-quality lives with respect2174and dignity.2175    To fulfill DAV's service mission assisting veterans, their2176families, caregivers and survivors seeking benefits earned as a result2177of their military service, we have over 4,200 chapter, department,2178transition and national service officers (NSO) nationwide; including2179DAV accredited county veterans service officers. Today there are over21801.1 million veterans and their survivors who have chosen DAV to be2181their representative before the VA and last year we helped them file2182over 560,000 claims for benefits to the Veterans Benefits2183Administration (VBA), taking over 3.1 million actions to support them.2184This assistance, like all of DAV's charitable services, was provided at2185no charge to veterans and their families, and DAV receives no2186compensation of any kind from the government for providing these2187services. Our comments are informed by the collective experience and2188expertise of our benefits experts.2189    The Subcommittee's hearing comes in the wake of a series of2190outrageously misleading and highly inaccurate stories that The2191Washington Post published last fall. Frankly, DAV was shocked and2192disgusted to read the Post stories and deeply disappointed with certain2193so-called veterans advocates who have been repeating and amplifying2194these falsehoods. To assess how well the VASRD has served and can2195continue to serve as an instrument to provide justice and compensation2196to veterans injured, disabled, and made ill from their service, it is2197necessary to first debunk several myths about VA disability2198compensation.2199    For example, the Post alleged that disabled veterans are2200``swamping'' the VA with ``false'', ``fraudulent'' and ``dubious''2201disability claims for injuries and illnesses because the Post considers2202them illegitimate. Nothing could be farther from the truth. According2203to the VA Office of Inspector General, there have been fewer than 2002204fraud convictions annually in recent years. With VBA processing almost22053 million claims in the most recent fiscal year, that equates to a2206fraud rate of less than 1/100th of 1 percent. To justify their2207conclusion that VA is ``swamped'' with illegitimate claims, the Post2208argued that common claims for conditions such as depression, PTSD,2209hypertension, diabetes, eczema, tinnitus, and pain were ``dubious'' and2210``exaggeration''. With veteran suicide still slowly rising, it is2211outrageous to assert that depression and PTSD are not real2212disabilities, just as it is absurd to argue that hypertension and2213diabetes are exaggerations. Moreover, severe eczema, tinnitus and pain2214can be highly disruptive and disabling to a veterans life.2215    The Post also advanced the myth that ``Congress and VA have made it2216easier to cheat and take advantage of the system,'' referring to the2217Sergeant First Class Heath Robinson Honoring our Promise to Address2218Comprehensive Toxics (PACT) Act of 2022 (P.L. 117-168) and the Veterans2219Appeals Improvement and Modernization Act (AMA) (P.L. 115-55). These2220landmark laws were expressly designed by Congress to make it easier for2221veterans to receive earned benefits because millions of them have faced2222unnecessary obstacles that delayed or too often denied their legitimate2223claims for benefits. It is a gross mischaracterization to imply that2224these laws made it easier for criminal veterans to steal taxpayer2225dollars, rather than recognize how the laws have fundamentally improved2226the ability of millions of veterans to receive long overdue justice and2227compensation.2228    Another misunderstanding the Post and others continue to promote is2229that VA disability compensation should only go to veterans unable to2230work. According to the Post story, ``The current [VA] disability2231program was designed 80 years ago to provide a safety net for2232unemployable [emphasis added] veterans wounded or injured during World2233War II.'' That statement demonstrates ignorance about the history and2234purpose of VA's disability compensation system, how it has evolved over2235the years, and how it operates today. It is important to recognize that2236the VA disability compensation system is fundamentally different than2237Social Security Disability Insurance and workmen's compensation2238programs that are only concerned with a person's ability to work. This2239is because military service is a uniquely dangerous type of work for2240the men and women who wear the uniform. Further, unlike other hazardous2241occupations, service members are not able to quit their jobs whenever2242they choose, since they are under orders. They are also not able to sue2243the Federal Government if they are injured, regardless of the2244circumstances, due to the Feres Doctrine\1\.2245---------------------------------------------------------------------------2246    \1\ Feres v. United States, 340 U.S. 135 (1950)2247---------------------------------------------------------------------------2248    The VA disability compensation was not created only to assist2249``unemployable'', veterans, nor was it designed to compensate for2250veterans' lost earnings, a common misunderstanding. Instead, beginning2251after World War I, Congress created and over the course of many years2252evolved a system centered on providing compensation to disabled2253veterans based on ``...the average impairments in earnings2254capacity...'', a legal phrase that may sound like economic loss, but in2255reality, measures functional loss. Under this standard, a blind or2256paralyzed veteran who through perseverance is able to overcome their2257disabilities and work is still recognized as having suffered a loss of2258functional capacity and deserving of compensation. The fact that they2259have been able to overcome their disability does not alleviate our2260Nation's obligation to compensate them for the price they paid and will2261continue to pay for the rest of their lives.2262    For these reasons, VA disability compensation uses an ``average2263person'' standard rather than an ``individual'' one that would require2264VA to evaluate the unique characteristics and circumstances of each of2265the millions of veterans who are wounded, injured, or made ill in2266service. Creating such a system based on each individual veteran's2267actual loss of earnings would not only be impractical - since most2268service members leaving the military have never had a full-time2269civilian job - but would also be dramatically more complicated, time-2270consuming, and expensive to implement. What this also means in practice2271is that disabled veterans are strongly incentivized to seek meaningful2272work since doing so will not result in a reduction in their disability2273compensation.2274    In fact, this is one of the most important but often overlooked2275strengths of the current VA disability compensation system: disabled2276veterans are incentivized to continually improve their health and well-2277being in order to pursue meaningful employment and entrepreneurship.2278The Post apparently believes that even severely disabled veterans -2279those who have lost limbs, are blind or paralyzed - only merit2280disability compensation when they are unable to work. This view fails2281to recognize all the time and effort it may take for these men and2282women to overcome such disabilities, the impact on the families and the2283other parts of their lives, including how it often shortens their2284lives. Providing disability compensation is just one way that our2285government helps to keep the promise to the men and women who served.2286    Another common myth is the false belief that VA's disability rating2287system, and specifically the VASRD, has not been updated or modernized2288since 1945. While there was a major overhaul of the rating schedule2289following World War II, particularly to add new psychological2290conditions, there have been literally hundreds of changes and updates2291to the VASRD since then, as can be seen in the Code of Federal2292Regulations (CFR) Appendix A to Subpart B of Part 4. More recently,2293since September 2017, VA has comprehensively reviewed and updated the2294rating schedule for at least eight of the 15 body systems, and is2295actively working on the others.2296    Mr. Chairman, almost two decades ago, after Congress created the2297Veterans Disability Benefits Commission to explore whether major2298changes were needed to VA's benefit programs, one of my DAV2299predecessors testified that the disability compensation system was:23002301    ``...fundamentally sound and the most practical approach to the2302complex task of fairly compensating a large number of veterans for whom2303the effect of disability is as diverse as the demographic and2304socioeconomic characteristics of the members of the military force and2305the citizens of our Nation from which those members come.'' \2\2306---------------------------------------------------------------------------2307    \2\ Testimony of Rick Surratt, DAV Deputy National Legislative2308Director, before the Committee on Medical Evaluation of Veterans for2309Disability Compensation of the Institute of Medicine, July 7, 2006.23102311    This statement echoes a famous quote attributed to Winston2312Churchill, who observed that, ``democracy is the worst form of2313government except for all those other forms that have been tried...''2314While the VA rating system and the VASRD is not perfect, DAV continues2315to believe that is the most effective and efficient way to fairly and2316equitably compensate veterans for the disabilities, injuries, and2317illnesses they have suffered in service to the Nation.2318    We also believe that some of the questions being raised about2319whether the VA disability compensation system is properly structured2320are the result of persistent problems with the claims processing2321system. If veterans were able to receive fast, accurate, and2322transparent decisions on their claims for benefits, confidence in the2323system could be significantly improved. To help accomplish that, DAV2324offers the following recommendations to make the claims processing2325system work better for veterans.23262327          Allow veterans to file claims by phone2328        VA allows a veteran to submit an Intent to File (ITF) form by2329        phone, but not a formal claim, such as for an increased2330        evaluation or secondary condition. We believe a veteran should2331        be able to contact the VA by phone and file a claim for any2332        condition at any time, just as they can for an ITF.23332334          Amend VA's policy on incorrect forms2335        Currently, the VA treats claims filed on an incorrect form2336        merely as a request for a claims application, which can result2337        in a veteran receiving a delayed effective date and potential2338        loss of tens of thousands of dollars in benefits. To remedy2339        this situation, VA should accept any filing made by a veteran2340        for benefits as a clear statement of the veteran's ``intent to2341        file'' a claim and protect that effective date.23422343          Allow veterans to certify their symptom statements2344        during examinations2345        When veterans receive VA disability examinations, they are2346        often required to describe symptoms of conditions they are2347        claiming to be used in making a rating decision. However, when2348        they receive their claims decisions, many times the symptoms2349        they reported during the exam are different from what was2350        recorded by the examiner. To alleviate this problem, VA should2351        add a step in the exam process that allows veterans to review2352        and certify that the symptoms they reported have been2353        accurately recorded.23542355          Strengthen presumptive decision-making processes for2356        toxic exposure claims2357        Presumptive service connection is used to improve the process2358        and outcomes for veterans filing benefit claims related2359        primarily to military toxic exposures and environmental2360        hazards. The historic PACT Act created new presumptives for2361        burn pits and other airborne hazards, however, it did not cover2362        all affected veterans and all toxic substances. The DAV and2363        MOAA report, Ending the Wait for Toxic-Exposed Veterans,2364        includes a number of recommendations to build on the PACT Act2365        and create a more effective presumptive decision-making process2366        to improve the accuracy and timeliness of toxic-exposed2367        veterans claims for disability compensation.23682369          Optimize the use of technology, particularly AI2370        In order to improve both productivity and accuracy, VBA must2371        continue to maximize and optimize the use of advanced2372        technology, including artificial intelligence (AI), which can2373        significantly increase processing speed and reduce errors.2374        However, its application must be carefully implemented and2375        continuously monitored to ensure essential expertise and2376        decision-making authority is retained by human employees.23772378          Ensure VA has the resources to improve accuracy and2379        timeliness of claims2380        Due to the enactment of the PACT Act in August 2022, along with2381        expanded outreach efforts to veterans in crisis or at risk of2382        suicide, VBA has seen a tremendous influx of new benefit claims2383        and a larger claims backlog. Thanks to staffing increases in2384        2023 and 2024, the rising backlog was stemmed early in 2025 and2385        has since declined. However, we urge the Committee to closely2386        monitor staffing levels at VBA, and particularly VA's 30,0002387        FTE force reduction last year, to ensure there are adequate2388        resources to process veterans claims quickly and accurately.23892390    Mr. Chairman, we appreciate the Committee's interest in reviewing2391the VA rating schedule and how well it serves disabled veterans. While2392it is not perfect, we believe it is a proven and reliable methodology2393to fairly compensate the men and women who have served, suffered, and2394sacrificed for the country. We look forward to working with the2395Committee and VA to continually review, and when appropriate, update2396the VASRD and other aspects of VA's disability compensation to keep the2397promise to the men and women who served.23982399                    Prepared Statement of Berry Law24002401[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]24022403  Prepared Statement of Veterans of Foreign Wars of the United States24042405    Chairman Luttrell, Ranking Member McGarvey, and members of the2406subcommittee, on behalf of the men and women of the Veterans of Foreign2407Wars of the United States (VFW) and its Auxiliary, thank you for the2408opportunity to testify on the Department of Veterans Affairs (VA)2409ongoing modernization of the Veterans Affairs Schedule for Rating2410Disabilities (VASRD), which is a critical component of VA's disability2411compensation system.2412    The VFW considers this review as essential to ensuring the accuracy2413of disability compensation ratings while also providing equitable2414financial relief to veterans whose service-connected injuries or2415illnesses have caused, or may cause, undue economic hardship. As we2416begin this most important discussion publicly, we must note no2417witnesses appearing before the subcommittee for this hearing represent2418national VA-accredited organizations that routinely interact with VA2419and the rating schedule on behalf of claimants. Notably absent are2420organizations such as the VFW, Disabled American Veterans, the American2421Legion, the National Association of County Veterans Service Officers,2422any accredited agents or attorneys, or their representative trade2423associations that collectively hold power of attorney for millions of2424VA beneficiaries, and possess decades of direct, practical experience2425navigating the complexities and nuance of the VASRD in real-world2426adjudication.2427    Moreover, anyone who is accredited through VA has a regulatory2428requirement under 38 CFR Part 14 to understand the intricacies of the2429VASRD. Without witnesses who routinely train on and apply the VASRD for2430claimants seeking benefits, this hearing risks trusting academic or2431theoretical assessments rather than current, veteran-centered2432perspectives grounded in daily practice. This may unintentionally shape2433the subcommittee's understanding of the VASRD in ways that do not fully2434reflect its operational realities.2435    The VFW is particularly concerned that mischaracterizations or2436misunderstandings about the VASRD may go unchallenged, including2437assertions that it is inherently flawed due to its perceived age, that2438the combined ratings table philosophy is incoherent, or that disability2439compensation should be tied to employability. These arguments, while2440often presented as justification for radical reforms, carry serious2441implications for veterans and their families. Absent testimony from2442accredited advocates who can explain these principles in practical2443terms, the VFW believes the subcommittee may accept these positions2444without sufficient scrutiny or rebuttal from those most familiar with2445how these standards protect veterans from economic harm resulting from2446service-connected disabilities.2447    If these issues are not fully and publicly examined in the hearing2448room, the conversation risks moving in directions that undermine long-2449standing principles of veteran disability compensation. This2450compensation is first and foremost recognition of diminished earning2451capacity caused by injuries or illnesses incurred in service. Likewise,2452the combined ratings table reflects deliberate calculations intended to2453balance equity, consistency, and sustainability. These are complex2454matters that demand input from experienced practitioners who represent2455veterans every day, not just abstract policy discussions.2456    For these reasons, we believe the subcommittee has a responsibility2457to convene an additional future hearing that includes testimony from2458accredited Veterans Service Organizations, agents, and attorneys with2459experience applying the VASRD on behalf of claimants. Committee members2460deserve to hear directly from those who understand the downstream2461consequences of proposed changes. Similarly, we recognize that our2462perspective is not the only perspective on this matter, and we invite2463public dialog and scrutiny of our perspective from members of the2464subcommittee to reach the best possible outcome for our veterans.2465Veterans deserve nothing less than a complete, balanced, and fully2466informed record before the subcommittee contemplates any legislative2467reforms to this critical system.2468    The current VA disability rating framework has been in existence2469since April 1, 1945. For more than 80 years, this framework has2470undergone continued modernization to ensure veterans receive fair and2471accurate compensation based on current medical science and labor market2472realities. The basis of the current system is centered on the ``whole2473person'' formula, establishing a mathematical calculation that assesses2474each disability as independent of one another.2475    This structure works hand in hand with a veteran's ``average2476impairment'' and the claimant's current disability picture. Previous to2477this implementation, a veteran who was fortunate enough to be granted a2478disability rating received payments based on ``occupational variants''2479that were grounded in the veteran's pre-war occupation. The current2480structure offers a more objective evaluation based on the ``average2481impairment of earnings capacity'' more reflective of the typical person2482in civil occupations. The justification for this structure is grounded2483in tort law, as the VFW has noted in its recent discussions over The2484Washington Post's misrepresentation of the current VA disability2485system. This fact was recently reinforced in a Military.com editorial2486by contributor and Marine Corps veteran Haley Fuller, reminding readers2487that service-connected disability payments ``were not designed as a2488safety net for those unable to function in civilian life. They were2489designed as a liability mechanism.''2490    Any deliberation on changes to the VASRD must respect this legal2491fact. Proposals like eliminating compensation for so-called minor2492disabilities or means testing the receipt of compensation must be2493stopped before ever coming before Congress. The VFW invites discussion2494with the subcommittee on these principles to ensure that there is2495consensus that ``average impairment'' and ``lost earning potential''2496mean that veterans drawing service-connected compensation can both work2497and thrive financially, but that these factors do not absolve the U.S.2498Government of its responsibility to resolve the tort.2499    Every American who volunteers for military service understands that2500service is dangerous. Every enlistment contract obligates the service2501member to upon order report to ``combat or other hazardous2502situations.'' Understanding this contractual obligation, veterans2503cannot sue the military for resolution of occupational illnesses or2504injuries under the well-established Feres doctrine. Eroding this2505paradigm would compromise the good order and discipline of the military2506and undermine the willingness of Americans to volunteer for this2507inherently dangerous profession. This is why the VFW has vocally2508opposed anyone who whispers the notion of eroding this benefit system,2509scaling back compensation systems, or radically manipulating the rating2510schedule.2511    While some view providing benefits to veterans as a sacred2512obligation, it is in fact much simpler than that. It is fulfilling a2513contract. Honor the contract.2514    At the time of its implementation, the schedule categorized2515approximately 1,600 medical conditions into broad body systems. The2516criteria were heavily designed to evaluate the physical trauma more2517common to World War II such as shrapnel and gunshot wounds,2518amputations, and infectious diseases. In the present day, there are2519more than 1,100 specific diagnostic codes, organized into 15 body2520systems that may qualify a veteran for disability compensation.2521    This is clearly indicative of the changes in how medicine has2522advanced, but it also indicates that VA has been receptive to changing2523with the times. We know that on today's modern battlefield, troops are2524more likely to survive catastrophic injuries or diseases that may have2525been fatal in past conflicts. The current rating system is reflective2526of these advances that have been adjusted as medicine and other2527technologies continue to evolve.25282529MODERNIZATION25302531    The VA's modernization plan is centered on a phased revision of all253215 body systems in the VASRD. This effort involves updating outdated2533diagnostic criteria, incorporating modern medical terminology, and2534aligning evaluation criteria with contemporary clinical and functional2535evidence. Part of this modernization includes Earnings Loss Studies2536(ELS) that use data from multiple Federal sources to better understand2537how disabilities impact veterans' earning capacity, which is a critical2538data source for setting compensation levels. Organizationally, the VFW2539has asked for updates to any available ELS data on multiple occasions2540but has yet to receive any useful information. This data is critical to2541ensure that veterans are fairly compensated for injuries during service2542that impact their financial well-being. Additionally, this critical2543information will help show more clearly the long-term effects of2544illness or injury incurred in service in a way that is often overlooked2545in the civilian sector, and especially in recent news articles that2546have painted veterans as undeserving and even criminal.2547    Many veterans who have rightfully been awarded a disability payment2548end up unemployed or underemployed because of long-term or unseen2549effects of their service. This is particularly true in veterans who2550experience the consequences of mental health or traumatic brain2551injuries. Previous occupations may trigger symptoms or cause2552disruptions in their daily employment. Employers may not be aware of2553these injuries and do not understand why the veteran needs to be absent2554from work for treatment or the side effects of medications. This can2555result in veterans taking jobs that do not require exposure to loud2556noises, interactions with the public, or other stressors that may have2557a negative result. The rating system, whether in its current form or2558future state, is critical to acknowledge and be sympathetic to the2559symptoms they may suffer and provide the necessary compensation to make2560up for lost wages.2561    To date, VA has made measurable but nominal progress. Several body2562systems, such as digestive, dental, endocrine, gynecological, and2563others, have recently been revised or updated with new criteria.2564Updates to the digestive system, which added or refined evaluation2565criteria for conditions like celiac disease and irritable bowel2566syndrome, became effective in 2024. Additional proposed updates for2567respiratory, auditory, and mental disorders are underway, with public2568commentary periods concluded and rulemaking in progress.2569    Despite these efforts, implementation has been slower than expected2570and extended far beyond initial timelines. According to the Government2571Accountability Office (GAO), the comprehensive update has been delayed2572by lengthy internal reviews and lack of clear metrics. As a result,2573full completion is now projected for Fiscal Year 2026, far behind VA's2574original intent. The VFW provided comments to the Federal Register as2575far back as April 2022 for proposed changes to mental disorders among2576others. Through the last two Administrations, we have asked for2577progress reports as to the remaining proposed changes and final rules.2578We have been consistently told that the regulations are still under2579review.2580    We are happy to note that over the past 3 years limited progress2581has taken place. However, it has been inconsistent and, at times,2582obscure. While VA has published updated criteria for some body systems,2583major areas still await final rulemaking and implementation. Several2584proposed changes have been delayed multiple times, leaving veterans and2585stakeholders uncertain about timing and the potential effects of the2586proposed changes. This prolonged uncertainty undermines confidence2587among veterans, family members, and survivors.2588    There are considerable advantages to the modernization plan.2589Updated criteria reflect contemporary medical understanding, removing2590archaic language and measurement concepts, and enabling adjudicators to2591make clearer, more consistent decisions. By continuing to evaluate and2592incorporate earnings loss data, there will be a closer tie between2593disability evaluation and real-world economic impact. This can lead to2594fairer and more equitable compensation among veterans. It will also2595encourage those who may have shied away from seeking benefits and2596health care treatment to pursue the benefits their service has earned2597them.25982599CHALLENGES26002601    However, this modernization effort also faces substantial2602challenges. The slow pace of rulemaking and implementation frustrates2603veterans who have waited years for meaningful updates. The lack of2604transparency, clearly defined metrics, and organizational leadership as2605noted in GAO reports, makes it difficult to assess where bottlenecks2606persist and how they will be resolved.2607    As VA moves forward with modernizing the rating schedule, it must2608also continue to invest in its IT infrastructure. This has long been a2609concern of the VFW and our partner organizations. The constant changing2610of platforms and systems may be an operational necessity, but it also2611has unintended consequences. If VA were to complete its review today,2612it is more than likely that the underlying systems VA depends on to2613process claims still would not be up to date to manage these vast and2614complex changes. This will lead to continued delays in benefits and an2615excess workload.2616    The VFW has long held that we support the use of AI and analytics2617to assist in the claims development and review process. It has the2618potential to increase the efficiency of evidence gathering, improve2619accuracy, and promote consistency in benefit decisions. We agree that2620changes to the rating schedule and its underlying support system are2621necessary to support objective review and decision-making. However, we2622remain steadfast in our position that VA must balance technology and2623human discernment. An overreliance on underdeveloped technology may2624lead to poor quality in decisions, especially when considering the2625unique human factors of each disability claim. While AI is a powerful2626tool to promote efficiency, the VFW maintains that claims must include2627human review prior to issuing any final decisions. VA should ensure2628that regulatory changes and the use of technological platforms enhance2629the process but do not replace the human element of supporting2630veterans.26312632CONCLUSION26332634    In closing, the modernization of the VA Schedule for Rating2635Disabilities represents a potential vital step toward a more just and2636contemporary disability compensation system for our Nation's veterans,2637if it is conducted with the needs of the veteran as its central2638obligation. While the current plan has yielded some updates and2639demonstrates a commitment to consistent, evidence-based revisions, its2640execution has been hampered by delays and management challenges.2641    VA's advisory mechanisms, such as the Advisory Committee on2642Disability Compensation, provide important stakeholder input, but they2643too have consistently highlighted the complexity of this reform. These2644committees are designed to guide periodic review and revision of the2645VASRD, yet their outputs must be integrated into a larger regulatory2646process that has proven slow and administratively heavy.2647    The VFW is ready to work with VA and this subcommittee to overcome2648these persistent obstacles. VA must continue to honor the selfless2649service of veterans, family members, and survivors. We look forward to2650working together to ensure equitable benefits for all entitled2651claimants. The VFW urges VA to accelerate progress, provide clear2652updates to stakeholders and this subcommittee, establish clear2653milestones, and maintain transparent communication with veterans and2654Congress.2655    Chairman Luttrell, Ranking Member McGarvey, this concludes our2656testimony. We are happy to answer any questions you may have.26572658Information Required by Rule XI2(g)(4) of the House of Representatives26592660    Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW2661has not received any Federal grants in Fiscal Year 2026, nor has it2662received any Federal grants in the two previous Fiscal Years.26632664The VFW has not received payments or contracts from any foreign2665governments in the current year or preceding two calendar years.26662667                               [all]