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“Hidden Wounds: Effectively Supporting Veterans with TBI”

House Veterans Affairs Committee, Health Subcommittee Hearing

March 5, 2026 (recording here)

HEARING INFORMATION

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

• Dr. Rachel McArdle: Deputy Executive Director, Rehabilitation and Prosthetic Services, U.S. Department of Veterans Affairs

• Dr. Joel Scholten: Executive Director, Physical Medicine and Rehabilitation, U.S. Department of Veterans Affairs

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

• Mr. Al Johnson: Army Veteran, Flight Surgeon

• Mr. Buster Miscusi: Marine Corps Veteran, Graduate of Operation Mend

• Dr. Russell Gore, MD: Chief Medical Officer, Avalon Action Alliance

TOP-LINES TO SHOW YOU ARE IN THE KNOW

1. Members from both parties agreed that traumatic brain injury is one of the most complex and long-lasting injuries veterans face, often affecting mental health, employment, and family life years after service.

2. Witnesses testified that TBI rarely occurs alone. Many veterans are also dealing with PTSD, chronic pain, sleep disorders, and other conditions that require coordinated, long-term care.

3. Several witnesses illustrated the growing concern around repeated blast exposure in training and combat, noting that many service members develop symptoms even without a single major incident.

4. There was also a policy debate over the BEACON Act of 2026, with some members arguing it would expand treatment capacity through partnerships, while others warned it could divert resources from existing VA programs.

5. Across the discussion, one theme kept coming up: veterans want faster access to care and treatment options that address the full scope of their injuries, not just the symptoms.

PARTY LINE PERSPECTIVES

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairwoman Mariannette Miller-Meeks mentioned that March is Brain Injury Awareness Month and discussed the importance of improving care for veterans with traumatic brain injury (TBI). She stated that the VA has strong systems in place, including polytrauma centers and research programs, but stressed that the agency must improve consistency in patient care and the quality of its data reporting. The Chairwoman cited examples from VA Office of Inspector General (OIG) reports in which veterans who screened positive for TBI did not receive appropriate follow-up care, including several cases that ended in suicide. She said that veterans deserve consistent, high-quality treatment and that the VA must ensure its data and clinical practices support that goal.

• Ranking Member Julia Brownley emphasized that TBIs are among the most common service-related injuries and often lead to lifelong challenges for veterans. She outlined the VA’s polytrauma system of care, calling it a strong integrated model capable of providing coordinated treatment for TBI and related conditions. She expressed concern about legislation such as the BEACON Act of 2026 that would divert VA funding to outside organizations, arguing it could weaken the VA’s direct care and research programs. The Ranking Member asserted that strengthening and resourcing the VA’s existing care system is the best way to improve outcomes for veterans with TBI.

SUMMARY OF KEY POINTS (PANEL ONE)

• Dr. Rachel McArdle stated that the VA provides comprehensive, integrated care for veterans living with TBI through its nationwide polytrauma system of care. She explained that TBI often occurs alongside other conditions such as PTSD, chronic pain, and sleep disorders, requiring coordinated treatment and individualized care plans. Dr. McArdle highlighted the VA’s research initiatives, telehealth expansion, and tools such as the Concussion Coach mobile app that help improve access to care and advance understanding of TBI. She said that the VA remains committed to advancing diagnostics, expanding brain health initiatives, and delivering long-term, veteran-centered care for those affected by TBI.

• Ranking Member Brownley asked what the VA would do with an additional $60 million in funding to advance care for veterans with TBI. Dr. McArdle responded that she could not provide a detailed response during the hearing and would take the question for the record after reviewing VA programs. When asked whether the VA needed the additional funding, Dr. McArdle reiterated that she would follow up with the Ranking Member’s office.

• Ranking Member Brownley asked the witnesses to explain the VA’s integrated approach to treating TBI and co-occurring conditions such as PTSD and how it affected veteran outcomes. Dr. Joel Scholten responded that VA research showed veterans receiving evidence-based PTSD therapies also experienced improvements in cognitive functioning related to TBI symptoms. He underscored that individualized care plans, integrated services, and involvement of families and caregivers improved treatment effectiveness and were easier to coordinate within the VA health care system.

• The Ranking Member questioned how the VA addressed differences in TBI symptoms and experiences between male and female veterans. Dr. Scholten explained that VA research found female veterans often experienced higher cumulative trauma exposure, including military sexual trauma and intimate partner violence, which required additional screening and integrated mental health care. He added that research showed women with TBI often experienced worse psychological health outcomes, reinforcing the need for individualized care plans.

• Rep. Kimberlyn King-Hinds described a constituent and veteran suffering from severe symptoms who struggled to connect his TBI to service-related toxic exposures and asked whether toxic exposure could be considered for presumptive service connection. Dr. Scholten could not comment on presumptive service connection policies but explained that the VA screens all post-9/11 veterans for TBI and provides specialist evaluations and individualized care plans. When Rep. King-Hinds asked about research linking toxic exposures to brain injury, Dr. Scholten confirmed that studies on the long-term effects of toxic exposures were underway and offered to provide additional information for the record.

• Rep. King-Hinds also asked when veterans are referred for TBI treatment and how Congress could help improve screening and services. Dr. Scholten explained that veterans are screened for TBI when they first enter VA health care, and those with positive screens are referred to specialists for evaluation. He added that increasing awareness and encouraging veterans to enroll in VA health care would help improve access to TBI services.

• Rep. Herb Conaway asked how the VA’s tiered polytrauma system of care supports veterans with TBI who live far from major rehabilitation centers. Dr. McArdle explained that the nationwide network includes more than 110 TBI clinical teams and uses telehealth and virtual care to ensure access for veterans in rural areas. She claimed the system focuses on providing individualized care and connecting veterans with services either directly through the VA or through community care when needed.

• Rep. Conaway inquired about how VA research has advanced the diagnosis and treatment of TBI. Dr. Scholten explained that VA research led to the development of universal TBI screening for post-9/11 veterans and greater integration of mental health services due to the high rate of co-occurring conditions. He also noted that research findings supported the creation of intensive evaluation and treatment programs at polytrauma rehabilitation centers for veterans with complex symptoms.

• Rep. Conaway then asked whether diverting VA clinical care funding to outside programs, such as those proposed in the BEACON Act, could interfere with the VA’s research and treatment efforts. Dr. McArdle answered that the VA would need to review the issue further and would provide a formal response for the record.

• Rep. Greg Murphy questioned the treatment options the VA offers when standard therapies for TBI and PTSD are ineffective. Dr. Scholten explained that clinicians conduct comprehensive evaluations and develop individualized treatment plans that may include physical therapy, occupational therapy, speech therapy, and evidence-based mental health treatments. Rep. Murphy then argued that the VA should consider hyperbaric oxygen therapy as a treatment option and criticized the agency for not adopting it more widely, urging further review of emerging research.

• Rep. Kelly Morrison asked how important it was for TBI care to be integrated with treatment for other co-occurring conditions experienced by veterans. Dr. Scholten responded that integration was critical because TBI often interacts with other diagnoses, exposures, and traumas affecting a veteran’s health. He explained that VA research increasingly treats TBI as a chronic condition requiring long-term management, including rehabilitation followed by ongoing brain health and wellness planning.

• Rep. Morrison inquired about the advantages that the VA’s polytrauma system of care offers compared with fragmented health systems. Dr. McArdle explained that the system provides team-based, coordinated care and case management that integrates primary care, mental health, and specialty services. She stated that the VA’s unified health system allows providers to deliver comprehensive wraparound care designed to improve outcomes for veterans with complex injuries.

• Chairwoman Miller-Meeks asked how long a typical TBI screening takes and whether it is similar to screening used by the military or in civilian settings. Dr. Scholten replied that the VA screening takes roughly 30–60 seconds and is similar to the screening used by the Department of Defense, though it differs from civilian screening because many veterans are evaluated months or years after their injuries. He added that the VA’s screening is designed for a population with past exposure rather than acute injuries.

• The Chairwoman followed up on what TBI treatment may look like for future veterans as warfare and exposure risks evolve. Dr. Scholten explained that treatment depends on each veteran’s history, symptoms, and cumulative exposures and therefore requires individualized care plans developed with the veteran and their caregiver. He said that research supports integrated, holistic care with team-based coordination and strong mental health involvement.

• Chairwoman Miller-Meeks asked whether veterans living far from polytrauma centers could receive team-based care virtually. Dr. Scholten confirmed that telehealth is widely used within the polytrauma system and mentioned that more than half of veterans treated in TBI clinics had some form of virtual care in the previous fiscal year. He added that the VA operates more than 110 specialized TBI teams and can also coordinate care with community providers when necessary.

• Chairwoman Miller-Meeks then questioned whether the VA has the capacity to treat the number of veterans with TBI now being identified through screening. Dr. Scholten claimed that the VA’s network of specialized teams and community care partnerships helps ensure veterans receive timely care. When asked about how many veterans may have undiagnosed TBI, he said he could not estimate the total but noted that roughly 20 percent of veterans screened receive a positive result requiring further evaluation.

• Rep. Jack Bergman inquired about the difference in care provided at the five polytrauma rehabilitation centers compared with other network sites and clinics. Dr. Scholten explained that the major centers offer more intensive inpatient rehabilitation programs and access to broader medical expertise, including specialties such as neurosurgery and orthopedics. He added that once veterans complete intensive treatment at those centers, they transition back to their home regions, where local VA facilities continue coordinated care.

• Rep. Sheila Cherflius-McCormick asked how the VA ensures cultural competency among providers when treating veterans, particularly given concerns about suicide risk. Dr. Scholten responded that the VA’s integrated system is designed around military and veteran-specific experiences and includes strong coordination with the Office of Suicide Prevention and research programs focused on identifying and reducing suicide risk.

• Rep. Cherfilus-McCormick questioned how the VA is improving diagnostic accuracy for TBI, given limitations in screening tools and biomarkers. Dr. Scholten explained that the VA is investing approximately $50 million in TBI-related research, including efforts to develop better biomarkers and improve identification of co-occurring conditions that affect suicide risk. He stated that research findings are intended to translate directly into improved diagnostic and treatment approaches.

• Rep. Cherfilus-McCormick then asked whether shifting funding outside the VA through grant programs such as those proposed in the BEACON Act could undermine the VA’s research infrastructure and continuity of care. Dr. Scholten answered that while the VA aims to provide integrated care internally, it sometimes relies on community providers when services cannot be delivered quickly or when specific expertise is unavailable. He underlined that care delivered outside the VA should still be integrated back into the veteran’s overall treatment plan.

SUMMARY OF KEY POINTS (PANEL TWO)

• Mr. Al Johnson testified that he suffered a TBI during the January 8, 2020, Iranian ballistic missile attack on Al Asad Air Base in Iraq, where he was serving as an Army flight surgeon. He explained that the blast exposure left him with TBI, PTSD, cranial nerve damage, and other long-term medical conditions, and he described how many other service members experienced similar injuries that were not immediately detected through existing screening tools. Mr. Johnson claimed that early screening and documentation are critical because missed diagnoses can prevent veterans from accessing care and benefits. He urged improvements in the detection and monitoring of blast exposure and toxic environmental hazards to better protect and support service members.

• Mr. Buster Miscusi described his experience living with TBI following low-blast exposure during his service in the Marine Corps and explained how the condition gradually affected his cognitive function, emotional stability, and daily life. He said that traditional treatment approaches did not fully address his symptoms until he received care through the Operation Mend program at UCLA, which focused on team-based rehabilitation and included his spouse as part of the care process. Mr. Miscusi argued that caregivers should be recognized as essential partners in treatment and that programs integrating families into rehabilitation can significantly improve outcomes. He believed that similar integrated care models should become the standard across the VA system.

• Dr. Russell Gore shared that TBI is often a chronic condition that produces long-term functional and psychological challenges for veterans and significantly increases suicide risk. He said that while the VA has made meaningful progress through programs such as the polytrauma system of care, many veterans with TBI do not receive coordinated treatment or do not access VA care at all. Dr. Gore argued that the scale of the problem exceeds current capacity and that more integrated rehabilitation programs and partnerships are needed to expand access to treatment. He supported the BEACON Act as a way to fund research and expand evidence-based neurorehabilitation programs that could improve outcomes and reduce veteran suicide.

• Ranking Member Brownley asked Mr. Miscusi what factors were preventing the VA from implementing care models similar to Operation Mend and whether diverting $60 million under the BEACON Act would help or hinder those efforts. Mr. Miscusi responded that he could not comment on the funding structure but believed the VA had caring providers and the underlying capability to deliver this care. He suggested that the main barrier was organizational coordination rather than resources and stated that Operation Mend demonstrated how those pieces could be structured effectively.

• Ranking Member Brownley questioned how the BEACON Act could be considered a supplement to VA care when it appeared to redirect funding from existing VA mental health and PTSD programs. Dr. Gore replied that he viewed the legislation as a way to build partnerships, expand treatment capacity, and establish evidence for a new standard of care for TBI. He argued that intensive rehabilitation programs could improve outcomes and noted that far more veterans could benefit from such care than are currently receiving it.

• Rep. King-Hinds asked Mr. Johnson what Congress could do to improve the lives of veterans with TBI and requested that he describe his daily experience living with the condition. Mr. Johnson explained that his TBI had forced him to stop practicing independently in emergency medicine because of difficulty managing complex medical decisions. He urged Congress to establish a comprehensive medical surveillance program for service members exposed to the Al Asad attack, including cancer screening, brain imaging, and long-term monitoring for toxic exposure and TBI-related health conditions.

• Rep. King-Hinds also asked Mr. Miscusi what Congress could do to improve care for veterans with TBI and what daily life with the condition looks like. Mr. Miscusi said that Congress should examine whether institutional barriers within the VA were preventing timely treatment and prioritize whichever programs deliver care to veterans fastest. He added that living with TBI requires ongoing daily management and medical devices to control symptoms such as migraines and neurological episodes.

• Rep. Cherfilus-McCormick asked Dr. Gore whether there was evidence that shifting funding to outside organizations would expand access to care or treat more veterans than keeping those funds within the VA. Dr. Gore replied that research evidence supported the effectiveness of intensive neurorehabilitation programs and underlined that the proposed funding would primarily support research needed to establish these treatments as a standard of care. He said that once the evidence base is established, the VA could determine how best to allocate resources to deliver the care.

• Rep. Cherfilus-McCormick asked about clinician credentialing and military cultural competency within the civilian programs partnered with Avalon Action Alliance. Dr. Gore stated that credentialing standards were comparable to those used by the VA and that many clinicians had military or VA experience. He added that his program also provides specific training in military and veteran cultural competency to ensure providers understand the unique needs of service members.

• Rep. Murphy inquired about the vagus nerve stimulator Mr. Miscusi uses to manage symptoms and whether he received it through the VA. Mr. Miscusi answered that the device had significantly reduced the frequency of his neurological episodes and that he ultimately received the treatment through the VA after it was identified as necessary.

• Rep. Murphy then asked Dr. Gore about his treatment approach and why some veterans seek care outside the VA. Dr. Gore explained that many veterans arrive after experiencing fragmented care and benefit from intensive interdisciplinary rehabilitation programs that coordinate multiple specialists.

• Rep. Bergman clarified that the BEACON Act does not require the VA to divert $60 million but instead allows funding to be allocated for research and treatment expansion. He then asked Dr. Gore to explain the difference between care at VA polytrauma rehabilitation centers and other VA clinics. Dr. Gore claimed that polytrauma centers provide intensive, multidisciplinary treatment programs lasting several weeks, whereas other clinics typically provide referrals to separate services delivered over longer periods with less centralized coordination.

• Rep. Pete Stauber asked Mr. Johnson about evidence suggesting that Iranian missiles used in the Al Asad attack may have contained radioactive or toxic materials. Mr. Johnson could not definitively determine whether the warheads were “dirty,” but he noted that environmental testing identified radioactive isotopes and that service members later experienced health issues after the attack. He argued that many affected veterans lack access to coordinated cancer screening or monitoring because there is no formal surveillance program for those exposed.

• Rep. Stauber asked whether veterans present at the Al Asad attack are currently receiving adequate care and whether a medical surveillance program would help. Mr. Johnson responded that many veterans have dispersed after leaving service and may not know what screenings they need, leaving them under-triaged for potential health risks. He believed that a structured surveillance program would help identify health problems earlier and ensure these veterans receive appropriate care.

• Chairwoman Miller-Meeks asked the witnesses whether they believed outside providers delivering TBI care were culturally competent in treating veterans. Mr. Miscusi, Mr. Johnson, and Dr. Gore each agreed that they believed the providers they worked with were culturally competent. Chairwoman Miller-Meeks emphasized that many veterans want greater choice in where they receive care and argued that expanding treatment options could help address unmet needs.

• The Chairwoman asked Mr. Johnson how common repeated low-level blast exposure is among service members. Mr. Johnson shared that repeated blast exposure from training activities such as breaching and mortar fire is far more common than widely recognized. Chairwoman Miller-Meeks then asked Dr. Gore whether the current VA system is adequately meeting the demand for TBI treatment; he replied that care could be significantly improved.

• Chairwoman Miller-Meeks and Ranking Member Brownley concluded the hearing by acknowledging both the strengths and the challenges of the current VA system for treating TBI. Ranking Member Brownley held that while community partners play an important role, she believed additional funding should strengthen VA programs directly rather than shift resources away from them. Chairwoman Miller-Meeks again underlined the need to expand access to care and improve coordination to better meet the needs of current and future veterans with TBI.

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