Reevaluating the Rating Schedule: Examining VA’s Efforts to Modernize Disability Benefits
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House Veterans' Affairs Subcommittee on Disability Assistance and Memorial Affairs U.S. House of Representatives
Follow its sittingsSpeaker 2
Thank you, Chairman Latrell, and good afternoon, everyone. I appreciate you all being here today. Mister chairman, I am grateful to you for holding this hearing. The VA schedule for rating disabilities, or VASRD, is a massive program. It's big in size, it's big in impact, and it's absolutely central to how we support our veterans.
Everything we do on this committee starts with one simple idea, that when a service member raises her right hand and serves this country, we owe her a system that works. If she's injured or becomes ill because of her service, she's earned care, benefits, and services. Full stop. And the process to get those benefits shouldn't be so confusing or slow that she feels lost before the process even begins. This hearing shouldn't be about cutting those services. It should be about cutting red tape.
Veterans shouldn't need a law degree or a medical degree and a decade of patients just to get what they've earned by serving our country. We also shouldn't be afraid of change. I, for one, think the VA's schedule for rating disabilities is outdated. Medicine has changed. Diagnostics have changed.
The nature of military service itself has changed. The injuries and illnesses our service members face today look very different to what they did 80 years ago. So, yeah, the schedule needs to be updated. But the goal has to be clear, and that's to modernize the system without harming the veterans. That's the line we cannot cross.
That's the mission that is central to this committee. So I have a few questions that I think we can begin to answer today. If we're trying to figure out whether the current schedule actually works, we've got a real challenge. There's almost no up-to-date publicly available research on how VA's compensation system is performing. How do we fill that gap?
What additional data do we need? How do we get it? How do we use it? Today's hearing is about understanding the methodology VA is using to update this disability rating schedule, then I welcome that. Because across multiple administrations, VA's work on VASRD has been a black box.
Veterans deserve transparency. Congress deserves transparency so that we can help our veterans. Mister chairman, I also wanna address something that we've been hearing in the media a little bit, that there's a growing narrative that the disability compensation is somehow too generous, or that it's arbitrary, and there's encouragement for veterans to game the system. I want full transparency. I wanna know everything that's going on, but I resent that characterization of our veterans.
Our veterans, it's not who they are, and it's not what this program is. These benefits are not handouts. They're not freebies. They're a recognition of service and sacrifice. And for many veterans, they're the only support they have when service-connected conditions make work difficult or impossible.
Mister chairman, you know better than I do about the risks that military service carries, and that most civilians will never fully understand. Those risks don't end when someone takes off their uniform. They can follow a veteran for the rest of their life, and they cannot be reduced to a simple earning loss formula. We also have to remember that health relates to the whole person. A diagnosis that sounds minor to you or to me might be a sign of something much bigger.
A veteran who has cystic acne that's linked to Agent Orange exposure isn't just dealing with acne. They're living with the consequences of toxic exposure, and that context matters. We also have to remember what these programs are. No matter how big they are or how big they get, the heart of these programs is our veterans, human beings, our brothers, sisters, moms, dads, sons, and daughters who put on a uniform willing to serve us, people who deserve the dignity and care they have earned in exchange for that service. Which brings me to the last point I will raise, Mr. Chairman.
My concern today is that we only have one veteran service organization testifying. Veterans are not modelists. They go into different branches of the service with different experiences at different times. Their voices should be central to this conversation. I hope that we can have more conversations with the VSOs on this topic as we move forward.
Their voices are important, the most important ones in this discussion. Mister chairman, I'm looking forward to a productive and honest discussion today. I hope this is just the beginning of our oversight of this issue. There's a lot more work to do, and I yield back.
Speaker 1
Thank you, Mr. McGarvey. I'd like to introduce our witnesses. Our lead witness from VA is Ms. Nina Tan. Miss Tan is the executive director of the compensation service at the Veterans Benefits Administration. Good afternoon.
She's joined with Doctor Sokol, correctly pronounced. As a medical officer in compensation services at the Veterans Benefits Administration. Thank you both for being here today. I ask that you please stand. Raise your right hand.
Do you solemnly swear the testimony you're about to provide is the truth, the whole truth, and nothing but the truth to help you God? Let the record reflect that the witnesses have answered in the affirmative. You may be seated. Miss Tan, in any moment, if you need to k. Miss Stan, you're now recognized for five minutes for your opening statement.
Speaker 3
Good afternoon, Chairman Latrell, Ranking Member McGarvey, and members of the subcommittee. I appreciate the opportunity to appear before you.
Speaker 3
Good afternoon, Chairman Latrell, Ranking Member McGarvey, and members of the subcommittee. I appreciate the opportunity to appear before you today to discuss VA's efforts to modernize disability benefits. I am accompanied today by Doctor Ulias Sokol, medical officer with the Veterans Benefits Administration. For disability compensation or pension purposes, a veteran's disabilities are evaluated using the guidance in the VA schedule for rating disability or VASRD, also known as the rating schedule. Under the authority established by 38 USC 1155, VA secretary shall adopt and apply a schedule of ratings of reductions in earning capacity from specific injuries or combination of injuries.
This rating shall be based, as far as practicable, upon the average impairments of earning capacity resulting from such injuries in civil occupations. The secretary shall, from time to time, readjust this schedule of ratings in accordance with experience. VA is committed to updating its disability rating criteria to accurately reflect medical science, advancements, improved technology, and current terminology. These updates allow VA to ensure its disability evaluations more accurately compensate veterans based on impairments and average earning ability. While VA has made numerous changes to the VAZRD, it has not completed a holistic, comprehensive update since 1945.
In 2003, the Government Accountability Office or GAO deemed VA's disability program high risk because VA had not systematically updated the VA ZRD. In response, VA developed a modernization plan in 2009 with the goal of comprehensively updating all 15 body systems of the VASRD. VA established work groups that included medical and VA policy subject matter experts and used the analysis following a thorough review of established medical research to begin the rulemaking process, which involves drafting and publishing a proposed and final rule for each body system. To date, VA has completed updates on 11 of the 15 body systems. Any updates made to the VAZRD are point forward in that they do not impact veterans currently service connected for that particular condition or veterans who filed their claims prior to the implementation date of the new rules.
VA anticipates publishing the final rules for all four body systems in three rule makings by the end of FY 2026, which will complete the first holistic, comprehensive update since 1945. In 2019, VA established the VASER D program management office with a mission of revising the VAZRD through a rulemaking body system by body system in staggered cycles of recurring reviews as well as in response to GAO's high risk recommendations. VA has successfully met three of the five high-risk categories identified by GAO and has partially met the remaining two as we continue the iterative process of ensuring alignment of the VAZRD evaluation criteria with medical, scientific, and technological advancements. The rulemaking process generally takes two to five years to complete, but can take longer due to the length, excuse me, due to the length and medical complexity of the VAZRD proposed updates. Updates to the VAZRD require coordination to implement required claims processing changes and to provide training and guidance to clinicians on the disability benefits questionnaires and to claims processors charged with correctly applying the current disability evaluation criteria.
Following the completion of the first holistic and comprehensive update to the VASER D since 1945, VA will actively pursue opportunities to update the VASER D. In our next phase, VA plans to continue updating the VASER D with the evolution of medical science, technology, and treatment modalities. While VA aims to update the schedule to simplify the claims process for veterans and to promote a fair, objective, and efficient process, VA will also standardize rating terminology, incorporate the effects of court decisions, and address contemporary claims processing issues to assist claims processors charged with delivering fair, efficient, and timely benefit decisions to veterans. VA is focused on completing the first holistic change and anticipates starting the next phase of this iterative process at the end of this fiscal year. In closing, VA remains committed to modernizing disability benefits by making continuous updates to the VASRD.
We thank the committee for your continued support of programs that serve the nation's veterans, and look forward to working together to further enhance delivery of benefits and service to veterans. Mister chairman, this concludes my statement. My colleague and I are prepared to respond to any questions that you or other members of the subcommittee may have.
Speaker 1
Thank you, Miss Tanya. The written statement, Miss Tanya, will be entered into the record. We'll now move to the questioning. So just I'm gonna ask some clarification questions. By 2026, all body systems will be complete, and this first will be completely buttoned up.
Speaker 1
Okay. That's great news. Good to hear that. Can you explain to me, and I can appreciate the complexities of this, why this has taken so long? Because I don't wanna have to ask you this question at the end of 2026 of why we haven't completed it.
So, can you explain to me? And I understand when we're diving into the, you know, mental health issue, and I know that that is almost impossible to figure out. Right? Can you explain to me why the last three have taken so long, considering I won't put 1945 in there, just from the late 2010s to now.
Speaker 3
Sure. So we've actually been updating all along. We have focused in primarily some of the most recent updates, from 2017, but we have updates all the way back to 1994.
Speaker 3
Update is to go through a final rule in which we are using updated medical evidence, science, technology to look at each of the body systems as you mentioned, and we're looking at each of the diagnostic criteria that goes along with it.
Speaker 3
So we have a series of processes through our work groups and the development, where we look at all sorts of data from the medical community. And doctor Sokol can speak more about.
Speaker 3
So we use a combination. We look at the published literature. We use resources from things like the American, Los Angeles American Heart Association, for example. We look at peer review literature, all sorts of data and information.
Speaker 1
We're bringing that internal into the VA system. Aggregated data outside and internal to the VA is all aggregated internal to the VA. Correct?
Speaker 3
So when we develop, when we establish a working group, we have a number of SMEs and clinical advisors both in VA and outside of VA, and they look at current medical literature from those types of associations and things of that nature. So they're bringing all of that data in. And we do have clinicians not only in VBA, in compensation service, and our MDO office, which you're familiar with, at the VHA. And those are some of the sources who then look at the available data and evidence, and they pull that.
Speaker 1
out process. Where are we currently with the advancements of machine learning and artificial intelligence?
Speaker 3
So we're open to exploring how we can bring technology into this process. I think we have a unique.
Speaker 1
Why not? Because the world around us is. Sure. And you may not be able to answer that question, but I know somebody in your department who I'm gonna call as soon as this hearing's over with to ask why implementation of AI and ML is not in this rating discussion, because it makes absolute sense for it to be.
Speaker 3
And I think as our focus has been on this first holistic update, as we move into our next iteration, that's something that we're absolutely welcome to explore. And so I think there is an opportunity for that, sir. And I can take that back or as you if you.
Speaker 1
Please do. I'd actually like to have an answer to that. It makes more sense to me now in an understanding of how machine learning is effectively changing the dynamics of how we interpret med medicine. Okay. Because I can assure you our veterans will be very pleased to know that we can do this in a matter of milliseconds, months, and years.
And these platforms can do that for us. Implementation is where we seem to be hung up. And not to beat up on the VA too much, but the VA can be very siloed at times. And I think that might be a missed opportunity if we just continue down the kind of the railway that we're on with. And by all means, I know that our everyone that touches this information is brilliant.
But, when you can process information at a peta flap, peta at peta flop speeds, that's, that is a game changer.
Speaker 2
Thank you, Mr. Chairman. I’ll build on that point for just a second. I don't wanna speak for you at all, but, you know, I know we don't wanna hear something's too complicated, especially if that means five and ten years from now. It's really a lot more complicated because we didn't do something today that we should be doing. So I just wanna build on that a second.
Miss Tan, I'll start with you. As I said at the beginning, veterans are at the heart of every single thing we do. That's what this committee is about. It's about serving our veterans. I'd like to start by asking the department's process for including veteran VSO feedback in your methodology.
So until the notice and comment period for proposed rules, it's, to me, that's too late. So I wanna know to what extent and through what process do you ask stakeholders for their input before you get into the rule-drafting phase?
Speaker 3
So we do follow the American Procedures Act, and within that, we do have limited opportunities which we can have what is considered ex parte conversation so that we are not being unduly influenced or having more weight or access to more information for any group of stakeholders and others so that we may obtain transparency. So we do invite through that required sixty-day public comment period, as we invite anyone to provide input into that process. So we don't actually currently have processes in which we're doing it because we're bound by those requirements of the APA.
Speaker 2
And I appreciate you being clear. At the end, there getting to the point, it doesn't happen. And to take this out of government speak, when you said there's limited opportunities for ex parte conversation, what that really means is we're not talking to veterans before y'all come up with a rule. And to me, that needs to change. And you said unduly influenced.
I don't view this as undue influence. I think talking to the end user of this service is of paramount importance, particularly because this is all about helping our veterans. And we know this. Sometimes something can look good on paper, and then it gets into practice, and it doesn't work the way you intended, even if you had the best intentions. Getting that feedback from our veterans is really important.
I understand that the disability compensation advisory committee exists, but their work is infrequent, and it's increasingly sidelined by this administration. So can you commit to doubling down on efforts to get more veteran input into this process at an earlier stage?
Speaker 2
Thank you. We would love that. And as I understand it, VA is working on a new loss-earning study given how old the previous one is. When do you expect to complete that study, and will you commit to making both the data supporting that study and its results public?
Speaker 3
So we are evaluating the deliverables from that study. We actually had contractor support that ended at the '25. So my team is actually in the process of evaluating that information from those studies, which was a test program and a proof of concept to kinda see where we go next from that.
Speaker 2
But can we see the data supporting the study and the results when it's all finished?
Speaker 2
Yeah. And I'm gonna press you a little bit on that because I think we deserve better than that, and I know our veterans deserve better than that. This is not a gotcha moment. Right? This is asking for the data used in conducting a study and the results that impact our veterans.
And we wanna understand how we're coming up with these calculations that our veterans oftentimes depend on when they have been injured because of their military service, and what that means for them. So it's really important for anyone to have that, and for it to be a transparent, inclusive process so we know what's going on. So we're gonna keep following up with you on that. It needs to be more than an answer, a throwaway answer in a committee of we'll take that back to somebody. I know our veterans are entitled to that information, and I want to make sure they get it.
As I understand it, the VA has historically provided updates to GAO on your ongoing work around revising VASRD. When was the last time VA met with him? Have you shared your methodology with him recently?
Speaker 3
So we do meet with GAO regularly. The last status update, I can't give you the exact date when we did that. I do know in FY twenty five, that's when we had the increase and move to partially met for the monitoring stage of the high risk list criteria. So we do have ongoing communications with GAO and others, and provide status updates as required.
Speaker 2
I think it would also be this is another thing. I just think it's helpful to have a second set of eyes on this type of thing to validate the methodology, to make sure we're coming up with the best system to help our veterans, especially these are our veterans who have been injured in their service or are disabled because of their service. So, appreciate that. And, mister chairman, my time has expired. I yield back.
Speaker 4
Thank you, Mr. Chairman. Had a chance here to last twenty minutes or so, just kinda reflect on what everybody was saying. A couple of thoughts. 1945, my dad was just mustering out of the navy after World War II. Okay.
And I think about his last endeavor before he passed some 40 years ago was he was a volunteer driver for the, for the county VSO to get the veterans to the VA hospital over by the Minneapolis Airport. And I, you know, I think about my parents, what they went through in their depression and in World War two. But we're using the date here, 1945, in current data. Scares the hell out of me in some ways, because it means we didn't change. And someone said a couple of different ways, it's complicated.
Yeah. And as life is tough, but it's tougher when you're not exactly, you know, embracing it every day. It gets more complicated. It's like a ball of bureaucratic string that was built over time. Nobody knows where it starts, where it ends.
All they know is this big ball of string, it's a reason to say no. So having said that, let me just ask, in a sense of urgency, would be extremely helpful and desired within the Veterans Administration as well as everybody involved in this, whether it's the VSOs, the veterans, but especially the bureaucracy of the Veterans Administration. Because if it is complicated, it's up to those of us in charge of what we're doing right now to uncomplicated it as best we can. And when you heard about AI and ML, that's a way to begin the unraveling and the uncomplicated of it. To what extent do outdated portions of the VASRD, is it you've been used that in a pronunciation and an acronym VASRD?
VASRD. Yeah. Boy. Varsity, as opposed to the junior varsity? Okay.
You
Speaker 4
To what extent does the outdated portions of it make it harder for the VA to consistently and accurately evaluate modern complex conditions among younger veterans. Because we know based on the nature of war, the injuries that were received in World War One, World War Two, Korea, Vietnam, Desert Shield, Desert Storm, OIF, OEF have changed because of the nature of the fight, the survivability, etc., etc. But, are we getting rid of the outdated stuff? I mean, regardless of timelines, do you really think when all is said and done, this will really be reflective of the types of injuries that our veterans are receiving in conflicts today?
Speaker 3
Yes, sir. I do. As part of our updates, and again, to be clear, it's not that we have not updated since 1945. The systemic and holistic update has not been completed, but we have updated body systems, diagnostic codes, and we do remove outdated terminology. We remove outdated testing and things that are not accepted in the medical and clinical community.
We remove instances where there may be subjective criteria. And I'll use for an example in the proposed rule for the neurological body system where some nerve paralysis could be rated by mild, moderate, or severe. Well, that's not really a great objective criteria then for someone to use. So we're adding testing and objective and measurable components that help reflect the current disability picture, like you mentioned, of what our veterans are experiencing today. So we add new diagnostic codes.
We, like for mental health, for example, we're proposing updates that adapt to the DSM four.
Speaker 4
Okay. I guess it would be helpful if you could, you know, not today, but give us something that shows a sense of urgency that actually shows that because we hear it. But I can be honest with you. I don't see it. Okay?
Yes. And I'll just leave it at that, and I'll yield back, Mr. Chairman.
Speaker 5
Thank you, mister chairman, for holding this important hearing today, and thank you to the witnesses. Miss Tan, what is VA's plan for future updates of the VASRD, and what criteria is VA using to prioritize future updates?
Speaker 3
Thank you for that question. So we are using the lessons learned from this first iteration and best practices. We are looking at ways to be more strategic in that. So we don't just necessarily wanna take a look body system by body system, but where we have evidence and data that supports it, we need to take another look. So some of that may come from studies and things such as our earnings loss studies if we're able to use that.
We'll use areas where we know in medical science that have changed and been updated through technology and treatment modalities. So we will look at the body systems. We will also look at individual diagnostic codes. And based off the available evidence, we will prioritize those remaining updates for the next phase of updates with all of that information in mind. So trying to take a much more strategic, project management focused approach to it, I think, because we do have this experience and lessons learned from this first holistic update that will be completed by the end of this FY.
Speaker 5
So, Tan, does VA have a project management plan or other document that outlines goals, objectives, or a schedule for future updates? And if not, is there a timeline for VA to develop such a plan?
Speaker 3
So we do have a plan for the first iteration, which is coming to a close, as I mentioned before. And we are working on what that project management plan for the next iteration will look like, so that we do have schedules, milestones, and things like that to measure our progress and to make sure that we are following good project management principles for our future updates.
Speaker 6
Thank you, Mr. Chairman. I just got some probably quest easy questions to answer. Why sleep apnea? Is that military-related?
Speaker 3
So it can be. And for VA disability purposes, we look at disabilities that were incurred in, or caused by, or aggravated by military service. So if something started during military service, then we have a responsibility according to the law to service connect sleep apnea for any residual disability based on that.
Speaker 6
Really? Okay. How much of this, and I realize this is not vision driven, but how much of this is customization that's allowed among the different contractors? How much of that, because we see that, I see that often. We allow too much customization across the VA.
Speaker 3
So we have criteria, which must be supported by clinical findings and medical evidence. That is.
Speaker 3
So we do cut down on areas of free text, but we do need the doctor's observations. So we do, but we use testing. We use clinical criteria, and we look at the entire disability record, and we don't rest anything on just one single piece of evidence.
Speaker 6
There's a statement in here that more veterans are relying on disability. Is that actually true, or do we see a growth in this?
Speaker 3
I don't have any evidence to support that. More evidence, excuse me. More veterans are relying on this benefit. We do have veterans that are employed. Most veterans that we serve are actually employed in some part and gainfully employed in many situations.
Speaker 6
And would you just give me, and you may have already covered this, and you probably have, and I apologize if you have. Give me a short dissertation on impairment, disability versus financial inability to earn. Why that distinction? And how's that working in all of this review that you're doing? This seems to me to be part of the crux of what we're asking here.
Speaker 3
So part of our evaluations, we look at occupational impairment and functional loss. And so I think when in VA terms, when we look at things like TDIU, which I'm sure you're familiar with, when we find veterans who are unemployable because of service-connected disabilities, if they don't meet that criteria, otherwise, then we have benefits in store for that. But you could very easily have a 100% service-connected disabled veteran who is able to work. For us, a disability and a 100% evaluation do not mean unable to work in many situations. So disability compensation does not mean that a veteran cannot earn wages, that they are unemployable.
It means that based on the residual impairment, VA finds them to be 100% disabled because of the severity of their disabilities.
Speaker 6
Right. And how are you going to apply either one of those really to mental health, which is a growth industry, as we know? Mental health amongst veterans is.
Speaker 6
rampant. How is that working with mental health? Because it's a little bit different from physical impairment.
Speaker 7
Good afternoon. Currently, the portion of the rating schedule which addresses mental disorders is in the final stages of its publication as a final rule. We did publish the proposed rule several years ago, which received overwhelmingly positive feedback from the veterans community and from clinicians. And that is because we adhered to the latest approach to assessing the functional impairment due to mental disorders, which is outlined in great detail in DSM-5, which is the governing document for all psychiatrists and clinical psychologists to assess the level of functional impairment due to mental disorders. And in this new portion of the rating schedule, we will be able to adequately address the level of functional impairment and corresponding occupationally significant disability.
And, we're looking forward to publishing it by the end of the fiscal year 2026.
Speaker 6
Okay. And real quickly, what has the toxic exposure law done to your to this examination, this review of your disability criteria?
Speaker 3
Sorry, sir. So we have a process by which we look at toxic exposures through our military. I'm sorry. It's called the MISC for it escapes me right now what that group looks at, but that's a separate group that looks for things based off our presumptive conditions, based off the codified requirement for that disease process. So we look at those slightly differently based off exposures and what the science and evidence shows based off that exposure.
Speaker 1
Thank you, Mr. Youssef. If we're using DSM five, what data? Can you give me, doctor Stoker, can you give me kind of a time frame of the data that we're currently using to define mental health for the vascular system? And let me give you a little bit more depth to this. Yes.
Will
Speaker 1
bit on the feet of work. That might before I showed up to this wonderful place, my focus was on neuroscience. And one thing my professors told me when I was in grad school is that what you're gonna learn today will not be correct in five years, and how were they right? So make it it's not more or less a concern because research is research, but are we about to do an implementation of information that is already outdated? Mhmm.
Speaker 7
Well, let me revisit DSM five. DSM five is updated on average every 16 to 18 years.
Speaker 7
Great big committee which gathers all the data between the DSM publications. And, the current DSM, DSM five was published in 2013, and it had introduced a lot of changes to the way we look at the functional impairment due to mental disorders.
Speaker 1
In 2013, a severe traumatic brain injury and there were three levels of traumatic brain injury in 2013, mild, medium, and severe. That's it?
Speaker 7
Actually, the biggest introduction was the multidimensional approach to the way we look at mental health and mental disability. And those multidimensional approach means that all of us are built the same way. And there are a certain number of domains of function, such as ability to interact with others, cognition, self care, and so on and so forth. And that multidimensional approach, which was introduced based on a great deal of data by DSM-5, is the basis of our review of the VAZR DVA rating schedule for disability mental disorders portion.
Speaker 7
be updated by the end of FY 26. It's updated already. It will be published, this final rule.
Speaker 1
'23 is 10 plus 1. Okay. That's concerning. Because how much more we know today will not be near as much as we know tomorrow when we're dealing with the beautiful mind that sits between our ears, which every single human being is different, which I'm sure you absolutely know. Miss Tan, the 2020, give me a do you have a date?
I'm big on dates. Because the day after this thing goes hot, I would like you and doctor Circle sitting in front of us and assuring us that we got a green light and we're good to go. Do you have a?
Speaker 3
We anticipate our remaining final rules to be published around the summer of 2026.
Speaker 3
And then we'll have time for implementation and an effective date, sir, beyond that.
Speaker 1
26. Interesting. Okay. Mister McGraw, you good? General?
Mister White, do you have a question? You good? What's yourself? Good to go? Okay.
Thank you very much for your testimony today. Thank you. And, again, thank you for everything that you're doing for our veterans in the Department of Veterans Affairs. I like to say this every single time we have a hearing. The VA is one big machine.
Everybody plays their role. And every morning that we wake up, every morning that you wake up, we absolutely know that who we're serving is our veterans, and we're here because of them. So thank you, and have a very blessed day.
Speaker 1
Yes, ma'am. And what's the first panel? Is up panel number two may be seated.
Speaker 1
Our first witness on this panel will be Miss Elizabeth Curta. Miss Curta is the director of education, workforce, and income security at the Government Accountability Office. Second witness on the panel is Mr. Philip Armour. Mister Armour is the director of the Rand School of Public Policy PhD program, and a senior economist at Rand. And our third witness is doctor Kailan Hunter.
Doctor Hunter is the chief executive officer of Iraq and Afghanistan Veterans of America. What branch?
Speaker 1
I feel like as a navy guy, I should say something. Okay. Thank you for your service. I would like to welcome the witness to our second panel. I'm gonna witness to say, please ask that you stand and raise your right hand.
Do you shall only swear the testimony you're about to provide is the truth, the whole truth, and nothing but the truth. Help you, God. Thank you. Let the record reflect that the witnesses have answered in the affirmative. Miss Curtis, you're now recognized for 5 minutes to deliver your opening testimony.
Speaker 8
Good afternoon, Chairman Luttrell, Ranking Member McGarvey, and members of the subcommittee. I'm pleased to discuss GAO's work on VA's efforts to update its disability rating schedule. When veterans file claims for disability compensation, VBA claims processors use the rating schedule to determine monthly compensation. VA's disability compensation program provides billions of dollars in benefits to millions of veterans and their families. VA must be able to make accurate decisions about the amount of compensation a veteran receives as a matter of fairness to veterans, and to ensure the program is achieving its intended results.
VA has struggled to stay current with the needed updates to the rating schedule. In 2003, we designated VA's disability compensation program high risk, in part because its rating schedule did not fully reflect advances in medicine and technology, and changes in the labor market that have occurred since 1945. VA is required to base its compensation decisions on the average loss in civilian earnings resulting from a veteran's service-connected disability, but it has never updated this information based on data-driven analysis. My testimony today discusses VA's progress on updating the medical and earnings-loss information in the rating schedule, as well as remaining challenges. Medical information includes the types of disabling conditions that veterans may have, organized into the 15 body systems.
Earnings loss information is the average decrease in expected earnings caused by disabilities. VA has taken positive steps to improve the process for updating medical information. In terms of progress between 1945 and 2009, VA mainly focused on updating the rating schedule with new medical terms and criteria for determining a condition's severity. In 2009, VA embarked on an ambitious effort to comprehensively update both medical and earnings loss information. These changes included establishing an office to plan and oversee these efforts.
VA has also begun making plans for a ten-year cycle for updating the medical information to more systematically consider advances in the evaluation and treatment of medical conditions. Since 2009, VA has completed updates to the medical information for 11 of the 15 body systems. And after years of fits and starts, VA has also begun testing its own earnings-loss studies. VA is testing how the department could produce earnings loss data and update the rating schedule with this information. However, VA still faces challenges keeping its rating schedule up to date.
It is yet to complete comprehensive revisions of four body systems. VA's attempts to revise some of these systems have been going on for years. In addition, information about how veterans' disabilities affect earnings loss remains a major gap. It is uncertain whether or when VA will complete these studies and use the information to update the rating schedule. Going back decades, VA and external studies have evaluated the average loss of earnings for veterans with service-connected disabilities and suggested that not all veterans were being equitably compensated.
For example, certain external studies suggested that veterans with mental health conditions were being under-compensated. As of today, VA has not updated its rating schedule with earnings loss information. Consequently, ratings determinations for all earnings loss calculations remain based on information from over 8 decades ago. We've been monitoring VA's efforts to fix these problems through the lens of our high-risk list. As of 2025, VA has met three of the five criteria for removal from the list.
It has shown leadership commitment, developed an action plan to address the root causes of its problems, and has been monitoring its progress. To have this area removed from the high risk list, VA must continue to meet these three criteria and fully meet two more: capacity and demonstrated progress. Capacity involves things like identifying and applying the resources needed to implement its plans, and demonstrated progress means VA is accomplishing its goals and objectives for updating the rating schedule. Ultimately, without a rating schedule that fully reflects present day medicine and changes in the labor market since 1945, VA may overcompensate some veterans while undercompensating others. This concludes my prepared statement, and I'm happy to address your questions.
Speaker 1
The written statement, Miss Carter, will be entered into the record. Mister Army, you're now recognized for 5 minutes.
Speaker 10
Chairman Luttrell, ranking member McGarvey, members of the committee, thank you for your invitation to testify. As a labor economist, I research how health conditions impact individuals' ability to earn income and the design of disability programs. Today, I will focus on four points related to the economic effects of disability and describe the implications for VA disability compensation. By statute, VADC benefits consider veterans' earning losses from service-connected disabilities, not just a medical rating of impairment severity. The most recently published VA commissioned earning loss study was in 2008.
Although there have been more recent studies, none of these studies have incorporated modern disability research findings, specifically how different elements of disability programs can independently impact earnings. Evidence from other programs shows that cash and noncash disability benefits do directly affect earnings, but no research exists on how VA's programs impact today's veterans' earnings. Updated earnings loss studies that incorporate research on today's veterans would inform more accurate disability ratings. Alternatively, a move toward individualized disability determinations could also increase accuracy and eliminate the need for detailed earnings loss studies, but would require statutory changes. To zoom out, in disability studies, there is a distinction between impairment and disability.
Physical or mental conditions can lead to impairment, a reduction in the functioning of a body system or structure, which can be diagnosed by medical professionals. Disability, however, relates to how these conditions lead to limitations in societal participation. And for many disability programs in The US, there's a focus on how impairments lead to work disability, specifically reduced earnings capacity. Unlike with impairments, evaluating work disability requires consideration of the economic consequences of health conditions, and thus requires collaboration between medical and labor force experts. VA disability compensation is aptly named.
By statute, a veteran with a service-connected health condition receives a rating that, quoting here, shall be based upon the average impairments of earning capacity resulting from such injuries in civil occupations. Given the statutory requirements, VA has commissioned studies to estimate how service-connected health conditions translate into average earnings losses. In general, these studies compare earnings of veterans with service-connected ratings with earnings of otherwise similar nonveterans or veterans without ratings. But there are two issues facing the state of VA earnings loss studies. First, to be relevant, earnings loss studies need to reflect the current employment environment.
However, the last published study relied on data from at least 20 years ago. Since then, there have been substantial changes in medical treatments, veteran disability evaluation, and the labor market, such as, for example, substantial increases in remote work. Furthermore, a rated health condition is rated because of its impact on earnings capacity, but the rating then facilitates access to VADC benefits and additional VA programs. How participation in VA programs affects the earnings of veterans is largely unknown. Yet, since the publication of the last earnings loss study, research on the causal impacts of other disability programs has proliferated.
Specifically, there's now strong evidence on how the benefits in those programs have direct effects on earnings. For example, recent evidence indicates that low cost sharing, health care access, and targeted vocational rehabilitation benefits, similar to benefits offered by the VA, can facilitate return to work and higher earnings. Not accounting for these program-induced earnings increases would make average earnings losses appear less severe, but only due to the success of the programs. But other programs are different from VAs and serve different populations. And the field of disability research also tells us that program details matter and that different populations respond differently.
These other findings are suggestive of potential VA effects, but are not conclusive. Because we do not have a clear understanding of the relationship among VADC, other VA programs, and veterans' earnings, we have limited ability to evaluate these programs' effectiveness, and thus, limited ability to estimate earnings losses from service-connected work disability. Other disability programs also offer potential alternatives to the average earnings-loss approach. The VADSE statute reflects a concept known as disability-based average justice, or the notion that individuals with similar levels of disability should receive the same rating and the same compensation. Most other disability systems take an individual justice approach to at least disability determination, where an applicant's disability is rated based on the impacts of their health condition on their own earnings capacity, not on the average work disability.
Regardless of the conceptual framework, recent research from social security and workers' compensation programs can provide insight into how the impact of VA programs on earnings could be incorporated into the current average justice framework or on how VADC could implement an average justice framework. Yet these other programs serve distinct populations, so additional research with insights from today's veterans is essential to ensure an accurately implemented VADC program. Thank you for your time, and I look forward to your questions.
Speaker 1
The written statement for mister Armour will be entered into the hearing record. Doctor Hunter, you're now recognized for 5 minutes.
Speaker 9
Chairman Latrell, ranking member McGarvey, members of the subcommittee, thank you for the opportunity to testify today. Iraq and Afghanistan Veterans of America is dedicated to improving the lives of post nine-eleven veterans, and it is an honor to speak on their behalf today. But it is also concerning that at today's hearing, there's only one veteran organization represented. This despite the fact that veterans who engage with the Vassar are not a monolith, and there are several voices not in this room, including those that directly work with veterans to navigate the benefit process. And I hope in future conversations, we can include more veteran voices.
Modernization should be done with us, not merely on our behalf. Veterans Affairs is currently undertaking a process of modernizing the varsity, attempting to reflect both the realities of injuries experienced by service members and advancement in medical science. The modern veteran population faces conditions and occupational realities that were not examined in many of the previous efforts. For example, traumatic brain injuries, toxic exposure, military sexual trauma, and complex mental health disorders are central to the post-9/11 veteran experience and have a significant impact on veteran quality of life and long-term employment outcomes. Current modernization efforts to be undertaken by the VA include earning loss studies to incorporate data on how service-connected conditions affect veterans' earning capacity and to align compensation with functional impairment and labor market realities.
However, there remains virtually no transparency into how these studies are being conducted, and whether or not they truly reflect the complete reality of the veteran experience. Early loss studies may provide us useful data, but are an incomplete lens to view the problem. For example, the Congressional Budget Office study on disability compensation focused only on male veterans. Despite the fact that when this study was conducted, women made up the fastest-growing group of veterans. And we do have significant evidence to show that women veterans, even when fully employed, have different earnings than their male peers.
As a representative of the generation that has seen the largest increase in women's service, this shows why it is critical that veteran voices are included at the table to ensure fulsome and essential studies. And while the VA shares some similarities to other disability compensation programs, there are fundamental differences between veteran and civilian populations. Military service impacts the human body physically and mentally in ways that few civilian occupations ever will. From high physical risk occupations to repeated exposures to toxic substances, to increased risks for interpersonal harmful behaviors, and to having little control over where one lives, military service comes with inherent health risks. Vassariety is one way that the country recognizes and compensates the individuals who volunteered and accepted these risks on behalf of the American people.
This system also exists in a unique legal framework shaped by the Ferris Doctrine, which prevents service members from suing the federal government for injuries incurred during military services. Because veterans cannot legally seek tort damages for pain and suffering or loss of quality of life, disability compensation often also serves not just as income replacement, but redress for harms incurred while choosing to serve one's country. Many service connected conditions such as chronic pain, migraines, PTSD, sleep disorders may not immediately remove a veteran from the workforce, but still impose real lifelong impairments that merit compensation. Veteran service organizations for decades have been advocating to include lagging quality of life indicators in disability compensation calculations, and that total compensation should look not just at the ability of veterans to be employed, but the compound and long-term medical impacts of service-connected illnesses and injuries. New research is also showing that quality of life indicators may be uniquely impactful to veterans and may exacerbate existing employment challenges.
Vassarity as a program is also not just an investment in those that served, but an investment in our long-term national security. Veteran care after service is still a strong recruitment tool for military service, which requires public trust. Veterans participation in the modernization process will increase the confidence that these reforms are justified, fair, and aligned with modern veterans' needs, and it maintains the buy-in of one of the country's best recruiting assets, those of us who have already served. Like many other veterans' organizations, IAVA stands ready to support the VA in these modernization efforts, and our members are eager to engage. In our most recent polity priority survey, over 50% of IAVA members cited modernizing the process as their top area they would like to be involved in.
And, additionally, of our members that have a disability, over 65 percent report that their disability payments are essential to their overall financial well-being. Thank you for your commitment to America's veterans, and I look forward to your questions.
Speaker 1
The written statement of Doctor Hunter will be entered into the hearing record. Well said, doctor Hunter. Alright. Mister Armour, now I was trying to pick your opening statement apart as best I could, but what I took from it is, I think we're in trouble. Now I'm gonna ask you to talk to me.
I consider myself a highly educated guy, but if you wouldn't mind putting it in crayon for me, what you just said is do we have the capability to get there from here with compensation levels through this rating system? It didn't sound like it. And you were doing a comparative analysis of the civilian population and the veteran population with doctor Hunter most eloquently defined both, which, again, good job. Can we do this, or is this an uphill battle that we will constantly have VA in front of us saying it will be next year?
Speaker 1
Analytic, you got it. You, I'm gonna beat on you, but you got a PhD. That means you're.
Speaker 10
Way smarter than me. We can do the earnings loss. We can do modern earnings loss studies. That's right. I think transparency about the methods that are used in it, all the methods kind of used so far from the work cited in my testimony and the other panelists.
It's outdated or it's using kind of estimation techniques that are just not actually getting It will
Speaker 1
Have to land somewhere. This panel right here and subcommittee and full committee all the way to where it needs to go. It will always be outdated. Where is the landing zone for us? Because we're gonna have this conversation with the VA.
And the fact that the other veteran organizations, Miss Doctor Hunter, as you state, this is welcome to sit in front of this committee at any time. I welcome it. We, if I may, welcome that.
Speaker 10
So we've done this kind of research for other programs. They do differ in these ways, but modern techniques can do it, and they can do it relatively quickly in terms of, you know, months and years instead of decades.
Speaker 1
Okay. Doctor Curtis, the VA in a position to get this thing completed and push it across the finish line in 2026 in your personal opinion?
Speaker 1
What from the information that you've gathered and the research that you've done, what are we looking at?
Speaker 1
The final state? Man, I tell you what, you'd be surprised how many people are in the final stages in the United States government. I mean, we're like there.
Speaker 1
The electronic health care record has been in the final stages for the past 10 years, and we're about 50,000,000,000 into it. It's still not done. Matter of fact, we're shutting it down.
Speaker 8
Yeah. Meaning they're just before the OMB phase, I guess. Right. You know, with the final rule. So it's possible that they can be done this year, and we are hopeful.
We would love them to be done this year. I can't be sure they will. We have not seen an update on their progress since June, and we haven't had a substantive update on their action plans since August 2024.
Speaker 1
I'd be interested to know how once the 15 body systems the rescheduling is complete. We have 15 body systems that we consider. Okay. How do we continue to update that at a pace that stays relevant to science and medicine? Doc mister Army, you got something for that?
You're a doctor, aren't you?
Speaker 10
you? PhD. Yeah. Yeah. Again, I think we can do these analyses much, much faster.
We have the capacity. Data access is the biggest issue, I think, right now.
Speaker 1
Analysis to application is the death of this place. You know what I mean, look around in the walls. Everybody wants to write about something. We have to touch human bodies. I mean, I'm so sick and tired of that.
I'm not beating up on you. I'm talking out loud for the world to hear this. How do we stay relevant? In your personal and professional opinion, once this thing goes nuclear. Is that a possibility?
Or, Miss Curtis, are we gonna be having this conversation five years from now, that we're still using the DSM-5 and the information that we have on traumatic brain injuries dated from 2013? I'm sure doc the doctor Dexter's gonna crack off on this one in a hurry when it's her turn.
Speaker 8
Yeah. I am not a medical doctor either. So, I think, it's possible for Verbier to stay up to date, and I think they need to stay up to date. But they will have to continue to have really rigorous and realistic planning. They need to address some of the root causes of their issues.
For example, the internal review process. I took a look at all the stakeholders internally to VA, and there's something like 18 different parts of VA that have to look at the draft rule, and 16 levels according to them, 16 levels of review. Then once you're done with that, there's external parties or something like 11 external parties that they review with. So.
Speaker 1
It is. I mean, the complexity is in the mind. I mean, but it is so important for us to figure this out. Us, we, the department of veterans, figure this out because it is the veterans that are feeling the pressures. Mister McGravey, you're recognizer.
Speaker 2
Thanks, Mr. Chairman. And I'm just gonna pick up on what you were saying, doctor Armour. I used to work with a lawyer who would say, handle expression. He said, you can get it fast, good, and cheap. Pick any two of the three.
Right. If you're at, what is the best and fastest way to keep up to date?
Speaker 10
I think it's facilitating access to data for researchers. There's a paper, that doctor Hunter cited, forthcoming by David Silver and Jonathan Jang looking at the impacts of ratings for mental conditions on quality of life outcomes and on health care utilization. That was it's a phenomenal project. I think that represents the current state of what research can do in this field. It's entirely limited to outcomes that the Veterans Health Administration has access to.
Speaker 10
I so I can't speak to specifically the internals of that study. I think, in general, getting linkages between VBA and VHA to occur is pretty much impossible to have happen. Let alone the other aspect of this, which is the earnings law studies, those data generally need to come from the Social Security Administration, which has they will not export individual data, but kind of will allow for some MOUs to understand it. Those setting those up, facilitating that, that enables research to be done, kind of the good research. And yeah.
Speaker 8
Can I comment on that? Yeah. VA actually has in place agreements now with the Social Security Administration and the IRS and some other entities to do that kind of data exchange. So they have made progress in that area. I just wanted to point that out.
Speaker 2
Good. It sounds like we still need to have some progress in that area. Know, one thing we need to draw us help on, and I can tell you on this committee, we're not gonna accept the idea that we can't do this, because I think we can. Doctor Hunter, you want to say something?
Speaker 9
Yeah. I'll just add to the conversation. Yep. And I will disclose, Phil and I were colleagues until just a little while ago here. There's also a big issue in the transparency of these studies being done.
We hear a lot that VA is making these, like, having these MOUs, doing all of these data, but they're doing it in a black box, which doesn't allow for either organizations like RAND and other FFRDCs to actually do reproduction surveys or do the data or do the studies faster often through tools or for VSOs to validate and understand, like, are you actually representative at this hierarchy of the population? And we end up with studies like the CVO does that excludes the fastest growing part of our population. So data transparency coming out of the VA is one of the biggest blockers to being able to do these fast and accurately.
Speaker 2
That should be something we should be able to help fix a little bit, I would think, Mr. Chairman. Doctor Hunter, I'm gonna go over to you. Thank you for your service. Appreciate that. Wanna get away from, we've been out of government speak now for a solid three minutes.
I hope we can stay in this zone. I'm just gonna ask you, point blank. Do you think the VA disability is overly generous right now? No. K.
Have you spoken with anybody who does? No. Okay. Good. What would you say to someone who thinks that veterans who receive VA disability are somehow taking advantage of taxpayers or are scamming the system?
Speaker 9
I would first say that when you raise your right hand to serve, you make a contract with the United States, and that is that we put our lives on the line twenty-four seven. And as a result, we are to be taken care of for the time when we are done.
Speaker 2
And I think that contract you make when you raise your right hand and give yourself to the service is both a legal and a moral obligation that we have as a country. I wanna ask you about the statutory mandate for the basis of disability ratings. The law says, quote, the rating shall be based upon the average impairments of earning capacity resulting from such injuries in civil occupations, which is wonderful statutory language. Say, you get injured in the service, we're gonna look at your disability rating based on a civilian counterpart. And it's that civil occupations part that concerns me, because military occupations do not always line up with civilian occupations.
You yourself, Doctor Hunter, you were an attack pilot on a helicopter. I'm not sure there's a civilian equivalent for that type of job. I haven't found it.
Speaker 2
I don't think it's there. And, you know, whether it is a navy seal, whether it is an artillery crewman, we're gonna have trouble lining this up. So, doctor Hunter, how do you compare injuries and illnesses that happen in military service with those in civilians?
Speaker 9
They're not comparable. The military service, as I stated, has physical risks that are unique. There are mental and psychological risks there that are new, unique. There are environmental risks that are unique. And one of the biggest areas of sort of divergence between the civilian and military occupations is that military service members have very little to no control over where they spend their time, what environmental factors might be around them, what they are exposed to, the types of injuries they may receive.
And so a lot of the research that is done on the civilian side also includes some opt in. Right? Some buy into whatever career path they choose to be in, in terms of how those calculations are done. The military, that is also removed, which goes back to some of this contract that there is a volunteer to do whatever the country asks you to do. And both the type of injuries and the environment in which those injuries might take place are divergent in medical aspects as well as the moral contract that we have made with the country.
Speaker 2
Thank you very much. I do think that how, when, and where the injuries occur are often important in military service just as the injury itself. So, mister chairman, I'm out of time. I yield back.
Speaker 4
Thank you, Mr. Chairman. It's really fascinating to sit here and listen to the discussion back and forth because I sense everybody here is no matter what role you're playing, you're sitting out there in a crowd. We're all here for the betterment for veterans outcomes, which is a good thing. Not necessarily in Washington DC can that be said in every hearing room, but I'll just leave that for a discussion of a different time. I'd like, and this is not a generic question.
It's a specific question for any of you to respond. To what extent do silos currently exist that inhibit the breakthrough results and the speed at which we need the change that we know needs to occur occurs. Would anybody like to address the, however you wanna address silos.
Speaker 8
Yes. There are silos that exist that prevent the speed of things getting done.
Speaker 4
Okay. In that case, so we agree that there are silos. I think that's not a surprise. Is the level of understanding of those that those silos exist, let's say, the veterans administration, to acknowledge they exist and then deal with the fact that do they need to exist? Do we need is it additive in a positive way for the outcomes?
Because sometimes we have to work to get things done, but if we work too long in a silo, we don't share the information. So as the veterans administration looks at their reorganization of the business, which was just announced not, you know, in the last month or so, do you believe that a part of being able to speed up the process here towards positive results, it would be a positive effect to, in its however it's done, breakdown, rewicker, whatever you wanna call the silos?
Speaker 9
Sir, I'll answer that one, I'll answer it both now as a CEO of a veteran organization and someone who was a public policy researcher before coming into this role. Absolutely. And particularly breaking down the silo between the VA and the veterans in this research. One of the things I learned very early on doing public policy research is that numbers are all great and fine in spreadsheet, but the rubber meets the road when you engage the population that whatever you are researching is going to be impacting. And so breaking down that silo, it'll allow information to get to the VA faster about the reality of what is happening to veterans rather than waiting ten years of the study.
Talk to us. Ask us. We can tell you that very quickly, as well as allow for a more, you know, robust and rapid updating of the system to meet the realities. We talk a lot, and we hear in the news all the time that warfare and the type of modern warfare is expanding at this exponential rate. We have whether it's advancements in technologies or the change in the type of enemies that we have.
And if the VA remains siloed and cut off in doing their research and not interacting with those who most recently served, there is always gonna be this lag. We are always gonna be playing catch up and saying, oh yeah. Well, next time, we'll deal with this injury. Next time, we'll look into this body system. Next time, we'll figure this out.
And so from where we sit, absolutely, we are here and ready and want to break down those silos and work to ensure that our veterans are taken care.
Speaker 4
of. Anybody else want to comment? Okay. That's right. Silences, you don't want to comment.
Okay. So along with the silos, what can we do from your perspective as a committee to advance the decrease, or excuse me, the increase in transparency? Because once you've got the silos broken down, how do you set the environment where now if you're working on this project, we're all working, but, you know, there's that transparency of data exchange. Any thoughts?
Speaker 8
Well, I think certainly, hearings like this are a great way to make situations at VA more transparent and having testimony. I think encouraging the agency to be forthcoming and transparent with information with the GAO, for example. We have had a good dialogue with them in the past number of years as we've been monitoring their progress on the high risk issue. But sometimes the information has to go through extensive levels of clearance, and takes a lot of time to get to us. And we just would prefer to have a more give and take kind of relationship on these things because we think that would help give us an opportunity to respond to them sooner, and, you may help things keep things from going off track.
Speaker 4
Okay. Thank you. Mister chairman, thank you. I see I'm over my time. I yield back.
Speaker 11
Thank you, Mr. Chair. I wanna thank you and the ranking member for holding this hearing today, and I wanna thank our witnesses for being here to testify, too. I'm also glad there is bipartisan agreement that the VA schedule for rating disability should be modernized, and it is essential that we get this right. We need to require transparency from the VA and a process that incorporates feedback from medical experts, economists, and of course veterans themselves. My late father-in-law was an army ranger and received disability compensation for the injuries he sustained in combat.
We know that so much has changed since veterans like my father-in-law served, both in terms of the nature of military service as well as significant advances in medical research and treatment. We know more than ever, we have the f we know more about the effects of military service on veterans' physical and mental health, and it's critical that we put this data as well as veterans' experience to use as we tackle this important issue. Doctor. Hunter, I want to begin with you. As you noted, women are the fastest-growing group of veterans.
According to VA, women made up about 4% of the veteran population in 2000. By 2040, VA expects that number to increase to 18%. What should VA be doing to incorporate data that accurately accounts for the increasing population of women veterans?
Speaker 9
When we look at women veterans, and particularly for this topic in particular, there are two areas that need to be done. One is ensuring that when we are looking at the actual impacts of certain injuries, illnesses, and exposures, women are part of the clinical studies to understand what the impairments actually are. There is a long history of medical research excluding women, and so we are basing women's conditions off of what men have experienced. And we know that women aren't just little men in this regard. So, actually, doing the clinical studies to understand the impact on women is essential.
And when we're looking at earnings loss statements as well, women need to be considered in the workforce aspect of this. You know, we look at a lot of conditions that may triple or almost quadruple impact women if we look at things like reproductive health care issues that are connected to service-related conditions and what that does to workforce engagement. We also have a whole, like, host of new issues since women have been involved in ground combat of the musculoskeletal system that have not been studied. And so we cannot make accurate determinations without knowing that, and which is why, again, the veteran community stands here willing and wanting to be involved.
Speaker 11
I appreciate that. And thank you for bringing reproductive health care and its impacts into it. As an OBGYN myself, I think that's critically important. Doctor. Hunter, in your testimony, you mentioned that post nine-eleven veterans are more likely than previous generations to endure experiences that contribute to diagnosed mental health disorders, both from the psychological and physiological perspective.
Traumatic brain injury, toxic exposure, and military sexual trauma are all factors that have to be considered to meet the needs of the modern-day veteran population. As we continue to learn more about these various forms of trauma, how these various forms of trauma affect a veteran's quality of life and economic prospects, what role do veteran service organizations have to play in ensuring the needs of the veteran are reflected in any proposed changes to the rating schedule?
Speaker 9
Thank you so much for bringing up the mental health side of this too. And I think VSOs have three or four big areas that we play in. One is we are the frontline touchpoints with veterans. As IAVA, we conduct multiple surveys a year to understand the experiences in closer to real time than any of these VA studies can be. And so if we want to know how this is impacting people, we can tell.
We actually have that data. When we talk about data sharing and transparency, we can get it to you in a much faster way. Additionally, one of the big parts of this is that VSOs engage with veterans who may not be in the VA system. When VA is doing their studies, they have a huge bias that we haven't even talked about, of the fact that when they are looking at outcomes, they are looking most often at people who are already part of the VHA system. Part of what we want to do is catch that wherever it is between 20-50% depending on what study you read of veterans who are outside of the system, and we are the conduit to those people.
We are the conduit to the people that is actually the hardest to get the data on, which is important. And then third, we're a trusted agent. There has been historic distrust through all of the scandals and all of the reporting, the VA has been all over the place and how much the veteran community actually trusts them. VSOs are often more trusted organizations, and we can serve a role in helping the VA build that trust back in the veteran population through collaborative work.
Speaker 11
Thank you so much. Oh, so many more questions, but I see my time has expired. One more. Thank you, Mr. Chair.
Speaker 5
Thank you, Mr. Chairman. I wanna thank the witnesses for appearing today. Miss Curtis, does GAO believe that VA is still treating this rating schedule updating as a project instead of a program?
Speaker 5
Does GAO believe that VA is still treating this rating schedule updating overhaul as a project instead of a program?
Speaker 8
No. They have they're treating it like a program. They have a program office that they have established. They've staffed it mostly. And those staff have been, you know, developing and promulgating the regulations to provide the medical updates.
They have also been working on the earnings loss studies.
Speaker 5
So how does the schedule influence the claims processing workload? And do you believe that the lack of updates is causing issues within the VBA when it comes to claims processing?
Speaker 8
No. I don't think it really affects the claims processing. You know, down the road, if they change the regulations, it'll have an impact. They'll have to make updates to a lot of the training and all the inputs that go into the process so that it's up to date and in line with the regulations. I think the impact is more along the lines of the equity issues we've been discussing today, where outdated information might lead some veterans to be overcompensated and others to be undercompensated.
I mean, if you're just strictly on an earnings or loss basis.
Speaker 5
Yeah. So, mister Armor, when researchers evaluate the impact of veterans' benefits, what challenges exist in isolating the effects of a single benefit when many veterans are accessing multiple programs at the same time?
Speaker 10
There's a lot of challenges with that. That's actually a fundamental concern here, is that we don't have a sense of why some veterans access certain programs at different times, and thus the impacts that that program participation in those programs has. So it's very difficult to tease apart, you know, for these earnings losses. You know, was it vocational rehabilitation, the VR and E services that went into it? Was it kind of the access to VA health care being priority group 1 through 3 that had an impact, or is it just fundamentally the health condition itself improved?
These are all things that are, from the data alone, quite challenging because we just don't have an evidence base on the impacts of these programs or, also, like, how benefits themselves sort into using them. And, yeah, so I guess I'll leave it at that.
Speaker 12
Thank you, mister chair, and thank you both, our ranking member as well as you for your leadership in this. I think this is a really important topic, and I'm grateful for this today. I appreciate the committee being engaged in bipartisan as well. This is unique in Congress to have folks who are aligned, so thanks. To our witnesses, thank you also for your service, as well as being here today.
As a physician, I strongly believe that disability rating schedules must be data-driven, medically sound, comprehensive, and centered on veterans' lived experiences. So certainly need to include women in those studies, as well as many other conditions. I'll just share as a medical student and then as a medical resident in the early 2000s, thirty years after the Vietnam War. I cared for patients in the VA system with complex and poorly understood systemic symptoms. Over time, research made clear that many of these conditions were linked to agent orange exposure, something that many of the veterans expressed suspicion of but felt very, we'll say, gaslit these days.
We weren't saying that then, but not trusted. The frustration, the betrayal, the despair I saw, so many veterans experienced left an impression. It also showed how long it can take for science to catch up to exposure impacts, and why ongoing monitoring and research are essential. So, as a pulmonologist, the lungs in particular are uniquely vulnerable. They're the only organ continuously exposed to the outside world without any protective barrier unless we put something on.
Toxics exposures are constantly evolving as we know on this committee, which means our understanding of their long term health impacts must evolve as well. So, first, for mister Armour, you noted or doctor Armour, sorry. You noted that the last VA commission's RAN studies were conducted more than 20 years ago before much of our current understanding of toxic exposure, PTSD, and traumatic brain injury were available. From your perspective, what are the most important next steps to ensure veterans are benefiting from the most up-to-date science when disability rating schedules were reviewed and updated?
Speaker 10
I mean, just updating those earnings loss studies and, in particular, like, bringing in kind of the things issues that we've observed from other disability programs to address, like, I think those modern techniques.
Speaker 12
And just to follow-up on that, that is sufficient, you think, for the science to catch up as well.
Speaker 10
So I'll speak as an economist on what the economic angle would be. Okay. I think that that would check that box, but I'm not a physician.
Speaker 12
No. Of course. And, obviously, it's an unfair question for many of you. I'll just state that we need to have ongoing evaluation and iterative evaluation of our medical information in the same way that I hear you arguing for economic information. The second question, I'm proud that my bipartisan bill to strengthen the veterans' readiness and employment program, the VRNE act, with a lot of support from people here past both the house and senate, and I'm continuing to work to better support VRNE counselors.
Mister Armour, can you speak to the role of rigorous research in evaluating and strengthening RNE, and what this program can tell us about earnings losses associated with service-connected disabilities?
Speaker 10
I can tell you, I think there's tremendous potential to learn those things. I think the current state of research on it is such that it's very difficult to identify the causal impact of those services. That there are, there's a the VRNE longitudinal study is one sort of study that's been going on for stretch of time. But, again, it's sort of a study that doesn't use modern methods in comparing kind of people who did get services versus those who didn't and the subsequent outcomes. So I think that there are ways in which we could, there's a lot of potential to find out for whom it's working for and what those impacts are.
We just don't have that evidence base right now.
Speaker 12
Very good. Not good, but, obviously, you've expressed the need for implementing change to how we collect data. And so, Doctor Hunter, disability rating decisions must be grounded in sound medical evidence. Proposals to lower disability ratings based on whether a condition is treated raise serious concerns for me. Take obstructive sleep apnea as an example.
When untreated, it can worsen hypertension, heart failure, and significantly increase risk of heart attack and stroke. Trying to lower ratings to treatment could discourage veterans from seeking care, which puts their health at risk and may ultimately cost more for the VA as well as cost of productive life years for those veterans. Doctor Hunter, from a veteran's perspective, can you speak to the concerns around lowering disability ratings based on treatment status?
Speaker 9
So in addition to what you mentioned about potentially discouraging veterans from getting care, there is also the very real thing that we need to look at about treatment for veterans who may not live close to VA systems. Like, I'm out in the West as you are. And for me, I get all of my care at the VA, and I often have to try to travel three and a half to five hours depending on the weather conditions to get some specialized care. If we say, well, you're getting care, you're not getting compensation. The other thing that we have to look at is how that removes people from the workplace.
What is the added stress and time and, you know, hardship that is put on an individual, which is something that needs to be looked at as the total overall compensation. And we don't wanna say we are correcting one issue and making a bigger problem, which is why these updated studies need to be done. Additionally, what it doesn't take into effect is the long-term impacting quality of life issues that arise even if a condition is considered treated. There still is often a lagging quality or defect of life indicator. And I actually encourage the committee to encourage the VA to look at studies coming out of Australia and Canada and Israel where they actually include, like, verified quality of life measures into their veterans disability compensation programs that have had outcome or had results of actually improving workplace outcomes through addressing the fact that there were initial quality of life concerns.
And just through the redress payments from those, you end up having much better long term economic outcomes as well.
Speaker 6
Thank you, Mr. Chairman. Miss Kurda, I was very curious that the management of disability compensation claims has been on your high risk list since 2003. And yet you said that, August '24, January, February, and June '25, you got a lot of input. Can you estimate how much of the advances they've made happened since August '24? Just a rough estimate.
Speaker 8
That I can't tell you much. I would say it's not true that's the first time we've heard from them. We've actually been talking to them pretty infrequently since about 2019. And we saw progress more in more recent years. It took a while.
We went through a process of deciding, okay. What are the root causes of these issues? VA came up with the root causes. They developed an action plan to address those root causes. The first version was more like a list of stuff we've done.
It wasn't a plan. So then they had to go back to the drawing board and come up with a plan that had milestones and goals and, you know, and we ended up being something we thought was an actionable plan. And they had something they could monitor their progress against. So it just it's been a multiyear effort, and it hasn't all been since '24.
Speaker 6
Well, I would ask you what can Congress do to help GAO? Because not just in VA, but across the government, you have hundreds of reports that haven't been acted on by many of the departments. So I think Congress ought to be looking at GAO, how we help you to get things implemented. Now let's go back to your five criteria for removing them from the GAO high risk list. They've met leadership commitment, an action plan, and monitoring.
Less so in capacity, which is basically the resources. It's not capacity. It's resources. It demonstrated progress. We've got a saying in Texas, when you look at the three that they've met, they're still fixing to do something.
Speaker 6
So they haven't done, I mean, logistics is everything. If they haven't provided the resources for the capacity to do it, then they're not gonna demonstrate progress. So I think this is a very telling chart that you've given us, that they really need to do something now that they've made the commitment apparently. And then, Doctor Arbor, you talked about individual versus average justice. You spent a lot of time on that with Social Security.
Now Social Security Administration supposedly has outdated computers, old coding, and yet you basically said that the Social Security Administration does a far better job individualizing plans. Can you kinda talk to that?
Speaker 10
So I'll say, historically, Social Security has been very welcoming to the research community in allowing us to conduct research on how the disability termination process works and at sort of which stage. They do contract with states to actually administer the first stage of it. But for each kind of level of that, they've shared a lot of their earnings data, their benefit data. And we have really provided over the years, like, a lot of strong results on sort of every stage of their determination process, sort of how it works. And that's allowed them to make various policy decisions to provide that feedback back to that determination process.
They've also engaged in a lot of national academies of science, engineering, medicine panels to update their own listings.
Speaker 6
Well, that's not really my question because you get a very individualized plan from Social Security Administration. These are your earnings. This is your disability. This is, I mean, it's pretty detailed, and it's individualized. And yet you say that VA uses an average justice sort of model.
And yet we spend a lot of time individually, and part of that is the problem. We have a sixty-six percent of claims have errors, and forty-four percent of all I've forgotten the data. But, I mean, we have a tremendous error rate. Why is that if we're using average justice as opposed to individualized? Because it looks to us as though we spend a lot of time with the individual.
Can you explain that?
Speaker 10
I can speak to how Social Security does this and how they separate the determination process into two steps. One is a listing of impairments. These are conditions that are sort of severe enough that through medical evidence alone, can determine that there's a disability. So there's like that. And they have an all or nothing determination as well as another thing that makes Social Security a little clearer.
But then if there is not that listing of that level of severity, then it's an individualized assessment that they have, and it's a residual, it's trying to estimate functional capacity at that individual level. And so they've done a, you know, spelling things out for the things that can be easily spelled out, and then having an individual assessment where they see people's earnings leading up to it. You know, they have physicians comment not just on the medical component, but on the functional capacity component. And then they have a lot of oversight of that particular process. So they've split apart that decision instead of trying to schedule everything.
Speaker 6
Thank you very much. I think that's something we might do a deeper dive on. Chairman, I yield back.
Speaker 2
Thank you, Mr. Chairman. I just want a couple of quick follow-up questions. Miss Carter, earlier I asked VA if they would commit to sharing their methodology with you. Would you be receptive to that?
Speaker 2
Perfect. And beyond sharing methods and data, is there anything more that you would ask a VA to better provide oversight, accountability, and quality assurance in this rating schedule?
Speaker 8
Just quicker turnarounds on things. When we ask for information, just instead of having to wait a long time for clearances and stuff, you know, just get it to us. If it exists, they should be able to provide it.
Speaker 2
Thank you. And one common theme between the first panel and you all seem to be these silos of information. These silos are terrible things that I think are hurting our veterans. They're holding information and keeping it from people who need it, when it should be shared. It should be transparent.
Doctor Armour, you've talked a little bit about this, and we seem to be dealing with several information gaps, in part caused by some of these silos, which leads to nonexistent research, out-of-date datasets. What other sorts of basic research need to happen? And does it make sense to have that before people start talking about radically changing the VA compensation system?
Speaker 10
I think given the state of knowledge on the economic consequences of sort of VA benefits that, yeah, we just don't have a lot of publicly available research on, right, on today's veterans and today's system. So I think, yes, kind of more research. And in particular, I think it is not highly complicated. I think it is sharing the existing data that Social Security has, that VBA, that VHA has together could provide if that were more widely available, if more research could be conducted on that in a way in which there's transparency and comments so that modern techniques could be used. I think that would answer a lot of questions.
Speaker 2
Very quickly. Again, if things moved. Transparency and sharing of information, I like it. Mister chairman, I yield back to you.
Speaker 1
Mister McGraw, I have since my time in academia to the time I'm sitting next to you today trying to convince, I don't care which institute of higher learning you're talking about, and that famous catchphrase of silos, how do you sew the seams between the two? And who else had the willingness to open? Like, in my personal opinion, the VA should be the premier institute of research on the planet, a lot of information that is inside the VA system. And they've always been, since I've had the opportunity to work alongside the VA or with the VA, very protective of us, the veteran community. That information is some of the most cherished data on the planet.
And everyone's knocking on the door saying, please let us engage with you to share this information so we can move any side, any kind of information forward. And VA has always been very reluctant of that because who's gonna fall on the sword? Who's gonna take responsibility if there is a breach and the information is gone, lost, taken, or worst case scenario? And conversations on a committee with secretaries, deputy secretary, who you're talking to. And this kinda goes to what you're talking about, Hunter, mister Armour is, yes.
If other institutions, whether that's VSO or any institute of higher learning, had the opportunity to do that, where would we be now? And I've been having this conversation for 12, 15 years, so I can only imagine how long you guys have been having it. I speak to the broader research base. You guys look like you're in your twenties. How do we break that down?
We do. It is a fair question, and I can understand and I really appreciate where we are in the protection mechanism, especially in the branches of artificial intelligence, machine learning, and the bad actors that are pushing that out to take from us that we can't defend against. As we incorporate machine learning, language models into this data to find these answers, at what point, this is a fair question to ask, at what point do we find the answers to solve the issues of the brain? What if we have the ability to get rid of sleep apnea or tinnitus or the varying degrees of heart disease and exposures from being in combat? Where do we sit then? Do we ask the veterans, like, hey.
We're gonna give you this, everything's gonna be okay. Or do we grandfather it in and we move forward into the next generation? These are discussions we're gonna have to have. Be pleasantly surprised how challenging those discussions are going to be. But it lends itself to what Mister Self was saying, is at what point do we say, hey.
Look. We can fix these things. How do we engage with the veterans so they'll receive it? How's the VA implement it? And then how do we move forward to make sure that we don't talk about 1945 infrastructure, which I still find moderately entertaining.
I'll never say we're moving fast enough because of all the veterans in my district that walk up to me and say we're not. I'm listening. As a veteran myself, I have that same response. I do understand how complicated the VA system is, just from this side. I've never actually been inside the VA, but having offline after-school conversations of how challenging it could be, it is.
I just, you know, hope and pray every single day that they keep moving forward. We'll do everything that we can on this committee to make sure that they have what they need. And as problem sets continue to increase, and, you know, it seems like we always have to talk about dollar bills. Well, I'm gonna be quite honest. You know what?
Dollar bills are something that's extremely hard to find even in the VA, considering how far in debt we are as a country. And we beg, borrow, steal, and kick a lot of butt to get the money for our veterans, because we wouldn't be sitting there having this conversation. It wasn't for you all. And we were willing to do that. We'll make sure we do it right.
It has to be done right. I want to thank all of our witnesses for joining us today to discuss how the department can address the long-standing delays in updating the rating schedule, more importantly, how we ensure this does not remain a recurring problem for our future and for our veterans. When the rating schedule is outdated and or applied inconsistently, it creates confusion, frustration, and delay, and that's something that we do not want. Updating this system is necessary. I am excited about the opportunity.
This will be closed up, and we will complete this at the '22 of this year. This committee will be on standby to see if that actually happens. Rick, remember you have closing remarks. We're good to go.
Speaker 1
Yep. I ask unanimous consent that all members may have five legislative days to revise and extend their remarks and include extraneous material. Without objections, so ordered. We are adjourned.
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