▶ 0:21:58Good morning. This legislative hearing of the subcommittee on health will now come to order. Without objections, the chair may declare a recess at any point. I'd like to welcome all members and witnesses to today's hearing. Today, we'll discuss 15 bills addressing a wide range of issues facing the nation's veterans. Every every single one of these bills has one goal in mind, putting veterans at the front of every decision we make when it comes to their healthcare. I'd also like to encourage all members to keep that common goal in mind as we discuss this legislation before the committee.
▶ 0:22:31I'm looking forward to a very productive discussion with my colleagues on these important bills. First, I want to highlight the Wings Act introduced by Representative Kiggins. This bill would require the VA to examine the long-term neurological and mental health effects associated with military aviation service. Military aviators experience unique exposures during their careers, and significant questions remain about the long-term effects of those exposures on their health and well-being.
▶ 0:22:58This bill would help in um help VA ensure that future policy and treatment decisions are informed by evidence. I thank my friend Representative Kiggins for her leadership on this issue and I'm proud to support this legislation. I would also like to mention the Veteran Burial Timeliness and Death Certificate Accountability Act introduced by Whip Emmer. This bill would ensure accountability and timeliness at the VA by requiring certification of death within 48 hours.
▶ 0:23:23This would allow any official coroner to certify the death of a veteran when the VA is unable to meet a 48 hour requirement. This common sense legislation addresses an unacceptable reality that our veteran families can face weeksl long delays in receiving their loved ones death certificate. This can delay burials and access to survivor benefits that these families have rightfully earned. The goal of this bill is to ensure that those who served our country are laid to rest without any unnecessary delays.
▶ 0:23:50The Veterans Stand Act, introduced by General Bergman, reflects our commitment to improving care for veterans living with spinal cord injuries and disorders by authorizing VA to offer annual preventative health evaluations to eligible veterans. This bill would also expand veterans access to life-saving prosthetics and other mobility devices that assist with spinal cord injuries.
▶ 0:24:11VA has the important responsibility of not only treating our veterans, but also anticipating complications, preserving their independence, and assuring they have access to the highest quality medical care available. This bill would assist VA in this mission, and I'm proud to support it. I'd also like to highlight the tours act introduced by representative Valado. In the line of duty, our service members make sacrifices daily to protect our nation. For many, those sacrifices do not end on the battlefield.
▶ 0:24:40Instead, they reappear here at home in the form of post-traumatic stress, moral injury, isolation, and hopelessness. This home-fought battle is reality for thousands of veterans. And with over 17 veterans dying by suicide every day, it is a fight we must continue to better understand and better equip our equip ourselves to win. The tours act would do just that.
▶ 0:25:00By requiring VA to study its chapency services and faith-based programs through data collection and reporting, we can highlight the importance of whole health and spiritual This data would help VA replicate the areas where its mental health services are making a positive difference in the epidemic of veteran suicide.
▶ 0:25:19And I personally heard from veterans in my district that were at the edge ready to commit suicide and they have told me that the chaplain was there and saved them from that dire consequence. I'm grateful to Representative Valado for his leadership on this important issue. I'm also proud to highlight several pieces of legislation uh that Dr.
▶ 0:25:41Murphy, Representative Breznahan, and I have introduced that would improve coordination between the VA and the Department of Health and Human Services in administering benefits and services throughout the Veterans Community Care Program. These three bills would establish memorandum of understanding to enable data sharing between the VA and the Centers for Medicare and Medicaid Services. The goal is to ensure that veterans enrolled in VA care and other federal health programs experience a more coordinated system while helping reduce duplicative or fraudulent payments.
▶ 0:26:10When these agencies lack access to the same information, it creates administrative burdens, unnecessary costs for taxpayers, and a more challenging system for veterans to navigate. I thank Representatives Murphy and Breahan for introducing these bills, and I'm proud to support them. Today, just four days ahead of our nation's 250th anniversary, let us recommmit ourselves to putting veterans first.
▶ 0:26:31As chairwoman, one of my reasons for being here is to ensure that every veteran has the chance to live with the dignity, purpose, and hope they have so justly earned through their service to our nation. This morning, we're also joined by several of our colleagues, not on the committee, who will speak in support of their bills. I appreciate their dedication to serving our nation's veterans. I ask unanimous consent that the following members be allowed to wave one to today's hearing.
▶ 0:26:56Representative Valado of California, Representative Breznahan of Pennsylvania, Representative Herrian of North Carolina, Representative Min of California, Representative Venman of Virginia. With that, I now yield to Yankee member Brownley for any opening remarks she may have.
▶ 0:27:10Uh, thank you, Madam Chair, and I am also looking forward to hearing from our witnesses about the bills on today's agenda. I know that many of our colleagues will be here to speak in support of their bills, so I'll keep my remarks relatively brief. Uh, several of the bills on today's agenda aim to improve transparency in the delivery of veterans health care.
▶ 0:27:30Representatives Dexter and Murphy have introduced the VHA Open Policies Act, which will require public posting of directives, policies, and guidance relating to veterans health programs. This will help Congress and the public better understand how VHA is directing its facilities to implement its programs.
▶ 0:27:51Representative Vinman and Hammeday have introduced the VHA Personnel Transparency and Accountability Act and Ranking Member Tano has introduced the VA Healthc Care Capacity Assessment Act. Among other things, these two bills will help shed light on current staffing levels at VA medical facilities and projected future demand so that we can better equip the VA health care system to meet our veterans needs.
▶ 0:28:20Finally, Representative Men and Fitzpatrick have introduced the Fostering Trust Act, which will enable us to better monitor suicides and attempted suicides that AC occur at VA medical facilities and at community care facilities and help us begin to identify trends and potential solutions to these extremely tragic events.
▶ 0:28:44I do however have some concerns with three bills on the agenda that relate to data sharing between VA and the Centers for Medicare and Medicaid Services commonly known as CMS. While I appreciate the stated intention of these bills to avoid duplicative payments by federal health care programs, I'm not convinced that these bills will accomplish that goal.
▶ 0:29:08Instead, I'm concerned they may be a thinly veiled effort toward privat privatizing veterans health care and helping to boast the profits of private insurance companies that offer Medicare Advantage plans. As VA states in its testimony, it already has in place a data sharing agreement with CMS, which enables it to identify providers who have submitted claims for payment to both VA and Medicare.
▶ 0:29:36VA also points out that these bills do not address veterans dual enrollment in triricare and how and how a more coordinated effort between the VA CMS and DoD would increase its ability to identify and eliminate duplicative improper and erroneous billing and payments.
▶ 0:29:57I'm concerned that these bills could result in more dy eligible veteran veterans care being shifted from VA to community providers through traditional Medicare and Medicare Advantage plans. For example, a provision in the discussion draft on coordination in administering the veterans community care program fails to define duplicative health care and could be interpreted to broadly deny VA provided care to veterans when similar
▶ 0:30:27services are available through the veterans Medicare advantage plans. This bill promotes a model in which Medicare or Medicare Advantage could become the primary source of care for dually eligible veterans and VA would increasingly function as a payer or provider of last resort.
▶ 0:30:47Under the data sharing requirements of these three bills, commercial insurers could argue for even higher capitated payments under Medicare Advantage than they already receive due to CMS having greater insight about veterans additional health care needs. The capitated payments that go to Medicare Advantage plans are intended to cover all of the v beneficiaries health care.
▶ 0:31:13However, most veterans who are currently enrolled in Medicare Advantage plans are getting the majority of their care at VA medical facilities. If the goal is to address taxpayers paying twice for veterans VA care, both in the form of VA spending and in the form of capitated payments to Medicare Advantage plans, there already exists a much simpler solution, the Guard Veterans Health Care Act, which was introduced by Representative Dogget, ranking man member Takano,
▶ 0:31:44Representative Mur Murphy, and others. The legislation provides authority for VA to bill Medicare Advantage plans for the care VA directly provides. Researchers from Brown University have estimated that taxpayers could save an estimated 12.1 billion dollars per year if VHA was allowed to seek reimbursement from Medicare Advantage plans. Once again, I look forward to hearing from my colleagues and our witnesses about the bills on today's agenda.
▶ 0:32:13And I will yield back. Uh, thank you, Ranking Member Brownley. I guess we got the memo. Um, we have a full pink, we have a full agenda today, so I'll be holding everyone to three minutes per bill to ensure we can move in a timely fashion. I now recognize um Dr. Murphy to speak uh for three minutes on behalf of his legislation.
▶ 0:32:37Thank you, Madam Chairman. Um, thank you for ranking member Browley and and the comments. Um, you made I I will address a couple of them. I'm the sponsor of the Veterans Care and Coordination Act of Medicare is the largest source of insurance coverage for VHA enrolles with over 50% in either traditional Medicare or Medicare Advantage plans. According to Brown, as was cited, the VA paid more than 78 billion for health services from 2011 to 2020.
▶ 0:33:04They also found that while the VHA paid for veterans healthcare, taxpayers simultaneously simultaneously made full payments for each dyenrolled veter veteran to their Medicare Advantage plan. Let me let me say that again. Taxpayers simultaneously made full payments for each dyenrolled veteran to their Medicare Advantage plan. Last year, the Rand Corporation also highlighted potentially duplicative payments for dually enrolled veterans, both for veterans and taxpayers. This is not an attempt to privatize the VA.
▶ 0:33:34It's not an attempt to uh push everybody to community care. It's an attempt to stop the duplicative pay duplicative payments. In some instances, the veteran may be paying a premium for Medicare Advantage but not using any manmade covered care and the government may be providing a monthly subsidy to the MA plan regardless of whether the veteran uses any care covered by that plan. Frankly, to me, this seems ridiculous. Why are we paying twice for the same thing?
▶ 0:34:00As a first step, again, as a first step, because if the VA were had this in place right now, why aren't they doing it? My bill seeks to promote data sharing, coordination to improve veteran healthcare management, reduce billing areas, and optimize resource use across the VA and Medicare programs. The bill requires VA and HHS to issue a memorandum of understanding to within one year to reciprocal access to veteran health data and enable HHS to identify veterans enrolled in both plans.
▶ 0:34:28Um, by sharing data, we we will create a more efficient delivery system for our veterans and avoid duplicative payments. Um, I received uh the VA's testimony. One of their recommendations and concerns is uh that we believe coordination between the VA, the Department of War, and HHS would be most effective in identifying and eliminating duplicative and improper payments. I welcome the support and if we do an an amendment in the nature of a substitute to include the Department of War, I'm fine with that. Um again, we don't need to be paying twice for the same health care.
▶ 0:34:57And if we're paying Medicare Advantage plans basically for nothing, then we need to stop that. As many know, I'm not a huge fan of the way Medicare Advantage is acting these days. also co-lead of Dr. Dexter's bill, the Veterans Health Administration online publication, an easy navigation of policies act of 2026. Woo, mouthful. Bill directs the under secretary of the VA for health to make all national policies of the VHA publicly available online.
▶ 0:35:20I think this is common sense and an excellent piece of legislation increases transparency by ensuring the public has timely access to VHA policies and our charis helps our cherish veterans and all that support them to remain up to date. the website would be up to date updated monthly. I think these are both excellent bills and I recommend um passage of them at the appropriate time. Thank you, Madam Chairman. I'll yield back.
▶ 0:35:42Uh thank you, Dr. Murphy. The chair now recognizes Dr. Dexter for three minutes to speak on her.
▶ 0:35:47Thank you very much, Chair Miller Meeks and and Ranking Member Brownley for convening today's hearing and for the opportunity to speak on my bill, the VHA Open Policies Act. I also very much extend my gratitude to Dr. Murphy for his partnership in this effort.
▶ 0:36:03This legislation reflects a genuine collaborative effort and I'm grateful for your support in advancing the principle that effective congressional oversight requires access to the information that Congress needs, not just the information the executive branch chooses to share. The premise of this bill is simple. VHA's national policies and underlying guidance and procedures govern some of the most consequential um decisions in a veteran's life.
▶ 0:36:29what care they receive, how they travel to get it, what benefits they are entitled to. And yet, many of those underlying documents live only in the VA's intranet, inaccessible to veterans and those looking to ensure our taxpayer dollars are being used to deliver the care our veterans deserve. The VHA open policy act policies act would require the VA to publish all of that material on a publicly accessible website. This should not be controversial. It's already done by CMS.
▶ 0:37:00It's baseline transparency expectation and it should not be something that we resist. I thank the VA for engaging with our office on this legislation. We look forward to continuing the dialogue and we are committed to getting this right. But I will be direct about something. We have heard the argument that VA is already working to improve transparency and that existing processes, FOYA, congressional inquiries, and formal requests are sufficient.
▶ 0:37:28With respect, the facts do not support that conclusion. Let me give this example that's very concrete from why a requirement is necessary. Last September, I joined my Republican colleague, Representative Lutrell, in sending a bipartisan letter to VA asking for data on average weight times and drive times for VA care in the community. This was not a hostile inquiry. It was not an adversarial demand.
▶ 0:37:54It was a request to ensure that veterans have access to tools they need to make informed decisions about their own care, something we all want. For months, we heard nothing. Despite consistent follow-up at the staff level, our letter went unanswered. I raised it directly in a hearing with Assistant Secretary Topping. Still nothing. I raised it again with Secretary Collins. Only after that second escalation, five months after the original letter, did we finally receive a response in February of this year.
▶ 0:38:23I will be clear, I do not like duplicative requirements. I do not want to legislate things that should be done administratively or in rule. My strong preference is for the VA to choose to do the right thing. But I have to be honest with this committee with a bipartisan goodfaith request on an issue where we are naturally aligned to have that take five months and escalation to the assistant secretary and a second escalation to the secretary himself to get a response. That tells me something.
▶ 0:38:53And what it tells me is this. We cannot get a timely answer to an easy question. Then we absolutely will have a hard time from a member of Congress. Our veterans are not going to get the answers that they deserve. I have very little confidence that when Congress asks a harder question, when we are chasing something the VA would rather not answer, that we will get any answer at all to be able to protect our veterans.
▶ 0:39:16It is our responsibility, all of us on this disean, in office, accountable. The VHA open policies act is a straightforward action we can take to ensure we can do so for our veterans each and every one of us represent. I urge my colleagues to support this bill and thank you. I yield
▶ 0:39:36Uh thank you, Dr. Dexter. The chair now recognizes Representative King Hines for three minutes to speak on her bill.
▶ 0:39:43Thank you, Chairwoman Miller Mekes and Ranking Member Rowley for holding this legislative hearing on several important bills, including my legislation to support veterans in the Northern Marana Islands and the Freely Associated States. I'm proud to sponsor HR 9316, the Travel Assistance for Veterans in Medical Deserts Act. Under current law, veterans generally must have a service connected disability rating of 30% or higher to qualify for VA's beneficiary travel program.
▶ 0:40:08While that standard may work in places with access to VA facilities, it creates an unjust burden for veterans in the Northern Marana Islands where there is not a single VA medical facility available. For veterans in my district, travel is not a choice, it is a necessity. Regardless of their disability rating, they must leave home to receive most forms of care because there are simply no local alternatives. Today, there's only one part-time primary care provider serving veterans across our three populated islands, Sipantin, and Rooda. Dr.
▶ 0:40:37Ada provides exceptional care, but there are limits to what primary care alone can accomplish. Specialty services are unavailable, and when veterans require more advanced treatment, they must travel to Guam, Hawaii, or the continental United States. A veteran with a 10 or 20% disability rating should not be denied travel assistance simply because the Department of the Veterans Affairs has not established a medical facility in our islands. This inequity is exactly what HR 93166 seeks to address.
▶ 0:41:03The travel assistance for veterans in medical deserts at would wave the 30% disability rating requirement for veterans residing in the CNMI and the FAS. Vets should not have to shorter the financial burden of traveling hundreds or even thousands of miles to access care that is unavailable where they live. Our veterans answered the call to serve this nation. We should not make them pay extra simply because they live they happen to live in some of America's most remote communities.
▶ 0:41:28I urge my colleagues to support this legislation and ensure that all veterans whether they live stateside in the CNMI or in the freely associated states have equitable access to the care they have earned. Thank you and I yield back. Uh, thank you, Representative King Hines. The chair now recognizes Representative McGarvey for three minutes to speak on his bill.
▶ 0:41:47Thank you, Madam Chair, and for ranking member for allowing me to be here as part of this committee today. I want a chance to speak to you about an issue that is deeply personal for so many families. It's caregiving youth. Now, caregiving youth is what we're going to call them in this committee and in the title of the bill. But what is it really? It's kids who are taking care of their parents. Kids who are taking care of service members and veterans because of chronic disease, illness, or What do those people look like? I'll tell you about one.
▶ 0:42:16Eliza, she was nine years old when her father, who was a staff sergeant in the Air Force, was injured by a roadside bomb. He's he came home and from that point on her childhood focused on his recovery, the emotional ups and downs, the memory losses, uh the everyday tasks that were made harder by his traumatic brain injury. It was his daughter Eliza who quietly stepped in to help. Now, nobody knew why she was showing up to school exhausted. Nobody knew why she didn't have time for friends.
▶ 0:42:45And no federal program recognized what she was carrying. She was invisible in every system meant to help her family. See, a kid like Eliza is never going to refer to herself as a caregiver. But they bear responsibilities far beyond their years. And they do it without recognition or support. We know what this means for their lives. Some struggle in school. Some miss out on friendships. Some don't have the opportunity to participate in activities or sports.
▶ 0:43:14Some face anxiety or depression. And these kids shouldn't have to sacrifice their education, their well-being, or really their childhood to make sure that their family or loved one gets the care that they need. So right now, federal programs don't identify caregiving youth or coordinate support across agencies. They're invisible. That's unacceptable. We have a responsibility to understand who they are, to understand what they need, and how we can make sure that they're not left behind.
▶ 0:43:45That's why I introduced the National Task Force on Caregiving Youth of Veterans Act. It brings together the VA, DoD, the Department of Education, and HHS to figure out how many caregiving youth there are and what challenges they face. It requires consultation with families and experts and requests targeted policy recommendations to expand resources, improve mental health support, create department specific programs, and more. This isn't a partisan issue. This is a human issue.
▶ 0:44:15It's about recognizing the full reality of service and sacrifice in military veteran families. I look forward to working with you all to move this bill forward. Thanks again for including it in today's discussion and I yield back. Thank you, Representative Garvey. The chair now recognizes Representative Kiggins for three minutes to speak on her bill.
▶ 0:44:32Thank you, Chairwoman Meeks, and thank you to the witnesses for being here today to discuss the importance of these pieces of legislation. One of the bills on the agenda today is my bill, the Warrior Impact from Neurological and GeForce Stress Act or the Wings Act. I'd especially like to thank uh we have a person on the second panel, a woman from my district who is a gold star spouse, Chelsea, who will be sharing her story uh of her former or of her husband who was a uh F-18 pilot.
▶ 0:45:00But we've done significant work in this committee to take care of our veterans, especially in the mental health space, access to mental health, making sure they have timely care, uh, comprehensive care. We've looked at things like blast exposures and TBI. We've looked at, especially the special ops community who has had a significant amount of exposure to these things and has really been leading in so many uh, ways to to uh, point out what these cognitive changes are that our military members are experiencing.
▶ 0:45:28We've looked at cancer rates for people like aviators. We passed a bill last Congress to study that. Uh but I I wanted today and to highlight with my bill a very special group of people are aviators from the military who are exposed in different ways and and in the cognitive space and some of their changes. as a former Navy pilot, married to an F-18 pilot, now the mother of an F-18 pilot.
▶ 0:45:51Many of my friends, my family, my Navy family, uh are are these special people who fly through the air, who we tend tip of the spear, mobile air superiority into harm's way. When they land on an aircraft carrier, they are frequently traveling about 200 miles an hour and can stop in a mere second. Think about what that does to and and when you talk to them and actually spend some time talking to them, they'll say we only black out sometimes for a couple of seconds.
▶ 0:46:16They will tell you that if you spend some time and we have failed to look at these brain changes in our aviators, but the stories I've heard far too often from my my friends uh some of friends of my family, people very close to me and the funerals that I've attended too many times for former aviators. We have to take a better look at this issue. Aviators are different. They will not complain when they have so much as a sniffle because if they complain, they will not fly. They cannot complete their mission.
▶ 0:46:46It is so important that we treat them differently. And we highlight this issue because they suffer in silence and their families suffer in silence. They're exposed to things like geforces to oxygen pressure changes, radar equipment, electric equipment in addition to the usual stressor stressors and uh and just situations that we have in military life. As a nurse practitioner and a healthcare provider, I know that good policy comes from the research, evidence-based research. So, what my bill does is to make sure that we are prioritizing that.
▶ 0:47:15We are looking at at conducting a long-term study of the cognitive and psychological impact of military aviation. The study will also examine the link between flight exposure and risk of TBI, depression, PTSD, and suicide among aviators. I want to thank the committee for considering this legisl legislation along with the other important bills before us today. I also want to thank our witnesses, especially Chelsea, for sharing their expertise and helping highlight the importance of these issues. I look forward to continuing the work with the committee to expand and improve veteran healthcare. With that, I yield back. Thank you.
▶ 0:47:46Thank you, Representative Kiggins. The chair now recognizes Representative Vinman for three minutes to speak on his Mr. Kennedy. Oh,
▶ 0:48:02Representative Kennedy.
▶ 0:48:04No problem. Vindamman's a greatl looking guy. Uh, Chair Miller Meeks, Ranking Member Brownley, and members of the subcommittee, thank you for the opportunity to speak in support of my bill, HR 9433, the VA Coaching into Care Act. This committee and our panel of witnesses today know all too well the mental and behavioral health challenges our veterans face each and every day. Millions of veterans across the US struggle with depression, anxiety, post-traumatic stress, and suicidal thoughts.
▶ 0:48:33Every single day, statistically, approximately 17 US veterans take their own lives. And in fiscal year 2025, about half of veterans under 50 years old use the VA for support related to mental health challenges. Behind every service member is a family member, spouse, or partner who also serves, giving unwavering support day in and day out, no matter the struggle.
▶ 0:48:57They are often the first to recognize early warning signs of a mental health crisis, respond, and seek the care needed for the loved one before it's too late. In recognizing this burden of care, the VA created the coaching into care program in 2011, a successful service within the office of mental health and suicide assistance that provided spouses and partners of atrisisk veterans with guidance on recognizing early warning signs of a mental health crisis and how to respond when a veteran may be experiencing thoughts of suicide.
▶ 0:49:26Unfortunately, this program was discontinued on March 1st, 2024. And today, these calls are rerouted to VA caregiver support lines, which is often overburdened with high call volume, high demand, and long wait times. Additionally, the hotline responder is oftentimes unaware that they can provide resources to individuals who are not formally recognized as caregivers.
▶ 0:49:49Between 2010 and 2025, the number of veterans who received mental health care directly from the Veterans Health Administration grew by about 80%, an increase in demand for support services, made worse by a reduction in critical resources through discontinuation of the coaching into care program.
▶ 0:50:08This leaves a significant gap in support not just for our nation's veterans, but for the spouses, partners, and loved ones who are instrumental in ensuring that we quickly act to help our veterans in crisis and prevent tragedies that far too often families have experienced. To close this gap, my bill, the VA Coaching into Care Act of 2026, restarts this program at the VA for three years, providing phone-based counseling and guidance for family members of at risk veterans.
▶ 0:50:36It strengthens the VA mental health support system and put simply will save lives. This hotline staffed by social workers and psychologists who specialize in crisis intervention will provide family members with access to realtime mental health support resources, ensuring that those beyond formally recognized caregivers can intervene when a veteran's life is at risk. We ask a great deal of those who serve our country.
▶ 0:51:02In this body, it's our responsibility to care for those who've protected us, our livelihoods, liberty, and democracy. It's also our duty to support the people who care for them. This legislation is about uplifting our veterans and those who stand by their side on their hardest days, navigating the trials and tribulations that come with supporting someone after service. I'm proud to lead this legislation that will strengthen our support system, improve access to mental health services at the VA, and ultimately save lives of veterans. I yield back.
▶ 0:51:37Thank you, Chairwoman Miller Meeks and all members of the subcommittee for your time today. Since 2001, more than 6,000 veterans have died by suicide each year. Each loss not only impacts the service members loved ones and their community, but the greater veteran population. The VA's National Veteran Suicide Prevention Annual Report is one of the most valuable tools for understanding this crisis. But one important gap remains.
▶ 0:52:02We don't have meaningful data on how the VA's chapency service and other faith-based programs may help reduce veteran suicide. That's exactly what my bill, the tours act, seeks to address. This legislation directs the VA to conduct a two-year study on the relationship between participation in the chapency or and other faithbased uh services on the risk of suicide among veterans. Because conversations with chaplain are private, there hasn't been enough data in this area in the past.
▶ 0:52:31However, the TOR act takes steps to ensure veteran privacy by preserving the confidentiality of religious communications and ensuring that participation is entirely voluntary. For many veterans, healing involves more than medical treatment alone. Chaplain provide spiritual care, emotional support, and a trusted presence for veterans of every faith, often reaching those who may not be ready to seek help elsewhere.
▶ 0:52:56We believe these services make a difference, and this study will help us better understand their impact so we can make informed decisions about the future investments. Our veterans continue to face physical, emotional, spiritual challenges after their service and we owe it to them to ensure the care VA provides reflects the full range of those needs. I want to thank the subcommittee for their time and I urge all me members to support this common sense bill. Thank you and I yield back.
▶ 0:53:24Thank you, Representative Valado. Their chair now recognizes Representative Min.
▶ 0:53:29Thank you, Chair Meeks and Ranking Member Brownley for holding today's legislative hearing. I also want to thank Representative Fitzpatrick for agreeing to co-lead this important bipartisan legislation to try to strengthen transparency and accountability in the care of our nation's veterans. This bill, HR918, builds on previous legislation introduced by Representative Max Rose in the 116th Congress, the Fight Veteran Suicide Act.
▶ 0:53:54Uh but what's clear several Congresses later is that there is still significant work to do in this regard of properly addressing suicide. that this is unfortunately one of the most persistent and urgent challenges facing service members, veterans, and their families today. According to the VA, in 2023, there were 60 almost 6,400 veteran suicides deaths, 39% of which were receiving VHA care either in 2022 or 2023.
▶ 0:54:20In 2023, suicide was the 12th leading cause of death for veterans and was the second leading cause of death for veterans under the age of 45. This is an important district across the nation, but including in my district, which has about 24,000 veterans and their families uh across Orange County. Of course, that number is much higher. We need better accountability, transparency, and data to try to deliver the right resources and care for those struggling.
▶ 0:54:46My bill, the Fostering Trust Act of 2026, would try to do this by requiring the VA to notify the House and Senate Veterans Affairs Committees, as well as the members of Congress representing the district where a facility is located and the district where the veterans reside when a suicide or attempted suicide happens.
▶ 0:55:05Standardizing this notification process and the important u information that each notification would include uh would help strengthen this body's ability to try to focus its efforts legislative and otherwise and deploy resources more effectively to address the crisis. This bill specifically would expand existing reporting requirements to cover veterans receiving care through VA community care providers. Require the VA to notify Congress within seven days of a suicide or attempted suicide occurring at a VA facility or a community care provider facility.
▶ 0:55:35Would require the VA to provide Congress with follow-up information regarding the veteran's interaction with VA or community care providers and ensure that immediate family members are informed of any VA support services or assistance for which they may be eligible. Uh this bill of course emphasizes transparency, accountability, and support for veterans in crisis. I think these are important values and I uh am grateful for the by broad bipartisan support for this. So I I urge my colleagues to support this legislation. I yield back.
▶ 0:56:04Uh thank you, Representative Men. The chair now recognizes Representative or General Bergman for three minutes to speak on his bill.
▶ 0:56:12Thanks, Madam Chair. Uh, I appreciate the opportunity to speak on my bill the Veterans Stand Act. I want to start by welcoming Miss Brittany Elliott back to the subcommittee along with her father, Morgan. And it's great to see you all again. Miss Elliott's willingness to come back and tell her story again says more about why this bill matters than anything I could say here today. Miss Elliott served as a United States Marine.
▶ 0:56:42She earned the right to expect that when she came home, the VA would fight for her the way she fought for our country. Instead, Miss Elliott spent four years fighting her own VA just to keep a device that helped her reclaim her life after her injury. That should never have taken four years, and it shouldn't take four years for anyone else.
▶ 0:57:04The VA cares for more than 27,000 veterans with spinal cord injuries and disorders every year through 25 regional centers and over 130 clinics nationwide. That's a real commitment to our veterans and I don't take it for granted. None of us should. But a network like this is only as good as the care it actually delivers to the veteran. The Veteran Stand Act is simple.
▶ 0:57:31It requires the VA to actually perform annual evaluations it claims to have to already be doing. It requires those evaluations to include a real look at assist of technologies, exoskeletons, neurom modulation, powered mobility devices, not just whatever happens to be on hand locally.
▶ 0:57:52It requires the VA to bring in a spinal cord specialist, clinicians, veteran service organizations, and the manufacturers who actually understand these devices instead of making decisions in a vacuum, especially a bureaucratic vacuum. And it holds the VA accountable by requiring regular reporting to Congress. Nearly half of all spinal cord injuries happen between the ages of 17 and 30. That means a lot of our veterans are looking at decades of life, productive life, in front of them.
▶ 0:58:22The least we owe them is a system that keeps pace with what modern medicine can offer and the advancements in technology that make that life that they're going to be leading full positive if somewhat modified in a lot of cases electronically. With that, I yield back.
▶ 0:58:40Thank you, General Bergman. The chair now recognizes Representative Representative Vinman, aka Representative Kennedy to speak for three minutes on his bill.
▶ 0:58:50Thank you, Chair. Uh, Rep. Kennedy is also not a bad looking guy, so I appreciate that.
▶ 0:58:56Um, thank you, Chair Miller Meeks and Ranking Member Brownley. After serving 25 years in uniform, I know firsthand the sacrifi sacrifices our service members, veterans, and military families make every single day. Veterans have earned every benefit this nation provides, and that is why it's critical we ensure they have timely access to highquality care at VA health facilities.
▶ 0:59:19My district, Virginia 7th, is home to one of the newest, largest, and most state-of-the-art VA facilities in the country, the Fragsburg VA Healthc Care Center. I attended the ribbon cutting for the facility in March of last year and was encouraged that veterans in my district would be able to receive excellent health care in their community rather than commute to large city centers like DC or Richmond.
▶ 0:59:41Unfortunately, the top complaint I hear from veterans in my district to this day is that the facility remains understaffed and my constituents still need to travel long distances or experience extended wait times in order to receive care. It's particularly disconcerting driving by this beautiful facility, new facility on I95. You can't miss it. And seeing the parking lot nearly empty.
▶ 1:00:05That's why I'm here today to discuss my bipartisan bill, the health, the Veterans Health Administration Personnel Transparency and Accountability Act. This measure requires the VA to report facility staffing monthly instead of quarterly and to do so with greater specificity regarding which roles are vacant at each facility. Veterans, Congress, and advocacy organizations cannot hold the VA accountable if they rely on stale, outdated, and unclear data.
▶ 1:00:32My bill ensures that veterans and their allies gain a clearer picture of staffing levels at the agency, enabling us to hold a VA to the highest standards that our veterans deserve. I hope that you all support this common sense measure, and I yield back.
▶ 1:00:48Thank you, Representative Vinman. The chair now recognizes Representative Herrian for three minutes to speak on his bill.
▶ 1:00:54Well, thank you, Madam Chairwoman, and uh good morning to all of my colleagues. Thank you for allowing me to come here before the committee today and talk about the Foreign Medical Program Integrity and Improvement Act. What are we doing here? The FMP exists for one reason and one reason alone, to make sure that veterans that have service connected disabilities that either live or travel abroad are actually able to access the medical care that they have earned. When there's no VA nearby, the FMP steps in.
▶ 1:01:24There's an issue, though. The program has tripled in size since 2018. Claims are up 150%. Reimbursements are up 263%. And that would be fine, but there has been essentially zero additional oversight to match that growth. This has led to some problems.
▶ 1:01:44In February of this year, the GAO confirmed that I think many uh on this committee already suspected that the FMP had no fraud controls, no assigned lead, no risk framework, no dearmment list, nothing. It was a program without control, meaningful control. And that had some negative outcomes. We had one in Panama.
▶ 1:02:07Uh just to list out what this cost, uh a group of criminal doctors and pharmacies working together build the VA for services that were never rendered. This cost taxpayers an estimated loss of $67 million. After the VA finally suspended 36 different providers, the project they the VA projected that the savings from fiscal year 2025 alone were in excess of $25 million.
▶ 1:02:36That's what action looks like, but imagine if we had prevented it in the first place. On top of that, the program still runs on legacy it and mails paper checks in violation of federal law. Veterans are waiting 8 to 10 months to get reimbursed by this program. So, what does this bill do? It's got four fixes. Number one, payment caps. We've got to reimburse at the lesser amount of build or at Medicare rates.
▶ 1:03:02This is something that will absolutely close the loophole that Panama exploited. We've got to do deathmaster file checks. No payments to or buy anyone who's listed as deceased. The IRS does this. Medicare already does it. The FMP does not, but it needs to. Third, we've got to have a dedicated fraud coordinator and a debarment list. There's got to be one person accountable, mandatory IG referrals, and a do not pay list that is distributed directly to veterans.
▶ 1:03:32And fourth, creates a thirdparty administrator and a hard IT deadline. We've got to modernize claims processing. And we've got to get this done within one year of enactment. There's got to be no more stalled migrations across federal government Veterans who retire overseas, I think we all agree, don't stop being veterans. They've got to stop navigating a fraud riddled system to get the care that they have earned. The VA agrees with these recommendations.
▶ 1:03:59It's time to actually implement these recommendations to hold the VA accountable, not just ask them politely. Panama, in my opinion, was the canary. If we don't act, we're choosing to let it happen again. And that'll happen on the backs of our veterans and the American taxpayer. Thank you, and I yield back.
▶ 1:04:15Thank you, Representative Herrian. The chair now recognizes Representative Breahan for three minutes to speak on his bill.
▶ 1:04:21Thank you, Mr. Mr. chairwoman and to the ranking member for inviting me here today to discuss my legislation, the protect seniors and veterans from healthc care fraud act. Many of our nation's veterans who receive health care through the VA are also enrolled in Medicare and some are eligible for Medicaid. While the VA and the CMS currently operate under a computer matching agreement to help reduce improper double billing under traditional Medicare, the information sharing is limited and does [snorts] not extend to Medicare Advantage or Medicaid.
▶ 1:04:52As a result, the agencies face unnecessary challenges identifying and preventing improper payments, leaving tax dollar taxpayer dollars vulnerable to waste and abuse. My legislation builds on existing agreements by expanding information sharing to include both Medicare Advantage and Medicaid.
▶ 1:05:09Specifically, it directs the VA and the Department of Health and Human Services to enter a memorandum of understanding establishing reciprocal access to enrollment and billing information, giving both agencies the tools they need to better detect improper billing, prevent fraud, and protect the integrity of both these critical health care programs. Theou would remain in effect for two years and would support improved oversight and coordination between federal health care systems for the purposes of preventing double billing.
▶ 1:05:37The [snorts] bill would also require a report to summarize the results of the agreement and assess whether the data sharing partnerships successfully reduce duplicative and improper payments. This is common sense solution that should have been implemented years ago. Veterans enrolled in both VA healthcare and CMS programs deserve a more efficient and accountable system that protects their benefits, safeguarding taxpayer dollars, and ensures federal health care resources are used as intended. Thank you again for having me here today.
▶ 1:06:04I hope I can continue to work with the members of this committee to advance this legislation and I yield
▶ 1:06:09Thank you, Representative Breahan. Seeing that uh no other members wish to uh speak, um we will forego a round of questioning for the members until after the witness presentation. For those off committee members, you may remain uh here to ask your questions your the witnesses questions if uh time is feasible. I uh our first panel is already at the table. Joining us from the Department of Veterans Affairs is Dr.
▶ 1:06:34Lisa um Arfons, acting assistant under secretary for health for the VA's office of integrated veteran care. She is accompanied by Dr. Mark Koiger, U VA's assistant acting assistant under secretary for health for patient care services and Dr. Mark uh Cobellia, VA's executive director, National Programs for Veterans Health Administration. I'll ask the witnesses to please stand and raise your right hand.
▶ 1:07:01Do you sw solemnly swear that the testimony you're about to provide is the truth, the whole truth, and nothing but the truth? Uh, thank you. And let the record reflect that all witnesses have answered in the affirmative. Dr. Afren, you're now recognized for five minutes to present the department's
▶ 1:07:18Thank you, Chairwoman Miller Meeks, Ranking Member Brownley, and distinguished members of the subcommittee. Thank you for the opportunity to testify today on a number of bills affecting VA healthc care programs and services. I am joined by Dr. Mark Koiger, acting assistant under secretary for health for patient care services and Dr. Mo Cellia, executive director of national programs for VHA. I will briefly summarize VA's positions on the bills we will be discussing today. Additional details are provided in my written statement.
▶ 1:07:48VA supports the intent of the Veteran Burial Timeliness Timeliness and Death Certificate Accountability Act and looks forward to working with the committee to address two issues. VA supports the intent of the Wings Act to study long-term physiological and psychological effects of military aviation and we also look forward to working with the committee to address some concerns we have with the specific language.
▶ 1:08:11VA supports the underlying objective of the draft bill to expand eligibility of veterans with service connected disabilities who reside in certain territories or the freely associated states for beneficiary travel. However, the bill is unclear on several critical aspects regarding eligibility and scope of benefits. We welcome working with the committee to resolve these issues.
▶ 1:08:34Regarding the VHA's personnel transparency act, VA supports greater transparency, but has concerns about shifting from quarterly to monthly reporting. Monthly data are susceptible to human resources processing variation and short-term volatility on the Foreign Medical Program Integrity Act. VA strongly agrees with the need to modernize and strengthen VFMP oversight, and we agree with GAO's recent findings on fraud risks.
▶ 1:09:01However, we recommend amending the bill to address the issues VA is experiencing with the FMP and to avoid creating additional issues. We would welcome working with the committee to address these concerns. VA does not support the Veteran Stand Act because VA already provides annual comprehensive preventive evaluations to all veterans with spinal cord injuries and disorders. We are also concerned about the requirement to consult with device manufacturers and broad reporting mandates.
▶ 1:09:30VA does not support the Fostering Trust Act as written. While VA shares the goal of congressional oversight on veteran suicides, the bill also raises significant privacy concerns and could create barriers to community providers participation in VA care. VA does not support the VHA open policies act, but is dedicated to transparency for veterans. VA already maintains a public website with directives, handbooks, and notices.
▶ 1:09:58Publishing internal operational guide books would not improve public understanding, but would impede VA's ability to update guidance quickly. VA does not support the banial staffing report bill as its requirements are substantially duplicative of existing statutory reporting obligations, including the VA mission act and inspector general mandates. VA does not support the tours act as written.
▶ 1:10:24VA already has authority to study chapency in spiritual care in relation to suicide prevention and we plan to begin that work this year. Finally, VA does not support the three draft bills regarding data coordination between VA and HHS. VA agrees with the premise we should not pay twice for the same services and VA already has a data matching agreement with CMS towards that goal.
▶ 1:10:50However, these bills do not grant new authority and more importantly, they do not address the core obstacle. Current law limits how VA and HHS can share billing and payment data. VA would welcome working with the committee on legislation that directly addresses these data sharing limitations. VA remains committed to working collaboratively with this subcommittee to improve care and services for veterans, beneficiaries, and their families. We appreciate the opportunity to share our views and are happy to answer your questions.
▶ 1:11:20Thank you.
▶ 1:11:22Thank you very much uh Dr. Afence. The chair will now recognize ranking member Brownley uh for five minutes for any questions she may have.
▶ 1:11:31Uh uh thank you to the VA for being here [clears throat] and thank you for your testimony. Excuse me. I wanted to talk briefly about the um tours act, the suicide prevention and chapency engagement. So can you briefly expand on the ways that VA is currently [clears throat] incorporating chaplain services and religious organizations in its suicide prevention work?
▶ 1:11:55Yes. Uh Mark Cabellia uh national programs and I'm happy to take that question. Thank you for asking it. Um so the chaplain are a critical part of VA care, spiritual care to veterans. Um and has long been recognized as something that u veterans uh uniquely deserve. I want to know how you're coordinating them into suicide prevention
▶ 1:12:16Sure. I'm happy to. The several several initiatives are all already underway. One is uh the chaplain are participating in guided therapy training for suicide prevention. They have several ongoing projects with our office of suicide prevention to further enhance that cooperation.
▶ 1:12:37Chaplain are also uh participating in several projects with our readjustment counseling service to integrate chaplain services in suicide prevention at our vet centers.
▶ 1:12:48Thank you for that. I have heard from outside groups like the um American Humanist Association and Center for Free Thought Equality that the process for becoming a VA recognize ecclesiastical endorsing organization can be cumbersome.
▶ 1:13:12How many pending applications does VA currently have and how long have these applications been Thank you for that question. I I'll take that for the record and we'll get you accurate information on that.
▶ 1:13:25Well, I would like to get that information from you. Uh, [clears throat] recently DoD reduced its list of excuse me, [clears throat] reduced its uh list of recognized religious faiths and belief systems from 211 faiths down to just 31. Given this drastic shift, it's likely that DoD may no longer recognize the religious faith or belief of some active duty service members.
▶ 1:13:53Does VA currently collect any data about veterans religious beliefs and or are there any plans to limit the number of recognized religious beliefs at VA um as DoD has
▶ 1:14:06We have no such plans.
▶ 1:14:08Very good. So you will get back to me on the the other question on applications. Great. Um so on the coaching into care act um are you currently tracking how many non-caregivers call into caregiver support line and the kinds of services that they are
▶ 1:14:33I believe uh to answer that question, thank you for the question. I believe we have some of that information. Um, and we can certainly get back to you with that. Uh, but I don't have it handy with me today.
▶ 1:14:42Okay. Um, and can you tell me how you communicate to caregiver support line responders that non-caregivers can call the line and what resources do you provide to non-aregivers?
▶ 1:14:58How do you communicate that?
▶ 1:15:00Uh, yeah, thank you for that question. Our caregiver support program uh provides a broad range of outreach and education and they always talk about the services the clinical and u behavioral services that are available to caregivers through the caregiver support program. So it is widely um provided as education and outreach.
▶ 1:15:21So on the um Veterans Stand Act as drafted, does VA interpret the Veterans Stand Act to mean that it would be required to evaluate veterans for any investigational investigational or nonV uh nonVDA approved devices.
▶ 1:15:41Ma'am, we would um we would again any veteran who has a uh spinal cord injury or disease is evaluated thoroughly by u VA and we evaluate them in terms of what devices may be able to help uh with mobility and uh improved prod outcomes.
▶ 1:16:11Okay. So, uh in the bill it specifies implantable spinal cord uh stimulators must be FDA approved, but it does not include similar language for other assistive technologies like spinal cord neurom modulation powered exoskeletons and speech generating devices.
▶ 1:16:32uh what implications would that have for VA's existing clinical protocols and the development of future clinical protocols for veterans with spinal cord injuries or disorders? Ma'am, any uh FDA approved devices uh we would absolutely uh look at and evaluate um if those devices could be used to improve mobility, improve um the outcomes of veterans,
▶ 1:17:04then uh those are all potential options. So you would only evaluate or current practice is only to evaluate uh non or excuse me FDA approved devices.
▶ 1:17:19The FDA approved devices um we would consider for evaluation.
▶ 1:17:25Thank you. I yield back.
▶ 1:17:27Thank you. Ranking member Brownley. The chair now recognizes Representative King Hines for any questions that she may
▶ 1:17:35Chairwoman. So I want to first of all thank you for going over the bill and and making recommendations as to how we can make it better. Obviously we wouldn't have a need for this legislation if we actually had a seabach right and so you know the thought behind this was how do we address an ongoing problem where there are just no services and how do we ensure that the vets who have served wherever they live especially in remote communities can have access.
▶ 1:18:01And so, uh, one of the things, one of the concerns that that you raised in your assessment of the bill is, um, the eligibility for travel. Uh, and I guess I under current law, uh, you know, beneficiary travel is tried is tied into specific purposes. And so, I kind of wanted to kind of hear from you, uh, what how you think that that should be drafted.
▶ 1:18:30I'm certainly not trying to create any special uh privileges, you know, creating further financial burden, right? I I'm just trying to bring people up to up to par regardless of, you know, their the the geography that they live in. And so, what what what do you recommend that scope should look like?
▶ 1:18:50Yes. Thank you so much. Appreciate that. Uh really it's it's looking at for compensation and pension exams, vocational rehab opportunities, and really better defining what are unique needs for those veterans in in those areas to make sure that we are covering their beneficiary travel that is helpful for them.
▶ 1:19:09Okay. So let's work together on that then because I think you would have access to better data than than we do in terms of those types of services that should be covered, right?
▶ 1:19:20Yes, ma'am. I think the other concern that you that you raise is that um you know whether this legislation creates a whole new program or does it rely on existing authority and so I wanted to get further clarification from you. Um, so if the bill explicitly states that the expanded eligibility operates consistently with existing authorities, would that address your concern?
▶ 1:19:50And and can you just, you know, further flesh out the concerns with regards to covered jurisdictions and the freely associated states so that you know folks who are tuning in understand where the underlying concerns are.
▶ 1:20:04Yes, that thank you so much. um and and better alignment and understanding with uh 38 USC 1111 would be helpful along with then section 1724 in coordination with KFA. Um looking at those collectively would give us a better understanding of making sure that we have consistent language. Um and that we are covering territories with the freely associated states and then other uh very small islands in the Pacific that we also want to understand if those should be covered as well.
▶ 1:20:33again providing veterans with the most opportunity for for coverage.
▶ 1:20:36Yes. I think you know you mentioned that we had left out island. I think it was intentional, right? Because I don't think there's any vets living there anyhow. And I and I'm very, you know, as a micro, as a woman from Micronia, I'm very well with the Kofa estates agreement. And so I'm certainly not trying to, you know, overstep authorities here.
▶ 1:20:55What I'm looking for basically is just technical assistance to how to ensure that whatever are, you know, uh are allowable under existing agreements and to ensure that we're not overstepping lanes, right? Uh we're not getting into international agreements. We're just literally sticking with what's provided currently provided for under existing statutes.
▶ 1:21:18Um the other thing is you you made further recommendation for reforms like prepayment instead of reimbursement, clearer, you know, and improved payment rates. Can you flesh that out just a little bit for me in the last minute that I have?
▶ 1:21:31Sure. That affects all beneficiary travel and we do recognize opportunities again to streamline our beneficiary travel process for veterans. Um and as you point out with the 30% service connected, are there opportunities for us to expand on that? Uh so with this bill, do we then naturally question what we're doing uh for beneficiary travel within the states as well? And so that is worth a conversation, but we look forward to working with you.
▶ 1:21:55Yeah, I I I would really uh love to have a conversation to just go over perhaps some like technical amendments, right, as to the language of the bill, but also to kind of just look at the travel program in and of itself and how do we make it better for everybody.
▶ 1:22:07Yes, ma'am. Thank you.
▶ 1:22:08Thank you, Madam Chair. I yield back. Uh
▶ 1:22:09thank you, Representative King Hind. The chair now recognizes Dr. Dexter for five minutes for any questions you may have.
▶ 1:22:15Thank you, Madam Chair. As we've discussed, veterans deser deserve timely, transparent information about how the VHA delivers their healthcare. This is basic. It's a standard that we should all agree on. As a physician, I know very well that policies affect the delivery of care and patients need all the relevant information to make a decision and to be able to access care promptly. The VHA open policies act which I lead with Dr.
▶ 1:22:43Murphy addresses exactly that. The Veterans Health Administration must be an entity veterans can trust. Transparency is fundamental to that trust and Congress has a role in part and as a partner in supporting the VHA in upholding your Your testimony highlighted perceived implementation challenges with making more VHA policies publicly available.
▶ 1:23:12I am committed to ensuring we resolve those um challenges to make sure that timely access to information is delivered to our veterans. So Dr. Afrons our funds I'm sorry what is necessary to achieve this outcome? making VHA policies as accessible as they are for CMS. Um, I just accessed it very easily online, travel policies and others. It's updated regularly.
▶ 1:23:40Please help me understand what do we need to do for the VA to uphold the same standards that CMS
▶ 1:23:46Yes. And thank you. First of all, we support transparency and with that transparency does make an understanding that veterans then when they receive that information have a full awareness and can interpret it. If we are providing policies and guide books and documents that veteran and the public cannot understand, I don't think that that advances the intent of full transparency in this in this situation.
▶ 1:24:10Um what we are worried about however um are the delays that would be associated with making public documents 508 compliant. Um and that would then keep us from actually um putting out and delivering very technical detailed um uh standard operating procedures that we sometimes have to turn around very quickly uh to get out to the field.
▶ 1:24:34Um so we are concerned that again with the transparency that we are committed to there would be a misunderstanding if we are not providing the right documentation that that veterans can easily assess.
▶ 1:24:46So help me understand how it's more complicated to get that information available to veterans than it is to other civilians. Um CMS is able to do it. Why why is the VHA not able to do it? So public period, we want to make sure that it's 508 accessessible and compliant so anyone has access and an understanding of that data. So we don't think that it's different.
▶ 1:25:13We're welcome to work with CMS and understand how they're doing it. Um so we can understand how to get that guidance out.
▶ 1:25:21Yeah. And I I think our veterans um already are frustrated with access to information and so there should be a higher level of commitment I think at this point trying to make sure that they are able to access that. Um for now I I understood that your stance is that foyer requests um are one way um that veterans can access information. And I'm just going to note for the record you were nodding. So um
▶ 1:25:48yes ma'am. How long does it take for a FOYA request to be fulfilled right now?
▶ 1:25:54We'll take that for the record.
▶ 1:25:56Okay. And um I would also submit as a member of Congress who asked us a bipartisan question. It took us five months with escalation to the secretary themselves to get the information. I suspect FOYA requests are not going to be within 90 days of a bill being passed or 30 days of an update. I just will stand on that. that is unacceptable for our veterans, especially those needing to access care.
▶ 1:26:22We have had um committee staff trying to help find out travel um policies and other things. And even here, we can't access that. So, not only do members of Congress and our teams need access to this, but veterans and their caregivers and care providers need access. I've been in a VA on the internet. I cannot be the one as a doctor who has to find that information for our veterans.
▶ 1:26:50We are already um impeding the ability to deliver care for our physicians. So, and our other VA employees. It should be publicly accessible as urgently as possible. Thank you, Madam Chair. I yield back.
▶ 1:27:03Thank you, Dr. Dexter. The chair now recognizes uh Representative Kiggins for five minutes for any questions she may
▶ 1:27:10Dr. for our funds. Military aviators have been exposed to repeated G-forces, hypoxia, vibration, and other occupational hazards for decades. What measures, if any, has the VA taken to test and treat our aviators due to long-term neurological effects of these exposures? And do any studies even
▶ 1:27:31Congresswoman. Um, thanks for the question and and your question, uh, actually resonates personally with me. I uh am I spent 36 years in the Air Force as a uh former aviator and flight surgeon. I have over 2,200 uh hours in military in a variety of military aircraft to include fighters and helicopters. So uh so yes uh this is very important.
▶ 1:28:01The uh VA uh again looks at has an has an office that looks at a variety of um potential issues or exposures that uh service members had uh during their time that they were uh again in the service uh to include uh aviation type exposures.
▶ 1:28:28I mean, you're probably familiar with uh uh fuels exposures and things like that. So, there are ongoing studies in a number of areas that look at that. Um I also had while on active duty had the opportunity to serve as a commander of the human performance wing at Wright Patterson Air Force Base. Um and again uh in that capacity we did uh a lot of research in those areas.
▶ 1:28:56I also worked with the naval aeromedical research lab that was coll-located there. So I am very familiar with uh the aviation type issues that uh could potentially exist longer term.
▶ 1:29:15So do we make that connection then with former aviators when they when they do show up for mental health especially diagnosis and treatment? Do we uh is there are they looked at differently using that background that you kind of described since seems like there's an awareness but I know that uh you know I feel like we we haven't identified really even what some of the long-term impacts are of aviation especially carrier landings.
▶ 1:29:40I feel like that's a little bit of a different sub no light to the Air Force, but uh but we do land rather quickly on carriers and so that that impact that jarring impact which you and I have both as a helicopter and Air Force pilot probably never experienced, but just listening to those people on my district, that's that's an just an added factor when we think of things like TBIs and even you look at sports injuries, might repetitive concussions, these types of of things.
▶ 1:30:06So, uh, so I want to make sure we're looking especially at at our carrier pilots a little bit, uh, differently, but all aviators. And so I'm just wondering if if we are, uh, making that connection if they, it takes so much for them to show up for to even ask for help.
▶ 1:30:19So when they do show up for some type of mental health treatment, are we are we looking at them in a different So, um I would have to uh get back to you to find out if those specific type of questions are asked, you know, say during a mental health visit.
▶ 1:30:39I know that when uh military exposures are talked about and there are certainly uh instances when veteran come when veterans come to the VA that those are focused on. I again I don't know that that those are brought up at something like a mental health visit or other visits per se.
▶ 1:31:03And that's what this bill hopes to accomplish. The fact that we can make that connection that that either uh you know is it is it uh is a repetitive concussing? Is it some type of exposure? or is it what is it that we have sub you know subject our aviators to that we can make that connection so that we can better help to to test and treat for whatever their their mental health diagnosis is I mean uh depression anxiety there's there's some you know big ones but then there's also maybe a little less noticeable that are uh that you know maybe personally they
▶ 1:31:33see or their family members see or caregivers so so I just want to make sure we're kind of at least studying looking at it because again evidence-based research is always where we start in healthcare And then uh just real quick, does the VA work with or employ flight surgeons? You know, you you mentioned flight surgeons and those are who are assigned to us in squadrons who are our healthcare providers. Those are the people you're going to come to first line of defense. So So are we are we making that connection? They are probably have the most expertise. They are, you know, sources of wealth of experience.
▶ 1:32:04Does the VA make any type of connections with flight surgeons? Um so that specific question I'm I'm unsure of. Um but what I can tell you is clearly there are people uh or there are physicians who are employed with VA who were flight surgeons like myself.
▶ 1:32:26Um, we also have the uh health outcomes and military exposures office and they actually focus on uh any type of military exposures to include uh specifically aviators and all of the different uh environments uh that aviators are exposed to.
▶ 1:32:48So that office can specifically uh start to look at um the medical literature to see what kind of studies have already been done in terms of exposures. Um and uh to your point uh if they can't find anything then uh look and decide do we need to set up a study in this particular area because there is no health related data on it yet. Good. And that's what our bill helps to accomplish.
▶ 1:33:19Thank you very much. I
▶ 1:33:20thank you for yielding. The chair now recognizes Dr. Conaway for five minutes for any questions you may have.
▶ 1:33:26Uh thank you, Madame Chair. And thank you and uh ranking member for bringing us here today. Thank you Dr. R. Frans and your um fellow physicians from the VA for presenting yourself to us today for questions. Um we can all agree uh that more needs to be done to eliminate the instances uh in which both the centers of Medicare and Medicaid services and the VA are bill or build for the same episode of care by a veteran. Uh this sort of double billing question.
▶ 1:33:56Currently Medicare Advantage plans receive capitated payments which are meant to cover the entire costs of an enrolles healthcare. But as it turns out, the VHA often uh provides the u the payments for those episodes of care.
▶ 1:34:14Um and so uh it would uh that veterans are paying for Medicare Advantage plans and then because they have a VA benefit uh the VA is sort of carrying the bulk of of the payments for episodes of care um and uh episodes of healthcare needed by the veteran.
▶ 1:34:34Um we are all supportive I presume to eliminate and reduce uh improper uh billing um improper payment duplicative uh bills being proposed and sent forward. Um the proposed draft uh that we heard about today would direct the Secretary of Veterans Affairs to seek uh to enter into a memorandum of understanding with the Secretary Secretary of Health and Human Services to avoid uh these duplications uh and erroneous billings I just mentioned.
▶ 1:35:02Um, again, in situations where the VA um administration's providing care for someone with a Medicare Advantage plan, uh, my concern is that that draft that we've heard today is not uh, doing enough and that um, uh, to deal with this these concerns and that the Medicare Advantage plans are improperly uh, gaining revenue um, that should otherwise um, not be paid to them.
▶ 1:35:29So, um, Miss Arins, can you tell us what the, um, what the VA is doing to correct this problem of duplicative payments or bills and payment for services that are being paid for by the VA when someone has a second plan that is Medicare Advantage uh, that is uh, designed to pay for their care.
▶ 1:35:49Yes, thank you. Uh so as we announced last year, we are already in an agreement with uh HHS looking at duplicate payments. Um up to this point, CMS has uh has uh recouped most of the funds with that. VA has is on its way to recouping about 5 million in expected funds with that data sharing. We're at about 4.1 million right now. Um this is of course not the bulk of our healthcare delivery.
▶ 1:36:17um and our community care network under our TPAs as um the the contracts already capture duplicate payments that to asssure that VA is not paying. Um so with the structure of CMS and then the varied structure with with VA those recruitment efforts are are a little bit different. Um but within VA and our community care network we already have reduced improper payments down to around 2%.
▶ 1:36:44So we are doing a lot with with our TPA in this work. Thank
▶ 1:36:48Oh, that's good to hear. We did have uh introduced in the previously a bill HR 4077, the guard's veterans healthc care act. Um this bill came through the full committee here and uh would give the authority uh for the veterans uh for your um administration to build Medicare Advantage plans. Is that that's what you're doing actually to get this recoup this money? are you billing them? Um, and I don't you might not be using this act.
▶ 1:37:17I guess it's not in law, but um is this uh I don't know if you're aware of it, but that was a bipartisan bill and and we think that might also help you do the job that we all want to see you do.
▶ 1:37:28Yes. Thank you. So, we bill separately through uh our TPA. Our TPA's bill their providers and then we pay our TPA. in terms of the um agreement that we have. We'll get those details to you to to explaining what we're what we're paying and who we're we're getting funds from.
▶ 1:37:44Thank you for that. I just wanted to move on. I think I have a little bit of time uh to deal with um to ask questions about a bill we heard from today by Representative Men uh regarding uh suicidality among our veterans.
▶ 1:37:58And um uh does the VA track um episodes of suicide that occur outside of of the uh Veterans Administration out of uh outside of Veterans VA facilities that is we're so the VA is made aware of some of those completed suicides.
▶ 1:38:18Um, and the typically it's we're notified either through the third-party administrator or through local physicians um or other healthcare providers that might be associated and and sometimes the family will alert us that um a veteran that we may have had shared care with a community provider. Um
▶ 1:38:35there's no process to search death certificates to identify this. You're it's you're going to have to receive this information. You don't have any I guess proactive way to get at this
▶ 1:38:44That's correct. We don't we don't have a system in place that allows us to systematically do that.
▶ 1:38:50Uh thank you Dr. Conaway for yielding. The chair now recognizes Dr. Bergman for five minutes or General Bergman for five minutes for any questions you may have.
▶ 1:38:58Is there a Hollywood line in there? Dr. General whatever general surely never mind. Not General Hospital. Anyway, not a soap opera. Uh let's start with a rhetorical question first. Not to be answered, just to be thought about.
▶ 1:39:12Is the VA the very best place entity to evaluate and monitor spinal cord injuries and advance new technologies because when we think about places like the Mayo Clinic or John's Hopkins or whatever not every entity is a specialist in everything but I think that's something that we need to consider here as in this particular case we look at what is the VA spectacular at and what are the things that Maybe you could get
▶ 1:39:42it done better outside and the VA becomes a recipient of good good advanced, you know, technology. So, uh, Dr. Arons, your written testimony suggests that tracking how many veterans with spinal cord injuries and disorders that are evaluated, who's offered devices, whose qualifies, and who You know, all of those bureaucratic steps would impose too great a burden to report to Congress.
▶ 1:40:14does that make sense? Is there any burden? It's too hard. General General Bergman. Um, first of all, I think that the VA uh through its uh spinal cord in
▶ 1:40:30Oh, let me let me I don't want to cut you short, but yep. Compare it to the advancement of the electronic health since we're bringing that. That's been a long road. a road paved with more than But when you have advancements like the electronic health record, how do we equate the two so we can get results?
▶ 1:40:51Um, sir, if I understand your question correctly, I I think that by bringing that uh health record online, the ability to track uh veterans, particularly veterans with spinal cord injuries and uh disorders through the system will become a lot easier um and a lot a lot more uh effective and efficient as veterans move around the country.
▶ 1:41:20So, we're going to get better, but right now we're opposing some things because we're not there yet.
▶ 1:41:26I didn't say that we were opposing
▶ 1:41:28I heard I thought a couple of Dr. Arons said something about you. You oppose some things.
▶ 1:41:33How do you How's this? Where's the VA sit on this?
▶ 1:41:37Yeah, sir. I'm not sure I understand the question. Sit on what? The electronic health record.
▶ 1:41:46Oh, the exoskeletons. Okay. It's very visible actually.
▶ 1:41:50I understand sir the exoskeletons uh the VA is certainly supportive of the use of exoskeletons um in veterans that have spinal cord injuries and uh disorders. Um but what we also do is we recognize that those exoskeletons also come with potential risks. And so uh what we do is
▶ 1:42:15you know you know anybody who served in uniform and you served in uniform and I thank you sir for your commitment.
▶ 1:42:22We naturally are risktakers to an extent and for any bureaucracy to not be willing to take appropriate risk for mission accomplishment which basically means better technologies. And I we could we could talk for a very long time about advancements in medical technologies. Uh I was involved in that market for 30 plus years.
▶ 1:42:49So not without I was I was around when Da Vinci became reality and that was not Leonardo. Okay. Yes sir. So give me a quick answer not a bureaucratic answer. Absolutely sir.
▶ 1:43:04Um we absolutely uh understand that sometimes you do take risk but again in the medical profession you know we start off with first do no harm and so we want to make sure that the devices are evaluated appropriately both in terms of will they be beneficial to
▶ 1:43:25but the point is there are other entities think of Dean Cayman when he when he invented what he invented is does VA um psychologically do you want to be part of the solutions going forward?
▶ 1:43:46Sir, absolutely.
▶ 1:43:47Or just evaluating what somebody else has brought to you and then having a process that takes too long because these veterans live every day with limited mobility.
▶ 1:43:56Yes, sir. The VA is not just uh
▶ 1:43:59Okay. My my my time is up. But you get the point.
▶ 1:44:04Yes, sir.
▶ 1:44:04The VA can do so much better, but sense of urgency within any bureaucracy is essential for better outcomes. Madam Chair, I yield back.
▶ 1:44:15Thank you very much, General Bergman. I now recognize myself for five minutes. Dr. Um, Arfons, in your testimony, you state that uh the VA strongly agrees with the need to enhance and improve the foreign medical program and supports the bill subject to amendments. What specific amendments does VA need from Congress to strengthen program integrity, reduce fraud, waste, and abuse, and protect veterans receiving care overseas?
▶ 1:44:39Yes, ma'am. Thank you. Uh, we do appreciate this bill. uh we do as I mentioned previously uh is understand the scope of authority with FAS and KOFA um to make sure that we are aligning and providing those veterans in foreign countries um equal and equitable opportunities. Um the bill also suggests that we use Medicare rates and Medicare rates only uh when discussing the uh lesser of the two build charges or federal rates. Uh we would like to explore triricare.
▶ 1:45:09Triare does have international rates that may be uh more appropriate for this this set of veterans and for this type of healthcare delivery. So we would like to see that language expanded. Um there is the the language around the reimbursement of claims after a provider passes away. Um this is not necessarily a a sign of fraud.
▶ 1:45:33Um, we do want to make sure that claims that have been received after either a veteran passes away or in in cases when a provider of that care may pass away that they are still paid for their services when either of them uh were still alive. So, we would like clarity in that. Uh, there is no appeals process right now for veterans and the providers. We do think that that is an important piece of of legislation.
▶ 1:46:00Um, and then finally, we have some concerns that notifying all FMP enrolles of someone who may be on a uh disbarred list may be confusing, especially for those veterans who have no intention of traveling to Panama or other places.
▶ 1:46:15Thank you. Uh, Dr. Alfren, the VA cites data showing nearly onethird of veterans who use an exoskeleton during the trial period decide against using it beyond that trial period. But the framing ignores the other side of the VA's own statistic. roughly twothirds of those veterans do not decline continued uh use.
▶ 1:46:34Now, I started out my career in the military as a nurse, actually on a neurosurgical unit at Walter Reed, uh taking care of spinal cord injuries, halos, striker frames, and then taking care of patients once they've left their military military facility at home providing care.
▶ 1:46:50So, in something that can help a veteran to be independent and functional, especially our young veterans, why is the VA relying on one-third of those who do not continue as a reason to oppose the bill rather than focusing on how Congress can improve access for the majority of veterans who do use and benefit from this technology? Ma'am, we we do not oppose the bill because of the one-third of veterans who don't use a device, who don't end up using the device.
▶ 1:47:21Um, we would be happy to work with the committee on the verbiage because there are aspects of the bill as it is written uh that would be problematic for the VA. And so, we'd be more than happy to work with the committee to try and uh address those.
▶ 1:47:38Thank you. be happy to work with you so that our veterans that have spinal cord injuries get access to this technology and can lead productive functional and uh lives uh that are um important to them as well. Um Dr. uh Arfons roughly 17 veterans continue to die to die by suicide every day. Congress has a responsibility to better understand every intervention that may help reduce this number and we've not seen uh those outcomes uh uh reduce at this time.
▶ 1:48:08Your testimony states that no additional authority is needed to accomplish the intent of the tours act. However, if the VA already has the authority to study the relationship between chapency services, faith-based programs, and veteran suicidality, why has it not done
▶ 1:48:26Thank you for the question. U yes, we recognize that we have the authority and we're actually planning to do exactly such a study.
▶ 1:48:34Uh thank you. I'm going to yield back uh the balance of my time. On behalf of this subcommittee, I want to thank all of you for your testimony and for joining us here today. You're now excused and we'll wait a moment as the second panel comes to the witness table.
▶ 1:49:53Welcome everyone and thank you for your participation today. On our second panel, we have uh Brandon Lee Wilson, chief operating offer officer, Asheville Bunkome, Community Christian Ministry, Britney Melissa Elliot, Marine Corps Veteran and Advocate, Chelsea Maria, Gold Star Spouse, and Alex Rich, director of data and an analytics, common defense education fund. Thank you all for attending today. I'll ask witnesses on the panel to please stand and raise your where you can, please stand and raise your right hand.
▶ 1:50:23Uh, Miss Elliot, if you prefer to sit, that's fine. Do you solemnly swear that the testimony you're about to uh provide is the truth, the whole truth, and nothing but the truth? Uh, thank you. You may uh sit. Let the record reflect that all the witnesses have answered in the affirmative. Mr. Wilson, you're now recognized for five minutes. Chairman uh Miller Meeks, uh, Ranking Member Brownley, and distinguished members of the committee.
▶ 1:50:50Thank you for the opportunity to testify today in support of the Trauma Outreach, Understanding, and Resiliency Through Spirituality Act, commonly known as the Tours Act. My name is Brandon Wilson. I am a United States Marine Corps veteran and currently serve as the chief operating officer of the Asheville Bunkham Community Christian Ministry, one of North Carolina's largest faith-based nonprofit human service organizations.
▶ 1:51:13For more than four decades, our organization has served veterans through housing, employment, behavioral health, health care, and supportive services programs. Throughout my career, I've had the privilege of serving veterans at a local and a state level. Today I oversee a wide array of programs serving veterans experiencing homelessness, behavioral health challenges, and economic hardships. We are work we work to maximize every available investment and create sustainable solutions for the communities that we serve.
▶ 1:51:41Like many veterans, my own personal transition from military service was not a single event, but a process. While my uniform came off, the search for purpose continued. My faith played an important role in helping me navigate this very transition. One passage that become partic particularly meaningful during that season was Hebrews 10:24-25. And let us consider how we may spur one another on toward love and good deeds.
▶ 1:52:08Not giving up meeting together as some are in the habit of doing, but are encouraging one another and all more as you see the day that is approaching. This passage encourages not to journey through life challenges alone, but to remain connected to one another and encourage one another toward purpose and service. My support for the Tours Act is also shaped by loss. On August 3rd, 2016, I lost a fellow Marine and friend Corey Hafner to suicide.
▶ 1:52:34Like so many families and communities, we were left asking what connections, relationships, or protective factors might have made a difference. It was during this time that VA chaplain and the strength of my faith helped me carry me and my fellow Marines through the our journey of grief, reminding us that healing is not physical and mental. It is awfully oftentime deeply spiritual as well. Throughout my career, I've worked with thousands of veterans facing an array of hardships. One lesson has remained consistent.
▶ 1:53:02Veterans heal, recover, and successfully transition through connection, not isolation. The veterans who thrive are often the ones who we are reconnected with something larger than themselves. Family, community, service, work, and too many times, faith. These connections provide belonging, accountability, and hope.
▶ 1:53:20The Department of Veterans Affairs 2025 National Veteran Suicide Prevention Report identifies social isolation as one of the most significant risk factors associated with suicide and a common and as a meaningful protection against it. However, there is in no mention or reference to chaplain in this report as previously stated today. Chaplain have a long-standing and important role in the lives of veterans, and the impact is known and testified to by thousands of veterans who owe their lives to chaplain and spiritual counsel.
▶ 1:53:51Yet, we have no record or data of the measurable impact on veteran outcomes. Chaplain routinely walk alongside service members and veterans through combat, grief, moral injury, transition, and recovery. They often help individuals navigate questions of meaning, purpose, guilt, forgiveness, and hope through this The question before us is not whether chaplain are valuable. The question is whether we are willing to study their impact with the same rigor as we apply to other interventions within the VA system.
▶ 1:54:20If engagement with chaplain contributes to stronger social connectedness, increase treatment engagement, improve mental health outcomes or reduce suicide risk. We should understand this relationship. The tours act does not replace clinical care. It strengthens our understanding of one potential component within the broader continuum of care. Chaplain meet veterans where medicine and paperwork cannot. At the intersection of the heart and soul of the human struggle.
▶ 1:54:44In my experience, chaplain are often the first person veterans trust with their battles and the last person who would ever give up on them. We have spent decades studying what places veterans at risk. The tours act gives us an opportunity to better understand what helps them to heal. I respectfully urge the committee to support the tours act and continue exploring ev every evidenceinformed pathway that may strengthen resilience, improved well-being and reduce suicide among the men and women who have served our nation.
▶ 1:55:13Thank you for this opportunity to testify and I look forward to any of your questions and I remain simplis.
▶ 1:55:20Thank you very much Mr. Wilson, Miss Elliot, you're now recognized for five Madam Chairwoman Miller Meeks, Ranking Member Brownley, and distinguished members of the subcommittee. My name is Britney Elliot, and I'm a medically retired US Marine Corps veteran. I'm honored to join you today, now my second appearance before the subcommittee to discuss the critical importance of the spinal trauma access to new devices act or the stand act. While I regret to inform you that I could not display the technology, due to my recent hand surgery, it's not medically safe to do so.
▶ 1:55:49I am so grateful to General Bergman again for his reauthoring and I want to personally thank Chairman Bost and Congressman Nice and Gottenheimer for their willingness to co-lead this effort. My thanks as well to those who have agreed in a bipartisan fashion to co-sponsor the stand act. I would also strongly encourage those on the committee that who have supported stand in the last Congress to do so again. It's no less important now. By way of background, I'm a medically VA medically eligible veteran and I'm fully paralyzed from my chest down as a result of a head-on collision with a drunk driver July 3, 2015.
▶ 1:56:18After which I was simply placed in a VA wheelchair and told I would never walk again. In 2017, I was introduced through social media, not the VA, to a device that I that I thought may have some utility for me if I were to ever regain the ability to stand and walk, the personal powered exoskeleton. I've approached my providers at the Memphis VA and started pushing to gain access to the technology. After significant hesitation by my local providers, I was finally able to get them to agree to enroll me in VA's landmark study on these devices. The study was being undertaken at several VA facilities across the country, but not in Memphis.
▶ 1:56:49So, I traveled at my own expense to the St. Louis VA Medical Center at Jefferson Barracks. I spent three weeks undergoing intensive training on the device and su successfully completed the trial well in advance of the normal pace. I am a Marine after all. At which point, I was able to take the device home and start using it. I took it everywhere. Unfortunately, the story does not end there. When I returned to the St. Louis VA in 2018, my provider, the very same provider who entered me into the trial, informed me she would not support my continued use of the device.
▶ 1:57:18And to this day, has failed to provide sufficient rationale for that decision. The device was returned to the VA and I was left in a chair and told, "You should get used to it because that's all you can expect." As a trained war fighter, that was simply not and is not good enough. For the next four years, yes, that's right, four years, I was engaged in a local and regional battle to regain access to the device that had already changed my life.
▶ 1:57:39Thanks to a forward-thinking physician at the Sunny McGomery VA Medical Center in Jackson, Mississippi, I was seen, reevaluated over the course of weeks, again on my own dime, and ultimately provided a new device, which I still have, and used nearly every day of my life. I am eternally grateful to this provider as his disposition was not of one of an agency bureaucrat but one that carefully considered the entirety of the medical evidence and the utility of this device for me a young vibrant and motivated marine.
▶ 1:58:04I'm also extremely pleased to the revised language and stand specifically calls out the use of neuro stimulation technologies that are now increasingly being used in the community and VA to help restore vital bodily function in areas often traumatized by paralysis.
▶ 1:58:19I have been very fortunate enough to to have experienced this technology as well again in the community and fun and again not finding about it through the VA but on my own since my VA will not provide it and I do believe this has enormous potential for me and other veterans like me.
▶ 1:58:36While my exoskeleton affords me the opportunity to ambulate, these technologies return to me some of what was lost in terms of my ability to better manipulate my hands, reduce spasticity, which can create pain and and can make daily activities a challenge, ultimately easing what would normally be simple everyday tasks. These fights should not need to happen. But the system in many cases, it seems to me, is built to protect itself instead of the veterans it serves. In my view, stand as critical for a few reasons.
▶ 1:59:04As you all know, the bill seeks to codify what VA is already supposed to be doing in the way of performing annual examinations. I can tell you with absolute certainty they are not. I've only had seven exams over the last 10 years and I had to push for several of those myself. Additionally, I think it is imperative that VA assess the viability of assist of technologies for all veterans with SCI as simply forcing them to stay in chairs if they are clinically eligible for other devices is just simply not good enough. The Stand Act mandates this type of assessment.
▶ 1:59:32One thing I've learned over my years of fighting the VA is that clinical behavior is often very difficult to change. One way to accomplish change, however, is to demand accountability for those responsible for making clinical decisions. This bill seeks to accomplish this by two means. Make the VA reportable to Congress on their success against the metrics I mentioned and hold VIS leadership accountable through their annual performance evaluations for those same metrics.
▶ 1:59:54In conclusion, Madam Ranking Member Brownley, and members of the subcommittee, I am confident Stan can truly be tr life-changing for those like me who have faithfully served our nation and dramatically reduce the burden on the veteran to have to engage in yearon year-on-year battles to receive the technologies they have earned through their service. I yield
▶ 2:00:12And thank you, Miss Elliot, Miss Maria, you're now recognized for five minutes.
▶ 2:00:17Chairwoman Miller Meeks, Ranking Member Brownley, and distinguished members of the committee. Thank you for the opportunity to speak with you today. My name is Chelsea Maria and I'm honored to represent the critical importance of the Wings Act. I want to personally extend gratitude to Congresswoman Kiggins for introducing this act. Before today ends, as you've heard, an estimated 17 veterans will die by suicide.
▶ 2:00:44In a span of 18 months, three experienced Super Hornet pilots died by suicide. I am here today because one of them was my husband, Commander Doug Maria. Doug spent nearly 20 years as an FA18 fighter pilot in the US Navy. He completed 675 carrier landings, 80 combat missions, and served as a top gun instructor. To many, he represented the very best of naval aviation.
▶ 2:01:13Imagine going from zero to 200 mph in just one second. your brain slamming into the back of your skull. Now imagine doing that 675 That is part of the reality we are urging Congress to study. But flight hours and credentials are documented and known. I came here to share what you could not see. What was happening inside our home as the suffering deepened.
▶ 2:01:42There is one sentence I will hear over and over in my head for a lifetime. often said in pain in the middle of the night facing insomnia, Doug would say, "Something is off in my brain. There is something wrong with me." He searched for answers in every way he knew how. He looked into his family medical history. He spent the night hours researching symptoms and possibilities. But the one thing he could not do was get h the help he needed. Why?
▶ 2:02:12Aviators carry a deep reality that being honest could cost them their entire career. Suffering in silence in the safety of their homes is often the answer they're left to. When his flight suit was on, he flew every fight flight with precision. He led his squadron to win awards, exhibit top tier readiness, and the highest of qualifications.
▶ 2:02:37When his flight suit came off, I saw the insomnia, the isolation, decision-making anxiety, and the slow loss of normal daily life. Sometimes getting out of the bed was harder than getting into the If there's one thing I need you to remember today, it is this. Excellence can hide suffering, and official records miss what families see every single day.
▶ 2:03:04Research conducted by the Army Staff College on aviators shows the same gap. Nearly half screened positive for mental health conditions such as depression. The official records captured only a small portion. Culture does not change without clear research and data. And one of the most powerful warning signs comes from inside the Navy community itself.
▶ 2:03:30In 2024, a former FA18 pilot and current Navy flight Navy physician submitted a memorandum for record warning about preventable loss of life in the strike fighter community. As part of that effort, an anonymous forum was conducted with active duty and veteran aviators. Of the 20 aviators who expressed concern, three reported having contemplated or attempted suicide. This is not a distant statistic.
▶ 2:04:01This is a room full of people trained to perform at the highest level, quietly carrying risk, our systems are not fully seeing. In the days after Doug died, a junior pilot from his command reached out to me. He told me that when he had become med down and was struggling with depression and substance use, Doug saved his life. Doug was the reason he stayed in service and the reason he did not lose his life or his own family.
▶ 2:04:29That was less than six months before Doug chose to die by Since Doug's passing, I have heard from current aviators with 12 to 22 years of service who have been suffering in silence but told no one in fear of being grounded. Just last night, another pilot's wife texted me these words. He hung his flight suit up and he got the help he so desperately needed. That is the choice too many pilots and families are facing.
▶ 2:04:59Hang up the flight suit or suffer in silence. This is why the Wings Act matters and is critical. A suicide should not be what's saving another person's life. We need to study what aviators endure while they are still here with us and a culture that allows them to be honest before crisis. Thank you and I'm happy to answer any questions you may have.
▶ 2:05:26Thank you, Miss Maria, Mr. Rich, you're now recognized for five minutes.
▶ 2:05:31Chairman Miller Meeks, Ranking Member Brownley, and distinguished members of the subcommittee on behalf of Common Defense, I thank you for this opportunity to testify regarding our positions on pending legislation. These are tough topics. I want to start by telling you about a conversation I had on Friday. I went to a baseball game with a friend and at one point in the conversation, my friend pulled out these three coins that he carries with him everywhere he goes. Each of these coins represents a friend of his who served in uniform and went on to take their own life.
▶ 2:06:01My friend has had these coins with him every time that I've met him for the whole time that I've known him. And I had no idea. This is entirely too common in the veteran community. This is why mental health staffing levels are so critically important. This is why I am so profoundly disturbed by the more than 2,300 cuts to mental health staffing that Secretary Collins made at the beginning of this fiscal year.
▶ 2:06:24I'm here today to voice Common Defense's emphatic support for the VHA Personnel Transparency and Accountability Act, which is a discussion draft that was inspired by our work in analyzing VHA job cuts. Congress cannot hold VA leadership accountable without persistent transparency on facility level staffing. This bill would close that gap. I'm Alex Rich and I'm the data director at Common Defense. We're a veteran led progressive grassroots organization.
▶ 2:06:51I'm also a former Air Force special operations pilot and crash investigator. I carried that crash investigation experience forward with me after 10 years in uniform into public health research and earned a PhD in health informatics. The state of veteran mental health care today is the most heartbreaking investigation of my career. According to the most recent available data, we lose 17 veterans per day to suicide.
▶ 2:07:16The VA projects a 38% growth in mental health u demand between 2023 and 2033. The VA consistently reports real struggles in staffing up to meet that demand. Despite all these facts, VA leadership recently engaged in an unprecedented wave of mental health staffing cuts.
▶ 2:07:36This spring, after months of delays, the VA finally sent Congress a one-time extract of the more than 26,000 job cuts that they made around VHA at the beginning of this fiscal year. At common defense, we were able to compare these cuts to the VA's August report of severe staffing shortages. We found more than 10,000 instances where a facility reported a severe staffing shortage in a particular occupation in August and received a cut in that occupation at the end of the year.
▶ 2:08:04We built vhadata.org or to help policymakers understand these cuts and recognize the strain that they put on VA facilities. You can see that strain in the wait times that VA posts every day on its access to care website. In January, at a Senate Veteran Affairs Committee hearing, Senator Blumenthal cited access to care data showing that new patients were waiting 50, 60, and 70 days for mental health individual appointments.
▶ 2:08:29Secretary Collins, instead of addressing Senator Blumenthal's legitimate concerns, said, and I quote, "As of January 21st, the national average for mental health care for new patients is 18.8 days of wait time." Well, detailed access to care data from the VA's own website tells a very different story. Common Defense downloads all of that weight time data every day for every facility.
▶ 2:08:51And so we can tell you that on January 21st, the date cited by Secretary Collins, more than twothirds of the facilities that reported new patient individual mental health weight times showed weight times that were in excess of the VA's 20 days or less target. In fact, 31 of those facilities reported weight times that were longer than 90 days. Facility level data lets Congress see the details that define veterans lives.
▶ 2:09:15The national average wait time doesn't mean anything to a veteran forced to wait more than three months for a mental health care appointment at the facility nearest them. The VHA Personnel Transparency and Accountability Act was written to address the lack of transparency around facility level staffing at facilities around the country. The bill would require the VA to publish staffing data in the form of monthly reports of encumbered positions at each facility by occupation code. These are the problems driving these weight times.
▶ 2:09:44and this is the only path toward holding VA leadership accountable for adequately staffing VA facilities, particularly in the critical area of veteran mental health care. I appreciate your time and I look forward to your You know, as a pilot, if you had more than one button, your chances of pushing the wrong one was 50%.
▶ 2:10:13So, um, I'll try to reduce that. Miss Brownley, you're recognized for five minutes.
▶ 2:10:21Thank you, General. Um, your humor is always welcomed in this committee. So, um, so first I just want to say to Mr. Wilson, Miss Elliot, and Mrs. Maria, thank you for your service. And Mrs. Maria, thank you for your husband's service and your service for to our country. Thank you to all of you for your service. Um, Mr.
▶ 2:10:47Rich, I I just, you know, I wanted to go back um and sort of take a a a deeper dive and what you're saying about data, transparency, weight times, etc. So, um, why is it so important that Congress and the public also have access to facility level data on the number of positions that are filled within each occupation? And how could this help us better understand VHA's capacity to meet veterans needs for health care services?
▶ 2:11:19Thank you, Congresswoman. For for a while, I was a teaching fellow in healthcare operations at the Yale School of Management. And when I was there, I founded a practicing program where we put students into the Yale New Haven Health System to deal with these kind of queuing theory and wait time problems. What I would teach my students is that they could not start their first process improvement meeting until they had access to three buckets of data. They had to have staffing, demand, and wait times. And that staffing data doesn't mean how many you budgeted for. It doesn't mean how many vacancies you have.
▶ 2:11:48It means how many people are actually there doing the work to serve the patients. So what we saw at the beginning of this fiscal year was an uh reduction in staffing that we didn't find out about for months. So if we had that facility level staffing data at a on a monthly basis to be able to watch what's going on, we could understand what's going on with these weight times that continue to be problematic at facilities around the country.
▶ 2:12:13Thank you. And um with regards to weight times, this has been an issue for me since I've been on on the committee really in terms of how VA calculates weight times. And for me, weight times is from the day you pick up the phone and ask for an appointment to the day you walk into the facility to be treated. That's that's weight times. But the VA doesn't count it that way.
▶ 2:12:37It's um you know it's picking up the phone and it's asking for the appointment and then it's about a call back to confirm you know when you can come. I mean there's a lot of different things that could happen in there and they only count from when the appointment is confirmed to the point that um they walk into the office. And I've been trying to get them to change that forever. And so, you know, when Secretary Collins comes in and says, "Oh, no.
▶ 2:13:05Wait times are, you know, much shorter than you say they are." I mean, it it's probably he's he's looking at the VA's calculations. You tell me if I'm correct or not. Um, but I believe that he's just looking at the calculations in the incorrect way in which they in which they calculate and that those weight times are are far worse. Um, so if you could talk a little bit about that.
▶ 2:13:30Yes, ma'am. So there are there are two sides to my brain on this front. On the one front, I used to be a pilot and pilot math means we don't want to do math. It's difficult to do math while you're doing a couple hundred miles an hour. So you want things to be as simple as possible. That's one end of the spectrum. The other end of the spectrum is I'm a health informaticist and I love that data and math and geekery. So in health informatics there are always challenges like this. How much detail do we need? How how fine grain do we need to get things?
▶ 2:13:57Uh I think an issue with Secretary Collins's numbers is that he does not release the methodology and the data on which he bases his conclusions. And if he did, it becomes a math problem. It becomes something that we can all address and understand. And until he does, there are market differences between what they publish on VHA uh access to care and what he quotes in testimony. I think that's a significant issue.
▶ 2:14:18I think to your point that uh the lived experience of veterans uh waiting for care is different from what's reported is important and we can continue to get better detail on that but for right now the way they do report it we have significant problems around the nation.
▶ 2:14:32Thank you. Um and um I just have a little bit more time, but I wanted to um with regards to uh Congresswoman Higgins's bill, the Wings Act, um in your testimony, uh you elaborate on why it's important for VA to study the neurological effects of military aviation on U2 pilots and maintenance personnel. Can you talk a little bit about that?
▶ 2:14:57Yes, ma'am. As a as a health informaticist and a public health researcher, I am a strong supporter of all surveillance programs, particularly those that uh focus on military populations. I think it's incredibly important to track the kind of carrier landings and hygiene issues that this bill addresses. Uh as a former military aviator, I also am acutely aware that air crew comprise a relatively small proportion of the team that puts us up in the air.
▶ 2:15:23And so all the maintainers who kept all my jets in good condition and kept me coming home safely went through the kind of harsh chemical solvent exposures, jet fuel exposures, noise, vibration exposures that I did without any of the protections of the kind of anti- fatigue rules that I experienced as a pilot. So I think it's important to track what goes on with them as well. We're seeing high suicide rates among the maintainer population.
▶ 2:15:46Also specific to U2 pilots, they would qualify under this bill via their use of T38s, but also an exposure that they experience is hypobaric high altitude exposure which causes uh brain damage that you can see in imaging and neurocognitive effects.
▶ 2:16:01Excuse me, sir. I know the time has expired and you just when you went entered hyperbaric then we could have a whole another hearing on that.
▶ 2:16:08I just wanted to say to Dr. Rich, thank you too for your service. All right, Congresswoman Kagans, you're
▶ 2:16:17Thank you. Thank you so much again to all of our panelists today, especially uh to Chelsea from my district for sharing your very impactful just story with us. But uh so m Mrs. Maria, I'd like you to talk a little bit about just why you started the Doug Maria Memorial Foundation and what you've heard are some of the biggest concerns among aviator families when seeking help through the VA and the barriers they're facing from from what you've heard. Do you feel like the VA and and actually active duty uh as well?
▶ 2:16:46That's a whole another discussion, but have not done a great job in taking care of our aviators. So, what are the things and some of the stories you've heard?
▶ 2:16:56Yes, ma'am. Um, in my experience, the common barrier that seems to show up both personally and in some studies that have been conducted in forums is a barrier around fear of disclosure to medical records. Um, announcing or sharing a med a mental health issue causes loss of um career trajectory and being downed.
▶ 2:17:25As a pilot, this is a particular barrier that pilots experience. And to the other part of your question, Congresswoman Kiggins, I would say I commonly hear um personal testaments from the pilots who are struggling with everyday activities such as memory loss. As spouses, we see and witness it in our homes where we're um continuing to repeat ourselves.
▶ 2:17:50Even making a choice such as taking the trash out is debilitating to some of these pilots and individuals in the safety of their home. The increased anxiety and mood swings um continued fear even of being in social settings with families. All of these are indicative of brain The unfortunate part is that from my understanding we have not studied brain trauma on pilots specifically.
▶ 2:18:19And I believe that that's what this winged wings act is giving us the opportunity to do to look at data and understand what's happening in the brains of these as they search for answers.
▶ 2:18:32Thank you. And pilots just they don't complain. We were kind of taught that early on. You know, we uh we we certainly don't complain about things that could impact our ability to to fly, such as mental health. So, I think there's there's a lot of work to to still do to overcome those stigmas, those barriers to even asking for help, especially while we're still on the active duty side, but even as we as we transition out of the military into the veteran space, I mean, that's what this committee does is take care of of the then the rest of our lives and that that longer time.
▶ 2:19:02So, really understanding what those psychological impacts are. So, can you elab elaborate a little bit more on why the the cognizant the the cognitive and psychological impacts on aviators brain health might be different from other military professions? Have you heard from other families who have received any treatment for issues like this from the VA? Uh, or do you still feel like we are we're kind of loop lumping all veterans together?
▶ 2:19:27I want aviators to and that's what this bill does just take a put them in kind of a special bucket because I feel like we have never done that where we've looked at some of the special challenges. So So do you do you feel like that that's true and then also have you heard of any success stories of people who have received VA care in the special bucket? Ma'am, I'd like to address the second question first. Um I unfortunately have not heard of success stories where the VA has intervened uh specifically with the pilot community.
▶ 2:19:57It comes back to the barrier of fear and disclosing. I will say that aviators exposure profile is very different namely the common factor of geforce and blast pressure impact. As we all know the professional sports community has studied this in football and then a study was conducted by the army staff college um specific to aviators.
▶ 2:20:24However, blast pressure impact geforce and some of the conditions that the aviators are experiencing to my knowledge have not been studied and are still being privately held confidentially within their family. I hope that further answers your
▶ 2:20:41Yeah, there's obviously much more work to do and um you talk about even the launching, the arresting of the of the aircraft, uh just those in addition to all the other G-forces, pressurization, electronic equipment, all the things. I just think that this is an important opportunity that we definitely cannot miss. And so, it's certainly been a privilege to to shed some light uh as one of the one of the few uh military pilots that we have here in Congress. But I just want to give you an opportunity in the last few seconds. Is there anything else you'd like to share with the committee?
▶ 2:21:11I thank you again for being here and sharing your impactful story. The final thing I'd like to share with the committee is for this not to be the end of the discussion on this. I am curious if the committee would be willing to sit down with senior leaders in the Department of War and medical personnel to talk about this issue.
▶ 2:21:31Great. Thank you again so much. I yield
▶ 2:21:34Thank you, Dr. Conway. You're
▶ 2:21:37Uh, thank you, General. Um, Mr. Rich, I wonder if you can share with us, um, as you look to compile very important data on staffing. We know in New Jersey, we've passed laws on this um, to try to make sure that in particularly in ICU units and labor and delivery and other parts of the hospital, uh, that we knew what was going on there.
▶ 2:22:05And um it's it's not an easy it's not as easy as you might think to actually get those numbers and have them be accurate. Do you have some suggestions on how or what kind of technology or other um methodologies we need to bring uh to bear to this question so that we get uh the kind of accurate data that would allow us to take action uh to to improve um the situation with these this deplorable policy in my view of cutting uh all of these mental health providers when they're so
▶ 2:22:35desperately needed now at this time.
▶ 2:22:39Thank you Congressman. I think one of the challenges here is that there is never a silver bullet technological solution to problems like this. These are often uh policy issues and issues around the way that transparency is or is not enforced on a system. Uh one of the amazing things about the VA is the VA access to care website that on a daily basis publishes these weight times and lets the public see what's going on.
▶ 2:23:04We don't yet have that for staffing levels, but at common defense, we've built vhadata.org that lets you see the trending in your district on any given day. That's updated.
▶ 2:23:14Well, I pulled it up on my phone here. I have to get access to it. So, we'll take a we'll take a look at that.
▶ 2:23:18Good to hear, sir.
▶ 2:23:19Um and um I would just say that u again dealing with hospital staff to to get I mean people are out um people uh you know call out sick. There's there are issues this comes up all the time. getting accurate data is just a difficult u process and I do wonder um if there's a way to make that uh better. U Miss Maria um can you give us some insight?
▶ 2:23:43It sounds like doesn't happen very often, but are you aware of of mechanisms besides, I guess, ad hoc ones where someone happens to socially involved with someone or some some relationship that allows a family member to get to a decision-making in in a chain of command um to address a concern about a a pilot or someone who's who's otherwise struggling.
▶ 2:24:10Thank you for the question, sir. I am not currently aware um nor did I experience a way to reach for help.
▶ 2:24:21Thank you. And just um mindful of time, Miss Elliot, and I might have missed it as I was um following your testimony, but could you um if you already said, and I apologize asking you to go over it again, what were you told when the device that you were using uh to help uh with your quality of life was taken from you or you no longer had access to it? What was what explanation was profered?
▶ 2:24:48I was simply told she did not have to give me a reason. she was the provider and that her decision stood.
▶ 2:24:55There was no explanation. Absolutely
▶ 2:24:57No question about cost, availability, nothing like that. It was just that uh a decision was made. I guess I'm assuming a clinical decision, although we have to be careful about assuming a clinical decision was made that it was not something that uh that you needed. I presume any explanation at all? She just said that she decided that I didn't need the technology and she was going to deny me access to it and she did not have to give me a reason why.
▶ 2:25:20uh did you at the time of hearing this were was there some could you see someone else to get a second opinion as often happens uh on the economy as we say I mean uh what was your what avenue did you have to deal with that and try to get the equipment that you needed in the wake of hearing that uh distressing news
▶ 2:25:37I went to several other providers and asked them to please override her
▶ 2:25:41within the VA system
▶ 2:25:42within the VA system I get all my care through VA
▶ 2:25:44I see
▶ 2:25:45and they all told me that because she was the clinician who gave me permission to do the study um because she said no without an explanation. They also would say no. I had one only one clinician after four years that said prove me to me that you can use it travel and I and I'll see you and then we can go from there.
▶ 2:26:06And I proved not only that I could use the device successfully and safely and and only then did he write the prescription for me to have my own device, but thanks to him is the reason I have my device today. and just and so it's a device that has been approved by the FDA for um a particular clinical use that we're this was not an experimental device. It was one that was already approved by FDA or
▶ 2:26:29it was already approved by FDA.
▶ 2:26:30I see. All right. Thank you. I yield
▶ 2:26:34Thank you, Dr. Conaway. The chair now recognizes General Bergman for five minutes for any questions you may have.
▶ 2:26:39Yeah. Thank you, Madam Chair. Uh, Miss Elliot, I'm going to kind of dig right into the middle here quickly because um, more and more people are beginning to know your story because you've persevered through this for a long time. You've been that that beacon of hope for others. So, you still shine brightly. Thank you.
▶ 2:26:57Um, the VA has stated that the reporting requirements in the Veterans Stand Act would pull staff away from doing their daily work with veterans with spinal cord injuries and disorders. Is the VA even currently meeting the mark in terms of delivering this care?
▶ 2:27:19uh veterans like myself, the annual examinations that are so frequently referred to in the spinal cord injury community uh sometimes, you know, they don't happen or they're virtual. Uh with a spinal cord injury, you know, how can you possibly provide a comprehensive annual examination virtually? Uh we have require hands-on care that our needs are different.
▶ 2:27:39Uh but also uh if it was just a checkbox, they ask us about our meds, they ask us about mental health, they ask us about other things, why would this technology not easily be included into yes, I'm interested, no, I'm not, and follow up an appointment.
▶ 2:27:53Um it's not difficult to to introduce it, but they just won't do if capacity, work capacity, number of people you have to do, the number of tasks required is truly an issue, are there community-based resources that could train veterans on these vices instead? Example, you can learn to fly in a couple of different ways.
▶ 2:28:19You can go through military flight training or you could go through civilian flight training. In the end, you have a qualified pilot or maintainer. So, are there other, you know, community-based entities who are could do this?
▶ 2:28:32Yes, actually, um, the manufacturer would is more than willing to teach any community-based provider, uh, that's willing to take on the challenge to teach a veteran to use a device safely and effectively. Uh
▶ 2:28:47so it's almost like in some ways I mean those of us who who for whatever reason maybe have gone through a little physical therapy there are different physical therapy pl you know therapists that we can go to maybe you know slightly different but the end result is is the same. So there's a variety of
▶ 2:29:04for you. Okay. Um uh do you think there are others or do you personally know of others who may be clinically eligible for the devices you have gained access to but are simply just being told no. I do because I travel with my device and I do frequent other VA events. I have veterans all across this country who only introduce the technology when they see it firsthand and ask me tons of questions.
▶ 2:29:33Well, I'm not a clinician and I can't determine if they're clinically eligible. They do have a spinal cord injury and but their providers will simply not ask. And if they do ask, they're being told no. I actually had a veteran uh out of Palo Alto, California. He was the very first veteran to ever get access to technology and he could not wait to tell me how much it changed his life. I met him at Winter Sports Clinic and uh he got access to technology after a battle, but uh it took a while.
▶ 2:30:00And uh there's other veterans just like him that are begging for access to the technology and simply being told no. There's no capacity is the is the most common thing that they're hearing or they just aren't
▶ 2:30:13You know, I'd like to um I'm going to yield back the rest of my time here in a second, but I think it's a very positive way to end the fact that that the Veterans Administration can be, if it chooses, a shining example of how things should be done. Let's see if we can figure out a way to make that happen. Yes, sir.
▶ 2:30:30In that
▶ 2:30:33Oh, in that case, I would like to yield the rest of my time to the chair.
▶ 2:30:38Thank you very much, Miss Elliot. In your testimony, you describe uh fighting VA for years to regain access to an Exoell. As a matter of fact, four years uh after you had already successfully used one and experienced significant improvements in your health. Based on your experience, what would you say to the VA officials who argue the Stand Act is unnecessary because VA already has the authority and policies needed to provide these technologies?
▶ 2:31:04Yes, they already have the authority, but they're not doing it. Veterans are begging for access to technology that they're just not getting through the VA or through anyone else because the VA restricts spinal cord injuries to only get care through them. While there are providers in the community, we do get all of our care through them. And that is the unfortunate reality that we face every day.
▶ 2:31:24And this is going to, you know, you have to forgive me. I was a nurse taking care of spinal cord injury, uh, traumatic brain injury patients in the army when I was active duty. Then I took care of them postactive duty uh, in their homes. And so I'm going to apologize for this. It's kind of a technical thing. In the four years where you did not have your exoskeleton, so I think you'd be able to to give us an anecdotal experience. uh the exoskele exoskeleton permitting upright posture.
▶ 2:31:54Did it reduce some of the muscle weakness and atrophy that one experiences by being remaining in a chair or in a bed and the bow and bladder function especially constipation that you get movement as we know ambulatory movement helps in that regard. So, do you think that there was these other health benefits that you obtained by having access to the exoskeleton that you could tell from the time you used it, the four years you didn't, and then having it again?
▶ 2:32:22Absolutely. So, a lot of people just think that exoskeletons are for walking, but veterans like myself have found that it helps with urinary tract infection, bowel function, and bone density, spasticity, mental health. Um there's other there's several other factors with circulation getting actually to the feet um and moving those that that it's not just walking. And I and I I think that's important for people to understand.
▶ 2:32:48There are multiple health benefits that veterans like myself are reporting that we're seeing with access to this Yeah, I know it was rather technical and uh given that it's lunchtime, it might not be the most uh polite thing to bring up in a hearing, but I think what's important about that is that we know that these are costly devices. Whether or not that comes into the decision-making of the VA or not, I don't know.
▶ 2:33:11But my point in saying this is that you're preventing other further medical conditions whether it's mus muscle wasting ba bow and bladder urinary tract infections certainly me uh mental health and brain health but venous stasis uh venousasis ulcers all of that is preventing other medical conditions as a result of uh being non-ambulatory. So so thank you for your uh your truthfulness and answering that question even though it's anecdotal.
▶ 2:33:38Um, Miss Maria, uh, your testimony was very compelling and I remember as a freshman uh, congresswoman coming uh, here uh, in the 117th Congress and we passed uh, in the FY22 NDAA the Brandon Act, which said that a member of the military could address their superiors or could seek mental health care without that affecting their promotion, their job, um, or their ability to to stay in the
▶ 2:34:08It seems to me that that would apply to aviators as well and that aviators as long as they're not under um uh you know brain health impairing medication should be able to do their job but also receive the assistance and the help they need. They as you as you very eloquently said they shouldn't have to hang up their flight suit in order to ask for help.
▶ 2:34:30So, do you think the Brandon Act is something that we could uh try to enforce upon you know the military uh for uh you know aviators in order to get them the assistance they need and or PET scans and other things that we're passing in this committee to look at traumatic brain injury or trauma um or concussive injury, blast injury which you're correctly describing in the back and forth on landing an air aircraft Thank you for the question and
▶ 2:35:01while I will say I'm not an expert on that particular bill, I will say that the aviation community is very unique in itself in that um the direct effect of disclosing any sort of information related to mental health be it therapy, needing therapy or having symptoms or experiencing symptoms like anxiety immediately refer to um loss the flight status.
▶ 2:35:29Not in all instances, but there is a very common factor um between aviators and disclosing of that information that impacts their career.
▶ 2:35:39So based on your testimony, you've made it clear that aviators can appear fully mission capable being a doctor. I I understand that completely while privately suffering from serious neurological and mental health symptoms. Based on what you've seen with your husband and his colleagues, why is it important for Congress to require proactive longitudinal study through the Wings Act and it may even require imaging studies as well?
▶ 2:36:06Thank you again for that question. Brain injury seems obvious from the outside, but we've never given aviators the chance to know. To date, we do not have data and research that studies their brains while they are alive. referencing one study that I would like to share with you.
▶ 2:36:28Current technology cannot definitively assess microscopic damage, though it can detect changes in structural and functional connectivity and injury, increases in inflammation, and other potentially relevant factors impacting the brain. This means it's critical to study aviators brain activity and the impact of repeated trauma and geforce while they are here with us, not wait until someone passes away to be able to study the impacts on the brain.
▶ 2:36:57Uh, thank you very much, Miss Maria. Um, I yield back. I want to thank all of our witnesses for being here today. Ranking member Brownley, would you like to make any closing remarks?
▶ 2:37:07I will just say that this has been a good hearing. I think there are, you know, some excellent bills here. I think there are some bills that with a few modifications that we can work on together, we could move all of these bills forward in a bipartisan way. Thank you very much. Ranking member Brownley uh could not agree more. As a matter of fact, uh although uh ranking ranking member of the full committee, uh Takano is not here.
▶ 2:37:33Uh I would wonder if uh he would want to be um uh receptive to having an amendment to his bill or modification to his bill uh in looking at uh VA assessment of staffing, how long it takes the VA to actually hire somebody, i.e. from the application process to uh to the uh time they're brought on board. I know my own personal experience over nine months I had had numerous job offers, still waited to hear from the VA.
▶ 2:38:01finally got a job from the VA uh or notified I was going to get the job, but by that point in time, I'd already taken a job uh elsewhere. So, I I do think there are some very good bills here, especially uh as they care for our uh veteran community. Again, want to thank all of our witnesses, both from the VA uh and uh from Civilian Life, for being here today. Um sorry, I ran out of time. I had a question for you also, Mr. Rich. Uh but um on behalf of the subcommittee, I want to thank you again uh for the witnesses and the members for being here today.
▶ 2:38:31I look forward to working uh with you to address the issues facing our veterans as well as uh uh the full committee. Uh the complete written uh statements of today's witnesses will be entered into the hearing record. I ask unanimous consent that all rem all members have five legislative days to revise and extend their remarks and include extraneous material. Hearing no objection so ordered. This hearing is now uh adjourned.