remote roundtable to ensure that everyone can participate in a meaningful way. first, if you are experiencing conductivity issues, please make sure you or your staff contact our designated technical support so those issues can be resolved immediately. to ensure members and participants can have robust engagement, i ask that participants remotely continue to remain visible, unless they experience conductivity issues or unable to appear on camera. also, i ask that all dissidents remain muted so background noise does not appear hearing when someone else is speaking. given the large number of participants, it will be necessary to have some structure. accordingly, it is my intent moved through title by title with 10 to 20 minutes of discussion. i would also ask that participants raise their hands should they have questions, and i will do my best to alternate. in addition, i ask that members and participants keep their question and conference to a couple of minutes. does any member have a question about procedures for this roundtable? hearing none and seeing on, we will proceed. today, i'm thrilled to welcome our esteemed veterans advocates and veterans service organizations to this virtual roundtable to discuss two critically important matters to our veterans and their families. in-service toxic exposures. when we send servicemembers into harm's way, we made a pact to care for them and pay -- to care for them. they pay for that care when they come home -- to care for them and pay for that care when they come home. veterans have been denied care, citing lack of absolute proof. it places the burden to prove toxic exposure on veterans themselves. every day, more and more veterans speak out about exposure to environmental hazards and other toxic substances during their military service. recently, i'm encouraging toxic exposed veterans to share their experiences. the committee has heard from over 400 veterans in 48 states. these reflections are horrible, and i would like to share some with you now. a navy veteran describe how toxic exposures could overwhelm the senses. he wrote, "you could not escape [the jet fuel]. you could see it, smell it, and taste it." an air force veteran describe his dealings with the v.a., stating, "i continued to be rejected because they say it is impossible to prove that it is service-related. i never worked with chemicals before my service or since. i feel like a nuisance to the v.a. health system." i heard from the widow of an army veteran who said, "no wife should have to bury her 22-year-old husband because of his exposure to unsafe conditions while in service to his country." it is incredibly clear to me that we need to pass legislation now. the speaker has committed to bringing this bill to the floor if we do so, so we need to be prepared to bring the best possible version of this bill to the floor. this bill has gone through the legislative process, including a full committee hearing and markup. this is now the time to bring together stakeholders and committee members to discuss the path forward where there is common ground and where we need to get down to brass tacks. our bipartisan bill will address the gamut of issues affecting toxic exposed veterans' access to ga care and -- trivia care and benefits -- access to v.a. care and benefits. it will open up health care to more than 3.5 million veterans exposed to burn pits and establish a resumption of care for over 23 respiratory illnesses. it is time congress and the american people backup "thank you for your service" with action. toxic exposed veterans have held up their part of the pack. now, it is our turn. we know the true cost of our promise, but we cannot renege on our responsibility to toxic-exposed veterans because of any preconceived sticker shock. over the past 20 years, congress and our country have made the choice to spend trillions on other priorities while sending service members into harm's way at the cost of $6.4 trillion. we know this congress is willing to find money when it wants to. that has been demonstrated by adding $25 billion to the last national defense authorization. so, the question is -- how can we improve this bill to ensure support and passage? i'm interested to hear what my colleagues across the aisle would like to change that would still uphold this sacred promise. when our country goes to war, we do not nickel and dime the department of defense, and we should not do so when it comes to the care of our veterans. i'm grateful to have all of you here for our discussion today. ranking member, i would like to give you the opportunity to add any meaningful remarks. ranking member: thank you, mr. chairman. i want to thank everyone for joining us here today. i'm grateful to each of you for our -- for your commitment to our veterans. your commitment represents understanding the challenges posed by toxic exposure all too well. we discussed those challenges last june. the committee was painfully underprepared to vote on a bill at that point. we were working on a minimum cost information and receive radio silence from the biden administration. we now have some of the information, and it is clear we have more work to do. i appreciate the roundtable as a first step, but given the focus on the act, we will not be able to discuss everything we need to today. for example, we likely will not have the opportunity to discuss the new work the v.a. is doing to better support toxic exposed veterans at this time. v.a. recent actions should inform our work on this issue, not compete with it. and as i have said before, we need to work as partners on a parallel path with each other and the senate to get this done. we have not done that thus far. and our work to support toxic exposure -- exposed veterans has suffered for it. i understand the senate is currently exploring a phased approach to address toxic exposure that would prioritize care for those who need it now. those of us who attended last year's legislative hearing may remember jim price's testimony. jim, combat veteran whose wife tragically passed away from conditions likely linked to toxic exposure. i know many of you worked with lauren and mr. dearly. to quote jim's testimony, "and if it's are great -- "benefits are great, but they mean nothing to someone who is dead because they did not get care." jim put it perfectly. we need to focus on taking action steps now to expand care to those who need it most before it is too late. additionally, we still need to identify a way to pay for toxic exposure legislation. the cbo estimates the act would cost roughly $280 billion in new mandatory spending and 140 $7 billion in new discretionary spending. we do not have hundreds of billions of dollars in offsets laying around. -- and $147 billion in new discretionary spending. i believe we need to preserve offsets for toxic exposure and let the focus be that. i remain committed to find a way to support toxic-exposed veterans in a way that is fiscally responsible for future generations. i believe we can do that. speaking as a veteran myself, i don't think that is too much to ask. veterans are taxpayers, too. we should be mindful of how we spend their money on their behalf. i look forward to seeing where each of your organizations might be on all of these items and, to be honest, in robust discussion we need to have this afternoon about the way to move forward. thank you, mr. chairman, for having this roundtable, and i look forward to this discussion today. with that, i yield back. chair takano: thank you, ranking member. i will now introduce our participants from the veterans advocacy and pso communities. joining us this afternoon is mr. john stuart, veteran advocate. mr. john fields, veterans advocate. ms. rosie lopez torres, executive director, mr. patrick murray, director of national institutes of service to veterans of foreign wars for america, the deputy national legislative director for stable american veterans, consulted for vietnam veterans america, lindsay church, mr. alex mirsky, deputy director of government affairs under warrior project, ms. burge, government relations and communications associate, iraq and afghanistan veterans of america -- ms. birch, legislative associate the american legion, mr. cory titus, director of veterans benefits and reserve affairs military officers, the military officers association, mr. roscoe butler, associate legislative director, and mr. jim vale, national service director of veterans benefits and policy aligned with those associations. in the interest of time and to keep things moving, i would like to begin our discussion and turn to title i of the bill, expansion of health care eligibility. can you share the wounded warrior project's perspective? your sound is still -- >> can you hear me? i want to thank you for holding this roundtable and for inviting us to participate in this discussion on the bill we strongly support. i want to start by acknowledging their work many bills introduced to this congress, and you have put them together to create copper hints of solutions for veterans who were exposed. while there were many necessary provisions in this bill that i know we will be discussing today, which include scientifically more, i have to talk about title i, which would expand permanent health care to all veterans who were exposed during their military service regardless of disability claims. we believe this is critical, not only for veterans already suffering from exposure-related illnesses, but from a preparative standpoint as well. i would like to point out that vietnam veterans have permanent guaranteed access to health care due to exposure to agent orange. current veterans need the same access for the same reasons. if i could, i would like to illustrate the point by briefly telling you the story about a warrior. scott was a marine who deployed twice to afghanistan as a combat engineer and dog handler where he was exposed to burn pits. he spent time with the docs to see if they could still sniff the munition from the burning waste. the burn pits were used as a training area in his case. eventually, he was honorably discharged. he never felt the need to enroll in v.a. medical care or put in a disability claim because he felt that he suffered no significant disabilities. it was not until eight years later in spring 2020 he started experiencing severe abdominal pain and losing weight rapidly, and at that point, he knew something was wrong, try to enroll in his local v.a., but learned he was not eligible since he never filed a claim, and he was beyond the five-year enhanced eligibility period for combat veterans. over the course of the next several months, scott accumulated about $20,000 in medical bills seeking diagnosis and treatment for his condition and it was not until later that year a friend who served with connected him to wounded warrior project. we were able to get him service-connected, not for his toxic exposure, but for other things, and enrolled in v.a. his diagnosis a few months later was terminal pancreatic cancer. understandably, he cannot help but wonder if his cancer would have an operable if it was caught months sooner when he initially tried to enroll. mr. chairman, we believe no veteran who is serving in an area of known exposure should ever be turned away from the v.a. unfortunately scott is not alone. we estimate there are as many as 750,000 veterans currently ineligible for v.a. health care enrollment due to the fact they have been unable to establish service-connected disability within five years of discharge. that's 750,000 veterans who served in areas of known exposure who are now operating without a safety net should they become ill, and we don't think any of them should ever be turned away like scott was. for this reason, we strongly believe that guaranteed access can care for exposed veterans -- and care for exposed veterans is absolutely critical and should be part of any toxic exposure solution from congress. once again, i would like to thank you, mr. chairman and turn it back over to you at this point. chair takano: thank you for that testimony. it was very heart rendering to hear that story. i will now ask the first question under title i. title i is updating the definition of toxic exposure risk activity, the actual language in the bill. it is basically the definition, something that everybody here, minority members, majority members, pso community advocates -- can we live with this toxic exposure and risk activity definition? to me, any activity -- is this a revision that we can support? are there any concerns? is there anybody who cannot support it? that might be an easier way to respond. is there anybody who cannot support this revised definition? yes? go ahead. >> thank you, mr. chairman. does this revised definition also include the dates and locations that are listed in -- i believe it is section 302? chair takano: this revised definition -- no, it does not include dates. that's something we should take note of. we will take that under discussion and keep things moving. mr. vale, you have a comment on title i? mr. vale: thank you, mr. chairman. first off, i want to say with support this legislation. i also want to point out that it is not good policy to overpromise and under deliver. if this is not done correctly, we could run the risk of repeating the sins of the past. a lot of good people -- a lot of good people work at v.a. and their hands are often tied. good legislative intent sometimes ends up with rulemaking that results in unintended consequences. vha is operating at full capacity right now, according to our understanding. when considering the influx of new, eligible veterans this legislation will provide for, it only seems natural that this is too great a burden for vha to bear itself. consequent the, it falls on community care networks to deliver health care to veterans. is this too great a burden for the community care networks to bear? has the full cost to fund this additional demand for health care been considered? this is happening right now. dependence are being turned away from military treatment facilities to the community -- dependents are being turned away. how can they handle more patients such as the veterans eligible under this legislation? are we unintentionally creating a perfect storm, giving somebody a benefit they cannot access? that's really frustrating, so i ask for rephrasing and underfunded mandate. we support the legislation but are concerned about having funding to support it. thank you. chair takano: thank you. we definitely have noted your concerns. let me go on to ranking member bost. ranking member bost: thank you, mr. chairman. this is a question i want to ask everybody that is involved with title i here. would you agree that addressing eligibility for health care should be our first priority? if everybody agrees, i will move on, but if you don't agree, let me know that. that is going to lead to my second question. then would you support a proposal that extends eligibility for care without extending benefits -- without expanding benefits? in other words, to the opening statement that i made, which is there's people that need the care now, so let's move forward with that, provide that at a level that we can and then continue to work toward the longer goal for this bill. anybody disagree with that? >> i just have a comment. my concern is how well-equipped is the v.a. to handle those complex patients coming in with underlying diseases that up until now they are passing off as psychosomatic issues? they are diagnosing people with mental health issues as opposed to these underlying cancers that are killing veterans. i will give you an example -- sergeant wednesday black, who was on jon stewart's show recently -- he died. my biggest concern would be what training would be facilitated to these clinicians? are they trained in occupational medicine? are they trained in epidemiology? there is so much it takes to properly affect these kinds of health issues. that would be my only concern, is i don't want to see what is happening now continue to happen. ranking member bost: that is probably one of the reasons why it is so vitally important to get the input from the v.a., so we know where they are, what they can handle, but also, as i said in the opening statement in our last hearing, while we are doing this, we are doing nothing , and that is not a good place to be. we can chew gum and walk, ok? we can do this and provide for those that have and can be diagnosed and still continue to work on the registration rather than -- you understand what i'm saying? that's the concern here. chair takano: mr. brown, i understand you have a response. mr. brown: representative bost, a question i have would be what about the people who have the terminal cancers and are unable to work? how would the compensation -- i mean, where would it come from? ranking member bost: that's what i'm saying. we can continue to work to try to get that done as quickly as possible, too, but the situation is we do know those that are exposed. we do know those that need the medical treatment that they can receive right now. we can move forward with getting that part out and taken care of and then continue. we do that with legislation every day. that is how we create legislation, quite often. we move forward knowing that we can definitely positively do this, and let's keep working to try to get it better and better and better, but right now, we are not doing anything. mr. brown: is that going to go back to cover earlier veterans from before 9/11 with the known exposures the v.a. has on their website already, or is that solely for the post 9/11 veterans? chair takano: my understanding is that it would address the post-9/11 veterans, not pre-9/11 veterans. it is a system being created now, something being done now. i don't think we have data for pre-9/11 vets. mr. brown: i understand what you're are saying. the v.a. already has the known exposures listed or previous appointments before 9/11. that's what i was wondering, if those would be added into the system. chair takano: they are planning -- that is also in the enclave now -- the conclave now. i do want to keep this moving. next, ms. watkins. go ahead. ms. watkins: i appreciate everyone being here today, and i think everybody wants to do the right thing and make sure that the burn pits particularly of the post 9/11 generation, does not live through the same experience that our vietnam vets who went through agent orange went through who went through years and years of studies and demands on their time to make their case in the v.a. while people died from exposure. we are trying to avoid repeating recent history, and i appreciate everyone being here. i have a part of the bill that we are considering. representative peter mayer and i did the burn pit exposure act just to make it easier and have some presumption when you walk in. obviously, it costs money to treat people who have been exposed to these things. i think we all know deep down that it is part of our responsibility, and i would just note for my colleagues on the others of the aisle who are so worried about the money, all but on of you voted for the $25 billion increase to the defense budget. just to be consistent here, if you are going to be deeply concerned about the spending of money, i would expect the same scrutiny to a bill you passed and voted on in december that we are now giving to helping our veterans. i would just ask rosie, if you could -- just from your experience, you know, i think it is is sometimes hard when you do policy to just -- you sort of lose your ability to understand what this means for human beings. i know your experience through your husband was really powerful when i heard it. talk about his experience of trying to make his case and what it means so that this committee understands what our veterans are going through every day just to get that recognition. ms. torres: well, look -- and thank you so much to everyone for this opportunity. it is years and years. i worked with the v.a. for 23 years, so i sort of understood the red tape we were about to face, but it was years and years of delay on both the department of defense the department of veterans affairs side. we basically went to every health care facility within the system. to prove a point, and then most importantly, to try to get answers, right? i already knew the outcome was going to be even over the work injury center. between that, we had nonprofit organizations filling the gap financially because we had already exhausted our life savings. in my husband's case, it was more of us being forced to find an answer because his employer was getting ready to let him go, right? he was state police in the state of texas, and then they forced him to resign after we finally were able to receive a solid diagnosis from dr. robert miller over at vanderbilt university. prior to that, every answer was just basically a diagnosis of unknown etiology, anxiety. it was very frustrating. we knew that we were not the only family experiencing this hardship, so after you exhaust all your life savings in trying to access care, which we are still sort of there. he was recently hospitalized for the same issues as the gentleman aleks morosky talked about. we don't know if he has pancreatic cancer. it is a possibility. the challenges these families face, aside from trying to access care, is you hear story after story of these survivors' widows spending their last days with their loved one trying to create money statement from their loved ones' brothers and sisters during wartime just to figure out how to put food on the table for their children once their loved ones are gone. we know it is handled on a case-by-case basis, but that is not enough. it is very scary to think about going to the v.a. even their own staff tells us if you have tricare, go on the outside. it will take forever. this is their own staff giving this kind of advice and encouragement. while i know the v.a. is working on things, the reality is that in this community of people impacted, you know, there's neither the presumption nor the health care happening. i know veterans that have walked into appointments and they leave hopeless. i don't know how many people have put a bullet in their head because they are so hopeless at the end of the day. they are losing their homes, their vehicles, their jobs. so much so that -- and i will end with this -- the unjust is behind all of this is leroy's job loss will now be heard before the u.s. supreme court because it is not ok to treat veterans the way they have been treating. so i just encourage from every perspective, we have collected data and there are people in every district coming forward and saying the same thing. thank you. >> thank you, mr. stuart -- thank you, rosie. mr. stewart? >> i want to say as we are talking about funding and getting a different perspective on what the reality of this should be. they have to decide if there are -- in what is generally seen as the community as an adversarial process that can tie the exposure in iraq and afghanistan to the conditions they are suffering now. there should really only be one job. how do we implement first rate toxic exposure health care for the iraq and afghanistan veterans so they can receive, in the way that things have gotten better with traumatic brain injury, if you went down years ago, amputees and now it is world-class surgeries, world-class prosthetics, and riveted -- and rehabilitation. but it took attention and money and we have to establish that for the veterans of iraq and afghanistan because the cost 15 years later, and yet burden of proof and scrutiny is always on the veteran. so when we talk about wanting to get them to health care now, access to a system that does not understand toxic exposure does not help anyone. there is a burn pit center for excellence at the v.a.. the funding is $6 million to $7 million year. 15 years after the dod knew this storm was coming. they spend $90 million a year on viagra, just to give you perspective. if a budget is a list of your priorities, i think this shows where everything stands. the v.a. is afraid of being overwhelmed. and all the conversations we should be having -- the only conversation we should be having is a collaborative effort to bring the v.a. together and create first-rate toxic exposure health care, not benefits later because if you are sick with pancreatic cancer not having your benefit, what are you living on? so the idea we have to split everything up and create more bureaucratic processes is unacceptable. the bottom line is our country exposed our veterans to poison for years, and we knew about it, and we did not act with urgency and appropriateness. therefore, we have lost men and women who served this country. they have died from our inaction . so i just want to step back for a second and don't worry so much about the protocol and things like that. let's not lose the big picture. i know everyone wants to do the right thing and it is appreciated, but i do not want to get lost in the sauce. >> thank you, jon. i have in line some following members. i will take one more question for title i and keep others in the queue for the discussion. we can go back to title i, but we have to keep this moving. ms. miller makes, you have an opportunity to make a comment. >> thank you. this question comes from a 24 year military veteran who spent his entire life in a v.a. facility after his ship went down in world war ii. and i have a friend who developed cardiomyopathy after desert storm. my concern is this. there is a tremendous health care surge -- health care shortage. i know we are going to be voting on a bill that might alleviate that but there are personnel shortages and specialist shortages. i think it is a valid point to bring up, and i think it was mentioned, saying someone has a benefit does not get them health care. it only gets them a benefit. so is there a possibility, and could we envision a phased-in approach to health care access for toxic exposed veterans as we continue to determine the science on whether the exposure is related to organic problems or disease? that's it. >> thank you. let's move on to title to -- titled two. for this discussion on title two , mr. murray, you are recognized to begin the discussion. >> good afternoon. thank you, chairman to condo -- chairman takano on this opportunity. we are confident that with this many people pulling in the direction, we can accomplish the goal. there is getting -- there is difficulty forgetting care. military service is synonymous with toxic exposure. for decades, and around the world. the burden of proof has been put on the veteran for decades and it is far past time to change that. the process is updating how presumptive's are updated -- presumptive's are granted. we are encouraged about updating the process and hope the result is something we are in favor of but there are concerns about details in the pilot program. we have to keep lines of communication with the v.a. open in order to achieve success. the point of the program is to hammer out what works and what doesn't and hopefully produce a great product. the next step is trying to find what works. the vfw has supported many pieces of legislation and there are parts of other bills that we think would get the job done right. the team proposes an independent commission outside the v.a.. we have seen time and time again that v.a. secretaries have failed to solve the problem and that belief is there should be an independent body in the process. we believe there should not only be internal boards. a comment on -- a combination of both is best. proposing a timeline for officially declining or accepting is critical because for far too long, studies have waited for decisions for years while veterans get sick and die. we might have differing opinions on how the end product should look but we can agree that the current process is broken and does not help veterans. we need to do something to fix it and we are all here to make it happen. thank you. chairman takano: thank you, mr. murray, for your comment. v.a. suggests the proposed approach to the presumption process would add more complexity to the process and further delay answers veterans seek. they request we strike this framework but the v.a. has developed their own framework for presumptions. there is nothing to prevent this or the next secretary from changing or eliminating it. by putting requirements of law we ensure the framework remains in place for future exposures. does everyone agree? if not, why not? i would like feedback at this point on title two and putting framework into law. >> the assertion that this would delay it further is wrong. toxic exposure is not getting done at all so this will not delay it. you cannot delay something that is not being done. this would put it into law. the v.a. presumptive process is different. what they did in rolling out a pilot without bringing in everyone ahead of time is not the best way. we would prefer to get brought into format so then we do not waste time and have to go back. i do not think we would delay it. we have to do something to make it speedy. secretary mcdonough said there is a perceived level of denial. they are denying about 80%. it is a reality. we have to get it turned around. whatever we can do to get something on the books, that is what needs to happen. >> we appreciate the fact the v.a. is doing a pilot program to have a framework. we believe framework is necessary but will have to be codified in any event. chairman takano: go ahead, mr. butler. >> i have a comment regarding title i. i agree it is important that we do not put benefits and health care -- but something needs to be done immediately because benefits are not being given to the veterans. it should not be whether we have the resources to provide care of service. it should be, what is the right way to provide the benefits they deserve today and move forward in ensuring, i like the prevention in title i that provides for a report on whether v.a. has the resources necessary to meet the needs and if not, to provide a report to congress on what it is. that allows the framework for v.a. to get the resources needed to provide a full continuum of health care benefits to veterans but we should not delay it to put one benefit at odds with the other. chairman takano: thank you, mr. butler. we need to move on. >> as we are trying to work through this, i need to know what the scientific standard is that congress should put in place to establish the new presumptions of exposure. and then, do you believe the v.a. pilot program will establish the presumptions of exposure will increase transparency and improve the process with what we are doing now with the pilot program? >> the scientific standard of association, not causation, was a sticking point. the v.a. has gone back and revised it. more transparency, we hope so. as we saw, it was difficult to explain a presumptive process. how do we explain it to the members who do not do this every day? they feel like they are going against and adversarial process. we want there is transparency and easy to understand and get veterans the care they need. >> i agree with what has been said so far but we need to remove the burden of proof from veterans. it took me seven years to get my disability approved for toxic exposure. it will take -- eight took six emergency room trips on thousands of dollars. and during those years, the nodule in my long doubled in -- in my lung doubled in size and now i need screenings for cancer. we need to remember that for all of the veterans that are dying, we have some that are just finding out they have been exposed and we have future veterans that do not know that it will be their future. we have to look at the vietnam veterans and what the presumptions are because there are similarities but we need to bring in a panel of doctors with some of the top pulmonologist in the world. set them down and take a look at some of the cases and decide what the top presumptions will be so that we can stop removing the burden of proof. i have to be my own lawyer, advocate, medical advisor, put everything together in an organized way and submit it to the v.a. in hopes they will approve it. i was part of the 20% but 80% of us are not getting the care. >> i can show you 20 to 30 years worth of reports that those from the gulf worm -- the gulf war -- the v.a. has never [indiscernible] and they are the ones who contracted to do the studies and there are hundreds of conditions like that but none of them have ever been added as a presumptive under the v.a. chairman takano: thank you. mr. levin, go ahead. >> thank you for convening the roundtable. my question is for pat murray and john stuart. -- jon stewart. it seems obvious that everyone wants to do the right thing, but nobody wants to pay for. what message does it send to our service members and veterans if we dismiss the comprehensive reform we need because of the cost of what is doing so obviously the right thing? what do you think this says about our values as a nation? >> i think the pay for all of this was our plane ticket overseas. that is what paid for the care and benefits. there are plenty of people who raise their right hand to do what it is and there is no consideration about what taxes will be used for it 20 years from now. and it is completely unacceptable. the cost of war is this. this is a continuation of it. this is critical to put together the total cost of being in the mirror to -- the total cost of being in the military. >> we are a country that loves its veterans. we support the troops and we put on our flag pins and we stand and they get discounts at denny's. but the true support of having their backs is when they need it and when they are sick and dying due to the service they gave to this country and they come back and are put under scrutiny and are made to beat defendants in cases about their own health care. it is unacceptable and it is the lowest hanging fruit of a functioning society. so much of this is just pure common sense and if we could just stand back for a moment outside the bureaucratic impact of all of this and stop thinking about the process, i would challenge every congressional leader in this call, go back to your district and dig a 10 acre pit and put everything in that pit and burn it and put in hazardous materials. the smoking gun in this case is literally smoking guns. burn the pit 24 hours a day, seven days a week. but tell your constituents, don't worry, 15 years from now we will convene a panel to discuss whether or not the health issues you are having are in your head or not. and we will make you get a lawyer to prove it. we have all of these diseases lined up. ground zero in manhattan was a burn pit. the men and women who sat in that pile and dug through it suffered the same illnesses and diseases we are seeing now. we have created programs and and act administered by the department of justice that is effective, targeted, deals with prevention and scrutiny and health care. you do not need to reinvent the wheel. we should not have blinders on to this idea that this process and these diseases, we have not been allowed to use burn pits in the u.s. since the 1970's. the eta has already gone through the list of immune issues and pulmonary issues and cancers. why are we really litigating this when thousands of veterans, their lives depend on the urgencies -- on the urgency of your actions? so that is my thought. >> thank you. chairman takano: we need to move on. i would ask mr. lee are meant to be the last comment on title two. >> thank you. i think the thing to point out in reference to presumption on codifying and waiting for v.a. and saying v.a. takes too long, there are many examples. look at the agent orange in vietnam veterans. it took an act of congress because v.a. did not get it done. so any process forward -- going forward must be transparent and should be codified so we are protected from administrations who will not take action in the future. chairman takano: thank you. we will move on to title iii. thank you for the discussion. mr. leirmann, you are going to lead our discussion on title iii. >> thank you. title iii establishes a presumption of exposure, also known as a concession of exposure. this means v.a. will concede exposures as identified and determined by v.a. secretary to include roughly 50 different toxins and 17 countries as related to burn pit exposure. these were already identified by the u.s. army and v.a. currently recognizes the toxins. so by establishing the concession of exposure, we are removing the burden of proof on veterans. they do not have to prove what they were exposed to. this concession of exposure will concede that they were there and this is what they were exposed to. right now 78% are denied and this could help change it by conceding that yes, they were exposed, and it will also require v.a. to provide the medical opinion and an exam if there is not medical -- if there is not sufficient medical evidence. let's say we have presumptive diseases but a veteran has one that isn't on the list. this will help them get direct service connection. so this is a huge part of the bill. you are giving veterans a fighting chance, whether there is a presumptive disease, list, and it is removing obstacles for them to get what they need and they do not have to prove exposure. i am disappointed to hear that the health care in title i, the proposal would exclude the veterans listed under title iii, those exposed to burn pits from the first persian gulf and post 9/11 to now. these are veterans who in many cases no longer have the five-year access and health care so i think that amendment misses the mark. this will not catch everyone, even the entire post 9/11 generation. i do not think we should put our eggs in that basket. and finally on how to pay for it , why do veterans have to pay for their own benefits? why do we have to cut programs for one group of veterans to pay for this other group to get benefits? we do not have to come up we choose to. it is a self-imposed rule. we can change it. we do not believe that the cut should apply to veterans benefits. thank you. chairman takano: thank you. i want to go straight to my question for title iii. when it comes to improving, at the v.a. states the use of eiler is premature. is this a valid reason for not codifying the use of this time? wouldn't we want the intent of use firmly established? if there is feedback to this question, please. >> to address that, i think eiler has potential going forward but it is not complete. if we codify it too soon, v.a. might say the exposure is not in eiler so you were not exposed. we want to make sure we do not get to that point. codifying it now for the future, there's nothing wrong with that. but we do not just want to go down the path that if it is not in eiler, it didn't happen. because we all know there are 60 years of toxic exposures that will never show up. we do not want to limit veterans by relying solely on eiler. chairman takano: i hear you. >> what is the most effective way to determine if those exposed to toxins at a specific location? what would be the criteria set? >> ranking member, we have gone through this round and around. there are still people who have been exposed in thailand, cambodia, guam. exposure is synonymous with service. people in hawaii right now are drinking gasoline. and were not even talking about that. this is domestic exposure, as well. military service is what we are looking towards as synonymous with exposure. >> outside of the individual servicemember having monitors and measuring everything they are breathing and doing over there, there is no way to truly track the exposure dose and experience -- exposure dose someone has. that is a problem earlier generations faced. they do not have the measurements to keep track so therefore the v.a. doesn't think they were exposed and it takes so long for them to finally get around to saying they might have , like seven years later after desert storm when the dod sent out letters about chemical exposure and by that time most people were already sick. then they are trying to get claims approved and the v.a. is looking at them like there was nothing there. >> let me just say this. i'm trying to work with everyone on this panel to understand that. but what you just said is if you serve, you automatically get it, regardless of where you are at, what you were exposed to. that changes the whole process of what we are trying to work on here because we are trying to get something that will pass in congress. that means there have to be guidelines set forth. i might totally agree with you, but trying to get a majority of my colleagues to do the same is beating a dead horse if we do not come up with criteria. that is the standard that has been there. if it is going to be that if you joined the military, no matter what, you automatically get the benefits, that is something we can look at, but i do not know how you will get that through. >> i understand the difficulty. what i just outlined is basically everyone, everywhere, at all times. but we are trying to get it focused where it is needed the most. but frankly, there are other things we are not talking about. we are focusing on burn pits and those at weapons dumps. what i am trying to identify is that this is a pervasive problem throughout the military so while it seems adversarial at v.a., it should not be. it should be a given that if someone comes in and says, i was exposed, the reply is, you bet you were. >> looking at the national academy of sciences studies in which they say, we cannot draw a conclusion about exposure to burn pits and conditions we are seeing, even within the studies what they really say is we have insufficient data. a lot of the problem is pentagon at dod do not have the sufficient data and the pot -- and the time has passed. so is there no way -- so there is no way to create a cohort study. with 9/11 we got fortunate in that the v.a. had a cohort study they had been doing prior to 9/11 so they had a perfect lineup of the date of exposure versus pre-data. by pentagon's own admission, the data they have is insufficient and will never be sufficient. so what we are doing is holding up the health care and benefits for veterans based on data that the pentagon has not been able to provide. and it will never get better. so i think that is the catch-22 we have placed the veterans in. because now they are forced to go and prove their own case. even if you smoked for 20 years and you got lung cancer and a doctor and medical board tried to make you prove that your lung cancer came from smoking, someone could always come in and say, you lived in the city and breathed smog. we have to start living by the code of the v.a., which is the veteran gets the benefit of the doubt. it is not causation, it is not even correlation. so i think that is the issue we get into as we try to define it, which is why all that the esso's are talking about presumption being the one thing that should lift the burden of proof. because the data does not actually exist. chairman takano: thank you. mr. drone, quickly. >> thank you. i think the veteran gets the benefit hits the nail on the head, end of story. thank you for including the presumptions act in the bill to move this process forward. some points of business, we always took care of our people and i sit on this committee and the veterans appropriations committee where this is going. we know how crucial it is to take care of our people. our people are our veterans. so i love -- i would love to hear from mr. stewart on the human cost of not getting the legislation done. that is the cost. every day there is the human cost of not getting it done. and secondly, is 18 months enough time for the v.a. to implement? we got a covid vaccine and less. can we do it in less? i think we should. lives are at stake every day. >> i think we need to look at it as a national security issue. when you see how easily things go through and the money being spent, i think our veterans need to know that when they come home, they will not be discarded. one veteran who served in iraq and afghanistan said to me, if another country was doing to our veterans what we are doing to our veterans, we would be at war. it is a chilling statement from someone who is boots on the ground and afghanistan. a young man who has seen a lot of colleagues get sick and die and a government that seems inactive, uncaring, and unmoving. as far as the amount of time for implementation, that should be the entire conversation here. the entire conversation should be, how do we implement first-class toxic exposure health care and prevention and benefits for those who have served? end of survey -- end of story. we can simplify this if we just keep our eyes on the larger picture. sergeant winston black said in a heartbreaking way, it is too late for me but i am going to spend my time on earth advocating for others so that what happened to me does not happen to my brothers and sisters and so when i meet my maker, i can stand proud. and just a little while ago, he passed away. we are losing the battle for the hearts and minds of our own veteran community. it is unacceptable for a country who speaks so highly of their veteran community and purports to love them so much. and here's the crazy part. it is so doable. and it is so within reach with intention and collaboration. that is what is missing. the v.a. should be separate from this process. but the v.a. should be doing is coming to congress and saying, here are the weak spots in our health care system and here is how we think we can bolster it. here are the resources we need to do it. let's move forward together. it can be done. chairman takano: thank you. >> every day is too late for one more mom or one more dad. we need to trust our veterans. they trusted us when they went to war for us. thank you. chairman takano: thank you. >> i tell you from my personal experience, i am part of the burn pit community. i lived in iraq and i feel like i am a ticking time bomb. i have already seen friends who have brain cancer and rare cancers. we are all getting it. i feel scared every time i go for a check eight that something -- a checkup that something will be found. no one told me anything when i got sent to iraq in 2005. i was told, get on a plane and do what the country asks of you and we will take care of you when you come home. this country gave a tax cut to the richest people in this country. so if you are wondering how to pay for this, why don't you really look at those tax cuts. there is plenty of money. there was plenty of money for us when we cut taxes under trump, under obama, under george bush jr., and there is plenty of money to take care of veterans if it was prioritized. i want to point out, we will end up doing it anyway. it's the same thing that happened with agent orange. but we ended up taking care of people at the end of the lives when it was more expensive. if we did it on the front end, we could catch the disease early and manage it. because in the end, congress is going to give in. but it might be five years from now and it will end up costing more. it makes no sense. if we seem to be able to borrow for tax cuts, we can borrow for this. thank you. chairman takano: thank you. one final word on this title. >> good afternoon. the legion is grateful for your commitment. i am a legislative associate at the american legion and i served as a marine from 2005 two 2010. i have witnessed burn pits in close proximity to where the troops slept and lived and fought. the recent passage of the blue water navy act was a result of years of advocacy and came decades after exposure for the veteran. veterans are coming home with illnesses and conditions caused by toxins. that is a fact. we have to act now. we keep talking about the costs. like others said, no one asked about the cost when we started the war. it has to be counted as part of the cost of war. the v.a. has to be reactionary. they have not always been at the forefront. they wait for a certain number of veterans to pass away from a certain exposure and when the number reaches a certain amount, that may act. -- then they act. they are not being proactive. and we hope together we can pass this comprehensive legislation that will allow to establish presumptions of exposure by creating a framework for transparency the v.a. can use to establish additional presumptive illnesses in the future. we cannot keep legislating one illness at a time. thank you. chairman takano: i will move on to the next title. it will be led by or the opening of the discussion will be led by ms. roach. -- birch. >> thank you. i have a toxic exposure disability. this issue is very important to me. the presumption piece is no less critical than the other components. this lifts the burden on the veteran from proving their illness. presumptions help with preventative care in that it establishes better preventative care and what doctors can look for, which helps catch problems in the early stages, not only then saving a life but saving money in the long run. the war is not just on the battlefield. these impacts will become more visible as time goes on, as it has for every other war. there is a battle to be fought to ensure that those who volunteered to serve the country are taken care of, no matter the cost. it puts the veteran at the forefront. we were a blank check to our nation. we are not asking for the same in return, but only what is owed to us, care for the injuries sustained while in service, visible and invisible. the time to act is now for the sake of current and future veterans. cost was not a driver when congress and the white house went to war so they should not shy away for paying what was incurred. chairman takano: thank you, ms. burch. mr. lamb and mr. louise, you are in q after -- in queue after me. my first question, let me preface it. the v.a. does not support our agent orange presumption, stating the expansions are inconsistent with dod. to those present here agree with that assessment? >> no. >> no. the evidence records i show that the title showed several agent orange explosions -- exposures. we do not agree with v.a., either. chairman takano: thank you. i saw mr. brown shake his head. >> correct. the partner we work with in analyzing legislation, we strongly agree and support the expansion to cover veterans in that section of this legislation. chairman takano: thank you. go ahead, ranking member bost. >> how can the v.a. expand research on the health effects of burn pit exposure? do we just automatically put into the title these and then say do not expand it anymore? or are we still looking? as we tried to get this passed, we have to make sure we have answers and just writing a check is maybe something we might agree on this panel, but we have to get it through everybody else . chairman takano: who else wants to comment? >> v.a. can accept science outside their own evidence. it is even written in four asian orange exposure and certain illnesses. so looking at other places is a first rate step and then finding a way to do some comprehensive studies on those who were exposed so we can add potentially more in the future if needed beyond what we have. the v.a. already has the authority to look outside the national academies, they just need to exercise it. chairman takano: ms. torres, i saw your comment in the chat about the 9/11 model being a good model to look at. i want to clarify, in addition to other qualifications, it would apply concession to airborne hazards and access to health care based on locations. does anyone else want to briefly respond to ranking member bost? if i hear you correctly, you are concerned that maybe these presumptions are without rhyme or reason and arbitrary. i do not think that is the case. >> i did not mean it that way. but as we are moving forward, we put these down, and then what standard we use for research? if we are not going down the path that automatically when enlisted from here on out you were covered and assuming everyone is exposed, what criteria do we use? how do we encourage the v.a. to use it? we do not want to go down the path of blue water navy or agent orange. i disagree that it saves money by doing it earlier. with blue water navy it wouldn't have saved money because they waited until two thirds of them died off to provide the benefit. that is not the way we want to do it, either. chairman takano: ok, mr. bost, if someone else could chime in, what i recall is the most relevant respiratory illnesses had more presumptions. the rare cancers because they are rare and happening in very young people, they are not as prevalent by definition. i want to move on to mr. lamb. go ahead. >> thank you. i want to say one thing based on experience in this committee and i was hoping our witness from the v.a. could respond. i represent a large chapter of vietnam veterans in america and focus on agent orange. i was shocked that we are still trying to establish presumptions almost 60 years after exposure to place. the post 9/11 veteran community that has grown and represented on this call, just like other veterans groups, are never going to give up on this issue. i want to make sure everyone understands that, those who voiced concerns about cost and pace. everyone keeps fighting for these people, and some have passed away and that will make other people fight harder. it will make the community work harder and harder to establish presumptions. they are not giving up. so this discussion about how and when and the pace, it's a little academic. it is happening. the american public supports it. eventually, they got it for agent orange. it makes sense to act in the whole purpose of a presumption is saying that there was this toxicity and it ties to the veteran. mr. brown, i do not know if anyone has ever done a study or a calculation of all that was lost in the time the vietnam veterans were waiting for benefits for hypertension and hypothyroid and the different things you have had to fight for, bladder cancer. but if you could fill us in on the cost of waiting so the committee understands how stupid it is to try to punch this down the field. >> the cost of waiting, how do you put a cost on a life? someone who served this country is diane from rare cancers, from exposures that they were exposed to under deployment. i do not know how you put a cost on a life for people that the government sent into harm's way to start with. i cannot begin to understand that concept or to see how you can properly put a cost on an individual's life. what i can tell you is that v.a., for the past 15 years, their own research has shown significant increases in hypertension among herbicide exposed veterans, even giving the existing framework for adding those presumption conditions, and they failed to do so. this should serve as a powerful cautionary tale to the opponents for creating a new one-size-fits-all framework. it leaves v.a. in the driver's seat. in this legislation, we >> thank you mr. brown. i would like to think -- the vietnam veterans of america chapter in my area. dr. louisa, i'm sure you've asked on this topic. >> think you mr. chairman, thank you to all the veterans out there. to your strong leadership. this is an important title we need to discuss. this is across the soul of the bill. it is based on a bill that you all worked together to produce. it is the presumptive benefits for veterans exposed to toxins act, a bipartisan a bicameral bill that originated from our veteran communities. we are moving it forward, it is now title iv of this important bill. it is the sole of honoring -- the vital organ that keeps this patient alive in order to ensure we get the care and benefits that the veterans need. and their widowed spouses, who are relying on this. it is the heart that addresses the family as well. i just want to review some of the excuses i've been hearing over and over. first, wait a minute, we need to do more research on that. it goes back to the original excuse there's not enough i of the bins. i've said over and over, clarifying this misinformation. there is enough evidence to suggest that toxic smoke can produce illnesses in the lungs and cancers and autoimmune diseases. carcinogens cause cancer. toxic smoke contains cancer. they've identified carcinogens in the soil, exposed veterans develop cancer, it is very straightforward. there's enough evidence extrapolating from firefighters who were exposed to jet fuel that was burned. there is enough evidence in our own u.s. environmental research that prevents burns from being conducted in our backyards or industries in the united states. there is enough evidence with a high enough suspicion that these are causing these onus is. we don't have to go beyond the scientific papers. we can just listen to our veterans and our veteran's widows who are out over and over again who say they have no other risk factors. they are absolutely healthy. now they are dying or dead from these different illnesses. the other excuse has been, this will be too much of a strain for the institution. these are unfunded mandates and we don't know how the institutions are going to handle it. it is our responsibility. we must do that for our veterans. that institution argument is from individuals who put the institution first. i am telling you, we must put our veterans first. we must give our veterans, the veteran centric and veteran focused. we must take care of our veterans like our emergency department. the other excuse it costs too much. that is a value statement. i don't know about you, my value is to put people first. our veterans are taking care of my value instead of getting tax breaks to the tunes of millions and millions. is to give the veterans the care that they need, because they need it right now. the other excuses that the pace is too fast. this is ridiculous. as the widows of our veterans, if we are moving too fast. ask folks like libre and others who are suffering from constrictive bronchiolitis, who are oxygen dependent and unable to care for their family, or others. if we are moving too fast. when i and veterans here at that the pace is too fast, what they are hearing is that they want to delay until dead. just like what happened when agent orange and are vietnam veterans. since i been hearing about this a beginning real-time feedback from the veterans in my district. a veteran answer the call to duty, while serving in south iraq, he breathe didn't talk the fumes, particular matter and carcinogens. other military items that were disposed of. when he returned home, he noticed his breathing in the fumes had caused a toll on his body. he was later diagnosed with an aggressive form of testicular cancer. despite his doctorate's belief that -- doctorate's belief that this would lead to a claim, the v8 denied his claim. i have one tells me her ex-husband is still having constant coughing, chronic coughing illnesses after being deployed in the middle east. ms. burke, have you heard from members of your organization that have been diagnosed with cancer that their doctors believe was due to exposure, and their claims were denied by the v8? -- v.a.? >> yes we heard thousands of thousands of veterans, their player veterans getting denied benefits that have rare cancer. i am 34, i look healthy. i got all kinds of health issues. they push you to the side and say you cannot have cancer, you are young, you're healthy. they find out later, he did have cancer. -- he did have cancer. now it is stage iv, with luck. >> sadly this is a common theme throughout our veteran's stories. what we need is to end the excuses, to take care of our veterans. making sure the presumptive benefits is maintained. for those of you who think this is the way we are going to save costs, by illuminating some of the cancers or pulmonary illnesses in this list, i have news for you, you will not attempt this without resistance or fight. this is what is going to save lives. this is what is going to bring justice to the widows were currently suffering trying to raise their family. >> thank you. last word on the section to. thank you for clarifying this issue about the rare cancers. the presumptions are being dealt with by the v.a.. are you still with us? did he go. >> he might have had to run out to do some 9/11 business. to drive home his point, i'm going to give you the worst case scenario. the worst case presumption is this. but somewhere along the line, the v-8 will pay the health cost and benefit for someone -- for their colon cancer and turns out their colon cancer wasn't necessarily caused by burn pit. that is the worst case scenario. in terms of presumption. the v.a. in this body have to remove their blinders. the evidence on the carcinogens that are in the smoke is overwhelming. in medical papers outside of the national academy. it all exists. the 9/11 health and compensation program exists as well. one that is appropriate they could easily be followed. if the well was there. it works, it is effective, it honors the taxpayers, it is not wasteful or fraudulent. if you are looking for a responsible program that can help finally address the topic -- toxic exposures issues, it is there. >> thank you. ivan -- now going to move on to title v. i want to thank you all for the discussion on title for. -- title iv. >> thank you, chairman. ranking member and members of the may 2 take the time to listen to us here. the authorized the v.a. to conduct scientific research, military center regions with airborne toxins. it is critical for the v.a. to determine how -- illnesses that have yet to be identified a the v.a. at this time. the v.a. will -- establish a strategic plan to ensure the research is collaborative, transparent and coordinated with oversight. the point i want to make, the v.a. has a reputation of being reactionary. when trying to provide care for veterans in the past, we cannot let -- wait for another 40 years for this generation of war-torn veterans to receive their health care. transform the v.a. so they can transform toxic exposures in the future, being proactive. this research is what allows them to determine what common illnesses are affecting veterans today. what common cancers are post 9/11 veterans going to get intend years, in 15 years. this statement laying to cancers determined to be positively identified with toxic exposure veterans. we have to think about families and dependents of veterans. the main goal of this section is to allow v.a. to have that crown jewel of research they have, this section is what allows them to do that. thank you so much. >> thank you. again was my question, under title v, the v.a. requests we strike the health care studied, stating that no science or evidence has been found that connects adverse health effects, with eight an individual in utero with exposure. is this a site we are pursuing on behalf of our dependence? >> yes. >> i'm not -- i'm going to move on to ranking member bosc. >> thank you mr. chairman. i want to expand on this. this is directed toward you. i think you mentioned it in your opening, do you believe v.a. has been aggressive enough to pursue the research regarding the health effects of toxic orders? >> ranking member, it is my personal -- while the v.a. has made attempts, the american legion believes the efforts could be more. there could be more efforts to be more collaborative with the bso community including -- vso community, including the pilot program, it would've been appreciated. those within the vcs out communities, we note their partner. we have to work with them. i don't want to come off as being disrespectful or rude. we do believe their efforts could be more collaborative and transparent. >> i think many members believe the -- sat that, too. >> one thing, not coming down too hard on the v.a. but thinking outside the box, at the v.a., we constantly talk about how overworked they are. what about working in the community. how many medical -- eager medical students that want to research, want to get their hands into these things. why can't i work with local medical schools, national jewish health, johns hopkins, the list goes on. and work together with the v.a. to remove some of that burden on the v.a. in hopes that the research can come off quicker that the research is now backing up the health care needs of veterans, making sure they are being taken care of. one other point is that i keep hearing you say, what do we do? veterans though right after jury's even -- active-duty service, is going to be harder to get to them. one idea in my head, when i was getting at is billed to -- i was getting out of the military, have questions to ask. everything is that they do x-rays. i had an x-ray of my chest because i had been exposed in prior coughing and so forth. i had this nodule at no idea i was there, next thing i know i'm getting scans in this. many veterans are getting out of the military without of that -- without any of that screening. because i did, they got me disability. some don't start showing symptoms until afterwards. if they had that screening, it wouldn't be getting denied for benefits. why don't we lay the framework for this preventative screening that helps some of the veterans now instead of retroactively. >> i yield back. >> thank you. >> thank you mr. chairman, the v.a. would say it more needs to be done as far as research. it is not exactly -- the research to support more benefits. these presumptive's are crucial, you will have all the time of. you look at the age of our vietnam vets and the poor health therein, they don't have time to fight an appeal to in their claim. we just one, in thailand, settlement, we've been fighting this for 25 years. it kept denying it, our vets don't have time to go through the board. the presumption is either to grant a direct service connection and eliminate the shades of gray that exist, the current rules, it is too complicated and they don't want to take a risk and granting it. at the bso, how may times have we been told, i can't read this. the board has more authorities to grant. >> the board -- this is corporate culture at the v.a., they do not want to grant agent orange. our vets are running out of time. we slipped fully support section 43. it makes it easier. they told me when i come to work, i don't think what can i do to best serve this veteran, i come to work thinking how can i maximize this for mike -- so i make my quota so i don't get fired. the easier you make it for the writer to make their points, the more likely to get the grant. that's why those are so helpful and so important. we support the section 43. i yield back my time. >> i have a question if you don't mind, chairman. >> your recognize. >> this is going back to the previous title. vietnam veterans of america and acs, we do not support changing the current framework for vietnam veterans that may be processed, that is currently on the books. this new under the owner the packed act lisa more restrictive policy. looking at that study earlier, for 15 years the v.a. had a study showing hypertension and higher rates in vietnam herbicide exposed veterans. never acted upon that study, even though it clearly is growing research. from the same section, and honor are packed, section 405 concerning belfer veterans, for the most part, this section -- desert storm veterans, for the most part this section, what comes from the go for veteran presumptive claims -- gulf war veteran presumptive claims. what with this legislation due to address that? we met with this committee before the pandemic took place. right before they shut down capitol hill. we were promised around table to address the matter and never came. just because we are adding presumptive's, is the v.a. going to be able to do these presumptives where this still not leading to a 73% denial rate like with global veterans chronic illness, and 93% denial rate for undiagnosed illness. >> thank you mr. brown. let us now move on to the next title. here's the ranking member. >> would like to apologize to everyone, i've got to get to another, this is vitally important. i will continue to monitor this, i appreciate the time to attend today. i apologize and i have to leave. >> thank you, i know your staff is with us. taking in all the information as well. i appreciate your participation. it's going to title six. perhaps you can combine your talents at the end of your discussion opener. libby recognize -- >> thank you chairman, ranking member and members of the committee. we believe that toxic exposure should not be a byproduct of service, but since it is, its impact -- it is imperative to address the issue with health care plus benefits, without delay. the importance of these provisions cannot be understated. we can make the most sound policy, without the ability to implement these changes agencywide and get information -- are members continued to refer to claims for toxic exposure witnesses and being added to the burn pit registry. sometimes waiting for -- years for their claims to be reviewed. these denials are not just time-consuming and frustrating, they can take place -- it could take their lives. additionally, including in this provision is outreach guardian -- veterans regarding benefits. we reach out to disenfranchise veterans, mainly minorities. primordial -- primary minority veterans, even without exposure to burn pit -- out straight -- outreaching getting this into their hands can and will save lives. in question 505, we wanted to address the factors age and gender race is not included in the research. we believe it is imperative for two reasons, some specific racial ethnic but minority veterans are more susceptible to certain diseases. in addition, you also have higher rates of veterans in combat roles where they are more likely to be exposed to these toxic chemicals. adding rates as a provision is imperative. in addition, i'm not very aggressive, going back to the question about whether or not we provide health care now and benefits and have this conversation later, it is important that nobody is going to disagree between need to be providing health care for these issues. but looking at history, from the minority veteran perspective, everyone -- minority veterans are left out. we continue to do this, we are going to see higher rates of denial among minority veterans unless access. in our opinion, we absolutely have to be doing -- we are going to meet the stopgap right now. so may people are being turned away. going back to mr. stuart sacco comment about the national security issue, you are correct. military veterans after trust institution to keep going. i'm a third-generation servicemember, to tell my child to serve after i see this? they would've told me the same. you're going to limit the number of people were able to serve in the military. as a veteran myself, i was told to follow and obey lawful orders. who is making the dod do that? if there is a -- why are u.s. troops being exposed to these in other areas. who is making sure the department of defense is following the same lawful orders you are asking us to uphold. the dod is responsible for paying for this, we cannot from the veterans benefits. it was not our fault, we followed orders. if we are going to go somewhere the v.a. is telling us to go, -- if we had walked away we would've been a deserter. we didn't have a choice. we were all stuck there. you continually hear people who say i was ready to die for my country, i didn't think it would happen five years after, dying from cancer. as our community's legacy. that is 9/11's legacy. we have to do better to keep that national security pact. if we can set afford to send people to war, we can take care of them when they come back. >> thank you, ms. church. i would like to get mr. titus to open up discussion on title vii so we can discuss title six and seven together. i've seen members with their hands raised. you are in ther queue. >> members of the hx up we appreciate you holding this roundtable discussion to discuss toxic exposures. toxic exposure reform is long overdue, we will be dedicating resources to this issue. we appreciate the opportunity to share title vii. section 701 creates a health registry for substances. as we learn more about this with their community, health registry is vital. section 702 shows us loaded. -- shows us why. recognizes there are over 67 sites the variety of toxic substances that veterans and their families were exposed to of the years. trading a registry is important so we can gather data on the health conditions of those who serve under a variety of circumstances. section 703 and 704 require reporting on -- collecting this information is important because it ensures an understanding of exposures service members face. it requires regular reporting on the accuracy. we are encouraged by the chits. see -- transparency and oversight being offered. because of the nature of war, there will always be exposure to data limitation. we should not take the against veterans. as white this is so important. this -- we should be empowering veterans and service members to find a way to interact with their health records. they have allowed potential to do so, we will make sure this is -- in an effective way. the sections in title vii work to address veteran's overlooked for generations. a better care for future generations. if the outer -- honor the pack act is passed. >> thank you. ms. karen -- ms. keenan from the vfw, want to comment on the title? >> thank you chairman. on title vii, i think what this does is recognizes that toxic exposures can even occur on domestic military installations. just touching back on title ii, and the framework which v.a. recognizes -- there will be more exposures. there are already new exposures. this entire comprehensive package is so critical, because there are going to be things, title vii is starting to point towards what those new things are. thank you. >> thank you ms. keenan. go ahead. >> thank you, is determined. just a comment on section six, i think this title doesn't necessarily get as much attention. it is extremely important for health care providers to have better training on toxic exposures, also for veterans benefits and administration personnel to get better training on top of the exposures. the culture at v.a. has been brought up a couple times. it comes to toxic exposure claims, it is one of denial. the veterans disability claim system works pretty well on most things, except for toxic exposures. i've use this analogy before, if adjudicator looks at a claim of a person who was a parachute jumper and says you've got training jumps and i've got bad knees, they are willing to make the connection and say yes, as likely as not, you're bad knees were caused by your parachute jumps, when they look at someone exposed to burn pit for two years and have pancreatic cancer, they're not willing to sate you may have had the cancer anyway. we need to make sure the a personnel know they can grant those claims in the same way for great claims for physical disability. >> thank you. >> thank you mr. chair. brothers and sisters from the military, thank you for joining us today. the work you've done today, the sacrifices you've made are going to improve health care for my children, my son when he becomes -- when he goes into the military and enters combat. this is about the next war as well, your sacrifices are not going to be unnoticed. this is a very emotional topic. thank you for your adverse -- advocacy, and the 9/11 commission. you have improved the lives of many given a great deal of attention to this serious subject. going forward, there is a degree of responsibility dod does have. recruiting, training, sending towards of all the young men and women who choose to serve. they don't train to be a civilian and when they kick you out, good luck, godspeed, we are all counting on you. >> that has got to change. no veteran should become a veteran without first -- receiving a full medical workup. until that occurs, it is on the military, when we did go into combat, you are exposed, whether you're getting shot out -- shot at, inhaling any sort of gases, right now, the responsibility is on the v.a. and the veterans themselves to point out what they are exposed to. we cannot accept that. a government must be -- the officer in charge of all that going to combat, to say we were exposed, take him right now, noting the road curved numbers, you will be taken care of, you will have to have these conversations a more. i yield back, got broadview, your sacrifices, many of you have had difficulties with the v.a., the d8 -- v.a. owns you a lot. i yield back. thank you mr. chair. >> and your sentiments. -- i appreciate your sentiments. do you have any questions? >> i just want to add one more thing mr. chairman in terms of talk about the research matters in title v. this is a lifelong situation, a lot of service members are exposed to toxic substances. we need to continue efforts, continue research throughout the lives. something came out about an increase in dementia for service members exposed to agent orange decades prior. i think that we need to continue to follow these issues through. to the next generation of service members. >> thank you. >> chairman, i want to thank you for this opportunity. i want to thank all the veterans for being here and sharing your stories and advocating for our endeavoring. it is a matter of priority and intentions. and we value our veterans provide them with the benefits necessary. i don't believe now is the time to nickel and dime on the issues, a matter of life and death for our veterans. i also want to emphasize the value of making sure we use the most effective, efficient ways necessary to be able to benefit all veterans. to be able to serve them. ultimately, about back to time during the fourth of july, i was able to speak to many veterans and able to talk about the benefits they're necessary. there are many stories of people that stop me where they are not quite sure what was affecting them that they knew something was wrong. this piece of legislation, the honoring our packed act, as chairman of the subcommittee on technology and modernization, i been the v.a.'s investment to include those in the -- is my understanding is been exposed to those -- the bait struggled to handle the surgeon claims, faster processing of veterans claims. ms. keenan, and lindsay if you could, i would like to hear your perspectives. on to support v.a. in providing the benefits included in the packed act --. >> i will jump in, christina from that vfw. as part of the independent budget, we are planning to recommend additional funding to modernize and update their i.t. systems to deal with the current backlog and for the potential future increase in toxic exposure claims. this is likely a multi-your project. we are making those formal recommendations through the budget with her partners. -- with our partners. >> we also support the recommendation to increase the budget and decrease -- increase the capacity of -- we are hearing from members across the board they are waiting for .5 years. they don't know how long it is going to take. we also know that the eight's technology infrastructure is lacking severely. in order to make this happen, we need to be building the structures now to be able to support when this does go through. we can't use the surge of claims as an excuse for not moving this legislation forward. they already know this is an issue. you have to be prioritizing this to ensure -- 80,000 people after 4.5 years is absurd. making sure that people have the ability to get to this process in their lifetime, which may or may not be for .5 years. >> i'm going to call mr. brown and mr. hawthorne -- hawthorne. --cawthorn. >> to give you an example how rare these cancers are, i worked with two different v.a. secretaries to get a brain cancer presumptive based upon v.a.'s own research for both for veterans. they push this all the way to the office of management and budget, it was denied in 2016. dr. did the same in 2017 and it was denied. even with the research and v.a. wanting to do the right thing, you had other agencies who didn't see fit to grant funding for them. >> thank you for bringing that up, i think you for bringing that example up. >> mr. cawthorn? >> thank you very much. of our representatives, i appreciate you being here, i would like to join this question, with the vfw or at lindsay, when would you believe is the ideal time to let veteran's no when they are eligible and what benefit they are billed -- they are eligible for quick in regards to burn pits? he brought a great play of enlightening and informing the soldiers when they're leaving the service to become veterans, when they should warn about all these. i look forward to anyone who wants to answer that. >> i will jump in quickly. during the packed program, it is not too early. it does have credit and service on no terry installations. a time for their benefits before their discharge. the earlier, the better. some of the complaints we've heard with veterans is the lack of information. whether it is through email, technology or just at the v.a.. on what their benefits are and what they can do if they believe they were exposed to toxic substances. there really isn't a point of time that it is too early, whether it is in-service service, as they are transitioning or at the first point of contact with the department of veterans affairs. >> i agree that the issue at the very latest is the are transitioning from service. as a veteran myself, i would say before they go on deployment. we should be talking about toxic exposure before anyone is exposed. we should have options. we don't have an option to walk away. we don't have the option to walk away from post, or a burn pit. before getting exposed, and as it happens while you're are on deployment or in theater, you should be told when you are leaving. while there, you should be told more. that is going to increase prevention and early detection. what is happening now, people get 4.5 years, 10 years postexposure and they are dying. why are we not looking at this 10 years ago when they were exposed at making sure they have the tools they need to manage what is coming? should not be caught off guard by cancer or asthma or something they weren't expecting when dod knew years ago. >> thank you. i'm going to go to -- his hands up first. phil had. >> thank you, chairman. i want to make a comment in reference to what representative moran was saying, i.t. infrastructure, as important. they could hire 10,000 more people to help, if we don't have the tools to expedite the process now, we are going to be in a world of hurt. there are over 200,000 backlog claims today. this is a heavy investment in v.a. infrastructure, i.t. infrastructure, the automation is being tested out the original office for increased claims. we should be heavily investing in that so we whiten -- one, don't have backlog claims. we should be paying ahead so the system is up to handle whatever comes this way in toxic exposed veteran stopping the price. -- stop paying the price. >> thank you chairman carried at least 12 years ago, there was pre-deployment training and post-deployment training. that is the perfect time to educate about what airborne toxins are known to be where they're going, whether it is a pamphlet, a powerpoint or just talk to the corpsman dock, this is something that should be enough pre-deployment and post-deployment training. >> if you don't mind me asking a quick follow-up question, forgive my egg grants, of never served before. our people there being deployed, do their training, did they know is a burn pit active are these airborne pathogens are in the area? >> i can explain to what i remember from 12 years ago. i was the junior corporal. sometimes you volunteers sometimes you get voluntold. the burn ban would be full of what i remember the most were envelopes. yet what your parents addresses, your friends addresses to get out and eight, zone. it is security to protect the information. once or twice a week it ended up from box, take it to the junior private in the squadron. that poor kid would have to go watch the burn pit and breathing , i'm sure he went every three days, whenever the burn box with foil -- burn box fill. that is why remember. >> you are asking if commanders know about this. the dod overall new about this. the contractors start the brain pits, make the dod sign a letter stating that the dod never go back and pursue against the contractor for the burn pits. here is the list of the known effects of toxic exposures they're going to come from these burn pits that could further cause -- the dod is the one signing these contracts. to protect the contractors because they know how bad these are. >> thank you. >> thanks mr. chairman. i want to respond to congressman cawthorn, he asked for my input on his question as well. it can't be too early to start telling people about these issues. no matter how good, especially the tens issue program, it is always going to be too much information. you have to continue to tell them afterwards. these are questions the primary care doctor should be having with them. it is never too early but it is during and after as well. the backlog this could potentially create, we don't like the v.a. to have backlog, when there's no reason. some backlogs are good backlogs. those are those creating because we are getting right veterans into the system. there's a temporary backlog created, that is not necessarily concern. >> i'm going to give you the last word. let me just say there is such a thing is the benefit of the discharge program which i did see in action during thanksgiving break. that does make a good attempt to deliver benefits upon discharge, give the veteran a physical. please understand this does not include the subject matter of today. it includes all the benefits, something -- roofline deceiving zero -- is available on some basals in some places, but not everywhere. does not solve this issue of all our veterans exposed to burn pits in the post-9/11 era in the desert storm era. he been so patient. i commend you for sticking through. not even are members of congress to that -- do that. >> i'm incredibly popular. the fact i would rather do this is a rotisserie to my stamina. -- a testament to my stamina. >> talk about technology and capacity and resources, they all come back to one fundamental tree, that is priority. priority and intention. we keep hearing from congress, people of the pentagon and dod, the surprise sale expressed about the amount of people that may be coming forward. we've been at war for 20 years. dod is the one making the v.a.'s customers. this could all be seen coming from 100 miles away. dod and ba both knew, their internal documents show in 2008 and 2010 the toxic forger was a deadly hazard for american troops. fee eight new what was coming. the idea that all of the sudden there is this capacity search that no one understood or saw coming, it is the -- it is as though they were filling up bathtub for years then went what is all this water on the floor? we've been at war for 20 years. there are 3.5 million veterans. they these giant burn pits. we all knew this was coming. the idea we haven't been building capacity up to this point is negligent. and everybody's part. i think the message, the dod has an enormous part to play in this is also true. it is easy to go after the v.a., dod is the one where there's almost no oversight over the massive resources that they get. and those resources have to be used to funnel into v.a. to help them take care of the soldiers and not just force readiness, but part of national security and force readiness is the trust rebuild with the veteran community that you live up to the obligations they have lived up to. the final point is technology. this is the one that is the most unforgivable. for god sakes, you got darpa, the pentagon, they got robot dogs out there trying to figure out how to diffuse minds yet dod second's -- some of these are guys on typewriters. it sounds like a joke. what it reflects is this, priority. the men and women who served are the greatest asset of the united states military. and yet, they are the lowest on the totem pole when comes to resources. we always have money for the technology, the defense contractors, with sovereign immunity for the defense contractors. we balance the budget on the backs of those who come home and try to reintegrate. that is the changing culture that has to take place. i know i'm talking to the via sews and their representatives are gone, it is crazy we are having this meeting. i'm thankful it is getting done, this has to get done and has to get done with common sense and intentionality. thank you very much for having us -- having this, it is much appreciated. >> thank you mr. stewart. you point out the stark contradictions. i want to echo some of what the doctor said earlier. it echoes what ms. keenan said about the contractors that signed documents saying they wouldn't be held liable. dod itself does not fall under the same regulations the other businesses in the united states fonder -- fall under. they would never have allowed these pulpit -- burn pits trip existed. burn pit of the size you mentioned earlier simply would not be tolerated in the bounds of the united states of america. but dod can do it because they're not bound by osha regulations. it is an entity to itself. i want to thank each of you for this discussion. when our country goes to war, we don't hesitate to pay for guns and tanks, their service members needs. but, you know, guns and tanks are the only cost a war. we must ensure we keep our promise to toxicants posed veterans they shouldn't have to fight v.a. or congress for the benefits they've earned and deserved. no marking congress cry for physical restraint comes to caring for our veterans. -- fiscal restraint when it comes to caring for our veterans. i do want to thank the ranking member and all the republican members and staff are participating into date's meeting. -- today's meeting. it is my hope we will come together and speak with a unified voice. and make veterans are priority. -- our priority. with that, i'm going to call these proceedings to close. thank you all for your participation once again. thank you. 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