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LEGISLATIVE HEARING ON: H.R. 272; H.R. 353; 

H.R. 359; H.R. 421; H.R. 423; H.R. 1356; H.R. 

1688; H.R. 1862; H.R. 2464; H.R. 2914; H.R. 

2915; H.R. 3016; AND, DRAFT LEGISLATION TO 

AUTHORIZE VA MAJOR MEDICAL FACILITY 

CONSTRUCTION PROJECTS FOR FY 2015 AND 

TO MAKE CERTAIN IMPROVEMENTS IN THE ADMINISTRATION OF VA MEDICAL FACILITY CONSTRUCTION PROJECTS 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

FIRST SESSION 

TUESDAY, JULY 14, 2015 

Serial No. 114–31 

Printed for the use of the Committee on Veterans’ Affairs 

( 

Available via the World Wide Web: http://www.fdsys.gov 


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COMMITTEE ON VETERANS’ AFFAIRS 

JEFF MILLER, Florida, Chairman 

DOUG LAMBORN, Colorado 

GUS M. BILIRAKIS, Florida, Vice-Chairman 

DAVID P. ROE, Tennessee 

DAN BENISHEK, Michigan 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

JACKIE WALORSKI, Indiana 

RALPH ABRAHAM, Louisiana 

LEE ZELDIN, New York 

RYAN COSTELLO, Pennsylvania 

AMATA COLEMAN RADEWAGEN, American 

Samoa 

MIKE BOST, Illinois 

CORRINE BROWN, Florida, Ranking 

Minority Member 

MARK TAKANO, California 

JULIA BROWNLEY, California 

DINA TITUS, Nevada 

RAUL RUIZ, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

KATHLEEN RICE, New York 

TIMOTHY J. WALZ, Minnesota 

JERRY MCNERNEY, California 

JON TOWERS, Staff Director 

DON PHILLIPS, Democratic Staff Director 

SUBCOMMITTEE ON HEALTH 

DAN BENISHEK, Michigan, Chairman 

GUS M. BILIRAKIS, Florida 

DAVID P. ROE, Tennessee 

TIM HUELSKAMP, Kansas 

MIKE COFFMAN, Colorado 

BRAD R. WENSTRUP, Ohio 

RALPH ABRAHAM, Louisiana 

JULIA BROWNLEY, California, Ranking 

Member 

MARK TAKANO, California 

RAUL RUIZ, California 

ANN M. KUSTER, New Hampshire 

BETO O’ROURKE, Texas 

Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records 

of the Committee on Veterans’ Affairs are also published in electronic form. The printed 

hearing record remains the official version. Because electronic submissions are used to 

prepare both printed and electronic versions of the hearing record, the process of converting 

between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process 

is further refined. 


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C O N T E N T S 

Tuesday, July 14, 2015 

Page 

Legislative Hearing on: H.R. 272; H.R. 353; H.R. 359; H.R. 421; H.R. 423; 

H.R. 1356; H.R. 1688; H.R. 1862; H.R. 2464; H.R. 2914; H.R. 2915; H.R. 

3016; and, Draft Legislation to Authorize VA Major Medical Facility Construction Projects for FY 2015 and to Make Certain Improvements in the 

Administration of VA Medical Facility Construction Projects ......................... 1 

OPENING STATEMENTS 

Dan Benishek, Chairman ........................................................................................ 1 

Julia Brownley, Ranking Member .......................................................................... 2 

Prepared Statement ......................................................................................... 39 

WITNESSES 

Hon. Tim Walberg, U.S. House of Representatives, 7th Congressional District; 

Michigan ............................................................................................................... 4 

Prepared Statement ......................................................................................... 50 

Hon. Steve Stivers, U.S. House of Representatives, 15th Congressional District, Ohio .............................................................................................................. 5 

Prepared Statement ......................................................................................... 50 

Hon. Kyrsten Sinema, U.S. House of Representatives, 9th Congressional District, Arizona ......................................................................................................... 7 

Hon. Doug Collins, U.S. House of Representatives, 9th Congressional District, 

Georgia .................................................................................................................. 9 

Prepared Statement ......................................................................................... 51 

Hon. Sean Duffy, U.S. House of Representatives, 7th Congressional District, 

Wisconsin .............................................................................................................. 11 

Prepared Statement ......................................................................................... 53 

Hon. Mike Coffman, U.S. House of Representatives, 6th Congressional District, Colorado ....................................................................................................... 12 

Prepared Statement ......................................................................................... 54 

Hon. Charles Boustany, U.S. House of Representatives, 3rd Congressional 

District, Louisiana ............................................................................................... 14 

Prepared Statement ......................................................................................... 55 

Hon. Jeff Denham, U.S. House of Representatives, 10th Congressional District, California ..................................................................................................... 15 

Prepared Statement ......................................................................................... 56 

Hon. Brad Wenstrup, U.S. House of Representatives, 2nd Congressional District, Ohio .............................................................................................................. 16 

Ian de Planque, Legislative Director, American Legion ....................................... 20 

Prepared Statement ......................................................................................... 57 

Adrian Atizdo, Assistant National Legislative Director, Disabled American 

Veterans ................................................................................................................ 21 

Prepared Statement ......................................................................................... 67 

Carlos Fuentes, Senior Legislative Associate, National Legislative Service, 

Veterans of Foreign Wars of the United States ................................................ 23 

Prepared Statement ......................................................................................... 78 

Madhulika Agarwal MD, MPH, Deputy Under Secretary for Health for Policy 

and Services VHA, U.S. Department of Veterans Affairs States and Janet 

P. Murphy MBA, Acting Deputy Under Secretary for Health for Operations 

and Management, VHA, U.S. Department of Veterans Affairs ....................... 30 


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IV 

Madhulika Agarwal MD, MPH, Deputy Under Secretary for Health for Policy 

and Services VHA, U.S. Department of Veterans Affairs States and Janet 

P. Murphy MBA, Acting Deputy Under Secretary for Health for Operations 

and Management, VHA, U.S. Department of Veterans Affairs—Continued 

Prepared Statement ......................................................................................... 86 

Accompanied by: 

Jessica Tanner, General Attorney, Office of General Counsel, U.S. 

Department of Veterans Affairs 

STATEMENT FOR THE RECORD 

American Academy of Audiology and the American Speech-Language Association ........................................................................................................................ 104 

Children of Vietnam Veterans Health Alliance .................................................... 105 

International Hearing Society ................................................................................ 106 

National Medical Association ................................................................................. 110 

Paralyzed Veterans of America .............................................................................. 111 

VetsFirst, a Program of the United Spinal Association ....................................... 118 

Warrior Canine Connection .................................................................................... 122 


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LEGISLATIVE HEARING ON: H.R. 272; H.R. 353; 

H.R. 359; H.R. 421; H.R. 423; H.R. 1356; H.R. 

1688; H.R. 1862; H.R. 2464; H.R. 2914; H.R. 2915; 

H.R. 3016; AND, DRAFT LEGISLATION TO AUTHORIZE VA MAJOR MEDICAL FACILITY 

CONSTRUCTION PROJECTS FOR FY 2015 

AND TO MAKE CERTAIN IMPROVEMENTS IN 

THE ADMINISTRATION OF VA MEDICAL FACILITY CONSTRUCTION PROJECTS 

Tuesday, July 14, 2015 

U.S. HOUSE OF REPRESENTATIVES, 

COMMITTEE ON VETERANS’ AFFAIRS, SUBCOMMITTEE ON HEALTH, Washington, D.C. 

The subcommittee met, pursuant to notice, at 10:31 a.m., in 

Room 334, Cannon House Office Building, Hon. Dan Benishek 

[chairman of the subcommittee] presiding. 

Present: Representatives Benishek, Bilirakis, Roe, Huelskamp, 

Coffman, Wenstrup, Abraham, Brownley, Takano, Kuster, and 

O’Rourke. 

Also Present: Representative Walz. 

OPENING STATEMENT OF CHAIRMAN DAN BENISHEK 

Dr. BENISHEK. The subcommittee will come to order. 

Before we begin, I would like to ask unanimous consent for my 

friend and colleague and member of the full committee, Mr. Walz 

from Minnesota, to sit on the dais and participate in today’s proceedings. Without objection, so ordered. 

Good morning, and thank you all for joining us today as we discuss legislation that would impact and improve the healthcare provided to our veterans by the Department of Veterans Affairs. 

Our agenda this morning is ambitious. It includes 13 bills ranging in scope from ensuring quality healthcare outcomes for the 

growing number of women veterans to reforming VA’s management 

of major medical facility construction projects. 

Given that we have a lengthy hearing ahead of us, I will limit 

my opening comments to discussing the bill on our agenda that I 

am proud to sponsor, H.R. 2464, the Demanding Accountability for 

Veterans Act. 

This bill would address a troubling pattern that we have seen repeatedly in subcommittee hearings and roundtables where the VA 


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inspector general identifies a recommendation to resolve a serious 

issue, the VA fails to take appropriate action, and veterans suffer 

as a result. 

Such negligence and inaction would be unacceptable for any organization, but it is particularly unacceptable for a taxpayer funded Federal Government department that is charged with caring for 

the men and women who have served our Nation in uniform. 

The Demanding Accountability for Veterans Act would require 

the IG to provide the Committee on Veterans’ Affairs of the House 

and the Senate with copies of all reports submitted to the VA to 

including an explanation of any changes made to the report that 

were recommended by the VA during the drafting process and the 

name of the VA employee responsible for taking action in response 

to the report’s content. 

In turn, the VA will be required to promptly notify each named 

employee of his or her responsibility to take action, direct that the 

employee resolve the issue at hand, and provide the employee with 

counseling and a mitigation plan to support him or her in fully addressing the inspector general’s recommendations. 

The bill would further require the VA to include an evaluation 

of whether or not the employee took appropriate action in his or 

her annual performance review, prohibit the VA from paying a 

bonus or performance award to any employee who failed to resolve 

an issue under their purview. 

An earlier version of the Demanding Accountability for Veterans 

Act passed the House resoundingly last Congress. I look forward to 

similar passage this Congress. We owe it to our veterans and to the 

taxpayers who pay VA’s bills to ensure that poor-performing VA 

bureaucrats are held accountable for failing to provide the highquality care that our veterans have earned and deserve. 

The Demanding Accountability for Veterans Act is critical to 

doing just that and I encourage all my colleagues to join me in supporting it. 

With that, I would like to thank all of our witnesses and audience members today for being here and I yield to Ranking Member 

Brownley for any opening statement she may have. 

OPENING STATEMENT OF RANKING MEMBER JULIA 

BROWNLEY 

Ms. BROWNLEY. Thank you, Chairman Benishek, and thank you 

for calling this hearing today. 

These hearings are an important part of the legislative process. 

It is essential to our responsibilities to advance worthy legislation 

that addresses and improves medical services available to our veterans. Access to safe, quality healthcare is and must be the priority 

for the subcommittee. 

I am particularly pleased to see so many of my colleagues here 

today to testify on their legislation and I thank you so much for 

your interest in the well-being of veterans across our country. 

Mr. Chairman, while there are many worthy bills on the agenda 

today, I will focus on just three that are being considered at this 

hearing today. 

H.R. 421, the Classified Veterans Access to Care Act, introduced 

by Congresswoman Sinema would ensure that veterans with classiVerDate Aug 31 2005 13:13 Oct 04, 2016 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 Y:\98-686~1.TXT PAT

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fied experiences have appropriate access to mental health services 

from the Department of Veterans Affairs. 

This bill was introduced in the last Congress and passed this 

committee as part of H.R. 4971 introduced by our colleague, Congressman O’Rourke. However, this bill was never considered by the 

full House, and I would like to thank the chairman for including 

it on the agenda today and would like to express my full support 

for this bill. 

I have two bills on the agenda today that I have recently introduced. The first one, H.R. 2914, the Build a Better VA Act, is a bill 

that would modify the current process for approving Department of 

Veterans Affairs’ medical facility leases. 

Under current law, every major medical facility lease which incurs yearly rental costs of over a million dollars must be authorized 

by Congress. In addition, recent changes made to VA’s leasing process require the VA to submit leasing proposals to the General Services Administration for delegation to the VA. 

This requires approval by the Committee on Transportation and 

Infrastructure in the House. Therefore, VA leases must be approved by the Transportation and Infrastructure Committee and be 

approved by Congress. 

In 2012, the Congressional Budget Office changed its method of 

scoring VA leases. Instead of scoring the annual cost of the lease, 

CBO scores now reflect the cost for the duration of the lease, often 

20 or more years. 

For instance, CBO now scores a 20-year lease which costs the department $5 million a year at $100 million. Prior to 2012, CBO’s 

score would have reflected the true cost of $5 million, a considerable difference. 

CBO’s new scoring mechanism has made it impossible for the 

Veterans’ Affairs Committee to authorize leases within the current 

budget caps despite the fact that no new money is actually spent. 

The result has been significant delays in leasing of new facilities, 

further delaying needed care for veterans across the country. 

The population of veterans is growing. The demand for VA 

healthcare is increasing and many veterans trying to access VA 

care face long wait times and crumbling infrastructure at outdated 

VA clinics and medical centers. 

CBO’s actions have made authorizing new leases for veterans’ 

medical facilities which are desperately needed in under-served 

veteran communities across the United States cost prohibitive. 

This bill would simply allow major medical facility leases to be 

authorized by a committee resolution rather than the legislation. It 

would return the authorization process to the Veterans’ Affairs 

Committee to what it was before requiring a committee resolution. 

It would also harmonize this process with the requirement of the 

General Services Administration and the longstanding practice of 

the Transportation and Infrastructure Committee for federal buildings. 

This more rational approach would ensure that veterans have 

the facilities they need to get the healthcare they have earned and 

deserve and will help address the unacceptable wait times faced by 

many of our veterans. 


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I have also introduced H.R. 2915, the Female Veterans Suicide 

Prevention Act. This bill would direct the secretary of Veterans Affairs to identify mental healthcare and suicide prevention programs 

and metrics that are effective in treating women veterans as part 

of the evaluation of such programs by the secretary. 

By analyzing data from 23 states and VA’s suicide repository of 

more than 170,000 adult suicides over a ten-year period, VA researchers found in a May 2015 report that suicides among women 

veterans increased by 40 percent from 2000 to 2010 compared to 

a 13 percent increase in suicide among civilian women. 

In fact, female veterans are nearly six times as likely as other 

women to commit suicide. My bill is intended to ensure that the 

VA addresses these tragedies by requiring that VA’s evaluations of 

mental healthcare and suicide prevention programs include specific 

metrics on women veterans and by requiring the VA to identify the 

mental healthcare and suicide prevention programs that are the 

most effective and have the highest satisfaction rates among our female veterans. 

While I am disappointed that the department has not submitted 

views on my two bills before us today, I look forward to receiving 

those views in the not too distant future. 

Mr. Chairman, I look forward to the testimony from our witnesses today and their views on how to improve upon the many 

bills that we are considering. Thank you, and I yield back the balance of my time. 

[THE PREPARED STATEMENT OF RANKING MEMBER JULIA

BROWNLEY APPEARS IN THE APPENDIX] 

Dr. BENISHEK. Thank you, Ms. Brownley. 

I am honored this morning to be joined by several of my colleagues to speak in support of their legislation. Joining us this 

morning is the Honorable Tim Walberg from Michigan; Sean Duffy 

from Wisconsin I imagine will be joining us here shortly; Steve 

Stivers from Ohio; Honorable Kyrsten Sinema from Arizona; the 

Honorable Doug Collins from Georgia; the Honorable Mike 

Coffman from Colorado; the Honorable Jeff Denham will probably 

be joining us as well; and the Honorable Charles Boustany from 

Louisiana; as well as the Honorable Brad Wenstrup from Ohio. 

Thank you all for being here today. 

Mr. Walberg, we will begin with you. You have five minutes to 

present your testimony. 

STATEMENT OF HON. TIM WALBERG, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF MICHIGAN 

Mr. WALBERG. Chairman Benishek, Ranking Member Brownley, 

and members of the subcommittee, I thank you for allowing me the 

time to speak this morning in support of my legislation, H.R. 272, 

the Medal of Honor Priority Care Act of 2015, which raises the 

Medal of Honor recipients to Priority 1 level of care, I believe to 

be a common-sense, I hope noncontroversial and certainly bipartisan piece of legislation. 

As members of this committee are well aware, the Congressional 

Medal of Honor is the highest award for valor which can be bestowed upon an individual serving in the United States Armed 

Forces and is awarded to soldiers who have displayed conspicuous 


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gallantry and intrepidity at the risk of life above and beyond the 

call of duty. 

The Medal of Honor is a distinguished award given to a select 

few. Less than 3,500 have been awarded and 16 awards have gone 

to soldiers who fought in the recent conflicts in Iraq and Afghanistan. Currently there are only 79 living Medal of Honor recipients. 

My State of Michigan, as you know, Mr. Chairman, is privileged 

to have two living recipients. Corporal Duane E. Dewey and Private First Class Robert Simanek both received the declaration for 

their heroic action in the Korean War and hearing of the harrowing 

stories of bravery has reminded me of the sacrifices American soldiers are willing to make to protect their comrades and their country. 

Medal of Honor recipients are brought most appreciation and I 

believe the small portion of our servicemembers who have gone 

above and beyond the call of duty and earned the highest honor in 

our Nation’s Armed Forces have earned the right to be placed in 

the top priority group to receive their healthcare benefits. 

I would be remiss if I did not mention the idea for this legislation 

came from a veteran who lives in my district and works with the 

veteran community. All veterans deserve access to the healthcare 

they have earned. But as you all know, the VA uses a priority system to determine eligibility for these healthcare services. 

Some of the factors that will affect a soldier’s priority group 

ranking are whether the soldier has service-connected disability, 

whether they were a former prisoner of war, the time and place of 

service as well as income level. 

Currently Medal of Honor recipients are in Priority Group 3. 

This bill is very similar to legislation approved by this committee 

during the 113th Congress. I am proud to have support of the 

VFW, Paralyzed Veterans of America, The American Legion, IAVA, 

and to once again have the support of my colleagues from both 

sides of the aisle on this bill. 

I thank the chairman for permitting me to appear before the subcommittee today, and I certainly would appreciate your support. 

Thank you. 

[THE PREPARED STATEMENT OF TIM WALBERG APPEARS IN THE APPENDIX] 

Dr. BENISHEK. Thank you, Mr. Walberg. 

Mr. Stivers, you are recognized for five minutes. 

STATEMENT OF HON. STEVE STIVERS, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF OHIO 

Mr. STIVERS. Thank you, Mr. Chairman. 

I want to thank Chairman Benishek and Ranking Member 

Brownley for including my bill, the bipartisan Veteran Dog Training Therapy Act, in today’s legislative hearing. 

As the committee members probably know, 22 veterans commit 

suicide every day. The ranking member just talked about her bill 

that she is working on on female suicide. This is a deeply personal 

issue for me. I am a colonel in the Ohio Army National Guard, 

served in Operation Iraqi Freedom, and I have known people who 

have sadly taken their own lives. 


VACREP0180 with DISTILLER
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This epidemic requires immediate action. I appreciate what you 

are already doing, but I know there is more we can do. The tie between posttraumatic stress disorder and traumatic brain injury 

and suicide is well-documented, and I know you are taking steps 

to improve treatments for both those conditions. 

However, every individual is unique and different people respond 

differently to different therapies. That is why I have introduced the 

Veterans Dog Training Therapy Act with my colleague, Tim Walz 

from Minnesota. 

Thank you for your work on this. I appreciate it. 

Our bill seeks to expand access to an alternative therapy that is 

proven effective and it works for a lot of people. Anybody that owns 

a dog knows that when you are petting your dog, hanging out with 

your dog, you know, your emotions just kind of ease away. 

So essentially what our bill does is it creates three to five pilot 

programs in VA facilities around the country and then that pilot 

would be studied for expansion if it works or elimination if it 

doesn’t work. 

These veterans would essentially get a chance to help learn occupational skills while training a service dog and on completion of the 

dog’s training, that dog would then be given to a disabled veteran 

for future service. 

This is not a program we made from scratch. It emulates and 

copies a very successful model of a nonprofit called the Warrior Canine Connection which is at several Department of Defense medical 

facilities and one VA facility already in Menlo Park. 

So it works and it is a model that we know will work. That is 

why we decided to copy it. Veterans that are enrolled in this program have shown significant improvements and I believe that this 

pilot would bear out the same results. 

And it is important to note that some of the wounded warriors 

who benefit from service dog therapy had not been responding to 

other treatments. So this is something that works when a lot of 

other things fail. 

Kaiser Permanente actually did some research on the effectiveness of service dogs in treating PTSD and traumatic brain injury 

related symptoms. The study has shown that veterans who own 

service dogs have fewer symptoms of PTSD and depression, better 

interpersonal relationships, and an overall improvement in mental 

health. Maybe we should get some service dogs in Congress. 

It should also be noted that Congress did direct a research study 

in the 2010 NDAA which was signed into law in 2009, but that 

study won’t be completed until 2019. There is already research out 

here that shows this works. We need to get this in the field as soon 

as possible. 

Twenty-two suicides a day, almost one an hour. If we can do 

things to prevent it, we should not wait ten years. So that is why 

Mr. Walz and I have introduced this bill. Again, this is not made 

up from scratch. It emulates the Warrior Canine Connection successful model and tries to emulate it and expand it for the future 

into VA facilities. 

I met one of the dogs from Warrior Canine Connection just last 

week and, you know, when she was in the office, everybody was 

calm. These service dogs just work. And so I know that this bill 


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will make a difference. I know that the study won’t be completed 

until 2019, but I implore you don’t wait on a study that we all 

know what it is going to say. 

And I am a little disappointed I will say in the VA study. They 

have been training these dogs as like guard dogs and that is not 

what a service dog is. They need to train them in being gentle and, 

you know, very docile. And that is what Warrior Canine Connection has done. 

Again, this bill will help us as we try to address some of these 

people that have traumatic brain injury and posttraumatic stress 

disorder that aren’t responding to other therapies and it will help 

keep their mental health in a better state. The results have been 

proven in this Kaiser Permanente study. 

I know my time is up, but I really appreciate you hearing my testimony today and I hope you will take this bill and help us get it 

done because it is really important and it can really help save lives. 

Thank you so much. Again, I want to thank Tim Walz for his 

work on it. I want to thank the chairman and ranking member 

again for allowing me to be here. And I implore you to please take 

action on this bill. Thank you. 

[THE PREPARED STATEMENT OF STEVE STIVERS APPEARS IN THE

APPENDIX] 

Dr. BENISHEK. Thank you very much. 

Representative Sinema, please go ahead. 

STATEMENT OF HON. KYRSTEN SINEMA, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF ARIZONA 

Ms. SINEMA. Thank you, Chairman Benishek, and thank you, 

Ranking Member Brownley, for holding today’s hearing. 

I want to first start by saying thank you to my colleagues who 

have introduced important bills to improve the quality of care 

available to veterans, especially Chairman Benishek’s legislative, 

the Demanding Accountability for Veterans Act. 

We introduced this important bill together to improve accountability and to hold VA employees responsible for solving problems 

at the VA. 

I am here today to discuss H.R. 421, the Classified Veterans Access to Care Act. And thank you, Chairman Benishek, for allowing 

me time to speak today and to both the ranking member and the 

chairman for cosponsoring this legislation. 

The Classified Veterans Access to Care Act ensures that veterans 

with classified experiences can access appropriate mental health 

services at the Department of Veterans Affairs. Our bill directs the 

secretary of the VA to establish standards and procedures to ensure that a veteran who participated in a classified mission or 

served in a sensitive unit may access mental healthcare in a manner that fully accommodates the veteran’s obligation to not improperly disclose classified information. 

The bill also directs the secretary to disseminate guidance to employees of the Veterans Health Administration including mental 

health professionals on such standards and procedures on how to 

best engage these veterans during the course of mental health 

treatment with respect to classified information. 


VACREP0180 with DISTILLER
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And, finally, this bill directs the secretary to allow veterans with 

classified experiences to self-identify so they can quickly receive 

care in an appropriate setting. 

I am working on this issue because just over two years ago, a 

veteran in my district, Sergeant Daniel Somers, failed to receive 

the care he needed and tragically lost his life to suicide. No veteran 

or family should go through the same tragedy that the Somers family experienced. 

Sergeant Somers was an army veteran of two tours in Iraq. He 

served on Task Force Lightning, an intelligence unit. He ran over 

400 combat missions as a machine gunner in the turret of a 

Humvee. Part of his role required him to interrogate dozens of terrorist suspects and his work was deemed classified. 

Like many veterans, Daniel was haunted by the war when he returned home. He suffered from flashbacks, nightmares, depression, 

and additional symptoms of posttraumatic stress disorder made 

worse by a traumatic brain injury. Daniel needed help and he and 

his family asked for help. 

Unfortunately, the VA enrolled Sergeant Somers in group therapy sessions which Sergeant Somers could not attend for fear of 

disclosing classified information. Despite repeated requests for individualized counseling or some other reasonable accommodation to 

allow Sergeant Somers to receive appropriate care for his PTSD, 

the VA delayed providing Sergeant Somers with appropriate support and care. 

Like many, Sergeant Somers’ isolation got worse when he 

transitioned to civilian life. He tried to provide for his family, but 

he was unable to work due to his disability. Sergeant Somers 

struggled with VA bureaucracy. His disability appeal had been 

pending for over two years in the system without resolution, but 

he didn’t get the help he needed in time. 

On June 10th, 2013, Sergeant Somers wrote a letter to his family. In the letter, he said I am not getting better. I am not going 

to get better and I will most certainly deteriorate further as time 

goes on. He went on to say I am left with basically nothing, too 

trapped in a war to be at peace, too damaged to be at war, abandoned by those who would take the easy route and a liability to 

those who stick it out and thus deserve better. So you see, not only 

am I better off dead, but the world is better without me in it. This 

is what brought me to my actual final mission. 

Sergeant Somers’ parents, Howard and Jean, were devastated by 

the loss of their son, but they bravely shared Sergeant Somers’ 

story and created a mission of their own. Their mission is to ensure 

that Sergeant Somers’ story brings to light America’s deadliest war, 

the 22 veterans that we lose every day to suicide. 

Many of you have met with Howard and Jean. They are working 

closely with Congress and the VA to share their experiences with 

the VA healthcare system and find ways to improve care for veterans and their families. 

Our office worked closely with Howard and Jean to develop the 

Classified Veterans Access to Care Act. And if the committee moves 

this bill forward, I ask on behalf of Dr. and Mrs. Somers that the 

committee amend the title of the bill to the Sergeant Daniel 


VACREP0180 with DISTILLER
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Somers’ Classified Veterans Access to Care Act in memory of Sergeant Somers’ service and sacrifice. 

I appreciate the support this committee gave to our bill during 

the 113th Congress. I look forward to continuing to work with the 

committee to ensure that no veteran feels trapped like Sergeant 

Somers did and that all veterans have access to appropriate mental 

healthcare. 

Thank you, Chairman Benishek and Ranking Member Brownley, 

for including H.R. 421 in today’s hearing. Thank you. 

Dr. BENISHEK. Thank you. 

Mr. Collins. 

STATEMENT OF HON. DOUG COLLINS, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF GEORGIA 

Mr. COLLINS. Thank you, Mr. Chairman. 

Chairman Benishek, Ranking Member Brownley, and distinguished members of the subcommittee, thank you for the opportunity to testify on H.R. 423, the Newborn Care Improvement Act. 

My legislation amends Title 38 of the United States Code to improve the care provided by the secretary of Veterans Affairs to 

newborn children. And I am very appreciative of the subcommittee’s consideration of this legislation. 

The motto of the VA comes straight from Abraham Lincoln’s second inaugural. He got that idea straight from scripture. So the 

challenge for us is to care for him who shall have borne the battle 

and for his widow and his orphans. This isn’t new as we have already heard this morning. 

Since September 11th, 2011, more than a quarter of a million 

women have answered the call to serve. They face terrorism in the 

deserts and in the mountains of Iraq and Afghanistan. So in the 

21st century, we must also consider she who shall have the borne 

the battle. When she returns, what of her children? 

The finest military in the world is powered by men and women 

in their physical prime. Young women who decided to serve this 

country in the Armed Forces aren’t immune from the same questions that all young women face about whether to pursue a career, 

a family, or both, yet they are offered a healthcare system that for 

so many years has been designed to serve men. 

With the increasing number of female veterans, the VA must expand its care and services to meet their needs. Maternity care tops 

that list of needs and I have offered one of the ways that we can 

help. 

In 2010, Congress passed and the President signed the Caregivers and Veterans Omnibus Health Services Act of 2010 to provide short-term newborn care for women veterans who receive their 

maternity care through the VA. Signed into law on May 5th, 2010, 

this legislation authorized up to seven days of newborn care. 

On January 27th, 2012, the Department of Veterans Affairs published a regulation officially amending VA’s medical benefits package to include up to seven days of medical care for newborns delivered by female veterans who are receiving VA maternity care benefits. The rule which became effective December 19th applied retroactively to newborn care provided to eligible women vets on or after 

May 5th, 2011. 


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Since the seven-day authorization was enacted by Congress in 

2010, we have learned about the unique challenges facing female 

veterans and changing trends in the veterans seeking maternity 

and newborn care from the VA. According to a study published in 

the Women’s Health Journal this past year, 2008 to 2012, the overall delivery rate by female veterans utilizing VA maternity benefits 

increased by 44 percent and a majority of the women using VA maternity benefits had service-connected disability. 

Just last week, the U.S. Navy announced that it has tripled the 

amount of paid maternity leave for personnel in the navy and marine corps. Effective immediately, 18 weeks of maternity leave will 

be available. 

Secretary Mabus stated in a press release with increased maternity leave, we can demonstrate the commitment of the navy and 

marine corps to the women who are committed to serve. 

In the same way, unless Congress extends the authorization for 

length of newborn care coverage provided by the VA, there will be 

veterans who face difficult financial decisions and complexities in 

navigating insurance options at the same time that their newborn 

is fighting for their life. 

This is why I introduced H.R. 423 to demonstrate Congress’s 

commitment to meeting the needs of female veterans and providing 

a little longer for their newborn care. My legislation extends the 

authorization of care from seven to 14 days and provides for an annual report on the number of newborn children who receive such 

services during such fiscal year. 

Improved data on the trends in female veterans utilizing newborn care will help Congress and the VA better meet their needs 

in years to come. Should this subcommittee place my legislation on 

their markup calendar, which I hope they will do, I would request 

an amendment be adopted adding the reporting requirement to an 

existing report the VA is required to produce. 

Although it is vitally important that Congress and the VA have 

this data, I don’t want the VA to produce yet another report when 

instead we could add this requirement to an existing report. 

Some may ask why the VA should provide more newborn care 

coverage to female veterans than the average private sector employee receives. These women have risked their lives to protect our 

Nation. Just because they are no longer serving in active duty does 

not mean that our responsibility to them ends. In fact, their service 

to our country may jeopardize the very lives of their future children, thus responsibility to them is even greater. 

A recent study examined more than 16,000 births to female veterans. Having PTSD in the year before delivery increased a woman’s risk of spontaneous premature delivery by 35 percent research 

showed. This study gives us a convincing epidemiological basis to 

say that, yes, PTSD is a risk factor for pre-term delivery 

The study’s senior author said an investigator at the March of 

Dimes prematurity research center at Stanford University said 

mothers with PTSD should be treated as having high-risk pregnancies. Premature infants often need longer hospitalizations after 

they are born and are more likely than full-term infants to die. 

These premature infants who survive may face long-term developVerDate Aug 31 2005 13:13 Oct 04, 2016 Jkt 000000 PO 00000 Frm 00014 Fmt 6633 Sfmt 6633 Y:\98-686~1.TXT PAT

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mental problems and, unfortunately, the number of female veterans with PTSD is not insignificant. 

According to the VA, 20 percent of female veterans in conflicts 

in Iraq and Afghanistan have been diagnosed with PTSD and these 

are not just the female veterans serving in combat. 

And on a personal note, I know what it is like to be a parent of 

a little baby who needs intensive medical care. For an extended period of time after my daughter was born, I could not even hold her 

until she was over ten days old. 

So it is my hope that any new mother who has given selflessly 

to her country wouldn’t have to worry about Congress standing in 

her way if she tries to give selflessly to her own child. And our goal 

should always be to provide the mother with the best prenatal care 

she needs to give the newborn the best chance of healthy delivery. 

To the members of the subcommittee, I know my time is short 

and I have submitted a statement. This is something that we can 

do to support those who supported us. In a new and changing 

world with women serving proudly and strongly, this is something 

we can do to protect them and also give best care to them and their 

newborns when they have served us and into a new world of the 

VA. 

And with that, Mr. Chairman, I yield back. 

[THE PREPARED STATEMENT OF DOUG COLLINS APPEARS IN THE

APPENDIX] 

Dr. BENISHEK. Thank you, Mr. Collins. 

I think I am going to go back to Mr. Duffy. 

Mr. Duffy, could you give your testimony, please. 

STATEMENT OF HON. SEAN DUFFY, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF WISCONSIN 

Mr. DUFFY. Yes. Good morning. Thank you, Chairman Dr. 

Benishek and Ranking Member Brownley, for holding today’s hearing and I appreciate the opportunity to testify on H.R. 353, the Veterans Access to Hearing Health Act. 

I introduced this bill along with Representative Walz from Minnesota and Ruiz from California to address the long wait times and 

lack of access to care for our veterans for audiology services. 

Our aging and younger veterans are returning home from the 

battlefield and they are seeking care from the VA in regard to 

hearing loss and tinnitus more than any other disability facing 

them today, yet the VA does not have the capability to keep up 

with the demand of these services. 

A recent Washington Post article cited that since the VA scandal 

broke last year, the number of veterans on wait lists for appointments has actually increased by 50 percent. Audiology services are 

a major factor in those wait times. According to the VA, nearly half 

of all patients waiting for care are waiting for audiology services. 

So we are all talking about personal stories today and I have one 

from my district. Roger Ellison, a 70-year-old Vietnam vet from 

Marshfield, Wisconsin, he is having hearing problems. So he goes 

to the VA and tries to set up an appointment. And they tell him 

he has to wait six months to get an appointment. 

I don’t know how someone could go six days let alone six months 

when you can’t hear. So instead he paid out of pocket, went to 


VACREP0180 with DISTILLER
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someone in his local community, a hearing aid specialist, and was 

able to get fitted for hearing aids. Pretty simple solution, but it 

would have been nice if the VA could have actually cared for him. 

Audiology services not only affect our older generation, but they 

are also affecting our younger generation too. Roger and thousands 

of other veterans are in situations because the VA, they are only 

allowed to use audiologists and not other capable providers to fulfill 

hearing aid services for our veterans. 

While audiologists are great resources for the VA to provide good 

services for our veterans, there is just not enough of them. There 

is too much demand. And so if you look for solutions on the committee, you can say let’s try to spend more money and hire more 

audiologists. Well, that is great, but it is pretty tough to hire people into the VA and we don’t have a lot of money. 

So what could we do that could actually resolve this problem, 

care for our veterans, and not spend really any more money? The 

answer is let’s use hearing aid specialists. They are qualified. Veterans can get these services in their own communities. They can 

get their hearing aids fitted, adjusted, make minor repairs. And 

then we are going to lift the burden off the audiologists so they can 

actually focus on the more serious cases. 

But why are we backing up audiology appointments with hearing 

aid tweaks, hearing aid fittings? This can happen actually in the 

home community. This is a simple solution that doesn’t cost money 

that is going to help our veterans out and it lifts the burden. And 

I think that is why we have such a bipartisan coalition that has 

come together on this bill. 

I would ask for you to respectfully consider a simple solution to 

a really big problem for veterans who can’t hear. And if we come 

together, it is one of those small fixes that again makes a big difference. 

So I thank you for allowing me to testify and thank you for your 

consideration. I yield back. 

[THE PREPARED STATEMENT OF SEAN DUFFY APPEARS IN THE AP- PENDIX] 

Dr. BENISHEK. Thank you, Mr. Duffy. 

Mr. Coffman, are you ready to go ahead? 

STATEMENT OF HON. MIKE COFFMAN, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF COLORADO 

Mr. COFFMAN. Yes, Mr. Chairman. 

Thank you, Chairman Benishek and Ranking Member Brownley, 

for holding this legislative hearing and including my bipartisan 

bill, the Women Veterans Access to Quality Care Act. 

Although the Department of Veterans Affairs has made some 

progress in recent years, the fact remains that the VA is a system 

largely designed for male veterans. 

A recent comprehensive study conducted by the Disabled American Veterans entitled Women Veterans, The Long Journey Home 

found serious gaps in almost every aspect of programs that serve 

women vets. 

In recent years, the active-duty military has made incredible 

strides towards fully incorporating women into the ranks. Though 

more work needs to be done, those long overdue changes in the DeVerDate Aug 31 2005 13:13 Oct 04, 2016 Jkt 000000 PO 00000 Frm 00016 Fmt 6633 Sfmt 6633 Y:\98-686~1.TXT PAT

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partment of Defense have increased the pool of eligible recruits, 

raising the standards to make our military the most professional 

that our country has ever had. 

As more and more of these women leave military service and become veterans, it is critical that the VA quickly adapt its facilities 

and culture. The aim of my bill is to increase gender-specific access 

to healthcare within the VA, improve healthcare outcomes for our 

women veterans, and improve VA’s facilities to ensure that they 

protect the privacy and dignity of all veterans. 

The need for this bill is largely illustrated simply by reviewing 

the rapidly changing demographic composition of the VA patient 

population. Between 2003 and 2012, the number of women veterans using VA healthcare nearly doubled. In 2012, women made 

up only 6.5 percent of the VA patient population, but are estimated 

to encompass over ten percent by 2020. 

Meanwhile, nearly 20 percent of all new recruits in the military 

are women. The women veteran patient population also has unique 

characteristics when compared to the male VA population. The median age of a female patient in the VA is 49 years old compared 

to 64 for male patients. Only 13 percent of men within the VA were 

45 years old or younger compared to 45 percent of women. 

These are dramatic changes to the VA’s patient population and 

the former almost exclusively male VA healthcare system simply 

hasn’t kept up with the changes. My bill addresses the VA’s lapses 

in healthcare quality and access for its women patients in five 

ways. 

First, my bill requires the VA to establish standards to ensure 

VA facilities meet the specific needs of women and integrates those 

standards into its strategic capital investment planning process. 

The Government Accountability Office found in 2010 that none of 

the VA hospitals it surveyed were compliant with the VA’s own 

policies related to privacy for women veterans. 

Just to cite a few examples, the audit found that check-in desks 

were in busy mixed-gender areas and gynecological examination tables faced towards doorways. Additionally, despite VA’s requirements that gynecological exam rooms have immediately adjacent 

restrooms, often women were required to walk down long hallways 

in high traffic, mixed-gender corridors to access restrooms. 

At a hearing in this room in April, I asked a panel of veteran 

service organizations’ experts whether these conditions have improved in the past five years. And the committee learned that these 

problems continue to persist nationwide. 

Second, my bill holds VA medical facility directors accountable to 

performance measures which include women’s healthcare outcomes 

and it requires the reporting of those outcomes. As with many 

other areas in the VA, there is an incredible lack of accountability 

which is hindering true progress and reform. 

Third, my bill ensures the availability of OB/GYN services at VA 

medical centers and requires the VA to conduct a pilot program to 

increase residents and graduate medical education positions. 

In 2010, nearly half of the women veterans who use VA 

healthcare had at least one reproductive health diagnosis. It is absolutely essential that these veterans have quick and reliable access to appropriate gender-specific care. 


VACREP0180 with DISTILLER
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Fourth, my bill improves outreach to women veterans by requiring the VA to provide state and veterans’ agencies with contact information for veterans. One of DAV’s findings in its report was that 

information on veterans’ programs and eligibility is often difficult 

to access and scattered across various programs or Web sites. Increasing outreach to women veterans through collaboration with 

VA’s state agency partners is vital. 

Finally, my bill mandates a new comprehensive GAO study of 

the VA’s ability to meet the needs of women veterans including an 

examination of wait times, gender-specific care availability, VA 

training, differences in health outcomes, and security and privacy 

within VA facilities. 

During my own military career, I have witnessed quite a number 

of challenges that the military has had to confront. Each time it 

overcame the obstacles and always emerged as a more effective 

fighting force. I have full confidence that the VA can do the same. 

I hope my bill can jumpstart the cultural sea change required at 

the VA to ensure our women veterans are provided the same benefits they earned in service to our Nation just like their male counterparts. I am grateful for the support of many of our Nation’s veterans and veteran service organizations have provided for this bill 

and I urge all of my colleagues on the committee today to join me 

in this effort. 

Thank you, Mr. Chairman. I yield back. 

[THE PREPARED STATEMENT OF MIKE COFFMAN APPEARS IN THE

APPENDIX] 

Dr. BENISHEK. Thank you, Mr. Coffman. 

Dr. Boustany, could you begin your testimony. 

STATEMENT OF HON. CHARLES BOUSTANY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF LOUISIANA 

Mr. *Boustany.* Thank you, Chairman Benishek, Ranking Member Brownley, and members of the subcommittee, for inviting me 

to testify before you today. 

As the committee considers reforms to the Department of Veterans Affairs operations, I really appreciate the opportunity to 

speak on behalf of my legislation, H.R. 1862, the Veterans Credit 

Protection Act. 

Unfortunately, the VA’s long history of delayed payments has 

brought me here to testify before you today. Too many veterans are 

forced to contact offices across our districts to resolve credit issues 

caused by the VA’s refusal to pay claims for emergency medical 

care. 

When these brave Americans require a trip to the emergency 

room because they have a serious illness or they fear that their 

lives are in danger, the last thing on their minds should be fear 

that the VA will fail to pay their claims. The last thing that should 

be on their mind are concerns about the VA damaging their credit 

rating. 

One such veteran in my district, Al Theriot of Abbeville, Louisiana, waited over two years for the VA to finally process and pay 

his emergency medical care bills which the agency did only after 

Mr. Theriot contacted my office and appeared on local television 


VACREP0180 with DISTILLER
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twice to describe his experience. This is just unacceptable. It is terrible and disrespectful service for our veterans. 

I submitted documentation from the VA to the subcommittee 

early in June demonstrating the scale of this problem. Just to reiterate some of the findings, data provided to me as of April 2015, 

the VA’s chief business office indicated that only 14, 14 percent of 

emergency medical care claims originating from VISN 16, which includes my home State of Louisiana, were being processed within 30 

days. In total, the data demonstrates a national backlog of over 

$878 million. 

The Veterans Credit Protection Act is an important step to rooting out the problems within the VA that caused this out of control 

backlog. First, the legislation mandates the VA to set up a toll-free 

hotline for veterans to report credit issues caused by delayed emergency medical care claims. 

It also requires the VA to conduct outreach alerting veterans of 

how to resolve these issues. Too often veterans tell me they cannot 

get in touch with the VA or that the employees they speak with 

cannot adequately answer their questions. 

Creating a dedicated call line and ensuring the VA implements 

a better framework for communicating solutions with veterans is 

an absolutely necessary step toward eliminating the backlog. 

My bill also requires VA to report annually to Congress on the 

chief business office’s effectiveness with respect to timely claims 

processing. Their report must include information on the number 

of veterans who have reported credit issues due to delayed payments, the number of proper invoices submitted, the amounts owed 

on those invoices, and how long it took the VA to pay those claims, 

among other bits of information. 

In addition to requiring the VA to report on the status of claims, 

H.R. 1862 aims to improve the chief business office operations by 

requiring the VA to examine comments made by medical providers 

regarding the claims processing system and delayed payments and 

report these comments to Congress along with a description of best 

practices to ensure timely claims payment in the future. 

No veteran should ever have to decide whether or not to sacrifice 

their health and safety to avoid a potential financial burden if the 

VA fails to pay for a trip to the emergency room. 

I want to sincerely thank the subcommittee for your efforts to ensure better care for America’s veterans and for inviting me to be 

a part of this important discussion. Thank you. 

[THE PREPARED STATEMENT OF CHARLES BOUSTANY APPEARS IN

THE APPENDIX] 

Dr. BENISHEK. Thank you, Dr. Boustany, for your wise use of 

your time. 

Mr. Denham, would you please begin your testimony. 

STATEMENT OF HON. JEFF DENHAM, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF CALIFORNIA 

Mr. *Denham.* Thank you, Mr. Chairman. 

Committee members, eye clinics staffed by the VA doctors of optometry including residents are among the busiest primary care 

settings in the veterans healthcare system. 


VACREP0180 with DISTILLER
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This bill, 1688, is aimed at improving access to primary eye care 

in the VA by making a modest increase in the number of optometry 

residency positions in the VA. 

My bill seeks to amend the Choice Act by designating 20 of the 

1,500 new graduate medical education residency positions to the 

field of optometry. Although VA optometrists provided comprehensive eye exams and other essential care to more than 1.2 million 

veterans last year, the need for eye health and vision care is expected to grow further in the coming years. 

Serious eye trauma is the second most common injury among 

those who served in Iraq and Afghanistan, with 16 percent of all 

wounded servicemembers experiencing problems ranging from distorted vision to blindness. Additionally, up to 75 percent of all TBI 

patients experience vision problems. 

Increasing the number of optometry residents at the VA is one 

of the ways to enhance the VA’s ability to address chronic patient 

care backlogs as well as train new doctors of optometry in advanced practices. 

Since the VA established its first optometry residency in the 

1970s, the program has proven to be an essential, cost-effective 

force multiplier to boost eye care teams and make veterans 

healthier and more engaged in their own care. 

I would appreciate your support on H.R. 1688 to improve access 

to this important care for our veterans by adding 20 additional optometry residents to the VA over the next ten years. 

Thank you, and I yield back. 

[THE PREPARED STATEMENT OF JEFF DENHAM APPEARS IN THE AP- PENDIX] 

Dr. BENISHEK. Thank you, Mr. Denham. 

Dr. Wenstrup, present your bill. 

STATEMENT OF HON. BRAD WENSTRUP, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF OHIO 

Dr. WENSTRUP. Good morning, Chairman Benishek, Ranking 

Member Brownley, and members of the committee. Thank you for 

the opportunity to speak on the VA Provider Equity Act, H.R. 3016. 

This bipartisan legislation which is currently cosponsored by 

every doctor on the VA Committee and the ranking member of this 

subcommittee would increase access to care for our veterans by 

changing outdated standards to move VA podiatrists to the same 

fee schedule as doctors of medicine and osteopathy within the VA. 

After years of war, we have a new generation of Iraq and Afghanistan veterans returning with lower extremity injuries. These 

needs along with diabetic-related complications, peripheral neuropathy often linked to Agent Orange exposure, orthopedic maladies, 

vascular compromise, and many other conditions require ongoing 

care from the Veterans Health Administration that podiatrists are 

uniquely trained to provide. 

The need is dramatic. The Department of Veterans Affairs treats 

more than 45,000 veterans who have lost limbs and 1.8 million 

more veterans within the VA are at risk of amputation, but the 

wait times remain unacceptable. 

For those veterans seeking podiatric care within the VA, 93 percent of new podiatry patients wait more than 15 days for an apVerDate Aug 31 2005 13:13 Oct 04, 2016 Jkt 000000 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 Y:\98-686~1.TXT PAT

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pointment. More than two-thirds of them wait more than 30 days. 

These wait times exist because the VA is struggling to recruit and 

retain experienced podiatrists. 

Forty-two percent of VA podiatrists leave the VA system within 

five years of being hired and every time a podiatrist leaves, the average time to fill a vacant podiatry position is one year. The problem, a self-imposed one, is that the VA is not competitive with the 

private sector when it comes to hiring and retaining podiatrists. While the maximum salary for a VA podiatrist is $132,000, the average salary for podiatrists in the profession is $183,269 according to a 2013 APMA survey. That is a $50,000 difference between 

the industry average and the maximum that our VA podiatrists 

can make. It is no wonder that many of our veterans are losing 

their VA podiatrists to the private sector. 

The VA Provider Equity Act would place podiatrists on the same 

fee schedule as doctors of medicine and osteopathy within the VA. 

Since the VA first established podiatric pay standards in 1976, 

podiatric education, training, and practice have increased exponentially. Medicare recognized these changes over 20 years ago and 

implemented fee schedule reform in 1991. I think it is time for the 

VA to do the same. 

Additionally, H.R. 3016 would make podiatrists eligible for the 

same promotions in leadership positions within hospital systems 

that they often currently hold in the private sector. 

I thank the chairman and ranking member for their support and 

the commitment to increasing access to healthcare for our Nation’s 

veterans. I ask for the support of my colleagues in advancing this 

important legislation. Let’s ensure that access to podiatric care is 

included in the comprehensive first-class healthcare that all veterans deserve. 

Thank you. 

[THE PREPARED STATEMENT OF BRAD WENSTRUP APPEARS IN THE

APPENDIX] 

Dr. BENISHEK. Thank you, Dr. Wenstrup. 

And I want to thank all the members of the first panel, all my 

colleagues for their interest in improving veterans’ healthcare and 

thanks for the great ideas. 

I am not going to ask any questions, but I think Mr. Walz had 

asked to go first because he is on a tight schedule for comment. Is 

that true, Mr. Walz? 

Dr. WALZ. Well, I don’t want to irritate my colleagues, Mr. Chairman, but I would be honored and appreciative if I could. 

Dr. BENISHEK. Yeah, go ahead. 

Dr. WALZ. Well, thank you to the chairman and thank you to the 

ranking member, first for allowing me to be here, more importantly 

to all of my colleagues for putting forth thoughtful legislation to 

improve the lives of veterans and families. 

I think it is really important that this committee, while we simultaneously hold people accountable for the failings that are unacceptable, we also provide alternatives, provide solutions. 

And I think that that old adage of we can sit around and curse 

the darkness or we can light a few candles, there is certainly some 

cursing that needs to be done on some of these things, but I think 

each of these pieces of legislation provide the VA opportunities to 


VACREP0180 with DISTILLER
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partner and to do things and continue to build on things that are 

working right. 

I would just spend a minute. The two bills that I was lead cosponsor on with my colleagues, Mr. Duffy’s bill on getting the hearing aids and the backlog, this makes good sense. It is smart. It is 

cost effective. It gets veterans out there. And we are doing it in 

many cases. I think this codifies it to the point where we can more 

effectively use our private sector and local providers to get folks out 

there. 

This one is personal to me, too, as nearly 25 years in the artillery, hearing loss is something that all of my peers experience and 

I know that the quality of life that improves when you get quality 

care makes a big difference. 

And then Mr. Stivers was here to talk about it. It may seem like 

a small thing, but he is exactly right. The therapy dogs make a 

huge difference. And if it provides solace and care for one veteran 

and we have the opportunities to be out there and do that, I think 

he is right. His piece of legislation starts to move that forward. 

And I know most of my colleagues here all have witnessed this 

with veterans. It is a very powerful thing. And there is research 

to support it, but this is one of those that seeing is believing with 

what happens. 

So I thank the chairman again for a very productive hearing and 

my colleagues for bringing up thoughtful legislation. And, again, I 

do think it’s incumbent upon us to provide our oversight, help provide that accountability, but then also to provide and partner with 

ways that find solutions. And each of these pieces of legislation we 

heard today, I think, does exactly that. 

So thank you, Chairman, for the courtesy, and I certainly look 

forward to the support on all these pieces of legislation. 

Dr. BENISHEK. Thank you, Mr. Walz. 

I don’t have any questions myself or further comments other 

than my statement. 

Do any of my colleagues on this side? Dr. Roe, you have a comment—— 

Dr. ROE. Just a couple. Thank you. 

Dr. BENISHEK [continuing]. Or question? 

Dr. ROE. Thank you. I will be very brief. 

But certainly Tim Walberg’s, Congressman Walberg’s, his bill 

ought to be passed. That is just so common sense. Those Medal of 

Honor winners ought to have Secretary McDonald on speed dial. 

We should honor them. That should be no question. 

I think one of the things I think on Congressman Collins that 

caught my attention was I found it a little bit surprising that we 

only provide two weeks’ care for the baby that is born of the mother and we provide her six weeks of care. I don’t know why we 

wouldn’t just parallel those, marry those up and say, look, the baby 

goes for a six-week checkup just like the mother does. And why in 

the world are we putting two weeks? I would encourage us to have 

the same thing for the baby, that the first six weeks of care—exactly like the mother. That makes no sense to me. 

So I would ask my colleague if he would consider an amendment 

to his bill just to do that, if that would be something we would like 

to discuss. It makes absolute sense. 


VACREP0180 with DISTILLER
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And I know that on the therapy dogs that Congressman Walz 

brought up, they can be very relaxing unless you have a Sheltie 

like I did which chewed up over a thousand dollars worth of my 

shoes. That was very stressful to me personally. I had to have therapy to keep from strangling that dog. Anyway, he is still at the 

house. And that wasn’t all he chewed up either. I could go into a 

whole book on that. But I totally agree with that bill. 

And I don’t think we ought to be prescribing just as he was—congressman walks in, how many residency slots that—I don’t think 

Congress ought to be doing that. I think those residency slots are— 

those 1,500 slots, the VA can see where their needs are. I believe 

the VA people can decide that. I truly believe that. 

I think it would be very bad if I walked up and said we need six 

OB/GYN slots and 14 internal medicine slots. I don’t think we need 

to micromanage that. I think the VA has the ability to see where 

their needs are. I would let them make those decisions. And just 

to comment there, I think that is a bad thing to get into for us to 

be telling those just how many they should have. 

Other than that, I will yield back my time. 

Mr. TAKANO. Mr. Chairman, before he yields back, would you 

yield just ten seconds to me? 

I want to associate myself with your remarks on the GMEs. That 

is all. Thanks. 

Dr. BENISHEK. Thank you, Dr. Roe. 

Do you have any questions? 

Ms. BROWNLEY. No. 

Dr. BENISHEK. Ms. Kuster. 

Ms. KUSTER. Thank you, Mr. Chair. 

I just want to associate myself with the bills introduced by my 

colleague, Julia Brownley, and in particular the Female Veterans 

Suicide Prevention Act. And I wanted to address an issue. 

I want to join Dr. Roe in the six weeks. I agree matching that 

up makes sense. I would imagine most of the babies are going 

home healthy in the first week, but the ones who stay, that is the 

most stressful situation and they should get the care that they 

need. 

And I just had a few questions, but I don’t need to get into the 

details right now on Mr. Coffman’s bill because I know there was 

some question from the VA. This is more by way of a comment. 

In White River Junction, Vermont, we have a new women’s treatment facility that I would love to include if we get to do some kind 

of a hearing, field hearing from our oversight committee, but they 

had a chance to have a group of women veterans that participated 

in the planning of that. And so they were able to bring out some 

of the psychological issues for them about seeking care. 

And even the architecture was designed—it is a renovation, by 

the way. We have nothing new up there, but it is a renovation of 

a very old facility. But they took into account their feelings of being 

safe and protected, even the way they designed the entrance, the 

way they designed the waiting room, the way they designed the actual physical rooms where they, you know, have their medical 

exams. 

Obvious things once you think about it, but just very, very helpful. So I would love to work further with you on this. I think it is 


VACREP0180 with DISTILLER
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really important and I appreciate our colleagues on the other side 

and how much interest they have in women, health for women veterans in the VA system. 

So thanks. 

Dr. BENISHEK. Thank you. 

Any comments or questions? Dr. Abraham. 

Dr. ABRAHAM. I just want to say I was a very proud cosponsor 

of Dr. Wenstrup’s bill. The hearing aid, the accountability, the 

credit protection, I think they are great bills, and I just look forward to them advancing very quickly. 

Dr. BENISHEK. Thank you, Dr. Abraham. 

Any other comments? 

All right. I guess the first panel is over with. 

Let’s invite the second panel to the witness table. Joining us on 

the second panel today is Ian de Planque, the Legislative Director 

for The American Legion; Adrian Atizado, the Assistant National 

Legislative Director for the Disabled American Veterans; and Carlos Fuentes, Senior Legislative Associate for the National Legislative Service of the Veterans of Foreign Wars of the United States. 

I thank you all for being here this morning and for all your hard 

work and advocacy on behalf of our veterans. I look forward to 

hearing the views of your members. 

And if you are ready, Mr. de Planque, you may begin. 

STATEMENT OF IAN DE PLANQUE 

Mr. DE PLANQUE. Good morning, Chairman Benishek, Ranking 

Member Brownley, and members of the committee. I am fortunate 

to be here today and speak on behalf of the American Legion, our 

National Commander Mike Helm, and more than two million members in over 14,000 posts across the country that make up the 

backbone of the nation’s largest wartime service organization. 

There are many excellent pieces of legislation for consideration 

today. You have our full written remarks and in the interest of 

time I would like to focus on a couple of key bills. 

H.R. 1356, the Women Veterans Access to Quality Care Act of 

2015, addresses critical needs the American Legion has worked to 

raise awareness of for many years. Women are currently the fastest 

growing demographic serving in the military; however, the VA 

healthcare system is still based on an older design from a time period when women did not represent a substantial portion of veterans seeking care. And the legacy of that older design is obstacles 

for women who seek care. The American Legion has surveyed 

women veterans and we have dedicated special focus of our System 

Worth Saving Task Force report to the experiences of women using 

the VA healthcare system. 

We have learned women veterans often do not self-identify as 

veterans and that VA staff often do not see women as veterans. 

Women veterans do not need to be asked, how did your husband 

serve in the military? They need to be asked, how can VA serve 

you to thank you for your service? 

This legislation should go a long way towards establishing consistency by establishing standards for all facilities. The reporting 

mechanisms in the bill will help all of the stakeholders keep apprised of VA’s progress on better integrating women’s healthcare. 


VACREP0180 with DISTILLER
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More transparency leads to better communication between stakeholders. 

Everyone wants to ensure all veterans are well served in VA. 

This legislation will help work to close gaps and ensure all veterans are served with equal attention to their care. 

The American Legion is also glad to see attention being given to 

serious reform in VA large scale construction projects. The Construction Reform Act attempts to ensure competent management of 

serious large scale construction projects such as major hospitals so 

that those projects do not spiral out of control as they have in years 

past. The American Legion believes VA should be allowed to focus 

on what they do well, providing care to veterans, and that large 

scale construction management should go to organizations that are 

dedicated solely to that mission of construction. It only makes 

sense that a doctor to treat patients, select carpenters, masons, 

electricians for building the places to treat those patients. Keep VA 

in the business of treating patients. 

Finally we are happy to see that attention is being given to fixing 

the long standing problem with CBO scoring of leases for community based outreach clinics. CBOCs are a critical component of the 

21st Century model for delivery of care within the VA and for the 

last couple of years we have had to scramble to find slapped—together—work around measures once the Congressional Budget Office changed the manner in which the leases for CBOCs are scored. 

H.R. 2914, the Build a Better VA Act, will create a more permanent solution to the problems created by the change in scoring. 

Just last year the uncertainty surrounding leases for 27 CBOCs 

created doubt, concern, and fears of lost coverage for hundreds of 

thousands of veterans until a short term solution was worked into 

the Veterans Access to Care, Choice, and Accountability Act. As the 

American Legion has been involved in working towards a solution 

since the beginning we knew that last year the 27 leases only represented a temporary reprieve from the bigger problem. We still 

have to find a long term fix. The American Legion believes this legislation can work towards that fix. 

Again, I thank the committee for their hard work and for your 

consideration of this large slate of legislation, as well as your dedication to finding solutions for problems that stand in the way of delivery of healthcare for veterans. I am happy to answer any questions. 

[THE PREPARED STATEMENT OF IAN DE PLANQUE APPEARS IN THE

APPENDIX] 

Dr. BENISHEK. Thank you, Mr. de Planque. Mr. Atizado, you may 

begin. 

STATEMENT OF ADRIAN ATIZADO 

Mr. ATIZADO. Chairman Benishek, members of the subcommittee, 

thank you for inviting DAV to testify at this legislative hearing. As 

you know, DAV is a nonprofit veterans service organization. We 

are comprised of 1.2 million members and we are all dedicated to 

one goal, and that is to empower veterans to lead high quality lives 

with respect and dignity. 

So today nearly 2.3 million women are veterans of the military 

service and that number is expected to continually grow into the 


VACREP0180 with DISTILLER
22 

future as they comprise 50 percent of active duty personnel and 18 

percent of the Guard and Reserve. There are three bills on today’s 

agenda directed to improve healthcare and services to women veterans, H.R. 423, the Newborn Care Improvement Act; H.R. 1356, 

Women Veterans Access to Quality Care Act of 2015; and H.R. 

2915, the Female Veterans Suicide Prevention Act. 

H.R. 423 will provide a newborn child of certain women veterans 

receiving VA maternity care with post-delivery care for up to 14 

days after the child’s birth. H.R. 1356 seeks to improve the VA 

healthcare system to provide safe, comfortable, and high quality 

care to women veterans. It would establish standards for VA to 

meet in this regard and requires an accounting of those parts of VA 

that do not meet these standards. H.R. 2915 would direct VA to 

identify mental healthcare and suicide prevention programs that 

are most effective and have the highest satisfaction among women 

veterans. 

These bills are in line with DAV Resolutions 39 and 40, both of 

which support program improvements and enhanced resources for 

VA mental health programs as well as medical services for women 

veterans. And as Mr. Coffman had mentioned, they are also in line 

with the recommendations put forth by DAV in our 2014 report, 

‘‘Women Veterans: the Long Journey Home.’’ For these reasons 

DAV is pleased to support all of these measures. 

DAV also supports H.R. 3016, which would reclassify VA podiatrists for purposes of appointment and compensation in the same 

category as other VA physicians. Now podiatrists play a critical 

role in maintaining foot health and dealing with injuries and diseases of the foot and ankle, however doctors of podiatry were 

inexplicably excluded when Congress enacted VA physician pay reform back in 2004. We believe their appointments and compensation should be made commensurate with those of other physicians 

in the VA. 

H.R. 2914, the Build a Better VA Act, would prohibit the appropriation of funds to support any VA major medical facility lease unless the Committee of Veterans’ Affairs of both chambers adopt resolutions approving the lease. We thank the bill’s sponsor for the intention of improving the authorizing committees’ role in overseeing 

VA’s leasing program and to provide more specific guidance to the 

Appropriations Committees in funding VA leases. DAV is aware of 

issues surrounding VA infrastructure and capital planning matters 

and our national resolution calls for modernizing aging VA facilities and to do so in a timely manner. It specifically calls on Congress to resolve, as my colleague Ian de Planque from the American 

Legion had referred to, as a delay of dozens of major medical facility leases for several years due to disagreements in the administration over out year costs for such leases. 

While we oppose the bill in its current form, DAV stands ready 

to work with the bill’s sponsor and the subcommittee and VA to ensure this legislation will indeed provide the improvements that it 

purports. We already understand that VA is experiencing delays 

ranging from six months to 13 years for major facility leases with 

an average delay of more than three years. 


VACREP0180 with DISTILLER
23 

This concludes my testimony, Mr. Chairman. I would be happy 

to answer any questions you or members of the subcommittee may 

have. Thank you. 

[THE PREPARED STATEMENT OF ADRIAN ATIZADO APPEARS IN THE

APPENDIX] 

Dr. BENISHEK. Thank you, Mr. Atizado. Mr. Fuentes, you may 

begin. 

STATEMENT OF CARLOS FUENTES 

Mr. FUENTES. Chairman Benishek, Ranking Member Brownley, 

and members of the subcommittee, on behalf of the men and 

women of the VFW and our auxiliaries, I would like to thank you 

for the opportunity to present our views on legislation pending before this subcommittee. 

The bills we are considering today are aimed at improving the 

healthcare the VA provides our nation’s veterans and we thank the 

subcommittee for bringing them forward. I would limit my remarks 

to bills we have recommendations to improve. 

The VFW supports the Veterans Credit Protection Act, which 

would assist veterans with credit issues resulting from unpaid 

healthcare claims. In the past year VA has made organizational 

changes to the claims process to improve timeliness and accuracy 

of healthcare claims, however the VFW continues to hear that nonVA care providers continue to bill veterans for care VA is obligated 

to pay. The VFW believes that the best way to prevent veterans 

from being wrongfully charged is to ensure VA pay the claims on 

time and accurately. This is why we recommend that the GAO report include an evaluation of the accuracy of VA’s healthcare 

claims process. 

This legislation also requires VA to assist veterans with credit 

issues that result from any healthcare claim, regardless of if VA is 

authorized to pay such a claim. While the VFW believes the VA 

should assist veterans in achieving financial independence, we do 

not support overwhelming VA’s chief business office with claims it 

is unable to resolve. We recommend that the subcommittee limit 

assistance through the VA toll free hotline to healthcare claims VA 

is authorized to resolve. 

The VFW supports the Building a Better VA Act, which would 

streamline the congressional process for authorizing VA major facility leases. This legislation would authorize the Committees of 

Veterans’ Affairs of the Senate and the House of Representatives 

to approve VA major facility leases without requiring legislation. 

However, it does not eliminate the requirement for the House 

Transportation and Infrastructure Committee to pass similar resolutions. The VFW recommends that the subcommittee exempt VA 

leases from such a requirement. 

This legislation also fails to address other factors that hinder 

VA’s ability to enter into major facility leases. Currently VA lacks 

a revolving fund to insure its major facility leases in the case it is 

unable to abide by contractual agreements and is required to pay 

out the full cost of the lease without receiving appropriations. VA 

currently relies on the GSA revolving fund to insure major VA facility leases. We urge the subcommittee to establish a VA revolving 

fund for VA leases. 


VACREP0180 with DISTILLER
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The VFW supports the Female Veterans Suicide Prevention Act, 

which would improve VA mental healthcare and suicide prevention 

programs offered to women veterans. As VA and Congress work to 

expand availability of women—specific care at VA medical facilities, they must also focus on expanding research on the psychological and physical effects war has on women veterans. Without 

such research women veterans may go unnecessarily undiagnosed 

or untreated for serious conditions. The VFW strongly supports this 

legislation and recommends that the subcommittee expand it to include evaluation of which mental healthcare and suicide prevention 

programs produce the best healthcare outcomes for women veterans. VA and Congress have already identified several programs 

that are proven to work and are well received by women veterans, 

such as the childcare pilot program and the retreat counseling program for women veterans. The VA and Congress must ensure these 

programs are expanded and successfully implemented. 

The VFW supports the Construction Reform Act of 2015, which 

would require VA to enter into project management agreements for 

major construction projects over $100 million; calls on VA to apply 

industry standards when constructing medical centers; and authorizes the funding of four major construction projects. While the VFW 

agrees that VA’s role in managing construction projects should be 

reduced, establishing a specific cap with no waiver process would 

lead to VA managing projects that would be better suited for third 

party managers, or prevent it from managing projects that are over 

the cap which they could clearly manage. We recommend that the 

subcommittee establish a waiver process in the plan and design 

phase that would allow VA to manage larger projects when appropriate and authorize the committee’s jurisdiction to require appropriate below cap projects to be managed by the third party. 

Mr. Chairman, this concludes my testimony. I look forward to 

any questions you or the members of the subcommittee may have. 

[THE PREPARED STATEMENT OF CARLOS FUENTES APPEARS IN THE

APPENDIX] 

Dr. BENISHEK. Thank you, Mr. Fuentes. I yield myself five minutes for questions. Mr. Atizado, I read your written statement 

about my bill 2464 was sort of surprising and different from some 

of your colleagues on your comments. You wrote, demanding accountability for veterans acts would result in a major chilling effect 

on candidates for VA management positions, as well as those already occupying those positions. Do you think that VA employees 

really are adverse to accountability, Mr. Atizado? 

Mr. ATIZADO. Well Mr. Chairman, thank you for the question. I 

do not believe that the chilling effect and holding folks accountable 

in federal agencies are mutually independent. I think part of the 

problem here may be that applying this standard just to one federal agency will discount consideration of managers and SESers. 

Dr. BENISHEK. Well believe me, I would like to have everybody 

in the government be accountable. Trust me. But this is a problem 

that really identified, you know, through this hearing process that, 

you know, the VA agrees there is a problem, and agrees they are 

going to fix it, and yet they never name anybody to be accountable 

and it never gets fixed. I mean, you have seen this yourself, haven’t 

you? 


VACREP0180 with DISTILLER
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Mr. ATIZADO. Yes, sir. 

Dr. BENISHEK. How would I, other than holding somebody accountable and naming them, do you have any suggestions as to 

how else I should do this? 

Mr. ATIZADO. Well I think one of the questions that we have 

asked which we have a hard time getting a straight answer for is, 

why is the current structure not working properly? It seems to me 

that—I believe it was a hearing in the Senate where it was intimated that the tools are there but VA seem to not be able to use 

them the way they are intended. 

Dr. BENISHEK. Well maybe you are right about that. It is just 

that whenever I try to identify the person who is responsible for 

not making things happen within the VA, nobody seems to be that 

person. Do you understand what I mean? The reason I am doing 

this is that for 30 years the IG has told the VA, you need a plan 

to hire physicians. Eight different times the IG has told the VA 

that. And the VA has agreed with them every time. And yet, they 

never developed a central plan to hire physicians and nobody 

seems to know why. You understand my frustration here? I mean, 

I am just trying to solve this problem. 

Mr. ATIZADO. Yes, Mr. Chairman. If you will notice in our testimony, we do not have specific resolutions to support or oppose the 

bill. We just raise concerns because of what it may do to the 

healthcare system, both good and bad. We understand, believe me, 

we understand on a daily basis that when we encounter employees 

in the VA healthcare system who do not meet the standards that 

we normally see in caring, compassionate employees, everywhere 

from the janitors to the surgeons. And we would like to have those 

individuals held accountable, whether it is for poor performance or 

just—— 

Dr. BENISHEK. Right. Right. Mr. Fuentes or Mr. de Planque, do 

you have any comments you would like to make on about Mr. 

Atizado’s comments? 

Mr. FUENTES. I do, Mr. Chairman. One of the things that I think 

is overlooked when it comes to accountability is the difficulties VA 

faces when hiring physicians and staff to replace the ones that they 

hold accountable. I mean, what we have seen is VA would rather 

have an underperforming employee than to have no employee for 

a year. So when it comes to accountability our recommendation is 

to also take a look at hiring practices and Congress should assist 

VA in addressing why it takes so long to hire a new employee. 

Dr. BENISHEK. Mr. de Planque. 

Mr. DE PLANQUE. I would agree with what he just said in that 

if you are going to be looking at removing employees you also have 

to look at shortening the amount of time it takes to bring new ones 

on. I think that is a critical component. But I also agree with kind 

of the point of this legislation. And that is, you know, taken from 

the example of, you know, if you come across somebody and you 

need to start performing CPR you look at somebody and say specifically, Dr. Benishek, go call 911. Because if you put it out to the 

group then everybody in that crowd standing around watching you 

is going to assume somebody else is going to do it. And we have 

seen this so many times with IG reports and GAO reports. There 


VACREP0180 with DISTILLER
26 

are all these recommendations, and VA agrees to them, but it is 

not specifically tasked to any sort of thing. 

Dr. BENISHEK. Right. 

Mr. DE PLANQUE. And I think this is what you are trying to get 

to. 

Dr. BENISHEK. Right. 

Mr. DE PLANQUE. That notion that in a crisis give the task to 

somebody. And I think the legislation as you talked through it and 

as we looked at it, it is not necessarily about firing people if they 

do not do it. It is putting together a plan and giving those people 

who are tasked with fixing that thing that a report identified with 

a plan and if they cannot follow through that plan then there are 

follow up measures. And at some point down the road possibly if 

they continue to be unable to do it then you are talking about—— 

Dr. BENISHEK. Right. 

Mr. DE PLANQUE. [continuing]. Removing that person. But it is 

more about assigning an individual accountability. And I think that 

is actually a pretty strong idea. 

Dr. BENISHEK. Ms. Brownley. 

Ms. BROWNLEY. Mr. Chairman, again, I thank everyone for being 

here today and being our partners in trying to move forward good 

policy for our veterans across the country. And I appreciate all of 

you for your support of the Female Veterans Suicide Prevention 

Act. I appreciate it very much. I think it is, if we are going to serve 

all veterans, and serve them well when it comes particularly to 

mental health, that we must with regard to our women veterans 

disaggregate the data, get the right metrics, get the best practices. 

Because I feel convinced and compelled that in many, many cases 

women are going to respond differently than men will and it is important for us to get that right and get the right data to inform 

us. So thank you for that. 

And Mr. Atizado, I know that my bill has not been out for very 

long, on the Build a Better VA Act. I appreciate your willingness 

to sit down and work with us on it. And I would welcome that and 

look forward to it. Because I think, I mean I think this is a problem 

that has to be solved. I mean we, we go through all of the studying 

to determine where the needs are across the country, to have 

health clinics and CBOCs across the country. And yet the way we 

are addressing this issue now and the way it is scored, we have got 

a long list of needs but we cannot satisfy them because they are 

scored sort of outrageously and unrealistically. And I think that we 

need to help to streamline the process. I think we had a process 

that worked. I think we have a process right now that is not working for veterans. And that is what we are trying to do here, is to 

streamline it to bring some similarity about how we treat federal 

buildings and treat sort of health clinics for veterans in a similar 

fashion and bring the responsibility I think closer to this committee 

and to the, and to Congress itself. 

So I appreciate your willingness to sit down and help. I appreciate the support from the other two panelists and really look forward to working with you to be able to solve this problem that we 

know the need out there is tremendous. We have talked a lot in 

testimony over the course of the years, is we want to push out and 

bring clinics to more rural areas and to areas that are going to 


VACREP0180 with DISTILLER
27 

reach our veterans, make it easier for our veterans to access health 

services from the VA. And I think if we can fix the process we can 

meet our objective. So I thank you very much and appreciate your 

testimony today. And I yield back. 

Dr. BENISHEK. Thank you, Ms. Brownley. Dr. Roe. 

Dr. ROE. Just one. First of all, thank you all for advocating for 

veterans, what you do every day of your life. And it has got to be 

rewarding work. Thank you for doing it. My only question, Mr. 

Chairman, is on the Construction Reform Act. I am really, I am not 

sure, as I said here before, that I can vote to let the VA build another major project because they include us in the—I want to make 

sure that I understand this bill very carefully and I understand the 

intent of it. But there have been, I mean, there have been some fiascos out there that are beyond comprehension. The one in Aurora, 

Colorado where $1 billion dollars was spent. And now we are, now 

this committee is part of it. I have to go back home and to talk to 

veterans and talk to taxpayers there that want to help veterans. 

But when they see these excesses they think, my gosh, I mean how 

much healthcare, how many visits could we have had to doctors 

and to the medical centers based on a $1 billion dollar overrun? 

And I am afraid if we let the VA get in control of these again, the 

same thing is going to happen again. We will be sitting here talking about the same thing. 

So I just want to understand this bill better. I certainly have 

read it and it does have a lot of good things in it. But I want us 

to really have incredible oversight over that process. Or as I think 

Mr. Coffman has recommended, the Corps of Engineers have done 

a great job. They bring these projects in on time, under budget. 

And that is what we need to look at. I do not know how in the 

world Aurora ever happened. I, to this day I cannot explain. And 

now we are going to have to provide $1 billion in taxpayer funding, 

and it is not through yet, to get this project done. And we will finally get it done. I know we are going to, for the veterans that are 

waiting on care in Colorado. And that whole region, it will be a referral area. But that is just a comment. And I certainly look for 

help on the committee. And I yield back. 

Dr. BENISHEK. Thank you, Doctor. Ms. Kuster? Do you have any 

questions? Mr. Coffman. 

Mr. COFFMAN. Thank you, Mr. Chairman. And first on the construction, and I think, you know, obviously the bill is a step in the 

right direction. But I agree with Dr. Roe, it does not go far enough. 

And I think that the, having Aurora, Colorado in my district, the 

biggest cost overrun. But let me tell you, there have been a lot of 

other horrible cost overruns, although they do not exceed Aurora. 

I think there was a GAO report from 2013, April, 2013, that said 

that all major construction projects at that time were each hundreds of millions of dollars over budget and years behind schedule. 

I think that they should be stripped of all new construction authority, period, and that should revert to the Army Corps of Engineers. And this bill, I think, has that $100 million and below. But 

I think, you know, if you give them $100 million it could be, you 

know, what is that in terms of cost overruns? Is that $300 million 

by the time the project is done? And there is no ability to revert 

automatically once there is cost overruns to, say, an entity like the 


VACREP0180 with DISTILLER
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Army Corps of Engineers who have built similar projects, you 

know, as you mentioned, Dr. Roe, on budget, within schedule. 

Let me ask a question on H.R. 1356, the Women Veterans Access 

to Quality Care Act. I asked this question at a hearing in April and 

I would like to ask it again. Because there is a different representation on this panel today than there was then. In 2010 the GAO 

found that VA was not complying with its own privacy policies and 

facility standards for women veterans. These are policies designed 

to ensure the safety, dignity, and privacy of women patients at the 

VA. Based on the feedback of your membership, if GAO did the 

same review today, what would they find? Would anybody like to 

comment on that? Yes, Mr. Fuentes? 

Mr. FUENTES. Thank you for the question, Congressman. Before 

drafting testimony for women specific hearings, we have actually 

reached out to women veterans in leadership roles in our organization and many other women veterans who have reached out to us. 

And they see and the ones that attend a women’s clinic feel that 

they are appropriate and that it is great service. But there is a long 

way to go. One of the things that we heard consistently was when 

there are OB/GYNs on staff, many times they are part-time. Right? 

And they do not have the time or the staff to take care of all the 

women veterans that that facility serves. 

Mr. COFFMAN. Thank you. Anyone else? 

Mr. DE PLANQUE. I was going to say that is also very consistent 

with what we found and that we continue to go there. And you see 

that these things are not improving. I know Sergeant Major Walz 

once made a point about, you know, the VSOs come in and they 

say the same things over and over and people have criticized that, 

but if they say the same things over and over it means it is not 

getting fixed. And this is, to see this and to see legislation that is 

attempting to address that, to us, that is heartening because it 

means the message is getting through that these problems are still 

out there. When we talk to women veterans who are out there, I 

mean, we have them integrated on our staff, we have them, you 

know, throughout all levels. And you know, they just want to be 

treated right and that is not so crazy a thing to ask. And so when 

you go out there and you see that they still do not have the operating, or the examination tables aligned correctly, it is a basic fix 

that cannot be that hard to fix. And it is just not being done. That 

is a consistency factor. And so there has been an attempt to address it and they are getting better, but VISNs are inconsistent. 

From VISN to VISN, you know, you do not know what you are 

going to get. And I think that is kind of a watchword for VA. 

Mr. COFFMAN. Okay. The 2010 GAO report also found that some 

of the VA medical centers surveyed offered specialized gender specific healthcare services, things like abnormal cervical cancer 

screening, obstetric care, and infertility evaluations only two or 

fewer days per week. Are you finding that your female membership 

is having difficulties getting appointments for gender specific 

healthcare services at the VA? Yes? 

Mr. ATIZADO. Mr. Coffman, thank you for that question. I think 

that ties back to your original question. I think for the most part 

VA is doing better. It is doing better as a matter of policy. I think 

the field is really trying to catch up to what the policy that comes 


VACREP0180 with DISTILLER
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out of VA headquarters is attempting to instill in the healthcare 

system. 

As far as access to care, yes, at VA facilities, especially for those 

that do not have the critical number of women veteran patients, access at that facility can be a little, not as good, it could be much 

better. But what we do find out is they are much more apt to be 

able to provide that service in the community if they cannot provide it in the VA facility. 

Mr. COFFMAN. Okay. Thank you, Mr. Chairman. I yield back. 

Dr. BENISHEK. Mr. O’Rourke. 

Mr. O’ROURKE. Mr. Chairman, I would just like to join my colleagues in thanking the representatives from the veterans service 

organizations for being here. I think they were very clear in their 

comments on the proposed legislation. And I would just join my colleagues in asking that where we find fault in how we are trying 

to achieve accountability, that we offer improvements and certainly 

not lose the urgency of addressing some of these issues and boldly 

working to change the culture and the performance and outcomes 

for veterans that we see at the VA today. But I know that that is 

what you are interested in doing and have made proposals to do 

that. So I thank you. 

And I want to thank the chairman for his efforts to ensure accountability and my colleagues for the bills that they have proposed. And I think we are doing our best to strike that balance in 

ensuring accountability without being punitive and working constructively with the VA, and ensuring that ultimately that we 

serve the veteran and see improved performance outcomes. And I 

think that is what we are all interested in doing. And I hope, and 

I am looking forward to hearing the testimony of the VA, I hope 

that is the spirit in which the VA approaches this issue. Because 

the VSOs, the VA, the members of Congress, this is the team that 

is going to be able to fix this. And we need to make sure that each 

partner is willing to do that. So thank you and the ranking member for putting this hearing together today. 

Dr. BENISHEK. Thank you. If there are no further questions, the 

second panel is now excused. And I will welcome our third and 

final panel to the witness table. Joining us from the Department 

of Veterans Affairs is Dr. Madhulika Agarwal, the Deputy Under 

Secretary for Health for Policy and Services; and Janet Murphy, 

the Acting Deputy Under Secretary for Health for Operations and 

Management. They are accompanied by Jessica Tanner, General 

Attorney with the Officer of General Counsel. Dr. Agarwal and Ms. 

Murphy, you are recognized for five minutes. 


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STATEMENT OF MADHULIKA AGARWAL, MD, MPH, DEPUTY 

UNDER SECRETARY FOR HEALTH FOR POLICY AND SERVICES, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND JANET P. MURPHY, MBA, 

ACTING DEPUTY UNDER SECRETARY FOR HEALTH FOR OPERATIONS AND MANAGEMENT, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY JESSICA TANNER, GENERAL ATTORNEY OFFICER OF GENERAL COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS 

STATEMENT OF MADHULIKA AGARWAL 

Dr. AGARWAL. Good morning, well it is almost good afternoon, 

Chairman Benishek, Ranking Member Brownley, and members of 

the subcommittee. We appreciate your continued efforts to support 

and improve veterans healthcare. Thank you for the opportunity to 

testify on the bills on today’s agenda and to discuss their impact 

on VHA’s healthcare. Joining me today is Ms. Janet Murphy, Acting Deputy Under Secretary for Health for Operations and Management; and Ms. Jessica Tanner, Attorney in the Office of General 

Counsel. 

Mr. Chairman, we appreciate the committee’s attention to many 

subjects that are important to veterans. We support many of the 

bills on the agenda today, beginning with the Medal of Honor Priority Care Act which will ensure responsive and appropriate 

healthcare for Medal of Honor recipients. 

We support H.R. 421, the Classified Veterans Access to Care Act. 

Currently veterans who serve in classified missions can receive 

mental health services with VA medical treatment facilities safely 

and at minimal to no risk to national security. We agree that it 

would be beneficial to establish standards and procedures to ensure 

that veterans have access to mental healthcare in a manner that 

accommodates the veteran’s obligation to not improperly disclose 

classified information. 

We agree that the Newborn Care Improvement Act should provide additional inpatient treatment for a full term newborn facing 

complications such as fever or respiratory distress after delivery. 

This support comes with a caveat for additional resources that are 

going to be needed to implement the bill. 

We support the Veterans Credit Protection Act. The reporting required in this bill would result in improved relationships between 

veterans and providers by decreasing negative reporting of financial information on a veteran’s credit history as a result of delayed 

payment by VA. It will also improve timeliness of payments to providers, decrease interest payments by VA, and protect veterans 

credit ratings. We also support the draft bill to amend the role of 

podiatrists in the VA. 

At this time the department is still reviewing H.R. 2914, H.R. 

2915 and the draft bill on construction reform. We would be glad 

to follow up with your staff to address any technical concerns. 

In reference to H.R. 2464, the Demanding Accountability for Veterans Act of 2015, I would like to state that the vast majority of 

VA employees who come to work do their best serving veterans everyday. Ninety thousand of the 300,000 VA employees are veterans 


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themselves, which is the largest percentage of veterans employed 

by any civilian agency. Accountability remains a top priority for the 

Secretary and we would want to make sure that these accountability bills have no unintended consequences. This bill may affect 

the Secretary’s ability to manage effectively and could adversely 

impact the collaborative process between the Inspector General and 

the Secretary. 

VA supports the intent of H.R. 353, Veterans Access to Hearing 

Health Act of 2015, however we feel that this bill is unnecessary 

because the Secretary already has the authority to appoint other 

specialists such as licensed hearing aid specialists and to prescribe 

standards for these specialties. Similarly, the Secretary has the authority to accomplish the goals of H.R. 1688. VA currently has the 

ability to create additional optometry residency positions and 

therefore legislation is not needed. 

As for the Women Veterans Access to Quality Care Act of 2015, 

we support the intent of the bill and are taking several actions already to address the issue of the structural standards. VA regularly outperforms the private sector in both cervical cancer screening and the breast cancer screening, and has significantly improved 

internally in closing the gender disparity in areas such as lipid 

screening, depression screening, and immunizations. 

H.R. 359, the Veterans Dog Training Therapy Act, we value the 

identification of effective treatment modalities to address PTSD 

and other post-deployment mental health symptoms. However, VA 

has significant concerns about the provisions in this bill. These concerns are detailed in our written testimony. 

Thank you, Mr. Chairman and Ranking Member for the opportunity to testify before you today. My colleagues and I are pleased 

to answer any questions that you all may have. 

[THE PREPARED STATEMENT OF MADHULIKA AGARWAL APPEARS IN

THE APPENDIX] 

Dr. BENISHEK. Thank you, Dr. Agarwal, I appreciate it. I will 

yield myself five minutes for a few questions. Apparently the VA 

failed to provide views of our cost estimates for many of the bills 

on today’s agenda, including Chairman Miller’s draft bill on construction and both of Ranking Member Brownley’s bills. When can 

the subcommittee expect to receive the official views and cost estimates for these bills? 

Dr. AGARWAL. Chairman, that is a good question. They are currently under review in the department itself and as expeditiously 

as we can we will get it to you. 

Dr. BENISHEK. Is there a date you have in mind? 

Dr. AGARWAL. I—— 

Dr. BENISHEK. Because we always try to get, you know, Dr. 

Agarwal, a specific date. 

Dr. AGARWAL. You know, sir, we will do our best to get it out as 

early as we possibly can. I could not give you a date. 

Dr. BENISHEK. All right. Regarding my bill, 2464, the Demanding 

Accountability for Veterans Act, I believe that the VA’s objections 

are a little overstated. I understand your concerns about how the 

bill will impact situations where the department does not concur 

with the IG and/or the IG’s finding involve other federal agencies 


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with the VA. Would you be willing to work with me to provide technical assistance to address these issues? 

Dr. AGARWAL. Yes sir, we will. 

Dr. BENISHEK. Can you tell me how often the VA requests 

changes to draft IG reports? 

Dr. AGARWAL. VA recognizes the independent role of the OIG and 

the draft changes, there are no changes made to the recommendations except to provide technical correction if that is needed or necessary. So it is not a matter of how many times we change the 

draft. We never do. The IG’s recommendations remain the IG’s recommendations. We only provide some technical corrections if they 

are needed. 

Dr. BENISHEK. All right. How exactly do you think that the Demanding Accountability for Veterans Act would negatively impact 

the relationship between the VA and the Inspector General? 

Dr. AGARWAL. So as I stated earlier, Chairman, most, I would 

say the vast majority of our employees continue to serve the veterans every single day with great integrity and care. The concern 

that has been expressed in relationship to the bill is the technical 

corrections that are necessary sometimes before any misinformation is communicated further down the road. And it is essential 

that—— 

Dr. BENISHEK. Well, I guess I do not understand that. What does 

that mean? Misinformation communicated down the road, what is 

that? I do not understand that. 

Dr. AGARWAL. I, let me see, for Ms. Murphy, if you could provide 

some examples? 

Ms. MURPHY. Thank you, Chairman Benishek. So I think what 

Dr. Agarwal is talking about is when we get the draft report we 

check, we look to see if there are misstatements. So for example, 

it might be 1,000 patients and when we go back and look at our 

data it is 859. I mean, and it is those kinds of changes. The IG’s 

recommendations are their recommendations. And you know, they 

do not change them for us. But we sometimes can provide information to clarify, strengthen the recommendations, make them, make 

them more complete. And so those are the kinds of things that we 

try to work with the IG on. 

Dr. BENISHEK. All right. Well you know, and my point of this legislation, which you have heard me speak of many times, is that we 

have a very difficult time here sometimes finding why something 

has not been implemented when you yourselves know that IG reports are often concurred with but not really implemented, the 

changes that are recommended in the IG report. And we want to 

move that process forward and have the changes that the IG recommends implemented on a timely basis and have someone’s name 

we can identify who is responsible for that. Do you have a strong 

aversion to that idea, Dr. Agarwal? 

Dr. AGARWAL. No, sir. Every employee is accountable and should 

be held accountable for their actions because we have a responsibility towards the organization and the veterans that we serve. But 

in many instances it is not one single individual who is responsible 

for some outcome. 

Dr. BENISHEK. Well, but maybe there should be, though. That is 

the whole point of this. Because otherwise they all raise their 


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hands and say it was not my fault and then nobody ends up being 

accountable. Do you understand? 

Dr. AGARWAL. And there are instances when it is necessary that 

there is only one entity or one individual who is responsible, then 

that person is, there are actions that are taken subsequently. 

Dr. BENISHEK. It has been difficult for us to determine that. I am 

sorry. I am out of time, doctor. But I am going to yield to Ms. 

Brownley. Maybe she will be able to follow up, thanks. 

Ms. BROWNLEY. Thank you, Mr. Chairman. And thank you both 

for, well three of you, for being here this morning. And you know, 

I just wanted to speak to the two bills that are, I have put forward 

that we have heard about today in the hearing. And I understand 

that you have not weighed in on either H.R. 2914 or H.R. 2915. 

But just wondering if you could just comment briefly about the intent of each one of those? And if you generally agree or generally 

disagree? 

Dr. AGARWAL. I will comment on H.R. 2915 and I will ask Ms. 

Murphy to comment on H.R. 2914. With H.R. 2915, which is an 

amendment to the Clay Hunt in focusing on women’s mental 

health and suicide prevention, we agree with the intent. In fact, we 

are going to be doing the evaluation as part of the Mental Health 

Act. And we believe that with that intent we can certainly see on 

how that can be accomplished. 

Ms. BROWNLEY. And H.R. 2914, Ms. Murphy. 

Ms. MURPHY. Thank you, ranking member. The, I will just start 

by stating that we will take all the help we can get on leases. It 

is a process now that we struggle with. I have something to do with 

leases everyday, where someone is having difficult getting leases 

through. We have, so it is a complicated process. 

I would also say that Deputy Secretary Gibson has stood up a 

VHA-wide, VA-wide, excuse me, including VHA, process to really 

look at our lease process from start to finish. And we would really 

welcome working with you on this bill to see where we could provide technical assistance to help us get the help we need with our 

leasing process. It is partly on us but it is also partly a function 

of the current process and the requirements that we are, the hoops 

that we are required to go through for our leases. 

Ms. BROWNLEY. Do you know what Secretary Gibson’s timeline 

is? 

Ms. BROWNLEY. Deputy Secretary Gibson? We have been meeting 

for about the past month. I do not know the exact timeline but he 

always likes things done fast. So I am presuming he has got a 

month timeline or thereabouts but I know he is all about getting 

it done fast. 

Ms. BROWNLEY. Well I welcome your offer and would like very 

much to work with you. Because I do feel like we are, I think we 

are, you know, we are making progress in terms of what some of 

our objectives are of wait time, access to healthcare, so forth and 

so on. We understand where the needs are, we have identified 

where the needs are. And we have got a process that is just standing in the way where we had a process that seemed to work. And 

this was supposed to be the improved upon process but yet it is 

just putting us further behind. So I appreciate that. 


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I just wanted to comment briefly on H.R. 359, too, the Dog Training Therapy Act. And you know, I know that we are waiting for 

data to be able to make some decisions on this. I guess, you know, 

the first question would be when do you anticipate having results 

of a research study so that we can finally formulate and move forward on this decision? And I, you know, my comment would be is 

that I think all of us are always pressing for, you know, data driven, decision making here, up here on the dais. On the other hand, 

you can get to a place where you have the data or you let the data 

stand in the way from what a common sense solution might be for 

our veterans. And we talk a lot about alternative options for folks 

who are suffering from mental health. And I think we could all 

agree that this is common sense, that working with dogs is a very 

positive thing for some of our veterans and for the veterans that 

it works for it works for very, very well. So if you could just answer, you know, what your intention is in terms of moving forward 

on this concept? 

Dr. AGARWAL. Ranking member, as you probably are aware there 

were several complications that took place in the pilot in Tampa 

with the paired dog study related to the service dogs and PTSD. 

And so right now there is a multi-site study going on in three 

places where the dogs are being paired as service dogs and the 

emotional support dogs. And the outcomes we believe would be 

available, the results would be available in three years. 

Similarly there is a Department of Defense study which is about 

the dog training as a treatment modality for veterans with PTSD 

and other mental health related conditions. That is something that 

the Department of Defense is doing and we, I do not know exactly 

when to expect the results from that particular study. 

Ms. BROWNLEY. Well, thank you. And I just would comment I 

think that there is plenty of data out there, probably outside of the 

VA there are a lot of nonprofits across the country that are providing dogs and utilizing dog therapy. And I just think that if we 

are going to wait three more years, you know, to make a determination on this, is just, you know, I think that we should find a 

way to really streamline this. And it has been something that I 

think our veteran community really wants, people believe in it, and 

we should move forward on it. So thank you, I yield back. 

Dr. BENISHEK. Thank you, Ms. Brownley. Mr. Coffman. 

Mr. COFFMAN. Thank you, Mr. Chairman. Dr. Agarwal, if I said 

it right, can you tell me why the Department of Veterans Affairs, 

why the leadership insists on being involved in construction management going forward after the incredible debacle in my congressional district with a VA hospital that is now projected to be over 

$1 billion in cost overruns? I mean, with all the problems that we 

have identified in this committee on the healthcare side, why do 

you not want to focus on that? Instead of something you obviously, 

that the Department of Veterans Affairs obviously cannot do? 

Dr. AGARWAL. So we certainly appreciate all the help that Congress, you and others have been providing our top leadership in 

helping manage the construction issues, especially in Denver. I do 

not know very much about construction. But I will ask and see—— 

Mr. COFFMAN. Well nobody in the department does so you are 

not alone. 


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Dr. AGARWAL. I certainly probably am the least informed 

about—— 

Mr. COFFMAN. You might know more than the folks that were 

managing the project in Aurora, but go ahead please. 

Ms. MURPHY. Well, I did renovate my kitchen, sir. 

Mr. COFFMAN. Oh, well I do not want to know how much it cost. 

Ms. MURPHY. But truthfully, I think we would agree that some 

of the projects have been less than well managed. But I would say 

that hearkening back to Deputy Secretary Gibson’s testimony at 

the recent hearing where he mentioned that we have an independent group looking at our construction process. That report will 

come to Congress at the end of September. I think it will help us 

understand where our issues are. 

I think we have also put some things in place in the meantime 

that will help us, just things that you would commonly find in the 

industry. Thirty-five percent of design done before we give out a 

dollar. We have a construction advisory group, a project review 

board, it is called, that is helping us look at our projects. So I think 

better oversight, better management of the projects, bringing in 

more experts to help us, engineering, medical equipment experts, 

so that we are planning these things early on in the process. So 

I guess I would say there is information coming to Congress about 

our construction process from the independent third party and I 

think that will be revealing in terms of where we need to go. 

Mr. COFFMAN. Well I would ask you to take a message back to 

your leadership, and that is that the Veterans Administration 

needs to focus on what their core responsibilities are, and that is 

taking care of our nation’s veterans. Squandering $1 billion on a 

single project that was supposed to cost $600 million is simply inappropriate and is offensive to our nation’s veterans. Because that 

could have gone to caring for our veterans. That could be, that 

could be in healthcare, or that could be in providing benefits for 

our veterans in terms of making sure that they get the care and 

the benefits that they deserve through their military service. And 

so, and the fact, and how many people have been fired in the construction management section besides one whistleblower? How 

many people have been fired in the Veterans Administration for, I 

mean, if we look at the GAO report for 2013, this is not a new 

issue. I mean, in 2013 it was identified that not only was the Aurora project hundreds of millions of dollars over budget and years 

behind schedule, but every major construction project that the VA 

was doing at that time was each hundreds of millions of dollars 

over budget and each years behind schedule, the four projects that 

were identified there. And at that time VA leadership took no action in terms of correcting its problems. And now the American 

people are somehow supposed to trust you, the Veterans Administration know that, oh, everything is going to be okay. Everything 

is not going to be okay. Please tell me how many people have been 

fired. 

Dr. AGARWAL. I do not know the answer to that, sir. 

Mr. COFFMAN. Can you get that information back to the committee? 

Dr. AGARWAL. We could take it for the record. 


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Mr. COFFMAN. I believe the answer is zero. The answer, except 

for one whistleblower, the answer is zero outside of that. And if not 

for the whistleblowers in the VA, the rank and file, men and 

women who really care about serving our nation’s veterans, let me 

tell you this committee would not be aware of all the problems that 

have come forward in the VA. It is that rank and file who truly 

want to care and some in leadership, but mostly just the rank and 

file. Men and women who work in the VA who fundamentally care 

about taking care of our nation’s veterans. With that, Mr. Chairman, I yield back. 

Dr. BENISHEK. Thank you, Mr. Coffman. Mr. O’Rourke. 

Mr. O’ROURKE. Thank you, Mr. Chairman. For Dr. Agarwal, the 

concerns that you have about the chairman’s bill Demanding Accountability for Veterans Act are understandable. I would like to 

know what the counter proposal is, though. Because it, I think it 

is easy and fair enough to point out from the VA’s perspective 

weaknesses in a proposal to address accountability. But what is 

more important is actually getting that accountability. So what is 

the VA’s proposal to address this issue that Dr. Benishek is trying 

to get at? 

Dr. AGARWAL. Congressman, let me attempt to answer a fairly 

complex question as briefly as I can. I think it is very clear that 

we lay very, clarify all expectations of our employees up front, especially when we recruit them as to what is expected of them. And 

I know that it is done on somewhat, I would hope on a routine 

basis, but I think we have to be very consistent in how we sort of 

establish that. We need to have very specific and measurable goals 

that our employees understand on how they are going to help serve 

the veterans and achieve the goals of the department. We need to 

make sure that all the barriers that they face are eliminated and 

that is the support of the management and leadership in helping 

solve that. 

I am not sure if I am exactly answering your question the way 

you have intended it to be. But I think those are some of the very 

specific things that we can begin to do. 

Mr. O’ROURKE. Yes, I think for me at least the larger point is 

that I believe I have heard the Assistant Secretary and the Secretary both acknowledge the need for greater accountability within 

the VA. And that is important, admitting that you have a problem. 

But then the very next important step is detailing a plan to resolve 

that problem that has a defined goal and end date so that we can 

in turn know what the progress the VA is making towards that 

goal. 

To date I have not heard that. Or at least, I have not heard it 

succinctly and in a way that I can understand and communicate to 

the veterans that I represent. And in the absence of that I think 

proposals like the one presented by our chairman are very compelling. And I think there is a natural tension between the VA and 

its oversight committee, or this committee which has oversight responsibility and authority and that is probably healthy. When it 

becomes adversarial and the proposals that we make are rejected, 

again, perhaps for good technical, legal, and reasons of function 

and form within the VA, and are not then answered with a proVerDate Aug 31 2005 13:13 Oct 04, 2016 Jkt 000000 PO 00000 Frm 00040 Fmt 6633 Sfmt 6633 Y:\98-686~1.TXT PAT

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posal from the VA itself, it makes it very hard not to move forward 

with something in the absence of anything else from the VA. 

So I understand your, the answer that you just gave. But it is 

not a proposal or a plan that I can take back to my veterans who 

ask me, hey Beto, what are you guys doing about the VA? There 

is a steady drumbeat of unfortunate news from the VA, not because 

we have on the whole bad employees. And I agree with you. I think 

the vast majority of those who work for the VA are spectacular people doing very difficult jobs who could be making much more doing 

something else but they do it because they share that same mission 

that you and I have, which is to serve that veteran who has served 

this country. But we do have some people who are in the way of 

progress or who are actively stopping our ability to serve veterans 

and those people need to be held accountable. And so I think that 

is what we are looking for. 

Let me quickly move to a statement that Ms. Murphy made in 

answer to Ms. Brownley’s question about needing all the help you 

can get when it comes to leases. Beyond what Ms. Brownley has 

offered, do you have any other requests from Congress that would 

help you and give you additional statutory authority that you need 

to be able to execute leases more quickly and more effectively, and 

get more facilities online and more veterans treated sooner rather 

than later? 

Ms. MURPHY. Thank you, Congressman. I am not an expert on 

leases. I am an expert in trying to get healthcare services up and 

running. So my interaction with leases is at that nexus. I certainly 

think we could get our really skilled and informed lease people 

with you and with this group to help figure out if there are other 

things that we need besides what Ranking Member Brownley has 

proposed. I mean, obviously we want to make sure that what we 

end up with actually works, and I think that is your goal too, and 

actually facilitates the process. So I would love to come back and 

provide more technical assistance and additional input that you 

might need. I am very glad to do that, and get the right people 

here to do that. 

Mr. O’ROURKE. Mr. Chairman, let me just conclude by saying 

that I appreciate that answer. I look forward to working with you. 

I also appreciate your answer on the question about the Construction Reform Act and that the Secretary is going to be coming forward with something in September, at least having more information that can help us better understand the issue. 

We are not likely to get a major facility in El Paso in part because of the royal screw up in Colorado, in Louisiana, in Nevada, 

in Florida. I mean, hundreds of millions of dollars, over $1 billion 

in overage in all of those projects. And in part because of that 

being able to execute these leases with willing partners in communities like El Paso that are sorely underserved and have some of 

the worst performance metrics in the country are incredibly critical 

for our success. So I just want to let you know that you have a 

partner in our office in getting those leases done. Because if we do 

not that veteran in El Paso and other parts of the country will not 

be served. So we look forward to working with you on that. And 

with that I yield back to the chairman. 


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Dr. BENISHEK. Thank you, Mr. O’Rourke. Does anyone have any 

other questions they would like to ask? Well, I think we can excuse 

the third panel then. Thank you very much for coming this morning. 

I ask unanimous consent that all members have five legislative 

days to revise and extend their remarks and include extraneous 

material. With no objection, so ordered. 

I would like to once again thank all of our witnesses and audience members for joining this morning and this afternoon. This 

hearing is now adjourned. 

[Whereupon, at 12:29 p.m., the subcommittee was adjourned.] 


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PREPARED STATEMENT OF REP. WALBERG TESTIMONY FOR MEDAL OF HONOR

PRIORITY CARE ACT (H.R.272) 

Chairman Benishek, Ranking Member Brownley and Members of the Subcommittee, I thank you for allowing me the time to speak this morning in support 

of my legislation, H.R.272, the Medal of Honor Priority Care Act of 2015. 

As the Members of this Committee are well aware, the Congressional Medal of 

Honor is the highest award for valor which can be bestowed upon an individual 

serving in the United States Armed Forces and is awarded to soldiers who have displayed conspicuous gallantry and intrepidity at the risk of life above and beyond the 

call of duty. The Medal of Honor is a distinguished award given to a select few. Less 

than 3,500 have been awarded, 16 awards have gone to soldiers who fought in the 

recent conflicts in Iraq and Afghanistan. Currently there are only 79 living Medal 

of Honor recipients. 

My state of Michigan is privileged to have two living recipients, Corporal Duane 

E. Dewey and Private First Class Robert E. Simanek. Both received the decoration 

for their heroic action in the Korean War, and hearing of their harrowing stories 

of bravery has reminded me of the sacrifice American soldiers are willing to make 

to protect their comrades and their country. 

Medal of Honor recipients deserve our utmost appreciation, and I believe the 

small portion of our servicemembers who have gone above and beyond the call of 

duty and earned the highest honor in our nation’s Armed Forces have earned the 

right to be placed in the top priority group to receive their healthcare benefits. I’d 

be remiss if I did not mention the idea for this legislation came from a veteran who 

lives in my district and works with the veteran community. 

All veterans deserve access to the healthcare they have earned, but as you all 

know, the VA uses a priority system to determine eligibility for these healthcare 

services. Some of the factors that will affect a soldier’s priority group ranking are 

whether the soldier has a service-connected disability, whether they were a former 

prisoner of war, the time and place of service, as well as income level. Currently, 

Medal of Honor recipients are in Priority Group 3. 

This bill is very similar to legislation approved by this committee during the 

113th Congress, which was supported by the VFW, Vietnam Veterans of America, 

IAVA, the American Legion, and AMVETS. I’m proud to once again have the support of my colleagues from both sides of the aisle on this bill. 

I thank the Chair for permitting me to appear before the Subcommittee today. 

f 

PREPARED STATEMENT OF STEVE STIVERS

I want to thank Chairman Benishek for including my bipartisan bill, the Veterans 

Dog Training Therapy Act, in today’s legislative hearing. 

As the Committee Members are well aware, it is estimated that 22 current and 

former service members commit suicide each day. This is a tragedy that requires 

immediate action and I want to commend the Committee Members for their commitment to addressing this matter. 

It is known that post-traumatic stress disorder (PTSD) contributes to suicide 

among the veteran population and Congress has taken steps to improve treatments 

of the condition. However, every individual is unique and responds differently to 

available therapies and treatments. 

That is why I introduced the Veterans Dog Training Therapy Act with my colleague and good friend, Tim Walz. Our bill seeks to expand access to an alternative 

therapy that has been proven effective for many veterans who suffer from the invisible scars of war. 

Specifically, our legislation would establish a service dog training pilot program 

at 3–5 VA facilities as selected by the VA Secretary. Results of the pilot would be 

studied for consideration of expanding the program. Under the pilot program, veterans suffering from PTSD would be connected to service dog training organizations. 

These veterans would learn useful occupational skills while training service dogs. 

Upon completion of their training, each dog would be provided to a disabled veteran—enabling veterans to help other veterans. 

This program is not made from scratch; it is an almost identical model to the successful service dog training program conducted by the non-profit organization Warrior Canine Connection at several Department of Defense medical facilities and one 

VA Hospital location. Veterans enrolled in this program witnessed significant improvements in PTSD and TBI-related symptoms. It is also important to note that 


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some of the wounded warriors who benefited from the service dog training therapy 

program had not been responding successfully to other treatment options. 

The effectiveness of service dogs in treating PTSD and TBI-related symptoms is 

supported by preliminary research from Kaiser Permanente, which has shown that 

veterans who own service dogs have fewer symptoms of PTSD and depression, better interpersonal relationships, a lowered risk of substance abuse and better overall 

mental health. 

It should also be noted that Congress directed the VA to conduct a research study 

on the efficacy of service dogs in treating these injuries in the 2010 NDAA, which 

was signed into law in September of 2009. Since then, the agency has blundered 

so badly in the design and implementation of its own study that research results 

are not expected until 2019—10 years after the study was ordered by Congress. 

These veterans cannot wait any longer. 

I do not claim that my bill will completely solve PTSD. But it is clear that many 

veterans have been helped by service dog training therapy programs and that it has 

promising potential to significantly aid in the treatment of many individuals who 

are struggling with invisible wounds in the VA system —brave men and women who 

are not responding to other treatment methods. 

Lastly, psychological conditions like PTSD are not new. These conditions have 

confronted American soldiers returning from all wars. We must address this issue 

now so that we can end the current suicide epidemic and to ensure that the best 

treatments are available for soldiers returning from future conflicts. 

Again, I appreciate the Chairman for allowing me to testify today and holding this 

hearing. 

f 

PREPARED STATEMENT OF DOUG COLLINS, 

Chairman Benishek, Ranking Member Brownley, and distinguished members of 

subcommittee, thank you for the opportunity to testify on H.R. 423, the ‘‘Newborn 

Care Improvement Act’’. My legislation amends title 38, United States Code, to improve the care provided by the Secretary of Veterans Affairs to newborn children. 

I am very appreciative of the Subcommittee’s consideration of this legislation. 

The motto of the Veterans Administration comes straight from Abraham Lincoln’s 

Second Inaugural. He got the idea straight from scripture. So the challenge for us 

to ‘‘care for him who shall have borne the battle, and for his widow, and his orphan,’’ isn’t a new one. 

Since September 11, 2001, more than a quarter of a million women have answered the call to serve. They’ve faced terrorism in the deserts and mountains of 

Iraq and Afghanistan. So in the 21st century, we must also consider she who shall 

have borne the battle. 

When she returns, what of her children? 

The finest military in the world is powered by men and women in their physical 

prime. The young women who decide to serve this country in the armed forces aren’t 

immune from the same questions that all young women face about whether they 

pursue a career, a family, or both. Yet they are offered a healthcare system that 

for so many years has been designed to serve men. 

With the increasing number of female veterans, the VA must expand its care and 

services to meet their needs. Maternity care tops that list of needs, and I’ve offered 

one way we can help. In 2010, Congress passed and the President signed the ‘‘Caregivers and Veterans Omnibus Health Services Act of 2010’’ to provide short-term 

newborn care for women veterans who received their maternity care through the 

VA. Signed into law on May 5, 2010, this legislation authorized up to seven days 

of newborn care. 

On January 27, 2012, The Department of Veterans Affairs published a regulation 

officially amending VA’s medical benefits package to include up to seven days of 

medical care for newborns delivered by female Veterans who are receiving VA maternity care benefits. The rule, which became effective Dec. 19, applied retroactively 

to newborn care provided to eligible women vets on or after May 5, 2011. 

Since this seven day authorization was enacted by Congress in 2010, we’ve 

learned more about the unique challenges facing female veterans and the changing 

trends in these veterans seeking maternity and newborn care from the VA. According to a study published in the Women’s Health Issues Journal this year, from 

2008–2012 the overall delivery rate by female veterans utilizing VA maternity benefits increased by 44 percent and a majority of the women using VA maternity benefits had a service-connected disability. 


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Just last week, the U.S. Navy announced it has tripled the amount of paid maternity leave for personnel in the Navy and Marine Corps. Effective immediately, 18 

weeks of maternity leave will be available. Secretary Mabus stated in a press release that ‘‘with increased maternity leave, we can demonstrate the commitment of 

the Navy and Marine Corps to the women who are committed to serve.’’ 

In the same way, unless Congress extends the authorization for length of newborn 

care coverage provided by the VA, there will be veterans who face difficult financial 

decisions and complexity in navigating insurance options at the same time that 

their newborn is fighting for their life. 

This is why I introduced H.R. 423—to demonstrate Congress’ commitment to 

meeting the needs of female veterans by providing a little longer for their newborn. 

My legislation extends the authorization of care from seven days to 14 days and provides for an annual report on the number of newborn children who received such 

services during such fiscal year. Improved data on the trends in female veterans utilizing newborn care will help Congress and the VA better meet their needs in the 

years to come. 

Should this subcommittee place my legislation on their markup calendar, which 

I hope they do, I would request an amendment be made to add the reporting requirement to an existing report that the VA is already required to produce. Although it’s vitally important that Congress and the VA have this data, I don’t want 

VA to produce yet another report when instead we could add this requirement to 

an existing report. 

Some may ask why the VA should provide more newborn care coverage to female 

veterans than the average private sector employee would receive. These women 

have risked their lives to protect our nation. Just because they are no longer serving 

in active duty does not mean our responsibility to them ends. In fact, their service 

to our country may jeopardize the very lives of their future children and thus our 

responsibility to them is even greater. A recent study examined more than 16,000 

births to female veterans. Having PTSD in the year before delivery increased a 

woman’s risk of spontaneous premature delivery by 35 percent, the research 

showed. 

‘‘This study gives us a convincing epidemiological basis to say that, yes, PTSD is 

a risk factor for preterm delivery,’’ said the study’s senior author, Ciaran Phibbs, 

PhD, associate professor of pediatrics and an investigator at the March of Dimes 

Prematurity Research Center at Stanford University. ‘‘Mothers with PTSD should 

be treated as having high-risk pregnancies.’’ 

Premature infants often need long hospitalizations after they are born and are 

more likely than full-term infants to die. Those premature infants who survive may 

face long-term developmental problems. And unfortunately, the number of female 

veterans with PTSD is not insignificant. According to the VA, 20% of female veterans of the conflicts in Iraq and Afghanistan have been diagnosed with PTSD. And 

these are not just the female veterans serving in combat. 

I know what it’s like to be the parent of a little baby who needed intensive medical care for an extended period the moment she was born. It’s my hope that any 

new mother, who has given selflessly to her country, wouldn’t have to worry about 

Congress standing in her way as she tries to give selflessly to her own child. 

Our goal should always be to provide the mother with the pre-natal care she 

needs to give her newborn the best chance of a healthy delivery with no post-natal 

complications. There are significant needs and challenges that a female veteran 

faces when returning home from the battlefield such as homelessness, sexual and 

physical abuse, and mental health conditions such as Post Traumatic Stress Disorder. And this legislation won’t solve all of those great challenges. But my hope 

is H.R. 423 will give her a little peace of mind knowing her newborn will get some 

extra help from the VA and that Congress is committed to her and her family. 

In a focus group conducted on Women Veterans’ Reproductive Health Preferences 

and Experiences and published by Women’s Health Issues Journal in 2011, one Marine said, ‘‘I can essentially say that I gave my reproductive years to the Marine 

Corps. And those are the years you can serve . . . You know, you do sacrifice and 

you say, well, ‘‘mission first before a family mission,’’ type of thing and the more 

I think about I think, you know, the VA probably should address that part of womanhood and have that understanding.’’ 

There are multitudes of ways that the VA must adapt to better meet the needs 

of female veterans. By increasing the authorization of care, we can ensure that Congress is not standing in the way of the VA seeking to do just that. Absent the legislative change made by H.R. 423, the VA cannot provide more than 7 days of care. 

And I believe that is unacceptable. 

In closing, we owe it to our female veterans to expand and improve the healthcare 

services that the VA can provide them and their children. Female veterans face 


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unique challenges and barriers, including very limited newborn care coverage. While 

the majority of female veterans who receive maternity care from the VA are able 

to return home with their newborn within the current seven day time frame, some 

cannot due to newborn health complications. It is these veterans and their children 

that need Congress’ help today. 

Expanding the authorization of care from seven to 14 days will give these female 

veterans more time to make alternate arrangements and secure private or public 

insurance for their newborn’s continued health needs. 

I thank the Chairman and Ranking Member for holding this hearing and I’m 

happy to discuss this legislation further with any of my colleagues. Thank you. 

f 

PREPARED STATEMENT OF SEAN DUFFY

Good morning. Thank you, Chairman Benishek and Ranking Member Brownley, 

for holding this hearing today. I appreciate the opportunity to testify on behalf of 

H.R. 353, the Veterans’ Access to Hearing Health Act. I introduced this legislation, 

along with Rep. Tim Walz (MN–01) and Rep. Raul Ruiz (CA–36), to help address 

the long wait times and lack of access our veterans are facing in regard to audiology 

services. 

Our aging and younger veterans returning from the battlefield are seeking help 

from the VA for hearing loss and tinnitus more than any other disabilities facing 

them today. Yet, the VA does not have the capability to keep up with demand for 

these services. 

A recent Washington Post article cited that since the VA scandal broke last year, 

the number of veterans on wait lists for appointments has actually increased by 

50%. Audiology services are a major factor in the wait times veterans are facing. 

According to the VA, nearly half of all patients awaiting care are waiting for audiology services. 

Veterans, like my constituent Roger Ellison from Marshfield, should not be fighting the VA for care. Roger is 70 years old and a veteran of the Vietnam War. He 

suffers from hearing loss, but when he sought help from the VA, he was told he 

could not get an appointment for six months. Unfortunately, Roger couldn’t wait 

that long, so he went to his local hearing aid specialist – and he was seen that day. 

Roger was willing to pay out of pocket for his hearing aids because six months was 

just too long to wait. 

Audiology services not only affect the older generation, but also the younger generation returning from overseas. Roger and thousands of other veterans are in this 

situation today because the VA is allowed to use only audiologists—and not other 

capable providers—to fulfill hearing services to veterans. While audiologists are a 

great resource for the VA and provide good service for veterans, there are not 

enough to keep up with the demand. 

Hearing aid specialists are a perfectly viable option and stand at the ready to help 

our veterans in need. Hearing aid specialists have gone through a 1–2 year apprenticeship training period, have completed a comprehensive written exam, and are certified by the state to test hearing, and fit and dispense hearing aids. They are qualified to support the specialized services of audiologists by fitting, adjusting, and making minor repairs to hearing aids. By allowing hearing aid specialists to serve in 

their licensed role at the VA, the current burden audiologists have of performing 

all hearing services will be lifted. With the provisions of H.R. 353 in place, VA audiologists can turn their attention to specialized cases and complex conditions, and 

people like Roger won’t be waiting six months for hearing aids or simple adjustments. 

My legislation also asks for a detailed report from the VA on the timely access 

of hearing health services, the contracting policies in regard to providing services 

outside the VA, the staffing levels in the audiology department, and a description 

of performance metrics. 

H.R. 353 has the support of the National Guard, the Retired Enlisted Association, 

Veterans’ Health Council, Vietnam Veterans of America, the American Academy of 

Otolaryngology, the Wisconsin American Legion Executive Committee, and 27 of our 

colleagues. 

As Americans, we can never repay our debt to veterans like Roger, but Congress 

can pass common-sense measures like H.R. 353 to help make their lives back home 

a little easier. I urge the Committee to pass my legislation quickly and appreciate 

your support today. 

I yield back the balance of my time. 


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PREPARED STATEMENT OF THE HON. MIKE COFFMAN

Thank you Chairman Benishek for holding this legislative hearing and including 

my bipartisan bill—the Women Veterans Access to Quality Care Act. 

Although the Department of Veterans Affairs has made some progress in recent 

years, the fact remains that the VA is a system largely designed for male veterans. 

A recent comprehensive study conducted by the Disabled American Veterans (DAV) 

entitled ‘‘Women Veterans: The Long Journey Home,’’ found serious gaps in almost 

every aspect of programs that serve women vets. 

In recent years the active-duty military has made incredible strides towards fully 

incorporating women into the ranks. Though more work needs to be done, these 

long-overdue changes in the Department of Defense have increased the pool of eligible recruits, raising the standards to make our military the most professional that 

our country has ever had. As more and more of these women leave military service 

and become veterans, it is critical that the VA quickly adapt its facilities and culture. 

The aim of my bill is to increase gender-specific access to care within the VA, improve healthcare outcomes for our women veterans, and improve VA’s facilities to 

ensure they protect the privacy and dignity of all veterans. 

The need for this bill is largely illustrated simply by reviewing the rapidly changing demographic composition of the VA patient population: 

1. Between 2003 and 2012, the number of women veterans using VA healthcare 

nearly doubled. 

2. In 2012 women made up only 6.5% of the VA patient population, but are estimated to encompass over 10% by 2020. 

3. Meanwhile, nearly 20% of new recruits are women. 

The women veteran patient population also has unique characteristics when compared to the male VA population: 

1. The median age of a female patient in VA is 49 compared to 64 for male patients. 

2. Only 13% of men within VA were 45 years old or younger compared to 45% 

of women. 

These are dramatic changes to the VA’s patient population, and the former—almost exclusively male—VA healthcare system simply hasn’t kept up with the 

changes. 

My bill addresses the VA’s lapses in healthcare quality and access for its women 

patients in five ways: 

First, my bill requires the VA to establish standards to ensure VA facilities meet 

the specific needs of women and integrates those standards into its Strategic Capital 

Investment Planning process. 

The Government Accountability Office (GAO) found in 2010 that none of the VA 

hospitals it surveyed were fully compliant with the VA’s own policies related to privacy for women veterans. Just to cite a few examples, the audit found that checkin desks were in busy mixed-gender areas and gynecological examination tables 

faced towards doorways. Additionally, despite VA requirements that gynecological 

exam rooms have immediately adjacent restrooms, often women were required to 

walk down long hallways in high-traffic, mixed-gender corridors to access restrooms. 

At a hearing in this room in April, I asked a panel of Veteran Service Organization (VSO) experts whether these conditions have improved in the past five years, 

and the Committee learned that these problems continue to persist nationwide. 

Second, my bill holds VA medical facility directors accountable to performance 

measures which include women’s health outcomes and requires the reporting of 

those outcomes. As with many other areas in the VA, there is an incredible lack 

of accountability which is hindering true progress and reform. 

Third, my bill ensures the availability of OB–GYN services at VA medical centers 

and requires VA to conduct a pilot program to increase residency and graduate medical education positions. In 2010, nearly half of the women Veterans who used V– 

A healthcare had at least one reproductive health diagnosis. It is absolutely essential that these veterans have quick and reliable access to appropriate gender-specific 

care. 

Forth, my bill improves outreach to women veterans by requiring the VA to provide state veterans agencies with contact information for veterans. One of the DAV’s 

findings in its report was that information on veteran programs and eligibility is 

often difficult to access and scattered across various programs or Web sites. Increasing outreach to women veterans though collaboration with VA state agency partners 

is vital. 

Finally, my bill mandates a new comprehensive GAO study of the VA’s ability to 

meet the needs of women veterans, including an examination of wait times, genderVerDate Aug 31 2005 13:13 Oct 04, 2016 Jkt 000000 PO 00000 Frm 00058 Fmt 6633 Sfmt 6621 Y:\98-686~1.TXT PAT

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specific care availability, VA training, differences in health outcomes, and security 

and privacy within VA facilities. 

During my own military career, I have witnessed quite a number of challenges 

that the military has had to confront. Each time, it overcame the obstacles, and always emerged as a more effective fighting force. I have full confidence that the VA 

can do the same. 

I hope my bill can jump-start the cultural sea change required at VA to ensure 

our women veterans are provided the same benefits they earned in service to our 

nation just like their male counter-parts. 

I’m grateful for the support many of our nation’s veterans and Veteran Service 

Organizations have provided for this bill, and I urge all of my colleagues on the 

Committee today to join me in this effort. 

f 

PREPARED STATEMENT OF THE HON. CHARLES W. BOUSTANY, JR., M.D. 

Chairman Benishek, Ranking Member Brownley and Subcommittee Members: 

First, thank you to Chairman Benishek, Ranking Member Brownley and all Subcommittee members for inviting me to testify before you today. As the Committee 

considers reforms to Department of Veterans Affairs’ operations, I appreciate the opportunity to speak on behalf of my legislation, H.R. 1862, the Veterans’ Credit Protection Act. 

Unfortunately, the VA’s long history of delayed payments has brought me here 

today. Too many veterans are forced to contact my office to resolve credit issues 

caused by the VA’s refusal to pay claims for emergency medical care. When these 

brave Americans require a trip to the emergency room because they believe their 

lives are in danger, the last thing on their minds should be fear that the VA will 

fail to pay their claims. 

One such veteran, Mr. Al Theriot of Abbeville, LA, waited over two years for the 

VA to finally process and pay his emergency medical care bills, which the Agency 

only did after Mr. Theriot contacted my office and appeared on local television twice 

to describe his experiences. This is absolutely unacceptable. 

I submitted documentation from the VA to the Subcommittee in early June demonstrating the scale of this problem. To reiterate those findings, as of data provided 

to me in April 2015, the VA’s Chief Business Office indicated that only 14% of emergency medical care claims originating from VISN 16, which includes my home state 

of Louisiana, were being processed within 30 days. In total, the data demonstrates 

a nationwide backlog of over $878 million. 

The Veterans’ Credit Protection Act is an important step to rooting out the problems within the VA that caused this out-of-control backlog. 

First, my legislation mandates the VA set up a toll-free hotline for veterans to 

report credit issues caused by delayed emergency medical care claims. It also requires the VA to conduct outreach alerting veterans of how to resolve these issues. 

Too often, veterans tell me they cannot get in touch with the VA, or that the employees they speak with cannot adequately answer their questions. 

Creating a dedicated call line and ensuring the VA implements a better framework for communicating solutions with veterans is an absolutely necessary step toward eliminating the backlog. 

My bill also requires the VA to report annually to Congress on the Chief Business 

Office’s effectiveness with respect to timely claims processing. Their report must include information on the number of veterans who have reported credit issues due 

to delayed payments, the number of proper invoices submitted, the amounts owed 

on those invoices and how long it took the VA to pay those claims. 

In addition to requiring the VA to report on the status of claims, H.R. 1862 aims 

to improve Chief Business Office operations by requiring the VA to examine comments made by medical providers regarding the claims processing system and delayed payments, and report these comments to Congress, along with a description 

of best practices to ensure timely claims payment in the future. 

No veteran should ever have to decide whether or not to sacrifice their health and 

safety to avoid a potential financial burden if the VA fails to pay for a trip to the 

emergency room. I sincerely thank the Subcommittee for your efforts to ensure better care of America’s veterans, and for inviting me to be part of this important discussion. 


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PREPARED STATEMENT OF REP. JEFF DENHAM

Despite making improvements in the backlog of veterans’ care in the VA via the 

CHOICE Act, there remains long wait times for patients to be seen within the VA. 

Eye care clinics staffed by VA doctors of optometry, including residents, are among 

the busiest primary care settings in the veterans’ healthcare system. As you know, 

lengthy wait times can make it more difficult and even discourage veterans from 

seeking care they need. H.R. 1688 is aimed at improving access to primary eye care 

in the VA by making a modest increase in the number of optometry residency positions in the VA. My bill seeks to amend the Choice Act by designating 20 of the 

1,500 new graduate medical education residency positions to the field of optometry. 

Although, VA optometrists provided comprehensive eye exams and other essential 

care to more than 1.2 million veterans last year, the need for eye health and vision 

care is expected to grow further in the coming years. Serious eye trauma is the second most common injury among those who served in Iraq and Afghanistan, with 16 

percent of all wounded service members experiencing problems ranging from distorted vision to blindness (according to the Armed Forces Health Surveillance Center). Additionally, the joint Department of Defense/Department of Veterans Affairs 

Vision Center of Excellence has reported that up to 75 percent of all traumatic brain 

injury patients experience vision problems. 

The VA is the largest integrated healthcare provider in the country and plays a 

leadership role in defining the education of future doctors of optometry. Through its 

partnerships with affiliated academic institutions, the VA optometry residency program has grown to be the largest clinical optometry training program and accounts 

for 50% of the profession’s residency training. Optometry residents are valuable 

members of the healthcare team; they can provide early diagnosis and treatment for 

such vision threatening conditions as diabetic eye disease and neurological disorders, preventing costly procedures and rehabilitation later. Also, optometry residents, as members of the primary care team of medical providers, screen and refer 

veterans for untreated hypertension, diabetes and other systemic diseases. 

These much needed primary health services are not available at all VA medical 

facilities and the demand outpaces the supply. Increasing the number of optometry 

residents at the VA is one way to enhance the VA’s ability to address chronic patient care backlogs as well as train doctors of optometry in advanced practices. VA 

officials recently recognized the importance of eye exams in keeping veterans 

healthy and active in a March 2015 advisory they issued stating, ‘‘The eye is the 

only place in the human body that a functioning nerve, arteries and veins can be 

viewed without cutting the body open. These are all evaluated during the eye examination and reveal a lot about a person’s general health. Early signs of diabetes, hypertension, atherosclerosis and carotid artery stenosis are often detected with an ocular health exam, and lead to diagnosis and management of these life threatening 

conditions.’’ 

Since the VA established its first optometry residency in the 1970s, the program 

has proven to be an especially cost-effective force-multiplier to boost the eye care 

team and make veterans healthier and more engaged in their own care. I would appreciate your support on H.R. 1688 to improve access to this important care for our 

veterans by adding 20 additional optometry residents to the VA over the next 10 

years. 


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THE AMERICAN ACADEMY OF AUDIOLOGY AND THE AMERICAN SPEECH-LANGUAGE

ASSOCIATION

Regarding H.R. 353 

The American Academy of Audiology (Academy) and the American Speech-Language-Hearing Association (ASHA) respectfully submit this joint statement for the 

record in opposition to H.R. 353, a bill that would permit the VA to hire hearing 

instrument specialists to deliver hearing healthcare services that currently can be 

provided only by or under the supervision of a licensed audiologist. While we appreciate and support the intent of the bill’s sponsors to ensure appropriate access to 

hearing health services by our nation’s veterans, we do not believe that the legislation will accomplish this goal or address problems that may exist related to wait 

times for hearing aids or hearing healthcare services. 

Hearing loss is one of the top service related disabilities for veterans and requires 

complex and comprehensive treatment. While noise-induced hearing loss is common, 

veterans frequently present with complex auditory and vestibular pathologies that 

may be exacerbated by tinnitus, traumatic brain injury, or post-traumatic stress disorder. This complexity is further intensified by the increased number of veterans 

with combat-related hearing loss. 

The provision of hearing aids is neither simple nor straightforward. As with all 

technologies, the technology of hearing aids is becoming increasingly more complex, 

and the options beyond hearing aids, such as streaming capabilities, direct audio 

input, or Bluetooth coupling, are becoming more numerous. Coupled with advances 

in understanding complex ear-brain interactions, the provision of hearing aids requires advanced education and training to effectively serve our veterans. 

Audiologists are doctoral-level professionals who are qualified to evaluate the effects of acoustic trauma and ear injuries on hearing, and to diagnose and treat 

tinnitus, hyperacusis, vestibular issues, auditory processing disorders, and hearing 

loss. Audiologists can determine appropriate sound amplification devices and systems as well as select, evaluate, fit and verify the performance of all amplification 

devices, including hearing aids. More importantly, audiologists are trained to determine the appropriate treatment program for hearing loss—which may or may not 

include hearing aids—and to evaluate the effectiveness of the treatment. The VA 

currently employs more than 1,100 audiologists. 

Hearing aid specialists are trained in the fitting of hearing aids. While some 

states require a college-level associates degree as a minimum educational requirement to become a hearing aid specialist, many states still require only a high school 

diploma. Further, there are no national standards or dedicated curricula that outline the core competencies of a hearing aid specialist. In its testimony before the 

committee last year on legislation similar to H.R. 353, the Veterans Affairs Administration expressed concern that the lack of standardized education for hearing instrument specialists could lead to fragmented hearing healthcare services and limit 

delivery of comprehensive care. Given the minimal training required to become a 

hearing instrument specialist in comparison to the rigor of training for an audiologist, this provider type is poorly equipped to deliver the level of care that veterans 

require. Veterans would not be well served by expanding the list of eligible providers to include hearing aid specialists. Indeed, we believe the legislation could result in a compromise in the quality of hearing healthcare services that already exists for veterans. 

Another career classification for hearing aid specialists as proposed by H.R. 353 

is unnecessary and administratively burdensome. Hearing aid specialists can now 

be hired under the Health Aid and Technician Series 0640 of title 5. The level of 

education and training for hearing aid specialists is consistent with the knowledge, 

skills, and abilities of health technicians who work in VA audiology clinics under 

the supervision of an audiologist. Many VA audiology health technicians are hearing 

aid specialists. The VA also has the capability to contract services from hearing aid 

specialists ‘‘where timely referral to private audiologists or other VHA facilities is 

not feasible or when the medical status of the veteran prevents travel to a VHA facility or a private audiologist’’. VHA Handbook 1170.02. Section 1170.02 defines the 

role of the audiology health technician, in part, to increase productivity by reducing 

wait times, to enhance patient satisfaction, and to reduce costs by enabling health 

technicians to perform tasks that do not require the professional skills of a licensed 

audiologist. The job of these technicians includes, for example, checks of hearing 

aids and other amplification devices, trouble shooting and minor repairs to hearing 

aids, ear molds and other amplification devices and electroacoustic analysis of hearing aids. No modification of existing law is needed for the VA to hire or contract 

with hearing aid specialists, consistent with their scope of practice. 


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The Academy and ASHA are aware that the VA Office of Inspector General (OIG) 

report dated February 20, 2014, found that the VA was not timely in issuing new 

hearing aids to veterans or in meeting timeliness goals to complete hearing aid repair services. We are hopeful that the Veterans Access, Choice, and Accountability 

Act, enacted on August 7, 2014, will help to address access to care issues that may 

exist within the VA. Our organizations stand ready to provide assistance to the VA 

and the committee in developing a sustainable and workable system that ensures 

quality care and outcomes to our veterans. To that end, we would propose that the 

committee consider granting the VA the authority to hire more audiologists. There 

is no shortage of audiologists seeking employment with the VA. We would also propose that the committee consider authorizing additional funding both to hire additional audiologists for the VA and to contract with private audiologists. 

The American Academy of Audiology is the world’s largest professional organization of, by, and for audiologists. The active membership of more than 12,000 is dedicated to providing quality hearing care services through professional development, 

education, research, and increased public awareness of hearing and balance disorders. 

The American Speech-Language-Hearing Association is the national professional, 

scientific, and credentialing association for 182,000 members and affiliates who are 

audiologists; speech-language pathologists; speech, language, and hearing scientists; 

audiology and speech-language pathology support personnel; and students. ASHA 

supports its members through professional development, research, advocacy and 

public awareness of communication, hearing and balance disorders. 

f 

CHILDREN OF VIETNAM VETERANS HEALTH ALLIANCE

Chairman Benishek, Ranking Member Brownley, and other distinguished members of the subcommittee, thank you for the opportunity to share Children of Vietnam Veterans Health Alliance’s stance on H.R. 353, before you today. 

Children of Vietnam Veterans Health Alliance (COVVHA) is committed to serving 

as a voice for the children of Vietnam veterans, including second and third generation victims of Agent Orange and Dioxin Exposures worldwide. We believe in empowering each other to hold the companies and governments responsible for causing 

so much devastation and suffering to our generations. 

On behalf of COVVHA, I am writing to express our appreciation for the House 

Veteran’s Affairs Committee Subcommittee on Health’s efforts on H.R. 353, which 

would increase veterans’ access to hearing healthcare services by enhancing the Department of Veterans Affairs’ (VA) ability to utilize hearing aid specialists. 

In a February 2014 audit of hearing aid services, the VA’s Office of Inspector General found that new hearing aids were not being issued in a timely manner and that 

the VA was failing to meet its five day timeliness goal. Inadequate staffing was partially attributed to the delays in hearing service. 

It is particularly troubling that the VA has not created an appropriate staffing 

model to meet the ever growing need for hearing services amongst veterans. With 

hearing loss and Tinnitus continuing to be the most prevalent service-connected disabilities affected veterans who receive disability compensation, failure to adjust 

staffing is unacceptable. 

This legislation would allow the VA to hire hearing aid specialists—an ability the 

VA currently does not have the authority to do—and ask that the VA report back 

to Congress on an annual basis regarding wait times and the number of audiologists, hearing aid specialists and hearing techs hired by the VA. It truly is a common sense piece of legislation that would help deal with the current backlog faced 

by many of our nation’s veterans. 

As you may be aware, COVVHA expressed our support for H.R. 353 in a letter 

addressed to Congressmen Duffy, Ruiz, and Walz on following the bills introduction 

in the 114th Congress and we continue to strongly support the bill. We believe that 

passage of this bill will help those Veterans in need of hearing aids, who are unable 

to access them due to physical limitations, long distances to VA facilities, and long 

wait times for appointments. 

Sincerely, 

Kelly L. Derricks, 

Founder and President, 

Daughter of Vietnam Veteran Harry C. Mackel, Jr., U.S. Air Force (deceased). 


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1David Chandler, PhD, ‘‘Perspective from Department of Veterans Affairs,’’ Presentation to 

the Institute of Medicine’s Committee on Accessible and Affordable Hearing healthcare for 

Adults, April 27, 2015. Lucille Beck, PhD, ‘‘Meeting the Challenges of VA Audiology Care in the 

21st Century,’’ presentation to the Association of VA Audiologists, March 19, 2012. 3 Chandler, ‘‘Perspective from Department’’ (see footnote 1). 

4 Beck, ‘‘Meeting the Challenges’’ (see footnote 2). 

5 Chandler, ‘‘Perspective from Department’’ (see footnote 1). 

6 Beck, ‘‘Meeting the Challenges’’ (see footnote 2). 

7 VA Office of Inspector General, ‘‘Audit of VA’s Hearing Aid Services,’’ February 20, 2014. 

INTERNATIONAL HEARING SOCIETY ON H.R. 353 

Chairman Benishek, Ranking Member Brownley, and esteemed Members of the 

Subcommittee: 

International Hearing Society thanks you for the opportunity to comment on H.R. 

353. IHS stands in full support of the bill, which would create a new provider class 

for hearing aid specialists within the Department of Veterans Affairs (VA), thereby 

enabling the VA to hire hearing aid specialists to help deliver hearing aid services 

to Veterans. The bill would also require the VA to report annually to Congress on 

appointment wait times and the utilization of providers for hearing-related services, 

which would make the VA’s efforts to address the backlog more transparent and 

provide much needed data to inform Congress about Veterans’ experiences in accessing hearing aid services through the VA. 

The International Hearing Society, founded in 1951, is a professional membership 

organization that represents hearing aid specialists, dispensing audiologists, and 

dispensing physicians, including the approximately 9,000 hearing aid specialists 

who practice in the United States. IHS promotes and maintains the highest possible 

standards for its members in the best interests of the hearing-impaired population 

they serve by conducting programs in competency accreditation, testing, education 

and training, and encourages continued growth and education for its members 

through advanced certification programs. 

The VA continues to see a dramatic rise in the demand for audiology services. According to the VA the number of unique Veterans that received VA audiology services in FY 2014 was 903,075, an increase of 19% since 2011, with 52,138 new Veterans in 2014 alone (a 5.8% increase).1⁄2 The number of hearing aids ordered per 

year by the VA has also dramatically increased with more than 800,000 ordered in 

2014,3 up 34% since 2011.4 With tinnitus and hearing loss being the two most prevalent service-connected disabilities for veterans receiving federal compensation combined with the aging Veteran population, the demand will continue to rise. And despite clinical audiologist-hiring within the VA following a similar growth track with 

a 26% increase in staffing between 2011 and 2015,5 the high demand and subsequent backlog continue to affect the VA’s ability to deliver timely and high-quality 

hearing healthcare.6

IHS and its members have a great deal of respect for VA audiologists. They provide a wide variety of critical services to our Veterans, including compensation and 

pension exams (over 151,000 performed in 2012),7 programming and providing support for cochlear implant implantation and use, vestibular (balance) disorder services, tinnitus services, hearing conservation, hearing aid services and assistive device use, and advanced hearing testing. They also partner with several medical disciplines and are part of the Traumatic Brain Injury and Polytrauma teams, addressing balance and auditory issues. Further, VA audiologists also responsible for training and supervising audiology health technicians. 

The high demands on VA audiologists’ time and expertise means that the VA is 

not currently able to meet all Veterans’ needs for hearing healthcare services. To 

that point, in February 2014, the VA Inspector General released a report, ‘‘Audit 

of VA Hearing Aid Services’’ that found that ‘‘during the 6-month period ending September 2012, VHA issued 30 percent of its hearing aids to veterans more than 30 

days from the estimated date the facility received the hearing aids from its vendors.’’ The audit also found that deliveries of repaired hearing aids to Veterans were 

subject to delay partially due to ‘‘inadequate staffing to meet an increased workload, 

due in part to the large number of veterans requiring C&P audiology examinations.’’ 

Further, in an April 2015 presentation to the Institute of Medicine’s Committee on 

Accessible and Affordable Hearing healthcare for Adults, VA Rehabilitation and 

Prosthetic Services Department Chief Consultant, David Chandler, PhD, cited that 

‘‘nearly half of all patients awaiting care in the VA are for audiology services.’’ 

In a practical sense, as a result of the backlog and delays, many Veterans are experiencing long wait times for appointments, shortened appointments, and limited 

follow-up care and counseling. Hearing aid specialists are observing an increase in 

the number of Veterans who seek care in their private offices as well. These VetVerDate Aug 31 2005 13:13 Oct 04, 2016 Jkt 000000 PO 00000 Frm 00110 Fmt 6633 Sfmt 6621 Y:\98-686~1.TXT PAT

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8 VA Office of Inspector General report ‘‘Audit of VA’s Hearing Aid Services,’’ February 20, 

2014. 

erans request hearing aid specialists’ help with hearing aid adjustments and repairs, oftentimes because they do not want to wait for the next available VA appointment, which may be months away, or because the distance to the closest VA 

facility that offers audiology services is too far to travel. There are also many Veterans who choose to purchase hearing aids at their own expense through a private 

hearing aid specialist, rather than using the benefits they’ve earned and are entitled 

to, because they want to work with someone local who they trust and ensure their 

hearing aids are properly programmed, address their loss, and can be adjusted or 

repaired in a timely fashion. This relationship also enables them to obtain support 

from their hearing professional on demand, which is important to those with daily 

commitments or who are employed, and is especially critical to those who are new 

users of hearing aids. For a point of reference, in the private market, a new user 

would typically see their hearing aid specialist 4–6 times in the first three to six 

months to help them to adapt to a hearing world and optimize their success with 

hearing aids. 

Considering the safety risks involved as well as the impact untreated hearing loss 

can have on one’s personal relationships and mental well-being, the VA needs an 

immediate solution to deal with the backlog and get Veterans the help they need. 

We also know that our working-age Veterans are anxious to contribute to society 

through employment, and properly fit and programmed hearing aids are necessary 

for their success in obtaining and maintaining meaningful employment. 

H.R. 353 provides the VA a much needed solution by creating a new provider 

class for hearing aid specialists to work within the VA. Hearing aid specialists can 

help the VA hearing healthcare team by providing hearing aid evaluations; hearing 

aid fittings and orientation; hearing aid verification and clinical outcome measurements; customary after care services, including repairs, reprogramming and modification; and the making of ear impressions for ear molds—just as they are currently authorized to do in the VA’s fee-for-service contract network. 

By adding hearing aid specialists to the audiology-led team to perform these specialized hearing aid services independently, audiologists will be able to focus on Veterans with complex medical and audiological conditions, as well as perform the disability evaluations, testing, and treatment services for which audiologists are 

uniquely qualified to provide—thereby maximizing efficiency within the system and 

supporting the team-based approach, a common model in the private market. Adoption of the hearing aid specialist job classification at this juncture will also be advantageous given the fact that VA Audiology and Speech Pathology Service management will be developing staff and productivity standards as a result of the Inspector 

General’s audit and recommendations,8 and would be able to consider the use of 

hearing aid specialists as they develop their model. 

Also, by virtue of the report language in H.R. 353, which would shine a light on 

the VA’s utilization of hearing aid specialists in its contract network, it is our hope 

that the VA would take better advantage of this willing and able provider type to 

help address the need for hearing aid services. To open up additional points of access, the VA can and should eliminate unnecessary policy restrictions that impact 

VA clinics’ abilities to utilize hearing aid specialists in the contract network. 

HEARING AID SPECIALIST QUALIFICATIONS

Hearing aid specialists are regulated professionals in all 50 states and in the nonVA market, hearing aid specialists perform hearing tests and dispense approximately 50% of hearing aids to the public. They are licensed/registered to perform 

hearing evaluations, screen for the Food and Drug Administration (FDA) ‘‘Red 

Flags’’ indicating a possible medical condition requiring physician intervention, determine candidacy for hearing aids, provide hearing aid recommendation and selection, perform hearing aid fittings and adjustments, perform fitting verification and 

hearing aid repairs, take ear impressions for ear molds, and provide counseling and 

aural rehabilitation. 

Training for the profession is predominantly done through an apprenticeship 

model, an accepted and appropriate path given the hands-on and technical skill involved in the profession. And while licensure requirements vary from state to state, 

in addition to the apprenticeship experience, candidates generally must hold a minimum of a high school diploma or an associate’s degree in hearing instrument 

sciences. These requirements merely create a floor, evident in the fact that 87% of 

hearing aid specialists have obtained some college coursework, or an associates or 


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9 International Hearing Society, Health Policy and Payment Survey, June 2013. 

10MarkeTrak VIII: The Impact of the Hearing Healthcare Professional on Hearing Aid User 

Success, The Hearing Review, Vol 17 (No.4), April 2010, pp. 12–34. 11Demand for Audiology Services: 30–Yr Projections and Impact on Academic Programs, Journal of the American Academy of Audiology, Ian A. Windmill and Barry A. Freeman, 24:407– 

416, 2013. 

higher academic degree.9 In nearly every state, candidates must pass both written 

and practical examinations, and in many states a distance learning course in hearing instrument sciences is required or recommended. Ultimately, when making hiring decisions, the VA will have the ability to determine which candidates meet their 

needs. 

Hearing aid specialists are already recognized by several Federal agencies to perform hearing healthcare services. The Standard Occupational Classification (SOC) 

identifies hearing aid specialists within the Healthcare Practitioners and Technical 

Occupations category (29–2092), and the Federal Employee Health Benefit program 

and Office of Policy and Management support the use of hearing aid specialists for 

hearing aid and related services. And while Medicare does not cover hearing testing 

for the purpose of recommending hearing aids (a policy that applies to all dispensing 

practitioners), hearing aid specialists provide hearing testing, hearing aids, and related services for state Medicaid programs around the country. Further, most insurance companies contract with hearing aid specialists to provide hearing tests and 

hearing aid services for their beneficiaries. 

Finally, evidence shows that there is no comparable difference in the quality and 

outcomes of hearing aid services based on site of service or type of provider (audiologist or hearing aid specialist). A well-respected industry study found that instead 

the best determinant of patient satisfaction is whether the provider used best practices like fit verification, making adjustments beyond the manufacturer’s initial settings, providing counseling, and selecting the appropriate device for one’s loss and 

manual dexterity.10

VA STRATEGIES TO ADDRESS DEMAND

To address the demand for audiology and hearing aid services, the VA has been 

relying on the use of teleaudiology, audiology health technicians, and contract audiologists outside the VA setting. While IHS applauds the VA for its efforts to better 

serve the needs of Veterans, each of these strategies has its limitations. Though 

teleaudiology can make audiological services more available in remote settings, the 

cost of staffing and facilities are needlessly high, especially given that hearing aid 

specialists have fully-equipped offices, oftentimes operate in rural settings, and perform home and nursing home visits. Audiology health technicians have a very limited scope of duties, which does not include hearing aid tests or the fitting and dispensing of hearing aids, and they must be supervised by audiologists. Hiring hearing aid specialists to work as health technicians, as the VA currently does, significantly limits their role and effectiveness. Finally, increased reliance solely on audiologists may also limit access as there are not enough audiologists to fill the current 

and future need for hearing care services. In order to fill the need, the number of 

licensed audiologists needs to double in size within the next 30 years to 32,000; 

however only about 600 are entering the profession annually. Even the best case 

scenarios for increasing the number of graduates and reducing attrition still fall 

short.11

In a June presentation, VA Deputy Chief Patient Care Services Officer for Rehabilitation and Prosthetic Services, Dr. Lucille Beck, PhD, cited several barriers to 

the delivery of hearing healthcare services for the VA, including ‘‘Some VA sites 

having space constraints that challenge expansion of current audiology services’’, 

‘‘Some veterans are very old or sick and cannot travel outside of the home’’, and 

‘‘Lack of developed hearing healthcare networks and standards for VA to partner 

with the community.’’ In each of these areas, hearing aid specialists, both internally 

and through their expanded use in the fee-for-service network can help. 

As the federal government seeks to become more efficient and cost-effective, we 

urge the Subcommittee to pass H.R. 353, which will round out the VA hearing 

healthcare team to mirror the private-market model, and increase Veterans’ access 

to care, improve overall quality, and reduce cost. Again, using hearing aid specialists as health technicians is not the answer; this limits service delivery and underutilizes the skills and expertise hearing aid specialists can offer to the VA hearing 

healthcare team. Now is the time to embrace hearing aid specialists in the role they 

are trained and licensed to play to help meet the hearing healthcare needs of our 

Veterans, which will only continue to rise in the coming years. 


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Thank you for your consideration and for your service to our Veterans. With questions, please contact government affairs director Alissa Parady at 571–212–8596 or 

aparady@ihsinfo.org. 


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NATIONAL MEDICAL ASSOCIATION, SUBMITTED BY LAWRENCE SANDERS, JR., MD, 

MBA 

On behalf of the National Medical Association (NMA), I am pleased to express our 

support for H.R. 353, aimed at improving hearing healthcare services and outcomes 

for our nation’s Veterans. We acknowledge that Veterans’ hearing healthcare needs 

could be better served through increased access to services and improved quality of 

care, and believe that hearing aid specialists can help accomplish this goal. Specifically, we support the inclusion of hearing aid specialists as a provider class within 

the Department of Veterans Affairs (VA). NMA also supports the lifting of restrictions that currently limit the circumstances in which the VA can contract with hearing aid specialists to provide hearing aid services to VA-eligible Veterans, and in 

doing so create parity with audiologists for the provision of VA-hearing aid services. 

Founded in 1895, the NMA is a national, professional and scientific organization 

representing over 30,000 African American physicians who are committed to improving the quality of health among minorities and disadvantaged people through 

its membership, professional development, community health education, advocacy, 

research and partnership with federal and private agencies. The NMA advocates for 

policies that would assure equitable and quality healthcare for all people. 

Hearing aid specialists are a member of the hearing healthcare team, comprised 

of otolaryngologists, audiologists, and hearing aid specialists; and are credentialed 

by all 50 states through licensure to perform hearing tests and provide hearing aid 

dispensing and fitting services. By integrating this team member into the VA provider system and utilizing the team-based approach, NMA believes service delivery 

can become more efficient and effective for the Veterans who are currently enrolled 

and those who will be transitioning into the VA system in the years to come. Further, increasing the external network of VA hearing healthcare providers to include 

hearing aid specialists would improve Veterans’ access to convenient, comprehensive, and timely care; and would provide them the standard of care that currently 

exists in the public marketplace. 

It is for the aforementioned reasons, that the National Medical Association respectfully urges the Subcommittee and full Committee to pass H.R. 353 favorably. 

Thank you. 


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Æ 


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