Legislative Hearing on: Discussion Draft: the “BEACON Act”; H.R.6444, the “Blast Overpressure Research and Mitigation Task Force Act”; H.R.6526, the “Clarity on Care Options Act”; Discussion Draft: the “Data Driven Suicide Prevention Act”; H.R. 2283, the “RECOVER Act”; Discussion Draft: the “Health Desert Reform Act”; H.R. 2426, the “Veterans Mental Health and Addiction Therapy Quality of Care Act”; H.R 6652: the “US Vets of the FAS Act”; H.R. 4509, the “NOPAIN for Veterans Act”; H.R. 5999, To amend title 38, United States Code, to direct the Secretary of Veterans Affairs to furnish an opioid antagonist to a veteran without requiring a prescription or copayment; H.R. 6001, the “Veterans with ALS Reporting Act”; Discussion Draft: the “Whole Health for Veterans Act.”
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House Veterans' Affairs Subcommittee on Health U.S. House of Representatives
Follow its sittingsSpeaker 1
This morning, we're also joined by several of our colleagues who will speak in support of their bills. We appreciate their dedication to serving our nation's veterans. In accordance with committee rules, I ask unanimous consent that the following members be permitted to participate in today's committee hearing: representative Pat Fallon, representative Ryan McKenzie, representative Greg Lanzman, and representative Chris Daluzio. Without objection, so ordered. I now yield to Yankee member Brownlee for any opening remarks she may have.
Speaker 2
Thank you, madam chair, and thank you to our witnesses today for providing your testimony on the legislation we are considering. I'm excited that we are considering several of my Democratic colleagues' bills on today's agenda. I know the sponsors of these bills will be on the first panel to speak about the importance of those bills, so I will try to keep my remarks brief. But I appreciate my colleagues, Congressman Lanzman and Congressman Conway, for introducing bills to build on VA's work to protect veterans from the risk of opioid overdose. I'm also glad we will consider Congressman Crow's legislation to further our understanding of ALS and the causes of veterans' increased risk of the disease.
Finally, I look forward to considering Congressman D'Luzia's bill to ensure veterans are not overly burdened by copays for participating in VA whole health services. However, I must express some serious concerns about several of the Republican-sponsored bills on today's agenda. The Recovery Act, the Beacon Act, the Health Desert Reform Act, and the Data-Driven Suicide Prevention Act share a common theme. They all siphon money from existing VA programs and redirect it to outside organizations and providers to do the very same things VA is already doing, but with fewer guardrails and fewer requirements to ensure the quality of care. Taken together, these bills represent a concerted effort to circumvent VA's direct care program and research enterprise, and create no-strings-attached handouts of VA funding to private companies.
Not only is this wasteful and duplicative, but it could lead to a further fracturing of continuity of care for our veterans. Worse still, the grant programs that would be created by the Recovery Act and the Beacon Act lack meaningful mechanisms of oversight for VA to ensure that Veterans are receiving the quality care and evidence-based standards of care through these grant programs. I'm on record acknowledging that there will always be a place for community care in geographic regions and in specialties where the VA cannot directly provide needed care. However, there is a difference between participating in the community care network and creating competing and duplicative programs through which private providers can be paid to deliver care with minimal requirements for veteran cultural competency, care coordination, and communication with the VA, all the while avoiding rigorous oversight of care outcomes. This is what will happen if the Recovery Act, the Beacon Act, and the Health Desert Reform Act are allowed to become law.
If private providers wish to provide care to veterans, they should ensure they can meet the VA Community Care Network requirements and enroll in it instead. I don't believe we should be creating carve-outs or grant programs that would allow private providers to avoid the requirements of the VA Mission Act and still financially benefit from VA funding. I would note that many organizations who have gone on the record supporting these bills already participate in VA's community care network, and some are already receiving grants from VA's Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program. It seems to me that creating new grant programs for which these organizations are uniquely eligible under the RECOVER Act and the BEACON Act does nothing but enable these organizations to double or triple dip and receive reimbursements for community care, in addition to the new grant funding. That does not seem fiscally responsible.
Speaker 3
To me. I will continue to oppose legislation that does nothing to ensure veterans receive quality care and instead simply siphons money from VA straight into the pockets of private entities without any guardrails. I'm looking forward.
Speaker 2
To hearing from our witnesses today, and to some productive rounds of questions. With that, I yield back to your women normally.
Speaker 1
Per bill, to ensure we can move in a timely manner. General Bergman, if you're not ready to go, I'm gonna recognize Miss King Heinz. You're up unless you're not ready, and I'll go to Miss King Heinz. K. Miss King Heinz, you're recognized for three minutes to speak on your discussion draft of your bill.
Speaker 4
Thank you, Chairwoman Miller Meeks, and thank you to the ranking member and to my colleagues for the opportunity to speak today. I'm proud to discuss my bill H.R. 6652, a bill that is about honoring a commitment Congress made just two years ago through the COFA Act and ensuring that the Department of the Veterans Affairs follows through on that promise. FAS citizens serve in the US military at among the highest rates per capita. However, the brave FAS citizens who have chosen to return home after their service face disproportionate challenges to receiving their full benefits, including access to medical care when residing in the Pacific Islands. When the COFA Act was enacted, it recognized a long-standing obligation to veterans and families from the freely associated states.
The United States agreed to expand access to care and to ensure that those veterans are no longer left behind because of geography or administrative discretion. But despite that clear intent, implementation has remained stalled, and too many veterans are still waiting for those commitments to translate into real, reliable care. HR 6652 is necessary because a promise alone is not enough. This bill makes clear that BA must fully deliver on what they agreed to under the COFA Act. It ensures that essential components of care are not treated as optional, but as required parts of the services veterans receive.
This bill does not require anything extraordinary. It ensures access to telehealth, mail order pharmacy services, and makes beneficiary travel more accessible. This legislation provides clarity, consistency, and accountability so that veterans and their families can depend on the care they were promised, rather than navigating uncertainty or delays. Our veterans upheld their end of the bargain through their service to this country. Congress acted through COFA, and now it's time for the VA to make good on that agreement.
I look forward to working with my colleagues in the department of VA to ensure this promise is fully and finally kept. I yield my time.
Speaker 1
Thank you, representative King Heinz. The chair now recognizes General Bergman for three minutes for any comments you may have on his bail. General Bergman yields. The chair will now recognize committee members to speak for three minutes on behalf of their legislation. The chair recognizes Representative Lansman for three minutes.
Speaker 5
Thank you, madam chair. Thank you to all the members, ranking member, for having me in today's legislative hearing and allowing me to talk about my bill, H.R. 4590, the No Pain for Veterans Act. I also wanna thank our colleagues, representatives of Van Orden, Papas, Bergman, Seul, and Hamada, for partnering with me on this important issue. The opioid epidemic is.
Speaker 5
it's a disaster. Right? You know, across the board, it has really hit our veterans, and you all know that. This is a really frustrating situation because there are all these FDA-approved nonopioid pain treatments for veterans, for everybody. And the VA won't provide those to veterans even though the FDA has approved them, and they work, and veterans are asking for pain relief that won't ruin their lives.
And the VA is saying no. No. No. It's gonna require an act of Congress to update what we can provide to veterans. As such, we're trying to get this bill onto the floor or, you know, onto the docket and pass.
There is a companion bill in the Senate. We can get it done. It will make a big difference for veterans, who are asking for, looking for nonopioid, you know, based pain relief. And, you know, the statistics are staggering, but you all know just how problematic, you know, this addiction can be. And our veterans are going through all kinds of, you know, dealing with all kinds of issues that require some pain management.
And, again, this just would allow the VA to provide veterans with what Medicare folks and other folks in the private sector or with private insurance get, which is a slew of nonopioid related, or nonopioid based, pain relief. So, hopefully, we can get this on the floor or on the docket. And I appreciate your efforts in letting me speak here and encourage everyone to vote for it, encourage their colleagues, and folks in the senate to do the same so we can get this passed. Thank you. I yield back.
Speaker 1
The gentleman Nielsen chair now recognizes Representative Fallon for 3 minutes to speak on his bill.
Speaker 6
Thank you, madam chair, for the opportunity to discuss our bill, HR 2426, the Veterans Mental Health and Addiction Therapy Quality Care Act. This bill is an important step in ensuring that our veterans are receiving the best possible care across all treatment settings and to identify gaps, or, for that matter, best practices that could inform future policy. Today, approximately 18 veterans die of suicide daily. It's eighteen, too many, and this is not an abstract number. These are real men and women who served our nation.
Not only do they return home and they continue fighting battles, and all too well or all too often, unfortunately, they fight those alone. This bill arises from a longstanding concern about how to best serve veterans' mental health and addiction care needs, particularly in light of the mixed delivery systems and persistent suicide and treatment access challenges. Over the last decade, Congress has worked in a bipartisan way to expand access to care, including through community care programs that allow veterans to seek treatment outside the VA. That effort was necessary and well-intentioned. However, access alone is not enough.
Quality matters, and outcomes matter. Lives depend on it. HR 24 26 addresses an important fundamental question. Are we truly delivering the highest quality mental health and addiction care to our veterans, regardless of where that care is provided? What we still lack is an independent, objective assessment of how mental health and addiction therapy delivered by VA providers compares with care delivered by non-VA providers.
Competition is a good thing. This bill directs that such a study be undertaken by the department of the VA, and it will do two things, primarily. One, assess the quality of care across a broad set of modalities, including telehealth, inpatient, outpatient, intensive outpatient, and residential treatments. And secondly, perhaps most importantly, the department must make the findings of that report public. If the outcomes of this study show strengths, we should, of course, build on them.
And if they reveal gaps in community care, we should fix them because we must fix. And if it reveals exceptional care in any facet, we need to replicate that success everywhere. And here's the bottom line. Suicide rates are unacceptably high. Doing nothing is not acceptable.
Our veterans and their families are being devastated by suicide, and we have the ability and the obligation to demand accountability and work towards improvements. I wanna thank my colleagues on both sides of the aisle who have supported this legislation, specifically our Democratic co-lead, Representative Sanford Bishop. I'd also like to thank the veterans advocates who continue to rightfully push us to do better. This is not a partisan issue. It's a national responsibility, and I urge this esteemed subcommittee to give HR 24 26 thoughtful consideration and swift action.
Our veterans have already given us so much, and given so much to this republic. We owe them the care that is worthy of that sacrifice. And thank you, madam Chair. Yield back.
Speaker 1
The gentleman from New York, the chair now recognizes Representative Delusio for three minutes for any comments he may have on his bill.
Speaker 7
Thank you, Chairwoman Miller-Meeks, Ranking Member Brownlee. It's great to be back in front of the health subcommittee. Thank you for having me and considering my bill, H.R. 6848, the Whole Health for Veterans Act. This bill will help more, my fellow veterans, improve their health and well-being through access to the VA's Whole Health program. And I know the subcommittee members know that VA whole health is a comprehensive program.
It helps veterans build a personal health plan that works for them, as directed by their care team. It does things like teach veterans to treat their health proactively, provides resources and oversight for things like strength and mobility training, and is tailor-made to help each veteran meet their own unique goals. When veterans are more actively involved in their own care, it improves health care outcomes and, in turn, can lower health care costs. I've seen this in action in Pittsburgh. I've heard from veterans who are part of this program, and they talk about how it saved them from surgery or other interventions that could be much more costly and invasive in their lives.
So I think it's something for us to build on. I think it's common sense that we can make this program available to all veterans. But, unfortunately, last October, co-pays were introduced, charging VHA priority groups six through eight veterans 15 per visit. And around that time, I heard from a constituent, a veteran, who loves this VA whole health program and the care he gets there, but talked about how he'd be unable to participate due to the cost now for the program. So my bill addresses this to fix the problem by codifying an already existing prohibition on copays for priority groups 1 through 5 veterans, and then caps the monthly copayments for other priority groups at $30 a month.
Veterans who want to improve their health and work with their care team, I think, should be able to do it without paying a fortune. VA health care ought to be the best in the world. As I understand it, VA has provided some feedback on the bill. I looked at it. I think there are issues that we can edit and incorporate, update on this bill, and work through.
So I'm excited to work with the subcommittee. I invite support from both parties here, madam chair, and I yield back.
Speaker 1
The gentleman Niels, the chair, now recognizes Representative McKenzie to speak for three minutes on his bill.
Speaker 8
Thank you, madam chair. It's a pleasure to join the House Committee on Veterans Affairs. And before I begin, I would like to extend my thanks to all of our veterans for their service to our country. Veteran suicide remains an urgent challenge facing our country. Despite years of effort, the overall rate has remained stubbornly high, and too often, we learn after the fact that many of the warning signs were missed.
One of the most troubling realities is that more than half of our veterans who died by suicide were not engaged with VA health care in the years before their death. That tells you something important. The traditional episodic screening, often based on self-reporting, is not enough to identify risk early and consistently. That's why I'm introducing the Data-Driven Suicide Prevention and Outreach Act of 2025. The bill directs the VA to establish a time-limited competitive grant program to support the development of predictive models that can identify risk factors before the crisis point.
And they can do that by responsibly integrating benefits data, service records, and clinical information. By leveraging new technologies, we have the potential to revolutionize how we treat and monitor the crisis of veteran suicide, providing more opportunities for timely intervention that will ultimately save lives. Importantly, this bill does not replace clinicians, nor does it create a black-box algorithm. Instead, it empowers decision makers and builds on the VA's knowledge of what works. Initiatives like the REACH VET program have shown that predictive analytics can help flag veterans at elevated risk and prompt earlier outreach and care engagement.
What this legislation does differently is encourage innovation with guardrails. Grants are limited to organizations with demonstrated expertise in health care AI, data security, and clinical deployment. Models must be explainable, interoperable, and clinically actionable. They must comply with VA cybersecurity standards, and any findings must be shared with the VA for system-wide evaluation. We also intentionally prioritize areas with elevated suicide risks and high crisis volumes with the suicide hotline.
Also, we look at where there are long mental health wait lines, and we can help prevent duplication of efforts or a missed opportunity to intervene. Artificial intelligence holds promise, but it's still new and carries real risks, which we want to recognize. And this measure, this bill takes a balanced and measured approach with a pilot program. Stakeholders have emphasized that these predictive schools can be helpful, and I've seen it in my local community where health networks utilize AI running in the background. And, again, it becomes a force multiplier where doctors can then go out and actually treat more of these situations that deserve their attention and should be prioritized.
So I would like to thank the chair for recognizing us and allowing me to be with the committee today, and appreciate the consideration of this important legislation. Thank you, and I yield back.
Speaker 1
Thank you, representative McKenzie. As is our practice, we'll forego a round of questioning for the members. For those of committee members, you may remain to ask questions later if you desire. Our first panel is already at the table. Excuse me.
The chair now recognizes General Bergman to speak for three minutes on his bill.
Speaker 9
Yeah. Thank you, chairwoman. There seemed to be a slight disconnect here when I walked in. I didn't think I was going to be speaking on this. So we'll get our staffs together to make sure that we know when timing is right.
But thanks for the opportunity. But this is a discussion draft of what we have titled the Beacon Act, and it's Veterans TBI Breakthrough Exploration of Adaptive Care Opportunities nationwide act. The bill would direct the secretary of the VA to carry out programs awarding grants to eligible entities to study and conduct randomized controlled trials with respect to the neurorehabilitation treatments for chronic mild traumatic brain injury. Additionally, grants would be available to design those treatments, as well as measure the effectiveness of already funded treatments. Nonprofits, academic institutions, and health care providers with expertise in neurorehabilitative therapies would be eligible.
And in the analysis of this, the randomized controlled trials measure the effectiveness of a new intervention or treatment and have been recognized as the gold standard for effectiveness research. The bill would dedicate resources to a prevalent issue like lost TBIs that occur each year as many are mild TBIs or concussions. So this is not about, as we hear so many times, privatizing the VA. This is enabling the veterans administration, through a grant process, to enable other scientific entities to do more breakthrough therapies that are gonna not only help veterans, but also others that suffer from mild TBI. And with that, I yield back.
Speaker 1
Thank you, General Bergman. Joining us today, from the Department of Veterans Affairs, are doctor Mark Connagar, VA's acting assistant undersecretary for health for patient care services. He's accompanied by Doctor Lorente, VA's acting assistant undersecretary for health for integrated veteran care. Doctor Koenager, you're now recognized for five minutes to present the department's testimony.
Speaker 10
Good afternoon, Chairwoman Miller-Meeks, Ranking Member Brownlee, and members of the subcommittee. Thank you for the opportunity to testify today on several bills that would impact VA health care programs and services. As a family practice physician, I understand the importance of comprehensive patient-centered care and the trust that veterans place in us. My nearly 37 years in uniform have strengthened my commitment to delivering the highest quality care. I had the privilege of commanding the largest US military hospital in Iraq during 2009 to 2010, an experience that underscored the value of coordinated, timely care and saving lives.
Today, as acting assistant undersecretary for health for patient care services, I oversee 16 national program offices that support a wide range of clinical professions and care settings, including geriatrics, rehabilitation, and whole health. These experiences guide my work as we strive to strengthen VA health care for all who have served. I am joined by Doctor Maria Lorente, acting assistant undersecretary for health for integrated veteran care. Before we begin, I would like to apologize for the delay in providing testimony to this committee. VA is working on process improvements internally as well as externally to make sure this is prevented in the future.
While I will briefly highlight VA's position on several bills, my full written testimony provides detailed views on all 12 bills under consideration. Turning to the substance of the legislation, several of the bills on the agenda would require the VA to establish new grant programs. VA has concerns with these bills, as grants may not be the most appropriate means of providing the intended support. Grants are one way, but not the only way of providing financial assistance to nongovernmental agencies. VA would welcome the opportunity to discuss these bills further with the committee to determine if a different structure might be more appropriate.
First, regarding the RECOVER Act, VA strongly supports efforts to expand access to veteran-centric evidence-based mental health. While we have concerns with certain provisions in the bill, we greatly value the committee's leadership in this issue, and welcome the opportunity to work together on approaches that strengthen care coordination and deliver the greatest impact for veterans. Second, VA supports the Veterans' Mental Health and Addiction Therapy Quality of Care Act, subject to amendments and the availability of appropriations. This bill is consistent with VA's current efforts to compare the quality of VA and non-VA mental health and addiction therapy care. Third, although VA appreciates the intent of the No Pain for Veterans Act, this bill would undermine VA's well-established evidence-based formulary process, which ensures medications are safe, effective, and economical.
Fourth, regarding H.R. 5999, VA supports expanding access to opioid antagonists subject to amendments and appropriations. While naloxone is already widely available at no cost to enrolled veterans, eliminating prescription requirements could increase risks of waste and fraud. Fifth, regarding the Veterans with ALS Reporting Act, VA supports the intent, but some provisions may duplicate existing efforts. We welcome the opportunity to collaborate on strategies at advanced research and care, without diverting resources from patients. Similarly, the Veterans Health Desert Reform Act underscores the importance of improving access for rural veterans, a goal the VA strongly supports.
However, the bill as written appears to create no new authority to further this goal. Finally, VA appreciates the committee's focus on innovation through research and technology, including proposals related to traumatic brain injury and suicide prevention. These are critical areas where VA invests heavily. In closing, VA remains steadfast in its commitment to delivering world-class health care to veterans. We share the committee's goals of improving access, quality, and outcomes.
And we look forward to working with you to refine these proposals so they strengthen care without unintended consequences. We are happy to answer any questions you may have.
Speaker 1
Thank you, Doctor Connor. As is my usual practice, I'll reserve my time until after all members have had a chance to ask their questions. I now recognize ranking member Brownlee for five minutes for any questions she may have.
Speaker 2
Thank you, madam chair. So I think I wanted to direct this question to doctor Lorente. As I cited in my opening comments and VA cited as well, significant concerns with the recovery act, among other things, your written testimony points out that grantees would be able to receive financial support from VA in the form of grant funds, still be able to bill the VA for services under the existing VA community care program, and also be able to bill veterans' other health care insurance. So I just I can't see how this makes sense to me. Well, three opportunities to perhaps triple dip with the VA.
VA already has a community care network. Why is it important to adhere to the community care eligibility and authorization process that was established under the Mission Act?
Speaker 11
As you pointed out, the community care program does have a series of requirements to make sure that the providers who are delivering services to veterans have the needed credentials, have the privileges, and offer the quality of care that we expect they will deliver. That is, in fact, one of the concerns that we do have with the bill as written. It doesn't really specify requirements. And as written, a community provider could potentially get one of these grants and offer services through one of these grants that might not be eligible, might not meet the requirements under the community care program. It's why we really do welcome an opportunity to work with Congress to revise the language, so that we can address some of these concerns.
Speaker 2
Thank you for that. And, to follow-up, on another bill, VA already administers the Staff Sergeant Parker Gordon Fox suicide prevention grant program, which is intended to address the upstream factors that contribute to suicide risk, such
Speaker 2
Housing and employment instability, and lack of social support and engagement. We also have the Compact Act, which allows VA to cover emergency treatment for veterans experiencing acute, suicidal crises. Both the Fox grant program and the compact act program serve veterans regardless of whether they are enrolled in or otherwise connected to VA health care. Given that, does VA think it needs the grant program that would be created under the Recovery Act, or would it be duplicative?
Speaker 11
As was described by doctor Koenager, one of the questions that we have is whether a grant process or a grant program is the most effective mechanism to expand access to, especially mental health and suicide prevention care for veterans. VA is always looking for opportunities to expand access to those types of services, because we recognize that there are areas of the country where it may be more difficult to access those types of services. Again, we would really like to work with the committee first to determine what is the most effective mechanism to be able to conduct a pilot program, so that we can be cost-effective. And at the same time, if there's an opportunity to expand services, we take that opportunity.
Speaker 2
Thank you for that. And, probably the last question that I have time for. Doctor. Koninger, is there any statutory or practical barrier to VA either through its existing research infrastructure or through its academic affiliates program being able to research, develop, implement novel or alternative treatments for TBI?
Speaker 10
Ma'am, I will have to take that question back to looking to make sure that there are no statutory requirements. I just don't have that information offhand, but I can get back to the committee.
Speaker 2
Okay. So let's see. I think I don't have time for this, so I will yield back.
Speaker 1
Thank you, ranking member Brownlee. The chair now recognizes Representative Hamade for any questions you may have.
Speaker 13
Thank you, Chairwoman. President Trump has made veterans his priority again. He's expanded community care, slash bureaucratic red tape, and put the veteran, not the bureaucracy, first. I'm with him all the way. Now the Veterans Access Act and my Caring Act are built on the same foundation.
Veterans deserve seamless access to care, whether it's inside the VA or in the community. Doctor Koenager, can you explain to me step by step how you are implementing the president's directive to ensure medical records actually follow the patient?
Speaker 11
The medical records are really bidirectional. So when we refer veterans to community providers, we first have to provide them with some sort of consultation or referral. In some cases, that referral will include information about laboratories, diagnostic imaging so that the community provider understands what is being asked, when the veteran is referred. Similarly, once the community provider completes their evaluation, their treatment recommendations, they send those records back to the VA. At the present time, unfortunately, there are several different ways in which those records come to the VA.
One of the things that we are in the process of doing through the request for proposals that is currently in solicitation that's been published is to be able to streamline those efforts where the TPAs that receive the award will create essentially a portal where the medical records from the community providers will now be centralized in order to be able to streamline that process.
Speaker 11
To the best of my knowledge, no. But I'm happy to take that back and get additional information.
Speaker 11
We're expecting to make the awards, I believe, in March. There's a ninety-day review period, and, I think the awards solicitation closes at the end of this month.
Speaker 13
Now that's the biggest concern. Then when I go back to my district, there are a lot of veterans, you know, they lose their medical records. The VA does community care. So I really encourage the department to prioritize this because this is a constant theme I hear. But can you assure us after this is implemented, hopefully, when you have the right RFP that you select, that the veteran isn't going to be waiting weeks for community providers' records to actually reach the VA?
Speaker 11
You have my assurance that that absolute goal is that we're going to be receiving these records and then being able to upload them into the veterans electronic health record. Because the specific mechanics are not currently in place, unfortunately, that's about the extent of what I can say right now.
Speaker 13
Arizona has many rural communities that are miles from the nearest VA facility. President Trump understands that the veteran in rural Arizona matters just as much as the one here in Washington, DC. Now the Veterans Health Desert Reform Act we're considering today addresses this head-on. How is the VA proactively identifying these medical deserts right now?
Speaker 10
So the VA has certain processes in place within the office of rural health. So that office has been up and running for quite some time now. They have identified a lot of areas where veterans have to travel extended periods to get to health care. And they have, again, through the office of rural health, we are engaging with those veterans on a regular basis.
Speaker 13
But do you wait for the veteran to bring this issue to you? Are you being proactive about it?
Speaker 10
No. The office is proactive in terms of outreach to veterans. I yield back.
Speaker 1
The gentleman yields the chair, now recognizes Doctor Conway for five minutes for any questions you may have.
Speaker 14
Thank you, madam chair. And thanks to ranking member Brownlee for bringing us here today to discuss these important pieces of legislation. I wanted to discuss a particular vulnerability that veterans have with respect to their use of opioids. Many people in the service have chronic pain, service-related injuries, and other trauma. And so people with chronic pain, as I'm sure you're aware, are at higher risk of opioid reliance.
Some 289,000 vets have used opioids in the short term, and there are 162,000 veterans who are on long term opioid use as of data in 2023. Thank you. And so would you describe the standard of care is that, particularly for people on long term opioid use, that naloxone be available as a preventative for death related to opioid use. So, would you describe the current process by which a veteran, who has VA benefits, can receive naloxone, this standard of care treatment to prevent preventable opioid-related deaths?
Speaker 10
So, right now, a veteran can walk up to a pharmacy. And if they are high risk, there are standing orders with the pharmacy, so they can ask the pharmacist, and the pharmacist uses those standing orders to provide the veteran with the naloxone. And, again, the naloxone is provided free of charge to veterans. We also distribute naloxone through health fairs and other means.
Speaker 14
So, that's very good. So they can get the prescriptions, or they can get their naloxone in the various forms without a prescription. Also, I guess, in pill form because it does have uses in helping people that have alcohol dependence as a problem, and preventing or helping people to relieve themselves or reach beyond alcohol dependence. So it's free access. It mirrors a lot.
You would say the VA system that is mirroring what many states have done in this area by providing easier access to this lifesaving.
Speaker 14
Chemotherapeutic. Moving on. Discussing another piece of legislation on the list today. Can you, I understand there's a current process through which providers and patients can submit formal requests for new drugs to be included in the VA national formulary. Can you briefly explain what that process is and how long it takes on average for requested drugs to be added to the formulary?
Speaker 10
So, veterans, of course, we have medications that are on the formulary and that are not. All FDA-approved medications, veterans have access to all of them. So if it is not on the formulary, a veteran can go to their provider, ask a provider for a prescription, and generally within 96 hours, we'll get the medicine.
Speaker 14
Now my understanding is that the DOD formulary and the TRICARE formulary is broader than what is available to veterans receiving VA care. And one of the pieces of legislation seeks to ensure that the veteran who relies on VA care for their health care has the same easy access to drugs that are already approved in other federal formularies. Are your thoughts on that?
Speaker 10
So I am not aware of the specifics of what the DOD has on their formulary. I would have to get back to you with specifics.
Speaker 1
The gentleman Yolts, the chair, now recognizes Representative King Heinz for five minutes for any questions she may have.
Speaker 4
Thank you, madam chairwoman. So, fun little fact. The Northern Mariana Islands is a part of Greater Micronesia. And so the folks from the COFA states, the Republic of the Marshall Islands, the federal states of Federated States of Micronesia, Palau, you know, we're all Micronesians. And one of the commitments that I made was that I was gonna be their champion here in Congress because they don't have representation, although they have served this country.
So I thank you for the opportunity to have this conversation today regarding my bill. So, doctor Koenigher, you in your testimony, you referenced the unique legal consideration involved in extending VA benefits to veterans from the freely associated states. You specifically mentioned that the department continues to support a phased implementation approach to ensure durable access to care and continuity of services, particularly in geographically isolated and high-risk environments. So, I guess I wanna understand that statement a little bit more, and I wanted a clarification on what specific legal questions the VA is still working through.
Speaker 11
So to provide some examples, let's talk about the medications. There are certain medications that can be transported, based on Department of Transportation regulations and laws. And then there are others that are considered hazardous and cannot be transported or cannot be easily transported. There are certain medications that require certain types of refrigeration. Those would be logistically complicated to be able to send via mail order to, as you described, very, you know, in some cases, some fairly isolated areas over a broad geographic distance.
I'm not saying that it's impossible to do some of these things, but we would need to be able to figure out how to do them. That's on our side. On the federal, the FAS side, we would also need to understand what are their regulations, what are their restrictions, if they have any, with respect to the use of medications. Are there some medications that they do not allow? And so that's just an example of the types of things that would have to be worked out in agreements.
Similarly, on the provider side, we have the authority for US providers to deliver services, for example, via telehealth. But those providers don't necessarily right now have licenses, if you will, to practice medicine in the Federated States. It's something that would have to be worked out in the agreement. These are just a couple of the examples of the types of logistical issues that would need to be worked out. We welcome the opportunity, not only to work with Congress, but to work with our interagency partners in order to see what we can do with respect to the options that would be available to deliver the services.
Speaker 4
So are those regulatory changes that are required, or are there specific laws which prohibit these agreements from being negotiated? And how does that interplay with regards to what the commitments that we've made with the COFA agreement that was passed two years ago?
Speaker 11
I would respectfully request that you allow me to take that back for the record, because I don't know the answer to your question.
Speaker 4
Okay. Well, thank you for that. My other question is, you know, one of the issues that were raised with regards to this legislation is the cost. Right? And what has been done basically to kind of more fully vet what that looks like?
And whenever cost comes up, it kind of aggravates me because we didn't talk about costs when, you know, folks from the FAS signed up and served our country. Right? And so, where are we at with that?
Speaker 11
Yes. So we have been working at trying to examine and evaluate what some of the potential costs would be based on the types of services that would be offered, the types of medications that are likely to be needed, and then, the beneficiary travel component to try to come up with an estimate. The cost estimates also would necessarily be a result of what the actual utilization turns out to be, and that's not something that we know right at this point in time. It's something that we are working on to try to see if we wouldn't be able to obtain an estimate and a projection.
Speaker 1
Thank you very much. Representative King Heinz Echerna recognizes Representative Sherfelis McCormick for five minutes for any questions you may have.
Speaker 15
Thank you so much, and thank you for our witnesses who are here. I have so many questions. Florida's district is Florida has some of the top numbers of our veterans who we serve, and I hear a lot from them that one of the issues they have, not just the distance and how long it takes them. I have some people tell me it takes them a day to actually get to the VA. And so, distance is a huge issue.
But, also, I hear from them that cultural competency is also when they have to go outside. So, what are some of the safeguards that you have in place? Because we know our veterans are facing specific needs, and they've had specific harms that are unique to their situations, especially when it's service-related. So are there any safeguards in place to make sure that they're getting similar care that the VA would give them?
Speaker 11
So when we talk about cultural competency, it's important to define which culture we're talking about. In the VA, of course, we first and foremost start with the veteran culture.
Speaker 11
Because the needs, the experiences, and the health outcomes of veterans are quite different than what one typically would see in a civilian population. So there is a strong component of cultural competency with respect to the military culture, veteran health outcomes. The PACT Act recently mandated toxic exposure training for every VA provider, just as an example. So I think that there's very strong training for the VA with respect to the veteran culture. There are those same types of trainings afforded on some external websites that the VA uses.
The one that is most used by our community providers is called train. And, thereto, we offer training to the community on cultural competency for military culture and for veteran culture. Beyond that, of course, one could think of being a woman as a subtype of culture, and being a woman veteran is also very, very unique. It's one of the reasons why VA has established not only the women's health program and women's health clinics in our VAs, but also providers that have specific training to be women's health care primary providers.
Speaker 15
So I wanted to pause on that because that's getting to the root of the issue that we've been finding, is that there's so much uniqueness when it comes to our veterans, not just from the military culture, but then when we're looking at individuals such as women, which are growing populations. And that concern really comes in because the training right now is voluntary. There's no real standardization when it comes to the community-based care that they're receiving. You know, we submitted an amendment that would introduce that kind of standardization where anybody who's actually helping or servicing our veterans is trained the same way so they can recognize burn pits or they can recognize whatever they've gone through, which would save our veterans a lot of time as they're trying to cipher what issues they have. So do you have anything in place that would be mandatory, or do you believe that any kind of mandatory standardization when it comes to community care would actually be more advantageous to our veterans?
Speaker 11
Thank you. That's a wonderful question. To the best of my knowledge, we do not have anything in place right now that is mandatory. It doesn't mean that there haven't been many conversations and discussions about that topic. I think that the biggest challenge is, if we started creating a whole host of mandatory requirements, would that then limit and/or restrict the availability of those communities.
Speaker 15
Now in other areas, because I know there's continuing education for our health care professionals all the time, have we seen any burdens before? Because I don't see any other continuing education when we actually look at priorities. Right? The priority is to make sure our veterans are taken care of and to make sure if our veterans are presenting any kind of issue that the VA can pick up, that community care can pick it up just as fast. And they're not going through a system for years where the VA could have found it.
So have you seen that before, that the actual training has caused less accessibility?
Speaker 11
I would have to take that back for the record in order to be able to provide you with that answer. Thank you. Mhmm.
Speaker 1
General Women Yields, the chair now recognizes General Bergman for five minutes for any questions you may have.
Speaker 9
Thank you, madam chair. Doctor. Koenigher, one of the biggest challenges with mild chronic TBI, traumatic brain injury, is that it can be hard to recognize and is often masked by other conditions. From the VA's perspective, what are the consequences of underdiagnosis or misdiagnosis for veterans?
Speaker 10
Yeah. I certainly, the consequences of underdiagnosing or misdiagnosing any medical problem would have a negative impact on the veteran. And so whether it's mild TBI or any other medical condition, VA providers strive hard not to underdiagnose or misdiagnose.
Speaker 9
Yeah. So, you know, you're a medical professional. The idea, I'm sure, from your perspective, is you wanna get it right as best you can the first time. Absolutely. That's, I mean, that's, you know, the oath you've sworn to uphold, and I thank you for that.
So, you know, on a different note here, but still along the same lines, doctor Kanigur, many veterans struggling with mental health challenges never enter the VA system before engaging in self-destructive behaviors like suicide. They just don't, they're not in the system. So how do we, you know, calculate the numbers? As such, the true scope of need is likely far greater than existing data would reflect. Reducing suicide risk requires meeting veterans where they are, within their communities.
The expectation, especially in districts like mine where it's rural and remote, I mean, hours' drive from any kind of clinician. This underscores the need for flexible, accessible care that engages veterans the moment they first seek help. If implemented, and I'm being specific here, how could the RECOVER Act, sponsored, you know, introduced by Chairman BOSS, change the way veterans experience mental health care at the moment they first raise their hand for help?
Speaker 11
So we welcome the opportunity to be able to identify mechanisms to expand just the type of access that you described. I think one of the advantages in the language as written is that the providers would be encouraging veterans to enroll and engage with the VA to receive VA health care services in addition to any services offered in the community. However, we do have some significant concerns as written, and would like to work with the committee to best address those concerns.
Speaker 9
Well, and I appreciate that. You know, the mission act became the choice act and then, you know, became community, you know, all of those things that have morphed over time here over the last decade. And, unfortunately, still, we are, in some ways, as a committee, struggling with dealing with the veterans administration to shape the environment for the ability to, first of all, get the first step of diagnosing the issue, which means contact with the veteran. So I appreciate your willingness to take a look at different ways to make that initial contact because, you know, there's not a one-size-fits-all, especially in those rural and remote areas. With that, Madam Chair, I yield back.
Speaker 1
The gentleman yields. The chair now recognizes herself for five minutes for any questions she may have. Doctor Conninger, if the pilot in my health deserts bill proves effective, how could it reshape access to care for veterans living in health care deserts nationwide and, in fact, worldwide?
Speaker 10
Ma'am, we are the VA, and we are always in support of trying to engage veterans in health deserts or, you know, in very rural areas. And, again, the office of rural health has done a lot of work in those areas to identify and, again, define, you know, what a rural area is and then reach out to the vets who live in those rural areas and try and get them first enrolled in the VA and then figure out how to best work with them so that they can have access on a regular basis, whether it be through things like ridesharing or telehealth or services like that.
Speaker 1
And, doctor Rentier, just in response to a comment from my colleague about standardization and mandatory training for individuals, whether they're within the V providers, whether they're in the VA system or in a community care system. Is it mandatory that a veteran go to community care, or is that something they request?
Speaker 11
So it's, first of all, they have to meet the eligibility criteria for community care. And then, secondly, we offer them the choice. They it's the veteran's preference. If they want to go to community care and are eligible, then, you know, we'll do everything we can to facilitate. If they prefer to receive care from the VA, then we will honor their preference.
Speaker 1
Thank you. I just wanted to emphasize that point that it is voluntary in the choice of the veteran where they receive that care. Doctor. Koniger, why is it important to explore care delivery models that leverage existing non-VA health systems and health deserts?
Speaker 10
I think what the VA wants to do is to make sure that it provides the absolute best care to veterans as possible. And as doctor Lorente just said, you know, we need to consider all aspects of care, whether it's in the VA or outside of the VA, and make sure that veterans have access to the best care.
Speaker 1
Thank you. As a veteran, married to a veteran, I couldn't agree more. So I yield back on behalf of the subcommittee. I wanna thank you all for your testimony and for joining us here today. You're now excused, and we'll wait for a moment for the second panel to come to the witness table.
Speaker 1
Order. I welcome everyone and thank them for their participation today. On our second panel, we have the honorable Charles Rudolph Paul, ambassador to the United States of the embassy of the Republic of the Marshall Islands, mister James Whaley, chief executive officer for Mission Roll Call, Miss Elizabeth McCoy, associate director of government affairs, Wounded Warrior Project. Miss Kay Conwell Smith, deputy chief of military and veterans policy at the American Psychological Association. Thank you once again for attending today.
Ambassador Paul, you're now recognized for 5 minutes.
Speaker 16
Madam chairwoman, ranking members, members of the subcommittee, thank you for the opportunity to testify on veterans' health care, issues affecting the Republic of the Marshall Islands and the other freely associated states. The Republic of the Marshall Islands stands in one of the closest strategic relationships the United States maintain with any sovereign country. Under our compact of free association enacted into law, we permit the United States to exercise a core element of our sovereignty, strategic denial. Across the region spanning from Hawaii to Asia, we also host a critical US military installation that the joint chiefs of staff describe as the world's premier range for missile testing and space operation support. The United States also actively recruits in the Marshall Islands as if we were a US state or a territory.
Our citizens enlist at some of the highest per capita rates of any US jurisdiction. They serve honorably, deploy globally, and retire as U.S. veterans. Yet today, many of these veterans are effectively unable to return home because they cannot access the health care they earn through their service. The issue was central during the negotiations of the Compact of Free Associations Amendments Act of 2024. Congress clearly intended that the veterans' health care be made available in the freely associated States.
That intent was reinforced in last year's continuing resolution and the National Defense Authorization Act. However, despite clear statutory authority and treaty obligation, the Department of Veterans Affairs has not acted to implement this care on the ground. As a result, veterans must choose between remaining in the United States or returning home without access to VA health care. The Republic of the Marshall Islands strongly supports congressional action to resolve this gap and ensure the compact commitments are fulfilled. The issue is deeply personal at the highest levels of our government.
The minister of foreign affairs and trade of The Republic Of The Marshall Islands, the honorable Kalani Canego, is himself a retired US Army veteran who honorably served 20 years qualifying for full retirement. For more than a decade, he served as an army recruiter and personally recruited approximately 200 martial-use men and women to the United States armed forces, individuals who trusted the United States and answered its call to service. This issue is also personal to me. My younger brother medically retired from the United States Army after his 13 years of service, including three combat tours in Iraq. He now lives in the Marshall Islands and cannot access the health care he would receive if he remained in the United States.
My nephew is currently serving on active duty. He wants to return home after his service, but worries whether he'll be able to receive the care if he does. No veteran's decision to return home should depend on whether they can access basic medical care. Importantly, it is not a request for new benefits. Section 209a4 of the Compact Amendments Act explicitly directs The United States to enter into agreements to ensure the provisions of veteran services in the freely associated states.
Congress has spoken clearly. The authority exists. The obligation is explicit. This is also a national security issue. Veterans living in the Marshall Islands strengthen local capacity, reinforce trust in the RMI US relationship, and serve as a stabilizing force in a strategically sensitive region.
The Republic of the Marshall Islands stands ready to work constructively with Congress, the Department of Veteran Affairs, and the administration to implement what the compact already promises. Our veterans are not their commitment to the United States. Implementing veterans' health care in the freely associated states is not an expansion of benefits. It is the fulfillment of a solemn obligation. Thank you, and I look forward to your questions.
Speaker 1
Thank you, Ambassador Paul. Mister Whaley, you're now recognized for 5 minutes for your testimony.
Speaker 3
Good afternoon, Chairwoman Miller Meeks, Ranking Member Ron Lee, members of the health committee, distinguished guests. Thank you for the opportunity to testify today on behalf of Mission Roll Call and the veteran community. Our mission is straightforward. We collect data from veterans, and we make sure that information helps inform decisions made in Washington. We use polling and direct engagement to bring real, unfiltered veteran perspectives to policymakers and the public.
Amplifying this data on behalf of veterans and their families allows us to advocate for meaningful change that improves the lives of those who have served. The legislation under consideration today seeks to address and improve the lives of multiple generations of veterans, addressing traumatic brain injuries, suicide prevention, access to care in remote and rural areas, mental health, opioid addiction, and more. Mission roll call survey data shows a strong need within the veteran community to address these issues in ways that place veterans first and deliver care when and how a veteran will benefit most. One area where this need is especially clear is suicide prevention and mental health care delivered outside of the VA facilities. Emission roll calls national suicide prevention polling in July 2025, nearly 80 percent of veterans told us that preventing suicide requires clinical treatment and community-based support working together, not in isolation.
More than ninety percent said it is extremely or very important to include community-based organizations and prevention efforts, and an equally strong majority emphasize the importance of training, coordination, and accountability. The recovery act reflects those priorities by strengthening evidence-based mental health capacity in the community, ensuring providers are trained to understand veterans' risks, and requiring outcome reporting so Congress and the VA can assess what is actually working. To veterans, this is about a system that meets veterans where they are, especially when timely access to care can be the difference between stability and crisis. While suicide prevention only brings veterans into mental health systems, many of the underlying drivers of risk begin earlier and go untreated. Mission roll call survey data shows that over 95 percent of veterans say it's very important to have access to specialized TBI care, including care delivered outside the VA.
Yet among veterans seeking care for TBI-related symptoms, 73 percent report that assessing appropriate treatment is somewhat or very difficult. The BEACON Act responds directly to that gap by creating a structured evidence-based framework for evaluating innovative approaches for veterans and chronic with chronic TBI. Veterans are asking the VA to test, confirm promising therapies responsibly, publish results, and expand access where evidence supports it. From the veterans' perspective, the BEACON Act is about restoring function, reducing downstream mental health risk, and giving clinicians better tools to intervene before injuries compound into lifelong disability. In addition, mission roll call supports efforts to modernize veteran care by expanding evidence-based options while holding the system accountable for outcomes.
The No Pain for Veterans Act moves VA toward broader use of effective nonopioid pain management therapies, while the Veterans Mental Health and Addiction Therapy Quality of Care Act ensures Congress and the VA have reliable, independent data on how mental health and addiction care performs across VA and community programs. These measures reflect what veterans consistently ask for in our surveys. Care that is grounded in evidence, reduces risk, and is evaluated based on real-world results. Mission Roll Call has always advocated that geography should not determine where a veteran receives timely care and supports legislation that addresses access gaps for veterans who live far from VA facilities or outside the Continental United States. The Veterans Health Desert Reform Act and The US Vets of the Freely Associated States Act recognize this reality and seek to leverage community providers, telehealth, and mail order pharmacy service to close those gaps.
We believe good policy starts with listening to the veteran community and ends with accountability. Veterans overwhelmingly seek better access to care in a manner that supports their life and family, rules that can be easily understood, and outcomes that can be measured and improved. The legislation before you reflects meaningful progress towards those goals, and we appreciate the subcommittee's continued focus on practical solutions that make the veteran and family central to the provision of care. Thank you, chairman.
Speaker 1
Thank you, Mr. Whaley. Miss McCoy, you are now recognized for 5 minutes.
Speaker 17
Chairwoman Miller Meeks, ranking member Brownlee, and members of the subcommittee. Thank you for the opportunity to testify. Today's agenda includes many bills that are aligned with the Wounded Warrior Project's mission to honor and empower warriors. And I am pleased to speak on several that would have a heightened impact on the post nine-eleven wounded, ill, and injured veterans that we serve. My remarks today focus on the link between mental health and brain health, and why investment in brain health is essential.
Military-related traumatic brain injury, a signature wound of post nine-eleven service, can significantly increase neurological conditions that influence physical and psychological functioning, such as chronic pain, depression, and anxiety. To that end, a traumatic brain injury can both directly and indirectly elevate the suicide risk. These realities underscore the need for continued investment and innovation. Scientific advancements have demonstrated that brain health must be treated as a lifelong whole health priority both during and after military service, just as we have learned with mental health. Yet much about brain function remains unknown, reinforcing the need for bold investment in research and advancement to improve outcomes.
To address these challenges, we must move toward a strategic framework that integrates three pillars: prevention, treatment, and innovation. First, prevention and early identification of brain injuries are critical. Service members in training and combat can be exposed to blast overpressure and repetitive head impacts that accumulate over time. We encourage alignment of lifecycle data and standards from the Department of War to the Department of Veterans Affairs. Shared baselines, common measures, and longitudinal tracking so that no veteran falls through the cracks during their transition.
Legislation such as HR 6444, the blast overpressure research and mitigation task force act, strengthens blast exposure research and seeks to translate evidence into standardized screening and safeguards while assuring assessments migrate with the veteran from their time in uniform to civilian life. For these reasons, we are pleased to support this legislation. Second, personalized, outcome-driven treatment is essential because brain injury manifests differently for every veteran. Precision approaches, tailored neurorehabilitation, nonpharmacologic therapies, and integrated mental health support offer pathways to measurable improvements in cognition, mood, and functioning. We support HR 6993, the BEACON Act, which would seed innovation and clinical evaluation across nonprofits, academia, and community partners.
We encourage streamlined funding so pilots add capacity, rather than divert existing mental health resources. Third, proactive suicide prevention should take brain health into account. Predictive analytics can help clinicians identify veterans at higher risk and engage them earlier with safety planning, follow-up, and tailored treatment. But technology should not be used as a shortcut. Innovation should enhance proven strategies, not replace them.
To that end, Wounded Warrior Project supports the discussion draft, data-driven suicide prevention and outreach act of 2025. Veterans have earned care that is consistent. While public and private collaboration is essential to ensuring veterans receive the highest quality of care, VA should remain the coordinator of programs and grant funding. Where shortages persist, especially in rural areas, we support piloting practical access solutions that meet veterans where they live, making sure data flows back to the VA and measures outcomes. We are pleased to support the discussion draft Veterans Health Desert Reform Act of 2024.
The legislation included in today's hearing moves beyond incremental fixes and strives towards a bold, integrated vision for brain health that supports the service member to veteran lifecycle. Wounded Warrior Project stands ready to partner with the subcommittee, VA, the Department of War, and community innovators to identify and prevent injury of the brain, create personalized outcome-driven treatment, and build proactive suicide prevention programs that take brain health into consideration. Thank you for your leadership and for the opportunity to testify this afternoon.
Speaker 1
Thank you, Miss McCoy. Miss Conwell Smith, you're now recognized for five minutes for your testimony.
Speaker 12
Chairwoman Miller Meeks, ranking member Brownlee, and distinguished members of the subcommittee, thank you for the opportunity to testify. I am Conwell Smith, the deputy chief for military and veterans policy for the American Psychological Association. APA is the nation's largest scientific and professional organization representing psychology with more than 190,000 members and affiliates. Today, more than 7,000 psychologists work in the VA, though that number has declined by nearly 300 since 2020. APA is proud of VA psychology's role in decades of mental health clinical and research advancements.
My testimony focuses on ensuring that the legislation under consideration upholds the highest standards of veteran care, regardless of where care is delivered. Several bills create new delivery models, programs, and access points operating outside the VA's direct care and community care programs. APA is concerned that building parallel systems risks further fragmenting care, separating veterans from coordinated treatment teams, and weakening the benefits of the VA's integrated care model. Two bills in particular, the RECOVER Act and the Draft Health Desert Reform Act, are well-intentioned efforts to expand access, but we fear risk unintentionally reducing the quality of veteran health care without stronger safeguards. APA recognizes the need to supplement VHA care.
However, veterans should have the same expectations of quality and safety, whether they are treated inside or outside the VA. To that end, our recommendations are as follows. Number one, APA strongly supports requiring key training for all community providers, including those providing care through separate VA-funded grant programs. The RECOVER Act provides 60,000,000 in grants to mental health facilities serving veterans, but does not require clinicians to meet the training standards expected of VA providers. Notably, suicide prevention training is not mandated, even though the bill targets areas with high veteran suicide risk.
Veterans deserve clinicians who understand military culture, common service-related conditions, and VA medic clinical expectations. Number two, APA leads with psychological science and emphatically recommends the use of treatments scientifically proven to be effective for the assessment and the treatment of mental health disorders. The RECOVER Act does not require provider training and evidence-based practices, leaving a significant gap in provider readiness to treat conditions disproportionately impacting veterans, such as post-traumatic stress, depression, and substance use disorders. Additionally, the BEACON Act risks weakening longstanding VA leadership and traumatic brain injury research and treatment by creating a parallel research pathway outside the existing rigorous VA processes. The VA's evidence-driven system has contributed to some of the most impactful TBI advances.
Any new framework should reinforce, not bypass, that scientific rigor. Number three, APA supports requiring facility accreditation and strong quality assurance for any agency providing mental health services to veterans. The RECOVER Act does not require accreditation by the Joint Commission or the Commission on Accreditation of Rehabilitation Facilities, diverging from accepted VA standards. Moreover, legislation should require standards for demonstrating improved clinical outcomes. Without outcome measures and enforcement, neither Congress nor the VA can assess impacts on veterans, positive or negative.
Number four, effective mental health care relies on coordinated care supported by shared health records. Removing the VA as the coordinator of care and creating increased fragmentation of services could worsen continuity of care challenges that veterans already experience. APA recommends requiring all community providers to participate in the timely medical record exchange with the VA. This ensures clinicians have the full health history needed to provide safe and consistent care. Number five, APA supports efforts to give veterans the information they need to make informed decisions about their care.
We're encouraged by the creation of a publicly available directory for CHAMPVA health care providers as required in the Clarity on Care Options Act. We also support the intent of the Veterans' Mental Health and Addiction Therapy Quality of Care Act. However, the bill falls short in enabling meaningful comparisons and quality assessments. It is an honor to represent the American Psychological Association and advocate for the essential work psychologists do for our veterans and the military. And as the spouse of a disabled army veteran who is with me here today and who receives his care through the Hampton VA Medical Center, ensuring high-quality care across all settings is deeply personal to me.
Distinguished members of the subcommittee, we know that each of you is earnest in your commitment to improve veteran health care access and quality. The VA remains a national leader, and we stand ready to work with you on these legislative endeavors. Thank you.
Speaker 1
Thank you, miss Commonwealth Smith, and thank you to all of our witnesses for their thoughtful input. Ranking member Brownlee, you're now recognized for five minutes for any questions you may have.
Speaker 2
Thank you, madam chair. Thank you, Miss Smith, for your testimony. Miss Smith, as written, the BEACON Act would be paid for by diverting funding from existing VA mental health care programs and from VA's National Center for PTSD. Can you expand on how diverting these funds will impact VA's ability to provide clinical care and continue to conduct research through programs?
Speaker 12
Thank you for that meaningful question. The VA's National Center for PTSD is a recognized leader across all of our health care system. I think the concern is that sidestepping scientific rigor, the VA, and the gains made in PTSD and TBI research could potentially cost much more than money. It could cost clinical advancements. And so I think working, figuring out how different entities work in tandem, but maintaining a very high level of standards and not defunding the VA is a critical approach.
Speaker 2
Thank you for that. And, know, I asked this question of the second panel, but I was just curious to know if you are aware of any statutory or practical barriers to VA either through its existing research, infrastructure, or academic affiliations programs? I am not. Thank you. So, I also noted in my opening statement that I have concerns about the weak oversight mechanisms of the grant program that would be created by the recovery act.
Miss Smith, I'd like to get your take on whether the recovery, the RECOVER act, is robust enough from a clinical perspective. And from your read of the bill, would it expand existing services or improve the quality of care for veterans?
Speaker 12
I think as far as expanding services, my read of the bill is that it does not necessarily do so. It allows grantees to build a VA and other insurers and also receive a $1,500,000 grant with no requirement to treat higher numbers of veterans. On the quality front, unlike VA facilities, the bill doesn't impose accreditation requirements, peer review processes, or evidence-based treatments, or training in those evidence-based treatments. And I believe that it requires one provider to be trained in cultural competency. And, obviously, APA feels very strongly that all providers of mental and behavioral health care should receive core competency training.
Thank.
Speaker 2
you. And, are there any requirements in the bill that would ensure grantees engage in care coordination of the VA, returning medical records, or making sure veterans receive follow-up care from VA?
Speaker 12
I don't believe that the bill mentions transmitting records to the VA. And, of course, there's not a requirement to join the community care program where oversight exists. You know, there was a recent GAO report that demonstrated that 33 percent of VA referrals to behavioral health, in the existing community care program, were missing the initial visit record. So this is a very serious problem, and I really appreciate that members of the committee were addressing the importance of shared record exchange to quality of care.
Speaker 2
Thank you. And another question, if there is any way that Congress would know whether the recover act grantees are following evidence based practices and the provision of care, for veterans?
Speaker 12
I don't believe without a requirement, I don't believe that there would be an ability to know. I think oversight and accountability require processes that I am not familiar with regard to this bill.
Speaker 2
And what kind of clinical outcomes would you expect to see reported following the provision of care by a Recover Act grantee versus similar care delivered by the VA?
Speaker 12
Well, we're encouraged that the bill does mention clinical outcomes, but it's a vague word without, again, requirements and a building structure. Without evidence of grantee-level effectiveness, how can Congress or the VA know what the positive and negative impacts are on veterans? So we don't know that those care outcomes would be related to the symptom improvement, for example. And I think we could look to the congressional report on the Fox grants to demonstrate that if you don't have requirements and you don't have enforcement, there might be little there to be able to evaluate a program's effectiveness.
Speaker 2
Thank you for that. And, I will yield back, but I will just say that, you know, I certainly respect the intentions of this bill, but I just feel like it needs more accountability, more guardrails, to ensure evidence-based practices and quality of care. So I yield back.
Speaker 1
Thank you, ranking member Brownlee. The chair now recognizes Representative King Hines for five minutes for any questions you may have.
Speaker 4
Thank you, madam chair. First of all mister Oehly, great to see you again. It was great meeting you the other day when we had the Beacon Act press conference.
Speaker 4
Honorable Charles Yokwe, a lot of my questions are gonna be focused on conversations about the RMI and my legislation that expands the not expands, but actually upholds the current statutory requirements to extend VA benefits to our freely associated state citizens. And let's just start off by having you describe what are the most unique challenges that our vets face in the freely associated states, and how many of them are actually returning home?
Speaker 16
Thank you. Thank you very much, congresswoman, for that. And, so some of the unique challenges that our vets are experiencing living in the Marshall Islands, basically, as outlined in my statement, health care. I mean, a lot of them did not identify if they are veterans when they get health care because there's no benefit for them to doing so. And, also, there are different types of, like, health care needs that the islands are just not equipped to provide, because we don't have wars or combat zones near or anywhere around our islands.
So there are certain things like PTSD, things of that nature.
Speaker 4
So that's kinda what I wanted to get into in terms of the types of actual physical conditions, whether it be PTSD or any type of visible injury. Right?
Speaker 16
Right. Yes. So, like, visible injuries, things like, you know, lost limbs, from being active duty, but also mental, a lot of mental issues, and mental health issues where a lot of folks that, you know, commit suicide in veterans. Just a couple of months ago, a veteran jumped off a ship.
Speaker 16
And there's really no treatment facility, for we have one psychiatrist in the Marshall Islands for the whole country. So the veterans are not getting the care that they deserve.
Speaker 4
So you heard the conversation, the dialogue that I had with the VA in the previous panel, and, you know, you heard the challenges that they raise with regards to the transportation of medication and whatnot. Right? The shipping issue and the different statutes that are required to be negotiated. Mhmm. I think it'd be helpful for the panel to kinda hear what your health care system sounds like, what it is actually, what is there.
Because when you hear that description, makes it seem as if you have zero health care facility and no medication is currently being shipped in? I mean, in your testimony, you pointed out that there's actual Department of Defense presence there, which I assume, you know, there's regular goods and commodities that are being brought in through DOD. And so can you just speak on that with the very little time that we have?
Speaker 16
Sure. Thank you so much. Yeah. So, the house, so we have dispensaries and hospitals that are being built by compact funds for over the past 35 years. So we have doctors that are trained and licensed from The United States in the Marshall Islands.
And in fact, if I may speak to, about September 2024, we started engaging the VA, to discuss, do environmental scans, what the facilities are in the Marshall Islands. And I believe about January, February 2025, we're this close to starting negotiating an agreement. So that was about less than 6 months going back and forth. We would hold monthly meetings with the VA, and, you know, we're this close to executing an agreement that would resolve a lot of the issues that were brought up today. So, I believe we can get there.
Would keep talking and try to come up with an agreement so we can provide the health care that is needed.
Speaker 1
Thank you. The gentlewoman yields back. The chair now recognizes Doctor Dexter for five minutes for any questions she may have.
Speaker 18
Thank you, chair Meeks, and thank you to our ranking member, for her service here. It's gonna be very sad without you here on our subcommittee in a year. We have you. So, Miss Smith, thank you so much for coming, and I very much appreciate that your statement reflects your organization's commitment to high-quality, outcomes-driven, and accessible health care for our veterans. As you said, for our veterans, it's awful if those things are often best possible when veterans have access to clinicians and facilities that are accredited and fully trained and really culturally competent.
I also just wanna shout out the outcome, transparency, and accountability that you referenced because it's really crucial. I'm a physician, was honored to practice in a VA. It's crucial for making sure that what we think is science-based is actually driving better outcomes for our patients. So thank you for calling that out. Last thing I wanted to highlight is your statement about the medical record exchange.
Having provided care in a VA as well as a community care provider, I cannot list how many times we led to redundant care or subjected people to recurrent, repeated, unnecessary treatments because we didn't realize they had already been given somewhere else. So I want to ask some questions related to the Health Desert Reform Act, which I will reiterate is very well intentioned. We have to be able to provide community care to our veterans when they don't have access to a VA that can give timely care. That is absolutely this is not a political issue. This is a priority issue that I think we all share here.
The section of the bill on oversight, I'll just note, is less than a page long, and it includes rather vague requirements that the VA secretary track access, cost, quality, and veteran satisfaction for each hospital that enters into an agreement under the bill. Miss Smith, do you have confidence that this requirement will be sufficient to ensure the care delivered by those hospitals is of equivalent or superior quality to the care delivered by a VA facility?
Speaker 12
As it is currently written, I don't feel like there is the structure to give me that confidence. Am I encouraged that it could be? Certainly. But I just think as it's written right now, no. I would have to say no.
Speaker 18
And I share that concern. And under this bill, there appear to be very few parameters placed on pilot program eligibility. It does not stipulate that for profit or private equity backed hospitals cannot take advantage of the program, nor does it require that a hospital be located in an area with a demonstrated wait time or drive time issue. In your opinion, what risks does this pose in terms of possible exploitation, overutilization, or unnecessary duplication of services?
Speaker 12
APA has long been concerned that unfettered growth in the community realm without accountability could have a negative impact on the integrated care system of the VA. So we do share that concern. I think there, again, I do think that there are structures even in the community care program that provide more oversight that could be applied in this case.
Speaker 18
And I just wanna highlight an issue that I've raised in this committee. The VA budget, unfortunately, is a zero sum game. If we take it from VA facilities to provide this care, it doesn't come back. And this bill includes no cap on the amount of funding that can be used to furnish care through the arrangements that it authorizes. So that means it's entirely possible that we could siphon large amounts of funding away from the VA, where we know our veterans get the highest quality and best satisfaction.
This has been documented. So and for uncertain quality, and it may or may not be necessary. Is that your concern as well?
Speaker 12
It is our concern. You know, we're down 300 psychologists over just this past year, and we know that the demand for mental health treatment within the VA is skyrocketing. And so I think that, you know, using funds to also invest in the VA's ability to meet the demand by staffing is a really important piece of the puzzle. So if money is going from one place to the other, how can we reinvest it there as well?
Speaker 18
And with my last few seconds, I just wanna underline that because I have heard that even physicians who have long been practicing, at least in our Portland VA, that they cannot get their patients in for appointments because the staff who help coordinate or get them in for those appointments have been dismissed. So it feels like right now we should be underlining the commitment to making sure VA veterans have access to the VA facilities that we have already funded. Thank you. And with that, I yield back.
Speaker 1
Thank you. The general lady yields. The chair now recognizes General Bergman for five minutes for any questions he may have.
Speaker 9
Thank you, madam chair. Mister Whaley, good to see you again. Good to see.
Speaker 9
Just like a couple of days when we were out on the lawn or over and, you know, presenting on what you all do, and you do it very well. Thank you. In talking with veterans in my district and across the country, it's clear that mild chronic TBI is far more common than is often recognized, frequently missed, and undiagnosed. This prevalence seems to exceed what the VA's current clinical footprint alone would suggest. With only five polytrauma centers nationwide, the current system simply does not have the capacity to meet the full scope of the need.
The question: why is additional targeted funding necessary, and what kinds of community partners, nonprofits, or academic centers are best positioned to extend that care and innovation beyond the VA's walls?
Speaker 3
Thank you, sir, for that question. We listen to veterans. We take their opinions in an unbiased, unfiltered way, and then we share it, of course, with all of you and with the media, as well as our fellow veterans. It's clear when we speak to them that they want to be able to have the ability to get treatment early on in this process, before it exaggerates, before it grows, before it affects their job, before it affects their family. It's a spiraling effect.
Right? When one thing goes bad, then the next, and then the next, and before we know it, on a slippery slope to a bad place. When we can get to this early and get treated and get access to health care in a proper way, then we can mitigate that. We can slow it down. We can give them the assets and the technology and the medication in some cases that they need.
When I think about organizations that are doing great work here, I think about the Avalon Action Alliance, which has a number of facilities and partners across the country that right now are doing that god's work for helping veterans with TBI, sometimes very mild, sometimes very severe. And they're doing it in a way that is very costly to them and not sustainable long term for them to do without getting support. I think it's important for us to realize that this is a national issue, not just a veteran issue. And that if we can't solve TBI for those that have served our country, then we're not gonna be able to solve TBI for our citizens. And so I think it's important to invest in this.
I think it's important to make sure we have the assets to do that. We've been the best and brightest organizations to take a look at this. Obviously, we need guardrails. Right? I mean, there have to be checks and balances to make sure that this is done in the right way.
But I applaud the efforts of those on this committee and all of you for your work. I think everybody has the best intentions here, and we want the very best for our veterans and their families. And I say their families because if you have one veteran that has this problem, it affects his spouse. It affects the children. And when we think about it, there are 18,000,000 veterans in our country.
When you think about those dependents, you're now talking about 30 or 40 million Americans that this impacts. And right now, we're only having access to half of those veterans through the VA. This is a big problem. Thank you.
Speaker 9
Yeah. Thank you. And I noticed that admission roll call that I took a photo of, it said the keyword takeaway is listening because in any conversation or any dialogue, at least one entity has to be listening. So thank you for being a listener. Miss McCoy, if this research leads to clear evidence of what works, how could that improve day-to-day care for veterans living with DBI?
Speaker 17
Thank you for that question, sir. I would like to echo many of Mister Whaley's points here, that it really is our belief that innovation can come from anywhere. We are committed to efforts that reduce suicide risk among veterans living with long-term effects of brain injury, and that is a population that we serve regularly. I believe that all of these efforts collaboratively can be streamlined, as you point out under the Fox grant. And, ultimately, it's going to improve alignment, avoid duplication of care, and really improve medical outcomes for veterans.
Speaker 9
Thank you. And, you know, this is not a we talk about in weapon system fire-and-forget. What we're trying to do here is not a fire-and-forget. We just throw something out, create the beacon. You know, whatever it is we're trying to do, the therapy, it's not a fire-and-forget.
We gotta keep working it, because things are gonna change. And with that, Madam Chair, I yield back.
Speaker 1
Thank you, General Bergman. The chair now recognizes Doctor Morrison for five minutes for any questions she may have.
Speaker 19
Thank you, madam chair. And ranking member Brownlee, I reiterate Dr. Ductester's comments. Thank you for your service and for your mentorship. You will be dearly missed. And thanks to each of the witnesses testifying before the committee today.
Grateful for your presence. In Minnesota, I represent Minnesota's 3rd District, and we are very proud of the Minneapolis VA. It goes above and beyond for veterans in our state. And while certainly a testament to the leadership and community in Minnesota, this recognition is also a timely reminder of how critical health care workers are to the success of the VA. Intentionally tackling this burnout underscores how important investing in the VA workforce is, and our ability to deliver on the promise that we've made to our veterans.
Having myself been one of the seventy-plus percent of American doctors who has completed part of their medical training at a VA hospital, it also leads me to think about the unique challenges that veterans face when it comes to mental health, substance use disorder, and overdose risk. As our country struggles with the opioid crisis nationwide, my heart breaks for our veterans that research has repeatedly shown to be at higher risk of death from overdose, further complicated by chronic pain, service-related injuries, or other service-related trauma. A major part of what compelled me to serve in Congress was my firsthand experience as a doctor seeing how difficult navigating our health care system can be. Helping veterans face unique challenges and elevated risk requires intentional work to break down the barriers. Now as a member of this committee, I'm honored to have the opportunity to lead policies that will help meet veterans where they are.
And that's why I'm proud to have joined with another experienced doctor, Congresswoman Conway, to introduce HR R. 5,999, the Veteran Opioid Emergency Treatment Act. This bill would reduce the barriers veterans face to accessing naloxone, a life-saving medication that can rapidly reverse an opioid overdose. Medication that would be lifesaving in such critical moments should not be out of reach to veterans as a result of cost or difficulty in scheduling appointments. I'm grateful for the bill's inclusion in today's hearing, and I look forward to continuing to work with Doctor Conway and my colleagues as the bill moves through the committee.
Speaker 19
Could you elaborate on the importance of a consistent system-wide approach to ensuring timely access to naloxone? Why is this access and consistency of particular importance to veterans?
Speaker 12
Well, thank you for the question. Recognizing the conditions that disproportionately impact veterans is part of how we approach treating them. And so we are recognizing that there is the there there is definitely a sensitivity to substance use disorder, and we must do all that we can to prevent unnecessary veteran death.
Speaker 19
Thank you. And in your testimony, you highlight the importance of training an exceptional health care workforce. How does investing in VA providers protect the quality of care that veterans receive?
Speaker 12
Well, you mentioned already in your comments about being part of the 70 percent who receive their training in the VA. I have the pleasure of working with VA psychologists who are just tremendous public servants, but they also spend time training the next generation of mental health providers. And I think a lot of times it's lost that the VA is not only important to our veterans, which is first and foremost, it's important to each and every one of us, because they really are training the health care workforce. If I can add, because you meant burnout, you mentioned burnout earlier, we're finding more and more psychologists' clinical time is being taken up, you know, their entire day is filled with clinical scheduling, and it's not leaving the time for clinical training supervision. And that concerns us because I do think that there are training programs at certain VA facilities that are dying on the vine only because they don't have the time and the people to foster the training.
Speaker 1
The general lady yields. The chair now recognizes Representative Kiggins for five minutes for any questions she may have.
Speaker 20
Thank you, madam chair, for just conducting the hearing today to talk about important pieces of legislation that will improve access to care for our veterans throughout the VA. Included in the hearing today is my legislation, the Clarity on Care Options Act. CHAMPVA is vital for caregivers and dependents of permanently disabled veterans. It ensures they can continue to support the veteran in their lives and still receive the health care services they require. To support our veteran caregivers and find providers more easily, I introduced the Clarity on Care Options Act, which directs the VA's Community Care Network to create a public-facing list of all providers who are in network for CHAMP VA enrollees.
It's important for patients, for providers. There's a lot of confusion. The more we talk about all the other great issues we talked about today, from mental health care, how we're addressing addictions, court continuity of care issues, all the things we're working on. I need my veterans out there to know to have kind of a directory so that they can find where the community care partners are. So that's just what my bill does, is establish this directory.
We have so many in some of great places our veterans live like Hampton Roads, and, just I think it would be a great addition to complementing care. So I just had a couple of questions. First to miss McCoy, what barriers do you see eligible families most commonly facing when they're enrolling in CHAMPVA? What barriers do they face after having access to the program?
Speaker 17
Thank you so much for your question, Representative Kiggins. Surviving families and caregivers often face heightened mental health risks and require consistent, comprehensive support. We are in support of this bill, and fully encourage efforts to expand information on how to access essential health care information. We believe that a national registry provides a powerful tool for these beneficiaries to secure the care and support that they deserve.
Speaker 20
Great. Thank you. And are there specific populations such as surviving spouses, caregivers, or dependents with disabilities who face disproportionate challenges accessing CHAMPVA? Absolutely. Which would you say, or what are some of the more challenged groups?
Speaker 20
I would agree with that too. And, again, for Miss McCoy, what are the most common reasons Champ VA claims are delayed or denied?
Speaker 20
I think a lot of times our veterans probably access just either Google searching or, you know, look even hearing from friends, and they make appointments in their seat. And then they find out after the fact that those were not in the network, which is what this bill is hoping to prevent. And last question for Miss McCoy. What factors contribute to delays in enrollment, and what steps could reduce those delays?
Speaker 17
At this point, I would say perhaps the vision restructure, although it has not been implemented. We don't know what those changes will look like, but I'm hopeful that we'll see positive outcomes with the vision restructuring.
Speaker 20
Good. I hope so too. And, again, I think just the directory. And, really, I'd like to see an overhaul of even just logging on to the VA system sometimes, you know, as a veteran, married to a veteran, even daughter of veterans. It's just for me personally, logging on, that log on process can be simplified, and even finding GI Bill, you know, health benefits, VA home loan.
There's all the benefits that are there, but I just need my veterans to be able to access and understand that. So, hopefully, this Champ VA piece will at least provide a little bit of clarity for our community care partners. And I have a quick question then for Miss Conwell Smith, and welcome from I know you're from my hometown in my district. So have you heard from psychologists that service champ VA, that are having trouble just servicing our beneficiary? And what is the most common issue that psychologists are running into?
Speaker 12
I have not heard this directly, but we can certainly go back to our membership and gather more information about this. I think that you highlighted challenges of navigation of any veteran in their family, and I think those of us that are in veterans' families know those too well.
Speaker 20
Yes. Very much so. And I know just psychologists are important care partners for us, and there's a shortage of mental health care providers. And we often speak of mental health. But thinking of the people who provide the mental health, we need to do more of that and making sure that the providers know too, and then the patients have a directory.
But there's clarity kind of on both sides. So that's what we hope to accomplish with this bill. But thank you so much, and I yield back.
Speaker 1
The general lady yields. I now recognize myself for five minutes to ask questions. And this is a question both for Mister Whaley, Miss McCoy, and then Miss Conwell Smith. And I realize that you're not clinicians per se, but, as I've listened to the testimony, the questions today, and the bills before us, I'm thinking about the blast injury, mild TBI. So I, e, a wave, shock wave, but not an actual concussion, and how difficult that is when we don't test for that.
So would there be some validity to either an algorithm-based test and or screening prior to discharge from the military for those individuals who during their training, although they may not be in combat, but during their training may have exposure to a blast neurotrauma and not a TBI or concussion in the typical diagnosed fashion.
Speaker 3
Thank you for that insight and question. We couldn't agree more. We have talked to a number of veterans either on our roundtables or in our polling and find out on a systemic basis that many times someone doesn't know they've had a TBI until a number of things have happened. And by then, you're kind of picking up the pieces versus getting.
Speaker 1
And I realized the brain activity and connections may be very different than what you see in a TBI. Right. And so I don't have a lot of time because I wanna ask other questions. So, Miss McCoy?
Speaker 17
Thank you for your question. I think it directly leads into HR 6444, which is this establishment of the task force where we are able to begin to accumulate and or leverage currently collected data on the DOD side of the house and allow that full migration of information to accompany the service member as they move into veteran status. And, again, to your point, we know that blast overpressure has been kind of linked to cumulative neurological effects. How those build in each veteran and service member over time are so distinct that, at this point, you know, we don't know what we don't know. And so investment in research and innovation is just key.
And I think this task force will be an important infrastructural step to that goal.
Speaker 1
Thank you. And how could, the pilot and some of these bills that we presented today are discussion bills, so I appreciate all the input from all of our members and our witnesses. How could the pilot in the health deserts bill reduce travel burdens or delays for care and veterans? And I can assure you in Iowa, especially Northwest Iowa, but even in my district, veterans may have to travel two hours to go to a VA facility, clinic, which has lesser services. And in many states, including Texas, a very populated state, that drive can be over that.
So if you're talking about a visit for coordinated care or whatever type of care you want, that could be a five-hour travel time, just back and forth, without including the physician visit. So, Miss McCoy?
Speaker 17
Thank you very much. I appreciate and agree with your point, and I think that this is filling a crucial need. I mean, you think about a veteran that's maybe going to a hospital where certain providers or certain care modalities are covered under the community care network, and others may not. So an initial appointment may be covered, but a scan or, you know, some sort of MRI may not be covered. That fragmentation of care has to be incredibly frustrating.
It's inefficient, and ultimately, it's a barrier to care. So, a streamlined contractual agreement can produce positive outcomes for veterans.
Speaker 1
Thank you. And, Miss Conwell Smith, and, as a physician and a veteran, I appreciate your focus on clinical outcomes. Do you consider it a favorable clinical outcome for 17 percent of veterans to still die by suicide? So, has the VA been successful? Is that a good clinical outcome measure?
Speaker 12
I would go back. Thank you for the question. I would go back to the advances and progress within the VA when it comes to mental health treatment and effective treatments for mental health disorders, which I think have been extraordinary.
Speaker 1
Neither do we, but that certainly is a clinical outcome, and we haven't moved the needle. And so I think looking at approaches that deliver care to veterans, whether it's through telemedicine, community care, VA care, and algorithm-based care, new research. I think it's important all of us on this committee wanna make sure that, number one, PTSD, veteran suicide, that TBI veterans are getting the care that they need. And then lastly, let me just say, Ambassador Paul, I don't have a question for you, but I just wanted to thank you for coming, for testifying today, and coming this long way to make sure that veterans in your area, in the Marianas Islands, and the FAFs are, that their needs are met as well. So thank I didn't want you to leave without my personal thank you.
So, thank the witnesses for being here today. Just in closing, I think we're looking at some bills, discussion drafts. I appreciate all of the input. And then ranking member Brownlee, do you have any closing remarks you would like to give?
Speaker 2
I don't think so. But I think, you know, there have been a lot of good bills here today, and that, you know, certainly require serious consideration. And I think we've had a good discussion on many of these bills in ways in which they can be improved, so that we can move them forward.
Speaker 1
Thank you, ranking member Brownlee. On behalf of the subcommittee, I wanna again thank all of our witnesses and members, including the VA who was on the first panel, doctor Koniger and doctor Lorente for being here today. I look forward to working with you, to address the issues facing our veterans and also the suggestions that we've had from our witnesses and our members today. The complete written statements of today's witnesses will be entered into the hearing record. I ask unanimous consent that all members have five legislative days to revise and extend their remarks, and include extraneous materials.
Hearing no objections, so ordered. This hearing is now adjourned, but please, this room is being used immediately after this. So, when the meeting's adjourned, please exit the hearing room. Thank you.
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