Transcripts For CSPAN2 Veterans 20240706

And now Veterans Affairs secretary Denis Mcdonough testifies before the senate Veterans Affairs committee on president bidens 2024 budget request for the agency. He weighed in on the camp lejeune water contamination suits, the agencys claims process and womens healthcare. There was also testimony from the heads of various veterans groups. This is just over an hour and 45 minutes. [inaudible conversations] [inaudible conversations] [inaudible conversations] i am going to call this hearing to order. We are little bit ahead. I want to thank Denis Mcdonough and our friends and partners for joining us today. For those of you joining us on television, you will hear a great opening and questioning of the secretary of the va and what is interesting is we have three folks who are going to do a combined statement which will be particularly entertaining, i think. Something to look forward to. We are here to take a closer look at the president s fiscal year 24 budget request from the department of Veterans Affairs, a time when theres Unprecedented Demand for Va Health Care and services, we have to make sure the department is equipped to pay for our veterans. Over the past year, the va completed 1. 7 million disability compensation pension claims. And served 6. 3 million veteran patients, 115 million employments. Through the demand it is only increasing, last summer as congress came together, a historic step that has delivered all areas for veterans and survivors, their va care and benefits that they have earned. This law created an exposure fund to cover the new costs of delivering this earned support. I have serious concerns about the attempt to got the fund whether it is attempts to relitigate the nature or purpose of the fund or place artificial caps or make dramatic cuts to the fund, it is all bad news. I might say this was we send folks off to war, we put it on the credit card. They come back, we make excuses not to fund their benefits. In montana, something comes out of the backside available. After finally making good on our pledge to address the costs of war, our next step cannot be to renege on that pledge. Im concerned with house efforts to rescind 1. 8 billion, reimbursing Community Care. Let us not forget, to not cut va healthcare. And job Training Programs and what was next. And with livelihoods at risk each month. Treasury makes 25 billion in payments, of that 25 billion, nearly half is for benefits payments of 7 million veterans. The rest pays for salaries and keeps va medical clinics open and reimburses private providers to receive care in the community. The debt limit is reached while payments could be delayed or stopped, creating incredible uncertainty for the nation and veterans who served this nation and made the country what it is today. Lets get past the political posturing and make sure veterans are not harmed because representatives in congress can act like adults and do what they were sent here to do. They have forgotten their mission was with that said, i want to hear from Denis Mcdonough on concerns, priorities and impressions of the 24 budget. I turn it over to my friend. Welcome to Denis Mcdonough and our witnesses. I appreciate all of you being with us today and appreciate hearing your testimony about the fy 24 budget request. There have been big changes the chairman mentioned since the last time we met for this purpose, namely the enactment of the Heath Robinson honoring are packed act. I know one thing that has not changed is there is bipartisan bicameral commitment to provide resources needed to support veterans and their caregivers, survivors independents. I am committed to protecting and prioritizing and supporting veterans and ongoing budget talks and i know my colleagues in the house and senate share that commitment. Nearly 70 of the federal spending is on autopilot, or what is known as mandatory program. The passive approach to the federal budget got us in this deficit mess in the first place. Veterans are not insulated from rising inflation and slow Economic Growth caused by outofcontrol spending. As a longtime member and Ranking Member of this committee, my priority will always be to make certain the va has the funding it needs to provide timely and high quality Healthcare Benefits and services to the men and women who served our nation. I believe this and every va budget request can be judged through a single lens and that is what will deliver for veterans. This years budget request is the largest yet for the va totaling 325 billion. That is a big number and it should lead to big improvements for veterans. The point i am trying to make, ive done it myself from time to time in which we brag about the amount of money we spent or the increases we are providing veterans. If bigger numbers were all that was needed to deliver we would have better results so it is what we can deliver. With bigger numbers and better results we still wouldnt have better suicide rates, hundred of thousands waiting on claim backlog, troubled new Electronic Health records, 12 months of a trend of meaningful decline in access to care. Scores of recent reports from the Inspector General and Accounting Office detailing serious and sometimes fatal failures. Persistent problems getting the va to respond to basic requests for information from the committee. Im interested in hearing im interested in hearing from the secretary on how the budget request will produce different results from past years. Im interested in hearing the secretary justify healthcare that outpaced the demand for va healthcare. We request 11 increase but the projected need for that increase is 3. 5 . This is the first budget request that includes the topic exposure fund and the va is asking 20 billion for the fund in fiscal year 24. When the fund was established 9 months ago it was not projected to reach 20 billion until fiscal year 2030, six years from now. Given that the va doesnt have a way to track the number of veterans and rolling in the enhanced eligibility authority or raise this concern about unexpectedly high influx of claimants, this request needs explaining. Delivering more money for veterans is not the solution but delivering Better Outcomes is. I have no doubt but i wouldnt want to put you in my category but have no doubt we that there is any disagreement about the need for better results. For these reasons it is good or congress put Veterans First by remaining engaged in the budget process and avoiding the urge to turn a blind eye to issues facing the va to more mandatory spending. It is time we get it right for our veterans, loved ones and i thank you once again for all being here and i look forward to our conversation. Thank you. I agree with the debt that you may on the money. We talk about how much money has increased when in fact it is how the money is spent. That only includes the va and every budget we put our hands on. Todays hearing will consist of two panels, first, we have a great honor to have the secretary of the va, secretary Denis Mcdonough to talk about the va 2024 budget. Budget. Well, thats good. Is that okay with you . Now i i feel guilty. I know, i know. Thats a great Opening Statement. That will get two points right off the bat, right . Mr. Secretary, in your testimony that you have written, you highlighted the v. A. Has delivered more care and more benefits to more veterans over the last two years the meantime in our nations history. Put more of that in perspective for us. Yeah. Well, thank you very much, mr. Chairman. It is important to keep in mind that these big numbers deleted to Better Outcomes. We are not big on just measuring what we put into, what you give us to put into veterans care but we actually measure what it means for veterans and their families. Just last thursday there was a release of a report, actually was consolidation of 40 separate reports, looking at care provided by the v. A. , including throughout the pandemic. What that report found, from one of the leading medical journals in the country found, is that v. A. Provided care is at least as good as and overwhelmingly, overwhelming number of cases care better than care provider and other settings including private Health Care Setting so were very proud of that. Just consider the clinical appointments and engagements with had in the last year, 115 million clinical encounters, 40 million inpatient encounters at v. A. Facilities, 31 million telehealth appointments, 38 Million Community care appointments. You already talked to the benefits side of this at the 1. 5 million claims that we processed last year. 15 ahead ofare that number year on year. The point is these dollars mean real engagements. These engagements been Better Outcomes for veterans. And i standnd by the assertion that we are now providing more benefits and more care to more veterans than it anytime in the v. A. s history. Can you tell me about firsttime veterans entering the system. Who are they . The most, the Fastest Growing cohort of veterans are Women Veterans. We have just as result of the pact act we had 77,000 new enrollees in v. A. Healthcare. Ast i i say the fastest growg cohort are Women Veterans, but the beauty of the pact act that you all gave us last year the president signed in august is that it allows us to restart a conversation with younger and more diverse veterans, at the same time were deepening engagement with Vietnam Veterans including those who have hypertension. As a result of exposure to agent orange. We are seeing younger veterans, more diverse veterans, including more gender diverse veterans, meaning more women in our care and worse thing that record as the pact act. There is been debate the last coupleas weeks about the bill te house passed that cut programs, and the debate most of the debates revolve around veteran benefits act. Senator rand paul addressed it in his Opening Statement and by the way he is an honest broker and believe what he says when he says well to make sure Veterans Benefits and Health Care Programs are funded. But as a look at that bill the attempt recent 1. 8 billion for v. A. Medical services ib modernization facilities, 1. 8 billion. And the question for me becomes if we didnt cut any veteran benefits this isnt called benefits because it has to do with administration . I i guess thats way to look at although v. A. Medical services is the a medical services. You had chance to look at the bill and look at the proposal put out buyer agency. Tell me what you see that comes out of that and what kind of impacts that came to fruition. A bill by the way the speaker said did not cut benefits in fact, called the president a liar when, in fact, the president was the one who was telling the truth. Thank you, mr. Chairman. Obviously the bill itself is vague for the reasons you talk about such a difficult to ascertain, but weve looked at this a lot of different ways. Weve been talking with members on all sides of this debate since january whenar this debate really got engaged. If you just apply the 22 budgeb cut to v. A. , which again may not be what end up happening at the end of the day maybe it is less than that, but if you just take the top lines of the bill and recognize that v. A. Is not held harmless the way, for example, dod is held harmless in the bill, then we are going to be confronted with very significant challenges. I will just give two examples. We think that if, if that 22 cut applied to v. A. Healthcare, that would mean 30 million fewer outpatient visits of the type that i just talked through that we had last year. Those are all patient visits in the direct care system or in the Community Care system. Alternatively, if you look at it from the benefits administration, again i talked about the fact that claims filed our 30 above where they were a year ago. We are fulfilling 15 more claims year on year than we did a year ago. And were able to do that because some efficiency with him but also because of hiring we have carried out. If you apply the 22 reduction, that would mean 6000 fewer staff there. With 28,000 staff there for the first time. We have talked many of the members of this committee through how our staffing model works, where we are in that staffing model. But if there are 6000 fewer personnel to process claims, that will beth an extension of a timeline that already too long. Senator moran. Chairman, thank you. Mr. Secretary, the v. A. Inspector general recently found a substantial, there was a substantial comingling between the 14. 4 billion in supplemental funding the v. A. Received under covid19s related care and the v. A. s regular appropriations. It seems to me that would be separate account but thats not what the inspector found is my understanding, what i read. The intent of the supplemental was to support urgent timelimited needs, kind of one time or one period of time circumstances, not to create an artificial increasing of a v. A. s budget. What steps did the v. A. Take to make sure cost projections for fiscal year were talking about,o years, 24, 25 were not based upon those supposedly one time amounts of money . Its a fair question. This has been an historic challenge for v. A. How does it account for supplemental funding . Many years,ck many, do with the age of our infrastructure and how we track the stuff and ituc also has to o with where we push the money to for operators to execute it. The important thing we have done is we have now taken responsibility for that, the outlays of those dollars, and put it the hands of the cfo here in headquarters. We are making sure that he and i are directly responsible ultimately. The covid funds . Those funds being the medica care funds, and so rather than making every individual facilith have to account and try to forget where this money come from, what color it is, were going toak make sure that we dot at headquarters. We work that out with omb. Weve been briefing her staff about this because we think this is an important change. Secondly, we have regularly updated the committee on how it is that we are spending the sons and thats whys we can have confidence that we have now that will use the overages that weve had to date w which remember the overages were for what we expected to be a surge of care as people come back to us at the end of the pandemic. Weve had that conversation in this room. We have great confidence will use that money this year, and partially into next year. Our regular updates to you guys help us do that. But the ig has routinely raised this issue of supplemental funds with us. Were kind of figure out a good way to do it. We think as i said bring the responsibility of this to the cfo level is a a way to do t none of this obviates the need to continue to stay in close touch with the committee and make sure that the Committee Sees clearly how were spending the money. Y. I understand the v. A. Plans to track expenditures from the Toxic Exposure Fund fun toe they are justified. How will the the v. A. To fid track which healthcare is associated with exposure to environmental hazards and which care is not pursuant to the law that created the font . We have had now a handful of discussions with your teams here in the committee and with others among the appropriators and the house as well about our methodology. We arer comfortable with our methodology. We havee worked this through wih omb. Were working it through withmb your team. I will let them characterized to you their degree of comfort. If we have to change it methodology will do it, but the base case is that we are in a position to ensure that as the law envisioned, Toxic Exposure Funds, will be spent only for toxic exposure requirements. And weve made sure we have given clear guidance to the field. Again, operating as a do with the cfo and meet responsibly for this to make sure that we can execute it that way. So the problems or the lack of accounting of the money from covid which you are not trying to address by bringing it to the central office, that is not anything that would suggest the same probleme will occur for the money in the fund for toxic exposure . We wont have the same problem we had with covid money being comingled. The department will be able to e determine what is appropriatee spent for toxic exposure benefits . Yeah, we think yes. And again the methodology, the basis on which we have established that methodology to track that funding fundg where talking through with your teams in very minute detail. Are also going to continue to not only talk to you but continue to be subject to the igs oversight, to the gaos oversight, to ombs oversight, and if there is something we need to s change we will change it. But we havee great confidence that it will be able to invest the toxic exposure dollars for toxic exposure care. Mr. Secretary, thank you. Senator brown. Thank you, mr. Chairman. I appreciate what you said about deity being held harmless and the v. A. Not. Senator tester and chairman tester and i and others fighting for the pact act remember last summer when it was perilous weather was going to pass because some people said it was too expensive. I do roundtables. Im going to do one on the pact act in every county in the state. I think i did the 31st when the other day and there is a sentiment theres always money for defense but too many people want to skimp on spending on the v. A. , so mr. Sp chairman, thank u for your work on that. Mr. Secretary, thank you for all that you were doing in so many ways. I want to thank you for taking the right step in stopping the Electronic Health records issue. I know weve talked many times. I appreciate your attention to that enter understanding there that staff at chalmers and columbus, their hard work, i visited there as you have. You did the right thing and we ngwant to keep working with you. I want to talk about the pact act. Do you have numbers up to date, numbers on how many veterans . I like to say when i do these roundtables that this is government doneis right. This bill passed effort remember in august b of 2022. By january you were headed up and running and hundreds of thousands of veterans were and thats exactly the way government should run and all of us are proud to be part of that. Do you have any uptodate numbers on how many people have been served . Thanks thanks very much. As off may 6, 251,584 total veterans or survivors have had completed pact act related claims. We are granting at about 80 . Thats the beauty of the presumption, is that were able to grant at a much higher rate, its 79. 7 . The average, this is a troubling number, the average days for completing a pact act related claim right now is 155 days. I think there is series of reasons for that. I think the biggest is that some claims were filed either related to our initial three presumptive claims or filed shortly after the president signed the law and we did nothe begin to process te pact act claims until january. So we should see that average number of days go down. We have about, as i said earlier, about 77,000, a little over 77,000 new enrollees in vha health care ass result of that. We have many more existing enrollees who qualify for m greater access to get as result of the pact act. Thank you. I participate as an observer in a screening event in toledo in northwest ohio in march and itit was and a limiting experience to see what veterans go through. You have been more handson than any the a sector ive seen intrinsically out in seeing that action. Ivethon heard from advocates ad get additional screening, many of them in poor health and had to have invasive lung biopsies to complete these. What steps is a v. A. Taking two of the less invasive diagnostic techniques such as advanced technology screenings . So the toxic exposure screens you talked about and are enabled by the law we have now had about 3. 3 million veterans complete those screenings. Very interesting, because somewhere between 3540 , i dont have the most recent number, and fluctuate in there, of cases of the screenings, we have veterans about whom we learn some new exposure that that veteran may have experienced. So thats allowing us to get to know the veterans already in our care better. There are technological challenges. One of the things we think most veterans suffer from, which is bronchiolitis, which the test for which are so invasive as to make them actually not useful, potentially harmful for thet veteran. N. So thats why we have stood up in the pact act enabled us to stand up a special organization focused just on the science of the exposures, as well as new techniques to verify the existence of the condition. That team meets on a regular basis. We just met with him late last week onn this. But not only did you set up the presumptive process for us, but you also given us additional authorities to make sure that we are testing new technologies to make the confirmation of these conditionsns, including bronchiolitis, less invasive. Thank you. Mr. Chairman, thank you. Mr. Secretary, your help a special century taken office in chillicothe in cincinnati and columbus and help for the national v. A. , thank you for all that. Thank you, mr. Chairman. Thank you, mr. Chairman. Secretary mcdonough, thank you c for your Opening Statement and congratulations on your daughters upcoming graduation, 15 minutes from my home, davis in college. I want to thank you for the great and you gave me back in my office. Probably known to most folks i voted against the pact act are, in fact, in spite of the fact i worked a lot on it. It did nobody can do with the numbers. It had to with operational challenges that i hope were going to get them to clear up, but you get a to be optimistic based on a briefing you giving in the room. Can you give me asphyxiationsecond cliff notes version on some of the risks and how you managed i did to the 150 day, youve got to bend that them but i think you have a plan . Can you share that with me . Thank you very much, senator tillis. What we know now after years of watching the benefits process in particular, the claims filing process, since that is overwhelmingly the main door that United States enter at the ecole its a very human intensive process. We need to make assessments about how many vets we anticipate filing claims that we need to make sure that we have trained people ready to handleth those claims. So starting in the end of fiscal year 2021, will we begin hiring we now have 28,000 vba professionals. Importantly, they are not only hired but they are good chunk of them are now through the training process such that they can beginch to add to our abiliy to reduce the backlog of claims that get filed. A good example of this is that yesterday we had the single biggest day of claims completion in history of v. A. We completed 9245 claims yesterday. We are still getting more claims in any given day from that but we are able now to move many more claims to the process. We can see through the expected surge of claims right now and we have a strategyy on how to then manage the size of that workforce through attrition on the other side. Managing to the pace, getting down to what you think the future run rate is going to be is good news, so count me in to help. Thank you. As a go forward. With respect to the discussion about the house bill, the house bill was the house bill. We know that the negotiation thatat is going to come from the president speaker makowski is going to produce something different. I think its going to be speaker mccarthy. I think it would be fair to veterans. You make and 77,000 of people. Pact act is muchpublicized. We got more people to contact the v. A. , even if 20 are not getting the presumption, we now have a relationship but hopefully that isip a positive r those who may be didnt get the news on the n presumption that t least are engaged. We know the suicide rate among veterans who have no relationship with the v. A. Isthose who do. Theres a lot ofth reasons why e need to get people to the v. A. Theres also a lot of reasons why im absolutely sick of the camp lejeune toxic ads that are on t tv. However, think theres a great opportunity there to connect with more veterans. But i heard i think it was an upright committee andct exchange between senator sullivan and senator hirono on capping fees, which is going be very difficult getting a consensus on. And i asked by step to take a look at draftingoo a bill that e call the patriot bill of rights. One of the things i would like tong do is to get support in congress for an informed veteran for they signed a retainer for these attorneys that arer spending millions of dollars on ads. I think it represents a great opportunity for the v. A. I know they contact the department of the navy but i was thinking something as simple as a document before they signed a retainer agreement that says you need to understand what your rights are independently without representation of an attorney, number one. Contact the v. A. Er number two, contact a local congressional representative. We do thousands of v. A. Cases every year in our office. Im sure the other members to theo same. So make them aware of the fact that congress members, state offices help veterans every day. Their case may or may not rise to a level where the need legal representation. Make them aware of recognize those who also have experience in skates and let them go that process before they sign that retainer agreement. Whats wrong with that idea . You and i talked about this in your office and this, we, special on camp lejeune where we just had a study published last week wheremp a veteran at camp lejeune is 70 more likely to suffer parkinsons and not. Then one not deployed. We have a lot of presumptive already for camp lejeune. So we want to make sure that vets understand you dont have to hire a lawyer to get your v. A. Benefits. We are aggressively using all of our communication tools to do that, and having some success with that. Anything that will allow us to get to more of what we call the untethered vets, those vets not get him relationship with us is a positive thing as far as were concerned. Senator murray. One. Mr. Secretary, good to see. As you and us told us yesterday today announced an agreement for the new contract that a been made with oracle and its really important to see that v. A. Is your enticing reliability and responsivenesses in patient safy across the contracts iet appreciate that. Just last week gl released a report indicating the v. A. Had not established target goals to assess User Satisfaction and lacks a basis for determining when satisfaction has been putting up with system to be deployed at any other sites. I support the reset period and i support efforts before but only after you are confident about the safety and effectiveness of the system and have a clear, established satisfaction markers. What matters is what the providers and veterans on the ground think. Our veterans you and i both know deserve the best healthcare we can offer and it is our job to make sure the v. A. And oracle but he gets this right. I have a couple questions around this. When do you expect to have a revised request for theue ehr account in fiscal year 24, as well as an estimate of whether you need the funds requested to support the rollout in the i. T. Medical facility account . So first of all i just want to make sure were absolutely clear that roughly a little bit over 400 million that was set aside for this year weve communicated to you and the Appropriations Committee we do not anticipate needing that money this year, some want to be very clear about that. On the updated request, both for the rest of this year and then into next, i think we need a look at the time but not much. I dont have a specific timeline for you here, but we recognize that this one year option that we have just exercise is a great opportunity for us to test whether we can get those five sites working. Andon not only that but we have provided in each of those five sites that you have brought to our attention, and we have vets in each of those five sites who have big expectations and they are tired of waiting. We are not asking for a lot of extra time but we want to get this right rather than get it fast. Rather than give you a firm commitment, i can tell you this is number one issue for us at the department to come to the committee with a revised request. You have plans to establish targets to assess User Satisfaction . User satisfaction is going to end up, is a critical part of this. Whether we have a specific target set, i will get back to you on that, but one of the principled ways were going to be able to figure out whether were working in the five, in the five sites is going to be User Satisfaction. That will be part of the evaluation . Correct. Whether with specific targets laid out on some timeline is what li are there any changes you made a plan to make on provided feedback . A big part of it is the enhanced Accountability Measures around uptime and system reliability. That comes directly from the user experience. Thank you. We are following the story closely. Ive noticed. Reallyaris appreciate the das diligence on this. Thank you. Senator boozman. Thank you. Mr. Secretary, again, thank you for being here today. Be we enjoyed hearing your priorities regarding the budget last week, and we do appreciate all that youre doing come all, all the hard work for the men and women that have served. In regard to the hrm, one of the things i hear from people who are either not on the authorizing committee or on, you know, Appropriations Committee, is dod has successfully got a bunch of things going in various installations. We are struggling. I support the move to back off. I think that was wise of you to do and i think you got really good support for doing that. Can you explain why dod is having success . Whats the difference . Why arece we struggling when thy didnt . I know theres good reasons but can you expound on that . Look, i think the number one reason that we have help systems thatve are built for different populations and for different outcomes. As a general matter our patience with this longer, and our patience, our veterans have more complicated Healthcare Systems situations, and so as a result, our system is that much more complicated. I think thats the main issue. The other question is, when we have struggled with reliability, oftentimes in fact, in the last three weeks weve had these two outages for the first time in some 70 plus days. Those outages in fact, the entire system. So its not just v. A. Also impact dod. And so my point is that because of your pressure on us i think are making the entire system more reliable, including for dod. I think notwithstanding the fact that our system is more complex and a patients have more demanding healthcares situatio, i think the work that you put us through is going to make the whole system including for dod come for coast guard, st, that h more effective. Thats helpful. When you came and talked about your budget, you recognized te growth of the number of Women Veteranswo seeking care in the v. A. And which has more than tripled over the last o 20 year. Fiscal year 24 request includes more than 1 billion for gender specific womens healthcare and to win a 57 million to support the womens healthll Program Office last congress with legislation, the service act which was signed into law expands the eligibility for vha members, mammography screenings to veterans were exposed to toxic substance. Thats really a good story about all the great things you been able to do in various ways. Can you touch and how the info mentation for the service act is going and are the any challenges that youre facing that we can be helpful with you . Let me start by saying that you have been tireless in giving us additional authorities andal additional funding to do exactly all things you just ticked through, and we are very, not only very proud of that but we are very grateful for that. On the service act, its in the well underway. We began providing breastcancer risk assessments in march of this c year, including coincidet with the toxic exposure risk assessments. Me we are working through the development of a dashboard to make sure you can follow along with the implementation of that. Project will be an additional 52,000 52,000 breastcancer risk assessments across all sites. Incidentally, as we learned last week where new guidance is, breastcancer screening should start at 40. Its pretty clear that your advocacy for the service act was well ahead of even this more, this more cutting edge assessment last week. Theres going to be challenges in some facilities where Women Veterans are coming to us and enrolled because theyve heard about this screen. So thats going to create some Administrative Burden but there is not in sync and i to name that. Theres anything we need from you for that but that will be a challenge. But that means were getting more United States into her healthcare. [inaudible] absolutely good news. Thank you, mr. Secretary. Senator king. Thank you, senator. Mr. Secretary, welcome to the committee. Thank you. One of the issues, isohunt both Armed Services and this committee, is a transition. Yes. It seems to me even though we have made great progress we are still not there. Yes. What i would like to getou fm you is some thoughts about how we could make this a warmer handoff if you will because the data suggest that that transition, that two or three year period after leaving active duty as a moment of danger. And so i wondered if you had some thoughts about how we come something for might be able to do to make this a more effective process in order to protect our veterans. Yes. I think your instinct is exactly correct, in my view. I have talked about this with secdef. Were looking at this a lot. I worry sometimes that we think the answer is to overload the transition, the tap program. Handing a veteran of 300 page form is not the answer. Right. As you know i am not a vet, but i can like when is late in the white house, i signed a lot of Different Things that it wasnt going to go to any extra thing that i wanted, that it didnt want to go to. So what we think very strongly is we need to fit our programming and opportunities into veterans lives through a Customer Experience a journey, rather than make them fit our stuff on our schedule. So wereso making good progressn this and that may mean that were talking too veterans outside the tap program and were using the Program Using the time as you say in that year to three years after the transition to establish a connection with them. One suggestion that i been looking at is right now an active Duty Service Member has to opt in to have their data conveyed to the Veterans Service officer in the state. If we made that an opt out, it would probably increase the amount of contact. My vision is, frankly, someone needing the veteran at their airport sang welcome home. Here h are some resources. Heres my number. Heres the v. A. Number. But we have to be able to contact the veteran. Now, if they dont want to be contacted thats fine but with thisis cadre of vsos and people out there that are very willing to help the we have to make that connection easier. We are in conversations with the National Association of state directors of Veterans Affairs. That would be the contact i think. So we have not been a first rate parker to our state partners on this. We give them data. Its not readable. Its not usable. We are trying to make that better. When i was governor i would call our states 800 numbers just to see what you got as a consumer. Thank you herself as the customer as as a good way to approach something likewa this. These state directors of Veterans Affairs in each of your state we are working with each of them come in each of your states. They are not shrinking violets, and we are hearing from them that we have not been a good partner. Were working that because we do think that that ready handoff is really important. Just in limited time, a couple of c points. Im still concerned about onboarding time and the cumbersome this of the hiring process. It strikes me that decentralizing to some extent would be good, number one. If you need to hireu Administrative Assistant at togas hospital in maine you shouldnt have to go through boston and washington. Number two, some reciprocity come so got somebody that is in customs and Border Patrol they dont have to go through a hole in the process of background checks and on those kinds o. Reciprocity would speed up the process. I hope again this is one of those things where back away and say if were going to design a hiring process from scratch with a blank sheet of paper, what would it look like . And then compared to what we have now. Yeah. I appreciate that very much. We feel like weve had a good, we feel like weve had the best two quarters in hiring and basically two decades. But onboarding is still a major headache. We are looking at that process from soup to nuts. I talked with you yesterday about a couple of things in particular, the way we handle drug testing did not make any sense to me, for example, a were getting into the specifics on this to ratchet down that time to onboard. We are losing people because speedy its an opportunity cost. Massive opportunity cost, as these are people who want to come to work for v. A. We should make it so hard. Our time to hire, our time to onboard is coming down. Good. But its come down int some places from four months. Nobody can take a job and do not be paid for four months. Okay. So we are on this. I will continue to report to you on this. But some of the stranger talking about things were looking at. Moving authority to hire to the field simultaneous carrying out the onboarding steps rather than doing them sequentially turkeys areth all things were making god progress on. Tragedy can you indulge me for one more question . Make it short. Thank you. I knew you would understand. The medical records it is short. Accountability is crucial. Yes. I think you ought to be targets. If you dont have destination you never get there. I think this contract is very important, but youve got to have standards in it that provide some accountability and some penalties if they are not met. Otherwise, this is such a complex, large process but ultimately its got to work. If it doesnt work, the people who we he where contracting wh shouldnt get paid. Sont i hope you will be very toh about accountability. And you got this one year, give got something hanging over them and want you to be very aggressive about that. We are going to do that. I think senator murray is challenging us. 100 agree, i think we got improved accountability metrics, including enhanced credits when, the v. A. When the system is down as it has been inextricably belasco i said three weeks, i think its a last month. Its maddening. There ought to be accosted that. We have to measure it inha dollars but its really measured in vets outcomes. Senator murray is also challenging us to be very deliberate about your satisfaction measurement. I take that, capable of you are saying on that and we will get to the bottom of it. Thank you. Senator blackburn. Thank you, mr. Chairman. Senator king get such a great devotion this morning at prayer breakfast. I was happy to let him move forward and take that time. Secretary mcdonough, very quickly. Weve talked a lot about staff and return to work. What percentage of the das d. C. Staff has returned to in person what . I love specific number but i would get you that specific number. As and that also submit to e the agencies official telework policy. Short. We want to know that. Ive got legislation called the show of work, the show up at in order to try to get people back to work in these agencies. Okay. The wait times and the backlogs are continuingd to grow and the think thats a problem. Let me ask you also some of the employers ive talked to in tennessee have talked about people taking second jobs, second remote work jobs. So do you have any employees that are taken second jobs where theyre working two jobs remotely . Has that happened . Not that im aware of but let me take that on and i will come back to you. I would appreciatendnd knowig that. And seeing where you are with those issues. I know you are working on a Work Environment plan. Whats the status on that . Status is that we submitted our first draft of that to the omb. In fact, when an denier i would be going to a meeting on that over at the interagency. We feel really strongly about it. I feel quite proud of the work our workforce is carried out the last couple of years. Productivity at vba, the Veterans Benefits administration, is the highest its ever been. Even though they are maxed telework right now, they are at higher productivity rates than we were in 2019. I feel good about that. What about the backlog . The case backlog is about 215,000, its a less than i read somewhere the pact act had, you are saying a half million requests for service because of pact act,ic is that accurate . Overall, yeah, we have seen about 500,000 packed specific claims filed. And so, but we will get you the exact date if you want to see. I would love to see that. How many claims filed come how many claims completed, average time to completion. Of course as you know i believe Community Care is a big part of that. Weve got more legislation we are working on that we think with help with that and we would appreciate hearing from you. I do want to come to something that to meto was very troublings i was reading it last night and looking through the interim report. And you know you are president obamas chief of staff from january 13 to january 17. All i would like to know from, during that time of staff did you participate in any meetings with the fbi regarding the investigation of the Trump Campaign . Its been a long time since i thought about that but i would be more than happy to go back and take a hard look at that and get you an answer. I would appreciate knowing that, and i think its important to know what your involvement was with the fbi in pushing for that. My understanding is that you were in the 2016 meeting in the situation room with president obama, susan rice, and other top officials where they discussed the russia collusion issue. Is that accurate . Im not sure i know which meeting youre talking about but i would be more than happy to look. I think it was julyy of 2016. Reported in the report and you were in there, and that is of concern to me. You are charged with leading a very important agency. The work that you do is vital to our veterans, and it is of tremendous concern to me as i was reading this report last night. It was also a source of disappointment to me that you would have been involved in this process of weaponizing the fbi. This is something that should never happen. People do not want to see two tiers j of justice. And as we talk about the v. A. , they want to see a standard of service for everybody, and the want see that consistency. At you know that you may been a participant in this investigation, that you were a part of this meeting as is detailed in the situation room, that theym, carried out this ho, this, made it all up, statement of her imagination. To discredit someone. I wouldnt want someone discrediting maggie in that regard, or the chairman, or any of us, or you. So it is with great disappointment that i read all of that. Thank you, mr. Chairman. Senator hassan. Thank you, mr. Chairman, and thank you, and Ranking Member moran for this hearing. Thank you, secretary mcdonough for being here today and also for our recent conversations. And just before i a little bit about what weve covered in this recent conversations i just want to reaffirm that its my understanding that you agree that all americans should be equal before the law. Absolutely. Thank you. What we have been talking about in recent weeks is really a major concern to New Hampshire veterans. Its a condition of our manchester medical center. As you know the manchester v. A. Medical center is 73 years old and Facility Maintenance failures that led to the cancellation of many veterans appointments in just the past few years. I really appreciate you taking the time to walk me and senator shaheen through the plans that you and your team are working on to ensure that these problems can i continue to recur. I know from our conversations that you and i both care a lot about getting these renovations at manchester uptodate and completed. We also talked about the importance of transparency and ensuring that veterans that what is being planned in what they can expect each project them when they can expect each project to be completed. When would you be able to make public a comprehensive plan on projects for the manchester v. A. So veterans will know what to expect . Yeah, thanks very much for the question and thanks for all the work on this. Our goal would be to make something public this summer, summer of 2023. By that i mean july or august. Okay. I appreciate that and i think it will be very important to New Hampshire veterans and her whole community to meet that deadline, if not earlier. I appreciate the das work to complete muchneeded repairs at the manchester v. A. That were caused by flooding when a pipe burst last year. I know your team has been working hard to get these important repairs done as fast as they can. What are the next steps beyond these initial repairs to ensure that the manchester v. A. Is for the renovated to prevent these types of problems in the future course when will the v. A. Start on this work and was expected timeline for completion . All just talk to a couple of things here for the record. One is we need to many of these renovations are complete cuttings of these facilities. We are able to fund those through nonrecurring maintenance projects. We had minor Construction Projects onsite including the new womens, the womens clinic and Specialty Care in addition to we also have a Major Construction issue on the seismic project on campus if the plan is a fully renovate the facility floor by floor so that the facility remains in use during those sequential upgrades. Those renovations include removal and replacement of all obsolete utilities. That includes plumbing, installation of new insulation on exterior walls to prevent the kind of freezing that weve seen. Installation of the windows, installation of new modern heating, air conditioning anddi ventilation systems. Installation of new finishes, and optimize space layout for designed clinical use. Now, heres our approximate schedule. Fall of 2023 the fourth floor operating room and the suites will be completed and returned to use. December 2024, the third for construction will be completed. Spring 2025, the fourth floor construction which will be partially completed, and then spring 2025 the second floor construction will be completed. Winter 2027, the fifth floor construction completed. And thente winter 2026, sixth floor construction completed. The womens clinic is expected toe be posted for an award this summer, and the award is gran the Fourth Quarter of this year. And then for the womens clinic, the award granted in the Fourth Quarter of this year, with the timeline for completion . The timeline for completion, im just looking at to make sure, can i take that when i get back to you just make sure i give you the exact number . Yep. And thats fine. What i escort him trying to commit it is what we have talked about. Exactly. I just dont have the number. Thats okay, but lets get it so we can make it public to people so you all have timeline toto go by. I also just think its important for people to understand that onlys the timeline but with the overall renovations what you all are trying to do is make sure you are repairing this systole to a point where we will not see thesee ongoing failures, whicht really been incredibly disruptive to veterans in New Hampshire. Thankin you. Center quick healing blumenthal. Good afternoon, mr. Secretary,. Hello, senator. The chairman is referring to my leg. I know. I broke into yukon victories parade. I saw that i sent you know. I apologize for my delay in responding. You are very kind, thank you. I want to focus on healthcare for the veterans of connecticut and just say im hoping that plans for continued work on the v. A. Facility in west haven are proceeding and i can touch base with you on that. Count on that. Thank you. I also want to follow up on a letter i sent to your office regarding veterans who were stationed at a base in uzbekistan, known as k2. The veterans clinic has brought a lawsuit on behalf of veterans who were stationed there and who were exposed to soviet era hazardous waste, including uranium, asbestos and chemical weapons. There is ample evidence they were exposed to these toxins but theres also tremendous amount of information, department are stillcords that classified for reasons i dont understand. And so i have written the secretary austin urging him to declassifytt those records. I would simply ask you for your commitment that you will support expanding healthcare to these veterans who were exposed. Youve got that commitment. Thank you. I want to take him a momentk about education benefits. Yes. The next generation of veterans is entering the civilian marketplace is much more dynamic and competitive. As you well know i strongly believe that v. A. Can play a Critical Role in enabling veterans success. As the dad of two veterans who had made use of education benefits, thankfully, programs like the transition assistance program, veterans writing this Deployment Service and the g. I. Bill provide infallible resources to veterans and their families. I believe that the post9 11 g. I. Bill is one of the most powerful tools at a veterans disposal right now. But the educational landscape has changed significantly since president roosevelt signed the law about 80 yearsw ago. In your view how does they be a need to change to meet the needs of these younger veterans . Many of them are of a different mindset, they are exiting the service i want toxi pursue highr education. How does the v. A. Need to change its practices or methods to meet those needs . Yeah, i think the main thing we have to do is we have to make sure that we are meeting veterans they are. Making sure that they understand the full suite of support that is available to them, irrespective of what they want to go study or what skills they want to go develop next. The more we fit that program into their lives, the better case that were able to make to them about the usefulness of these investments. The better informed they will be to make those decisions. Its b on as to make that case e individual veterans. Thank you. I want to offer a sort of personal testimonial to the importance of the pact act. One of my sons has just gone for screening at the urging of his dad. Good. And was extremely impressed by the quality of the questions and the caring and so forth. Great. Thanks. Thank you. Thank you. Senator tillis. Thank you, mr. Chairman, and mr. Secretary, good to see again. Nice to see you. I want to begin by thanking you for the visit to alaska. Appreciated it. Appreciate you getting out alld over the state and hopefully you had a good time. Very much. Hopefully you enjoyed the steak night at the vfw. But i ate fish. I know you did eat fish. Youre a better catholic than i am. But, so i wanted, and i appreciated the broad diversity of meetings that you engage in, and again getting all over the state with me and with senator murkowski, very much appreciated. Up on that follow meeting you had with Valerie Davidson and the alaskan native Tribal Health consortium. This is on the different 26 different reimbursement agreements with the v. A. And these Tribal Health providers. Yes. On january 5, 2021, the proper and reimburse cure for native veterans act was signed into law and requires the prc services to be covered, the purchase preferred care are again a newe. You guys had a d discussion on that. I was part of a lot of that. When you met, it was one the issues youd discuss. Did you guys have come or maybe can you provide the committee a firm date when the Tribal Health providers can expect the agreements to include reimbursements for the prc services . Can i get back to you with that. Was absolutely. I know scott located but its an important issue. Absolutely. Raised every time. I hope we can get the v. A. s support. I thought we had it. This is on the camp lejeune victims act and the lack of any contingency i dont know its taking so long. Weve put forward a bill thats compromised up to 17 caps, the vfw supports it the American Legion supports it, theres a whole host of reasons why the 33 some of my colleagues are suggesting is just too much and i mean, this is literally an example, here is a pot of money, is it going to sikkema reasons and their families or is it going to go to trial lawyers. Okay . I can see how trial lawyers can be helpful on some of this, but not at 33 . We were just on the phone with doj folks who by the way agree with the bill and trying to get biden doj to come out officially for that. Some of them think that 17 is actually too high, but theyre talking about, just today we hurt that some of these law firms are charging 50 contingency fees. Its robbery and Everybody Knows its wrong and the problem the camp le jeune filings is august 2024 so im being ropeadoped, we all know why. The trial lawyers are going to win, sikkema reason and their families are going to lose. So, anyway, your teams been good on this, all the arguments, you need good lawyers, i mean, were going to get good lawyers, youre seeing the ads on tv. These guys arent doing it out of the goodness of their hearts to help the marines, theyre doing it to get rich. Can i get your commitment, mr. Secretary, just in the next week or so and sit down with us, here is where we are, we support the sullivan bill, its reasonable. Compromise up, the American Legion wants this, vfw wants this, one of the Top Priorities and the more you delay, and by the way you guys wanted when we were working on the pac block and blocked by some of my colleagues for reasons we know. And i care deeply about it, its wrong. We all know its wrong. And like i know what a priority this is for you, and but it is for the marines and their families. And im not and the vfw and the American Legion, all veterans. Im not disputing that either. Let me say two things, one, its and you know this because you used to work downtown, too, on the other side. Its hard for me to get in the lane of doj and dod on their requirements. But ill say this, v achltva is you know so, this question of the right number and whether or not there are caps, thats not really our thing, but i can tell you that we use caps. Yeah. Every lawyer uses caps. This is one of the few its the federal claims tort act uses caps. This is one of the few that has no caps and i think its almost exclusively one of the few and its just so, so, i mean, i think you understand this spot im in, which is i have my interagency partners, doj is the lead and its a dod account and i want to make sure im doing my part by them. Doj i think is very for caps, and again, you know, im how would you recommend we try to resolve this . You guys obviously play a role because its veterans and the department of the navy as you mentioned. So its dod and by the way, even the numbers we had from the department of the navy. Just talking to them today, almost none of these are going through the adjudication with the navy. Theyre going to trial. And the reason theyre going to trial is, average claim is 10 million. 10 million. Okay. So, one of the arguments, senator durbin and well, you cant, you wont get good lawyers if its a small contingency fee, just do the math on that. If you take away two million for the whats called the health award. Health care received out of 10 million, thats 8 million. 17 of 8 million 1. 36 million dollars. Thats pretty good pay day for a lawyer. So thats from the navy today. So the navy wants it, doj wants it, i think you guys want it. I just, it kind of sickens me that we cant get progress on this. So maybe, do you have a suggestion on what we would do, seriously, that congress, the committee, those three agencies because this is an injustice. The moneys going to trial lawyers, 50 contingency fees and we heard that today. Some of your guys testified last fall, you know, it was up to 60 , geez louise how greedy can you be . My commitment to you, let me talk to secretary austin or to im sorry, to the attorney general and to the secretary of the navy and let me see if i understand precisely what theyre doing on this. I want to not in Public Session get ahead of them on whatever it is that theyre doing. So okay, mr. Chairman, its an issue. Ranking members. I just kind of baffled that were letting this linger and look, i know why some people want it to linger because august, 2024 is the deadline and then its over. And then the trial lawyers win and the marines get screwed and thats just wrong, totally wrong. Everybody knows it. Everybody knows it. And were not doing a damn thing about it. You guys are going to ropeadope me. Youre going to ropeadope me. Youre not ropeadoping me, youre ropeadoping sick marines and their families and i dont know why were not more urgent about this, all of this. Senator sullivan, youve brought this up in many different forms and i appreciate it, i know you feel passionate about it, but i want to give you a little history so you know. I dont know if youre on this committee, with senator and leadership on this committee and hes the one that started the camp le jeune and start senator tillis took that up along with senator blumenthal and introduced and put it into the pac act. With no caps. We wanted caps on your side. No, no. And nearly every wanted caps every one of these hearings i did not hear anything. I know the truth. About caps, and i was at every one of the clear. I know the truth. Then why dont you agree to my 17 bill right now . Because its my bill and the highway. Senator durbin has a bill. And i moved up from you commit to work with me to get caps. Im all about reasonable fees, but ill tell you Something Else im about, im about choice. And i dont want the federal government telling me who im going to hire for an attorney and i dont think we should be telling marines that and dont give me that. You know thats exactly thats baloney. Dont give me that, you have no idea what youre talking about. No, no, dont give me the high and mighty crap. Im doing high and mighty i want to do for the marines. You know this is a place from compromise. I moved from 10 to 17 already, and thats called compromise. And to have this conversation right now you guys are going to ropeadope this so that the deadline happens and theres no caps. Lets be honest. Do you think having no caps. We could have caps tomorrow if you would come to the table. Thats ridiculous. Ive been working dont give me that, mr. Chairman. Were going to move on. This is a dereliction of duty on your part right now and it burns me up. I love your claims, but back them up with facts. Yeah, i have all the facts in the world. You make them up. You guys made sure there was no caps, thats what happened. Thats total baloney. Then agree to my bill. Total baloney. Theres bills out there supported by the vsos that will get cap. Vso support my bill. And support durbins bill, too. And by the way, this is an issue that needs to be taken up by durbins committee. It the jurisdiction this have committee. No, it isnt. Its a jurisdiction where did the camp le jeune act come from. It came from here. Right. But when youre talking legal issues, it automatically goes come on, mr. Chairman, youre stumbling over your words. You need to fix it. You committed in front of the when the vsos, the American Legion and when all the veterans were here in front of this committee, 500, and i asked you to work with this on me and they all cheered, they want it, they support my bill. They support durbins bill, too. Why would and that why would they support a bill that takes 20 more of a chunk out of their awards that theyve earned . They do. Well, i wish youd commit right now to work with me on this. Its pretty hard to work with somebody who cares about marines and families. Making up political issues. Im not making a political issue at all. Im trying to put caps on awards which is what every federal bill in the country that we pass has. I think this is one of the few that has no caps. And it can happen, it can happen. All right. Im ready to work. Thank you. Thank you, mr. Mcdonough i would appreciate your testimony and answer and i would ask there are other questions by the members. Committee make sure to respond to them in a timely manner that concludes our first panel and well part with the second panel now, interestingly enough were going to hear the second panel well hear from vsos, each year the independent budget hears promises we need for those who serve our nation and ive said many Times Congress needs to take cues from the veterans and look forward to your thoughts on this year budget proposal. First i want to introduce morgan brown, National Legislative better of paralyzed veterans of america and shane leerman, deputy National Legislative of disabled veterans. Patrick murphy, director of the National Legislative services, veterans of foreign wars. And provide an Opening Statement, one joint statement before you begin, gentlemen, i want to say we have a nomination hearing coming up on deputy secretary for the va, tania bradsher. That hearing may 31st, and i would encourage all the members of this committee to meet with her and visit with her and find out what shes made of. With that i turn it over to the floor to you three gentlemen and whoever wants to start can. Chairman tester, Ranking Member moran and members of the committee on behalf of the independent budget, Veterans Services organizations, i want to thank you for the opportunities to offer our comment on vas budget request for fiscal year 2024 in advanced appropriations for fiscal year 2025. Our recommendation of nearly 140 billion for medical care spending in fiscal year 2024 and 157 billion of advanced appropriations for fiscal year 25 represents our best estimates of the funding va needs to fully and timely deliver all authorized programs, services and benefits to americas veterans. We were encouraged by the administrations proposed budget for the va and believe much of it reflects the needs of health care and benefits for those who serve their families, families, caregivers and survivors. However, missed the mark in a few areas, for example, vas medical and prosthetics and Research Programs to help all veterans and americans, and requested 938 million in fy2024 compared to 980 million recommended by the ib. As you know, the Va Health Care system has faced significant challenges and undergone historic reforms in recent years to improve veterans access to timely and high Quality Health care. While va has received increased funding levels to support the Veterans Health care system, and an increasing number of veterans are seeking va care, the lack of resources for adequate staffing and Facility Improvements are adversely impacting accessibility to care and benefits and must be addressed. We urge congress to honor the promise made to the men and women who served our country by continuing your longstanding bipartisan support of those who have borne the battle. And this concludes our remarks, mr. Leerman will discuss the programs. And 4. 1 billion dollar for. Operation increase of roughly 406 million over the current appropriations level. This includes additional 100 million for overtime. In fiscal year 2022, bba completed over 1. 7 million rating decisions done with mandatory overtime. Vba has completed 1. 1 million decisions in fiscal year, this overtime will greatly enhance production to address increase in claims due to the pac act, the existing pending claims and drive down the backlog. Mr. Chairman, within va call centers, there are approximately 1600 employees. It is estimated that one va claim, one va claim generates eight separate contacts to va call centers. As of may 6th there are over 800,000 pending claims and vas predicting over one million new claims, which means that va could receive over eight million phone calls to the call centers which would significantly strain the existing work force. Therefore, we are recommending 50 million for additional 400va call center employees. In reference to the board of veterans appeals, we recommend approximately 325 million, and increase roughly of 40 million. In fiscal year 2022, the board scheduled over 56,000 hearings, but held only a little over 30,000 hearings. At the beginning of this fiscal year, the board had over 75,000 hearings pending. We recommend an additional 20 veterans law judges. Additional 200fte and other positions to assist in driving down the backlog. The estimated cost is approximately 20 million. Thank you, this concludes my remarks and i return to vfws pat murray. Mr. Chairman, although the asset and infrastructure review process broke down and stalled last year due in part to concerns about assumptions and market assessments, many of vas recommendations for expansion and construction of new health care facilities, as well as repairs and maintenance of existing ones were widely supported. And va Capital Structures the backlog continues to grow faster than va can address them. And the office of construction and Facilities Management more the individual va facilities have the staff to oversee the amount of work necessary to decrease the backlog. And investing in the oversight and completion of these critical project will save va money in the longterm and potentially save lives if done constructly. Must hire additional fte, adding personnel to an office of Strategic Planning and increasing the personal and individual major facilities to oversee local projects is critical to decreasing this backlog. And as stated in previous hearings, va has an infrastructure backlog. And should be requesting at least 10 to 13 billion annually to address this. If we keep underfunding va infrastructure of necessary amounts, in five years, 120 to 150 backlog in projects and the true need for the va, but va request does not match the real need, its only a fraction of the total amount necessary. We urge this committee and Appropriation Committee to look at the actual need for infrastructure and the resources that they need instead of what theyre looking for. Thank you to provide our remarks on these important topics, were prepared to answer any questions that you have. I appreciate all of your testimonies and appreciate for you being here. Start with you, mr. Brown, last month we tried to do a package of bills to do right by veterans, called the Elizabeth Dole veterans improvement act, 2023. Five bills introduced in this committee that we combined and sent out committee and however, many of my colleagues blocked the advancement becoming law. What it did improved home care options for veterans basically would save money in the long run and improve quality of life. It would direct va to study the use of Medicinal Cannabis for treating invisible wounds of war. That doesnt mean the va would be growing cannabis, but the va would find out the impact of cannabis on them. And help native americans achieve ownership of homes. I know pva was a supporter of this legislation. Mr. Brown, can you tell us what further delayed passage of this veterans means for the folks who are part of your organization . Certainly, mr. Chairman. The members of this committee well know that the number of veterans that are going to be needing longterm care is expected to significantly increase over the next decade and its important that va implements policies now to ensure that these veterans can safely age at home and remain active participants in their communities. Unfortunately, vas home and communitybased services are not offered at all Va Health Care facilities, even though theyre desperately needed. The Elizabeth Dole veterans programs improvement act would have ensured programs like veterans directed care, Homemaker Home Health and homebased primary care are available at all va medical injuries. Giving greater number of veterans, catastrophically disabled veterans the ability to receive care in their homes, which is where they would prefer to receive it. It also instructs va to test a program that would provide Home Health Aids for set rance veterans pro siding in communities with Home Health Aids and as you know, thats severely impeding access for veterans as well as many aging americans, to receive needed home care. The ibvsos have been very supportive of efforts like this to help curb the effects of shortages and bolster the direct care work force. Although it was not included in the Elizabeth Dole improvement act. We appreciate your and the Ranking Members commitment to finding a way to raise the cap on the amount that va can pay for the cost of home care. This provision in particular is extremely important to the few hundred veterans whose care is of their Service Connected conditions exceeds the cap and therefore, they must pay out of their pocket, rely on medicaid, or be placed in an institutional setting. Okay, thank you. This question is for all three and ill try to make it quick and you guys are quick on your answers. As you know, Veterans Employment Service agent, handles transition employments and Homeless Veterans programs and this include classes and labor indicated that budget cuts would affect all the programs and lead to reduced services for our veterans and im particularly concerned about Cutting Service to the Homeless Veterans and finding living wage jobs. Please tell us about the cutting of veteran services and if returned to fy22 funding would hurt homeless jobless transitioning veterans . You can start again. Thank you, mr. Chairman. This is going to have a huge impact on dol for a long of region, but specifically its going to hurt their Homeless Veteran Reintegration Program through the department of labor and for veterans. Its estimated that its going to basically take away that potential for up to 5,000 Homeless Veterans for job training, for additional skills and even homeless and those at risk. Were also concerned that it could potentially even have some overlap and some problems with the dol and with tax specifically which would impact hundreds of thousands of veterans being separated from service. Okay, anybody like to add to that . I could add just a little if i would, if i may. The vas annual suicide report noted the largest cohort of veterans dying by suicide are those age 18 to 24 and its important to remember that dol vets is one of the few agencies that engages with this particular group of veterans, either through the tap problem or through employment services, so, these many of these positions have already been impacted by reduced budgeting and cutting them even further could be detrimental to the lives of veterans. One final question, pat. You got to hear the conversation between senator sullivan and myself about two bills and one that he has and one that senator durbin has on caps. Could you let us know . I think your organization supports both bills. Could you tell us know your thoughts . We do, senator, tester. We support putting reasonable caps on any bills that affect camp le jeune justice act. Its similar to our concern about unaccredited claims assistance taking exorbitant amount of money from veterans and reasonable caps put in place and we hope that our supporters in the house and the senate will come to a good compromise to make sure that veterans and specifically in this case, those marines, from years ago, are taken care of. Chairman, thank you. One of the things i think about the pac act that is i appreciate is its attempt at trying to provide some fairness to veterans who separated from service more than 10 years ago, within the last 10 years, excuse me, and what is your view of how well the department is conducting the outreach necessary to get those and really, other veterans . Do we need to be focused on encouraging and assisting, reviewing, asking questions of the va about that effort . Ill go ahead and take that one real quick, senator. For 25 years, ive been a benefits advocate and seen all the different programs that have come into effect over the last 25 years and i would have to say unequivocally, ive never seen an Outreach Campaign like the va is doing now with the pac act ever before in my career, never with when they added additional benefits for Vietnam Veterans and made changes in the 90s and not even in the 2000s. So i think its impressive of what theyve already done and i think that they can do more, but specifically theyve already conducted 1560 pac act awareness events around the country and ive attended several myself and i think that va is then more clap rah tiff collaborative with these than any other Program Since the appeals to modern association act. And when i hear compliments, nothing i look for an answer that theyre failing. Anybody else need to comment on that arena . One of the problems that were experiencing, i understand its a bugetary issue, its one that we raised during the debate about the pact act. Is that we created the Toxic Exposure Fund and its been a bit of a battle from time to time in this committee, but it is it certainly has been, you know, successful in setting aside resources and understand thats important, but for it also has unintentionally created new mandatory scoring for va legislation that previously relied on discretionary funding only. We saw that in fact in the bill that the bill we took to the floor that senator tester just asked mr. Brown about. We need to find a way that gets us in a position in which every other bill is not handicapped by the score of cbo, creating the necessary paygo rules to be complied with. Any thoughts about, i mean, maybe your answer is that we forego paygo, not a solution thats happening these days, but i suggest we need help, without being accused of doing anything harmful to the pact act. I want to be not only not accused, not doing anything harmful to the pact act. I want to find a way to solve this problem so we can move forward with other pieces of legislation that are important to other veterans as well. Any thoughts . Senator moran, im very glad you brought up first skipping paygo, but what we want to do, we received a briefing i believe from cbo and they talked about what we believe, some of the more outrageous things that theyre looking at could come from the Toxic Exposure Fund. I believe it was va police scheduling system was one of the more outlandish examples they used. Thats not what the pact act Toxic Exposure Fund was intended for. We hope that we can clarify that, that we believe will help ease the scoring problem. So, your suggestion is that education of cbo and its scoring information . I think that will be step one. Okay. What was in the law is not va police scheduling system so some clarification on that, i think, would help. Okay, anybody else . I appreciate that answer and the second part of your answer. Because i think this is really person. Its going to be a problem for us, time and time again, if we dont get this scoring issue with cbo is all and im pleased that the vfw and perhaps others are doing some of our work in education as cbo. Thank you. Mr. Brown, i wanted to follow up on your point on raising the cap for noninstitutional extended care services. If you want to contradict me, you may certainly, and i wont be offended by my understanding is that we are working to fulfill the commitment that we made to work to find a solution. 13 billion dollars was the score for that provision. We dont think thats accurate and were trying at this point to get information from the department of Veterans Affairs so that we can go back to cbo to get something much more, which we believe, realistic than what they are currently thinking. So, we are trying to educate the cbo as well. But to do that, we need the help from the department of Veterans Affairs with the information and data and statistics that they have. Am i missing anything . No, sir. It sounds like were in 100 agreement on that. All right. Thank you all. I do want to thank you for being here, and i appreciate what you guys do. How you represent your members and being able to be here. Look, some of you guys have caught in the back room and youre here at every hearing and i appreciate that. We make a promise to those that serve our country to deliver for them and if the vas going to make good on that promise, they have to have resources to do so. I think that both the secretary and you gentlemen have shared valuable insight as we move forward with the appropriations process for 2024. And this includes ensuring the va has resources in the pact act and improved care, and services for veterans of all areas