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Hearing to Consider Pending Nominations

Senate Veterans Affairs Committee

February 19, 2025 (recording here)

HEARING INFORMATION

Witness & Written Testimony (linked):

• The Honorable Paul Lawrence Ph.D.: Nominee to be Deputy Secretary of Veterans Affairs

Keywords mentioned:

• Department of Government Efficiency (DOGE), electronic health record (EHR) implementation, VA staffing, PACT Act, data security, claims backlog, accountability, transparency, technology, fraud, disability benefits

IN THEIR WORDS

OPENING STATEMENTS FROM THE COMMITTEE

• Acting Chairman Thom Tillis convened the hearing to consider the nomination of Dr. Paul Lawrence for Deputy Secretary of Veterans Affairs, emphasizing the significance of the role in overseeing the VA’s operations and modernization efforts. He reviewed Dr. Lawrence’s military background and prior service in the VA, noting his tenure as Under Secretary for Benefits in the first Trump administration and his accomplishments in reducing the disability claims backlog. Chairman Tillis expressed appreciation for Dr. Lawrence’s willingness to serve again and welcomed his family.

• Ranking Member Richard Blumenthal acknowledged the importance of the Deputy Secretary’s role in executing critical VA programs. He voiced numerous concerns over recent VA policies and decisions that he felt undermined veterans’ care, claiming that his questions to the VA often went unanswered. He detailed several alarming developments, including delays in opening new clinics, service reductions, and issues related to veterans' personal data security. Ranking Member Blumenthal criticized the administration’s actions regarding personnel terminations and ethical conflicts, calling for greater transparency and asking Dr. Lawrence to demonstrate his commitment to veterans.

• Chairman Tillis responded to the Ranking Member’s remarks by urging a focus on facts, stating that some early allegations about VA policies had been disproven. He addressed concerns about personnel changes, suggesting that many affected employees were probationary hires and that some transitions were typical following a change in administration. He then dismissed claims of mass terminations in critical positions and instead pointed to prior budgetary issues, attributing some VA challenges to legislative decisions. The Chairman expressed confidence in Dr. Lawrence’s ability to bring stability to the VA and reiterated the importance of evaluating his nomination based on facts.

SUMMARY OF KEY POINTS

• Dr. Paul Lawrence thanked the Committee for considering his nomination and expressed gratitude to President Trump for selecting him. He shared his military background and family history of service, illustrating his personal commitment to veterans. He recounted his accomplishments as VA Under Secretary for Benefits, including reducing the claims backlog, increasing home loan approvals, and launching several key programs. Dr. Lawrence pledged to work collaboratively with Congress to modernize the VA’s electronic health records, improve veteran healthcare options, and ensure accountability within the department.

• Chairman Tillis expressed frustration over the high costs and inefficiencies of the VA's electronic health record (EHR) implementation. He asked Dr. Lawrence what mistakes had been made and what could be done to correct them. Dr. Lawrence acknowledged the issues with the EHR system and pointed to the importance of accountability, contractor oversight, and a clear implementation plan. He stated that if confirmed, he would work with VA Secretary Doug Collins to execute a strategy that maximized efficiency for veterans.

• The Chairman asked Dr. Lawrence what he learned from reducing the VA benefits backlog and how those lessons could be applied to other VA processes, including EHR implementation. Dr. Lawrence noted that the backlog was already low when he took over but was further reduced through oversight, performance measurement, and technology improvements. He stressed that eliminating bureaucratic inefficiencies was crucial and credited the success to process optimization and boosting employee morale.

• Ranking Member Blumenthal pressed Dr. Lawrence on whether he would commit to responding to outstanding information requests from the Committee within one week of confirmation. Dr. Lawrence avoided giving a direct "yes" or "no," instead stating that he would receive the requests, review them, and determine the best way to provide responses.

• Ranking Member Blumenthal criticized the VA’s lack of transparency and raised concerns over the firing of over 1,000 VA employees, the influence of Elon Musk’s team on IT systems, and the impact of these actions on veterans' care. Dr. Lawrence stated that his understanding was that the Musk-affiliated VA personnel had only accessed contract and IT management information, not veterans’ personal data. He did not directly support or oppose the terminations, instead citing a VA press release that described the firings as affecting non-mission-critical employees. The Ranking Member challenged Dr. Lawrence’s reliance on press releases and urged him to seek firsthand knowledge of the situation that he believes is harming veterans.

• Chairman Tillis asked Dr. Lawrence whether he had been consulted on any personnel decisions made in the first 30 days of the administration. Dr. Lawrence stated that he had no involvement in the personnel decisions, had not been consulted, and had only seen public reports.

• Sen. Tommy Tuberville shared his frustration over the VA’s slow adoption of advanced medical treatments, such as hyperbaric chambers and ultrasound therapy for post-traumatic stress disorder (PTSD). He asked whether Dr. Lawrence would support integrating such innovations. Dr. Lawrence agreed that new medical technologies could benefit veterans and committed to exploring partnerships with external organizations to expand care options.

• Sen. Tuberville referenced a VA Inspector General (IG) report detailing failures in the fiduciary program, where $24 million in benefits were mismanaged. He asked how Dr. Lawrence would address these issues. Dr. Lawrence acknowledged the challenges in fiduciary oversight and pledged to investigate and improve accountability measures.

• Sen. Mazie Hirono questioned Dr. Lawrence about the firing of 1,000 VA employees, stating that these were probationary workers in a system already struggling with staffing shortages. She asked whether he was concerned about the impact on veterans. Dr. Lawrence reiterated that he was not involved in the decision-making but cited VA statements claiming the layoffs were carefully reviewed to avoid affecting critical services.

• Sen. Hirono pointed out that Dr. Lawrence contributed to Project 2025, which proposed outsourcing VA services. She asked whether he intended to push for privatization. Dr. Lawrence downplayed his role in Project 2025 and stated that he only wrote about efficiencies in benefits processing. He firmly stated that he did not support privatizing the VA and echoed the VA Secretary’s opposition to such efforts.

• Sen. Tim Sheehy criticized the VA’s inefficiency, noting that it costs three times as much as the private sector to deliver healthcare. He asked how Dr. Lawrence planned to reform the VA to make it as efficient as the Department of Defense (DoD) healthcare system. Dr. Lawrence agreed that efficiency needed to be examined and committed to reviewing cost discrepancies. He suggested that part of the issue might stem from the complexity of the veteran patient population and VA operational processes.

• Sen. Sheehy highlighted the difficulties veterans face when transitioning from military service to VA care. He asked how Dr. Lawrence would address these challenges. Dr. Lawrence, a veteran himself, acknowledged the frustrations of transitioning. He said he supported ensuring smooth information transfers between the DoD and VA, reducing redundant paperwork, and helping veterans secure employment and housing post-service.

• Sen. Maggie Hassan criticized the administration’s firing of VA employees, arguing that it was being conducted recklessly and without transparency. She asked how Dr. Lawrence would rebuild morale and ensure the VA could recruit the workers it needed. Dr. Lawrence underscored the importance of the VA’s mission and the positive work environment it provided. He argued that top-performing employees appreciated accountability and welcomed the removal of underperformers.

• Sen. Hassan expressed skepticism, arguing that the administration was using a "meat cleaver" approach instead of a "scalpel" in its workforce reductions. Chairman Tillis responded that workforce reductions at the VA were not unprecedented and that previous administrations had also sought to cut non-critical positions. He also stated that the VA had an annual attrition rate for probationary employees and that workforce decisions should be viewed in that context.

• Sen. John Boozman spotlighted a vocational school in Arkansas designed for veterans and questioned the policy barring non-accredited institutions from Transition Assistance Program (TAP) sites. He asked if Dr. Lawrence would work with the VA-DoD Joint Executive Committee to resolve this. Dr. Lawrence agreed to look into the issue and expressed support for effective training programs that improve veteran employment outcomes.

• Sen. Boozman noted prior budget challenges and asked if the FY26 VA funding request was accurate or if additional funding would be required. He also asked how Dr. Lawrence planned to improve communication between the VA and Congress. Dr. Lawrence stated he needed more details before commenting on the budget but pledged to work closely with the Chief Financial Officer. He acknowledged congressional frustration over VA communication and committed to improving proactive engagement with Congress.

• Sen. Boozman then discussed the Not Just a Number Act, which requires the VA to collect data on veteran suicides. He asked how the VA could use this data to improve suicide prevention efforts. Dr. Lawrence agreed that suicide prevention efforts had not shown enough progress and committed to exploring data-driven approaches to identifying and implementing more effective solutions.

• Sen. Ruben Gallego praised the PACT Act, which expanded care for veterans exposed to burn pits, but noted that many veterans were unaware of the benefits. He asked how the VA planned to increase outreach. Dr. Lawrence agreed that more outreach was necessary and underlined the importance of low-tech, in-person engagement, such as town halls. He committed to increasing communication efforts and ensuring veterans were informed of their eligibility.

• Sen. Gallego expressed concerns that President Trump’s executive order rolling back diversity, equity, and inclusion (DEI) initiatives could negatively impact culturally competent communication. He asked whether Dr. Lawrence would seek a waiver or push for changes to maintain outreach efforts for diverse veteran populations, such as Native American and female veterans. Dr. Lawrence acknowledged the importance of tailored outreach and agreed to look into whether the EO restricted engagement with specific veteran organizations.

• Sen. Angus King called for seamless transitions for veterans from active duty to VA services and noted past efforts to pre-register active duty personnel in the VA system. Dr. Lawrence expressed support for the initiative and agreed that simplifying the transition process was crucial.

• Sen. King questioned the assertion that recent VA layoffs were carefully reviewed and requested data to verify that claim. He noted that the VA likely lost closer to 3,000 employees, considering natural attrition, and warned that reducing administrative staff could hinder veterans’ ability to schedule appointments. Dr. Lawrence agreed that verifying the layoff process was important and committed to reviewing the data. He noted that safeguards were in place to retain critical personnel but agreed to follow up on their effectiveness.

• Regarding the VA’s EHR system, Sen. King criticized the no-bid contract that was awarded to Cerner, stating it had led to implementation failures. He also questioned a government-wide early retirement letter, arguing that it could result in the unintended departure of top-performing employees. Dr. Lawrence acknowledged that he was not involved in the decision-making but agreed to review the process and ensure lessons were learned from past mistakes.

• Sen. Marsha Blackburn mentioned that the VA claims backlog had ballooned to nearly 954,000, a dramatic increase from the 64,751 claims when Dr. Lawrence previously served as Under Secretary. She asked how he planned to reduce the backlog. Dr. Lawrence committed to reviewing the backlog issue and applying past process and technology improvements to address it.

• Sen. Blackburn alleged that VA unions had resisted EHR adoption and returning to full-time in-office work. She asked how Dr. Lawrence planned to address this. Dr. Lawrence emphasized that the VA’s mission was to serve veterans and that anything interfering with that mission needed to take a backseat. He supported policies requiring employees to return to in-person work if necessary.

• Sen. Blackburn then raised concerns about delays in renewing Community Care Network (CCN) contracts, which allow veterans in rural areas to seek care outside the VA. Dr. Lawrence agreed to work with the Secretary to ensure these contracts remained on track and to prevent disruptions in care for veterans.

• Sen. Tammy Duckworth criticized the administration’s mass firings, noting that some of the dismissed employees worked at the Veterans Crisis Line. She asked whether Dr. Lawrence would commit to reviewing the layoff process to ensure that critical services were not disrupted. Dr. Lawrence agreed to review the process and, if confirmed, examine what happened with the Veterans Crisis Line terminations.

• Sen. Duckworth shared her concerns that veterans who used hiring preference programs were incorrectly classified as probationary employees and wrongfully fired. She asked whether Dr. Lawrence would call on President Trump and Elon Musk to investigate and correct this issue. Dr. Lawrence committed to looking into the OPM process for coding probationary employees and ensuring that veterans were not unfairly terminated.

• Sen. Patty Murray stated that the VA’s EHR system was failing veterans and that previous VA officials had given the same reassurances for years without meaningful change. She asked how Dr. Lawrence planned to hold Oracle accountable and fix the system. Dr. Lawrence pledged to review past mistakes and claimed that his prior experience in implementing VA technology solutions distinguished him from previous officials. He acknowledged the need for urgency in resolving EHR issues.

• Sen. Jim Banks noted that the original plan for EHR included standardizing VA operations, which had not occurred. He asked how the VA could successfully implement the new system without standardization. Dr. Lawrence acknowledged the issue and agreed that standardization was critical. He committed to reviewing the project’s status and making necessary corrections.

• Sen. Elissa Slotkin expressed concerns that senior VA leaders, including Secretary Collins, had committed to standing up against harmful cuts but were later overridden when 1,000 employees were laid off, including veterans. She asked if Dr. Lawrence would push back against future cuts that could harm veterans' care. Dr. Lawrence committed to opposing cuts that directly impact veterans' care and benefits. However, he reiterated that the recent layoffs were described to him as "non-mission critical" and that supervisors had a role in protecting essential employees.

• Sen. Slotkin followed up, claiming that Elon Musk and his team had gained unauthorized access to sensitive federal data, including taxpayer information, and asked if Dr. Lawrence would block similar access to veterans’ records. Dr. Lawrence unequivocally stated that Musk’s team should not have access to veterans’ records and that his understanding was that they did not currently have access. He stated that VA data security protocols are strict and prevent unauthorized personnel from accessing private information.

• Chairman Tillis said that the VA’s EHR project faced predictable failures due to unclear requirements, excessive customization, and poor data integration. He requested that Dr. Lawrence provide a structured "stop, start, continue" report within 90 days of confirmation, outlining which project elements should be halted, changed, or retained. Dr. Lawrence agreed in principle but did not commit to the 90-day timeframe, citing the need to first assess the situation thoroughly. Chairman Tillis acknowledged the need for flexibility but said that any competent leader should be able to diagnose project failures within 90 days.

• Ranking Member Blumenthal sought clarification that Musk or any unauthorized party would not gain access to veterans' records. Dr. Lawrence reaffirmed that unauthorized individuals should not have access to VA records. The Ranking Member then asked whether Dr. Lawrence would resign if Musk or his team were granted access to veterans' data. Dr. Lawrence refused to answer hypotheticals but stated that he would use his authority to prevent unauthorized access.

• Sen. King referenced Project 2025, which suggested reducing "improper payments and fraud" in veterans' benefits, and asked whether the report implied that veterans were committing fraud. Dr. Lawrence clarified that most "improper payments" resulted from administrative issues, such as delayed reporting of a veteran’s death, rather than fraud by veterans.

• Sen. King warned that investigating improper payments could require scrutinizing veterans' medical records, contradicting Dr. Lawrence’s earlier statements about protecting privacy. Dr. Lawrence disagreed, arguing that fraud detection could be done through administrative records rather than direct medical file access.

• Sen. King cited a section of Project 2025 that suggested revising disability rating awards to achieve "significant cost savings." He noted that the report suggested only "partially" preserving benefits for current claimants and asked if Dr. Lawrence supported reducing veterans’ disability benefits. Dr. Lawrence stated that he did not support reducing benefits and clarified that Project 2025 referred to periodic adjustments to disability rating schedules, which the Government Accountability Office (GAO) encourages to ensure fairness.

• Chairman Tillis once again praised Dr. Lawrence’s prior service as Under Secretary for Benefits, highlighting that he had been confirmed previously by a voice vote, a sign of bipartisan confidence. He encouraged Dr. Lawrence to push back against misguided directives from within the administration and use his professional judgment to advocate for veterans.

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