▶ 0:16:46Chair Moran: Our committee will come to order. I express gratitude to our witnesses for joining us. 24 pieces of legislation sponsored by me, the ranking member, and senators from both sides of the aisle including two bills I introduced.
▶ 0:17:05Chair Moran: One would allow families of servicemembers to stay at ba fisher houses if the service member is being treated at a nearby or near a va fisher house while prioritizing space for family members.
▶ 0:17:23Chair Moran: The serve act would prove relations between the ba medical centers to improve access to care for veterans and I appreciate the support of the legislation across capitol hill and from veteran service organizations.
▶ 0:17:44Chair Moran: I'm pleased to see its inclusion here and I look forward to seeing how it will benefit the veteran and military communities moving forward. Dr. today's hearing -- back to today's hearing, the bills on the agenda represent bipartisan priorities that would build on success congress achieved expanding access to care and benefits for veterans, survivors and family and I'm sure all of us share that.
▶ 0:18:15Chair Moran: I'm grateful to the sponsors of these bills for their work on these pieces of legislation. I'm grateful to the va for providing technical assistance enter veteran service partners for working with us to improve and enhance the bills. I yield to the ranking member senator blumenthal.
▶ 0:18:35Sen. Blumenthal: Thanks Mr. chairman. I appreciate the opportunity to do testimony on important bipartisan legislation today. Before we begin, I think we have to reckon nice the importance of the votes we will take tomorrow, one of them to extend the health care tax credits under the affordable care act that will affect literally 267,000
▶ 0:19:07Sen. Blumenthal: Veterans who rely on the aca and tax credits, to afford health insurance. Whether you support the aca, whether you have other views on what might be appropriate, in the long run if we had tons of time, the fact is we face a deadline of the end of the year when these tax credits will expire and 260 7000 veterans
▶ 0:19:38Sen. Blumenthal: Will no longer be able to of board aca -- afford aca coverage if these are not extended. These are primarily veterans who are not eligible for medicaid, tricare and medicare and not eligible to get care through the va, leaving them with the aca marketplace plans as the only option for health care coverage. The aca is not perfect. We need to lower the costs of health care generally. We need to work on reforms.
▶ 0:20:11Sen. Blumenthal: And we need to eliminate any fraud that exists in these programs. But the fact of the matter is, the consequences of failing to extend the tax credits will be devastating to veterans and their families. Veterans will be forced to navigate a perfect storm. The understaffed va health care system, increased wait time, medicare cuts and the loss of affordable health insurance. They deserve better.
▶ 0:20:38Sen. Blumenthal: So do millions of americans who will be impacted by the potential failure to extend these tax credits. I hope we approve them, to the benefit of those veterans and countless americans affected. On the legislation today, I want to particularly thank Mr.
▶ 0:20:58Sen. Blumenthal: Statement for his work alongside the veterans legal services clinic to improve how the federal appellate courts process appeals. I have worked with the yellow veterans legal services clinic and I know how important their work is. The veteran appeals efficiency act is one of many bills we are here to discuss.
▶ 0:21:28Sen. Blumenthal: And I will be supporting many if not all of them. For example, the molly loomis act which would explore health conditions prevalent among descendants of veterans who are exposed to toxic substances during their service, and we have to confront the painful legacy of discrimination.
▶ 0:21:52Sen. Blumenthal: The commission on equity and reconciliation uniform service act would investigate the harm done to lgbtq service members and veterans, many of whom received punitive discharges and were forced to hide their identities and denied benefits. These measures are not partisan. This committee generally is not partisan.
▶ 0:22:18Sen. Blumenthal: I welcome the support of my republican colleagues for these important members -- measures we will hopefully advance.
▶ 0:22:25Chair Moran: Thank you. I will introduce our first. From the department of veterans affairs, Ms. devlin, the -- accompanied by Dr. thomas o'toole, deputy -- thank you both for being. Ms. devlin, I recognize you for your statement.
▶ 0:22:51Ms. Devlin: Thank you for inviting us to speak on the v.a. Views on the legislation before us today. I'm joined by Dr. thomas o'toole deputy assistant under secretary health from the veterans administration. I would like to apologize for the delay providing testimony to this committee. Va is working on process improvements, internally and externally to ensure this is prevented in the future. >> most likely external.
▶ 0:23:24Ms. Devlin: There are 24 bills on today's agenda and while I can't address each one of them in opening remarks I welcome the opportunity to answer sessions and provide additional information. Va; full views are submitted for the record and for -- written testimony. We noted where amendments would be needed to ensure usability of implementation. I will highlight several bills where we support them or support the intent.
▶ 0:23:52Ms. Devlin: The fisher house availability act of 2025 introduced by chairman moran would expand access to temporary lodging and fisher houses or appropriate facilities for veterans and families, not only when the veteran receives care but when a family member is receiving care. We appreciate that chairman's leadership and support the bill subject to availability of appropriations. V.a.
▶ 0:24:15Ms. Devlin: Supports the intent to serve act, which seeks to improve access to care for veterans by leveraging the department of war facilities and providers. Ba does not support the bill as currently drafted but we value our partnership with the department of war and are confident our relationship will ensure veterans receive high quality care. We represent -- we want to refine the language and ensure clarity around your vita rolls from a veteran choice and coordination of care.
▶ 0:24:46Ms. Devlin: Suicide prevention remains one of the secretaries top priorities and we appreciate the intent behind the saving our veterans live act, and while we do not supported as drafted due to spoken costs, the $5 million annual authorization in particular, va has launched a lockbox distribution program for veterans at medium to high risk of suicide who have access to firearms.
▶ 0:25:13Ms. Devlin: This includes provider ordering, tracking and distribution, supported by va's mandatory suicide prevention program which is updated and expanded. Va appreciates the intent of the molly are loomis act which would mandate research on descendants of veterans exposed to toxic substances. We want to long-term -- understand impacts but existing programs in partnership with the national academies of sciences provides a robust framework for this research.
▶ 0:25:44Ms. Devlin: We support the intent of the purple heart education act which would allow purple heart recipients to transfer post 9/11 g.I. Bills to get benefits to the -- to the defendants. As current law requires coordination with the department of war for approval and management of transferred benefits.
▶ 0:26:09Ms. Devlin: We appreciate the intent of the obligations to aberdeen's trusted heroes act of 2025 introduced by ranking member blumenthal. We cite concerns as written subject to appropriations but we welcome the opportunity to continue working with you and your staff to amend the language. Va appreciates the goals of the veterans appeals efficiency act introduced by senator banks and ranking member blumenthal.
▶ 0:26:35Ms. Devlin: We support efforts to improve transparency in the appeals process but recommend amendments to ensure feasibility. We suggest reporting legacy and ama are deals mediums accurately which would allow va to sunset reporting on legacy romance once they are. We recommend against the requirement to track and were part -- report when adjudicators don't follow instructions.
▶ 0:26:59Ms. Devlin: This would require a new review system for post remand decisions, using significant resources. Va anticipates challenges tracking noncompliance. If the agency of original jurisdiction grants a claim without following board instructions it is unclear whether the outcome would be considered non-client under the bill language. Under the appeals modernization act post remand decisions are noted automatically returned to the board as a result v.a.
▶ 0:27:31Ms. Devlin: Cannot confirm compliance with remand instructions unless the veteran chooses to appeal. That concludes my statement. Thank you for the opportunity to discuss these important legislative proposals to improve benefits for veterans, service members and families. While I was unable to cover all of the bills, my colleague and I would be happy to answer questions.
▶ 0:27:51Chair Moran: Thank you, and I thank you and that va for providing technical assistance in the serve act. Ms. devlin and Dr.
▶ 0:28:04Chair Moran: O'toole, besides the mandates to improve health care resource sharing between va and dod, how else do you think that va, dod and congress can work together to improve access to care for service members and veterans in these federal programs? What do we do to make this a better, broader system?
▶ 0:28:27Ms. Devlin: I will ask my colleague to answer.
▶ 0:28:32Dr. O'Toole: Thank you. Question speaks to an opportunity. Both systems have a long history of collaborating together. Both systems have a shared mission. Clearly, we want to also ultimately improve the transition from active duty to civilian life.
▶ 0:28:57Dr. O'Toole: There are several things, I think the serve act is a great step forward and I appreciate the opportunity to work with you and your staff on concerns we have. I think as we move forward, issues of the processes of credentialing and privileging, and potentially working together with clinicians and military
▶ 0:29:29Dr. O'Toole: Treatment facilities in a seamless capacity, is an opportunity to look at models we have for instance with level f hcc and chicago health system is a strong collaborative model to continue to develop. I think this is an important and prioritized area for us.
▶ 0:29:48Chair Moran: Thank you for those suggestions and comments. I want to speak a moment about fisher house and express gratitude to those involved in fisher house for the tremendous service they provide to veterans of's -- and service members. The issue addressed in the legislation was in part a result of the v.a.
▶ 0:30:14Chair Moran: Unable to continue the practice they had previously due to a lack of clarity in the law. The bill is designed for clarity. I want to make sure you support this legislation but there is no question, the clarity, the ambiguity is no longer going to necessitate a decline of the opportunity to serve service members families.
▶ 0:30:42Dr. O'Toole: I'm happy to speak to that than that is what we have heard. Our facilities have also looked at the bill and this provides that level of clarity so thank you.
▶ 0:30:53Chair Moran: And then, finally, let me turn to senator blumenthal.
▶ 0:31:04Sen. Blumenthal: Thanks Mr. chairman. I want to focus on the aca tax credits. I have seen an estimate that a 1% increase in reliance by veterans on v.a. Health care produces $2.6 billion in additional costs.
▶ 0:31:27Sen. Blumenthal: If 267,000 veterans are denied the aca, tax credits, and they are not extended, presumably, some major number will go to the v.a. Health care system, significantly raising costs to the v.a. Have you done an analysis on the impact on the v.a. Health care system of 260 7000 veterans losing their aca health insurance coverage?
▶ 0:31:58Dr. O'Toole: I am not aware of an analysis. I definitely take your word in terms of that transition, but I can't speak to any specific analyses or numbers. You would have to take it from the record.
▶ 0:32:16Sen. Blumenthal: It wouldsen.
▶ 0:32:17Blumenthal: Be fair to say the initial cost to the v.a. Health care system will be in the billions of dollars if we fail, if the senate fails to vote tomorrow to extend the health care subsidies?
▶ 0:32:26Dr. O'Toole: Based on what you describe in terms of the numbers and analyses, yes, sir.
▶ 0:32:32Sen. Blumenthal: You don't dispute them?
▶ 0:32:33Dr. O'Toole: No reason to dispute them but I also want to be clear that we have not done the analyses. I have not done the analysis.
▶ 0:32:45Sen. Blumenthal: You would be in a position to dispute them if they sounded wildly --
▶ 0:32:50Dr. O'Toole: Yes.
▶ 0:32:54Sen. Blumenthal: You know, there have been recent reports about the apparent demise of the doge program. But the v.a. Still has yet to share, despite bipartisan requests, a list of 1000 contracts that have been cut by secretary collins.
▶ 0:33:21Sen. Blumenthal: In connection with the doge, elon musk program. The v.a. Has yet to respond to my may 19 letter demanding a full accounting of these haphazard cuts, and despite promises from multiple v.a. Leaders, to brief the committee on the cuts, we have yet to receive a briefing.
▶ 0:33:46Sen. Blumenthal: Within the vba and bha, do you have a full list of the contracts canceled as a consequence of doge for because of the cuts made by the secretary?
▶ 0:34:00Ms. Devlin: I rejoined vba in may of this year so I wasn't there for the doge activities but I can tell you we have the contracts we need to support our mission.
▶ 0:34:13Sen. Blumenthal: Do you have a list of the contracts that have been canceled?
▶ 0:34:17Ms. Devlin: I don't personally have that list.
▶ 0:34:19Sen. Blumenthal: Does anyone?
▶ 0:34:20Ms. Devlin: I would have to get back to you on that.
▶ 0:34:23Sen. Blumenthal: Do you know, Dr. o'toole?
▶ 0:34:26Dr. O'Toole: I don't. We would have to get back to you on that.
▶ 0:34:30Sen. Blumenthal: I can't speak for the committee but I can for myself. I have no clue as to what excuse there could be for failing to provide us with this after so many months, so many communications and hearings and the letter I sent. So if you could take that message back, I would appreciate it. Dr.
▶ 0:34:57Sen. Blumenthal: O'toole, last time you were here was in may. My office sent a request to the v.a. Immediately preceding that hearing for data that we used to receive from the department. Some of it was publicly available regarding v.a. And community care. V.a. Wait times and community care wait times.
▶ 0:35:24Sen. Blumenthal: 200 days later, since I made the request, I have not received any of the information that I asked for. As deputy assistant under secretary for health or clinical services, you oversee vha field operations. When was the last time you received updates on wait times at the v.a., or for community care?
▶ 0:35:49Dr. O'Toole: We track data related to v.a. Wait times on a frequent basis and we do track that. I would have to defer to my colleagues at the ibc office in terms of what community wait times are.
▶ 0:36:05Sen. Blumenthal: Can you give us an update?
▶ 0:36:05Dr. O'Toole: Off the top of my head no, but I'm happy to --
▶ 0:36:11Sen. Blumenthal: Kevin -- can you give us an update before we leave for the holiday break?
▶ 0:36:17Dr. O'Toole: Dr. o'toole: I will definitely try.
▶ 0:36:19Sen. Blumenthal: That completes my question.
▶ 0:36:21Chair Moran: Thank you. Senator tillis.
▶ 0:36:26Sen. Tillis: Dr. o'toole, senator blumenthal asked about 250 thousand or so people who might be on aca subsidized care. Do we know whether, can you try to identify, frankly, if they are v.a. Eligible I would prefer for them to get care from the v.a.
▶ 0:36:50Sen. Tillis: So this may represent, I understand the fiscal impact but this may be an opportunity to find, spot the people going to the exchange buying health care coverage when we can give them the extraordinary coverage they can get within the v.a. The concern with that, is it like calling role by asking people who are absent to raise their hand? How would we find those people and what was the basis for the analytics?
▶ 0:37:16Sen. Tillis: It is one thing to estimate, but how can we get to a level of granularity where we can reach out to them and say there is an alternative? Whether or not the subsidies get extended?
▶ 0:37:27Dr. O'Toole: It is a great question. Having been practicing in the v.a. For 20 years, I'm an advocate of the. Care we provide in that system. I don't know. We would have to get back to you.
▶ 0:37:43Sen. Tillis: If we have an influx and covered veterans, we will have to deal with funding, but if they aren't getting the subsidy on the exchange there may be funding we should talk about. It would be helpful for us to get that, regardless of what occurs. I'm always looking for veterans to get the best care they can end that is through the v.a. When they are eligible. Ms.
▶ 0:38:12Sen. Tillis: Devlin, you covered about eight or 10 of the bills on the list I have before me. You have a formal position you have communicated on the other pending bills, the longer list?
▶ 0:38:25Ms. Devlin: Yes. We submitted testimony for the record on all bills.
▶ 0:38:31Sen. Tillis: Are there any hard no's, that you don't agree with the intent and think it is a bad idea?
▶ 0:38:38Ms. Devlin: We did have some opposition.
▶ 0:38:42Sen. Tillis: As and we don't want this to be passed and that is in the record?
▶ 0:38:45Ms. Devlin: Yes.
▶ 0:38:47Sen. Tillis: Thank you. The only other question I had specifically, let me see if I can find the bill. 2807 restoring eligibility standards for placement in eligible cemeteries, what is your position?
▶ 0:39:07Ms. Devlin: Our nca partners are not here to testify on the bill.
▶ 0:39:14Sen. Tillis: Was that submitted to the record?
▶ 0:39:16Ms. Devlin: . It was.
▶ 0:39:18Sen. Tillis: What was the position in the record?
▶ 0:39:21Ms. Devlin: I will look it up in the testimony. If you would like to ask me another question while I look.
▶ 0:39:32Sen. Tillis: That is the last one.
▶ 0:39:35Ms. Devlin: Trying to avoid the awkwardness of going through.
▶ 0:39:41Sen. Tillis: I appreciate your preparation. Thankfully they are in numerical order.
▶ 0:39:48I Wanted Ms. Devlin: I wanted to give you the exact language so I don't go on the record with the wrong language.
▶ 0:39:58Sen. Tillis: I think I'm only a cosponsor on the purple heart veterans education act but that one gets out to me, it stands out in that I think we have to have significant consultation with doj and it sounds like directionally we are supportive. We really need to get that right.
▶ 0:40:26Sen. Tillis: There are instances where I can think of tragic events in north carolina where it would be appropriate, my personal opinion, appropriate given the circumstances at face value would not justify may be making an exception but I do to look at it and have a very tight set of standards and I think strong consultation with doj before I'm willing to support it.
▶ 0:40:52Chair Moran: Senator murray.
▶ 0:40:54Sen. Murphy: President trump came into office saying he would make ivf free. Instead, not only has the president not done a thing to lower the cost of ivf, he stood by as speaker johnson put a straightforward provision to make ivf more affordable for service members part of the ndaa.
▶ 0:41:19Sen. Murphy: I'm disappointed to see my veteran families health services act was left off the agenda today. That bill would give more service members and veterans the opportunity to grow their families coming through ivf by expanding fertility services under -- covered under v.a. And d.o.b. Health care. Seems like republicans talk a big game about ivf but when it comes to policy, it is clear who is in the driver seat.
▶ 0:41:48Sen. Murphy: Antiabortion extremists like speaker johnson. I want to make it clear that it is outrageous that republicans won't lift a finger to help our service members, or anyone for that matter, to access ivf and I think it is important that everybody here understands that. Dr. o'toole, are you aware service members face a higher rate of infertility compared to the rest of the population?
▶ 0:42:15Dr. O'Toole: I'm not familiar but I take your word on it.
▶ 0:42:20Sen. Murray: It's true and service members as we know lay their lives on the line for our country. I believe and I think many people do that the least we can do is help them start their families when they come home. I'm registering my deep disappointment and hoping that can change. As the daughter of a purple heart veteran I know how much they sacrificed for our country.
▶ 0:42:45Sen. Murray: I take seriously our responsibility to be there for them when they need it and right now, not all purple heart veterans are treated only when it comes to benefits -- equally when it comes to benefits. Post 9/11 that -- veterans can transfer veteran benefits, but a constituent told me he received his purple heart after his service and was unable to transfer his g.I.
▶ 0:43:12Sen. Murray: Bill benefits to his daughter when she was looking to go to college. The bill I'm offering, which I'm glad to see on the agenda, would fix the loophole. Ms. devlin, you mentioned you wanted changes but let me ask are you supportive of this legislation?
▶ 0:43:27Ms. Devlin: We do support the intent of this and it is technical amendments to ensure department of war is involved in the process as they make, they are responsible for transferring eligibility.
▶ 0:43:42Sen. Murray: I'm happy to talk with you about your recommendations. I think this is an important piece of legislation and I hope we can move on it. Let me ask about the molly loomis research for descendants of toxic exposed veterans act. This is near and dear to me. Molly was born with spina bifida and it is believed to be caused by her father's exposure to agent orange when serving in vietnam.
▶ 0:44:09Sen. Murray: Despite research showing descendants of toxic exposed veterans experience lifelong medical issues, there is yet to be comprehensive government led study of the issue. My bill simply takes a critical step forward by requiring research on health conditions prevalent in the descendants of veterans exposed to toxic substances during their service. Talk a little bit about how the research v.a. Would prepare v.a.
▶ 0:44:42Sen. Murray: . Veterans.
▶ 0:44:43Ms. Devlin: We take research objectives seriously and for individuals with spina bifida whose parents were exposed to toxic substances, there is the chapter 18 program that supports them. That program continues today to support those dependents.
▶ 0:45:02Ms. Devlin: There has been no significant association we have seen through the national academy of science research to indicate there is generational, there are generational impacts based on toxic exposures, but we do have the infrastructure in place and with the pact act we have the infrastructure to determine which objectives to take on with the groups that exist.
▶ 0:45:29Sen. Murray: It is my understanding there is research on the descendants of toxic exposed veterans experiencing lifelong medical issues. I think it is important for us to look at this to make sure. I think you for inclusion of the. -- I thank you for inclusion of the bill.
▶ 0:45:44Chair Moran: I took an interest in regard to next-generation affecting the next generation by the service of parents and grandparents and I'm over to working with you on this and other legislation. >> thank you for being here today.
▶ 0:46:04Chair Moran: I want to talk a little bit about, get some feedback on my legislation that I introduced with senator sheehy from montana, a larger and more rural state than north dakota. It is called critical access for veterans care act. The v.a. Did testify to it. I'm going to read a little bit of it.
▶ 0:46:29Chair Moran: It reads like the girls I to ask out in high school and then they would say we like you, you have a good personality. V.a. Strongly agrees with the intent to improve the quality -- I just, no conclusions. But you can guess. V.a. Strongly agrees with the intent to improve the quality and availability to veterans in rural areas.
▶ 0:46:57Chair Moran: We support the goal of improving access to rural veterans and one to work with the committee to clarify how this would integrate with existing care processes. States as rural as north dakota and montana have limited v.a. Providers and facilities. . In north dakota we have one hospital in fargo which is on the eastern edge of the state. The community care program literally can be a lifeline.
▶ 0:47:25Chair Moran: I say can be because the thing that prevents it from being a lifeline as often as it should be is the roadblocks put up, the fine print and the exceptions, all of the slow walking and administrative hurdles for veterans and providers themselves to participate.
▶ 0:47:44Chair Moran: We have seen some administrations, prior administrations intentionally put up roadblocks to deter veterans from using this option although it is the law and an option we have told veterans many times is available to them. After hearing from veterans and rural health care providers and leaders across north dakota I propose the solution, it is simply, to simplify access to the critical access network.
▶ 0:48:14Chair Moran: Whether it is hospitals, rural health clinics. As a point of emphasis, critical access is a designation specific to health care providers where they are the only hospital and provider in an entire region. Many miles between the providers .
▶ 0:48:36Chair Moran: Our system effectively discriminates against our veterans, compared to their neighbors, nonveteran neighbors and friends and family by giving them less access to care that is readily -- readily available, then they have currently. We have so much opportunity here. I'm willing to work obviously, always willing to work to improve the details of legislation.
▶ 0:49:06Chair Moran: We want to get it right, but parts of the testimony indicate that v.a. Wants to maintain control. That is always the deal. The good language in the world, however, as long as we agree. That is not really a culture change. That is maintaining control. The goal is to give rural veterans access to local hospitals without the strings attached.
▶ 0:49:30Chair Moran: We talk about weight lines -- lines in the waiting room that senator blumenthal talked about, that is one thing but the lines we are talking about our days and weeks and months to get permission to get the care across the street rather than across the state. I understand and want to make the language clear. You probably hear quite a bit that prior authorization process for veterans is a nightmare.
▶ 0:49:58Chair Moran: It is not only, it takes a long time but it is the wrong result. It is just awful to do. I worry if the bill is watered down, we turn the authority back over to the bureaucracy to decide. I have a lot of support and I have several letters including from the american hospital association supported the legislation as it is.
▶ 0:50:22Chair Moran: Other rural health care leaders from ross north dakota -- across north dakota, I would like to submit them for the record.
▶ 0:50:30Chair Moran: So ordered. >> with whatever time is remaining, Dr. o'toole, maybe you can elaborate.
▶ 0:50:39Dr. O'Toole: Thank you senator. Let me say first, we strongly support the intent and the need for this legislation. As it relates to rural veterans. I think the sticking point you noted is really how to create clarity in the language and direction as it relates to prior authorization versus clinical necessity.
▶ 0:51:06Dr. O'Toole: That can be achievable and we are looking forward to working with you on how to get appropriate language to make that work. >> thanks Mr. chairman and ranking member blumenthal for the hearing. Thank you for your service to our nation's veterans. Ms. devlin, this may be a question Dr.
▶ 0:51:28Dr. O'Toole: O'toole is better positioned to answer but as you both know, president trump in may signed an executive order that required the secretary of the v-8 or direct a feasibility study and create an action plan regarding bringing a full service va hospital to new hampshire. This plan was due to the president last month.
▶ 0:51:51Dr. O'Toole: My colleagues and I wrote a letter to the secretary asking him to make the action plan publicly available and that citizens can have input and provide feedback. 10 which ever one to be was in a better position to respond, can you tell me when the action plan will be made available for constituents to review and comment on?
▶ 0:52:13Dr. O'Toole: I don't have the specific information. I will say this is a priority for the secretary. It is something I know a lot of people are working on, and we will take it for the record to get that information.
▶ 0:52:25Sen. King: I would appreciate that. We would like to have the secretary come to new hampshire and it was a good visit but we have been asking for this for a while. Ms. devlin, I want to change gears and discuss how scammers are targeting veterans. Scammers, I bet everybody here has gotten a text or emailer phone call and been the target of a scam.
▶ 0:52:52Sen. King: According to the federal trade commission, veterans and military retirees reported nearly $420 million lost to fraud last year. When you include active military members, reservists and families, the number climbs to over 580 million. According to the ftc the top fraud affecting military and veterans was imposter scams, those scams adding up to almost $200 million.
▶ 0:53:19Sen. King: Can you discuss how scams and financial losses can affect veterans and their families and what the v.a. Is doing about it?
▶ 0:53:24Ms. Devlin: Thank you. . We take this seriously and we have multiple efforts underway to prevent fraud from happening, from affecting veterans but it does affect veterans. I would like to share that we have in the last couple years prevented $9.6 million from being stolen from veteran accounts. The bad guys are always changing approaches and we are evolving to make sure we are one step ahead as much as we can.
▶ 0:53:54Ms. Devlin: A lot of what happens is the redirect, the attempt to redirect finances from a veterans account to another account and that is the $9.6 million that we prevented. When it does happen, we provide one-on-one remediation support so if a servicemember or family member is subject to, or the victim of fraud, we will provide remediation support through our fraud team.
▶ 0:54:20Ms. Devlin: We do extensive outreach and communications with the latest scheme where veterans are getting a v.a. Overpayment notice and it is untrue and we sent out communications and reached millions of veterans with the information.
▶ 0:54:32Sen. King: I appreciate that. You mentioned the fraud remediation teams. One of the things I would like to continue to do his work with you to address this issue and find ways to strengthen our support and prevent even more losses. One way to do that is to make sure they v.a.'s efforts on scam prevention and information are supported. Senator cornyn bandai introduced the bipartisan be safe act which would require that the v.a.
▶ 0:54:59Sen. King: Have a scam and -- considering this is codified and supported so there is a specific person in office to lead the v.a. Scam prevention efforts across administrations. I would love to work with you on that legislation and interested in what additional ways you think congress and the v.a. Can work together to address scams and fraud.
▶ 0:55:25Ms. Devlin: Happy to work with you on that.
▶ 0:55:28Sen. King: For my colleagues, the overall cost of these scams now, economy wide around the world, is over $1 trillion in losses per year. It is outpacing the illicit drug trade so we do something we have to take on together.
▶ 0:55:47Chair Moran: Thank you. >> thank you for being here. I appreciate you and senator blumenthal for coming to the meeting and this is good stuff that we are discussing.
▶ 0:56:10Chair Moran: I want to start discussing the veteran burial timeliness and death certificate accountability act. Families of veterans suffer delays in certifying their loved ones passing as long as eight weeks. This creates difficulties for the families to receive death benefits and burial owners and forces local governments to maintain possession of the veterans body. Mr. o'toole, this -- does v.a.
▶ 0:56:38Chair Moran: Policy allow physicians to certify a death certificate and states that require a physician or corner to certify?
▶ 0:56:44Dr. O'Toole: Thank you senator and specifically related to this bill, I want to note that v.a. Supports it absolutely although there are some amendments we would recommend.
▶ 0:56:58Dr. O'Toole: The first is that physician assistants who are practicing as independent providers in primary care, specifically we feel should be included in those clinicians able to sign a death certificate, which is standard practice in many states already.
▶ 0:57:19Dr. O'Toole: Our other request is instead of 48 hours, we go to two business days, which is our current practice, and reflects the challenges with 95% of deaths occurring outside of a v.a. Facility so the logistics with holidays, weekends and so forth.
▶ 0:57:41Dr. O'Toole: >> can you explain the processes a physician must go through to sign a death certificate and compare that process for one of veteran passes away outside of a v.a. Facility?
▶ 0:57:55Dr. O'Toole: Can tell you from my own experience, usually it is a notification by the medical examiner or a mortician's office about a death, and requesting the certification be completed in a certain time.
▶ 0:58:16Dr. O'Toole: Obviously, it is greatly facilitated if the patient has been seen recently, and the records are appreciated for natural causes. Again, it is a little trickier if the patient hasn't been seen recently, or the death occurred in circumstances that might not be consistent. And that is pretty usual, whether it is in the v.a. Or outside the system.
▶ 0:58:42Dr. O'Toole: We stood up in office recently and put out a directive as well as training for all of our v.a. Clinicians that is intended to clarify and codify those processes internally. >> very good. Ms. devlin, can you speak to the importance of death benefits for the families of veterans and the consequences of delaying their delivery?
▶ 0:59:06Ms. Devlin: Absolutely. We work with many sources of information for first notice of death because we want to make sure the survivors received their benefits in the most timely manner. We reduced our inventory of dependency and compensation claims dramatically, working on getting those benefits to survivors.
▶ 0:59:29Sen. Boozman: I'm proud to be a cosponsor of the safe act of 2025, veterans are uniquely targeted by scammers. Can you talk about the legal difficulties in recovery from a scam?
▶ 0:59:46Ms. Devlin: I'm not an expert in legal recovery from scams but I can tell you we take seriously protecting veterans from fraudsters. We have many efforts underway. As I mentioned earlier, the bad guys are always changing tech makes which means we have to continually evolve practices.
▶ 1:00:05Ms. Devlin: We saved veterans from multiple fraud attempts based on our efforts, and I can tell you identity theft and other types of fraud can be very catastrophic for families. Financial loss, loss of credit and problems can result. That is why we provide one-on-one remediation to veterans and families if that happens. >> what does the v.a. Lack that a fraud officer could provide?
▶ 1:00:34Ms. Devlin: And you repeat the question? >> what does the v.a. Lack an ability that a scam and fraud officer could provide? Capability now creating a fraud
▶ 1:00:45Officer Ms. Devlin: . We did support the bill. Having that position codified in law, that being a permanent position and that individual work with the administrations because we have unique positions that are uniquely different in terms of how fraud can affect our veterans we serve. >> very good. These are not little things, they are things that do affect people a great deal.
▶ 1:01:17Officer Ms. Devlin: Both with inconvenience, and as you pointed out, just, the adverse things that can happen as a result of scams. And two, not being able to get a death certificate in a timely fashion. We can argue about what timely is but it some cases it is not timely and we need to react -- we need to correct that. Thank you Mr. chairman.
▶ 1:01:49Officer Ms. Devlin: >> thank you Mr. chairman. I wanted to talk about 926, the bill that we introduced. Senator collins has joined in support. It involves, sorry, that is next. It involves a lockbox for firearms. I don't have to talk about the grave history of suicides among veterans. 75% of which involve firearms.
▶ 1:02:20Officer Ms. Devlin: I did a calculation, one every two hours, one veteran takes their own life with a firearm. What we are proposing is based on a successful program in utah where it is basically a free lockbox for veterans that apply. There is no second amendment issues. It is voluntary.
▶ 1:02:44Officer Ms. Devlin: The research as I'm sure you know, if you can lengthen the time between ideation and action you will save lives. The department has a pilot program and I worry about the cost but I hate to think that cost will be the barrier to saving lives. What is the value of one veteran's life? I hope you will take a closer look at the bill.
▶ 1:03:13Officer Ms. Devlin: I don't think, we estimate $5 million per year, 33,000 lockboxes. That is a pretty good uptake rate. Dr., your thoughts?
▶ 1:03:26Dr. O'Toole: Thank you senator. . Thank you for introducing the bill. I know we have talked about it previously and this is a priority for the secretary and for the v.a. Any suicide is one too many and you are absolutely right, anything that creates space between the impulse and the action, whether it is securing medications or securing firearms, critically important and will save lives.
▶ 1:03:58Dr. O'Toole: We need to work with you on this. I think our concerns about the appropriated, recommended appropriated amount of $5 million is something I hope we can work through to be able to create some comfort in terms of what is the right amount.
▶ 1:04:18Dr. O'Toole: Our efforts to date have been focused on providing lockboxes to those veterans identified as having moderate or severe risk, and clearly coupling that with the wraparound services and mental health services and social support services.
▶ 1:04:36Sen. King: That has limited uptake.
▶ 1:04:39Dr. O'Toole: We need to do more. I was going to add, we have begun cables that are more generally available. But the technology and the capacity with lockboxes is preferable.
▶ 1:04:52Sen. King: Let's continue our discussion because I think, like I said, every two hours, a veteran dies by firearm suicide and we should do would -- whatever we can. I would like to submit for the record I think it is, the communications from 24 different groups supporting this bill. If I could submit that for the record. The second issue I want to talk about briefly is false.
▶ 1:05:22Sen. King: One out of every four people over 65 have a debilitating fall. The cost of one fractured hip is $40,000-$60,000. This is a low hanging fruit of lowering the cost of health care. It is an epidemic in this country and the senators and I have a bill that basically puts a focus on the issue within the department by creating an office of falls prevention.
▶ 1:05:54Sen. King: My philosophy of management is we need somebody in charge who is responsible for a particular program, otherwise it falls away. One throat to choke, I used to put it in business. I'm talking about someone who is responsible every day for trying to prevent falls among veterans.
▶ 1:06:15Sen. King: I think you have been somewhat negative about the bill, but seriously, this is something that is the low hanging fruit of prevention not only of financial cost but the terrible toll it takes on our veterans and their families.
▶ 1:06:33Dr. O'Toole: You are absolutely right. Falls are a preventable cause of significant morbidity, mortality, and we obviously with our aging veteran population need that focus. Are concerned or basis -- our concern or basis for objection is that most of the work is underway. We launched a falls office within the national office of patient safety this past year.
▶ 1:07:04Dr. O'Toole: We are doing a lot of the things that the legislation calls for, and our concern is that creating or enacting the legislation, we don't want that to be taking from the momentum of what we are currently doing. But let me please extend the offer for us to work with your office to be able to find some common ground with this.
▶ 1:07:35Sen. King: I would appreciate that. It might be modifications to what you are already doing and beefing it up because this is a real opportunity to relieve a lot of pain and suffering for veterans and also pain and suffering for taxpayers. Thank you Mr. chairman.
▶ 1:07:50Chair Moran: Thank you.
▶ 1:07:53Sen. Slotkin: Thanks for having this hearing. You are coming to the end because I'm at the end of the dais. It is almost over. You have had the grab bag of issues so it does not like the hearing on one issue. Thank you for taking our particular questions. I want to follow up an issue I feel strongly about which is toxic exposure for veterans. Particularly burn pits.
▶ 1:08:23Sen. Slotkin: I was a cia officer and lived in iraq for many years and the burn pit exposure come you didn't have to be a doctor to understand that it is pretty crazy to live close to a place where you burn all kinds of trash. We passed the pact act which I think was an important lesson that we weren't going to let 9/11 veterans have to fight for early years the way the agent orange folks, exposure folks in vietnam had to fight.
▶ 1:08:52Sen. Slotkin: And we got a bunch of new veterans into v.a. Care who served in places where we burn trash. I was proud play a small part in that. The bill I'm interested in now is kind of the next part of that story, which is the molly loomis research for descendants of toxic exposed veterans act.
▶ 1:09:17Sen. Slotkin: It is a question that is unknown right now, if you are exposed, you have toxic exposure to burn pits and you sir for a long time, what if anything do you pass on to your kids? There is a lot of open questions about that. The bill is basically can we research that and get data behind that? I understand the v.a. Is against it. Can you walk me through your feeling on the bill, and what is the next step the v.a.
▶ 1:09:46Sen. Slotkin: Is looking at for talking exposure -- toxic exposure for the 9/11 era particularly?
▶ 1:09:53Ms. Devlin: We believe we have the. Place. Part of it was put in place by the pact act to research conditions and exposures that have signs behind them and we do preliminary research and we determine which ones we need to delve into and do more extensive research. We work with the national academy of sciences in medicine and engineering on these.
▶ 1:10:18Ms. Devlin: There has not been a significant association shown at this point that shows any descendants impact of toxic exposures. We are researching other exposures and I'm happy to share those with you.
▶ 1:10:31Sen. Slotkin: You have a program that has been funded were sponsored by the v.a. That looks at the descendants, not -- certainly we had a debate in the pact act about which conditions would qualify. Do we have science to link to the toxic exposure, which I get. But is there a funded project looking at the descendant piece, the children?
▶ 1:10:54Ms. Devlin: It is not specifically looking at descendants. We determine which exposures, which locations, particles, specific items that veterans are exposed to during service and determine which ones require further research. The last research on toxic exposure for descendants was in 2018 and did not show a significant association.
▶ 1:11:21Sen. Slotkin: I would like to see it because we hear this. We need the science behind it but we hear from veterans that folks, many of them have had children and they feel like there are similarities across what they are seeing in their children so I think it is important we understand and have done the work. But I will look at the 2018 stuff. I think the demand signal is there.
▶ 1:11:45Ms. Devlin: Happy to share it with you.
▶ 1:11:46Sen. Slotkin: The other issue I wanted to talk about was on this communication when veterans leave the v.a. System and go on the open market for their care. Something that has been much discussed here. We keep hearing there are problems when someone goes out on intercommunity care, their records coming back to the v.a. And there is a drop off.
▶ 1:12:13Sen. Slotkin: So there is a bill, a bipartisan bill, the caring for our veterans health act that would improve information sharing between the v.a. And these normal providers out on the market. Can I get your thoughts on that? Because we want them to get care but it should be up to the veteran -- it should not be up to the veteran to get the records to the v.a.
▶ 1:12:35Dr. O'Toole: It is a concern and a challenge for us. And we are investigating, identifying issues and problems as well.
▶ 1:12:50Dr. O'Toole: Much of the efforts involved are going to be captured in the nexgen contract, with the enhanced role of the third-party administrators in terms of collecting and managing those records. Our mission on the bill is that we are better served working through a contractual and business arrangement rather than having to legislate for the outcomes we are trying to achieve.
▶ 1:13:19Dr. O'Toole: But we share your concerns with this as a strategy issue.
▶ 1:13:24Sen. Slotkin: I yield back.
▶ 1:13:25Chair Moran: I was just expressing to senator blumenthal that I think he and I to my knowledge were the first to introduce legislation, and it became law, it was the toxic exposure research act of 25th teen that looked at the consequences to the next generation of toxic exposed veterans.
▶ 1:13:50Chair Moran: My awareness of the issue came from the vietnam veterans of america forum conference in wichita that I attended, and that is why I indicated I am interested in continuing, senator murray asked a similar western, interested in working with you and others, I was going to ask Ms. devlin when I think I heard her say, research was done according to the toxic exposure act of 2015. And the conclusion of the research was what?
▶ 1:14:22Ms. Devlin: The conclusion of the research from 2018 was that there was no significant association between toxic exposures in the asia areas related to children, descendants of those veterans.
▶ 1:14:36Chair Moran: What did the research consist of? How was the research conducted?
▶ 1:14:40Ms. Devlin: It was conducted in collaboration with the national academy of sciences in medicine. We can provide you the report.
▶ 1:14:47Chair Moran: I have seen it. It has been a while. Did you indicate as a result of that conclusion, there is no research currently ongoing at the v.a. Related to this topic with the next generation for the veteran parent or grandparent?
▶ 1:15:09Ms. Devlin: Not to my awareness, unless Dr. o'toole is familiar. Not on descendants specifically. >> just to clarify, are you aware of other research outside the ba that's ongoing with respect to this issue?
▶ 1:15:26Ms. Devlin: I'm not aware of any research on descendants.
▶ 1:15:30Dr. O'Toole: I'm not aware but I have not been actively tracking. We do track it as part of the pack act of current veterans, but as far as descendants, I don't know. 2018 was a while back.
▶ 1:15:47Chair Moran: 10 years ago what I recall from the conference I intended -- attended was very vivid and stuck with me. The circumstances I heard about and saw related to veterans and their next generations.
▶ 1:16:07Sen. Slotkin: Certainly have heard from vietnam veterans, their perception that things can be passed on to their kids, but would just offer -- and I am not a scientist, but agent orange exposure can't be exactly the same as burn pit exposure. At a minimum if you have a bipartisan interest in supporting that kind of research , it is part of what we owe to folks if there is a possibility it affects their children.
▶ 1:16:37Sen. Slotkin: I would be happy to see this committee push it forward. >> if I'm -- if I may, I think senator slotkin is right, that this area cries out for bipartisan action and I am struck by the stories I have heard from veterans about children bearing the diseases and afflictions that are attributed by medical experts to
▶ 1:17:08Sen. Slotkin: The exposure to the burn pits and other kinds of toxic substances, including in this country at camp lejeune. Thank you, Mr. chairman, and thank you, senator slotkin.
▶ 1:17:29Chair Moran: Thank you, Ms. devlin and Dr. o'toole, for joining us today. We will now dismiss you. -- ounce -- that sounds like a harsh word. We will now ask the next panel to approach the desk and join us. Thank you.
▶ 1:18:09Chair Moran: Thank all three of you for being here. Mr. brown, I will recognize you first.
▶ 1:18:15Mr. Brown: Thank you, Mr. chairman and ranking member blumenthal and members of the committee. Paralyzed veterans of america would like to thank you for the opportunity to testify on pending legislation impacting v.a. That the committee is reviewing today. Obviously there are many bills on the docket so I'm going to limit my comments to just three that we feel most closely impact our members.
▶ 1:18:43Mr. Brown: Pva supports the veteran review and reclaim act, which seeks to limit v.a. Authority to deny a veterans claim solely on the veteran's failure to appear for medical examination associated with the claim. Thousands of veterans claims for service connection, claims for increase, and for other benefits like total disability, individual unemployability, and aid and attendance have been denied solely because of missing an examination.
▶ 1:19:13Mr. Brown: There are legitimate reasons a veteran may not be able to attend a scheduled exam. We are aware of numerous instances where v.a. Contractors erroneously reported the veteran as a no-show. Veterans with cid's often encounter multiple barriers in travel when compared to other veterans and are apt to miss some appointments. We believe the passage of this legislation will in short a missed exam isn't the only basis for denying the claim.
▶ 1:19:44Mr. Brown: V.a. Should carefully consider whether an examination is needed as many veterans with scid already receive most of their care through the scid system of care, therefore the records have adequate information to provide an accurate picture of their disabilities.
▶ 1:20:02Mr. Brown: We also support the veterans appeals efficiency act, which would establish additional requirements for the board of veterans appeals, such as information on higher-level reviews, supplemental claims, and notices of disagreement.
▶ 1:20:19Mr. Brown: It also requires the tracking of claims pending the national work queue, not assigned to an adjudicator, case is remanded by the board, veterans appeals improvement and modernization act cases pending a hearing, and when a decision-maker did not comply with the board to a vs decision. We recognize the value of and support efforts to track data to improve the effectiveness and accuracy of claims processed.
▶ 1:20:48Mr. Brown: The data sought by this legislation will be meaningless unless the department addresses the problems that hinder their ability to attain proper medical opinions, since this continues to result in re-mandible errors. This act would give the board the authority to aggregate certain claims.
▶ 1:21:05Mr. Brown: While pva does not oppose allowing the board to aggregate appeals involving common questions of law or fact, we believe that before that can be done a feasibility study should be conducted and the findings reviewed. Then legislation based on those findings should be brought forth. In times of fiscal constraint, joint use agreements between dod and v.a.
▶ 1:21:30Mr. Brown: Should be prized for their ability to increase access to care for service members and veterans while reducing overall federal spending. Such agreements allow for the sharing of medical personnel, facilities and resources which can lead to faster access to high-quality care, and improved medical outcomes. They also reduce bureaucracy and improve the efficiency of the system.
▶ 1:21:57Mr. Brown: Dod nba have had the authority to execute these agreements for decades but have never really used them to achieve their full potential. Pva supports the serve act, which reinforces some existing authorities and will improve access to health care by improving collaboration and increasing the use of these agreements between the two departments. I thank you again for the opportunity to share our views and I will be happy to answer any questions.
▶ 1:22:24Chair Moran: Thank you. Ms. springer, your testimony.
▶ 1:22:27Ms. Springer: Good afternoon, chairman moran, ranking member blumenthal, members of the committee. On behalf of the men and women of foreign wars of the united states, thank you for the opportunity to provide remarks. Written testimony includes the vfw's positions on all the bills under consideration. I will highlight three.
▶ 1:22:49Ms. Springer: The vfw supports 165 seven, review every veterans claim act 2025, legislation we have championed the last few years. This bill would ensure the v.a. May not deny a disability claim solely because the veteran missed a compensation pension examination. We believe this bill would move v.a. Toward a more flexible, veteran centered claims process. When scheduling conflicts arise, veterans should not be penalized.
▶ 1:23:18Ms. Springer: We understand veterans miss appointments for many reasons, such as illness, lack of transportation, were conflicts, simple misunderstandings, and should not be forced to restart their claim because of a missed appointment. Vfw has assisted many veterans who had to reopen claims for this reason. The process is burdensome and can be exhausting. We recommend v.a. Return the claims to work queue with a missed medical examination flag so the process can resume where it stopped.
▶ 1:23:48Ms. Springer: We recommend when the evidence in the file establishes the existence and severity of the disability and would lead to a favorable outcome, v.a. Should adjudicate the claim based on that evidence. When the record is insufficient, the cmp examination should remain mandatory to ensure an informed decision.
▶ 1:24:08Ms. Springer: Vfw supports s 1992, veterans appeals efficiency act of 2025, which would give the board of veterans appeals, the court of appeals of veterans claims tools to approve the efficiency of appeals, reduce the backlog of appeals, and allow appellate to receive quicker decisions.
▶ 1:24:28Ms. Springer: It would allow bba to aggregate some claims, assign appeals simultaneously, and grant bba presidential authority if feasible that would reduce preferential legislation and clarify evidentiary support for the advancement of the docket request and the typical timeline for a decision.
▶ 1:24:50Ms. Springer: The bill would expand the courts's ability to certify class actions, resolve systemic actions that affect veterans at once, and codify the courts authority to issue limited romance, which would allow bva to correct an error without opening an entire appeals. The limited romance would enhance efficiency but are rarely used because no clear criteria currently exists. This legislation would change that. Many veterans wait up to two years for a decision, longer if they request a hearing.
▶ 1:25:22Ms. Springer: With the number of pending appeals, bva cannot make progress using current processes. These tools would require -- would provide the opportunity to break that paradigm and streamline the process. We support the bills enhanced reporting and data tracking requirements and recommend two editions. Track the impact of natural disasters on docket advancement because that can significantly delay case movement.
▶ 1:25:49Ms. Springer: And track cases in which inevitable survivor request substitution for a deceased claimant for the purpose of pursuing the claim to completion. The v.a. Supports the discussion draft titled sharing resources for veterans everywhere, or serve act. This would strengthen collaboration and research sharing between v.a., dod, expand health care access for veterans, especially those who live near military medical treatment facilities.
▶ 1:26:16Ms. Springer: Allowing veterans in rural and underserved areas to utilize nearby military hospitals would reduce travel, shorten wait times, make better use of federal medical capacity that might otherwise go unused. Increased resource sharing would promote better systems integration between dod nba, facilitate joint training, all of which would contribute to better continuity of care for active duty service members and veterans.
▶ 1:26:44Ms. Springer: While successful implementation would require funding, staff, and data integration, this proposal would represent an opportunity to leverage existing federal health care resources for veterans. Chairman moran and ranking member blumenthal, thank you for the opportunity to share remarks. I look forward to answering your questions.
▶ 1:27:02Chair Moran: Thank you. Mr. stichman.
▶ 1:27:05Mr. Stichman: I would like to thank chair moran, ranking member blumenthal, and the members of this committee for the opportunity to present our views regarding the pending legislation before the committee.
▶ 1:27:19Mr. Stichman: Nvlsp firmly supports, as do my colleagues on this panel, the veterans appeals efficiency act, s1992, which contains several reforms which would meaningfully improve speed, accuracy, and efficiency in the adjudication of benefit claims at the v.a. And the veterans board.
▶ 1:27:46Mr. Stichman: First, the veterans appeals efficiency act would restore the supplemental jurisdiction the veterans court used to have for cases in which a veteran denied benefits by the bva seeks certification of its appeal to the veterans board has a class action. As 1992 would overrule the recent decision for the federal circuit.
▶ 1:28:12Mr. Stichman: The rule announced bars the large majority of similarly situated veterans with pending claims at the bva or a claims at the bva or ro from being included in the class and counting towards the requirement of there being at least 40 punitive class members.
▶ 1:28:34Mr. Stichman: S1992 would require the veterans court to use the same approach used by all other article three courts who handle class actions, namely counting towards the numerosity requirement, similarly situated veterans with appeals pending before the bva or on supplemental claims before the regional offices.
▶ 1:28:58Mr. Stichman: This would ensure the continued viability of class actions, which for years have helped streamline the v.a. Benefits system. Second, section 2e of s1992 would encourage the court to exercise existing authority to issue limited romance.
▶ 1:29:23Mr. Stichman: Currently when the veterans court encounters a defect that requires agency action on one issue in an appeal involving multiple issues, the court typically remands the entire case back to the bva for correction of one error without addressing any of the other issues. This piecemeal approach adds years to the adjudication and results in substantial delays for veterans.
▶ 1:29:52Mr. Stichman: The court possesses the ability to issue limited romance while remaining -- retaining jurisdiction over the rest of the case but rarely does so because it's authority is not well defined and current precedent confines its use to exceptional circumstances.
▶ 1:30:11Mr. Stichman: The veterans appeals efficiency act codifies the court to a fiesta existing authority to order limited remands and exhorts the veterans court to develop guidelines governing their use, including authority to require the bva to act within a specified timeframe so that the case may expeditiously return to the court for a final court decision that disposes of the entire appeal.
▶ 1:30:38Mr. Stichman: By directing the court to articulate standards for when and how limited remands will be used, this bill will enable all participants to understand when limited remands are available and the proper process for requesting them. This reform turns an underused mechanism into a practical, accessible means of reducing delay and expediting relief.
▶ 1:31:09Mr. Stichman: In addition, nvlsp supports section 2d1 of the veterans appeals efficiency act, which aims to reduce the backlog of appeals by confirming the vba's authority to aggregate appeals.
▶ 1:31:27Mr. Stichman: While more than 70 other federal agencies have rules that facilitate aggregation of administrative appeals, the bva is an outlier and insisting it lacks power ever to group together appeals raising the same question of law or fact for efficient adjudication.
▶ 1:31:50Mr. Stichman: The bill would codify the authority of the bva to aggregate claims in appropriate cases after a federally funded research and development center does an assessment with bso input of the feasibility of bva aggravation and presidential decision-making. I would be happy to answer any questions you may have.
▶ 1:32:14Chair Moran: Back to my practice of law or law school, I'm not sure which, but something sounded familiar in your testimony.
▶ 1:32:23Sen. Blumenthal: I apologize, I have another commitment I have to go to, but I think this testimony has been very important and I have no substantive questions. If I think of any, I will pose them in writing. I want to thank every one of you for your service and we hopefully will move forward. Thank you, and I think the chairman for his courtesy.
▶ 1:32:51Sen. Blumenthal: I also want to put in the record, if I may, an analysis from the urban institute. I believe I referred to it earlier. It provides the basis for the number, 267,000 veterans that I mentioned earlier is the number that would lose their insurance if these subsidies are not extended.
▶ 1:33:14Chair Moran: No objection to be entered. Senator king, is it helpful if you go before I do? Now that I have offered, you could accept. [laughter] senator king, along with senator banks, 1657. I consider its passage a priority.
▶ 1:33:44Chair Moran: It seems odd to me that it's necessary and I was wondering if any of you have the statistics that demonstrate how often someone is denied their opportunity for a claim because of missing a physicians appointment. Is it a significant problem or a rarity? I will check with my caseworkers and I will find out.
▶ 1:34:10Mr. Brown: I don't think it's a data point that we actually track, but we are aware from time to time talking with our service officers that they are having to go back after the fact and attempt to get one of our members back into the system.
▶ 1:34:30Chair Moran: Certainly I encourage the v.a. To fix the problem itself immediately in the absence of that, or even with that occurring. I look forward to the passage of the legislation. I want to ask about the serve act, really for each of you or any of you who have thoughts you would like to share.
▶ 1:34:57Chair Moran: Working directly with service members and veterans, where do you see the biggest gap in health services during transition from dod to v.a., and do you believe this legislation can be part of the solutions to those problems and desire to improve the continuity of care? Mr. brown, you seemed perhaps the most anxious.
▶ 1:35:19Mr. Brown: I was just thinking what would be the greatest area for me. If you don't mind, I will share my personal experience. Currently I am fortunate my primary care manager for v.a. Is a provider I saw while serving on active duty.
▶ 1:35:40Mr. Brown: I think one of the bigger advantages in terms of transition, if we were to expand access for veterans to be seen in the dod system, certainly being able to see a provider that already knows your history so you don't have to repeat it would be a clear advantage.
▶ 1:35:58Chair Moran: You have heads nodding behind you, so you hit upon a point that apparently needed to be made. I assume the availability of that opportunity is going to be geographic. It depends on where the provider and veteran is.
▶ 1:36:14Mr. Brown: That is true. I happen to live outside andrews air force base and she works on allentown road, so most fortunate.
▶ 1:36:22Ms. Springer: I would go along with Mr. brown's comments. I will use a personal story as well. I am a tricare beneficiary, but very similar in some cases. I think transition from active duty to veterans status, there is a lack of familiarity in the process. I use a military clinic aboard fort meyer, and that is just like being on active duty.
▶ 1:36:50Ms. Springer: I have a primary care manager where they get me in for appointments. If they can't do it, they send me to another clinic or out in town, where it's very familiar. I think that would help transitioning service members keep up with their medical, get signed up, and go to a place that's familiar, a military treatment facility.
▶ 1:37:13Chair Moran: Part of my interest revolves around fort riley and urban army hospital and the v.a. In topeka in particular, but v.a. Hospitals in kansas. I was thinking that would be rare in kansas because we live so far from fort riley and the urban army hospital.
▶ 1:37:34Chair Moran: For a lot of service members who retired retire near the last place they served, there is a military hospital that would be of great benefit, so I appreciate both of those stories. Mr. stichman?
▶ 1:37:51Mr. Stichman: I have nothing further to add.
▶ 1:37:53Chair Moran: One more question. That's on the fisher house. Just for my help, I think there is a piece of legislation we will be able to pass into law, but I will be speaking about it with my colleagues either in person or on the floor of the senate.
▶ 1:38:16Chair Moran: Based upon your members' experiences, how significant is the unmet demand for lodging today and do you believe expanding eligibility will improve access to care? Why or why not? What role does housing play in access to care and is it a challenge in many places? Ms. springer, you seem the most interested.
▶ 1:38:37Ms. Springer: This hasn't been brought to my attention as a huge problem, but anytime you get care you have to think about the logistics. Where am I going to house my family members? How much is it going to cost? How is that going to affect my willingness to go? If there is unused space in the fisher houses, which are wonderful institutions, that's a very positive thing to do rather than have it sit empty.
▶ 1:39:08Ms. Springer: Have people fill it up, active duty members and families, is a very good thing and we support this proposal.
▶ 1:39:16Chair Moran: I would use the opportunity to thank fisher house and what great work they do across the nation.
▶ 1:39:24Sen. King: I would like to join you in thanks to the fisher foundation for the work they do. It's amazing. On the issue of transition, we had a built in for a hearing that would allow active duty servicemembers to pre-enroll in v.a. Health care before they transition out, so there is no gap. Mr. brown, you have any views on that idea?
▶ 1:39:49Mr. Brown: I believe we would support that legislation.
▶ 1:39:53Sen. King: That's what I was hoping you would say. Mr. brown, you heard me in my exchange with the doctor about falls. We have a bill in to try to focus the attention of the v.a. On falls. Give me your thoughts on that.
▶ 1:40:12Mr. Brown: So pva supports your legislation. I think you mentioned it twice now. One out of four veterans over the age of 60, was it? So I don't meet the second criteria yet, but I did meet the first criteria yet. You have to count me twice because I have two major falls that have resulted in a significant health issue.
▶ 1:40:41Mr. Brown: One that not only incapacitated me for several months but also required my wife to take off time to work to get me to my appointments and back and forth and extensive physical therapy and the like. I personally understand the value of fall prevention. We know that every major area, service area within vha certainly has their individual fall prevention programs.
▶ 1:41:12Mr. Brown: It's extremely important for veterans with an sei, ms, and als. I do agree v.a. Would benefit from having that one single point of contact. From the sounds of things from Mr. o'toole's testimony, it sounds like they are already headed that direction, and I'm sure you will look into that with them and verify that. Otherwise, we think your legislation is appropriate.
▶ 1:41:41Sen. King: Any other comments on that?
▶ 1:41:46Ms. Springer: We would actually propose the existing structures v.a. Already has be strengthened. There are already offices that deal with falls prevention. We are not in favor of creating a separate office, but instead take the opposite is already doing this, strengthen them, codify what they are doing, and ensure discussion about falls is that every medical appointment, not just the annual physical.
▶ 1:42:15Ms. Springer: Every time the veteran comes in for care, somebody is asking about falls because it is significant and can lead to other more serious health problems. >> we will look forward to working with Mr. o'toole at the agency to strengthen the current structure and give it a focus that will increase the effectiveness.
▶ 1:42:38Ms. Springer: The second issue I wanted to talk about, the bill I mentioned with senator sheehy on safe gun storage. Ms. springer, any thoughts about that issue?
▶ 1:42:50Ms. Springer: We support that bill. We are very aware of the problem of suicide in our veteran population and we do think that would help decrease those incidents. Anything we can do to separate a person who may be having an impulsive thought and lethal means is something we would support. You can easily roll this out and get it running. We do support this bill.
▶ 1:43:19Mr. Brown: Pva shares the same view.
▶ 1:43:22Sen. King: Thank you for this hearing.
▶ 1:43:27Chair Moran: Senator king, let me ask this panel. You heard the testimony of the v.a., Ms. devlin and Dr. o'toole. Anything you heard that you want to ask them in a written question? Something they said or didn't say that you would like me to further explore? Apparently Dr. o'toole and Ms. devlin passed the test.
▶ 1:43:55Chair Moran: I think we are going to conclude the hearing and I want to again thank the second panel for their testimony as well as the first. I thank the members of our audience and the members of our committee for being here today. Senators who would like to submit written questions for additional statements have a week to do so. I asked our witnesses to respond to any questions they receive in a timely manner.
▶ 1:44:27Chair Moran: We have had conversations this afternoon about how we want to have a markup on these bills and move forward. I have asked the staff to schedule that as expeditiously as we can. We intend to move forward -- >> senate time or real-world time?
▶ 1:44:46Chair Moran: I can tell you senate time has something to do with whether we will be expeditious. They are related. >> I do have advice. If saint peter ever says you have 10 minutes to live, your response could be, could it be during a 10 minute senate vote? Because you will have about an hour.
▶ 1:45:06Chair Moran: Well said. With that, our hearing is adjourned. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap.org]