45 minutes. Chairman tester i am going i want to thank secretary mcdonough and her friends and partners for joining us today. For those of you joining us on television, you will hear a great opening and questioning of the secretary of the v. A. We have three people who were going to do a combined statement , which will be particularly entertaining. So we have something to look forward to. Chairman tester we do. We are here to take a closer look to the president s 2024 budget request for the department of Veterans Affairs. We have to ensure the department is wellequipped to care for our veterans. The v. A. Completed more than 1. 7 million disability claims. They served over 6. 3 million veteran patients, more than 150 million employments. Demand is only increasing. This law created a fund to cover the new cost of delivering. I have serious concerns to got the fund. Gut the fund. It is all bad news. We send people off to war, we put it on the credit card. They come back and we make excuses not to fund their benefits. After finally making good on our overdue pledge to address the costs of war for veterans, our next step cannot be to renege on that pledge. Lets not forget even if house colleagues make good on their promise to not gut v. A. Care [indiscernible] make no mistake, by tying cuts to the debt ceiling, they are putting veterans livelihoods at risk. Each month treasury makes payments on behalf of the v. A. Nearly half as for benefits payments for more than 7 million veterans and their families. The rest pays for medical clinics and reimburses private providers for people who receive care in the community. If the debt limit is reached all these payments could be delayed or stopped, creating uncertainty for this nation and for the veterans that serve this country. Lets get past the political posturing and ensure our veterans are not harmed. With that said, i look forward to hearing directly from secretary mcdonough on the fy 24 budget. Sen moran i appreciate all of you being with us today and i look forward to hearing your testimony about the v. A. s budget request. There has been some big changes since the last time we met for this purpose, namely the enactment of the honor in our packed act. Pact act. I am committed to protecting support for veterans in the ongoing budget talks and i know my colleagues share that commitment. 70 of the federal spending is on autopilot or on mandatory programs. This is what got us in this deficit mess. Veterans are not insulated from rising inflation and slowed Economic Growth caused by outofcontrol spending. As a longtime member and now Ranking Member of this committee, my party will be to make certain the v. A. Has the funding it needs to provide highquality Health Care Benefits and services to the men and women who served our nation. I believe this and every v. A. Budget request could be judged through a single lens of what will it deliver for veterans. This years budget request is the largest yet for the v. A. , totaling 325. 1 billion. That is a big number and it should lead to big improvements for veterans. We should not brag about the amount of money we spend, but if bigger numbers were all that was needed to deliver, we would have better results. So it is what we can deliver. With bigger numbers, and better results, we still would not have higher veteran suicide rates, hundreds of thousands of veterans waiting for their earned benefits, new Electronic Health records, meaningful decline in access to care, scores of recent reports from the Inspector General detailing serious and fatal failures, persistent problems getting the v. A. To provide timely responses to basic requests for information. I am interested in hearing from the secretary this afternoon on how this budget request will produce different results from past years. I am also interested in hearing the secretary justify budget increases for v. A. Health care. The veterans help administration is requesting a little an 11 increase. This is the first budget request that includes the Toxic Exposure Fund. When the fund was established nine months ago it was not projected to reach 20 billion until 2030, six years from now. Given that the v. A. Does not have a way to track the number of veterans who are enrolling, and has not raise this concern, this request needs explaining. Delivering more money for veterans is not the solution, but delivering that her outcomes is. I have no doubt about what the secretary shares. Ive no doubt we disagree that there is any disagreement about the need for better results. For these reasons it is critical that congress put Veterans First by remaining engaged in the budget process. It is time to get it right for our veterans, their loved ones and i thank you for all being here. Chairman tester i agree with the point you made on the money. It is how the money is spent that is important here. That includes every budget we put our hands on. Todays hearing is just the two panels. We have the great honor to have the secretary of the v. A. , secretary Denis Mcdonough to talk about the v. A. 2024 budget. In your testimony that you have written, you highlighted the v. A. Has delivered more care to more veterans over the last two years than any time in the nations history. Put more of that in perspective for us. Thank you very much sec. Mcdonough thank, mr. Chairman. We are not big on just measuring what we put into, what you give us to put into veterans care, but we measure what it means for veterans and their families. Just last thursday, there was a release of a report, consolidation of 40 separate reports looking at care provided by the v. A. , including throughout the pandemic. That report found that v. A. Provided care is at least as good as and overwhelmingly better than care provided in other settings, including private health care settings. So we are very proud of that, but if you just consider clinical appointments we have had with veterans in the last year, 115 million clinical encounters, 40 million inpatient encounters at v. A. Facilities, 31 million telehealth appointments, 38 Million Community care appointments. You are ready talk through the benefits side of this at the claims we processed last year. We are 15 ahead of that number year on year. These dollars mean real engagements. These engagements mean Better Outcomes for veterans and i stand by the assertion that we are now providing more benefits and more care to veterans than at any time in the v. A. s history. Who are they . The Fastest Growing veterans are Women Veterans. Just everest as a result of the pact act, we have 77,000 new enrollees in v. A. Health care. The Fastest Growing cohort is Women Veterans. The beauty of the pact act that you gave us last year is that it allows us to restart a conversation with the younger and more diverse veterans at the same time weird opening our engagement with vietnam veterans. We are seeing younger veterans, more diverse veterans, including more gender diverse veterans, meaning more women, in our care. There has been debate about the bill the house passed that cut programs. Most of the debate revolved around veteran benefits. Senator moran address stated in his opening statement. Addressed it in his opening statement. As i look at the bill, they attempt to rescind 1. 8 billion for v. A. Veterans services. The question for me becomes if we did not cut any veteran benefits, this is not called benefits because it has to do with administration . I guess that is the way they look at it. You had a chance to look at that bill and the proposal put out by your agency. Tell me what you see that comes out of that and what impacts it would have . A bill that would by the way the speaker said did not cut benefits, but call the president a liar, when effect the president was telling the truth. Sec. Mcdonough the bill itself is vague for the reasons you talked about. We have looked at this a lot of different ways. We have been talking with members on all sides of this debate is january when this debate really got engaged. If you just apply the 22 budget cut to v. A. , which may not be what ends up happening, maybe it is less, but if you take the top lines of the bill and recognize that v. A. Is not held harmless. The way for example dod is held harmless then we are going to be confronted with significant challenges. We think that if that 22 cut is applied to v. A. Health care, that would mean outpatient visits of the type i talked through that we had last year. Those are outpatient visits in the Community Care system. Alternatively, if you look at it from the benefits administration , talked about the fact that claims filed are 30 above where they were a year ago. We are fulfilling 15 more claims year on year than we did a year ago. We are able to do that because of efficiency we found and hiring we carried out. If you apply 22 reduction, that would mean 6000 fewer staff there. We have 20,000 staff there for the first time. We talked this committee through how our staffing model works. But if there are 6000 fewer personnel to process claims, that will be an extension of a timeline that is already too long. The v. A. Inspector general found a substantial commingling between the 14. 4 billion in simple mental funding the v. A. Received under covid19 and the v. A. s regular appropriations. He seems to me that would be separate accounts, but that is not with the inspector found. The intent of the supplemental was to support urgent timelimited needs, one period of time circumstances, not to create an artificial increasing of the budget. What steps did the v. A. Take to make sure cost projections were not based upon those supposing onetime amounts of money . Sec. Mcdonough this has been a historic challenge for the v. A. , how does it account for supplemental funding. This goes back many years. It has to do with the age of our infrastructure, how we track the stuff and it also has to do with where we push the money for our operators to execute it. The important thing we have done, as we have now taken responsibility for that. And put it in the hands of the cfo here at headquarters. We are making sure that he and i are directly responsible, ultimately. The covid funds those funds being the medical care funds. Rather than making every individual facility have to account and try to figure out where this money comes from, we are going to make sure that we do it at headquarters. We worked that out with omb, we have been brief your staff about this because we think this is an important change. Secondly, we have regularly updated the committee on how it is that we are spending these funds and that is why we can have the confidence that we have now and we will use the overages that we have had today, remember those overages were for what we expected to be a surge of care as people come back to us the end of the pandemic, we have had that conversation. We have great confidence we will use that money this year. And partially into next year. Our regular updates to you guys help us do that. But the ig has routinely raised this issue of supplemental funds, we are trying to figure out a good way to do it. We think bringing responsibility of this to the ceo cfo level is the way to do it. But none of this obviates the need to continue to stay in close touch with the committee and make sure that the Committee Sees clearly how we spend the money. I understand the v. A. Plans to track expenditures from the toxic exposure fun to make sure they are justified. How will the v. A. Define and track which health care is associated with exposure to environmental hazards in which care is not pursuant to the law that created the fund . We have had a handful of discussions with your teams here in the committee and with others among the appropriators and the house as well about our methodology. We are comfortable with our methodology, we have worked this through with omb, we are working it through with your team. All of them will characterize to you their degree of comfort, if we have to change that methodology we will do that. The base case is that we are in a position to ensure that as the law envisioned, talking exposure funds, will be spent only for toxic exposure requirements. And we have made sure that weve given clear guidance to the field. Again operating as we do with the cfo and meet responsible to make sure that we can execute. So the lack of accounting from the money from covid, which you are now trying to address by bringing it to the central office, that is not anything that would suggest the same problem will occur for the money in the fund for toxic exposure . We wont have the same problem we had with covid money being comingled, the department will be able to determine what is appropriately spent for toxic exposure benefits. We think yes. In the methodology, the basis on which we establish that methodology to track that funding is something we are talking through with your teams in very minute detail. But we are also going to continue to not only talk to you but continue to be subject to oversight to the gaos oversight to ombs oversight, and if there is something we need to change we will change it. But we have great confidence that we will be able to invest the toxic exposure dollars for toxic exposure care. Senator brown . Thank you i appreciate what you said about dod being held harmless in the v. A. Not. Other senators and i fighting for the pack act last summer when it was perilous whether it was going to pass because some said it was too expensive, i do roundtables, im going to do one in every county in the state, i did one on the 31st the other day. There is always money for defense but too many people want to skimp on spending on the v. A. So thank you for your work on that. Secretary, thank you for all you are doing in so many ways. Thank you for taking the right step in stopping the Electronic Health records. I know we have talked many times, i appreciate your attention to that and your understanding their that the staff at chalmers and columbus, their hard work, i visited there as you have. You did the right thing and i want to keep working with you. I want to talk about the pact act. Do you have numbers up to date on how many veterans, i like to say when i do these roundtables that this is government done right. This bill passed in august of 2022, by january 8 are headed up and running and hundreds of thousands of veterans were getting care. That is exactly the way government should run and all of us are proud to be a part of that. You have uptodate numbers on how many have been served . As of may 6, 251,584 total veterans or survivors have had completed pact act related claims. We are granting at about 80 . That is the beauty of the presumption, is that we are able to grant at a much higher rate, it is 79. 7 . This is a troubling number, the average days for completing a pact act related claim right now is 155 days. I think there is a series of reasons, the biggest is that some claims were filed either related to our initial three presumptive claims were filed shortly after the president signed the law and we did not begin to process the pact act claims until january. We should see that average number of days go down. We have about, as i said earlier, about 77,000, a little over new enrollees and vh a health care as a result of that. There are many more existing enrollees who qualify for greater access to care as a result of the pact act as well. I participate as an observer at a screening event in toledo, in northwest ohio in march and it was an illuminating experience to see what veterans go through. You have been more handson than any v. A. Secretary i have seen them going out and seeing the action. I have heard from veterans and advocates who need additional screening, many are prohealth and had to have invasive biopsies in order to complete these. What steps is the v. A. Taking to implement less invasive diagnostic techniques such as advanced technology screenings . The toxic exposure screenings youve talked about are enabled by the law, we have now had about 3. 3 million thats complete those screenings. It is very interesting because somewhere between 35 and 40 , i do not have the most recent number, of cases of those screenings we have veterans about whom we have learned some new exposure that that veteran may have experienced. That is allowing us to get to know the veterans already in our care better. There are technological challenges, one of the things that we think most veterans suffer from which is bronchiolitis, the test for which are so invasive as to make them actually not useful. Potentially harmful to the veteran. So that is why we have stood up in the pact act enabled us to stand up. A special organization focused just on the science of the exposures as well as new techniques to verify the existence of the condition. That team meets on a regular basis, we just met with them late last week. Not only did you set up the presumptive process for us you have also given us additional authorities to make sure that we are testing new technologies to make confirmation of these conditions, including bronchiolitis less invasive. Thank you. Mr. Secretary, your work especially since you have taken office, in cincinnati and columbus and your help for the national v. A. , thank you for all of that. Thank you mr. Chairman secretary, for your opening statement. Congratulations on your daughters graduation. It is a fine institution, 15 minutes from my home. I want to thank you for the great thing you gave me back in my office, most folks know i voted against the pact act in spite of the fact i worked a lot on it. He did not have to do with numbers and had to do with operational challenges that i hoped we could clear up, but you gave me a reason to be optimistic. Can you give me a 62nd cliffs notes version on some of the risk, i did hear the 150 days, but i think you have a plan for that . Can you share that with me . Thank you, what we know now after years of watching the benefits process in particular. The claims filing process. So since that is overwhelmingly the main door that thats enter at the v. A. It is a very human intensive process. We need to make assessments about how many vets we anticipate filing claims and we need to make sure you have trained people ready to handle those claims. Starting in the end of the fiscal year 2021, we began hiring. We now have 28,000 vba professionals, importantly they are not only hired a good chunk of them are now through the training process. Such that they can begin to add to our ability to reduce the backlog of claims that get filed. A good example is yesterday we had the single biggest day claims completion in the history of the v. A. , we completed over 295,000. We are still getting more claims on any given day than that but we are able now to move many more through the process. We can see through the expected surge of claims right now and we have a strategy on how to then manage the size of that workforce through attrition. Getting down to what you think the future run rate is going to be as good news so count me in to help. Thank you. As we go forward with respect to the discussion about the house bill, we know that the negotiation that is going to come from the president and Speaker Mccarthy is going to produce Something Different and i think that it is going to be fair to veterans. I wanted to talk about you mention 77,000 new people. Pact act was much publicized, we got more people to contact v. A. , even if 20 are not getting the presumption we now have a relationship and hopefully that is positive for those that may be did not get the news on the presumption, but at least they are engaged. We know the suicide rate among veterans who have no relationship with the v. A. Is higher than those that do, there is a lot of reasons why we need to get people to the v. A. There are also a lot of reasons why i am sick of the camp lejeune toxic ads on tv. There is a great opportunity there to correct connect with more veterans. Senator hirono mention camping fees which is going to be difficult to get a consensus on. I asked my staff to take a look at drafting a bill that we call the patriot bill of rights, one of the things i would like to do is get support in congress for informed veteran before they sign a retainer for these attorneys that are spending millions of dollars in ads. I think it represents a great opportunity for the v. A. I know that they contacted the department of the navy, but i was thinking something as simple as a document before they sign a retainer agreement that says you need to understand what your rights are independently without representation of an attorney. Number one, contact the v. A. Number two, contact a local congressional representative. We do thousands of v. A. Cases every year in our office, i am sure the other members do the same. Make them aware of the fact that congress members, state offices help veterans every day. Their case may or may not rise to a level they need legal representation, make them aware and recognize those who also have experience in this case and let them go through that process before they sign that retainer agreement. What is wrong with that idea . You and i talked about this in your office and especially on camp lejeune, we just had a study published last week were veterans at camp lejeune are 70 more likely to suffer parkinsons than not, we have a lot of presumptives already for camp lejeune. We want to make sure that vets understand that you do not have to hire a lawyer to get your v. A. Benefits. We are aggressively using all of our communication tools to do that. And having some success with that. Anything that will allow us to get more of what we get the untethered vets, those vets not yet in relationship with us, is a positive thing as far as we are concerned. Thank you very much mr. Chairman, mr. Secretary welcome. As you know and has told us, the v. A. Announced a new agreement that a new contract had been made with oracle. It is really important to see that the v. A. Is prioritizing reliability and responsiveness and Patient Safety across the contract so i appreciate that. Just last week gao released a report indicating the v. A. Had not established target goals to assess User Satisfaction and until the v. A. Lacks a basis to determine being deployed at other sites i support efforts to move forward but only after you are confident about the safety and effectiveness of the system and have a clear, established satisfaction markers. What matters is what the providers and veterans on the ground think. Our veterans deserve the best health care we can offer and it is our job to make sure the v. A. And oracle get this right. I have a couple questions. When do you expect to have a revised request for the eh are count in fiscal year 24 as well as an estimate of whether you need the funds requested to support the rollout in the i. T. And medical facility accounts. First of all, i want to make sure we are absolutely clear that a little over 400 million that was set aside for this year , we have communicated to you in the Appropriations Committee that we do not anticipate needing that money this year. I want to be very clear about that. On the updated request, both for the rest of this year and into next, i think we need a little bit of time but not much. I dont have a specific timeline for you here, but we recognize that this one year option that we have just exercised is a great opportunity for us to test whether we can get those five sites working. And not only that but we have providers in each of those five sites. And we have vets in each of those five sites that have big expectations and are tired of waiting. We are not asking for a lot of extra time but we want to get this rate rather than get it fast, rather than give you a Firm Commitment i can tell you this is a number one issue for us at the department to come to the committee with a revised request. Do you have plans to establish targets to assess User Satisfaction . User satisfaction is a critical part of this. Whether we have a specific target set, i will get back to you on that. But one of the principal ways we are going to be able to figure out whether we are working in the five sites is User Satisfaction. That will be part of the evaluation . Correct, whether we have specific targets on a timeline is are there any changes you plan to make on feedback at this point . A big part is enhanced Accountability Measures and system reliability. That comes directly from the user experience. Thank you we will let you know we are following this closely. We appreciate the v. A. s diligence on this. Senator boseman . Mr. Secretary, thank you for being here today. We enjoyed hearing your priorities regarding the budget last week and we do appreciate all that you are doing. All of the hard work. For the men and women who have served. In regard to the hrm, one of the things i hear from people who are either not on the authorizing committee or the Appropriations Committee is dod has successfully got a bunch of things going in various installations. I support the move to back off. I think that was wise of you to do. I think you got really good support for doing that. Can you explain why dod is having success, whats the difference . Why are we struggling when they didnt . I know there are good reasons but expound on that. I think the number one reason is we have Health Systems that are built for different populations and for different outcomes. As a general matter our patients are with us longer. And our patients, our veterans have more complicated Health Care Systems and situations. As a result our system is that much more complicated. I think thats the main issue. The other question is when we have struggled with reliability oftentimes, in the last three weeks we had two outages for the first time in 70 plus days. Those outages impact the entire system so its not just v. A. , they also impact dod. My point is because of your pressure on us we are making the entire system more reliable including for dod. I think notwithstanding the fact that our system is more complex and our patients have more demanding health care situations, i think the work youve put us through is going to make the whole system, including for dod and for coast guard that much more effective. When you came and talked about your budget you recognize the growth of the number of Women Veterans seeking care in the v. A. Which has more than tripled over the last 20 years. In fiscal year 24 they requested more than one billion for gender specific Womens Health care and 257 million to support the Womens Health program office. Last congress we have legislation, the service act was signed into law which expands the eligibility for vha members for mammography screenings for veterans. It is a good story. Can you touch on how the implementation for the service act is going and are there any challenges that you are facing that we can be helpful with you . Let me start by saying you have been tireless in giving us additional authorities and additional funding to do exactly all the things you just ticked through and we are not only very proud of that but very grateful for that. The service act implementation is well underway, we began providing Breast Cancer risk assessments in march of this year including a coincident with the toxic exposure risk assessments. We are working through the development of a dashboard to make sure you can follow along with the implementation of that. We project that in this fiscal year as a result of the service act there will be an additional 52,000 Breast Cancer risk assessments across all sites. Incidentally as we learned last week there are now new guidances where Breast Cancer screenings should start at 40. It is pretty clear that your advocacy for the service act was well ahead of even this more cutting edge assessment last week. Theres going to be challenges in some facilities where Women Veterans are coming to us on enrolled because they have heard about the screening. That is going to create some Administrative Burden but theres not anything i need from you with that. That will be a challenge, that means we are getting more vets into our care. That is absolutely good news. Thank you mr. Secretary. Welcome to the committee, one of the issues i serve on both Armed Services in this committee, is the transition. It seems to me even though we have made great progress were still not there. What i would like to get from you is some thoughts about how we could make this a warmer handoff because the data suggests that that transition, that two or three year period after leaving duty is a moment of danger. So i wondered if you had some thoughts about some things we might be able to do to make this a more effective process in order to protect our veterans. I think your instinct is exactly correct, in my view i have talked about this. We are looking about this a lot. I worry sometimes that we think the answer is to overload the transition, the top program. And handing a veteran a 300 page form is not the answer. Yes. As you know i am not of that but i have signed out of jobs before and i was not going to go to any extra thing that i do not want to go to. What we think very strongly, is we need to fit our programming and our opportunities into veterans lives through a Customer Experience journey. Rather than make them fit our stuff. On our schedule. So we are making Good Progress on this, that may mean that we are talking to veterans outside the tap program and we are using the program in that time in that year or three years after they have transitioned to establish a connection with them. One suggestion that i have been looking at, right now and active Duty Service Member has to often to have their data conveyed to the Veterans Service officer in their state. If we made that an opt out, it would probably increase the amount of contact. My vision is someone beating the veteran at the airport. Saying welcome home, here are some resources, here is my number, here is the v. A. Number. But we have to be able to contact the veteran and if they dont want to be contacted that is fine. But we have this cadre of esos and people out there that are willing to help and we have got to make that connection easier. We are in conversations with the National Association of state directors of Veterans Affairs. That would be the contact. We have not been a firstrate partner to our state partners on this. We give them data, its not readable or usable. We are trying to make that better. When i was governor i would call our states 800 numbers just to see as a consumer. Think of yourself as a customer is a good way to approach Something Like this. The state directors of Veterans Affairs in each state, we are working with each of them. They are not shrinking violets. We are hearing from them that we have not been a good partner and we are working on that because we do think that ready handoff is really important. A couple points, i am still concerned about onboarding time. In the cumbersome notice of the hiring process. It strikes me that decentralizing it to some extent would be good. You need to hire Administrative Assistance at togas hospital in maine you should not have to go through boston and washington. And some reciprocity. If youve got somebody that is in customs and border control, they dont have to go through a whole new process of background checks and those kinds of things. Reciprocity would speed up the process so i hope this is one of those things where back away and say if we were going to design a hiring process from scratch is a blank sheet of paper, what would it look like. Then compare it to what we have now. I appreciate that. We appreciate feel like we have had the best two quarters and hiring in two decades. But onboarding is still a major headache. We are looking of that process. I talked with you yesterday about a couple of these things in particular, the way we handle drug testing does not make any sense to me. But we are getting into the specifics to ratchet down that time to onboard. We are losing people. It is an opportunity cost. Massive, these are people who want to come to work for v. A. And we should not make it so hard. Our time to hire, to onboard is coming down. But it is coming down in some places from four months. Nobody can take a job and then not be paid for four months. We are on this, i will continue to report to you on this. But some of those things you are talking about are things we are looking at. Moving authority to hire to the field simultaneous carrying out the onboarding steps rather than doing them sequentially. These are things we are making progress on. Can you indulge one more question . The medical records. Accountability is crucial. Chair senator murray i think there ought to be targets if you do not have a destination you will never get there. I think this contract is very important but you have got to have standards. That provide some accountability and some penalties if they are not met. Otherwise this is such a complex , large process. Ultimately it has got to work and if it doesnt the people we are contracting with should not get paid. So i hope you will be very tough about accountability and you have got this one year, something hanging over them. I want you to be very aggressive about that. We are going to do that, i think senator murray is challenging us. I 100 agree we have got are accountability metrics are including enhanced metrics when the system is down when it has been inexplicably, twice in the last three weeks. It is maddening. There will be a cost of that. There is already a cost of that and we have to measure it in dollars but it is really measured in veteran outcomes. Senator murray is also challenging us to be very deliberate about User Satisfaction measurement, i take what both of you are saying on that and we will get to the bottom of it. Thank you. Thank you mr. Chairman, and senator king gave such great devotion this morning at prayer breakfast, i was happy to let him move forward and take that time. Secretary mcdonagh very quickly, we talked very quickly about staff. What percentage of the v. A. s d. C. Staff has returned to in person work . I dont have a specific number but i will get you it. And also submit to me the agencys official telework policy. Sure. We want to know that i have legislation called the show up act in order to try to get people back to work in these agencies. The wait times and the backlogs are continuing to grow and i think that is a problem. Let me ask you, some of the employers ive talked to in tennessee have talked about people taking second jobs, second remote work jobs. Do you have any employees that have taken second jobs where they are working two jobs remotely . Has that happened . Not that i am aware of but i will take it and come back to you. I would appreciate knowing that and seeing where you are with those issues. I know you were working on a Work Environment plan. What is the status on that . We have submitted our first draft to the omb. When i am done i will be going to a meeting on that at the interagency. We feel really strongly about it. I feel proud of the work that our workforce has carried out in the last couple years. Productivity at the Veterans Benefits administration is the highest it has ever been even though they are maxed telework right now, they are at higher productivity rates than we were in 2019. I feel good about that. Right now the case backlog is about 215,000, it is a little less i read somewhere that packed act you are seeing a half million requests for service because of the pact act is that accurate . Overall we have seen about 500,000 packed specific claims filed. But we will get you the exact data if you want to see it. I would love to. How many fleet claims filed, average time to completion. As you know i believe Community Care is a big part of that and weve got more legislation we are working on that we think would help with that and we would appreciate hearing from you. I do want to come to something that to me was very troubling, as i was reading it last night and looking through the durham report. I know you were president of almost chief of staff from january 13 to january 17. As i was reading through some of that i would like to know from you, during that time as chief of staff, did you participate in any meetings with the fbi regarding the investigation of the Trump Campaign . It has been a long time since i thought about that but i would be more than happy to go back and take a look at that and get you an answer. I would appreciate knowing that and i think its important to know what your involvement was. With the fbi. In pushing for that. My understanding is that you are in the 2016 meeting in the situation room with president obama, susan rice and other top officials where they discussed the russia collusion issue. Is that accurate . I am not sure i know which meeting you are talking about but i will be more than happy to look. I think it was july 2016 reported in the report and you are in there. That is of concern to me. You are charged with leading a very important agency, the work that you do is vital to our veterans and it is of tremendous concern to me as i was reading this report last night. It was also a source of disappointment to me. That you would have been involved in this process of weaponizing the fbi. This is something that should never happen. People do not want to see two tears of justice. As we talked about the v. A. They want to see a standard of service for everybody and they want to see that consistently and to know that you may have been a participant in this investigation and that you are a part of this meeting as detailed in the situation room, that they carried out this hoax. Made it all up. Figment of her imagination. I would not want somebody discrediting the chairman or any of us or you in that regard so it is with great disappointment that i read that. Thank you chairman. Thank you chairman and thank you you Ranking Member moran for this hearing, thank you secretary mcdonagh for being here today. And also for our recent conversations and just before i talk a little bit about what we have covered in those recent conversations, i just want to reaffirm that it is my understanding that you agree that all americans should be equal before the law. Absolutely. Thank you. What we have been talking about in recent weeks is really a major concern to New Hampshire veterans, it is a condition of our manchester Medical Center. As you know that Medical Center is 73 years old and Facility Maintenance failures have led to the cancellation of many veterans appointments in the past few years. I really appreciate you taking the time to walk me in the senators to the plans that you and timo were working on to ensure that these problems do not continue to recur. I know from our conversation that you and i both hear a lot about getting these renovations at manchester up to date and completed. We also talked about the importance of transparency and ensuring that veterans know what is being planned and what they can expect each project, when they can expect each project to be completed. When will you be able to make public a comprehensive plan on projects for the manchester bas so that veterans will know what to expect . Thank you for the question and for all your work on this. Our goal would be to make something public this summer, summer of 2023. By july or august. I appreciate that and i think it will be very important to New Hampshire veterans and our whole community to meet that deadline if not earlier. I appreciate the v. A. s work to complete much repairs at the manchester v. A. That were caused by flooding when a pipe burst last year. I know that your team has been working hard to get these important repairs done as fast as they can. What are the next steps beyond these initial repairs to ensure that the manchester v. A. Is fully renovated to prevent these types of problems in the future. When will the v. A. Start on this work and what is the expected timeline . Many of these renovations are complete cuttings of these facilities. We were able to fund those through nonrecurring maintenance projects. We have minor Construction Projects onsite site including the new Womens Health clinic and special care addition. We also have a Major Construction issue on campus. The plan is to fully renovate the facility floor by floor so that the facility remains in use during those sequential upgrades. Those renovations include removal and replacement of all obsolete utilities, that includes plumbing, installation of new insulation on exterior walls to prevent the freezing we have seen. Installation of new windows, installation of new modern heating, air conditioning and ventilation systems. Installation of new finishes, and optimized space layout for clinical use. Here is our approximate schedule. Fall of 2023 the fourth floor operating room in the suites will be completed and returned to use. December 2024 the third floor construction will be completed. Spring 2025 the fourth floor construction will be partially completed and then spring 2025 the second floor construction will be completed. Winter 2027 floor construction completed, and then winter 2026 the sixth floor will be completed. The womens clinic is expected to be posted for an award this summer. In the award granted in the Fourth Quarter of this year. For the womens clinic, the award granted in the Fourth Quarter of this year, what is the timeline for completion . Can i take that want to get back to you just to make sure i give you the exact number . Yes. What im trying to communicate is what weve talked about. I just dont have the exact number. Thats ok lets get it and make it public to people so you will have a timeline to go by. I just think its important for people to understand the timeline but also the overall renovations of what youre trying to do. To make sure you are repairing this facility to a point where we wont see these ongoing failures, which have been incredibly disruptive to veterans in New Hampshire. Thank you. Senator blumenthal . Good afternoon mr. Secretary. The chairman is referring to my leg, i broke it in a uconn huskies victory parade. I saw that. Thank you for your note, i apologize for my delay in responding you are very kind. I want to focus on health care for the veterans of connecticut and say that i am hoping that plans for continued work on the v. A. Facility in west haven are proceeding and that i can touch base with you on that. Count on that. Thank you. I also want to followup on the letter i sent to your office regarding veterans who were stationed at a base in use becca stand. Also known as k2. The yale veterans clinic has brought a lawsuit on behalf of veterans station there and who are exposed to soviet era Hazardous Waste including uranium, espressos and chemical weapons. There is ample evidence they were exposed to the toxins but there is also tremendous amounts of information in possession by the department of defense, records that are still classified for reasons i dont understand. I have written to secretary austen urging him to declassify those records. I would simply ask you for your commitment that you will support expanding health care to these veterans who were exposed. You have got that commitment. Thank you. I want to take a moment to talk about education benefits. The next generation of veterans is entering a civilian marketplace that is much more dynamic and competitive. I strongly believe the v. A. Can play a Critical Role in enabling veteran success. As the dad of two veterans who have made use of education benefits thankfully, programs like the transition assistance program, veterans rhetoric readiness, Employment Service and the g. I. Bill provide invaluable resources to veterans and their families. I believe that the post 9 11 g. I. Bill is one of the most powerful tools at a veterans disposal right now. But the educational landscape has changed significantly since president roosevelt signed the law about 80 years ago. In your view, how does the v. A. Need to change to meet the needs of these younger veterans . Many of them of a different mindset, exiting the service and want to pursue Higher Education and how does the v. A. Need to change its practices or methods to meet those needs . I think the main thing we have to do is we have to make sure we are meeting veterans where they are. Fitting our programs into their lives rather than us expecting them to change their lives to meet our requirements. Making sure that they understand the full suite of support that is available to them irrespective of what they want to go study or what skills they want to go develop next. The more we fit that programming into their lives the better case we are able to make to them about the usefulness of these investments. The better informed they will be to make those decisions. It is on us to make that case to individual veterans. Thank you. I want to offer a personal testimonial to the importance of the pact act, one of my sons had just gone for screening at the urging of his dad. And was extremely impressed by the quality of the questions and the caring and so forth. Thank you. Thank you mr. Chairman. Mr. Secretary, nice to see you again. I want to begin by thanking you. For your visit to alaska, i appreciated it. I appreciated you getting out all over the state and hopefully you had a good time. Very much. Hopefully you enjoyed the steak night. I eat fish. I know you did eat fish. Youre a better catholic than i am. I appreciated the broad diversity of meetings you engaged in getting all over the state with me with the senator and congresswoman. I wanted to followup on the meeting you had with Valerie Davidson and the Alaska Native Tribal Health consortium. This is on the different reimbursement agreements with the v. A. And these Tribal Health providers. On january 5, 2021 the reimbursed care for native veterans was signed into law and required the p. R. C. Services to be covered with the purchase referred care. I know you had a good discussion on that, i was part of a lot of that. When you met with a and thc, it was one of the issues you discussed. When the Tribal Health provider, when they can expect the agreements to include reimbursements for the p. R. C. Services . Can i get back to you with that . I know it is complicated and it is important issue. The next issue, it is an issue i raised every time. I hope we can get the v. A. s support. I thought we had it. This is on the camp lejeune victims act and the lack of any contingency, i dont know why this is taking so long. We put forward a bill that compromised up to 17 caps, the vfw supports it, the American Legion supports it, there is a whole host of regent reasons why the 33 of some of my colleagues are suggesting its its just too much. This is literally an example of here is a pot of money, does it go to sick marines and their families or is it going to go to trial lawyers . I can see how trial lawyers can be helpful but not at 33 . We were just on the phone with some doj folks who agree with the bill i am trying to get to come out officially for that some of them think that 17 is too high. But they are already talking about, just today we heard some of these law firms are charging 50 contingency fees. It is robbery. We all know it. Everyone in Congress Knows its wrong. Here the problem, the deadline for the camp lejeune filings is august 2024. I am being roped. We all know why, the trial lawyers are going to win and sick marines and their families are going to lose. Anyways, your team has been good on this, theres all these arguments i mean we are going to get good lawyers. Youre seeing the ads on tv. These guys are not doing it out of the goodness of their heart to help marines. They are doing it to get rich. Can i get your commitment mr. Secretary in the next week or so to sit down with us and say here is where we are, we support the sullivan bill, its reasonable. These compromise, the American Legion wants it the vf w wants it, and the more we delay by the way you guys wanted it when we were working on the pact act it just got blocked by some of my colleagues here for reasons we all know about. Any thoughts on that . I know we talked about it. I care deeply about it because this is wrong. We all know its wrong. I know what a priority this is for you. But it is for the marines and their families. In the vfw and the American Legion and veterans. I am not disputing that either. Let me say two things. You know this because he used to work downtown on the others. It is hard for me to get in the lane of doj and dod on their requirements. But i will say this. This question of the right number and whether or not there are caps, thats not really our thing. But i can tell you that we use caps. Every law uses caps this is why the federal claims torts act uses caps. I think its almost exclusively one of the few so i think you understand the spot i am in. I have minor agency partners, the dod account, i want to make sure im doing my part by them. The doj thinks for caps. Again how would you recommend we try to resolve this because you obviously play a role. The department of the navy as you mentioned, its dod, by the way even the numbers we have from the department of navy just talking that them today almost none of these are going through adjudication with the navy they are going to trial. The reason is average claim is 10 million bucks. So one of the arguments, you wont get good lawyers if it is a small contingency fee. Just do the math. If you take away 2 million for whats called the health award, health care received out of 10 million, that is 8 million. 17 of 8 million is 1. 36 million. That is a pretty good payday for a lawyer. That is from the navy today. So the navy wants it, doj wants it, i think you guys want it. It just kind of sickens me that we can get progress on this. So maybe do you have a suggestion on what we would do, seriously for congress or the committee or those three agencies . This is an injustice. The money is going to trial lawyers, 50 contingency fees. Your guys testified last fall, it was up to 60. How greedy can you be . My commitment to you is why dont you let me talk to secretary austen and the attorney general and to the secretary of the navy let me see if i understand precisely what they are doing on this. I wanted not in Public Session get ahead of them on whatever it is they are doing. Ok mr. Chairman. It is an issue. And Ranking Members. I am just baffled we are letting this linger. I know why some people wanted to linger because august 2024 is the deadline. And then it is over. And then the trial lawyers when. And then the marines get screwed. That is just wrong. Totally wrong. Everybody knows it. And we are not doing a thing about it. You guys are just going to rope a dope me. You are rope a doping six marine sick marines and their families. Everybody knows its the wrong thing to do. I dont know why all of this. Senator sullivan you have brought this up in many forms and i know you are passionate about this but i want to give you a little history. I dont know if you are on this committee when senator started the camp lejeune. He took that up along with senator blumenthal, and it was debated many times. And it was introduced and we put it into the pact act. With no contingencies, with. We wanted caps mr. Chairman. Every every one of these hearings i know the truth about caps. And i was every one of the hearings. The senator also has a bill. I am all about reasonable fees. I have all the facts in the world. You guys make sure there are. Total baloney. Are you going to agree with my bill . Will you support my bill . This is an issue that needs to be taken up by the committee. When you are talking about legal issues mr. Chairman you are stumbling over your words. I wish she would commit right now to work with me on this. It is to make a political issue i am not trained to make a political issue at all. Im just trying to put caps on it. This is one of the very few that has on it. It can happen. I am ready. Thank you. We appreciate your testimony, your words. There will be other questions by the committee. Make sure you respond to them. That concludes the first panel. Boosting enough, we will hear from the essos. Vsos. Ive said many times that Congress Needs to take its cues from veterans. First up, paralyzed veterans of america. I also have chairman of disabled veterans of america. Also will provide my opening statement, an opening statement. I also want to say that we have a nomination hearing coming up. That hearing is going to be held on may 30 first at 3 00 p. M. I would encourage all members of the committee to visit with her and find out what she is made of. Members of the committee, want to thank you for the opportunity to offer comments on the v8 budget request and advanced appropriations at fiscal 25. 157 of advanced appropriations, represents our best estimates to fully and timely deliver all authorized programs and benefits to americas veterans. We are encouraged by the proposed budget and believe much of it accurate accurately assesses the needs of caregivers, family, survivors. Although it has missed the mark in a few areas. The Research Program generates discoveries that contribute to all americans. Compared to that 980 million recommended. The v. A. Health care system has faced significant challenges and undergone significant reform right right reforms through the years. The v. A. Has received levels and an increasing number of veterans are seeking v. A. Care. The lack of resources and adequate staffing are adversely impacting access to care and benefits and must be addressed. We urge congress to honor the promise made by continuing longstanding bipartisan support. This concludes my remarks on health care. The dad will now discuss benefits programs. Thank you. It is recommended an increase over the current level. Its an additional 100 million or overtime. In fiscal 2022, there was 1. 7 million rating decisions not with mandatory overtime. They have already completed 1. 1 million decisions in this fiscal year. This 100 Million Dollars in overtime will greatly enhance their ability to handle the increasing claims and the impact. Within the a call centers there are approximately 1600 employees. It is estimated that one v. A. Claim generates eight separate contacts to be a call center. As of may 6, there are over 800,000 pending claims and over one million new claims which means that the v. A. Receives over 8 million phone calls to call centers which would strain the workforce. We are recommending 50 million for an additional 400 call center employees. We recommend your hundred 25 million, an increase of roughly 40 million. The board scheduled over 56,000 hearings that held only a little over 30,000. The beginning of this fiscal year the board had over 75,000 hearings pending. We recommend an additional 20 and other positions to assist in drake driving down the backlog. The estimate cost is approximately 20 million. Thank you. This concludes my remarks. Mr. Chairman, although the process broke down last year, two parts about assumptions and market assessment. Many of the recommendations for expansion as well as repairs and maintenance of existing ones were widely supported. The backlog of projects continues to grow faster than the v. A. Can address them. Neither the Facility Management nor the actual facilities have the amount of staff necessary to decrease the backlog. Addressing the oversight will save money in the longterm and potentially save lives if done correctly. The v. A. Must hire additional personnel and increase the personnel at increase at individual facilities is critical to decreasing the backlog. There is a backlog over 125 billion. The v. A. Should be requesting at least 25 additional yearly. In five years will be talking about the 120 backlog. This outlines through need where the infrastructure work. The v. A. Request does not match the real need, it is only a fraction. Its we urge the committee we urge the committee to look at the actual resource need instead of what they are asking for. Thank you for the opportunity to provide our remarks on these important topics. We are prepared to answer any questions you have. I appreciate all of your testimonies. Let start with mr. Brown. Last month we tried to do a package of bills, these were five bills introduced in the committee. They were sent out unanimously. So my colleagues blocked it from advancement into becoming law. It was improved home care options or veterans. It would have saved us in the long run and improve the quality of life. They were interviewing veterans and finding the impact of that cannabis has had. It would help native americans achieve ownership of homes. I know that the v. A. Was a supporter of this legislation. Can you tell us what further delay this means for part of the organization. The members of this committee no that the number of veterans who will be meeting longterm care is expected to significantly increase over the next decade rude it is important that the v. A. Implements policies now ensure that these veterans can safely age at home and remain active participants in their communities. Unfortunately, v. A. Home based services are not offered at all help facilities, even though they are desperately needed. Its the veterans improvement act would have ensured programs had care at all the eight Medical Centers, giving a greater number of veterans catastrophically disabled veterans the ability to receive care in their homes which is where they prefer to receive it. It also instructs the v. A. To test the program which would allow home aides to veterans residing in communities where there is a shortage of Home Health Aides. The shortage of Home Health Aides is severely impeding access for veterans as well as many aging americans to receive the needed home care. They have been very supportive of this to help curb the shortages and bolster the workforce. Although it was not included in the improvement act, we appreciate your in the Ranking Members commitment to finding a way to race the cap on the amount that the v. A. Can pay for health care. This provision is in play important to the few hundred veterans who have the service care issues that exceed the cap and they must pay outofpocket, rely on medicaid or be placed in an institutional setting. Its this question is for all three. The Veterans Service handles the training program. This includes cap classes and budget cuts i am concerned about Cutting Services to veterans in the home program that would enable them to find better wages and better jobs. Please tell me if the levels if returning to the levels of funding would hurt the homeless, jobless transitioning veterans . Thank you. This is going to have a huge impact for a lot of reasons, specifically it will hurt the homeless veteran reenter Reintegration Program through the department of veterans. It is going to take away that chance for up to 5000 veterans for job training and additional skills. We are concerned it could potentially have some overlap in problems with the dol and caps specifically which will impact hundreds of thousands of veterans being separated from services. Anyone would like to add . The v. A. s annual suicide report noted that the largest cohort of veterans dying from suicide of those that are aged 1824. This is one of the few agencies that engages with this particular group of veterans, either through the cap program or through services. Many have already been impacted by reduced budgeting and cutting them even further would be detrimental to a lot of these veterans. One final question. We got to hear the conversation about to bills on caps. Could you let us know if youre organization supports one or both bills . We support putting reasonable caps on any bills that affect the justice act. It is similar to our concern about unaccredited claims taking absorbent amount of money. We hope that our supporters in the house and senate will come up with a good compromise to make sure veterans and marines from years ago are taking care of. Thank you. One of the things i think about the pact act is i appreciate its attempt at trying to provide fairness to veterans separated from service more than 10 years ago. Within the last 10 years, excuse me. What is your view on how well the department is conducting the outreach necessary to get those and other veterans . We need to be encouraged on asking questions from the v. A. About that effort. I will take that one. 425 years, i have been an advocate. I have seen all of the different programs have come into effect over the last five years and i have never seen an Outreach Campaign like the v. A. Is doing now ever before in my career. No and they added additional acts, when they made changes in the late 1990s, in the 2000. I am impressed with what they have already done and i think they can do more. Specifically to have already conducted many awareness events around the country. I have attended several myself. I think the v. A. Has been more collaborative with the community that i have seen in any other Program Since the modernization act. I am happy when i hear compliments of good things that are happening. Anyone else need to comment on that . Ok. One of the problems we are experiencing, i understand it is a budget issue, one we raise during the debate about the act, we created the Toxic Exposure Fund and it has been a bit of a battle from time to time in the committee but it certainly has been successful in setting aside resources. I understand it is important but has also unintentionally created new scoring implications that were previously provided on discretionary funding only. We saw that in the bill that we took to the floor that the senator just asked mr. Brown about. We need to find a way so that every other bill is not handicapped by the score created by necessary roles. Necessary rules. Probably not something happening in these days but i would suggest that we need some help without being accused of doing anything harmful to the pack act , not only does not accused but its doing anything helpful. I want to find a way to move forward. Any thoughts . I am glad you brought this up first. What we really want to do, we received a briefing last week, what we believe are some of the most outrageous things, v. A. Police scheduling was one of the more outlandish examples. That is not what it was intended for. We hope we can clarify that, that it will help ease the scoring. Think education and its scoring information . I think that is step one. But within the law was not police scheduling. Anybody else . I appreciate the answer. I think it is really important. Will be a problem for us if we do not get the scoring issue resolved period perhaps some others are doing our work. Thank you. Mr. Brown. I want to follow up on your point on raising the cap. If you want to contradict me, you may. My understanding to fulfill the commitment we have made to work to find a solution. 1300 was a score and we do not think that is accurate. We want to go back to get something realistic. We need the help of the department of affairs. Am i missing anything . No. It sounds like we are 100 agreement on that. Want to thank you for being here. I appreciate what you do and how you represent your members. I appreciate that. We made a promise to those that have served our country, to deliver for them. The v. A. Has been good on that promise. I think the secretary and you gentlemen have shared the insight. As we move forward, this includes the pact act will continue to improve care for veterans of all areas. We will keep the record open for a week. The hearing is adjourned. [captions Copyright National cable satellite corp. 2023] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [background noises]