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“Hearing to Consider Pending Legislation”

Senate Veterans Affairs Committee

May 21, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked) (Panel One):

• Thomas O’Toole, MD: Acting Assistant Under Secretary for Health for Clinical Services, Veterans Health Administration, U.S. Department of Veterans Affairs

• Kenneth Smith: Assistant Deputy Under Secretary, Operations Management, Office of Field Operations, Acting Executive Director, Education Services, Veterans Benefits Administration, U.S. Department of Veterans Affairs

• Phillip W. Christy: Acting Principal Executive Director and Chief Acquisition Officer, U.S. Department of Veterans Affairs

Witnesses & Written Testimony (linked) (Panel Two):

• Morgan Brown: National Legislative Director, Paralyzed Veterans of America

• Brian Dempsey: Director, Government Affairs, Wounded Warrior Project

• Jon Retzer: Deputy National Legislative Director for Health, Disabled American Veterans

Keywords mentioned:

• Veterans' care, community care, accessibility issues, care coordination, mental health, brain health, rural transportation, women veterans, caregiver support, VA staffing, research contracts, Medicare integration, veterans' benefits, disability access

IN THEIR WORDS

OPENING STATEMENT FROM THE COMMITTEE

• Chairman Jerry Moran noted the time constraints on the hearing and introduced the witnesses, acknowledging the value in their remarks about the bills under consideration. He withheld further comments and introduced the first panel.

SUMMARY OF KEY POINTS (PANEL ONE)

• Dr. Thomas O'Toole apologized for the delay in submitting the VA’s testimony and highlighted several bills under discussion. The department supported the intent of the Acquisition Reform and Cost Assessment Act (S.1591) but opposed Section 6 regarding a new cost assessment office. He voiced support—often with requested amendments—for multiple bills including the MEDAL Act of 2025 (S. 214), the Veterans Health Care Freedom Act (S. 219), the Coordinating Care for Senior Veterans and Wounded Warriors Act (S. 506), and others addressing brain health research (S. 800) and rural transportation grants (S. 784 and S. 827). However, the VA opposed several measures, such as extending CHAMPVA benefits to children up to age 26 (S. 605) and the DRIVE Act of 2025 (S. 599), and withheld full views on the Guard and Reserve GI Bill Parity Act (S. 649) pending further review.

• Chairman Moran asked what the VA was currently doing to facilitate timely and efficient information sharing with the Centers for Medicare & Medicaid Services (CMS) and avoid duplication, as outlined in S. 506. Dr. O'Toole responded that the VA already performs care coordination through its primary care group and expressed concern that adding new coordination requirements could create redundancies. He mentioned that data sharing between CMS and the VA has been a long-standing challenge but said that the VA is working to improve this through electronic health record (EHR) modernization and the expansion of Oracle’s health data exchange.

• The Chairman inquired about the importance of the VA License Portability Act (S. 1533) and what barriers exist without expanded license portability. Mr. Kenneth Smith stated that the VA strongly supported moving from the longstanding pilot program to a permanent structure. He noted that 86% of medical disability exams are conducted by non-physician healthcare providers and suggested revising the bill’s language accordingly. He also raised concerns about contract examiners receiving evidence directly, as they are subcontractors not in a direct contractual obligation with the VA.

• Sen. Angus King joked that the VA seemed to support all of his bills and offered to work on any amendments.

• Sen. Maggie Hassan asked whether Dr. O'Toole had been consulted about the VA’s plan to lay off 80,000 workers, following up on previous testimony. Dr. O'Toole replied that while he was not consulted and was unaware of specific analyses, other senior physicians had been involved. He claimed that the matter was pre-decisional and offered to provide more information for the record.

• Sen. Hassan pressed for transparency, emphasized oversight responsibilities, and asked how the VA would decide on new clinical services and engage stakeholders in establishing a full-service medical center in New Hampshire. Dr. O'Toole agreed with the importance of engagement and said that he would provide more information later.

• Ranking Member Richard Blumenthal questioned the cancellation of VA contracts with Harvard University related to suicide prevention and clinical trials. He cited a New York Times article stating such cancellations could lead to preventable veteran suicides. Dr. O'Toole confirmed that he was aware of the article but said he could not speak to the specifics and would take the question for the record. Ranking Member Blumenthal expressed frustration, warning that the lack of transparency and accountability was contributing to nomination holds and oversight failures.

• Sen. Patty Murray asked what resources were currently available for women veterans experiencing early menopause and whether the VA planned to expand those services. Dr. O'Toole acknowledged the importance of the issue but did not have current resource information and promised to provide it.

• Sen. Murray also asked about the fate of VA clinical trials halted during a 90-day pause and requested a list of canceled trials. Dr. O'Toole again said he did not have the information and would provide it within one to two weeks. He also lacked specifics on establishing a permanent in-house mammography service in VISN 20, but he committed to following up.

• Sen. Murray then expressed concern over how the VA could implement new legislation, such as the Elizabeth Dole Act, while also planning to cut tens of thousands of employees. Dr. O'Toole replied that the VA supported the Dole Act and was working actively on implementation, including on provisions he was personally involved with. He promised to provide updates to Sen. Murray’s staff.

SUMMARY OF KEY POINTS (PANEL TWO)

• Mr. Morgan Brown spoke for Paralyzed Veterans of America (PVA), conveying their support for the majority of the bills on the agenda. He highlighted strong support for rural transportation legislation, the Veteran Caregiver Reeducation, Reemployment, and Retirement (RRR) Act (S. 879), the Service Dogs Assisting Veterans (SAVES) Act (S.1441), and the Veterans’ Education, Transition and Opportunity Prioritization Plan Act (S. 1543). He focused on three additional bills: the Veterans Accessibility Advisory Committee Act of 2025 (S. 1383), which he said is necessary due to persistent access barriers at VA and community facilities; S. 599; and S. 605. Mr. Brown underscored the need for equitable treatment of veterans' families and the VA’s leadership role in accessibility.

• On behalf of Wounded Warrior Project, Mr. Brian Dempsey strongly supported S. 800 to address the long-term effects of blast injuries and improve personalized care through expanded biomarker research. He endorsed S. 506, emphasizing its relevance to younger veterans with catastrophic injuries who rely on Medicare and VA services. Mr. Dempsey also expressed support for the Servicewomen and Women Veterans Menopause Research Act (S. 1320), S. 879, and S. 1383, highlighting each bill's importance to improving health outcomes and quality of life for veterans and caregivers.

• Mr. Jon Retzer acknowledged that Disabled American Veterans (DAV) supported all 20 bills on the agenda, with no concerns on five of them, but offered specific recommendations on others. He said that DAV supported the intent of S. 506 to improve coordination for dual-enrolled veterans but urged stronger oversight and case management by the VA to prevent fragmented care. He raised concerns about the inclusion of non-medical roles in nurse registries in the Veterans Homecare Choice Act of 2025 (S. 635), calling for clearer definitions and alignment with existing VA home care programs. Mr. Retzer also voiced concern with S. 219, warning that shifting resources to private sector care without additional funding would erode the VA’s specialized services. He stressed that DAV members believe the VA remains the best provider of veteran-specific, whole health care.

• Chairman Moran was struck by Mr. Brown’s testimony regarding the VA’s shortcomings in accessibility for disabled veterans, particularly the lack of accessible diagnostic equipment. Mr. Brown acknowledged that while the VA made initial strides after adopting 2017 standards for accessible medical equipment, progress had since stalled. He shared examples where veterans were unable to receive care due to inaccessible equipment and suggested further Committee oversight. He added that many access problems could be mitigated by including veterans on an advisory committee who could flag such issues from lived experience.

• Sen. King proposed that veterans service organizations (VSOs) like PVA could help identify facility accessibility gaps through nationwide assessments, noting that many accessibility challenges are not obvious to those without disabilities. Mr. Brown agreed and claimed that PVA often notifies facilities of issues via service officers, but broader systemic tracking and response within the VA is needed. He pledged to take the idea of a nationwide audit back to PVA leadership.

• Chairman Moran asked Mr. Dempsey to explain the importance of S. 879. Mr. Dempsey cited a RAND report showing that over a third of post-9/11 caregivers live below 130% of the federal poverty line and often lack savings or insurance. He believed that the bill would help caregivers transition out of their roles by supporting financial security, career recovery, and retirement options.

• The Chairman asked Mr. Retzer to elaborate on challenges faced by dual enrollees in both VA and Medicare, and how the proposed pilot program might help. Mr. Retzer mentioned that coordination is difficult without interoperable EHRs and highlighted the importance of VA care coordinators being trained in both VA and Medicare systems. He said that dual enrollees, often older and rural, need culturally competent and geographically informed support to prevent fragmented care and reduce unnecessary costs.

• Sen. King thanked Mr. Retzer for his stance that community care should not supplant VA care. Mr. Retzer agreed and pointed to trends in rising care needs among women, aging, and younger veterans with high disability ratings. He reiterated that maintaining VA infrastructure and staffing is critical to meeting these growing and specialized needs.

• Sen. King asked whether available data distinguishes between community care and VA-provided episodes of care. Mr. Retzer replied that he would have to check, but he believed some VA dashboard data does track trends in care delivery and use by rural veterans.

• Chairman Moran asked whether the VA or others have a clear understanding of the characteristics of veterans not enrolled in VA health care. Mr. Retzer responded that he did not have a definitive answer but noted that with roughly 18 million veterans and 9 million enrolled, many must be relying on private-sector care. He committed DAV to continue investigating who is not being served and why.

• In closing, the Chairman spoke about his bill with Sen. Jacky Rosen to ensure accurate religious representation on headstones at overseas veterans’ cemeteries. He entered supporting comments from multiple organizations into the record without objection.

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