▶ 0:22:25Right. Good. Oh my goodness. Good afternoon. We're time time fly. I don't know. Anyway, thank you for coming today. Hey everyone in the audience, thank you for attending the committee hearing today in disability assistance memorial affairs. Chair may declare recess at any time. The subcommittee hearing will come to order. Good afternoon. Again, thank you to our witnesses for being here today.
▶ 0:22:49This afternoon, the subcommittee is examining the VA schedule for rating disabilities, otherwise known as the varsity and the department of efforts modernization. this modernizing this system. The varsity is the scale that determines how the veteran service connected conditions are evaluated which then determine a veteran's eligibility eligibility for benefits, overall disability ratings, and ultimately the amount of tax-free money they receive each month.
▶ 0:23:15While the varsity is incredibly is incredibly overly over complicated, it is important to step back and know that the schedule affects real lives. It allows VA to deliver compensation to veterans for their service connected disabilities and ensure all veterans are evaluated at the same standard. Congress created the university with a clear purpose to compensate veterans for the average impairment caused by their service conflicted connected disabilities to their earnings capacity. The rating schedule was created in 1945.
▶ 0:23:45While parts of it have been updated over time, the overall framework remains unchanged. In 2007, VA advisory committee on disability compensation concluded that the rating schedule was outdated and recommended a full review of all 15 body systems. VA formally began the effort in 2009 with a complete with a plan to complete this work by 2016. 10 years later, VA has only completed a review of 11 body systems out of the total 15.
▶ 0:24:12According to the testimony provided in a Senate hearing last year, VA has now extended its timeline to 2026. Again, this is more than 10 years beyond the original goal. VA VA VA has made but it is inconsistent thus far in my personal opinion. The veterans of today's the veterans of today deserve a system that evaluates their disabilities based on the medical evidence of today's medical practices.
▶ 0:24:37The respiratory and the respiratory, endocrine, muscularkeeletal, and digestive systems have been updated in the past 10 years, but several important systems remain unfinished. The neurological, cardiovascular, and hematologic systems are still in various stages of review despite many of these conditions being common and often complex. Mental health remains the most concerning VA proposed updates to the mental health rating criteria in 2022, but those changes have not been finalized.
▶ 0:25:04As a result, one of the most heavily relied upon portions of the rating schedule continues to operate under criteria that many believe no longer reflects modern clinical understanding or the full scope of functional impairment that veterans experience. Just as important, VA has not undertaken a comprehensive review of the economic component of the rating schedule. That component is supposed to connect medical findings to loss of earning capacity. Without updating this, the system risks drifting further away from its statutory purpose of benefiting veterans.
▶ 0:25:33This uneven modernization has real consequences on the veterans community and their families. And when rating criteria are outdated and inconsistent, examiners and raiders are left actually just to fill the gaps. That increases the likelihood that similar claims are handled differently. Recent GA reporting has highlighted inconsistent outcomes for similar conditions, outdated medical and occupational criteria, and quality review processes that are not strong enough to catch errors before they affect veterans.
▶ 0:26:01VA currently VA's current quality assurance approach relies on limited samplings that often fail to identify broader area trends trends excuse me and too often problems are discovered only after decisions have already been issued leading to rework appeals and additional delays systems matter standards matter and today oversight obviously matters and I'll close with this for veterans the disability rating process is not an abstract process exercise policy exercise it is often the moment when they sit across from the system
▶ 0:26:31and ask for help sometimes years after they left the military. When the process feels outdated, inconsistent or confusing, veterans do not lose confidence in a form or regulation. They lose confidence when they ask for help. Where will it be? Modern modernizing the rating schedule is not just about updating language or revising revising criteria. It's about trust. It is about ensuring that when a veteran raises their right hand and serves, the system they return to is worthy of that commitment. With that, I will yield to the ranking
▶ 0:27:04Thank you, Chairman Latrell, and good afternoon, everyone. Appreciate you all being here today. Mr. Chairman, I am grateful for you holding this hearing. The VA schedule for rating disabilities, or VASRD, is a massive program. It's big in size. It's big in impact, and it's absolutely central to how we support our veterans. Everything we do on this committee starts with one simple idea. that when a service member raises her right hand and serves this country, we owe her a system that works.
▶ 0:27:34If she's injured or becomes ill because of her service, she's earned care, benefits, and services. Full stop. And the process to get those benefits shouldn't be so confusing or slow that she feels lost before the process even begins. This hearing shouldn't be about cutting those services. It should be about cutting red tape. Veterans shouldn't need a law degree or a medical degree and a decade of patience just to get what they've earned by serving our country. We also shouldn't be afraid of change.
▶ 0:28:05I for one think the VA's schedule for rating disabilities is outdated. Medicine has changed. Diagnostics have changed. The nature of military service itself has changed. The injuries and illnesses our service members face today look very different to what they did 80 years ago. So yeah, the schedule needs to be updated. But the goal has to be clear and that's to modernize the system without harming the veterans. That's the line we cannot cross. That's the mission that is central to this committee.
▶ 0:28:35So I have a few questions that I think we can begin to answer today. If we're trying to figure out whether the current schedule actually works, we've got a real challenge. There's almost no up-to-date publicly available research on how VA's compensation system is performing. How do we fill that gap? What additional data do we need? How do we get it? How do we use it?
▶ 0:28:55If today's hearing is about understanding the methodology VA is using to update this disability rating schedule, then I welcome that because across multiple administrations, VA's work on Vassor D has been a black box. Veterans deserve transparency. Congress deserves transparency so that we can help our veterans. Mr. Mr.
▶ 0:29:14Chairman, I also want to address something that we've been hearing in the media a little bit that there's a growing narrative that that disability compensation is somehow too generous or that it's arbitrary and there's encouragement for veterans to game the system. I want full transparency. I want to know everything that's going on, but I resent that characterization of our veterans. Our veterans, that's not who they are, and it's not what this program is. These benefits are not handouts.
▶ 0:29:44They're not freebies. They're a recognition of service and sacrifice. And for many veterans, they're the only support they have when service connected conditions make work difficult or Mr. Chairman, you know better than I do about the risks that military service carries and that most civilians will never fully understand. Those risks don't end when someone takes off their uniform.
▶ 0:30:11They can follow a veteran for the rest of their life and they cannot be reduced to a simple earnings loss formula. We also have to remember that health relates to the whole person. A diagnosis that sounds minor to you or to me might be a sign of something much better, bigger. A veteran who has cystic acne that's linked to Agent Orange exposure isn't just dealing with acne. They're living with the consequence of toxic exposure.
▶ 0:30:37And that context We also have to remember what these programs are. No matter how big they are, how big they get, the heart of these programs are our Human beings. Our brothers, sisters, moms, dads, sons, and daughters who put on a uniform willing to serve us. People who deserve the dignity and care they have earned in exchange for that service. Which brings me to the last point I will raise.
▶ 0:31:07Mr. Chairman, my concern today that we only have one veteran service organization Veterans are not monoliths. They go into different branches of the service with different experiences at different times. Their voices should be central to this conversation. I hope that we can have more conversations with the VSOs on this topic as we move forward. Their voices are important, the most important ones in this discussion. Mr.
▶ 0:31:36Chairman, I'm looking forward to productive and honest discussion today and I hope this is just the beginning of our oversight into this issue. There's a lot more work to do and I yield back.
▶ 0:31:44Thank you, Mr. McGarby. I'd like to introduce our witnesses. Our lead witness from VA is Miss Nina Tan. Miss Tan is the executive director of compensation service at the Veterans Benefits Administration. Good afternoon. She's joined with Dr. So, correctly is a medical officer in compensation services at the Veterans Benefits Administration. Thank you both for being here today. I ask that you please stand.
▶ 0:32:14Raise your right hand. Do you solemnly swear the testimony you're about to provide is the truth, the whole truth, and nothing but the truth. Help you God. Let the record reflect that the witnesses have answered in the affirmative. You You may be seated. Miss Miss Tan, any any moment if you need to Okay. Uh, Miss Tam, you're now recognized for five minutes for your opening statement.
▶ 0:32:37Good afternoon, Chairman Latrell, Ranking Member McGarvey, and members of the subcommittee. I appreciate the opportunity to appear before you.
▶ 0:32:44St. Is your mic on?
▶ 0:32:45Yes, sir. Is
▶ 0:32:46okay. Thank
▶ 0:32:48uh good afternoon, Chairman Latrell, Ranking Member McGarvey, and members of the subcommittee. I appreciate the opportunity to appear before you today to discuss VA's efforts to modernize disability benefits. I am accompanied today by Dr. Ulia SoCal, medical officer with the Veterans Benefits Administration. For disability compensation or pension purposes, a veteran's disabilities are evaluated using the guidance in the VA schedule for rating disability or VASD, also known as the rating schedule.
▶ 0:33:16Under the authority established by 38USC1 1155, VA secretaries shall adopt and apply a schedule of ratings of reductions in earning capacity from specific injuries or combination of injuries. This rating shall be based as far as practicable upon the average impairments of earning capacity resulting from such injuries in civil occupations. The secretary shall from time to time readjust this schedule of ratings in accordance with experience.
▶ 0:33:46VA is committed to updating its disability rating criteria to accurately reflect medical science advancements and improve technology and current terminology. These updates allow VA to ensure its disability evaluations more accurately compensate veterans based on impairments in average earning ability. While VA has made numerous changes to the Vazard D, it has not completed a holistic comprehensive update since 1945.
▶ 0:34:14In 2003, the Government Accountability Office or GAO deemed VA's disability program high-risisk because VA had not systematically updated the Vazard D. In response, VA developed a modernization plan in 2009 with the goal of comprehensively updating all 15 body systems of the Vazard D.
▶ 0:34:34VA established workg groups that included medical and VA policy subject matter experts and used the analysis following its thorough review of established medical research to begin the rulemaking process which involves drafting and publishing a proposed and final rule for each body system. To date, VA has completed updates on 11 of the 15 body systems.
▶ 0:34:57Any updates made to the Vazard D are point forward in that they do not impact veterans currently service connected for that particular condition or veterans who filed their claims prior to the implementation date of new rules. VA anticipates publishing the final rules for all fourbody systems in three rulemakings by the end of FY2026 which will complete the first holistic comprehensive update since 1945.
▶ 0:35:26In 2019, VA established the Vazard D program management office with a mission of revising the VASD through rulemaking body system by body system in staggered cycles of recurring reviews as well as in response to go GAO's high-risisk recommendations.
▶ 0:35:43VA has successfully met three of the five high-risisk categories identified by GAO and have partially met the remaining two as we continue the iterative process of ensuring alignment of the Bazard D evaluation criteria with medical, scientific and technological advancements. The rulemaking process generally takes two to five years to complete, but can take longer due to the length uh to excuse me due to the length and medical complexity of the Vazard D proposed updates.
▶ 0:36:14Updates to the Vazard D require coordination to implement required claims processing changes and to provide training and guidance to clinicians on the disability benefits questionnaires and to claims processors charged with correctly applying current disability evaluation criteria. Following the completion of the first holistic and comprehensive update to the Vazard D since 1945, VA will actively pursue opportunities to update the Vazard D.
▶ 0:36:43In our next phase, VA plans to continue updating the Vazard D with the evolution of medical science, technology, and treatment modalities. While VA aims to update the schedule to simplify the claims process for veterans and to promote a fair, objective, and efficient process, VA will also standardize rating terminology, incorporate the effects of court decisions, and address contemporary claims processing issues to assist claims processors charged with delivering fair, efficient, and
▶ 0:37:13timely benefit decisions to veterans. VA is focused on completing the first holistic change and anticipate starting the next phase of this iterative process at the end of this fiscal year. In closing, VA remains committed to modernizing disability benefits by making continuous updates to the Vazard D. We thank the committee for your continued support of programs that serve the nation's veterans and look forward to working together to further enhance delivery of benefits and service to veterans. Mr.
▶ 0:37:42Chairman, this concludes my statement. My colleague and I are prepared to respond to any questions that you or other members of the committee subcommittee may have.
▶ 0:37:50Thank you, Miss Tan. The written statement, Miss will be entered into the record. We'll now move to questioning.
▶ 0:37:58So, just I'm going to ask some clarification questions.
▶ 0:38:01By the end of 2026, all body systems will be complete and this
▶ 0:38:06program will be completely buttoned up. this first holistic comprehensive review of
▶ 0:38:11all 15 body systems.
▶ 0:38:13All 15 body systems
▶ 0:38:14by the by about the end of fiscal year
▶ 0:38:16by the end of this fiscal year.
▶ 0:38:17Okay, that's great news. Good to hear
▶ 0:38:21Can you explain to me and I can appreciate the complexities of why has this taken so long? Because I I don't want to have to ask you this question at the end of 2026 of why we haven't completed it. So, can you explain to me and I understand when we're diving into the mental health issue and I know that that is almost impossible to figure out, right?
▶ 0:38:47Um, [clears throat] can you explain to me why the last three have taken so long considering and I won't put 1945 in there just from the the late 2019s to
▶ 0:38:59Sure. So, we've um actually been updating all along. We um have focused in primarily some of the most recent updates have been um from 2017 but we have updates all the way back to 1994.
▶ 0:39:11What is an update?
▶ 0:39:12Uh update is to through a a final rule in which we are using updated medical evidence, science, uh technology to look at each of the body systems as you mentioned and we're looking at each of the diagnostic criteria that goes along with that.
▶ 0:39:28Where are we aggregating our data from? So we have a series of processes through our workg groups um and the development where we look at um all sorts of data from the um medical community um and Dr. Soal can speak more about
▶ 0:39:44our medical community or outside the VA. So we use a combination. We look at published literature. Um we use uh resources from things like all the American uh let's say American Heart Association for example. We look at peerreview literature. Um all sorts of of data and information.
▶ 0:40:04We're bringing that internal to the VA system. Aggregated data outside in internal to the VA is all aggregated internal to the VA. Correct. So when we develop when we establish a working group, we have a number ofmemes and clinical um adviserss both in VA and outside of VA and they look at current medical literature um from those types of associations and things of that nature.
▶ 0:40:29So they're bringing all of that data in and we do have clinicians um not only in VBA in compensation service and our MDO office which you're familiar with at VHA um and those are some of the sources who then look at the available data and evidence and they pull that
▶ 0:40:46process are where we currently sit with the advancements of machine learning and artificial intelligence.
▶ 0:40:52So we're open to exploring how we can bring technology into this process. I think we have a unique opportunity.
▶ 0:40:59We haven't done that yet.
▶ 0:41:01I'm not in the process of bazard Um but
▶ 0:41:05why not? Because the world around us is
▶ 0:41:11and you you may not be able to answer that question, but I there I know somebody in your department who I'm going to call as soon as this hearing is over with to ask why implementation of AI and ML is not in this rating discussion because it makes absolute sense for it to be. And I think as our focus has been on this first holistic update as we move into our next iteration, that's something that we're absolutely welcome to explore. And so I think there is opportunity for that, sir. And I can take that back or as if you
▶ 0:41:40please do. I'd actually like to have an answer to that. It it makes more sense to me now in an understanding of how machine learning is effectively changing the dynamics of how we interpret med.
▶ 0:41:51Okay? uh because I can assure you our veterans will be very pleased to know that we can do this in a matter of milliseconds, in a matter of months and years and these platforms can do that for us. Implementation is where we seem to be hung up. And not to beat up on the VA too much, but the VA can be very siloed at times. And I think that might be a missed opportunity if we just continue down the kind of the the railway that we're on with.
▶ 0:42:17And by all means, I know that our our everyone that touches this information is brilliant. But uh when you can when you can process information at a pedoph
▶ 0:42:35Thank you, Mr. Chairman. And I'll build on that point for just a second. I don't want to speak for you at all, but you know, I know we don't want to hear something's too complicated. um especially if that means five and 10 years from now uh it's it's really a lot more complicated because we didn't do something today that that we should be doing. So I just want to build on that a second. Um Miss Tan start with you. As I said at the beginning, veterans are at the heart of every single thing we do. That's what our this committee is about. It's about serving our veterans.
▶ 0:43:03So I'd like to start by asking the department's process for including veteran VSO feedback in your into your methodology. waiting until the notice and comment period for proposed rules. It's to me that's too late. So I want to know to what extent and through what process do you ask stakeholders for their input before you get into the rule drafting
▶ 0:43:24So we do follow the American Procedures Act. Um and within that we do have limited opportunities which which we can have what is considered exparte uh conversations so that we are not um being unduly influenced or having uh more weight or access to more information for any group of stakeholders than others so that we maintain transparency.
▶ 0:43:47So, we do uh invite through that required 60-day public comment period um as we invite anyone to uh provide input into that process. Um so, we don't actually um currently have processes in which we're doing that because we're bound by those requirements of the APA.
▶ 0:44:05Yeah. And I and I appreciate you being clear and at the end there getting to the the point it doesn't happen. And and to take this out of government speak when you said there's limited opportunities for exparte conversation. What that really means is we're not talking to veterans before you all come up with a rule. And to me that needs to change. Um and you said unduly influenced. I don't view this as undue influence.
▶ 0:44:29I think talking to the enduser of this service is of paramount importance particularly because this is all about helping our veterans and we know this sometimes something can look good on paper and then it gets into practice and it doesn't the work work the way you intended even if you had the best intentions getting that feedback from our veterans is really important um I understand that disability compensation advisory committee exists but their work is infrequent and it's increasingly sidelined signed by
▶ 0:44:59this administration. So, can you commit to doubling down on efforts to get more veteran input into this process at an earlier stage?
▶ 0:45:07I will identify ways that we can do that, sir.
▶ 0:45:09Thank you. We we would love that. And as I understand it, VA is working on a new loss earning study given how old the previous one is. When do you expect to complete that study? And will you commit to making both the data supporting that study and its results public? So we are evaluating the deliverables from that study. We actually had contractor support that ended at the end of FY25.
▶ 0:45:32So my team is actually in the process of evaluating that uh information from those studies um which was a test program and a proof of concept to kind of see where we go next from that.
▶ 0:45:44But can we see the data supporting the study and the results when it's all
▶ 0:45:50I will take that back, sir.
▶ 0:45:51Yeah. And and I'm going to press you a little bit on that because I think we deserve better than that and I know our veterans deserve better than that. This is not a gotcha moment, right? This is asking for the data used in conducting a study and the results that impacts our veterans and we want to understand how we're coming up with these calculations that our veterans oftentimes depend on when they have been injured because of their military service and what that means for them.
▶ 0:46:20So, it's really important for anyone to have that and for it to be a transparent, inclusive process so we know what's going on. So, um, we're going to keep following up with you on that. It needs to be more than an answer, a throwaway answer and a committee of we'll take that back to somebody. I know our veterans are entitled to that information and I want to make sure they get it. Um, as I understand it, the VA has historically provided updates to GAO on your ongoing work around revising VASD.
▶ 0:46:48When was the last time VA met with him and have you shared your methodology with him
▶ 0:46:53So, we do meet with uh GAO regularly. Uh the last status update um I can't give you the exact date when we did that. I do know in uh FY25 that's when we had the increase and move to partially met for the monitoring stage of the high-risisk list criteria. So, we do have ongoing communications with GAO and others and provide status updates as required. And have you shared it with any outside researchers at all?
▶ 0:47:19Uh, not to my knowledge, sir.
▶ 0:47:20I think it would also, this is another thing, I just think it's helpful to have a second set of eyes on this type of thing. Uh, to validate the methodology to make sure we're coming up with the best system to help our veterans, especially these are our veterans who have been injured in their service or are disabled because of their service. So, appreciate that. And Mr. Chairman, my time is expired. I yield back.
▶ 0:47:42Thanks, sir. Mr. Bergman, General, you're recognized, sir. Thank you, Mr. Chairman. Had a chance here to last 20 minutes or so just kind of reflect on what everybody was saying. Couple of thoughts. 1945, my dad was just mustering out of the Navy after World War II. Okay.
▶ 0:48:02And I think about his last endeavor before he passed some 40ome years ago was he was a a volunteer driver for the uh for the county VSO to get the veterans to the VA hospital over by the Minneapolis airport. And I you know I I think about my my parents what they went through in the depression and then World War II. But we're using the the date here, 1945.
▶ 0:48:30Incurrent data scares the hell out of me in some ways because it means we didn't change. And and someone said a couple of different ways, it's complicated. Yeah. And as uh life is tough, but it's tougher when you're not exactly, you know, embracing it every day. It gets more complicated. It's like a ball of bureaucratic string that was built over time. Nobody knows where it starts, where it ends.
▶ 0:48:57All they know is it's this big ball of string and it's a reason to say no. So having said that uh let me just ask a just just in a sense of urgency would be would be extremely helpful and desired within the veterans administration as well as everybody involved in this whether it's the VSOs the veterans but especially the bureaucracy of the veterans administration because if it is complicated it's up to those of us in
▶ 0:49:27charge of what we're doing right now to uncomplicate it as best we can and when you heard about AI and ML that's a way to begin the unraveling and the uncomplication of it. Um to what extent do outdated portions of the the VASD is you even use that in a pronunciation in an acronym Vazard.
▶ 0:49:54Yeah boy. Varsity. Varsity. Huh. As opposed to the junior varsity. Okay. You got to say schedule, sir. I to what extent does the out outdated portions of it make it harder for the the VA to consistently and accurately evaluate modern complex conditions among younger veterans because we know based on the nature of war the injuries that were received in World War I, World War II, Korea, Vietnam, Desert Shield, Desert
▶ 0:50:24Storm, OAF, OEF have changed because of the nature of the fight, the survivability, etc., etc. But, um, are we getting rid of the outdated stuff? I mean, I mean, regardless of timelines, do you really think when all is said and done, this this will really be reflective of the types of injuries that our veterans are receiving in conflicts today?
▶ 0:50:50Yes, sir, I do. As part of our updates, and again, to be clear, it's not that we have not updated since 1945. the systemic and holistic update um has not been completed but we have updated body systems, diagnostic codes and we do remove outdated terminology. We remove outdated testing and things that are not uh accepted in the medical and clinical community.
▶ 0:51:13we remove uh instances where there may be um subjective criteria um and I'll use for an example in the proposed rule for uh the neurological body system where some of nerve paralysis could be rated by mild, moderate or severe. Well, that's not really great objective criteria then for someone to use.
▶ 0:51:34So, we're adding testing and objective and measurable um components that help reflect the current disability picture like you mentioned of what our veterans are experiencing today. So, we add new diagnostic codes. We uh like for mental health for example, we're use we are proposing updates um that adapt to the DSM4.
▶ 0:51:56So, let me I know you could Okay. Is there a sense of urgency?
▶ 0:52:01Okay. I I guess it would be helpful if you could, you know, not today, but give us something that shows a sense of urgency that actually shows that because we hear it,
▶ 0:52:14but I I can be honest with you. I don't see it. Okay. And I'll just leave it at that and I'll yield back. Mr. Chairman, Thank you, Mr. Chairman, for uh holding this important hearing today and thank you to uh the witnesses.
▶ 0:52:44Miss Tan, what is VA's plan for future updates of the VA SRD and what criteria is VA using to prioritize future updates?
▶ 0:52:55Thank you for that question. So we're using the lessons learned from this first iteration um and best practices. We are looking at ways to uh be more strategic in that. So we don't just necessarily want to take a look body system by body system but where we have evidence um and data that supports that we need to take another look. So some of that may come from uh studies and things such as our earnings loss studies if we're able to use that.
▶ 0:53:20We'll use um areas where we know in medical science that have changed and updated through technology and treatment modalities. Uh so we will look at the body systems. We will also look at individual diagnostic codes and based off the available evidence we will uh prioritize those remaining updates or the next phase of updates with all of that information in mind. So trying to take a much more strategic uh pro project management focus approach to it.
▶ 0:53:48I think uh because we do have this experience and lessons learned from this first holistic update that will be completed by the end of this FY. So, Miss Tan, does VA have a project management plan or other document for uh that outlines goals, objectives or a schedule for future updates? And if not, is there a timeline for VA to develop such a plan?
▶ 0:54:12So, we do have a plan for the first iteration which is coming to a close as I mentioned before. Um and we are working on what that project management plan for the next iteration will look like so that we do have schedules, milestones and things like that to measure our progress and to make sure that um we are following good project management principles uh for our future
▶ 0:54:34Thank you, Mr. Chairman. I yield back the balance of my time.
▶ 0:54:37Thank you, ma'am. Mr. Self, sir, you're recognized for five minutes.
▶ 0:54:40Uh thank you, Mr. Chairman. I've just got some some probably question easy questions to answer. Why sleep apnoa? Is that military related?
▶ 0:54:53So it can be and for VA disability purposes, we look at disabilities that were incurred in or caused by or aggravated by military service. So if something started during military service then we have a responsibility according to the law to service connect sleep apnea for any residual disability based upon that okay how much of this and I realize this is not uh vision driven but how much of this is customization that's allowed amongst
▶ 0:55:23the different contractors how much of that because we see that I see that often we allow too much customization across the VA.
▶ 0:55:34So, are you referring to our disability uh benefits?
▶ 0:55:37Yeah. Yeah. The the
▶ 0:55:39So, we have criteria um which must be supported by clinical findings um and medical evidence. That is
▶ 0:55:45how much of that is customizable?
▶ 0:55:47Um so, we do cut down on areas of free text, but we do need the doctor's observations. So we do uh but we use testing uh we use uh clinical criteria and we look at the entire disability record and we don't rest anything on just one single piece of evidence.
▶ 0:56:06Um there's a statement in here that more veterans are relying on disability. Is that actually true or is that uh do we see a growth in this? I don't have any uh evidence to support that more evidence, excuse me, more veterans are relying on this benefit. Uh we do have veterans that are employed. Most veterans um that we serve are actually uh employed in some part and gainfully employed in many situations.
▶ 0:56:34And would you just give me and you may have already covered this and you probably have and I apologize if you have. give me a a short dissertation on impairment disability versus financial uh inability to earn. Why that distinction and how's that working in all of this uh this review that you're doing? This seems to me to be part of the crux of what we're asking here.
▶ 0:57:00So part of our evaluations, we look at occupational impairment and functional loss. Um, and so I think when in VA terms when we look at things like Tdiu, which I'm sure you're familiar with, when we find veterans who are unemployable because of service connected disabilities, if they don't meet um that criteria um otherwise, then we have benefits in store for that.
▶ 0:57:23But you could very easily have an 100% service uh service connected disabled veteran who is able to work for us. Uh and disability and 100% evaluation does not mean unable to work in many situations. So disability compensation does not mean that a veteran cannot earn wages that they are unemployable. It means that based off the residual impairment, VA finds them to be 100% disabled because of the severity of their disabilities.
▶ 0:57:53Right. And how are you going to apply either one of those really to mental health, which is a growth industry, as we know, mental health amongst veterans is is is rampant. Uh how is that working with mental health? Because it's a little bit different than physical
▶ 0:58:10Certainly. And
▶ 0:58:11how are you going to apply that?
▶ 0:58:12I'm going to ask Dr. so called to address that because she's done a lot of the work in that area.
▶ 0:58:19Good afternoon. Currently, the portion of the rating schedule which addresses mental disorders is in the final stages of its publication as a final rule.
▶ 0:58:34We did publish the proposed rule several years ago which uh received overwhelm uh positive feedback from the veterans community from clinicians and that is [clears throat] because we adhered to the uh latest uh approach to assessing the functional impairment due to mental disorders which is outlined in great detail in DSM5
▶ 0:59:04which is the governing document for all psychiatrists and clinical psychologists to assess the level of functional impairment due to mental disorders. And in this new uh portion of the rating schedule, we will be able to adequately address the level of functional impairment and corresponding occupationally significant and uh we're looking forward to publishing it
▶ 0:59:35at the by the end of the fiscal year 2026.
▶ 0:59:39Okay. And and real quickly uh what has the toxic uh exposure uh law done to your to to this examination this review of your disability criteria?
▶ 0:59:53I will ask Miss Tank to weigh in on this question please.
▶ 0:59:57Just quickly I'm out of time.
▶ 0:59:59Sorry sir. So we have a process by which we look at toxics exposures through um our military um I'm sorry it's called the MIS for it escapes me right now what that group looks at but that's a a separate group that looks for things based off presumptive our presumptive conditions based off the uh the codified requirement for that disease process. So we look at those slightly differently based off exposures and what the science and evidence shows um based based off that exposure. And you've made my point.
▶ 1:00:28It com more complexity. I yield.
▶ 1:00:32Thank you, Mr. S. If we're using DSM5, what what data? Can you give me Dr. So, can you give me kind of a a time frame of the data that we're currently using to to define mental for um the vaster system, varsity system
▶ 1:00:55and let me give you a little bit more depth to this. Yes. Will you please expand a little bit on the data [clears throat] port? before I showed up to this wonderful place, my focus was in neuroscience. And one thing my professors told me when I was in grad school is that what you're going to learn today will will will not be correct in five years and how were they right? So it's not more or less a concern because research is is is research. But we about to do an implementation of information that is already outdated.
▶ 1:01:28Well, uh let me uh re revisit DSM5. DSM5 uh is updated on average every 16 to 18
▶ 1:01:39Great. There is a great home run great big committee which uh gathers all the data between the um DSM publications and uh the current DSM DSM5 was published in and it had uh introduced uh a lot of changes to the way we look at the functional impairment due to mental disorders.
▶ 1:02:08In 2013, a severe traumatic brain, there were three levels of traumatic brain injury in 2013, mild, medium, and severe. actually, the biggest introduction was the multi-dimensional approach to the way we look at the mental uh health and mental disability. And those multi-dimensional approach means that all of us are built the same way.
▶ 1:02:34And there are certain number of uh domains of function such as ability to interact with others, cognition, self-care and so on so forth. And that multi-dimensional approach which was introduced uh based on a great deal of data by DSM5 is the basis of our review of the Vazer DVA rating schedule for disability mental disorders portion
▶ 1:03:04and that won't be that will not be updated until the DSM5 comes out with the DM
▶ 1:03:08the the it will be updated by the end of
▶ 1:03:13It's updated already. It will be published this uh final rule
▶ 1:03:17off of the DSM DSM5.
▶ 1:03:20Yes, it's based on DSM5 multi-dimensional approach
▶ 1:03:23which is 15 years ago. Somebody did the math on. No, it was uh
▶ 1:03:2823 is 10 plus. That's that's concerning [clears throat]
▶ 1:03:34because how much more we know today will not be near as much as we know tomorrow when we're dealing with the beautiful mind that sits between our ears, which every single human being is different, which I'm sure you absolutely know.
▶ 1:03:48U Miss Tan, the end of 2020. Give me a Do you have a date? I'm I'm big on dates because the day after this thing goes hot, I would like you and and Dr. Stoke sitting in front of us and assuring us that we are we got a green light and we're good to go. Do you have a
▶ 1:04:04We anticipate our remaining final rules to be published around the summer of of
▶ 1:04:10Summer of 26
▶ 1:04:12and then we'll have time for implementation and an effective date, sir. Beyond that,
▶ 1:04:16summer of 26. Interesting. Okay, Mr. McGary, you good? Mr. Wagon, you have a question. You good? Yourself? Good to go. Okay. Thank you very much for your testimony today. Thank you again. Thank you for everything that you're doing for our veterans and the Department of Veterans Affairs. I like to say this every single time we have a a hearing. The VA is one is a big machine. Everybody plays their role.
▶ 1:04:46And every morning that we wake up and every morning that you wake up, we absolutely know that who we're serving is our veterans and we're here because of them. So, thank you and have a very blessed
▶ 1:04:57Yes, sir. Thank you. Thank you.
▶ 1:04:59Thank you for this opportunity.
▶ 1:05:00Yes, ma'am. And once the first panel is up, panel number two may be seated.
▶ 1:06:43Armor like the hot dogs. Yeah. first witness on this panel will be Miss Elizabeth Curta. Miss Curta is the director of education, workforce, and income security at the government accountability office. Our second witness on the panel is Mr. Philip Armor. Mr. Armor is the director of the Rand School of Public Policy, PhD program and a senior economist at Rand. And our um third witness is Dr.
▶ 1:07:14Kylan uh Hunter. Dr. Dr. Hunter is the chief executive officer of Iraq and Afghanistan Veterans of America. What
▶ 1:07:22Marine Corps. Best one. [laughter]
▶ 1:07:25Feel like it's a Navy guy to say something. But okay. Thank you for your service. Um I would like to welcome the witness to our second panel. Um and the witness to say, please ask that you stand and raise your right hand. Do you only swear the testimony you're about to provide is the truth, the whole truth, and nothing but the truth. So help you God. Thank you. Let the record reflect that the witnesses have answered in the affirmative. Miss Cody, you're now recognized for five minutes to deliver your opening testimony.
▶ 1:07:54Good afternoon, Chairman Lutrell, Ranking Member Maccgarvey, and members of the subcommittee. I'm pleased to discuss GAO's work on VA's efforts to update its disability rating schedule. When veterans file claims for disability compensation, VBA claims processors use the rating schedule to determine monthly VA's disability compensation program provides billions of dollars in benefits to millions of veterans and their families.
▶ 1:08:20VA must be able to make accurate decisions about the amount of compensation a veteran receives as a matter of fairness to veterans and to ensure the program is achieving its intended results. VA has struggled to stay current with needed updates to the rating schedule. In 2003, we designated VA's disability compensation program high-risisk in part because its breeding schedule did not fully reflect advances in medicine and technology and changes in the labor market that have occurred since 1945.
▶ 1:08:52VA is required to base its compensation decisions on the average loss in civilian earnings resulting from a veteran's service connected disability, but it has never updated this information based on datadriven My testimony today discusses VA's progress on updating the medical and earnings loss information in the rating schedule as well as remaining Medical information includes the types of disabling conditions that veterans may have organized into the 15 body systems.
▶ 1:09:21Earnings loss information is the average decrease in expected earnings caused by those disabilities. VA has taken positive steps to improve the process for updating medical information. In terms of progress, between 1945 and 2009, VA mainly focused on updating the rating schedule with new medical terms and criteria for determining a condition's severity. In 2009, VA embarked on an ambitious effort to comprehensively update both medical and earnings loss information.
▶ 1:09:52These changes included establishing an office to plan and oversee these efforts. VA has also begun making plans for a 10-year cycle for updating the medical information to more systematically consider advances in the evaluation and treatment of medical conditions. Since 2009, VA has completed updates to the medical information for 11 of 15 body systems. And after years of fits and starts, VA has also begun testing its own earnings loss studies.
▶ 1:10:20VA is testing how the department could produce earnings loss data and updating the writing schedule with this information. However, VA still faces challenges keeping its rating schedule up to date. It is yet to complete comprehensive revisions for four body systems. VA's attempts to revise some of these systems have been going on for years. In addition, information about how veterans disabilities affect earnings loss remain a major gap.
▶ 1:10:46It is uncertain whether or VA will complete these studies and use the information to update the rating schedule. Going back decades, VA and external studies have evaluated the average loss of earnings for veterans with service connected disabilities and suggested that not all veterans were being equitably compensated. For example, certain external studies suggested that veterans with mental health conditions were being As of today, VA has not updated its rating schedule with earnings loss information.
▶ 1:11:17Consequently, ratings determinations for all earnings loss calculations remain based on information from over eight decades ago. We've been monitoring VA's efforts to fix these problems through the lens of our high-risk list. As of 2025, VA has met three of the five criteria for removal from the list. It has shown leadership commitment, developed an action plan to address root causes of its problems, and has been monitoring its progress.
▶ 1:11:44To have this area removed from the high-risisk list, VA must continue to meet these three criteria and fully meet two more, capacity and demonstrated progress. Capacity involves things like identifying and applying the resources needed to implement its plans. And demonstrated progress means VA is accomplishing its goals and objectives for updating the rating schedule.
▶ 1:12:05Ultimately, without a rating schedule that fully reflects present- day medicine and changes in the labor market since 1945, VV VA may overcompensate some veterans while unc undercompensating others. This concludes my prepared statement and I'm happy to address your questions. The written statement will be entered into the record. Mr. Army, you're now recognized for five minutes.
▶ 1:12:29Chairman Latrell, Ranking Member McGarvey, and members of the committee, thank you for your invitation to testify. As a labor economist, I research how health conditions impact individuals ability to earn income and on the design of disability programs. Today, I will focus on four points related to the economic effects of disability and describe implications for VA disability compensation. By statute, VADC benefits consider veterans earning losses from service connected disabilities, not just a medical rating of impairment severity. The most recently published VA commissioned earning loss study was in 2008.
▶ 1:13:00Although there have been more recent studies, none of these studies have incorporated modern disability research findings, specifically how different elements of disability programs can independently impact earnings. Evidence from other programs shows that cash and non-cash disability benefits do directly affect earnings, but no research exists on how VA's programs impact today's veterans earnings. Updated earnings loss studies that incorporate research on today's veterans would inform more accurate disability ratings.
▶ 1:13:26Alternatively, a move toward individualized disability determinations could also increase accuracy and eliminate the need for detailed earnings loss studies, but would require statutory changes. To zoom out, in disability studies, there is a distinction between impairment and disability. Physical or mental conditions can lead to impairment, a reduction in the functioning of a body system or structure which can be diagnosed by medical professionals. Disability, however, relates to how these conditions lead to limitations to societal participation.
▶ 1:13:53And for many disability programs in the US, there's a focus on how impairments lead to work disability, specifically reduced earnings capacity. Unlike with impairments, evaluating work disability requires consideration of the economic consequences of health conditions and thus requires collaboration between medical and labor force experts. VA disability compensation is aptly named. By statute, a veteran with a service connected health condition receives a rating that, quoting here, shall be based upon the average impairments of earning capacity resulting from such injuries in civil occupations.
▶ 1:14:23Given the statutory requirements, VA has commissioned studies to estimate how service connected health conditions translate into average earnings losses. In general, these studies compare earnings of veterans with service connected ratings with earnings of otherwise similar non- veterans or veterans without ratings. But there are two issues facing the state of VA earnings loss studies. First, to be relevant, earnings loss studies need to reflect the current employment environment. However, the last published study relied on data from at least 20 years ago.
▶ 1:14:49Since then, there have been substantial changes in medical treatments, veteran disability evaluation, and the labor market, such as, for example, substantial increases in remote work. Furthermore, a rated health condition is rated because of its impact on earnings capacity, but the rating then facilitates access to VADC benefits and additional VA programs. How participation in VA programs affects the earnings of veterans is largely unknown. Yet, since the publication of the last earnings loss study, research on the causal impacts of other disability programs has proliferated.
▶ 1:15:19Specifically, there's now strong evidence on how the benefits in those programs have direct effects on earnings. For example, recent evidence indicates that lowcost sharing healthcare access and targeted vocational rehabilitation benefits, similar to benefits offered by the VA, can facilitate return to work and higher earnings. Not accounting for these program induced earnings increases would make average earnings losses appear less severe but only due to the success of the programs. But other programs are different than VAS and serve different populations.
▶ 1:15:46And the field of disability research research also tells us that program details matter and that different populations respond differently. These other findings are suggestive of potential VA effects but are not conclusive. Because we do not have a clear understanding of the relationship among VADC, other VA programs and veterans earnings. We have limited ability to evaluate these programs effectiveness and thus limited ability to estimate earnings losses from service connected work disability. Other disability programs also offer potential alternatives to the average earnings loss approach.
▶ 1:16:17The VADC statute reflects a concept known as disability based average justice or the notion that individuals with similar levels of disability should receive the same rating and the same compensation. Most other disability systems take an individual justice approach to at least disability determination with where an applicant's disability is rated based on the impacts of their health condition on their own earnings capacity, not on the average work disability.
▶ 1:16:40Regardless of the conceptual framework, recent research from Social Security and workers compensation programs can provide insight into how the impact of VA programs on earnings could be incorporated into the current average justice framework or on how VADC could implement an average justice framework. Yet, these other programs serve distinct populations. So, additional research with and insights from today's veterans are essential to ensure an accurately implemented VADC program. Thank you for your time, and I look forward to your
▶ 1:17:09The written statement for Mr. Armor will be entered into the into the hearing record. Dr. Hunter, you're now recognized for five minutes.
▶ 1:17:15Chairman Latrell, Ranking Member MacGarvey, and members of the subcommittee, thank you for the opportunity to testify today. Iraq and Afghanistan Veterans of America is dedicated to pro improving the lives of post 911 veterans and it is an honor to speak on their behalf today. But it is also concerning that at today's hearing there's only one veteran organization represented.
▶ 1:17:35This despite the fact that veterans who engage with the VASD are not a monolith and there are several voices not in those in this room including those that had directly work with veterans to navigate the benefit process and I hope in future conversations we can include more veteran voices. Modernization should be done with us not merely on our behalf.
▶ 1:17:56Veterans Affairs is currently undertaking a process of modernizing the VASD, attempting to reflect both the realities of injuries experienced by service members and advancements in medical science. The modern veteran population faces conditions and occupational realities that were not examined in many of the previous efforts.
▶ 1:18:14For example, traumatic brain injuries, toxic exposure, military sexual trauma, and complex mental health disorders are central to the post 911 veteran experience and have a a significant impact on veteran quality of life and long-term employment outcomes. Current modernization efforts to be undertaken by the VA include earning loss studies to incorporate data on how service connected conditions affect veterans earning capacity and to align compensation with functional impairment and labor market realities.
▶ 1:18:42However, there remains virtually no transparency into how these studies are being conducted and whether or not they truly reflect the complete reality of the veteran experience. Early loss studies may provide us useful data, but are in an incomplete lens to view the problem. For example, the Congressional Budget Office study on disability f uh compensation focused only on male veterans. Despite the fact that when this study was conducted, women made up the fastest growing group of veterans.
▶ 1:19:13And we do have significant evidence to show that women veterans, even when fully employed, have different earnings than their male peers. As a representative of the generation that has seen the largest increase in women's service, this shows why it is critical that veteran voices are included at the table to ensure wholesome and uh essential studies.
▶ 1:19:36And while the VASD shares some similarities to other disability compensation programs, there are fundamental differences between veteran and civilian populations. Military service impacts the human body physically and mentally in ways that few civilian occupations ever will. from high physical risk occupations to speed repeated exposures to toxic substances to increased risks for interpersonal harmful behaviors and to having little control over where one lives.
▶ 1:20:04Military service comes with inherent health risks. Vassard is one way that the country recognizes and compensates the individuals who volunteered and accepted these risks on behalf of the American people. This system also exists in a unique legal legal framework shaped by the Ferris doctrine which prevents service members from suing the federal government for injuries incurred during military services.
▶ 1:20:27Because veterans cannot legally seek tort damages for pain and suffering or loss of quality of life, disability compensation often also serves as not just income replacement, but redress for harms incurred while choosing to serve one's country. Many service connected conditions such as chronic pain, migraines, PTSD, sleep disorders may not immediately remove a veteran from the workforce, but still impose real lifelong impairments that merit compensation.
▶ 1:20:58Veteran service organizations for decades have been advocating to include lagging quality of life indicators in disability compensation co calculations and that total compensation should look not just at the ability of veterans to be employed but the compound and long-term medical impacts of service connected illnesses and injuries. New research is also showing that quality of life indicators may be uniquely impactful by uh to veterans and may exacerbate existing employment challenges.
▶ 1:21:27Vassor as a program is also not just an investment in those that served, but an investment in our long-term national security. Veteran care after service is still a strong recruitment tool for military service, which requires the public trust. Veterans participation in the modernization process will increase the confidence that these reforms are justified, fair, and aligned with modern veterans needs. And it maintains the buyin of one of the country's best recruiting assets, those of us who have already served.
▶ 1:21:55Like many other veterans organizations, IAVA stands ready to support the VA in these modernization efforts and our members are eager to engage. In our most recent policy priority survey, over 50% of IAVA members cited modernizing the process as their top area that they would like to be involved in. And additionally, of our members that have a disability raising, over 65% report that their disability payments are essential to their overall financial well-being.
▶ 1:22:23Thank you for your commitment to America's veterans and I look forward to your questions.
▶ 1:22:27The written statement of Dr. Hunter will be entered into the hearing record. Well, well said, Dr. Hunter. All right, Mr. Armor. I was trying to pick your opening statement apart as best I could, but what I took from it is I think we're in Now, I'm going to ask you to talk to me.
▶ 1:22:47I consider myself a highly educated guy, but if you wouldn't mind putting it in crayon with for me what you just said is, do we have the capability to get there from here with compensation levels through this rating system? It didn't sound like it. And you were doing a comparative analysis to the civilian population and the veteran population with Dr.
▶ 1:23:11Hunter most eloquently defined both which again good Can we do this or is this a uphill battle that we will constantly have VA in front of us saying it will be next
▶ 1:23:27I I can speak for the
▶ 1:23:30You got you I'm gonna I'm gonna beat on you a little bit. You got a PhD. That means you're way smarter than me.
▶ 1:23:35We we can do the earnings law studies. We can do modern earnings loss studies. That That's right. I think transparency about the methods that are used in it pretty much all the methods kind of used so far from the the work cited in my testimony and the other panelists it's outdated or it's using using kind of estimation techniques that are just not not actually getting
▶ 1:23:54it will always be outdated
▶ 1:23:57not always
▶ 1:23:58we have to land somewhere this panel right here and subcommittee then full committee all the way to where it needs to go it will always be outdated where is the landing zone for us because we're going to have this conversation with VA and the fact that other veteran organizations M Dr. Hunter as you as you state this this is an anyone is welcome to sit in front of this committee at any time.
▶ 1:24:24I welcome it. We if I may welcome that.
▶ 1:24:29So we've done these kind this kind of research for other programs. They do differ in these ways but but modern techniques can can do it and they can do it relatively quickly in terms of you know months and years instead of decades
▶ 1:24:40defined relatively quickly for the federal government months and years instead of decades. Dr. Curt, is the VA in a position to get this thing completed and pushed across the finish line in summer of 2026 in your personal opinion? I can't tell you that they will be done in 2026. Um we
▶ 1:25:02what from the information that you've gathered and the research that you've
▶ 1:25:06What are we looking at?
▶ 1:25:08They're in the final stages. Um they
▶ 1:25:10final st man. I tell you what, you'd be surprised how many people are in final stages in the United States government. I mean we're like there
▶ 1:25:18that's what I that's all I know.
▶ 1:25:19I mean electronic healthcare records been in the final stages for the past 10 years and we're about 50 billion into it and it's still not done. Matter of fact, we're shutting it down.
▶ 1:25:27Yeah. Meaning they're just before the uh the OM phase, I guess, you know, where with the final rule. Um so it's possible that they can be done this year and we are hopeful. We would love them to be done this year. Um I I can't sh be sure they will. uh we have not seen an update on their progress um since June of last year and um we haven't had a a substantive update on their action plans since um August of 2024.
▶ 1:25:56I'd be interested to know how once this the uh 15 body systems this rescheduling is complete we have 15 body systems that we consider okay how do we continue to update that at a pace that stays relevant to science and medicine doc Mr.
▶ 1:26:17Army you got something for that you're a doctor aren't you Again [laughter] I I I think we can do these these analyses much much faster. We have we have the capacity data access is the biggest issue. I think right now
▶ 1:26:35analysis to application is the death of this place. You know how look around in the walls. Everybody wants to write about something. We have to touch human bodies. I mean I'm so sick and tired of of that. I'm not beating up on you. I'm talking out loud for the world to hear How do we stay relevant in your personal and professional opinion once this thing Is that is that a possibility or Miss Curt?
▶ 1:27:02Are we going to be having this conversation five years from now that we're still using the DSM5 and the information that we have on traumatic brain injuries data from 2013? I'm sure doc Dr. Dexter is gonna clack off on this one in a hurry when it's her turn.
▶ 1:27:15Yeah, I am not a medical doctor either. So, um I I think um it's possible for Vervier to stay up to date and I think they need to stay up to date. Um but they will have to continue to um have really rigorous and realistic planning. They need to address some of the root causes of their issues. For example, uh the internal review process.
▶ 1:27:37Um I took a look at all the stakeholders internally to VA and there's something like 18 different eight parts of VA that have to look at the draft rule and 16 level according to them 16 levels of review. Then once you're done with that there's external parties there's something like 11 external parties that they they review with.
▶ 1:27:55So it is I mean the complexity is mind-numbing but it is so important for us to figure this out us we the department of veterans are to figure this out because it is the that are feeling the pressures. Mr. McGra you're recognized sir.
▶ 1:28:13Thanks Mr. Chairman. And I'm just going to pick up on what you were just saying Dr. Armor. I used to work with a lawyer who would say an old expression. He said you can get it fast good and cheap. Pick any two of three. Right. Figure out what is the best and fastest way we keep up to date. I think it's facilitating access to data for for researchers. There's a a a paper uh that Dr.
▶ 1:28:41Hunter cited um forthcoming by uh David Silver and Jonathan Jen looking at the impacts of of ratings um for mental mental conditions on quality of life outcomes and on healthcare utilization. That was it's it's a phenomenal project. I think that represents the current state of what research can do in this this field. It's entirely limited to outcomes that the the Veterans Health Administration has access to.
▶ 1:29:05Where's the lag in data coming from?
▶ 1:29:08I so I can't I can't speak to specifically the internals of of that that study. I think in general getting linkages between VBA and VHA to occur is is pretty much impossible to to have happen. uh let alone the other aspect of this which is the earnings law studies those data generally need to come from the social security administration which has they will not ex export individual data but but kind of will will allow for someus to understand it those setting those up facilitating that that enables research to to be done
▶ 1:29:38kind of the good research and yeah
▶ 1:29:41can I comment on just to comment on that um VA actually has in place agreements now with the social security social security administration um and uh the IRS and some other entities to do that kind of data exchange. So, they have made progress in that area. I just wanted to point that
▶ 1:29:57Well, it sounds like we still need to have some progress in that area. And you know, one thing we need help on and I can tell you on this committee, we're not we're not going to accept the idea that we can't do this because I I think we can. Dr. Hunter, you want to say
▶ 1:30:09Yeah, I'll just add to the uh the conversation and I will disclose uh Phil and I were colleagues intelligence a little while ago here. There's there's also a a big issue in the transparency of these studies being done. We hear a lot that VA is making these like having theseUS doing all of these data, but they're doing it in a black box which doesn't allow for either organizations like RAND and other FFRDC's to actually do reproduction surveys or you do the data or do the studies faster often through tools or for VSOs
▶ 1:30:39to validate and understand like are you actually representative of the entirety of the population and we end up with studies like the CBO does that excludes the fastest growing part of our of our population. So data transparency coming out of the VA is one of the biggest blockers to being able to do these fast and accurately.
▶ 1:30:59That should be something we should be able to help fix a little bit. I would think, Mr. Chairman, um Dr. Hunter, I'm going to go over to you. Thank you for your service. Appreciate that. I want to get away from We've been out of government speak now for a solid three minutes. I hope we can stay in this zone. Uh I'm just going to ask you point blank. Do you think the VA disability is overly generous right now? No. Okay. Have you Have you spoken with anybody who does?
▶ 1:31:22No. Okay, good. Um, what would you say to someone who thinks that veterans who receive VA disability are somehow taking advantage of if taxpayers are scamming the system?
▶ 1:31:31I would first say that when you raise your right hand to serve, you make a contract with the United States. And that is that we put our lives on the line 247 and as a result, we are to be taken care of for the time when we are done. And I think that contract you make when you raise your right hand and give yourself to service is both a legal and a moral obligation that we have as a country. Uh I want to ask you about the statutory mandate for the basis of disability ratings.
▶ 1:31:59The law says quote the rating shall be based upon the average impairments of earning capacity resulting from such injuries in civil occupations which is wonderful statutory language say you get injured in the service we're going to look at your disability rating based off a civilian counterpart. And it's that civil occupations part that concerns me because military occupations do not always line up with civilian occupations. You yourself, Dr. Hunter, you were an attack pilot on a helicopter. I'm not sure there's a civilian equivalent for that type of job.
▶ 1:32:29I don't
▶ 1:32:29found it. I was looking for it for a long time. I haven't found it.
▶ 1:32:32I don't I don't think I don't think it's there. And um you know, and whether it is a Navy Seal, whether it is uh an artillery crewman, we're going to have trouble lining up. So, Dr. How do you compare injuries and illnesses that happen in military service with
▶ 1:32:47They're not comparable. The military service, as I stated, there are physical risks that are unique. There are mental and psychological risks there that are new unique. There are environmental risks that are unique. And one of the biggest uh areas of uh sort of divergence between the civilian and military occupations is that military service members have very little to no control over where they spend their time. what environmental factors might be around them, what are they are exposed to, the types of injuries they may receive.
▶ 1:33:17And so a lot of the the research that is done on the civilian side also in includes some some optin, right? Some buy into whatever career path they choose to be in in terms of how those uh calculations are done.
▶ 1:33:30the military that is also removed which goes back to some of this contract that there is a volunteer to do whatever the country asks of you to do and both the type of injuries and the environment in which those injuries might take place are divergent in medical aspects as well as the the moral contract that we have made with the country.
▶ 1:33:52Thank you very much. I I do think that how when and where the injuries occur are often important in military service just as the injury itself. So Mr. Chairman, I'm out of time. I yield back.
▶ 1:34:00Thanks, sir. General Bergman, sir, you're recognized for five minutes.
▶ 1:34:04Thank you, Mr. Chairman. Um, it's um really fascinating to sit here and listen to the discussion back and forth because I I sense everybody here is no matter what role you're playing, even you're sitting out there in the crowd, we're we're all here for the for the betterment for veterans outcomes, which is a good thing. Not necessarily in Washington DC. Can that be said in every hearing room? But I'll just leave that for a discussion of a different time.
▶ 1:34:36I'd like and this is a generic it's not a generic question. It's a specific question for any of you to respond to. To what extent do silos currently exist that inhibit the breakthrough results and the speed at which we need the change that we know needs to occur occurs. Would anyone like to address the however you want to address silos?
▶ 1:35:08Yes, there are silos that exist that prevent the speed of things getting done.
▶ 1:35:13Okay. in that in that case. So we agree that there are silos. I think that's not a surprise. Is the level of of those that those silos exist, let's say within the Veterans Administration to acknowledge they exist and then deal with the fact that do they need to exist? Do we need is it is it is it additive in a positive way for the outcomes?
▶ 1:35:42because sometimes we have to work to get things done, but if we work too long in a silo, we don't share the information. So as as the Veterans Administration looks at their reorganization of the visions which was just announced not you know in the last month or so. Do you believe that a part of being able to speed up the process here towards positive results?
▶ 1:36:08It would be a positive effect to to um in its however it's done break down rewicker whatever you want to call the silos. Uh sir, I'll answer that one and I'll answer it both from now as a CEO of a veteran organization and someone who was a public policy researcher before coming into this role. Absolutely. And particularly breaking down the silo between the VA and veterans in this research.
▶ 1:36:33One of the the things I learned very early on doing public policy research is that numbers are all great and fine in the spreadsheet, but the rubber meets the road when you engage the population that whatever you are researching is going to be impacting. And so breaking down that silo, a it'll allow information to get to the VA faster about the reality of what is happening to veterans rather than waiting 10 years of the study. Talk to us, ask us. We can we can tell you that very quickly.
▶ 1:36:59as well as allow for a a more you know robust and rapid updating of the system to meet the realities. We talk a lot and we hear in the news all the time that warfare and the type of like modern warfare is expanding at this exponential rate. We have whether it's advancements in technologies or the change in the type of enemies that that we have.
▶ 1:37:19And if the VA remains siloed and cut off doing their research and not interacting with those who most recently served, there is always going to be this lag. We are always going to be playing catch-up and saying, "Oh yeah, well next time we'll deal with this injury. Next time we'll look into this body system. Next time we'll figure this out. And so from where we sit, absolutely. We are here and ready and want to break down those silos and work [clears throat] to ensure that that our veterans are taken care of.
▶ 1:37:49Anybody else want to comment? Okay, that's right. Silences. You don't want to comment. Okay. Um so along with the silos, what can we do from your perspective as a committee to advance the decrease or excuse me the increase in transparency?
▶ 1:38:16Because once you've got the silos broken down, how do you set the environment where now if you're working on this project, we're all working, but you know there's that transparency of data exchange. Any thoughts?
▶ 1:38:35Well, I I think certainly uh hearings like this are a great way to um make situations at at VA more transparent and having uh testimony. Um I think um encouraging the agency to be um forthcoming and transparent with information with GAO for example. Um we we have had a a good dialogue with them in in the past number of years as we've been monitoring their progress on the high-risisk issue.
▶ 1:39:02Um but sometimes the information has to go through extensive levels of clearance and takes a lot of time to get to us. Um, and we just would prefer to have a more give and take kind of relationship on on these things because we think that would help give us give us an opportunity to to respond to them sooner and um, you may help things keep things from going off track.
▶ 1:39:22Okay. Thank you, Mr. Chairman. Thank you. I see I'm over my time. I yield
▶ 1:39:27Dr. Morrison, you're recognized for five
▶ 1:39:32Thank you, Mr. Chair. I want to thank you and the ranking member for holding this hearing today. And I want to thank our witnesses for being here to testify to. I'm also glad there is bipartisan agreement that the VA schedule for rating disability should be modernized. And it is essential that we get this right.
▶ 1:39:50We need to require transparency from VA and a process that incorporates feedback from medical experts, economists, and of course, veterans My late father-in-law was an Army Ranger and received disability compensation for the injuries he sustained in combat. We know that so much has changed since veterans like my father-in-law served, both in terms of the nature of military service as well as significant advances in advances in medical research and treatment.
▶ 1:40:19We know more than ever uh we have the ef the we know more about the effects of military service on veterans physical and mental health and it's critical that we put this data as well as veterans experience to use as we tackle this important issue. Dr. Hunter I want to begin with you. As you noted women are the fastest growing group of veterans. According to VA women made up about 4% of the veteran population in 2000.
▶ 1:40:45By 2040, VA expects that number to increase to 18%. What should VA be doing to incorporate data that accurately accounts for the increasing population of women veterans?
▶ 1:40:59we look at at women veterans and particularly for this topic um in particular, there's two areas that need to be done. One is ensuring that when we are looking at the actual impacts of certain injuries, illnesses and exposures that women are part of the clinical studies to understand what the impairments actually are.
▶ 1:41:18There is a long history of medical research excluding women and so we are basing women's conditions off of what men have experienced and we know that women aren't just little men in uh in this regard. So actually doing the clinical studies to understand the impact on women is essential. And when we're looking at at earnings loss statements as well, women need to be considered in the workforce aspect of this.
▶ 1:41:44You know, we look at a lot of conditions that may, you know, triple or almost quadruple impact women. If we look at things like reproductive health care issues that are connected to service related conditions and what that does to workforce engagement, uh we also have a whole like host of new issues since women have been involved in ground combat of the muscularkeeletal systems that have not been studied.
▶ 1:42:07And so we cannot make accurate determinations without knowing that and which is why again the veteran community stands here willing and wanting to be involved. I appreciate that and thank you for bringing reproductive healthcare and its impacts into it. As an OBGYn myself, I I think that's critically important. Dr. Hunter, in your testimony, you mentioned that post 911 veterans are more likely than previous generations to endure experiences that contribute to diagnosed mental health disorders, both from the psychological and physiological perspective.
▶ 1:42:38Traumatic brain injury, toxic exposure, and military sexual trauma are all factors that have to be considered to meet the needs of the modern-day veteran population. As we continue to learn more about these various forms of trauma, how these various forms of trauma affect a veteran's quality of life and economic prospects, what role do veteran service organizations have to play in ensuring the needs of the veteran are reflected in any proposed changes to the rating Thank you so much for bringing up the the mental health side of this too.
▶ 1:43:08And I think VSOs have three or four big areas that we play. One is we are the frontline touch points with veterans. As IAVA, we conduct multiple surveys a year to understand the experiences in closer to real time than any of these VA studies can be done. And so if we want to know how this is impacting people, we can tell you. We we actually have that data. When we talk about data sharing and transparency, we can get it to you in a much faster way.
▶ 1:43:36Additionally, one of the big parts of this is that VSOs engage with veterans who may not be in the VA system. When VA is doing their studies, they have a huge bias that we haven't even talked about. The fact that when they are looking at outcomes, they are looking most often at people who are already part of the VHA system. Part of what we want to do is catch that wherever it is between 20 and 50% depending on what study you read of veterans who are outside of the system and we are the conduit to those people.
▶ 1:44:06We are the conduit to the people that is actually the hardest to get the data on which is important. And then third we are a trusted agent. There is a there has been historic through all of the scandals and all of the reporting the VA has been all over the place and how much the veteran community actually trusts them. VSOs are often more trusted organizations and we can serve a role in helping the VA build that trust back in the veteran population through collaborative work.
▶ 1:44:34Thank you so much. So many more questions but I see my time has expired. One more.
▶ 1:44:41Thank you, Mr. Chair.
▶ 1:44:42Thank you, Mr. Chairman. Want to thank the witnesses for appearing today.
▶ 1:44:48Miss Curta, does GAO believe that uh VA is still treating this rating schedule updating overhaul as a project instead of a program?
▶ 1:45:01Uh I'm not sure I understood your
▶ 1:45:04Does GAO believe that VA is still treating this rating schedule updating overhaul as a project instead of a
▶ 1:45:12No. Uh they have they're treating it like a program. They have a program office that they've established. They've staffed it mostly um and those staff have been um you know developing promulgating the regulations to to to um provide the medical updates. They have also been um working on the earnings law studies. So, how does a schedule influence the the claims processing workload?
▶ 1:45:39And do you believe that the lack of updates is causing issues within VBA when it comes to claims processing?
▶ 1:45:47Uh, no. I don't think it really affects the claims processing. Um, you know, down the road if they change the regulations, it will have an impact. They'll have to make updates to um a lot of the training and all the um inputs that go into the process so that it's up to date in in line with the regulations. Um, I think the impact is more along the lines of the equity issues we've been discussing today where um, outdated information might lead some veterans to be overcompensated and others to be undercompensated. I mean, if you're just strictly on an earnings loss basis.
▶ 1:46:17Yeah. So, Mr. Armor, when researchers evaluate the impact of veterans benefits, what challenges exist in isolating the effects of a single benefit when many veterans are accessing multiple programs at the same time? There's a lot of challenges with that. That's actually a fundamental concern here is that we don't have a sense of why some veterans access certain programs at different times and thus the impacts that those that program participation in in those programs has.
▶ 1:46:47Uh so it's very difficult to tease apart, you know, for these these earnings losses, you know, was it vocational rehabilitation, the VR services that that went in went into it? Was it kind of the uh the access to VA healthcare being priority group one one through three that had an impact or is it just fundamentally the health condition itself improved?
▶ 1:47:08These are all things that are from the data alone are are quite challenging because we just don't have an evidence base on the impacts of these programs or also like how how benefits themselves sort into into using them. Um and yeah, so I guess I'll leave it at that.
▶ 1:47:24Thank you, Mr. Chairman. I yield back the balance of my time. Thank you, ma'am. Dr. Dexter, you're recognized for five minutes.
▶ 1:47:31Thank you, Mr. Chair, and and thank you both um our ranking member as well as you for your leadership in this. I think this is a really important topic, and I'm grateful for this today. Um I appreciate the committee being engaged and and bipartisan as well. This is unique in Congress to have folks who are aligned. So, thanks. Um to our witnesses, thank you also for your service as well as being here today.
▶ 1:47:55uh as a physician I strongly believe that disability rating schedules must be data driven, medically sound, comprehensive and centered on veterans lived experiences. So certainly need to include women in those studies as well as many other conditions. I'll just share as a medical student and then as a medical resident in the early 2000s, 30 years after the Vietnam War, I cared for patients in the VA system with complex and poorly understood system symptoms.
▶ 1:48:22Over time, research made clear that many of these conditions were linked to agent origin exposure. Something that many of the veterans ex expressed suspicion of but felt very, we'll say, gas lit these days. We weren't saying that then, but not trusted. Um, the frustration, the betrayal, the despair I saw um so many veterans experience left an impression. It also showed how long it can take for science to catch up to exposure impacts and why ongoing monitoring and research are essential.
▶ 1:48:52So, as a pulmonologist, the lungs in particular are uniquely vulnerable. They're the only organ continuously exposed to the outside world without any protective barrier unless we put something on. Toxics exposures are constantly evolving as we know on this committee, which means our understanding of their long-term health impacts must evolve as well. So, um first, um for Mr. Armor, you noted or Dr. armor. Sorry.
▶ 1:49:17You noted that the last VA commission's RAND studies were conducted more than 20 years ago before much of our current understanding of toxic exposure, PTSD, and traumatic brain injury were available. From your perspective, what are the most important next steps to ensure veterans are benefiting from the most up-to-date science when disability rating schedules are reviewed and updated?
▶ 1:49:40I mean just up updating those earnings loss studies and in particular like bring bringing in kind of the things that the issues that we've observed from other disability programs to to address like I think those modern techniques
▶ 1:49:50and just to follow up on that that is sufficient you think for the the science to catch up as well.
▶ 1:49:55So I'll speak as an economist on what what the economic angle would be s I think that that that would that would check that box but on I'm not a
▶ 1:50:03No, of course. and and I obviously it's an unfair question for many of you. I'll just state that we need to have ongoing evaluation and iterative um evaluation of our um medical information in the same way that I hear you arguing for economic information. Um the second question, I'm um proud that my bipartisan bill to strengthen the Veterans Readiness and Employment Program, the VRNE um act with a lot of support from people here past both the House and Senate.
▶ 1:50:34And I'm continuing to work to better support VR&E counselors. Mr. Armor, can you speak to the role of rigorous research and evaluating and strengthening VR&E and what this program can tell us about earnings losses associated with service connected
▶ 1:50:48I can tell you I think there's tremendous potential to learn those things. I think the current state of research on it is such that it's very difficult to to identify the causal impact of of those services. Um that there are uh there's the VR longitudinal study is one sort of uh study that's been been going on for stretch of time but again it's sort of a study that doesn't use modern methods and comparing kind of people who did get services versus those who didn't and the subsequent outcomes.
▶ 1:51:14So I think that there are ways in which we could there's a lot of potential to find out for for whom it's working for and and what those those impacts are. We just don't have that evidence base right now.
▶ 1:51:24Very good. Not good. But obviously you've expressed the need for um implementing change to how we collect data. Um and so Dr. Hunter, uh disability rating decisions must be grounded in sound medical evidence. Proposals to lower disability ratings based on whether a condition is treated raise serious concerns for me. Um, take obstructive sleep apnea as an example.
▶ 1:51:48When untreated, it can worsen hypertension, heart failure, and significantly increase risk of heart attack and stroke. Trying to lower ratings to treatment could discourage veterans from seeking care, which puts their health at risk and may ultimately cost more for the VA as well as cost of um productive life years for those veterans. Dr. Dr. Hunter, from a veterans perspective, can you speak to the concerns around lowering disability ratings based on treatment status?
▶ 1:52:15Yeah. So, in addition to what you mentioned about it potentially discouraging veterans from getting care, there is also the very real thing that we need to look at about treatment for veterans who may not live close to VA symptoms. Like, I'm I'm out in the West as a as are as are you. And for me, I get all of my care at the VA and I often have to try travel 3 and a half to 5 hours depending on the weather conditions to get some specialized care. If we say, well, you're getting care, you're not getting compensation.
▶ 1:52:43The other thing that we have to look at is how does that remove people from the workplace? What is the added stress and time and you um hardship that is put on a on an individual which is something that needs to be looked at as the total overall compensation. We don't want to say we are correcting one issue and making a a bigger a bigger problem which is why these updated uh studies need to be done.
▶ 1:53:08Um additionally what it doesn't take into effect is the long-term impacting quality of life issues that arise even if a condition is considered treated. There still is often a lagging quality of defect uh of life indicator. And I actually encourage the the committee to encourage the VA to look at studies coming out of Australia and Canada and Israel where they actually include qu like verified quality of life measures into their uh veterans disability compensation programs that have had um outcome or
▶ 1:53:38had results of actually improving workplace outcomes through addressing the fact that there were initial quality of life concerns and just through the the redress payments from those you end up having much better long-term economic outcomes as well.
▶ 1:53:53Thank you. I appreciate your patience.
▶ 1:53:55Yes, ma'am. Mr. Self, [clears throat] you're recognized for five minutes, sir.
▶ 1:53:58Uh thank you, Mr. Chairman. Uh Mr. Carter, um I was very curious that you're the management of disability compensation claims has been on your high-risk list since 2003. uh and yet you you said that uh August of 24, January, February, and June of 25 you got a lot of input. Can you estimate how much of the re of the advances they've made were happened since August of 24?
▶ 1:54:28Just a rough estimate. that I can't tell you much. I would say it's it's not true. That's the first time we've heard from them. We we actually have been talking to them pretty infrequently since about 2019. Um and we but we saw um progress more in more recent years. Um it took a while. We we went through a process of deciding okay what are the root c what are the root causes of these issues? VA came up with root causes.
▶ 1:54:58They developed an action plan to address those root causes. The first version was more like a list of stuff we've done. It wasn't a plan. Um, so then they had to go back to the drawing board and come up with a plan that had milestones and goals and you know at ended up being something we were we thought was an actionable plan and they had something they could monitor their progress against. So it just it's it's been a multi-year effort and it hasn't all been since 2040. Well, I I would ask you, what can Congress do to help GAO?
▶ 1:55:26Because not just in VA, but across the government, you have hundreds and hundreds of reports that haven't been acted on by many of the departments. So, I think Congress ought to be looking at GAO, how we help you to get things implemented. Now, let's go back to your five uh criteria for removing them from the GAO high-risisk list. Uh they've met leadership commitment, action plan, and monitoring. less so in capacity, which is basically resources.
▶ 1:55:57It's not capacity, it's resources, and demonstrated progress. Well, we've got a saying in Texas, when you look at the three that they've met, they're still fixing to do something.
▶ 1:56:09So, they haven't done I mean, logistics is everything. If they haven't provided the resources for the capacity to do it, then they're not going to demonstrate progress. So I I I think this is very telling chart that you've given us that they really need to do something now that they've made the commitment apparently. Um and then um Dr.
▶ 1:56:35Armor uh you talked about individual versus average justice. You spent a lot of time on that with the social security. Now, Social Security Administration supposedly has outdated computers, old coding, and yet you basically said that the Social Security uh administration does a far better job individualizing plans. Can you kind of talk to that?
▶ 1:57:03So I I'll say historically social security has has done has been very welcoming to the research community in allowing us to conduct research on how the disability determination process works and at sort of which stage they do contract with they contract with states to actually administer the first stage stage of it.
▶ 1:57:22But for each kind of level of that they've been they've shared a lot of their earnings data, their their benefit data and we have really we've been provided over the years like a lot a lot of strong results on kind of the every stage of their determin determination process sort of how it works uh and that's allowed them to make various policy decisions uh to provide that feedback back to that that determination process. They've also engaged in a lot of nationalmies of uh science engineering medicine panels to update their own listings.
▶ 1:57:51Well, well, that's that's not really my question because you get a very individualized plan from Social Security Administration. These are your earnings. This is your disability. This is I mean, it's pretty detailed. Uh, and it's individualized. And yet, you say that VA uses average justice sort of model. And yet, we spend a lot of time individually. And part of that is the problem.
▶ 1:58:13We we have a 66% of of claims have errors and and 44% of all I've forgotten the the data, but I mean we have a tremendous error rating. Why is that? If we're using average justice as opposed to individualized because it looks to us as though we spend a lot of time with the individual. Can you explain that?
▶ 1:58:34I I can speak to how Social Security does this and how they they separate the determination process into two steps. One is a listing of impairments. These are conditions that are sort of severe enough that through medical evidence alone can determine that there's a disability. So there's like that and they have an all or nothing determination as well is another thing that makes that makes social security a little clearer.
▶ 1:58:54Um but then if there is not that listing of of that level of severity then it's an individualized assessment that they have and it's a residual it's it's trying to estimate functional capacity at that individual level. Uh and so they've done a you know spelling things out for the things that can be easily spelled out and then having an individual assessment where they see people's earnings leading up to it. You know they have have physicians comment not just on the medical component but on the functional capacity component and then they have a lot of oversight of that particular process.
▶ 1:59:23So they've split apart that that decision instead of trying to schedule
▶ 1:59:27Thank you very much. I think that's something we might do a deeper dive on. Chairman I yield back.
▶ 1:59:33Thank you Mr.
▶ 1:59:36Go ahead.
▶ 1:59:38Thank you, Mr. Chairman. I just want to couple of quick followup questions. Miss Carter, earlier I asked VA if they would commit to sharing their methodology with you. Would you be receptive to that?
▶ 1:59:48Perfect. And and beyond sharing methods and data, is there anything more that you would ask a VA to better provide oversight, accountability, and quality assurance in this rating schedule? um just quicker turnarounds on things uh when we ask for information just instead of having to wait a long time for clearances and stuff you know just get it to us if it exists they should be able to provide it.
▶ 2:00:09Thank you. And one common theme between the first panel and between you all seem to be these silos of information. These silos are terrible things that I think are hurting our veterans. They're holding information and keeping it from people who need it when it should be shared. It should be transparent. Um Dr. armor. You've talked a little bit about this and we seem to be dealing with several information gaps in part caused by some of these silos which leads to non-existent research outofdate data sets.
▶ 2:00:38What other sorts of basic research need to happen and does it make sense to have to have that before people start talking about radically changing the VA compensation system? I I think given the state of knowledge on the economic consequences of of sort of VA benefits that that yeah we that we just don't have a lot of publicly available research on on right on today's veterans and and today's system.
▶ 2:01:03So I I think uh yes kind of more more research and in particular I think it it's not it's not highly complicated. I think it is sharing the the existing data that social security has that that VBA that VHA has together could provide if that were more widely available if more research more research could be conducted on that in in a way in which there's transparency and comment so that modern techniques could be could be used. I think that would answer a lot of questions very quickly. Again, if things
▶ 2:01:33transparency and sharing of information I like it, Mr. Chairman, I yield back to
▶ 2:01:39Mr. McGarby. I've since my time in academia to the time I'm sitting next to you today trying to convince I don't care which institute of higher learning you're talking about and that famous catchphrase of silos how do you sew the seams between the two and who will have the willingness to open like in my personal opinion the VA should be the premier institute of research on the planet amount of information that is inside of the VA and
▶ 2:02:10they've always been since I've had the opportunity to work alongside the VA or with the with the VA very protective of us the veteran community that information is some of the most cherished data on the planet and everyone's knocking on the door saying please let us engage with you to share this information so we can move any side any kind of information forward and VA's always been very reluctant of that because who's going to fall on the
▶ 2:02:40who's going to take responsibility if there is a breach and the information is gone or lost or taken or worst case scenario and conversations on a committee and with and and with secretaries deputy secretary who you're talking to and this kind of goes to what you were talking about Dr. Hunter you Mr.
▶ 2:02:57term is yes if if other institutions whether it's VSO or any any any institute of higher learning had the opportunity to do that where would we be and I've been having this conversation for 12 15 years so I can only imagine how long you guys have been having it I I speak to the broader research base you guys look like you're in your 20s how do we break that down we do it is a it is a fair question and I can understand and I really appreciate where we are in the protection mechanism especially
▶ 2:03:27in advances of artificial intelligence, machine learning, and the bad actors that are pushing that out to take from us that we can't defend As we incorporate machine learning, language models into this data to find these answers, at what point, this is a fair question to ask, at what point do we find the answers to solve the issues of the brain?
▶ 2:03:49What if we have the ability to get rid of sleep apnnea or tenitus or the varying degrees of heart disease and exposures from being in combat? Where do we sit then? Do we ask the veterans like, "Hey, we're going to give you this and everything's going to be a-ok okay or does we do we grandfather it in and we move forward into the next generation?" These are discussions we're going to have to have. You'd be pleasantly surprised how challenging those discussions are going to be, but it lends itself to what Mr.
▶ 2:04:16self was saying is at what point do we say hey look we can fix these things how do we engage with the veterans so they'll receive it how's the VA implement it and then how do we move forward to make sure that we don't talk infrastructure which I still find moderately entertaining I'll never say we're moving fast enough because of all the veterans in my in my district that walk up to me and say we're not I'm listening And as a
▶ 2:04:46veteran myself, I I have that same I have that same response. I do understand how complicated the VA system is just from this side. I've never actually been inside the VA, but having offline after school conversations of how challenging it could be, it is. I just, you know, I hope and pray every single day that they keep moving forward. We'll do everything that we can on this committee to make sure that they have what they need.
▶ 2:05:14And as problem sets continue to increase and it seems like we always have to talk about dollar bills. Well, I'm going to be quite honest. You know what? We dollar bills is something that's extremely hard to find even in the VA considering we how far in debt we are as a country. And we beg, borrow, steal, and kick a lot of butt to get the money for our veterans because we wouldn't be sitting there having this conversation it wasn't for you all. And we're have when we're willing to do that, we make sure we have to do it right.
▶ 2:05:43It has to be done right. I want to thank all of our witnesses for joining us today to discuss how the department can address the long-standing delays in updating the rating schedule and more importantly how we ensure this does not remain a recurring problem for our future for the future and for our veterans. Um when the rating schedule is outdated or applied inconsistency, it just creates confusion, frustration and delay and that's something that we do not want. Updating the system is necessary.
▶ 2:06:10I I I am excited about um the opportunity this will be closed closed up and we will complete this at the summer of 20 of this year. Uh this committee will be on standby to see if that actually happens. Um rank member do you have closing remarks? We good to go?
▶ 2:06:28Thank you, Mr. Chairman. I ask unanimous consent that all members may have five legislative days to revise and extend their remarks and include extraneous material without objection. So ordered. We are adjourned.