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98–634 2016

LEGISLATIVE HEARING ON: DRAFT LEGISLATION 

TO IMPROVE REPRODUCTIVE TREATMENT PROVIDED TO CERTAIN DISABLED VETERANS; 

DRAFT LEGISLATION TO DIRECT THE DEPARTMENT OF VETERANS AFFAIRS (VA) TO SUBMIT 

AN ANNUAL REPORT ON THE VETERANS 

HEALTH ADMINISTRATION; H.R. 271; H.R. 627; 

H.R. 1369; H.R. 1575; AND, H.R. 1769 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON VETERANS’ AFFAIRS 

U.S. HOUSE OF REPRESENTATIVES 

ONE HUNDRED FOURTEENTH CONGRESS 

FIRST SESSION 

THURSDAY, APRIL 23, 2015 

Serial No. 114–17 

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 

Thursday, April 23, 2015 

Page 

Legislative Hearing on: Draft Legislation to Improve Reproductive Treatment 

Provided to Certain Disabled Veterans; Draft Legislation to Direct the 

Department of Veterans Affairs (VA) to Submit an Annual Report on the 

Veterans Health Administration; H.R. 271; H.R. 627; H.R. 1369; H.R. 1575; 

and, H.R. 1769 ...................................................................................................... 1 

OPENING STATEMENT 

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

Julia Brownley, Ranking Member .......................................................................... 3 

Hon. Jeff Miller 

Prepared Statement ......................................................................................... 35 

WITNESSES 

Hon. Gus Bilirakis, U.S. House of Representatives 12th District, Florida ......... 4 

Prepared Statement ......................................................................................... 36 

Hon. Janice Hahn, U.S. House of Representative, 44th District, California ...... 6 

Prepared Statement ......................................................................................... 38 

Hon. Jackie Walorski, U.S. House of Representative, 2nd District, Indiana ..... 7 

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

Blake Ortner, Deputy Government Relations Director, Paralyzed Veteran of 

America ................................................................................................................. 14 

Prepared Statement ......................................................................................... 41 

Louis J. Celli Jr. Director, National Veterans Affairs and Rehabilitation Division, The American Legion .................................................................................. 15 

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

John Rowan, National President, VVA .................................................................. 17 

Prepared Statement ......................................................................................... 60 

Adrian Atizado, Assistant National Legislative Director, DAV ........................... 19 

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

Rajiv Jain M.D., Assistant Deputy Under Secretary for Health for Patient 

Care Services, VHA, U.S. Department of Veterans Affairs .............................. 28 

Prepared Statement ......................................................................................... 73 

Accompanied by: 

Janet Murphy, Acting Deputy Under Secretary for Health for Operations and Management, VHA, U.S. Department of Veterans 

Affairs 

And 

Jennifer Gray, Attorney, Office of the General Counsel, U.S. Department of Veterans Affairs 

FOR THE RECORD 

Hon. Corrine Brown, FC Ranking Member 

Prepared Statement ......................................................................................... 92 

American Health Care Association ........................................................................ 93 

American Society for Reproductive Medicine ........................................................ 94 


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IV 

Concerned Veterans for America ............................................................................ 96 

RESOLVE: National Infertility Association .......................................................... 97 

Veterans of Foreign Wars of the United States .................................................... 98 

Wounded Warrior Project ........................................................................................ 104 


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LEGISLATIVE HEARING ON: DRAFT LEGISLATION TO IMPROVE REPRODUCTIVE TREATMENT PROVIDED TO CERTAIN DISABLED 

VETERANS; DRAFT LEGISLATION TO DIRECT THE DEPARTMENT OF VETERANS AFFAIRS (VA) TO SUBMIT AN ANNUAL REPORT 

ON THE VETERANS HEALTH ADMINISTRATION; H.R. 271; H.R. 627; H.R. 1369; H.R. 1575; 

AND, H.R. 1769 

Thursday, April 23, 2015 

U.S. HOUSE OF REPRESENTATIVES, 

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

The subcommittee met, pursuant to notice, at 10:00 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, Ruiz, Kuster, 

and O’Rourke. 

Also present: Representatives Walorski and Titus. 

OPENING STATEMENT OF CHAIRMAN DAN BENISHEK 

Mr. BENISHEK. The subcommittee will come to order. 

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

friends, colleagues, and members of the full committee, Congresswoman Jackie Walorski of Indiana and Congresswoman Dina Titus 

of Nevada, to sit on the dais and participate in today’s proceedings. 

Without objection, so ordered. 

Thank you all for joining us today as we discuss seven bills that 

will impact the healthcare provided to our Nation’s veterans by the 

Department of Veterans Affairs’ healthcare system. 

The bills on our agenda today are draft legislation to improve reproductive treatment provided to certain disabled veterans; draft 

legislation to direct VA to submit to an annual report on the Veterans Health Administration; H.R. 271, the Creating Options for 

Veterans Expedited Recovery or COVER Act; H.R. 627 to expand 

the definition of homeless veteran for purposes of benefits under 

the laws administered by VA; H.R. 1369, the Veterans Access to 

Extended Care Act of 2015; H.R. 1575 to make permanent the pilot 

program on counseling in retreat settings for women veterans 


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newly separated from service; and, H.R. 1769, the Toxic Exposure 

Research Act of 2015. 

I am proud to sponsor two of the bills on our agenda, the draft 

bill to direct VA to submit an annual report on the Veterans 

Health Administration and H.R. 1769, the Toxic Exposure Research Act of 2015. 

The draft bill would require the VA to submit an annual report 

to Congress regarding the provision of hospital care, medical services, and nursing home care by the VA healthcare system. The annual report would contain information regarding access to care, 

quality of care, workload, patient demographics and utilization, 

physician compensation and productivity, purchased care, and 

pharmaceutical prices. 

This measure is the result of the subcommittee’s oversight hearing in January where the Congressional Budget Office testified 

that VA provided limited data to Congress and the public about its 

costs and operational performance and that if it was provided on 

a regular and systemic basis could help inform policymakers about 

the efficiency and cost effectiveness of VA’s services. 

Similar sentiments were echoed by witnesses from The American 

Legion and the Independent Budget. VA must become more transparent and forthcoming about the care that it provides to our Nation’s veterans so that Congress, stakeholders, taxpayers, and veterans can make informed determinations about the services that 

the department is offering and how they can be improved. 

The intent of our hearing in January was to determine the cost 

and value of VA care. But during our discussion, it became painfully obvious that the department leaders were unable to provide 

basic information about, say, how much the VA spends on a single 

patient encounter in a VA primary care clinic. 

As a doctor myself, it is unfathomable to me that the VA either 

does not have or is unwilling to share granular data about the cost 

of the services it provides. This bill and the free flow of information 

that it will require of the VA on a yearly basis will fix that once 

and for all, resulting in a better, stronger VA healthcare system 

that our veterans deserve. 

My other bill, the Toxic Exposure Research Act of 2015, would 

establish a national center for research into the health conditions 

experienced by the descendants of veterans exposed to toxic substances. It would also create an advisory board who would be responsible for advising the national center, determining health conditions that result from toxic exposure, and studying and evaluating the cases of exposure. 

In addition, it would authorize the Department of Defense to declassify documents related to a known incident in which at least a 

hundred servicemembers were exposed to a toxic substance that resulted in at least one case of related disability. 

Finally, it would create a national outreach campaign jointly led 

by VA, DoD, and the Department of Health and Human Services 

on the potential long-term health effects of exposure to toxic substances by servicemembers, veterans, and their descendants. 

As I said before, injuries or illnesses that result from exposure 

to toxic chemicals can have life-long and generational effects, the 

impacts of which we do not yet fully understand, but are nevertheVerDate Aug 31 2005 09:31 Jul 22, 2016 Jkt 000000 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 Y:\98-634.TXT PAT

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less painfully prevalent to the veterans and family members who 

experience them. 

For them and for future generations, we must do more to recognize, research, and treat toxic exposure issues and thoroughly 

evaluate the long-term effects exposure can have not just on those 

who serve but on their children and grandchildren as well. 

Mr. BENISHEK. Enough about my bills. In addition to those bills, 

I am proud to be an original cosponsor for H.R. 627 which would 

expand the definition of a homeless veteran to include veterans and 

their families who are fleeing from domestic or dating violence, sexual assault, stalking or other life-threatening conditions in their 

current home and lack the resources to obtain other permanent 

housing. 

Veterans who are living in a violent home deserve our support 

as they recover from the devastating effects of intimate partner violence and begin to reclaim their lives. 

I am grateful to my friend and colleague, Congresswoman Janice 

Hahn from California, for championing their cause with this legislation and I urge all my colleagues to join us in cosponsoring H.R. 

627. 

The draft bill 1769, H.R. 1769 and H.R. 627 are supported by a 

number of our veteran service organizations and I thank them all 

for their support and comments and recommendations. I look forward to working closely with them, the department, and other 

stakeholders beginning with today’s hearing to strengthen these 

and all the bills on our agenda where needed and advance them 

through the subcommittee without delay. 

I thank all of our witnesses and the audience members for being 

here today and I will now yield to the Ranking Member Brownley 

for any opening statements she may have. 

OPENING STATEMENT OF RANKING MEMBER JULIA 

BROWNLEY 

Ms. BROWNLEY. Thank you, Mr. Chairman, for calling this hearing this morning. 

I don’t have any bills to speak to today personally, but I do look 

forward to hearing from members and witnesses today regarding 

the five bills and two pieces of draft legislation that are on the 

agenda this morning including yours, Mr. Chairman. 

As we deliberate on the multitude of issues and concerns that are 

before us each and every Congress, it is critical that we are as informed as we possibly can be on all of the issues. We rely on the 

information we receive during these legislative hearings to improve 

upon the services and benefits that the Department of Veterans Affairs provides to our veterans and their families. It is also important that we are made aware of any unintended consequences that 

may arise from these different bills. 

Today we will hear, as the chair has already stated, we will hear 

from the panels on a variety of bills concerning the subcommittee’s 

jurisdiction. We have two bills addressing the treatment of mental 

health, one on domestic violence and on homeless veterans, one on 

research and to toxic exposures, and a bill that addresses the provision of extended care services to veterans. 


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In addition to the five bills, we will hear about two pieces of draft 

legislation. The first would authorize VA to provide in vitro fertilization services to eligible veterans and spouses. The second requires the VA to submit a report to Congress on hospital care, medical services, and nursing homes. 

I am on the record as a supporter of reproductive rights for all 

our veterans. Too many of our young men and women have been 

injured so severely that having children is now not an option. IVF 

might not be the solution for these families and we need to be sensitive to their needs also. 

Hopefully we can work together to find a way forward to ensure 

that all veterans who want a family including same sex veterans 

will have all the support and assistance they may need to do that. 

I appreciate all the witnesses being here today. I appreciate the 

chair calling this meeting and I look forward to everyone’s testimony. I yield back. 

Mr. BENISHEK. Thank you. 

Well, we are this morning to be joined by several other of our 

members who are sponsoring legislation this morning. Mr. Miller, 

the chairman of the committee, will be in, Congressman Gus Bilirakis from the 12th District of Florida, Congresswoman Janice 

Hahn from the 44th District of California, Congresswoman Jackie 

Walorski from the 2nd District of Indiana. 

I think I will start with Mr. Bilirakis. Would you please go ahead 

with your legislation. 

STATEMENT OF HON. GUS BILIRAKIS, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF FLORIDA 

Mr. BILIRAKIS. Mr. Chairman, I appreciate it very much and I 

want to thank the ranking member as well. 

Thank you for holding this very important hearing and giving me 

the opportunity to discuss my bill, H.R. 271, the Creating Options 

for Veterans Expedited Recovery Act, the COVER Act. 

Statistics show that one in five veterans who serve in Iraq and 

Afghanistan have been diagnosed with the posttraumatic stress. 

Now, we must responsibly ask ourselves are we doing enough when 

it comes to addressing mental health in our veterans’ population. 

I don’t think so. 

Recent data has shown that every day in this country, approximately 18 to 22 veterans take their own lives. This statistic answers the question I posed earlier. It is obviously more—Mr. Chairman, more needs to be done in my opinion. That is why I introduced the COVER Act in the 114th Congress. 

The COVER Act will establish a commission to examine the Department of Veterans Affairs’ current evidence-based therapy treatment model for treating mental illness among veterans. It will also 

analyze the potential benefits of incorporating complementary, alternative treatments available within our communities. 

The duties of the commission designated under the COVER Act 

include conducting a patient-centered survey within each Veteran 

Integrated Service Network. The survey will examine several different factors related to the preferences and experiences of veterans when they have dealt with the Department of Veterans Affairs. 


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Instead of presuming to know what is best for veterans, we 

should just ask the veteran. It is as simple as that. Then we can 

work with veterans on finding the right solution that best fits their 

own unique needs. Not one size fits all. 

The scope of the survey will include the experience of a veteran 

when seeking medical assistance within the Department of Veterans Affairs, the experience of veterans with the non-VA medical 

facilities and health professionals for treating mental health illness, the preferences of a veteran on available treatments for mental health and which they believe to be most effective, the prevalence of prescribing prescription drugs within the VA as remedies 

for treating mental illnesses, and outreach efforts by the VA secretary on available benefits and treatments. 

Additionally, the commission will be tasked with examining the 

available resources on complementary, alterative treatments for 

mental health. Then the commission will identify what benefits 

could be attained with the inclusion of such treatments for our veterans seeking care at the VA. 

Some of the alternative therapies include among others, of 

course, accelerated resolution therapy, music therapy, yoga, acupuncture therapy, meditation, outdoor sports therapy, and training 

and care for service dogs. 

Finally, the commission will study the potential increase in 

health claims for mental health issues for veterans returning from 

the most recent theaters of war. We must ensure that the VA is 

prepared with the necessary resources and infrastructure to handle 

the increase in those utilizing their earned benefits to address the 

mental and physical elements incurred from military service. 

Once the commission has successfully completed their duties, a 

final report will be issued. Its recommendations and findings will 

be made available based on the analysis of the patient-centered 

survey, alternative treatments, and evidence-based therapies. 

The commission will also be responsible for creating a plan to implement those findings in a feasible, timely, and cost-effective manner. 

Last Congress, I was very pleased that the subcommittee considered the COVER Act in a legislative hearing. At this hearing, all 

the VSOs and organizations testified and have supported the 

COVER Act. I want to thank all again, all of you really for your 

support through your testimonies given today. 

In this year’s draft, I was also pleased to incorporate the recommendations offered by the Vietnam Veterans of America. They 

suggested that appointees on the commission must not have proprietary, financial, or any other conflicting interest in any of the treatment considered, and I think that is very reasonable and I appreciate their recommendations. 

In closing, we have the support from veterans and the organizations that work closely with them. And it is clear that there is a 

need to do more and that is what we need to do. We need to do 

more for our true American heroes. We have that responsibility. 

We have that duty. 

The question now is this: What do we intend to do about it? We 

definitely have to act on this bill and I really appreciate, Mr. 


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Chairman, you agendaing this bill today and I would love to see 

it marked up very soon. 

With that, I urge my colleagues again to support this bill and cosponsor this bill. Let’s get this done for our heroes. Thank you. 

[The prepared statement of Gus Bilirakis appears in the Appendix] 

Mr. BENISHEK. Thanks, Mr. Bilirakis. 

Now we will hear from our colleague, Representative Hahn. You 

are now recognized for five minutes. 

STATEMENT OF HON. JANICE HAHN, A REPRESENTATIVE IN 

CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. HAHN. Thank you. And thank you, Chairman Benishek, for 

holding this hearing. It is an honor for me to be with Ranking 

Member Brownley and really all the distinguished members of this 

committee. Thank you. 

Homeless veterans are such a pressing problem for this Nation. 

More than 62,000 veterans are homeless on any given night and 

over 120,000 veterans will experience homelessness over the course 

of the year. And while only seven percent of Americans qualify as 

veterans, they make up nearly 13 percent of the homelessness population in this country. Sadly, my hometown, Los Angeles County, 

has the most homeless veterans in the Nation. 

And today I wanted to address one segment of homeless veterans, those who are homeless because of domestic violence. Currently the Department of Veterans Affairs’ definition of homeless 

veterans does not include veterans who are homeless because of domestic violence. And across the country, we know too many victims 

of domestic violence feel there is nowhere for them to turn. 

And lacking resources, help, and a safe place to go, many of these 

victims feel like their only choice is to remain with their abusers. 

And tragically too often women veterans are among those who find 

themselves in this horrible situation. 

According to the VA, 39 percent of our women veterans report experiencing domestic violence. That is well above the national average. And, however, because of antiquated laws on the books, they 

have not been eligible to access resources designated for homeless 

veterans. 

I approached Chairman Benishek with my legislation, H.R. 627, 

which updates the definition of homeless veteran to include victims 

fleeing domestic violence. And not only was he extremely supportive, but he joined me in introducing it. And for that, I really 

thank you, Chairman. 

Our legislation will update the definition of homeless veteran to 

include veterans fleeing domestic violence and will correct what I 

believe is an oversight and ensure that veterans fleeing domestic 

violence can receive benefits from the VA. This is a minor change, 

but it has great importance to ensure that our veterans do not feel 

trapped in dangerous situations. 

H.R. 627 is endorsed by countless veterans’ organizations such as 

the Veterans of Foreign Wars, AMVETS, the National Coalition for 

Homeless Veterans, the Servicewomen’s Action Network, Blinded 

Veterans Association, and we have many more on that list. 


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Providing benefits to veterans driven to homelessness by domestic violence is, I think, something we should all support and we 

have supported that in the past. In fact, I have worked with House 

Appropriations Veterans Affairs’ subcommittee to include report 

language the past two years to make these benefits available. 

But that process only helps until the next year and has to be repeated every year to provide this temporary help. I think it is time 

to stop making temporary fixes. This legislation permanently fixes 

this loophole for veterans. And while it is unknown how many veterans will be helped by this bill, I just believe if it helps one veteran get the support they need and to leave a dangerous situation, 

then our work here will be worth every minute. Let’s step up to 

provide these heroes who have protected us with the resources they 

need including a place where they can be safe and protected. 

In conclusion, I want to thank you for working with me to solve 

an urgent problem and I yield back the balance of my time. 

[The prepared statement of Janice Hahn appears in the Appendix] 

Mr. BENISHEK. Thank you very much. 

Representative Walorski, you are recognized for five minutes. 

STATEMENT OF HON. JACKIE WALORSKI, A REPRESENTATIVE 

IN CONGRESS FROM THE STATE OF INDIANA 

Ms. WALORSKI. Good morning. Thank you. 

Chairman Benishek, Ranking Member Brownley, members of the 

committee, thank you for the opportunity to discuss H.R. 1369, the 

Veterans Access to Extended Care Act. This important bill would 

expand veterans’ access to certain healthcare services and allow 

former servicemembers to receive those services from local providers. 

Currently VA offers a variety of long-term services and support 

to veterans including nursing home care, adult day care, respite 

care. Non-VA providers at community organizations must contract 

with the VA under the Service Contract Act to provide these services. 

The Service Contract Act’s burdensome reporting requirements, 

the Department of Labor, along with the compliance costs discourage local providers from entering into contracts with the VA. This 

situation has left many veterans and their families without the 

ability to find providers close to home. 

In February of 2013, the VA issued a proposed rule which would 

have allowed providers to enter into these agreements with the VA 

under the same guidelines that providers for Medicare enter into 

agreements with CMS. Non-VA providers would no longer be considered federal contractors, relieving them from the burdensome reporting requirements. 

In conjunction with a Senate letter that was sent June of 2014, 

Congresswoman Tulsi Gabbard and I along with 107 of our colleagues in the House sent a letter in August of 2014 to Secretary 

McDonald encouraging the release of the final VA provider agreement rule. Unfortunately, despite the willingness of the department, the VA never had the legislative authority to begin to enact 

the rule. 


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In response, Representative Gabbard and I introduced H.R. 1369, 

Veterans Access to Extended Care Act. This commonsense bill 

gives the VA the legislative authority, the fix it needs to follow 

through the original proposed rule. Specifically this bill exempts 

extended care service providers from being treated as federal contractors for the acquisition of goods or services. 

The bill also relieves providers from certain reporting requirements to the Department of Labor. Lastly, it includes quality assurance provisions to ensure the safety and a high standard of care 

our veterans deserve. 

Incentivizing more local providers to work with the VA will increase access to care that is closer to home, allowing family and 

friends to provide additional support structures to our veterans. 

The family structure during these times is vital to ensuring a veteran’s quality of life. 

These individuals have sacrificed so much in the name of liberty, 

they should not have to worry about being able to find care close 

to home because their hometown providers don’t have the necessary resources to qualify as a government contractor. Eliminating 

this designation will encourage more extended service providers to 

enter into agreements which will provide much more options, many 

more options to our veterans. 

Providing veterans with the care they need and deserve continues to be a top priority of mine and most of us on this committee. I am grateful to work with Representative Gabbard, Senator Hoeven, Senator Manchin, and the committee in addressing 

this critical issue for our veterans. 

And I thank you again, Mr. Chairman, Ranking Member 

Brownley, for the opportunity to be here today. I yield back my 

time. 

[The prepared statement of Jackie Walorski appears in the Appendix] 

Mr. BENISHEK. Thank you very much for your testimony. 

The chairman of the committee is expected to be here to testify 

on behalf of his legislation as well, but I am not going to ask any 

questions of the members here in the reference of time because I 

know I am going to have adequate time to talk to them as time 

goes by here in the House. 

Ms. Brownley, do you have any questions? 

Any questions for the panel members from any of the members? 

And thank you. The first panel is excused. And then we will proceed with the second panel. 

Mr. TAKANO. Dr. Benishek, just a real quick question of Mr. Bilirakis and Mr. Ruiz, Dr. Ruiz. 

Your commission that you are trying to set up is a very interesting one to me and I commend you for the bill. And I gather the 

big impetus is to try and find ways to not necessarily—I mean, 

former Secretary Shinseki I remember talking about the use of 

medications and how we are using too much of them with our veterans. 

I want to share with you that I was at an event probably last 

session with a California Commission for the Humanities and Professor Emeritus David Glidden of University of California Riverside 

is a professor of philosophy. And one of the participants was a feVerDate Aug 31 2005 09:31 Jul 22, 2016 Jkt 000000 PO 00000 Frm 00012 Fmt 6633 Sfmt 6633 Y:\98-634.TXT PAT

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male veteran who had taken part in his philosophy class which explored the big moral questions about life, you know. 

And it strikes me that a lot of veterans face not just the mental 

issue, mental health issues but the spiritual issues. We send young 

people into battle, many of them not really thinking about the 

moral consequences of war, and they come back with all that 

weighing on their minds. And rather than medications, many of 

them just really could benefit by going to a well-considered course 

put together by a very talented person in humanities. 

And I wonder if you might consider looking at including a perspective, say, from the National Endowment for the Arts or the National Endowment for the Humanities ways to leverage those budgets and encouraging our humanities and arts community to think 

about how they can engage with our veterans. And this is also providing a pathway that is different than medication. 

And one of the things that this veteran mentioned was that 

sometimes there is a stigma attached to seeking mental health and 

this is another pathway that a veteran can take that, you know, 

doesn’t necessarily mean that they have to feel like they are stigmatized by that. 

And, of course, we want to remove the stigma period. 

Mr. BILIRAKIS. Absolutely. 

Mr. TAKANO. But it is a thought I wanted to offer. 

Mr. BILIRAKIS. Oh, I would be willing to discuss that with you. 

Mr. TAKANO. Yes. Thank you. 

Mr. BILIRAKIS. Again, you know, the examples that I used are 

just examples and we are not limiting it to that. And I would like 

to hear maybe from Dr. Ruiz, too, because he is a cosponsor of my 

bill, the prime cosponsor. But I would take that into consideration. 

I would be happy to discuss that with you. 

Mr. RUIZ. Thank you. I think that the commission will be looking 

at events like that and that is why want to form the commission—— 

Mr. BILIRAKIS. Absolutely. 

Mr. RUIZ [continuing]. Because then they can look at what the 

state-of-the-art mental health counseling and therapy exist out 

there and start to incorporate those for our veterans. And I think 

it will be helpful. 

Mr. TAKANO. Yes. With all respect to the medical background, 

and I don’t want to diminish any—we don’t want to diminish the 

role of medication or therapy, but thinking of also the nonmedical 

ways of also treating folks even with the existing budgets or even 

a tiny bit of leverage from Federal Government to try these other— 

so I was hoping that you would look at representing on the commission folks within the humanities and the arts as well. 

Mr. COFFMAN. Mr. Chairman. 

Mr. BENISHEK. Yes. 

Mr. COFFMAN. Mr. Bilirakis, one thing I would like the—my concern as a combat veteran is that the largest cost driver I think 

probably in VA healthcare is posttraumatic stress disorder in terms 

of disability payments. 

In talking to professionals in psychiatry and psychology and the 

different therapists seem to think that with the proper treatment 

that the stress disorders from being in a combat zone could be 


VACREP0180 with DISTILLER
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brought down to a level where it is no—that those stressors are no 

longer debilitating, yet one of the considerations I think your commission should look at is should there be a requirement or what 

can we do to encourage those who are on disability for 

posttraumatic stress disorder to receive treatment because I think 

it is a disservice to those veterans and it is, quite frankly, as a taxpayer, it is a disservice to the taxpayers of this country. 

We have got to figure out how to help people. We have got two 

different definitions. The Department of Defense sees 

posttraumatic stress as a wound and the Veterans Administration 

sees it as a disability. I think we have got to link those two up. 

As a combat veteran, I see it as a wound and wounds are treatable. 

Some may not be. 

But the system makes no effort or little effort and so I think that 

it ought to be a factor to say what can we do to restructure the 

system going forward, or does it need to be restructured going forward, I don’t know, that creates a mechanism whereby people are 

encouraged or required to participate in treatment. 

Mr. BILIRAKIS. That is definitely worthy of a discussion. And, 

again, the idea behind this bill is we need to give the veteran the 

choice because not one size fits all with regard to the therapy. So 

I will take all these matters under consideration, but we got to 

pass the bill first. Thank you. 

Mr. BENISHEK. Mr. Ruiz, Do you have a comment? 

Mr. RUIZ. Yeah. I would like to make a statement regarding this 

bill and applaud Mr. Bilirakis for the work that you are doing for 

our veterans in improving their mental health services. 

So I would like to thank Mr. Chairman and Ms. Ranking Member and thank also the panelists that we are going to hear from 

today, the veteran service organizations for joining us. The VA’s 

mission is to care for those that, quote, ‘‘shall have borne the battle.’’ And the most essential part of that task is to heal our wounded warriors, our wounded veterans. However, more and more our 

soldiers are returning with psychological wounds, illnesses that do 

not present as obviously as physical maladies but are just as damaging. 

That is why I am an original cosponsor of H.R. 271, the COVER 

Act, which I am glad to see included in today’s hearing. This bill 

will ensure that no stone is left unturned in exploring ways to provide timely, effective, veteran-centered mental healthcare for those 

who have served in our Armed Forces. 

I am proud to have worked with outstanding veteran service organizations and the veterans in my district to ensure that the VA 

listens to the foremost experts on what veterans need, the veterans 

themselves. 

In that same spirit, this bill will help give veterans a voice in 

their treatment by requiring a comprehensive survey of veterans’ 

experiences and preferences. To achieve real progress towards improving mental healthcare in the VA, we must incorporate veterans’ recommendations. 

As a physician who has treated the whole range of patients that 

come into the emergency department, I know that one-size-fits-all 

approach doesn’t work for veterans with mental health needs. This 

bill will help give our veterans mental healthcare options that work 


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for them and will lay the groundwork for future solutions that are 

the product of listening to our veteran community. 

I look forward to working with Vice Chairman Bilirakis and 

other members of this committee to create an inclusive process 

where veterans’ voices and views are heard and I urge my colleagues to support this bill. 

Thank you and I yield back. 

Mr. BENISHEK. All right. Thanks. 

Does anyone else have any questions or comments? 

Mr. ROE. Just very briefly I guess to just second what two of my 

colleagues have said. 

One, Mr. Coffman, I think you are absolutely right on. We should 

stop calling this posttraumatic stress disorder and posttraumatic 

stress and look at how we heal these veterans and get them back 

into the workforce and have productive lives, not to say that I have 

this condition. 

If you have been in war, I have said this many times here, and 

somebody shoots at you, that is going to make you anxious. There 

would be something wrong with you if you didn’t. And you are 

going to—I mean, I would think there would be something really 

wrong if you didn’t get scared if somebody shot at you. 

And I think the goal ought to be with the commission is how do 

we, and I think this is a, Mr. Bilirakis, a tremendous idea that you 

all have come up with, to finally get in one arena a group of people, 

experts to put together some ideas about how we do what you are 

saying, about how we get these folks who are on disability, get 

them back in the workforce and get them back at productive lives. 

I think that is something we absolutely have to do. 

And, Mr. Takano, I could not agree more with you in including 

some alternative things like the arts, music. I can tell you it is very 

beneficial for people and can be very healing to people. And having 

used that myself, I know it works. And so I think it is a phenomenal idea. 

I am very supportive and I think we need to expand, Mr. Bilirakis, what you are doing and with all these ideas that have come 

in. I think this it is a wonderful idea. 

And with that, I yield back. 

Mr. BENISHEK. Great. Okay. Ms. Kuster, Do you have a question 

as well? 

Ms. KUSTER. Just a quick comment. I wanted to thank you, the 

chair. I have been an adoption attorney for 25 years and worked 

with a lot of people in the area of reproductive health and just 

wanted to say I support the effort in your bill. And I think it is 

an important point. 

And then I think Representative Walorski is gone, but I just 

wanted to thank her for her efforts and also Representative Hahn, 

the bill about women and her homelessness issue, about domestic 

violence and women trying to seek shelter and safety. 

So I just want to commend the chair and the panel for some 

great legislation and look forward to working with you all. 

Mr. BENISHEK. Well, thanks. 

Ms. KUSTER. Thank you. 

Mr. BENISHEK. Appreciate that. 


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Mr. Miller has arrived, so he wants to present his legislation as 

well. Mr. Miller, you are recognized. 

Mr. MILLER. Thank you very much, Mr. Chairman, to the ranking member. And I apologize for being late this morning, but it is 

always good to be in the Subcommittee on Health. I appreciate all 

the members’ attention and your diligence at the full committee 

level and certainly with what is going on here today. 

I want to talk with you about issues as it relates to reproductive 

treatment that is provided to certain disabled veterans. Now, currently the conflicts in Iraq and Afghanistan over the last decade 

have resulted in significant increases in reproductive organ and 

spinal cord injuries among our servicemembers. These wounds can 

have serious and life-long repercussions on the daily lives of our 

veterans and their families, not the least of which can be the inability to conceive a child. 

While the Department of Veterans Affairs does provide a number 

of fertility services to veterans, VA is currently prohibited via regulation from providing in vitro fertilization, one of the most wellknown and arguably most effective assisted reproductive technologies. The VA is prohibited also by statute from providing any 

such treatment to a veteran’s spouse. 

In contrast, the Department of Defense has been providing IVF 

to severely-wounded servicemembers since 2010. What this disparity results in is having severely-disabled veterans having to decide whether or not to pursue a family through IVF before they 

separate from the service while still actively recovering from their 

wounds and during what can be a highly stressful transition period 

or pay for the procedure out of pocket once they move to veteran 

status. 

Because IVF can be costly, for some veterans waiting until they 

are in VA care can mean having to choose between a financial freefall or foregoing their dreams of having a child altogether. This is 

an agonizing and unacceptable choice that this draft bill would 

help prevent veterans with these disabilities from ever having to 

make. 

The draft bill would authorize VA to provide assisted reproductive technology in addition to any fertility treatment already authorized to enroll veterans whose service-connected disability includes an injury to the reproductive organs or spinal cord that directly results in the inability to procreate without the use of assisted reproductive technology. 

Assisted reproductive technology is defined in the bill to include 

IVF as well as other technologies determined by VA as appropriate 

to be used to assist reproduction. In furnishing IVF or similar procedures to an eligible veteran, VA would also be authorized to provide services to that veteran’s spouse. Like DoD, VA would be limited to providing eligible veterans three in vitro fertilization cycles 

resulting in a total of not more than six implantation events. 

The draft bill would further stipulate that VA is authorized to 

provide for storage of genetic material for three years after which 

the veteran and his or her spouse is responsible for the cost of such 

storage, that VA cannot process or make any determinations regarding the disposition of genetic material, and that VA is required 


VACREP0180 with DISTILLER
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to carry out activities relating to the custody or disposition of genetic material in accordance with the relevant state law. 

Finally, the draft bill would prohibit VA from providing any benefits relating to surrogacy or third-party genetic material donation. 

So in short, this legislation mirrors the IVF benefit that is provided 

to active-duty servicemembers in DoD, creating parity between the 

two departments while opening the door for parenthood for disabled veterans who may otherwise not have the resources to pursue such a path. 

And I am proud to say that this proposal is supported many of 

our VSOs, by resolve the National Infertility Association and by the 

American Society for Reproductive Medicine. And I want to thank 

all of them for their support, for this draft, and for their thoughtful 

comments and recommendations for how it could be improved. 

I look forward to working hand in hand with each of you subcommittee members to address those suggestions and otherwise 

strengthen the language in the draft bill before it is introduced and 

moved forward. This draft is derived partly from the recent subcommittee roundtable wherein fertility among disabled veterans 

was discussed in depth. And I am grateful to you, Dan, for holding 

the roundtable as well as this hearing today. And I urge my colleagues support this draft bill and I yield back. Thank you for your 

time. 

Mr. BENISHEK. Thank you very much, Mr. Chairman. 

Any other comments for the chairman? 

Mr. Roe. 

Mr. ROE. Just very briefly some history. In vitro fertilization 

came along in my career as an obstetrician/gynecologist. Dr. Patrick Steptoe in England did a hundred laparoscopic in vitro implantations before he had one success. Egg gatherings, he did a hundred. It is now standard medical therapy. 

And I wholeheartedly support this legislation. It is past due. We 

should do this for our very, very seriously-wounded veterans who 

want to have families. I can’t think of anything more honorable to 

do than this. 

I yield back. 

Mr. BENISHEK. Thank you. 

I think with that, we will ask the second panel to take the stage 

here. Joining us on the second panel is Blake Ortner, the Deputy 

Government Relations Director for the Paralyzed Veterans of 

America; Louis Celli, Jr., the Director of the National Veterans Affairs and Rehabilitation Division for The American Legion; John 

Rowan, the National President of the Vietnam Veterans of America; and Adrian Atizado, the Assistant National Legislative Director for the Disabled American Veterans. 

Thank you all for being here and for your hard work and advocacy on behalf of our veterans. I appreciate you being here to 

present your views of your members. 

And I think we will begin with Mr. Ortner. Mr. Ortner, you are 

recognized for five minutes. 


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STATEMENTS OF BLAKE ORTNER, DEPUTY GOVERNMENT RELATIONS DIRECTOR, PARALYZED VETERAN OF AMERICA; 

LOUIS J. CELLI JR., DIRECTOR, NATIONAL VETERANS AFFAIRS AND REHABILITATION DIVISION, THE AMERICAN LEGION; JOHN ROWAN, NATIONAL PRESIDENT, VIETNAM VETERANS OF AMERICA; ADRIAN ATIZADO, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS 

STATEMENT OF BLAKE ORTNER 

Mr. ORTNER. Chairman Benishek, Ranking Member Brownley, 

and members of the subcommittee, Paralyzed Veterans of America 

would like to thank you for the opportunity to present our views 

on legislation before the subcommittee. 

PVA supports the draft legislation to provide assisted reproductive technology or ART such as in vitro fertilization to certain disabled veterans. For many disabled veterans, one of the most devastating results of spinal cord injury or dysfunction is the loss of 

or compromised ability to have a child. 

While the Department of Defense does provide ART to 

servicemembers and retired servicemembers, VA does not. When a 

veteran has a loss of reproductive ability due to a service-connected 

injury, they must bear the total cost for any medical services 

should they attempt to have children. Procreative services provided 

through VA would ensure that disabled veterans are able to have 

a full quality of life that would otherwise be denied them due to 

their service. 

The bill also offers veterans the option of cryopreservation of genetic material for three years to protect their viability to have a 

family in the event medical treatments or medications affect the 

quality of their genetic materials. 

While PVA strongly supports this draft legislation, it is limited 

in addressing the needs of women veterans. Some women veterans 

with a catastrophic injury may be able to conceive through IVF but 

be unable to carry a pregnancy to term due to their disability. In 

such an instance, implantation of a surrogate may be their only option. 

The current draft of the bill is not inclusive of all women veterans with a catastrophic reproductive injury and we believe clarification is necessary where the draft prohibits any benefits relating 

to surrogacy or third-party genetic material donation. 

PVA generally supports draft legislation to require a yearly evaluation of overall effectiveness of the Veterans Health Administration in improving access to care and the quality of it. In order to 

improve this bill, PVA strongly encourages adding language to reinstate the reporting requirement that expired in 2008 on the capacity of VHA to provide specialized services to disabled veterans. 

The VA has not maintained its capacity to provide for the unique 

healthcare needs of severely-disabled veterans, veterans with spinal cord injury or disease, blindness, amputations, and mental illness. 

Currently within the SCI system of care, VA not meeting capacity requirements for staffing or number of inpatient beds is consistently reported throughout the system. VA has eliminated staffing 


VACREP0180 with DISTILLER
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positions or operated with vacant healthcare positions for prolonged periods of time. When this occurs, veterans’ access to VA decreases, remaining staff become overwhelmed with increased responsibilities, and the overall quality of healthcare is compromised. 

As a component of its workplace planning, VA tracks this information and is able to compile and use the collected data for annual 

reports, so this should not be an undue burden. 

PVA understands the intent of and generally supports the Toxic 

Exposure Research Act of 2015. However, the bill does not discuss 

the processes should the advisory board conflict with the findings 

of IOM. We encourage the subcommittee and VA to work together 

to ensure legislation fulfills the IOM Committee recommendations. 

PVA supports H.R. 271, the Creating Options for Veterans Expedited Recovery Act. PVA believes that effective medical care, traditional or alternative, ought to be readily available to a veteran in 

need and that all VA mental healthcare should meet the specific 

individual need of the veteran on a consistent basis. 

Complementary and alternative medicines give veterans with 

mental illness as well as catastrophic disabilities additional treatment options and the commission could offer an opportunity to 

identify additional best practices across medical disciplines. 

PVA supports H.R. 627 to expand the VA’s definition of homeless 

to match the definition used by the Department of Housing and 

Urban Development since 1987. Domestic violence is just as much 

a public health matter as homelessness and for women veterans, 

it is a major cause. Thirty-nine percent of women veterans report 

experiencing domestic violence, well above the national average. 

As a result of definitions outlined in Title 38, these veterans are 

not eligible to access resources for homeless veterans. 

PVA generally supports H.R. 1369, the Veterans Access to Extended Care Act of 2015, which would allow veterans to obtain nonVA long-term services and supports from local providers. The bill 

would also allow LTSS providers to enter the VA provider agreement rather than contracting with VA, thereby avoiding the complex processes required under the Service Contract Act. 

Finally, PVA supports H.R. 1575, a bill to make permanent the 

pilot program on counseling in retreat settings for women veterans 

newly separated from service in the Armed Forces. The bill would 

provide VA with the authority to extend the program using the 

same measurements and eligibility requirements. It is essential 

that Congress reauthorize this program as we believe the value 

and efficacy is undeniable. 

Mr. Chairman, PVA thanks the subcommittee for the opportunity 

to submit our views and I would be happy to answer any questions. 

[The prepared statement of Blake Ortner appears in the Appendix] 

Mr. BENISHEK. Thank you very much for your testimony, Mr. 

Ortner. 

Mr. Celli, you may begin your statement, five minutes. 

STATEMENT OF LOUIS J. CELLI, JR. 

Mr. CELLI. I can’t remember a hearing in recent history where 

The American Legion completely supported and stood behind every 

bill being offered for consideration. What this demonstrates is an 


VACREP0180 with DISTILLER
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overwhelming bipartisan partnership with veteran service organizations and with veterans to ensure the Congress gets it right. 

On behalf of our National Commander Mike Helm and the millions of veterans that make up The American Legion, thank you. 

Good job. 

The World Health Organization defines reproductive health as a 

state of complete physical, mental, and social well-being at all ages 

and stages of life and not merely the absence of reproductive disease or infirmity. According to a study of veterans who served during OIF and OEF, 15 percent of women and nearly 14 percent of 

men reported that they had experienced infertility. 

As a result of more than a decade of war, thousands of male and 

female servicemembers are returning home with physical and/or 

psychological wounds resulting in a variety of fertility and reproductive health issues. Many young servicemembers have been documented with low testosterone levels that can be attributed to the 

medications that they take for their physical injuries or conditions 

such as TBI or PTSD. That is why The American Legion supports 

the draft bill to amend Title 38 to improve the reproductive treatments provided to certain disabled veterans. 

The American Legion has always been a vocal advocate of transparency and open communication between the American people 

and government. Last December, CBO suggested that an annual 

report similar to the one that DoD produces relative to TRICARE 

would help policymakers evaluate cost efficiencies. And The American Legion agrees. 

Additional data, particularly if it was provided on a regular 

basis, could help inform policymakers about the efficiencies and 

cost effectiveness of VHA services. The American Legion through 

testimony and resolution has consistently called upon VA to maintain transparency in all aspects of data reporting. 

This is why we not only support this draft legislation, but we 

also continue to support H.R. 216 introduced by Ranking Member 

Brown, the Department of Veterans Affairs’ Budget and Planning 

Reform Act. 

Last month, The American Legion commander sent a team of six 

experts to Los Angeles to work with veterans and learn more about 

the West Los Angeles land usage agreement. While in LA, we 

reached out to and worked directly with homeless veterans so that 

we could get a firsthand sense of the homelessness problem in Los 

Angeles. 

What we discovered was that while expanding the definition of 

what it means to be a homeless veteran as 627 seeks to do and is 

something we support, we also realize that there is a large number 

of homeless veterans that do not qualify for VA services and who 

are completely overlooked in the administration’s goal to eradicate 

veteran homelessness this year. 

Veterans who have less than honorable discharges due to struggles with PTSD or other service-connected issues are not eligible 

for HVRP or other VA services. The American Legion calls on VA 

and this committee to address this issue and work with VA to ensure these veterans are properly served. 

And finally, in September 2013, The American Legion published 

our report, The War Within. This report was a result of comprehenVerDate Aug 31 2005 09:31 Jul 22, 2016 Jkt 000000 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 Y:\98-634.TXT PAT

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sive research conducted by our PTSD/TBI Ad Hoc Committee which 

found that, one, VA and DoD have no well-defined approach toward 

the treatment of TBI; two, providers are merely treating the symptoms; and, three, DoD and VA research studies are weak in the 

area of new non-pharmacological treatments and therapies such as 

virtual reality therapy, hyperbaric oxygen treatment, and other 

complementary and alternative medicine therapies. 

In February of last year, The American Legion conducted a TBI 

and PTSD veteran survey to evaluate the efficacy of VA’s TBI and 

PTSD medical care and to see how veterans who are suffering from 

these signature wounds are being treated. The survey showed that 

59 percent reported either feeling no improvements or feeling worse 

after undergoing treatments for their TBI and PTSD symptoms. 

Thirty-three percent have terminated their treatments and therapies prior to completing them. And the veterans we surveyed reported that they were taking up to ten different medications for 

PTSD and TBI symptoms. 

In June 2014, The American Legion along with military.com 

sponsored a TBI and PTSD symposium and again focusing on complementary and alternative therapies. More information about this 

symposium can be found in my written testimony. 

In closing, The American Legion strongly supports the use of 

complementary and alternative medicines and supports the funding 

necessary to assist veterans suffering with PTSD and TBI with 

complementary, non-pharmacological treatments that allow our returning veterans to actively participate in their own recovery programs without unnecessary sedation or over-medication. 

Thank you. 

[The prepared statement of Louis J. Celli, Jr. appears in the Appendix] 

Mr. BENISHEK. Thank you very much for your comments, Mr. 

Celli. 

Mr. Rowan, you can proceed with your testimony. 

STATEMENT OF JOHN ROWAN 

Mr. ROWAN. Chairman Benishek and Ranking Member 

Brownley, excuse my voice. I have been dealing with a cold for the 

last week. The change in weather is just driving me crazy. 

We, too, support all of the proposed legislation before us this 

morning. The reproductive treatment issue is certainly one we are 

concerned about. One of the problems that we saw with the Agent 

Orange issue was the fact that a lot of veterans because of exposure to Agent Orange had reproductive rights issues, that they had 

terrible problems. 

When we had our town hall meetings on Agent Orange, there 

was a lot of complaints by the wives of miscarriages and stillborns. 

And so any effort at all to work in that area is a blessing. 

The annual report on VHA, I don’t understand why that hasn’t 

always been done, quite frankly, and it is just another area that 

we have been supporting for a long time which is as much congressional oversight as possible is a good thing. And the more information that you have to make your oversight worthwhile will certainly 

work in that direction. 


VACREP0180 with DISTILLER
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We support Representative Bilirakis’s COVER Act. It is an interesting area for us. One of the things we always complained about 

years ago when the Vietnam veterans came home, frankly, was the 

over-medication of Vietnam veterans, way too much Thorazine and 

not enough treatment, and led to all kinds of problems, not the 

least of which was some serious issues that ended up with people 

being put away in jail for a long time. 

So the only caveat we might add, we thank the congressman for 

adding the issue on the membership, but we would also ask that 

any review may ensure that any alternative treatment have a real 

scientific evidence background. 

Unfortunately, I hate to say it, but there is a lot of people running around saying they have got a cure for PTSD. And while they 

may have some reasonable alternative medicine or alternative process, some of these things get a little overblown and, unfortunately, 

can become real scams. So we appreciate the effort, though, and I 

think this commission can go a long way on that. 

Expanding the definition of homeless, that is an issue, you know, 

not surprising. We need to do more on that issue. There was even 

a problem out in Long Island where we got homeless veterans a 

place to live and because they had a place to live, they couldn’t get 

funding because now they had a place to live even though the place 

was a homeless program. I mean, the VA didn’t make sense. They 

didn’t want to fund it. Finally they did, thank God, and I think 

Congressman Zeldin, one of your colleagues, had a lot to do with 

that. 

So I have been working on homeless veterans since 1981 when 

they were first discovered in the City of New York. And we applaud 

the efforts in LA County and we really applaud the efforts of the 

VA in West LA. They really are starting to make some changes out 

there. And I am sure Congresswoman Hahn will be pleased to see 

that. 

We support the other programs, the women’s treatment program 

and the retreat sounds extremely interesting. And the expansion of 

extended care, of course, is something near and dear to us. Unfortunately, many of my members are becoming older obviously and 

need more of that assistance. 

But the main bill we are here for is 1769. We believe this may 

be the most important bill for veterans since the Agent Orange Act 

of 1991. And the key to this is the fact that we would begin to finally look at what happens to toxic exposure not only to the veterans but to veterans’ families because interestingly enough, if you 

look at what the VA has already agreed to, male veterans only get 

children with spina bifida. Female veterans have a much longer list 

of diseases that affect their children that has been agreed to by the 

VA often, again, with reproductive issues being the forefront. 

So our firm belief that this is so important and having gone out 

again, we have had over 200 town halls across the country and it 

has really been discouraging about what we have been hearing 

from the veterans. But the key aspect of this act is the multigenerational issue. So we not only talk about Vietnam veterans 

and the effects of Agent Orange, but we talk about the effects of 

all the folks that went to the Persian Gulf in 1991 and we talk 


VACREP0180 with DISTILLER
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about all the folks who have been in and out of Iraq and Afghanistan to this day. 

We are already getting concerns about some of the folks coming 

home and some of the effects on their children. So we really, really 

look forward and we thank you all for the support for this act. 

Thank you. 

[The prepared statement of John Rowan appears in the Appendix] 

Mr. BENISHEK. Thank you for your comments, Mr. Rowan. 

Mr. Atizado, please proceed with your testimony. 

STATEMENT OF ADRIAN ATIZADO 

Mr. ATIZADO. Thank you, Mr. Chairman, members of the subcommittee. I want to thank everybody here for inviting the DAV to 

testify at this legislative hearing. 

As many of you know, DAV is a 1.2 million service-disabled veteran service organization and our mission is to empower veterans 

to live high-quality lives with respect and dignity. Many of these 

bills aim to do just that. 

We are pleased to present our views on the bills under consideration, but for the sake of brevity, I will only talk about three bills 

and refer the subcommittee to our written testimony for our position and comments on the others. 

First, DAV supports the intent of H.R. 271, the COVER Act. As 

has been discussed here before, this is a bill that would allow for 

complementary, alternative medicines to grow in the VA healthcare 

system. Our resolution from our members calls for access to a complete continuum of services for complementary and alternative 

medicine. 

As part of the Independent Budget, we have long supported the 

advent of the availability of these therapies in the VA healthcare 

system for all generations of wounded, ill, and injured veterans, although we do call the subcommittee’s attention to the bill’s language that may need just a little bit of clarification as to whether 

the commission that would be established by the bill is expected to 

study Veterans Benefits Administration claims with regards to 

mental health disability or whether the claims the bill language 

uses should be replaced by maybe a more clinically differentiated 

expression. 

The second bill is H.R. 1369 which DAV really does thank Representatives Walorski and Gabbard for introducing. It is a necessary bill. The bill would actually help to address adverse effects 

that many veterans are feeling right now in the community. 

A lot of service-connected disabled veterans who are in nursing 

homes and skilled nursing facilities are facing very precarious situations where they are not sure who is going to be able to pay for 

their care because VA is having a little bit of difficulty trying to 

address their provider agreement authority. 

Now, this bill is in line with our resolution and our resolution 

talks about enhancing long-term services and supports for our 

members. Our members like with the Vietnam veteran generation 

and the newest generation are facing services that need to be provided closer to their home and that is one of the weaknesses in the 

bill that we ask that the committee consider. 


VACREP0180 with DISTILLER
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Some of these services deal with a specific VA program that is 

just beginning to expand and because there are problems with VA’s 

authority to implement its provider agreement with private sector 

providers, that program is being adversely affected. 

Finally, we would like to thank the subcommittee for its continued efforts in improving VA’s women veterans’ healthcare programs and services. We are pleased, definitely pleased to support 

H.R. 1575. 

Now, Congress mandated VA to assess the pilot program which 

is the subject of this bill and in that assessment, the results describe it as a successful program that improves the ability for 

women veterans to reintegrate into civilian life. 

Making permanent VA’s pilot program for counseling treatments 

for newly-separated women veterans is keeping with our resolution 

which calls for enhanced medical services and benefits for women 

veterans. 

Equally important is the bill would fulfill a key recommendation 

to Congress in DAV’s report, Women Veterans’ Long Journey 

Home. This report reveals that America’s nearly 400,000 women 

veterans using VA are at risk by a system historically focused on 

caring for male veterans. 

The report paints a compelling picture of federal agencies and 

community service providers that consistently fail to understand 

that women are impacted differently by military service and deployment when compared to male experiences. 

It also points to challenges that are needed in overall culture and 

services provided by Federal Government and local communities 

and it lists 27 specific recommendations. 

Mr. Chairman, this concludes my statement. I would be pleased 

to answer any questions you or other members of the subcommittee 

may have. 

[The prepared statement of Adrian Atizado appears in the Appendix] 

Mr. BENISHEK. Thank you very much for your testimony, Mr. 

Atizado. 

We have just called for votes, so I was going to ask my questions 

and then maybe let the ranking member ask and then we will reconvene after votes to conclude. Sorry about the delay here, but 

they moved votes up apparently. 

So I just have a few questions. I want to talk just a minute about 

the legislation I talked about, to get this annual report. I am trying 

to figure out what data to get, and I want to try to be able to determine what is the cost of the care that we are providing our veterans through the VA? You know, we don’t know; they are spending a billion dollars on a hospital here, a billion dollars on a hospital there, and what does it actually cost them to take care of a 

patient coming through the door? And I want to find that out because I think we need to, give our veterans maybe more for the 

money that we are spending in the VA. 

So, Mr. Rowan, do you have any further information that you 

want to present, because you did comment on the bill? 

Mr. ROWAN. Yeah, I think that the issue is where our spending 

is. I mean one of the things that we have had concerns about has 

been this massive growth of bureaucracy, you know, with the 


VACREP0180 with DISTILLER
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VISNs and other things, rather than the money being spent on 

care providers. You know, how much are we actually spending on 

doctors, rather than managers? How much are we spending on 

nurses, rather than managers? 

And that would be an interesting breakdown to see how that 

works in the actual provision of services. I mean if we just—if we 

take the overall budget and just whack it up by the number of veterans, you get a number, but that doesn’t give you an idea of what 

it is being spent on, and that has really been our concern for a long 

time. 

Mr. BENISHEK. Well, it is my concern, too, because I mean if you 

take the whole budget and the number of veterans that are in the 

system and you come up with a thousands-of-dollars-per-veteran 

number. 

Mr. ROWAN. Right. 

Mr. BENISHEK. But you can’t figure out what it actually costs. 

Does anyone else have any comment on that? 

Mr. ATIZADO. Mr. Chairman, if I remember correctly, CBO’s report and their testimony, that you have referred to in your statement when we reviewed that, it was very easy to come to the realization that what you are trying to do is compare one health testimony to another, and in CBO’s report they basically say it is nearly 

impossible. 

Now, even if VA were to provide a report like DoD does for 

TRICARE, CBO even says that might not even do it. There may 

be some information that VA would be able to provide that is either 

unavailable or partially available or just nonexistent in the private 

sector. I believe this is an important question and it is one that 

really is at the heart of the subcommittee’s oversight responsibility. 

It should be answered, but perhaps it should be posed to the research community. Most of the seminal studies in CBO’s report 

about comparing costs talk about research studies done in the early 

1980s, 1990, as early—as late as 2001 and is probably something 

that should be sent back to them for a little bit closer examination. 

Mr. BENISHEK. I appreciate your input because I am trying to 

get, the right stuff, the right numbers, the right data, so that we 

can, make some changes to the VA to make it better a0nd more responsive to the needs of veterans. So I am hoping that we can continue to work together to help me find the right data. 

Does anyone else have any input there? 

Mr. CELLI. I do, thank you. 

And The American Legion agrees that while it may be difficult, 

it is not impossible. And while it may be difficult to completely formulate the type of data that we would need in order to make informed decisions, that doesn’t preclude us from starting and gathering some form of data and that has to be a partnership with VA. 

VA has to be open enough to be able to provide that data when requested and right now we are not seeing that type of transparency 

when it comes to efficiencies of cost. 

We also need to make sure that VA is projecting and programming out efficiently so we can look back then, three, four, five years 

from now and say, well, this is what VA said that they wanted to 

do and what they wanted to spend their money on and this is what 

they wanted to do as far as new projects goes and be able to look 


VACREP0180 with DISTILLER
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at that and say, well, how did that go? And it is okay for it to 

change, but without a plan, then it is almost reckless. 

Mr. BENISHEK. Thank you. I am going to yield back my time, and 

we will give Ms. Brownley some time here before we run off to 

votes. Thanks. 

Ms. BROWNLEY. Thank you, Mr. Chairman. 

Mr. Rowan, you testified or mentioned the fact that based on 

some data that women were suffering a lot more in terms of their 

reproductive health because of exposure to any kind of toxic material. Do we have any hard data on that in terms of exposure for 

women, specifically? 

Mr. ROWAN. You know, I don’t know if there is exact data, but 

when you look at the presumptive illnesses that VA has agreed to, 

men only have spina bifida where the women have several, most 

associated with their reproductive organs and their issues and effects on those, and that is intriguing to me, why the women have 

that problem, but not the men. I mean, you know, because there 

is really a lot of concern about the genetic effect of toxic exposure 

which may lead to all kinds of genetic problems carried over into 

the next generations. So that is why we think that it is important 

that we take a look at all of that. 

You know, there were several states that were starting to do that 

many years ago back in the 1970s and 1980s, New York, New Jersey, Michigan, I think, started to look at that, but then, unfortunately, there was no funding for it and nobody wanted to keep up 

with it. And they were starting to look at the data of the children 

of Vietnam veterans, and they may need to go back to try to find 

some of that, if it still exists or take a look at new ones. And we 

are really concerned not only about us, but looking forward. 

Persian Gulf have been out 20 years now, so there should be a 

lot of data on them. And the new folks, we should start tracking 

them now, you know. I always tell the anecdotal story, I have a 

cousin who is, you know, in his early 40s as a Seabee Reservist, 

went to Iraq twice, dealt with all kinds of horrible cleanup stuff, 

dealt with all kinds of exposures. He came home, and after his second tour, he got non-Hodgkin’s lymphoma and his third child was 

born with downs syndrome. Now, is there a connection? I am not 

a scientist. I can’t tell you for sure, but somebody ought to study 

it and that is what we are just saying. 

One of the problems we have had with the whole Agent Orange 

issue is for all these years, they have never really done a decent 

study. They have never really done a decent scientific review. IOM 

has been relying on all kinds of extraneous studies done around the 

world to come up with all of these things and we have waited all 

these years. I mean I am going to be 70 in September and, you 

know, it only took three years ago when they added ischemic heart 

condition. I mean I don’t want to see that happen to the Persian 

Gulf vets and I certainly don’t want to see that happen to the new 

vets, that they have to wait 40 years to find out that they have 

problems with their children, that they need to take a look at. 

Ms. BROWNLEY. Absolutely. I couldn’t agree more with your comments. 

I also wanted to just ask the whole panel, based on Ms. Brown’s 

bill, H.R. 1575, what are your thoughts—the VA made a suggesVerDate Aug 31 2005 09:31 Jul 22, 2016 Jkt 000000 PO 00000 Frm 00026 Fmt 6633 Sfmt 6633 Y:\98-634.TXT PAT

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tion, I think, that we should, in terms of expanding the population 

of eligible veterans, that we should also include men, as opposed 

to strictly women. Does anybody have a comment with regards to 

that? 

Mr. ROWAN. I will be honest, I am not an expert in this field— 

I never really followed up on it—but that was my first reaction 

when I read the bill and looked at that pilot program as, gee, a retreat form. That is not a bad idea, but why do we do it just for 

women? Why not men as well? 

I remember former Chairman Filner when he was here, one of 

the things he talked about was reverse boot camp. You know, the 

idea of we bring people home—we spend all this time and effort 

and money to make people into warriors and then when they come 

back, we don’t spend a nickel to make them into civilians again; 

that is an interesting concept. 

Ms. BROWNLEY. Any other comments from—— 

Mr. CELLI. Yes, I would like to dovetail on what Mr. Rowan said. 

During World War II, after veterans left combat, they had a threeor-four-week journey back on a boat to reintegrate with their platoons and really decompress. Right now, you can go from the battlefield to your living room in 15 days, 10 days, 5 days in some 

cases, and veterans really need that time to decompress. And I 

think that is a huge component of some of the illnesses that we are 

seeing now just being exasperated; they don’t have time to deal 

with it. 

Ms. BROWNLEY. Do you think that if we included men and 

women, that we should keep them separate, men going together to 

one place and women going together in another? 

Mr. CELLI. Congresswoman Brownley, I cannot answer definitively whether it should be a separate cohort in each retreat. But 

I do know this, the idea of having a retreat specifically for women 

veterans really came out of the idea that they are such a small 

population compared to the overall veteran population, and because 

they are so small, their ability to support each other and have 

some kind of peer support group to learn from each other’s experiences became all the more important. 

Now, whether that would apply to male veterans with that specific respect may not necessarily be the case, but I would hope that 

VA would have some kind of reasoning, other than, well, that is another part of the population for male veterans to be put in a retreat 

setting. 

Ms. BROWNLEY. Thank you. I am over my time and I yield back. 

Mr. ROWAN. If I might add, Congresswoman, the other issue here 

is I would remiss—my vice president would take me to task—she 

ran a program in Philadelphia for women veterans and she would 

be the first one to tell you that unfortunately homeless women veterans have a high-rate of military sexual trauma and that may be 

a perfect reason why they need to be taken on separately, as from 

the men, to give them that space to be able to deal with those 

issues that they may not be willing to deal with. 

Ms. BROWNLEY. Thank you. 

Mr. BENISHEK. Gentlemen, I am going to ask your indulgence. 

We are going to have to go into a recess to do the votes, and we 


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will reconvene as soon as possible after the votes are over. Thank 

you. 

[Recess.] 

Mr. BENISHEK. The subcommittee hearing is back in session. 

Since we don’t have any other members, I am going to ask a few 

more questions of this panel here, since I have some time, and I 

think Ms. Brownley may have a few more questions, too, and see 

if any other folks show up to ask their questions. 

I was just going into this question of the reproductive treatment 

that we hope to provide for disabled veterans. Some of the testimony in the record suggested that, there should be included surrogates and third-party donations. I understand the reason for those, 

but the DoD doesn’t provide those benefits and the VA has expressed some concern in previous hearings, on this issue. So I am 

just wondering how we are going to deal with this going forward, 

and does anyone here have any other concerns about the complexities that would be involved with the addition of a surrogacy provision in the draft bill. I know, Mr. Ortner, you probably have another comment to make on that. 

Mr. ORTNER. Yes, Mr. Chairman. You know, the approach of 

PVA has always been to—that the VA and DoD should try and 

bring someone with a disability, especially a catastrophic disability, 

as much of a recovery as they can. Their quality of life should be 

back to as much as normal as it can be. Now, of course, you know, 

in our written testimony, we commented on the challenges of the 

individual’s who has got a catastrophic SCI where they may have 

been able to have IVF, but they are not going to be able to carry 

it to term. And the concern we have on this situation, is that even 

though DoD doesn’t supply it, we think DoD should. Because you 

have still got a situation of an individual that lost the ability to 

have children due to their service and we also see it as being probably a very, very small number of individuals that are going to 

have this condition, which is primarily why we, in our testimony, 

we talked about there needs to be a little clarification. Because, obviously, it is probably not something you just say, well, we are 

going to open it up and anybody can have a surrogate. But we 

probably think there are those situations where you have got those 

situations where that individual is unable to carry the child that 

should have a consideration. 

Regarding the genetic material, that is another thing, third-party 

genetic material. We think there is probably a very unique situation where you are going to have, possibly, you know, individuals 

that are going to suffer from something that causes a damage to 

the genetic material. But as we saw with Gulf War syndrome, as 

we have seen with the various toxic substances is that you experience in service, you can have that situation. Essentially, what we 

are doing is because if someone serves, they have lost that ability 

to have children and we think they should have that. 

Mr. BENISHEK. All right. Thank you. Anyone else have anything 

further on that? 

Mr. ROWAN. No, I would just concur with what the gentleman 

was saying in that regard. Clearly, the in vitro fertilization is one 

aspect of it, but our concern is going back to the toxic exposure 

issue is the effect of genetic material on exposures. But the issue 


VACREP0180 with DISTILLER
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of women, especially who have been hurt in the military and the 

impact on them is interesting. Because, I was relating a story, I 

had a client when I was doing service-prep work back in the twos, 

early twos, who, she had only been in the Army like a year and 

a half and then broke her hip severely and they did a mediocre job 

in putting her back together, quite honestly, and she was having 

some issues with it. 

We got that dealt with, but then when she got pregnant, she was 

very concerned about whether or not she was going to be able to 

carry a baby to term, whether it would affect her—what the hip 

would do, how she would get around. And, unfortunately, this was 

the early days of women’s programs inside the VA, but we managed to get her help. But it, clearly to me is one of those things 

that the PVA people are well-aware of and we would support any 

effort to assist those folks. 

Mr. BENISHEK. Well, thank you very much. I will yield back the 

remainder of my time. 

Ms. Brownley, do you have any more questions for the panel? 

Ms. BROWNLEY. Just one quickly. I just wanted to first comment 

that—and to applaud Mr. Bilirakis and Dr. Ruiz and Ms. Walorski 

for their bill on alternative approaches to mental health issues. 

You know, one part of that bill is looking at outreach efforts to veterans for mental health services, and in my mind, I feel as though 

that is an extremely, extremely important component because, I 

think particularly for our Vietnam veterans and our older veterans, 

getting them to mental health, but getting them to the place where 

they feel comfortable seeking the help is probably 90 percent of the 

issue. And so, you know, how do we encourage and make it feel 

right and say for our veterans to seek that health out. So I think 

that is really, really important. 

I just wanted to ask the panel, and really all of you, you know, 

the VA continues to talk about the work that they have been doing 

and continue to do around alternative therapies for mental health. 

I know we have an extraordinary program in my district with 

equine therapy that has been very successful for our veterans. I am 

just wondering, at this juncture, how would you grade the VA in 

terms of how well they are/we are doing with regards to alternative 

approaches to mental health. Just, you know, a quick response, 

no—it doesn’t have to be evidence-based, just your general reaction 

to what would you give the—what grade would you give the VA? 

Mr. CELLI. I can tell you that based on the firsthand research 

that The American Legion has done, the grade would not be superior. I think there is a lot of work to be done. I think that the VA 

is looking at those options and it is something that we are interested in looking at with them, similar to things like this bill. 

You know, the VA has come a long way with things like the vet 

centers, which have really taken this issue head-on, during the 

time of Vietnam, when Vietnam veterans were coming back. They 

have vocational rehabilitation, which has almost an endless supply 

of resources to help veterans rehabilitate back into society. Maybe 

they could look at some kind of mental health center that is unique 

to PTSD. You know, maybe if there was a specific PTSD program 

that charged these centers with looking at alternative therapies, 

trying to get them off medications and graded them based on sucVerDate Aug 31 2005 09:31 Jul 22, 2016 Jkt 000000 PO 00000 Frm 00029 Fmt 6633 Sfmt 6633 Y:\98-634.TXT PAT

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cess rates, maybe there would be some more out-of-the-box type of 

thinking. 

Ms. BROWNLEY. Do you still believe that outreach is a critical 

component to—— 

Mr. CELLI. Absolutely. Ninety percent of the veterans that we 

spoke to did not know what their options were. And we need to 

make sure that stakeholders, Congress, VA, the American public in 

general, knows that—or is able to communicate to veterans and 

participate in that outreach to let them know what their options 

are. And, again, vet centers is a wonderful tool to help do that; it 

is probably the best kept secret in VA. 

Mr. ROWAN. Clearly, the vet centers, we helped establish those 

things, and I remember back in the Reagan years, trying to fight 

back the OMB from killing them. Thankfully we succeeded, but the 

problem we always had with them is they only focused on the veteran. They didn’t do enough to bring the family into the picture. 

I must tell you that my colleagues in Australia—I have been 

doing family counseling with the veterans for 35 years—and that 

would help a lot if that was added, so that they would be able to 

work with spouses, children, whatever; the whole secondary PTSD 

issue is a big issue. 

As far as outreach, the VA has got a very bad mark. I would give 

it an F. I don’t think they do anywhere near enough of outreach. 

And, frankly, all the alternative stuff is done by private-sector organizations, and the one thing about—hopefully with Bilirakis’ proposal with this commission is that they would review all of those 

things and really try to understand what are really scientifically 

attainable and what are not, and what are just figments of people’s 

imagination. I mean, don’t get me wrong, I love my dog and, you 

know, if I hang out with my golden retriever, he has a lot of fun 

and he can certainly lower my anxiety levels, but the bottom line 

is that without a treatment program on top of that, it is not 

enough. So complementary is the keyword there and alternative, 

not instead of. 

Ms. BROWNLEY. Yes. Any other comments from any other panelists? 

Mr. ORTNER. Well, we have only got a couple of seconds, but I 

think the biggest challenges with the VA—I kind of go a little more 

with the Legion. I would give them maybe a C. But I think it is— 

I think part of the challenge with the VA is it is a huge bureaucracy; bureaucracies are resistant to change. And I think in the case 

of the VA, they are more concerned about having an embarrassment from a fraudulent program than they are necessarily helping 

every veteran. 

And that sounds negative, but I don’t mean it in that way. It is 

just like Mr. Rowan mentioned, which I worked on back in the 

1990s, a lot of fraudulent things going on and quack medicine. 

There is reason to be resistant, but I think that is one of the challenges with the alternative things. 

As for outreach, that is absolutely critical. I worked homeless 

issues back in the mid-1990s, and the outreach was key, but it 

really wasn’t the VA doing the outreach; it was the homeless centers and things like that, that were doing the outreach, funded by 

the VA. But a lot of that has to do with mental illness, getting out 


VACREP0180 with DISTILLER
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there and interacting with those people, and that can be challenging because there is a lot of fear going into those environments 

to deal with that. 

Ms. BROWNLEY. Thank you for watching the clock for me. I yield 

back. 

Mr. BENISHEK. Thanks. Ms. Titus, you are recognized for five 

minutes. 

Ms. TITUS. Well, thank you, Mr. Chairman. And thank you and 

the ranking member for allowing me to sit in today. 

I want to agree with the ranking member, Ms. Brownley’s comments, that we need to expand this legislation. I hope that we can 

work together to be sure these treatment options are available for 

all our veterans. As it is currently written, it is possible that there 

are veterans who meet all the requirements contained in this draft 

legislation, such as having a service-connected disability that prohibits procreation, but due to their sexual orientation, they won’t 

be able to receive this assistance. 

Now, I would like to ask the members of the panel if they have 

any concerns that this legislation fails to offer services to legally 

married same-sex couples. Mr. Ortner, you mentioned some exceptions that might be needed to be considered. You mentioned 

surrogacy and third-party genetic donations, but what about samesex couples, if they are denied these benefits as veterans, is that 

really fair? So I would ask you all to comment on that. 

Mr. ORTNER. Well, Ms. Titus, PVA does not have a position on 

that, and I am not in a position to comment due to that. 

Mr. BENISHEK. Who wants to jump in? Okay. 

Mr. ROWAN. The bottom line for us has been when we have dealt 

with gay rights issues, quite frankly, is if the law allows it, we are 

in favor of it. I mean it started when they finally allowed people 

to come into the military openly gay. 

Ms. TITUS. Yes. 

Mr. ROWAN. I mean if you are going to let them in, they are a 

veteran when they come out. So if they are a gay veteran, they are 

a gay veteran. I mean I think that there is a lot of adjustment society is going to be making over the next decade or so on these 

issues. 

We got involved when we talked about the spousal benefits questions and that got interesting real fast. And, you know, obviously, 

some people have very strong opinions on that and they are not 

going to be in favor of it, but our feeling was just simple: if it is 

the law, then it is the law and it ought to cover every veteran, not 

one or—some veterans yes, some veterans, no. 

Ms. TITUS. Okay. 

Mr. CELLI. The American Legion has a similar view. We have a 

resolution that states that there should be equality amongst all 

veterans and all generations of veterans. So if they are a veteran 

and they apply for VA services, they should be entitled to the same 

VA services as any other veteran. 

Ms. TITUS. I am glad to hear you say that. 

Mr. ATIZADO. Thank you, Congresswoman Titus. I will tell you 

this, the mission of the DAV is very clear. What we are about is 

making sure that any service injury that a veteran sustains while 

performing honorable service for this nation, should be given the 


VACREP0180 with DISTILLER
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opportunity to be given high-quality life, and as I mentioned, to 

lead it with respect and dignity. So if a servicemember happens to 

have a certain sexual orientation, but they are injured and unable 

to have a—are injured and have reproductive difficulties, while we 

don’t have a specific resolution on it, based on our mission, we 

would like to ensure that that member have the same and enjoy 

the same benefits as their counterparts. 

Ms. TITUS. Well, thank you. That seems to me only fair: A veteran is a veteran is a veteran, and all veterans deserve equal benefits. Many states now recognize marriage equality and it is very 

likely that the Supreme Court is going to be making that decision 

here this summer, so we want to be sure that we don’t enact policy 

that discriminates and doesn’t provide benefits that all our veterans have earned. So I appreciate hearing your comments on that 

and I yield back. 

Mr. BENISHEK. Thank you, Ms. Titus. 

In the absence of any further questions, the panel is excused. 

Thank you very much, gentlemen. 

I will now call up the third panel. This is Dr. Rajiv Jain; he is 

the assistant deputy under secretary for health for VA Patient 

Care Services. 

Thank you, Dr. Jain for coming and waiting for awhile as we 

concluded our voting procedures there. You may proceed with your 

testimony when you are ready. 

STATEMENT OF RAJIV JAIN, M.D., ASSISTANT DEPUTY UNDER 

SECRETARY FOR HEALTH FOR PATIENT CARE SERVICES, 

VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF 

VETERANS AFFAIRS; ACCOMPANIED BY JANET MURPHY, 

ACTING DEPUTY UNDER SECRETARY FOR HEALTH FOR OPERATIONS AND MANAGEMENT, VETERANS HEALTH ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; AND 

JENNIFER GRAY, ATTORNEY, OFFICE OF THE GENERAL 

COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS 

STATEMENT OF RAJIV JAIN, M.D. 

Dr. JAIN. Well, thank you, Mr. Chairman, Ranking Member 

Brownley, and Members of the Committee. Thank you for inviting 

me here today to present our views on several bills that would affect the Department of Veterans Affairs programs and services. 

Joining me today to my right is Ms. Janet Murphy, acting deputy 

under secretary for health for operations and management, and to 

my left is Ms. Jennifer Gray, attorney in the Office of General 

Counsel. 

I would like to start with Chairman Benishek’s bill, to amend the 

Title 38 United States Code to direct the secretary of veterans affairs to submit an annual report on furnishing of hospital care, 

medical services, and nursing home care by the Department. We 

support this bill and are already providing much of this information on our Web site and through the mandated reports to Congress. The costs associated with this and other bills on the agenda 

are included in my written statement, so I won’t go through them 

now. 


VACREP0180 with DISTILLER
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The VA also supports H.R. 627, a bill to amend Title 38 that expands the definition of homeless veteran for purposes of benefits 

under the laws administered by the secretary of veterans affairs. 

This will align us with HUD’s definition of homeless. 

Regarding H.R. 1369, VA appreciates the Committee’s interests 

in updating our authority to purchase extended care services from 

the community providers. We are currently developing a legislative 

proposal to address our authority to purchase hospital care, medical services, and extended care services. We look forward to working with the Committee on this vital legislation. 

We support the concept Congressman Miller’s draft bill to amend 

Title 38 to improve the reproductive treatment provided to certain 

disabled veterans. We would like to expand the language, however, 

to include all veterans who might be eligible. 

VA supports H.R. 271, a bill to exam the efficacy of VA treatment of mental disorders and the potential benefits of incorporating complementary alternative treatments available in nonDepartment of Veteran Affairs medical facilities within the community; however, we have concerns with some of the language that 

may interfere with the stated goals of the bill. We would like to 

work with the Committee to amend the language. 

We support the intent of H.R. 1575, a bill to amend Title 38 to 

make permanent the pilot program on counseling and retreat settings in women veterans, newly separated from their service in the 

Armed Forces. While VA agrees that providing these retreats is 

beneficial to women veterans, it should be made permanent. Other 

veteran and servicemember cohorts could benefit from this treatment modality. 

As discussed in previous hearings, while we support the efforts 

to enhance research on the diagnosis and treatment of health conditions of the descendants of veterans exposed to toxic substances 

during service in Armed Forces, we are unable to support this bill 

because a center would duplicate the efforts of other federal agencies and other reasons that are discussed further in our written 

testimony. 

Finally, I would like to say to give the VA its best view, we have 

worked in collaboration with many agencies to solidify the views 

provided on many of the bills discussed today. 

Thank you, Mr. Chairman, for the opportunity to testify before 

you today. My colleagues and I would be pleased to respond to any 

questions that you may have. 

[The prepared statement of Rajiv Jain, M.D. appears in the Appendix] 

Mr. BENISHEK. Thank you, Dr. Jain, for coming and for your testimony and comment. 

I am going to yield myself five minutes for questions. Dr. Jain, 

the VA opposes this H.R. 1769 on the grounds that other federal 

departments and agencies are poised to support research on multigenerational health effects of toxic exposures. The VA’s research 

programs have been praised elsewhere in this hearing and are, I 

am sure, more than up to the tasks set forth in the bill. What is 

more, the VA’s testimony lists the VA War Related Illness and Injury Study Center, the VA Office of Research and Development, 

and the VA Office of Public Health, among those whose work would 


VACREP0180 with DISTILLER
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be duplicated, according to the VA by the national center proposed 

in H.R. 1769. 

I have a couple of questions that follow up with that. What other 

departments or agencies do you think are better positioned to study 

the effects of toxic exposure on veterans and their descendants 

than the VA and why? 

Dr. JAIN. So, thank you, Mr. Chairman, for that question. I think 

I wanted to, again, make it very clear that we certainly support all 

of the work that needs to be done to find out if there are any impacts from the exposure to toxic agents for veterans and their descendants. So, in general, we are completely in agreement in doing 

whatever we can do and we must do. 

The concern comes into play, sir, if you really look at these disorders that happen from exposure to toxic agents, they are extremely rare. So you need large populations to really come to any 

meaningful conclusion of the cause and effect. So a lot of our experts feel that the exposure in the civilian setting and the exposure 

in the military setting has a lot of parallels where we can learn 

from both sets of exposures. And so having, for example, the national center for—the National Institute of Environmental Health 

Sciences or The Center for Disease Control that also have significant efforts in looking at that, if we could structure a solution that 

could collaborate and partner with those agencies, we could maybe 

have a better chance in achieving scientifically proven impacts that 

I think would—— 

Mr. BENISHEK. I don’t think there is anything in the bill that excludes. 

Dr. JAIN. Right. 

Mr. BENISHEK. You know, it is a research coordination bill; although, I don’t think it excludes getting data from anywhere. 

Dr. JAIN. It wasn’t clear, sir, but I think if the intent is that the 

Center could work with other agencies and could begin to have that 

broader sense, then that could be something we can definitely look 

at. 

Mr. BENISHEK. Okay. Then let me ask you another question here. 

What does it say about what is going on in the VA War Related 

Illness and Injury Study Center and the VA Office of Research and 

Development and the VA Office of Public Health? I mean shouldn’t 

we coordinate all of that in one place to explore toxic exposure 

issues? 

Dr. JAIN. That, we would agree with you, sir. The only point that 

we were making is that we have these areas, the war related centers, the ORD, all of these departments are constantly looking at 

the published literature. They are trying to understand what is 

going on. 

Mr. BENISHEK. I understand why you say that, but, you know, 

they also said that focusing solely on military exposures would likely result in inconclusive research. Well, a lot of people in the civilian life weren’t exposed to Agent Orange. Most people were exposed 

in the military setting. 

And it is similar—and it is very difficult—I would say in the 

burn-pit situation, most of the people that were exposed to toxic 

fumes in burn pits, that doesn’t seem, to me, a very common civilian exposure. Now, there may be other exposures that are more 


VACREP0180 with DISTILLER
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common in the civilian life than there are in the military; I would 

say maybe lead exposure would be maybe an example of that. But 

there is lead exposure in the military, and maybe that could be coordinated. You know, depleted uranium exposure doesn’t occur that 

often. I mean there are lots of things that are kind of specific to 

the military, Dr. Jain, and that I think really doesn’t—you know, 

your argument really doesn’t wash with me, okay. So I think that 

is not a very good reason to be advocating against a legislation, in 

my opinion. 

Do you have any rebuttal for my comment there? 

Dr. JAIN. No, sir. The only thing that I would offer that I was 

going to suggest, sir, is that if we could have an opportunity to 

work with you and the Committee, to work with some of this language, so that we can achieve some of the goals that we are looking 

for. That is all we are saying. But we agree with what you are saying. 

Mr. BENISHEK. Yes. Well, I am happy to have you involved in the 

process, Dr. Jain. We just want to make some progress here. 

Dr. JAIN. Absolutely. 

Mr. BENISHEK. In view of time, I am going to ask—I am going 

to ask the ranking member if she has any questions. 

Ms. BROWNLEY. Thank you, Mr. Chair. 

And I will just follow up on your line of questioning regarding 

your bill. Mr. Jain, you have testified that these exposures are so 

rare it is hard for you to come up with a scientific response. But 

what exposures do you define as rare? 

Dr. JAIN. Well, I am not talking about the exposure is rare, but 

what I am saying is that the science indicates that when you look 

at diseases or conditions caused by toxic agents, those are rare, because you get into play the genetic factors, heredity, age, the time 

of exposure, duration of exposure, the type of agents, so there are 

a lot of agents. So I think my only point is that these are rare conditions, so you need larger sets of populations. So whatever solution we come up with, I think as long as we have access to the largest population base that we can think of so that we can get to the 

real bottom of this, I think is all we are saying. So, we are supportive of that. 

Ms. BROWNLEY. Yeah. I would just say that I think in this case, 

you know, it is the VA and government in general that I think has 

to take a lead on these issues, and if we don’t, who will? I think 

it is just our responsibility, you know, to do so. 

So another question I wanted to ask with regards to H.R. 627 

with homelessness, in response to domestic violence in veterans’ 

homes, you are saying that you are already serving these veterans; 

it is not so much of a problem, yet you lacked the detailed data regarding the size and the characteristics of this population. So, can 

you explain to us how you know that you are already serving this 

population? 

Dr. JAIN. So, I think I am going to turn to my colleague, Ms. 

Murphy. She is more familiar with this topic. Janet? 

Ms. MURPHY. Thank you, Congresswoman. 

So, we collect a lot of data on the veterans that we serve in our 

homeless programs and, fundamentally, any veteran who needs— 

we don’t turn down veterans who need homeless services, so we 


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don’t distinguish that you are fleeing domestic violence, so we can’t 

serve you. So we are already serving those veterans. 

How many? We would have to come back—take a look at that 

and come back with that information for you. I think this is really 

a technicality, is correcting the law so it is codified in law and consistent with HUD language, the language in HUD’s regulations, 

that we are all—because that is our very strong partner in all of 

this. But we are already serving those women veterans and men 

as well, because men also flee from domestic violence. So we will 

continue to do that and we will see if we can find information 

which quantifies that for you. 

Ms. BROWNLEY. So when you say you don’t turn anyone down, 

a homeless veteran who needs permanent housing or temporary 

housing, you don’t turn anyone down, but there is not enough housing for the homeless veteran population, at least in Los Angeles 

County there is not, and I think in my county, in Ventura County, 

it is the same. 

Ms. MURPHY. We don’t turn anyone down in terms of access to 

services, then the challenge becomes to find them the housing. We 

have plenty of HUD vouchers. We have vouchers available to provide them housing. The challenge is finding the housing, particularly in areas like Los Angeles, San Francisco, Seattle, but, you 

know, we continue to work the problem. 

Ms. BROWNLEY. And you are also saying that you don’t collect 

that data in terms of bifurcating within the homeless population of 

veterans, who of the veterans are—who have—who are there because of domestic violence. 

Ms. MURPHY. I need to verify that. We collect a lot of data on 

our population that we serve and I would need to clarify whether 

we collect that specific data and whether that was—we were able 

to tease that out and make that available. 

Ms. BROWNLEY. Well, I would appreciate it. 

Ms. MURPHY. We certainly should be collecting it, if we are not. 

Ms. BROWNLEY. And if you would, get back to me or the Committee with that information, I would appreciate it. 

Ms. MURPHY. Absolutely. 

Ms. BROWNLEY. I yield back. 

Mr. BENISHEK. Thank you. 

Ms. Titus, you are recognized. 

Ms. TITUS. Thank you, Mr. Chairman. 

Dr. Jain, I would just go back to the point that I was making 

earlier that I worry that Chairman Miller’s bill is written in such 

a way that it denies benefits to certain veterans. And I appreciated 

your comment that you would like to see it expanded so that you 

could serve all veterans. 

Do you agree that the legislation, as written now, would not offer 

options to same-sex couples who might need help starting a family? 

Dr. JAIN. Thank you for that question, Congresswoman. This has 

a lot of legal implications, so I am going to turn to my OGC colleague, Jennifer, to address that. 

Ms. TITUS. Okay. 

Ms. GRAY. Yes, thanks, Congresswoman. 

You have raised some important questions on an important issue 

with this legislation, and we will need to research this further, but 


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we are more than happy to discuss the applicability of this provision with you at a later date once we have looked into it a little 

bit more. 

Ms. TITUS. You needed help to say that, Dr. Jain. 

Dr. JAIN. Let me just clarify. I think that there is no question 

that we feel that restoring the physical and mental capability of 

our veterans is a very important mission of the VA. And the ability 

to be a biological parent is very important for one’s mental and 

physical well-being and sense of well-being, so we are very much 

in support of this concept and I think that if the thought is to begin 

with the most severely injured veterans first, we certainly understand that. But at some point, we do feel that the who IVF technologies should be made available to a broader group of veterans 

who have medical and other reasons for not being able to be a biological parent. So I am just stating to you the broader sense that 

we have, but there are some legal issues with that, and that is why 

I wanted to turn to my colleague. 

Ms. TITUS. I appreciate that, and I would thank you very much 

if you could get back to me on that so we could work together on 

this to be sure that all our veterans receive the benefits that they 

serve. 

Thank you, I yield back, Mr. Chairman. 

Mr. BENISHEK. Thank you, Ms. Titus. 

I have just another question I want to ask Dr. Jain, too. In the 

written testimony, Dr. Jain, you stated that the VA appreciates the 

intent of the draft bill to direct VA to submit an annual report on 

the Veterans Health Administration, but notes that the bill may be 

unnecessary as the data and related measures contemplated by the 

bill are already compiled as part of an ongoing, automated process 

for data that are available publicly; yet, in the testimony before the 

subcommittee in January, the Congressional Budget Office stated 

that the VA provided limited data to the Congress and the public 

about its costs and operational performance, and that if it was provided on a regular and systemic basis, it could help inform policymakers about the efficiency and cost-effectiveness of VHA’s services. So similar sentiments were also issued by the Independent 

Budget and The American Legion and by others during testimony 

on the first panel. 

Can you explain the discrepancy between what you said in your 

testimony and the testimony of the Congressional Budget Office 

and the others regarding the VA’s record of transparency? 

Dr. JAIN. Sir, so this, you could consider this, in part, an evolution, I guess, you could say in our thinking. But the current secretary has made it very clear that we want to be transparent. And 

as you know, sir, the impact of a lot of the Choice Act legislations, 

we are in the process of preparing a lot of the reports, so when we 

saw your bill, we certainly understand the intent of what you want, 

but our only clarification that we would like to work with you and 

the Committee, is to understand what you are looking for so at the 

end of the day we can give you and you are satisfied with the report. That is the only hesitation of the—— 

Mr. BENISHEK. Right. Right. 

Dr. JAIN. Yes. 


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Mr. BENISHEK. Well, I think, you know, if you are already compiling the data that is required in the bill, presumably that information could be compiled into a report and provided to us. 

Dr. JAIN. We are and, yes, that is correct. 

Mr. BENISHEK. It seems to me that the information—that you 

may have the information, but it is not compiled in a way that 

makes any sense to us. And, basically, what I am trying to figure 

out is what somebody else mentioned here, too: How much money 

are we spending on nurses and doctors and how much money are 

you spending on bureaucrats? Most hospitals and other people 

around the country who provide healthcare, they can define those 

kinds of numbers. The VA doesn’t. I want to be sure that the billions of dollars that we are sending to the VA gets spent in the 

most effective way that gives the most care to our veterans and it 

is not being eaten up by a bureaucracy. 

And I think that we don’t have access to those kinds of numbers, 

Dr. Jain, and those are exactly the kinds of numbers that I am asking you for. Where is the money going and how are you compared 

to everybody else in spending these billions of dollars that we send 

to the veterans healthcare? 

Dr. JAIN. Absolutely, sir. I think once we can work with you and 

the Committee to understand your needs—we don’t have that data 

ready-made; that is the difference, I think, is what I believe what 

was stated in the previous testimony. And we don’t have it today, 

either. We have pieces of that, but if we understand your needs, 

we are willing to work with you and to provide to you—— 

Mr. BENISHEK. Well, I am glad that you agree with me that there 

is more data—— 

Dr. JAIN. Right. 

Mr. BENISHEK [continuing]. That VA needs to provide to policymakers so we can make better decisions. 

Dr. JAIN. Yes, sir. 

Mr. BENISHEK. So I am happy to hear that from you. 

I am going to yield back, and does anyone else have any other 

questions that they would like to ask? 

Well, thank you very much, Dr. Jain for being on the panel. 

Thank you for being here, and all the others, and for those who 

attended as well. We may be submitting additional questions for 

the record, and I would appreciate your assistance in ensuring that 

an expedient response to these inquiries is given. And with that, 

if there are no further questions, the third panel is excused. 

I ask unanimous consent that all members have five legislative 

days to revise and extend their remarks and exclude extraneous 

material. Without objection, so ordered. 

I would like to thank, again, all the witnesses. The hearing is 

now adjourned. 

[Whereupon, at 12:46 p.m., the subcommittee was adjourned.] 


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APPENDIX 

PREPARED STATEMENT OF THE CHAIRMAN JEFF MILLER

It is a pleasure to be here today with you, Subcommittee Ranking Member Brownley, and other Members of the Subcommittee on 

Health as well as with representatives from our Veterans Service 

Organizations (VSOs), interested stakeholders, and audience members to discuss my draft bill to improve the reproductive treatment 

provided to certain disabled veterans. 

The conflicts in Iraq and Afghanistan over the last decade have 

resulted in significant increases in reproductive organ and spinal 

cord injuries among our servicemembers. 

These wounds can have serious and life-long repercussions on the 

daily lives of our veterans and their families, not the least of which 

can be the inability to conceive a child. 

While the Department of Veterans Affairs (VA) does provide a 

number of fertility services to veterans, VA is currently prohibited 

via regulation from providing In Vitro Fertilization (IVF), one of 

most well-known and arguably most effective assisted reproductive 

technologies. 

The VA is also prohibited by statute from providing any such 

treatment to a veteran’s spouse. 

In contrast, the Department of Defense has been providing 

IVF to severely wounded servicemembers since 2010. 

What this disparity results in is severely disabled veterans having to decide whether or not to pursue a family though IVF before 

they separate from service-while still actively recovering from their 

wounds and during what can be a highly stressful transition period-or pay for the procedure out-of-pocket once they move to veteran status. 

Because IVF can be costly, for some veterans, waiting until they 

are in VA care can mean having to choose between financial 

freefall or forgoing their dreams of having a child altogether. 

That is an agonizing and unacceptable choice that this draft bill 

would help prevent veterans with these disabilities from ever having to make. 

The draft bill would authorize VA to provide assisted reproductive technology, in addition to any fertility treatment already authorized, to enrolled veterans whose service-connected disability includes an injury to the reproductive organs or spinal cord that directly results in the inability to procreate without the use of assisted reproductive technology. 

Assisted reproductive technology is defined in the bill to include 

IVF as well as other technologies determined by VA as appropriate 

to be used to assist reproduction. 

In furnishing IVF or similar procedures to an eligible veteran, 

VA would also be authorized to provide services to that veteran’s 

spouse. 

Like DoD, VA would be limited to providing eligible veterans 

three in vitro fertilization cycles, resulting in a total of not more 

than six implantation attempts. 

The draft bill would further stipulate that VA is authorized to 

provide for storage of genetic material for three years, after which 

the veteran and his or her spouse is responsible for the costs of 


VACREP0180 with DISTILLER
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such storage; that VA cannot possess or make any determinations 

regarding the disposition of genetic material; and, that VA is required to carry out activities relating to the custody or disposition 

of genetic material in accordance with the relevant state law. 

Finally, the draft bill would prohibit VA from providing any benefits relating to surrogacy or third-party genetic material donation. 

In short, this legislation mirrors the IVF benefit that is provided 

to active-duty servicemembers in DoD, creating parity between the 

two Departments while opening the door to parenthood for disabled 

veterans who may otherwise not have the resources to pursue such 

a path. 

I am proud to say that this proposal is supported by many of our 

VSOs, by RESOLVE: The National Infertility Association, and by 

the American Society for Reproductive Medicine. 

I thank them all for their support of this draft and for their 

thoughtful comments and recommendations for how it may be improved. 

I look forward to working hand-in-hand with Subcommittee 

Members to address those suggestions and otherwise strengthen 

the language in the draft bill before it is introduced and moved forward. 

This draft is derived partly from the recent Subcommittee roundtable where infertility among disabled veterans was discussed in 

depth and I am grateful to you, Dan, for holding that roundtable 

as well as this hearing today. 

I urge all of my colleagues to join me in supporting this draft bill 

and, with that, I yield back. 

f 

PREPARED STATEMENT OF THE HON. GUS M. BILIRAKIS

Chairman Benishek, Ranking Member Brownley, and members 

of the Health Subcommittee, 

Thank you for holding this very important hearing and for the 

opportunity to discuss my bill, H.R. 271, the Creating Options for 

Veterans’ Expedited Recovery (COVER) Act. 

With statistics showing that one in five Veterans who served in 

Iraq and Afghanistan have been diagnosed with Post-Traumatic 

Stress, we must responsibly ask ourselves—are we doing enough 

when it comes to addressing mental health in our Veteran population? 

Recent data has shown that every day in this country—an estimated 18–22 Veterans take their own lives. This statistic answers 

the question I posed earlier. It is obvious more needs to be done. 

That is why I reintroduced the COVER Act in the 114th Congress. 

The COVER Act will establish a commission to examine the Department of Veterans Affairs current evidence-based therapy treatment model for treating mental illnesses among veterans. Additionally, it will analyze the potential benefits of incorporating complementary alternative treatments available within our communities. 

The duties of the commission designated under the COVER Act 

include conducting a patient-centered survey within each Veterans 

Integrated Service Network. The survey will examine several difVerDate Aug 31 2005 09:31 Jul 22, 2016 Jkt 000000 PO 00000 Frm 00040 Fmt 6633 Sfmt 6633 Y:\98-634.TXT PAT

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ferent factors related to the preferences and experiences of Veterans with regard to their interactions with the Department of Veterans Affairs. Instead of presuming to know what is best for Veterans, we should simply ask them and work with them on finding 

the right solutions that best fits their unique needs. 

The scope of the survey will include: the experience of a Veteran 

when seeking medical assistance with the Department of Veterans’ 

Affairs; the experience of Veterans with non-VA medical facilities 

and health professionals for treating mental health illnesses; the 

preferences of a Veteran on available treatments for mental health 

and which they believe to be most effective; the prevalence of prescribing prescription drugs within the VA as remedies for treating 

mental health illnesses; and outreach efforts by the VA Secretary 

on available benefits and treatments. 

Additionally, the commission will be tasked with examining the 

available research on complementary alternative treatments for 

mental health and identify what benefits could be attained with 

the inclusion of such treatments for our Veterans seeking care at 

the VA. Some of these alternative therapies include, among others: 

accelerated resolution therapy, music therapy, yoga, acupuncture 

therapy, meditation, outdoor sports therapy, and training and care 

for service dogs. 

Finally, the commission will study the potential increase in 

health claims for mental health issues for Veterans returning from 

the most recent theatres of war. We must ensure that the VA is 

prepared with the necessary resources and infrastructure to handle 

the increase in those utilizing their earned benefits to address the 

mental and physical ailments incurred from military service. 

Once the Commission has successfully completed their duties, a 

final report will be issued and made available outlining its recommendations and findings based on their analysis of the patientcentered survey, alternative treatments and evidence-based therapies. The Commission will also be responsible for creating a plan 

to implement those findings in a feasible, timely, and cost effective 

manner. 

Last Congress, I was very pleased this subcommittee considered 

the COVER Act in a legislative hearing. At this hearing, all the 

Veterans Service Organizations (VSOs) and organizations testifying 

had supported the COVER Act. I want to thank you all again for 

your support through your testimonies given today. 

In closing, we have the support from Veterans and the organizations that work closely with them. And it is clear that there is a 

need to do more in how we—as a nation—address these challenges. 

The responsibility is ours. The question now is—what do we intend 

to do about it. With that, I urge all my colleagues to show your 

support for our nation’s heroes by signing onto H.R. 271. Let’s get 

this done for our Veterans and let’s work together on finally getting 

them ‘‘covered.’’ 


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PREPARED STATEMENT OF HON. JANICE HAHN

I would like to thank this Subcommittee, especially Chairman 

Benishek and Ranking Member Brownley—two friends of mine— 

for holding this important hearing. 

Homeless veterans are a pressing problem for this nation. More 

than 62,000 veterans are homeless on any given night, and over 

120,000 veterans will experience homelessness over the course of 

the year. 

While only 7% of Americans qualify as veterans, veterans make 

up nearly 13% of the homelessness population. 

Sadly, my home of Los Angeles County has the most homeless 

veterans in the nation. 

Today, I want to address one segment of homeless veterans— 

those who are homeless because of domestic violence. Currently, 

the Department of Veterans Affairs’ definition of homeless veterans 

does not include veterans who are homeless because of domestic violence. 

Across the country, too many victims of domestic violence feel 

that there is nowhere for them to turn. Lacking resources, help and 

a safe place to go, some victims stay with their abusers. 

Tragically, too often women veterans are among those who find 

themselves in this horrible situation. According to the VA, 39% of 

our women veterans report experiencing domestic violence, well 

above the national average. However, because of antiquated laws 

on the books, they have not been eligible to access resources designated for ‘‘homeless veterans.’’ 

I approached Chairman Benishek with my legislation—H.R. 627, 

which updates the definition of ‘‘homeless veteran’’ to include victims fleeing domestic violence, not only was he extremely supportive of it, he joined me in introducing it. For that, I thank you 

Mr. Chairman. 

Our legislation will update the definition of homeless veteran to 

include veterans fleeing domestic violence, and will correct this 

oversight and ensure that veterans fleeing domestic violence can 

receive benefits from the VA. 

This is a minor change of great importance to ensure veterans 

do not feel trapped in dangerous situations. 

H.R. 627 is endorsed by countless veterans organizations, such as 

Veterans of Foreign Wars (VFW), AMVETS, The National Coalition 

for Homeless Veterans, The Service Women’s Action Network, 

Blinded Veterans Association, and the list goes on and on. 

Providing benefits to veterans driven to homelessness by domestic violence is something we all should support—and have supported in the past. 

In fact, I have worked with the House Appropriations Veterans 

Affairs Subcommittee to include report language the past two years 

to make these benefits available. That process, however, only helps 

until the next year and has to be repeated every year to provide 

temporary help. 

Now is the time to stop making temporary fixes. This legislation 

permanently fixes this loophole for veterans. 


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1 Use of Medicare Procedures To Enter Into Provider Agreements for Extended Care Services, 

Proposed Rule: RIN 2900–AO15. Federal Register Vol. 78, No. 30 (February 13, 2013). 

While it is unknown how many veterans will be helped by this 

bill, if it provides one veteran the support they need to leave a dangerous situation, our work here will be worth every minute. 

We must step up to provide these heroes who have protected us 

with the resources they need including a place where they can be 

safe and protected. 

In conclusion, I want to thank you for working with me to solve 

an urgent problem, and I yield back the balance of my time. 

f 

PREPARED STATEMENT THE HON. JACKIE WALORSKI

Good morning Chairman Benishek, Ranking Member Brownley, 

and members of the Committee. Thank you for the opportunity to 

discuss H.R. 1369, the Veterans Access to Extended Care Act. This 

important bill will allow the Department of Veterans Affairs (VA) 

to enter into provider agreements for extended care services. 

VA offers a variety of long-term services and supports to veterans in the form of nursing home care, adult day care, respite 

care, domiciliary services, hospice and palliative care. Care is provided through VA medical centers, State Veterans Homes, or other 

community organizations. Currently, non-VA providers at community organizations must contract with the VA to provide these 

kinds of services. Under the Service Contract Act (SCA), these community providers are considered federal contractors, a designation 

that imposes burdensome reporting requirements relating to the 

demographics of contractor employees and applicants, ultimately 

discouraging numerous providers from entering into contracts with 

the VA. For these organizations, reimbursement from the VA for 

caring for veterans is simply not worth the cost of compiling and 

reporting the data required by general federal contract law. This 

situation has left many veterans and their families without the 

ability to find providers close to their homes. 

On February 13, 2013, the VA released proposed rule, RIN 2900– 

A015, which would have increased access to these non-VA extended 

care services from local providers,1 by permitting these providers to 

enter into agreements with the VA under the same guidelines that 

providers for Medicare enter into agreements with the Centers for 

Medicare & Medicaid Services (CMS). This means that non-VA providers would no longer be considered federal contractors. Non-VA 

providers would still have to comply with all federal hiring laws, 

but they would be relieved from the burdensome reporting requirements. 

In conjunction with a Senate letter that was sent in June of 

2014, Congresswoman Tulsi Gabbard and I, along with 107 of our 

colleagues in the House sent a letter in August of 2014 to Secretary 

McDonald encouraging the release of the final VA provider agreement rule. Unfortunately, despite the willingness of the Department, the VA never had the legislative authority to begin with to 

enact this rule. 


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In response, Representative Gabbard and I introduced H.R. 1369, 

Veterans Access to Extended Care Act. This commonsense bill 

gives the VA the legislative authority it needs to follow through 

with the original proposed rule. Specifically, this bill amends subparagraph (B) of section 1720(c) (1) of Title 38 of the U.S. Code by 

adding an exemption for extended care service providers from being 

treated as federal contractors for the acquisition of goods or services. The bill also modifies section 6702(b) of Title 41 of the U.S. 

Code, which relieves providers from certain reporting requirements 

to the Department of Labor. Lastly, it includes quality assurance 

provisions to ensure the safety and a high standard of care our veterans deserve. Should a provider fail to comply with a provision of 

the agreement, VA has the authority to terminate the agreement. 

Eliminating this contractor designation will encourage more extended care service providers to enter into agreements, which will 

provide veterans with more options in the community. 

Incentivizing more local providers to work with the VA will increase access to care that is closer to home allowing nearby family 

and friends to provide an additional support structures to our veterans. The family structure during these times is a vital part of ensuring a veteran’s quality of life. These individuals have sacrificed 

so much in the name of liberty; they should not have to worry 

about being unable to find care close to home because their hometown providers do not have the resources necessary to qualify as 

a government contractor. Eliminating this designation will encourage more extended care service providers to enter into agreements, 

which will provide veterans with more options in the community 

that will allow their family, friends to provide an additional support structure for them. Providing veterans with the care they need 

and deserve continues to be a top priority of mine and every member of this committee. I am grateful to work with Representative 

Gabbard, Senator Hoeven, Senator Manchin, and the Committee in 

addressing this critical issue for veterans. I thank you again for 

this opportunity to speak today. 


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STATEMENT FOR THE RECORD

STATEMENT OF HON. CORRINE BROWN, FULL COMMITTEE, RANKING

MEMBER

Women Veterans Readjustment and Reintegration 

Mr. Chairman and Members of the Committee, I would like to 

offer this testimony on behalf of H.R. 1575, legislation to honor the 

service and sacrifice of our heroic women veterans recently separated from military service after prolonged deployments. This bill 

extends and makes permanent a very successful pilot program at 

the Department of Veterans Affairs which provides psychiatric and 

psychological counseling and support in retreat settings for newly 

returned women veterans. 

This legislation follows the release of a report by the Veterans 

Health Administration showing that this limited, 2-year pilot program, run by the Readjustment Counseling Service, has shown 

positive, measurable results helping returning women veterans experiencing post-traumatic stress, depression, sleep disturbances 

and isolation. Many of these servicewomen have been evaluated as 

service connected for severe PTSD. 

In surveys, participants have consistently reported experiencing 

a marked decrease in stress symptoms and an increase in coping 

skills, including understanding better how to develop support systems and to access available resources at VA and in their communities following the program and as they reenter civilian life. 

The Veterans Health Administration has completed six retreats 

in the two year pilot period. Post 9/11 women veterans, often combat veterans, are brought together in groups of about 20, in outdoor 

settings. Transportation is paid for. These one-week sessions were 

held in California, Colorado, New Mexico and Connecticut. The veterans, most of whom are coping with the effects of severe PTS, 

some as a result of sexual trauma while in the military, participated in trust building exercises and worked with counselors and 

psychological educators to build peer support. Other services offered on an as-needed basis are financial and occupational counseling and conflict resolution training. 

H.R. 1575 provides VA with permanent authority to extend the 

program using the same measurements and eligibility requirements in the original law, P.L. 111–163. This expansion will mean 

an increase in the number of sessions and locations for the program. VA must submit a report to Congress every two years on the 

program. 

This program is limited, well run and highly successful thereby 

providing us with a bit of good news and, more importantly, a 

chance to ensure a healthier, more successful transition back to civilian life for a specific group of heroic women warriors. 

I appreciate the opportunity to provide this testimony on behalf 

of H.R. 1575, invite my colleagues’ support, and look forward to its 

enactment as soon as possible. 


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AMERICAN HEALTH CARE ASSOCIATION

Dear Chairman Dan Benishek: 

I serve as the president and chief executive officer of the American Health Care Association (AHCA), the nation’s largest association of long term and post-acute care providers. The association advocates for quality care and services for the frail, elderly, and individuals with disabilities. Our members provide essential care to 

millions of individuals in more than 12,000 not for profit and for 

profit member facilities. 

AHCA, its affiliates, and member providers advocate for the continuing vitality of the long term care provider community. We are 

committed to developing and advocating for public policies which 

balance economic and regulatory principles to support quality of 

care and quality of life. Therefore, I appreciate the opportunity 

today to submit a statement on behalf of AHCA for the hearing 

record in strong support of the Veterans Access to Extended Care 

Act (H.R. 1369/S. 739), which would grant the U.S. Department of 

Veterans Affairs (VA) the legislative authority to enter into Provider Agreements for extended care services. 

The VA released a proposed rule, RIN 2900–A015, on Provider 

Agreements in February of 2013. This important rule, among other 

things, increases the opportunity for veterans to obtain non-VA extended care services from local providers that furnish vital and 

often life-sustaining medical services. This rule is an example of 

how government and the private sector can effectively work together for the benefit of veterans who depend on long term and 

post-acute care. Last Congress, close to half of the U.S. Senate 

chamber and 109 U.S. House members signed onto a letter to the 

VA encouraging the release of the final VA provider agreement 

rule. It was determined that the VA needs the legislative authority 

to enter into these agreements, which the Veterans Access to Extended Care Act provides. 

It is long-standing policy that Medicare (Parts A and B) or Medicaid providers are not considered to be federal contractors. However, if a provider currently has VA patients, they are considered 

to be a federal contractor and under the Service Contract Act 

(SCA). The Veterans Access to Extended Care Act would ensure 

that providers could enter into VA Provider Agreements, and would 

therefore not have to follow complex federal contracting and reporting rules that come with being deemed a federal contractor or 

under the SCA. 

Federal contracts come with extensive reporting requirements to 

the Department of Labor on the demographics of contractor employees and applicants, which have deterred providers, particularly 

smaller ones, from VA participation. The use of Provider Agreements for extended care services would facilitate services from providers who are closer to veterans’ homes and community support 

structures. Once providers can enter into Provider Agreements, the 

number of providers serving veterans will increase in most markets, expanding the options among veterans for nursing center care 

and home and community-based services. Services covered as extended care under the proposed rule include: nursing center care, 


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geriatric evaluation, domiciliary services, adult day healthcare, respite care, and palliative care, hospice care, and home healthcare. 

AHCA endorses H.R. 1369/S. 739, and applauds Congresswomen 

Jackie Walorski (R–IN–2nd) and Tulsi Gabbard (D–HI–2nd) and 

Senators John Hoeven (R–ND) and Joe Manchin (D–WV) for introducing this important legislation that will ensure that those veterans who have served our nation so bravely have access to quality 

healthcare. Thank you again for the opportunity to comment on 

this important matter. 

Sincerely, 

Mark Parkinson, AHCA/NCAL President & CEO 

f 

AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE

Dear Chairman Dan Benishek: 

Thank you for the opportunity to offer comments regarding draft 

legislation to allow the Department of Veterans Affairs to provide 

reproductive treatment to disabled veterans that includes in vitro 

fertilization. The American Society for Reproductive Medicine is 

pleased that you have considered this bill for a public hearing. It 

is nothing but unjust to send our military personnel into harm’s 

way and to not provide health care services to address health care 

needs that arise due to their service and dedication to our country. 

ASRM solidly supports the provision of fertility services to severely 

wounded veterans, particularly given that similarly situated individuals with coverage under TRICARE are allowed this covered 

benefit. 

ASRM is a multidisciplinary organization of nearly 8,000 medical 

professionals dedicated to the advancement of the science and practice of reproductive medicine. ASRM members include obstetrician/ 

gynecologists, urologists, reproductive endocrinologists, nurses, 

embryologists, mental health professionals and others. As the medical specialists who present treatment options for patients and perform procedures during what is often an emotional time for them, 

we recognize how important a means to addressing their medical 

condition can be for those hoping to build their families. 

The draft legislation would direct the Secretary of Veterans Affairs to provide fertility treatment, including in vitro fertilization, 

to a disabled veteran who has an injury to his/her reproductive organs or spinal cord and such injury directly results in the veteran 

being unable to procreate without assisted reproductive technology. 

Importantly, the draft bill provides the same treatment for the veterans’ spouse. We find that the coverage regarding number of in 

vitro fertilization attempts and number of years of storage of genetic material is reasonable. In providing for the coverage of 

cryopreservation of genetic material, we would recommend the bill 

specifically include gametes (sperm and egg) and also embryos that 

may be created as part of the assisted reproduction procedure. It 

is important that the cryopreservation of genetic material include 

gametes because the disabled veteran may not be in a position to 

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pare for that treatment. The cryopreservation of gametes allows for 

the processes of fertilization and transfer of any resulting embryos 

to occur when the patient is ready for that process. 

The bill could go further to specifically include coverage of services to those affected by infertility caused by exposure to toxins 

during their deployment as these exposures can also compromise 

one’s ability to reproduce. So too, fertility preservation is a common 

concern for military personnel with orders to deploy. While this is 

not currently a covered benefit under TRICARE and it is not within this panel’s jurisdiction to make requirements of the TRICARE 

program, fertility preservation is an important topic to raise. The 

technology exists to provide these services. The nature of the promises we make to those individuals who risk everything for our country warrants a thoughtful examination of whether this benefit 

should also be part of the covered services for military personnel. 

ASRM would further recommend that the bill allow for the use 

of donor gametes as part of the covered treatment options. For 

some severely injured veterans, sperm or egg retrieval may be impossible. The desire to have a family is no less important to those 

individuals and third party collaboration as a family building option is an appropriate medical option for some infertile patients. 

The bill limits required treatments to disabled veterans or their 

spouse. Until such time that every state legally recognizes the marriage of same sex partners, the effect of this bill will be that only 

those veterans whose marriage is deemed legal will be furnished 

those services outlined in the bill. This effectively denies coverage 

to injured veterans who are single or who are in same sex partnerships. It is no longer a stigma to reproduce outside of the context 

of marriage, or a male/female marriage, and ASRM would recommend that holding veterans to a standard that is not the norm 

any longer in today’s society is discriminatory just as denying to 

these individuals the ability to serve in the military. 

Thank you for the opportunity to comment on this bill and for 

your attention to this important public health issue. Our nation’s 

military personnel and veterans deserve to have access to the full 

complement of infertility treatments that are available and we are 

pleased that this committee has recognized the need to correct the 

inequities that exist between the health plans available under the 

DoD and the Veterans’ Health plans. 

Sincerely, 

Rebecca Z. Sokol, MD, MPH, President, 

American Society for Reproductive Medicine 


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1 Congressional Budget Office. (2014). Comparing the Costs of the Veterans’ Health Care System With Private-Sector Costs (CBO Publication No. 49763). Washington, DC: U.S. Government 

Printing Office. Retrieved from https://www.cbo.gov/sites/default/files/cbofiles/attachments/ 

49763–VA—Healthcare—Costs.pdf. 

CONCERNED VETERANS FOR AMERICA

Draft Legislation on Reproductive Treatment for Disabled Veterans 

To amend title 38, United States Code, to improve the reproductive treatment provided to certain disabled veterans. 

CVA has no position on this legislation. 

Draft Legislation Requiring an Annual VHA Report 

To amend title 38, United States Code, to direct the Secretary of 

Veterans Affairs to submit an annual report on the Veterans 

Health Administration and the furnishing of hospital care, medical 

services, and nursing home care by the Department of Veterans Affairs. 

CVA supports the principles of the legislation, which requires 

more detailed reporting from VHA in important areas where data 

have been lacking. In order to ensure accountability, it is important 

that VHA report its performance numbers in a way that enables 

decision-makers and veterans to assess their efficiency and efficacy. 

A CBO report released last December which examined the comparative cost of VA-provided healthcare versus and private-sector 

healthcare notes that ‘‘Comparing health care costs in the VHA 

system and the private sector is difficult partly because the Department of Veterans Affairs (VA), which runs VHA, has provided limited data to the Congress and the public about its costs and operational performance’’. 1

This legislation would be an important step towards making sure 

that the VHA and the VA become more transparent institutions, 

which would benefit both the taxpayers and the veterans. While 

CVA remains committed to comprehensive reform of VHA and the 

Department of Veterans Affairs, these reporting requirements are 

an important step toward more accountability and better care for 

our veterans. 

CVA supports this legislation. 

Draft Legislation: The Toxic Exposure Research Act of 2015 

To establish in the Department of Veterans Affairs a national 

center for research on the diagnosis and treatment of health conditions of the descendants of veterans exposed to toxic substances 

during service in the Armed Forces that are related to that exposure, to establish an advisory board on such health conditions, and 

for other purposes. 

CVA has no position on this legislation. 

HR 271: The Cover Act 

To establish a commission to examine the evidence-based therapy 

treatment model used by the Secretary of Veterans Affairs for 

treating mental illnesses of veterans and the potential benefits of 

incorporating complementary alternative treatments available in 

non-Department of Veterans Affairs medical facilities within the 

community. 

CVA has no position on this legislation. 

HR 627: To Expand of Definition of Homelessness 


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To amend title 38, United States Code, to expand the definition 

of homeless veteran for purposes of benefits under the laws administered by the Secretary of Veterans Affairs. 

CVA has no position on this legislation. 

HR 1369: Veterans Access to Extended Care Act of 2015 

To modify the treatment of agreements entered into by the Secretary of Veterans Affairs to furnish nursing home care, adult day 

health care, or other extended care services, and for other purposes. 

CVA believes that this legislation represents a good step forward 

in alleviating the problems that the Department of VA has in providing veterans access to the care that they need and increasing 

the partnership between VA and private sector care, by simplifying 

the process that non-VA providers must go through to enable them 

to provide extended care to veterans. CVA strongly believes that it 

is important to ensure that there are more choices for veterans regarding the services that are available to them within the current 

overall institutional arrangement, and that VA should work with 

private-sector healthcare providers in effective ways to ensure that 

veterans receive the quality of care they deserve. This legislation 

is in keeping with that goal. 

CVA supports this legislation. 

HR 1575: Retreat Counseling for Women Veterans 

To amend title 38, United States Code, to make permanent the 

pilot program on counseling in retreat settings for women veterans 

newly separated from service in the Armed Forces. 

CVA has no position on this legislation. 

f 

RESOLVE: 

THE NATIONAL INFERTILITY ASSOCIATION

Dear Chairman Dan Benishek: 

Thank you for the opportunity to provide this statement regarding draft legislation to improve reproductive treatment provided to 

certain disabled veterans. This is incredibly important legislation 

for our wounded warriors who expect our government to care for 

them if they are injured in their service to our country. The ability 

to procreate is the most basic and fundamental desire of human 

beings. If that ability is damaged as a result of their service, then 

we owe it to them to provide access to medical treatments that will 

allow them to become a parent. 

RESOLVE: The National Infertility Association was founded in 

1974 to provide information, support, awareness and advocacy for 

women and men living with infertility. RESOLVE is the oldest and 

largest patient advocacy organization in the U.S. and the only patient organization advocating for access to infertility services for 

our active duty military and veterans. We applaud the committee 

for discussing this important topic. 

The draft legislation provides for certain disabled veterans to access in vitro fertilization (IVF). Right now the Veterans Administration is prohibited from providing access to IVF, which causes a 


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critical gap in coverage since that same benefit is offered to wounded service-members still covered under TRICARE. While the 

TRICARE supplemental benefit for certain wounded service-members is needed, most of those who could benefit from IVF transition 

to the Veteran’s health system and by the time they are ready to 

become a parent, they discover that the VA does not provide access 

to IVF. This draft legislation will fix this gap in service and solve 

a major problem facing our disabled veterans. 

This bill also provides for access to reproductive care for the 

spouse of a veteran. While the VA is not responsible for the 

healthcare of spouses and dependents, reproduction is unique in 

that male and female gametes (sperm and egg) are needed as well 

as a female to carry the pregnancy. Only providing care to the male 

or female does not work—both must be treated. 

We do ask that the committee consider all of the injuries that 

may result in infertility, as the bill only covers injury to the reproductive organs or spinal cord. Amputations, Traumatic Brain Injuries and exposure to toxins and chemicals can also impact the ability to procreate without assisted reproductive technologies. All of 

our wounded veterans with infertility should have access to this 

coverage. 

We applaud the committee for this important first step in opening up advanced reproductive care to veterans. We are hopeful that 

this first step will lead to further coverage in the future for all veterans, not just those with a service related injury; access to IVF for 

service-members covered under TRICARE; coverage for fertility 

preservation before deployment (the freezing of sperm, eggs and/or 

embryos); access to care for those who are single or not married 

with infertility; and coverage for the use of donor gametes (donated 

sperm, egg or embryos) for those who can no longer produce viable 

gametes to have a child. 

We stand ready to work with Congress to get this important legislation passed as quickly as possible. Our Veterans are waiting— 

we owe it to them to fix this coverage gap with the VA and let 

them access the advanced medical care that they need and so deserve. 

Sincerely, 

Barbara L. Collura, President & CEO 

RESOLVE: The National Infertility Association, 7918 Jones 

Branch Drive, Suite 300, McLean, VA 22102, www.resolve.org 

bcollura@resolve.org, 1–703–556–7172 

f 

VETERANS OF FOREIGN WARS OF THE UNITED STATES

Statement of Carlos Fuentes, Senior Legislative Associate National Legislative Service, Veterans of Foreign Wars of the United 

States APRIL 23, 2015 

Mr. Chairman and Members of the Subcommittee: 

On behalf of the men and women of the Veterans of Foreign 

Wars of the United States (VFW) and our Auxiliaries, thank you 

for the opportunity to offer our thoughts on today’s pending legislation. 


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H.R. 271, Creating Options for Veterans Expedited Recovery 

(COVER) Act: 

The VFW supports this legislation, which would establish a commission to examine the efficacy of the Department of Veterans Affairs’ (VA) mental healthcare and identify ways to improve outcomes. 

Too often, the VFW hears stories of veterans who have been prescribed high doses of ineffective medications to treat their mental 

health conditions. Many of these medications, if incorrectly prescribed, have been known to render veterans incapable of interacting with their loved ones and even contemplate suicide. With 

the expanding evidence of the efficacy of non-pharmacotherapy modalities, such as complementary and alternative medicine (CAM) 

therapies, VA must ensure it affords veterans the opportunity to 

access effective mental health treatments that minimize adverse 

outcomes. 

VA has made a concerted effort to change its mental healthcare 

providers’ dependence on pharmacotherapy to treat mental health 

conditions and manage pain. In 2011, the Minneapolis VA Medical 

Center launched its Opioid Safety Initiative. Aimed at changing 

the prescribing habits of providers, the Opioid Safety Initiative 

educates providers on the use of opioids, serves as a tool to taper 

veterans off high-dose opioids, and offers veterans alternative— 

non-pharmacotherapy—modalities for pain management. Last 

month, VA deployed the Opioid Therapy Risk Report, a byproduct 

of the Opioid Safety Initiative, to enable providers to better track 

and manage their patients’ high-dose prescriptions. 

Timely and accessible mental healthcare is crucial to ensuring 

veterans have the opportunity to successfully integrate back into civilian life. With more than 1.4 million veterans receiving specialized VA mental health treatment each year, VA must ensure such 

services are safe and effective. VA has made progress in reducing 

its dependence on pharmacotherapy to treat mental health conditions and manage pain. However, more can be done to ensure veterans have access to CAM therapies that minimize side effects and 

improve outcomes. 

H.R. 627, to expand the definition of homeless veteran for 

purposes of benefits under the laws administered by the 

Secretary of Veterans Affairs: 

The VFW is pleased to support this legislation, which would clarify the definition of homeless, thereby aligning it with the McKinney-Vento Act to include those displaced by domestic violence. 

No veteran should ever be homeless, and expanding the definition of homeless to include veterans who are fleeing situations of 

domestic abuse is the right thing to do. This change would ensure 

veterans who have the courage to leave their abusive and sometimes life-threatening situations receive access to the benefits VA 

already provides to thousands of homeless veterans. The VFW believes this legislation will significantly improve the lives of those 

who become homeless as a result of difficult circumstances outside 

of their control, and help them begin a new chapter in their lives. 

H.R. 1369, Veterans Access to Extended Care Act of 2015: 


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The Veterans Access to Extended Care Act of 2015 would 

strengthen VA’s authority to enter into provider agreements with 

extended care facilities, while ensuring such facilities meet certain 

safety and quality standards. The VFW supports this legislation, 

but urges the Subcommittee to ensure it provides VA the authority 

it needs to properly administer all of its nursing home, assisted living, patient-directed and extended care authorities and programs. 

VA has the authority to enter into provider agreements with extended care facilities to provide long-term care to veterans who 

need nursing home level services. However, a recent opinion by the 

Department of Justice found that VA provider agreements must 

comply with Federal Acquisition Regulations (FAR). Thus, VA has 

been unable to proceed with its plans to use its provider agreement 

authority to expand the extended care services it provides veterans. 

The VFW has heard from many private sector extended care facilities that want to care for veterans, but do not have the staff to 

comply with the onerous compliance requirements under the FAR. 

As a result, veterans throughout the country received notice that 

they may be uprooted from the nursing homes they have called 

home for many years. For example, the VFW has received assistance requests from nearly a dozen family members of veterans in 

a nursing home in Lincoln, NE, that may no longer be able to provide services to veterans if its provider agreement with VA is not 

renewed. One of the veterans has rapidly progressing multiple sclerosis and needs comprehensive healthcare services. His family tells 

us he is satisfied with the ‘‘excellent care’’ he receives and was 

looking forward to calling the nursing facility ‘‘his home for the remainder of his days.’’ This legislation would ensure this veteran 

and many like him are able to remain in the extended care facilities they call home, and authorize VA to provide the same opportunity for countless veterans. 

H.R. 1575, to make permanent the pilot program on counseling in retreat settings for women veterans newly separated from service in the Armed Forces: 

This legislation would make retreat counseling services permanent for transitioning women veterans. The VFW supports this legislation and would like to offer suggestions to strengthen it, which 

we hope the Subcommittee will consider. 

VA’s counseling retreat program has served as an invaluable tool 

to help newly discharged women veterans seamlessly transition 

back into civilian life. The VFW supported the original program established by the Caregivers and Veterans Omnibus Health Services 

Act of 2010 and is happy to see this program continue. 

Another successful program created by the Caregivers and Omnibus Health Services Act of 2010 is the childcare pilot program. This 

program has been well received by veterans at all four pilot sites 

and has also contributed to the success of the counseling retreat 

program. The VFW has heard from veterans who say they could 

not have completed their treatment programs if not for the services 

offered through VA’s childcare pilot program. 

When extending successful mental healthcare programs, such as 

the retreat counseling program for women veterans, the Subcommittee must ensure external barriers to access are removed to 

grant veterans the opportunity to receive the VA healthcare and 


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services they need. The VFW urges the Subcommittee to amend 

this legislation to extend and expand the childcare program to 

every VA medical center to ensure newly discharged women veterans with children are not precluded from obtaining the benefits 

and services they have earned and deserve. 

H.R. 1769, Toxic Exposure Research Act of 2015: 

The Toxic Exposure Research Act of 2015, which would establish 

an advisory board and a national center for research, would begin 

to address the multiple health issues faced by veterans and their 

descendants as a result of service-related toxic wounds. The VFW 

is pleased to offer its strong support for this legislation. 

This nation has a long history of offering healthcare and compensation benefits to veterans who suffer traditional wounds on the 

battlefield. Veterans who suffer from toxic wounds, however, have 

traditionally faced a much more difficult road towards accessing 

the healthcare and benefits they have earned and deserve. The 

VFW believes that toxic wounds are wounds just the same and 

should be treated just as seriously as physical or mental wounds. 

Veterans who suffer from conditions as a result of service-related 

toxic exposure are equally deserving of VA healthcare and benefits. 

Toxic wounds are different than other wounds, since toxic exposures have the potential to affect a veteran’s descendants for several generations. For this reason, we strongly support the provision 

of this bill that would establish a national center for research to 

study the health effects service-related toxic wounds have on the 

descendants of individuals who were exposed to toxic substances 

during their military service. 

Children of Vietnam veterans who were exposed to Agent Orange 

receive VA care and benefits for spina bifida, a debilitating health 

condition associated with a parent’s exposure to dioxins found in 

Agent Orange. The VFW suspects that descendants of Vietnam veterans may suffer from additional health conditions that may be associated with exposure to Agent Orange. In addition, exposure to 

toxic substances is not limited to Vietnam veterans. The descendants of veterans who were exposed to toxic chemicals during the 

Gulf War, veterans of Iraq and Afghanistan exposed to open air 

burn pits, and service members exposed to contaminated water in 

Camp Lejeune, just to name a few, may all be suffering from diseases at a higher rate than the general population. This legislation 

is a step toward ensuring veterans’ descendants can finally get the 

care and benefits they need. 

Draft Legislation to Improve the Reproductive Treatment 

Provided to Certain Disabled Veterans: 

This important legislation would expand VA’s authority to furnish fertility treatments to veterans who have lost their ability to 

start a family as a direct result of their service-connected injuries. 

The VFW supports this legislation and would like to offer suggestions to strengthen it, which we hope the Subcommittee will consider. 

Due to the widespread use of improvised explosive devices during 

the wars in Iraq and Afghanistan, both female and male service 

members have suffered from spinal cord, reproductive, and urinary 

tract injuries. Many of these veterans hope to one day start famiVerDate Aug 31 2005 09:31 Jul 22, 2016 Jkt 000000 PO 00000 Frm 00105 Fmt 6633 Sfmt 6633 Y:\98-634.TXT PAT

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lies, but their injuries prevent them from conceiving. When these 

veterans seek fertility treatment from VA, they are told VA services are very limited. In fact, VA is prohibited from providing certain fertility treatments like In Vitro Fertilization. This legislation 

would expand VA’s authority by aligning it with the Department 

of Defense’s authority to furnish assisted reproductive treatments 

to severely injured service members. 

However, service-connected infertility is not limited to those who 

have suffered reproductive organ and spinal cord injuries. Other injuries and illnesses such as Traumatic Brain Injuries and other 

mental health conditions are known to cause infertility. Such veterans deserve the same opportunity to start a family as their fellow 

veterans who have suffered injuries to their reproductive organs. 

For that reason, the VFW urges the Subcommittee to expand the 

eligibility for infertility treatment to severely wounded, ill, or injured veterans who have infertility conditions incurred or aggregated by their military service. 

Additionally, veterans may have personal objections to assisted 

reproductive technologies such as In Vitro Fertilization and would 

like to pursue other options, such as adoption. However, VA is not 

currently authorized to help veterans cover the cost of adoption. 

The VFW believes that VA must have the authority to provide veterans the fertility treatment options that are best suited for their 

particular circumstances. For that reason, we urge the Subcommittee to grant VA more expansive fertility treatment authorities. 

This legislation takes several steps toward ensuring veterans 

who have lost their ability to reproduce have the ability to start a 

family. It would authorize VA to cryopreserve a veteran’s genetic 

material for up to three years. Starting a family is a life changing 

decision that takes time and should not be hastily made. The VFW 

strongly supports giving veterans the opportunity to delay such a 

decision. However, we urge the Subcommittee to expand the three 

year window. When totaled, a veteran’s recovery, education and career advancement may cause them to wait years before they are 

physically and financially prepared to start a family. The VFW recommends that veterans be allowed to cryopreserve their genetic 

material for a minimum of 10 years. This will prevent veterans 

from feeling rushed into making family planning decisions before 

they are ready. 

Additionally, many severely wounded, ill, and injured veterans 

have not lost the ability to produce gametes, but have lost the ability to conceive. The VFW strongly supports the provision that 

would authorize VA to furnish fertility treatments to non-veteran 

spouses. 

Draft Legislation to Direct the Secretary of Veterans Affairs 

to submit an annual report on the Veterans Health Administration: 

The VFW supports this legislation, which would require VA to 

report the utilization and efficiency of the healthcare it provides 

America’s veterans. Such reports would enable Congress to conduct 

proper oversight of the department’s Veterans Health Administration. 


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Information Required by Rule XI2(g)(4) of the House of Representatives 

Pursuant to Rule XI2(g)(4) of the House of Representatives, the 

VFW has not received any federal grants in Fiscal Year 2014, nor 

has it received any federal grants in the two previous Fiscal Years. 

The VFW has not received payments or contracts from any foreign governments in the current year or preceding two calendar 

years. 


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Æ 


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