[House Hearing, 118 Congress]
[From the U.S. Government Publishing Office]


                         LEGISLATIVE HEARING ON

              H.R. 1753; H.R. 3790; H.R. 4016; H.R. 4190;.
              H.R. 4306; H.R. 5559; H.R. 5891; H.R. 5870;
                  H.R. 5870; H.R. 5890; AND H.R. 5938

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

                                HEARING

                               BEFORE THE

                       SUBCOMMITTEE ON DISABILITY 
                      ASSISTANCE AND MEMORIAL AFFAIRS

                                 OF THE

                     COMMITTEE ON VETERANS' AFFAIRS

                     U.S. HOUSE OF REPRESENTATIVES

                    ONE HUNDRED EIGHTEENTH CONGRESS

                             FIRST SESSION

                               __________

                      WEDNESDAY, NOVEMBER 8, 2023

                               __________

                           Serial No. 118-38

                               __________

       Printed for the use of the Committee on Veterans' Affairs
       
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]       


                    Available via http://govinfo.gov
                    
                               __________

                   U.S. GOVERNMENT PUBLISHING OFFICE                    
54-349                      WASHINGTON : 2024                    
          
-----------------------------------------------------------------------------------                     
                    
                     COMMITTEE ON VETERANS' AFFAIRS

                     MIKE BOST, Illinois, Chairman

AUMUA AMATA COLEMAN RADEWAGEN,       MARK TAKANO, California, Ranking 
    American Samoa, Vice-Chairwoman      Member
JACK BERGMAN, Michigan               JULIA BROWNLEY, California
NANCY MACE, South Carolina           MIKE LEVIN, California
MATTHEW M. ROSENDALE, SR., Montana   CHRIS PAPPAS, New Hampshire
MARIANNETTE MILLER-MEEKS, Iowa       FRANK J. MRVAN, Indiana
GREGORY F. MURPHY, North Carolina    SHEILA CHERFILUS-MCCORMICK, 
C. SCOTT FRANKLIN, Florida               Florida
DERRICK VAN ORDEN, Wisconsin         CHRISTOPHER R. DELUZIO, 
MORGAN LUTTRELL, Texas                   Pennsylvania
JUAN CISCOMANI, Arizona              MORGAN MCGARVEY, Kentucky
ELIJAH CRANE, Arizona                DELIA C. RAMIREZ, Illinois
KEITH SELF, Texas                    GREG LANDSMAN, Ohio
JENNIFER A. KIGGANS, Virginia        NIKKI BUDZINSKI, Illinois

                       Jon Clark, Staff Director
                  Matt Reel, Democratic Staff Director

       SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS

                    MORGAN LUTTRELL, Texas, Chairman

C. SCOTT FRANKLIN, Florida           CHRIS PAPPAS, New Hampshire, 
JUAN CISCOMANI, Arizona                  Ranking Member
ELIJAH CRANE, Arizona                CHRISTOPHER R. DELUZIO, 
KEITH SELF, Texas                        Pennsylvania
                                     MORGAN MCGARVEY, Kentucky
                                     DELIA C. RAMIREZ, Illinois

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

                              ----------                              

                      WEDNESDAY, NOVEMBER 8, 2023

                                                                   Page

                           OPENING STATEMENTS

The Honorable Morgan Luttrell, Chairman..........................     1
The Honorable Chris Pappas, Ranking Member.......................     2
The Honorable Mike Bost, U.S. House of Representatives, (IL-12)..     3
The Honorable Keith Self, U.S. House of Representatives, (TX-03).     4
The Honorable Abigail Davis Spanberger, U.S. House of 
  Representatives, (VA-07).......................................     5
The Honorable Darrell Issa, U.S. House of Representatives, (CA-
  48)............................................................     6
The Honorable Juan Ciscomani, U.S. House of Representatives, (AZ-
  06)............................................................     7
The Honorable David J. Trone, U.S. House of Representatives, (MD-
  06)............................................................    26

                               WITNESSES
                                Panel 1

Ms. Beth Murphy, Executive Director, Compensation Service, 
  Veterans Benefits Administration, U.S. Department of Veterans 
  Affairs........................................................     8

        Accompanied by:

    Mr. Kevin Friel, Deputy Director, Pension & Fiduciary 
        Service, Veterans Benefits Administration, U.S. 
        Department of Veterans Affairs

    Mr. Kenneth Arnold, Vice Chairman, Board of Veterans' 
        Appeals, U.S. Department of Veterans Affairs

                                Panel 2

Mr. Shane Liermann, Deputy National Legislative Director, 
  Disabled American Veterans.....................................    27

Ms. Quandrea N. Patterson, Associate Director, Veterans of 
  Foreign Wars of the United States..............................    28

Mr. Zachary M. Stolz, Partner, Chisholm, Chisholm, & Kilpatrick 
  LTD............................................................    30

                                APPENDIX
                    Prepared Statements Of Witnesses

Ms. Beth Murphy Prepared Statement...............................    41
Mr. Shane Liermann Prepared Statement............................    48
Ms. Quandrea N. Patterson Prepared Statement.....................    55
Mr. Zachary M. Stolz Prepared Statement..........................    58

                       Statements For The Record

American Veterans (AMVETS).......................................    63
National Organizations of Veterans' Advocates (NOVA).............    65
Paralyzed Veterans of America (PVA)..............................    69
Quality.Timeliness.Customer Service (QTC)........................    71
Special Operations Association of America (SOAA).................    74

                          APPENDIX--continued

ALS Association..................................................    78
Service Woman's Action Network (SWAN)............................    80
The Honorable Gerald E. Connolly, U.S. House of Representatives, 
  (VA-11)........................................................    81
Military-Veterans Advocacy, Inc..................................    83

 
                         LEGISLATIVE HEARING ON
              H.R. 1753; H.R. 3790; H.R. 4016; H.R. 4190;
              H.R. 4306; H.R. 5559; H.R. 5891; H.R. 5870;
                  H.R. 5870; H.R. 5890; AND H.R. 5938

                              ----------                              


                      WEDNESDAY, NOVEMBER 8, 2023

             U.S. House of Representatives,
  Subcommittee on Disability Assistance & Memorial 
                                           Affairs,
                            Committee on Veterans' Affairs,
                                                   Washington, D.C.
    The subcommittee met, pursuant to notice, at 12:02 p.m., in 
room 360, Cannon House Office Building, Hon. Morgan Luttrell 
(chairman of the subcommittee) presiding.
    Present: Representatives Luttrell, Ciscomani, Crane, Self, 
Pappas, Deluzio, McGarvey, and Ramirez.
    Also present: Representatives Bost, and Trone.

         OPENING STATEMENT OF MORGAN LUTTRELL, CHAIRMAN

    Mr. Luttrell. Good morning. Thank you everybody for coming 
in today. Excuse, just so everyone knows, I am in another 
committee that is in the middle of a markup right now. I will 
be handing the chair off to Mr. Bost. Thank you, sir. The 
Chairman for VA is here and he will be taking that as soon as I 
finish my remarks.
    The subcommittee will come to order.
    Good afternoon. We are here to discuss the 10 bills that 
would benefit veterans and their families. These bills would 
increase accountability and transparency for both the VA Board 
of Veterans Appeals and the VA Fiduciary Program, improve the 
VA appeals process by building on the accomplishments of the 
Veteran Appeals Improvement and Modernization Act of 2017, 
recognize and increase access to disability compensation for 
female service members who serve as members of the cultural 
support teams (CST), increase access to benefits for military 
firefighters and surviving spouses of veterans who suffered 
from Amyotrophic Lateral Sclerosis (ALS) as well, and expand 
access to disability exams for rural and underserved veterans.
    I am proud to have introduced two bills on today's agenda. 
H.R. 5890, the Review Every Veterans Claim Act, would prevent 
VA from denying certain types of claims solely because a 
veteran misses one VA exam. I believe it is ridiculous that 
under the current law, when a veteran misses their VA 
disability compensation and pension (C&P) exam without 
providing good cause or rescheduling, VA automatically denies 
the veteran's claims. That is not legitimate governing, in my 
opinion. That is working against the veteran. There is no 
reason why a veteran who has been pursuing their VA claim for 
years, has had undergone multiple VA exams, should have to 
start completely over because they missed one exam.
    My bill would prevent VA from denying a claim solely 
because a veteran failed to appear for one exam while having an 
open VA benefit claim. The bill would ensure that veterans 
receive an access to a comprehensive decision based on 
considerations of all of the evidence in their VA claim file, 
including every disability exam they have already appeared for.
    My other bill, 5891, the Veteran Appeals Decision Clarity 
Act, would build on Chairman Bost's and House Republicans' work 
to modernize the VA appeals process. The bill would require the 
VA Board of Veterans Appeals to notify veterans of the evidence 
the Board did not consider when making a decision on a 
veteran's claim. In return, veterans would have more 
transparency from the Board and when we allow our veterans to 
have access to all the information they need to decide whether 
they want to request the VA consider the left out evidence in a 
potential future claim.
    The bill would also require the Board to explicitly state 
in its decision which appeal forms successfully started an 
appeal and which did not. Right now, when the Board overlooks 
or incorrectly rejects a veterans' appeal form as untimely but 
does not issue an explicit decision stating that, the U.S. 
Court of Appeals cannot correct the Board's mistakes, sending 
veterans back to square one. My bill would cut through the red 
tape and ensure the U.S. Courts of Appeals can hold the Board 
accountable for their mistakes. Let me say this again, their 
mistakes, not the veterans', where right now, that falls on the 
veterans' shoulders.
    I look forward to working with Chairman Bost and my 
colleagues on this subcommittee to advance these important 
proposals today. I also appreciate the feedback from the 
witnesses who have joined us. I know my colleagues have worked 
hard on each of these proposals to improve the overall 
disability benefits process for the veterans and their 
families. This is a top personal priority for Chairman Bost and 
myself, having gone through the VA disability claims. I welcome 
a healthy decision about the merits of all the legislations, 
and I am looking forward to the input from the VA and the other 
stakeholders. I appreciate the discussions we are holding today 
and having--excuse me, I appreciate the discussions we are 
going to have today on the bills, but that does not guarantee 
that all of them will move to markup, especially since some of 
these bills have a high cost and are not fully offset. I now 
yield to the Ranking Member Pappas for his opening remarks.

       OPENING STATEMENT OF CHRIS PAPPAS, RANKING MEMBER

    Mr. Pappas. Thank you very much, Mr. Chairman, for 
convening this hearing. I want to welcome our colleagues who 
are joining us from off committee and all of the witnesses who 
are contributing to this session here today. Thank you for your 
shared goal of improving the lives of our veterans and their 
family members.
    Today, we have several critical measures aimed at enhancing 
the experiences of veterans, their survivors, and dependents 
when seeking access to their hard-earned benefits from VA. For 
example, Representative Slotkin has introduced H.R. 3790, the 
Justice for ALS Veterans Act. This legislation would ensure 
that families of service members diagnosed with ALS receive 
critical assistance. While the cause of ALS remains unknown, it 
is established that veterans are twice as likely to be 
diagnosed with ALS compared to civilians. Alarmingly, ALS 
patients typically have a life expectancy of just 2 to 5 years, 
often leaving their families without necessary assistance. The 
proposed bill aims to broaden the scope of increased VA 
dependency and indemnity compensation (DIC) to encompass the 
surviving spouse of a veteran who succumbed to ALS related to 
their service, irrespective of the duration of the veteran's 
affliction before passing.
    Additionally, my colleagues Representatives Connolly and 
Trone have introduced bills targeting fraud against veterans in 
VA's fiduciary program. These bills are H.R. 4016, the Veteran 
Fraud Reimbursement Act and H.R. 4190 the Restoring Benefits to 
Defrauded Veterans Act. Together, these bills seek to safeguard 
and support veterans, their survivors, and their estates by 
providing avenues for compensation and benefits restitution in 
cases of fraudulent activity by fiduciaries, something this 
subcommittee has heard a great deal about.
    Furthermore, Representative Spanberger has put forward H.R. 
4306, the Michael Lecik Military Firefighters Protection Act, 
named in honor of a Virginia veteran and firefighter who passed 
away in 2021 after a long battle with cancer. This bill aims to 
build on the efforts that were led in the last Congress with 
the The Sergeant First Class Heath Robinson Honoring our 
Promise to Address Comprehensive Toxics (PACT) Act to address 
the legacy of toxic exposure among service members and 
veterans.
    Now currently, VA does not acknowledge the direct service 
connection between military firefighting and cancer beyond 1 
year following active duty. This bill would establish the 
presumption that veteran firefighters who become disabled by 
serious diseases, including heart disease, lung disease, and 
certain cancers, contracted the illness due to their service in 
the military. This bill represents an important first step in 
tackling the toxic legacy of Per- and Polyflyoralkyl Substances 
(PFAS) exposure among service members. There is much more to 
do, certainly on the broader issue.
    Of course, there are other bills today on the agenda from 
colleagues on both sides of the aisle, and I look forward to 
the testimony that we will hear on them, and I hope it will 
provide this subcommittee with valuable information to refine 
and pass these bills before us to offer much needed services to 
our Nation's veterans and their survivors. With that, I yield 
back.
    Mr. Bost. [Presiding] The gentleman yields back. I now 
recognize myself to introduce and talk about the bill I have 
before the committee today.

                     STATEMENT OF MIKE BOST

    Mr. Bost. I am proud to have introduced my bill, H.R. 5559, 
the Protecting Veterans Claim Options Act. My bill will remove 
the new and relevant evidence requirement for supplemental 
claims filed within 1 year of VA denial of a veteran's 
disability claim.
    When the veterans file a supplemental claim, they expect VA 
to consider their additional evidence and issue a new decision 
on that claim. The new and relevant requirement is meaningless 
to the veteran who simply wants decisions on their claim. This 
is an unnecessary burden for the proof of the veteran. The 
veterans are forced to first convince the VA that their 
additional evidence is new and relevant. This process violates 
every veteran's right to continue the pursuit of VA benefit 
claim. This can add months and sometimes years of waiting to 
the process.
    Veterans are being punished simply by submitting additional 
evidence to support their VA benefit claim. My bill would 
ensure that no veteran has to jump through hoops in the claims 
process. My bill would also ensure that our veterans have all 
the information they need to navigate the appeals process after 
the Board denies their claim. When a veteran appeals the 
Board's decision to the Veterans Court, they often learn 
exactly what evidence is needed for them to succeed in their 
claim for the VA benefits. My bill would allow veterans to 
submit such additional evidence to the Board after the Veterans 
Court sends the case back to the Board to fix its mistakes.
    My bill would ensure that each step of the veterans claims 
appeals process is effective. We have more and more veterans 
submitting claims and coming to VA, and we owe it to these men 
and women to make the process as effective and efficient as 
possible.
    I look forward to the discussions on my bill today, and 
with that, I yield back, and now recognize myself again.
    I like the flow on this. Here, you can have that. Thank 
you.
    All right. We have got a full agenda today, so I will be 
holding everyone to 3 minutes per bill so that we can get 
through this all. You know, Jeff Miller used to chair this and 
he called this whenever we held them real tight, we called it a 
rodeo hearing. That means when the light turns red, you got 8 
seconds to finish or we throw you out.
    This morning, we are joined by several of our colleagues--
and I will not be throwing you out, we will let you finish, 
okay--both on and off the committee who are going to be 
testifying about the bills they have sponsored. Now we first 
want to recognize Representative Self for his bills.

                    STATEMENT OF KEITH SELF

    Mr. Self. Thank you, Mr. Chairman, for holding this 
hearing. My bill is H.R. 5870, the Veterans Appeals 
Transparency Act, and I believe this bill represents a vital 
step toward making the appeals process for our veterans more 
transparent, fair, and streamlined. The Board currently 
publishes the average time it takes for the Board to issue 
decisions in cases on each of its dockets. These averages can 
be misleading, and those averages provide veterans with no 
accurate sense of where they are in line.
    Further, the Board does not report to veterans, the public, 
and Congress exactly how far behind they are in working down 
their backlog of cases in each docket. One of the key 
provisions of my bill is the requirement for the Board to 
publish information about which appeals in each of the Board's 
dockets are actively working on during a given week. This is a 
critical step toward transparency and ensuring that veterans 
have a sense of where they are in line.
    Another important aspect of this legislation is 
clarification it provides regarding the appeals process. I will 
get to that in just a second. My bill clarifies that the 
appeals process under the Veterans Appeals Improvement and 
Modernization Act was always meant to be streamlined. My bill 
makes it clear that this streamlined process, veterans have the 
option to submit a single administrative review request such as 
a supplemental claim, higher level review request, or notice of 
disagreement within 1 year of the most recent VA denial of 
their claim. This streamlined approach is veteran friendly 
because veterans can navigate a single appeal stream and VA can 
easily track that stream.
    However, a recent legal development has brought complexity 
into the appeals process. The Terry v. McDonough decision by 
the Veterans Court interpreted the Appeals Modernization Act 
(AMA) as allowing veterans to submit multiple administrative 
review requests against a single VA denial as long as they file 
within the one-year deadline. This has created a convoluted 
system that will undoubtedly be challenged in court by both 
veterans and the VA and challenging to navigate. This 
convoluted system might just end up being more complicated than 
the legacy appeal system the Appeals Modernization Act was 
intended to fix.
    My bill corrects the Veterans Court misinterpretation of 
Congress's intent when Congress passed the Appeals 
Modernization Act. This, along with your bill, Chairman, the 
Protecting Veterans Claim Options Act, will simplify the 
appeals process while protecting every veteran's right to 
appeal denials of their claims handed down by the agency of 
original jurisdiction. A clear and streamlined process is 
beneficial for our veterans. Ultimately, my bill restores 
clarity and efficiency to the appeals process. I yield back.
    Mr. Bost. I thank the gentlemen for yielding back. Yes, we 
do. We recognize Representative Spanberger, and you are 
recognized for 3 minutes to speak on H.R. 4306, the Michael 
Lecik--how do you pronounce it?
    Ms. Spanberger. Lecik.
    Mr. Bost. Lecik, Okay. Military Firefighters Protection 
Act.

             STATEMENT OF ABIGAIL DAVIS SPANBERGER

    Ms. Spanberger. Thank you so very much, Chairman Bost. 
Thank you to the Ranking Member Takano. Thank you to the 
members of the committee. Mr. Pappas, thank you for your kind 
introduction of this legislation. Thank you for the opportunity 
to testify before the committee in support of my bipartisan 
Michael Lecik Military Firefighters Protection Act.
    I am here today not only as a Congresswoman, but also as a 
representative who had the privilege of getting to know Mike 
Lecik and his family, including his wife, Tiffany, and his 
three beautiful daughters. Mike was a former U.S. Air Force 
firefighter who selflessly served our Nation. He deployed twice 
to the Middle East. He later became the chief fire inspector at 
the U.S. Army Garrison, Fort Gregg-Adams.
    In 2021, Mike Lecik tragically passed away due to multiple 
myeloma, a rare and aggressive form of cancer that attacks the 
body's plasma cells. He was only 41 years old. Mike's service 
to our country undoubtedly led to his cancer, and civilian fire 
departments across the country recognize the connection between 
the chemicals used in firefighting and certain types of cancer. 
However, the Veterans Health Administration (VHA) currently 
does not cover treatment costs for diseases like Mike's because 
the VA still inexplicably fails to recognize the direct service 
connection between military firefighting and life-threatening 
illnesses such as his, if it is more than 1 year beyond active 
duty.
    This injustice must be rectified. The Michael Lecik 
Military Firefighters Protection Act would finally provide 
veteran firefighters with the compensation, healthcare, and 
retirement benefits that they have earned through their 
service. This legislation would create a presumption that 
veteran firefighters who become disabled by serious diseases, 
including heart disease, lung disease, and certain cancers, 
that they contracted these illnesses due to their military 
service. This presumption of service-connected illness is so 
important.
    It would also extend the window of time for veteran 
military firefighters to claim presumptive service connections 
to 15 years. By establishing this presumption, the VA would 
finally be able to provide long overdue benefits and treatment 
costs coverage to veteran firefighters like Mike, who gave so 
much of themselves to our country.
    I am proud to lead this legislation alongside my Republican 
colleague, Congressman Don Bacon, himself, the former U.S. Air 
Force chief. Our bill would at long last recognize the link 
between occupational hazards faced by military firefighters and 
the development of these devastating diseases. Scientific 
evidence demonstrates the connection between firefighting and 
the increased risk of certain diseases, and it is time for the 
VA to recognize this fact. Many states have already 
acknowledged this link, but the VA does not.
    We have bipartisan support to fix this issue, demonstrating 
that this is a cause that transcends party lines and unites us 
in the name of gratitude to our military firefighters. 
Throughout his fight with cancer, Mike never stopped advocating 
for his fellow veteran firefighters. It is why I introduced 
this bill. It is why I continue to push for it. As Members of 
Congress, in his memory, in his honor, we have the opportunity 
to make sure that his fellow military firefighters receive the 
care, the benefits, and the recognition that they have earned. 
Thank you to the committee, and I yield back.
    Mr. Bost. Thank you, Representative Spanberger, and we 
appreciate it. Thank you for your testimony today. I want to 
now recognize Representative Issa and recognize him for 3 
minutes to speak on H.R. 1753, the Jax Act.

                   STATEMENT OF DARRELL ISSA

    Mr. Issa. Thank you, Mr. Chairman, and thanks for this 
opportunity to talk about a small bill, 310 brave women who 
were CSTs. They did not fight, but they carried weapons. They 
carried 60-pound packs. They, in fact, as cultural support team 
members, were essential to our operations in Iraq and 
Afghanistan.
    As many of you know, within Islam, women have a special 
role, particularly in countries like Afghanistan, one in which 
they are uncomfortable, or even in fact, could become frantic 
if confronted by a man, let alone a man with a gun. In order to 
get cooperation and information and to save lives on both 
sides, the United States military employed these special brave 
women, many of them intelligence officers, but all of them 
willing to do everything their male counterparts did.
    We are relatively new to women in combat at this level, and 
as a result, it is not surprising that the VA, and for that 
matter, the Department of Defense (DOD), was not prepared to 
have their DD 214s, and their VA records show this direct 
combat activity. As we all know, Post-Traumatic Stress Disorder 
(PTSD) and other injuries occurred during their operations. In 
fact, put them in a special category of people, mostly men, but 
310 women. Currently without a designation, these 300-plus CSTs 
find themselves being treated as noncombat individuals, not 
recognized along with their counterparts. In a perfect world, I 
guess we would simply update all of them to say that they were 
men. Since that is not in the making here today, let us simply 
say that this Act designates them in a way, in a one-time way, 
effectively, but a model for the future, to make sure that 
women are recognized and treated for their combat activities 
equally.
    This is a bipartisan effort with more than 25 cosponsors. 
To say the least, we could have gotten more cosponsors, but our 
goal was to keep it simple. This is something where we can cure 
a wrong by simply having a designation.
    I want to close with just one thing. Many of you probably 
are aware that Congressional Budget Office (CBO) decided there 
was a score. I ask you, if there has ever been a time in which 
to look at CBO and roll your eyes, it would be this one. These 
women are entitled to what they are to receive, and if there is 
a change in what they receive, it is not a score. It is evening 
a score, making it right. I thank you for your indulgence and 
for moving this legislation. I yield back.
    Mr. Luttrell. Thank you, Ms. Spanberger, forgive my 
absence. Mr. Issa, having been part of the spec work community, 
working alongside women in combat, and I mean actual 
gunfighting combat, I support everything that you are doing. I 
just wanted to add that. Mr. Ciscomani, you are recognized, 
sir.

                  STATEMENT OF JUAN CISCOMANI

    Mr. Ciscomani. Thank you, Mr. Chairman. I appreciate it, 
and my fellow members of the subcommittee for convening today 
to discuss my bill, H.R. 5938, the Veterans Exams Expansion Act 
of 2023.
    I represent southeastern Arizona, including parts of the 
Tucson metropolitan area, but also very rural areas in Cochise 
County, Graham County, and Greenlee County, which borders New 
Mexico. Veterans in our rural areas have historically had 
issues with access to care and benefits due to the lack of 
resources nearby. This bill aims to close those gaps by 
extending the license portability that VA-certified 
practitioners currently have and also expands this authority to 
dentists, optometrists, and so on. This authority helps 
veterans who may have difficulty getting to a VA facility or a 
contract facility for their exams because of their disability 
or because of the rural area in which they live.
    We must meet our men and women who serve our country where 
they are, and it is in Congress' responsibility to ensure that 
the VA has the authorities they need to do so. I urge all my 
colleagues to support this legislation. I yield back, sir.
    Mr. Luttrell. Thank you, Mr. Ciscomani. As is our practice, 
we will forego a round of questioning for the members. Any 
questions may be submitted for the record. I now invite our 
second panel to the table. In accordance with committee rules, 
I ask unanimous consent that Representatives Issa of California 
be permitted to participate in today's subcommittee hearing. 
Never mind, he left.
    Everyone ready? All right. Joining us today from the 
Department of Veterans Affairs is Ms. Beth Murphy, Executive 
Director of Compensation Services at the Veterans Benefits 
Administration (VBA). She is accompanied by Mr. Kevin Friel, 
Deputy Director of Pension and Fiduciary Services at the 
Veterans Benefits Administration and Mr. Kenneth Arnold, the 
Vice Chairman of the Board of Veterans Appeals.
    I ask all witnesses, please stand and raise your right 
hand.
    [Witnesses sworn.]
    Mr. Luttrell. Please be seated. Thank you. Let the record 
reflect that all witnesses answered in the affirmative. Ms. 
Murphy, you are now recognized for 5 minutes to present the 
Department's testimony.

                    STATEMENT OF BETH MURPHY

    Ms. Murphy. Thank you. Good afternoon, Chairman Lutrell, 
Ranking Member Pappas, and members of the committee. Thank you 
for the invitation to discuss our views on pending legislation. 
Thank you for introducing my colleagues Mr. Friel and Vice 
Chairman Arnold from the Board of Veterans Appeals.
    VA offers support for much of the proposed legislation 
before us today. We have provided detailed comments in the full 
testimony to include areas of support and concern, along with 
noting certain provisions that could be clarified or amended in 
the text of the bills. We look forward to collaboration with 
the committee on those provisions.
    I will briefly highlight key points on each. First, VA 
supports H.R. 4016, the Veteran Fraud Reimbursement Act, which 
would streamline reissuance of benefits in fiduciary misuse 
cases, enabling timelier repayment of misused funds to veterans 
and their survivors.
    VA supports the intent of H.R. 1753 to ensure proper 
recognition of veterans combat service. However, we cite 
concerns with specific elements and have provided feedback in 
our testimony for the committee's consideration.
    VA appreciates the aim of H.R. 3790, which would amend 
existing law to extend increased indemnity and--dependency and 
indemnity compensation paid to surviving spouses of veterans 
who died from ALS, regardless of how long the veteran had such 
disease prior to death. VA supports this bill but requests 
amendment to include criteria for determining whether a 
disability has a high mortality rate.
    Moving to H.R. 4190, the Restoring Benefits to Defrauded 
Veterans Act, this bill would address reissuance of misused 
benefits in cases where reissuance did not occur prior to the 
beneficiary's death. VA supports the bill if amended. We have 
highlighted our concerns and suggestions in the written 
testimony.
    Regarding H.R. 4306, the Michael Lecik Military 
Firefighters Protection Act, this bill represents a veteran 
centric approach to addressing health effects related to 
firefighting during active military service. VA supports this 
bill if amended. We recommend changes to enhance administrative 
efficiencies and ensure fairness and equity, such as removing 
some of the qualifying requirements.
    VA supports the intent of H.R. 5938, the Veterans Exam 
Expansion Act, to improve temporary licensure requirements for 
contract healthcare professionals performing medical disability 
exams for VA and for other purposes. VA would advocate to 
remove the license portability sunset date and expand the 
definition of a healthcare professional.
    VA appreciates the intent of H.R. 5890 to preclude VA from 
denying a claim for benefits solely because the veteran failed 
to appear for a VA medical exam scheduled in connection with 
the claim. However, we do have some concerns, including the 
effect the bill may have on practices of some in the for-profit 
disability benefits questionnaire completion industry. We 
provided additional details in the testimony and welcome 
opportunity to discuss those concerns with the committee.
    Regarding H.R. 5559, the Protecting Veterans Claims Options 
Act, VA cites concerns with part of the bill and does not 
support other provisions. In particular, VA is concerned that 
the bill would negatively impact progress made since 
implementation of the Appeals Modernization Act by rolling back 
some of that law's key provisions. We welcome opportunity to 
discuss the bill further.
    Moving to H.R. 5870, the Veterans Appeals Transparency Act 
of 2023, this bill aims to improve processing for claims for 
benefits by VA and transparency of actions by the Board. VA is 
committed to make ongoing improvements to these programs. 
However, the intent of some of the proposed language is 
unclear. VA does not support the bill unless amended. We have 
provided specific comments in the testimony for consideration.
    Last, VA does not support H.R. 5891, the Veterans Appeals 
Decision Clarity Act, for several reasons outlined in our 
testimony, including that the bill would add significant delays 
to appeals processing timelines, increase the appeals backlog, 
and result in confusion among veterans.
    In closing, thank you again for the opportunity to discuss 
this important legislation to improve benefits and services for 
veterans, service members, survivors, and their families. We 
look forward to working with you and are prepared to respond to 
your questions.

    [The Prepared Statement Of Beth Murphy Appears In The 
Appendix]

    Mr. Luttrell. Ms. Murphy, thank you for your testimony. We 
will now move into a line of questioning. Mr. Arnold, good 
afternoon, sir. VA testimony states that the Veterans Appeals 
Decision Clarity Act would add significant delays to appeal 
processing timelines, but the Board judges should already know 
the time periods during which untimely evidence was submitted 
and therefore cannot be considered. Why do you think the 
general statement that my bill would add significant delays to 
the Board issuing a decision?
    Mr. Arnold. Yes, sir, thanks for asking that question. 
Basically, the Board opinions have grown in length based on the 
procedural requirements. I mean, in some cases, they are as 
long as a Supreme Court opinion. In this case, what happens is 
when a veteran chooses under AMA to come to the Board, there is 
an evidentiary window. Either they come in clean, everything 
that VBA, for instance, considered is the record, consider 
that.
    Mr. Luttrell. We can make believe that no veteran is going 
to come in clean. It is not in the cards, I do not think, but 
anyway.
    Mr. Arnold. Sir, actually about 45 percent right now choose 
that option, consider what VBA had, and just make a decision 
judge. Then another percentage of the people say, hey, I got 90 
days to offer additional evidence. They can add 90 days to add 
or get delays on that. Or they can request a hearing, at which 
time they can offer evidence at the hearing plus 90 days after 
that.
    One of the challenges here is in the waiting period, for 
instance, for a hearing or for the court to get to the 
decision, very often the veteran will send in news articles or 
even thousands of pages of information for the Board to 
consider, but it is outside those evidentiary windows. I am 
worried that a requirement like this would cause so much 
administrative burden to identify the time period that we 
received it and why it could not be considered that it turns 
into essentially a gotcha exercise. You put the wrong date, and 
then it is a basis for remand from the court.
    Mr. Luttrell. The legislation is trying to streamline the 
process.
    Mr. Arnold. Yes, sir.
    Mr. Luttrell. For more or less what I am understanding you 
are saying is the veterans overloading the system with 
arbitrary, superfluous material that does not need to--is that 
the case?
    Mr. Arnold. Not intend----
    Mr. Luttrell. For us, we are trying to streamline it so the 
veterans are taken out of the equation once it enters into the 
VA system.
    Mr. Arnold. Yes, sir.
    Mr. Luttrell. I find it hard to believe through all the 
Inspector General (IG) investigations that I have sat in front 
of today that it is on the veterans, it is the veteran's fault, 
and not--I am going to throw this one at you--and not the VA's 
lack of ability to create a structured environment to process 
the applications appropriately.
    Mr. Arnold. Not at all, sir. The concerns that we are--
first of all, I am going to say that the Board makes mistakes 
all the time. We are human. This is not an issue of the veteran 
complicating the system. The veteran is trying to just get as 
much information to VA as possible on their claim. When you----
    Mr. Luttrell. The VA is hand-walked through this process by 
all the VA staff, correct? More or less from start to finish.
    Mr. Arnold. Yes, sir. Yes, sir.
    Mr. Luttrell. I do not really say that we cannot put the 
veteran in the position that it is their fault. I hate to say 
that----
    Mr. Arnold. Sure, it is----
    Mr. Luttrell [continuing]. but they are not trained in law 
and they are not the judges and they are not the Board.
    Mr. Arnold. No, sir. I am not saying that at all. The 
overwhelming majority, almost all veterans come in represented. 
They get free representative.
    Mr. Luttrell. Sure, yes, sir. I got it, yes. I got it.
    Mr. Arnold. They are being guided through the process. What 
happens is we provide direct interface with veterans even when 
they are represented, and they will send us information via the 
mail. It is often duplicative. I saw this news article in the 
Veterans of Foreign Wars (VFW) magazine, I wanted to share 
that. It is about Agent Orange. It is a whole bunch of 
information that the Board cannot consider because the choice 
that they made when they came into the Board with their 
representative on how they wanted us to review the case, this 
is a bunch of extraneous information that if we had to call it 
out specifically in our opinions and list each of those pieces 
of evidence and talk about when we received it and why we 
cannot consider it, we are adding a lot of burden.
    Mr. Luttrell. The challenge that comes into that and where 
I have a problem is on my side, not only as Member of Congress, 
but as a veteran, is that if the more information that I gather 
from your side, the better off I am going to be, or they are 
going to be. I find it troublesome that there is more or less 
an irritability that providing the veteran themselves with more 
information, and that may be two sentences, it may be three, 
and I do not know.
    Mr. Arnold. Yes, sir.
    Mr. Luttrell. Again, you shoulder a very heavy rucksack, 
okay? Having answers, this is something I hear from my veterans 
all day, the more information I can have from those that I am 
engaging with, the better off I am going to be in order to 
solve my problem. If I just receive a letter in the mail from 
the VA that says, hey, you have been declined.
    Mr. Arnold. Yes, sir. That is----
    Mr. Luttrell. That is where this piece of legislation 
cleans the process some.
    Mr. Arnold. Yes, sir. One of the most robust, the most 
robust decision you are going to get out of the Board is if we 
are denying, because we have to provide the reasons and bases 
for why we are denying your appeal.
    Mr. Luttrell. That is important, yes?
    Mr. Arnold. Super important.
    Mr. Luttrell. The veteran needs to know that, correct?
    Mr. Arnold. They absolutely do.
    Mr. Luttrell. Okay.
    Mr. Arnold. Absolutely. Sir, as a 30-year veteran and as 
somebody who is the beneficiary of getting our sole income as a 
family when I was growing up was my dad's 100 percent 
disability benefits and related, like, free milk free lunch 
program, this is super important to me. It is why I am at VA. I 
really I love what we are trying to do with these things for 
how we can benefit the veteran. This is one that I am so 
worried it is just going it is going to slow down how we do our 
decisions. It is going to create complexity in the appellate 
space with the courts. I know some people probably have 
questions about that. That is going to be gotcha exercises that 
just contribute to the churn and keep more people waiting in 
line. That is my biggest concern.
    Mr. Luttrell. Yes, sir. All right.
    Mr. Arnold. Yes.
    Mr. Luttrell. I will circle back. My time is up. I yield to 
the ranking--excuse me--I recognize the ranking member for his 
line of questioning.
    Mr. Pappas. Thank you, Mr. Chairman. Ms. Murphy, if I could 
start with you on H.R. 4306. This is the Michael Lecik 
legislation that Representative Spanberger spoke about before. 
This would establish a service connection based on a specific 
occupation, which is a first, I believe, as opposed to dealing 
with specific service dates and locations. It is based on what 
we know to be true, where firefighters are exposed to toxic 
substances, including PFAS, through their work, and creates 
presumptives around that. You mentioned that you could support 
this legislation if amended. Could you explain a little bit 
further what you mean by that and how you would like it to be 
changed?
    Ms. Murphy. Thank you, Ranking Member Pappas. This is 
really a veteran centric bill, as I mentioned before. What we 
have seen when we are talking about actual claims processing, 
the more complexities that you add to a process, the more 
difficult it can be to navigate for the claims processors and 
to get to yes for the veteran. In particular, the requirements 
for a 10 percent minimum evaluation, the 15-year disease 
manifestation period, and the aggregate of 5 years, adding up 5 
years of service in that particular occupation are some of 
those complexities that would make this more difficult, 
potentially, for our claims processors.
    Stripping out those requirements that way, we are not 
hunting for additional records, it looks like this person was 
in 4 years and 2 months. We need, you know, 10 more months. 
Those are the sorts of changes that we are advocating, is strip 
out those complexities and just make it more streamlined for 
our claims processors and for the veterans.
    Mr. Pappas. Okay. Can you address the broader issue about 
PFAS exposure? I know we have got hundreds of military bases 
around the country where there is PFAS contamination that our 
service members have been exposed to. We are talking about 
drinking water near or on military installations. How can VA 
address this challenge if we do want to move in this direction 
of ensuring that people get access to care and benefits through 
their service who have been exposed to these substances?
    Ms. Murphy. Certainly, sir. This is a great start, Congress 
putting this presumptive in place. I will tell you that we on 
the benefits side have been working increasingly more with our 
VHA partners in the health outcomes, military exposure, or home 
office, who they are doing the surveillance, the research, 
studying the PFAS issue. It is an important one, and I think it 
is coming to a head, but certainly not fast enough. This bill 
would move us forward faster on a topic that is recognized, is 
being researched, but is just not there yet on the VA side.
    Mr. Pappas. Okay. Switching gears to H.R. 3790, this is the 
ALS Veterans Act legislation that Representative Slotkin has 
introduced. You mentioned that you would support this if it was 
modified to include criteria for determining whether a 
disability has a high mortality rate. I am wondering what 
criteria VA uses to determine if a service-connected disability 
has a high mortality rate currently and how these criteria 
could be incorporated to ensure consistency moving forward as 
we consider this legislation.
    Ms. Murphy. Chairman--I am sorry, Congressman, I am going 
to turn to my colleague, Mr. Friel----
    Mr. Pappas. Thank you.
    Ms. Murphy [continuing]. who is the expert in this matter.
    Mr. Friel. Yes, thank you for the question. To clarify the 
ALS, today if a veteran passes away from ALS, the surviving 
spouse is entitled to DIC because we have made that connection. 
What this law will do, what this proposed bill will do, is 
allow us to pay them the additional eight-by-eight, which is 
where we identify that a veteran was 100 percent for 8 
consecutive years and the spouse was married to them for that 
timeframe, and pay the additional, like today, it is $313 in 
benefit.
    Where we talk about the high mortality rate, our concern 
is, is that it is not just about mortality, right? I guess it 
is about speed. I am not trying to be cold hearted, but speed 
to death, right? From onset of the disability to when the 
beneficiary passes away. We know ALS is a rapidly progressing 
disease and does not give the veteran potential to meet that 8-
year period. That is kind of where we are trying to look at the 
requirement for the high--the definition of the high mortality 
rate as it relates to a disability that is, you know, has a 
short lifespan from onset to the potential death of the person
    Mr. Pappas. Well, I guess my question is, should not we be 
supporting the work that VA clinicians and researchers are 
doing around that, as opposed to Congress making a 
determination?
    Mr. Friel. Yes, and we were just kind of looking for 
clarity on Congress's intent. Is it 5 years, is it 7 years? You 
know, like what is the actual timeframe that we would be 
looking at where we consider it a high mortality rate?
    Mr. Pappas. Okay. Well, maybe we can keep working to refine 
that. I appreciate the flag. Yield back my time.
    Mr. Luttrell. Thank you, Mr. Pappas. Chairman Bost, you are 
recognized for 5 minutes, sir.
    Mr. Bost. Thank you, chairman. Ms. Murphy, with the AMA, 
the supplemental claim option was intended to allow veterans 
the option for filing additional evidence for their claim. 
Under the current law, when VA decided that the veteran did not 
file a new and relevant evidence, VA refuses to issue the 
decision on the claim for the benefits. Now, this effectively 
has forced thousands of veterans to start the claims process 
all over again. How do you think my bill would ensure that the 
veterans receive a decision on their VA claim that they can 
then appeal?
    Ms. Murphy. Chairman Bost, if I could make kind of an 
overarching statement about many of these are appeals-related 
bills. I think VA's position is that we certainly want more 
clarity.
    Mr. Bost. Right.
    Ms. Murphy. We want it to be more streamlined, easier to 
understand, simplified. AMA has been in progress now for, you 
know, 5, 6 years. We have learned from that. I think the 
process that we used to create the AMA legislation was one of 
the most solid that I have heard great feedback from 
stakeholders. The fact that folks got to come to the table, be 
heard, give their perspectives, and really contribute to a 
holistic change from a system that was not working for 
anybody----
    Mr. Bost. Right.
    Ms. Murphy [continuing]. VA or veterans.
    Mr. Bost. It was not working.
    Ms. Murphy. I think to the extent that we can continue that 
forward movement----
    Mr. Bost. Mm-hmm.
    Ms. Murphy [continuing]. collectively, rather than having 
maybe one-off changes and tweaks to the process, would be what 
VA would support more.
    Mr. Bost. Okay.
    Ms. Murphy. Does that makes sense?
    Mr. Bost. Let me say this, because you know how much I was 
involved with this.
    Ms. Murphy. Yes, absolutely.
    Mr. Bost. Let me say that. Then I am going to ask Mr. 
Arnold a question as well. Like any legislation, once we put it 
in place and then we start implementing, we see how different 
agencies, it is not doing everything that we want. That is why 
we tweak. It is, and it was our concern the long, long, long 
wait times, and we do not want to tweak and cause those long 
wait times to come back. We also know where we have seen the 
flaws.
    As we are trying to work through this, it is for the 
veteran that we are trying to make the decision so that their 
claims can be handled. There has to be--the frustration that a 
person could feel if all of a sudden they said, okay, I have 
got new evidence, and now all of a sudden it just gets dropped 
and we are going to start the whole thing over again. That is 
the frustration we feel.
    Mr. Arnold, I am going to ask you something here. In your 
testimony, you suggested the veterans would file more appeals 
with the court simply to add additional evidence that would 
further delay the final resolution of the appeals that they 
originally filed. I just want to let you know I disagree with 
that, okay? They do not file Appeals Court to prolong their 
claim. They are wanting to get their claims taken care of. They 
want a final, correct decision on their claim from the Board. 
After the court sends a claim back to the Board, veterans 
cannot file additional evidence to the Board. Their only option 
is start new claims process all over again with VBA. Why do you 
think the focus is on returning the claim to VBA to look to 
additional evidence rather than making the Board--making it so 
sure that the Board can consider evidence when it is fixed--
when it is just fixing a mistake that they may have caught?
    Mr. Arnold. It is a great question, sir. I started on the 
day that--I started on the day that--I am button-challenged. 
Sorry, sir. I started on the day that AMA was implemented fully 
in 2019. I was not at the table in 2017 when all of the sausage 
making happened. As I understand it and the evidence is proving 
this, that there was a--in all of the debate amongst the 
stakeholders, it was a really important facet of what I think 
is incredible legislation under AMA. As a veteran, I am so 
proud of that. I mean, you built a four-lane highway.
    Mr. Bost. I am too.
    Mr. Arnold. Yes, you built a four-lane highway and but we 
are not recognizing is all the tractor trailers that are on it. 
I got that analogy from our new chairman when he started a year 
ago when we were educating him, he goes, this is a beautiful 
four-lane highway. There is all these tractor trailers that are 
blocking progression.
    I would view what we are trying to do here in a piecemeal 
fashion is it is time for people to step back and look more 
holistically. This part of the legislation that is proposed 
would add a new 90-day window when one important facet that 
everybody agreed to with AMA for accountability purposes is the 
evidence and information that was considered by VBA, that is 
what the Board looks at. Thumbs up, thumbs down. Did you get it 
right because you said no. We added a kicker as part of the 
compromise, you can have 90-day windows at the Board if you so 
choose to supplement it. You got something else you want to 
tell us after getting that no from VBA. It was, I am looking at 
the case plus what you want to add.
    Then we make our decision. It is only going to the court 
really, if we denied it, although that is not always true 
either. If we deny and we give the reasons and basis for why we 
have to deny, it comes back from the court oftentimes to say, 
explain further. The court's looking at the case that the Board 
looked at. Here, we would be talking about now it is an 
entirely new case. I am going to be honest, given the passage 
of time, sir, for how long this whole process takes with the 
court, and something that I am really glad you are pointing 
out, what happens is when it comes back to the Board, the 
condition's often gotten worse. It is a new case. Somebody has 
been waiting an extra 2 years. Now, their foot's numb from 
their back, and it was not 2 years ago when they were at the 
Board.
    The challenge with that is then there is new medical 
evidence that really, we are not supposed to play doctor at the 
Board. We can evaluate the evidence that does come in, but 99 
times out of 100, we are going to have to say, we got to send 
this back to VBA anyway to have them evaluate this new set of 
conditions that the veteran is facing. That is what I am 
worried about, because we very liberally grant delays when 
people need evidence for good cause, and it is not uncommon to 
see multiple additional delays. I want the veteran to get the 
fastest decision they can. If the Board gets it wrong, heck, I 
want the court reverse it and grant. Please, do not make these 
veterans wait any longer. I am with you, sir.
    Mr. Bost. Okay.
    Mr. Arnold. Our concern with this was it is adding delays 
and we actually cannot really solve it in most cases then.
    Mr. Bost. I am out of time, but we will talk more about 
this, I guarantee it.
    Mr. Arnold. Yes, sir.
    Mr. Bost. I yield back.
    Mr. Luttrell. Thank you, Chairman Bost. Mrs. Ramirez, you 
are recognized for 5 minutes.
    Ms. Ramirez. Thank you, Chairman Luttrell. You really are 
committed to making sure that we experience how it feels 
physically on the other side. I appreciate the seating chart 
here.
    I want to transition and first to say thank you to the 
witnesses that are here today. I also want to talk about the 
importance of uplifting and amplifying the contributions of 
women, women veterans. Even as a Member of Congress, look 
around, I find myself often being the only woman in the room on 
this side. Certainly, in many more cases, the only Latina. I 
think it is important to acknowledge that and how critical it 
is for us to be in these spaces, certainly for me to be able to 
serve my community.
    While I know that our women in uniform do not serve for 
recognition, their sacrifices and their contributions are too 
often overlooked. That is why it is so important that our 
service women and their contributions to our country and our 
communities are uplifted and truly recognized. Ms. Murphy, I 
first want to ask you a quick question around the cultural 
support team program. Can you describe how important the 
cultural support team program is to achieving the U.S. military 
objectives?
    Ms. Murphy. Thank you for the question. We have been in 
initial conversations with the Department of Defense, our 
colleagues in DoD, about what this cadre of service persons 
did, what their roles were. We are still in those early 
learning phases. We are in that gathering information from DoD 
to understand what their role and missions were.
    Ms. Ramirez. Okay. Well, can you describe how important it 
is that those service women be fully recognized for their 
engagement in combat in order to receive the benefits and care 
that they have earned?
    Ms. Murphy. We go out of our way, we bend over backward 
every claim we touch, we look at all the facts and 
circumstances, we take the evidence into consideration. 
Sometimes in cases maybe such as this, when all of the 
information is not there that we need to demonstrate what that 
service member did, where they were, what may have happened to 
them during service, that is where we are kind of hamstrung in 
the claims process. The more transparency that we could have 
and the more information about this cadre of individuals, we 
would be better positioned to assist.
    Ms. Ramirez. Got it. A couple of yes or no questions.
    Ms. Murphy. Yes, ma'am.
    Ms. Ramirez. Thank you for your response.
    Ms. Murphy. Mm-hmm.
    Ms. Ramirez. In your opinion, have service women been 
historically not fully recognized?
    Ms. Murphy. I do not have an opinion on that. We just take 
each case by case and we process the claims----
    Ms. Ramirez. Okay.
    Ms. Murphy [continuing]. and proceed that way.
    Ms. Ramirez. Let me ask you a follow up.
    Ms. Murphy. Yes, ma'am.
    Ms. Ramirez. This is also yes or no, and maybe you could 
answer yes or no in this case. Do you think this is something 
that the VA should actively work to correct to make sure that 
service women are fully recognized?
    Ms. Murphy. Yes. We should do everything we can to gather 
all the necessary information so that we can say yes on every 
case that we encounter that we are able to.
    Ms. Ramirez. Yes. Well, thank you so much, Ms. Murphy. 
During my time in the committee, one of my priorities has been 
to address fraud and waste at every level, from education to 
veteran benefits. We certainly have to strengthen the 
protection of our most vulnerable communities, and that 
includes veterans. Ms. Murphy, your testimony provides that 
this bill will enable timelier reissuance of misused benefits 
to veterans and their survivors and enable more effective 
application of VA resources toward more productive methods of 
oversight to protect beneficiary funds.
    Let me ask you a follow-up question. In Fiscal Year 2022, 
there were only 25 investigations into fiduciary misuse opened 
and referred for prosecution. Of those 25, eight cases were 
declined for prosecution. Are all instances of misuse by 
fiduciary intentional?
    Ms. Murphy. Ma'am, if I could turn to my colleague, Mr. 
Friel. He is the subject matter expert here. Thank you.
    Ms. Ramirez. Great, thank you.
    Mr. Friel. Thank you for the question. No, not all issues 
or circumstances of misuse are intentional. In some cases, we 
find that, you know, the individual just made a mistake. They 
withdrew money from an account, you know, used the wrong debit 
card, or things like that. We work with them to correct it and 
identify the circumstances. I do not know, is that the 
question?
    Ms. Ramirez. Yes, no, that is helpful. I mean, just in my 
last 20 seconds, I mean, how are funds that were negligently 
misused recovered?
    Mr. Friel. We actually create a debt for them that is 
transmitted out, you know, and we give them an opportunity to 
repay. If we are unable and unsuccessful with that, we transmit 
that debt to Treasury, and then Treasury does their piece in 
garnishing, you know, tax returns or other assets to collect 
that debt.
    Ms. Ramirez. All right. Well, thank you, Mr. Friel. With 
that, I yield back. Thank you, Chairman.
    Mr. Luttrell. Thank you, Mrs. Ramirez. Mr. Self, you are 
now recognized for 5 minutes.
    Mr. Self. Thank you, Chairman. I have heard a great deal 
here about concern about adding to the VA workload. I am 
addressing my H.R. 5870, Veterans Appeals Transparency Act of 
2023. Mr. Arnold, is it true that the law requires the Board of 
Veterans Appeals to issue decisions in docket order?
    Mr. Arnold. Yes, sir.
    Mr. Self. Does that mean that the Board is already 
carefully tracking and selecting the range of dates of cases 
for each docket, each Board docket that are being assigned to 
veterans law judges for a decision at any one time, you are 
tracking it at any given time?
    Mr. Arnold. We know what we are distributing for cases at 
any given time, sir. The pace at which they are decided when 
they are with the judge, there is some variability on that. 
Yes, sir.
    Mr. Self. Got it. Given those two answers, can you 
elaborate on why your testimony states that it would be 
administratively burdensome to simply publish what the Board is 
already doing?
    Mr. Arnold. Yes, sir. Administratively burdensome, but 
actually our greater concern, even though it says that is how 
confusing it would be for the veteran, which is why I go to 
the----
    Mr. Self. That is my next question, so----
    Mr. Arnold. Oh, yes, sir. Okay. Let me go to administrative 
burden----
    Mr. Self. Right.
    Mr. Arnold [continuing]. first of all, sir. I am going to 
tell you that the line is changing at every moment of every 
day. To understand how appeals move through the Board in docket 
order, there is a bunch of exceptions to that. In any given 
year, let us say we do 100,000 decisions. Last year we did 
103,000-plus. One hundred thousand decisions every year, 30 
percent of those, so 30,000, are advanced on the docket. We get 
notified this veteran moved to hospice. This veteran's----
    Mr. Self. Well, let me----
    Mr. Arnold [continuing]. stage four. They jump to the head 
of the line. Yes, sir.
    Mr. Self. Let me stop you stop you there. How far do they 
move?
    Mr. Arnold. They move to the head of the line.
    Mr. Self. To the head of the line?
    Mr. Arnold. Yes, sir. Every time I have got somebody who is 
like, say, a stage four, they move to hospice. They are at end 
of life, over the age of 75, very advanced age. They are--there 
is a motion, or on the Board's own motion, they are moving to 
the head of the line in the fast pass lane.
    Mr. Self. How often do you publish them now?
    Mr. Arnold. In terms of what we are doing with dockets?
    Mr. Self. Yes.
    Mr. Arnold. What we are doing now, sir, is because the 
range might be 10 years in a given week, I could be doing a 
case that has a 2004 date and a date--all right, well, yes.
    Mr. Self. Well, how often do you publish?
    Mr. Arnold. We publish monthly. We update our average days 
to complete them and average days that cases have been pending 
by docket.
    Mr. Self. Okay. I am still not following why it would be 
burdensome if you took a weekly update or whatever, but let us 
move to the----
    Mr. Arnold. Yes, sir.
    Mr. Self [continuing]. misleading. I assume it is because 
of the changes that you are talking about.
    Mr. Arnold. Yes, sir.
    Mr. Self. I accept the fact that you might have 30,000 in a 
year, did you say?
    Mr. Arnold. Yes, sir.
    Mr. Self. That move to the head of the line. Would it not 
then be possible to have a separate category of them that you 
notify them as opposed to simply publishing? I got the issue.
    Mr. Arnold. Yes, sir. What--the better way to explain this 
is it is 30 percent----
    Mr. Self. I do not want the outliers to drive the entire--
--
    Mr. Arnold. Yes, sir.
    Mr. Self [continuing]. system.
    Mr. Arnold. Yes. That is 30 percent of what moves in the 
line. I still got 200,000 in line at the end of the year----
    Mr. Self. Correct.
    Mr. Arnold [continuing]. which is unconscionable to me. 
Then there is another 15 percent that come back from the court. 
They go to the head of the line by law. By law, they must be 
expedited. That is the second category. Now I am up to 45 
percent. Then everything that has to go back to VBA, either as 
a pass-through remand from the court, or because we say I 
cannot call this thumbs up or thumbs down. This needs a new 
exam. You did not have a duty to assist. That is another 25 
percent. 70 percent of what we put out every year essentially 
cuts the line.
    Mr. Self. Okay.
    Mr. Arnold. That is happening constantly.
    Mr. Self. Okay. I----
    Mr. Arnold. Yes, sir.
    Mr. Self [continuing]. I have got that. If you did it, then 
the next question is, once they jump to the head of the line, 
how long is it before they get heard?
    Mr. Arnold. Again, it depends on how many the judge can 
decide. Right now, we are deciding on average of, say, 2,000 to 
2,200 cases a week.
    Mr. Self. Per judge.
    Mr. Arnold. No, sir, at the Board.
    Mr. Self. Ah-ha.
    Mr. Arnold. Yes, sir.
    Mr. Self. We have whittled it down quite a bit. I still 
think, and I have got 25 seconds, from this discussion, you 
have enlightened me, and I appreciate your answers.
    Mr. Arnold. Yes, sir.
    Mr. Self. I think we can do a better job. That is what this 
bill does. Now, I have not even gotten to the other issue in 
the bill, but great discussion, I think we can do a better job 
in the bill of making it transparent to the veterans. I yield 
back.
    Mr. Arnold. Yes, sir.
    Mr. Luttrell. Thank you, Mr. Self. Mr. McGarvey, you are 
recognized for 5 minutes, sir.
    Mr. McGarvey. Thank you, Mr. Chairman. To switch gears just 
a little bit here and appreciate what you guys are doing. Also, 
you know, thank you all. One of the things I try to say at 
every committee hearing is this committee is united in its 
effort to protect our veterans. I think we do share the common 
mission of making sure that the men and women who put on a 
uniform to take care of us, that we are doing everything we can 
to take care of them, that we are doing everything we can, just 
as when they go in, as when they come out.
    One of the things we know is that in the Veterans Board of 
Appeals, we are dealing with our veterans who are out of the 
service, but we are taking care of them, right? The people who 
are taking care of them are in a way still part of the VA, 
still on their active-duty tour. In order to make sure that we 
are properly taking care of our veterans, we have got to make 
sure that we have enough people within the veteran system who 
are qualified and ready to take care of them.
    One of the things I am worried about is the adjudication of 
appeals and making sure that those appeals are adjudicated 
correctly because I do not think any veteran should ever have 
their earned benefit taken away from them. I know you guys 
probably share my feelings on that. While there are several 
bills on the agenda today aiming to enhance service and 
transparency at the Board of Veterans Appeals, I want to 
highlight that there is not a bill to improve the recruitment 
and retention of the board of attorneys who are on the front 
lines of moving those veterans claims forward.
    Again, we are taking care of our veterans. They have done 
their tour. They have earned this benefit. We have people right 
now taking care of them who are still on the front lines and 
need help. The Board of Veterans Appeals currently faces a 7 
percent attrition rate in board attorneys, which is well above 
the average in the Federal workforce. This is why I found it 
surprising that the Board downgraded the full performance level 
of board decision writing attorneys hired after November 2021 
from GS-14 to GS-13. For such a small but critical subsection 
of the VA workforce, with fewer than 1,000 decision-writing 
attorneys, it seems like a misstep not to fully compensate our 
public servants and have the best tools at our fingertips to 
attract the top talent for our veterans. Again, these are the 
people who are processing these claims to make sure our 
veterans get the benefits they deserve.
    Mr. Arnold, what can this subcommittee do to help address 
this counterproductive policy to improve recruitment and 
retention at the Board, which is going to make sure that 
veterans, including those in Louisville, including those in 
Kentucky, who are waiting for appeal decisions, have their 
appeals handled quickly by the best and by the brightest?
    Mr. Arnold. That is a great question, sir, and I am really 
glad you asked it. First of all, I am proud that in the 5 years 
I have been at the Board, the attrition rate for attorneys has 
dropped from 13.9 percent in Fiscal Year 2018, that is what I 
inherited, to 7.4. We got a ways to go. Like you said, 7.4 is 
not acceptable----
    Mr. McGarvey. Right.
    Mr. Arnold [continuing]. to me. The one thing I just want 
to correct, sir, is we did not downgrade our attorneys from GS-
14. We did change our automatic career ladder system where 
there is an automatic, assuming successful performance, up to 
13, and then there is I am going to call it a competition, but 
not with numbers attached to it. There is essentially an 
evaluation. Are you ready to make that step as a GS-14 
attorney, where we are relying on you more than you are relying 
on us to help learn the craft----
    Mr. McGarvey. Okay.
    Mr. Arnold [continuing]. on that. This was an important 
development in our attorneys. I am going to say the Board of 
Veterans Appeals has become really an employer of choice in a 
lot of different areas in terms of the diversity that we are 
able to hire and the scope and breadth of people we are 
attracting. Last year, our open announcement, we had 1,705 
applicants. We evaluated or interviewed 600, and almost 700 of 
them. We extended offers to about 300, and we onboarded over 
200 so far this year. We are going to rinse and repeat.
    We have got people who want to come to--we changed our 
workforce to being virtual. That was something that we really 
struggled with. Did they need to be in the office, especially 
in the early years? That is contributed to we got people all 
over the country now that are really kicking it. Our 
productivity, it shows what we are gaining from it.
    We increased our attorney ranks by 16 percent last year, so 
we are beating the attrition curve. Again, losing one is not 
okay for me. I will tell you there is some internal policy 
stuff with respect to retention. The law is already on the 
books, but we have some VA policies that we have been working 
on really hard to allow the ramp up time for attorneys where we 
do not have to make a go, no go decision as quickly on, hey, 
they are going to be able to swim here as fast as we are trying 
to move through the veterans' line. Thank you, sir.
    Mr. McGarvey. No, thank you. Thank you, Mr. Chairman. I 
yield back.
    Mr. Luttrell. Thank you, sir. Mr. Crane, you are recognized 
for 5 minutes.
    Mr. Crane. Thank you, Mr. Chairman. I was told it was going 
to be Mr. Ciscomani next, but I do appreciate you sticking me 
on this side.
    Mr. Luttrell. You are welcome.
    Mr. Crane. All right.
    Mr. Ciscomani. They went by looks, so. Mr. Crane, you were 
next.
    Mr. Crane. What did you say?
    Mr. Ciscomani. They went by looks. Yes, yes, you got it.
    Mr. Crane. Okay. Thank you. Thank you, sir.
    Mr. Luttrell. We can shift over to Mr. Ciscomani if you 
would like.
    Mr. Crane. No, no, no. I will take it now. Thank you.
    First question. I consistently receive feedback from 
veterans in my district regarding significant shortcomings in 
the VA's claims processing. These ongoing issues result in 
delays and denials for veterans, mainly stemming from 
mishandling the review of new evidence submitted by veterans 
contributing to major setbacks. Specifically, Ms. Murphy, when 
the VA recognizes a deficiency in new and relevant evidence in 
a supplementary claim, does this obligate veterans to restart 
the entire process for claiming compensation?
    Ms. Murphy. Thank you for that question. It depends on the 
case. I know that sounds like not the answer you are looking 
for. When we are looking at claims, when we are looking at 
supplemental claims, we do have two different lanes that were 
created by AMA. If you have a closed record, we go to the 
higher-level review. If there is additional evidence, that 
would be a supplemental claim. The new and relevant evidence, 
it helps us manage to work. It helps us make sure that 
actionable claims are being considered and moving forward. We 
are trying to avoid just churn or rehashing if the same or 
similar evidence is received over and over again. It helps us 
balance our resources and make sure that those actionable 
claims can move forward more quickly.
    Mr. Crane. Thank you, Ms. Murphy. What type of 
communication is the veteran receiving typically at that time 
the decision is being made?
    Ms. Murphy. There are notification letters at different 
stages. We received your claim. You have this option. This was 
the decision on your claim. Here are your options for, you 
know, higher level review, supplemental claim, appeal. There 
are follow-up letters that are sent. We also have a very robust 
call center. They are answering millions of claims a year----
    Mr. Crane. Okay.
    Ms. Murphy [continuing]. inquiries a year, and they are 
available to answer questions. I also want to give credit to 
our Veterans Service Organization (VSO) partners and other 
advocates who assist greatly in this process.
    Mr. Crane. Thank you. This is a follow up for my colleague, 
Mr. Lutrell. Mr. Arnold, VA's testimony refers to letters that 
the Board sends veterans when the Board could potentially 
reject their notice of disagreement. He was not talking about 
those letters. He thinks those letters are a good thing. What 
he is really talking about here are the letters that the Board 
administrative staff sends veterans letters actually rejecting 
their appeals. I think it is unacceptable that veterans must 
dispute those rejection letters in order to get a decision from 
a Board judge that the court can review.
    Mr. Lutrell's bill would get rid of that unnecessary hoop 
that veterans have to jump through just to get their notice of 
disagreement in front of a Board judge. His bill would ensure 
that any Board rejection of a veteran's appeal can be reviewed 
by the court, and his bill would also ensure that the Board 
will be held accountable for when it improperly rejects a 
veteran's appeal. Do you agree that when the Board improperly 
rejects a veteran's appeal, the Board should be held 
accountable for that error?
    Mr. Arnold. I absolutely do, sir, and we have a process in 
place to do that. I think there is some confusion around this. 
When a veteran, and we get, you know, thousands and thousands 
of appeals on a weekly basis, when they file their notice of 
disagreement, if it is timely or not, yes, we have 
administrative staff who are essentially hand jamming that into 
the system.
    This is where I mentioned earlier, and I really appreciate 
Chairman Lutrell's comment about mistakes and the Board being 
accountable for mistakes. Mistakes do happen.
    Mr. Crane. Absolutely.
    Mr. Arnold. That letter notices the individual, if you 
think we got this in error, please tell us, because it is then 
going to go to a Board member judge. I created an Office of the 
Clerk of the Board that is headed by a judge right now. It will 
be headed by an executive Board member with a presiding judge 
when we are done. Right now, a presiding judge is there to rule 
on that when it comes in and actually give a formal 
determination. They are not waiting for 2 years in line waiting 
for it to actually get distributed to a judge, which is one 
thing I worry about the----
    Mr. Crane. Thank you.
    Mr. Arnold. Yes, so, yes, sir.
    Mr. Crane. Real quick, what does that accountability look 
like, Mr. Arnold, when there is a mistake like that?
    Mr. Arnold. For the individual employee----
    Mr. Crane. Yes.
    Mr. Arnold [continuing]. or for the judge or what are you--
--
    Mr. Crane. Yes.
    Mr. Arnold. Sir, it runs the gamut and it just it kind of 
depends. There is actually an en banc decision that we got in 
the Kearns case that went for over 2 years up in the Court of 
Appeals for Veterans Claims, where we were notified when that 
mistake was made. We tried to immediately rectify it, and then 
went on 2 years of litigation to eventually be dismissed 
because we docketed it. We docketed that appeal. Then it 
occurred in the first week of when we were evacuating for 
COVID----
    Mr. Crane. That----
    Mr. Arnold [continuing]. at the end of March.
    Mr. Crane [continuing]. so, it really----
    Mr. Arnold. That was a----
    Mr. Crane [continuing]. does not answer to my question as 
far as accountability is.
    Mr. Arnold. That was a set of circumstances where the 
mistake that was made at the time when we were converting to 
all virtual operations at the beginning of COVID we extended a 
lot of grace to the individual that made that miscount. I think 
they were off by a day or two when they did it. In that 
particular case, there is no formal repercussions for that 
other than essentially a counting line.
    Mr. Crane. Can you give us an example of any repercussions 
or accountability that is actually that employees are held to 
when mistakes that affect veterans' lives are----
    Mr. Arnold. Sir, I would not get into personnel actions in 
this kind of forum, but I am happy to talk about that offline 
in terms of how we hold people accountable.
    Mr. Crane. Is that secret information?
    Mr. Arnold. It is not secret information, sir, but I would 
not talk about. You asked for an example on a particular case, 
and I am just I am super cautious about talking about any 
particular set of circumstances on how we handled it.
    Mr. Crane. Okay. Well, this is the VA committee, and we are 
asking about accountability. You said that you believe in 
accountability, and you said that it happens. We are just 
wanting to know, what does that look like? Nobody is asking 
for----
    Mr. Arnold. Yes----
    Mr. Crane [continuing]. an employee to be thrown in prison 
or to be----
    Mr. Arnold. Yes, sir. No, Okay.
    Mr. Crane [continuing]. you know, whipped, but.
    Mr. Arnold. Generically speaking, so we created an Office 
of the Clerk of the Board that has been now built out over the 
course of the last couple of years. It is currently headed by a 
dual-hatted executive. We are in the process of creating 
another senior executive position to oversee this function. 
There is a presiding judge who is detailed there for up to a 
year. They oversee right now this whole process. The 
administrative, from inbound operations, like you are talking 
about here, when somebody files an appeal and they are 
responsible for accountability in that whole process for how an 
appeal moves through the Board from the time it is filed until 
the time a decision goes out the door.
    I will say one thing I am the most proud of is how the 
veteran trust increases in the Board throughout that journey. 
It increases about 10 to 11 percent in trusting the Board to 
above 50 percent, which I find really incredible when we are 
only granting about a third of the time. Almost 20 percent of 
veterans say when they roll craps and they get a denial at the 
Board, when they get that final decision, they say they trust 
the Board. That is because of the way we handled it and the way 
we were accountable for ourselves and the way that we educated 
them for why it was still a no.
    I appreciate it, sir. I really do. Accountability is a big 
watchword for me.
    Mr. Crane. Yes, it sounds like a watchword, but yet, with 
all due respect, sir, it does not sound like you gave me any 
example of any accountability that, you know, any actions that 
are taken at all. Honestly, sir, that is one of the biggest 
problems with the American citizens and the U.S. Government, is 
that they feel as if there is never any accountability. I have 
been trying to ask you for the last 3 minutes, can you give us 
an example of, you know, any administrative actions, 
accountability that has been taken when mistakes are made on 
these claims and yet this panel has not heard any. That is a 
problem. Thank you. I yield back.
    Mr. Luttrell. Thank you, Mr. Crane. Mr. Ciscomani, you are 
recognized for 5 minutes, sir.
    Mr. Ciscomani. Thank you, Chairman, and thank you to the 
panel for being here. Just a few minutes ago, I talked about 
the bill, of course, and a little bit on my district. Just to 
reiterate, I serve in Arizona's 6th congressional District, 
southeastern Arizona, and I have over 70,000 veterans in my 
district, two military bases, both in Tucson, the Davis-Monthan 
(DM) Air Force Base, and also in Sierra Vista, Fort Huachuca 
Army Base. Very important issue in my district.
    I have just a few questions and I am going to direct them 
to you, Ms. Murphy. The first one, how has the temporary 
authority of licensed portability granted in Isakson and Roe 
been useful for veterans in more rural areas, or those veterans 
with issues traveling to their exam appointment from the five 
counties that I serve in Arizona? Four of those are considered 
rural counties, and even the fifth, Pima County, has some areas 
that could be rural as well. Very important question for my 
district.
    Ms. Murphy. Congressman, the ability to use contract exam 
support to augment what VHA's ability to conduct C&P exams, it 
has been tremendous. It is been phenomenal. The ability to have 
that flexibility to utilize providers across state lines in 
rural areas has further enabled that support. It has been 
essential.
    Mr. Ciscomani. Thank you. Would you mind also, Ms. Murphy, 
elaborating on the VA's concern that my bill does not 
adequately cover the definition of a healthcare professional?
    Ms. Murphy. I want to clarify that we are thankful and 
appreciative of all the expansion in this area. I do not want 
to come across that we are not appreciative. I would ask my 
colleague, Mr. Friel, to expand on your question.
    Mr. Friel. Thank you. What VA is asking is that we actually 
get a little more expansion into the bill. As Ms. Murphy said, 
we appreciate the expansion that is been granted, but we would 
also like the opportunity for VA to be able to identify and 
designate, you know, specific physicians, dynamics that would 
meet the need of VA without having to have a congressional 
mandate, you know, to identify this particular physician group 
as being acceptable for VA purposes. Allow VA to do that, which 
would allow us to expedite, you know, treatment for where--when 
a condition is something that we do not yet have a physician 
that is covered for it, and allow VA to opt that particular 
group of physicians into the program.
    Mr. Ciscomani. Thank you to both. Last question, Ms. 
Murphy, how do you think talking about here the expansion and 
the extension of the license portability authority, how will 
that contribute to veterans receiving more timely and accurate 
decisions?
    Ms. Murphy. It will be a great expansion. Being able to 
identify which healthcare professional that we deem necessary 
to provide the C&P exam, any of that flexibility, any of the 
portability that comes with that, like I said before, it just 
further expands our ability to go find the veteran where they 
are. We have heard over the years concerns about veterans who 
have had to travel long distances for their C&P exam. That is 
not something that we want to put them through. Any of these 
authorities enable us to meet the veteran where they are more 
effectively.
    Mr. Ciscomani. We have got a few more seconds here, and I 
can either yield it back to my friend Representative Crane to 
continue the exchange with Mr. Arnold, but I think I will skip 
on that for a second. Although I am very interested in the 
accountability as well. I think that is essential in all that 
we do. Kind of like in the same light here, when you did this 
expansion, I think for us here, and this is part of what I 
think Mr. Crane was getting at, is important to know how this 
impacts people and give examples. Not always are we asking with 
name and last name on things, but I do think it is important 
to, when it comes down to accountability, get some guidance of 
how you usually approach these kinds of things. I think that is 
important to us to better understand and actually, to some 
extent, support whatever effort is out there so we can--but we 
need to better understand that.
    Now, in this case with Ms. Murphy, you talked a little bit 
about how this impacts and gave a few examples. Can you just 
give me in the last 20 seconds how this exactly would help, and 
maybe just a couple of examples on that.
    Ms. Murphy. So, if we are speaking still about 
accountability, sir?
    Mr. Ciscomani. No, no, I am sorry.
    Ms. Murphy. Oh.
    Mr. Ciscomani. I went back and forth. You are right.
    Ms. Murphy. Okay. I am sorry.
    Mr. Ciscomani. No, I am talking about the expansion and the 
extension of the----
    Ms. Murphy. Oh, oh.
    Mr. Ciscomani [continuing]. of license portability.
    Ms. Murphy. Certainly. I think if we could ask for, you 
know, still one more thing is expanding or taking away any of 
the sunset provisions so that we do not have to keep coming 
back and asking for extension would be also something that 
would be very helpful.
    Mr. Ciscomani. Thank you. I yield back, sir.
    Mr. Luttrell. Thank you, sir. In accordance with committee 
rules, I ask unanimous consent that Representative Trone from 
Maryland be permitted to participate in today's subcommittee 
hearing. Without objection, so ordered. Mr. Trone, you are 
recognized for 5 minutes, sir.

                    STATEMENT OF DAVID TRONE

    Mr. Trone. Thank you, Chairman Lutrell, and thank you, 
Ranking Member Pappas, for this hearing today to review 
legislation that will help support our veterans. It was an 
honor to serve on the Disability Assistance and Memorial 
Affairs (DAMA) subcommittee last Congress, and I am thankful to 
have the opportunity to testify on behalf of my bill Restoring 
Benefits to Defrauded Veterans Act. I want to thank my co-lead, 
Mr. Ciscomani, a member of this committee. Thank you for your 
leadership in advancing this bill.
    As we approach Veterans Day, we are all reminded of the 
courageous men and women who have dedicated their lives to our 
country. It is now our job to ensure we pass legislation that 
improves their quality of life and tackles the various 
challenges that they face today. Today, as a proud son of a 
World War II Navy combat veteran, I am here to shine a light on 
an issue that affects far too many of them, fraud.
    Many veterans fall victims to financial predators, online 
scams, identity theft. These veterans are then exploited out of 
their benefits that they have so rightfully earned. Last year, 
the Federal Trade Commission reported over 195,000 complaints 
from military consumers, including over 150,000 reports from 
veterans and military retirees. The military community reported 
monetary harm over $414 million of fraud, an increase of 50 
percent from the year before.
    Under current law, if a veteran passes away before their 
case is resolved, the family cannot be reimbursed for those 
lost dollars. Unacceptable. Our bill, the Restoring Benefits to 
Defrauded Veterans Act, will help those veterans and their 
families reclaim the defrauded dollars and give them access to 
the money they are entitled to. This legislation required the 
Secretary of Veterans Affairs to reissue misused benefits to 
the beneficiary's estate and costs when the beneficiary passed 
away before that reissuance.
    While we ask so much of our service members, we must never 
forget their in-service has been on the families who are there 
to support their systems back home. It is the best that we can 
do to ensure these earned benefits stay with their loved ones. 
I encourage my colleagues support this commonsense bill will 
help our vets and their families reclaim defrauded dollars and 
give them access to money they deserve. Thank you, Mr. 
Chairman. I yield back.
    Mr. Luttrell. Thank you, sir. Ladies and gentlemen, thank 
you so much. It is a heavy rucksack that you carry. We know 
that. We understand that. We listen to our veterans in our 
districts. It is our job to explain to you what we are hearing 
at our level. It is our job to provide oversight so that these 
fraudulent waters are streamlined in a way that the ship will 
sail smoothly, and it is not an easy task. The machine that you 
work for is incredible, but it is very important. Thank you 
very much for coming today. On behalf of the subcommittee, I 
thank you for your testimony and joining us. You are now 
excused. We will for a moment, and then the third panel will 
come to the witness table. Have a blessed day.
    Good afternoon. Is everyone ready to start this fun filled 
day? Outstanding. Welcome, everyone, and thank you for coming. 
Our third panel includes Mr. Shane Liermann, Deputy National 
Legislative Director for Disability American Veterans, Ms. 
Quandrea Patterson, N. Patterson, excuse me, Associate Director 
for Veterans of Foreign Wars of the United States, and Mr. 
Zachary Stolz, partner at Chisholm, Chisholm, and Kilpatrick. I 
will please ask all witnesses to stand and raise your right 
hand.
    [Witnesses sworn.]
    Mr. Luttrell. Please be seated. Thank you. Let the record 
reflect that all witnesses answered in the affirmative. Mr. 
Liermann, you are recognized for 5 minutes to present the 
testimony of Disability American veterans.

                  STATEMENT OF SHANE LIERMANN

    Mr. Liermann. Thank you. Chairman Lutrell. Ranking Member 
Pappas, and members of the subcommittee, Disabled American 
Veterans (DAV) is grateful for the opportunity to appear before 
you today and our written testimony covers the 10 bills being 
considered. However, my comments this afternoon will focus just 
on a few of these. Mr. Chairman, DAV is a congressionally 
chartered and VA accredited veteran service organization that 
provides VA claims and appeals representation to veterans and 
their families at no cost.
    H.R. 3790, the Justice for ALS Veterans Act would provide 
the DIC kicker to survivors of veterans who died due to 
service-connected ALS. If a veteran is 100 percent disabled 8 
years prior to their death, the survivors will receive an 
additional monthly DIC payment, which is commonly referred to 
as the DIC kicker.
    Individuals diagnosed with ALS usually live only 2 to 5 
years after diagnosis. Sadly, many veterans are unable to meet 
DIC's 8-year requirement for their families to receive the 
kicker. The Justice for ALS Veterans Act would provide the 
kicker to families of veterans who die due to service-connected 
ALS, regardless of the 8-year period.
    Mr. Chairman, DAV strongly supports the Justice for ALS 
Veterans Act, which is evident by the over 24,000 emails our 
members have sent to Congress in support of this legislation. 
We must ensure veteran survivors and their families receive the 
benefits they deserve and are not penalized from receiving 
increased compensation due to the rapid progression of ALS.
    H.R. 5890, the Review Every Veterans Claim Act, would not 
allow VA to deny a veteran's claim solely based on failing to 
report for a VA exam. VA will deny a claim for an increase, for 
example, based on that missed examination. Although the 
evidence of record may contain sufficient evidence for that 
increased evaluation, VBA will deny based on that failure to 
report.
    Mr. Chairman, for over 25 years as a VA-accredited benefits 
advocate, I have personally seen thousands of claims denied 
just for this reason. This is legislation that could be a game 
changer. Not only would this impact claims for service 
connection but would apply to all claims for a benefit under 
VA's jurisdiction. We believe the Review Every Veterans Claim 
Act would be applied to other claims such as total disability 
based on individual unemployability and aid and attendance. DAV 
strongly supports the Review Every Veterans Claim Act as it 
would provide meaningful reform to the claims process while 
ensuring VA's decision-making process is based on the entire 
evidentiary record.
    H.R. 5938, the Veterans Exam Expansion Act would expand 
license portability for VA contract examinations. Specifically, 
it will allow and extend the ability for certain medical 
professionals to provide VA claims exams across state lines. 
The current license portability expansion that began in January 
2021, has resulted in over 1,400 providers completing over 
150,000 medical appointments and over 425,000 disability 
benefits questionnaires. This legislation would expand the 
license portability for psychologists, podiatrists, dentists, 
and optometrists, as well as extend the authority from 3 to 5 
years, expiring in January 2026.
    Previously, DAV recommended that the license portability be 
made permanent and that all medical professionals that are able 
to conduct VA exams within the Veterans Health Administration 
be included in a permanent extension. Mr. Chairman, DAV fully 
supports the Veterans Exam Expansion Act as license portability 
has had a positive impact for veterans living in highly rural 
areas, Tribal lands, and incarcerated veterans, all while 
assisting in reducing the backlog of examinations, which has a 
direct impact on the backlog of claims. We urge swift passage 
as the current authorization expires in January 2024.
    Mr. Chairman, this concludes my testimony, and I look 
forward to any questions you and the subcommittee may have.

    [The Prepared Statement Of Shane Liermann Appears In The 
Appendix]

    Mr. Luttrell. Thank you, Mr. Liermann. Ms. Patterson, you 
are now recognized for 5 minutes to present the testimony of 
the Veterans of Foreign Wars of the United States.

                STATEMENT OF QUANDREA PATTERSON

    Ms. Patterson. Thank you, Mr. Chairman. Chairman Lutrell, 
Ranking Member Pappas, and members of the Subcommittee, on 
behalf of the men and women of the Veterans of Foreign Wars of 
the United States, to include its auxiliary, thank you for this 
opportunity to provide our remarks on legislation pending 
before this subcommittee.
    The VFW views on today's bills can be found in my written 
testimony. I will take the opportunity to highlight a few of 
them. The VFW supports the Review Every Veterans Claim Act of 
2023 that limits the authority of VA to deny a claim of a 
veteran for benefits on the sole basis of failure to appear for 
a medical examination. VA has made significant improvements to 
ensure filing for service disability compensation is easier for 
veterans. However, one of the major frustrations that remain 
for veterans is the practice of denying benefits due to a 
missed medical examination. The VFW has assisted countless 
veterans that have had to reapply for benefits because they 
fall within this category.
    Life happens to us all, and competing priorities can at 
times make it impossible for a veteran to make the scheduled 
examination. Restarting a VA claim for this reason is 
unnecessary, and veterans would benefit from a process that 
does not place so much power in a missed appointment. We look 
forward to working with the subcommittee to address our 
concerns.
    Fraudulent practices and growing scams are plaguing the 
veteran community as compensation measures are approved by 
Congress to provide for those who served and their families. 
The VFW continues to stand against predatory acts and for 
making victims whole who have experienced predatory advances.
    Our position on fiduciary matters is unchanged from 
previous testimony, but it bears repeating. The VFW supports 
H.R. 4016, Veteran Fraud Reimbursement Act and H.R. 4190, 
Restoring Benefits to Defrauded Veterans Act that seeks to 
restore benefits to veterans and their families who are victims 
of abuse or fraud by fiduciaries.
    Historically, VA could make automatic payments only when 
veterans were defrauded by their fiduciaries in certain cases. 
A provision within the Isakson and Roe Veterans Healthcare and 
Benefits Improvement Act of 2020 intended to correct this 
inequity and allow for automatic reimbursements in all 
instances of fiduciary fraud. It has also created a requirement 
for VBA to make a negligence determination and for VA to 
investigate its own culpability in all cases of fiduciary 
misuse before reissuing payments to beneficiaries.
    According to a 2021 Office of Inspector General (OIG) 
report, it took VBA an average of 228 days to complete misuse 
determinations on 40 cases. Some cases took a year or longer. 
These delays perpetuate hardship for many veterans and their 
family members who are eligible to receive these benefits. We 
support this legislation that seeks to provide relief for this 
already vulnerable population.
    The VFW supports H.R. 4306, Michael Lecik Military 
Firefighters Protection Act, to establish presumptions of--I 
mean to establish presumptions of service connection for 
diseases associated with firefighting. Many military 
firefighters report the use of firefighting foam in training 
operations and the presence of PFAS chemicals in bunker gear. 
Our members who served as military firefighters reported 
continuous exposure to these chemicals during training and 
faced a significant occupational risk due to health hazards.
    We have a suggestion to expand and improve the language of 
this legislation so all veterans exposed to these chemicals are 
provided with the care and benefits that they have earned. We 
believe that the 5-year requirement as a firefighter is too 
long, as it only takes one exposure to cause harm. 
Additionally, there should not be a time limit for when the 
veteran can file a claim, as many of these conditions manifest 
years after exposure. This legislation is incredibly important 
to prevent PFAS from becoming another situation like Blue Navy 
or Camp Lejeune, in which veterans became sick and died waiting 
decades for their conditions to be properly recognized and 
appropriately treated.
    Chairman Lutrell, Ranking Member Pappas, thank you for the 
opportunity to provide my remarks. I look forward to your 
questions.

    [The Prepared Statement Of Quandrea Patterson Appears In 
The Appendix]

    Mr. Luttrell. Thank you, Ms. Patterson. Mr. Stolz, you are 
now recognized for 5 minutes to present the testimony of the 
Chisholm, Chisholm, and Kilpatrick.

                   STATEMENT OF ZACHARY STOLZ

    Mr. Stolz. Thank you, Chairman Lutrell, Ranking Member 
Pappas, and members of the subcommittee. Good afternoon. I am 
Zach Stolz, a partner with Chisholm, Chisholm, and Kilpatrick. 
CCK is a law firm with dozens of VA accredited attorneys and 
advocates handling VA benefits claims at all levels of the 
process. I have personally spent the bulk of my career 
practicing before the U.S. Court of Appeals for Veterans Claims 
and the U.S. Court of Appeals for the Federal Circuit. I would 
like to focus my opening remarks on the procedural issues 
contained in some of the proposed bills.
    The Appeals Modernization Act has brought with it both good 
and bad so far. Good, faster decisions at the regional office, 
more choice and control for our veterans. Bad, some massive 
delays at the Board of Veterans Appeals due to complications 
for both adjudicators and veterans with simultaneously running 
procedural systems.
    H.R. 5559, Protecting Veterans Claims Option Act, would 
have a positive effect on the VA adjudicatory system. Amending 
38 United States Code Section 5108 and requiring VA to 
adjudicate all supplemental claims filed within 1 year of the 
original decision without a requirement for new and relevant 
evidence would help to advance the non-adversarial nature of 
the VA claims system. The bill also has provisions close to my 
heart as an advocate who handles cases at the Courts of Appeals 
for Veterans Claims (CAVC), the amendment to 38 U.S.C. 7113. 
This amendment would aid the thousands of veterans whose claims 
are sent back to the Board on remand from the court. The 
amendment would put AMA veterans on the same footing as their 
legacy counterparts by providing a 90-day period in which the 
appellant could submit evidence directly for Board 
consideration.
    Appellants are currently sent back to the lane from which 
the appeal originated. This process leads to a number of 
scenarios in which efficiency is reduced and it subjects 
veterans to needless shuffling around VA. Even worse, it costs 
many veterans their place in line at the Board because in the 
AMA, veterans do not retain their docket numbers once the case 
is sent back to the regional office. It may seem esoteric, but 
if the Board decides for any reason to remand a veteran's case 
back to the regional office, the veteran has to start the 
appeal process to the Board at the very end of the line.
    Given the 3-to 5-year delays at the Board that we already 
know about, this is devastating for pursuing appeals. This 
amendment to 7113 is certainly a step in the right direction 
and will help get the right issues before the right 
adjudicators at the right time.
    Speaking of Board delay, until recently, the only appeals 
being decided in the AMA at the Board were those cases advanced 
on the docket for advanced age, severe financial hardship, and 
serious illness. What about everyone else? It is unclear 
sometimes what is happening at the Board. Combining H.R. 5559 
with Section 3 of the Veterans Appeals Transparency Act, 5870, 
would mandate more transparency at the Board that is critically 
needed. In my written testimony on this subject, I mentioned 
the frustrations we encountered in attempting to get basic 
information for how the Board was adjudicating appeals. This 
section is a good step in requiring more transparency and 
better information from the Board.
    Last for my opening remarks, I would like to offer support 
for H.R. 5891, the Veterans Appeals Decision Clarity Act. Under 
the proposed amendment to 38 U.S.C. 7104, when the Board 
declines to consider evidence because it was not received 
during a period permitted under section 7113, it would be 
required to, ``identify the time when such evidence was 
received and provision of section 7113 of this title that 
establishes that such evidence may not be received at such 
time.'' In other words, the Board has to let a veteran know 
when evidence came in and that they cannot use it. It would 
also require the Board to state the adequacy of the timeliness 
of a notice of disagreement.
    All of this is essential for veterans and their advocates 
to navigate this very complicated system. I would also suggest 
that it would be better for personnel at the Board and at the 
regional offices. It could cut down on unnecessary claims, 
questions, and requests from veterans.
    It is always good to remember this is a non-adversarial 
system. There is no traditional discovery. This puts veterans 
in a position to understand what is happening in their cases, 
both substantively and jurisdictionally. Thank you so much for 
the opportunity to be here today, and I look forward to your 
questions.

    [The Prepared Statement Of Zachary Stolz Appears In The 
Appendix]

    Mr. Luttrell. Thank you, sir. We will move into our first 
line of questions. Mr. Stolz, do you agree with the VA's 
statement that Board decisions on appeals would be delayed if 
we required the Board to provide a general statement about the 
timeframes during which untimely evidence was submitted?
    Mr. Stolz. No. I do not quite understand. With all due 
respect, and I know the Board of Veterans Appeals has a 
Herculean task, and I do not in any way want to advocate for 
something that would slow them down. From where I sit and it is 
just from where I sit, they have to do this work anyway. The 
Board member and their staff is going to have to go through the 
evidence that comes in. They have to do it writing it in one or 
two sentences, I think, as you pointed out, Mr. Chairman, I do 
not see how that would slow down the Board in any meaningful 
way. Would it create a little bit more typing? Yes. Would it 
slow them down in a meaningful way that will affect veterans? I 
do not see it.
    Mr. Luttrell. Okay. What happens when the Board sends a 
veteran a letter rejecting their notice of disagreement?
    Mr. Stolz. Well, what happened in the case before the court 
is it becomes very confusing, and it is happened several 
thousand times. I do not know that there is one simple case I 
can talk about the one----
    Mr. Luttrell. I am sure everyone is different.
    Mr. Stolz. Everybody is different, right. It is confusing, 
because you get this, you do not get appeal rights, and you get 
a letter from probably, and the way that I understand that it 
was working, and I understand that perhaps some of it has been 
fixed, but the way that it was working in what is a publicly 
recorded case, is administrative staff sent a letter. The 
veteran got very confused by it. You try to fix it through the 
Board, then the Board issues a decision that should have 
appellate rights, and then you get your day in court. The fast 
answer is you get something that you cannot appeal. You cannot 
appeal.
    Mr. Luttrell. Cannot.
    Mr. Stolz. That is my understanding.
    Mr. Luttrell. Can the veteran appeal the rejection letter 
to the court? You said, no.
    Mr. Stolz. Not directly. They have to go through the Board, 
and then the Board would have to issue a decision.
    Mr. Luttrell. Do you think that a veteran should have to go 
through the extra hoop of disputing a rejection letter from the 
Board administrative staff in order to receive a Board decision 
by a Board judge that the court can review for accuracy?
    Mr. Stolz. I do not.
    Mr. Luttrell. Mr. Liermann, how would the Review Every 
Veterans Claim Act help veterans who are filing claims other 
than original claims for compensation, such as claims for 
increased compensation?
    Mr. Liermann. Thank you. Actually, it would have a big 
impact. Whenever a veteran files a claim for an increase 
evaluation when the condition has grown in severity, VA 
automatically is going to order them an examination if there is 
no evidence currently to grant that increase. In a lot of 
cases, if the veteran fails to report for that for the 
increase, VA will automatically deny it from that part because 
they requested the exam solely for the increase.
    Then we have to come back and say, well, no, actually, the 
veteran tried to reschedule the exam, and for some reason, that 
did not get relayed. Now we have a denial. Now we got to find a 
way to fix it to where if they cannot deny it solely for that 
reason, the veteran is going to have more continuity or more 
time to continue through the process without being just stymied 
up front for failing to report.
    Mr. Luttrell. Okay. Thank you. Mr. Pappas.
    Mr. Pappas. Thank you, Mr. Chairman. Thank you all for your 
comments here. I think these are all incredibly helpful as we 
go about our work.
    Ms. Patterson, maybe I could start with you. We heard 
earlier from Representative Issa about his legislation, the Jax 
Act. I understand that VFW supports the bill, and a lot of us 
up here do. From my perspective, the constraints on eligibility 
in the bill make it narrow, and it leaves people behind, for 
example, the Lioness teams of Iraq in 2003. My question is, 
should we be looking to improve the bill to make sure that we 
do not continue to leave groups of women veterans behind?
    Ms. Patterson. Thank you for that question, sir. We also, 
VFW also agrees that if there are other categories of veterans 
out there who have experienced similar situations to where they 
are not included, that we do revise the bill, or that we do 
things to make sure that they are included.
    Mr. Pappas. Thank you for that. Similarly, the way the bill 
is drafted causes some confusion as to who is eligible under 
the bill, and particularly, it seems to limit eligibility to 
veterans who have previously filed a claim and had that claim 
denied. We all know that veterans often decline to file a claim 
in the first place because of the perceived futility in some 
cases of doing so. I imagine that it is particularly true for 
the women that we are discussing today. I am wondering if VFW 
would support removing the requirement that a veteran must have 
previously filed a denied claim in order to be eligible under 
this Jax Act?
    Ms. Patterson. Absolutely.
    Mr. Pappas. Okay. Mr. Liermann, I see you nodding as well. 
Would you provide any comments on that legislation?
    Mr. Liermann. Yes and thank you. I think once they 
determine that they have combat exposure, everything is 
applicable at that point. I do not think it would just--they 
would have to have been denied before. I think that presumption 
of combat, which is so important to help veterans establish 
benefits, I think that would override what their language 
writes, but we would be supportive of correcting that. When 
there are a group of other women veterans that fit those 
categories and criteria under DoD, absolutely we think it 
should be expanded.
    Mr. Pappas. Thank you for that. Maybe I could follow up 
with you about a separate piece of legislation. This is 
Representative Slotkin's bill, the Justice for ALS Veterans 
Act. I understand that DAV supports the bill, has mobilized its 
membership to reach out to their Member of Congress in support 
of the legislation. We thank you for that.
    One provision instructs VA to identify other diseases or 
illnesses with similar characteristics of fast progression and 
high mortality, and that also may deserve similar treatment to 
what is being proposed for ALS under the bill. Can you talk 
about DAV support and what other conditions that you may see 
that we should consider with the same treatment as ALS under 
this legislation?
    Mr. Liermann. Thank you. Just real quick to make reference 
to what was discussed earlier, we believe that it is already 
ALS in itself meets the criteria of a rapid progressing 
disease, because once a veteran files a claim for it, it is an 
automatic 100 percent disability evaluation within the VA. We 
think that meets that already, especially when you look at the 
average of 3 to 5 years from the diagnosis until the veteran 
passes.
    Other conditions, pancreatic cancer, which is now a 
disability presumptive to the PACT Act, would be one other 
disability that I would clearly mention because of its 
devastating effects, and sometimes it is a weight 
manifestation, so it does progress very rapidly.
    Mr. Pappas. I am sure you must have members that either 
have ALS or have firsthand knowledge about how terrible this 
disease is. I am wondering if you also could provide some 
comment on what the additional DIC payment would mean to 
survivors of veterans who suffered from ALS.
    Mr. Liermann. When the veteran passes, the family no longer 
gets the veteran's compensation. The family and the surviving 
spouse would have to apply for what we often refer to as DIC, 
or dependence indemnity compensation. Right now, that is about 
40 percent of what a 100 percent veteran receives. It is a 
great reduction in their income. Making them eligible for this 
additional compensation or the kicker is going to help improve 
the quality of life for that family after the veteran has 
passed.
    Mr. Pappas. Thank you very much. I yield back, Mr. 
Chairman.
    Mr. Luttrell. Thank you, sir. Mr. Crane, you are recognized 
for 5 minutes.
    Mr. Crane. Thank you, Mr. Chairman. Thank you guys for 
showing up. I realize we are here today, ultimately, to make 
sure that our veterans are taken care of. I do believe that the 
vast majority of people in this room, and at the VA as well, 
try and do everything they can to take care of our veterans.
    That being said, there are circumstances where that does 
not happen, and I think that is one of the things that we are 
looking into today. Were you guys in the room when I was asking 
the panel before you about accountability? What did you guys 
think about the responses that I was getting? Ms. Patterson, I 
want to start with you. Did it sound like there was any 
accountability whatsoever as far as, you know, any, you know, 
any counseling documentation being put into records? You know, 
clearly, I was just asking for, hey, can you tell the panel 
what happens when people at the VA make mistakes? What do you 
think of that, Ms. Patterson?
    Ms. Patterson. Thank you for that question. The VFW thinks 
that accountability for veterans, whether it is in the 
processing of the claims or for those who are involved in the 
process, the processing of the claims, the more clarity that is 
out there, the more that it can be clear that this is the 
consequence to failing a veteran in this process, the more 
proficient the process will be.
    Mr. Crane. Yes.
    Ms. Patterson. I did not hear where there is a process or 
what that process is. I did not think you were asking for 
names. You were just asking for what is the process? How do 
you----
    Mr. Crane. Thank you.
    Ms. Patterson [continuing]. determine who is accountable? 
If people who are doing things wrong, if they know that if they 
do not do certain things, that there is a consequence. We would 
like to see also a clear, you know, process that does hold 
people accountable just so we can ensure that the veterans are 
being taken care of.
    Mr. Crane. Thank you, Ms. Patterson. Mr. Stolz, you realize 
this is an oversight hearing, right?
    Mr. Stolz. I do.
    Mr. Crane. Do you think that that is appropriate, that, you 
know, those of us that are tasked to not only fund the VA, but 
also conduct oversight of it, be given reasonable answers to 
questions such as, is there any accountability when individuals 
at the VA make mistakes?
    Mr. Stolz. I do.
    Mr. Crane. You do? Did you think that the answers that this 
panel was given are acceptable?
    Mr. Stolz. I did not hear a direct answer to your question, 
Mr. Crane.
    Mr. Crane. Did it sound like I was asking for specifics, 
specific names?
    Mr. Stolz. It did not.
    Mr. Crane. Okay. What about you, sir, on the end? Liermann, 
Mr. Liermann?
    Mr. Liermann. I do not believe the question was answered to 
your point. There was no actual discussion on the 
accountability. Again, I have been doing this for 25 years for 
DAV at five different locations around the country. We reviewed 
rating decisions, would find problems, take them back to 
coaches, people within VA, to explain an issue.
    When it comes to accountability, my experience has been it 
is there. It just may not move nearly as quick as we want it to 
or have the correct measures that we deem would be appropriate.
    Mr. Crane. Yes.
    Mr. Liermann. Accountability is a big issue for us, but I 
think sometimes it is hard to actually see it take place.
    Mr. Crane. Thank you. I want to reiterate that I do not 
believe that the vast majority of employees at the VA are 
making mistakes or making mistakes on purpose. I do believe 
that they try and do a good job. I agree with the chairman who 
said that we understand that the individuals sitting on that 
panel have a very daunting and difficult task. This is a huge 
organization. As somebody, you know, who came from the military 
myself and then started a small business, I can tell you that 
when we had employees that, you know, continually made 
mistakes, we tried to document those mistakes, have a 
counseling, and, you know, made sure that that went their 
personnel file, so that if we continue to see the same mistakes 
over and over and over again, we could take, you know, follow 
on actions. Possibly, if it got too bad, even termination.
    It is disappointing when we have these oversight hearings 
and we are not just talking about products being made like at 
my company. We are talking about actual veterans, their 
families, their health, their lives. If there is no 
transparency or accountability, it makes me understand why I 
hear the same things from veterans in my district over and over 
and over again about the type of care that they are receiving, 
the type of communication they are receiving, the type of 
transparency that they experience. Thank you. I yield back.
    Mr. Luttrell. Thank you, Mr. Crane. Mrs. Ramirez, you are 
recognized for 5 minutes.
    Ms. Ramirez. Thank you, chairman. You know in the panel 
right before this, I mentioned that one of the priorities for 
me is to ensure that we continue to recognize the service of 
women. I certainly just want to follow up on a few questions 
related to female veterans, and then I want to move into a 
couple of other things. Mr. Liermann, can you speak to the 
importance of women veterans being fully recognized and how 
recognition in combat can result in access to benefits?
    Mr. Liermann. Absolutely and thank you. As we were 
discussing earlier, the presumption of combat will open up 
doors to where a veteran will not have to prove a specific 
disability as long as it is consistent with the hardships of 
combat. That is why this is such an important presumptive.
    Getting people recognized, women veterans who may not have 
been recognized before as at combat, this is going to help 
their ability to get claims granted, to not have to be burdened 
with an over amount of evidence to prove it, and it is going to 
streamline the process for them to get access to those 
benefits.
    In reference to women veterans as a whole, DAV has been 
championing this particular issue for women veterans for 
decades. We came out with a Women Veterans Report in 2014, 
2018, and we are currently going to be putting out another 
Women Veterans Report going to be focusing on the importance of 
mental health and women veterans. We are hoping to have that 
out in March or April of next year, and we will make sure----
    Ms. Ramirez. Great.
    Mr. Liermann [continuing]. the committee gets a copy of it.
    Ms. Ramirez. Thank you. I was about to ask you when we can 
expect it, so thank you. I appreciate that.
    I want to shift gears a tad bit, and I want to go to your 
testimony. In your testimony, you state that the Director of 
Claims and Fiduciary Inspection Division, the Office of Audits 
and Evaluations of the VA OIG--a mouthful--confirmed that 
negligence determinations by the VA do not have a specified 
time period and that beneficiaries are waiting more than 400 
days for reimbursement of misused funds. My question for you 
is, can you describe how this wait is impacting, wait time is 
impacting veterans?
    Mr. Liermann. It is a matter between paying their rent, 
buying groceries, getting prescriptions, because once that 
misuse has been done, they stop making any payment.
    Ms. Ramirez. Yes.
    Mr. Liermann. Now that veteran's family is not getting any 
compensation payment for that 400-day period until they either 
make a determination of the misuse or establish a new fiduciary 
and then set up new funds. We are talking potentially a year 
and a half of a veteran's family not having direct access to 
compensation just for the basic daily needs.
    Ms. Ramirez. Yes. You could imagine in that year and a 
half, where a shelter, where food, with basic needs, and the 
impact that they have. I ran a homeless shelter, so I can tell 
you I have seen the impact of both female veterans and male 
veterans. I want to ask you just a few more questions before my 
time is over. Does your organization work with veteran 
fiduciaries?
    Mr. Liermann. DAV provides free representation for veterans 
and their families. We have and do represent veterans that have 
fiduciaries, and I have interacted and represented them myself 
multiple times over the last 25 years, and our organization 
does on a daily basis.
    Ms. Ramirez. Okay. What does this procedural fix mean 
practically for veterans and their families?
    Mr. Liermann. Well, it is giving them access back to their 
compensation. I mean, fiduciaries do a very difficult job, and 
when there is a decision of misuse or waiting for it, that 
slows down what the fiduciary can do, but more importantly, 
slows down the access to veterans and their families for the 
money. This fix would give them access to their compensation 
much faster than waiting for that determination.
    Ms. Ramirez. I got a little bit, about 45 seconds left. I 
am going to give you 30 of those seconds to share with us here 
to the committee, is there any suggestions you have for 
additions or changes to the current legislation we are 
discussing or any of the legislation before us today? Go.
    Mr. Liermann. Oh, thank you. The Michael Lecik bill. DAV 
does not support it. We are a resolution-based organization, 
which means we must have a resolution to support it. We do not 
support it or oppose it. We are really concerned with the 5-
year must have served on active duty, then your disability must 
have been diagnosed within 15 years in order to get it service 
connected. When we do that to presumptives, what we are doing 
is limiting and restricting the number of veterans who are 
actually going to be eligible. If we want to do this to provide 
that benefit, we need to remove it. The other part of that I 
want to mention is----
    Ms. Ramirez. I am out of time. I am going to take what you 
gave us before the chairman rings the bell. I would love for 
you to be able to provide any of the other additional 
information, if it is not in the testimony, in writing. Thank 
you, Chairman. I yield back.
    Mr. Luttrell. Yes, ma'am. Mr. Pappas, closing remarks?
    Mr. Pappas. Well, thank you, Mr. Chairman, for convening 
this hearing, and I want to extend my gratitude to all the 
members and witnesses who participated in it. I appreciated all 
the insights that were shared, and I think this hearing 
highlighted some important issues. We received an abundant 
amount of feedback that is going to help us ensure we are 
working together on the bills that were put forward.
    I believe that both Republicans and Democrats share a 
genuine commitment to enhancing the well-being of veterans. I 
also believe we need to continue to uphold our promise that we 
made to veterans and their families who may face challenges in 
accessing the benefits to which they are entitled. For me, 
these benefits are vital in safeguarding the dignity and well-
being of all those who have served this great Nation.
    In advance of Veterans Day this weekend, I want to thank 
all those who have served this great country and who are 
serving today in uniform and extend my gratitude to our 
panelists for their insights. I want to thank all my colleagues 
for their contributions. Let us keep working together on these 
bills and see what we can get done here. Thank you, Mr. 
Chairman. I yield back.
    Mr. Luttrell. Thank you, sir. I look forward to working 
through these issues with the department and my colleagues on 
the subcommittee. The bills discussed today would provide 
important improvements for veterans going through the veterans 
claims and appeals process. They would also improve access to 
benefits for groups of veterans who earned their benefits.
    As I said before, the complete written statement of today's 
witnesses will be entered into the hearing record. I ask 
unanimous consent that the statements for the record submitted 
from the following members and organizations be entered into 
the hearing record. Representative Gerald Connolly of Virginia, 
American Veterans, AMVETS, National Organization of Veterans 
Advocates, NOVA, Paralyzed Veterans of America, PVA, Quality 
Timeless Customer Service, QTC, Special Operations Associations 
of America, SOAA, ALS Association, Service Women's Action 
Network, SWAN. Hearing no objection, so ordered.
    I ask unanimous consent that the letter of support for 
Military Veterans Advocacy is entered into the hearing record. 
Hearing no objection, so ordered.
    I ask unanimous consent that all members have 5 legislative 
days to revise and extend their remarks and include extraneous 
materials. Hearing no objections, so ordered.
    I thank the members and the witnesses for their attendance 
and participation today. I thank all the veterans and their 
spouses and families in the room today for show going up. God 
bless you. Thank you for your service. Happy Veterans Day. This 
hearing is adjourned.
    [Whereupon, at 1:57 p.m., the subcommittee was adjourned.]  
     
=======================================================================


                         A  P  P  E  N  D  I  X

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


                    Prepared Statements of Witnesses

                              ----------                              


                   Prepared Statement of Beth Murphy

    Good afternoon, Chairman Luttrell, Ranking Member Pappas and 
Members of the Subcommittee. I appreciate the opportunity to appear 
before you today to discuss pending legislation, including bills 
pertaining to disability compensation, VA fiduciaries and appeals. 
Accompanying me today are Mr. Kevin Friel, Deputy Director, Pension & 
Fiduciary Service, Veterans Benefits Administration and Mr. Kenneth 
Arnold, Vice Chairman, Board of Veterans' Appeals.

H.R. 1753 - To ensure that certain members of the Armed Forces who 
served in female cultural support teams receive proper credit for such 
service

    H.R. 1753 would require VA to consider service on a female cultural 
support team (CST) as combat service for purposes of determining 
whether a Veteran incurred a disease or injury during that period of 
service.
    VA supports the intent of the bill to ensure proper recognition of 
Veterans' combat service; however, as discussed below, we cite concerns 
with several specific elements, which we believe may prevent VA from 
being able to implement the legislation. VA has discussed this bill 
informally with the Department of Defense (DoD). Further collaboration 
between VA and DoD is needed to confirm both the number of Veterans who 
participated in CSTs and whether these Veterans meet the definition of 
``engaged in combat'' for the purposes of 38 U.S.C. 1154(b).
    Per VA's procedural guidance in M21-1.VIII.iv.1.D.2.b, there are no 
limitations as to the type of evidence that may be accepted to confirm 
engagement in combat. Any evidence that is probative of combat 
participation may be used to support a determination that a Veteran 
engaged in combat. The requested list and memo from DoD may be 
sufficient to satisfy this evidentiary requirement. However, VA notes 
that a finding that a Veteran engaged in combat for 1154(b) purposes 
requires that the Veteran ``have personally participated in events 
constituting an actual fight or encounter with a military foe or 
hostile unit or instrumentality, as determined [by VA] on a case-by-
case basis.'' Moran v. Peake, 525 F.3d 1157, 1159 (Fed. Cir. 2008).
    VA also provides the below comments on the bill. To obtain an award 
of service connection, a claimant must generally establish three 
elements: (i) a current disability, (ii) a disease or injury was 
incurred or aggravated during service (i.e., in-service incurrence) and 
(iii) a causal relationship between the current disability and the in-
service disease or injury (i.e., nexus). By statute, satisfactory lay 
or other evidence that an injury or disease was incurred or aggravated 
in combat will be accepted as sufficient proof of in-service incurrence 
if that evidence is consistent with the circumstances, conditions or 
hardships of such service even if the disease, disability or injury is 
not otherwise documented in the official record. Thus, if a CST Veteran 
states that a disease or injury was incurred in combat and the same is 
consistent with the circumstances, conditions or hardships of service, 
the rating activity and the examiner will accept the lay evidence as 
satisfying the ``in-service incurrence'' requirement for an award of 
service connection, even if there is no other record of the same. This 
would allow for grant of service connection of a disability, from 
traumatic brain injury to a musculoskeletal disability from carrying 
heavy gear, assuming the CST Veteran establishes a current disability 
and a causal relationship (i.e., nexus) between the current disability 
and the in-service disease or injury.
    The bill contains provisions specific to cases in which a Veteran 
or survivor (i) prior to the Act's enactment submitted a claim for 
service-connected disability or death;(ii) had such claim denied for 
lack of service connection; (iii) submits a claim within 3 years of the 
Act's enactment for the same disability that was previously denied. In 
those cases, the bill would specifically require VA to re-adjudicate 
entitlement to service connection and, if service connection were 
granted, to apply an unusually liberal effective date rule. Under 
current law, VA already has an obligation to re-adjudicate entitlement 
to service connection when the claimant submits another claim seeking 
service connection for the same condition if, since the last denial, 
there has been a change in law that would provide a new basis for 
entitlement. Combat Veterans are afforded a relaxed standard of proof 
to satisfy the ``in-service incurrence'' requirement for an award of 
service connection. Because this bill would enable CST Veterans to 
avail themselves of the same relaxed standard of proof, it would create 
a new basis of entitlement for which VA would already be obligated to 
re-adjudicate. Therefore, VA believes the re-adjudication provision is 
superfluous and recommends removing it.
    As for the effective date provision, H.R. 1753 authorizes an 
effective date as early as the date of the previously denied claim. 
Under existing effective date rules, an award of benefits pursuant to a 
liberalizing law will not be earlier than the effective date of the law 
or 1 year prior to the date VA receives the supplemental claim, 
whichever is later. While H.R. 1753 would also place a 3-year time 
limit for qualifying claimants to file a supplemental claim and have 
this effective date provision applied, it may nonetheless result in 
significant retroactive benefits for some claimants, depending on the 
original date of claim. This bill would carve out an effective date 
exception for only this small group of Veterans, which may be perceived 
as inequitable. VA would suggest amending this section of the bill to 
align with current laws concerning effective dates of claims.
    Mandatory costs to the compensation and pension account are 
estimated to be $69.2 million in 2024, $101.9 million over five years, 
and $147.1 million over 10 years. There are no discretionary costs may 
be associated with H.R. 1753.

H.R. 3790 - Justice For ALS Veterans Act of 2023

    Dependency and indemnity compensation (DIC) is a monthly monetary 
benefit payable to the qualifying survivors of Veterans who die from a 
service-connected disability or who die while either receiving or 
entitled to receive VA compensation for a disability that has been 
continuously rated totally disabling for a period of 8 or more years 
immediately preceding death. Under current law, a higher rate of 
benefits is payable to a surviving spouse if two conditions are met for 
a continuous period of at least 8 years immediately preceding the 
Veteran's death: the Veteran was married to the individual seeking 
benefits as a surviving spouse and the Veteran was either receiving or 
entitled to receive VA compensation for a disability rated totally 
disabling.
    H.R. 3790, the ``Justice for ALS Veterans Act of 2023'' would 
authorize payment of the higher DIC rate to surviving spouses of 
Veterans who die from amyotrophic lateral sclerosis (ALS) regardless of 
whether the Veteran had a disability rated as totally disabling for a 
continuous period of at least 8 years immediately preceding death. In 
addition, the bill would require that, within 180 days of enactment, 
the Secretary submit a report to Congress that identifies any service-
connected disability, other than ALS, that the Secretary determines 
should be treated in the same manner as ALS for purposes of entitlement 
to the higher rate of DIC. The report should include a comprehensive 
list of service-connected disabilities with high mortality rates and 
detailed information on the average life expectancy for persons with 
each such disability. We note that the bill recommends that the 
Secretary of VA identify similar service-connected disabilities with 
high mortality rates but does not define criteria for what is 
considered a high mortality rate. VA believes that a clear definition 
for a high mortality rate should be incorporated within the bill to 
ensure implementation that is consistent with congressional intent.
    We would support this bill, if modified to include criteria for 
determining whether a disability has a high mortality rate, and subject 
to the availability of appropriations.
    Mandatory costs are estimated to be $847,000 in 2024, $4.9 million 
over 5 years, and $11.9 million over 10 years. There are no 
discretionary costs associated with this legislation.

H.R. 4016 - Veteran Fraud Reimbursement Act

    H.R. 4016 would streamline reissuance of benefits in fiduciary 
misuse cases. Where VA finds that a fiduciary has received VA benefits 
for the use and benefit of a beneficiary's VA benefits, but uses those 
benefits for another purpose, 38 U.S.C. Sec.  6107 requires VA to 
reissue the misused benefits to the beneficiary or a successor 
fiduciary. The Johnny Isakson and David P. Roe, M.D. Veterans Health 
Care and Benefits Improvement Act of 2020 (P.L. 116-315), authorized VA 
to reissue the amount of funds misused by a fiduciary without regard to 
whether the misuse was due to VA's failure to exercise proper 
oversight. However, current law contemplates that VA will make a 
determination regarding whether VA failed to exercise proper oversight 
prior to any reissuance of benefits.
    VA supports this proposed legislation and its incorporation of 
language which would result in a shift of negligence considerations 
toward program oversight and away from an unnecessary determination 
tied to the reissuance of benefits that will occur regardless of the 
outcome of the determination. This proposal will enable timelier 
reissuance of misused benefits to Veterans and their survivors and 
enable more effective application of VA resources toward more 
productive methods of oversight to protect beneficiary funds.
    No mandatory or discretionary costs are associated with H.R. 4016.

H.R. 4190 - Restoring Benefits to Defrauded Veterans Act

    H.R. 4190 addresses reissuance of misused benefits in cases where 
reissuance did not occur prior to the beneficiary's death. This bill 
would provide a preferred hierarchy for payment of reissued funds to an 
individual or entity in a stipulated order of preference. Additionally, 
the bill would not allow for a reissued payment to be made to a 
fiduciary who misused the benefits of the beneficiary.
    VA supports the bill, if amended. For uniformity, VA suggests the 
various forms of the term ``reissuance'' be used in lieu of the various 
forms of the term ``repayment'' in 38 U.S.C. Sec.  6107. Existing 
statutes specifically address the disbursement of VA benefits that were 
either due and unpaid or paid, but not negotiated prior to the death of 
the beneficiary. See 38 U.S.C. Sec. Sec.  5121, 5122. In the reissuance 
context, however, the payment and negotiation of benefits necessarily 
occurred before the question of reissuance arose. See 38 U.S.C. Sec.  
6107(b) (providing that VA ``shall pay to the beneficiary or the 
beneficiary's successor fiduciary an amount equal to the amount of such 
benefit'' ). Existing law does not address disbursement of such funds 
if the claimant predeceases reissuance. Adding legislative language 
addressing who may receive payments representing reissued benefits on 
behalf of a deceased beneficiary would provide greater consistency and 
clearer legal basis for making such a determination prior to the 
reissuance of misused funds. Incorporating an order-of-priority would 
also align this statute with other sections of title 38 United States 
Code (i.e., 38 U.S.C. Sec. Sec.  5121 and 5122).
    Nonetheless, the proposed priority scheme differs from the priority 
scheme in those statutes in that the proposed priority scheme relies on 
state law. Where Federal law does not address questions of inheritance, 
State law applies. The proposed language would specifically direct VA 
to apply State law. An alternative would be to apply the same priority 
scheme currently codified in 38 U.S.C. Sec. Sec.  5121, 5122.
    Alternatively, VA suggests some modifications to the proposed 
prioritization. In the bill, the first priority class is ``[t]he estate 
of the beneficiary'' while the third priority class is ``[t]he next 
inheritor determined by a Court of competent jurisdiction. Yet, a 
decedent's ``estate'' typically refers to the individual's collective 
assets and liabilities at death. ESTATE, Black's Law Dictionary (11th 
ed. 2019). An inheritor is someone who is entitled to receive any 
assets remaining in the estate after all liabilities have been 
satisfied. INHERITOR, Black's Law Dictionary (11th ed. 2019). 
Therefore, VA recommends consideration of whether the first and third 
priority classes may be effectively coextensive.
    In the bill, the second priority class is ``[a] successor fiduciary 
serving the beneficiary when the beneficiary died.'' VA notes that 
existing caselaw establishes that a fiduciary does not have rights 
beyond the beneficiary himself. Youngman v. Shinseki, 699 F.3d 1301, 
1304 (Fed. Cir. 2012). VA is concerned that the bill language would 
create a disparity between successor fiduciaries in cases of prior 
misuse and fiduciaries in cases not involving any misuse: because the 
bill provides for reissuance to the successor fiduciary without 
directing what the successor fiduciary must do with the funds, the 
successor fiduciary would obtain a right to some of the Veteran's 
benefits based on the happenstance of misuse by a prior fiduciary.
    VA notes concern over the addition of proposed (c)(2) which 
provides that ``[t]he Secretary may not make a payment under this 
subsection to a fiduciary who misused benefits of the beneficiary.'' 
VA's concern is the wording would preclude a fiduciary who misused 
benefits, but who is also a member of the estate of the beneficiary as 
identified under proposed (c)(1)(A) or an inheritor as identified under 
proposed (c)(1)(C) from receiving payment of reissued funds. VA notes 
concern this imparts a legislative restriction which surpasses 
precedential legal estate disposition. This is particularly a concern 
if the fiduciary who previously misused benefits of the beneficiary is 
also a member of the beneficiary's estate or an inheritor. In this 
example, a previous fiduciary who is not the subject of the current 
misuse matter, but who did misuse benefits at one time, may be entitled 
to a reissuance payment following misuse by a more recent fiduciary. VA 
recommends the Committee consider removing the restrictive language 
within (c)(2) and instead explicitly provide that funds due to be paid 
to a fiduciary who misused benefits may not be withheld by VA. 
Ultimately, this would allow VA to reissue misused funds to the 
appropriate heirs while ensuring that estate administration laws are 
properly followed.
    No mandatory or discretionary costs are associated with H.R. 4190.

H.R. 4306 - Michael Lecik Military Firefighters Protection Act

    H.R. 4306, the Michael Lecik Military Firefighters Protection Act, 
would create presumptions of service connection for Veterans who were 
trained in fire suppression, served on active duty in a military 
occupational specialty or career field with a primary responsibility 
for firefighting or damage control for at least 5 years in the 
aggregate, and in whom one or more specified diseases manifest to a 
degree of 10 percent or more within 15 years of the date on which the 
Veteran separates from active service. The specified diseases are heart 
disease, lung disease, certain cancers and each additional disease for 
which the Secretary determines a presumption is warranted.
    VA supports this bill, if amended, and subject to the availability 
of appropriations. This bill represents a Veteran-centric approach to 
addressing health effects experienced by Veterans who trained in fire 
suppression and served on active duty in an occupation with a primary 
responsibility for firefighting.
    VA views the proposed presumption of service connection as a 
reasonable first step for Congress to address potential health outcomes 
from firefighting hazards to include exposures to per-and 
polyfluoroalkyl substances (PFAS), which are synthetic chemicals 
commonly used as a key ingredient in firefighting foams.
    This bill would also provide immediate relief for certain covered 
Veterans and at a much faster rate than if VA were to consider the same 
presumption under the new presumptive decision-making process created 
by the Sergeant First Class Heath Robinson Honoring our Promise to 
Address Comprehensive Toxics (PACT) Act of 2022.
    The establishment of a presumption for firefighters would 
streamline the claims process, thus reducing the number of claims that 
would be subject to medical opinions and other time-consuming 
development of evidence showing exposure to chemicals such as PFAS. 
However, VA supports a broader-based policy approach. To further 
enhance administrative efficiency and to ensure fairness and equity, VA 
recommends removal of the 10 percent minimum evaluation requirement; 
the 15-year disease manifestation period; and the requirement of 5 
years in the aggregate in an occupation or career field with a primary 
responsibility for firefighting.
    These requirements of H.R. 4306 are more onerous than the fiscal 
year (FY) 2023 National Defense Authorization Act provision that 
established a presumption for Federal firefighters under 5 U.S.C. 
8143b, which recognizes 16 diseases (mostly cancers) as presumptively 
related to fire suppression duties. Removing the above requirements 
would ensure Veteran firefighters do not face a higher standard of 
proof than other Federal firefighters. It should also be noted that the 
PACT Act did not include any such requirements for presumptions, and 
this has significantly streamlined the processing of PACT Act 
presumptive claims. Relaxing these standards would allow claims 
processors to process claims more quickly and at a higher accuracy 
rate. For example, analyzing the exact number of years and days that a 
Veteran served as a firefighter could involve extensive development and 
review of a Veteran's military personnel records which may or may not 
be conclusive regarding time spent in an occupation. Also, a review of 
firefighter mortality studies by Haas et al. (2003) did not observe an 
increase in all-or specific-cause mortality with increased time in 
firefighting occupation. And finally, amending the bill to streamline 
eligibility requirements would facilitate VBA's ongoing effort to 
automate disability compensation claims.
    Finally, although VA supports the bill, VA also provides the 
following discussion on the current state of the scientific evidence on 
health outcomes based on firefighting occupation. Notwithstanding the 
state of the scientific evidence (below), VA aims to ensure that 
military firefighters who may have been exposed to toxic substances and 
chemicals during military service do not have a higher burden of proof 
than other toxic-exposed Federal firefighters who may be entitled to 
compensation for these diseases under comparable Federal statutes (5 
U.S.C. 8143b).
    The International Agency for Research on Cancer (IARC) published a 
monograph in 2023 that classifies the firefighter occupation as a Group 
1 carcinogen (known to cause cancer in humans). This conclusion is 
based on sufficient evidence in multiple cohorts for mesothelioma and 
bladder cancer and limited evidence for colon, prostate and testicular 
cancers; malignant melanoma; and non-Hodgkin lymphoma. IARC noted that 
evidence for all other types of cancers in firefighters is inadequate. 
Additionally, recent studies and authoritative reviews have noted 
associations between kidney and testicular cancers and PFAS exposure 
specifically, with less conclusive evidence for breast cancer. In terms 
of other chronic health outcomes, a cursory review of the literature 
reveals an association between firefighting and cardiovascular disease 
risk. There is also evidence for lung diseases, such as sarcoidosis and 
interstitial lung disease, in firefighters. Further, an association has 
been noted between exposure to PFAS and the development of thyroid 
disease, as well as less evidence for an association with ulcerative 
colitis.
    Mandatory and discretionary costs are associated with H.R. 4306; 
however, additional time would be needed to complete estimates.

H.R. 5559 - Protecting Veterans Claims Options Act

    Under existing law, VA must re-adjudicate a previously decided 
claim if the claimant files a supplemental claim and identifies new and 
relevant evidence. Subsection 2(a) of H.R. 5559, the Protecting 
Veterans Claims Options Act, would remove the new and relevant evidence 
requirement with respect to supplemental claims filed within 1 year of 
the agency of original jurisdiction's decision on the earlier claim. 
The bill provides that subsection 2(a) would apply to supplemental 
claims filed on or after August 23, 2017, and directs VA to prescribe 
implementing regulations for subsection 2(a) within 180 days of the 
bill's enactment. Subsection 2(b) would add a new evidentiary window 
under 38 U.S.C. Sec.  7113(d) for cases that have been remanded by the 
Court of Appeals for Veterans Claims to include evidence submitted by 
the appellant and his or her representative, if any, within 90 days 
following such remand, which the Board of Veterans' Appeals (Board) 
shall consider in the first instance.
    VA cites concerns with subsection 2(a) and does not support 
subsection 2(b). With respect to subsection 2(a), VA is concerned that 
eliminating the requirement for new and relevant evidence in support of 
certain supplemental claims will result in needless re-adjudication of 
claims based upon identical evidentiary records, which would be 
unlikely to result in a different decision. VA does not consider such 
duplication of efforts to be an efficient use of scarce adjudicatory 
resources. This amendment would essentially collapse any distinction 
between a supplemental claim filed within 1 year of when the agency of 
original jurisdiction issued a decision and higher-level review of such 
a decision under 38 U.S.C. Sec.  5104B.
    VA also is concerned with the retroactive provision of section 
2(a)(3) of the bill. In effect, that retroactive provision would 
require VA to re-adjudicate every claim decision made after August 23, 
2017, upon submission of a supplemental claim without new and relevant 
evidence, since section 2(a)(1) of the bill eliminates any requirement 
for new and relevant evidence in support of supplemental claims filed 
within 1 year ``after the date on which the agency of original 
jurisdiction issues a decision with respect to such claim.'' The 
combined effect of these provisions would seem to require that VA re-
adjudicate every supplemental claim filed since August 23, 2017, that 
was in turn filed within 1 year of an initial decision on a claim but 
denied for lack of submission of new and relevant evidence. Once again, 
this will result in needless re-adjudication of claims based upon 
identical evidentiary records. It would also require VA to data mine to 
identify every claim filed since August 23, 2017, that might be 
eligible for re-adjudication, including those where claimants expressed 
no disagreement with VA's decision that the supplemental claim filed 
within 1 year of the initial decision was not accompanied by new and 
relevant evidence. VA does not consider such duplication of efforts to 
be an efficient use of resources.
    VA also notes that while the Appeals Modernization Act (AMA) was 
enacted on August 23, 2017, AMA was not fully implemented until 
February 19, 2019. Some claims were processed under AMA on an opt-in 
basis prior to that date, but for most claims, the term ``supplemental 
claim'' as characterized in AMA would not have been applied prior to 
February 19, 2019.
    In addition, VA is concerned that section 2(a)(4) of the bill 
requires VA to develop complying regulations within 6 months following 
enactment. VA generally estimates 1 year for development and 
publication of a regulation or regulatory amendment. Therefore, VA 
anticipates difficulty complying with this timeframe.
    With respect to subsection 2(b), VA believes that this newly 
proposed evidentiary window frustrates current jurisdictional 
considerations for having a closed appellate record for the Board of 
Veterans' Appeals (Board) and reviewing Federal Courts to consider. 
Approximately 6,800-7,700 remanded appeals are returned to the Board 
each year by the Court of Appeals for Veterans Claims (CAVC) and the 
majority of those remands require the Board to provide additional 
``reasons or bases'' for why the original, closed record considered by 
the Board was insufficient to grant the relief sought. This newly 
proposed evidentiary window would erode the carefully considered 
relevant evidence windows currently available to Veterans under AMA and 
may act as an inducement for appellants to file even more appeals with 
CAVC simply to add additional evidence that would further delay final 
resolution of the appeals they originally filed. This would contribute 
to even higher backlogs of pending appeals.
    We would welcome the opportunity to discuss the bill in more detail 
with the Committee.

H.R. XXXX - Veterans Appeals Decision Clarity Act

    Under current law, each decision of the Board must include a 
written statement of their findings and conclusions, and the reasons or 
bases for those conclusions, on all material issues of fact and law 
presented on the record; a general statement reflecting whether 
evidence was not considered in making the decision because the evidence 
was received at a time when not permitted under section 7113 of this 
title and noting such options as may be available for having the 
evidence considered by VA; and an order granting or denying relief. The 
Veterans Appeals Decision Clarity Act would further require that each 
Board decision includes a written determination as to whether the 
Notice of Disagreement was adequate and timely, and if there was 
evidence that was not considered because it was received outside the 
time limitations in section 7113, identification of the time when such 
evidence was received and the provision of 38 U.S.C. Sec.  7113 that 
establishes that it may not be received at such time.
    VA believes that the bill would add significant delays to appeals 
processing timelines and lead to exponential growth in appeals 
backlogs. At the end of FY 2023, VA began to see a reduction in the 
number of appeals pending before the Board after AMA went into effect 
in 2019. However, VA also anticipates an increase in pending appeals 
due to implementation of the PACT Act. The bill would further delay 
resolution of appeals and would create an additional burden on the 
Board because, having identified the evidence received outside the 
allowable submission window, the Board would then have to provide a 
written statement of when each piece of evidence was received and the 
provision of section 7113 that is implicated. From VA's perspective, 
the closing of the evidentiary record is one of the foundational 
features of AMA, and one of its most valuable in terms of enabling VA, 
over time, to process appeals more efficiently. Requiring VA to 
individually list or summarize each piece of evidence received outside 
of the window of time permitted by section 7113 would dilute much of 
the administrative value of closing the record.
    The requirement would substantially increase the likelihood that 
Veterans will inappropriately appeal decisions with allegations that 
the Board failed to administratively identify each piece of evidence 
submitted outside the relevant evidentiary window and discuss why it 
cannot be received at such time. VA feels that this will cause 
increased confusion and slow the appeals process as Veterans and their 
representatives appeal Board decisions that fail to meet these new 
administrative requirements to CAVC, only to end up with a remand that 
requires the Board to cure the administrative deficiency without any 
substantive change in the ultimate outcome of the appeal. Under those 
circumstances, the attorney representing the appellant on such appeals 
to the Court will receive a substantial attorney fee under the Equal 
Access to Justice Act while the Veteran receives no better outcome than 
they had prior to the appeal.
    As for the adequacy and timeliness of a Notice of Disagreement, 
currently, written docketing notices must be sent to appellants and 
their representatives, advising them that their appeal was docketed or 
that there are potential timeliness or adequacy issues with the filing. 
These notices also provide an opportunity to appellants and 
representatives to dispute and/or cure any potential defects well in 
advance of when the case would be adjudicated. Those final timeliness 
and adequacy determinations that are disputed and potentially adverse 
to the appellant are ruled upon by a Veterans Law Judge on detail to 
the Office of Clerk of the Board. The bill would delay those formal 
determinations until the time when the Board formally adjudicates the 
case (which may be months or even years later), which will cause 
unnecessary delay and potential harm to appellants.

H.R. XXXX - Veterans Appeals Transparency Act of 2023

    The ``Veterans Appeals Transparency Act of 2023'' seeks to clarify 
which review options are available to claimants within 1 year following 
a decision by the agency of original jurisdiction (AOJ) and to clarify 
that only one review option may be selected at a time. In addition, the 
bill would require the docket dates of cases assigned to a Board member 
for a decision that week to be published weekly by the Board.
    VA does not support the bill unless amended. VA generally supports 
efforts to clarify or simplify the decision review and appeals process, 
and to clearly establish that only one decision review option is 
permissible at a time for any given issue; however, the impact of some 
proposed language in this bill is unclear absent amendment.
    Specifically, VA has concerns with the proposed removal of the 
phrase ``in succession,'' from 38 U.S.C. Sec. 5104C(a)(2)(B) as this 
may cause confusion, or inadvertently allow multiple, redundant 
decision or appellate reviews of the same evidence by the same 
appellate or reviewing body--a practice that is currently prohibited to 
ensure that each time a claimant exercises a review option it offers 
either a review of new evidence or a review by a higher-level body. For 
example, the statute as currently written, with its implementing 
regulations, prohibits claimants from challenging a higher-level review 
(HLR) decision by the AOJ by filing an HLR on the same issue with the 
AOJ; prohibits filing for an HLR by the AOJ of a Board decision and 
precludes requesting Board review of a Board decision. If such 
redundant review of the same evidence by the same reviewing authority 
were allowed under the proposed bill, it would create endless cycles of 
review by the same body of the same evidence, which would bog down the 
system and fail to offer a meaningful review process to claimants.
    If the bill's intent is to clarify the requirement to only pursue 
one decision review or appeal option at a time and to clarify in 
statute which specific review options are available to challenge either 
an AOJ or a Board decision, then VA suggests either leaving the current 
statutory language explaining that options may be exercised ``in 
succession'' for the reasons above, or adding the following language 
specifying which particular review options are available within a year 
following an AOJ, Board or CAVC decision, which mirrors current 
regulatory language in 38 C.F.R. Sec.  3.2500(c):

        ``(1) Following notice of a decision on an initial claim or a 
        supplemental claim, the claimant may file a supplemental claim, 
        request a higher-level review, or appeal to the Board of 
        Veterans' Appeals.

        (2) Following notice of a decision on a higher-level review, 
        the claimant may file a supplemental claim or appeal to the 
        Board of Veterans' Appeals.

        (3) Following notice of a decision on an appeal to the Board of 
        Veterans' Appeals, the claimant may file a supplemental claim 
        or file a notice of appeal to the Court of Appeals for Veterans 
        Claims.

        (4) Following a decision on an appeal to the Court of Appeals 
        for Veterans Claims, the claimant may file a supplemental 
        claim.''

    We note that to the extent the Committee opts to model the language 
on VA's current regulation, the Committee should be aware that VA has 
committed to change current paragraph (c)(4) to extend to review by the 
U.S. Court of Appeals for the Federal Circuit and the U.S. Supreme 
Court, and currently applies this rule pursuant to Policy Letter 20-01. 
Accordingly, the Committee could consider replacing ``a decision on an 
appeal to the Court to Appeals for Veterans Claims'' with ``completion 
of judicial review'' or a similar phrase.
    With respect to the weekly reporting requirement, VA believes that 
the requirement will be administratively burdensome to execute and, 
more importantly, may be misleading to Veterans and representatives 
because of how variable those docket dates will be. For example, 
approximately 2,000-2,500 appeals are adjudicated each week at the 
Board. Approximately 30 percent of cases adjudicated by the Board each 
year are Advanced on the Docket (AOD) cases which are automatically 
moved ahead of other cases which may have been pending much longer. 
These are cases involving Veterans with serious health conditions, 
severe financial hardship and advanced age. They will have docket dates 
that may be years ahead of others waiting. Another 35-40 percent of 
cases adjudicated are also expedited because they are legacy cases 
returned after remands from either the Court or the AOJ and they 
automatically move to the head of the line either because the law 
requires it (Court remands) or because the docket dates are much older 
in comparison to AOD cases or those waiting for first-time 
adjudication. Finally, original appeals (those getting first-time 
adjudication) will fall somewhere in between those two extremes. For 
example, the Board still has over 15,000 original Legacy system appeals 
that have not been adjudicated previously by a Board judge because so 
many other appeals (older Legacy remand cases and AOD cases under both 
AMA and Legacy) move ahead of them in line. It would be impossible for 
the Board to provide an exact estimate for when a particular appeal may 
be adjudicated because each appeal place in line is constantly based on 
which appeals are joining (or re-joining) the appeals queue each day.

H.R. XXXX - Review Every Veterans Claim Act of 2023

    The Review Every Veterans Claim Act of 2023 would preclude VA from 
denying a claim for VA benefits solely on the basis that the Veteran 
failed to appear for a VA medical examination scheduled in connection 
with the claim. VA has a statutory duty to provide a medical 
examination or obtain a medical opinion or when such examination or 
opinion is necessary to decide a compensation claim. A medical 
examination or opinion is necessary to decide a claim in certain cases 
in which the evidence of record is insufficient to support a grant of 
benefits, but there is a reasonable possibility that the examination or 
opinion will provide that evidence.
    VA notes that while this bill would prohibit denial of a claim on 
the sole basis that a Veteran failed to appear for a medical 
examination, there may be cases where, without the examination, there 
is insufficient evidence to support entitlement. Even if this bill were 
enacted, claims would still be denied in those circumstances. The only 
difference would be that the denial would be due to lack of sufficient 
evidence, not solely the failure to appear for the examination.
    VA cites concerns with this bill as written. While VA appreciates 
the intent, the bill may have the effect of continuing and worsening 
the practice of those involved in the for-profit Disability Benefits 
Questionnaire completion industry who often submit inconsistent and 
questionable disability impairment descriptions in exchange for large 
fees and a portion of any future VA compensation benefits awarded. 
These bad actors intentionally and specifically instruct Veterans to 
not report for their scheduled VA disability examinations.
    If a Veteran who fails to report for a VA examination establishes 
good cause for failing to report, VA will reschedule the examination. 
Absent good cause, VA action depends on type of claim at issue. If the 
examination was scheduled in connection with an original compensation 
claim, VA will decide the claim based on the evidence of record. If the 
examination was scheduled in connection with any other claim for 
compensation or a claim for pension or dependency and indemnity 
compensation, the claim will be denied solely on the basis of the 
failure to report for the examination. VA recognizes that this 
distinction may result in inequities. VA intends to consider whether a 
single rule should apply to all types of claims. Moreover, the bill, as 
written, is limited to compensation claims. VA recommends that the same 
principle apply with respect to pension claims. However, expanding the 
bill as written to include pension claims may have unintended effects.
    We would welcome the opportunity to discuss the bill in more detail 
with the Committee.

H.R. XXXX - Veterans Exam Expansion Act of 2023

    The Veterans Exam Expansion Act of 2023 would extend existing 
temporary licensure rules for contract health care professional who 
perform medical disability examinations for VA to podiatrists, dentists 
and optometrists. The bill would also extend the license portability 
sunset date from 3 years to 5 years. The bill also includes a reporting 
requirement for the 1-year period following the date of the enactment 
of this Act.
    While VA appreciates the legislation, VA seeks to further expand 
the definition of a health care professional to include any health care 
professional deemed appropriate by VA to conduct medical disability 
examinations. This definition, for example, does not include advanced 
practicing nurses. Expanding the definition of a health care 
professional to any health care professional deemed appropriate by VA 
to conduct medical disability examinations would provide VA with 
greater flexibility to complete such examinations.
    Additionally, while VA appreciates the extension of the Licensure 
Requirements (Portability) for Contractor Medical Professionals to 
Perform Medical Disability Examinations from 3 years to 5 years, VA is 
seeking to eliminate the Sunset Date on the Licensure Requirements 
(Portability) for non-physician Contractor Medical Professionals to 
Perform Medical Disability Examinations altogether. Removing the sunset 
date and expanding how a health care professional is defined are 
critical to ensure continuous completion of thorough, accurate and 
timely medical disability examinations to Veterans, thereby leading to 
timely and accurate rating decisions associated with VA benefit 
entitlement. Additionally, these suggested amendments would allow VBA 
the flexibility to use a wider range of qualified medical professionals 
and reach more Veterans.
    No mandatory or discretionary costs are associated with this 
proposed legislation. Any additional requirements could be funded under 
existing budget authority.

Conclusion

    Mr. Chairman, this concludes my testimony. My colleagues and I are 
prepared to respond to any questions you or other Members of the 
Committee may have.
                                 ______
                                 

                  Prepared Statement of Shane Liermann

    Chairman Luttrell, Ranking Member Pappas and Members of the 
Subcommittee:
    Thank you for inviting DAV (Disabled American Veterans) to testify 
at today's legislative hearing of the Subcommittee on Disability 
Assistance and Memorial Affairs.
    DAV is a congressionally chartered, VA-accredited, non-profit 
veterans service organization (VSO) comprised of more than one million 
wartime service-disabled veterans that is dedicated to a single 
purpose: empowering veterans to lead high-quality lives with respect 
and dignity. To fulfill our service mission, DAV directly employs a 
corps of benefits advisors, national service officers (NSOs), all of 
whom are themselves wartime service-connected disabled veterans, at 
every Department of Veterans Affairs (VA) regional office (VARO) as 
well as other VA facilities throughout the Nation, including the Board 
of Veterans' Appeals (Board).
    We are pleased to offer our views on the bills impacting service-
disabled veterans, their families and the programs administered by VA 
and the Veterans Benefits Administration (VBA) that are under 
consideration by the Subcommittee.

H.R. 1753 - to ensure that certain members of the Armed Forces who 
served in female cultural support teams receive proper credit for such 
service

    H.R. 1753 would recognize the honorable service of women veterans 
who served in a female cultural support team between January 1, 2010, 
and August 31, 2021, as engagement in combat with the enemy in course 
of active military service.
    Purely from a VA claims point of view, this would positively impact 
those women veterans seeking claims related to their combat service. VA 
regulation 38 Code of Federal Regulations, Section 3.304 (f), 
specifically relates to the requirements for service connection for 
post-traumatic stress disorder (PTSD).
    Subparagraph (f)(2) states, ``if the evidence establishes that the 
veteran engaged in combat with the enemy and the claimed stressor is 
related to that combat, in the absence of clear and convincing evidence 
to the contrary, and provided that the claimed stressor is consistent 
with the circumstances, conditions, or hardships of the veteran's 
service, the veteran's lay testimony alone may establish the occurrence 
of the claimed in-service stressor.''
    By establishing combat service for the women who served in the 
recognized female cultural support teams, H.R. 1753 would provide them 
what is often referred to as a verified stressor for PTSD claims. This 
would positively impact their ability to establish a claim for PTSD and 
have it granted based on their combat service.
    Additionally, the recognized combat service would make title 38, 
United States Code, Section 1154 (b) for application. It notes, ``in 
the case of any veteran who engaged in combat with the enemy in active 
service with a military, naval, air, or space organization of the 
United States during a period of war, campaign, or expedition, the 
Secretary shall accept as sufficient proof of service-connection of any 
disease or injury alleged to have been incurred in or aggravated by 
such service satisfactory lay or other evidence of service incurrence 
or aggravation of such injury or disease, if consistent with the 
circumstances, conditions, or hardships of such service, 
notwithstanding the fact that there is no official record of such 
incurrence or aggravation in such service, and, to that end, shall 
resolve every reasonable doubt in favor of the veteran.''
    In cases where a veteran asserts service connection for injuries or 
disease incurred or aggravated in combat, title 38, United States Code, 
Section 1154 (b) and its implementing regulation, 38 Code of Federal 
Regulations, Section 3.304 (d), are applicable. This statute and 
regulation ease the evidentiary burden of a combat veteran by 
permitting the use, under certain circumstances, of lay evidence. If 
the veteran was engaged in combat with the enemy, VA shall accept as 
sufficient proof of service connection satisfactory lay or other 
evidence of service incurrence, if the lay or other evidence is 
consistent with the circumstances, conditions, or hardships of such 
service.
    The United States Court of Appeals for the Federal Circuit (Federal 
Circuit) has held that in the case of a combat veteran not only is the 
combat injury presumed, but so is the disability due to the in-service 
combat injury. Reeves v. Shinseki, 682 F.3d 988, 998-99 (Fed. Cir. 
2012). Therefore, the veteran is not only competent to report an in-
service injury, but credible.
    H.R. 1753 would provide eligible women veterans with the uniqueness 
of presumption of a combat injury. In accordance with our Resolution 
No. 010, DAV supports this bill, as it will ease barriers for women who 
served in combat and assist them in establishing claims and appeals 
within VBA and the Board of Veterans' Appeals.

          H.R. 3790 - the Justice for ALS Veterans Act of 2023

    The Justice for ALS Veterans Act would provide the survivors of 
veterans who die of amyotrophic lateral sclerosis (ALS), the DIC 
``kicker'' amount without meeting the eight-year time period 
requirement.
    Currently, title 38, United States Code, Section 1311(a)(2), allows 
an additional DIC monthly payment of $331.84 to survivors in the case 
of a veteran who at the time of death was in receipt of or was entitled 
to receive compensation for a service-connected disability that was 
rated totally disabling for a continuous period of at least eight years 
immediately preceding death. This monetary installment is commonly 
referred to as the DIC ``kicker.''
    Studies have shown that veterans are twice as likely to develop ALS 
as the general population. ALS is an aggressive disease that leaves 
many veterans totally incapacitated and reliant on family members and 
caregivers. VA already recognizes ALS as a presumptive service-
connected disease and due to its progressive nature, automatically 
rates any diagnosed veteran at 100 percent disabled. Individuals 
diagnosed with ALS have an average lifespan of between two to five 
years. Sadly, many veterans are unable to meet DIC's eight-year 
requirement.
    In accordance with our Resolution No. 162, DAV supports the Justice 
for ALS Veterans Act, which would provide these increased DIC payments 
to surviving spouses of veterans who die from ALS, regardless of the 
current eight-year period.
    Earlier this year, our members sent over 24,000 emails to Congress 
to elicit support for the Justice for ALS Veterans Act. We must ensure 
veterans' survivors and their families receive the benefits they 
deserve and are no longer penalized from receiving increased 
compensation due to the fast progression of ALS.

            H.R. 4016 - the Veteran Fraud Reimbursement Act

    The purpose of the VA Fiduciary Program, under VBA, is to protect 
beneficiaries who are unable to manage their VA benefits. VBA appoints 
fiduciaries to receive direct payments on behalf of beneficiaries and 
disburse those funds for beneficiaries' care, support, welfare, and 
needs. VA beneficiaries rely on their appointed fiduciaries to make 
financial decisions in their best interests.
    VA fiduciary staff provide oversight to help prevent fiduciaries 
from misusing funds. Misuse occurs when a fiduciary spends a 
beneficiary's benefit payments for something other than the ``use and 
benefit'' of the beneficiary. Use and benefit is any expense reasonably 
intended for the care, support, or maintenance of the beneficiary or 
the beneficiary's dependents.
    Currently when there are allegations and reports of misuse of funds 
by the VA-appointed fiduciary, VA is required to investigate a VA 
negligence determination during misuse determinations. The July 2021 VA 
Office of the Inspector General (OIG) report found that in 40 cases, 
beneficiaries faced significant wait times in the processing of misuse 
determinations, an average of 228 days, negligence determinations, an 
average of 468 days, and reimbursements of misused funds, an average of 
426 days.
    At the September 28, 2023, hearing of this Subcommittee, Lisa Van 
Haeren, Director of Claims and Fiduciary Inspection Division in the 
Office of Audits and Evaluations of the VA OIG, confirmed that 
negligence determinations by the VA do not have a specified time period 
and beneficiaries are waiting more than 400 days for reimbursement of 
misused funds.
    H.R. 4016 would amend title 38, United States Code, Section 6107, 
by removing paragraph (a) ``Negligent Failure by Secretary.'' It would 
further add, in any case in which a fiduciary misuse all or part of an 
individual's benefits paid to a fiduciary, the Secretary would be 
required to pay the beneficiary or the beneficiary's successor 
fiduciary an amount equal to the amount of the benefit misused. In 
addition, the bill would require the Secretary to make a good faith 
effort to obtain recoupment from the fiduciary to whom the payment was 
originally made.
    H.R. 4016 would remove the requirements of negligent failures 
investigations by the VA before an issuance is remitted. DAV supports 
the Veteran Fraud Reimbursement Act in accordance with our Resolution 
No. 033, which calls for improvements to the VA Fiduciary Program.
    Our most vulnerable, veterans and beneficiaries who have 
fiduciaries, must be protected from fraud and misuse of their earned 
benefits. When the fraud and misuse is discovered, VA needs to respond 
with immediate repayment of those earned benefits.
    Beneficiaries should never wait for more than a year for the 
repayment of misused benefits. We are extremely concerned about the 
financial hardships this creates for veterans and their families.

      H.R. 4190 - the Restoring Benefits to Defrauded Veterans Act

    There are numerous reports of fraud and misuse by VA-appointed 
fiduciaries. For example, the VBA FY 2022 Annual Report noted fraud and 
misuse indicating that fiduciary personnel conducted 2,067 misuse 
investigations, of which 817 fiduciaries were removed. Of the cases VA 
referred to the VA OIG, 25 misuse cases were accepted by OIG for 
further investigation.
    Under current statute, title 38, United States Code, Section 6107, 
if a veteran dies before their case with VA concerning misused funds by 
the fiduciary is resolved, the veteran's family cannot seek 
reimbursement for these funds.
    The Restoring Benefits to Defrauded Veterans Act would require VA 
to reissue misused benefits to a beneficiary's estate in cases where 
the beneficiary predeceased reissuance and would provide reissued 
benefits to either the veteran's estate, successor, or next inheritor. 
Most importantly, the Restoring Benefits to Defrauded Veterans Act 
would not allow the VA to make any reissuance to any family member who 
was the fiduciary and was misusing the veteran's benefits.
    DAV supports H.R. 4190, as it is in alignment with our Resolution 
No. 095, which calls for meaningful claims reform. The Restoring 
Benefits for Defrauded Veterans Act will not allow family members who 
defrauded the veteran to receive any of the reissued benefits, which is 
a significant reform to the claims process. However, DAV is concerned 
about situations where the family member who misused funds is a part of 
the estate and will still reap the benefits of the restored funds that 
they originally misused.

   H.R. 4306 - the Michael Lecik Military Firefighters Protection Act

    H.R. 4306 would establish presumptive service connection for 
certain diseases for veterans who were trained in fire suppression and 
served on active duty with a military occupational specialty or career 
field with a primary responsibility for firefighting or damage control 
for at least five years. Additionally, it would require that the 
disease be at a 10 percent degree or more within 15 years of the 
veteran's separating from active military service.

        The diseases that would be presumed due to firefighting are 
        listed as:

                  Heart disease;

                  Lung disease;

                  Brain cancer;

                  Cancer of the blood or lymphatic systems;

                  Leukemia;

                  Lymphoma (except Hodgkin's disease);

                  Multiple myeloma;

                  Bladder cancer;

                  Kidney cancer;

                  Cancer of the reproductive system (including 
                testicular cancer);

                  Cancer of the digestive system;

                  Colon cancer;

                  Liver cancer;

                  Skin cancer;

                  Lung cancer; and

                  Breast cancer.

    On December 23, 2022, the Federal Firefighter Fairness Act was 
signed into law. It creates the presumption that federal firefighters 
who become disabled by serious diseases, including heart disease, lung 
disease, certain cancers, and other infectious diseases, contracted the 
illness on the job. This law is similar to the legislation being 
discussed here today and is based mostly on exposures to perfluoroalkyl 
and polyfluoroalkyl substances (PFAS), man-made chemicals found in 
fire-fighting foams (or aqueous film forming foam; AFFF). However, to 
date, neither VA nor Congress has conceded exposure to PFAS chemicals 
found in the drinking supply of over 700 military installations.
    DAV, a resolution-based organization, does not have a specific 
resolution for this legislation and we take no position on H.R. 4306. 
However, we do have some concerns, thus our recommendations below:

        1. Remove the restrictions for exposure and disease 
        development. The ``Firefighters' occupational exposure: 
        Contribution from biomarkers of effect to assess health 
        risks,'' study published in the Environmental International, 
        Volume 156, in November 2021, does not cite a required amount 
        of exposure or a timeline for diseases to be manifested. Also, 
        the ongoing ``Fire Fighter Cancer Cohort Study,'' which started 
        in 2016, and aims to collect cancer-related information from US 
        firefighters over 30 years, has not yet yielded any results 
        based on required exposure timeframes or disease manifestation.

        The 2018 National Defense Authorization Act authorized the 
        Centers for Disease Control and Prevention (CDC) and the Agency 
        for Toxic Substances and Disease Registry (ATSDR), both 
        agencies of the of the U.S. Department of Health and Human 
        Services, to conduct exposure assessments in communities known 
        to have had PFAS. The study did not provide any time 
        requirements for exposure or time for the diseases to develop. 
        Additionally, the 2022 National Academies of Science, 
        Engineering, and Medicine (NASEM) report, Guidance on PFAS 
        Exposure, Testing, and Clinical Follow-Up, found no time 
        restrictions for exposure or disease development.

        It is evident that the time requirement of at least five years 
        as a firefighter and all diseases must be manifested within 15 
        years are not based on the current findings of the scientific 
        community. Therefore, we recommend that these restrictions be 
        removed from this presumptive legislation. These restrictions 
        will greatly limit the number of veterans who will be eligible 
        for the same exposures and diseases except to an arbitrary time 
        not based on science.

        2. Include PFAS exposure at all military bases with 
        contaminated water supplies. DAV strongly believes that if 
        there is legislation to address PFAS exposure for firefighters, 
        it must include the PFAS exposure in the contaminated water 
        supplies at potentially more than 700 military installations as 
        well. The previously noted NASEM report found suggestive 
        evidence of an association with PFAS exposure and increased 
        risk of breast cancer; liver enzyme alterations; increased risk 
        of pregnancy-induced hypertension; increased risk of testicular 
        cancer; thyroid disease and dysfunction and increased risk of 
        ulcerative colitis.

    The men and women exposed to toxins, whether as a firefighter or 
through exposure and consumption of contaminated water supplies, must 
be a priority to ensure they have the benefits and health care they 
have earned.

         H.R. 5559 - the Protecting Veterans Claim Options Act

    The Protecting Veterans Claim Options Act would provide needed 
clarity on Supplemental Claims and specifically, VA's regulatory 
provision of 38, Code of Federal Regulations, Section 3.2501. This 
would direct VA to accept any Supplemental Claim within one year of the 
VA decision in question, based on the evidence of record and not 
require New and Relevant evidence. Conversely, it points to any 
Supplemental Claim received after the one-year timeframe of the VA 
decision in question and would require New and Relevant evidence.
    The Appeals Modernization Act (AMA) provided the Supplemental 
Claims section as well as the requirement for New and Relevant 
evidence. However, the VA regulations do not clarify on the application 
thereof and has created confusion within VA and the regulation is not 
following the Congressional intent of Supplemental Claims and the 
requirement for New and Relevant evidence.
    Additionally, H.R. 5559 would require a change regarding remanded 
cases from the Court of Appeals for Veterans Claims (Court), that 
evidentiary record before the Board should ``include evidence submitted 
by the appellant and his or her representative, if any, within 90 days 
following such remand, which the Board shall consider in the first 
instance.''
    Without the ability to supplement the record after a Court remand, 
the veteran is forced to wait until after a decision from the Board to 
provide favorable evidence that may have changed the outcome of the 
Board's decision. Currently, the Board's AMA remand rate of appeals is 
near 40 percent. Allowing for post-Court remand evidence to be 
submitted in support of a veteran's Board appeal should serve to reduce 
the AMA remand rate.
    In accordance with our Resolution No. 095, DAV supports the 
Protecting Veterans Claim Options Act, as it will provide VA with 
needed clarity for Supplemental Claims and allow the Board to take 
jurisdiction over evidence submitted to the Court subsequent to a 
remand decision. H.R. 5559 will provide the required reforms to ensure 
the VA and the Board are adjudicating decisions and accessing evidence 
in the best interest of veterans and their families.

        H.R. 5890 - the Review Every Veterans Claim Act of 2023

    The Review Every Veterans Claim Act would limit the VA's authority 
to deny a veteran's claim solely based on the veteran's failure to 
appear for a medical examination associated with the claim.
    Currently, title 38, United States Code, section 5103A (d) 
paragraph (2) provides, ``the Secretary shall treat an examination or 
opinion as being necessary to make a decision on a claim for 
purposes....'' This requirement usually results in VBA denying a 
veteran's claim if they did not attend the requested examination, even 
if the rest of the evidence of record contains service medical records, 
private medical records and lay statements from the veteran.
    H.R. 5890 would strike that language from the statute and replace 
it with ``provide for a medical examination or obtain a medical 
opinion.'' Additionally, this legislation would add a new paragraph to 
the statute, ``If a veteran fails to appear for a medical examination 
provided by the Secretary in conjunction with a claim for a benefit 
under a law administered by the Secretary, the Secretary may not deny 
such claim on the sole basis that such veteran failed to appear for 
such medical examination.''
    Not only would these statutory amendments impact claims for service 
connection, but would apply to all claims for a benefit under VA's 
jurisdiction. We agree with this change, as in most claims for increase 
in an existing disability, VA will deny an increased evaluation solely 
on the missed examination. Although the evidence of record may contain 
sufficient evidence for the increased evaluation, VBA will deny based 
on the failure to appear. Additionally, this would be applied to other 
benefits claims such as Total Disability Based on Individual 
Unemployability (TDIU) and Aid and Attendance (A&A).
    In accordance with our Resolution No. 095, DAV supports the Review 
Every Veterans Claim Act, as this is meaningful and significant reform 
to the duty to assist. As it was allowing VBA to deny a claim based 
solely on a missed examination, we argue that it is interfering with 
the veteran's due process of a claim. Thousands of veterans' claims for 
service connection, claims for increase and for other benefits such as 
TDIU and A&A are denied solely on the basis of the missed examination. 
We look forward to the passage of the Review Every Veterans Claim Act 
and the positive impact it will have for veterans.

          H.R. 5891 - the Veteran Appeals Decision Clarity Act

    Effective February 19, 2019, the AMA was a historic overhaul of 
VA's appeals process. It provides claimants with three paths after a 
final VA decision, a supplemental claim, a higher-level review and an 
appeal directly to the Board, a Notice of Disagreement.
    Additional changes brought by the AMA are specific to the 
submission of evidence when establishing a Notice of Disagreement to 
the Board. The choices at this stage include:

      A direct review by the Board without a hearing or the 
submission of additional evidence.

      A review by the Board including additional evidence that 
must be submitted within 90 days from the date of the Notice of 
Disagreement.

      A hearing with a Veterans Law Judge at the Board with the 
opportunity to submit additional evidence within 90 days after the 
hearing was held.

    If additional evidence is received outside of those time periods, 
the Board cannot review or use that evidence in their decisions and is 
not required to note the receipt of such evidence in their decision. 
This creates confusion for veterans, VSOs, attorneys and claims agents 
as to when the evidence was received, why it was not considered and who 
has jurisdiction over said evidence.
    The Veteran Appeals Decision Clarity Act would require the Board to 
identify the time the evidence was received and acknowledge they cannot 
use it in their determination. Additionally, it would require the Board 
to state the adequacy and timeliness of the Notice of Disagreement.
    In accordance with our Resolution No. 095, DAV supports H.R. 5891, 
which calls for meaningful appeals reform by clarifying the evidence 
received outside of the mandated timeframes and that it cannot be used 
by the Board. The Veteran Appeals Decision Clarity Act will help to 
reduce confusion over evidence submitted during the appeals process. We 
acknowledge this will increase the requirements of Veteran Law Judges 
and attorneys in decision writing; however, it will further reform the 
appeals process while removing doubt of what evidence was considered or 
why it was not considered, thus providing veterans, VSOs, attorneys and 
claims agents with clarity on their potential next steps.

           H.R. 5938--the Veterans Exam Expansion Act of 2023

    The Veterans Exam Expansion Act would positively impact VA contract 
examinations for veterans' disability claims as it would expand license 
portability. In our testimony before this Subcommittee in July 2023, we 
recommended extending and expanding these authorities.
    Enacted in 2016, Public Law 114-315, section 109, ``Improvements To 
Authority For Performance Of Medical Disabilities Examinations By 
Contract Physicians,'' notes that a physician may conduct an 
examination pursuant to a contract, at any location in any state, the 
District of Columbia, or a Commonwealth, territory, or possession of 
the United States, so long as the examination is within the scope of 
the authorized duties under such contract. A physician is defined as 
one who has a current unrestricted license to practice the health care 
profession of physician.
    This allows contract exam vendors to provide examining physicians 
to rural areas that may not have examining physicians available in 
their state or territory. The provision speaks only to physicians and 
psychiatrists; however, it did not include other licensed health care 
professionals such as nurse practitioners, clinical psychologists, and 
other clinical health care professionals that are qualified to conduct 
VA examinations.
    In January 2021, the Johnny Isakson and David P. Roe, M.D. Veterans 
Health Care and Benefits Improvement Act of 2020, granted certain types 
of VBA-contracted examiners temporary authority for three years, until 
January 2024, to conduct exams in states other than those in which they 
hold a license.
    The GAO report of June 2023, ``Actions Needed to Clarify Program 
Requirements Regarding Examiners,'' looked specifically at this 
temporary portability used by contracted examiners. VBA officials and 
vendors said that the temporary expansion of license portability 
expanded access in underserved areas.
    The report noted that the guidelines VBA provided to its contracted 
exam vendors included inaccuracies and VBA conducted inadequate 
monitoring of the vendors. This contributed to vendors allowing 
ineligible examiners to conduct exams using license portability. For 
example, VBA incorrectly listed dentists as eligible for license 
portability in the guidelines it provided to vendors. This contributed 
to two of VBA's three vendors using dentists to conduct exams in states 
other than where they were licensed.
    Additionally, GAO's review found that one vendor used optometrists 
to conduct exams in states other than where they were licensed, which 
VBA officials said was not permitted. VBA acknowledged these errors and 
agreed with the GAO recommendations for correction.
    The report also showcases the impact of the expanded license 
portability. Vendors were able to send examiners to rural and high-need 
areas that did not have enough examiners to meet local demand. One 
vendor said license portability allowed them to continue serving 
veterans when natural disasters disrupted the availability of examiners 
in the affected states. For example, this vendor reported using license 
portability to send mobile clinics to Florida following Hurricane Ian 
in September 2022.
    Another vendor said license portability helped them serve more 
veterans living on tribal lands. All three vendors said expanded 
license portability helped them serve incarcerated veterans. Officials 
from one vendor said reaching these veterans historically has posed a 
challenge because not all examiners are willing to physically enter a 
prison, and license portability allowed them to use examiners willing 
to do so.
    In July 2023, information from VBA's Medical Disability Examination 
Office indicated that this license portability expansion in January 
2021 had resulted in 1,462 providers completing over 150,000 medical 
appointments and nearly 425,000 disability benefits questionnaires 
(DBQs). The provision of license portability has had a positive impact 
for veterans living in rural areas and tribal lands, and for 
incarcerated veterans, all while assisting in reducing the backlog of 
exams, which has a direct impact on the backlog of claims.
    H.R. 5938 would expand the license portability for psychologists, 
podiatrists, dentists and optometrists as well as extend the authority 
from three years to five years, now expiring in January 2026.
    DAV strongly supports the Veterans Exam Expansion Act, which will 
provide VA exams in all areas, specifically for rural and underserved 
veteran populations. Additionally, it addresses the deficiencies noted 
by the GAO report and will enable VA and contract examiners to provide 
more exams to more veterans than ever before. However, as we noted in 
our testimony of July 2023, we recommend that the license portability 
be made permanent and that all medical professionals that are able to 
conduct VA exams within the Veterans Health Administration be included 
in the permanent extension of license portability.

       Draft Bill - the Veteran Appeals Transparency Act of 2023

    The Veteran Appeals Transparency Act would amend Title 38 United 
States Code section 5104C(a) language to make it consistent with VA's 
interpretation in their regulatory provision of 38 Code of Federal 
Regulations Section 3.2500.
    Additionally, the Veteran Appeals Transparency Act would require 
``[o]n a weekly basis, for each docket, the Board shall publish the 
docket dates of the cases assigned to a Board member for a decision for 
that week.''
    In accordance with our Resolution No. 095, DAV supports the Veteran 
Appeals Transparency Act. The changes in language will provide 
consistency between the statute and regulatory provisions, resulting in 
more reliable and consistent VA decisions and appeals. By requiring the 
Board of Veterans' Appeals to weekly publish docket dates of cases 
being worked, this provides veterans, their families and 
representatives with greater understanding and transparency as to the 
status of the pending appeal, not to mention it will help Congress hold 
the Board accountable concerning appealed cases.
    This concludes my testimony on behalf of DAV. I am happy to answer 
any questions you or members of the Subcommittee may have.
                                 ______
                                 

                Prepared Statement of Quandrea Patterson

    Chairman Luttrell, Ranking Member Pappas, and members of the 
subcommittee, on behalf of the men and women of the Veterans of Foreign 
Wars of the United States (VFW) and its Auxiliary, thank you for the 
opportunity to provide our remarks on legislation pending before this 
subcommittee.

H.R. 1753, Jax Act

    The VFW supports this legislation to ensure that certain members of 
the armed forces who served in female cultural support teams receive 
proper credit for such service. A part of our organization's mission is 
to foster camaraderie among United States veterans of overseas 
conflicts. This aligns with the goal that the special operations forces 
had in 2010 when a female cultural support team was implemented to 
bridge a communication gap that prevented the maximization of strategic 
objectives during counterinsurgency in Iraq and Afghanistan. However, 
the Department of Defense 1994 Direct Ground Combat Definition and 
Assignment Rule created a barrier that would not allow the combat 
characterization assignment for females. The decision to implement 
these teams in Iraq and Afghanistan combat operations paved the way for 
a major change in this rule that integrated females into combat roles.
    Today, covered service is not classified as combat service. In some 
instances, this has a negative impact on the favorable awards of 
service-connected disability compensation and benefits. This 
legislation would allow the Department of Veteran Affairs (VA) to treat 
covered service as combat service and grant service-connected 
compensation and certain benefits when female veterans who participated 
in combat operations claim traumatic brain injuries, post-traumatic 
stress, and disabling physical trauma. It is unjust that the members of 
female cultural support teams, who facilitated a major change in combat 
roles, should be denied the full benefits they deserve from their 
hazardous duty experiences.

H.R. 3790, Justice for ALS Veterans Act of 2023

    The VFW supports this legislation. VA considers amyotrophic lateral 
sclerosis (ALS) a presumptive service-connected disease and, due to its 
progressive nature, automatically rates any diagnosed veteran at 100 
percent once service connected. If a veteran with service-connected ALS 
then dies, the surviving spouse is eligible to receive Dependency and 
Indemnity Compensation (DIC). In cases where a veteran had a VA 
disability rating of totally disabled with ALS for at least eight full 
years leading up to death and was married during those same eight 
years, the surviving spouse is then entitled to an additional monthly 
payment called the DIC kicker. A surviving spouse should be entitled to 
the eight-year provision regardless of how long the veteran had ALS. 
Taking into consideration the full-time care often needed for a person 
diagnosed with ALS and that the average life expectancy following 
diagnosis is from two to five years, we see this as an important 
addition for these survivors.

H.R. 4016, Veteran Fraud Reimbursement Act and H.R. 4190, Restoring 
Benefits to Defrauded Veterans Act

    The VFW supports both bills that seek to restore benefits to 
veterans and their families who are victims of abuse or fraud by 
fiduciaries. The Veterans Benefits Administration (VBA) appoints 
fiduciaries on behalf of veterans who are unable to manage their 
financial affairs due to injury, disease, age, or other reasons. It 
also investigates reports of fiduciary misuse of these funds. According 
to a July 2021 Office of Inspector General (OIG) report, from January 
1, 2018, through September 30, 2019, VBA staff initiated approximately 
12,000 allegations of misused benefits by fiduciaries.
    Historically, VA could make automatic repayments only to veterans 
defrauded by their fiduciaries in certain cases. A provision within the 
Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits 
Improvement Act of 2020 (P.L. 116-315) intended to correct this 
inequity and allow for automatic reimbursement in all instances of 
fiduciary fraud. An unintended consequence of this provision was that 
it created a requirement for VBA to make a negligence determination and 
for VA to investigate its own culpability in all cases of fiduciary 
misuse before reissuing payments to the beneficiaries. This has created 
an unnecessary and time-consuming process as VA's role in the 
appointment of the fiduciary or its lack of proper oversight does not 
change the outcome for the veteran.
    The OIG report identified significant wait times for beneficiaries 
and delays in repayments. Of the forty cases reviewed, it took an 
average of 228 days for VBA to complete the misuse determinations. Some 
cases took a year or longer. It also cited that negligence 
determinations were a key inefficiency in the reimbursement process. VA 
negligence determinations should never delay veterans from receiving 
their reimbursements, as this could potentially create significant 
financial hardship for an already vulnerable population.
    Additionally, we support the provision to ensure whenever the 
Secretary of Veterans Affairs determines repayment of those funds must 
be issued to the veteran, but the veteran has passed away, the funds 
would be paid to the veteran's estate. These benefits may be critical 
for the veteran's surviving spouse, next of kin, or caregiver.

H.R. 4306, Michael Lecik Military Firefighters Protection Act

    The VFW supports this proposal to establish presumptions of service 
connection for diseases associated with firefighting. Many military 
firefighters report the use of aqueous film-forming foam (AFFF) in 
firefighting and training operations, and the presence of per-and 
polyfluoroalkyl substances (PFAS) in bunker gear. Our members who 
served as military firefighters reported continuous exposure to AFFF 
during training and face a significant occupational risk due to the 
health hazards associated with these chemicals.
    We have suggestions to expand and improve the language of this 
legislation so all veterans exposed to these chemicals are provided the 
care and benefits they have earned. We believe the five-year experience 
requirement as a firefighter is too long. For these individuals, one 
exposure alone could cause harm. Additionally, there should not be a 
time limit for when the veteran can file a claim as many of these 
conditions manifest years after exposure. This legislation is 
incredibly important to prevent AFFF/PFAS from becoming another 
situation, like Blue Water Navy or Camp Lejeune, in which veterans 
became sick and died waiting decades for their conditions to be 
properly recognized and appropriately treated.

H.R. 5559, Protecting Veterans Claim Options Act

    The VFW supports the intent of H.R. 5559, and thanks Chairman Bost 
for what he is trying to achieve with this legislation. Far too many 
cases submitted in this category are left lingering with a ``no 
decision'' classification on Appeals Modernization Act reports. We 
believe the change of evidence threshold as written is too vague, and 
we are concerned about the unintended consequence of further adding to 
the appeals backlog. As VA works to streamline appeals processes and to 
ensure staff is knowledgeable and trained in the complex areas involved 
with some appeals, every effort must be made to provide veterans 
suffering from service-connected disabilities with the compensation 
they deserve. The retroactive component of this legislation is 
applauded along with the other aspects that protect veterans as they 
navigate this daunting process. The VFW is committed to working with 
Chairman Bost's committee staff to clarify the intent of this bill.

Discussion Draft, Veteran Appeals Decision of Clarity Act

    The VFW seeks further explanation on this legislation to amend 
title 38, United States Code, to improve decisions issued by the Board 
of Veterans' Appeals (BVA). This seeks to complete the communication 
from BVA to the veteran, making all aspects of the decision clear. To 
ensure that the full intent of the legislation is realized, 
clarification of lines 23-25 is requested with reference to Section 
7105 paragraph (1) of subsection (b). Specifically, a notice of 
disagreement or modern-day appeal to BVA via VA Form 10182 should be 
addressed prior to docketing of the claim at BVA. Therefore, 
referencing either after a decision has been made is irrelevant and 
cannot benefit the veteran. To wait until there is a BVA decision to 
learn that a notice of disagreement was inadequate or untimely only 
delays the opportunity for compliance or correction. This legislation 
should provide the veteran with recourse to address deficiencies in a 
timely manner prior to a final decision.

Discussion Draft, Veteran Appeals Transparency Act of 2023

    The VFW seeks further clarification on this legislation to make 
certain improvements to the processing of claims for benefits under the 
laws administered by the Secretary of Veterans Affairs and the 
transparency of BVA. This amendment is a positive clarifying change 
that provides guidance in actions that can be taken by the veteran. 
Although generally understood, this legislation amplifies options along 
with other resources and aids such as the VA appeals status tool. This 
calls for weekly publications of expected actions on each docket. The 
VFW believes that publishing claims that are docketed at BVA is not 
informative unless supporting information indicates the number of 
claims being decided during that period. Monthly publications as 
opposed to weekly should be considered and may be sufficient. 
Otherwise, it gives the impression that a much sooner decision is 
forthcoming. Further, there needs to be education on the fact that this 
is not a first in, first out process. If clarity reveals that the 
publishing of claims docketed for decisions each week implies that they 
will receive decisions that week, then it is exceptional and welcomed 
information to provide the public. These considerations would help 
fulfill the intent of transparency in this legislation.

Discussion Draft, Review Every Veterans Claim Act of 2023

    The VFW supports this legislation to amend title 38, United States 
Code, to limit the authority of the Secretary of Veterans Affairs to 
deny the claim of a veteran for benefits on the sole basis of failure 
to appear for a medical examination. VA has made significant 
improvements to ensure filing for service-connected disability 
compensation is easier for veterans. However, one major difficulty that 
remains is the practice of denying benefits due to a missed medical 
examination. Veterans miss appointments for many reasons and would 
benefit from a process that does not place so much emphasis on this 
aspect. This legislation is a step in the right direction for continued 
improvements.
    The VFW has worked with countless veterans who had to reapply for 
benefits because they missed examination appointments. Restarting a VA 
claim simply because of this is burdensome and unnecessary. We 
recommend that if an appointment is missed, then the file should go 
back into the queue in a type of hold that can be reactivated later. 
This would allow the veteran to restart the claim process from that 
point instead of starting over from the beginning.

Discussion Draft, Veterans Exam Expansion Act of 2023

    The VFW supports this bill that amends previous legislation to 
improve the temporary licensure requirements for contract health 
professionals who perform medical disability examinations for VA. 
Veterans deserve the best care possible, but not at the expense of 
timely service. It is important to develop an examination process that 
is proficient and well serves veterans with service-connected 
disabilities. Recent highlights in Government Accountability Office 
reports recommend changes that would produce better results with the 
practice of license portability. With well-developed procedures 
accompanied by proper oversight and clear guidance on the execution of 
this practice, the extension of license portability to include 
psychologist, podiatrist, dentist, or optometrist would be instrumental 
in the processing of PACT Act claims and all service-connected claims 
going forward. Recommendations including reporting requirements that 
measure the success of amendments proposed in this legislation would 
allow VBA to continue with appointments at a faster rate to the benefit 
of veterans.
    Chairman Luttrell, this concludes my testimony. Again, the VFW 
thanks you and Ranking Member Pappas for the opportunity to testify on 
these important issues before this subcommittee. I am prepared to take 
any questions you or the subcommittee members may have.

 Information Required by Rule XI2(g)(4) of the House of Representatives

Pursuant to Rule XI2(g)(4) of the House of Representatives, the VFW has 
not received any Federal grants in Fiscal Year 2023, nor has it 
received any federal grants in the two previous Fiscal Years.

The VFW has not received payments or contracts from any foreign 
governments in the current year or preceding two calendar years.
                                 ______
                                 

                  Prepared Statement of Zachary Stolz

    Chairman Luttrell, Ranking Member Pappas and Members of the 
Subcommittee:
    Thank you for inviting Chisholm Chisholm & Kilpatrick LTD (CCK) to 
testify at today's legislative hearing of the Subcommittee on 
Disability Assistance and Memorial Affairs.
    CCK is a public interest law firm, with offices in Providence, 
Rhode Island and Houston, Texas. We serve clients across the Nation 
focusing on veterans disability compensation, bequest management, and 
long-term disability insurance claims. Since 1999, CCK has represented 
thousands of veterans and family members before VA and the U.S. Court 
of Appeals for Veterans Claims. CCK has the most VA-accredited 
attorneys, practitioners, and claims agents of any law firm in the 
United States. The firm has been involved in legislative processes and 
landmark, precedent-setting cases that have benefited the entire 
veterans' community.
    We are pleased to offer our views on these bills impacting service-
disabled veterans and their families.

                           H.R. 1753: Jax Act

    H.R. 1753 is an important step in recognizing the honorable service 
of women veterans who deployed alongside Special Forces in Iraq and 
Afghanistan, expanding operational and intelligence-gathering 
capabilities. These veterans shared combat experiences with their male 
counterparts.
    By acknowledging combat service for the women who served as members 
of Cultural Support Teams, H.R. 1753 would positively impact their 
ability to establish entitlement to VA benefits.
    In cases where a veteran asserts service connection for an injury 
or disease incurred or aggravated in combat, 38 U.S.C. Sec.  1154(b) 
and its implementing regulation, 38 C.F.R. Sec.  3.304(d) (2023), 
apply. These provisions ease the evidentiary burden on combat veterans 
because VA must accept as sufficient proof of service connection 
satisfactory lay or other evidence of service incurrence, if the lay or 
other evidence is consistent with the circumstances, conditions, or 
hardships of such service.
    H.R. 1753 would provide these veterans with the appropriate combat 
presumptions already articulated in statute, regulation, and caselaw.

           H.R. 5890: Review Every Veterans Claim Act of 2023

    The Review Every Veterans Claim Act would limit VA's authority to 
deny a veteran's claim solely based on the veteran's failure to appear 
for a medical examination associated with the claim.
    Thousands of veterans' claims are denied only because the veteran 
missed a VA examination. In our experience, many of these scheduled 
examinations are unnecessary to adjudicate the claims. Yet, 38 U.S.C. 
Sec.  5103A(d)(2) currently says that ``[t]he Secretary shall treat an 
examination or opinion as being necessary to make a decision on a claim 
for purposes....'' This requirement often results in VA regional 
offices and the Board denying veterans' claims if they did not attend 
the requested examination, even if the comprehensive record before the 
VA contains other evidence, including service and private examination 
reports, supportive of the claim.
    The Review Every Veterans Claim Act would strike that language from 
the statute and replace it with ``provide for a medical examination or 
obtain a medical opinion.'' Additionally, this legislation would add a 
new paragraph to the statute: ``If a veteran fails to appear for a 
medical examination provided by the Secretary in conjunction with a 
claim for a benefit under a law administered by the Secretary, the 
Secretary may not deny such claim on the sole basis that such veteran 
failed to appear for such medical examination.''
    These changes would be enormously helpful to veterans seeking VA 
benefits. Many claimants have already submitted reams of medical 
evidence, testimony, service records, etc. It serves no purpose for VA 
to deny claims simply because of a missed VA examination, especially 
when the evidence is otherwise sufficient to grant a claim.

              HR 5938: Veterans Exam Expansion Act of 2023

    The Veterans Exam Expansion Act would positively impact VA contract 
examinations for veterans' disability claims. It would expand the 
license portability for psychologists, podiatrists, dentists, and 
optometrists as well as extend the authority from three years to five 
years--now expiring in January 2026.
    This will give veterans greater access to expert evidence 
substantiating their claims. This is particularly important under the 
Veterans Appeals Improvement and Modernization Act of 2017 (AMA) 
because the role of examinations and examiners is heightened due to the 
need for new and relevant evidence to begin the claims process or 
continue an option of review in the appeals process. Moreover, the 
supplemental claim lane has become the most popular selection for 
veterans seeking benefits due to a host of reasons, including the 
dramatic delays for appeals adjudication at the Board of Veterans' 
Appeals. The PACT Act has also expanded the need for Toxic Exposure 
Risk Activity examinations. The more professionals VA has on board to 
serve our veterans, the more streamlined claims processing can be.

            H.R. 5891: Veteran Appeals Decision Clarity Act

    Under the AMA, claimants submit their notices of disagreement 
directly to the Board, rather than to the regional office. See 38 
C.F.R. Sec.  20.203(a) (2023). This is a change from the Legacy system. 
See 38 C.F.R. Sec.  20.300 (2018). A recent case before the Court of 
Appeals for Veterans Claims, Kernz v. McDonough, demonstrates that the 
Board managed this change by having ``administrative 
professional[s]''--not Board members--review and determine the 
timeliness of NODs. Vet.App. No. 20-2365, Secretary's Response to 
Request for Class Certification and Class Action, Exhibit J p. 2 (filed 
5/17/21). If the administrative professional determined that the NOD 
was untimely, VA sent a letter signed by the Vice Chairman notifying 
the claimant that the appeal would not be docketed. Id.
    Unfortunately, however, the administrative professionals' 
timeliness determinations were often wrong. The result is that the 
Board erroneously failed to docket the timely appeals of an estimated 
2,000 claimants. Vet.App. No. 20-2365, Request for Class Certification, 
p. 5-6 (filed 2/5/21).
    Mr. Kernz sought to remedy this by appealing the untimeliness 
notice he received from the Board to the Veterans Court and requesting 
the Court certify a class of similarly situated claimants. While Mr. 
Kenz's appeal was pending before the Veterans Court, the Board took 
corrective action in his case and docketed his appeal. However, though 
it was undisputed that other claimants were also wrongly denied their 
right to a decision by the Board, the Board refused to identify those 
claimants and take corrective action in those individual claims. 
According to the Board, it would be too burdensome to identify these 
claimants. Due to its inadequate mechanisms for tracking the notice 
letters, it would have to manually identify the claimants who received 
the letters. Therefore, instead of identifying the injured claimants, 
the Board published a notice on its website inviting claimants to 
contact the Board if they received notice and believed it was wrong.
    In its decision earlier this month, the Court dismissed Mr. Kernz's 
appeal as moot because the Board had taken corrective action and 
docketed his individual appeal. See Kernz,--Vet.App.--, 2023 WL 
6459373, *7-9 (Oct. 4, 2023). And it refused to certify the class, 
citing the mootness of Mr. Kernz's appeal. Id. at *12-13. So, the many 
claimants who were adversely affected by the Board's plainly erroneous 
actions remain without a remedy, short of identifying the error by 
themselves and asking the Board to docket their appeals.
    This case demonstrates the necessity of passing this Act. It would 
ensure that Board members no longer delegate their responsibility to 
make decisions on all issues presented on appeal--including the 
timeliness of an NOD--to ``administrative professionals.'' Claimants 
would be entitled to a ``written determination of the Board whether the 
notice of disagreement was adequate and timely filed under section 7105 
of [Title 38].'' While this imposes an additional responsibility on the 
Board, it will result in a more complete decision from that body. This 
will place claimants in a better position to understand the decision 
and the rights it confers on them.

            H.R. 5559: Protecting Veterans Claim Options Act

    This Act contains a vital change regarding remanded cases from the 
Veterans Court in 38 U.S.C. Sec.  7113 proposed subsection (d). It 
would require the evidentiary record before the Board to ``include 
evidence submitted by the appellant and his or her representative, if 
any, within 90 days following such remand, which the Board shall 
consider in the first instance.''
    This change is important because in the AMA, veterans are currently 
sent back to the lane from which they originally appealed, without the 
ability to supplement the record. This is harmful because veterans have 
already waited years to have their day in Court. Without the ability to 
supplement the record after a Court remand, the claimant will be forced 
to wait until after a decision from the Board to provide favorable 
evidence that may have changed the outcome of the Board's decision. 
Moreover, the benefit that claimants were supposed to receive in 
exchange for losing the Board's assistance in developing evidence was a 
significantly lower Board remand rate. Yet, VA's own metrics document 
that the Board's remand rate in AMA is close to 40 percent, which 
remains much higher than anticipated. Allowing for post-Court remand 
evidence to be submitted in support of a claimant's Board appeal should 
serve to reduce the AMA remand rate. This is especially critical 
because Board remands in AMA further harm veterans, who are forced to 
file new appeals to the Board if those remands are denied by the 
regional office. When veterans file appeals again to the Board, they no 
longer retain their docket numbers before the Board, but are assigned 
new docket numbers. This means their appeals go to the back of the line 
for adjudication. So, the veterans fighting the longest are put in the 
position of waiting the longest, too.
    In the spirit of the choice and control the AMA provides veterans, 
veterans should be able to have a Board member decide their appeals 
without having to start over. The Protecting Veterans Claim Options Act 
is a critical correction to ensure veterans are not harmed by the AMA.

           Discussion Draft: Veteran Appeals Transparency Act

    This Act contains an important provision for veterans and their 
advocates to increase understanding of where claims are in the Board of 
Veterans' Appeals process. Requiring that ``[o]n a weekly basis, for 
each docket, the Board shall publish the docket dates of the cases 
assigned to a Board member for a decision for that week'' will allow 
for greater understanding and oversight of the Board's progress in 
working its docket.
    CCK spent months pursuing a writ of mandamus from the Veterans 
Court in Gray v. McDonough, 36 Vet.App. 117 (2023). While the petition 
ultimately became moot, it is telling that it took the Secretary's 
counsel months--and several Court orders--to provide basic information 
about how it was adjudicating cases in compliance with the laws 
governing docket order. Should this Act become law, it will help 
Congress hold the Board accountable and allow for veterans and 
advocates to have much needed information concerning where cases are in 
the appeals process.

               H.R. 4016: Veteran Fraud Reimbursement Act

    The proposed amendments to 38 U.S.C. Sec.  6107 are important to 
making whole a veteran who has been abused by the fraudulent practices 
of a fiduciary. Veterans who require the assistance of a fiduciary to 
manage their funds are, by definition, vulnerable. Often, investigation 
into fraud is a slow process, which can delay the remedy required to 
make the victim of the harm whole. This Act prioritizes providing a 
remedy to the veteran over a determination of whether VA was at fault. 
These solution-focused revisions are an important step in making 
defrauded veterans whole. Unfortunately, fraud perpetrated against 
veterans is prevalent especially as it relates to acquisition of 
benefits. We support measures aimed at reducing and eliminating fraud 
perpetrated against veterans and their families in the veterans 
benefits arena, especially those directed toward actors illegally 
charging fees or misusing funds belonging to veterans.

        H.R. 4190: Restoring Benefits to Defrauded Veterans Act

    This Act recognizes the harm claimants experience at the hands of 
fraudulent actors and provides additional recourse than currently 
exists to make them whole. The addition of proposed section (c), to 
reissue amounts when the beneficiary has predeceased resolution, is an 
important step in redirecting those funds appropriately.

                               CONCLUSION

    Thank you again for allowing us to present our views on this 
important legislation. If you have questions or would like to request 
additional information, please feel free to contact:

Zachary M. Stolz, Esq.
Partner
Chisholm Chisholm & Kilpatrick LTD
321 S Main St #200
Providence, RI 02903 zstolz@cck-law.com
401-331-6300

                       Statements for the Record

                              ----------                              


            Prepared Statement of American Veterans (AMVETS)

    Chairman Luttrell, Ranking Member Pappas, and Members of the House 
Committee on Veterans Affairs, Subcommittee on Disability Assistance 
and Memorial Affairs, AMVETS appreciates the opportunity to present you 
with our views on proposed legislation in the House.
    As the largest veteran service organization open to all who have 
honorably served, we are dedicated to pursuing those issues that stand 
to improve the quality of life for our nation's servicemembers, 
veterans, and their survivors. AMVETS works tirelessly to address these 
important concerns, and we are proud to provide our input on the 
legislation included in today's legislative hearing. We thank the 
Subcommittee for their consideration.

                      Regarding Surviving Spouses

    AMVETS is a service organization dedicated to veterans, 
servicemembers, and their families. As such, we as an organization 
unequivocally stand behind our surviving spouses who have lost their 
partners in the line of duty or due to service-connected conditions. We 
pursue numerous efforts on their behalf in full recognition of their 
immense and irreplaceable sacrifices.
    AMVETS supports H.R. 3790 - Justice for ALS Veterans Act of 2023. 
AMVETS recognizes the need to extend increased dependency and indemnity 
compensation (DIC) compensation to those whose spouses died due to 
amyotrophic lateral sclerosis. Regardless of how long a veteran or 
servicemember suffered from this ailment, this service-connected 
disability must be included among other recognized conditions eligible 
for DIC payments upon their passing.

                  Regarding Disability Exam Expansion

    AMVETS supports the Veteran Exam Expansion Act of 2023. AMVETS has 
heard from its membership and other trusted partners that there is a 
significant wait time for active duty servicemembers to receive 
compensation and pension exams to determine service-connected 
disabilities. Reducing these wait times and helping veterans complete 
their disability exams would allow new veterans to get their disability 
determinations, access to medical care, and compensation faster. Our 
nation's veterans deserve speedy, efficient processes to provide them 
with the benefits they earned.

                       Regarding Issues of Fraud

    AMVETS remains concerned about the increasing number of fraud cases 
related to veterans' benefits, claims, fiduciaries, and other relevant 
circumstances. As such, AMVETS has made numerous strides to educate and 
alert veterans to potential scams and fraudulent activity by immoral 
actors. Protecting our veterans and their earned benefits continues to 
be a top priority of our organization.
    AMVETS supports H.R. 4016 - Veteran Fraud Reimbursement Act. AMVETS 
believes that in cases involving a fiduciary misusing a veteran's 
benefits and related compensation, the VA must pay the beneficiary or 
the beneficiary's successor fiduciary the same amount that was misused. 
The VA must also investigate any misuse of funds by fiduciaries, 
holding them accountable for their actions and combating negligence 
within the Department of Veterans Affairs.
    AMVETS supports H.R. 4190 - Restoring Benefits to Defrauded 
Veterans Act. AMVETS supports the repayment of certain benefits to the 
estates of deceased beneficiaries whose benefits were misused by 
fiduciaries. Our organization believes that inheritors and successor 
fiduciaries are entitled to these benefits.

                    Regarding Presumptive Conditions

    AMVETS played a major role in the passage of the PACT Act last 
year, a monumental law that compensates veterans impacted by service-
connected toxic exposure. Similar to this effort, AMVETS continues to 
support the recognition of further conditions that impact 
servicemembers, both presumptive to their service and following their 
service experiences.
    H.R. 4306 - Michael Lecik Military Firefighters Protection Act. 
AMVETS supports this bill that would establish presumptions of service 
connection for diseases associated with firefighting. Such conditions 
included in this bill severely impact the quality of life for these 
veterans and should be acknowledged as service-connected.

   Regarding Transparency in VA Claims, Appeals, and Other Processes

    AMVETS supports H.R. 5559, the Protecting Veterans Claim Options 
Act, Chairman Luttrell's Review Every Veterans Claim Act, Chairman 
Luttrell's Veteran Appeals Decision Clarity Act, and Representative 
Self's Veteran Appeals Transparency Act. These bills work toward more 
transparent processes within the Department of Veterans Affairs, 
boosting accountability and accessibility for all of our nation's 
veterans. AMVETS believes that each veteran's claim must be granted the 
attention it deserves, and any further VA action with claims, appeals, 
or similar processes should be clearly communicated to impacted 
veterans.

                           Other Legislation

    H.R. 1753 - Jax Act. This bill seeks to properly credit members of 
the military who served in female cultural support teams. AMVETS 
supports the recognition of these servicemembers given their 
exceptional service to the United States.

                               Conclusion

    Chairman Luttrell, Ranking Member Pappas, and Members of the 
Subcommittee, I would like to thank you once again for the opportunity 
to provide commentary on these issues that impact AMVETS' membership, 
active duty service members, American veterans, and their surviving 
family members. As Congress continues its oversight of the Department 
of Veterans Affairs and works with the VA to address these concerns, it 
will be imperative to remember that this legislation will help improve 
the lives of millions of individuals who have dedicated their lives to 
defending our country. AMVETS looks forward to continuing to contribute 
to this conversation and keeping the interest of our veterans and the 
military-connected community at the forefront of national discourse. 
Thank you.

Executive Director Joseph Chenelly

    Joseph R. Chenelly was appointed national executive director of the 
nation's fourth-largest veterans service organization in May 2016. In 
this capacity, he administers the policies of AMVETS, supervises its 
national headquarters operations, and provides direction, as needed, to 
state and local components. Joe previously served as AMVETS' national 
communications director.
    Joe Chenelly is the first veteran of combat operations in 
Afghanistan and Iraq to lead one of the nation's four largest veterans 
service organizations' staffs. A native of Rochester, N.Y., Joe 
enlisted in the U.S. Marine Corps in 1998, serving with the 1st Marine 
Division, and was honorably discharged as a Staff Sergeant in April 
2006. He is a combat veteran of Operation Enduring Freedom and 
Operation Iraqi Freedom, having served in Afghanistan, Pakistan, Iraq, 
Kuwait, East Timor, and the Horn of Africa.
    Joe became a veterans' advocate, a journalist, and a political 
adviser after his time in uniform. He covered military and veterans 
matters on staff with Leatherneck magazine, the Military Times 
newspapers, USA TODAY, and Gannet News, reporting on operations in the 
Middle East, Southwest Asia, and Africa, as well as disaster relief in 
the United States. Joe was named one of the 100 ``most influential 
journalists covering armed violence'' by Action on Armed Violence in 
2013. He was the first U.S. Marine combat correspondent to step into 
enemy territory after September 11, 2001, as a military reporter in 
Pakistan and Afghanistan. He also reported from the front lines with 
American and Allied forces in Kuwait and Iraq as that war began. He was 
on the ground for the start of both Operation Enduring Freedom and 
Operation Iraqi Freedom.
    Joe served as AMVETS' national communications director in 2005 and 
for the past eight years as assistant national director for 
communications for the Disabled American Veterans (DAV) in Washington, 
D.C. leading grassroots efforts through social networking and new 
media.
    He has also served as president of Social Communications, LLC, and 
as a public affairs officer director for the Department of Navy. Joe is 
an alumnus of Syracuse University and Central Texas College. He resides 
in Fairport, N.Y., with his wife Dawn, a service-connected disabled Air 
Force veteran, and their five children.

ABOUT AMVETS

    Today, AMVETS is America's most inclusive congressionally chartered 
veterans service organization. Our membership is open to both active 
duty, reservists, guardsmen, and honorably discharged veterans. 
Accordingly, the men and women of AMVETS have contributed to the 
defense of our nation in every conflict since World War II.
    Our commitment to these men and women can also be traced to the 
aftermath of the last World War, when waves of former service members 
began returning stateside in search of the health, education, and 
employment benefits they earned. Because obtaining these benefits 
proved difficult for many, veterans savvy at navigating the government 
bureaucracy began forming local groups to help their peers. As the 
ranks of our Nation's veterans swelled into the millions, it became 
clear a national organization would be needed. Groups established to 
serve the veterans of previous wars wouldn't do either; the leaders of 
this new generation wanted an organization of their own.
    With that in mind, 18 delegates, representing nine veterans' clubs, 
gathered in Kansas City, Missouri, and founded The American Veterans of 
World War II on Dec. 10, 1944. Less than three years later, on July 23, 
1947, President Harry S. Truman signed Public Law 216, making AMVETS, 
the first post-World War II organization to be chartered by Congress.
    Since then, our congressional charter has been amended to admit 
members from subsequent eras of service. Our organization has also 
changed over the years, evolving to better serve these more recent 
generations of veterans and their families. In furtherance of this 
goal, AMVETS maintains partnerships with other Congressionally 
chartered veterans' service organizations that round out what's called 
the ``Big Six'' coalition. We're also working with newer groups, 
including Iraq and Afghanistan Veterans of America and The Independence 
Fund. Moreover, AMVETS recently teamed up with the VA's Office of 
Suicide Prevention and Mental Health to help stem the epidemic of 
veterans' suicide. As our organization looks to the future, we do so 
hand in hand with those who share our commitment to serving the 
defenders of this Nation. We hope the 116th Session of Congress will 
join in our conviction by casting votes and making policy decisions 
that protect our veterans.

  Information Required by Rule XI 2(g) of the House of Representatives

    Pursuant to Rule XI 2(g) of the House of Representatives, the 
following information is provided regarding federal grants and 
contracts.
    Fiscal Year 2023--None
    Fiscal Year 2022--None
    Fiscal Year 2021--None
    Fiscal Year 2020--None
    Fiscal Year 2019--None
    Fiscal Year 2018--None
    Fiscal Year 2017--None
    Fiscal Year 2016--None
    Disclosure of Foreign Payments--None
                                 ______
                                 

  Prepared Statement of National Organization of Veterans' Advocates, 
                              INC. (NOVA)

    Chairman Luttrell, Ranking Member Pappas, and members of the 
Subcommittee, the National Organization of Veterans' Advocates (NOVA) 
thanks you for the opportunity to offer our views on pending 
legislation.
    NOVA is a not-for-profit 501(c)(6) educational membership 
organization incorporated in the District of Columbia in 1993. NOVA 
represents nearly 850 accredited attorneys, agents, and qualified 
members assisting tens of thousands of our nation's military veterans, 
families, survivors, and caregivers seeking to obtain their earned 
benefits from VA. NOVA works to develop and encourage high standards of 
service and representation for persons seeking VA benefits.
    NOVA members represent veterans before all levels of VA's 
disability claims process, and handle appeals before the U.S. Court of 
Appeals for Veterans Claims (CAVC), U.S. Court of Appeals for the 
Federal Circuit, and the Supreme Court of the United States. As an 
organization, NOVA advances important cases and files amicus briefs in 
others. See, e.g., Henderson v. Shinseki, 562 U.S. 428 (2011) (amicus); 
NOVA v. Secretary of Veterans Affairs, 710 F.3d 1328 (Fed. Cir. 2013) 
(addressing VA's failure to honor its commitment to stop applying an 
invalid rule); Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019) 
(amicus); NOVA v. Secretary of Veterans Affairs, 981 F.3d 1360 (Fed. 
Cir. 2020) (M21-1 rule was interpretive rule of general applicability 
and agency action subject to judicial review); Buffington v. McDonough, 
No. 21-972 (February 7, 2022) (amicus in support of petition for writ 
of certiorari before U.S. Supreme Court); Van Dermark v. McDonough, No. 
23-178 (September 25, 2023) (amicus in support of petition for writ of 
certiorari before U.S. Supreme Court). In 2000, the CAVC recognized 
NOVA's work on behalf of veterans with the Hart T. Mankin Distinguished 
Service Award.
    NOVA also advocates for laws to improve the VA disability claims 
and appeals process. NOVA participated in the stakeholder meetings that 
resulted in the development and passage of the Veterans Appeals 
Improvement and Modernization Act of 2017, Pub. L. 115-55, 131 Stat. 
1105 (August 23, 2017) (AMA). As VA has implemented the new system over 
the last several years, NOVA has provided extensive training to our 
members on the statute, regulations, and practice under the AMA. We 
have also gathered information from our members across the country on 
their experiences advocating for clients in the new system. As such, we 
have a unique view of the strengths and weaknesses of this legislation. 
Our statement, therefore, will focus on the bills that impact the 
adjudication of claims and appeals: (1) H.R. 5559: Protecting Veterans 
Claim Options Act; (2) H.R. 5891: Veterans Appeals Decision Clarity 
Act; (3) H.R. 5870: Veterans Appeals Transparency Act of 2023; and (4) 
H.R. 5890: Review Every Veterans Claim Act of 2023.

           H.R. 5559: Protecting Veterans Claims Options Act

    The first major provision of this bill would amend 38 U.S.C. Sec.  
5108 by eliminating the requirement to submit new and relevant evidence 
with supplemental claims filed within one year of the original 
decision. The ``new and relevant'' standard was adopted in the AMA to 
replace the ``new and material'' standard required for reopening 
previously denied claims in the legacy system. The statute makes clear 
that the ``new and relevant'' standard is not intended to be a higher 
standard than the former ``new and material'' standard. See 38 U.S.C. 
Sec.  5108 note (the new and relevant standard ``shall not be construed 
to impose a higher evidentiary standard than the new and material 
evidence standard''). NOVA members report, however, that VA frequently 
rejects supplemental claims due to a purported lack of ``new and 
relevant'' evidence. By easing the standard, Congress recognizes the 
importance of the nonadversarial process before the agency. This 
amendment also more closely reflects the feedback of stakeholders 
during discussions of the original legislation, who generally advocated 
that the threshold requirement should be solely ``new'' evidence. NOVA 
supports this amendment.
    The second major provision of this bill would amend 38 U.S.C. Sec.  
7113 by adding a new subsection (d). This amendment is important to all 
appellants whose cases are returned to the Board of Veterans' Appeals 
(Board) after a remand from the CAVC. First, the amendment clearly 
provides for an appellant to submit additional evidence to the Board 
for consideration and requires the Board to allow a full 90-day period 
for such submission. Currently, appellants are sent back to the lane 
from which they originated. If an appeal was previously adjudicated 
through the direct review lane, for example, the appeal would be 
returned to that lane with no opportunity to add additional evidence. 
Such a restriction may rob the appellant of the benefit of the remand 
negotiated by the parties or ordered by the CAVC in a decision. It also 
promotes inefficiency in the system.
    But most importantly, by adopting this amendment, an appellant 
could have the appeal resolved more expeditiously and be spared a 
return to the agency to endure another multi-year wait if they are not 
granted the benefit at the agency level. An appellant in the AMA system 
does not retain their Board docket date when sent back to the agency, 
so this amendment could be a lifeline for veterans, families, 
survivors, and caregivers who have already waited years for VA and the 
Board to adjudicate their appeals. Not only is this amendment more 
veteran friendly, it promotes efficiency throughout the disability 
claims and appeals system. NOVA supports this amendment.
    NOVA requests that this provision be expanded to allow an appellant 
to choose to return to the hearing lane if desired.

            H.R. 5981: Veterans Appeals Decision Clarity Act

    NOVA supports the Veterans Appeals Decision Clarity Act. Under the 
proposed amendment to 38 U.S.C. Sec.  7104, when the Board declines to 
consider evidence because it was not received during a period permitted 
under Sec.  7113, it would be required to ``identify[] the time when 
such evidence was received and provision of section 7113 of this title 
that establishes that such evidence may not be received at such time.'' 
This language codifies the CAVC's intent as expressed in Cook v. 
McDonough, 36 Vet.App. 175 (2023). In that case, the Court stated that 
``[f]or a claimant to make an informed decision on whether and how to 
have VA consider any evidence not considered by the Board, the Board 
must accurately inform the claimant whether it did not consider 
evidence because it was received during a time not permitted by section 
7113, and what options may be available for having VA consider that 
evidence.'' Id. at 189. Codifying this clarification will reduce 
confusion and provide important information to an appellant so they can 
return to the supplemental claim lane if they choose, have the evidence 
considered, and preserve the earliest possible effective date.
    This amendment not only furthers the nonadversarial system intended 
by Congress, it also promotes agency efficiency. When appellants 
clearly understand what evidence has or has not been considered, it 
reduces the need for repetitive claims and appeals and helps to 
alleviate ongoing churn.
    In addition, requiring the Board to provide ``a written 
determination of . . . whether the notice of disagreement was adequate 
and filed timely under section 7105 of this title'' provides a 
definitive legal finding made by a Veterans Law Judge and not by a VA 
administrative employee. It is critical that this basic jurisdictional 
question be answered by the decision-maker to ensure there is no 
confusion about the appellant's ability to challenge such an important 
decision.

          H.R. 5870: Veterans Appeals Transparency Act of 2023

    NOVA does not support the Veterans Appeals Transparency Act as 
written. This bill amends 38 U.S.C. Sec.  5104C, which governs options 
following a decision by the agency of original jurisdiction. NOVA is 
concerned about the language added at (B)(ii), which requires the 
claimant to take the selected action ``in response to, and not later 
than one year after, the date of the most recent decision on the claim 
made by the agency of original jurisdiction.''
    As written, this language could codify the Secretary's erroneous 
position in a case just decided by the CAVC and serve to undermine 
Congressional intent to provide more choice and control to veterans 
over the adjudicatory process. Terry v. McDonough, No. 20-7251 (October 
19, 2023). VA denied Mr. Terry's claim for sleep apnea and he opted 
into the AMA via the Rapid Appeals Modernization Program (RAMP) by 
choosing a higher-level review (HLR). VA again denied service 
connection for sleep apnea and, within the year of the original denial, 
the veteran filed a supplemental claim. VA denied the supplemental 
claim, finding the veteran did not submit new and relevant evidence 
required to readjudicate the claim. Still within a year of the original 
decision, the veteran filed a VA Form 10182 seeking Board review. The 
Board denied the appeal, finding the veteran could not appeal the HLR 
because it was not the ``the most recent decision.'' On that basis, the 
Board reviewed the supplemental claim, determined there was no new and 
relevant evidence submitted, and denied the appeal without ever 
reaching the merits of the veteran's original claim. Not only was the 
veteran denied his right to one review on appeal of the claim as 
required under 38 U.S.C. Sec.  7104(a), the Board misinterpreted Sec.  
5104C(a) by rejecting his appeal.
    The Court agreed with Mr. Terry, holding that ``5104C(a) plainly 
provides that a claimant may file more than one administrative review 
request within 1 year of an initial AOJ decision on a claim, provided 
that such an administrative review request is not pending concurrently 
with another administrative review request.'' Terry, slip op. at 2.
    Because this bill would limit a claimant's options in the AMA, NOVA 
cannot support the amendments to the statute as written.
    NOVA appreciates and endorses the Subcommittee's plan to require 
more transparency from the Board. We suggest amending subsection (f) to 
state: ``On a weekly basis, for each docket, the Board shall publish 
the docketing dates of the cases that have been assigned to all Board 
members for decisions in the AMA system and legacy system and shall 
publish the docketing dates of all decisions issued by the Board in the 
AMA system and legacy system that week.'' Currently, the only way for 
advocates to obtain this information is by filing a Freedom of 
Information Act (FOIA) request with the Board, which can be a timely 
and expensive endeavor. When advocates petition the CAVC to order the 
Board to issue a decision on an appeal that has been languishing, the 
Secretary routinely asserts that the Board must adjudicate all non-
expedited appeals in docket order and asks the Court to dismiss the 
petition. Without any substantive information, the Court routinely 
grants the Secretary's request to dismiss. Amending subsection (f) will 
promote transparency and provide veterans and advocates with useful 
information regarding the status of their appeals.

           H.R. 5890: Review Every Veterans Claim Act of 2023

    NOVA supports the Review Every Veterans Claim Act of 2023. This 
bill would amend current 38 U.S.C. Sec.  5103A to provide that, ``[i]f 
a veteran fails to appear for a medical examination provided by the 
Secretary in conjunction with a claim for a benefit under a law 
administered by the Secretary, the Secretary may not deny such claim on 
the sole basis that such veteran failed to appear for such medical 
examination.''
    By eliminating denials based solely on the failure to appear for an 
examination, veterans will stop being unfairly penalized for situations 
often beyond their control. NOVA members frequently report instances 
where a veteran tries to communicate an inability to attend an 
examination for a host of reasons: conflict with work schedules, 
illness, family responsibilities, continuing concerns related to COVID-
19, a lack of transportation, etc. Sometimes they are unable to reach 
someone to reschedule or that request is not honored. In other cases, 
the veteran never receives notice of the examination. Veterans who are 
homeless or at risk of homelessness are particularly vulnerable. 
Amending this provision reflects a veteran-friendly policy.
    VA often schedules unnecessary examinations and reexaminations for 
veterans, which has been frequently reported by NOVA. See, e.g., 
National Organization of Veterans' Advocates, Statement for the Record 
Before the House Committee on Veterans' Affairs Subcommittee on 
Disability Assistance and Memorial Affairs Concerning ``VA Disability 
Exams: Are Veterans Receiving Quality Services?'' (July 27, 2023); 
National Organization of Veterans' Advocates, Statement for the Record 
Before the Senate Veterans' Affairs Committee Concerning Pending 
Legislation to Include Discussion Draft, S._, No Bonuses for Bad Exams 
Act of 2022 (July 13, 2022); see also Department of Veterans Affairs, 
Office of Inspector General, Veterans Benefits Administration: Veterans 
Are Still Being Required to Attend Unwarranted Medical Reexaminations 
for Disability Benefits (March 16, 2023), https://www.va.gov/oig/pubs/
VAOIG-22-01503-65.pdf. Unnecessary examinations are particularly 
troublesome considering the statutory requirement for VA to consider 
private medical evidence. See 38 U.S.C. Sec.  5125 (``a report of a 
medical examination administered by a private physician that is 
provided by a claimant in support of a claim for benefits under that 
chapter may be accepted without a requirement for confirmation by an 
examination by a physician employed by the Veterans Health 
Administration if the report is sufficiently complete to be adequate 
for the purpose of adjudicating such claim''). By amending 38 U.S.C. 
Sec.  5103A and prohibiting VA from denying a claim solely because of a 
missed examination, VA will be required to conduct a more fulsome 
review of the record to consider private evidence or ongoing VA 
treatment before ordering more examinations in a system that is already 
overloaded with requests.
    NOVA urges the Subcommittee to clarify the change in the heading. 
The current bill would strike ``COMPENSATION CLAIMS'' and replace it 
with ``CLAIMS FOR BENEFITS.'' This change appears overly broad as VA 
``claims for benefits'' encompass a broad range of services and awards 
that do not require an examination as a condition for a grant. By 
contrast, a heading such as ``CLAIMS FOR VA DISABILITY BENEFITS'' would 
be clearer and ensure that this prohibition against denials solely 
because of a missed examination would extend to all VA disability 
benefit claims and appeals.
    Finally, we ask the Subcommittee to continue to engage stakeholders 
and consider other amendments to ensure the promise of the AMA is 
fulfilled. Specifically, NOVA members report continuing high level of 
remands from the Board, i.e., approximately 40 percent, often due to 
inadequate examinations and/or remands for additional development/
examinations that often are unnecessary. Such a high level of remands 
was not intended in the AMA. In this new system, if an appeal is not 
granted on remand, it no longer retains its original docket date and 
claimants are then forced to start all over at the end of the line if 
they want to appeal back to the Board. NOVA members report many direct 
review cases are waiting far in excess of the 365-day intended 
timeframe for a decision. (Delays exceeding three years are now 
common.) Given these long delays now approaching or surpassing the wait 
times experienced in the legacy system, a legislative solution should 
be considered.

                               CONCLUSION

    Thank you again for allowing us to present our views on this 
important legislation. If you have questions or would like to request 
additional information, please feel free to contact:

Diane Boyd Rauber, Esq.
Executive Director
National Organization of Veterans' Advocates, Inc.
1775 Eye Street, NW
Suite 1150
Washington, DC 20006
(202) 587-5708
drauber@vetadvocates.org
                                 ______
                                 

       Prepared Statement of Paralyzed Veterans of America (PVA)

    Chairman Luttrell, Ranking Member Pappas, and members of the 
Subcommittee, Paralyzed Veterans of America (PVA), would like to thank 
you for the opportunity to submit our views on pending legislation 
impacting the Department of Veterans Affairs (VA) that is before the 
Subcommittee. No group of veterans understand the full scope of 
benefits and care provided by VA better than PVA members--veterans who 
have incurred a spinal cord injury or disorder (SCI/D). Several of 
these bills will help to ensure veterans receive much needed aid and 
support. PVA provides comment on the following bills included in 
today's hearing.

H.R. 1753, the Jax Act

    The Jax Act will ensure that women who served in cultural support 
teams assigned to the Commander of the United States Special Operations 
Command from January 1, 2010, through August 31, 2021, are recognized 
for their combat exposure in service while on active duty. While PVA 
supports the intent of this legislation, enhancements could be made to 
improve the bill's scope.
    There are nearly two million women veterans in the U.S. According 
to the VA, nearly 55 percent of them served in the Gulf or Post-9/11 
eras. As of December 2022, women made up more than 17 percent of the 
active-duty force and 21 percent of the National Guard and reserve 
component.
    The repeal of the Direct Ground Combat Exclusion Rule for Female 
Soldiers by the Department of Defense (DOD) in 2013 authorized women to 
serve in all combat occupations. This information underscores that the 
scope of this legislation, which would impact 310 women, is far from 
adequate.
    Women have served in combat and combat support roles since the 
Revolutionary War, a common statement often expressed by VA, DOD, and 
even Congress. To ignore that fact does a disservice to women veterans 
who have served this country through every major conflict we've faced 
as a Nation. The scope of H.R. 1753, as written, only covers women 
attached to Special Operations Command from 2010 through 2021, even 
though for the last years of that timeframe women were no longer exempt 
from combat. Women servicemembers were acting in the role of cultural 
support teams, female engagement teams, and the well-regarded Lioness 
Program well before 2010. To only offer recognition and support of such 
a small group of women does a disservice to women who have filled these 
roles and may also be facing difficulties when applying for VA 
benefits.
    PVA strongly supports the bill's goal of removing systemic barriers 
for women who served in combat. We hope to see additional legislation 
targeted toward other groups of women veterans in similar situations. 
Service connection is granted for illness or injury incurred during 
service, regardless of combat deployments. If women veterans are facing 
challenges in accessing VA benefits and experiencing persistent denials 
of their claims, VA needs to address this in a meaningful way.

H.R. 3790, the Justice for ALS Veterans Act of 2023

    Currently, if a veteran was rated totally disabled for a continuous 
period of at least eight years immediately preceding death, their 
eligible survivors can receive an additional $331.84 per month in 
Dependency and Indemnity Compensation (DIC). This monetary installment 
is commonly referred to as the DIC ``kicker.''
    Amyotrophic Lateral Sclerosis (ALS) is an aggressive disease that 
quickly leaves veterans incapacitated and reliant on family members and 
caregivers. Many spouses stop working to provide care for their loved 
one who, once diagnosed, only has an average lifespan of between three 
to five years. Because so few veterans survive beyond five years, the 
surviving spouses of veterans with ALS rarely qualify for the 
additional DIC benefit. Jann Vasiloff, the surviving spouse of PVA 
member George Vasiloff, was disqualified for this exact reason. 
Determined not to let this happen to other spouses, Ms. Vasiloff helped 
PVA craft the Justice for ALS Veterans Act to make the surviving 
spouses of future veterans with ALS eligible for the DIC kicker, 
regardless of how long the veteran had the disease.
    Members of this Subcommittee were supportive of this legislation 
when it was reviewed in October 2021, but some suggested that there may 
be other service-connected conditions that deserve similar 
consideration. The VA recognizes ALS as a presumptive service-connected 
disease, and due to its progressive nature, automatically rates any 
diagnosed veteran at 100 percent once service connected. Although we 
are unaware of other service-connected conditions that have a 100 
percent mortality rate, like ALS, we are pleased this version of the 
bill incorporates PVA's recommended language directing the VA to study 
the matter and provide their findings to Congress. With the addition of 
this language, Congress should not further delay passage of this 
critical language.

H.R. 4016, the Veteran Fraud Reimbursement Act

    In a July 21, 2021, report,\1\ the VA Office of the Inspector 
General (OIG) highlighted the significant wait times defrauded veterans 
in the VA fiduciary program face due to the universal negligence 
determination requirement. Some veterans even died before seeing their 
reimbursements. The purpose of the VA Fiduciary Program is to protect 
beneficiaries who are unable to manage their VA benefits because of 
injury, disease, advanced age, or if they are under age 18. Studies 
show veterans are particularly vulnerable to scams, including those 
perpetrated by someone entrusted with their care.
---------------------------------------------------------------------------
    \1\ VBA's Fiduciary Program Needs to Improve the Timeliness of 
Determinations and Reimbursements of Misused Funds (va.gov)
---------------------------------------------------------------------------
    Too often, we hear about VA-appointed fiduciaries failing to honor 
the trust given them and illegally misusing veterans' funds for their 
own personal gain. Unfortunately, not all veterans who have VA-
appointed fiduciaries are treated equally under federal law. If a 
fiduciary misuses a veteran's benefits, the VA will remove the 
fiduciary, but it can only re-issue stolen benefits to the veteran if 
the fiduciary manages benefits for ten or more veterans. According to 
VA, however, 80 percent of beneficiaries have a one-on-one relationship 
with their fiduciary. The ``10 or more'' requirement leaves thousands 
of veterans unable to recoup benefits lost through no fault of their 
own. PVA supports H.R. 4016, which makes it easier for veterans with 
disabilities to be made financially whole by the Veterans Benefits 
Administration (VBA) in the event they are defrauded of their benefits.

H.R. 4190, the Restoring Benefits to Defrauded Veterans Act

    Under current law, if a defrauded veteran passes away before their 
case with the VA is resolved, the veteran's family cannot seek 
reimbursement for the defrauded funds. PVA supports this bill, which 
directs VA to reissue misused benefits to the veteran's estate, 
successor, or next inheritor. The Subcommittee should, however, 
consider adjusting the text of the bill so it prevents any family 
members involved in the fraudulent activity from benefiting from funds 
restored to the veteran's estate.

H.R. 5559, the Protecting Veterans Claim Options Act

    PVA supports the Protecting Veterans Claims Options Act, which 
clarifies that veterans have one year to submit a supplemental claim. 
Also, if new and relevant evidence is included, all evidence of record 
would be considered. Occasionally, we see problems with the way VA 
interprets legislation that is directive in nature and we trust that 
the Subcommittee will work with VA to ensure that the bill's 
requirements are sufficiently clear to ensure that the Department will 
properly implement Congress's intent.

H.R. 5870, the Veteran Appeals Transparency Act of 2023

    PVA supports efforts like this bill to increase transparency of the 
Board of Veterans' Appeals and the appeals process. Some of the 
information required in the legislation is already published. Thus, we 
encourage the Subcommittee to work with the Board to limit duplicative 
work that could also prove to be confusing for veterans.

H.R. 5890, the Review Every Veterans Claim Act of 2023

    PVA strongly supports this legislation, which seeks to limit the 
VA's authority to deny a veteran's claim solely based on the veteran's 
failure to appear for a medical examination associated with the claim. 
Thousands of veterans' claims for service connection, claims for 
increase, and for other benefits like Total Disability Individual 
Unemployability and Aid and Attendance have been denied solely on the 
basis of missing an examination. There are many legitimate reasons why 
a veteran may not be able to attend a scheduled exam. We are also aware 
of numerous instances where VA contractors erroneously record the 
veteran as a ``no show.'' Passage of this legislation will ensure that 
a missed exam isn't the only basis for denying a veteran's claim.

Discussion Draft, the Veteran Appeals Decision Clarity Act

    PVA was honored to play a role in creating the new appeals system, 
along with some of the perfecting changes to the Appeals Modernization 
Act passed by Congress in recent years. We strongly support this 
legislation, which is consistent with prior U.S. Government 
Accountability Office recommendations. It restates what information the 
Board should provide veterans regarding the denial of an appeal, which 
is critical to ensuring that they are able to further pursue their 
claims, as needed.
    PVA would once again like to thank the Subcommittee for the 
opportunity to submit our views on some of the bills being considered 
today. We look forward to working with you on this legislation and 
would be happy to take any questions for the record.

  Information Required by Rule XI 2(g) of the House of Representatives

Pursuant to Rule XI 2(g) of the House of Representatives, the following 
information is provided regarding federal grants and contracts.

                            Fiscal Year 2023

Department of Veterans Affairs, Office of National Veterans Sports 
Programs & Special Events----Grant to support rehabilitation sports 
activities--$479,000.

                            Fiscal Year 2022

Department of Veterans Affairs, Office of National Veterans Sports 
Programs & Special Events----Grant to support rehabilitation sports 
activities--$ 437,745.

                     Disclosure of Foreign Payments

Paralyzed Veterans of America is largely supported by donations from 
the general public. However, in some very rare cases we receive direct 
donations from foreign nationals. In addition, we receive funding from 
corporations and foundations which in some cases are U.S. subsidiaries 
of non-U.S. companies.
                                 ______
                                 

    Prepared Statement of Quality.Timeliness.Customer Service (QTC)

    Chairman Luttrell, Ranking Member Pappas, and Members of the 
Subcommittee:
    Thank you for inviting QTC - a Leidos Company - to submit a 
statement for the Subcommittee's legislative hearing. Since our 
company's founding in 1981, we have focused on delivering high Quality, 
Timely, and Customer-focused examinations. Today, we are the leading 
provider of medical, disability and occupational health examinations. 
We are especially proud of our partnership with the Department of 
Veterans Affairs to serve those who have given much to our country. 
Claims development is the longest step of the claims process, with 
evidence gathering that includes examinations if the existing evidence 
is lacking. We provide veterans with critical access points to 
compensation and pension disability examinations through our 90 medical 
clinics, 19,000 subcontract providers, and 12 mobile medical clinics. 
QTC is pleased to offer our views on the bills under consideration by 
the Subcommittee, focusing on those bills that would impact disability 
examinations.

H.R. 5938, Veterans Exam Expansion Act of 2023

QTC supports H.R. 5938 and urges swift enactment of the bill with our 
    recommended enhancements.

    With the enactment of the Sergeant First Class Heath Robinson 
Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT 
Act), millions of Veterans with toxic exposures will receive expanded 
healthcare and compensation benefits from the Department of Veterans 
Affairs (VA). This landmark legislation established 24 presumptive 
conditions and is expected to lead to an influx of disability claims 
numbering in the millions. To process these claims, VA relies on 
contract primary care physicians, and specialty care physicians, to 
conduct medical disability examinations (MDEs) for Veterans. However, 
there is a national shortage of these medical providers who can conduct 
these exams.
    The United States faces a projected shortage of between 37,800 and 
124,000 physicians within 12 years, according to the Association of 
American Medical Colleges. The American Hospital Association called the 
workforce shortage that hospitals are experiencing a ``national 
emergency'' and projected the overall shortage of nurses to be 1.1 
million. This issue is especially acute among behavioral and mental 
health professionals. Today, more than 150 million people live in 
federally designated mental health professional shortage areas. 
According to the American Psychiatric Association, the country will be 
short between 14,280 and 31,109 psychiatrists, psychologists, and 
social workers within a few years. Moreover, demand for services is 
growing, exacerbated by the pandemic and a dwindling supply of 
professionals as they retire at a rate that outpaces new people 
entering the field. The shortage of behavioral health professionals is 
particularly acute in rural areas where many Veterans live.
    In March 2013, VA's disability claims backlog peaked at 611,000 
claims, and most Veterans waited more than 125 days to receive their 
disability benefits. To support VA's plan to reduce the claims backlog 
and relieve healthcare providers of the burden of conducting MDEs, 
Congress passed P.L. 113-235, which expanded contract examination 
coverage to VA Regional Offices (VAROs). This law enabled VA clinicians 
to focus on healthcare while contract examiners performed MDEs for 
disability claims, enabling the VA to achieve a functional zero in the 
claims backlog by the end of 2015.
    QTC used license portability to conduct 35,033 exams with 280 
providers in 2021 and increased the number of exams using license 
portability to 42,581 in 2022. License portability also enabled QTC to 
provide services to vulnerable Veterans who are hard to reach. Rural 
hospitals, which treat roughly one in five Americans, are struggling to 
stay open. Over 180 rural hospitals have closed since 2005, and another 
500 are at immediate risk of closing. Nearly 3 million Veterans in 
rural communities rely on VA for healthcare services. QTC's rural 
capacity has increased by more than 50 percent since Congress 
authorized licensed clinicians to practice across state lines.
    Not all Veterans are able to make their way to a clinic for an in-
person examination with physicians and other healthcare providers--and 
it's not always the best solution. To provide high-quality medical 
evaluations for Veterans who are homebound, have limited mobility, or 
are living in rural communities or areas with limited medical 
infrastructure, QTC now brings examination services to their doorstep. 
The company's 12 mobile medical clinics are state-of-the-art, RV-sized 
doctor's offices on wheels.
    The 12 mobile clinics traverse the entire continental United States 
to provide Veterans with all examination services that they would find 
in a permanent clinic. Available services include radiology, audiology, 
general medicine, vision services, and mental health exams. Staffed by 
licensed medical providers, these mobile clinics help reduce wait times 
from roughly 100 days to close to 2 weeks in many underserved 
communities, such as Veterans on tribal reservations. QTC completed 
24,000 remote exams for Veterans in 2021 and more than 14,000 exams 
from January through June 2022. H.R. 5938 will enable QTC to expand 
medical disability exam services to underserved communities.
    QTC recommends that the committee amend the legislation to provide 
VA with the flexibility to leverage the license portability authority 
for additional provider types, when needed, for providers completing 
disability examinations on behalf of VA. One way to do so is by 
granting contract medical disability examiners with the same license 
portability authorities that Veterans Health Administration employees 
already have under 38 USC 7402. In addition, QTC recommends that the 
license portability authority be extended to at least September 2028 to 
cover the duration of the current MDE contracts. This would allow the 
Department to be nimble and swiftly respond to the problem of providers 
not being available where veterans live.
    In 2016, Congress passed Veterans' Health Care and Benefits 
Improvement Act of 2016, which granted contract MDE providers license 
portability to ensure that the claims backlog stayed at functional 
zero. License portability, which authorizes a provider's license to 
cross state lines, is an effective solution to address the provider 
shortage in parts of the country where demand outpaces supply. In 2020, 
Congress expanded license portability to PAs, NPs, audiologists, and 
psychologists (38 USC 2002). We would like to thank Congress for 
passing S. 2795 last month, which extended license portability 
authority for PAs, NPs, audiologists, and psychologists. Additionally, 
we would like to thank the House of Representatives for passing license 
portability to the Department of Defense's Military & Family Life 
Counselors this year.
    With the enactment of the PACT Act, Congress provided the legal 
authority to expand disability benefits. However, Veterans will likely 
encounter extended wait times if Congress does not concurrently 
legislate full license portability authority to enable all types of MDE 
providers to deliver timely, high-quality exams.

H.R. 4306, Michael Lecik Military Firefighters Protection Act

QTC supports H.R. 4306, as introduced

    H.R. 4306 would establish a presumption of service connection for a 
list of diseases that are associated with firefighting. QTC supported 
the initial effort to baseline medical exams for first responders to 
the NYC World Trade Center (QTC) site after the September 11th 
terrorist attacks. We supported the Mount Sinai School of Medicine and 
the Federal Occupational Health team during 2007-2008. Under these 
contracts, we provided First Responders with the clinical evaluation 
needed for their own health and to monitor the effects of the 
exposures. The information gathered from these exams not only provided 
early detection of potential WTC-related health problems and enabled 
individuals to receive proper care and treatment. QTC stands by, ready 
to help if H.R. 4306 becomes law.

H.R. 5890, Review Every Veterans Claim Act of 2023

QTC supports the intent of H.R. 5890.

    H.R. 5890 would limit VA's denial of disability claims on the sole 
basis that the veteran failed to appear for a medical examination that 
is associated with the claimed condition. 38 U.S.C. 5103A governs VA's 
duty to assist claimants. The Department's obligation to help veterans 
develop their claims includes ordering examinations if the evidence is 
lacking and believes that examinations will be helpful in resolving the 
claim.
    QTC's scheduling process exemplifies the pro-claimant nature of the 
VA's duty to assist requirements by making multiple outreach attempts 
via phone calls, text messages, emails, and tracked mail packets. 
Contractually, we have 36 calendar days to schedule, conduct exams, and 
deliver the complete exam results back to VA. To meet this requirement, 
we will call the Veteran up to three times to schedule an appointment. 
If an appointment is not scheduled after the third attempt, then we 
send the Veteran a letter asking them to call us to schedule an 
appointment. If we don't receive a response from the Veteran within 3 
calendar days, then we will schedule an appointment proactively and 
send them an appointment letter. If the Veteran does not show, then we 
send the exam request back to VA. We always call the Veterans to remind 
them of their appointment a day or two in advance. With these attempts, 
we have maintained a low no-show rate of 5-7 percent, which is far 
lower than the VHA's average (8 18 percent for outpatient care) and the 
national average (23 percent across all medical specialties and a range 
of 10 percent for primary care and over 60 percent for mental 
health).\1\
---------------------------------------------------------------------------
    \1\ Milicevic, Aleksandra, Mitsantisuk, Kannop, Tjader, Andrew and 
et al. (2020) Modeling Patient No-Show History and Predicting Future 
Appointment Behavior at the Veterans Administration's Outpatient Mental 
Health Clinics. Military Medicine, Vol.185, Issue 7-8, pages e099-e004. 
https://doi.org/10.1093/milmed/usaa095
---------------------------------------------------------------------------
                                 ______
                                 

 Prepared Statement of Special Operations Association of America (SOAA)
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

                 Prepared Statement of ALS Association
[GRAPHICS NOT AVAILABLE IN TIFF FORMAT]

      Prepared Statement of Service Women's Action Network (SWAN)

    Chairman Luttrell, Ranking Member Pappas, and Members of the 
Subcommittee:
    The Service Women's Action Network (SWAN) appreciates the 
opportunity to submit a Statement for the Record on today's hearing 
that includes H.R. 1753 Jax Act. SWAN is a non-partisan, non-profit 
501(c)(3) that represents over 10,000 servicewomen and women veterans 
regardless of rank, military branch, or years of experience. SWAN has 
specifically worked to transform military culture and reform veteran 
services focusing since 2009 on opening all occupations to qualified 
women, holding sex offenders accountable in the military justice 
system, expanding access to services for a broad range of reproductive 
health care, and eliminating barriers to women's disability claims 
especially for those who have experienced military sexual trauma as 
well as barriers to those who experienced combat injuries but whose 
experience is not correctly documented in their service records.
    Today we want to acknowledge the efforts of the bi-partisan co-
sponsors of the Jax Act to recognize the combat contributions of some 
of the women who served in OIF/OEF. These women served on Cultural 
Support Teams with Special Operations Command units during the Global 
War on Terror from 2010-2021. These women served alongside their male 
counterparts and suffered casualties, but have not been fully 
recognized or credited for this dangerous and essential service. 
Unfortunately, their service was seldom appropriately documented so 
they have faced arduous barriers to receiving the care and benefits 
they earned. It is especially important that those who were in the 
Guard and Reserves are given everything they earned.
    While we recognize this legislation is a significant step forward 
for service women and women veterans, we also have to emphasize an 
often-forgotten point that U.S. History is filled with women who have 
served with or in the military under fire - many have been killed, 
wounded, and/or taken as POWs, and they too have not received adequate 
or appropriate care or full credit.\1\ All of these women helped open 
opportunities for qualified women further in 2013-2016 when the combat 
exclusion officially ended and since then. \2\
---------------------------------------------------------------------------
    \1\ Jeanne Holm, Women in the Military: An Unfinished Revolution, 
Novato: Presidio Press, 1992 (revised edition). We see this 
particularly starting in Desert Shield/Storm and through the changes in 
combat exclusion laws and policies and military restrictions that 
confronted commanders' realities ``on the ground'' starting in 1994. 
One only has to mention Jessica Lynch and Lori Piestewa to spark this 
recognition. See also Lorry M. Fenner, ``Either You Need These Women or 
You Do Not: Informing the Debate on Military Service and Citizenship,'' 
Gender Issues, Summer 1998, Vol 6., Number 3, ed. Rita J. Simon, New 
Brunswick, NJ: Rutgers University. Lorry M. Fenner and Marie DeYoung, 
Women in Combat: Civic Duty or Military Liability, Washington D.C.: 
Georgetown University Press, and ``Women in Combat: Civic Duty or 
Military Liability?,'' C-SPAN Videotape 166695 Part 1 of 1, 2001.
    \2\ Service Women's Action Network, Women in the Military: Where 
They Stand, 10th Edition 2019, pp.12-16 (https://
www.servicewomensaction network.org/swan-research). See also Ellen 
Haring, ``Gender and Military Organizations, in Chantal de Jonge Oudrat 
and Michael Brown, eds, The Gender and Security Agenda: Strategies for 
the 21st Century, pp. 90-112.
---------------------------------------------------------------------------
    The women of the Cultural Support Teams are fully deserving of the 
recognition and benefits this bill will provide. SWAN, however, must 
emphatically insist that this bill includes their predecessors-sisters 
of all the Services who served on Team Lioness and the Female 
Engagement Teams (FETs).\3\ These are the women from all the Services 
who served with USMC and Army ground combat units in 2003-2010 in Iraq 
and Afghanistan who pioneered and paved the way for the CST missions 
with the Special Operations Forces in 2010-2021. These women who 
volunteered (seldom receiving training or appropriate equipment) in the 
immediacy of war conditions served beside their male peers. These 
women, too, have earned (1) the correction of their records to document 
service in combat; (2) appropriate care and benefits; and, (3) the 
awards, recognition, and respect that have been denied them for so many 
years. Most importantly, these women increased the efficiency and 
effectiveness of field units as well as military readiness and the 
recruiting numbers for the All Volunteer Force (AVF).\4\
---------------------------------------------------------------------------
    \3\ Meg McLaren and Daria Sommers, ``Lioness: The Origins Story,'' 
Veterans Breakfast Club Podcast, particularly Episode 5 with CAPT Lory 
Manning USN, Retired, Women's Research and Education Institute and 
Shannon Morgan, Army Combat Veteran, August 24, 2023. Meg McLaren and 
Daria Sommers, Lioness (IMDb documentary), 2008, currently available on 
Amazon Prime.
    \4\ Sarah Percy, Forgotten Warriors: The Long History of Women in 
Combat, New York: Basic Books, 2023, especially pp. 268-281.
---------------------------------------------------------------------------
    This oversight can be easily corrected by expanding H.R. 1753 to 
specifically include the Lioness Teams and FET members from 2003-2010. 
They too provided critical intelligence to U.S. and allied forces as 
well as interacted with local populations where and when their male 
counterparts could not effectively do so. A different kind of conflict 
that required winning ``hearts and minds'' could not have been waged 
effectively without these women. They too fired weapons, protected 
their teammates, and faced death, injury, and disability. Army women 
first joined U.S. Marine Corps ground combat units for raids on 
locations where Iraqi women and children might be present. Later, 
Marines and Sailors participated in Lioness operations with both Marine 
and Army units. Let us never forget those women who fought for the 
first time in close combat in Ramadi when that was not technically 
allowed by law, and those who died in Fallujah, Holly Ann Charette, 21, 
and Ramona M. Valdez, 20, in 2005 or the others who died like Marine 
Cpl Jennifer M. Parcell in Anbar in 2007, or those who suffered seen 
and unseen injuries and yet have not received due recognition. Even by 
2005, 39 female U.S. troops had died in Iraq along with three Defense 
Department women, and six servicewomen had died in Afghanistan.\5\
---------------------------------------------------------------------------
    \5\ ``Female Troops in Iraq Exposed to Combat: Despite ban on women 
in combat, the front line in Iraq is everywhere, CNN, June 28, 2005.
---------------------------------------------------------------------------
    Again, SWAN greatly appreciates the recognition of the women who 
served with Special Forces from 2010-2021 during OIF/OEF in H.R. 1735 
Jax Act and its Senate companion. Now the sponsors have the opportunity 
to broaden this vital legislation in at least a small way. It should 
include the women of Team Lioness, from various specialties who were 
thrown into action with the USMC starting in 2004, and the women in the 
Female Engagement Teams, introduced first by Task Force Leatherneck in 
Afghanistan in 2009. These are the women who laid the ground work and 
inspiration for the Cultural Support Teams earlier. None of these women 
should ever be forgotten.
                                 ______
                                 

                 Prepared Statement of Gerald Connolly

    I would like to thank Ranking Member Pappas, Chairman Luttrell, 
Chairman Bost and Ranking Member Takano for bringing up the Veteran 
Fraud Reimbursement Act (H.R. 4016) in this legislative hearing of the 
Disability Assistance and Memorial Affairs Subcommittee of the House 
Veterans' Affairs Committee. This legislation will make it easier for 
veterans to be made financially whole in the event they are defrauded 
of their benefits and allow the Veterans Benefits Administration (VBA) 
to reimburse victims of fraud without first meeting unnecessary 
bureaucratic requirements. I would like to thank my friend 
Representative Ciscomani for championing this important effort with me 
to remove bureaucratic and unintended obstacles that have hampered 
veterans who have been defrauded by a fiduciary.
    In January 2021, Congress enacted the Johnny Isakson and David P. 
Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020. 
The bill included a provision meant to improve the VBA fiduciary 
program, which helps deliver benefits to veterans who cannot otherwise 
manage their finances. Unfortunately, one unintended consequence of the 
provision is that all cases of benefits misuse now require what is 
known as an internal negligence determination by VBA before a veteran 
who is a victim of fraud can be made financially whole. This 
determination, which is made for the purposes of improving VBA 
oversight, is immaterial to whether a veteran will be reimbursed. 
Furthermore, this extra, unnecessary step effectively extends the 
timeline for veterans to be reimbursed and creates a backlog of 
investigations. In some cases, a negligence determination can take well 
over a year, potentially causing late or deferred bill payments.
    In fact, in a July 21, 2021 report entitled, ``VBA's Fiduciary 
Program Needs to Improve the Timeliness of Determinations and 
Reimbursement of Misused Funds,'' the VA Office of the Inspector 
General (OIG) highlighted the significant wait times defrauded veterans 
in the VA fiduciary program face due to the universal negligence 
determination requirement. The report notes that some veterans even 
died before seeing their reimbursements.
    Veterans under the VA fiduciary program are a financially 
vulnerable population, with approximately 50 percent being pensioners. 
Delaying reimbursement of misused benefits to this underserved 
population through unnecessary negligence determinations is 
unacceptable. My bill removes the negligence determination requirement 
while allowing the VBA to instead conduct a statistically valid 
analysis of the misuse cases to determine the rate and nature of 
negligence on the part of the VBA. The negligence determination would 
ultimately become a part of a quality assurance measure conducted after 
the affected veteran had been reimbursed. We must ensure that oversight 
of VA processes does not result in a financial burden on those who 
sacrificed so much for our country.
    This legislation is of high importance to some of our most 
vulnerable veterans, and was drafted in close coordination with VBA, 
who supports making this change. I once again thank my friend, Rep. 
Ciscomani, Chairman Luttrell, Ranking Member Pappas, Chairman Bost, and 
Ranking Member Takano for considering this legislation during this 
legislative hearing and look forward to seeing this bill receive a vote 
in the House of Representatives.
                                 ______
                                 

        Prepared Statement of Military-Veterans Advocacy, Inc. 
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]

                                 [all]