[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]


                     COMMITTEE ON VETERANS' AFFAIRS
                               MEMBER DAY

=======================================================================

                          MEMBERS DAY HEARING

                               BEFORE THE

                     COMMITTEE ON VETERANS' AFFAIRS

                     U.S. HOUSE OF REPRESENTATIVES

                     ONE HUNDRED SIXTEENTH CONGRESS

                             FIRST SESSION

                               __________

                      TUESDAY, SEPTEMBER 10, 2019

                               __________

                           Serial No. 116-30

                               __________

       Printed for the use of the Committee on Veterans' Affairs
       
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                    Available via http://govinfo.gov
                    
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                     COMMITTEE ON VETERANS' AFFAIRS

                   MARK TAKANO, California, Chairman

JULIA BROWNLEY, California           DR. PHIL ROE, Tennessee, Ranking 
KATHLEEN M. RICE, New York               Member
CONOR LAMB, Pennsylvania, Vice-      GUS M. BILIRAKIS, Florida
    Chairman                         AMATA COLEMAN RADEWAGEN, American 
MIKE LEVIN, California                   Samoa
MAX ROSE, New York                   MIKE BOST, Illinois
CHRIS PAPPAS, New Hampshire          DR. NEAL DUNN, Florida
ELAINE G. LURIA, Virginia            JACK BERGMAN, Michigan
SUSIE LEE, Nevada                    JIM BANKS, Indiana
JOE CUNNINGHAM, South Carolina       ANDY BARR, Kentucky
GILBERT RAY CISNEROS, JR.,           DAN MEUSER, Pennsylvania
    California                       STEVE WATKINS, Kansas
COLLIN C. PETERSON, Minnesota        CHIP ROY, Texas
GREGORIO KILILI CAMACHO SABLAN,      GREG STEUBE, Florida
    Northern Mariana Islands
COLIN Z. ALLRED, Texas
LAUREN UNDERWOOD, Illinois
ANTHONY BRINDISI, New York
                 Ray Kelley, Democratic Staff Director
                 Jon Towers, Republican Staff Director

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public 
hearing records of the Committee on Veterans' Affairs are also 
published in electronic form. The printed hearing record remains the 
official version. Because electronic submissions are used to prepare 
both printed and electronic versions of the hearing record, the process 
of converting between various electronic formats may introduce 
unintentional errors or omissions. Such occurrences are inherent in the 
current publication process and should diminish as the process is 
further refined.
                         
                         C  O  N  T  E  N  T  S

                              ----------                              

                      TUESDAY, SEPTEMBER 10, 2019

                                                                   Page

                           OPENING STATEMENTS

Honorable Mark Takano, Chairman..................................     1
Honorable David P. Roe, Ranking Member...........................     2
Honorable Anthony Brindisi, U.S. House of Representatives, (NY-
  22)............................................................     3
Honorable Mike Bost, U.S. House of Representatives, (IL-12)......     7
Honorable Greg Steube, U.S. House of Representatives, (FL-17)....     8
Honorable Jack Bergman, U.S. House of Representatives, (MI-01)...    12
Honorable Lauren Underwood, U.S. House of Representatives, (IL-
  14)............................................................    38

                               WITNESSES

Honorable Steve Womack, U.S. House of Representatives, (AR-03)...     4
Honorable Steve Stivers, U.S. House of Representatives, (OH-15)..    10
Honorable Salud Carbajal, U.S. House of Representatives, (CA-24).    14
Honorable Scott Peters, U.S. House of Representatives, (CA-52)...    15
Honorable Vicky Hartzler, U.S. House of Representatives, (MO-04).    17
Honorable Stacey Plaskett, U.S. House of Representatives, (Virgin 
  Islands).......................................................    19
Honorable Dean Phillips, U.S. House of Representatives, (MN-03)..    21
Honorable Brian Mast, U.S. House of Representatives, (FL-18).....    23
Honorable Earl L. "Buddy" Carter, U.S. House of Representatives, 
  (GA-01)........................................................    24
Honorable David Rouzer, U.S. House of Representatives, (NC-7)....    26
Honorable Debbie Mucarsel-Powell, U.S. House of Representatives, 
  (FL-26)........................................................    27
Honorable Tom Malinowski, U.S. House of Representatives, (NJ-7)..    28
Honorable Darren Soto, U.S. House of Representatives, (FL-09)....    29
Honorable Elise M. Stefanik, U.S. House of Representatives, (NY-
  21)............................................................    31
Honorable Brad Wenstrup, U.S. House of Representatives, (OH-02)..    33
Honorable Kevin McCarthy, U.S. House of Representatives, (CA-23).    35
Honorable Tim Walberg, U.S. House of Representatives, (MI-07)....    37
Honorable Clay Higgins, U.S. House of Representatives, (LA-03)...    39
Honorable Lee Zeldin, U.S. House of Representatives, (NY-01).....    41
Honorable Bill Johnson, U.S. House of Representatives, (OH-06)...    43
Honorable Raul Ruiz, U.S. House of Representatives, (CA-36)......    44
Honorable Lloyd Smucker, U.S. House of Representatives, (PA-11)..    46
Honorable Joaquin Castro, U.S. House of Representatives, (TX-20).    48
Honorable John R. Carter, U.S. House of Representatives, (TX-31).    49
Honorable French J. Hill, U.S. House of Representatives, (AR-02).    53
Honorable Jim Baird, U.S. House of Representatives, (IN-04)......    54
Honorable Ann McLane Kuster, U.S. House of Representatives, (NH-
  02)............................................................    56
Honorable Ross Spano, U.S. House of Representatives, (FL-15).....    57
Honorable Robert J. Wittman, U.S. House of Representatives, (VA-
  01)............................................................    58
Honorable Jim Costa, U.S. House of Representatives, (CA-16)......    60

                                APPENDIX
                    Prepared Statements Of Witnesses

Honorable Steve Womack, U.S. House of Representatives, (AR-03) 
  Prepared Statement.............................................    65
Honorable Steve Stivers, U.S. House of Representatives, (OH-15) 
  Prepared Statement.............................................    66
Honorable Salud Carbajal, U.S. House of Representatives, (CA-24) 
  Prepared Statement.............................................    67
Honorable Scott Peters, U.S. House of Representatives, (CA-52) 
  Prepared Statement.............................................    68
Honorable Vicky Hartzler, U.S. House of Representatives, (MO-04) 
  Prepared Statement.............................................    69
Honorable Stacey Plaskett, U.S. House of Representatives, (Virgin 
  Islands) Prepared Statement....................................    70
Honorable Dean Phillips, U.S. House of Representatives, (MN-03) 
  Prepared Statement.............................................    71
Honorable Brian Mast, U.S. House of Representatives, (FL-18) 
  Prepared Statement.............................................    72
Honorable Earl L. "Buddy" Carter, U.S. House of Representatives, 
  (GA-01) Prepared Statement.....................................    73
Honorable David Rouzer, U.S. House of Representatives, (NC-7) 
  Prepared Statement.............................................    74
Honorable Debbie Mucarsel-Powell, U.S. House of Representatives, 
  (FL-26) Prepared Statement.....................................    75
Honorable Darren Soto, U.S. House of Representatives, (FL-09) 
  Prepared Statement.............................................    75
Honorable Elise M. Stefanik, U.S. House of Representatives, (NY-
  21) Prepared Statement.........................................    76
Honorable Brad Wenstrup, U.S. House of Representatives, (OH-02) 
  Prepared Statement.............................................    77
Honorable Kevin McCarthy, U.S. House of Representatives, (CA-23) 
  Prepared Statement.............................................    78
Honorable Tim Walberg, U.S. House of Representatives, (MI-07) 
  Prepared Statement.............................................    79
Honorable Clay Higgins, U.S. House of Representatives, (LA-03) 
  Prepared Statement.............................................    80
Honorable Lee Zeldin, U.S. House of Representatives, (NY-01) 
  Prepared Statement.............................................    80
Honorable Bill Johnson, U.S. House of Representatives, (OH-06) 
  Prepared Statement.............................................    82
Honorable Raul Ruiz, U.S. House of Representatives, (CA-36) 
  Prepared Statement.............................................    82
Honorable Lloyd Smucker, U.S. House of Representatives, (PA-11) 
  Prepared Statement.............................................    84
Honorable Joaquin Castro, U.S. House of Representatives, (TX-20) 
  Prepared Statement.............................................    84
Honorable John R. Carter, U.S. House of Representatives, (TX-31) 
  Prepared Statement.............................................    86
Honorable French J. Hill, U.S. House of Representatives, (AR-02) 
  Prepared Statement.............................................    86
Honorable Jim Baird, U.S. House of Representatives, (IN-04) 
  Prepared Statement.............................................    87
Honorable Ann McLane Kuster, U.S. House of Representatives, (NH-
  02) Prepared Statement.........................................    88
Honorable Ross Spano, U.S. House of Representatives, (FL-15) 
  Prepared Statement.............................................    89
Honorable Robert J. Wittman, U.S. House of Representatives, (VA-
  01) Prepared Statement.........................................    89
Honorable Jim Costa, U.S. House of Representatives, (CA-16) 
  Prepared Statement.............................................    90
                       Statements For The Record

Honorable Jahana Hayes, U.S. House of Representatives, (CT-05)...    93
Honorable Adriano Espaillat, U.S. House of Representatives, (NY-
  13)............................................................    94
Honorable Christopher H. Smith, U.S. House of Representatives, 
  (NJ-04)........................................................    95
Honorable Dave Loebsack, U.S. House of Representatives, (IA-02)..    96
Honorable Debbie Lesko, U.S. House of Representatives, (AZ-08)...    97
Joint Statement: by The Honorable Elijah Cummings, and The 
  Honorable Ted Yoho, U.S. House of Representatives..............    97
Honorable Glenn "GT" Thompson, U.S. House of Representatives, 
  (PA-15)........................................................    98
Honorable Gwen Moore, U.S. House of Representatives, (WI-04).....    99
Honorable Jenniffer Gonzalez-Colon, U.S. House of 
  Representatives, (PR- At-Large)................................   102
Honorable Peter DeFazio, U.S. House of Representatives, (OR-04)..   103
Honorable Sean Maloney, U.S. House of Representatives, (NY-18)...   104
Honorable Steve King, U.S. House of Representatives, (IA-04).....   105

 
               COMMITTEE ON VETERANS' AFFAIRS MEMBER DAY

                              ----------                              


                      Tuesday, September 10, 2019

                    Committee on Veterans' Affairs,
                            U. S. House of Representatives,
                                                   Washington, D.C.

    The Committee met, pursuant to notice, at 10:00 a.m., in 
Room 210, House Visitors Center, Hon. Mark Takano [Chairman of 
the Committee] presiding.
    Present: Representatives Takano, Lamb, Brindisi, Pappas, 
Cunningham, Cisneros, Sablan, Underwood, Roe, Bilirakis, Bost, 
Dunn, Bergman, Roy, and Steube.

           OPENING STATEMENT OF MARK TAKANO, CHAIRMAN

    The Chairman. Good morning. I call this hearing to order.
    I want to welcome our Committee Members back from the 
district work period. Welcome, first day of school, everybody. 
Hope you all bought new lunch pails and are ready to go.
    During the work period, we had a chance to hear from and 
connect with our constituents. Each of us represent veterans, 
which is why our Member Day Hearing is so important.
    In my own district, I recently met with the new Director of 
the Loma Linda VA, Karandeep Singh Sraon, and to discuss his 
plans to address facility conditions and inadequacies 
identified in a recent Inspector General report.
    Earlier this summer, I hosted a Veterans' Town Hall at VFW 
Post 10267 in Jurupa Valley, where I heard from veterans in my 
district about the service and quality of care at the Loma 
Linda VA; benefits for Blue Water Navy veterans; difficulties 
with veterans' disability benefits, benefits claims; and 
concerns about the privatization of the VA.
    Last week, my district hosted a Veterans Benefits Academy 
Workshop to assist homeless veterans, which is the first 
workshop in a series of classes that will be hosted to address 
numerous veteran-related topics.
    Since I began my tenure as Chairman of the House Committee 
on Veterans' Affairs, I have also visited VA facilities across 
the country to better understand the challenges our veterans 
face and how we might position VA to better serve the needs of 
all our veterans.
    In Orlando, I spoke with women veterans and toured an 
impressive, state-of-the-art facility that serves minority 
women and LGBT veterans. In the Pacific Northwest, I gained 
valuable insight into the VA's Electronic Health Records 
Modernization. In Puerto Rico, we heard from veterans impacted 
by Hurricane Maria and assessed how prepared VA is for future 
natural disasters. And, last week, I went to Little Rock VA 
with Representative Hill and asked about VA staffing, to ensure 
we can recruit and retain top employees.
    At the DAV convention in Florida, I reiterated again our 
work to better support veterans in crisis and answer veterans' 
questions about our work here in Congress. When speaking with 
Student Veterans of America, I shared our work to protect 
student veterans from predatory, for-profit institutions, and 
guarantee veterans have a clear pathway to expanded educational 
opportunities.
    Following an on-campus suicide in the Atlanta VA Medical 
Center, with Representative McBath and I, we learned how 
pervasive the problem of veteran suicide is at our facilities 
and so far, we have passed five bills to address it.
    Since then, I have reiterated my call for a VA-wide stand-
down to adequately address the crisis of veteran suicide and 
assess what changes we still need to make. I toured the Boston 
Veteran Affairs Medical Center (VAMC) and got to see the 
incredible, innovative research they are doing in the brain 
lab, but it is clear that we must do more.
    By talking with veterans across the country, I heard about 
the progress that we are making and the issues that we still 
need to address. I hope today's Member Day Hearing will 
continue this conversation, so that we can better advocate for 
veterans across this country.
    The Chairman. With that, I now recognize Dr. Roe for his 
opening statement.

       OPENING STATEMENT OF DAVID P. ROE, RANKING MEMBER

    Mr. Roe. Thank you, Mr. Chairman, and good morning and 
welcome back.
    I was proud to chair the Committee's first ever Member Day 
last year. Our Member Day represents a valuable opportunity for 
us to hear from Members, whether they are on the Committee or 
not, about the issues that are important to them and their 
veteran constituents. It is a pleasure today to be here for the 
Committee's second-ever Member Day.
    Having spent the last 6 weeks away from Washington during 
the district work period, I can say with certainty that some of 
the boldest and best ideas for solving the issues facing our 
Nation and our Heroes come from outside the beltway; from 
creative, hardworking Americans pursuing their vision of the 
American dream, and that is why I am excited to see so many of 
our colleagues participating in the hearing today. Each one of 
them represents a unique veteran community with challenges, 
successes, perspectives, and solutions all their own, and it is 
important that each of their voices is heard as this Committee 
continues our work to better serve veterans and their families.
    I look forward to doing that today, and I yield back.
    The Chairman. Thank you, Dr. Roe, and thank you for 
beginning this tradition, which I am very pleased to continue.
    I will now recognize our Committee Members until it is time 
to call up our first panel at 11:00 a.m. Since Mr. Womack, who 
is not on the Committee, is here and no Members of our 
Committee are looking to--well, he is the only Member before 
us--I know we have Members of our Committee, but I want to give 
him the courtesy of presenting for 5 minutes.
    Mr. Womack. I thank the Chairman. I have had a little 
disconnect with my team this morning, they are en route with my 
remarks. I just left conference. If you could give me just a 
couple of minutes, I will have a staff member here and I will 
be prepared to deliver my remarks, and excuse myself from the 
hearing. Thank you, sir.
    The Chairman. Okay. Mr. Womack, we will be glad to 
accommodate you.
    Mr. Roy. Mr. Roy. Mr. Roy, are you ready to present?
    Mr. Roy. I am not, Mr. Chairman, at this time. I am waiting 
on my staff as well. I apologize, I mean, to our Members.
    Mr. Womack. We are all a bit rusty.
    The Chairman. Mr. Lamb, are you ready? Oh, you are not on 
the list? Okay.
    Any of our--any Members present? Mr. Brindisi, are you 
ready to present? Okay. Go ahead, Mr. Brindisi. You are 
recognized for 5 minutes.

                 STATEMENT OF ANTHONY BRINDISI

    Mr. Brindisi. Thank you, Chairman Takano, and Ranking 
Member Roe, for the opportunity to testify today on the 
importance of addressing veteran and servicemember mental 
health, especially now during Suicide Prevention Awareness 
Month. I would also like to thank the Committee for their 
continued efforts to address veteran suicide this Congress. I 
know our Committee receives many requests and your 
consideration is greatly appreciated.
    We continue to witness a mental health crisis in the 
veteran community. Over the past decade, the number of veteran 
suicides has continued to rise. While the VA has done a better 
job of increasing awareness about veteran mental health and 
suicide, it is clear we must do more to make sure every 
American who has worn the uniform has access to mental health 
resources he or she needs.
    For this reason, I introduced H.R. 2629, the Care and 
Readiness Enhancement for Reservists, or CARE Act. This 
bipartisan legislation would expand eligibility for mental 
health services at VA to include members of the Reserve 
components of the Armed Forces.
    Members of the Guard and Reserve face a unique challenge in 
getting access to quality mental health care. National Guard 
members experience long periods of time between unit activities 
and they often live great distances from resources that are 
often concentrated on military installations. At the same time, 
the United States has never relied more on its National Guard 
and Reserve forces.
    Since 9/11, the National Guard has supported more than 
850,000 overseas deployments in Iraq, Afghanistan, and Kuwait, 
among other locations. During state emergencies, the Guard are 
the first military responders, helping to facilitate a unified 
and speedy response.
    The CARE for Reservists Act would close the gap in mental 
health care available to the Guard and Reserve.
    Currently, members of the Guard and Reserve undergo annual 
health assessments to identify issues that could impact their 
ability to deploy, but any follow-up care is typically pursued 
at their own expense. We continue to see many of our 
servicemembers, active, Guard, and Reserve, return home, 
struggling with Post Traumatic Stress Disorder (PTSD) and other 
mental health conditions after their deployments.
    According to the Department of Defense, the National Guard 
has the highest suicide rate of any other component of the 
Armed Forces. The VA is uniquely positioned in terms of its 
mission and infrastructure to help meet this gap in mental and 
behavioral health for members of the National Guard and 
Reserves. The VA, through its Vet Centers and health clinics 
around the country, can play a vital role in the provision of 
mental and health care for our Guard members and Reservists. I 
believe it is our responsibility as a Committee to expand the 
resources available to them and I urge the Committee to 
consider the CARE Act for Reservists Act, which has been 
introduced on the Senate side by Senators Tester and Moran.
    Thank you for your consideration and thank you for the time 
today.
    The Chairman. Dr. Roe.
    Mr. Roe. First of all, I agree with your premise that the 
Guard and Reserve served, I absolutely do, and we have a bill 
that will allow the Guard and Reservists to go to Vet Centers.
    You mentioned the Guard. In the State of Tennessee, we had 
that issue in 2011. Our new Commander had four suicides in the 
first 40-something days he was a Commander. He initiated a 
system called Guard Your Buddy, and I would love to talk to you 
about it. We have reduced Guard suicide rates by almost 70 
percent in the State of Tennessee. I have been yelling from the 
mountaintop, it seems that nobody will listen. It is a very 
inexpensive program, it works, we should be spreading this out 
all over the country, and I look forward to working with you on 
that issue.
    The Chairman. Thank you, Dr. Roe.
    Mr. Brindisi, thank you very much for your testimony, I 
appreciate it. I look forward to working with you as well on 
this issue.
    Mr. Womack, it looks like you have your remarks.
    Mr. Womack. Indeed.
    The Chairman. Okay. You may proceed, 5 minutes.

                   STATEMENT OF STEVE WOMACK

    Mr. Womack. Thank you, Mr. Chairman, and I appreciate your 
patience this morning as I awaited my remarks.
    Chairman Takano, Ranking Member Roe, distinguished Members 
of this Committee, thank you for the opportunity to speak 
before your Committee on a matter of great importance, not only 
to the great State of Arkansas, but to the country as a whole.
    On August 16th, former VA pathologist Robert Levy was 
indicted on three counts of involuntary manslaughter and 28 
counts of mail fraud, wire fraud, and making false statements 
to law enforcement. These charges stem from Mr. Levy's conduct 
while serving as Chief of Pathology and Laboratory Medical 
Services for the Veterans Health System of the Ozarks located 
in Fayetteville, Arkansas, in my district.
    While he was serving as Chief of Pathology, Mr. Levy was 
responsible for diagnosing veterans after examining their fluid 
and tissue samples. Unfortunately, he repeatedly showed up to 
work intoxicated, first from alcohol and then, in order to pass 
mandated alcohol tests, from a substance called 2M-2B. This 
substance produces a sensation like alcohol but cannot be 
detected on normal alcohol screenings. Mr. Levy was finally 
fired from the VA in April of '18 following 2M-2B being 
detected in a fluid sample.
    Mr. Chairman, this was not Mr. Levy's first time failing an 
alcohol test. He was required to pass mandatory alcohol 
screenings because in 2016 he was found to be intoxicated on 
duty. His blood alcohol content, Mr. Chairman, was 0.396, 
almost five times the legal limit, during the time he was 
scheduled to consult on a biopsy for a patient.
    Following this incident, Mr. Levy had his medical license 
suspended and he was sent to a VA-approved in-patient alcohol 
treatment program. He completed the program and was returned to 
duty with a stipulation that he submit to random alcohol and 
drug tests.
    Let me reiterate, returned to duty. A doctor who had showed 
up for work while intoxicated was returned to duty to care for 
our veterans. This is unacceptable.
    Mr. Levy was not just reinstated, he was allowed to return 
to his position as the Chief of Pathology with no direct 
oversight of his diagnoses.
    His egregious misconduct continued. He not only continued 
to show up for work while intoxicated, but also falsified the 
reviews his subordinates conducted of his work. This was only 
possible because he had been returned to duty as the Chief of 
Pathology.
    I will never understand why the VA returned Mr. Levy to 
duty as a supervisor without putting necessary safeguards in 
place to ensure that his work was properly reviewed. At the 
very least, an independent review process should have been set 
up to allow his subordinates to submit their reviews outside 
the usual chain of command. This situation jeopardized the 
health and well-being of our veterans, so much so that Mr. 
Levy's alleged actions have led to his arrest and Federal 
indictment.
    I know every person here believes that those who risk their 
lives for our country deserve the highest caliber of care 
possible. I know we also agree that no medical professional, 
especially doctors charged with diagnosing our veterans, should 
ever be intoxicated while on duty. We, as Members of Congress, 
must conduct vigorous oversight to determine, how could this 
happen?
    We have worked with your Committee to ensure the VA has 
taken the proper steps to support our veterans who were 
impacted by Mr. Levy's unacceptable conduct. I would like to 
thank you for your help and assistance.
    That being said, we have a duty to further support our 
veterans who were affected by these callous actions. I 
respectfully request your Committee investigate the actions and 
decisions made by the VA throughout the entirety of this 
episode. For the sake of the integrity of our VA medical system 
and the quality of care of our heroes, we must make sure they 
are never repeated.
    Specifically, I find it appalling that a doctor who was 
caught intoxicated on duty was allowed to resume caring for our 
veterans and return to his supervisory position.
    Furthermore, the way the VA engaged with my office, other 
Arkansas delegation offices, and this Committee was concerning. 
The VA is a department of the Federal Government and is subject 
to the oversight of Congress, but throughout the entire episode 
the VA was slow to provide certain important information to the 
relevant people.
    Mr. Chairman, I believe in second chances, but not in life-
or-death circumstances. Without the proper safeguards in place, 
there was no accountability, and now we have seen the result.
    The actions of this desperate individual hit home for me. 
Almost all of us have either served or have family members who 
are serving in the military. Our veterans stepped forward and 
swore to defend our country and our values against all enemies. 
We need to treat them like family--that means guaranteeing 
something like this never happens again in a VA facility.
    I do appreciate your time and your patience today, Mr. 
Chairman, and I am happy to answer any questions as I conclude 
my testimony.

    [The prepared statement of Steve Womack appears in the 
Appendix]

    The Chairman. Mr. Womack, I heard about the situation with 
the pathologist in your district and I was appalled. I want you 
to know that this Committee is taking action. The SubCommittee 
on Oversight and Investigations is scheduling a hearing on the 
credentialing process and this particular incident. We will do 
the oversight on a bipartisan basis and we will get to the 
bottom of this.
    I am particularly disturbed by your comments as they relate 
to the VA's relationship to you and other members of the 
Arkansas delegation. Congress does have a duty to do oversight 
and we will.
    Dr. Roe, do you have anything you want to add?
    Mr. Roe. Mr. Womack, thank you, and we are aware of that. 
Look, I have been on the credentials Committee of our hospital, 
there is a very--most, at least every hospital that I have been 
associated with have been on the staff, there is a system there 
for people who have come through a rehab program. You say 
second chances, but I can assure you that you do not get to 
supervise yourself, which was the great flaw here that 
occurred, you put the supervisor back as the supervisor and 
that should never have happened.
    Mr. Womack. I appreciate the attention of the Committee and 
grateful for the opportunity to give my testimony here at the 
Member Day today. Thank you so much, Mr. Chairman.
    The Chairman. Well, we are grateful for your testimony, and 
we see that you are doing your utmost to represent your 
constituents and to bring oversight, and this Committee will do 
its duty. Thank you.
    Dr. Dunn, do you have a presentation and are you ready?
    Mr. Dunn. I have no questions.
    The Chairman. You have no questions, okay.
    Mr. Bost, are you ready? Go ahead.

                     STATEMENT OF MIKE BOST

    Mr. Bost. Yes. Thank you, Mr. Chairman.
    Chairman Takano and Ranking Member Roe, thank you for 
holding this hearing and allowing me to speak on three 
important pieces of legislation that will help our Nation's 
veterans.
    Earlier this year, I introduced with my friend Jim Costa 
and the VA Health Center Management Stability and Improvement 
Act. The legislation was introduced after the VA medical center 
that many of my constituents use went years without a permanent 
director. No organization can successfully operate under a 
revolving door of short-term leaders, especially not one tasked 
with caring for American veterans.
    Unfortunately, the situation in my district was not unique. 
This bill pushes the VA to hire permanent directors at all VA 
medical centers. Ensuring consistent leadership is the least we 
can do for our Nation's veterans. Identical language passed the 
House by a voice vote last Congress as an amendment and I hope 
that we will once again pass this bill.
    Another bill that I plan to reintroduce is the VA Hospital 
Establishing Leadership Performance Act, or the VA HELP Act. 
The mission of the Department of Veterans Affairs is to care 
for those who shall have borne the battle. When the veteran's 
transition from the military, they deserve to have access to 
quality health care and services. Unfortunately, in too many 
instances the VA continues to fall short on that promise due in 
part to the failures in human resources officers.
    This issue hit close to home for me when a VA National 
Center for Patient Safety surveyed the Marion VA in my 
district. The Marion survey showed a decline in the key factors 
such as communication between management and staff and 
reporting problems to management.
    Committee staff then visited Marion in order to get a 
firsthand look at the issues at the facility. During the site 
visit, multiple employees raised concerns about the poor 
management and communication, distrust between leadership and 
management, and the lack of accountability. The common thread 
throughout has been an issue in human resources. The HR 
management is a critical part of delivering quality health 
care.
    This straightforward legislation instructs the VA Secretary 
to establish qualifications for HR positions within the 
Veterans Health Administration (VHA) and set a performance 
metric for these positions. This bipartisan bill had passed the 
House last Congress with 417-to-nothing vote and I hope the 
same can be done this Congress.
    Finally, earlier this year I introduced H.R. 1962, the VA 
Cost Savings Enhancement Act. This bipartisan legislation, 
introduced with Representative Josh Harder, will cut down on 
unnecessary spending at VA medical facilities by instructing 
the VA to install on-site medical waste treatment systems at 
medical centers where there will be a cost savings. A 2012 
study showed that on-site medical waste treatment at individual 
VA facilities may cost half as much as spent on waste off site, 
to take off site to treatment locations; however, little action 
had ever been initiated.
    This simple reform will also bring the VA up to the best 
practice standards from the Centers for Disease Control and 
Prevention, and World Health Organizations. The savings 
generated from this can be used to help our country's veterans. 
Identical legislation passed the House and Congress with 
overwhelming support last Congress.
    Again, Mr. Chair and Ranking Member, thank you for allowing 
me to testify, and I hope that these three bipartisan bills can 
soon be moved and have a chance to make it through the House, 
over to the Senate, and to be signed by the President. Thank 
you so much.
    The Chairman. Thank you for your testimony, Mr. Bost.
    Ms. Underwood, do you have a presentation or----
    Ms. Underwood. No.
    The Chairman. You do not, okay.
    Is there anybody--oh, Mr. Steube, would you like to 
present?
    Mr. Steube. Yes, Mr. Chairman.
    The Chairman. Go ahead. You are allotted 5 minutes.

                    STATEMENT OF GREG STEUBE

    Mr. Steube. Thank you, Mr. Chairman. I have got three bills 
before this Committee that I would like to talk about, and I 
thank you for the opportunity to do this.
    Thank you, Mr. Chairman. I would like to speak with the 
Committee about a couple of bills to ensure that Congress is 
treating our veterans, and making sure that they are receiving 
the care and treatment that they deserve.
    The first bill is the Enewetak Atoll Cleanup Radiation 
Study Act. From January 1977 through December 1980, 
approximately 6,000 veterans participated in the cleanup for 
the atoll nuclear testing site at Enewetak--I think I am 
pronouncing that correctly, I am sure there is somebody out 
there that can correct me--in the Pacific Ocean. The site was 
home to 43 U.S. nuclear tests from '48 and '58, and the cleanup 
was necessary to return the atoll to the Trust Territory of the 
Pacific Islands.
    The atoll cleanup was performed by a joint task group of 
the Department of Defense and Energy, which rehabilitated the 
area by conducting radiological surveys, removing contaminated 
soil and debris, demolishing contaminated buildings, 
transporting contaminated soil and debris to disposal sites, 
and preparing the area for the return of the inhabitants. In 
this process, veterans who served at the atoll were potentially 
exposed to dangerous doses of radiation through skin contact, 
breathing contaminated air, and drinking and bathing in 
contaminated water. However, there is conflicting scholarship 
on the subject.
    In 2018, the Department of Defense (DOD) conducted a 
radiation dose assessment and determined that veterans who 
served in the Enewetak Cleanup Project (ECUP) were not exposed 
to harmful levels of radiation, but ECUP vets disagree with the 
DOD's findings.
    Last year, in a roundtable before this very subCommittee, 
veterans and scientists cited specific issues with the 
methodology and the assessment of the DOD's review. The 
scientists from the National Academies of Sciences, 
Engineering, and Medicine stated that the DOD's methodology may 
have been outdated and, therefore, the DOD's assessment may be 
inaccurate.
    Though the DOD has refuted some of these claims, I think we 
owe it to these veterans to get to the bottom of this once and 
for all. That is why I have introduced this bill, which calls 
on the Department of Veterans Affairs to partner with the NAS 
to study the effects of radiation on veterans who served in 
that area. The bill instructs them to conduct a small-scale 
study to review the findings of the 2018 Radiation Dose 
Assessment (RDA) and determine if there are discrepancies with 
the DOD's findings. Then they will be required to report back 
to this Committee, so we can review their findings and 
determine next steps. The Secretary of the VA is also required 
to provide his plans to carry out any actions based on the 
study within 90 days of receiving the study.
    This bill would clean up some of the confusion around the 
DOD's RDA and address the concerns of the ECUP veterans. This 
is the least we can do to ensure that those who served our 
country get any benefits from their service to our country if 
they had negative health impacts.
    I have also introduced the Veteran Cannabis Use for Safe 
Healing Act. Receiving the appropriate treatment to address 
your health care needs using products that are legal in the 
State of Florida, the state I hail from, we have medicinal 
marijuana programs that are legal in the State of Florida and 
we are having challenges with veterans who are partaking in a 
state-approved, licensed cannabis program in the state with 
their benefits as it relates to the VA.
    This bill, the Veteran Cannabis Use for Safe Healing Act 
will prohibit the Secretary of Veterans Affairs from denying a 
veteran benefits due to the use of medical marijuana in states 
where the substance is legal. Specifically, the bill will 
codify Veterans Health Administration Directive 1315, Access to 
VHA Clinical Programs for Veterans Participating in State-
Approved Marijuana Programs, which currently protects veterans 
from being denied benefits based on participation in state-
approved medical marijuana programs. It is important to codify 
this directive and ensure that no future change of 
administration or policy could deny veterans their access to 
care.
    This bill also allows VA staff to help veterans fill out 
the forms necessary to enroll in a state-approved program 
instead of having to rely on a private physician. This makes 
things easier for the veterans who are in desperate need of 
these medical options.
    This bipartisan bill was introduced with Congressman Gil 
Cisneros of California and this Committee had a hearing on the 
bill in late April. I hope that we can move this bill to markup 
quickly, so that the veterans in states with legal medicinal 
marijuana can receive the care that they deserve.
    Lastly, I have introduced the Free Veterans from Fees Act. 
This bill waives application fees for special use permits for 
veterans' demonstrations and special events at war memorials on 
Federal land. These demonstrations or special events' primary 
purpose is to commemorate or honor either a group of people 
because of their service or immediate family members of 
veterans. It is important that we do all we can to honor our 
Nation's veterans. Our Nation has long valued giving our 
veterans the opportunity to travel to our Nation's capital, to 
visit national war memorials through national honor buses and 
honor flights. These men and women made a valiant sacrifice by 
serving in the Armed Services and giving them an opportunity to 
visit these memorials without fees is the least that we can do 
to recognize these services.
    I thank you, Chairman, for the time to discuss these bills, 
and yield back the balance of my time.
    The Chairman. Dr. Roe, any comment?
    Thank you, Mr. Steube, for your comments and your 
presentation.
    Do we have any other Members of the Committee that wish to 
present?
    Mr. Roy, no. Mr. Bilirakis. Anybody.
    Then I think we can recess. We will recess until 11:00, 
when we begin the hearing testimony from Members that are not 
on the Committee. We will recess until 11 o'clock.
    The Chairman. We have two Members that are ready to present 
and, rather than make them wait, I thought we would gavel in a 
little early.
    Mr. Stivers, 5 minutes.

                   STATEMENT OF STEVE STIVERS

    Mr. Stivers. Thank you, Mr. Chairman. I want to thank you 
for holding this hearing today to hear from Members, and I want 
to thank Ranking Member Roe for his support of this day for the 
Members to talk about their ideas on veterans' issues.
    As you all know, returning veterans suffer many invisible 
wounds, and it should be Congress' top priority to pursue every 
avenue to disrupt the tragic links between the separation from 
service and mental health illness such as post-traumatic 
stress, Traumatic Brain Injury (TBI), and, worst of all, 
suicide.
    Currently, Congress has authorized the Secretary of 
Veterans Affairs to provide service dogs for veterans with 
hearing, vision, mobility, and mental health needs; however, 
the VA regulations provide this benefit only if the veteran is 
diagnosed with a vision, hearing, or mobility impairment, 
specifically excluding veterans with mental health needs.
    For this reason, I have introduced H.R. 3147 to clarify 
congressional intent by stating that the Secretary may provide 
a service dog to a veteran regardless of whether the veteran 
has a mobility impairment. This zero-cost legislation would 
close the loophole that allows veterans access to animal 
therapies as Congress originally intended.
    To take these efforts further, I am introducing the PAWS 
for Veterans Therapy Act, joined by Representative Rice, 
Representative Dunn, Representatives Rutherford, Walz, 
Cisneros, and Slotkin. This legislation combines two of the 
most popular previously endorsed veterans dog therapy bills 
from the last Congress: the Veteran Dog Training Therapy Act, 
which was passed last Congress, and the PAWS Act, which also 
had a lot of cosponsors last Congress. Eight current Members of 
this Committee cosponsored one or both of those pieces of 
legislation.
    The new PAWS Act for Veterans Therapy would establish a 
pilot program in the VA in which the Secretary would contract 
with local therapeutic dog training organizations and help 
veterans suffering from post-traumatic stress to learn the art 
and science of dog training. This type of work therapy with 
animals is widely recognized as beneficial for veterans 
suffering these invisible wounds. Under this bill, the dog 
would be adopted by the veteran and provide continuing therapy 
during and beyond the training program, unless the veteran or 
the VA health provider opt out of this program.
    The VA, and policymakers on this Committee, have insisted 
on [MM2]waiting on the VA to complete a study. I can tell you, 
that will just cause unnecessary delay. This pilot program can 
be up and running immediately and should be up and running 
immediately. I know some people want to wait on the VA's study, 
but, frankly, our veterans deserve help immediately. We sit 
here during Suicide Prevention Month and World Suicide 
Prevention Day, we have too many veterans committing suicide 
and this is legislation that can help.
    I think there is sufficient reason to make sure we do this 
immediately. You know, we can change things based on whenever 
the VA gets their study done, but that would be another 6 
months to a year and my question for you today is, why wait? 
Why wait in getting these veterans help?
    There is a study conducted by Kaiser Permanente and another 
by Purdue University that show significant statistical benefits 
from this therapy in reducing substance abuse, enhancing, and 
encouraging interpersonal relations, reducing depression-
related metrics for veterans, including a reduction in suicide.
    What is more, the Palo Alto VA is already offering dog 
therapy training through the PAWS for Purple Hearts Program. In 
2017, then-Secretary Shulkin stated that he would not wait for 
more studies to be completed before moving forward, why then 
are we still waiting? We need to put veterans first and make 
sure that we move things along.
    If there is such concern about a pending study, I would 
point out that this legislation is only a pilot program. Let us 
move forward with it and get things moving.
    This Committee I know cares about our veterans and the 
mental health of our veterans, and that is why so many of you 
endorsed or cosponsored these bills last cycle. I would urge 
this Committee to move forward. We are going to introduce the 
PAWS Act this week and it will be with big bipartisan support, 
and I hope we can pass it soon, and then let us get a pilot 
program up and running and help our veterans as soon as we can.
    I want to thank you again for hearing my plea today and it 
is a very appropriate month and day to do it with National 
Suicide Awareness Day and National Suicide Awareness Month. 
Thank you for helping our veterans. Many of you have served and 
those who have not served are helping our veterans by your 
service today. I would urge you to help us by getting this bill 
moving.
    Thank you so much. I will be here and happy to answer 
questions, but I will visit with any Members that want to talk 
about this bill.
    Thank you, Mr. Chairman, I yield back.

    [The prepared statement of Steve Stivers appears in the 
Appendix]

    The Chairman. Thank you, Mr. Stivers, for your testimony.
    Any questions or comments from Members?
    Well, thank you. You are excused.
    General Bergman.

                   STATEMENT OF JACK BERGMAN

    Mr. Bergman. Good morning, Mr. Chairman.
    The Chairman. Good morning, General.
    Mr. Bergman. Chairman Takano, Ranking Member Roe, and my 
fellow Members of the Committee, I sincerely appreciate the 
opportunity to testify before you all today in support of 
legislation introduced by myself and fellow veteran 
Representative Chrissy Houlahan of Pennsylvania. Our bill, H.R. 
3495, the Improve Well-Being for Veterans Act, proposes a grant 
program for the Department of Veterans Affairs to make real 
strides in the fight to end veteran suicide, the crisis 
plaguing our Nation today.
    We have worked diligently to grow bipartisan support for 
this bill in the House, as well as in the Senate, where Senator 
Boozman and Senator Warner proposed this policy. I urge the 
Committee to take up the legislation as the next step in our 
work to end veteran suicide.
    Over the past 15 years, the VA has received billions of 
dollars from Congress for mental health and suicide prevention 
services, and the Committee has worked in a bipartisan manner 
to advance various related efforts. In this time span, however, 
the key statistic has not changed: approximately 20 veterans 
are still taking their own lives each and every day. There is 
still much work to be done, especially considering that the VA 
found that 14 of the 20 veterans who die by suicide each day--
that is 70 percent of those veterans--have had little or no 
contact with the VA care system.
    Thankfully, there are thousands of organizations throughout 
the Nation supplementing our efforts at the Federal level to 
provide veterans with a comprehensive list of services to 
assist with care, employment, and benefits. There is no single 
reason that leads to a veteran's decision to end their life, 
which is why this legislation raises a wide range of services 
and solutions to reduce suicidal ideations.
    The Improve Act will finally allow the VA to tap into, 
develop, and enhance this nationwide network of boots-on-the-
ground organizations providing countless life-saving services 
to veterans. Specifically, H.R. 3495 creates a new grant 
program that the VA can use to support and connect with non-
profits and community organizations, including state and local 
entities, that coordinate or deliver services to at-risk 
veterans.
    Under this new program, the VA would be authorized to 
support services that include, but are not limited to, 
outreach, mental health screening, suicide prevention 
education, case management, peer support, assistance in 
obtaining VA and other public benefits; medication management, 
therapy, and training; and assistance for childcare and 
financial planning.
    Additionally, before awarding any grants, the Improve Act 
requires the VA to consult with various stakeholders, including 
Veteran Service Organizations (VSOs), community mental health 
and suicide prevention partners, representatives for local and 
state governments, first responders, the National Guard and 
Reserves, and organizations with the experience required to 
design an information-measurement tool.
    To not measure outcomes when you create a program, I 
believe, is dereliction of duty on the part of the VA and us in 
Congress. This coordinated effort must determine the criteria 
for grant recipients and establish a framework for the VA and 
community partners to share information.
    The VA and these groups must also develop a measurement 
tool for grantees to use, which will allow the VA to track 
baseline, post-treatment, and long-term mental health data. 
These measurements will provide us with the information needed 
to study VA suicide on a large scale and make policy that 
addresses its very complex nature.
    To summarize, the Improve Act is a new strategy that 
enlists help from community partners close to veterans and it 
responsibly tracks the effectiveness of the VA's efforts.
    In my role as Ranking Member of the SubCommittee on 
Oversight and Investigations, I often ask for a sense of 
urgency from the decision-makers who testify before us. There 
is perhaps no more urgent matter for us as policymakers than to 
reach our veterans and servicemembers who might be 
contemplating suicide.
    We have seen a rising tide of support for the Improve Act, 
including National VSOs and the Secretary of Affairs, Mr. 
Robert Wilkie, who recently identified the need for the Improve 
Act in order to help the VA reach more at-risk veterans. The VA 
can not do it alone; we need the community involved in this.
    On behalf of my fellow veterans across the Nation 
struggling to deal with mental health issues, I request that 
the Committee formally consider H.R. 3495 and work to pass this 
bill in a bipartisan manner. I know that the staffs are working 
diligently to come up with language that we all can agree, but 
the end game is simple: stop veteran suicide and hold the 
entities accountable for providing those services.
    Thank you, Mr. Chairman, and I yield back.
    The Chairman. Thank you, General Bergman.
    Dr. Roe, you have a comment?
    Mr. Roe. Just a very brief comment. General Bergman, thank 
you for introducing this. It is going to be--you are correct, 
it is going to need to be an all-hands-on-deck. The VA can not 
do it alone. I am a perfect example of a veteran who is a 
Category 8 that can not go to the VA. If I needed those 
services, where would I go?
    We have some ideas for Guard and Reservists, we know that 
that rate is very high, but I think we are going to have to 
do--we can not keep doing exactly the same thing that we have 
been doing all these years. I agree with you 100 percent, we 
have got to offer other alternatives and certainly, if the VA 
supports this alternative, I think we should seriously look at 
it.
    I yield back. Thank you.
    The Chairman. Thank you, Dr. Roe.
    General Bergman, we spoke yesterday. I will be working with 
you and the Committee staff and your staff, and we will work 
together to make sure that the VA has the resources and 
expertise to administer grants properly. Then we also want to 
make sure that Congress has oversight over the program to hold 
the VA accountable. We just can not give them a blank check, 
but want to make sure that we have accountability in place, and 
we will work with you on this.
    Mr. Bergman. Thank you, Mr. Chairman. You know, there is--
as a Marine and as a veteran, we never ask for a blank check, 
all we ask is for the tools necessary to win the fight. I, 
under your leadership--and we are as good as we are as leaders 
because our staffs do all the hard work, and thank you for your 
support and the staff's diligent efforts working together on 
this.
    The Chairman. Yes. Thank you, General Bergman. I appreciate 
the bipartisan way in which we are trying to tackle this really 
stubborn problem, this stubborn challenge, and I appreciate the 
spirit in which we are doing this together.
    Mr. Carbajal, you are recognized for 5 minutes.

                  STATEMENT OF SALUD CARBAJAL

    Mr. Carbajal. Thank you, Chairman Takano, and Ranking 
Member Roe, thank you for the opportunity to address you today.
    I believe these Member Days are prime opportunities for 
Members to not only share challenges veterans are facing in our 
districts, but also to help the Committee identify issues that 
may be consistent across our Nation, or even issues that the 
Committee may not be aware of.
    I have the pleasure of representing the 24th Congressional 
District of California, the beautiful central coast where 
approximately 40,000 veterans reside. I represent a number of 
military installations, including Vandenberg Air Force Base, 
Camp Roberts, and Camp San Luis Obispo.
    I believe I represent one of the most beautiful districts 
in the country; however, as you all know, the cost of living in 
California is very high and finding affordable housing is 
extremely challenging, especially for veterans who are trying 
to make ends meet. On any given night, over 39,000 veterans are 
homeless across America, and 25 percent of our Nation's 
homeless veterans reside in California. This is why Congress, 
along with the Department of Veterans Affairs and the 
Department of Housing and Urban Development, came together to 
create the HUD-Veterans Affairs Supportive Housing Program, 
also known as HUD-VASH. The purpose of this program is to 
provide rental assistance for homeless veterans, along with 
case management and clinical services.
    The HUD-VASH program has provided housing assistance to 
veterans nationwide, including veterans in my district. I have 
learned that veterans, along with the local housing 
authorities, currently cannot take full advantage of this 
program due to the delays in getting referrals from the VA for 
VASH vouchers.
    For example, the County of Santa Barbara has a total of 261 
VASH vouchers allocated to them. From those 261 vouchers, 154 
VASH vouchers are currently under contract where veterans have 
been housed or are receiving services. Ten veterans have been 
approved for VASH vouchers and are searching for housing. 
Unfortunately, 97 of these allocated VASH vouchers are awaiting 
referrals from the VA.
    This issue was brought to my attention in May and, in 
August, 97 vouchers were still awaiting referrals from the VA 
in order to be used. What this means is that the local housing 
authorities could have been housing 97 more veterans just in my 
district alone if referrals from the VA had arrived in a timely 
manner.
    It is my understanding that this delay is a result of the 
VA being under-staffed, and the Department's inability to 
attract and retain staff caseworkers for VASH.
    We are all aware of the challenges that the VA faces when 
it comes to staffing, but I believe this is an area we must 
prioritize. The vouchers are available, but not being used to 
house veterans who desperately need a home. I think you will 
agree with me that that is unacceptable.
    The reason I am here today is to ask the Committee to work 
with me to address this very important issue. I have brought 
this issue up to the local, state, and Federal VA leadership, 
and I plan on continuing the discussion until a plan of action 
is presented, which there is none to date that I have seen, as 
we must do our best to provide homes to those who serve our 
country. I hope with this help, with the help of this 
Committee, we can provide the veterans in my district and 
veterans nationwide with a home to feel safe in, as they have 
done the same for our country.
    Thank you for the opportunity to raise this very important 
issue. I yield back, Mr. Chairman.

    [The prepared statement of Salud Carbajal appears in the 
Appendix]

    The Chairman. Thank you for your testimony, Mr. Carbajal. 
And I guess we will go through the questions and if there is--
we will go through the testimony, if there are any questions or 
comments later.
    Mr. Peters, you are recognized for 5 minutes.

                   STATEMENT OF SCOTT PETERS

    Mr. Peters. Thank you, Mr. Chairman and Ranking Member Roe. 
Thanks for having Members Day to hear from colleagues like me 
who have important legislation and priorities pending in this 
Committee.
    I miss serving directly on the Committee with you, 
although, as a San Diegoan, I continue to work on solutions for 
our Nation's veterans, and thank you as partners in our joint 
efforts to do so. I am also pleased that my friend and my new 
congressional neighbor, Mr. Levin, has represented San Diego's 
hundreds of thousands of veterans very well on this panel.
    I am here to thank you for passing two of my bills and to 
help end veteran homelessness, and to urge you to give some 
attention to oversight of the Office of Medical Inspector.
    First, thanks to you for marking up and passing a very 
important bill that would help more chronically homeless 
veterans secure housing and get crucial supportive services. 
H.R. 2398, the Veteran House Act, expands eligibility for HUD-
VASH vouchers to veterans with other than honorable discharges. 
Congress has acknowledged that other than honorable discharges 
deserve access to some VA homelessness services such as 
programs like grant and per diem, and supportive services for 
veteran families.
    Unfortunately, around the country there are chronically 
homeless veterans who are falling through the bureaucratic 
cracks due to their discharge status. They can not receive 
housing vouchers because they are ineligible for VA health care 
and, therefore, they can not receive the invaluable supportive 
services provided by the VA.
    Since this Committee took action on the bill, Senators John 
Tester, Todd Young, and Chris Murphy have introduced its 
bipartisan companion bill in the Senate.
    My other bill, the Homes for Our Heroes Act, seeks to find 
solutions for veterans experiencing homelessness in high-cost 
areas like my hometown of San Diego, where veterans living in 
those kinds of places, even if they have rental assistance, 
they may struggle to find an affordable place to live.
    Now I just wanted to turn our attention to a troubling 
story from the San Diego VA. In November 2018, our office 
learned of an investigation detailing alleged unapproved human 
research. The San Diego VA participated in a study examining 
alcoholic liver disease, which was one site among other 
research institutions of a larger NIH-funded study, led by the 
Pittsburgh Liver Research Center and UNC Chapel Hill. Nine 
patients diagnosed with alcoholic hepatitis received trans-
jugular biopsies and, according to whistleblower disclosures, 
this was not the standard of care and this was reported to the 
VA's Office of Medical Inspector.
    Due to follow-up from whistleblowers, the Office of the 
Special Counsel (OSC) conducted an independent investigation 
and found the VA's internal report unsatisfactory. The OSC 
report alleges that these samples were collected improperly, 
sometimes without patient consent, and could have put patients 
in harm's way. The Special Counsel urged the VA to, quote, 
``revisit its findings in this matter and take a truly critical 
look at research being conducted by the San Diego VA.''
    At the end of the last Congress, I wrote to this Committee 
requesting--as a member at that time, requesting a hearing to 
investigate what happened at the San Diego VA and, more 
broadly, to look at the Office of Medical Inspector (OMI) to 
ensure it is doing its job to ensure patient safety at every 
medical center across the country.
    We know that this is not the first time that OMI has 
investigated wrongdoing and has come up short on answers, 
according to the Special Counsel. My colleagues here will also 
remember the clinical neglect at the Manchester VA, the Special 
Counsel also there found OMI's reports to be unsatisfactory.
    My suggestion is that the Committee look into the OMI 
staffing capacity and their authority to make recommendations 
without deference of senior leadership in terms of their 
findings. My staff and I have worked with the Committee to 
receive additional documents, and we all agree it is our job to 
ensure that the Medical Inspector has enough resources to 
handle whistleblower disclosures, and we need to strengthen 
investigatory bodies to ensure improper allegations such as 
these are thoroughly vetted so that they do not come up again.
    I ask you to work with me to get answers regarding this 
instance and also that as a Committee that we examine the 
Office of Medical Inspector. Veterans who have served our 
Nation deserve the best care, opportunities, and support. I am 
proud to advocate for San Diego's veterans and look forward to 
our ongoing work to deliver it for them.
    Thank you very much for your time today, and I yield back.

    [The prepared statement of Scott Peters appears in the 
Appendix]

    The Chairman. Thank you, Mr. Peters.
    Ms. Hartzler.

                  STATEMENT OF VICKY HARTZLER

    Ms. Hartzler. Thank you, Chairman Takano and Representative 
Bost and other Members of this Committee, and I want to applaud 
you for once again holding this special opportunity for my 
colleagues and I to share about some initiatives we have to 
help veterans, and I have three bills that I want to present to 
you and I feel really good about that is going to help our 
veterans.
    I think, as a Committee and as a Congress, great strides 
have been made to ensure our veterans have the resources, care, 
and support they have earned; however, as I examine what more 
can be done for our veterans, I am convinced that many of the 
health care challenges our veterans face is a result of 
persistent under-staffing at the VA. I believe that a 
bipartisan bill I introduced with Representatives Correa, 
Wilson, Mooney, Rouzer, Lesko, and Bost, the VA Hiring 
Enhancement Act, will help the VA to fill some of their 40,000 
VA health care worker vacancies.
    Our bill has three main provisions. First, it would allow 
physicians to be released from non-compete agreements for the 
purpose of serving in the VA for at least one year. These 
agreements may serve a purpose in the proper context, but 
should never serve as a roadblock to caring for veterans within 
the VA system.
    Second, our bill updates the minimum training requirements 
for VA physicians. Completion of a medical residency is widely 
accepted as standard comprehensive training for clinical 
physicians in the U.S.; however, current law only requires that 
a physician be licensed in order to treat veterans. While in 
practice the VA currently hires almost exclusively those 
physicians who have completed a residency, this provision just 
simply updates those minimum requirements already established 
in law to ensure that they are appropriate.
    Finally, our bill would place veterans' hospitals on a 
level playing field with the private sector when it comes to 
recruiting timelines. Often private sector health care 
providers begin recruiting medical residents as they begin 
their final year of residency, sometimes even earlier. These 
residents often end up with a solid job offer from the private 
sector before VA recruiters have even been able to begin their 
recruiting process. Our bill authorizes VA recruiters to make 
job offers to physicians up to 2 years prior to fulfilling the 
VA's requirements, contingent on meeting all the requirements 
before they begin practicing at the VA. It offers job security 
to medical residents who want to work for the VA when they 
complete their training, and it allows VA facilities and 
recruiters to shore up appointments further in advance, helping 
them to plan and forecast medical workforce needs.
    We have worked closely with the Committee's staff, VA 
recruiters, and VSOs on this bill, and I am pleased to report 
that it has garnered wide support and formal endorsement from 
ten veterans service organizations, including The American 
Legion, Blinded Veterans Association, AMVETS, Disabled American 
Veterans, and Paralyzed Veterans of America. This measure is 
currently slated to be discussed at an upcoming Health 
SubCommittee hearing and it is my hope we can work together to 
move this bill to the House floor soon.
    In addition to VA staffing shortages, our veterans are 
facing another health care issue when experiencing a medical 
emergency. Current law provides for the reimbursement of 
ambulance transportation and emergency treatment at non-VA 
hospitals for certain veterans until they are medically stable. 
However, once stabilized, veterans must be transferred to a VA 
facility for any continued care they require or pay out of 
pocket for further treatment at the non-VA hospital. The 
problem is that Federal law does not currently allow for the 
reimbursement of the transfer for continued care, which often 
must be accomplished via ambulance and can be too expensive for 
patients to pay. The average cost for this necessary medical 
transfer is $500, but it can be far more expensive if the 
veteran lives in a rural area.
    To address this issue, I partnered with Representative Joe 
Cunningham, who was here earlier, to introduce bipartisan 
legislation that would fix the shortfall in the VA's statutory 
authority to reimburse certain veterans for emergency 
transportation. H.R. 3350, the VA Emergency Transportation Act, 
corrects this disparity by clarifying that these medical 
transfers are reimbursable. This change fixes a large, costly 
hole in the safety net the original law was intended to 
provide.
    Representative Cunningham and I are joined by over 40 
Members in supporting this critical measure. Additionally, 13 
veterans service organizations, including all of the big six, 
have voiced strong support for this necessary reform. Far too 
many of our veterans continue to face this unnecessary burden 
at their most vulnerable time, creating financial hardships and 
jeopardizing their health. We must act now to move this bill 
forward and protect our veterans.
    Finally, I would like to highlight one additional measure, 
H.R. 2433, the Veterans Preference Parity Act. Outdated Federal 
hiring rules prevent too many patriots from being recognized 
when competing for Federal positions. The Veterans Preference 
Parity Act rights this wrong by modernizing the archaic Federal 
hiring process and recognizing those who have served our 
Nation.
    Up to 44 percent of the Army National Guard and 70 percent 
of the Air National Guard serve honorably without qualifying 
for Federal hiring preference. Additionally, over 130,000 
working-age retired veterans do not qualify under the current 
system. The Veterans Preference Parity Act reforms outdated 
Federal hiring rules to allow all retired servicemembers, and a 
greater number of National Guard and Reservists, to qualify for 
veteran's preference.
    We are forever indebted to the brave men and women who 
serve in uniform and we owe them our continued support as 
veterans. The current Federal hiring preference statutes must 
be updated to reflect the way we utilize our Reserve component 
forces and need reward them who retire upon completion of their 
military career, not punish them. Please join me in reforming 
these outdated Federal hiring rules and support the Veterans 
Preference Parity Act today.
    Thank you again for allowing me this time, and I yield 
back.

    [The prepared statement of Vicky Hartzler appears in the 
Appendix]

    The Chairman. Thank you, Ms. Hartzler, for your testimony. 
Thank you very much.
    Ms. Plaskett, 5 minutes.

                STATEMENT OF STACEY E. PLASKETT

    Ms. Plaskett. Yes. Thank you. I would like to thank you, 
Chairman Takano and Ranking Member Roe, and the Members of this 
Committee, for the opportunity to speak on the issues affecting 
approximately 8,800 veterans in my district of the U.S. Virgin 
Islands. That is 8,800 veterans out of a population of 105,000. 
That is a tremendous percentage of individuals in the Virgin 
Islands who have served this country and live as veterans 
there.
    I appreciate the continued support with the intention to 
host a congressional delegation to the U.S. Virgin Islands. 
Although Members were unable to attend, Democratic Staff 
Director Megan Bland visited the territory to assess the 
Veterans Affairs Administration's efforts in emergency 
preparedness, outreach strategies, the implementation of the 
community care network, and connecting vet civilians to much-
needed VA resources.
    As a result of this visit, I believe the staff was left 
with the impression that veterans of the U.S. Virgin Islands 
have little to no access to VA health care. They identified the 
lack of access to immediate assistance following a disaster, 
under-staffing, and mismanagement of the local VA clinics, and 
the treatment of veterans under a contract that is now 
nullified.
    The Virgin Islands currently houses two VA clinics, one on 
St. Thomas and one on St. Croix, with no VA hospital. Although 
the Choice Program is available to Virgin Islands, some doctors 
are hesitant to participate due to delayed payments and being 
in a small market. This further exacerbates the issue of having 
only a small number of medical specialists capable of providing 
necessary service. In one case, a veteran required a heart 
specialist, but because only one was working in the territory, 
the veteran had to wait 2 months for an appointment; this is 
unacceptable.
    Community providers that treat veterans in the Virgin 
Islands are still operating under Choice contracts and were 
subject to funding that expired in June 6th, 2019. As of July 
21st, 2019, the VA had performed no outreach to community 
providers within the U.S. Virgin Islands regarding community 
care networks under the MISSION Act. This means that providers 
are treating veterans under contracts that were nullified in 
June of this year.
    It is discouraging that the Caribbean health care system 
and the VA central office failed to inform, educate, and enroll 
these providers in the new community care network created by 
MISSION Act.
    As a result of these limited resources, many veterans must 
communicate with and travel to the VA hospital in Puerto Rico, 
which leads to several major issues. First, veterans in some 
cases must pay up-front for air fare and hotel stay in Puerto 
Rico. Due to appointment times and limited airline schedules, 
there is a hardship when they must bring a companion. Second, 
communication barriers sometimes or often emerge because of 
significantly differing dialects, as well as language barriers. 
Third, numerous veterans have mentioned that they feel 
disadvantaged and prejudiced when acting with the VA hospital 
in Puerto Rico due to race and residency. Many Virgin Islands 
veterans have stories of abuse and mistreatment that are in 
most cases hard to prove and thus seldom recorded.
    Virgin Island veterans also complain that they must exert 
unnecessary effort to prove that their disabilities are 
service-related in order to receive the benefits that they 
deserve and those benefits which are given to other veterans 
living on the mainland. Vietnam-era veterans have expressed 
concerns still to this day about their burden of proof that 
post-traumatic stress disorder and exposure to Agent Orange are 
results of their military service. Despite the VA's recent 
efforts to revisit this issue, many veterans and their families 
believe that too little has changed and that these new efforts 
are inadequate for a population that placed their lives on the 
line for their country.
    All American veterans deserve a commitment from their 
country and government that proper health care will be provided 
regardless of geographic location. As the hospitals in the 
Virgin Islands are reconstructed following the destruction of 
Hurricanes Irma and Maria, I request that the Department of 
Veterans Affairs, and the House and Senate Veterans' Affairs 
Committees, consider funding a new component of the hospital 
system dedicated to veterans and capable of accommodating more 
severe health care needs than the clinics alone can provide, 
with actual contingency plans, unlike the one planned for 
Hurricane Dorian.
    Because the U.S. Department of Veterans Affairs reports 
enrolled veterans of the U.S. Virgin Islands a part of the 
Caribbean health care system, which also includes Puerto Rico, 
it is difficult to easily attain the population of veterans 
enrolled in the VHA that reside in the U.S. Virgin Islands. 
Because of the funding structure of VHA facilities, it is 
critical that enrollment in the VA reflect the overall 
population of veterans within the community.
    The lack of VHA care options on the various islands negate 
the incentives that stateside veterans may have to enroll in 
free or cost-reduced health care. As a result, VA and local 
leaders should better promote enrollment within the VHA for 
veterans in the U.S. Virgin Islands. There are a myriad of VSO 
posts, clinics, and outreach opportunities that the VA should 
better capitalize on as well.
    Thank you for your consideration, and I encourage you to 
increase the Federal commitment to the embattled veterans of 
the U.S. Virgin Islands. Thank you.

    [The prepared statement of Stacey E. Plaskett appears in 
the Appendix]

    The Chairman. Thank you, Ms. Plaskett. I do intend to get 
down to the VI at some point and I am sorry that this----
    Ms. Plaskett. Yes, I know that our veterans would love to 
see you there. They often feel very forgotten because of their 
distance and particularly because they are so subsumed by the 
size of Puerto Rico, which have so many barriers to English-
speaking veterans trying to operate in a Spanish-speaking 
clinic.
    The Chairman. Thank you for that----
    Ms. Plaskett. Hospital system. Thank you.
    The Chairman. --thank you for your testimony. Thank you.
    Mr. Phillips, thank you for appearing earlier than your 
appointed time, and I welcome other Members to take their seats 
who have appeared. So, Mr. Phillips, I now recognize you for 5 
minutes.

                   STATEMENT OF DEAN PHILLIPS

    Mr. Phillips. Thank you, Mr. Chairman and Ranking Member 
Bost, and Members of the Committee, for the opportunity to 
share a few of my concerns and fellow concerns raised to me by 
veterans and their families in Minnesota's Third Congressional 
District, the western suburbs of the Twin Cities that I 
represent.
    As a Gold Star son, myself, my gratitude for the men and 
women in uniform and the sacrifices that they have made is 
immeasurable. My birth father, Artie Pfefer, went to the 
University of Minnesota on an ROTC scholarship and later became 
a Captain in the U.S. Army. He was killed in a helicopter crash 
in Vietnam in 1969 when I was just 6 months old and, though I 
never met my father, I carry his memory with me every day and 
think of him every time I pull out my voting card.
    During my time in Congress, I have made it a priority to 
meet with and learn from veterans across Minnesota. In order to 
do this, my team created a Veterans Advisory Council, which is 
made up of individuals who serve veterans for a living. They 
represent many service organizations and their input has been 
invaluable.
    Last May, the Council and I hosted a Veterans and Military 
Servicemembers Community Conversation to invite the public in 
on the discussion. The Council advised me on legislation that 
came to our attention from conversations I had with 
constituents that night, and we continue to meet to discuss 
ways we can serve the veterans community in Minnesota. It is my 
hope the Council will continue to be a beacon for community 
outreach and engagement.
    One of the issues we are working on is veteran 
homelessness. This is a national problem that demands action 
now and Minnesota is leading the way in this effort. Thanks to 
our outstanding Governor, Tim Walz--who is a veteran himself 
and former Ranking Member of this very Committee--Minnesota has 
made it an official goal to be the fourth state to end veteran 
homelessness by getting to functional zero.
    A key part of this effort has been the Minnesota Homeless 
Veteran Registry, which was created in 2014 to identify all 
known homeless veterans, and ensure that they have access to 
appropriate housing and social services. The registry 
recognizes the underlying factors contributing to veteran 
homelessness, including mental health issues, substance abuse, 
and economic hardship. Housing and social justice professionals 
use the registry to identify homeless vets, reach out, and 
offer assistance. It has helped nearly 2,000 veterans find a 
home. But our work is not done, not nearly done. Congress can 
support this mission by incentivizing landlords to open up 
their spaces to veterans who need a more permanent housing 
solution.
    The issues our veterans face go well beyond housing. They 
need better health care that is convenient, accessible, and 
local. From the conversations I have had with many veterans, 
local elected leaders, and county veteran service officers, it 
has been made clear to me that there is a significant need for 
a Community Based Outpatient Clinic, a CBOC, in the 
southwestern part of our district. Right now, the closest CBOC 
to the south of our district is not adequate for our local 
veterans. The clinic is run down, has a confusing building 
layout, and is not accessible from the highway. I urge the VA 
to find CBOC sites that would serve as many veterans as 
possible and be accessible to the ones that depend on it for 
their health care needs.
    In addition to health care services, veterans must have 
access to quality mental health programs. The Clay Hunt Suicide 
Prevention for American Veterans Act, which became law in 2015, 
directs the VA to work with local non-profit mental health 
organizations in order to reach out into the community to serve 
veterans where they are. Minnesota has one of the most active 
National Guards in the country and, with more Guardsmen getting 
put into active duty every day, more veterans are at risk for 
suicide.
    Congress and this Committee must use its oversight 
authority to ensure that our veterans have access to mental 
health care and suicide prevention programs, and that the Clay 
Hunt Act is being thoroughly and effectively implemented.
    This Committee has been effective in passing monumental and 
long-awaited legislation this Congress, including the Blue 
Water Navy Act, of which I was a proud cosponsor. While this 
bill will bring justice to many vets who deserve benefits for 
their sacrifices, I am concerned with its implementation. The 
VA must be prepared to process these claims in a timely and 
thorough manner. Congress and this Committee must also use its 
oversight authority to ensure that our veterans have the 
benefits and care that they deserve, which includes not being 
subjected to extreme delays in processing.
    I stand ready to do whatever I can to address the concerns 
that have been raised by veterans and their advocates in my 
district, and I look forward to working with all Members on the 
House Veterans' Affairs Committee to support the men and women, 
and their families, who have served this country with honor and 
distinction.
    Thank you, Mr. Chair.

    [The prepared statement of Dean Phillips appears in the 
Appendix]

    The Chairman. Thank you, Mr. Phillips, for your testimony.
    I would now like to recognize Mr. Mast for 5 minutes, then 
I will call on Mr. Carter.

                    STATEMENT OF BRIAN MAST

    Mr. Mast. Thank you, Chairman.
    I am proud to know each and every one of you that sit on 
this Committee, and what I know about each and every one of you 
is that you want the absolute best for our veterans, I believe 
that in my heart about every member of this Committee. I know 
that you each want each servicemember to be treated with an 
unparalleled level of dignity and that that is what you fight 
for. I know that you want their treatments to be second to 
none, that the hospital facilities that they are served in be 
facilities that make every person who is not a veteran want to 
say, you know, damn, I wish I would have served just so that I 
can go into those facilities.
    I know that you want to bring an end to every frustration 
that every veteran has with any VA service that has ever been 
provided or not provided to them.
    Chairman, Ranking Member, I am not bring you the be-all, 
end-all solution to every problem that we face with the VA, but 
I am bringing you something that has been absolutely proven to 
help through trial. And this bill, with 20 bipartisan 
cosponsors, H.R. 2846, the Improving Access to Congressional 
Services Act, whereby the Secretary of the VA must share space 
in VA hospitals for Members of Congress to meet with their 
veteran constituents.
    The space that I have inside of my VA hospital is literally 
not much larger than the space of three or four of us sitting 
here, but its reach has been anything but small. It has 
inspired six other Members of Congress in Florida alone to also 
hold office hours inside of their VA medical centers for their 
veterans.
    It has allowed for World War II veterans, Korean War 
veterans, Vietnam War veterans, who otherwise have to take a 
bus to the VA, because they do not have their own 
transportation, to be able to meet with a Member of Congress 
without having to be transported somewhere else. It has given 
an outlet to VA staff who want to report issues that they have 
witnessed but are otherwise frightened to do so, but are happy 
that we are there on the ground, so that when they tell us 
something is going on we can go and put our own eyes on the 
issue, or our staffs can put our own eyes directly on that 
issue and see it for ourselves.
    It has simply been more convenient for hundreds of veterans 
to meet there with their Members of Congress instead of having 
to go to other offices. My office alone has had over 500 
individual veteran meetings with different veterans. It has 
opened the eyes of Members of Congress and their staffs about 
the states, the daily states of their local VAs, and it has 
created an immediate outlet for veterans who have been 
frustrated by some level of care that they have had, to the 
point that they felt nobody cared about them until they walked 
into that small office where they were listened to by their 
Member of Congress.
    These offices make a difference and, as I said as I opened, 
I know that is what each and every member of this Committee 
wants to do, it is to make a difference in the lives of each 
veteran.
    Some in the VA have said that this sort of thing does not 
exist with any other Federal agency and, therefore, should not 
exist in the VA, to which I say there has been no other Federal 
agency that has been so plagued by crisis after crisis after 
crisis across every administration.
    My questions to the Committee as you consider this 
legislation is this: has there been one veteran that has been 
hurt by the presence of these offices inside VA hospitals? Or 
has every veteran that has visited them benefitted by them? 
Does this create more accountability for the VA, the VA staff, 
and for Members of Congress, or less?
    The request is simple: make this law that Members of 
Congress can go do what they all say that they want to do, 
which is to make the VA better for each and every one of our 
veterans, by allowing them inside of the VA hospitals to go 
serve these veterans one at a time in an up-close and personal 
way.
    With that, I yield back the remainder of my time and I 
thank you for your consideration.

    [The prepared statement of Brian Mast appears in the 
Appendix]

    The Chairman. Thank you, Mr. Mast, for your testimony.
    Mr. Carter, 5 minutes.

             STATEMENT OF EARL L. ``BUDDY'' CARTER

    Mr. Carter. Thank you, Mr. Chairman, I appreciate it and 
appreciate everyone being here. I want to thank you for giving 
us this opportunity to testify on behalf of our constituents.
    Ladies and gentlemen, I have the honor and privilege of 
representing the First Congressional District of Georgia. We 
have many things to be proud of, not the least of which are 
that we are home to over 60,000 veterans. Unfortunately, 
although we have a large number of veterans in the coastal 
region of Georgia, where I have the honor and privilege of 
representing, our nearest VA hospitals are 2 hours away, one in 
Charleston, South Carolina, another one in Dublin, Georgia.
    Creating better access to health care for veterans has 
always been one of my highest priorities while serving in 
Congress. That is why I supported the VA MISSION Act during the 
115th Congress, specifically with its provisions that authorize 
VA hospitals to use telemedicine across state lines.
    I applaud the President for signing the VA MISSION Act into 
law; however, after meeting with VA officials, they brought to 
my attention that trainees were not authorized in the law to 
use the telemedicine system. Although this was likely a simple 
mistake in the legislation, this creates major problems in VA 
hospitals for a number of reasons. Most notably, it puts VA 
providers in legally precarious positions, because the VA uses 
trainees in all aspects of care, just like all non-VA hospitals 
do.
    Additionally, it puts trainees behind the 8 ball. They are 
missing a critical piece of accumulated experience, the 
telemedicine system, when working to eventually become a 
doctor.
    Earlier this Congress, I introduced H.R. 3228, the VA 
MISSION Telehealth Clarification Act, to remedy this issue. 
This bill now has bipartisan support among Committee Members, 
and I hope you all will consider the legislation in front of 
the Committee as soon as possible.
    Next, I hope the Committee will continue to make strides in 
improving the veterans appeal process. I am proud that Congress 
passed, and the President signed into law the Veterans Appeals 
Improvement and Modernization Act, which became effective this 
past February. As this law moves forward, I encourage the 
Committee to review its progress, continue to find ways in 
which it can be improved, and see how the VA can answer our 
constituents' appeals in a more efficient and accurate fashion.
    Finally, I trust that the Committee will keep veteran 
homelessness as one of its highest priorities for the remainder 
of the 116th Congress. Today, there are still just under 40,000 
homeless veterans in America. Another 1.4 million veterans are 
at risk of homelessness. Eleven percent--let me repeat that--
eleven percent of the U.S. homeless population in America are 
veterans. That is too much--one is too much. Too many of those 
are in the First Congressional District of Georgia. These 
numbers are simply unacceptable.
    We need to reassess all of our Federal programs working to 
combat veteran homelessness, but especially the accessibility 
of VA loans and the guidance given to veterans reintegrating 
into a civilian society. We try to do this in the First 
Congressional District. We have VA forms to let veterans know 
what is available to them. This is extremely important. We do 
it twice a year, once in the northern part of the district, 
once in the southern part of the district. In fact, we have got 
one coming up. We had one scheduled; unfortunately, the 
hurricane, we had to delay it, but we have got one scheduled 
for next month in the southern part of our district for the 
specific reason to let veterans know what is available to them.
    In all of these issues I have mentioned here today, we need 
to remember that our Nation's veterans are our heroes and they 
deserve the absolute highest respect upon their return home. 
The Federal Government simply can do a better job in veterans' 
access to health care, the appeals process, homelessness, and 
so much more.
    Again, I want to thank you as Committee Members for your 
work in these issues, they are extremely important; extremely 
important to veterans across the country, extremely important 
to veterans in the First Congressional District of Georgia. 
Thank you again, and I look forward to working with you and 
following your progress, and I yield back.

    [The prepared statement of Earl L. "Buddy" Carter appears 
in the Appendix]

    The Chairman. Thank you, Mr. Carter, for your testimony.
    I would now like to call Mr. Rouzer for 5 minutes.

                   STATEMENT OF DAVID ROUZER

    Mr. Rouzer. Thank you, Mr. Chairman, and the other Members 
of this very distinguished Committee for your work to 
strengthen care and resources for our Nation's heroes. I am 
particularly grateful for your willingness to allow Members who 
do not serve on this Committee the opportunity to raise issues 
and share concerns that we hear from our veterans back home.
    As you know, the great State of North Carolina has a long 
and rich tradition of military service, and we are blessed to 
have a very large community of veterans in the 7th 
Congressional District, which I have the honor to serve and 
represent.
    I would like to bring to the Committee's attention a bill I 
reintroduced, I introduced it last Congress and have 
reintroduced it this Congress, to help veterans restore their 
credit score when it has taken a hit because the VA failed to 
reimburse an outside provider. This is an issue that has been 
faced by many veterans in my district and my office has helped 
facilitate hundreds, literally hundreds of payments to outside 
providers by intervening with the VA to avoid a debt going to 
collection.
    The unfortunate reality is, there are many, many veterans 
across my district, across the State of North Carolina, and 
across our country that have had their credit destroyed through 
no fault of their own as a result of mismanagement and delays 
at the VA, particularly those dealing with emergency medical 
care.
    Quite honestly, I think we all can agree, this is 
unacceptable.
    H.R. 3012, the Veterans' Credit Protection Act, if enacted 
into law, will help provide veterans the help they need to 
restore their credit when they have been the casualty of 
mismanagement and late payments. In many cases, quite honestly, 
no payment at all is made by the VA to these outside providers 
of their care, and one of the consequences of that is you lose 
outside providers. Everybody has got to make a living.
    The Veterans' Credit Protection Act puts the onus on the VA 
to reach out to the veteran and inform them how to resolve 
credit issues caused by these delayed payments. In addition, 
this legislation requires the VA to submit a report to Congress 
on the effectiveness of the Office of Community Care in 
providing timely payment of proper invoices for emergency care.
    I appreciate the Committee's consideration of this bill, so 
that veterans will no longer have to worry about their credit, 
or lack of credit, because of the VA's failure to pay their 
claims.
    Thank you, Mr. Chairman, for allowing me the opportunity to 
testify today on this very important issue. I yield back.

    [The prepared statement of David Rouzer appears in the 
Appendix]

    The Chairman. Thank you, Mr. Rouzer, for your concern for 
veterans and for your testimony.
    I will next call on Ms. Mucarsel-Powell. Then, after that, 
Mr. Malinowski, followed by Mr. Soto, so you know the order.
    Go ahead, Ms. Mucarsel-Powell, for 5 minutes.

              STATEMENT OF DEBBIE MUCARSEL-POWELL

    Ms. Mucarsel-Powell. Thank you, Mr. Chair, and thank you to 
the Members of the Committee for allowing me to appear today to 
advocate for the veterans living in my community.
    One of the greatest challenges that veterans who live in 
Monroe County face is access to care. Former servicemembers 
living in the Florida Keys often have to travel more than 150 
miles just to travel to the Miami VA to get the access and the 
full set of care that they need. This was supposed to have been 
addressed when the VA Choice Program was established in 2014, 
and access to care in rural areas was supposed to be improved 
when Congress passed the VA MISSION Act in 2018 with the 
creation of the Veterans Community Care Program.
    Under the MISSION Act, any veteran living at least 40 miles 
away from a full-service VA is eligible to receive health care 
from a community health provider that is approved by the 
Community Care network.
    Although there is a VA clinic in Key West, it only provides 
basic care and often refers patients to the facility in Miami 
for most services. As such, many of our veterans have to travel 
for hours from their homes in the Keys to receive the care that 
they need. This program was supposed to be operational by June 
6th of this year. Unfortunately, in Monroe County, the 
providers in the local Community Care network have yet to be 
approved, so my constituents remain in limbo.
    Furthermore, veterans in my district have been subject to 
the continuous disruption in service from the handoffs between 
the VA's private partners, which are Health Net, Tri West, and 
Optum.
    My constituents were originally covered through HealthNet 
and when they left, TriWest temporarily took over. Now they are 
handing them over to Optum.
    During these handoffs, our veterans' health care needs have 
been abandoned. They have to travel long distances for care, 
often do not receive confirmation for appointments until the 
night before, and as a result can miss appointments when they 
are unable to secure transportation on such short notice.
    My office just recently heard from a constituent who had 
moved to the Keys and requires monthly treatments that can only 
be provided by a full-service VA. She had difficulty making an 
appointment with the Miami VA and was not informed of a 
confirmed appointment until the day before. Because of this 
short turnaround, she was unable to travel to Miami for her 
appointment. She was told to go through the community care 
network for her treatment more locally, but because the Keys 
does not have any approved providers, she had to forego the 
care she needed.
    Unfortunately, this story is all too common, Mr. Chair. It 
has become such a challenge that Monroe County's Director of 
Veterans Affairs often volunteers hours from her day just to 
drive veterans to the Miami VA so that they can access 
necessary health services.
    This, I would assume that you agree with me, is just not 
acceptable. Our veterans have made the ultimate sacrifice for 
our country when they answered their call to service. Really, 
it is our responsibility to be there for them and we cannot 
fail them.
    I would like to urge you and the Committee to push the 
Office of Community Care at the VA to address this issue and to 
have their private partners in TriWest and Optum Health to 
provide greater outreach to our local providers so that they 
can provide care to our vets in Monroe County.
    We also need more resources dedicated to our VA health 
clinics, so they have proper staffing to provide the full set 
of health care services at each facility. VA facilities in 
Monroe, and also in Miami-Dade should not have to struggle with 
understaffing issues that prevent our veterans from accessing 
the services that they have earned and that they depend on.
    I am looking forward to working with the Committee to 
address this issue, so that our Nation's veterans have access 
to the quality care that they have earned and that they 
deserve.
    Thank you so much for the opportunity to appear before the 
Committee.

    [The prepared statement of Debbie Mucarsel-Powell appears 
in the Appendix]

    The Chairman. You are welcome. Ms. Mucarsel-Powell, you 
have brought an issue to light about how well the Mission Act 
is doing in your district. The Committee staff will be looking 
into this.
    Mr. Malinowski, you are recognized for 5 minutes.

                  STATEMENT OF TOM MALINOWSKI

    Mr. Malinowski. Thank you so much, Chairman Takano, Ranking 
Member. I really appreciate this chance to testify on behalf of 
my district in New Jersey.
    You know, we often pause to thank veterans for their 
service in uniform. We do not often enough appreciate their 
service to us out of uniform. When I was growing up, I was 
privileged to have World War II and Korea vets as my mentors, 
teachers, coaches. When I worked at the State Department in the 
NSC, every national security decision I took part in was 
informed by the advice of veterans who had seen war firsthand. 
And now I am lucky to serve with one of the largest freshman 
House classes of military veterans in recent memory.
    We have got to recognize that the men and women returning 
to civilian life from military service today after nearly 20 
years of constant war zone deployments are facing a special set 
of problems in re-integrating into civilian society, including 
mental health problems that deny many of them the rewards they 
have earned and that deny us the benefits of their continued 
service.
    If today is an average day, as you well know, 20 veterans, 
servicemembers, reservists and members of the National Guard 
will die by suicide. In New Jersey alone, 67 veterans committed 
suicide in 2016.
    Veterans groups in my district have emphasized to me that 
the best way to address the trauma and sense of isolation that 
many of our returning warriors feel is to support peer to peer 
programs that connect them to the community. The New Jersey 
Veterans Network, for example, runs a mobile outreach program 
to make sure that every veteran who has sacrificed so much for 
our country receives the resources they need and deserve.
    Part of this work involves connecting them with VA services 
and other VFW American Legion type networks, but they stress 
that the most important part of their work revolves around 
connecting vets with the volunteer mentors and allies who are 
willing to help in their local communities. I think we should 
be looking for ways to support more of these grass roots level 
programs built around veterans helping fellow veterans.
    I have been heartened by hearing of the past successes of 
the VA's peer specialists' program. Suffering vets that have 
someone alongside them that has been down the same road are 
much more likely to follow treatment plans and achieve 
recovery. I would support any effort to reinforce and expand 
this type of peer to peer program.
    I am also heartened by some more specialized programs I 
have seen in my district, including programs such as equine 
therapy. I recently visited a wonderful program run by an 
organization called Spring Reins of Life who are recipients of 
the VA's adaptive sports grant. We need to do more to ensure 
that these kinds of programs can be covered by our health care 
system, perhaps exploring the possibility of a dedicated 
billing code.
    Senator Tester's mental health bill, S.785, includes a 
provision in support of these kinds of therapies. This 
bipartisan bill has many other important provisions, and I am 
very happy to hear that you are working hard on a house 
companion bill which I strongly support and looking forward to 
working with you.
    I also fully support, Mr. Chairman, the legislation that 
you have passed through the Committee to date. I was proud to 
co-sponsor H.R. 2435, the Accelerating Veterans Recovery 
Outdoors Act, which will create a task force to look at how the 
VA can better use public lands and spaces to treat veterans 
with mental health problems. I look forward to voting for it 
when it comes to the House floor.
    With that, I just want to thank you for giving me this 
opportunity to work with you to give back to those who have 
done so much to give to our country.
    Thank you, sir.
    Mr. Chairman. Thank you, Mr. Malinowski, for your 
testimony, and thank you for your passion and caring for our 
veterans.
    Mr. Soto, you are recognized for 5 minutes.

                    STATEMENT OF DARREN SOTO

    Mr. Soto. Thank you, Chairman. Thank you so much for 
hosting this critical hearing. I am here to talk about one bill 
specifically, the Improving Veterans Access to Congressional 
Services Act, that was discussed by my colleague, Congressman 
Mast as well.
    It would require the Secretary of the Department of 
Veterans Affairs to permit the use of VA hospitals' facilities 
by Members of Congress for purposes of meeting with 
constituents and resolving veteran related issues. It would 
also establish a standard operating procedure for the opening 
of new congressional offices in VA hospitals.
    Currently, there are only 2 of these offices across the 
Nation right now, one by Congressman Mast that was opened in 
January 2018, and one that we were able to open and now work 
along with our colleagues in Central Florida in August of 2018.
    I want to thank you, Chairman, for visiting our VA earlier 
this year and getting to see our sprawling office there that is 
about as big as a shoebox, but it is not the size that matters. 
It is the location.
    We had to wait 6 months. I read about how Congressman Mast 
had got his office. And they only make these leasing decisions 
every 6 months, and there are a whole bunch of hurdles to go 
through. One of the biggest issues was making sure there is 
enough space, obviously, and we took the smallest office 
available; and Number 2 was making sure that the lease complied 
with the Hatch Act, so we are required to close them during the 
October September election date on an election year, which is 
fine as long as we can get in there.
    As you may know, Florida is home to the second largest 
veterans' population in the Nation. I know my colleagues, 
Representative Mucarsel-Powell and Representative Dunn know 
that well. Over half of our cases are veterans' cases. You can 
imagine how much use this office gets.
    I want to walk through just briefly how it would work on a 
daily basis, which is we will have folks who may not 
unfortunately have a good experience at the VA. They have their 
appeals court right there. They could walk right into my 
office. We work with them or do a warm pass to another member 
if they have a different member of Congress than us.
    The big concern is we will lose them. We will lose them. 
They will never come back if they have a bad experience, while 
if we are able to help them, sometimes it is about making sure 
to get their appointments sooner than 6 or 8 months wait 
sometimes. Sometimes it is about paperwork that got lost in the 
shuffle. Sometimes it is just about one bad experience based 
upon personality conflicts.
    But the main role, I believe, we as Members of Congress 
have at the VA is, we are collaborators with the VA. We are 
here to just solve the problems that veterans may have at the 
VA without making it a whole big deal about it. Many of these, 
95 percent of them are resolved between great communications 
between our local VA officials and our office. It is a great 
way to hire veterans to work with veterans.
    I want to end where I began, which is this is a key way to 
help so many of our veterans in a real simple way, and I was 
honored to host you, Chairman, so that you could see it 
firsthand in Orlando, and thanks for coming to Central Florida.

    [The prepared statement of Darren Soto appears in the 
Appendix]

    Mr. Chairman. Thank you for your testimony, Mr. Soto. I was 
very pleased to make that visit and to see the wonderful state 
of the art facilities you have and become aware of just how 
fast the veteran population is growing in your community.
    Thank you for your testimony.
    Members are excused.
    Do we have any other--oh, Ms. Stefanik.
    Good to see you, Ms. Stefanik.

                 STATEMENT OF ELISE M. STEFANIK

    Ms. Stefanik. Good to see you, too.
    Good morning, Chairman Takano, Ranking Member Roe, and 
Members of the Committee. I am grateful for the opportunity to 
testify before the House Veterans' Affairs Committee and 
discuss an issue very important to my district.
    I proudly represent New York's 21st Congressional District 
where nearly 1 in 10 adults is a veteran. That is what makes 
the work of this Committee deeply personal to me and my 
constituents.
    Tomorrow, the subCommittee on health will discuss and 
debate several important pieces of legislation concerning 
veterans' health care, many of which have a special focus on 
improving the access and quality of care for women veterans.
    I applaud the Committee as well as your staffs for focusing 
on this ever-important topic.
    Another topic that the subCommittee will discuss tomorrow 
is H.R. 2816, the Vietnam Era Veterans Hepatitis-C Testing 
Enhancement Act. This is an incredibly important bill. To help 
my colleagues understand why, I would like to share a story 
with you.
    In 1970, Danny Kaifetz, a young man from the North Country 
in New York volunteered to serve in the United States Marine 
Corps while the country was embroiled in the Vietnam War. Danny 
completed training at Parris Island and went on to jungle 
warfare school and combat infantry training at Camp Lejeune.
    At some point during training, as any one of my colleagues 
who has been through boot camp knows, all the recruits were 
lined up like a factory assembly line and were inoculated with 
the necessary vaccinations. Back then, the armed forces, to 
include the Marines, used the Ped-o-jet Air Inoculation device, 
or ``jet gun,'' to quickly vaccinate one recruit after the 
next.
    As is difficult for us to imagine today, medics were not 
required to sterilize the devices in between the inoculations. 
In fact, Page 38 of the operator's manual explicitly states, 
``Sterilization not required between injections.''
    As we now know, this practice exposed thousands of recruits 
to dangerous and often deadly blood borne diseases. 
Contamination happened without discrimination to volunteers and 
to those who were drafted, to those who went on to serve 
honorably for several years, and those who did not make it 
through training, to those who saw combat and bear the 
emotional burdens of a horrific war, and those who, through 
some good fortune, were spared.
    Danny Kaifetz thought he was one of the lucky ones who was 
able to serve his country and fellow Marines without going to 
combat. He proudly fulfilled his duty and was distinguished 
with the Meritorious Service Medal at the completion of his 
service contract.
    But unbeknownst to him, Danny did not leave the military 
unharmed. Nearly 40 years later, in 2011, Danny was diagnosed 
with Hepatitis-C. He sought and received treatment at the VA, 
and today Mr. Kaifetz will tell you with gratitude that he owes 
his life to the outstanding medical staff at New York's VA.
    As you all know, Congress dedicated significant resources 
to enable the VA to test and treat veterans for the Hepatitis-C 
virus, and the VA has made significant progress to date.
    However, these efforts primarily focus on veterans enrolled 
in the VA, testing only 78 percent of the 2 million Vietnam era 
veterans enrolled in VA care. Estimates indicate as many as 1 
in 10 of the 8 million surviving Vietnam era servicemembers may 
be infected with Hepatitis-C due to the cross-contamination. Of 
those who do not meet VA eligibility criteria, as many as 7 
million are considered at high risk for Hepatitis-C infection 
and unaware of their status.
    Our veterans deserve better. The Vietnam Era Veterans 
Hepatitis-C Testing Enhancement Act focuses on Hepatitis-C 
screening and does not take away from the VA's efforts. It 
rather enhances them.
    Furthermore, the bill is budget neutral by utilizing 
resources previously allocated by Congress through the Honoring 
America's Veterans in Caring for Camp Lejeune Families Act. The 
concept has proven successful at a local level due to the 
extraordinary efforts led by my constituent, Danny Kaifetz, and 
American Legion Post 1619.
    We owe it to an entire generation of veterans to provide 
this valuable screening tool. I urge my colleagues to join the 
American Liver Foundation, the AIDS Institute, and Vietnam 
Veterans of America to support H.R. 2816.
    Madam Chairwoman and Ranking Member, I thank you for the 
opportunity to speak with you today, and I thank the entire 
Committee and staff for the invaluable work you do to support 
our Nation's heroes. I look forward to working with you, and I 
yield back the balance of my time.

    [The prepared statement of Elise M. Stefanik appears in the 
Appendix]

    Ms. Underwood. [Presiding.] Thank you so much.
    Did you have any comments?
    Okay. Thank you so much, Ms. Stefanik. We really appreciate 
this great piece of legislation and look forward to considering 
it further.
    As we wait for the next panel to arrive, we have been so 
fortunate to be able to tour many VA facilities in my district 
over the district work period. I visited the Hines VA facility 
in Chicago and talked with their now departed facility 
director, but was really inspired to work with Senator Tammy 
Duckworth to introduce a bill to allow for preventive services 
to be offered to all veterans without co-payments.
    This would be in line to create parity with the Affordable 
Care Act, which offered those services to individuals in the 
private insurance market, in Medicare, and obviously in 
Medicaid without cost sharing. Yet some veterans do have to pay 
for those preventive services. It is something that has been a 
disparity for a little while now, and so we are really excited 
to be able to offer access to those screenings and vaccines and 
contraceptive coverage and many other items.
    I have dropped that one in the hopper. We understand that 
later in the week, maybe tomorrow, there is going to be a 
legislative hearing on many other women's health-related bills.
    We have Caring for Our Women Veterans Act, which I am also 
very excited about, which would require the VA to take a look 
at their plans across the enterprise and making sure that each 
facility is properly prepared to care for each and every female 
veteran that they have the duty to care for across the 
lifespan.
    We know that female veterans are the largest and sort of 
fastest growing group of veterans in our country, and yet there 
is some inconsistent and maybe unequal amount or preparation 
for these facilities to care for the female veterans.
    I am looking forward for that piece of legislation and many 
others to be considered in this upcoming legislative hearing.
    With that, I think that we will temporarily recess until 
the next--oh, is he a member?
    Okay. Hi, sir. How are you?
    Oh, Mr. Wenstrup, you came in at just at the right time 
because we were going to recess, sir, but now we can just call 
on you to share some remarks with the Committee at your 
convenience.

                   STATEMENT OF BRAD WENSTRUP

    Mr. Wenstrup. I feel very special, and it is good to be 
with you having served on a Committee for 6 years, and I loved 
serving on VA, but got called elsewhere if you will. It is good 
to be back.
    Let me thank you, first of all, for holding this member day 
hearing. As I have often said, caring for our veterans is one 
of Congress's most sacred duties. As I said, I am extremely 
proud to have served on this Committee for quite some time and 
to be a veteran myself. Though I no longer serve on the 
Committee, I really never stopped serving America's veterans, 
and that is what brings me here today.
    I am extremely proud of the work that Congress and 
particularly this Committee has done to ensure better health 
care for our veterans. you know, last year we passed the VA 
MISSION Act, which we had been working on for several years and 
to create a health care system that truly puts veterans first 
by giving them more choice in their health care treatments.
    The health of our veterans is one of my highest priorities. 
As a physician you can imagine that that would be the case. 
Today I am here to advocate for another bill which will improve 
veterans' health care.
    Representative Kathleen Rice and I have introduced H.R. 
3700, which will prohibit smoking in all veterans' health 
administration facilities and repeal the antiquated 1992 law 
that requires the VHA to furnish and maintain designated indoor 
or outdoor smoking areas.
    As an Army Reserve doctor, I know that permitting or 
exposing patients to firsthand and secondhand smoke is 
dangerous, especially while they undergo treatment at VHA 
facilities. It is past time that Congress address this issue 
that it created in 1992 and fix the outdated law so that we do 
not continue to harm veterans seeking care at VHA facilities.
    Let us get us in step with the rest of the country and do 
what is right.
    According to the Centers for Disease Control and 
Prevention, smoking is the leading cause of preventable death 
in the United States, killing more than 480,000 people 
annually. There is no risk-free level of exposure to secondhand 
smoke.
    As such, the overwhelming majority of America's private 
health care systems and facilities, most Department of Defense 
medical facilities, and all Federal government buildings are 
smoke free. Yet there are nearly 1,000 designated indoor or 
outdoor smoking spaces at VHA facilities across the country. 
That is at least 1 in every state.
    In addition to the health concerns, such spaces are 
difficult to maintain and cost the VA more than $1.2 million 
annually. That is why I was pleased to see VA Secretary Robert 
Wilkie announce this June that beginning in October all VHA 
facilities will be smoke free.
    However, it has since come to my attention that this policy 
change has been challenged by the American Federation of 
Government Employees who argue that the smoke free policy 
should not apply to VA employees.
    I believe this is the perfect illustration of precisely why 
Congress needs to assert its authority and make clear, once and 
for all, that smoking is unacceptable in the medical facilities 
where our veterans seek care every day. H.R. 3700 would do 
exactly that, ensuring that no one can change, reinterpret, or 
strike down the smoke free policy.
    The VA strongly supports codifying the smoke free policy as 
do 2 dozen public health organizations such as the American 
Cancer Society Action Network, the American Lung Association, 
the American Heart Association, the Campaign for Tobacco Free 
Kids, and the Society of Thoracic Surgeons.
    I would also like to thank the Members of this Committee 
who have cosponsored H.R. 3700, Representative Greg Steube and 
Chris Pappas for their support of this bill.
    I ask the Committee, I urge you to consider H.R. 3700 at a 
future health subCommittee legislation hearing. This is 
important legislation which will build on the Committee's work 
to improve veterans' health care. I want to thank you for your 
consideration.
    With that, I yield back.

    [The prepared statement of Brad Wenstrup appears in the 
Appendix]

    Ms. Underwood. Well, thank you, Mr. Wenstrup.
    I would like to recognize Dr. Dunn.
    Mr. Dunn. Thank you very much, Madam Chair.
    Dr. Wenstrup, I want to thank you for a commonsense bill. 
It is amazing that we have to do that sometimes, but, you know, 
that is exactly what we are here for. I could not agree with 
you more, and I appreciate your efforts on behalf of all the 
veterans.
    Thank you. I yield back.
    Mr. Wenstrup. Well, thank you, Doctor. I know you have had 
the experience of seeing the negative effects of smoking long-
term, and whether it is firsthand or secondhand, I think we 
need to do all that we can to protect our veterans seeking 
better health.
    Ms. Underwood. Yes. As we know, in our country tobacco-
related illnesses are a leading cause of death, right, and so 
this is a good way to try to save some lives and prevent 
disease.
    Mr. Wenstrup. I believe you are a nurse, if----
    Ms. Underwood. Yes.
    Mr. Wenstrup. --I am not mistaken?
    Ms. Underwood. Yes, sir.
    Mr. Wenstrup. You understand this very----
    Ms. Underwood. Absolutely.
    Mr. Wenstrup. --well, too.
    Ms. Underwood. Thanks for your bill. Thanks----
    Mr. Wenstrup. You bet. Thank you.
    Ms. Underwood. --for coming in.
    Mr. Wenstrup. Appreciate it.
    Ms. Underwood. Okay. Did you have any other comments, Dr. 
Dunn?
    Mr. Dunn. Nothing else.
    Ms. Underwood. Okay. So--yes.
    Mr. Dunn. Here is----
    Ms. Underwood. Oh, how wonderful. You all are just coming 
in right in time. Mr. McCarthy has just walked into the room.
    Sir, I would be happy to recognize you to speak about your 
bill. Yeah, right there.

                  STATEMENT OF KEVIN MCCARTHY

    Mr. McCarthy. Thank you very much.
    Distinguished Members of the Committee, thank you for the 
opportunity to discuss with you today.
    I have a story about the veterans in my district in 
California. This is Central California. This is Bakersfield, 
Kern County. I have had the privilege to represent them for 
quite some time. For too long thousands of veterans throughout 
Kern County have patiently awaited a new community-based 
outpatient clinic to be built in Bakersfield, California.
    Now the existing clinic is outdated and cramped, and we can 
not fulfill the needs of the growing veterans we have 
throughout Kern County. 10 years ago Congress authorized the 
construction of 15 new community-based outpatient clinics. 
Included in that clinic was Bakersfield through Public Law 111-
82. Now the Bakersfield clinic is the only location that 
remains un-built, and that is unacceptable.
    I want to tell you the story why it is not built, and in 
telling the story, there is a flaw in our law that actually 
rewards people in the process not to have one.
    Now, first, veterans in my district had hoped that the VA 
would break ground on the new clinic all the way back in 2015. 
However, that hope was derailed when the VA chosen site was 
condemned by this high-speed rail authority for being in the 
path of this costly high speed rail project that now the new 
governor has actually declined to build.
    This was among the first of several unnecessary delays and 
setbacks for the clinic.
    Now last October we thought we solved this one more time. I 
was thrilled and I had announced that the VA had finally 
awarded a contract for a brand-new state of the art 30,000 
square foot Bakersfield clinic located on Knudsen Drive. This 
clinic would provide veterans with expanded mental health. It 
expanded women health care for veterans' services.
    Unfortunately, this award has become subject to severely, 
which I call dilatory protests. You know who is protesting, the 
current owner of the land where the current clinic is that is 
outdated.
    One after another after another he protests because if he 
protests, there is a dirty little secret. He gets rewarded. He 
protests so the veterans do not get a new facility, but you 
know what he gets in his? They double his lease. They double 
his lease payment. The VA was paying him a million dollars a 
month, but now that the new center is delayed, he gets $2 
million a month. You know who is protesting? He is protesting.
    Because he protests, he doubles his rent. Because he 
doubles his rent, the veterans are denied a new facility. We 
are the last, in the last 10 years, when Congress told us to 
build these. Our own law rewards somebody from stopping our 
veterans to have a new clinic and actually puts money in their 
pocket.
    Enough is enough. While I understood the government 
contracting process must allow for fair competition, I do not 
understand how this process can be so manipulated and how the 
Bakersfield clinic remains un-built while other VA facilities 
authorized in 2009 are currently serving veterans.
    As I said, the taxpayers are now getting ripped off. The 
veterans are now being denied, and the person causing it all is 
being rewarded. That should not work in this system. He is 
approximately getting twice as much, $2 million a month, for a 
lease on a building that does not fulfill the need of our own 
veterans.
    Every day delay is another delay that the taxpayers must 
pay higher rent. If he is successful, they will go back to the 
drawing board and not even use the location that they have 
already selected that works. This Federal contracting process 
must be transparent, and must be responsive, and it must be 
reasonable to the concerns. This goes beyond anything we 
believe.
    Lastly, the difficulty in building a new clinic in 
Bakersfield suggests that the Federal government's process for 
awarding contracts is liable to inefficiency and abuse. I hope 
my testimony today has shone a light on one part of this larger 
problem and will inspire future action.
    I look forward to your Committee and all Committee Members 
to ensure that the Bakersfield clinic comes to fruition, and 
that other veteran populations are not impacted by this broader 
systemic problem.
    If they are successful with what they are doing today, I 
will not be the only district that this happens to. Everyone 
that has an outdated facility will stop the improvement because 
they will be rewarded in their own process, but who will be 
denied are actually the veterans.
    I think we are better than that. I think it says a lot 
about our Nation on how we treat our veterans. That is why I 
would like to submit a letter from SASD Development Group for 
the record, and I thank you for the opportunity to testify 
today.

    [The prepared statement of Kevin McCarthy appears in the 
Appendix]

    Ms. Underwood. Well, thank you so much.
    I would like to recognize Dr. Dunn.
    Mr. Dunn. Thank you, Madam Chair.
    Mr. Leader, I share your sense of outrage at the way this 
has transpired. Obviously, the system is broken. I promise to 
work with you to address that as rapidly as possible.
    Thank you.
    Mr. McCarthy. I thank you, Mr. Dunn. I know the work that 
you have done as a veteran yourself, and I appreciate you 
taking the time and consideration. You, too, Congresswoman 
Underwood, about this. I appreciate it. I yield back.
    Ms. Underwood. Thank you, Leader McCarthy. We appreciate 
your time.
    Okay. With that let us just stall for just a few seconds 
because they have just been coming in the room. I think that we 
will go into a recess subject to the call of the chair.
    Thank you so much.
    Ms. Underwood. I call the Committee to order. I see we have 
been joined by Mr. Walberg, and so I would like to recognize 
you for 5 minutes, sir.

                    STATEMENT OF TIM WALBERG

    Mr. Walberg. I thank you and appreciate the efforts of this 
Committee today to hear ideas, and that is always a good thing.
    I want to thank Chairman Takano as well as Ranking Member 
Roe for the opportunity to testify, and each of you on the 
panel.
    Taking care of our country's veterans is one of the most 
important things we can do as Members of Congress. We say that 
all the time, and I think for the most part we attempt to. 
Sometimes we miss things. Our servicemen and women give their 
all in the name of our Nation, and it is the obligation of 
Congress and our Nation to give the same dedication to 
providing the highest quality of care for when our heroes 
return home.
    Many members of the armed forces endured unthinkable 
hardship in captivity as prisoners of war. While we will never 
forget those, who did not return home, there are those who do 
come back, thank God. For those that do, they deserve the 
highest priority of care at the VA.
    Therefore, I introduced the POW Priority Care Act which 
would move POWs to the front of the line, giving them Priority 
1 Level VA care.
    Under current VA care provisions, POW veterans are not 
among the top tier of care for the VA. Instead, POW veterans 
are in the third priority care group, often placing them at a 
disadvantage in health care options. The priority system 
classification determines eligibility for health care services 
at the VA. Factors determining priority assignment include time 
and place of service, income level and service-connected 
disability. The POW Priority Care Act would elevate POWs from 
Priority Group 3 to Priority Group 1 in terms of health care 
needs.
    By having Priority 1 status, POWs will have greater access 
to health care options at the VA. We can all agree, I am sure, 
that veterans and prisoners of war should not have to struggle 
to get the proper health care and medical services that fits 
their needs and is available.
    I want to thank Representative Krishnamoorthi, Guthrie and 
Rush for joining me in introducing this bipartisan legislation. 
The legislation is supported by the AMVETS, the POW MIA 
Families Organization, and we are continuing to gain support 
from other organizations.
    Prisoners of war have not only answered the call of duty, 
but they endured unthinkable hardship and made unquestioned 
sacrifice in service to our Nation.
    I thank you for this opportunity. I urge the Committee to 
markup H.R. 3527 so that it can advance to the floor of the 
House for a vote. I yield back.

    [The prepared statement of Tim Walberg appears in the 
Appendix]

    Ms. Underwood. Thank you so much.
    Dr. Dunn, did you have any comments?
    Mr. Dunn. I do not. Thank you.
    Ms. Underwood. Thank you so much for your time and for 
flagging this bill for the Committee and offering these words. 
We really appreciate your time today.
    Okay. The chair recognizes herself for 5 minutes.

                 STATEMENT OF LAUREN UNDERWOOD

    Ms. Underwood. According to the most recent VA national 
suicide data report, veterans who recently used Veterans Health 
Administration services had higher rates of suicide than those 
who did not. Veterans who use VHA services have physical and 
mental health care needs that are actively seeking care because 
those conditions are causing disruption to their lives.
    Many of these conditions are associated with an increased 
risk of suicide. Suicide attempts can be impulsive, and 
screening criteria are not always clinically effective, often 
relying on self-identification. Many suicide attempts involve 
little or no planning, and the time between suicidal ideation 
and attempted suicide could be a matter of minutes.
    This makes preventing veteran suicides incredibly 
difficult. A more proactive approach is needed to combat the 
veteran suicide crisis. Reducing access to lethal suicide 
methods is one of the few population level interventions that 
has been shown to decrease suicide rates. Building in time and 
space between the impulse to act and the means to harm oneself 
saves lives.
    During a House Committee on Veterans Affairs hearing on 
veteran suicide prevention, Dr. Keita Franklin, then National 
Director of Suicide Prevention at the VA said that if it were 
up to her, lethal means training would be provided to all VA 
staff. In response to follow up questions for the record, VA 
stated that, ``The goal of universal training for all VA 
related to lethal means safety is obtainable. It requires, 
though, a further expansion of our previous efforts.''
    Most people who survive a suicide attempt do not go on to 
die by suicide. If veterans can collaborate with their 
providers ahead of time to help them survive a suicidal crisis, 
they have likely prevented their suicide for the rest of their 
lives.
    As a result, I am introducing a bill that would direct the 
VA to provide lethal means training to all VHA staff who 
regularly interact with veterans, empowering VHA staff to speak 
with veterans about lethal means safety and suicide prevention 
plans.
    In a similar way, the most recent VA national suicide data 
report highlights that the highest rate of veteran suicide is 
among veterans age 18 to 34, a rate which has nearly doubled 
since 2005. As of 2018, every veteran in that age group would 
have begun their service after 9/11.
    According to the 2019 Iraq and Afghanistan Veterans of 
America member survey, 65 percent of respondents personally 
know a post-9/11 veteran who has attempted suicide, and 59 
percent personally know a veteran who has died by suicide. The 
majority of respondents reported service -connected clinical 
depression, post-traumatic stress, or other mental health 
injuries. Along with these risk factors for suicide, the 
respondents reported that the stigma of seeking help is the top 
reason for not getting the mental health care they need.
    Suicide attempts can be impulsive and screening criteria 
are not always clinically effective, often relying on self-
identification. Many suicide attempts involve little or no 
planning, and the time between suicidal ideation and attempted 
suicide could be a matter of minutes. This makes preventing 
veteran suicides incredibly difficult. A more proactive 
approach is needed to combat the veteran suicide crisis.
    I have introduced a bill that would provide all post 9/11 
veterans with a suicide prevention and lethal means counseling 
session as part of their first primary care visit with the VA.
    The session would empower veterans to recognize suicide 
risk factors and, if appropriate, create a suicide prevention 
plan with their primary care provider, providing space for a 
more personal discussion which de-stigmatizes suicide.
    As we know, this Committee has been uniquely focused on 
ending the veterans' suicide crisis, and I look forward to 
continuing to discuss these measures at a later date.
    Thank you.
    Ms. Underwood. We will now transition the chair to Mr. 
Sablan.
    Thank you.
    Mr. Sablan. [Presiding.] All right. Good afternoon, 
everyone. Mr. Higgins, your 5 minutes starts now.

                   STATEMENT OF CLAY HIGGINS

    Mr. Higgins. Mr. Chairman, thank you. I observe that my 
colleague, Dr. Dunn, the Ranking Member is injured. I warned 
him that Madam Chairwoman was a tough and intelligent person. I 
applaud him for his courage in hanging in there, Doctor.
    [Laughter.]
    Mr. Higgins. Ladies and gentlemen, thank you for allowing 
me to address you today. I respectfully request your strong 
support of H.R. 1527, a Long-Term Care of Veterans Choice Act. 
My bill authorizes the U.S. Department of Veterans Affairs to 
cover the cost of long-term care at medical foster homes for up 
to 900 veterans otherwise eligible for nursing home care 
through the VA.
    Medical foster homes are private homes in which a caregiver 
provides services to a smaller group of individuals who are 
unable to live without day to day assistance. It is an 
alternative to nursing homes for those who require nursing home 
care, but prefer a non-institutional setting with fewer 
residents.
    For many young veterans in need of round the clock care, 
medical foster homes can provide a more age appropriate, 
independent setting than traditional nursing homes.
    The U.S. Department of Veterans Affairs has run its medical 
foster home initiative since the year 2000, and today the 
Veteran Health Administration oversees more than 700 licensed 
caregivers caring for nearly 1,000 veterans in 42 states.
    To be eligible to provide care to veterans, VA medical 
foster home providers must already pass a background check, 
complete 80 hours of initial training, and 20 hours annually of 
recertification. They cannot work outside the home.
    Unfortunately, while the VA will cover the cost of home-
based primary care for eligible veterans living in medical 
foster homes, the VA does not cover the cost of medical foster 
home living arrangements for veterans otherwise eligible for 
nursing home care through the VA. Instead, these veterans must 
pay for medical foster home services out of pocket or through 
private insurance.
    Costs associated with medical foster home services range 
between $1,500 to $3,000 a month, which is significantly lower 
than the nearly $7,000 the VA would otherwise pay per patient 
at a state VA nursing home. This is a commonsense bill that 
allows us to provide greater care and access to needed full-
time care, nursing home level care to our veterans at a lower 
expense to the people in our treasure.
    In my home state of Louisiana, the VA operates state of the 
art veterans' homes that provide residents a high quality of 
care in an understanding, supportive environment. I can 
personally attest to the high quality of care and sense of 
well-being among veterans living at the Southwest Louisiana 
Veterans Home.
    But much like in the civilian world, there is no one size 
fits all standard of care for veterans. Veterans should be 
afforded flexibility to use the benefits they righteously 
earned in a manner that best suits their individual needs.
    H.R. 1527 gives much needed choice and personal agency back 
to these brave men and women who have selflessly sacrificed for 
our Nation. I am pleased that this critical legislation will be 
considered tomorrow in Committee.
    I thank you very much for this time and I yield the 
balance.

    [The prepared statement of Clay Higgins appears in the 
Appendix]

    Mr. Sablan. Mr. Higgins, thank you very much for your 
testimony, your statement. We are recording it.
    I am sorry.
    Mr. Dunn. Captain Higgins----
    Mr. Sablan. Dr. Dunn, do you have anything?
    Mr. Dunn. I do.
    Mr. Sablan. I am sorry. I apologize.
    Mr. Dunn. I just wanted to let you know that we take your 
concerns seriously. We have worked together on this Committee. 
I understand your concerns with that, and we will be taking 
that up very shortly in consideration.
    Thank you, again, for shining a light on this problem.
    Mr. Higgins. Thank you, my friend and colleague. I miss 
this Committee. The staff is fantastic on both sides and it is 
truly a bipartisan effort in reference of love for our veteran 
brothers and sisters. Thank you all----
    Mr. Dunn. Thank you.
    Mr. Higgins. --for considering my bill.
    Mr. Sablan. Yeah. Thank you, again.
    Mr. Zeldin, sir, please.

                    STATEMENT OF LEE ZELDIN

    Mr. Zeldin. Thank you, Mr. Chairman, Ranking Member as well 
for the opportunity to testify today.
    With September marking suicide prevention month, I would 
like to take this opportunity to testify on behalf of a program 
that has saved the lives of countless New Yorkers who put their 
lives on the line to defend the rest of us.
    I have the distinct honor of representing New York's 1st 
Congressional District located on the east end of Long Island, 
otherwise known as the greatest congressional district in 
America. Not only do we have the most beautiful beaches in the 
country and so much more, but the very communities we all call 
home played such an instrumental role in the founding of our 
great Nation.
    Today my home county of Suffolk boasting one of the highest 
concentrations of veterans in the country prides ourselves on 
our rich history and commitment to serving our Nation's 
veterans.
    Unfortunately, when our veterans return home from the 
battlefield too many find that their fight has just begun. The 
Department of Veterans Affairs, as this Committee knows well, 
estimates that approximately 20 veterans a day are taking their 
own life. Often times they are plagued by the individual wounds 
of war. They have been come to known as post-traumatic stress 
disorder, traumatic brain injury.
    One of those servicemen who was suffering from post-
traumatic stress disorder was Pfc. Joseph Dwyer, an Iraq war 
veteran from Mt. Sinai. His picture is behind me. As an Army 
combat medic, Pfc. Dwyer became the face of the Iraq war in 
2003 when this photo of him carrying an injured Iraqi child to 
safety went viral worldwide.
    Unfortunately, when he came back home to Long Island he 
returned with the mental wounds of war, and after years of 
struggling he lost his battle with PTSD in 2008. It is 
important to note that Joe did not commit suicide. He was 
seeking temporary relief from his pain and his last words were, 
I do not want to die.
    Understanding that Pfc. Dwyer was just one of the many 
local veterans struggling, I created the Pfc. Joseph P. Dwyer 
Veteran Peer Support Program as a New York State Senator in 
2012. The Dwyer program is modeled as a peer to peer support 
program for veterans suffering from post-traumatic stress 
disorder and traumatic brain injury. This model provides a 
safe, confidential and educational platform where all veterans 
are welcome to meet with other veterans in support of each 
other's successful transition to post-service life and seeks to 
build vet to vet relationships that enhance positive change.
    This program also incorporates a variety of therapeutic 
activities, such as horse training and fishing that provide for 
common experiences, learning and personal growth. My home 
county, Suffolk County, served as one of the 4 test counties in 
New York. Since then with the love and hard work of so many 
exceptional men and women locally, the program has successfully 
expanded to over 20 counties across New York, saving lives and 
assisting tens of thousands of New Yorkers battling PTSD and 
TBI.
    This year on top of fully funding the program, the New York 
state budget actually increased funding to this successful 
format. The way the program is organized, providing grants to 
localities has allowed each county to customize their 
individual program to their needs and the resources they have 
available while running an efficient and effective program.
    Counties only receive 100 to $300,000 each from New York 
State, and what they do with it is incredible. There are a lot 
of people who will come to Congress and they will propose a 
program and the numbers they will throw around are 7, 8, 9 
figures to solve this problem. What we are finding in our home 
county of Suffolk and what has now been expanded all across the 
State of New York is that with just 100 to $300,000 we are 
saving countless lives in our home county and across the state.
    Its continued track record of success is why I introduced 
H.R. 1749, the Pfc. Joseph P. Dwyer Peer Support Program Act to 
authorize the Secretary of Veterans Affairs to make grants to 
state and local entities to carry out peer to peer mental 
health programs all across our Nation, and help ensure all of 
our Nation's veterans have access to the support they need.
    I challenge and plead my colleagues on this great 
bipartisan Committee to accomplish what is now possible, 
efficiently ensuring that every veteran in America has access 
to a peer to peer support model that works, that saves their 
lives, their families, their jobs and so much more. This bill 
is co-sponsored by 21 of our colleagues, including Committee 
Members Kathleen Rice, Chris Pappas, Greg Steube and Elaine 
Luria.
    I would encourage you to speak to Congresswoman Rice. One 
of the counties is her home county of Nassau County where her 
home county is doing a great job implementing this program.
    Pfc. Dwyer is just one of the many veterans who has 
suffered from PTSD or TBI. More must be done when they return 
home. We must ensure these brave servicemembers have every 
resource they need to transition back into civilian life, and 
the Pfc. Joseph Dwyer Peer Support Program is the integral part 
of our veterans' success.
    Again, I thank the chair and Ranking Member for giving me 
the opportunity to testify today, and I ask you to please 
consider this legislation.
    I yield back.

    [The prepared statement of Lee Zeldin appears in the 
Appendix]

    Mr. Sablan. Yeah. Thank you very much for your bill and the 
story behind it. Yeah. I also come from a district where a 
program like that, the one you recommend and you are proposing, 
your bill would work very handily, very effectively in getting 
our veterans to transition back into their lives. We will keep 
an eye out on it.
    Mr. Dunn, Dr. Dunn, do you have----
    Mr. Dunn. Thank you for your testimony.
    Mr. Sablan. Well, thank you very much, sir, for your 
testimony.
    Mr. Zeldin. Thank you, Mr. Chair. Thank you, Ranking 
Member. I appreciate it and I would be happy to answer any 
questions anyone on the Committee has, including the great 
staff on both sides of the aisle.
    Mr. Sablan. Thank you, also, for the compliment to the 
staff.
    I am going to have to do something that is not normal. I am 
going to ask a question. Who came first, Dr. Ruiz or Mr. 
Johnson? Mr. Johnson? Okay. Yeah.
    Mr. Johnson, you are recognized for 5 minutes.

                   STATEMENT OF BILL JOHNSON

    Mr. Johnson. Well, thank you, Mr. Chairman.
    I appreciate this opportunity to share with you my support 
for the House Veterans Affairs Committee examining the 
effectiveness of a non-invasive procedure called Transcranial 
Magnetic Stimulation or TMS as a treatment option for veterans 
suffering from PTSD and TBI.
    We are all aware of the tragic increased risk for veterans 
suffering from PTSD and TBI of dying from accidental injury, 
viral Hepatitis and suicide compared to the general population. 
I am pleased to share with you efforts underway in Ohio to 
provide TMS as an additional alternative treatment for these 
veterans.
    As you may know, TMS treatments are approved by the U.S. 
Food and Drug Administration to treat depression. TMS therapy 
is conducted by non-invasive procedures through which an 
electromagnet is charged with electricity and then placed over 
specific points on a patient's skull, creating a powerful 
magnetic field that can positively affect brain cells.
    It does not involve surgery or require the use of sedation 
or other medications. However, there is growing evidence that 
in addition to treating symptoms of depression, TMS can also 
help veterans suffering from PTSD.
    You may be interested to learn that through the leadership 
of Ohio State Senator and retired Navy Seal Frank Hoagland, the 
State of Ohio has recently authorized a transcranial magnetic 
stimulation fund through the state treasury and a pilot program 
to be conducted by the directors of Veterans Services, Mental 
Health and Addiction Services, and Amvets.
    In coordination with the veteran's medical initiative, or 
VMI, and industry leaders in medical technology, the three-year 
program will make TMS available for veterans with substance use 
disorders or mental illness. I am very pleased to see Ohio 
taking action to provide our veterans with new and innovative 
individualized care and treatment options.
    Additionally, you may know that the VA Center for 
Compassionate Care Innovation, or CCI, has supported the 
expanded use of TMS treatment at the Providence VA Medical 
Center in Rhode Island, including for PTSD. As of June 2018, it 
was reported that over 150 patients have received TMS therapy 
since 2013 at the Providence Veterans Medical facility and 
demand continues to increase.
    I know that Ranking Member Roe, through his leadership and 
advocacy for veterans suffering from invisible wounds, I am 
greatly interested in hearing the Committee's thoughts on this 
TMS type of treatment.
    Also, Mr. Chairman, given the potential of this type of 
treatment to manage symptoms of substance use disorders and 
mental illness, I respectfully urge the Committee to hold a 
hearing to examine whether TMS is a viable alternative 
treatment option for veterans suffering from PTSD and TMI in 
addition to depression.
    Since some VA medical facilities have already treated 
veterans through TMS therapy, perhaps the VA could share with 
the Committee the effectiveness of this treatment in addition 
to whether VA plans to expand TMS treatment as an option, and 
what obstacles may be preventing other VA facilities from also 
offering TMS therapy to veterans.
    I want to thank you again for the opportunity to share with 
you the potential of a non-invasive treatment such as TMS 
therapy, and efforts being made in Ohio to expand treatment 
options for our Nation's heroes.
    I yield back the balance of my time.

    [The prepared statement of Bill Johnson appears in the 
Appendix]

    Mr. Sablan. Mr. Johnson, thank you very much for your 
testimony. Dr. Dunn will get to learn more about your program 
later as we go on.
    We are trying to make this as, you know, we move on so 
Members also have other things they need to get to.
    Mr. Johnson. Sure. All right.
    Mr. Sablan. Thank you, again, sir, for----
    Mr. Johnson. Thank you.
    Mr. Sablan. --for joining us today.
    Dr. Ruiz, sir, you have 5 minutes.

                     STATEMENT OF RAUL RUIZ

    Mr. Ruiz. Thank you, Mr. Chairman. I am Dr. Raul Ruiz and I 
am honored to represent California's 36th District, and I am 
proud to say it includes more than 45,000 veterans. It was an 
honor to have served on the Veterans Affairs' Committee and it 
is great to be back.
    I am here today to address one of the most pressing and 
urgent health threats facing veterans and servicemembers, 
exposure to burn pits. Our military uses burn pits to eliminate 
waste, including chemicals and plastics, creating giant plumes 
of black smoke containing carcinogens and particulate matter.
    For years the Department of Defense used burn pits in Iraq 
and Afghanistan even while recognizing that exposure to burn 
pits may pose health risks to our troops. In 2006, Air Force 
Lieutenant Colonel Darren Curtis, a bio-environmental 
engineering flight commander, conducted an environmental health 
assessment of the burn pit in Balad, Afghanistan, and wrote a 
memorandum alerting his commanding officer that the burn pit is 
an acute hazard for individuals. He added, ``What I see is an 
operational health risk to those that have been, are now and 
will be deployed to Balad.''
    The then Chief of Aeromedical services, James Elliott, 
wrote in concurrence to Lieutenant Colonel Curtis saying, ``The 
known carcinogens and respiratory sensitizers released into the 
atmosphere by the burn pit present both an acute and chronic 
health hazard to our troops and the local population.''
    These memos were ignored, and now veterans all across the 
country are developing rare and severe pulmonary diseases, 
cancers and autoimmune diseases despite living healthy 
lifestyles and not having any other risk factors.
    In addition, the VA has also acknowledged the severe health 
risks of burn pits. On April 26th, 2010 the Director of 
Compensation and Pension Service within the Veterans Benefits 
Administration writes training letters on October 3rd to all VA 
regional offices where he described an air sampling performed 
at Balad which include ``toxic organic halogenated dioxins and 
furans, or dioxin.''
    As we know, dioxin was present in Agent Orange. The letter 
describes that ``the widespread existence of burn pits only 
exasperates the high concentration of particular matter in Iraq 
and Afghanistan which, ``can affect the heart, lungs and cause 
serious health effects.''
    As a public expert myself, I know that when we have a high 
enough suspicion with a severe enough illness, we must act and 
act with urgency. We have independent research that raise 
suspicions of a causal link that veterans exposed to burn pits 
are developing serious illnesses and diseases.
    An article published in the reputable New England Journal 
of Medicine, Dr. Robert Miller from Vanderbilt University 
performed lung biopsies on 49 soldiers exposed to burn pits in 
Iraq and Afghanistan who were healthy before being deployed. 38 
of them were diagnosed with constrictive bronchiolitis.
    In another study, Seton Hall University Law School Center 
for Policy and Research analyzed 500 veterans who were exposed 
to burn pits while serving in Iraq and Afghanistan. 74 percent 
reported having respiratory issues such as sleep apnea, asthma, 
chronic sinus infections, chronic cough, and others. 26 percent 
of them had more severe illnesses such as brain cancer, lung 
cancer, heart and bronchial tubes and acute leukemia.
    We also have case studies that seem to raise extremely high 
suspicion. My constituent, Jennifer Kepner, a 39-year-old Air 
Force veteran with a healthy lifestyle and no other risk 
factors was stationed at Balad, was diagnosed with pancreatic 
cancer in 2016. Her oncologist determined that exposure to burn 
pits was the most probable link to her cancer.
    In October of 2017, Jennifer passed away leaving behind her 
husband and two children. I carry this photo with me in my 
office. It is in my office to remind me every day of the 
urgency of this problem. We are seeing a pattern of suspicious 
health effects that are costing the lives of our young veterans 
and servicemembers exposed to burn pits.
    This Committee cannot wait any longer. This Committee must 
put our veterans above bureaucracy. This Committee, and I am 
requesting that you take action now by starting to address this 
issue and my bill, H.R. 4137, the Jennifer Kepner HOPE Act, a 
bill to provide quality, affordable health care for all exposed 
veterans by making exposure to burn pits part of the priority 
group in Category 6, so that veterans who have been exposed can 
get low cost health care to get their subtle changes worked up 
in a timely fashion to detect severe illnesses so that they can 
save their lives, detect early cancers, et cetera, and save 
their families as well.
    We can not wait 10 years for the multi-cohort longitudinal 
prospective studies. Actually, it is 20 years that it would 
take to do a good study to decide whether or not we must act 
now. This is the issue that if you act now with the urgency 
with one intervention you can save countless of lives. This is 
your biggest bang for your buck, per se, to make the biggest 
difference in the health of veterans and save their lives.
    With that, I ran out of time.

    [The prepared statement of Raul Ruiz appears in the 
Appendix]

    Mr. Sablan. No. Thank you, Dr. Ruiz. I was actually 
enraptured by your testimony. The thing is we promise our men 
and women in uniform services that they will be taken care of 
and yet, despite that, in addition to the violence they are 
faced with while abroad while on active duty, we are creating 
other situations where they actually get sick as well.
    Thank you for your testimony. I can see the passion that 
you give it.
    Dr. Dunn does not have any----
    Mr. Dunn. Use your microphone.
    Mr. Sablan. Yeah. The microphone.
    Mr. Ruiz. If I may make a correction to my remarks. Balad 
is in Iraq, not Afghanistan.
    Mr. Sablan. All right. It is still very good testimony, Dr. 
Ruiz. Thank you.
    Mr. Ruiz. Thank you.
    Mr. Sablan. Yes. Thank you very much for being here.
    Mr. Smucker, you have 5 minutes, sir. Thank you.

                   STATEMENT OF LLOYD SMUCKER

    Mr. Smucker. Thank you, Mr. Chairman, and thanking you 
Ranking Member, Members of the Committee. I appreciate the 
opportunity to testify here today.
    Also, I would just like to thank you for your hard work and 
dedication to improving the lives of our veterans and their 
families. We all know that our servicemen and women have 
endured tremendous hardships and made significant sacrifices in 
their fight to preserve the freedom that we all enjoy today. In 
thanks for their courageous service, our veterans certainly 
have earned and deserve the highest quality care that we can 
provide.
    I also believe that if they are responsible for paying for 
any of that service through a deductible, that billing should 
be transparent and should be timely, which is why I am here 
today.
    Earlier this year I reintroduced the VA Billing 
Accountability Act. This same bill passed by voice vote in the 
House during the 115th congress, but, unfortunately, was like 
many other House passed bills stalled in the Senate and was 
never taken up there. Today I would like to once again urge 
consideration by the Committee of this bipartisan legislation.
    The bill is fairly straightforward. It provides certainty 
in the way the VA bills our veterans by requiring the VA to 
deliver a bill for payment no later than 180 days after a 
veteran receive care at a VA facility.
    Non-VA facilities must also increase their coordination 
with the department to ensure that copayment bills are 
delivered no later than 18 months after a veteran receives care 
from an outside provider. That is 18 months.
    This bipartisan legislation also increases transparency for 
veterans by requiring the VA to notify veterans on how they can 
receive a waiver or establish a payment plan before the VA can 
collect any delayed copayment.
    Now why is this necessary you may ask. The VA Office of 
Inspector General reported that in the fiscal year 2015 of 
roughly 15.4 million bills that the Veterans Health 
Administration issued that year, approximately 1.7 million, 1.7 
million, 11 percent of those were improper bills for the 
treatment of service connected conditions.
    In some cases, veterans received bills a full 5 years after 
they received their care. To help put this into perspective, 
the Veterans Health Administration collected a staggering $13.9 
million from our Nation's veterans inappropriately based on 
those numbers.
    It is simply unacceptable and must end. We should make it 
easier, not harder, for our retired servicemen and women to 
transition to post military life by not saddling them with 
bills for VA services received in years past. Many veterans 
live on fixed incomes and do not have the resources to cover 
unexpected costs caused by the mistakes of VA bureaucrats.
    My legislation provides needed reforms to the VA. Our 
veterans strongly deserve it, and I urge once again the 
consideration of the Committee and the passage of this 
bipartisan legislation.
    Thank you. I yield back.

    [The prepared statement of Lloyd Smucker appears in the 
Appendix]

    Mr. Sablan. Thank you, Mr. Smucker. Thank you.
    At this time, I recognize the Ranking Member, Dr. Dunn.
    Mr. Dunn. Thank you very much, Chairman Sablan.
    Lloyd, if I may be informal here, I thank you for bringing 
this back in front of us again. It is obviously a good bill. We 
do need to bring it back up and see if we can push it over to 
the Senate with some bells on it this time and maybe get some 
attention.
    I appreciate you. Thank you.
    Mr. Smucker. Thank you.
    Mr. Sablan. Yeah. Thank you very much, Mr. Smucker.
    At this time, Chairman Takano, the real Chairman is going 
to come in and take his seat.
    The Chairman. Thank you.
    Mr. Dunn. You were doing so great.
    Mr. Sablan. Thank you, Dr. Dunn.
    Mr. Dunn. Welcome back.
    The Chairman. Okay. Mr. Castro, welcome.

                  STATEMENT OF JOAQUIN CASTRO

    Mr. Castro. Thank you. Thank you, Chairman Takano, to the 
Ranking member, to the other Members of the Committee, thank 
you for holding this hearing and for inviting me and others to 
be here and testify.
    I would like to take my time to help shed some light on the 
health effects that have resulted from our men and women in 
uniform being exposed to burn pits while deployed on our 
Nation's behalf.
    My district, of course, includes San Antonio, Texas, a city 
with a significant active duty and veteran population. In fact, 
so much so that San Antonio is known as Military City, USA. It 
is from this veterans' population that I have heard firsthand 
the stories of those effected by burn pits. These brave 
servicemen and women have shared the challenges that they have 
endured as a result of their exposure to toxic fumes emanating 
from the burn pits.
    I would like to highlight one of the many veterans that I 
have had the honor to meet whose name was William Garza. He 
served as a corporal in the U.S. Marine Corp. and deployed to 
Iraq on behalf of our Nation. After being exposed to burn pits 
during this service, Corporal Garza was diagnosed with cancer. 
I visited him at his bedside in hospice care just this past 
March. A few days later at the age of 38, he passed away.
    William left behind a wife and two sons, and his story is a 
tragic one. Unfortunately, William's story is not unique. There 
are other veterans who are sharing a similar fate.
    It is just an example of a broader population of veterans 
suffering the consequences of exposure from burn pits 
throughout Afghanistan and Iraq. These veterans and their 
families have sacrificed for our Nation, only to endure 
significant medical issues after returning home. Often 
emotional and financial pressures accompany those conditions. 
Over 200 military bases in Operations Iraqi Freedom and 
Enduring Freedom produced several tons to several hundred tons 
of solid waste per day. Open air burn pits were the primary 
waste disposal method during the majority of the duration of 
these wars. Air sampling data indicate that smoke from these 
burn pits contained chemicals associated with respiratory and 
lung conditions.
    Our servicemen and women's exposure to this toxicity is 
undeniable, and the level of toxicity cannot be questioned. It 
is clear that the use of burn pits poses significant health 
risks to our military personnel serving in those countries for 
the first decade of conflict.
    We cannot afford to cast a blind eye to the level of 
exposure and the number of servicemen and women that were 
impacted, and we cannot afford to do nothing here in congress.
    Earlier this year I reintroduced the Family Member Access 
to Burn Pit Registry Act, H.R. 1001. Nearly 150,000 veterans 
and servicemembers have participated in the burn pit registry 
to document their health issues. These include lung diseases 
and cancers, which they believe originate from their exposure 
to the noxious fumes of burn pits.
    However, when an eligible veteran passes away before 
participating in the registry, the VA currently prohibits a 
family member of the deceased veteran from participating in the 
registry on the veteran's behalf.
    This bill would allow a family member to participate in the 
burn pit registry on behalf of a deceased veteran or 
servicemember, allowing them to document the experience of a 
loved one and put that into the burn pit registry.
    This will enhance the pool of shared experiences that our 
government can use to analyze the real effects of long-term 
exposure to burn pits.
    Additionally, this change in VA policy will not incur any 
additional cost. It is a commonsense fix to help bolster the VA 
burn pit registry.
    I also introduced the Burn Pit Veterans Revision Act or 
H.R. 1005. This bill will require the Secretary of Veterans 
Affairs to amend the ratings disability to add a diagnostic 
code and evaluation criteria for obliterative bronchiolitis. 
This is an illness we know was a direct result of exposure to 
burn pits. In fact, the U.S. Social Security Administration has 
added the disease after medical research causally related the 
disease to environmental toxins, including burn pits in Iraq 
and Afghanistan.
    However, the Department of Veterans Affairs has not 
formally recognized obliterative bronchiolitis. The VA uses 
specific 4-digit diagnostic codes that allow for accuracy in 
diagnoses and rating evaluations. This is a specificity that 
has largely been missing, resulting in inconsistent and 
inaccurate ratings. Similar to my other legislation, this bill 
will not cost any additional money because this condition is 
already being rated as other similar conditions.
    Consistent and accurate ratings will likely cut down on 
costs, lower the number of appeals, and ensure that veterans 
receive the care they need. These bills are each narrowly 
focused and effective ways to serve those who have served us.
    I ask for the Committee's consideration.

    [The prepared statement of Joaquin Castro appears in the 
Appendix]

    The Chairman. Thank you, Mr. Castro, for your testimony and 
for your concern and care about our veterans.
    Is there anybody else here?
    Judge Carter. Judge, welcome. You happened to walk in at 
the right time.
    Mr. Carter. Mr. Chairman, are you ready for me?
    The Chairman. I am ready, sir. 5 minutes.

                  STATEMENT OF JOHN R. CARTER

    Mr. Carter. Chairman Takano and Ranking Member Roe, and my 
colleagues, I thank you for this opportunity to speak to you 
today.
    You will have to excuse my voice. They stuck a bunch of 
tubes down my throat when they replaced both my knees. That 
kind of gave me a scratchy voice, which I have always had a 
little bit of one. Anyway, I will try to make myself heard.
    As I know you all are proud of the population you 
represent, well, I represent the largest veterans' population 
in the State of Texas, and I am therefore very committed to my 
veterans in every way. Almost every one of my neighbors that I 
can reach with a rock are veterans. It is really important that 
I be able to talk with these folks.
    I have done some stuff that I am very proud of. One of the 
things that I want to mention to you, and you were very 
supportive of this, the Veterans Transplant Coverage Act.
    At a point in time, we were not allowing non-veterans to 
donate live organs. We changed the law and I actually saved a 
lot of lives by allowing family members to donate organs and 
others that were good matches. We are all for that, we got it 
in the MISSION Act. All of you were very, very instrumental in 
helping me get this done. Once again, I hear from the veterans 
that bureaucracy is slowing down the process. When they find a 
donor, then there is somebody, some red tape somewhere slowing 
down the process.
    I think those of us that deal with the Veterans 
Administration--and I know you are well aware of this--we owe a 
duty to build a fire under the bureaucrats sometime when we 
have set up a good program and then they are, for wont of 
whatever reason, slowing them down. Because when you slow down 
somebody that needs a kidney or a liver, it could be fatal. I 
just raise that issue, because I am hearing from people in my 
state that there is a little bit of a slowdown in the process. 
I am sure we can get that resolved.
    When we meet with my veteran's population, within the new 
standards of the MISSION Act, that is a priority for me, and it 
is for you. I sent a letter, along with Roger Williams, to the 
VA and, as a result, we announced two new clinics, one in 
Killeen, which is the home of Fort Hood, the great place, and 
one in Copperas Cove, which is just to the north of Fort Hood, 
and I am really excited about those two new clinics. I want to 
thank all of you for being supportive of clinics.
    I am sure you are well aware, I talk with a lot of veterans 
and we have got a big VA hospital in Temple and one in Waco, 
but if you ask a veteran where they are happiest, these clinics 
make them really happy, because they get in, they see a doc, 
and they get out. The red tape is over at the hospital and the 
clinics move a lot better.
    Thank you for helping us get two new clinics. I encourage 
you--and I know you know this, I am not telling you anything 
you do not already know--these clinics really work and they 
really--it gives the veteran his time back, rather than sitting 
around all day, waiting in line at the Veterans Hospital. I 
encourage you and thank you for doing that.
    By the way, my veterans tell me they get top quality care 
at the clinics, and they get to see doctors right away and they 
get to know their doctors at the clinics, and all that is good.
    The long-overdue implementation of the VA Electronic Health 
Care Records is very challenging. I came into this Congress in 
2002 and I went on Milcon in 2004, and at that point in time VA 
and DOD's medical records could not talk to each other. And we 
had all the stories out at Walter Reed of people getting out 
there and sitting for days and days, waiting for medical 
records. We have put billions of dollars into this, both in the 
VA, and in DOD, which I served on both Committees, and it is a 
crime that we have not got it done yet.
    VA has always led, VA has always had a better health care 
record than DOD, but they could not communicate. Now, we raked 
them over the coals in my subCommittee this year, Democrats and 
Republicans alike. Mrs. Lowey threatened to crucify them, I 
think. But the real world is, that has got to be done and we 
need to be on their back to get it done, because if you let up 
roughly 5 or $6 billion and we had not done it, where did that 
money go? That is the question we have got to ask.
    We need to seriously be looking at these VA records and 
hopefully, hopefully, from what I am hearing, we are going to 
make a breakthrough this year, but both the Veterans 
Administration and you and me and the DOD have to be pressuring 
these people to get this job done, because, if we do not, this 
could go on until a lot of us are--I am already old and gray--
but until a lot of us are old and gray and wondering what in 
the hell happened to all that money. Let us be thinking about 
that.
    One of the things that really concerns us, and I know it 
concerns you, is homelessness among our veterans, both men and 
women. It is a national tragedy. While the VA appropriations 
bill provides $1.8 billion for VA homelessness assistance 
programs, the challenges of this issue are very formidable. I 
encourage this Committee to continue looking for innovative 
ways to address this issue while identifying areas where 
existing programs are working or falling short.
    I will tell you a program we did in Georgetown, Texas, 
which is in the heart of my district, it is where I was Judge 
for 20 years, because that is the county seat of my county, 
they started a program where they are building small, 
individual housing for the individual homeless veterans with a 
central community center and they can literally--they have 
people that are financing that home, and they can buy that home 
and live in it, and they can--some of them can pay only for 
one, some of them for two, some of them for four veterans to 
live in there, and so far it is working beautifully.
    They built--they are cookie-cutter, but they are nice. They 
look good. If you were shopping for a small house, you would 
buy that house whether you are a veteran or not a veteran, 
because they are very well done. They have all the amenities, 
all of the--they have the ramps and all the things they need, 
with the community center providing education programs and 
places where they can socialize with their other veterans, and 
they are all in a basically two-block area subdivision. It is a 
new and innovative idea. It will probably be coming across your 
desk in the future and you really ought to look at it, because 
when you ever give somebody ownership and they teach them how 
to take care of the property they own, they become better 
citizens and they have assets to pass on or to use later in 
their life.
    When you see that program--and I am sure some of your 
people have--take a look at it. They are doing it at other 
places, but I was very impressed, and our veteran community was 
very, very impressed.
    Getting a handle on short-term and long-term impacts of 
burn pits is getting to be a priority both for the VA and the 
Department of Defense. As you know, Appropriations provided $5 
million for the Center of Excellence devoted to this troubling 
issue. I strongly encourage authorizers to continue focusing 
their efforts on burn pits as we work in a bipartisan manner to 
take care of those who sacrificed to preserve our freedom. 
Supposedly, these burn pits are creating an awful lot of 
respiratory and other serious illnesses as a result of our 
soldiers being around them.
    I want to thank you for the opportunity to come here and 
visit with you. I want you to know my door is always open to 
any member of the veterans Committee. I am proud to work hand 
in hand with you on any of the needs you have. Do not hesitate 
to contact me on anything I can do as Ranking member of our 
subCommittee. I yield back. I will answer any questions you 
might have if you have any.

    [The prepared statement of John R. Carter appears in the 
Appendix]

    The Chairman. Mr. Dunn? Dr. Dunn, do you want to go?
    Mr. Dunn. Yes.
    The Chairman. Go ahead.
    Mr. Dunn. I just would like--thank you very much, Mr. 
Chairman. I wanted to say what an honor it was last session to 
work with you on the new transplant bill in the VA. And I think 
it is a huge improvement for our veterans.
    I also have in one of my cities one of these tiny home 
village concepts that is they concentrate on veterans, but it 
is not solely for veterans.
    Mr. Carter. That is right.
    Mr. Dunn. It is actually a very, very promising model. I 
thank you for underscoring that possibility as well. I thank 
you very much for your time.
    Mr. Carter. Well, thank you. Thanks for helping us out on 
that transplant. Just a good stories, I have had at least three 
veterans either drop me a note or call me and say, ``I got my 
new kidney and God bless you. My brother gave it to me, or my 
cousin gave it to me,'' and it has really been a blessing.
    The Chairman. Judge, I really appreciate your compliments 
on the clinics. It is always good to hear when the VA is doing 
things right, and I am pleased to hear about that, and I am 
really curious to know more about your housing solutions. It 
sounds very interesting to me.
    Mr. Carter. You bet. We have got them, but I would be glad 
to entertain anybody wanting to come to visit God's country in 
central Texas, I would be glad to have you, and show you 
around.
    The Chairman. Well, thank you so much for taking the time, 
for giving us your testimony, and thank you very much.
    Mr. Carter. Glad to be working with you. Thank you.
    The Chairman. Mr. Hill, you walked in just as I was about 
ready to declare a brief recess, but we do not have to recess 
now that you are here. As soon as you are ready, 5 minutes or 
so.

                  STATEMENT OF J. FRENCH HILL

    Mr. Hill. Thank you, Mr. Chairman. It is a pleasure to be 
here. I always thank our authorizing Committees that do Member 
Days. I commend you for it. Thank you for it. It was a pleasure 
to hose you in Arkansas' Second Congressional District this 
week. I hope you learned a lot of things about Little Rock. We 
were proud to have you there. My constituents always appreciate 
you and your predecessors coming and listening to people across 
the country, so we are grateful for your time.
    The Chairman. I was pleased to be there, and I did confirm 
that your airport is named after Bill and Hillary Clinton.
    Mr. Hill. It is. Both of them.
    The Chairman. People do not know.
    Mr. Hill. I appreciate the opportunity to testify in front 
of you today in support of expanded resources into homeless 
assistance programs and suicide prevention outreach by the U.S. 
Department of Veterans Affairs.
    It is especially fitting to discuss this critical topic 
here today during Suicide Prevention Month. According to the 
U.S. Department of Housing and Urban Development, approximately 
40,000 veterans are homeless on any given night in our country.
    In Arkansas, we have coordinated robust efforts across 
Little Rock to combat homelessness, but still over 250 veterans 
experience homelessness on any given day.
    I have got three veterans on my constituent team and they 
spend their time in our shelters helping our vets finding the 
services they need. They deserve that extra touch, and many of 
them are lost in the morass of not only homelessness, but in 
the search of understanding of our veteran programs that might 
be of assistance.
    My district is home to many of our brave veterans and 
servicemembers as a result of Little Rock Air Force Base and 
Camp Robinson being in the district. I have heard these 
concerns from our veterans about the difficulty of finding a 
home for themselves, as well as their families.
    That is why today I want to highlight a current bill 
dealing with this issue, Ms. Brownley's Homeless Veterans 
Family Act (H.R. 95). As I am sure you know, the VA's Homeless 
Providers Grant and Per Diem Program funds for community 
housing agencies provide services to our homeless vets.
    Currently, the VA does not have the authority to provide 
the reimbursements for the costs and services for minor 
children of homeless vets, limiting housing for veterans with 
young children.
    This bill would allow the VA to reimburse providers for 50 
percent of the costs of housing minor dependents of homeless 
vet.
    Ms. Brownley's bill is an example of how we must all work 
together and continue to move forward addressing this issue 
that plagues too many of our veterans and those suffering from 
homelessness.
    They have put their lives on the line to protect our 
freedoms and our safety, and in return it is our duty to do 
everything we can to ensure they get the proper attention and 
care that they deserve.
    For this reason, I respectfully request that you consider 
H.R. 95 and other legislation that addresses this critical 
issue that consumes the lives of too many of our veterans and 
their families.
    On behalf of the Second Congressional District in Arkansas, 
we thank you and all of the Members of this Committee for your 
care and attention to the needs of veterans. We congratulate 
you and Mr. Roe on recent legislative victories in the last few 
years that benefit our veterans in both the last Congress and 
in this Congress, and we thank you for your service. I yield 
back the balance of my time.

    [The prepared statement of J. French Hill appears in the 
Appendix]

    The Chairman. Well, thank you for the kind words, Mr. Hill. 
I will reiterate that it was my pleasure to join you in Little 
Rock and to meet your constituents. I was particularly 
impressed with the staffer that does your military and veterans 
affairs. A quite remarkable job that your office is doing in 
recovering benefits--owed benefits for your constituents. I 
commend you on that.
    As you know, recovering veteran benefits or helping 
constituents navigate the claims process at the VA as one of 
the primary activities of constituent services. Congratulations 
on that.
    Mr. Hill. Grateful for those comments. They work hard. 
Having three wounded warriors on my team is a real honor for me 
to serve with them, the people of Arkansas, and again, thank 
you for your work.
    The Chairman. You are welcome. You are welcome. Declare a 
brief recess. Maybe ten minutes or so. Ten minutes.
    The Chairman. Call the Committee back out of recess. We'll 
resume. Mr. Baird, are you ready?
    Mr. Baird. Yes.
    The Chairman. Okay. Five minutes, sir.

                  STATEMENT OF JAMES R. BAIRD

    Mr. Baird. Chairman Takano, Ranking Member Roe, Members of 
the Committee, I want to start by thanking you for the 
opportunity to come before you today. As a decorated Vietnam 
veteran, I care deeply about this country, and ensuring the 
veterans of our armed forces are taken care of and have the 
opportunities and benefits that they deserve. The important 
work that this Committee has done in the past, and that it 
continues to do, is essential in keeping our promise to our men 
and women in uniform as they transition back into civilian 
life.
    I am here today to highlight a piece of legislation I have 
authored called the ``VA Safe Opioid Return Act.'' This 
legislation is simple and common sense. My bill directs the 
Secretary of the Veterans Affairs Administration to ensure that 
certain Department of Veteran's Affairs medical centers have 
physical locations for the disposal of controlled substances 
medications, namely opioids. Any VA medical facility with an 
on-site pharmacy or a law enforcement officer present to 
monitor the disposal location, will be charged with having a 
physical location for veterans to dispose of unwanted or over-
prescribed medications.
    The inspiration for this bill came from the great success 
seen at the Roudebush VA Hospital in my home state of Indiana. 
Treating nearly 62,000 Hoosier veterans annually, the Roudebush 
VA decided to implement an opioid return receptacle in their 
facility after noticing a low number of participants or 
participation in their opioid mail back program, and having 
patients bring their unused medications to the ER or to their 
appointments.
    The Roudebush VA set out to put a DEA-compliant receptacle 
for just over $1,000 and bought 12 safe and secure liners for 
another $2,000. The staff from the engineering service 
installed the receptacle for no cost. Once in place, the 
receptacle was anchored to the floor, monitored under video 
surveillance, and placed away from the emergency department 
entrance, which was a DEA requirement. Emails were sent out to 
the staff to provide education, and descriptive data was 
collected from the time of its implementation.
    After opening to the public in May of 2016, the Roudebush 
VA saw a drastic increase in the amount of unused or unwanted 
medication it was collecting. From May to October of that year, 
the facility collected 452 pounds of medication, and an 
additional 30 pounds of drugs were mailed back in through the 
mail back envelope program. In just this 6-month period, this 
large amount of medication was safely returned to the reverse 
distributor or destroyed, ensuring that this potentially 
addictive medication found its way off the streets and away 
from the general public. This is why we need this bill.
    This model applied across the VA system to all VA medical 
facilities with pharmacies or on-site law enforcement personnel 
will go a long way toward getting this medication off the 
streets, or these medications off the street. With more than 50 
percent of our veterans suffering from chronic pain, and half 
of those receiving at least one prescription for opioids, it is 
imperative that we give our veterans easy, anonymous, and 
continually available way to dispose of their medications once 
they are no longer needed. Excuse me.
    This bill has yet to be introduced, but has already 
garnered a large support from both sides of the aisle with over 
29 original co-sponsors. I urge the Committee to consider this 
legislation for markup, and I believe that it can be passed 
through the House on suspension.
    I want to thank you again for the opportunity to come 
before you and before the Committee to address this important 
piece of legislation, and I look forward to hearing any 
questions or feedback that you may have. Thank you.

    [The prepared statement of James R. Baird appears in the 
Appendix]

    The Chairman. Thank you, Mr. Baird. I also want to thank 
you for--thank you for your testimony, but I also thank you for 
your service to our country.
    Mr. Baird. Thank you, sir.
    The Chairman. Dr. Dunn would like to make a----
    Mr. Dunn. Thank you very much, Chairman Takano. I want to 
say thank you also to my good friend, Mr. Baird. You shine a 
light on an important problem. We do have more drugs floating 
around in the VA system than should be. It is partly over-
prescribing, but it is also partly our fault in the system. We 
are mailing narcotics to patients who have chronic pain 
syndrome, and if they die, I have their families come into my 
practice and say, ``Here is a bag full of hydrocodone or 
oxycodone,'' that they are bringing into our office, because it 
keeps coming to them in the mail every month. How do we get 
this to stop?
    You are shining a light on a large problem, and you are 
also helping fix the problem, and I thank you for that. Thank 
you so much.
    The Chairman. Thank you, sir.
    Mr. Baird. Thank you, sir.
    The Chairman. Ms. Kuster, welcome back. You are welcome as 
to 5 minutes.

                   STATEMENT OF ANN M. KUSTER

    Ms. Kuster. Thank you, Chairman Takano. It is great to be 
back with you. Mr. Dunn, good to see you as well. I miss my 
time on the House Veterans Affairs Committee and I was honored 
and delighted to serve for 6 years, but I hope you are enjoying 
serving with my terrific new colleague, Chris Pappas, from New 
Hampshire.
    The Chairman. He has been a great addition, and he has also 
bene a great leader as chair of our Oversight and 
Investigations Committee. He will be very busy these next few 
weeks.
    Ms. Kuster. Absolutely. Absolutely. Well, I appreciate the 
opportunity to speak with you all about the important issues 
that are facing our servicemembers and veterans. During this 
August district work period, I had the opportunity to convene a 
moving discussion with local stakeholders and military families 
who have lost a loved one to suicide. Over the past years, I 
have held numerous roundtable events in my district to hear 
from veterans who have experienced Military Sexual Trauma 
(MST).
    Today's hearing presents an opportunity for this Committee 
to build off of what we have learned and address specific 
legislative proposals that will take care of our veterans and 
enhance access to quality care.
    My constituents in New Hampshire are aware of these crises, 
and we are all too familiar that approximately 20 veterans and 
1 to 2 servicemembers die by suicide every single day.
    Sexual assault rates for women have been at the highest 
since 2006, and how the VA handles the claims of survivors 
needs to be approached, as we have learned recently that the VA 
has mismanaged claims related to survivors of MST.
    In 2017 alone, the Veterans Benefits Administration 
rejected about 5,500 military sexual trauma claims. The IG 
report found that of the cases they sampled, close to 50 
percent were missing follow up interviews, new medical 
examinations, or other significant procedural work. It is 
important to note the high percentage of women are at greater 
risk of MST, but nearly 40 percent of veterans who disclose MST 
to the VA are men.
    As the Committee continues to advance legislation this 
Congress, I hope you will consider some of the following 
bipartisan proposals. I am very proud to co-sponsor the PAWS 
Act of--PAWS, P-A-W-S, Act of 2019 that allocates a grant 
program to private entities for service dogs that will help 
veterans who are struggling with the invisible wounds. The 
companionship of these service animals can make an enormous 
difference in the lives of veterans.
    I also helped my good friend and colleague, Representative 
Jackie Walorski, introduce bipartisan legislation earlier this 
year to expand eligibility for MST survivors. The VA provides 
counseling, health care services, and other treatment to 
veterans who experience MST. However, many survivors must 
travel long distances to receive treatment, but are unable to 
obtain travel benefits to access the care they need.
    Representative Walorski's thoughtful bill would allow 
veterans to be reimbursed for travel outside their Veterans 
Integrated Service Network when seeking treatment related to 
MST.
    Congress has a job to ensure that veterans and 
servicemembers have access to comprehensive health care. We may 
see this as a mental health issue, but we also have to 
acknowledge that veterans are coming home to a different world. 
We must help veterans connect with their community, engage with 
their passion, and find a new purpose to help mitigate suicidal 
ideation and learn ways to cope with the trauma they have 
endured.
    The VA has not yet released data relating to veterans dying 
by suicide since 2016. This data is critical to solving this 
epidemic, and I urge this Committee to request this data from 
the VA. I was so proud of the bipartisan work that we did on 
this Committee while I was a Member during my first 6 years in 
Congress. By putting politics aside and focusing on improving 
the lives of veterans, this is the most important bipartisan 
Committee on Capitol Hill, and I am so pleased to be with you 
again today. By working together and advancing bipartisan 
legislation, we can collectively fix the heartbreaking problems 
of veteran suicide and military sexual assault. And I thank you 
for your time.

    [The prepared statement of Ann M. Kuster appears in the 
Appendix]

    The Chairman. Thank you, Ms. Kuster, for your testimony and 
we will move on to Mr. Spano. Mr. Spano, you have 5 minutes.

                    STATEMENT OF ROSS SPANO

    Mr. Spano. Thank you, Chairman Takano. I appreciate your 
hosting this Member Day Committee meeting or hearing. The 
district that I serve is Florida's Fifteenth Congressional 
District. It is estimated to have over 55,000 veterans that 
live in the district in close proximity. The reason we have so 
many veterans is because we live--the district is in close 
proximity to MacDill Air Force Base, which is in Tampa, on the 
western side of Florida.
    The region is currently served by James A. Haley Veterans' 
Hospital located in Tampa. One of their biggest priories is the 
opening of a Lakeland VA Outpatient Clinic, which would provide 
service to Central Florida residents in my district, who now 
have to drive quite a ways to get to Haley.
    I appreciate the Committee's recognition of the importance 
of a Lakeland Outpatient Clinic. I do. To improve the care for 
my constituents. The VA Choice and Quality Employment Act of 
2017 authorized nearly $11 million for that facility, and that 
legislation was signed into law, Mr. Chairman, in August of 
2017. Over two years ago now.
    However, I am very, very discouraged. I am discouraged by 
the amount of time that it is taking for the project to make 
its way through the various agencies' approval processes. I 
recently received an update from the Office of Management and 
Budget that they anticipate completing their approval of the 
lease, again, we are now two years into this, in the next few 
weeks, at which point it will then be transmitted to the 
General Services Administration (GSA) for their approval.
    Under this timeline, I have been advised and been told that 
the lease award is planned for March 2021, and that the 
facility will open in March of 2024. I would appreciate any 
help that the Committee can provide in pushing these agencies 
involved in approving these leases to expedite this process so 
that the facilities that were approved in 2017 can provide the 
services that they were intended to provide in a window shorter 
than seven years. We can build a skyscraper in seven years. It 
should not take us seven years to open an outpatient facility, 
when all we are being required to do is secure leases for that 
property.
    There are many other priorities that I have, Mr. Chairman, 
but this is at the top of the list. And any support and help 
that you can provide me would be very, very appreciated.

    [The prepared statement of Ross Spano appears in the 
Appendix]

    The Chairman. Thank you for your testimony, and I agree 
with you. It should not be taking this long to build these 
clinics and to staff them. And so, we have been--my staff is 
taking notes, and we will be looking into this.
    Mr. Spano. Thank you, Chairman.
    The Chairman. Thank you. All right. I think there is--are 
we done? We are going to recess for--recess until the next 
member shows up.
    The Chairman. Mr. Wittman, welcome. You have 5 minutes for 
your testimony.

                 STATEMENT OF ROBERT J. WITTMAN

    Mr. Wittman. Well, thank you, Chairman Takano. Thank you, 
Acting Ranking Member Dunn. I appreciate the opportunity to be 
here with you today, and the other distinguished Committee 
Members and all the great work that you all do for our 
veterans.
    As I said, it is an honor and a privilege to testify in 
support of over 18 million veterans across the United States; 
750,000 of those reside in Virginia.
    I represent the First District of Virginia, which includes 
Fort A.P. Hill, Marine Corps Base Quantico, Naval Support 
Facility Dahlgren, all call this their home base. Additionally, 
constituents in my district support the mission at several 
installations in the National Capital Region and throughout 
Virginia and Maryland.
    As a member from a district so full of men and women who 
have made incredible sacrifices for our Nation, I have had the 
distinct pleasure to serve on their behalf. As such, I have 
been and will continue to be committed to our military and our 
veterans during my time in Congress.
    I routinely hear from veterans communities in my district 
by regularly convening a Veterans Advisory Council, engaging 
with veterans that I meet with, and who call into my office and 
hosting several Veterans Forums throughout the year, one of 
which Ranking Member Roe was kind enough to attend last year. 
In short, these platforms allow me to hear directly from 
veteran constituents, who have firsthand knowledge of the 
issues that they face.
    Through their feedback, I have outlined the following areas 
as my priorities for veterans: number one, increasing 
efficiencies in the Department of Veterans Affairs. Next, 
expanding veterans' access to medical care. Next, increasing 
collaboration to provide more services to veterans; and 
combating veterans' homelessness.
    In addition, I would like to commend this Committee for the 
work they have done to support veterans. Over the past few 
years, your work has increased veterans' access to medical 
care, and ensured we as a Nation continue to keep our promise 
to take care of those who protect our freedom. While our system 
is far from perfect, this Committee continues to strive to seek 
out and eliminate the hurdles that burden our veterans.
    Among this work, I would like to highlight the MISSION Act. 
Signed into law last year and took effect this June, this 
legislation expanded the VA Choice Program by increasing 
outside medical options, establishing a permanent community 
care program for veterans, and modifying how the VA utilizes 
private medical providers.
    Additionally, this Committee helped pass the Blue Water 
Navy Vietnam Veterans Act of 2019. Signed into law this past 
June, this legislation brought to an end a six-decade long 
struggle to provide benefits to approximately 52,000 ``Blue 
Water'' veterans who were exposed to Agent Orange during the 
Vietnam War.
    The work we do for our veterans, however, is never done. To 
this end, I would like to highlight two bills I have introduced 
that would further help our veterans.
    H.R. 1577, the VA Procurement Efficiency and Transparency 
Act would require the VA to track cost savings resulting from 
its contracting competitions, and to use standardized 
contracting procedures, ensuring dollars meant to support 
veterans are not wasted because of bureaucratic inefficiencies.
    Ultimately, this bill would improve procurement within the 
VA by putting in place consistent parameters for the VA to 
measure its cost savings from competition, while encouraging 
the VA to organize its templates for key procurement documents 
and share them across the organization. That is just making 
sure good practice gets replicated and inefficiencies get 
eliminated. The legislation will work to reform these archaic 
procurement rules through a commonsense procurement and 
transparency fix.
    Next is H.R. 2886, the Veterans Affairs Transfer of 
Information and Sharing of Disability Examination Procedures 
with DOD Doctors Act. Certainly, that is a mouthful, but this 
bill speeds up access to care for veterans by not subjecting 
them to another round of medical screenings before a disability 
rating is issued. Additionally, this bill further requires the 
Department of Veterans Affairs and Defense to share medical and 
service record data electronically.
    We know in some instances that happens, but it is not 
standard across the board, and some VA facilities and DOD 
facilities do it better than others. We just want to make sure 
it is standardized, and the transfer of information takes place 
quickly and seamlessly.
    We have made great strides recently in improving the VA's 
level of care for our veterans, but we have more work to do. My 
hope is that these bills can be part of that ongoing effort.
    Chairman Takano, I want to thank you for your efforts. I 
want to thank Ranking Member Roe for your spirit of 
bipartisanship in getting things done in the best interest of 
our Nation, especially those brave men and women that have 
served this Nation so bravely and nobly. It is a real honor for 
me to have the opportunity to testify before you today.
    I have long believed that the benefits afforded our men and 
women in uniform have been earned through sacrifice and 
hardship, and that those benefits should be protected. I look 
forward to continuing to work with the Committee to ensure our 
veterans have the resources they need and the benefits that 
they have earned defending our freedom. We, as a Nation, owe 
our veterans a debt that can truly never be repaid.
    Mr. Chairman, Ranking Member Dunn, thank you so much.

    [The prepared statement of Robert J. Wittman appears in the 
Appendix]

    The Chairman. Thank you, Mr. Wittman, for your testimony. 
Mr. Dunn, anything?
    Mr. Dunn. Just thank you very much.
    Mr. Wittman. Thank you, Dr. Dunn.
    The Chairman. Thank you. Mr. Costa, welcome. I recognize 
you for 5 minutes, if you are ready.

                     STATEMENT OF JIM COSTA

    Mr. Costa. Yes. Thank you very much, Mr. Chairman and the 
Ranking member, for allowing me to come before the Veterans 
Affairs Committee to advocate on behalf of constituents that I 
represent, but also constituents that many of us represent 
throughout the country that deals with the part of America's 
history on the Vietnam War.
    During the Vietnam War, as many of you know, the CIA 
covertly trained men and women in Laos, and they fought with 
our American soldiers' shoulder to shoulder.
    These indigenous forces conducted direct missions against 
the Communist forces and North Vietnamese supporters. Hmong 
soldiers saved countless American lives. Over the course of the 
war, more than 100,000 Hmong made the ultimate sacrifice by 
giving their lives, as well as injuries that they sustained 
with them for the rest of their lives.
    At the end of the war, President Ford thought that there 
ought to be some address to this group of people that stood 
with us, and there is a lot of stories that go back with it. I 
will not give all the details, but our American 
representatives, both in the military and with our foreign 
service, made the case to President Ford that these Hmong 
families from Laos, if given an opportunity, should be able to 
come to the United States and establish permanent residence for 
their contribution during that 15 year period.
    In essence, those that could come, there was not any 
airplanes. There were not any tickets. But those that could 
figure out a way to bring themselves and their families came, 
and became legal, permanent residents of the United States. 
They, like every other immigrant, have had their challenges to 
assimilate, whether it is in California or Minnesota, or 
elsewhere around the country, but they have assimilated.
    Their children, of course, have been born here. They have 
gone to school, and university, and now their children. Now, we 
are working on a second generation of Hmong families. I live in 
a part of California where they are a significant part of our 
community.
    Whether it be North Carolina, Minnesota, Rhode Island, 
anywhere where these communities have gathered and succeeded, 
they have become stronger and more prosperous. Of the--Amongst 
who became U.S. citizens, it is estimated that there are about 
5,000 still alive today that were part of the Secret Guerrilla 
Units, the SGU, that are very proud of their service. They are 
in their 70s, 80s.
    They brought this to my attention 10 years ago when General 
Vang Pao was still alive, their leader, who has since passed 
away that was not there something that we could do to fittingly 
honor them for their service to our country. We thought we 
would take the model that came from the Filipino soldiers, who 
fought with the U.S. soldiers during the World War II, and 
those Filipino soldiers who helped liberate the Philippines 
later on were given the opportunity to be buried in an American 
cemetery with full honors. We thought that precedent would be 
appropriate for these Lao Hmong soldiers, who were part of this 
special guerrilla unit.
    Now, legislation would authorize before you, that is going 
to be before your Committee, that internment in national 
cemeteries for all Hmong and Lao veterans who served in support 
of U.S. forces in Vietnam. Given their dedicated service to our 
Nation and to those U.S. citizens, we think it is an 
appropriate honor.
    We think they deserve it and they have earned it. Senator 
Murkowski, and Congressman Paul Cook, and our colleague from 
Rhode Island, Sheldon Whitehouse, have together worked on this 
legislation. We actually passed it in an omnibus package last 
year that was signed into law. What we discovered was that the 
definition under who became a citizen before the year 2000 and 
after created a glitch in terms of all those soldiers, we 
estimate 5,000 who are still alive today, that could qualify if 
they so choose, would be able to have this benefit and this 
honor.
    This legislation corrects that glitch and I think it could 
be a part of a larger package that the Committee might work on. 
For that, I have exceeded my 5 minutes, but I think it has a 
lot of merit. I think many on a bipartisan basis have supported 
this legislation, and we stand before you this afternoon to 
move it forward in any way that the Committee thinks is fitting 
and appropriate. I thank you.

    [The prepared statement of Jim Costa appears in the 
Appendix]

    The Chairman. Dr. Dunn, go ahead.
    Mr. Dunn. Thank you, Chairman Takano. And thank you very 
much, Representative Costa, for the comments. I am familiar 
with the Hmong people and the situation you described. I do not 
understand the glitch. I look forward to understanding what the 
glitch is we are fixing, but I applaud your efforts and the 
motivation behind them. Thank you.
    Mr. Costa. Thank you.
    The Chairman. Thank you, Mr. Costa, for advocating on 
behalf of a group of people who served our country, and who 
were allies of our country, and who became a part of our 
country. It is a justice long overdue, and I agree with you, I 
do believe they have earned the recognition that you are 
seeking for them. And with Dr. Dunn, we will treat it--we will 
look through the conforming changes you are trying to make in 
your bill, and we will get through this together. Thank you.
    Mr. Costa. Thank you very much. Obviously, we will work 
with the Committee and any insight that your Committee and 
staff have as to how we can make this work in a way that the 
Veterans Administration can implement it so that those Hmong 
Lao veterans who so choose to be honored will be able to have 
that appropriate recognition for their service to our country.
    The Chairman. Thank you very much. Thank you for your 
testimony.
    Mr. Costa. Thank you.
    The Chairman. Are we expecting more? All right. We are 
going to wait another 10 minutes and just----
    The Chairman. Today's hearing has been very informative. I 
would like to thank my colleagues for appearing in front of the 
Veterans Affairs Committee. We certainly learned some things we 
did not anticipate learning, and along with the testimony we 
heard about individual member's bills, we learned about 
individual member's difficulties with the VA. This has been a 
really great forum for us to take the pulse of the entire House 
of Representatives, and to get a sense of what we need to 
address with the VA Administration.
    With that, I now recognize my acting Ranking Member Dr. 
Dunn, for any closing remarks that he may have.
    Mr. Dunn. Thank you, Chairman Takano. This has been my 
first ever Members Hearing like this. It is a--I know it is not 
a common forum, but it is a great forum for us to actually hear 
from our Members. I am taking back a lot of notes, and we will 
be looking into a lot of these things. There are some good 
bills there. I appreciate the chance to work with you.
    The Chairman. Yes. I know our staff has been taking notes 
as well, and there is certainly plenty of oversight for us to 
do in a bipartisan manner.
    All Members will have 5 legislative days to revise and 
extend their remarks and include extraneous material. Again, I 
thank all the Members for their presentations. This hearing is 
now adjourned.
    [Whereupon, at 2:01 p.m., the Committee was adjourned.]

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                         A  P  P  E  N  D  I  X

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                    Prepared Statement of Witnesses

                              ----------                              

             Prepared Statement of Congressman Steve Womack
    Chairman Takano, Ranking Member Roe, distinguished members of the 
Committee, thank you for the opportunity to speak before your Committee 
on a matter of great importance to the people of Arkansas.
    On August 16th, former VA pathologist Robert Levy was indicted on 
three counts of involuntary manslaughter and 28 counts of mail fraud, 
wire fraud, and making false statements to law enforcement.
    These charges stem from Mr. Levy's conduct while serving as Chief 
of Pathology and Laboratory Medical Services for the Veterans Health 
System of the Ozarkslocated in Fayetteville, Arkansas, which is in my 
district.
    While he was serving as Chief of Pathology, Mr. Levy was 
responsible for diagnosing veterans after examining their fluid and 
tissue samples. Unfortunately, he repeatedly showed up to work 
intoxicated, first from alcohol and then, in order to pass mandated 
alcohol tests, from a substance called 2M-2B. This substance produces a 
sensation like alcohol but cannot be detected on normal alcohol 
screenings. Mr. Levy was finally fired from the VA in April 2018 
following 2M-2B being detected in a fluid sample.
    This was not Mr. Levy's first time failing an alcohol test. He was 
required to pass mandatory alcohol screenings because in 2016 he was 
found to be intoxicated on duty. His blood alcohol content was 0.396 -
almost 5 times the legal limit-during the time he was scheduled to 
consult on a biopsy for a patient.
    Following this incident Mr. Levy had his medical license suspended 
and was sent to a VA-approved in-patient alcohol treatment program. He 
completed the program and was returned to duty with the stipulation 
that he submit to random alcohol and drug tests.
    Let me reiterate, he was returned to duty. A doctor who had showed 
up to work while intoxicated was returned to duty to care for our 
veterans. This is unacceptable.
    Mr. Levy was not just reinstated, he was allowed to return to his 
position as the Chief of Pathology - with no direct oversight of his 
diagnoses.
    His egregious misconduct continued. He not only continued to show 
up to work while intoxicated, but also falsified the reviews his 
subordinates conducted of his work. This was only possible because he 
had been returned to duty as the Chief of Pathology.
    I will never understand why the VA returned Mr. Levy to duty as a 
supervisor without putting necessary safeguards in place to ensure that 
his work was properly reviewed. At the very least, an independent 
review process should have been set up to allow his subordinates to 
submit their reviews outside of the usual chain of command.
    This situation jeopardized the health and well-being of our 
veterans. So much so, that Mr. Levy's alleged actions have led to his 
arrest and a Federal indictment.
    I know every person here believes that those who risk their lives 
for country deserve the highest caliber of care possible. I know we 
also agree that no medical professional, especially doctors charged 
with diagnosing our veterans, should ever be intoxicated while working. 
We, as Members of Congress, must conduct vigorous oversight to 
determine how this could happen.
    We have worked with your Committee to ensure the VA was taking the 
proper steps to support our veterans who were impacted by Mr. Levy's 
unacceptable conduct. I want to thank you for your help and assistance.
    That being said, we have a duty to further support our veterans who 
were affected by these callous actions. I respectfully request your 
Committee investigate the actions and decisions made by the VA 
throughout the entirety of this episode. For the sake of the integrity 
of the VA medical system and the quality of care of our heroes, we must 
make sure they are never repeated.
    Specifically, I find it appalling that a doctor who was caught 
intoxicated on duty was allowed to resume caring for our veterans and 
returned to his supervisory position.
    Furthermore, the way the VA engaged with my office, other Arkansas 
delegation offices, and this Committee was concerning. The VA is a 
department of the Federal government and it is subject to the oversight 
of Congress, but throughout the entire episode the VA was slow to 
provide certain important information to the relevant people.
    I believe in second chances-but not in life or death situations. 
Without the proper safeguards in place, there was no accountability, 
and we have seen the result.
    The actions of this desperate individual hit home for me. Almost 
all of us have either served or have family members who have served. 
Our veterans stepped forward and swore to defend our country and our 
values against all enemies. We need to treat them like family - that 
means guaranteeing something like this never happens again at a VA 
facility.
    Thank you for your time today. I am happy to answer any questions 
you have.

                                 
           Prepared Statement of Representative Steve Stivers
    Thank you Chairman Takano and Ranking Member Roe for holding this 
Member Day today, and for giving me the opportunity to testify on 
behalf of veterans' issues in Ohio's 15th district.
    We all know that returning servicemembers suffer from invisible 
wounds. It must be Congress's top priority to pursue every avenue to 
disrupt the tragic links between separation from service and mental 
illness, such as PTS and TBI, and, worst of all, suicide.
    Currently, Congress has authorized the Secretary to provide service 
dogs for veterans with hearing, vision, mobility, and mental health 
needs. However, VA regulations provide this benefit only if the veteran 
is diagnosed with a vision, hearing, or mobility impairment-
specifically excluding veterans with mental health needs.
    For this reason, I have introduced H.R. 3147 to clarify 
congressional intent by stating the Secretary may provide a service dog 
to a veteran, regardless of whether the veteran has a mobility 
impairment. This zero-cost legislation would close the loophole to 
allow veterans access to animal therapies as Congress originally 
intended.
    To take these efforts further, I am introducing the PAWS for 
Veterans Therapy Act joined by Reps. Rutherford, Waltz, Cisneros, 
Sherrill, and Slotkin. This legislation combines two of the most 
popular and previously endorsed veteran dog therapy bills from last 
Congress: the Veteran Dog Training Therapy Act, which has passed the 
House in previous years, and the PAWS Act.
    The new PAWS for Veterans Therapy Act would establish a pilot 
program at the Department of Veterans Affairs (VA) in which the 
Secretary will contract with local therapeutic dog training 
organizations, and help veterans suffering with PTS to learn the art 
and science of dog training. This type of work-therapy training is 
widely recognized as beneficial therapy for our veterans suffering with 
this invisible disability.
    Under this bill, the dog would be adopted by the veteran and 
provide continuing therapy beyond the training program, unless the 
veteran and his or her VA health care provider opt out of the program.
    VA, and policymakers on this very Committee, have insisted on 
waiting for the VA to complete their study to evaluate the efficacy of 
these programs. At last update, I understand this VA-led study is 
expected to be complete by the end of next year.
    However, this does not appear to be a sufficient reason to wait and 
deny this therapy to veterans who need it. There is research that has 
already been conducted by Kaiser Permanente and Purdue University that 
showed significant statistical benefits from this therapy in reducing 
substance abuse, enhancing and encouraging interpersonal relationships, 
and reducing depression-related metrics for veterans with service dogs. 
What's more, the Palo Alto VA already offers dog training through the 
Paws for Purple Hearts Program.
    In 2017, VA Secretary David Shulkin stated that he "would not wait" 
for more studies to be completed before moving forward with dog 
therapies for veterans. Why, then, are we still waiting? Why are we 
putting veterans in need, in a holding pattern, while we sit to check 
an administrative box?
    If there is such concern over the certainty of this pending VA 
study, I would point out that this legislation provides a pilot program 
only - leaving the opportunity for Congress, and the VA to revisit any 
program following whatever conclusion the VA may or may not make from 
the study. Our veterans deserve our best efforts to deliver any relief 
from the symptoms and effects their service may continue to have on 
them.
    This Committee is aware and understands the mental health needs of 
our veterans will not be addressed with a single solution; rather, we 
must approach this problem thoughtfully and comprehensively, and no 
possible solution should be out of reach or placed in a holding 
pattern. Care that is delayed is care that is denied. This is one 
alternative therapy with incredible potential to make a difference in 
the lives of veterans now. I ask this Committee to seriously consider 
if the wait is worth that risk.
    I would like to thank the Chairman, Ranking Member, and Members of 
the Committee again for inviting me to testify today.

                                 
         Prepared Statement of Representative Salud O. Carbajal
    Chairman Takano and Ranking Member Roe, thank you for having me 
here this morning.
    I believe these Member Days are prime opportunities for Members to 
not only share challenges veterans are facing in their district, but 
also help the Committee identify issues that may be consistent across a 
number of districts, or even issues the Committee may not be aware of.
    I have the pleasure of representing the 24th district of California 
- the beautiful Central Coast - where approximately 40,000 veterans 
reside.
    I represent a number of military installations including: 
Vandenberg Air Force Base, Camp Roberts, and Camp San Luis Obispo. I 
believe I represent one of the most beautiful districts in the country.
    However, as you all know, the cost of living in California is very 
high and finding affordable housing is extremely challenging, 
especially for the veterans who are trying to make ends meet.
    On any given night, over 39,000 veterans are homeless across 
America, and 25% of our nation's homeless veterans reside in 
California.
    This is why Congress, along with the Department of Veterans Affairs 
and the Department of Housing and Urban Development, came together to 
create the HUD-Veterans Affairs Supportive Housing (HUD-VASH) program.
    The purpose of this program is to provide rental assistance for 
homeless veterans along with case management and clinical services.
    The HUD-VASH program has provided housing assistance to veterans 
nationwide including veterans in my district.
    However, I have learned that veterans, along with the local Housing 
Authority, currently cannot take full advantage of this program due to 
the delays in getting referrals from the VA for VASH vouchers.
    I learned that the County of Santa Barbara has a total of 261 VASH 
vouchers allocated to them.From those 261 vouchers:

      154 VASH vouchers are currently under contract where 
veterans have been housed and are receiving services.
      10 veterans had been approved for VASH vouchers and are 
searching for housing.
      Unfortunately, 97 of these allocated VASH vouchers are 
awaiting referrals from the VA.

    This issue was brought to my attention in May, and in August, 97 
vouchers were still awaiting referrals from the VA in order to be used.
    What this means is that the local housing authority could have been 
housing 97 more veterans, just in my district alone, if referrals from 
the VA had arrived in a timely manner.
    It is my understanding that this delay is a result of the VA being 
understaffed and the Department's inability to attract and retain staff 
case workers for VASH.
    We are all aware of the challenges that the VA faces when it comes 
to staffing, but I believe this is an area we must prioritize.
    The vouchers are available but not being used to house veterans who 
desperately need a home.
    This is unacceptable.
    The reason I am here today is to ask the Committee to work with me 
to address this issue.
    I have brought this issue up with the local, state, and Federal VA 
leadership, and I plan on continuing the discussion until a plan of 
action is presented, as we must do our best to provide homes to those 
who served this country. I hope, with the help of this Committee, we 
can provide the veterans in my district, and veterans nationwide, with 
a home to feel safe in, as they have the done the same for us through 
their service.
    Thank you for the opportunity to raise this important issue.

                                 
           Prepared Statement of Representative Scott Peters
    Chairman Takano and Ranking Member Roe:
    Thank you for hosting "Member Day" for your colleagues like me who 
have important legislation and priorities pending in your esteemed 
Committee.
    I miss serving on the Committee with you all - I continue to work 
on solutions for our nation's veterans and thank you all as partners in 
our joint effort to do so. I'm pleased my friend, Mr. Levin, has 
represented San Diego's hundreds of thousands of veterans very well on 
the panel.
    I'm here to thank you for passing two of my bills to help end 
veteran homelessness, and to urge you to provide oversight of the 
Office of Medical Inspector.
    First, thank you for marking up and passing a very important bill 
that would help more chronically homeless veterans secure housing and 
get crucial supportive services.
    H.R.2398, the Veteran HOUSE Act expands eligibility for HUD-VASH 
vouchers to veterans with other-than-honorable discharges.
    Congress has acknowledged that other-than-honorable veterans 
deserve access to some VA homelessness services, such as programs like 
Grant and Per Diem and Supportive Services for Veteran Families.
    Sadly, around the country, there are chronically homeless veterans 
who are falling through the bureaucratic cracks due to their discharge 
status. They can't receive housing vouchers because they are ineligible 
for VA health care, and therefore can't receive the invaluable 
supportive services provided by the VA.
    Since this Committee took action on the bill, Senators Jon Tester, 
Todd Young, and Chris Murphy introduced its companion bill.
    My other bill seeks to find solutions for veterans experiencing 
homelessness in high-cost areas, like San Diego. For veterans living in 
these areas, even if they have rental assistance, they may struggle to 
find an affordable place to live.
    Now I'd like to turn my attention to a troubling story from the San 
Diego VA. In November 2018, our office learned of an investigation 
detailing alleged unapproved human research.
    The San Diego VA participated in a study examining alcoholic liver 
disease, which was one site, among other research institutions, of a 
larger, NIH-funded study led by the Pittsburgh Liver Research Center 
and UNC Chapel Hill.
    Nine patients diagnosed with alcoholic hepatitis received 
transjugular biopsies. According to whistleblowers' disclosures, this 
was not the standard of care, and reported this to the VA's Office of 
Medical Inspector.
    Due to follow up from whistleblowers, the Office of the Special 
Counsel conducted an independent investigation and found VA's internal 
report unsatisfactory.
    The OSC report alleges that these samples were collected 
improperly, sometimes without patient consent, and could have put 
patients in harm's way. The Special Counsel urged the VA to "revisit 
its findings in this matter and take a truly critical look at the 
research being conducted" at the San Diego VA.
    At the end of last Congress, I wrote to this Committee requesting a 
hearing to investigate what happened at the San Diego VA, and more 
broadly to look at the Office of Medical Inspector to ensure it is 
doing its job to ensure patient safety at every medical center across 
the country.
    My staff and I have worked with the Committee to receive additional 
documents, and we all agree that it's our job to ensure the Office of 
Medical Inspector has enough resources to handle whistleblower 
disclosures.
    We need to strengthen investigatory bodies to ensure improper 
allegations such as these are thoroughly vetted.
    I ask you to work with me to get answers regarding this instance at 
the San Diego VA, and that as a Committee, as examine the Office of 
Medical Inspector.Veterans have served our nation, and deserve the best 
care, opportunities, and support. I am proud to advocate for San 
Diego's veterans, and I look forward to our ongoing work to deliver for 
them.
    Thank you very much for your time today, I yield back.

                                 
           Prepared Statement of Congresswoman Vicky Hartzler
    Chairman Takano, Ranking Member Roe, and distinguished members of 
the Committee, I want to applaud you for once again opening your doors 
and allowing me the opportunity to address you on Member Day. I also 
want to commend you for your continued commitment and dedication to 
improving outcomes for our veterans. I think as a Committee and as a 
Congress great strides have been made to ensure our veterans have the 
resources, care, and support they have earned. However, as I examine 
what more can be done for our veterans, I am convinced that many of the 
healthcare challenges our veterans face is a result of the persistent 
under- staffing at the VA.
    I believe that a bipartisan bill I introduced along with 
Representatives Correa, Wilson, Mooney, Rouzer, Lesko, and Bost, The VA 
Hiring Enhancement Act, will help the VA to fill some of the 40,000 VA 
vacancies. Our bill has three main provisions. First, it would allow 
physicians to be released from non-compete agreements for the purpose 
of serving in the VA for at least one year. These agreements may serve 
a purpose in the proper context but should never serve as a roadblock 
to caring for veterans within the VA system.
    Second, our bill updates the minimum training requirements for VA 
physicians. Completion of a medical residency is widely accepted as 
standard comprehensive training for clinical physicians in the United 
States. However, current law only requires that a physician be licensed 
in order to treat veterans. While in practice, the VA currently hires 
almost exclusively those physicians which have completed a residency, 
this provision will update those minimum requirements already 
established in law and ensure that they are the appropriate ones.
    Finally, our bill would place veterans' hospitals on a level 
playing field with the private sector when it comes to recruiting 
timelines. Often, private sector health care providers begin recruiting 
medical residents as they begin their final year of residency, 
sometimes even earlier. These residents often end up with a solid job 
offer from the private sector before VA recruiters are even able to get 
their recruiting process started.
    Our bill authorizes VA recruiters to make job offers to physicians 
up to 2 years prior to fulfilling the VA's requirements, contingent on 
meeting all requirements before they begin practicing at the VA. It 
offers job security to medical residents who want to work at the VA 
when they complete their training and allows VA facilities and 
recruiters to shore up appointments further in advance, helping them to 
plan and forecast medical workforce needs.
    We've worked closely with this Committee's staff, VA recruiters, 
and VSOs on this bill, and I'm pleased to report that it has garnered 
wide support and formal endorsement from 10 veterans' service 
organizations including the American Legion, Blinded Veterans 
Association, AMVETS, Disabled American Veterans, and Paralyzed Veterans 
of America. This measure is currently slated to be discussed at an 
upcoming Health SubCommittee hearing and it's my hope we can work 
together to move this bill to the House floor soon.
    In addition to VA staffing shortages, our veterans are facing 
another healthcare issue when experiencing a medical emergency. Current 
law provides for the reimbursement of ambulance transportation and 
emergency treatment at non-VA hospitals for certain veterans until they 
are medically stable. However, once stabilized, veterans must be 
transferred to a VA facility for any continued care they require or pay 
out-of-pocket for further treatment at the non-VA hospital.
    The problem is that Federal law does not currently allow for the 
reimbursement of the transfer for continued care, which often must be 
accomplished via ambulance that can be too expensive for patients to 
pay. The average cost for this necessary medical transfer is $500 but 
it can be far more expensive if the veteran lives in a rural area.
    To address this issue, I partnered with Congressman Joe Cunningham 
to introduce bipartisan legislation that would fix the shortfall in the 
VA's statutory authority to reimburse certain veterans for emergency 
transportation. H.R. 3350, the VA Emergency Transportation Act corrects 
this disparity by clarifying that these medical transfers are 
reimbursable. This change fixes a large, costly hole in the safety net 
the original law was intended to provide.
    Congressman Cunningham and I are joined by over 40 Members in 
supporting this critical measure. Additionally, 13 veterans' service 
organizations, including all of the "Big Six" have voiced strong 
support for this necessary reform. Far too many of our veterans 
continue to face this unnecessary burden at their most vulnerable time, 
creating financial hardships and jeopardizing their health. We must act 
now to move this bill forward and protect our veterans.
    Finally, I would like to highlight one additional measure, H.R. 
2433, the Veterans' Preference Parity Act. Outdated Federal hiring 
rules prevent too many patriots from being recognized when competing 
for Federal positions. The Veterans' Preference Parity Act rights this 
wrong by modernizing the archaic Federal hiring process and recognizing 
those who have served our nation.
    Up to 44% of the Army National Guard and 70% of the Air National 
Guard serve honorably without qualifying for Federal hiring preference. 
Additionally, over 130,000 working age retired veterans do not qualify 
under the current system. The Veterans' Preference Parity Act reforms 
outdated Federal hiring rules to allow all retired servicemembers and a 
greater number of National Guard and Reservists to qualify for 
veterans' preference.
    We are forever indebted to the brave men and women who serve in 
uniform and we owe them our continued support as veterans. The current 
Federal hiring preference statutes must be updated to reflect the way 
we utilize our reserve component forces and need to reward those who 
retire upon completion of their military career - not punish them. 
Please join me in reforming these outdated Federal hiring rules and 
support the Veterans' Preference Parity Act today.
    Thank you, again, for your time and consideration.

                                 
         Prepared Statement of Congresswoman Stacey E. Plaskett
    I would like to thank Chairman Takano, Ranking Member Roe, and the 
Members of this Committee for the opportunity to speak on the issues 
affecting approximately 8,800 veterans in my district, the U.S. Virgin 
Islands.
    I appreciate the continued support with the intention to host a 
Congressional Delegation to the U.S. Virgin Islands. Although members 
were unable to attend, Democratic Staff Director, Megan Bland visited 
the territory to assess the Veterans Affairs Administrations (VA) 
efforts in emergency preparedness, outreach strategies, the 
implementation of the Community Care Network and connecting civilians 
to much needed VA resources. As a result of this visit, staff was left 
with the impression that veterans of USVI have little to no access to 
VA healthcare. They identified the lack of access to immediate 
assistance following a disaster, understaffing and mismanagement of the 
local VA clinics, and the treatment of veterans under a contract that 
is now nullified.
    The Virgin Islands currently houses two VA clinics, one on St. 
Thomas and one on St. Croix, with no VA hospital. Although the CHOICE 
program is available in the Virgin Islands, some doctors are hesitant 
to participate due to delayed payments and being in a small market. 
This further exacerbates the issue of having only a small number of 
medical specialists capable of providing necessary service. In one 
case, a veteran required a heart specialist, but because only one was 
working in the territory, the veteran had to wait two months for an 
appointment. This is unacceptable.
    Community providers that treat veterans in the Virgin Islands are 
still operating under Choice contracts and were subject to funding that 
expired June 6, 2019. As of July 21, 2019, the VA had performed no 
outreach to community providers within the US Virgin Islands regarding 
Community Care Networks under the MISSION Act. This means that 
providers are treating veterans under contracts that were nullified on 
June 6, 2019. It is unclear how VHA is both authorizing and reimbursing 
for this care as the funds used to pay for care under the now void 
Choice Program are no longer available. While Congress is willing to 
support these providers as they seek reimbursement in the future, it is 
discouraging that the Caribbean Healthcare System and the VA Central 
Office failed to inform, educate, and enroll these providers in the new 
Community Care Network created by the MISSION Act.
    As a result of these limited resources, many veterans must 
communicate with and travel to the VA hospital in Puerto Rico, which 
leads to several major issues.
    First, veterans in some cases must pay up front for airfare and a 
hotel stay in Puerto Rico due to appointment times and limited airline 
schedules. There is a hardship when they must bring a companion.
    Second, communication barriers often emerge because of 
significantly differing dialects and language barriers.
    Third, numerous veterans have mentioned that they feel 
disadvantaged and prejudiced when interacting with the VA hospital in 
Puerto Rico due to race and residency. Many Virgin Islands veterans 
have stories of abuse and mistreatment that are, in most cases, hard to 
prove and thus seldom recorded.
    Virgin Islands veterans also complain that they must exert 
unnecessary effort to prove that their disabilities are service-related 
in order to receive the benefits they deserve. Vietnam-era veterans 
have expressed concerns about their burden of proof that post-traumatic 
stress disorder and exposure to Agent Orange are results of their 
military service. Despite the VA's recent efforts to revisit this 
issue, many veterans and their families believe that too little has 
changed and that these new efforts are inadequate for a population that 
placed their lives on the line for their country.
    All American veterans deserve a commitment from their country and 
government that proper healthcare will be provided, regardless of 
geographic location. As the hospitals in the Virgin Islands are 
reconstructed following the destruction of Hurricanes Irma and Maria, I 
request that the Department of Veterans Affairs and the House and 
Senate Veterans Affairs Committees consider funding a new component of 
the hospital system dedicated to veterans and capable of accommodating 
more severe healthcare needs than the clinics alone can provide, with 
an actual contingency plan, unlike the one planned for Hurricane 
Dorian.The Virgin Islands Office of Veterans Affairs estimates that 
there are approximately 4,000 on St. Croix, 4,000 on St. Thomas and 800 
on St. John. Because the US Department of Veterans Affairs reports 
enrolled veterans of the US Virgin Islands as part of the Caribbean 
Healthcare System which also includes Puerto Rico, it is difficult to 
easily attain the population of veterans enrolled in VHA that reside in 
the US Virgin Islands.
    Because of the funding structure of VHA facilities, it is critical 
that enrollment into the VA reflect the overall population of veterans 
within the community. The lack of VHA care options on the various 
islands negates the incentive that stateside veterans may have to 
enroll in free or cost-reduced health care. As a result, VA and local 
leaders should better promote enrollment within the VHA for veterans in 
the USVI. There are a myriad of VSO posts, clinics, and outreach 
opportunities that the VA should better capitalize on as well.
    I thank you for your consideration and encourage you to increase 
the Federal commitment to the embattled veterans of the U.S. Virgin 
Islands.

                                 
                  Prepared Statement of Dean Phillips
    Thank you, Chairman Takano, Ranking Member Roe, and Members of the 
Committee for the opportunity to share a few of concerns that have been 
raised to me by veterans and their families in Minnesota's Third 
Congressional District - the western suburbs of the Twin Cities.
    As a Gold Star Son, my gratitude for the men and women in uniform, 
and the sacrifices they have made is immeasurable. My birth father, 
Artie Pfefer, went to the University of Minnesota on an ROTC 
scholarship, and later became a Captain in the U.S. Army. He was killed 
in a helicopter crash in Vietnam when I was just six months old. I 
never met Artie, but I carry his memory with me every day.
    During my time in Congress, I have made it a priority to meet with 
and learn from veterans across Minnesota. In order to do this, my team 
created the Veterans Advisory Council, which is made up of individuals 
who serve veterans for a living. They represent many service 
organizations, and their input has been invaluable. Last May, the 
Council and I hosted a Veterans and Military servicemembers Community 
Conversation to invite the public in on the discussion. The Council 
advised me on legislation that came to our attention from conversations 
I had with constituents that night, and we continue to meet to discuss 
ways we can serve the veterans community in Minnesota. It is my hope 
the Council will continue to be a beacon for community outreach and 
engagement.
    One of the issues we are working on is veteran homelessness. This 
is a national problem that demands action - and Minnesota is leading 
the way in this effort. Thanks to our outstanding Governor, Tim Walz - 
who is a veteran himself and former Ranking Member of this Committee - 
Minnesota has made it an official goal to be the fourth state to end 
veteran homelessness by getting to functional zero.
    A key part of this effort has been the Minnesota Homeless Veteran 
Registry, which was created in 2014 to identify all known homeless 
veterans and to ensure they have access to appropriate housing and 
social services. The Registry recognizes the underlying factors 
contributing to veteran homelessness, including mental health issues, 
substance abuse, and economic hardship. Housing and social service 
professionals use the Registry to identify homeless vets, reach out, 
and offer assistance. It has helped nearly 2,000 veterans find a home. 
But our work is not done. Congress can support this mission by 
incentivizing landlords to open up their spaces to veterans who need a 
more permanent housing solution.
    But the issues our veterans face go beyond housing. They need 
better health care that is convenient, accessible, and local. From the 
conversations I have had with veterans, local elected leaders, and 
County Veterans Service Officers, it has been made clear that there is 
a significant need for a Community Based Outpatient Clinic (CBOC) in 
the Southwestern part of our district.
    Right now, the closest CBOC to the south of our district is not 
adequate for our local veterans. The clinic is run down, has a 
confusing building layout, and is not accessible from the highway. I 
urge the VA to find CBOC sites that would serve as many veterans as 
possible and be accessible for the ones that depend on it for their 
healthcare needs.
    In addition to healthcare services, veterans must have access to 
quality mental health programs. The Clay Hunt Suicide Prevention for 
American Veterans Act, which became law in 2015, directs the VA to work 
with local nonprofit mental health organizations in order to reach out 
into the community to serve veterans where they are. Minnesota has one 
of the most active National Guard's in the country, and with more and 
more Guardsmen being put on active duty, more veterans are at risk for 
suicide. Congress, and this Committee, must use its oversight authority 
to ensure that our veterans have access to mental health care and 
suicide prevention programs and that the Clay Hunt Act is being 
thoroughly and effectively implemented.
    This Committee has been effective in passing monumental and long-
awaited legislation this Congress, including the Blue Water Navy Act 
which I was proud to cosponsor. While this bill will bring justice to 
so many vets who deserve benefits for their sacrifices, I am concerned 
with its implementation. The VA must be prepared to process these 
claims in a timely and thorough manner. Congress, and this Committee, 
must also use its oversight authority to ensure that our veterans have 
the benefits and care they deserve, which includes not being subjected 
to extreme delays in processing.
    I stand ready to do whatever I can to address the concerns that 
have been raised by veterans and their advocates in our district. I 
look forward to working with all Members on the House Veterans Affairs 
Committee to support the men and women and their families who have 
served this country with honor and distinction.
    Thank you

                                 
                    Prepared Statement of Brian Mast
    Chairman Takano and Ranking Member Roe, I appreciate the 
opportunity to testify before the House Veterans' Affairs Committee on 
bipartisan legislation I introduced with 20 cosponsors, H.R. 2846, the 
Improving Veterans Access to Congressional Services Act. This important 
legislation, which this Committee held a hearing on in the previous 
Congress-and which was scheduled to be marked up-will ensure that our 
veterans receive the high level of constituent service they deserve by 
improving access to their congressional representatives.
    Like all members serving on this Committee, I take great pride in 
serving the veterans in my community and want them to know that their 
service and sacrifice is truly appreciated. That means being readily 
available to deal with, and quickly dispose of, any delay in the care 
or benefits they've earned. It also means being present in VA 
facilities to see first-hand the issues that exist, so that I can truly 
understand the challenges our veterans face. That's why I still do, and 
always will, get my healthcare from the Department of Veterans Affairs. 
Not only will I experience the issues and problems first hand, but I 
will also get the opportunity to see what is working well.
    That's also why I, along with a bipartisan congressional delegation 
from my area, fought so hard-overcoming more than a year of red tape 
and Federal bureaucracy-to open the first-ever congressional office 
inside a VA facility last year. Doing so allowed me to expedite the 
assistance I provide our veterans and improve the overall quality of 
service my office delivers. We get to interact with our vets on a 
regular basis and receive both positive and negative feedback on the 
operations of the facility. When common threads or issues surface, I 
can take them to the administration, and we can work collaboratively to 
resolve them.
    Additionally, when veterans have a negative personal experience at 
our VA facility, they know they can air their concerns or grievances at 
the highest possible level, without having to go out of the way to 
another office. It's another level of customer service that wouldn't 
otherwise exist without the presence of our congressional office.
    My staff and I have held more than 500 meetings with veterans in 
this office since it opened, and that doesn't include the many meetings 
taken by Representatives Deutch, Hastings and Frankel.
    Since I opened our office in the VA, I've been approached by 
several other members looking to replicate our efforts. In each 
instance, the feedback they received was pushback and hesitancy at 
their local VA. That's why I introduced the Improving Veterans Access 
to Congressional Services Act, which requires the Secretary of Veterans 
Affairs to permit the use of VA facilities by Members of Congress for 
the purposes of meeting with constituents. Additionally, this bill 
requires the Secretary to establish standard operating procedures to 
help facilitate and expedite requests for space within a VA facility by 
Members of Congress. By building on the lessons learned establishing 
the first VA Congressional office and removing the road-blocks I 
experienced, Members of Congress will be able to provide the high level 
of constituent services our veterans deserve.
    I truly believe that every Member of Congress should have this 
opportunity to open an office at their local VA, and Members of 
Congress should not have to face the bureaucracy and delays I 
experienced in opening my office in the West Palm Beach VA Medical 
Center.
    The more present Members of Congress are, the better quality of 
service our veterans receive. Not only will it help veterans in their 
communities, but it will afford those members an opportunity to be 
present for the successes and failures and to see first-hand how 
Congress can reform the VA. By building off the process established by 
the Veterans Administration when I opened my office, we can improve our 
vets' access to Congressional services as well as their overall care.
    Chairman Takano, Ranking Member Roe and members of the Committee, I 
appreciate the opportunity to testify on my legislation and I look 
forward to your questions.

                                 
              Prepared Statement of Earl L. "Buddy" Carter
    Memo To: Earl L. "Buddy" Carter

    To: Mr Buddy. Carter
    From: Hart
    Date: 9.5.19
    Re: House Veterans Affairs Committee Member Day Testimony - Talking 
Points

    Talking Points:

      Thank you Chairman Takano and Ranking Member Roe for 
having us all here to testify on behalf of our constituents.
      In the First Congressional District of Georgia, I have 
the honor and privilege of representing nearly 60,000 veterans.
      Unfortunately, although we have a large number of 
veterans in Coastal Georgia, our nearest VA Hospitals are 2 hours away 
- in Charleston, South Carolina and Dublin, Georgia.
      Creating better access to health care for veterans has 
been one of my highest priorities while serving in Congress.
      This is why, I supported the VA Mission Act during the 
115th Congress, specifically with its provisions that authorized VA 
hospitals to use telemedicine across state lines.
      I applaud the President signing the VA Mission Act into 
law.
      However, after meeting with VA officials, they brought to 
my attention that trainees were not authorized in the law to use the 
telemedicine system.
      Although likely a simple mistake in the legislation, this 
creates major problems in VA hospitals for a number of reasons.
      Most notably, it puts VA providers in legally precarious 
positions because the VA uses trainees in all aspects of care - just 
like in non-VA hospitals.
      Additionally, it puts trainees behind the 8 ball, missing 
a critical piece of accumulated experience - the telemedicine system - 
when working to eventually become a doctor.
      Earlier this Congress, I introduced H.R. 3228, the VA 
Mission Telehealth Clarification Act, to remedy this issue.
      The bill now has bipartisan support among Committee 
Members and I hope you all will consider the legislation in front of 
the Committee as soon as possible.
      Next, I hope the Committee will continue to make strides 
in improving the veterans appeals process.
      I am proud that Congress passed and the President signed 
into law the Veterans Appeals Improvement and Modernization Act which 
became effective this past February.
      As this law moves forward, I encourage the Committee to 
review its progress, continue to find ways in which it can be improved, 
and see how the VA can answer our constituents' appeals in a more 
efficient and accurate fashion.
      Finally, I trust that the Committee will keep veteran 
homelessness as one of its highest priorities for the remainder of the 
116th Congress.
      Today, there are still just under 40,000 homeless 
veterans in America.
      Another 1.4 million veterans are at risk of homelessness.
      11% of the U.S. homeless population are veterans.
      Too many of those are in the First Congressional District 
of Georgia.
      These numbers are unacceptable.
      We need to reassess all of our Federal programs working 
to combat veteran homelessness, but especially the accessibility of VA 
loans and the guidance given to veterans reintegrating into a civilian 
society.
      In all of these issues I have mentioned today, we need to 
remember that our nation's veterans are our heroes and they deserve the 
absolute highest respect upon their return home.
      The Federal government simply can do better in veterans' 
access to health care, the appeals process, homelessness, and so much 
more.
      Thank you for your work on these issues.
      I look forward to following your progress.

                                 
                   Prepared Statement of David Rouzer
    Thank you, Mr. Chairman, and the other members of this 
distinguished Committee for your work to strengthen care and resources 
for our nation's heroes. I am particularly grateful for your 
willingness to allow members who do not serve on this Committee the 
opportunity to raise issues and share concerns that we hear from 
veterans back home.
    The great state of North Carolina has a long, rich tradition of 
military service and we are blessed to have a large community of 
veterans in the 7th Congressional District, which I have the honor to 
serve and represent.
    Mr. Chairman, I'd like to bring the Committee's attention to a bill 
I reintroduced to help veterans restore their credit score when it has 
taken a hit because the VA failed to reimburse an outside provider.
    This is an issue that has been faced by many veterans in my 
district, and my office has helped facilitate hundreds of payments to 
outside providers by intervening with the VA to avoid a debt going to 
collection. And the unfortunate reality is that there are many, many 
veterans across my district, state and our country that have had their 
credit destroyed, through no fault of their own, as a result of 
mismanagement and delays at the VA, specifically dealing with emergency 
medical care.
    This is simply unacceptable.
    H.R. 3012, the Veterans' Credit Protection Act, if enacted into 
law, will help restore faith in the VA and provide veterans the help 
they need to restore their credit when they have been the casualty of 
mismanagement and late payments, and in many cases, no payment at all 
made by the VA to the outside providers of their care.
    The Veterans' Credit Protection Act puts the onus on the VA to 
reach out to the veteran and inform them how to resolve credit issues 
caused by these delayed payments. In addition, this legislation 
requires the VA to submit a report to Congress on the effectiveness of 
the Office of Community Care in providing timely payment of proper 
invoices for emergency care.
    I appreciate the Committee's consideration of this bill as soon as 
possible so that veterans will no longer have to worry about their 
credit because of the VA's failure to pay their claims.
    Thank you again, Mr. Chairman, for allowing me the opportunity to 
testify today on this very important issue.

                                 
              Prepared Statement of Debbie Mucarsel-Powell
    For years, veterans in Monroe County have struggled with access to 
care. Former servicemembers living in the Florida Keys often have to 
travel over a hundred miles to the Miami VA to have access to the full 
set of care they need. This was supposed to have been addressed when 
the VA Choice Program was established in 2014, and access to care in 
rural areas was supposed to be improved in 2018 when Congress passed 
the VA MISSION Act. This replaced the VA Choice program with the 
Veterans Community Care Program, or the VCCP. Under the MISSION Act, 
any veteran living at least 40 miles away from a full-service VA is 
eligible to receive health care from community health providers that 
are in the approved Community Care network.
    Although there is a VA clinic in Key West, they only provide basic 
care and often refer patients to the facility in Miami for most 
services. As such, many of our veterans have to travel for hours from 
their homes in the Keys to receive the care that they need. This 
program was supposed to be operational no later than June 6 of this 
year. Unfortunately, in Monroe County the providers in our network have 
yet to be approved, so although the MISSION Act went into effect this 
June, my constituents remain in limbo.
    Furthermore, veterans in my district have been subject to the 
continuous disruption in service from the handoffs between the VA's 
private partners: Health Net, Tri West, and Optum. My constituents were 
originally covered through Health Net, and when they left Tri West 
temporarily took over, and now they're handing over to Optum. During 
these various handoffs, our veterans' health care needs have been 
forsaken. They have to travel long distances for care, often do not 
receive confirmation for appointments until the night before, and as a 
result can miss appointments when they are unable to secure 
transportation on such short notice.
    My team recently heard from a constituent who had moved to the Keys 
and requires monthly treatments that can only be provided by a full-
service VA. She had difficulty making an appointment with the Miami VA 
and wasn't informed of a confirmed appointment until the day before she 
was told to come in. Because of such a short notice time, she was 
unable to travel to Miami for her appointment. She was informed that 
she could go through the Community Care Network for her treatment more 
locally in the Keys, but because there have yet to be any approved 
providers, she had to go without the care she needed.
    Unfortunately, this story is all too common. It has become such a 
challenge that Monroe County's Director of Veterans Affairs will often 
volunteer hours from her day to drive veterans to Miami's VA multiple 
times a week so they can access necessary health services. This should 
not be necessary, and what's happening in Monroe County is 
unacceptable. Our veterans sacrificed when they answered the call to 
serve - government inefficiency shouldn't be the reason they forego 
medical attention after they've served.
    Our veterans should have access to quality care, regardless of 
where they live. The men and women who served and defended our country 
should not have to forgo their care because they have nowhere to go to 
receive the treatment they need. I urge the Committee to push the 
Office of Community Care at the VA to address this, and to have their 
private partners in Tri West and Optum Health to provide greater 
outreach to our local providers so they can provide care to our vets in 
Monroe County.
    We also need more resources dedicated to our VA health clinics, so 
they have proper staffing to provide the full set of health care 
services at each facility. I urge the Committee to hold the VA 
accountable for all aspects of the MISSION Act, from the Community Care 
program to building out our VA health centers. VA facilities around the 
country like the one we have in Monroe County should not have to 
struggle with understaffing issues so they can provide the full set of 
comprehensive health care services our veterans have earned and depend 
on.
    I'm looking forward to working with the Committee and my colleagues 
in Congress to address this issue so that our nation's veterans have 
access to the quality care they've earned and deserve.

                                 
                   Prepared Statement of Darren Soto
    Thank you Chairman Takano and Ranking Member Roe for the 
opportunity to testify before the House Committee on Veterans' Affairs 
on my legislative priorities within the jurisdiction of the Committee. 
I truly appreciate the great sacrifice our veterans have given on 
behalf of the United States, and I take great pride in serving the 
needs of veterans in my community.

    H.R. 2846, Improving Veterans Access to Congressional Services Act 
of 2019, Rep. Brian Mast, 20 Cosponsors

    H.R. 2846 would allow the Secretary of Veterans Affairs to permit 
the usage of Department of Veterans Affairs (VA) facilities by Members 
of Congress to meet with veterans and provide constituent services.
    Allowing Members of Congress to use VA facilities would improve 
veteran access to their congressional representatives. H.R. 2846 would 
allow for expedited assistance and an overall enhancement in the 
quality of service to our veterans. Congressional offices would be able 
to readily acquire historical and medical documents in an expedited 
manner. Veterans will be able to get proper guidance on how to navigate 
the VA and be referred to the proper VA offices. Furthermore, 
Congressional offices would have a greater ability to adequately 
document concerns to the appropriate patient advocate and provide 
supporting documentation if the patient advocate does not meet a 
veteran's concern.
    Additionally, H.R. 2846, requires the Secretary to establish 
standard operating procedures to help facilitate and expedite requests 
for space within a VA facility by Members of Congress. This would 
further allow Members of Congress to observe the daily operations of 
the VA to address any concerns regarding VA procedures.
    H.R. 2846 is a reasonable solution to improve veteran services by 
removing roadblocks and providing high level constituent services. 
Thank you in advance for your consideration of this important 
legislation. I look forward to working with you as H.R. 2846 moves 
forward in the Committee process.
    Thank you Chairman Takano and Ranking Member Roe for the 
opportunity to testify before the House Committee on Veterans' Affairs 
on my legislative priorities within the jurisdiction of the Committee. 
I truly appreciate the great sacrifice our veterans have given on 
behalf of the United States, and I take great pride in serving the 
needs of veterans in my community.

    H.R. 2846, Improving Veterans Access to Congressional Services Act 
of 2019, Rep. Brian Mast, 20 Cosponsors

    H.R. 2846 would allow the Secretary of Veterans Affairs to permit 
the usage of Department of Veterans Affairs (VA) facilities by Members 
of Congress to meet with veterans and provide constituent services.
    Allowing Members of Congress to use VA facilities would improve 
veteran access to their congressional representatives. H.R. 2846 would 
allow for expedited assistance and an overall enhancement in the 
quality of service to our veterans. Congressional offices would be able 
to readily acquire historical and medical documents in an expedited 
manner. Veterans will be able to get proper guidance on how to navigate 
the VA and be referred to the proper VA offices. Furthermore , 
Congressional offices would have a greater ability to adequately 
document concerns to the appropriate patient advocate and provide 
supporting documentation if the patient advocate does not meet a 
veteran's concern.
    Additionally, H.R. 2846, requires the Secretary to establish 
standard operating procedures to help facilitate and expedite requests 
for space within a VA --facility by Members of Congress. This would 
further allow Members of Congress to observe the daily operations of 
the VA to address any concerns regarding VA procedures.
    H.R. 2846 is a reasonable solution to improve veteran services by 
removing roadblocks and providing high level constituent services. 
Thank you in advance for your consideration of this important 
legislation. I look forward to working with you as H.R. 2846 moves 
forward in the Committee process.

                                 
                Prepared Statement of Elise M. Stefanik
    Good morning Chairman Takano, Ranking Member Roe, and members of 
the Committee. I am grateful for the opportunity to testify before the 
HouseVeterans' Affairs Committee and discuss issues very important to 
my district. I proudly represent New York's 21st Congressional 
District-where nearly one in ten adults is a veteran. That's what makes 
the work of this Committee deeply personal to me and my constituents.
    Tomorrow the SubCommittee on Health will discuss and debate several 
important pieces of legislation concerning Veterans' healthcare, many 
of which have a special focus on improving the access and quality of 
care for women veterans. I applaud the Committee, as well as your 
staffs, for focusing on this ever- important topic.
    Another topic that the SubCommittee will discuss tomorrow is 
H.R.2816, the Vietnam Era Veterans Hepatitis C Testing Enhancement Act. 
This is an incredibly important bill. To help my colleagues understand 
why, I would like to share a story with you:
    In 1970, Danny Kaifetz, a young man from the North Country, 
volunteered to serve in the United States Marine Corps while the 
country was embroiled in the Vietnam War. Danny completed training at 
Parris Island, and went on to Jungle Warfare School and Combat Infantry 
Training at Camp Lejeune. At some point during training-as any one of 
my colleagues who has been through boot camp knows-all the recruits 
were lined up, like a factory assembly line, and were inoculated with 
the necessary vaccinations. Back then the Armed Forces, to include the 
Marine Corps, used the Ped-O-Jet air inoculation device, or "jet-gun," 
to quickly vaccinate one recruit to the next. And as difficult as it 
for us to image today, medics were not required to sterilize the 
devices in betweenthe inoculations. In fact, page 38 of the operator's 
manual, explicitly states "sterilization not required between 
injections." As we now know, this practice exposed thousands of 
recruits to dangerous, and often deadly, blood-borne diseases. 
Contamination happened without discrimination-to volunteers and to 
those who were drafted. To those who went on to serve honorably for 
several years and those who didn't make it through training. To those 
who saw combat and bear the emotional burdens of a horrific war and 
those who, through some good fortune, were spared.
    Danny Kaifetz thought he was one of the lucky ones who was able to 
serve his country and fellow Marines without going to combat. He 
proudly fulfilled his duty and was distinguished with the Meritorious 
Service Medal at the completion of his service contract. But, 
unbeknownst to him, Danny did not leave the military unharmed.
    Nearly forty years later, in 2011, Danny was diagnosed with 
Hepatitis C. He sought and received treatment at the VA, and today Mr. 
Kaifetz will tell you with gratitude that he owes his life to the 
outstanding medical staff at New York VA.
    As you all know, Congress dedicated significant resources to enable 
the VA to test and treat veterans for the hepatitis C virus, and VA has 
made significant progress to date. However, these efforts primarily 
focus on Veterans enrolled in the VA, testing only 78% of the two 
million Vietnam-era Veterans enrolled in VA care. Estimates indicate as 
many as 1 in 10 of the eight million surviving Vietnam Era 
servicemember may be infected with hepatitis C due to the cross- 
contamination. Of those who do not meet VA eligibility criteria, as 
many as seven million are considered at high-risk for hepatitis C 
infection and unaware of their status. Our veterans deserve better.
    The Vietnam Era Veterans Hepatitis C Testing Enhancement Act 
focuses on Hepatitis C screening and does not take away from the VA's 
efforts, rather enhances them. Furthermore, the bill is budget neutral 
by utilizing resources previously allocated by Congress through the 
Honoring America's Veterans and Caring for Camp Lejeune Families Act 
(P.L.112-154). The concept has proven successful at a local level due 
to the extraordinary efforts led by my constituent, Danny Kaifetz, and 
American Legion Post 1619. We owe it to a generation of veterans to 
provide this valuable screening tool. I urge my colleagues to join the 
American Liver Foundation, the AIDS Institute, and Vietnam Veterans of 
America to support H.R.2816.
    Mr. Chairman and Ranking Member, I thank you for the opportunity to 
speak with you today. And I thank the entire Committee and staff for 
theinvaluable work you do to support our nation's heroes. I look 
forward to working with you. I yield back.

                                 
                  Prepared Statement of Brad Wenstrup
    Chairman Takano and Ranking Member Roe, I would like to thank you 
for holding this Member Day hearing. Caring for our veterans is one of 
Congress's most sacred duties, and I was extremely proud to spend the 
first five years of my time in Congress serving our nation's veterans 
on this distinguished Committee.
    While I may no longer serve on this Committee, I will never stop 
serving America's veterans, and that is what brings me here today.
    I am extremely proud of the work that Congress, and particularly 
this Committee, has done to ensure better healthcare for our veterans. 
Last year, we passed the VA MISSION Act to create a healthcare system 
that truly puts veterans first by giving them more choice in their 
healthcare treatments. The health of our veterans is one of my highest 
priorities, and today I am here to advocate for another bill which will 
improve veterans' healthcare.
    Rep. Kathleen Rice and I have introduced H.R. 3700, which will 
prohibit smoking in all Veterans Health Administration (VHA) 
facilities, and repeal the antiquated 1992 law that requires the VHA to 
furnish and maintain designated indoor or outdoor smoking areas. As an 
Army Reserve doctor, I know that permitting or exposing patients to 
firsthand and secondhand smoke is dangerous, especially while they 
undergo treatment at VHA facilities. It's past time that Congress 
address this issue that it created in 1992 and fix the outdated law so 
that we do not continue to harm veterans seeking care at VHA 
facilities.
    According to the Centers for Disease Control and Prevention (CDC), 
smoking is the leading cause of preventable death in the United States-
killing more than 480,000 people annually- and there is no risk-free 
level of exposure to secondhand smoke. As such, the overwhelming 
majority of America's private health care systems and facilities, most 
Department of Defense medical facilities, and all Federal government 
buildings, are smoke-free. Yet there are nearly 1,000 designated indoor 
or outdoor smoking spaces at VHA facilities across the country-at least 
one in every state. In addition to the health concerns, such spaces are 
difficult to maintain and cost the VA more than $1.2 million annually.
    That's why I was pleased to see VA Secretary Robert Wilkie announce 
this June that beginning in October, all VHA facilities will be smoke-
free. However, it's since come to my attention that this policy change 
has been challenged by the American Federation of Government Employees, 
who argue that the smoke-free policy should not apply to VA employees. 
I believe that this is a perfect illustration of precisely why Congress 
needs to assert its authority and make clear once and for all that 
smoking is unacceptable in the medical facilities where our veterans 
seek care every day. H.R. 3700 would do exactly that, ensuring that no 
one can change, reinterpret, or strike down the smoke-free policy.
    The VA strongly supports codifying the smoke-free policy, as do 
over two dozen public health organizations such as the American Cancer 
Society Action Network, the American Lung Association, the American 
Heart Association, the Campaign for Tobacco-Free Kids, and the Society 
of Thoracic Surgeons. I would also like to thank the members of this 
Committee who have cosponsored H.R. 3700, Reps. Greg Steube and Chris 
Pappas, for their support of this bill.
    Chairman Takano and Health SubCommittee Chairwoman Brownley, I urge 
you to consider H.R. 3700 at a future Health SubCommittee legislative 
hearing. This is important legislation which will build on this 
Committee's work to improve veterans' healthcare, and I thank you for 
your consideration. With that I yield back the balance of my time.

                                 
                  Prepared Statement of Kevin McCarthy
    Chairman Takano, Ranking Member Roe, and distinguished Members of 
the Committee, thank you for the opportunity to appear before you today 
and discuss an issue that greatly impacts veterans in California's 
twenty-third congressional district, which I have the privilege of 
representing in Congress.
    For far too long, thousands of veterans throughout Kern County have 
patiently waited for a new Community-Based Outpatient Clinic to be 
built in Bakersfield, California. The existing Bakersfield clinic is 
outdated and cramped-no longer able to fulfill the needs of Kern 
County's growing veteran population. Ten years ago, Congress authorized 
the construction of 15 new Community-Based Outpatient Clinics, 
including a clinic in Bakersfield, in Public Law 111-82. The 
Bakersfield clinic is the only location that remains unbuilt. This is 
unacceptable.
    Veterans in my district had hope that the VA would break ground on 
the new clinic in 2015. However, that hope was derailed when the VA's 
chosen site was condemned by the High-Speed Rail Authority for being in 
the path of the costly high-speed rail project. This was among the 
first of several unnecessary delays and setbacks for the clinic.
    Last October, I was thrilled to announce that the VA had finally 
awarded a contract for a brand-new, state-of-the-art 30,000 square foot 
Bakersfield clinic, located on Knudsen Drive. This clinic would provide 
veterans with expanded mental health and women's health care services. 
Unfortunately, this award became subject to several dilatory protests 
by the owner of the current Bakersfield clinic facility. This has only 
further delayed-and continues to delay-our deserving veterans from 
accessing the expanded health care services that they have both earned 
and deserve.
    Many of these multiple protests have been dismissed or settled-when 
is enough enough?
    While I understand that the government contracting process must 
allow for fair competition, I do not understand how this process can be 
so manipulated and how the Bakersfield clinic remains unbuilt while 
other VA facilities authorized in 2009 are currently serving veterans.
    By delaying construction of a new clinic, the current leaseholders 
are preventing veterans from receiving care and taking taxpayers for a 
ride. The VA is paying $2 million per month to lease the Westwind Drive 
clinic on a month-to-month basis, according to data that the VA 
provided to my office. That's approximately twice what it paid under 
its longer-term lease.
    Every day of delay is another day the taxpayer must pay the higher 
rent. Worse, the influx of cash is perpetuating delays because the 
leaseholders can pay for the legal costs of their protests. It is an 
effective strategy for the leaseholders, but a raw deal for everyone 
else, especially our veterans.
    Yes, the Federal contracting process must be transparent and 
responsive to reasonable concerns. However, it must also be trustworthy 
and not lose sight of its ultimate goal: helping our deserving veterans 
receive the quality service they need. In its quest for fairness, the 
contracting process has failed the very people it is meant to help.
    The thousands of veterans in my community cannot be asked to wait 
any longer than they already have. Ten years is long enough. We must 
act quickly to ensure that the Bakersfield clinic is built to set a 
precedent that unreasonable dilatory tactics will not be tolerated.
    Lastly, the difficulty in building a new clinic in Bakersfield 
suggests that the Federal government's process for awarding contracts 
is liable to inefficiency and abuse.
    I hope my testimony today has shined a light on one part of this 
larger problem and will inspire future action. I look forward to 
working with Chairman Takano, Ranking Member Roe, and all Committee 
Members to ensure that the Bakersfield clinic comes to fruition and 
that other veteran populations are not impacted by this broader 
systemic problem. However we respond, our goal should be a contracting 
process that is efficient, transparent, and accountable.
    Above all else, it must not forget the needs of the American 
people, which it is meant to serve.
    And that is the point I want to leave with you today. There is a 
human element, a human tragedy, to the failures of the current system. 
You can tell a lot about the character of a nation by how it treats its 
veterans. That is why I will not rest until this issue is resolved and 
a new clinic in Bakersfield built.
    Our veterans deserve nothing less.
    I would like to submit a letter from SASD Development Group for the 
record. Thank you for the opportunity to testify today.

                                 
                   Prepared Statement of Tim Walberg
    Background: H.R. 3527, the POW Priority Care Act directs the 
Department of Veterans Affairs to elevate the priority group for 
Prisoners of War (POW) to Priority Group I, regardless of their 
service-connected level. Through enacting this legislation, POWs would 
receive the highest priority status for medical care at the VA.
    Currently, there are 3,500 POW eligible veterans enrolled in VA 
health services. 2,800 are already enrolled in the Priority 1 care 
group. This leaves roughly 750 POW still categorized in the Priority 3 
group.

    Intro:

      I want to thank Chairman Takano and Ranking Member Roe 
for the opportunity to testify today.
      Taking care of our country's veterans is one of the most 
important things we can do as Members of Congress.
      Our servicemen and women give their all in the name of 
our nation and it is the obligation of Congress and our nation to give 
that same dedication to providing the highest quality care for when our 
heroes return home.
      Many members of the armed forces endured unthinkable 
hardship in captivity as Prisoners of War, while we will never forget 
those who did not return home, there are those who do come back.
      For those that do, they deserve the highest priority of 
care at the VA.
      Therefore, I introduced the POW Priority Care Act, which 
would move POWs to the front of the line giving them Priority 1 level 
VA care.

    Summary:

      Under current VA care provisions, POW veterans are not among the 
top tier of care at the VA.
      Instead, POW veterans are in the third priority group, 
often placing them at a disadvantage in health care options.
      The priority system classification determines eligibility 
for healthcare services at the VA.
      Factors determining priority assignment include time and 
place of service, income level, and service-connected disability.
      The POW Priority Care Act would elevate POWs from 
Priority Group 3 to Priority Group 1 in terms of healthcare needs.
      By having Priority 1 status, POWs will have greater 
access to health care options at the VA.

    Conclusion:

      We can all agree that veterans and Prisoners of War 
should not have to struggle to get the proper healthcare and medical 
services that fits their needs.
      I want to thank Reps. Krishnamoorthi, Guthrie, and Rush 
for joining me in introducing this bipartisan legislation.
      The legislation is supported by AMVets and we are continuing to 
gain support from other organizations.
      Prisoners of War have not only answered the call of duty, 
but they endured unthinkable hardship and made unquestioned sacrifice 
in service to our nation.
      Thank you Mr./Mrs. Chairman and I urge the Committee to 
mark up H.R. 3527 so that it can advance to the floor of the House for 
a vote.

                                 
                   Prepared Statement of Clay Higgins
    Mr. Chairman,
    I respectfully request your strong support of HR 1527, the Long-
Term Care Veterans Choice Act. My bill authorizes the US Department of 
Veterans Affairs to cover the cost of long-term care at medical foster 
homes for up to 900 veterans otherwise eligible for nursing home care 
through the VA.
    Medical Foster Homes (MFH) are private homes in which a caregiver 
provides services to a small group of individuals who are unable to 
live without day to day assistance and are an alternative to nursing 
homes for those who require nursing home care but prefer a non-
institutional setting with fewer residents. For many young veterans in 
need of round-the-clock-care, MFHs can provide a more age-appropriate, 
independent setting than traditional nursing homes.
    The US Department of Veterans Affairs (VA) has run its medical 
foster home initiative since 2000, and today the Veterans Health 
Administration oversees more than 700 licensed caregivers caring for 
nearly 1,000 veterans in 42 states. To be eligible to provide care to 
veterans, VA medical foster home providers must already pass a 
background check, complete 80 hours of initial training and 20 hours 
annually, and cannot work outside the home.
    Unfortunately, while the VA will cover the cost of Home-Based 
Primary Care for eligible veterans living in MFHs, the VA does not 
cover the cost of MFH living arrangements for veterans otherwise 
eligible for nursing home care through the VA. Instead, these veterans 
must pay for MFH services out of pocket or through private insurance. 
Costs associated with MFH services range between $1500 - $3000 a month, 
which is significantly lower than the nearly $7,000 VA would otherwise 
pay per patient at a state VA nursing home.
    In my home state of Louisiana, the VA operates state of the art 
Veterans Homes that provide residents a high quality of care in an 
understanding, supportive environment. I can personally attest to the 
high quality of care and sense of well-being among veterans living at 
the Southwest Louisiana Veterans Home. But much like in the civilian 
world, there is no one-size-fits-all standard of care for veterans. 
Veterans should be afforded flexibility to use the benefits they 
righteously earned in a manner that best suits their individual needs.
    HR 1527 gives much needed choice and personal agency back to these 
brave men and women who have selflessly sacrificed for our nation. I am 
pleased that this critical legislation will be considered tomorrow in 
Committee. Thank you.

                                 
                    Prepared Statement of Lee Zeldin
    "Thank you Mr. Chairman, and Ranking Member as well, for the 
opportunity to testify today.
    "With September marking Suicide Prevention Month, I would like to 
take this opportunity to testify on behalf of a program that has saved 
the lives of countless New Yorkers who put their lives on the line to 
defend the rest of us.
    "I have the distinct honor of representing New York's First 
Congressional District, located on the east end of Long Island, 
otherwise known as the greatest Congressional District in America.
    "Not only do we have the most beautiful beaches in the country and 
so much more, but the very communities we all call home played such an 
instrumental role in the founding of our great nation.
    "Today, my home County of Suffolk, boasting one of the highest 
concentrations of veterans in the country, prides ourselves on our rich 
history and commitment to serving our nation's veterans.
    "Unfortunately, when our veterans return home from the battlefield 
too many find that the fight has just begun.
    "The Department of Veterans Affairs, as this Committee knows well, 
estimates that approximately 20 veterans a day take their own life, 
oftentimes they're plagued with the invisible wounds of war we have 
come to know as Post Traumatic Stress Disorder (PTSD) and Traumatic 
Brain Injury (TBI).
    "One of those servicemen who was suffering was PFC Joseph Dwyer, an 
Iraq War veteran from Mount Sinai. His picture is behind me. As an Army 
Combat Medic, PFC Dwyer became the face of the Iraq War in 2003 when a 
photo of him carrying an injured Iraqi child to safety went viral 
worldwide."Unfortunately, when he came back home to Long Island, he 
returned with the mental wounds of war, and, after years of struggling, 
he lost his battle with PTSD in 2008.
    "It is important to note that Joe didn't commit suicide. He was 
seeking temporary relief from his pain and his last words were, `I 
don't want to die.'"Understanding that PFC Dwyer was just one of the 
many local veterans struggling, I created the PFC Joseph P. Dwyer 
Veteran Peer Support Program as a NY State Senator in 2012. The Dwyer 
program is modeled as a peer-to-peer support program for veterans 
suffering from PTSD and TBI. This model provides a safe, confidential, 
and educational platform where all veterans are welcome to meet with 
other veterans in support of each other's successful transition to 
post-service life and seeks to build vet- to-vet relationships that 
enhance positive change. This program also incorporates a variety of 
therapeutic activities such as horse training and fishing that provide 
for common experiences, learning and personal growth.
    "My home county - Suffolk County - served as one of four test 
counties in New York, and since then, with the love and hard work of so 
many exceptional men and women locally, the program has successfully 
expanded to over 20 counties across New York, saving lives and 
assisting tens of thousands of New York veterans battling PTSD and TBI. 
This year, on top of fully funding the program, the New York State 
budget actually increased funding to this successful program."The way 
the program is organized - providing grants to localities - has allowed 
each county to customize their individual program to their needs and 
the resources they have available while running an efficient and 
effective program. Counties only receive $100,000 - $300,000 each from 
New York state and what they do with it is incredible.
    "There are a lot of people who come to Congress and they'll propose 
a program and the numbers they'll throw around are seven, eight, nine 
figures to solve this problem. What we're finding in our home County of 
Suffolk and what has now been expanded all across the State of New 
York, with just $100,000-$300,000, we are saving countless lives in our 
home county and across the state.
    "It's continued track record of success is why I introduced H.R. 
1749, the PFC Joseph P. Dwyer Peer Support Program Act to authorize the 
Secretary of Veterans Affairs to make grants to state and local 
entities to carry out peer-to-peer mental health programs all across 
our nation and help ensure all of our nation's veterans have access to 
the support they need. I challenge and plead with my colleagues on this 
great bipartisan Committee to accomplish what is now possible: 
efficiently ensuring that every veteran in America has access to a peer 
to peer support model that works to save their lives, their families, 
their jobs, and so much more.
    "This bill is cosponsored by 21 of our colleagues, including 
Committee members Kathleen Rice, Chris Pappas, Greg Steube and Elaine 
Luria. I would encourage you to speak to Congresswoman Rice. One of the 
counties is her home county of Nassau County where her home county is 
doing a great job of implementing this program.
    "PFC Dwyer is just one of the many veterans who have suffered from 
PTSD or TBI, and more must be done when they return home.
    We must ensure these brave servicemembers have every resource they 
need to transition back into civilian life and the PFC Joseph Dwyer 
Peer Support Program is an integral part of our veterans' success.
    "Again, I thank the Chair and Ranking Member for giving me the 
opportunity to testify today, and I ask you to please consider this 
legislation.
    "I yield back."

                                 
                   Prepared Statement of Bill Johnson

    HVAC Member Day Hearing Statement on TMS

    Thank you Chairman Takano and Ranking Member Roe for this 
opportunity to share with you my support for the House Veterans' 
Affairs Committee examining the effectiveness of a noninvasive 
procedure called Transcranial Magnetic Stimulation (TMS) as a treatment 
option for veterans suffering from PTSD and TBI. We are all aware of 
the tragic, increased risk for veterans - suffering from PTSD and TBI - 
of dying from accidental injury, viral hepatitis and suicide, compared 
to the general population. And, I am pleased to share with you efforts 
underway in Ohio to provide TMS as an additional, alternative treatment 
for these veterans.
    As you may know, TMS treatments are approved by the U.S. Food and 
Drug Administration to treat depression. TMS therapy is conducted by 
noninvasive procedures through which an electromagnet is charged with 
electricity and then placed over specific points on a patient's skull, 
creating a powerful magnetic field that can positively affect brain 
cells. It does not involve surgery or require the use of sedation or 
other medications. However, there is growing evidence that, in addition 
to treating symptoms of depression, TMS can also help veterans 
suffering from PTSD.
    You may be interested to learn that through the leadership of Ohio 
State Senator and retired Navy SEAL, Frank Hoagland, the state of Ohio 
has recently authorized a Transcranial Magnetic Stimulation Fund 
through the State Treasury, and a pilot program to be conducted by the 
Directors of Veterans Services, Mental Health and Addiction Services 
and AMVETS. In coordination with the Veteran's Medical Initiative (VMI) 
and industry leaders in medical technology, the three-year program will 
make TMS available for veterans with substance use disorders or mental 
illness. I'm very pleased to see Ohio taking action to provide our 
veterans with new and innovative individualized care and treatment 
options.
    Additionally, you may know that the VA Center for Compassionate 
Care Innovation (CCI) has supported the expanded use of TMS treatment 
at the Providence VA Medical Center in Rhode Island, including for 
PTSD. As of June 2018, it was reported that over 150 patients have 
received TMS therapy since 2013 at the Providence VAMC and demand 
continues to increase.
    Ranking Member Roe, given your leadership and advocacy for veterans 
suffering from invisible wounds, I am greatly interested in your 
thoughts on this type of treatment. And, Mr. Chairman, given the 
potential of this type of treatment to manage symptoms of substance use 
disorders and mental illness, I respectfully urge the Committee to hold 
a hearing to examine whether TMS is a viable, alternative treatment 
option for veterans suffering from PTSD and TBI, in addition to 
depression. Since some VA Medical facilities have already treated 
veterans through TMS therapy, perhaps the VA could share with the 
Committee the effectiveness of this treatment, in addition to whether 
VA plans to expand this treatment option and what obstacles may be 
preventing other VA facilities from also offering TMS therapy to 
veterans.
    Thank you, again, for the opportunity to share with you the 
potential of noninvasive treatments, such as TMS therapy, and efforts 
being made in Ohio to expand treatment options for our nation's heroes. 
I yield back the balance of my time.

                                 
                  Prepared Statement of Dr. Raul Ruiz
    Thank you, Mr. Chairman.
    I am Dr. Raul Ruiz, and I am honored to represent California's 36th 
district, which includes much of Riverside County in Southern 
California, and I am proud to say includes more than 45,000 veterans.
    It was an honor to have served on the Veterans' Affairs Committee, 
and it is great to be back.
    I'm here today to talk about one of the most pressing health 
threats facing veterans and servicemembers: exposure to burn pits.
    Our military uses burn pits to eliminate waste, including chemicals 
and plastics, creating giant plumes of black smoke containing 
carcinogens and particulate matter.
    For years, the Department of Defense used burn pits in Iraq and 
Afghanistan, even while recognizing that exposure to burn pits may pose 
health risks to our troops.
    Now, veterans all across the country are developing rare and severe 
pulmonary diseases and cancers, despite living healthy lifestyles and 
not having any other risk factors.
    Unfortunately, the VA and the DOD are not working together and are 
not doing everything in their power to give our servicemembers and 
veterans the care they need and the benefits they have earned.
    They claim that the studies on this issue find no direct link 
between exposure to burn pits and long-term, adverse health effects.
    The fact is, the studies that have been done are inconsistent, 
asked the wrong questions, lacked complete information, and are flat-
out insufficient to make a determination.
    We have to evaluate available case studies to demonstrate a clear 
pattern and raise suspicions.
    Many veterans exposed to burn pits emitting known carcinogens have 
developed rare auto-immune diseases, like constrictive bronchiolitis 
and rare cancers, with no other risk factors - indicating a possible 
causal link.
    As a public health expert, I know that when we have a high enough 
suspicion with a severe enough illness, we must act, and act with 
urgency.
    We can't wait 10 years for the multi-cohort longitudinal 
prospective studies to decide whether or not to act.
    We need to put our veterans above bureaucracy.
    We can start with these three things:

    First, stop our troops' exposure to these carcinogens out in the 
battlefield.
    Second, conduct public health education outreach to doctors so they 
understand the illnesses our veterans are facing and can make effective 
treatment recommendations.
    As part of that, we also need to reach out to veterans who have 
been exposed and train them to recognize subtle changes in their 
health, so they can get the appropriate medical care before their 
condition worsens.
    Third, we need to make sure that our veterans get medical treatment 
quickly, that it's covered by the VA, and that they receive the 
benefits their families rely on.
    This Committee plays a crucial role.
    I want to thank Chairman Takano and Ranking Member Roe for 
supporting the House passage of H.R. 1381, the Burn Pit Registry 
Enhancement Act, which I introduced with Senator Tom Udall.
    This bill will allow a veteran's designee to update their burn pits 
registry entry to reflect their cause of death.
    This data will be crucial to medical research evaluating the 
effects of burn pit exposure, which can save the lives of other exposed 
veterans.
    I call on the Senate to pass this bill to ensure the tragic loss of 
hundreds of veterans across our nation are properly counted in the burn 
pits registry.
    Our work is not over. There are more steps we can take immediately.
    First, I have started a bipartisan Congressional Burn Pits Caucus 
with Congressman Brad Wenstrup, and I invite everyone on this dais to 
join the caucus so we can get the answers our veterans deserve.
    Second, we must have hearings in this Committee to ask the VA these 
tough questions, such as why so many crucial details were left out of 
the studies, rendering them largely ineffective.
    Third, there is bipartisan legislation we can act on now to start 
addressing this issue, like my bill H.R. 4137, the Jennifer Kepner HOPE 
Act, a bill to provide quality, affordable health care for all exposed 
veterans.
    I will also soon be introducing the Veterans Right to Breathe Act, 
which will make pulmonary illnesses presumptive. This bill will allow 
veterans to receive the disability compensation benefits they have 
earned and deserve.
    I look forward to working with all of you to tackle this emerging 
health crisis for our veterans.
    Thank you again for allowing me to testify before the Veterans' 
Affairs Committee.

                                 
                  Prepared Statement of Lloyd Smucker
    Chairman Takano, Ranking Member Roe, and Members of the House 
Committee on Veterans' Affairs, thank you for the opportunity to 
testify before you today.First let me thank you for your hard work and 
dedication to improving the lives of our veterans and their families. 
Our servicemen and women have endured tremendous hardships and made 
significant sacrifices in their fight to preserve the freedom that we 
all enjoy today. Thanks to their courageous service, our veterans have 
earned and deserve the highest quality care we can provide.
    Which brings me to why I've come before you today. Earlier this 
spring I reintroduced the VA Billing Accountability Act and today I 
would like to urge consideration of this bipartisan legislation.
    My bill is fairly straight forward. It provides certainty in the 
way the VA bills our veterans by requiring the VA to deliver a bill for 
payment no later than 180 days after they received care at a VA 
facility. Non-VA facilities must also increase their coordination with 
the Department to ensure that co-payment bills are delivered no later 
than 18 months after a veteran receives care from an outside provider. 
Importantly, this bipartisan legislation also increases transparency 
for veterans by requiring the VA to notify veterans on how they can 
receive a waiver or establish a payment plan before the VA can collect 
any delayed co-payment.
    Why is this necessary? The Veterans Affairs Office of Inspector 
General reported that in Fiscal Year 2015, of roughly 15.4 million 
bills the Veterans Health Administration issued during 2015, 
approximately 1.7 million of those were improper bills for the 
treatment of service-connected conditions. In some cases, veterans 
received bills a full five years following their care. To help put this 
into perspective, the Veterans Health Administration collected a 
staggering $13.9 million from our nation's veterans inappropriately.
    This is simply unacceptable.
    We should make it easier, not harder, for our retired servicemen 
and women to transition to post-military life by not saddling them with 
bills for VA services from years past. Many veterans live on fixed 
incomes and do not have the resources to cover unexpected costs caused 
by the mistakes of VA bureaucrats. my legislation provides commonsense 
reforms to the VA by setting forth specific and immediate billing 
requirements so veterans receive timely VA bills that they can count 
on.
    Thank you again for the opportunity to testify before the Committee 
today, and for all the work that the members of this Committee do to 
ensure quality and affordable care for our nation's veterans.
    I yield back.

                                 
                  Prepared Statement of Joaquin Castro

    REMARKS

    Good morning Chairman Takano and Ranking Member Roe. Thank you for 
inviting each of us here today for this opportunity to highlight the 
important work that we are doing on behalf of our veterans community. I 
would like to take my time to help shed light on the health effects 
that have resulted from our men and women in uniform being exposed to 
burn pits while deployed on our nation's behalf.
    My district includes San Antonio, Texas - a city with a significant 
active duty and veteran population. In fact, San Antonio is also known 
as Military City USA. It is from this veteran's population that I have 
heard the firsthand stories of those veterans effected by burn pit 
exposure. Brave servicemen and women have shared the challenges that 
they have endured as a result their exposure to toxic fumes emanating 
from the burn pits.
    These veterans and their families have endured significant medical 
issues and the emotional and financial pressures that accompany those 
conditions. I have seen that these veterans are just a sample of a 
broader population of veterans exposed to burn pits throughout 
Afghanistan, Iraq. Numerous military bases in the Operations Iraqi 
Freedom and Enduring Freedom theatres of operation produced several 
tons to several hundred tons of solid waste per day.
    The Department of Defense has reported that burn pits in both Iraq 
and Afghanistan totaled over two hundred. Open-air burn pits were the 
primary waste disposal method during the majority of the duration of 
these wars. Air sampling data indicate that smoke from these burn pits 
contained chemicals associated with respiratory and lung conditions.
    Our servicemen and women's exposure to this toxicity is undeniable, 
and the level of toxicity cannot be questioned. It is clear that the 
use of burn pits posed significant health risks to our military 
personnel serving in those countries for the first decade of conflict. 
We can't afford to cast a blind eye to the level of exposure, and 
number of servicemen that are impacted, if we say as elected officials 
we are going to take care of our veterans.
    We cannot allow this toxic exposure to become the Agent Orange of 
our generation, which left servicemembers fighting for recognition and 
benefits for decades. This issue is bipartisan and impacts veterans of 
every creed and color, regardless of party affiliation. All of us here 
in Congress need to understand that.
    I have made the issue of burn pits central to my veteran's 
advocacy. Last year, I led a bipartisan letter to this Committee 
requesting a hearing on the use of burn pits and associated health 
effects. Earlier this year, I led a letter for the establishment of a 
congressionally directed medical research program that was focused 
specifically on the Burn Pit issue. I've also hosted town hall events 
on the issue in several Texas cities. However, today I would like to 
highlight the legislation I introduced this Congress that will help 
these veterans and their families.

    Family Member Access to Burn Pits Registry (H.R. 1001)

    Earlier this year, I reintroduced Family Member Access to Burn Pit 
Registry Act (H.R. 1001). Nearly 150,000 veterans and servicemembers 
have participated in the burn pit registry to document their health 
issues. These include lung diseases and cancers, which they believe 
originate from their exposure to the noxious fumes of burn pits.
    However, when an eligible veteran passes away before participating 
in the registry, the VA currently prohibits a family member of the 
deceased veteran from participating in the registry on the veteran's 
behalf.
    This bill would allow a family member to participate in the burn 
pit registry on behalf of a deceased veteran or servicemember - 
allowing them to document the experience of a loved one in the burn pit 
registry. This will enhance the pool of shared experiences that the 
government can use to analyze the real effects of long-term exposure to 
burn pits. Additionally, this change in VA policy will not incur any 
additional cost. It is a common sense fix to help bolster the VA Burn 
Pit Registry.

    Burn Pits Veterans Revision Act (H.R. 1005)

    I also introduced the Burn Pits Veterans Revision Act (H.R. 1005). 
This bill will require the Secretary of Veterans Affairs to amend the 
ratings disabilities to add a diagnostic code and evaluation criteria 
for obliterative bronchitis. This is an illness we know is a direct 
result of exposure to burn pits. In fact, The U.S. Social Security 
Administration has added the disease obliterative bronchiolitis after 
medical research causally related the disease to environmental toxins, 
including burn pits, in Iraq and Afghanistan. However, The Department 
of Veterans Affairs has not formally recognized obliterative 
bronchiolitis.
    The VA uses specific four-digit diagnostic codes that allow for 
accuracy in diagnosis and rating evaluations. This is a specificity 
that's largely been missing - resulting inconsistent and inaccurate 
ratings. Similar to my other legislation this bill will not cost any 
additional money because this condition is already being rated as other 
- similar - conditions. Consistent and accurate ratings will likely cut 
down on cost, lower the number of appeals, and ensure that veterans 
receive the care they need. These bills are each narrowly focused and 
effective ways to serve those who have served us.
    It's critical that we keep pushing hard to raise awareness around 
this issue, not just on Capitol Hill, but around the country. We need 
to encourage veterans to come forward and register with The Department 
of Veterans Affairs Airborne Hazards and Open Burn Pit Registry so that 
we can continue to fully understand the long-term health effects of 
burn pits exposure. As scientific evidence continues to surface, it's 
vital that we act on what we can in terms of counteracting the effects 
of these harmful burn pits and the ensuing health conditions. It is 
Congress' responsibility to ensure that we're providing servicemembers 
and veterans with the care they need on this matter and so many others.
    I would like to thank you Chairman Takano and Ranking Member Roe as 
well as everyone here today for working with and advocating for our men 
and women in uniform. There's nothing more important than protecting 
those who sacrifice their lives to protect us.

                                 
                  Prepared Statement of John R. Carter
    Chairman Takano, Ranking Member Roe, and colleagues, I appreciate 
the opportunity to speak to you today. As both the proud representative 
of the largest population of veterans in Texas and Ranking Member of 
the MilCon/VA Appropriations SubCommittee, I'm committed to putting the 
needs of our veterans FIRST!
    I authored the Veterans' Transplant Coverage Act which was added to 
the VA MISSION Act. I appreciate the Committee's support on this 
critical bill which requires the VA provide organ transplants to 
veterans from a live donor, regardless of whether that donor is a 
veteran. It's a common-sense approach to improving health care for our 
veterans. As the VA works to implement the MISSION Act, it is essential 
that both the letter and spirit of the Veterans Transplant Coverage Act 
is followed. Our veterans deserve to receive the health care they need 
without wading through bureaucratic red tape!
    Meeting veteran population needs within the new standards of the 
MISSION Act remains a priority for me. Following a letter from Rep. 
Roger Williams and myself, the VA announced the opening of two clinics, 
one in Killeen and the other in nearby Copperas Cove. While I am 
excited about the opportunity for more veterans to receive the 
treatment they've earned, I know that other areas of the nation with 
large veteran populations aren't as lucky. I urge the Committee to 
prioritize efforts to ensure veterans across the US have access to top-
quality care.
    Long-overdue implementation of VA Electronic Health Records remains 
challenging. The costs have been enormous and the technological hurdles 
are significant. While I am pleased that millions of records have been 
transferred, I am closely monitoring this issue. I strongly urge the 
Committee continue keeping the needs of veterans first in mind as it 
continues its important oversight of Health Records policies.
    Homelessness among our veterans, both men and women, is a national 
tragedy. While the VA Appropriations bill provides $1.8 billion for VA 
homeless assistance programs, the challenges of this issue are 
formidable. I encourage the Committee to continue looking for 
innovative ways to address this issue while identifying areas where 
existing programs fall short.
    Getting a handle on the short- and long-term impacts of burn pits 
must be a priority for both the VA and the Department of Defense. As 
you know, appropriators provided $5 million for a Center of Excellence 
devoted to this troubling issue. I strongly encourage authorizers to 
continue focusing their efforts on burn pits as we work in a bipartisan 
manner to take care of those who sacrifice to preserve our freedoms.
    Again, I appreciate the chance to express my priorities here today. 
I look forward to working with you to address the needs of our 
veterans.

                                 
                  Prepared Statement of J. French Hill
    Chairman Takano, Ranking Member Roe, and Members of the Committee:
    Chairman, it was a pleasure to host you in my district this past 
week and I hope you were able to learn a lot about some of the things 
going on in Arkansas.
    I appreciate the opportunity to testify in front of you today in 
support of expanded resources into homeless assistance programs and 
suicide prevention outreach by the U.S. Department of Veterans Affairs 
(VA).
    It is especially fitting to discuss this critical topic here today 
during Suicide Prevention Month.
    According to the U.S. Department of Housing and Urban Development 
(HUD), approximately 40,000 veterans are homeless on any given night.
    In Arkansas, we have coordinated robust efforts in Little Rock to 
combat homelessness, but over 250 veterans still experience 
homelessness on any given day.
    I've got three veterans on my constituent team and they spend time 
in our shelters really helping our vets. They deserve that extra touch 
and many of them are lost in the morass of not only homelessness, but 
also in search for and understanding of veteran programs that might be 
of help.
    My district is home to many of our brave veterans and 
servicemembers at Little Rock Air Force Base and Camp Robinson, and I 
have heard concerns from a number of our veterans about the difficulty 
in finding a home for not only themselves, but their families as well.
    One current bill dealing with this issue is Ms. Brownley's Homeless 
Veterans Family Act (H.R. 95).
    As I'm sure you know, the VA's Homeless Providers Grant and Per 
Diem Program funds community housing agencies that provide services to 
homeless veterans.Currently, the VA does not have the authority to 
provide the reimbursements for the costs of services for minor children 
of homeless veterans, limiting housing for veterans with young 
children.
    This bill would allow the VA to reimburse providers for 50 percent 
of the costs of housing minor dependents of homeless veterans.
    Ms. Brownley's bill is an example of how we must all work together 
and continue to move forward addressing this issue that plagues too 
many of our veterans and help all those suffering from homelessness.
    They put their lives on the line to protect our freedoms and 
safety, and in return it is our duty to do everything we can to ensure 
they get the proper attention and care they deserve.
    For this reason, I respectfully request that you consider H.R. 95 
and other legislation to address this critical issue that consumes the 
lives of too many of our veterans and their families.
    Thank you, and I appreciate your consideration.

                                 
                  Prepared Statement of James R. Baird

             H.R. -------- the "VA Safe Opioid Return Act"

    Opening Statement:

    Chairman Takano, Ranking Member Roe, Members of the Committee, I 
want to start by thanking you for the opportunity to come before you 
today. As a decorated Vietnam War veteran, I care very deeply about 
this country, and ensuring the veterans of our armed forces are taken 
care of and have the opportunities and benefits they deserve. The 
important work that this Committee has done in the past, and that it 
continues to do, is essential in keeping our promise to our men and 
women in uniform as they transition back into civilian life.
    I'm here today to highlight a piece of legislation I have authored 
called the "VA Safe Opioid Return Act." This legislation is simple and 
common sense. My bill directs the Secretary of the Veterans 
Administration to ensure that certain Department of Veteran's Affairs 
medical centers have physical locations for the disposal of controlled 
substance medications, namely opioids. Any VA medical facility with an 
on-site pharmacy or a law enforcement officer present to monitor the 
disposal location, will be charged with having a physical location for 
veterans to dispose of unwanted or overprescribed medications.
    The inspiration for this bill came from the great success seen at 
the Roudebush VA Hospital in my home state of Indiana. Treating nearly 
62,000 Hoosier veterans annually, the Roudebush VA decided to implement 
an opioid return receptacle in their facility after noticing a low 
number of participants in their opioid mail back program, and having 
patients bring their unused medications to the ER or to their 
appointments.
    The Roudebush VA set out to put in a DEA-compliant receptacle for 
just over $1,000 dollars and bought 12 safe and secure liners for 
another $2,000. Staff from the engineering service installed the 
receptacle for no cost. Once in place, the receptacle was anchored to 
the floor, monitored under video surveillance, and placed away from the 
emergency department entrance (a DEA requirement). Emails were sent to 
staff to provide education, and descriptive data was collected from the 
time of implementation.
    After opening to the public in May 2016, the Roudebush VA saw a 
drastic increase in the amount of unused or unwanted medication it was 
collecting. From May to October of that year, the facility collected 
452lb's of medication, and an additional 30lb's of drugs were mailed 
back through the mail back envelope program. In just this 6-month 
period, this large amount of medication was safely returned to the 
reverse distributor or destroyed, ensuring that this potentially 
addictive medication found its way off the streets and away from the 
general public. This is why we need this bill.
    This model applied across the VA system to all VA medical 
facilities with pharmacies or on-site law enforcement personnel will go 
a long way toward getting these medications off the streets. With more 
than 50% of veterans suffering from chronic pain, and half of those 
receiving at least one prescription for opioids, it is imperative that 
we give our veterans an easy, anonymous, and continually available way 
to dispose of their medications once they no longer need them.
    This bill has yet to be introduced but has already garnered large 
support from both sides of the aisle with over 29 original co-sponsors. 
I urge the Committee to consider this legislation for markup and 
believe that it can be passed through the House on suspension.
    I want to thank you again for the opportunity to come before the 
Committee today to address this important piece of legislation, and I 
look forward to hearing any questions or feedback that you may have. 
Thank you.

                                 
                  Prepared Statement of Ann M. Kuster

          "Ending Veteran suicide and military sexual assault"

      Thank you Chairman Takano and Ranking Member Roe for 
holding this important hearing today. As a former Member of the House 
Veterans Affairs Committee, it's nice to be back with my colleagues on 
the Committee who continue to do amazing work on behalf of our nation's 
veterans.
      I appreciate the opportunity to speak about important 
issues our servicemembers and veterans face.
      During the August district work period, I had the 
opportunity to convene a moving discussion with local stakeholders and 
military families who have lost a loved one to suicide. And over the 
past year, I've held numerous roundtable events in my district to hear 
from veterans who have experienced military sexual trauma (MST).
      Today's hearing presents an important opportunity for 
this Committee to build off what we learned and address specific 
legislative proposals that will take care of our veterans and enhance 
the access to quality care.
      My constituents in New Hampshire are aware of these 
crises, and we are all too familiar that approximately 20 veterans and 
1-2 servicemembers die by suicide every day.
      Sexual assault rates for women have been at it's highest 
since 2006 and how the VA handles their claims needs to be approached 
as we've learned recently the VA had mismanaged claims related to 
survivors of MST.
      In 2017 alone, the Veterans Benefits Administration 
rejected about 5,500 military sexual trauma claims. The IG report found 
that of the cases they sampled, 49 percent were missing follow-up 
interviews, new medical examinations or other significant procedural 
work.
      It is important to note the high percentage of women are 
at greater risk of MST, but nearly 40% of veterans who disclose MST to 
VA are men.
      As the Committee continues to advance legislation this 
Congress, I hope you will consider some of the following bipartisan 
proposals.
      I am a proud cosponsor of the Paws Act of 2019 that 
allocates a grant program to private entities for service dogs that 
will help veterans who are struggling with invisible wounds. The 
companionship of these service animals can make an enormous difference 
in the lives of veterans.
      I also helped my good friend Rep. Jackie Walorski 
introduce legislation earlier this year to expand eligibility for MST 
survivors.
      The VA provides counseling, health care services, and 
other treatment to veterans who experienced MST. However, many 
survivors must travel long distances to receive treatment but are 
unable to obtain travel benefits to access the care they need.
      Rep. Walorski's bill would allow veterans to be 
reimbursed for travel outside their Veterans Integrated Service Network 
(VISN) when seeking treatment related to MST.
      Congress has a job to ensure veterans and servicemembers 
have access to comprehensive mental health. We may see this as a mental 
health issue but we also have to acknowledge veterans are coming home 
to a different world.
      We must help veterans connect with their community, 
engage with their passion, and find a new purpose to help mitigate 
suicidal ideation and learn ways to cope with trauma.
      The VA has not released data relating to veterans dying 
by suicide since 2016. This data is critical to solving this epidemic, 
and I urge this Committee to request this data from the VA.
      I was so proud of the bipartisan work we did on this 
Committee while I was a Member during my first six years in Congress. 
By putting politics aside and focusing on improving the lives of 
Veterans, this is the most bipartisan Committee on Capitol Hill and I 
am so pleased to be with you today.
      By working together and advancing bipartisan legislation, 
we can collectively fix the heartbreaking problems of military sexual 
trauma and veterans suicide.

                                 
                    Prepared Statement of Ross Spano
    Introduction:

    Thank you, Chairman Takano, Ranking Member Roe, and the other 
Committee members for hosting this Member Day Hearing. The District I 
serve, Florida's 15th Congressional District, is estimated to have over 
55 thousand veteran residents. We are in close proximity to MacDill Air 
Force Base, and many servicemembers who are stationed there end up 
retiring in District 15.

    Priority:

    The region is served by the James A. Haley Veterans' Hospital 
located in Tampa. One of the biggest priorities for the facility is the 
opening of the new Lakeland VA Outpatient Clinic. This clinic would be 
a tremendous help for Central Florida veterans that live further from 
James A. Haley Hospital.
    I appreciate the Committee's recognition of the importance of a 
Lakeland Outpatient Clinic to improve care for my constituents. S. 114, 
the VA Choice and Quality Employment Act of 2017, authorized nearly 11 
million dollars for the facility. That legislation was signed into law 
in August 2017.
    However, I am discouraged by the amount of time it is taking for 
the project to make its way through the various agencies' approval 
processes. I recently received an update from the Office of Management 
and Budget that they anticipate completing their approval of the lease 
in the next few weeks, at which point it will be transmitted to GSA for 
their approval.
    Under this timeline, I have been told the lease award is planned 
for March 2021 and the facility would open in March 2024.
    I would appreciate any help the Committee can provide in pushing 
the Agencies involved in approving these leases to expedite the process 
so that the facilities that were improved in 2017 can begin serving our 
veterans sooner than 2024.
    Closing:

    While there are many other priorities I would like to work with you 
on to improve the care and services available to our nation's veterans, 
the expedited opening of the Lakeland Outpatient Clinic is my top 
priority. I appreciate you allowing me to appear before the Committee 
today and would welcome any questions you have.

                                 
                Prepared Statement of Robert J. Wittman
    Introduction:

    Chairman Takano, Ranking Member Roe, and distinguished members of 
the Committee, it is an honor and a privilege to testify in support of 
over 18 million veterans across the United States; 750,000 of which 
call Virginia home.
    I represent the First District of Virginia, which Fort A.P. Hill, 
Marine Corps Base Quantico, and Naval Support Facility Dahlgren call 
home. Additionally, constituents in my district support the mission at 
several installations in the National Capital Region and throughout 
Virginia and Maryland.
    As a member from a district so full of men and women who have made 
incredible sacrifices for our nation, I have had the distinct pleasure 
to serve on their behalf. As such, I have been and will continue to be 
committed to our military and our veterans during my time in Congress.

    Theme 1: Veteran Priorities

    I routinely hear from the veterans community in my district by 
regularly convening a Veterans Advisory Council, engaging with veterans 
that I meet with and who call into my office and hosting several 
Veterans Forums throughout the year-one of which Ranking Member Roe was 
kind enough to attend last year. In short, these platforms allow me to 
hear directly from veteran constituents who have first-hand knowledge 
of the issues they face.
    Through their feedback, I have outlined the following areas as my 
priorities for veterans:

    - Increasing efficiencies in the Department of Veterans Affairs.
    - Expanding veterans' access to medical care.
    - Increasing collaboration to provide more services to veterans; 
and
    - Combating veteran's homelessness.

    Theme 2: Commend the Committee of their Work

    In addition, I would like to commend this Committee for the work 
they have done to support veterans. Over the past few years, your work 
has increased veterans' access to medical care and ensured we as a 
nation continue to keep our promise to take care of those who protect 
our freedom. And, while our system is far from perfect, this Committee 
continues to strive to seek out and eliminate the hurdles that burden 
our veterans.
    Among this work, I would like to highlight the Mission Act. Signed 
into law last year and took effect this June, this legislation expanded 
the VA Choice Program by increasing outside medical options, 
establishing a permanent community care program for veterans, and 
modifying how the VA utilizes private medical providers.
    Additionally, this Committee helped pass the Blue Water Navy 
Vietnam Veterans Act of 2019. Signed into law this past June, this 
legislation brought an end to a six-decade long struggle to provide 
benefits to approximately 52,000 "Blue Water" veterans who were exposed 
to Agent Orange during the Vietnam War.

    Theme 3: Your Veterans Legislation

    The work we do for our veterans, however is never done. To this end 
I would like to highlight two bills I have introduced that would 
further help our veterans:

    H.R.1577 - VA Procurement Efficiency and Transparency Act: This 
bill requires the VA to track cost savings resulting from its 
contracting competitions and to use standardized contracting 
procedures, ensuring dollars meant to support veterans aren't wasted 
because of bureaucratic inefficiencies.

    Ultimately, this bill would improve procurement within the VA by 
putting in place consistent parameters for the VA to measure its cost 
savings from competition while encouraging the VA to organize its 
templates for key procurement documents and share them across the 
organization. This legislation will work to reform these archaic 
procurement rules through a commonsense procurement and transparency 
fix.
    H.R. 2886 - Veterans Affairs Transfer of Information and sharing of 
Disability Examination Procedures with DOD Doctors Act: This bill 
speeds up access to care for veterans by not subjecting them to another 
round of medical screenings before a disability rating is issued. 
Additionally, this bill further requires the Departments of Veterans 
Affairs and Defense to share medical and service record data 
electronically.
    We have made great strides recently in improving the VA's level of 
care for our Veterans, but we have more work to do. My hope is that 
these bills can be part of that ongoing effort.

    Conclusion:

    I want to thank Chairman Takano, Ranking Member Roe, and the 
distinguished members of the Committee for this opportunity to testify 
here today.I have long believed that the benefits afforded our men and 
women in uniform have been earned through sacrifice and hardship, and 
that those benefits should be protected. I look forward to continuing 
to work with the Committee to ensure our veterans have the resources 
they need and the benefits they have earned defending our freedom. We, 
as a nation, owe our veterans a debt that can truly never be repaid. 
Thank you.

                                 
                    Prepared Statement of Jim Costa
      I want to begin by thanking the Chairman and Ranking 
Member for allowing me to come before the Veterans' Affairs Committee 
to advocate on behalf of some of my constituents.
      During the Vietnam War, the CIA covertly trained Hmong 
men and women in Laos and led them into combat in support of U.S. 
Forces.
      These indigenous forces, fighting shoulder to shoulder 
with U.S. soldiers, conducted direct missions against the Communist 
forces and their North Vietnamese supporters. Hmong soldiers saved 
countless American lives, and over the course of the war, more than 
100,000 Hmong made the ultimate sacrifice.
      Since the end of the Vietnam War, thousands of Hmong and 
Lao families have resettled around the United States to become legal 
permanent residents or United States citizens and have greatly 
contributed to American society.
      From California to North Carolina and Minnesota to Rhode 
Island, these brave individuals and their families have made our 
country stronger and more prosperous.
      Of the Hmong who became U.S. citizens, approximately 
5,000 veterans are still with us today, and they deserve the choice to 
be buried in national cemeteries.
      That is why I introduced the Special Guerrilla Unit 
Veterans Service Recognition Expansion Act.
      This legislation would authorize the interment in 
national cemeteries of ALL Hmong and Lao veterans who served in support 
of U.S. Forces in the Vietnam War. Given the dedicated service to our 
nation of these U.S. citizens, we believe this is an appropriate honor.
      I believe the Hmong deserve this honor, and through their 
service to the United States, they have earned it.
      Mr. Chairman and Ranking Member, I encourage all my 
colleagues to support this legislation to honor the Hmong for their 
service.

                       Statements for the Record

                              ----------                              

                              Jahana Hayes
    Chairman Takano, Ranking Member Roe, thank you for the opportunity 
to testimony before the Committee today. Veterans' affairs are 
extremely important to both me and my constituents, and I appreciate 
the opportunity to be able to outline my priorities for you.
    Even before being elected to Congress, doing right by the veterans 
that have served our country, and their families, has been a priority 
for me. Connecticut's 5th District is home to so many of those brave 
men and women - I am grateful for their service and in awe of the 
sacrifices made by them and their families. But too often we fail these 
heroes by not providing the services they need when they return home. 
When our veterans cannot access quality healthcare, find a steady 
paying job, or a place to live - we have failed. We can, and must, do 
better. That is why the work of this Committee is so vitally important. 
Through this Committee and the leadership of Chairman Takano, Congress 
is making sure that soldiers exposed to Agent Orange or burn pits get 
necessary treatment, that vets utilizing the GI bill are not taken 
advantage of by predatory for-profit colleges, and that any veteran 
struggling with mental health issues is able to access suicide 
prevention resources, to name a few.
    Today, I would like to use this opportunity to review some of my 
legislative priorities that fall within the Committee's jurisdiction.
    As a teacher, I would like to start with education! Upon returning 
from service many veterans utilize the GI Bill to help fund their 
education. Unfortunately, veterans are often targeted by predatory for- 
profit institutions who seek to benefit from their enrollment. One way 
they do this is by exploiting the 90/10 Rule. The 90/10 Rule is a 
provision in the Higher Education Act (HEA) that prohibits for-profit 
institutions from receiving more than 90 percent of their revenue from 
Federal student aid. This includes such things as Pell grants and loans 
but does not include GI Bill benefits or other military tuition 
assistance. So, these institutions can receive 90 percent of their 
revenue from Federal student aid and still access a student veteran's 
GI bill benefits. This practice is dishonest and unfair. This loophole 
should be done away with.
    Another pressing issue facing our veterans is access to health care 
- both physical and mental. Each day 20 veterans, servicemembers, 
reservists, and members of the National Guard take their own life. That 
is 20 too many. I look forward to working with the Committee to address 
the issue of veteran suicide and ensure that no solider is left without 
the resources they need when they return home. Whether it is increased 
funding for medical care or ensuring that suicide prevention hotlines 
are adequately staffed, we owe these heroes this level of investment.
    Part of that care is figuring out new ways to better serve our 
veterans and get them the health care they need. Medicinal marijuana 
has been shown to help patients relieve insomnia, anxiety, pain, and 
even epilepsy. I believe that all patients deserve access to medicinal 
marijuana as a way to treat their chronic pain, PTSD, and other 
conditions. In speaking with veterans across my district, I have also 
learned that medicinal marijuana is particularly helpful for those 
suffering from PTSD. That is why I cosponsored H.R. 712, the VA 
Medicinal Cannabis Research Act of 2019. This bill would allow the VA 
to study the effect of cannabis on health outcomes for adults with 
chronic pain and PTSD.
    We must also ensure that veterans that are exposed to hazardous 
materials like burn pits or Agent Orange are able to obtain the medical 
treatment they need. That is why I was proud to cosponsor and vote for 
your bill, Mr. Chairman, H.R. 299, the Blue Water Navy Vietnam Veterans 
Act.
    When I meet with veterans across my district, one of the issues I 
hear about most is the financial instability many veterans face. There 
are several bills that address this issue and would give veterans the 
compensation and benefits they earned. Congress passed H.R. 1200, the 
Veterans' Compensation Cost-of-Living Adjustment Act of 2019, which 
would give veterans a raise, as well as the Gold Star Family Tax Relief 
Act, which will ensure that the benefits that veterans' families 
receive are not taxed at an unfair rate. Additionally, we must reduce 
unemployment and homelessness among veterans. H.R. 95, the Homeless 
Veteran Families Act, and H.R. 444, the Reduce Unemployment for 
Veterans of All Ages Act of 2019 would both go a long way in helping to 
combat these issues, and I am a proud cosponsor of each of these bills.
    When I visit with Gold Star families across my district, the offset 
between SBP and DIC benefits is one of the most common issues I hear 
about. That is why I worked with this Committee and the Senate 
Veterans' Affairs Committee to introduce the bipartisan Dependency and 
Indemnity Compensation Improvement Act, H.R. 3221. This bill would give 
Gold Star families an additional $300 per month. This allowance would 
bring benefits for surviving military families more in line with 
Federal employees and the DOD's SBP. The death of a servicemember 
should never lead a family to financial hardship, and we owe it to 
these heroes to give their families the full benefits they have earned.
    Finally, one of the areas I am most concerned about is female 
veterans. Currently, 10% of all veterans are female. That number is 
expected to rise by as much as 6.3% in the next 25 years! This is great 
news, however, many of the services offered to our veterans are not 
designed for women and do not adequately meet their needs. We must 
ensure that female veterans are able to get the health care they need, 
including access to an OB/GYN at the VA. But we must also make sure 
they have greater access to legal services. That is why I cosponsored 
H.R. 3189, the Improving Legal Services for Female Veterans Act, which 
would require the VA to partner with an NGO to provide legal services 
to female veterans.
    Later today, my office will meet with the Connecticut Veterans of 
Foreign Wars to discuss what else we in Congress can do to help our 
veterans. They are doing great work on behalf of veterans in my state, 
and I am excited to hear from them.
    Thank you again for this opportunity, Mr. Chairman. This Committee 
has done a lot of great work, and I look forward to continuing to work 
with you on these priorities and appreciate your time.

                                 
                           Adriano Espaillat
    Dear Chairman Takano and Ranking Member Roe,
    Thank you for allowing me the opportunity to submit this testimony 
and share with the Committee on Veterans' Affairs priorities of mine 
and my constituents in New York's 13th Congressional District. Over the 
past several months, including this most recent district work period, 
my staff and I have heard from veterans throughout Manhattan and the 
Bronx that I am privileged to represent.
    As a first order of business, I wish to voice my support for the 
Housing and Urban Development Veterans Affairs Supportive Housing (HUD-
VASH) program. I have long supported increased funding for this vital 
program, administered jointly by the Veterans Administration and Depart 
of Housing and Urban Development, and I want to encourage the Veterans 
Affairs Committee to work to expand eligibility and provision of HUD-
VASH. Many veterans in my district receive their care at the James J. 
Peters VA Medical Center in the Bronx, and several case managers and 
health care providers have told my staff and me that many service-
members they see are homeless and face threats to their health and 
well-being. Furthermore, without a home address, many veterans cannot 
receive their earned benefits, only worsening their plight. The current 
funding of HUD-VASH allows for too few to meet demand. I understand 
that housing exists in a limited market, but a great number of veterans 
who have sought support through the HUD-VASH program desperately need 
this assistance in order to be successful. I respectfully ask that the 
Committee continue to make this and addressing veteran homelessness in 
general a top priority.
    Also, in the discussion of housing, it has come to my attention 
that the VA Home Loan Program (Veterans Benefits Administration) has 
only issued or guaranteed only two home loans in Manhattan and just 21 
in all five boroughs of New York City. This is a tool that is 
underutilized and not widely advertised to veterans, servicemembers, 
and their families. I would ask the Committee to examine this disparity 
and explore a means to broaden the eligibility not just to single or 
multi-family homes, but also co-ops that are found more widely in 
densely populated metropolitan areas such as New York City.
    Finally, many servicemembers and veterans who served on or after 
September 11, 2001 and have returned to civilian life have been 
frustrated that landlords and housing management companies in certain 
instances are not accepting the Basic Allowance for Housing (BAH) 
granted to active and non-active duty individuals enrolled in higher 
education or job-training programs as a proof of income for a new 
lessee. While this is anecdotal and not a uniform standard of 
rejection, I know that even one instance is too many, especially when 
it comes to the benefit and stability that housing provides. Even in 
New York City, where the Commission on Human Rights and Department of 
Veterans' Services have made it abundantly clear that the BAH afforded 
through the Post 9/11 G.I. Bill is comparable to any other, "lawful 
source of income"\1\, I would ask that the Committee continue its 
vigilance and oversight of this issue to make sure that this does not 
become a pervasive trend.
---------------------------------------------------------------------------
    \1\  The New York City Administrative Code Title 8: Civil Rights 
(Sec.  8-102 Definitions.): The term "lawful source of income" includes 
income derived from social security, or any form of federal, state or 
local public assistance or housing assistance including section 8 
vouchers.; Sec.  8-107 Unlawful discriminatory practices
---------------------------------------------------------------------------
    I again thank both Chairman Takano and Ranking Member Roe for the 
opportunity to submit my testimony. Given the breadth of vitally 
important issues before the Committee on Veterans' Affairs, I am 
heartened that you have made a commitment to hear from colleagues who 
serve on other Committees and listen to their concerns. Thank you for 
your consideration and I look forward to working with you to address 
these issues.
    Sincerely, Adriano Espaillat
    Member of Congress

                                 
                           Christopher Smith

  Addressing the Urgent Need to Boost Therapy, Treatments for Veterans

    Thank you, Chairman Takano, for your continued efforts to support 
and improve the health programs available to our nation's veterans.
    Today, I ask the Committee to move H.R. 2435, the Accelerating 
Veterans Recovery Outdoors Act, which I introduced with Representative 
Adam Smith that would establish an interagency task force to increase 
the access to Federal lands for the purposes of veterans' medical 
therapy. This legislation empowers a newly created task force to 
identify barriers veterans face when accessing public lands for 
treatment, and provide recommendations to Congress, within a year, on 
ways to eliminate those barriers.
    Research has increasingly shown that outdoor recreation can be an 
effective form of treatment, rehabilitation, and healing for veterans. 
While many nonprofit organizations, veteran service organizations, and 
private companies have used the outdoors to help heroes heal, providing 
greater coordination among key agencies will provide new opportunities 
on public lands and other outdoor spaces.
    Consider the example of Blake, a combat-wounded veteran who served 
in Iraq. By the time he was 20, Blake suffered several traumatic 
experiences pushed him into depression, anxiety and PTSD. Three VA 
Psychiatric Wards and a substance abuse rehab left him barely clinging 
to hope, but it was a backpacking trip led by the Sierra Club Military 
Outdoors that changed his entire perspective of the tragedy that 
defined him until that point.
    Blake began participating in backpacking trips in Yosemite, Ansel 
Adams, and Big Bend. He says that shared experiences in the outdoors 
taught him "purpose, self-reliance and the healing powers of nature." 
He adds, "For in every Texas sunrise in the desert or a sunset next to 
an alpine lake, I found more beauty and serenity than I thought 
existed. I found camaraderie with my other veterans in sharing our 
stories on the trail. The darkness of what I had experienced couldn't 
compare to the light I saw in watching a trout swim in the Merced River 
with Half Dome looming nearby. And when the depression, anxiety and 
everything else that comes with PTSD creeps back into my life, I know 
just what do...strap on a pack and get outside!"
    According to the Department of Veterans Affairs' National Center 
for PTSD, between 11 and 20 percent of veterans who served in Operation 
Iraqi Freedom and Operation Enduring Freedom and 12 percent of those 
who served in Desert Storm have PTSD in a given year, and 30 percent of 
those who served in Vietnam will have had PTSD in their lifetime.
    H.R. 2435 will help determine how Congress, Federal agencies, and 
the private sector can better collaborate and identify outdoor 
initiatives to serve veterans. This legislation would not require the 
VA to prescribe recreational therapy but would simply help expose 
barriers to be overcome and new opportunities to be pursued so that 
public lands are more available for recreational activities, such as 
hiking, backpacking, fishing, horseback riding, rafting, and biking, 
which have proven to advance recuperation and healing. Ultimately this 
legislation will supplement the VA's major medical care programs with 
outdoor recreational therapy for military veterans.
    More than 75 veteran service organizations, outdoor recreation 
groups, and conservation organizations, including the American Legion, 
Veterans of Foreign Wars, Paralyzed Veterans of America, Disabled 
American Veterans, and Minority Veterans of America, have endorsed H.R. 
2435. Similarly, this bill has broad bipartisan support here in the 
House.
    As a nation we intend to invest $9.5 billion in mental health 
services and $222 million for suicide prevention outreach to combat the 
growing challenges of veteran suicide, PTSD, and other mental health 
for FY2020. This legislation is a cost-free way to complement 
comprehensive medical treatments and make use of our nation's outdoor 
resources to help more veterans heal.
    As the former Chairman of the House Veterans' Affairs Committee, I 
have been a long-time supporter of providing veterans with the quality 
healthcare they deserve, and I believe this bill builds upon holistic 
medical care and acknowledges the added benefits of outdoor recreation 
therapy.
    I look forward to working with the Committee to ensure this 
important legislation passes the House of Representatives.

                                 
                             Dave Loebsack

          H.R. 2997 - The Sgt. Brandon Ketchum Never Again Act

      I want to thank the Chairman and Ranking Member for the 
opportunity to highlight an issue of importance not just to veterans in 
my district, but to veterans and their families across the country.
      Our nation has a responsibility to ensure that our 
veterans are served with the same dignity and honor with which they 
have served. This includes providing veterans with access to the 
services they need to successfully transition from active duty to 
civilian life, including of course, comprehensive and accessible mental 
healthcare services.
      There is a devastating mental health crisis in our country, and 
it is disproportionately impacting our veteran community. As you know, 
we tragically lose over 20 veterans each day to suicide. One death of a 
veteran to suicide is too many, and we must address this national 
health crisis.
      Many of our nation's veterans face post-traumatic stress 
disorder and other serious mental health issues upon their return home, 
and these veterans have sacrificed too much to ever feel alone when in 
a crisis. When these veterans reach out, we as a country owe it to them 
to answer their call.
      Three years ago in my district, a veteran named Sgt. 
Brandon Ketchum died by suicide after being denied in-patient care at a 
VA Medical Center. Tragically, this is not the first time a veteran has 
asked to be admitted for mental healthcare at the VA in this country 
and been denied.
      This is unacceptable and we in Congress have the 
responsibility to pass legislation to ensure that it never happens 
again.
      My legislation, the Sgt. Brandon Ketchum Never Again Act, 
would require that when a veteran enrolled in the VA healthcare system 
requests at a VA Medical Center to be admitted for in-patient 
psychiatric care, the VA must provide that care for the veteran in the 
psychiatric ward of that Medical Center. If there are not enough beds 
or providers at that location, the VA must find care for the veteran 
for a non-VA facility.
      This bill would not prevent admissions as they currently 
operate, but rather would supplement existing policy. For example, if a 
veteran displays suicidal ideations but does not explicitly request to 
be admitted to the in-patient psychiatric ward, his or her doctor could 
still recommend admission.
      Sgt. Ketchum's tragic death reinforces the need for 
systemic change within the VA to ensure any veteran who is suffering 
from a mental health issue gets the treatment they need and deserve. 
Simply put, under the Sgt. Brandon Ketchum Never Again Act, if a 
veteran asks for in-patient mental healthcare from the VA, they will 
get it.
      By giving veterans the power to get the mental health 
treatment they want, we can take an important step to ensuring that no 
veteran ever again wonders whether he or she is "sick" enough to be 
admitted for psychiatric care.
      As a military parent, this issue is deeply personal to me 
and I am fully committed to working with the Committee to ensure that 
no veteran in need is ever turned away again.
      I hope the Committee will support my bipartisan 
legislation to improve access to mental healthcare for veterans in 
need. I thank the Chairman and Ranking Member for your time and 
consideration.

                                 
                              Debbie Lesko

    1.Chairman Takano (D-CA) and Ranking Member Roe (R-TN), thank you 
for your leadership of this Committee to advance policies to help our 
veterans' community.

    2.I am eternally grateful to the brave men and women who have and 
continue to fight to protect our nation and freedoms. Our veterans have 
served their country with honor, and I believe it is our duty as their 
Representatives to ensure they are cared for when they return home.

    3.As the Member of Congress representing Luke Air Force Base, I am 
especially committed to the well-being of our military veterans, and I 
look forward to working with this Committee to ensure they are well 
taken care of.

    4.It's my honor to be here today to advocate for my bipartisan 
bill,H.R. 1944, the VA Medical Center Transparency Act, which I 
introduced with my colleague, Congresswoman Susie Lee of Nevada.

    5.The purpose of my bill is to help veterans by increasing 
transparency of VA medical facilities, so that Members of Congress can 
better and more easily understand the strengths of VA medical 
facilities and help them to elevate the care our veterans receive.

    6.The bill would require every Director of a VA Medical Facility to 
write a factsheet annually that would include:

    a.(1) Statistics regarding patient volume, the most common health 
conditions treated, the average wait time, and other matters the 
Director deems appropriate;

    b.(2) A description of the successes or achievements of the 
facility, including actions taken to improve the facility and the care 
provided; and

    c.(3) A brief plan to improve the facility

    7.The fact sheet would be made publicly available online and in the 
relevant medical facility, and copies would be sent to the Secretary of 
the VA, both Veterans Affairs Committees, and to each Representative 
and Senator that represents the district or state in which the facility 
is located.

    8.This factsheet will not replace any report nor take resources 
away from the VA.

    9.Rather, this simple factsheet will allow our facilities to easily 
highlight their achievements and communicate their plans to elevate 
quality, and allow us as Members of Congress to better respond to their 
needs so that they can provide the optimal care for those who have 
served our country.

    10.Thank you for the opportunity to be here today, and I ask that 
the Committee move this bipartisan bill.

                                 
                    Elijah E. Cummings & Ted S. Yoho
    Chairman Takano and Ranking Member Roe,
    It is critically important that we protect student veterans who are 
using their benefits earned through the Post-9/11 GI Bill. This is why 
we introduced the Safeguarding Student Veterans Act, H.R. 4012. Our 
bipartisan bill will help make sure that student veterans are not 
harmed by troubled schools, including those operating for profit, by 
increasing coordination between the Department of Veterans Affairs and 
the Department of Education.
    Around the country, including in Maryland and in Florida, many 
colleges, especially those operating for profit have recently shut 
their doors. These closures have had devastating impacts on students 
and, in particular, tens of thousands of student veterans who were 
aggressively targeted for enrollment by these schools.
    Students who receive Post-9/11 GI Bill benefits made up a 
disproportionately large share of students at many of these for-profit 
schools when they closed. ITT Technical Institute had around 7,000 of 
its 40,000 students receiving these benefits and Education Corporation 
of America had about 4,000 student veterans out of 18,000 students.
    When these colleges close, student veterans are robbed of their 
education and a chance to better themselves.
    We must do better for our veterans.
    The Safeguarding Student Veterans Act will require the Department 
of Veterans Affairs and the Department of Education to coordinate in 
order to protect student veterans. The bill will also make sure that 
the Department of Veterans Affairs has a better understanding of the 
risks that certain schools pose to veterans, and that veterans have 
access to this important information when choosing which school to 
enroll in.
    Specifically, when a school has significant financial and 
compliance issues and is placed on Heightened Cash Monitoring status by 
the Department of Education, the bill requires that the information 
that schools hand over to the Department of Education will also be 
shared with the Department of Veterans Affairs.
    The Department of Veterans Affairs would then perform a risk 
analysis for these schools. The risk analysis would include information 
the Department of Veterans Affairs receives from the Department of 
Education as well as additional factors such as the volume of student 
complaints, rates of Federal student loan defaults by veterans, and 
veteran completion rates.
    This coordination between agencies and better understanding of the 
risk posed by these schools will help empower student veterans. The 
Department of Veterans Affairs would include the findings of the risk 
analysis as part of the Department of Veterans Affairs' online GI Bill 
Comparison Tool and notify veterans of the results of the risk 
analysis.
    The Safeguarding Student Veterans Act is supported by leading 
organizations working to enhance educational opportunities for veterans 
including Student Veterans of America, American Legion, Veterans 
Education Success, Maryland Attorney General Brian Frosh, Vietnam 
Veterans of America, Higher Learning Advocates, and High Ground 
Veterans Advocacy.
    We ask for the Veterans Affairs Committee's support for this 
important piece of legislation.

                                 
                          Glenn "GT" Thompson
    Chairman Takano and Ranking Member Roe:
    Good morning and thank you for the opportunity to share my 
priorities for the veteran community with the House Veterans Affairs 
Committee. As the father of an active-duty soldier who received a 
Purple Heart during Operation Iraqi Freedom, and a strong supporter of 
our nation's servicemembers, I appreciate your willingness to receive 
my testimony.
    I recognize the challenges facing this Committee and appreciate 
your ongoing support for our servicemembers, both active and retired. 
These brave Americans put their lives on the line regularly in the 
defense of a higher cause, so we have a responsibility to support them 
in the strongest and most responsible way possible.
    While I certainly understand that the Departments of Defense and 
Veterans Affairs have the best interests of our troops in mind, our 
oversight role is necessary to ensure these Departments stay on the 
right course.
    During the 116th Congress, I have co-sponsored nine bills that are 
within the Veteran Affairs Committees jurisdiction. Each of these bills 
are of importance to my constituency and the large veteran population 
that makes up my district. I have always taken pride in working to 
ensure that our nations veterans receive the help, protection, and care 
that they need when they return home.
    That is why some of my priorities this Congress include H.R. 592- 
the Protect Veterans from Financial Fraud Act of 2019. This bill, 
introduced by Rep. Julia Brownley, amends Title 38 to ensure that the 
Secretary of Veterans Affairs repays the misused benefits of veterans 
with fiduciaries and to establish an appeal process for determinations 
made by the Secretary of Veterans Affairs of veterans' mental capacity. 
Additionally, I have co-sponsored H.R. 303- the Retired Pay Restoration 
Act introduced by Rep. Bilirakis.
    In addition to these two bills, I have co-sponsored several other 
pieces of legislation that touch upon the heath and well-being of our 
nation's veterans. H.R. 663- the Burn Pits Accountability Act sponsored 
by Rep. Tulsi Gabbard, creates a registry of all servicemembers 
effected by the burn pits that many have come in contact while serving 
in Operation Iraqi Freedom, Operation Enduring Freedom, and in various 
countries in Africa. This list will enable those veterans effected to 
get the help they need before it is too late.
    I have also signed onto H.R. 3495- the IMPROVE Well-Being for 
Veterans Act, sponsored by Rep. Jack Bergman. Every day, 22 veterans 
take their lives. It is time that we, as legislators, do whatever we 
can to put an end to that awful statistic. H.R. 3495 will require that 
the Secretary of Veterans Affairs provides financial assistance to 
eligible entities to provide and coordinate the provision of suicide 
prevention services for veterans at risk of suicide, and veteran 
families through the award of grants to such entities.
    It is our duty to ensure that we protect our servicemembers when 
they return home from active duty. For this reason, I have also co-
sponsored H.R. 1802- the VA Billing Accountability Act, H.R. 485- 
VREASA, H.R. 303- Retired Pay Restoration Act, and H.R. 628- the 
WINGMAN Act. Each of these bills will contribute to the well-being of 
our nation's veterans. Whether it be through oversight, accountability, 
or programs to help them thrive.
    We must also ensure that we recognize our nations military history 
and all the great that our Soldiers, Sailors, Airmen and Marines have 
done for us over the years. It is because of this that I have co-
sponsored H.R. 2056, a bill that will recognize and honor the service 
of individuals who served in the United States Cadet Nurse Corps during 
World War II. Additionally, I have supported H.R. 3155- the 75th 
Anniversary of the End of World War II Commemorative Coin Act.
    Each one of these bills is indicative of my ongoing support of the 
veterans, not only in my district, but in the United States. As a 
Member of Congress, I take great pride in working hard for those who 
have selflessly continued to put their lives on the line so that we may 
enjoy the freedoms we do. Throughout my time in Congress I have always 
supported legislation that will give our active duty servicemembers and 
veterans the tools that they need to succeed.
    I respectfully request the Committee's support of these nine pieces 
of legislation that will help improve the lives of our military 
veterans. Thank you again for the opportunity to submit my testimony 
today. I look forward to working with you in the future.

                                 
                               Gwen Moore
    Chairman Takano and Ranking Member Roe,
    Thank you for the opportunity to testify about my priorities when 
it comes to veterans. I am profoundly grateful for the brave men and 
women veterans who have served our country.
    When our troops serve, they give up something in pursuit of a 
purpose greater than themselves. Many have given their limbs, or their 
lives so that others can be safe here at home. So many others carry the 
scars of their service buried inside, unsure how to allow themselves to 
heal.There is no other calling in life as humble, as selfless, or as 
respected than the sacrifice of a veteran.
    Milwaukee prides itself in taking care of veterans. In fact, we 
have one of the original "soldier's homes". This National Historic 
Landmark was a gift by the women of Milwaukee's Westside Soldier's Aide 
Society to the Federal government and authorized by President Abraham 
Lincoln to ensure that veterans had a place to receive care after 
coming home.
    It is important when talking about veteran's access to care, that 
we remember our Veteran brothers and sisters are not just numbers, they 
are people often struggling in unique circumstances, risk factors, and 
many times barriers to the services they deserve.
    I have identified the following priorities that I would like this 
Committee to address:

    Suicide Prevention

    An estimated 20 veterans tragically take their own lives each 
day.Each suicide is a tragedy for the individual, their families, and 
the larger community.
      In July, we saw a parking lot suicide at the Zablocki VA 
in my district. Despite numerous efforts and initiatives over the years 
by the VA and Congress to prevent veteran suicides, this number has not 
significantly changed in years. We must do more to save veteran lives 
including using every opportunity to identify problems and improve 
care, and access to care, for our veterans in need.
    I urge the Committee to take up and pass legislation such as H.R. 
3495, the Improve Well-Being for Veterans Act, a bill that authorizes 
the VA to coordinate with and issue grants to community partners to 
address veterans suicide.

    Missing Vets

    I am proud that my state of Wisconsin was the first in the nation 
to create a "green alert" system to help locate missing veterans. That 
law was passed as a result of a missing persons case involving one of 
my constituents, Corey Adams, an Air Force veteran from Milwaukee, who 
passed away in 2017 after going missing for 18 days. When Corey went 
missing, his family knew that something was wrong-Corey left his 
eyeglasses, phone, money, and medications at his parent's home, where 
he was last seen.
    Despite his family filing a missing person report within hours of 
his disappearance, it took eight days before the police determined he 
met the critical missing persons criteria. Unfortunately, 18 days after 
his initial disappearance, Corey Adams' body was recovered from a pond 
in a local park, just one mile from his mother's home.
    We have a responsibility to help ensure that our vets, including 
missing vets, come home safely My bill, the Corey Adams Searchlight Act 
(H.R. 1350), which would create a Green Alert program at the Department 
of Justice to support state and local efforts to locate and bring our 
missing veterans home safely.
    While Wisconsin has been a leader, other states including Delaware 
and Texas have followed and many more are taking steps to ensure our 
veterans do not fall through the cracks. While I work to enact my 
legislation, I believe it's critical that the Committee urge the VA to 
ensure that it is working with states, as much as it can, as these 
alerts are set up to help ensure coordination and to prevent a 
patchwork of systems that do not serve our veterans well.

    Homelessness

    Far too many who have served their country end up homeless. 
According to the National Coalition for Homeless Veterans, about 11% of 
the adult homeless population are veterans. Many others remain at high 
risk of homelessness. According to the National Coalition for Homeless 
Veterans, African American or Hispanic veterans are vastly 
overrepresented among this population.
    While the VA is not a housing agency, it plays a key role in 
helping to address this challenge, including through its ability to 
collaborate with governments, employers and community-based entities to 
house, employ and serve veterans exiting homelessness.
    We need to continue to push the VA to do more to combat 
homelessness, including through efforts such as HUD-VASH, a 
collaborative program with the U.S. Department of Housing and Urban 
Development (HUD) that pairs comprehensive case management and services 
from the VA with Housing Choice vouchers from HUD.

    VA Mission Act

    The MISSION Act was Congress' response to the looming expiration of 
the Choice Program -a program that allowed veterans to access private 
sector care when they live more than 40 miles from a VA medical 
facility or have to wait more than 30 days for an appointment. While 
Choice mitigated some access concerns, its complexity at times created 
considerable confusion among the veteran population, VA employees, and 
Congress. The MISSION Act was passed in the summer of 2018 to establish 
a new, streamlined community care program called the Veterans Community 
Care Program (VCCP).
    I continue to hear concerns regarding issues with how the MISSION 
Act is administered, including failures to promptly pay bills owed to 
the VA's community care partners. Specifically, a lack of adequate 
staffing has led to delays in processing bills from Community Care 
providers. There is also an ongoing need for the VA and its medical 
facilities to improve communication with community providers and 
veterans.
    The rise in people utilizing community care has created this back 
log. The lack of proper funding for Mission Act has exacerbated the 
issue.
    As the VA continues to implement the MISSION Act, we must also 
ensure that it does not ignore the needs of or degrade services 
available through the Veterans Health Administration for those veterans 
who prefer and rely on its health care services.
    As veterans service organizations (VSO) and previous VA leaders 
have noted, the caliber of many areas of VA care- including mental 
health, polytrauma, spinal cord injury and rehabilitation, prosthetics, 
Traumatic Brain Injury, and Military Sexual Trauma-does not exist in 
the community
    Community care is intended to supplement VA services. It is 
critical that the Committee ensure that the VA continues to 
appropriately invest in its facilities and staff to increase its 
capacity to deliver care.

    Take Care of the Staff and Employees that take care of our Vets.

    I have been troubled by this Administration's continuing attacks on 
the collective and other labor rights of the employees who are charged 
with providing care for our veterans.
    This Committee needs to help ensure that the labor rights of these 
employees are protected
    I have received numerous reports of VA management engaging in 
practices designed to both intimidate employees as well as deprive them 
of their right to representation at all levels of disciplinary 
proceedings.
    Additionally, I am concerned that in the current contract 
negotiations, VA management is attempting to upend the Federal 
collective bargaining process through the inclusion of provisions that 
may eliminate Federal workers' representation and workplace rights 
currently protected under the law.
    It is critical that the VA bargain with its unions in good faith 
with the objective of improving care for our veterans.
    Creating an environment of fear and intimidation among the staff 
does nothing to improve patient care nor does it serve the mission of 
the VA. The VA must ensure there is an environment in which it is able 
to recruit top notch, hardworking professionals, including doctors and 
nurses, in order to provide the outstanding care our nations' veterans 
deserve.
    Nearly 100,000 veterans work at the VA. We need to do right by them 
and the rest of the workforce, bearing in mind that more than 9 million 
veterans depend on the VA to provide them with world-class health care 
and other vital services they earned by sacrificing for our nation.

    Women's Health Care:

    It is critical that the VA be a place where all veterans feel 
welcome and receive the care they need and deserve. We must leave no 
veteran behind, regardless of gender.
    The VA has identified women veterans as its fastest growing 
demographic. The VA must do more to ensure that these veterans receive 
appropriate and timely care, including gynecological and obstetrics 
care which are critical core services for our women veterans.
    Congress must hold the VA's feet to the fire and continue to push 
for improvements when it comes to ensuring equal access to crucial 
gender specific services at the VA.

    I urge you to move legislation such as:
      The Improving Oversight of Women Veterans' Care Act (H.R. 
4096) which among other provisions, requires the VA to submit an annual 
report on access to (1) mammograms, (2) obstetric care, and (3) 
gynecological care for women veterans under community care networks. 
The report must include information on wait times, drive times, and 
reasons why appointments could not be scheduled. The bill would also 
require VA medical facilities to submit quarterly reports on health 
care standards for women veterans
      The Violence Against Women Veterans Act (H.R. 3867) would 
require the VA to improve the provision of VA services and benefits for 
veterans who experience domestic violence or sexual assault.

    Deportation of Veterans

    Every day, courageous men and women in our armed forces place 
themselves in harm's way to keep our nation safe. Many of these 
individuals are U.S. Citizens, but some are lawful permanent residents 
(LPR) at the time of their active duty in the U.S. Armed Forces.
    Our nation should not make it a priority to deport veterans. These 
individuals have fought for our nation. If an LPR veteran is convicted 
of a crime, even a non-violent offense or minor infraction, they face 
deportation under our existing immigration laws. While there is 
supposed to be a process that provides extra consideration for removal 
cases involving veterans, it appears that Federal officials haven't 
been following it.
    According to the Government Accountability Office, "When ICE agents 
and officers learn they have encountered a potentially removable 
veteran, ICE policies require them to take additional steps to proceed 
with the case." However, GAO found that "ICE did not consistently 
follow its policies involving veterans who were placed in removal 
proceedings from fiscal years 2013 to 2018."
    Once deported, it becomes difficult for these veterans to access 
the benefits they earned while serving, such as disability or 
retirement pay.

      I urge you to consider legislation such as the Veterans 
Visa and Protection Act (H.R. 2098), which would create a visa program 
to allow deported veterans who meet certain requirements to enter the 
U.S. as lawful permanent residents. The bill would also allow those 
readmitted to the U.S. to be eligible for the existing naturalization 
process for military service and would also stop the deportation of 
eligible veterans who are currently in removal proceedings.

    Urban Indian Veterans Health

    Two-thirds of veterans who are Native American live in urban areas 
and need access to culturally-competent care. While the VA has made 
efforts to ensure that Native American veterans receive care, including 
a 2010 memorandum of understanding with the Indian Health Service to 
promote inter-agency collaboration to help Native American veterans 
receive health care, urban Indian health centers operated by urban 
Indian health organizations (UIO) have not been able to benefit from 
those collaborations.
    In a 2018 report, the VA states that "UIOs are eligible, capable, 
and are entitled to receive reimbursement for the healthcare services 
they provide to AI/AN veterans," but argued that the VA does not have 
"current legal authority that allows for expanding existing 
reimbursement agreements to include UIOs."
    I would urge the Committee to encourage the VA to work with the 
Indian Health Service to provide greater access to culturally 
appropriate services for Native American Veterans that UIOs are in a 
unique position to provide.
    It is time for Congress to act to provide the VA with the same 
reimbursement authority for urban Indian health centers that already 
exists for the Indian Health Service, tribes, and tribal organizations. 
This would help Native American veterans get culturally-competent care, 
while at the same time helping relieve the burden on the VA system.
    I know that one bill has been introduced that is not before this 
Committee, the Health Care Access for Urban Native Veterans Act 
(H.R.4153) which would amend the Indian Health Care Improvement Act 
(IHCIA) to include "urban Indian organizations" (UIOs) under the list 
of entities eligible to enter into reimbursement agreements with the VA 
for treatment of Native American veterans.
    This is commonsense legislation that should be swiftly enacted. And 
as the Committee continues to consider legislation to help our 
veterans, it must consider the additional challenges and barriers 
facing Native American veterans.

                                 
                        Jenniffer Gonzalez-Colon
    Thank you, Chairman Takano and Ranking Member Roe.
    I appreciate the opportunity to discuss some of the issues 
currently impacting the veteran population in Puerto Rico.
    As you now, Puerto Rico continues to recover from the 2017 
hurricane season. All my constituents struggled with the aftermath, 
including our veteran community. We have a single medical center 
located in San Juan, and a network of clinics, including one in the 
municipalities of Arecibo and Ponce, which were particularly damaged 
after Hurricane Maria. I am pleased to see the VA is on track to 
reestablish services in these facilities, and I would like to continue 
working with the Committee to ensure it maintains construction work at 
a steady pace so that these clinics are ready to receive veteran 
patients as soon as possible.
    Another area I would like to enlist the Committee's help is 
hurricane preparedness. I commend VA staff in Puerto Rico for 
undertaking the monumental task of serving veterans after Hurricane 
Maria. Yet, I also recognize there is always room for improvement.
    For example, some VA facilities in Puerto Rico receive medication 
from Florida. Additionally, some medication is shipped directly to 
veterans from South Carolina. As we have seen with Hurricane Dorian, 
both states are susceptible to storms during the hurricane season and 
this can potentially cause medication shortages for veterans on the 
island. I therefore urge the consideration of alternatives, like 
utilizing medical supply vendors located in Puerto Rico, to minimize 
the impact of interrupted services due to hurricanes in other areas.
    Keep in mind that this would place the Medical Center in Puerto 
Rico in a better position to help veterans in other impacted areas.
    We also need to focus on making sure our veterans are well informed 
about the benefits available to them. For example, a constant source of 
complaints from veterans is provider shortages. As you know, shortages 
can delay appointments with a specialist. Veterans have options that 
allow them to see an outside provider should the VA not have the 
services they need available.
    However, I am finding that some veterans remain uninformed of this 
and other benefits available to them. I therefore urge the Committee to 
continue working with VSOs and ensure VA facilities properly educate 
our veterans and their family members on their benefits, like for 
example those included in the MISSION Act.
    I would also like to urge the Committee to help us address a 
similar problem consisting of vacancies within the VA. During this 
Congress,
    I reintroduced H.R. 846, the Veterans Serving Veterans Act, which 
passed the House under suspension during the 115th Congress, andH.R. 
2308, to amend the Veterans Healing Veterans Scholarship Program to 
include medical schools in Puerto Rico and one in Texas. Both bills 
would help veterans find jobs, while also mitigating staff shortages 
across the VA. I would like to respectfully request that we continue 
working together to move these bills forward, along with any other 
initiative you believe could be helpful on these issues.
    Lastly, I introduced H.R. 2171 to extend TRICARE Prime to military 
retirees in the island. I understand this is not under the VA 
Committee's jurisdiction, but it is an issue that challenges services 
available to veterans and their dependents on the island. Your support 
would be greatly appreciated.
    I want to thank you both for all the help and attention given to 
Puerto Rico after the 2017 hurricanes. Your visits to the island remind 
veterans that they are being heard and that we are working to meet 
their needs.
    Thank you and I yield back.

                                 
                            Peter A Defazio
    Chairman Takano and Ranking Member Roe:
    Thank you for the opportunity to submit testimony as part of the 
Committee's bipartisan Member day. I commend my colleagues on the 
Committee for their efforts to improve the lives of our nation's 
veterans and would like to address two important issues that have 
impacted veterans in my district and across the country.
    First, I call your attention to the Roseburg VA Health Care 
System's (RVAHCS) persistent recruitment and retention issues.
    Recent staff shortages in the RVAHCS forced the abrupt closure of 
the Roseburg Emergency Department (ED) and conversion to an Urgent Care 
(UC) facility. According to RVAHCS Director Keith Allen, Veteran 
Integrated Service Network (VISN) 20 senior leadership directed RVAHCS 
to implement a conversion from an ED to a UC facility because of 
"shortfalls in qualified providers to staff Emergency Department 
ancillary services, such as laboratory services, radiology services and 
respiratory services."
    Staffing shortages also limit the new UC operations to Monday 
through Friday, not seven days a week. There is no community care UC 
facility in Roseburg, so veterans have no access to immediate medical 
care after 8:00 p.m. or on weekends.
    I am gravely concerned the RVAHCS will continue to suffer from 
recruitment and retention problems without appropriate intervention. I 
have no doubt that VA care for veterans in my district will ultimately 
be degraded if these issues are not addressed.
    I wrote to Secretary Wilkie urging him to be actively engaged in 
helping the RVAHCS and VISN 20 maximize all pay flexibilities. I have 
also urged him to relay information to the Office of Personnel 
Management (OPM) about how consistent locality pay limitations have 
negatively impacted VA's efforts to recruit providers in Douglas and 
Lane Counties.
    The RVAHCS is not alone in its struggle to recruit and retain top-
tier health care providers. Rural VA health care systems across the 
country face similar problems.
    The health and wellbeing of our veterans is at stake. I urge the 
Committee to take a more thorough look at what Congress can do to help 
alleviate the persistent issues that create hurdles for veterans who 
need care. We must work harder to ensure that RVAHCS and other rural 
health care systems have the tools they need to recruit and retain high 
quality providers to meet the healthcare needs of our veterans.
    Secondly, I urge the Committee to take up legislation to authorize 
VA work-study student positions in congressional offices.
    In my district, we manage a high-volume of complex veteran 
constituent casework. Previously, veterans attending school could work 
as VA work-study students and be paid to work in congressional offices 
to help veterans with VA services and benefits.
    The stipend veterans received as work-study students encouraged 
them to participate in the work-study program in congressional offices 
for substantial amounts of time, sometimes years. Veterans in my 
congressional district gained invaluable experience and insight into VA 
casework and issues. Their prior military service also helped them more 
effectively communicate with veterans, and they were determined 
advocates for fellow veterans.
    One of my former work-study students, Justin Carney, worked in my 
district office from May 2005 through January 2008. He had to suspend 
his work-study position when he was deployed, but he returned to my 
district office to continue helping veterans as soon as he returned to 
the U.S. Justin now works for the VA in Los Angeles, where he has been 
for almost ten years. He has held a number of positions there, 
including Veterans Service Representative, Congressional Analyst, 
Management and Program Analyst, and now serves as a Coach.
    Another of my former work-study students, Whitney Couture, has 
worked for me for more than ten years and has assisted hundreds of 
veterans with their casework issues.
    In 2009, VA bureaucrats terminated this highly successful program. 
They said VA work- study students were never authorized to work in 
congressional offices, despite the fact that they had been working in 
congressional offices for more than twenty years.
    Terminating the program was a no-win situation: student veterans 
lost out on a tremendous opportunity to develop job skills while 
helping fellow veterans, veterans in need of assistance lost key 
advocates in congressional offices, and congressional offices lost 
invaluable assistance in responding to the needs of veteran 
constituents.
    Despite my efforts to reverse this wrong-headed decision, the 
program remains terminated. The VA has said that new legislation would 
have to be enacted to authorize work- study benefits for veterans 
helping veterans in a congressional office.
    As you well know, a significant portion of congressional casework 
is for veterans. In my district office, I currently have two full-time 
staff members managing casework for veterans.
    I believe there is no more appropriate way to honor our veterans 
and their service than by training their fellow veterans to assist them 
with their VA benefits.
    That's why I will reintroduce legislation this Congress to make it 
possible for veterans to again work in congressional offices as work-
study students. I urge the Committee to give this important bill full 
consideration so we can reauthorize this successful program and once 
again allow veterans to help veterans.
    Thank you for your time, and I look forward to continuing to work 
with the Committee on these and other important issues.

                                 
                          Sean Patrick Maloney
    INTRODUCTION

    Chairman Takano, Ranking Member Roe, and Members of the Committee, 
I thank you for the opportunity to provide testimony today. I am asking 
the Committee on Veterans Affairs to consider two of my bills, the "Get 
Veterans a Doctor Now Act" and the "Disabled Veterans Red Tape 
Reduction Act," to bring to Committee. These bills address two specific 
problems with how our government cares for the brave men and women of 
the uniformed services after they have returned from combat. I 
represent the United States Military Academy at West Point, as well as 
thousands of military families - both active and retired. I have 
engaged this community through multiple Veteran centered organizations, 
like VetsFirst, AMVETS, and the Military Order of the Purple Heart, 
which have been instrumental in the creation of this legislation. Our 
responsibility to honor those who are willing to sacrifice everything 
does not end when they return home and I appreciate the hard work the 
Members of this Committee do in that regard.

    GET VETERANS A DOCTOR ACT

    As our nation's veterans seek medical treatment, it is our duty to 
fulfill our promise to them by ensuring that VA medical centers are 
adequately staffed. The VA is facing a hiring backlog, which has left 
over 43,000 medical jobs unfilled, creating lengthy delays in access to 
service. This is unacceptable and another example of how our nation has 
fallen short in caring for those who were willing to fight and put 
their lives on the line for our freedom.Currently, the VA must wait to 
recruit resident doctors until they have completed their residency as 
doctors. My bill, the Get Veterans a Doctor Now Act, allows the VA to 
recruit resident physicians earlier, offering doctors a conditional job 
offer up to two years prior to their graduation. This bipartisan bill 
removes this limitation, allowing the VA to compete with the private 
sector for the best doctors.
    One way to correct the current backlog is to actively recruit 
physicians to work at VA facilities early in their careers. Changing 
recruiting provisions for VA health centers would not only help to fill 
open positions but would also ensure that our veterans get the care 
they deserve, in a timely manner. Allowing the VA to recruit doctors 
before they have completed their residency will increase competition 
between the private sector and VA hospitals, leading to higher quality 
care for our nation's veterans.

    DISABLED VETERANS RED TAPE REDUCTION ACT

    The Disabled Veterans Red Tape Reduction Act amends the Veterans 
Benefits Act of 2003 to extend through 2020 the Department of Veterans 
Affairs authority to have contracted physicians perform medical 
disability evaluations. This provision was included in the National 
Defense Authorization Act for Fiscal Year 2019. Easier access to 
medical disability evaluations will lead to veterans obtaining the 
benefits they're owed in a more efficient manner. The bill is a simple 
fix which will help the VA adequately serve our Veterans.

    CONCLUSION

    To close, I again want to thank the Committee for their time and 
attention to these two important pieces of legislation. I would be 
pleased to respond to questions you or the other Members of the 
Committee may have. The brave men and women I represent appreciate your 
leadership on these issues and respect for their service.

                                 
                               Steve King
    Good Morning Chairman Takano, Ranking Member Roe, and Members of 
the Committee. I am truly honored to speak before you today in support 
of my bill,H.R. 2994, the Restoring Maximum Mobility to Our Nation's 
Veterans Act of 2019. This critical legislation aims to ensure that our 
nation's veterans with service-connected disabilities are not simply 
afforded a wheelchair, but are equipped with the very best wheelchair-
one that affords maximum achievable mobility and function in the 
activities of daily life.
    The ability to pursue life to the fullest possible degree, even in 
the face of disability, is critical to ensuring that our nation's 
veterans are as healthy as possible- in body, mind, emotions and 
spirit. And the statistics prove the truth of that statement. 
Statistics demonstrate that an average of 20 veterans die by suicide 
each day in our nation. Six of each 20 are recent users of Veterans 
Health Administration (VHA) services in the two preceding years leading 
up to the tragic decision to commit suicide. In my home state of Iowa, 
there were 75 veteran suicides in 2014 alone. We mourn these precious 
lives that were lost unnecessarily and find it unthinkable that these 
trends should continue. We must do more, and we must provide better 
services, care and support that our nation's veterans need and deserve.
    According to current practice, when determining which wheelchair is 
best equipped for a particular veteran, a VA clinician will take into 
account medical diagnoses, prognosis, functional abilities, 
limitations, goals, and ambitions.
    Evaluation of mobility assesses musculoskeleta,l neuromuscular, 
pulmonary, and cardiovascular capacities and response, effort, quality 
and speed of mobility, and overall function. However, the VHA 
recommendations clarify that "Motorized and power equipment or 
equipment for personal mobility intended solely for a recreational 
leisure activity should not be provided...Motorized and power equipment 
designed for recreational leisure activities do not typically supp011 a 
rehabilitative goal."
    In view of suicide rates among our nation's veterans, how can 
motorized and power equipment designed for recreational leisure 
activities not support a rehabilitative goal? According to a study made 
available by the National Center for Biotechnology Information, which 
operates under the National Institutes of Health (NIH), "...leisure 
activities are defined as preferred and enjoyable activities 
participated in during one's free time, and characterized as 
representing freedom and providing intrinsic satisfaction. Individuals 
can recover from stress; restore social and physical resources through 
leisure activities. Leisure activities with others may provide social 
support and, in turn, mediate the stress-health relationship, enrich 
meaning of life, recovery from stress, and restoration of social and 
physical resources... "
    This description will sound accurate to anyone who has found rest, 
solace and rejuvenation in a preferred recreational activity. As 
someone who enjoys the outdoors, hunting, fishing and travel, I 
certainly can appreciate the importance of recreation to a healthy 
life. And as this reality affects our nation's disabled veterans, I 
have seen first-hand the benefit of recreation to their health.
    I have had the honor of hunting with my friend, Army Specialist 
Jack Zimmerman. Jack is a remarkable man and decorated veteran who lost 
both of his legs as a result of life- altering injuries caused by an 
improvised explosive device. After his injury, Jack had a long 
rehabilitation in front him. And he had to deal with trials that he 
simply should not have had to during that time, including the VA 
issuing multiple inadequate wheelchairs to him. As an outdoorsman, Jack 
needed a chair that could navigate uneven terrain without the risk of 
tipping over. Jack was made aware of an off-road powered-track 
wheelchair that could offer a heightened level of normalcy and 
enjoyment to his life. He contacted the VA to acquire one and waited 
months without success.
    Jack's wife ultimately was able to procure a powered-track 
wheelchair from an outside organization called the Independence Fund, 
which provides resources and tools that enable veterans to work through 
their physical, mental and emotional wounds and regain their 
independence.
    I am grateful for the Independence Fund and other organizations 
that make it their mission to provide for our veterans. But our 
veterans should not have to rely on such groups to do for them what 
their nation should. They fought for this nation and they should be 
cared for by this nation.
    In the aftermath of Iraq and Afghanistan, we have strived in 
Congress to halt veteran suicide. We have worked to ensure that every 
veteran has access to the health care and services they need. Sadly, 
the somber statistics demonstrate that we have far to go to adequately 
take care of our veterans. That's why I champion H.R. 2994, which 
amends Section 1701 of Title 38 of the United States Code to ensure 
wheelchairs provided to our veterans include "enhanced power 
wheelchairs, multi- environmental wheelchairs, track wheelchairs, 
stair-climbing wheelchairs, and other power-driven mobility devices." 
This legislation ensures that the Secretary of Veterans Affairs may 
provide a wheelchair to a veteran because the wheelchair restores an 
ability that relates exclusively to participation in a recreational 
activity.

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