▶ 0:21:50This legislative hearing of the subcommittee on health will now come to order. Without objection, the uh chair may declare a recess at any time. Given that votes have been moved to 3:00, uh we will in all likelihood declare a recess. I would like to welcome all members and witnesses to today's hearing. We have 12 important legislative proposals to consider here today. It's important to note that not all of the proposals will move forward in the legislative process, but many will.
▶ 0:22:16Congress is responsible for ensuring VA stewards its resources it effectively. Many of my colleagues bills would optimize VA's funding, talent, and capital. Other bills reinforce VA's mission to care for veterans and uh mental and physical health. I'm grateful to Representative Holidayiday for introducing the Health Professional Scholarship Program Improvement Act. One of the greatest resource drains at the VA is the broken student to employee pipeline.
▶ 0:22:41The VA loses untold investments in student clinicians by offering scholarships in exchange for employment commitments only for the VA not to keep its end of the deal. Students are consistently unemployed for months before the VA gives them a position. These students have been driven to the point where they cut their losses with the VA and seek jobs elsewhere at great financial cost to them and an opportunity cost to the VA. Representative Hammeday's bill would help end this unacceptable dilemma.
▶ 0:23:09The representing our seniors at VA act by Representative Kiggins would improve the geriatric and gerontology advisory committee. Under current law, there is no requirement for input from state veterans homes even though these homes are key partners in serving aging veterans. Representative Kiggin's bill would fix this oversight by making sure these homes have a seat at the committee table. The Veterans Patient Advocacy Act by Representative Molinar would increase the rural footprint for VA patient advocates.
▶ 0:23:36I know all too well how veterans in rural areas struggled to obtain care from the VA. I firmly support the bill's goal to have patient advocates accessible to rural veterans. I think we can all agree that we can always do more to ensure that VA's resources must keep evolving to reach veterans where they live. The Travel Act by Representative King Hines would also help our veterans living in remote areas. This bill would require a one-year billot for VA physicians at US territories like the Northern Marana Islands.
▶ 0:24:06Healthc care is not easy to come by in the these remote parts of the world. This bill would place VA practitioners in the right places at the right times. Representative Magcguire's bill, the VA data transparency and trust act, tackles the unending reporting requirements at VA and replaces them with the comprehensive and unified report on outcomes and metrics to improve VA programs.
▶ 0:24:27The laws today incentivize a system where consultants can create a cottage industry to broker reports, which diverts precious time and money away from VA's mission and only makes oversight more difficult. Congress has gained little from the manner in which it has received information from the numerous current VA reporting requirements. Representative Magcguire's bill would pull in the reigns and in improve outcomes for veterans. My bill, the Fiser House Availability Act, would make lodging in Fiser Houses more accessible for service members and their families.
▶ 0:24:56Fiser House Found Foundation is a nonprofit dedicated to providing lodging for veterans and service members in need. The VA owns most Fiser Houses. We know that service members and their families can stay at Fiser houses whenever they get care from the VA. However, a recent agency interpretation prohibits them from using VAowned Fiser House when receiving nonVA care, even though we all know there's more than enough room to house them. This bill does not displace veterans or veterans families.
▶ 0:25:25It's important to note it would simply ensure that service members have access to available lodging. I'm thankful to the Fiser House Foundation for supporting this bill and I'm proud to sponsor it. Representative Latrell's bill, the Saves Act, picks up where the popular Pause Act left off. This bill covers costs for service dogs that provide veterans mental and physical assistance. The therapeutic benefit of service dogs are well established. I thank Representative Latrell for his efforts to improve the availability of service dogs for veterans in need.
▶ 0:25:54Representative Dunn's bill would align non-smoking policies at VHA with most medical facilities in America. Currently, there is no protection in law against smoking at VHA facilities. As a physician, I know how important it is to make sure that patients breathe clean air when they receive care at the VHA facility. This bill would ensure that. Finally, a bill introduced by Dr. Murphy would create a pilot program to build on existing research into PTSD related inflammation and cellular stress.
▶ 0:26:22The continued prevalence of PTSD in our veteran population requires us to continue finding new and innovative ways of screening and diagnosing PTSD. The research from this pilot program could help equip VA with the tools for preventive rather than reactive care for PTSD. Again, these bills optimize VA and reinforce its mission to care for veterans mental and physical health in exchange for their service in uniform. I now yield to ranking member Brownley for any opening remarks she may have.
▶ 0:26:50Uh, thank you, Madam Chair, and thank you to our witnesses for making the time to to be here. I understand we will have uh votes. Uh, as the chairwoman said, that could interrupt us this afternoon, so I'll keep my remarks uh brief to allow us to get to everyone's testimony. While committee Democrats appreciate and are not opposed to the intent of many of the Republican bills on today's agenda, we would like to see some changes and improvements on some of these bills.
▶ 0:27:19I hope we will be able to work together collaboratively with our majority colleagues to make these improvements through the committee markup process and put forth the best possible legislation to support our veterans. I'm pleased we are considering three Democratic bills today, including my bill, the Champ VA Children's Care Protection Act.
▶ 0:27:40I first introduced this bill in 2019 and it has long been a priority for numerous veteran service organizations and organizations serving caregivers and survivors. Champier provides health care coverage for spouses and dependent children of veterans with permanent and total service connected disabilities and for the surviving spouses and children of veterans who have died from service connected disabilities.
▶ 0:28:07When the Affordable Care Act was signed into law in 2010, it required private sector health plans to allow children to stay on their parents' insurance until they are 26 years old. However, this ACA mandate was not extended to military or veteran health coverage. This inequity was addressed for Triricare in 2011, but to date we have not extended parody to the Champ VA program.
▶ 0:28:36It is long past time to write this wrong. I'm glad we will have a chance to hear directly from a caregiver, Miss Cara Benson, about what this legislation would mean for her and her family. I look forward to working with with VA to learn how we can address the department's concerns and ensure that caregivers and their families have the support that they deserve.
▶ 0:29:01To that end, I also appreciate that we're considering Representative Morlli's bill HR248, the Veteran Caregiver Re-education, Reemployment, and Retirement Act. This legislation will provide VA and other agencies additional authorities to support veteran caregivers as they transition out of VA's program of comprehensive assistance for family caregivers.
▶ 0:29:29The sacrifices caregivers make, including for their own earning potential and financial security, are immense, and we must support them by ensuring they have the tools and the resources they need. I know Miss Benson will also provide powerful testimony in support of Representative Morelli's bill. Finally, I know Congresswoman Bzinski will be here to discuss her own legislation, the VA mental health outreach and engagement act.
▶ 0:29:58So, I will briefly just say that I also support her bill. This legislation will ensure that VA conducts regular outreach and offers consultations to assess the needs of veterans with service connected disability ratings for mental health conditions. We know that veterans who are connected with VA care have better health outcomes and lower risk of suicide than veterans who are not connected.
▶ 0:30:25I'm glad Congresswoman Badzinsk's bill will allow more eligible veterans to engage with VA care. I look forward to hearing from all of our witnesses today. And with that, Madame Chair, I will yield back. Thank you, Ranky Member Brownley. We have a full agenda today. So, I'll be holding everyone two, three minutes per bill to ensure we can move in a timely manner.
▶ 0:30:48In accordance with committee rule 5E, I ask unanimous consent that Representative Latrell from Texas be permitted to participate in today's subcommittee hearing. Without objection, so ordered. I now recognize Representative Murphy for three minutes to speak on his bill. Thank you um Chairwoman Miller Meeks and Ranking Member Brownley for holding this uh meeting today. My bill HR 3886, the Veterans PTSD screening act is being discussed at today's hearing.
▶ 0:31:18You know, we talk a lot about uh mental health with our veterans, especially with PTSD and TBI, and anything that we can do to move the needle. I've been obviously a big fan of hyperbaric oxygen therapy, but any other thing that we can do to move the needle is critical in what how we're trying to help the veterans who have uh kept us free. I'm going to talk a little bit about something called RNA. RNA sequencing. DNA is in our body and DNA is a constant thing in our body.
▶ 0:31:44RNA rather changes with different uh experiences with different um memories etc um in our brain and so what we have found and has been well documented is the ability to measure RNA sequencing either microRNA or something called long digital RNA in different assays and these have become a um predicting point to determine levels of stress within the body where compared to controls um those who have experienced PTSD have a remarkably different
▶ 0:32:14pattern of RNA. And so what this bill is going to do, it's going to direct the VA to study um this RNA sequencing in five separate veterans VINs. And so I think it's going to be critical as we put our armamentarium as our toolbox gets bigger and bigger as technology advances that this will be a great tool. Now caveats, we don't want to ever deny care based upon what is founded with RNA sequencing. We also don't want to make this as a single modality.
▶ 0:32:41um we have to have a holistic approach to PTSD and being able to monitor just this one single variable really helps us but is not going to be the sole object for doing this. The science is growing. Um we're actually using this in some VAS right now as has been modeled in some VAS right now and being modeled in other places, trauma centers, etc.
▶ 0:33:02And I think we um are seeing as technology increases, especially with AI, that we're going to be able to use all these new different tools to help our veterans, those who've experienced PTSD, and hopefully come up with a cure one day, but if not, be able to monitor, to diagnose, and to monitor treatment as we uh treat our veterans. I'll ask for appreciation and love us to bring the the vote to committee. Thank you, Madam Chairman. I yield back. Uh thank you, Representative Murphy.
▶ 0:33:28Uh, the chair now recognizes Representative Badinsky for three minutes to speak on her bill. Thank you, uh, Chairwoman Miller Meeks, and thank you to Frankie Member Brownley. I appreciate this, uh, for giving me the opportunity to speak on my bill, HR 3863, the VA Mental Health Outreach and Engagement Act, which would expand VA's outreach to veterans about mental health services. I also want to thank my Republican colleague, uh, Mr.
▶ 0:33:57Edwards for co-leading this bipartisan bill. As a member of the Veterans Affairs Committee, I've heard from veterans unaware unaware of where to turn for support and care for the invisible wounds of war. We must support our veterans and provide them with the knowledge and resources to prosper following their service to our nation.
▶ 0:34:18My bill would ensure we are proactively reaching out to veterans with mental health related service connected disabilities and connecting them with the care that they need. Navigating the VA should never be a burden and this bipartisan legislation would help to make it easier for veterans to get the mental health care that they've earned. I'm also here today to speak in support of HR 3767, the Health Professional Scholarship Program Improvement Act.
▶ 0:34:48I want to thank my colleague on the committee, Congressman Holidayiday, for his leadership in bipartisan collaboration on this bill. VA's health professional scholarship program supports the students pursuing health careers while connecting VA with talented staff. But when program participants graduate, they are often met with delays in receiving a contract. Amid Veteran Health Administration staffing shortage shortages, we need solutions to address this inefficiency.
▶ 0:35:18This legislation would streamline the path for HPS participants to start working full-time, making it easier for veterans to get the care that they need. For both of these bipartisan bills, I'm committed to working with my colleagues on both sides of the aisle. the VA and BSOs to ensure we are continuing to improve health care for our nation's veterans. Thank you very much for the time and I yield back. Thank you, Representative Binsky.
▶ 0:35:46The chair now recognizes Representative King Hines for three minutes to address her bill. Thank you, Chairwoman Miller Meeks and Ranking Member Brownley for the opportunity to speak on my bill HR 3400, the Territorial Response and Access to Veterans Essential Life Care Act, or the Travel Act of 2025 for short, which aims to provide muchneeded medical care to the United States territories.
▶ 0:36:09My home, the Northern Marana Islands, has one contracted part-time doctors who sees and cares for hundreds of veterans who are spread across three islands. which means if a veteran needs specialized medical care, he or she must travel to Guam, Hawaii, or the continental United States for health care. This is not only acceptable, it's offensive to the people who have served our country. Veterans should not have to pay upfront for air travel, book appointments across the globe, or forego medical care entirely because there are no nearby accessible doctors.
▶ 0:36:38Our nation's have worked hard and sacrificed so much to provide for us. We owe medical care to our veterans. We are indebted for their service. The very least we can do is to ensure they can go to a cardiologist or a neuro or a when they need it. It is my hope that the travel act will begin to address the medical desert that veterans face every day in the northern Mariana Islands and all across the territories. This bill, once passed, will create a program similar to doctors without borders.
▶ 0:37:07Veterans Affairs, who supports this bill, will send doctors to the territories for periods of up to one year so they can practice specialized medical care on island. It won't bring the status of medical care for veterans in my district up to par with care available in the continental United States. But every little bit, any sort of improvement will help, and this bill does that. I ask and urge all of my colleagues in the House of Representatives to stand behind me as I advocate for our heroes across our territories. Thank you, Madam Chair. I yield my time back.
▶ 0:37:37Thank you very much, Representative King Hines. The chair now recognizes Representative Latrell for three minutes to speak on his bill. Thank you, Madam Chairwoman, and ranking member Brownley for inviting me to speak on the Service Dogs Assisting Veterans Act. This legislation is an important step forward towards improving access to service dogs for our veterans. That's why that program gives the secretary the authority to award competitive grants to nonprofits that provide service dogs to assist veterans who need them most. We're talking about men and women who have borne the weight of war.
▶ 0:38:07Many of them returning from a theater of combat with invisible wounds. Nearly one in five veterans from those conflicts live with post-traumatic stress, post-traumatic stress disorder, or other cognitive issues. Over 450,000 veterans have suffered at least one traumatic brain injury over the past two decades. These aren't just numbers. These are warriors now battling depression, anxiety, addiction, joblessness, homelessness. Right now, we're losing an estimated 17 to 22 veterans a day to suicide. This is absolutely a national crisis.
▶ 0:38:36ST service dogs are more than companions. They are a lifechanging They are life-changing. They assist veterans. They assist veterans in regaining a sense of normaly and control. They support those living with post-traumatic stress and traumatic brain injury and also assist vets dealing with mobility issues, vision loss, and hearing impairments. These dogs help our veterans live independently and stay active and re-engage with their families and their communities. This program is about giving back to those who never hesitated to serve.
▶ 0:39:05It's a step for it's a step towards healing and towards honoring the promise we made to our veterans. Cost is one of the biggest hurdles veterans must jump over when it comes to service dogs and I am pleased that this legislation would enable veterans to gain access to highly trained service dogs at no cost. Ensuring our veterans have access to the biggest resources as a team sport. Saves acts saves act team is comprised of dedicated members from across the political spectrum working to make this bill a reality.
▶ 0:39:33We also count numerous veterans organizations who are ready to execute and provide our veterans with highly trained service dogs who will make their life better. I'd like to thank this committee and ranking member McGarvey for their assistance. Thank you and I yield back. Thank you, Representative Latrell. The uh chair asks in accordance with uh committee rule 5E, I ask unanimous consent that Representative Maguire from Virginia be permitted to participate in today's committee subcommittee hearing. Without objection, so ordered.
▶ 0:40:01The chair now recognizes Representative Magcguire for three minutes to speak on his bill. I need a little team mate uh teamwork for my seal brother. Uh thank you, Madam Chair. Uh we wouldn't have a country without our men and women who risk their life or give their life.
▶ 0:40:18So for all of our men and women, our veterans, uh, thank you and ranking member Brownley, thank you as well and for the opportunity to speak on my bill HR 3643, the Virginia Data Transparency and Trust Act, which I was proud to introduce with my good friend, the chairman of the full committee, Chairman Mike Bose of Illinois. Information and access to reliable and accurate data are necessarily are necessary to all industries and government agencies.
▶ 0:40:44Nowhere is this need more apparent or more important than the Department of Veteran Affairs. Over the past 10 years, the VA's budget has increased by nearly 220% while the daily suicide rate has remained flat with 18 veterans committing suicide each day with some experts believing that number might be higher.
▶ 0:41:03We also cannot forget that last November, the Department of Veteran Affairs made egregious mistakes in its accountant and budget and practices and they came to Congress last summer asking for additional funds or else veterans would lose their benefits. This resulted in a $3 billion stop gap spending bill that was crushed rushed through Congress to ensure veteran benefits could continue only for us to learn months later that there was no shortfall at all.
▶ 0:41:29Clearly, Congress needs to have better oversight of how uh the VA spends taxpayer funds and where they spend it. Currently, the department provides Congress with a wide range of reports, but falls short of providing timely and accurate reports conducted by other agencies such as Department of Defense with regard to Triricare and the Center for Medicare and Medicaid Services.
▶ 0:41:51My bill would require that the VA provide an annual comprehensive report that would provide Congress and congressional support agencies with the necessary information to provide proper and clear oversight while allowing for greater visibility of veterans needs and the usage of certain programs. Without comprehensive and useful data, Congress cannot make informed decisions about veterans healthcare, disability compensation, or program funding.
▶ 0:42:17This bill modernizes the way the VA handles data, bringing it in line with other major federal agencies best practices. I'd like to thank uh Chairwoman Miller Mix for allowing me the time to speak and important on this important legislation today and I'll yield back the balance of my time. Thank you, Representative Seeing no other members here to speak on their bills. As is our practice, we will forego a round of questioning for the members.
▶ 0:42:43For those off committee members who are here, you may remain uh to ask questions of our witnesses uh if you have time. I now invite our first panel to the table. Thank you. Joining us today is Dr.
▶ 0:43:11Antwanet Chappelle with support from uh Dr. Elsie Wakers. Dr. Chappelle is deputy assistant under secretary for health and patient care services at VHA. Dr. Wakers is deputy executive director of the office of mental health and suicide prevention at VHA. Dr. Chappelle, you're now recognized for five minutes to prevent the department's Thank you, Chairwoman Miller Meeks, Ranking Member Brownley, and members of the subcommittee. Thank you for inviting us to discuss several bills affecting veterans affairs programs and services.
▶ 0:43:41My name is Dr. Antoanet Chappelle and I currently serve as the deputy assistant under secretary for health for patient care services and I am joined today by Dr. Elsa Wickers, deputy executive director for the office of mental health. While VA's detailed views views on each of the bills are included in my written statement, I will briefly highlight some of the bills. First, the representing our seniors at VA act.
▶ 0:44:08VA supports the intent and has already appointed a member of the National Association for State Veteran Homes to the Gerontology Advisory Committee of 20 in 2024. We have some concerns with the legislation as written. Next is HR1404, the Champ Children's Care Protection Act of 2025, which would extend Champ VA benefits for children until age 26.
▶ 0:44:34Champ VA is a medical care benefit for dependents of certain veterans similar to DoD's Triricare. However, VA does not support this bill because we believe this coverage up to age 23 is sufficient for our beneficiary population. VA is concerned that the bill would require resources that could otherwise be used to support patient care. VA agrees the intent of HR 2068, the Veterans Patient Advocacy Act.
▶ 0:45:02The bill aims to ensure rural veterans can access patient advocates. VA has expanded advocacy options for veterans such as local advocates, online platforms, and the VA hotline to meet veterans needs. VA has concerns with some of the bill's The Veteran Caregiver Reeducation, Reemployment, and Retirement Act, HR 2148, proposes several changes.
▶ 0:45:27It extends CHAMP VA benefits for 180 days for primary family caregivers after their designation ends, offering necess necessary transition time for seeking alternative healthc care coverage. The bill also suggests employment assistance and compensation including training for caregivers. VA supports section two of the bill subject appropriations. We generally support section three of the bill subject to appropriations.
▶ 0:45:56However, we do have some concerns with the certain provisions and would appreciate the opportunity to to discuss these concerns with the committee. The Service Dogs Assistant Veterans Act or the SAVES Act HR2605 requires VA to establish a pilot program to provide service dogs to eligible veterans. VA supports this, but recommends clarifying the bill's language for effective use of funds. We also propose aligning terminology with existing VA definitions.
▶ 0:46:27We do have concerns about including traumatic brain injury and post-traumatic stress disorder in the criteria given insufficient evidence of service dogs effectiveness for PTSD. Additionally, HR 3400, the travel act, proposes assigning traveling VA physicians to territories and possessions in the US.
▶ 0:46:49VA supports this with amendments to clarify the bonus eligibility and coordination of care, ensuring physicians providing provide care where is needed. We agree with the intent to expedite the employment process for health care professions. However, we do not support the bill seeking to expedite VA employment for health professional scholarship program participants within 90 days.
▶ 0:47:13VA supports the VA data transparency and trust act which requires VA to submit detailed reports and create a data sharing system for researchers. However, we recommend amendments to focus on desired topic areas to avoid complex and resource intensive implementation. The Fiser House Availability Act of 2025 aims to extend lodging benefits at Fiser houses.
▶ 0:47:39VA supports this, provided amendments to clarify eligibility for service members independents, ensuring the bill's language aligns with current practices. We strongly support the bill banning smoking in all VHA facilities. VA supports the intent of the draft bill directing VA to conduct a study on RNA sequencing to diagnose PTSD.
▶ 0:48:03We do have concerns with several of the bill's provisions and would appreciate the opportunity to discuss our concerns with the committee. VA supports the VA mental health outreach and engagement act support subject to amendments and the availability of appropriations. We would appreciate the opportunity to discuss amendments with the committee and provide technical assistance. This concludes my statement. We are happy to answer any questions you or other members of the subcommittee may have. Thank you.
▶ 0:48:32Uh, thank you for your testimony, Dr. Chappelle. Your full written statement will be entered into the record. As is my typical practice, I will reserve my time until all of the members have had a chance to ask their questions, especially with pending votes coming. Um, I now recognize Ranking Member Brownley for five minutes for any questions you may have. Thank you, Madam Chair. Um, Dr. Chappelle, thank you for being here.
▶ 0:48:54in your testimony, your written testimony anyway, uh you say that the that VA opposes the CHAMP VA because it's not an insurance plan. Is that correct? Yes. Yeah. So, if you could answer just a couple of questions for me, just yes, yes or no. Um the first one, does Champa have cost sharing requirements like deductibles and co-pays?
▶ 0:49:22I would need I would need to um take that for the record. Well, I can say that it does for the record. Are there any limitations to the services and supplies covered by Champ VA? I would also take that one for the It does. Does Champ VA use a formulary? Um I believe so, but I can get specifics for the record. it. Well, I I can tell you that it does.
▶ 0:49:51Does Champ VA have any prior authorization requirements for services like mental health and substance use treatment? I believe so, but I can I can I I can say tell you say that it does. Is Champ VA considered uh credible coverage for the purposes of the ACA's mandate that individuals have health insurance coverage?
▶ 0:50:19JVA is is a benefit uh but it but it's not an insurance policy per se. Well, the point that I'm trying to make here is that all the questions that I just asked you, the answers are yes. Um and and then of course you say that it's not not a health insurance policy, but it certainly sounds like one.
▶ 0:50:42It has, you know, the questions that I just asked you were sort of almost like a checklist for insurance policies. Um so it just seems to me that JV VA um you say it's not a health insurance uh policy. I I say it it certainly appears to be one. And as the old saying goes, if it walks like a duck and swims like a duck and quacks like a duck, it's probably a duck.
▶ 0:51:08Um so um if uh DoD's Triricare program, uh wasn't affected by the ACA either. However, Congress created the Triricare Young Adult Program in 2011 to provide health care for qualified young adults ages 21 to 26 who are unmarried and not eligible for an employer sponsored health plan.
▶ 0:51:32Why is VA advocating for the dependent and survivors of service disabled veterans to be treated differently and less than Triricare beneficiaries? this legislation would create that longstanding inequity. In her testimony on behalf of the Elizabeth Dole Foundation, Mrs.
▶ 0:51:55Benson suggests that our committee should use its oversight authority to authority to improve the administration of the Champ VA program and I certainly agree. She recounts the incredible number of hurdles she has to overcome in getting services covered, getting claims paid, and even simply getting VA to process the paperwork to reertify her child's status as a college student.
▶ 0:52:24And yes, I mean paperwork because Champ VA is still operating in my most humble opinion in the dark ages with paperbased forms and a monthsl long a month's long backlog in processing the mail. So Dr. Dr.
▶ 0:52:44Chappelle, seven weeks ago today, committee staff submitted a few simple questions to VHA regarding academic enrollment reertification requirements for JAMV VA beneficiaries. We have yet to receive a response despite our attempts to follow up. Can I have your assurance that we will receive answers to these questions within the next week, which will make it more than two months since we requested the information?
▶ 0:53:15Thank you. And I I don't have a timeline right now, but I can assure you that I will work with my colleagues and our office of congressional legislative affairs to ensure you have a response. But you can't state a timeline. Not a week, not two weeks, not a month, not three months, not at this time. I yield back. Thank you. Thank you, Representative uh Brownley. The chair now recognizes Representative Dr. Murphy for five minutes for any questions you may have. I'm going to hold off on pass on questions. I'll come back later. Thank you.
▶ 0:53:47The chair now recognizes Representative King Hines for any questions you may have. I just I have a couple of questions and so um I was reading over your comments to uh the proposed travel act and first of all thank you for for the support. Um so section the proposed section 7415B proposes to uh require traveling physicians to coordinate with non-depal providers to the extent necessary to ensure high quality and coordinated care.
▶ 0:54:17Um, how do you foresee the VHA implementing this program? Thank you. I'm going to pass that to Dr. Wakers. So, we would actually like to work with the committee to better understand what the intent is in that section uh so that we can have some clarity on what care coordination entails. Okay, great. We could make a plan together. I would love to have that conversation with you. Um, and just one other quick question.
▶ 0:54:41Um, so there was some objections with regards to um I think I want to say the the the pay section 7415 and I and I know that there's some concerns about the budget and um the language with regards to the retention bonus which is included in the legislation. So I just wanted to bring this up for situational awareness.
▶ 0:55:05Um so right now the cinema in general is having a hard time recruiting health care professionals just for regular care. Um and I think that is a direct result of you know just the difference in the quality of life that's here on the mainland as as it relates to back in the territories. And I'll give you an example. I'm really excited that he's introducing um the saves act which uh would you know allow for uh the VA to provide service care uh service animal.
▶ 0:55:36We don't have a vet and that's one of the biggest challenges is that you you do have these professionals who want to relocate there but your pets to the CNMI right now costs around $10,000 and so you know it's cost prohibitive right. Um, we don't have a mall. We don't have a shopping uh any type of major shopping center. Uh, our only movie theater has just recently closed down.
▶ 0:56:05And so, um, I would like to have conversation with you with regards to the challenges as it relates to recruitment and retention for people coming out to the territories. Absolutely. We'd be happy to engage in a conversation with you about that.
▶ 0:56:20I think the um the technical amendment uh suggestion is just to ensure that the language and the authorities that we have related to bonus eligibility um line up appropriately but absolutely understand the importance of being able to recruit highquality uh providers to be able to um come to to the islands and to help with the healthcare for our veterans there. All right. Thank you. I yield my time. Uh thank you. And if I can, I'll remind our witnesses to speak a little louder.
▶ 0:56:46The chair now recognizes Representative uh Bergman, General Bergman, for any questions you may have. Thank you, Madam Chair, and thank you to everybody who's here because we're all trying to do the right thing for the right reasons. Question is, how do we figure out what the right reasons really are and what the priorities are? We are in an oversight position here.
▶ 0:57:11You are the, you know, we're the higher higher headquarters that send you money and resources to do the mission. We we want to know how the mission is going. Okay. And I appreciate the honesty in your testimony. So, one specific question here as it relates to HR 3767 uh as it relates to the health professional scholarship program.
▶ 0:57:40I'm not going to go into details of what each whether you're a psychiatrist, a nurse practitioner, pharmacist, how many of those scholarships. So the health professional scholarship program providing scholarships for certain specialties. Um and I'll just say if you don't have the answer, you can take it for the record.
▶ 0:58:00Why is the VHA plan for FY 2026 the PA physicians assistance health professional scholarship program for returning veteran medics and corman? Do we have any detail at that? I don't want I don't want to play gotcha here, but I want to give you the opportunity to to ask, you know, answer the question based upon what you know. Thank you. I'll pass that to Dr. weakers.
▶ 0:58:31I'm going to have to take that for the record, sir. I don't have an answer for you today, but I'll get an answer for you. Well, the reality is here we need all different special, you know, proficiencies, specialties.
▶ 0:58:47And it would seem to me that when we have, you know, veteran medics and corman that are already, for lack of a better term, in most cases, battle tested, we would want to make sure that we um continue to develop their expertise and their ability to serve other veterans. So, this is a medical specialty that that we need to continue to move forward.
▶ 0:59:15This cannot be you know the not that I would get specific but um there's an ongoing discussion between nurse anesthetists and anesthesiologists that's we've been dealing with that for a very very long time and there's room for both the question is who supervises who who has charge of patient care etc etc so as we continue to look at the health care system of the future and physicians assistance as they might migrate into the VA system and
▶ 0:59:45maybe they go out into community care which the vast majority of veterans are looking for care in the community. Physician assistant in the world in which we live is a great step forward. And with that, Madam Chair, I yield back. Thank you, uh, General Bergman. The chair now recognizes uh, Dr. Conaway uh, for any questions he may have for five minutes. Hi, and thank you, Madam Chair, for recognizing me for a few moments.
▶ 1:00:14uh to make a statement and answer uh some questions. We are I'm assuming I just walked in. We're on um 3643, right? No. what's that? Okay. Um I just wanted to take a moment to um uh discuss HR 3643.
▶ 1:00:42the VA data transparency and trust act. Uh it aims to reauthorize a congressionallymandated report that expired in 2022 and significantly expands the number of elements that the VA is required to report. Dr. Chappelle, does the VA have the personnel and resources necessary to compile, calculate, and report this data? Thank you. Um so VA does support this bill subject to amendments.
▶ 1:01:07Um so the right now as written the the report is very broad and would require um a significant amount of time and resources um uh to to fully understand um what is desired and so we would appreciate the opportunity to meet with the committee uh so to narrow the the focus of of the specific topics.
▶ 1:01:29Um, I agree with the uh importance of transparency in this bill and strongly believe data points from the VA are essential for Congress to effectively conduct its oversight responsibility. I would and I you've just said that you have some concern about the breadth of the report. Uh, but I must say that I'm I am concerned about what's lacking um specifically how many staff are retiring, resigning, or leaving the VA uh along with their specific job titles.
▶ 1:01:55I'm also concerned about what's going on with new hires uh and what uh their titles are. Um it sounds like you wouldn't be able to pro uh you don't believe the D the VA, excuse me, is in a position to provide this data. We think uh I think and I think I hope I'm joined by everyone here.
▶ 1:02:13uh believe it's important to understand what's going on with the staffing levels in the VA and that uh that it's has the appropriate personnel and adequate numbers of personnel to complete its very important mission and certainly what's going on with hiring um and staffing etc would be important to our oversight function. So um what are your thoughts on on the things I suggest needed to go into the bill? So thank you. Thank you for the question.
▶ 1:02:41Um so that the resources that would be needed to collect um and and report on this data uh could potentially divert um from healthcare and benefits delivery, but we don't have a cost estimate at this time. And so we would really appreciate the opportunity to meet with the committee to fully understand what is really desired and needed so that we can come up with a better plan uh to move forward.
▶ 1:03:03Well, then I would ask then u do you know why um and of course you always know the answer to those questions we already asked them but uh you know it's my notes say of course this report um ceased a couple of years ago. Do you have an explanation for why um that happened? I don't know. I wasn't in my current position at that time but I'd be happy to take that for the record and provide a response for you.
▶ 1:03:27Um well uh I would just say that we know that staffing and the ability to fully uh staff the various departments within the VA plays an enormous role in the quality of care that's delivered to our our veterans. Gathering these data points would allow us to better understand how we can support the VA and ensuring they provide the high quality care that veterans deserve.
▶ 1:03:46Um, do you agree or that staffing levels uh have an important impact on the on the outcomes that we expect from the VA and that our veterans need the VA to produce for them and their care? Uh, yes, I do believe that um the veterans need the VA.
▶ 1:04:05Um, however, um, I I can assure you that the VA has worked with the White House and the Office of Personnel Management to exempt more than 300,000 positions from the hiring freeze and early retirement incentives or deferred resignation program. Um, so so we um, the department is committed to ensuring that um, we have the best employees in place to serve um, our veterans and the services that they need. Thank you, doctor. Um, Madam Chair, I yield back. Uh, thank you, Dr. Coleman.
▶ 1:04:35The chair now recognizes Representative Latrell for five minutes for any questions you may have. Thank you, Madam Chairwoman. Um, Dr. Chappelle, HR2605, the saves act. I I think I heard you say that the Department of Veterans Affairs does not support a portion of that because of the given service. It it says that the service dogs do not provide effectiveness for post-traumatic stress Yes.
▶ 1:05:01Say I want you to read that statement out of your notes. Make sure that I heard it The Service Dogs Assisting Veterans Act or the Saves Act HR 2605 requires the VA to establish a pilot program to provide service dogs for eligible veterans. VA supports this but recommends clarifying the bill's language for effective use of funds. We also propose aligning terminology with existing VA definitions.
▶ 1:05:28We do have concerns about including traumatic brain injury and post-traumatic stress disorder criteria in the um in the criteria given insufficient evidence of service dogs effectiveness. Insufficient evidence that that service animals assist veterans with post-traumatic stress disorder. That's the opinion of the Department of Veterans Affairs. Yes. And I'm going to pass this over to Dr. I bet it all right. Uh thank you, sir, for the question.
▶ 1:05:54Um the evidence uh does not support and what evidence the uh there's a study that was conducted uh one study one study the VA is basing that claim that you just threw at me off of one study I'd be very careful in the waters that you're going to swim in with me right now because I've been studying this for an extremely long period of time and one thing that I do know and I talked to hundreds of veterans that have posttraumatic stress disorder and post-traumatic stress and traumatic brain injury with service animals and they say this is a lifechanging event for them
▶ 1:06:24and it's the opinion off of one study in the department of veterans affairs to say that that is ineffective. We have a method in the existing uh regulations that we have around access to service dogs for mental health mobility dogs for veterans with PTSD and TBI and that's what we're speaking. So you're differentiating between a service animal and a therapy animal.
▶ 1:06:45And I'm speaking to a mental health mobility dog, mental health mobility service dog which can be uh provided for patients with PTSD and TBI. It's a sir. in the language in front of you.
▶ 1:06:59I need to add that subtext in there to make this thing I would I would like to work with you to make sure we have language that aligns the definitions we have that allow for the access when it's appropriate clinically for veterans with PTSD or TBI who have a mental health mobility uh disability. So, we have a a method. We need to align language.
▶ 1:07:18Sir, well, I can assure you if it doesn't happen today, within the next couple of days, you need to be in my office and make sure that it is absolutely the the way that it needs to be because this is something I'm not walking away from because I adamantly disagree with what you're saying. And since you're speaking for the VA, you don't want to go to war with me over this. I don't because there's a room full of veterans sitting behind you that I'm sure going to be on my side. I understand and I'm I'm committed to working with you and making sure we get the language that works uh so that we can ensure access to the service dogs through this pilot program.
▶ 1:07:47This is a conversation that most likely should have happened before you're sitting in front of the committee in an open The VA has expressed concerns that the Fiser House Availability Act will create an adverse influ interference that providing lodging to some service members is prohibited by law. On what legal authority does VA base its concern? If these concerns were alleviated, would VA support allowing DoD use of excess capacity in VA Fiser House residences?
▶ 1:08:18Thank you. Um uh yes, so VA does support this proposed bill. Um we would like to work with the committee on some technical assistance, but we do want to support um service members, their madam chair, when I yield back. Thank Thank you, Representative Latrell. The chair now recognizes again Dr. Murphy for any questions you may have. Okay. Uh the chair now recognizes herself for any questions uh she may have.
▶ 1:08:47They're uh calling for votes. So I'm going to be very very brief so we can try to complete this panel before uh we recess and then come back for the next panel. Dr. Chappelle, in your testimony, you state that due to the ambiguity of current law, active duty service members, and I think this is getting to the point Dr. Mr. L trail was making uh and their beneficiaries are being turned away even though the Fiser House Foundation is willing and able to support them if there is availability.
▶ 1:09:13Can you explain why my bill is necessary to clarify congressional intent and correct this error? Uh so currently um um the the current law does not um allow for uh triricare beneficiaries to stay in the Fiser home. Uh VA does support this and and does want to provide equitable access for our military families, but we need do need to have it codified in law. Dr. Chappelle, Congress often encounters difficulty getting timely information on performance outcomes and spending.
▶ 1:09:44Um I know that the VA spends countless hours preparing numerous and disperate reports for Congress. Would the VA support a centralized publicly accessible data platform as Congressman McGuire's bill proposes to streamline oversight and increase public trust? Thank you for your question. Um I I would have to take that back for the record. Ma'am, thank you very much. Um the other questions I'll have I'll submit for the record uh in order for time.
▶ 1:10:14Um we there's still 421 votes, so I think we have a few minutes. On behalf of this subcommittee, I want to thank you for your testimony and for joining us here today. You're now excused. We're going to wait a moment for the second panel to come to the witness table.
▶ 1:11:48Uh thank you very much. Welcome everyone and thank you for your participation today. The staff and I are watching votes very carefully. I'm hoping to push uh through to get through at least one of our testimonies uh and we can at least introduce the panel. Uh on our second panel today we have Dave Coker, president of the Fiser House Foundation. Randy Johnson, Marine Corps uh veteran, member of VFW Post 3457 and constituent of representative uh King Hines.
▶ 1:12:16Cole Lyall, director of the Veterans Affair and Rehabilitation Division at the American Legion. John Schmidt uh CEO of Ice Ipress Jeans um and uh Cara Cara Benson a caregiver fellow testifying on behalf of the Elizabeth Dole uh Foundation. Mr. Coker, you're now recognized for five minutes. Thank you, Chairwoman Miller Makes, and good afternoon to the members of the committee.
▶ 1:12:44My name is David Coker, and I have the privilege of serving as president of Fiser House Foundation. The Fiser House program was founded in 1990 by Zachary Fiser, a private citizen and patriotic philanthropist who believed that no military family should ever struggle to be by their loved ones side during a medical crisis. He built the first Fiser houses at the National Naval Medical Center and Walter Reed Army Medical Center.
▶ 1:13:11The vision was simple but powerful to create a home away from home for families traveling to be with a loved one receiving care. The Fiser House program has now grown into a network of 100 Fiser Houses located at Department of Defense hospitals and VA medical centers across the country and Because of the special mission of supporting both military and veteran families, it is fitting that the 100th Fiser House to be dedicated next month is located at the James A.
▶ 1:13:41Level Federal Healthc Care Center, the only fully integrated DoD and VA medical center in the country. Each home is now built through the generous support of the American public and donated to the Veterans Affairs for the military service it serves. To date, Fiser Houses have offered more than 12 million nights of lodging and saved families more than $650 million in out-ofpocket costs.
▶ 1:14:06When we gift to Fisher House to the Army, Navy, Air Force, or Veterans Affairs, our goal is to support these families in their time of greatest need. We know that having a loved one present improves recovery. Family members serve as caregivers, advocates, and are a tremendous source of strength. We believe they are essential to the healing process and that every veteran and service member deserves to have their loved one by their side.
▶ 1:14:34Of the 100 Fiser Houses, more than half support VA medical centers. In 2024, the VA Fiser houses serve more than 24,000 veteran families spanning all eras and Last fall, guidance was published which changed the way VA houses operate. It directed that only families of veterans receiving VA directed care were eligible for the support Fiser Houses provide.
▶ 1:15:02Even when rooms are available, families that have historically been welcomed must now be turned away. Last year, the occupancy rate at the VA Fiser Houses across the country was 53%. We would ask that if a room was available, consideration should be given to support the family of an eligible DoD The Fiser House supporting the Washington DC VA Medical Center is on the same campus as Children's National Hospital, the National Rehabilitation
▶ 1:15:32Hospital and the Washington Hospital Center. And last year, occupancy at that house was 22% and could have easily accommodated families receiving care at one of those facilities. The worldrenowned Paley Orthopedic and Spine Institute is located near the Fiser House supporting the Thomas Corey VA Medical Center in West Palm Beach, Florida.
▶ 1:15:5827 military children were referred to them for life-changing care last year. But today, their families are no longer eligible to stay in the Fiser There were three Fiser houses at the Debbie VA Medical Center in Houston, adjacent to the Texas Medical Center and MD Anderson. Last year, the occupancy rate was 63% and again because of this guidance, military families will be turned away.
▶ 1:16:27The bipartisan Fiser House Availability Act of 2025 would restore the flexibility that VA Fiser House managers once had, allowing the families of active duty service members and other eligible beneficiaries to stay on a space available basis while preserving the priority access for veterans. This change will not reduce access for veterans.
▶ 1:16:51It simply allows these homes already built, already staffed, and already serving to do what they were intended to do. Keep families of our nation's heroes together in the hardest moments of their lives. This bill is consistent with the memorandum of understanding between the Secretary of Defense and Secretary of Veterans Affairs titled Strengthening Our Partnership and Service to Those Who We Serve.
▶ 1:17:17and it will provide one more way for the two departments to work together to support both the military and veterans communities. On behalf of Fiser House Foundation and the tens of thousands of families we have the privilege of serving each year, I want to thank the sponsors of this bill and all of you for your support of our nation's service members, veterans, and their loved ones. Thank you for the opportunity to speak today. I welcome any questions. Uh thank you, Mr. Coker. Mr.
▶ 1:17:47Johnson, you're now recognized for five minutes. Thank you, Chairwoman Miller Meeks, Ranking Member Brownley, and members of this committee. My name is Brandy Johnson. I am a resident of the Northern Marina Islands, a veteran veteran of the United States Marine Corps, and for the past decade, I've had the privilege of assisting fellow veterans in the Northern Marianas, helping them navigate the VA system and access the benefits they earned through their service.
▶ 1:18:10I have traveled nearly 8,000 miles to be here today to speak in support of HR 3400, the territorial response and access to veterans essential life care act known as the travel act introduced by our delegate, Congresswoman Kimberlin King Hines. This is a good bill. In the Northern Marianas, we do not have a VA medical center. We do not have consistent access to specialty care or mental health services. When veterans need more than basic care, we are often told to leave the island, traveling thousands of miles, paying out of pocket, and spending weeks away from our families.
▶ 1:18:41The Travel Act helps to change that. It allows the Department of Veterans Affairs to send traveling VA positions into remote communities like ours instead of forcing the veteran to chase care across oceans. This bill brings care to the veteran. That is the right direction. I'm here to voice my support for the Travel Act, but also came this distance to give voice to the hundreds of veterans who could not be here. Veterans who serve this country with honor, who like me are not asking for special treatment. We're asking for what we would have received if we lived anywhere else in the United States.
▶ 1:19:10We are the only place in the nation where a veteran can call home but have no access to community-based outpatient clinic. No seabach at all. Veterans from every conflict, past and present, have been told that if they want the full range of care they have earned, they cannot live at home. Veterans seeking care at home see one doctor on Tuesdays and Thursdays. Dr. Ada has done a great job, but only but there is only one such only so much one person can do.
▶ 1:19:34Her office has one VA registered nurse, a veteran herself, but if she needs care or takes a much needed vacation, there is no one left to keep pace. Decisions on care, travel, and benefits happen in Guam or Hawaii. Resources come from Guam or Hawaii, and when those places are struggling or overloaded, we cannot reasonably expect them to prioritize our But what we want and what I believe we have earned is the right to live in the country that we fought for in the community we fought for and to have our services service speak for itself.
▶ 1:20:03We should not have to choose between access to care and being with home with our families. We stood the watch. We answered the call. That should be enough. I served in Iraq. I saw combat and I received the Purple Heart for it. I traveled here by choice, but many veterans are forced to travel simply to receive the care they need. That should not be the case. In the northern Marianas, I have served alongside and advocated for generations of veterans, those who fought in Vietnam, Panama, Iraq, and Afghanistan. All of them returned home to a system still not built to meet their needs.
▶ 1:20:33As I made my way here, I thought the thought of the Vietnam veterans in their 70s and 80s who served our nation even before our islands were formerly part of this country. They have spent a lifetime fighting for benefits that only trickled in slowly over decades. Now, even in their later years, they are still being asked to travel off island for basic, sometimes life sustaining care. I think of how difficult this travel is for them. I thought of the Gulf War veterans who opened a new chapter in America's military history but returned to the same old gaps in care and support.
▶ 1:21:00And I thought of my generation, those who served in Operation Iraqi Freedom and Enduring Freedom. We served with commitment. We returned home with hope, but we still face the same cycle of delay, denial, and distance. Of those generation of new veterans, I am proud to be part of a group that is organizing to support one another directly. Project Buddy Check 670 is an example of that effort.
▶ 1:21:22It reflects our belief that care for veterans does not always come in the form of a pill or prescription, but sometimes it comes from another veteran picking up the picking up the phone, checking in and listening. Project Buddy Check is a reminder that veterans seeking care that treats us as people, not just patients. But when but when even ordinary care is far to reach, I how can we expect a system to provide the mental health and holistic support for our veterans truly need? Generations of veterans have answered the call from our islands.
▶ 1:21:50I know the challenges we face are difficult to address, but again, we stood the watch. We bore the burden. That should be enough. It is time the system answered back. HR3400 is a strong start. I respectfully ask this committee to support it and continue advancing policies that bring real access, real dignity to every veteran, no matter where they live. Thank you for your time and for your unwaving commitment to those who serve. Uh, thank you, Mr. Johnson, and thank you for your uh long duration of travel to get here, Mr. You're now recognized for 5 minutes.
▶ 1:22:19Madam Chair, when they they called votes just Yes, sir. There's 327 people left to vote. I've never missed a vote time. Okay, sir. You may be excused if you want to be excused. I'm sorry, Mr. L. Well, uh, thank you, Chairwoman Miller Meeks, Ranking Member Brownley, distinguished members of the subcommittee. On behalf of National Commander James A. Lorsier Jr., and the 1.5 million dues paying members of the American Legion.
▶ 1:22:49Thank you for the opportunity to testify today discussing pending legislation that directly impacts the lives and well-being of Americans veterans. Today, the American Legion supports nearly all the bills under consideration because they reflect a bipartisan commitment to improving mental health outcomes, suicide prevention, addressing provider shortages, and safeguarding the dignity of those who have worn the uniform. First, HR 785, the Representing Our Seniors at BA Act. This bill appropriately recognizes the vital role that state veterans homes play in long-term care.
▶ 1:23:19As the average age of our veteran population reaches 75 this year, this legislation would add rep add a representative from the National Association of State Veterans Homes to the Geriatrics and Gerontology Advisory Committee. With over 169 homes now operating under NASVA, this change is both timely and necessary. Second, the VA data and transparency and trust act is a good step towards improving VA reporting on healthcare and benefits by expanding access to underlying data and requiring disagregation by gender, age, geography, and condition.
▶ 1:23:50This legislation enhances oversight, fosters collaboration, and enables evidence-based improvements in care delivery. We support the bill with amendments to clarify definitions like reliance on VA care and minimize administrative burden while urging the inclusion of data on caregivers, survivors, and emerging chronic conditions. We also offer strong support for HR 3400, the travel act, which would authorize temporary VA physician assignments to US territories like Puerto Rico and Guam.
▶ 1:24:17With physician short shortages reaching crisis levels in these areas, this legislation brings us closer to healthc care equity for veterans no matter where they live. Further, we commend the draft legislation directing VA to study RNA sequencing as a diagnostic tool for post-traumatic stress. While this technology should never be used as the sole basis for compensation decisions, it holds promise for advancing diagnostic precision and developing targeted therapies. We must embrace science without losing sight of the holistic nature of invisible wounds.
▶ 1:24:46Workforce develop development also remains a priority. That's why we support the bill establishing employment time frames for health professional scholarship program participants, a common sense measure to address critical shortages and ensure VA retains its pipeline of trained professionals. On caregiver support, HR 2148 expands transitional health care and provides stipens for career relicens recognizing the sacrifices caregivers make.
▶ 1:25:13These steps help veterans remain in remain inh home settings at a fraction of the cost of institutional care and ensure caregivers can reenter the workforce with dignity and purpose. Finally, HR 2605, the SAVES Act, would establish a grant program to expand access to service dogs through accredited nonprofits.
▶ 1:25:34VA's own research continues to confirm that veterans paired with service dogs experienced reduced post-traumatic stress symptoms, decreased suicidal ideiation, and improved quality of life. The VA itself offered a Fox grant to a service dog organization. Anyone who owns a dog will tell you they can be therapeutic. You don't need research. When fingers meet fur, magic happens.
▶ 1:26:00But I know from personal experience, having previously benefited from a service dog named Kaia, the profound power a specially trained dog can have in a veteran's life. This is why I helped author the original PAUSE Act of 2016. And Kai and I spent years advocating for its passage before she passed the compromised version passed in 2021. But the Saves Act builds on this effort and more closely aligns to the text of the original PAUSE Act than the compromised version that ultimately passed.
▶ 1:26:29I cannot overstate the power passage and implementation of this bill would have on veteran suicide prevention and improved mental health outcomes. Because of Kaia, I earned a bachelor's and a master's degree. I have a beautiful 2-year-old son, and I sit here today as a veteran advocate of the LAR in the largest division for the largest veteran service organization in the country because of my service dog.
▶ 1:26:57Chairwoman Miller Meeks, Ranking Member Brownley, thank you for the opportunity to testify and I stand ready to answer your questions. Uh, thank you very much, Mr. Lyall. Um, my apologies uh to the witnesses and those who are here uh due to the vote that has already been called uh in the House. The subcommittee will stand in recess subject to the call of the chair. I expect to reconvene uh 10 minutes after the start of the last vote. There's five votes.
▶ 2:25:43Good afternoon, Chairwoman Miller Meeks and um member Brownley and members of the subcommittee. Thank you for the opportunity to testify today. I want to begin not with the science but with the intention behind the science because when it comes to the life of veterans as one myself, I believe that intention matters. In 2010, the founder of I express genes, Dr. Joe Ing, molecular biologist and professor at the University of Alabama Huntsville, was at a routine faculty meeting. Tragedy struck when a colleague pulled a handgun out of her purse and murdered three people in front of him.
▶ 2:26:13Joe fortunately survived, but in the aftermath, he watched this spectrum of resilience occur among his peers. And Joe asked the question that would change everything. Could trauma have an imunological component? And that question set us on a path to transform trauma care forever. I met Dr. Ying. I'm in 2018. I'm John Schmidt. and I'm a CEO of I Express Jeans and a two tour Iraq combat veteran having served over 20 years in the army. When Joe and I crossed paths, I was still in uniform. I was trapped in a culture of silence.
▶ 2:26:41Like many of my peers and contemporaries, because of the risk to my career, I could not admit I was unraveling, depressed, anxious, and increasingly suicidal. That journey for me has turned into a mission. And today I testify not just as a veteran and a CEO but as a survivor advocating for the science to help me heal and I hope will help millions of others. While in uniform in uniform I earned a degree in microbiology and immunology from Vanderbelt University School of Medicine.
▶ 2:27:07It's a fateful step one that quietly equipped me to understand the science and the application of the technology that I stand before you advocating for. Together, our team at IE Express Genes has developed groundbreaking blood tests using the power of RNA transcriptto analysis, the trauma autoimmune indicator or TI as we call it. It identifies inflammation caused by trauma detectable before symptoms even surface to empower prevention, enable early intervention, and inform effective treatments for best possible outcomes.
▶ 2:27:37The TII test reads RNA transcription, how the body's genes are responding right now in real time, creating potential for limitless therapeutic strategies never before possible. Unlike genetics, which only tell us what might happen, RNA tells us what is happening. And this matters. This matters because it's the kind of inflammation that we detect is the root cause for the oxidative stress and the neuroinflammation that crosses the bloodb brain barrier and contributes to the anxiety, depression, and other hallmarks of PTSD.
▶ 2:28:05This lab developed test is already available commercially through our lab in Huntsville, Alabama. It's lowcost, it's scalable, and it's incredibly precise. With the VA, we're not starting from scratch. Uh we with our partnerships at VA Birmingham over the last two years, we've already demonstrated powerful results. In fact, as our cle key clinical research collaborators put it, quote, "Its high sensitivity, specificity, and translational relevance position it as an exceptional tool for clinical use.
▶ 2:28:31Given the clarity and consistency of the data it provides, I strongly advocate for its broader adoption and urge that it it be rapidly prioritized for clinical validation to support improved patient outcomes. End quote. PTSD and trauma related illness have long been treated based on symptoms and subjective reporting. But now with RNA transcriptto analysis, we can assess it objectively for the first time, offering a novel approach for diagnosing, treating, and even preventing trauma-induced disease.
▶ 2:28:59And today there is pro a promising patchwork of powerful therapies. Mindfulness, contrast therapy, EMDR, neuro feedback, ketamine assisted psychotherapy, and even psychedelics. But it's a choose your own adventure landscape for our veterans because we've lacked an objective compass. TAI is that objective compass. And we can use it to validate the effectiveness of all of these modalities and track clinical progress in real time. We are not starting from scratch here either.
▶ 2:29:24And we've already partnered with groundbreaking technology companies using hyperbaric oxygen to virtual reality with exceptionally promising early results. The VA has long pioneered technologies that went on to change the world. Let this be the next chapter, ushering in a new standard of precision mental health that is proactive, datadriven, and life-saving. I express Genes is a company born out of tragedy, led by those who've lived the realities of trauma, and built for a world finally ready to confront it. Let's lead the transformation of trauma care.
▶ 2:29:52Our veterans deserve it and so does every other American still waiting for their suffering to be seen, understood, and treated with precision. The opportunity is massive and as you know the need is urgent and only growing. But now with the science is ready. Let us transform trauma care together forever. Thank you for your time and I welcome your Thank you, Mr. Schmidt. I now recognize Miss Benson for five minutes. Members of the committee, thank you for inviting me to testify today.
▶ 2:30:21As the wife and caregiver of a severely injured and ill combat veteran, it is my honor to speak to some proposed legislation that could lessen the burden of each of our caregiving families face every day. I care for my husband, Eric, who deployed twice to Iraq as a combat engineer. My husband suffered multiple traumatic brain injuries during his years in service and is considered by VA to be permanently and totally disabled and unable to work. He is wheelchair dependent, struggles cognitively, suffers from migraines and blackouts, and is visually impaired. I am also mom to five amazing kids, three of whom have needed specialized care over the years.
▶ 2:30:50The day my husband was awarded permanent and total status, my children and I became eligible for Champa. I breathed a sigh of relief knowing that we too would have appropriate healthcare. In 2021, one of my children began attending college and needed monthly medications. We mailed the required certification paperwork, but when we went to fill the prescriptions, we found Champa wasn't active. I called, sat on hold for four hours, and learned Champa's central mail facility was six months behind on opening mail. Horrifyingly, Champa began requiring semester certifications in 2023 with no option to expedite activation for medical best interest.
▶ 2:31:21Since 2023, my child has suffered from last coverage between semesters due to the certification process in Champa's archaic mail system. Winter and summer break became a mix of timing medication pickups prior to coverage loss and paying out of pocket for any therapies or doctor's visits. This outdated system ensured my child was without insurance from November of 2024 to May of 2025.
▶ 2:31:43Caregivers need CHAMP for fixed beginning with ensuring our children who have already given up so much don't have to worry over the loss of coverage upon their 18th birthday or due to an archaic certification process. HR1404 the Champ for Children's Pro Care Protection Act would allow coverage until age 26 eliminating these egregious situations. It would align coverage with civilian insurers and the age at which dependents must begin to use their VA chapter 35 education benefits.
▶ 2:32:09It also recognizes the true nature and sacrifice of youth caregivers by allowing them to support they the need or support their needs as they transition from caregiving into adulthood. I understand a re VA's recent testimony. VA indicated they oppose this bill due the nature of Champa arguing that it's a medical service and not an insurance product. Champa provides explanation of benefits, approves or denies diagnostic and medical treatment codes and remits payment for enroles to providers for services.
▶ 2:32:35Champa even has out-of- pocket maximums, deductibles, co-pays, and a medication formulary with tiered pricing. Every year, enrolles receive a 1095b, attesting to the fact that Champa counts as minimum essential coverage under the Affordable Care Act. I admit I'm a lay person, but this feels like every other insurance product I have ever received through an employer. While I'm here to support extending Champ VA coverage to age 26, I implore this committee to use its oversight authority to improve the system itself so our families can use it to find appropriate care.
▶ 2:33:03To help you understand the challenges, let me explain what using Champ is like. In 2019, one of our children was hospitalized and need needed a residential facility. I was told to find a facility that would take Champa without the guidance of a provider network. I called over 20 facilities that were Tryare approved to see if they had a bed available or could add my child to their wait list. All but one turned me down immediately. The reason, prior authorization under Champa since January of that year was taking upward of 6 to9 months. The one residential facility that did agree to treat our child had a stipulation.
▶ 2:33:33We were to sign a $110,000 promisary note upon admission and the chance CH champ refused authorization and payment. Another of my children needed specialized therapy which was completed in 2021. In 2023, the provider called me to let me know they had finally received payment from Champa almost 27 months later. Unlike its Triricare counterpart, Champa has no contracted network of providers and no published fee schedule.
▶ 2:33:57Champa processes the majority of provider enrolly claims using a single traditional MA mail center, lengthening the time between claim submission, processing, and reimbursement. Filing and retaining providers willing to file it in my area, I'm sorry, file filing and retaining pay for services has become so cumbersome that the number of providers willing to file it in my area dropped to two practices, neither containing a pediatrician. Once again, I'm paying out of pocket for basic, routine, and pediatric care. I've stopped filing for reimbursement myself due to the burden of the process.
▶ 2:34:27It's one more bureaucratic fight caregivers like me don't need. Yet, I know another fight looms on the horizon. Not long ago, I firmly realized like so many other caregivers, I would likely become a survivor. Having given over a decade to being a caregiver, I was situated to outlive my veteran with no retirement, no active work credits, and almost no life insurance for my family's financial security. I'm not alone. Mosella Richardson Kamar, a 2025 Dole caregiver fellow from Delaware, studied for many years to become a civil engineer, but left her job to care for her veteran husband.
▶ 2:34:57Like myself, Mosella made this choice to ensure immediate well-being of her husband and sacrificed their own long-term professional goals and retirement potential for the benefit of the veteran. According to a recent Rand report, military connected caregivers saved this nation in help in healthcare costs by providing a minimum of $119 billion in unpaid care. In exchange, we face this harsh reality. When our caregiving ends, many of us will be financially destitute.
▶ 2:35:21Caregivers like Mosilla and me, we need you to pass HR 2148, the Veteran Caregiver Re-education, Remployment, and Retirement Act. This bill won't fix the entirety of the problem, but it is valuable first step in ensuring caregivers can begin to plan for retirement and establish safety nets of their own. More immediately, it will provide caregivers financial security by allowing for re-entry work re-entry programs and paying for relicensure in careers like teaching and engineering. Again, I'm honored to be here at the request of the committee and the Elizabeth Dole Foundation.
▶ 2:35:49To truly support the veteran, we must support the caregivers, survivors, and families who bear the burden of the war that continues to rage at home. I thank you for your time and attention, and I look forward to your questions. Thank you very much, Miss Benson, and thank you to all of you for that for your very insightful testimony. I now recognize ranking member Brownley for five minutes. Thank you, Madam Chair. Miss Benson, thank you for being here.
▶ 2:36:17Um, I think you and I think alike when it comes uh to the Champ VA bill, and you certainly have my commitment uh to continue to work hard on this. You know, I introduced this back in 2019, so it's been something that I've been trying to work on for a long time. And I can tell you before I even got to Congress, there were there there was there were a couple of members who have carried this bill.
▶ 2:36:43So, for a very long time, we've been trying to fight for some kind of parity and health care. So, um we will we will continue that fight and I agree that uh with you that we need more committee oversight um of the program and again I commit to you to uh make sure that that happens and hopefully you can join us again in in another hearing and I certainly would encourage uh Dr.
▶ 2:37:13Miller Meeks and uh to help me in that process. And I think we should we should try very hard to encourage the VA Office of Inspector General and the and the the Government Accountability Office to assist us in this effort to drill drill down.
▶ 2:37:29About 18 months ago, VA's Office of Integrated Veteran Care began an an initiative to what it calls the family member uh programs which included Champ VA. You're smiling. They plan to implement additional IT systems to administer the program and move away from a paperbased uh process.
▶ 2:37:55Have you noticed any improvements in the last 18 months as far as hold times when you call the Champ VA call center or processing times when you submit paperwork? I want to thank you for your commitment and the question. I actually called this morning and when I called at opening the whole time was an hour and a half which is not bad. They did now offer not bad. Um I'm used to four to six hours with Champier. Um, they did offer call back service now, which was new.
▶ 2:38:26Um, I called, uh, May 21st. I was here in town and spoke with another caregiver who was having similar reertification issues and she was able to get through. They told her they were opening mail from January. And tell me about the uh paper process. So, the paper process, um, I understand that there is I I actually just spoke with another caregiver whose wife is pregnant and diabetic.
▶ 2:38:54They're trying, well, I'm sorry, the veteran, his wife is pregnant, diabetic. They're trying to get her Champa turned on. Um, they went to go submit through the online portal, which is down. There is a fax number, which has been disconnected. Um, a fax number. Yes, ma'am. A fax number. That was the expedition process that we had always used in the past. I haven't seen a fax machine in a long time. I guess I should go over to the VA perhaps to see one. Yes.
▶ 2:39:21Um I can tell you that the way we were able to turn on my uh my insurance was that I called um I instituted a VHA executive inquiry. That executive inquiry allowed us to upload the documentation and bypass the mail system. And the ability to turn it on once that's uploaded is instantaneous. Is what? Instantaneous.
▶ 2:39:48I do not understand why we are on a male paper system when no other provider including other government medical benefits are. And um that that's the best answer I have is that no, I have not seen an improvement at all. I had a feeling that that was going to be your answer, but I wanted it for the record. So, thank thank you for that.
▶ 2:40:13Um, you know, in in addition to the Children's Care uh protection act, what what should we prioritize in terms of oversight or legislation to improve the CHAMP VA program for your family and for other families? My belief is again a wonderful question. My belief is the statute's outdated. It is. Yeah, the statute is very outdated. uh we have been a very small constituency.
▶ 2:40:38737,000 of those only about 48,000 according to the congressional report that was done in October of last year are actually users. Um we have to at least bring it up to the standard that is Triricare who has a contract who has providers. It is impossible for me to go to a provider and say you may or may not be paid Medicaid rates. Would you please accept this? The only mandated acptors are hospitals and urgent cares. Hospitals of what? In urgent cares. In urgent cares.
▶ 2:41:07Um and to the VA's point today that they're worried that the money that this would cost would take away from health care of the veteran. I argue we are health care. Yeah. Every caregiver, every youth caregiver, we provide billions in health care for our veterans. We save lives every day. We are the front lines. Yeah. We are providing that. And in exchange, we are left without our own care for ourselves because caregiving is stressful and destroys our own health.
▶ 2:41:37And our children who are higher special needs rates are left without coverage. and it's impossible to find coverage. And we are, as you said earlier, we are so behind even Triricare. And it's it's egregious. It is egregious. I agree with you.
▶ 2:41:55Um, my time is up, but I also hope um that the VA begins uh um the process of uh instituting the Elizabeth Dole bill because that too uh well, I shouldn't say that too, but that will be helpful and supportive of you uh as as a caregiver um to your husband and certainly to your children as well.
▶ 2:42:22So, um I I really enjoyed working with the Elizabeth Dole Foundation to to have that section in the bill that takes care of our caregiver. So, thank you for your husband's service. Thank you for your service and and helping him. And with that, I yield back. Thank you, M Brown. Chair now recognizes Representative King Hines for any questions you may have.
▶ 2:42:46So, first of all, I want to say thank you to each and every one of you for coming here and providing your testimony and sharing your insights uh with regards to different legislations that are before us. Uh time is money and traveling is is is very costly. So, I definitely appreciate it. And so, I want to start off first by saying thank you to TSL Foundation for supporting uh my very own constituent, Mr.
▶ 2:43:08Randy Johnson, who's made the 8,000mi trek here to Washington DC to amplify the voices of the veterans across the territory, specifically uh the Commonwealth of Northern Mariana Islands. And I want to focus my questions today to further flesh out some of the challenges that um the veterans in the CNI face by asking a couple of questions to Mr. Johnson.
▶ 2:43:30Um, so just for the record, prior to um a few up to about three months ago, you were employed by the district office by my predecessor and then the first couple months during my tenure um serving as a community case worker um basically serving our our our veterans.
▶ 2:43:50Um, so in your experience there, what are the the three areas of concerns that are frequently raised uh by the vets who come and and seek help at the office? Uh, thank you for your questions. The veterans seek um travel like um they have difficulty with travel mainly uh to their appointments. A lot of times the veterans have to pay out of pocket.
▶ 2:44:18So a veteran from Tenin and Roa traveling to Saipan have to pay out of pocket to travel to go see the VA doctor on Saipan and if they have to um get further care they have to go to uh go through Benny Travel which is on Guam and a lot of times Benny Travel will not issue the tickets immediately for them and sometimes it will may take up to a couple of days right even before their appointment schedule and at that point sometimes the veteran is stressed and was worried if they have to uh cancel
▶ 2:44:48or postpone their appointments and seek alternative care or alternative means by either fundraising for the necessary funds to travel or taking up personal loans. Um, and a lot of our veterans on those islands are on fixed incomes and so filing for reimbursement with the VA sometimes can be difficult.
▶ 2:45:06And I know a lot of our veterans are old school, so they'd rather talk to somebody in person and communicating with the VA uh is difficult on Guam because they're also working with their uh VA veterans on Guam. So our veterans are stuck with having to wait on calls sometimes or not get through and that poses a difficult challenge for them as well. All right.
▶ 2:45:29And tell us just a little bit just so that the committee has an idea what the cost of travel is for vets for example from from ROA or Tinian. Yes. And what all that entails. Yeah. So the travel between the inter islands can run up a couple hundred dollars round trip and that's just the veteran him him or herself. Oftentimes veterans are uncomfortable traveling by themselves so they would pay for their spouse or caregiver and that comes out of pocket and then they would have to file for reimbursement.
▶ 2:45:57Um but uh fortunately uh I have not heard of uh a delay in that reimbursement but I would have to assume that there has been delays because that was an issue uh during my employment during my uh the last delegate under delegate subl and that was something that we had tried to uh close gaps with with the reimbursement because a lot of these veterans don't just have a single appointment on Guam or Hawaii they have multiple appointments so while they're waiting for the reimbursement they have to push back their uh next appointment at
▶ 2:46:27times. So, in terms of specialized care, what are the the the areas of needs do do you foresee being something that will fulfill some of the medical requirements that are needed on the ground? Yes. So, the the one thing that been highlighted during discussions recently is the chiropractic care. I do know some veterans that do travel to Guam for chiropractic care, uh, including myself in the past.
▶ 2:46:52And those tickets can uh round trip run between $300 to $580 uh through United Airlines. And uh that just the airline itself. And then also you're considering the overnight stay because there's only one flight leaving to Guam daily and those can add up significantly for a veteran. All right. Thank you. I I yield back the balance of my time. Thank you, Chair. Thank you, Representative Kinghines. I now recognize myself for 5 minutes for uh questions.
▶ 2:47:22Mr. Ly, can you share with us how veterans around the country would benefit from Congressman Latrrell's Saves Act? Uh thank you for the question. Chairwoman Miller Meeks, obviously in my opening statement, I testified that I have a a large extensive personal experience with this as an enduser of uh a service dog, as somebody who's advocated and heard from other veterans uh for for years.
▶ 2:47:48You know, I think there's a misconception that uh service dogs, at at least at the VA, service dogs should be viewed uh simply as clinical tools. I think they also serve as a powerful backs stop uh to veteran suicide because when you are in that uh in that point, that critical crisis point, you feel unloved, you feel alone uh and you look down at the dog and you say, "I can't leave the dog and the dog would miss me." Right?
▶ 2:48:14it provides a sense of purpose that pills and therapy simply just won't ever do. Um I was a little upset to hear the the study that the VA cited, which I'm very familiar with the the study, um in my mind was set up to fail because the control group was emotional support animals, not u somebody that didn't have a service dog altogether.
▶ 2:48:36Uh but the study, even though I feel it was set up to fail, still showed positive results for reduced post-traumatic stress symptoms, depression, anxiety, any number of different things. Um in my long history of advocating for this, the amount of veterans that have reached out to me and said, you know, I I saw your story, uh and it prompted me to get my own dog, and if I had not had the dog, I would have killed myself is is just super powerful testimony to that end. Thank you. And Mr. Mr.
▶ 2:49:04Coker, would you mind sharing firsthand accounts of service members and their families inability to access your facilities due to the current policy and how my legislation would help prevent this from occurring You know, the VA medical centers have such a tremendous affiliation with academic medical centers and so often we believe that both within the DoD health system and the VA health system, you have worldclass health care, but sometimes the treatments
▶ 2:49:35need to be so and and when you don't have a safe, comfortable environment for your family to be there, you worry about do I max out the credit cards or you decide I'm going to accept what time I have left and I'll just forego treatment so that we can be together and and that is not a decision that a military member should have to make. Uh thank you very much.
▶ 2:50:04Ranking member Brownley, would you like to make any closing remarks? I have no closing remarks, but I thank you for bringing the witnesses here today and reviewing all of these bills and look forward to continuing to mark them up and move them forward. I want to also thank our witnesses and then again apologize for the 90-minute delay and recess uh as we had to go vote.
▶ 2:50:29Uh on behalf of the subcommittee, I want to again thank all of you, the witnesses and the members for being here today, and I look forward to working with you and the ranking member uh to address the issues facing our veterans. The complete written statements of today's witnesses will be entered into the hearing record. I ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material. Hearing no objection, so ordered. This hearing is now adjourned.