Senate Veterans' Affairs (Sullivan): Hearings to examine advancing the mission, focusing on evaluating the future of VA research.

Good afternoon. I don't know how it became 4 o'clock so quickly, but I apologize for being maybe 5 minutes late.

I want to thank our witnesses for being here this afternoon. Last year, the VA Research celebrated its centennial anniversary. Over the last 100 years, the VA's research has revolutionized medicine worldwide, from the first successful cardiac pacemaker implantation in 1960 to pioneering the internationally recognized standard for grading prostate cancer with the Gleason score. These historic advancements continue to transform not only the day-to-day lives of millions of veterans, but they benefit civilians as well. In 2016, the VA entered into a partnership with the Prostate Cancer Foundation establishing the Precision Oncology Program for Cancer of the Prostate.

The advancements of this program have fast-tracked life-saving FDA approvals and made certain that veterans in rural areas are receiving the same cutting-edge cancer therapies as veterans who live near urban research hospitals. The VA has long, long history of leading the world in medical innovation, and I hope they continue to lead that way long into the future. This is why I look forward to working with my colleagues in passing a piece of legislation that I'm particularly interested in: the VA's Precision Oncology Program for cancer for the prostate. Congress has the opportunity to safeguard this program funding, protect its infrastructure, and make certain that veterans battling prostate cancer continue receiving access to world-class care and specially tailored care that they have earned and deserved. I look forward, as I said earlier, to hearing from our witnesses today, how we can better equip our research community to serve our nation's heroes and make the VA research stronger, more sustainable, and more successful.

With that, I yield to the ranking member's colleague the former chairman of this committee, Senator Murray, for an opening remark. For open— you can do more than one remark. You can do more than one. For opening remarks. Okay, Senator Murray.

Thank you very much, Mr. Chairman, and thank you to all of our witnesses for being here today. Look, I think senators on both sides of this aisle have a real appreciation of VA's research enterprise, which has been at the forefront of cutting-edge science for more than 100 years. It's led to breakthroughs like the pacemaker, the first successful liver transplant, the nicotine patch, and CT scanning. But I'm not sure that the Trump administration has that same appreciation, and I'm very concerned by the actions by this administration that have demoralized a lot of our VA research staff and created instability in research funding and really put up barriers that has slowed the research process. On the very first day of the Trump administration, all VA research staff became subject to a hiring freeze.

And probationary firings. As a result, research at the Pittsburgh VA to predict stroke risk was put on hold. Enrollment into clinical trials for advanced cancer was delayed, and a clinical trial in Florida on preventing dementia and heart disease was canceled. Um, and Mr. Chairman, I, I could go on. I've heard a lot of stories like that, but— and so I'm deeply concerned.

In addition, the department also enforced vacancy cuts and staffing caps— on its facilities. Though those cuts technically exclude research staff, a study at a VA site in the Pacific Northwest was delayed because staffing caps prevented them from hiring nurses who are needed to administer that study. These workforce actions have taken a toll on employees at VA's central office responsible for getting new research studies up and running. VA researchers now report startup times for their studies often stretch to more than a year. Those delays are partially due to a wildly inefficient hiring process for VA research staff.

Researchers are reporting to us that the time to hire a new member of their staff now often takes up to 6 months. As a result, a planned study on RSV missed its enrollment window and could not even enroll participants. Another clinical trial closed after it took 6 months to hire a researcher. The study's principal investigator and its lead clinician both resigned from the VA after that debacle. VA researchers are not only being undermined by delays and cuts at the department, but also by instability and cuts at other federal agencies like the National Institutes of Health, which frequently provides funding for our VA researchers.

For example, a VA researcher's NIH grant for studying opioid use disorder among minority veterans was canceled. Why? It was deemed DEI. Large VA research sites are also reporting their non-VA federal funding is down a third or more compared to the previous year. And in one final blow to research, the Office of Management and Budget has proposed a— or published a proposed rule that would require all federal grants, including those for VA research, to be approved by political appointees.

That doesn't make sense. Let a political appointee overrule a scientist on what research is worth pursuing and funding. So given the current state of VA research under this administration, there is a demoralized workforce and they have limited access to non-VA federal funding. So it's really inexplicable to me to request a decrease in funding for VA research for fiscal year '27. I'm speaking here today in, in place of Senator Blumenthal, but I can tell you right now, as vice chair of Appropriations, it is my intention to rip Trump's budget up and write a new one.

I really hope our VA witnesses will take the concerns raised in this hearing seriously and commit to taking action to address them. If VA wants to ensure that it can recruit and retain the brightest minds to conduct research and provide clinical care for our nation's heroes, it has to work to restore the trust it's lost with a lot of its research staff. This committee and this Congress should stand up for research. And I— and it should stand up for science, and it should stand up for veterans. That's where I am, Mr. Chairman.

Thank you, Senator Murray. Testifying on today's first panel is Dr. Richard Nelson, Acting Executive Director for Discovery Education Affiliate Networks. He's accompanied by Ms. Latoya Prieur, Chief Human Capital Management, VHA, and Dr. Michael Kelly, Executive Director, National Oncology Program, Doctor, you are welcome to now testify and you're recognized.

Chairman Moran and distinguished members of the committee, thank you for the opportunity to discuss VA's research enterprise and its impact on veteran lives. The standard governing our work is simple: every dollar VA invests in research must be directly tied to veterans' health and well-being. I am joined today by Ms. Latoya Prier, Chief of Human Capital Management, and Dr. Michael Kelly, Executive Director of the National Oncology Program. I am currently serving as the Acting Executive Director of the Office of Discovery, Education, and Affiliate Networks, or DEAN. I lead the Veteran— Veterans Health Administration's research, innovation, and clinical training programs.

For 100 years, VA research has produced advances that change clinical practice well beyond VA, including the first implantable cardiac pacemaker, the nicotine patch, and the foundational work that created the modern CT scanner. That same principle shapes what we do not pursue. VA research is not a general-purpose science portfolio. It is a targeted investment in questions that matter to veterans, enforced through peer review Institutional Review Boards, and the Office of Research Oversight. This administration has taken a disciplined Veterans First approach to research.

The President's fiscal year 2027 budget requests over $480 billion for VA, including over $150 billion in discretionary funding and over $54 billion through the Toxic Exposures Fund to expand care for veterans impacted by environmental and occupational exposures. Within that investment, VA has sharpened its research enterprise to prioritize measurable clinical benefit, accountability, and faster translation of discovery into care. And this strategy is already producing results. We have grown the Cancer Clinical and Research Network to more than 100 VA medical facilities. Giving veterans access to cutting-edge clinical trials closer to home.

Our Lung Cancer Precision Oncology Program has delivered more than 1 million lung cancer screening scans, helping identify cancers earlier when treatment is most effective. And the Million Veteran Program now includes more than 1 million enrolled veterans, an unparalleled resource for advancing precision medicine. We measure success not by the number of projects funded, but by the number of veterans whose lives are improved. President Trump's Accelerating Medical Treatments for Serious Mental Illness Executive Order 14401 recognizes that not all veterans respond to standard mental health treatments. In response, VA announced a randomized placebo-controlled trial of MDMA-assisted therapy for PTSD and alcohol use disorder, with plans to enroll approximately 80 veterans through the VA Providence and VA Connecticut healthcare systems.

This is part of a broader psychedelic research portfolio of 19 additional active trials supported by more than $23 million in external funding, all conducted under rigorous federal safety protocols. VA also continues to lead research on toxic exposures, including burn pits and Agent Orange, and on traumatic brain injury and blast overpressure, following large veteran cohorts to develop next-generation brain health biomarkers and conducting a national clinical trial for mild TBI treatment. Looking ahead, our strategy is built on 3 priorities: expanding access to high-quality clinical trials, delivering real-world clinical impact, and leveraging VA's data for veterans' benefit. These priorities are executed through several programs. The Cooperative Studies Program, which is leading a landmark trial comparing non-invasive colorectal cancer screening with colonoscopy with deliberate outreach to rural veterans.

The Quality Enhancement Research Initiative, which speeds translation of evidence-based research findings into routine care for veterans, and the Million Veteran Program's continued research into the genetic underpinnings of PTSD, cardiovascular disease, and cancer. VA is also responsibly integrating artificial intelligence under human control into research and clinical care, including suicide prevention, opioid safety, oncology, and diagnostic imaging under our Trustworthy AI Framework, which prioritizes privacy, security, and clinical validation at every stage. In conclusion, VA's research legacy is one of groundbreaking discovery benefiting veterans and the American public alike. We will continue strengthening the oversight and mission-focused discipline that keeps this enterprise veteran-centered and aligned with our strategic priorities. Mr. Chairman, thank you and the committee for this opportunity, and we welcome any questions.

Thank you very much, Doctor. Um, Ms. Perrier, this committee continues to hear that onboarding essential research personnel routinely takes up to 5 or 6 months. It's a competitive scientific market. I have to assume we're losing top-tier researchers because of the VA centralized hiring process takes so long. Our research personnel included in the 30-day hiring pilot If so, how many have been hired through that pilot?

What other strategies are being pursued, or am I just wrong in my assumption? Senator Moran, thank you for that question. VA researchers are included in the Secretary's 30-day Time to Hire initiative. That initiative was just rolled out nationwide on July 13th, so it's too early to provide you with results at this moment. What I can share with you is that physician and nurse hiring has been prioritized.

Each morning, my staff pulls a list of all physicians and nurses that have been certified back to us by hiring officials, and we make sure those tentative and official job offers are prioritized over all others. While there may be some instances where it took 5 or 6 months to hire a researcher, Overall, the time to hire for researchers is 77 days, and that is below the Office of Personnel Management's 80-day time to hire metric, and that is how we measure success. Is that 77 days, uh, less than it used to be? Is there a pattern that shows improvement?

That 77 days That 77 days is a bit more than fiscal year 2025. We were at 74 days. Okay, uh, Dr. Zhang, uh, all the research priority areas in the FY27 budget requests see a decrease in funding except for homeless research, which is flat funded. How is the department managing the important research, uh, for suicide prevention, precision oncology, traumatic brain injury, and other priorities that saw a decrease in requested funding with less money and fewer staff?

Thank you, Senator Moran, for the question. Um, I would say right now that the 2% cut in our funding for fiscal year '26, President budget, is really around the multi-year nature of medical research and contract personnel attrition. But no program cuts have actually occurred. We feel very strongly that we're able to still support the mission with our current proposed funding.

Let me ask an additional question, but somewhat related. I raised the concern several years ago with the VA, uh, about funding research that was not focused on areas likely to achieve improved outcomes for veterans. And so the question is, how is the VA focused on prioritizing what research it funds? And I assume, or please confirm, that there's a component about the places that were most likely to get the most benefits? Thank you, Senator Moran, for the question.

Actually, I think this is actually a place where VA research has actually done some pretty incredible work already thinking about this. You know, our organization has really thought about how we become more of an enterprise for research all through the view and the mission of supporting the veteran. And the work that, I wish I could take credit for it, but I just started at this role, But the work that the leaders across research have already done to prioritize the funding and also the agenda for research across the organization has really been around this concept called the actively managed portfolios. And these AMPs are how we try and accelerate the issues and topics like traumatic brain injury, precision oncology, and other areas to accelerate the work much faster. And we have to find a balance between both actively managed portfolios, but also funding the full scope of science and research for veteran benefit.

So we also have what's known as broad portfolio, a broad portfolio strategy to support that as well. So I think we're actually trying to do that and we're in the process of creating more of a data-informed pathway to get to accountability, get to impact, and really get to veteran benefit faster. Thank you for that answer. Dr. Kelly, I had questions for you, but I've run out of time and I may just submit them in writing. Senator Murray.

Thank you, Mr. Chairman. You know, women, as we all know, are the fastest growing veteran population, but I am still very frustrated by the lack of progress and investment in understanding their really unique healthcare needs. Women veterans actually, especially those with PTSD or military sexual trauma, are more likely to experience early menopause, with one VA study finding that there are 3 times— they are 3 more times likely than any civilian woman to reach menopause before the age of 40. It's really important to make sure that our women veterans receive the evidence-based, high-quality healthcare that they deserve. But to get there, we need a really strong investment in menopause research at both VA in DOD, which is why I was very proud to introduce the bipartisan Servicewomen and Veterans Menopause Research Act, which will work to do that.

Dr. Zhang, I wanted to ask you today, what are the biggest gaps in our understanding of menopause among women veterans?

Thank you, Senator Murray, for that question. You know, just to kind of set the stage, the Office of Discovery Education and Affiliate Networks is really the office that oversees both research, academics, innovation and partnerships. And I tell you this because I think that women's health— and I agree with you— the women's health and the women population of veterans is clearly growing and going to be incredibly important, not just for research but for academics, for innovation, and frankly for partnerships. So to that end, I think that we are going to try and continue to support that from a research standpoint. Our budget for women's health research remains steady at approximately $40 million a year.

When it comes to your specific question about where the biggest gaps are, uh, I'd like to take that for the record and get you the actual, um, accurate information as best we can. Okay, if you could get that back to me and just tell me why you think continued investment in menopause research is critical. I think all investment in areas of, um, increase for veteran care is going to be important. And although I don't know specifically about that particular component of women's health, clearly given that the increase in women veterans utilizing VA resources is growing, we have to partner and do this work and find the places where we can make an impact and difference. Well, I think that's why my bill is so important, is because we clearly have a lack of understanding.

But it is really critical, and I hope I can work with the chairman to get that passed. Next. Now, the president's budget proposes a substantial reduction to VA's research program, not only through cuts to dedicated research appropriations, but also through reduced support from medical care accounts and lower projected reimbursements that many of our research programs rely on. Those reductions raise very serious concern about VA's ability to sustain its ongoing research and continue developing new innovations that improve our veterans' care. So, Dr. Zhang, If Congress were to cut $43 million from the budget, that's what President Trump's proposing, which high-priority research areas are most at risk?

Can you tell us, is it cutting toxic re— exposure research or prosthetic research or cancer research? Where would we see the cuts? Thank you, Senator Murray, for that question. Um, to be very direct, um, I think our goal would be to try and preserve the gem that is VA research as much as we could. Now, certainly I do not have direct control of the budget, so we will do whatever— we will take whatever we get.

In your capacity, you know where the money is. Where do you see those kinds of cuts hitting research the most? Yeah, thank you for that question. I don't know right now. I would say that I would look for things that are not our actively managed portfolios, which are our key acceleration priorities.

And to focus on things that we were exploring at an early stage as the places to make cuts if we had to. So the budget's been proposed, but you haven't thought about what the consequences are? Excuse me, sorry. The president sent that budget proposal. You see the cuts in at $43 million.

You haven't thought as an agency about where you're going to have to put those cuts in? Oh, I see. Thank you, Senator Murray. So from our perspective, The budget cut is really reflecting the attrition of contracts and also staff that have left during that time. Our actual plans and the support for research have not been affected by those budget cuts.

Okay, well, we do know last year 9 researchers were terminated with no warning and their research stopped, so you can't say that cutting personnel doesn't impact research. But I just— I only have 5 seconds left. I just want to emphasize what I made— comment I made in the opening remark about the pending OMB rule that would really undermine our current system and allow— take away decision-making power from our experienced scientists and just allow political appointees, whether this administration or into the future, decide where research is going to go. That is really concerning to VA researchers. We need decisions based on science, not based on somebody's mad at somebody or political decision in any administration.

Senator Murray, thank you. Senator Sheehy.

Thank you, Chairman. Dr. Zhang, recently you alluded to some of it in your comments. We've seen the MDMA-assisted therapy trial and a broader range of other research on novel therapeutics for PTSD, substance abuse, and others. I know you can't get into specifics, but kind of broadly speaking, you know, what's your assessment of it so far? And, you know, what do you think the future can look like?

Thank you, Senator Sheehy. You know, we're very, as an organization, very excited to support the frontiers of treatment for difficult things like PTSD and substance abuse, alcohol abuse as well, using tools like psychedelic medicine. What we are trying to do in research is to support this frontier work. I know that Dr. Ilse Wieckers has been here and also working very closely to brief this committee. And for further details specifically on that, I would refer to Dr. Wieckers.

But I will say from our research component, our goal is to support the science and support the frontiers. And that's what we're going to do.

I think in, in the vein of getting the solutions to the field as quickly as possible, um, we also want to be prepared for enterprise-level rollout of these type of therapeutics, both the care as well as the products themselves. So has there been any thought given yet to lifecycle management, um, actual rolling out of the novel therapies, uh, training of the staff, and how, how the logistics of that are going to happen once we get to FDA approval, once we get to VA-wide enterprise approval? Is that—. Is that planning process begun? Yes.

Thank you, Senator Sheehy. We've actually been really thinking about how we translate. And actually, I would say this is not just for psychedelics, but a lot of lines of our research. One of our core goals is how do we rapidly translate that to actual veteran impact? So when it pertains to specifically psychedelics, we've actually created as an organization an integrated project team to think about this both from a science standpoint, but also how do we operationalize this when it's safe, when the science supports it, to better benefit veterans.

Great. Yeah, that's good to hear because, you know, as you know, whether it's 22 a day or whether it's veterans paying for their own trips to Mexico or elsewhere to get these, these treatments, the sooner we can roll them out, the better. And I think the worst thing that could happen is, is we finish the trials we finish the double-blind studies and everything comes out great, and then it's another 5 to 10 years of bureaucratic rollout. No offense, but that's generally how the government works, and in that time we still have veterans in need. So I think it's just as important as we conduct the research that we also fast-track, without cutting corners, you know, the logistics of how we're going to physically roll that out when the time comes.

And I think a core component of that will be, of course, our community care networks, which There are existing providers that already do this in the private sector, so we don't have to reinvent the wheel in every case. There could be times where we can leverage that community care network in this, in this sector as well. So thanks for working on this. Appreciate being here. Thank you, Senator Sheehy.

And I would just say, you know, I think from my perspective, you know, I'm still relatively new, frankly, to the VA. I just joined the organization a little under 3 years ago. But I'm actually a second-generation VA physician. My mom is a primary care doctor at the Erie VA for the last 20 years. So although I'm not a veteran, I've seen and my family has benefited from VA for about half my life.

So I understand the value of the organization, what a gem research is at VA, and how it's improved not only veteran care, but American care and frankly care for humanity. So that is the pathway and kind of the overarching direction that I want, I want you all to know we have at VA. It's not just me, it's everyone I work with. And I work with so many researchers that are also veterans. And that's, that's such an incredible thing to see.

The mission is so important. And that's why we do this work.

Doctor, thank you for your comments in response to Senator Shaheen's question. Senator Bozeman.

Thank you, Mr. Chairman, very much. And Ranking Member Blumenthal, Blumenthal, for holding the hearing today. And we appreciate our witnesses for being here. VA research has transformed care for veterans while advancing medicine. For all Americans.

As healthcare continues to evolve, it is important that VA remain a leader in research and innovation so veterans continue to have access to the best possible care. Mr. Chairman, thank you for your leadership on precision oncology and for recently introducing the Precision Oncology Program for Cancer, the PROSTRATE Authorization Act. I especially appreciate your proposal to designate the Little Rock VA Medical Center as a Center of Excellence for the PopCap program. Arkansas has built a strong partnership between the Little Rock VA and the University of Arkansas for medical sciences.

I believe it's well positioned to become a national leader in precision oncology and research care for veterans, as it has in the past. Dr. Kelly, in fiscal year '24 Consolidated Appropriations Act, Congress provided $5 million to expand the Precision Oncology Program for cancer of the prostate to additional VA medical centers and increased academic cancer center partnerships. It's my understanding that VA instead used those funds to establish a broader precision oncology research program covering multiple cancers. Can you please clarify the VA's view on the PopCap program and how VA is ensuring the original congressional intent behind the funding has been followed.

Thank you, Dr. Bozeman, for that question. So first, I can't comment directly on the legislation speaking to the POPCAT, but to answer your question, when we were looking at the assignment that was given to us through the Cleveland-Dole Act, was passed in '22, about how to manage the, the PopCap and the future of that, we looked to our knowledge that we'd gained from other types of systems integration so that we could expand the PopCap effect across the entire enterprise. So we looked particularly to LPOP, which is the Lung Precision Oncology Program, which was at 114 sites, and we said that that was a good model that we knew worked. That model had done two notable goals that I thought were relevant to PopCap. One was molecular testing.

So for lung cancer, the testing rate had increased, as most recently, up to over 80%, which is higher than pretty much everybody else in the country.

And the— so that was one thing. So we noticed that the molecular testing rate was able to go up. And for prostate cancer, the molecular testing rate is still struggling. The centers that are identified in the POPCap— so there were 14 initial centers that were identified by the Prostate Cancer Foundation, and then VA, in collaboration with PCF, identified an additional 7 to increase the geographic coverage. Distribution.

And so what we saw was that even with those 21 sites, we could expand to over 100 sites, which is what we've done through the CCRN, the Cancer Clinical and Research Network. So that was one aspect of that. And we also saw that LPOP was able to roll out basically from nothing to over a million lung cancer screens. So we could impact every place in the entire country, and we thought that was the best model. So that's what we built the expansion of POPCap on, and then we also were able to roll in other programs that we had used in the past, such as the molecular testing program called NPOP, which provides all of the testing services.

It also does—. We also have germline. No, we appreciate that. I guess the question is, did we use the money? Was the $5 million—.

Yeah. So that money was used as we—. Yes. According to congressional intent. I think it was.

So that money was on the research side, I believe. We used the clinical money to support the clinical operations, obviously, but the $5 million was for research to be directed in that fashion. And that was what I understand was the basis for using that money to expand specifically for prostate cancer. So the CCRN mission and the selection of sites identifies only one cancer that they have to do, and that's prostate cancer. Very good.

Thank you. Senator Blackburn. Thank you, Mr. Chairman. Thank you to you all for Being here, Dr. Zhang, I want to come to you. I represent Tennessee.

And we have a wonderful program that takes place between Vanderbilt University and the VA. And of course, as you know, the Tennessee Valley Health Care is right there on the Vanderbilt University campus. And that system, that VA system there has more than 60 researchers that hold dual appointments at Vanderbilt and at the VA. And they're supporting over $50 million in VA-funded research. And we know, as you were talking with Senator Sheehy, this benefits veterans all across the country, and we appreciate that. What I'd like to hear from you all is what strategies are you looking at to really increase these partnerships, these centers of excellence, and to build this out further. I think that having these partnerships with research institutions like Vanderbilt is going to be much more helpful than just trying to stovepipe some of your work.

Thank you, Senator Blackburn. I, I want to first acknowledge that the incredible work happening in the Tennessee region, particularly when it comes to an incredibly strong VAMC partnered with an incredibly strong academic affiliate, particularly in fields like informatics and also in cancer are really some opportunities to partner and think about what's next. Behavioral health. And behavioral—. I will add.

Of course. And of course in Nashville, there's just so much expertise in healthcare just in general. The business of medicine really is in Nashville. I think that as we think about the future of research and and frankly, academics and innovation at VA, we have to think about setting foundations and infrastructure. And the first 100 years of research at VA has been pretty incredible.

I've heard it time and time again. I've said some of the big wins. We have more. And I think as we think about the future, we have to be flexible and we have to think about how we partner both with incredible academic groups but also with others to make the future happen in America for veterans. So I don't have anything specific to say about how we're going to do that at Vanderbilt other than actually just good timing.

So a couple weeks ago, we actually just had a great intro conversation with the Vanderbilt University senior leaders. So our— see, I think a strategic plan that you're building out would be important. So What are you doing with planning for centers of excellence in different disciplines in healthcare? Thank you, Senator Blackburn. That's actually what I was going to get to, is that the purpose of that conversation was to talk about that specifically and how we could find that synergy between the incredible work happening at Vanderbilt to the incredible work happening with our VAMCs and also our enterprise of research.

And then how are you engaging medical school students when you're on a campus like Vanderbilt. So how are you doing that engagement to encourage these that are getting ready to go through a residency and into practice to stay engaged with the VA and veterans health? Thank you for that question, Senator. I think that's a great point. So, um, I don't have the specifics on the exact residencies that we have with our Nash— sorry, our Tennessee VAMCs.

But I will say that our academic affiliates, we, we have well over approximately 90% of all medical schools, if not more, affiliated with VA. So clearly building the pipeline, yes, whether it's for clinicians, our researchers, or both, we have to leverage these pieces together. And actually, that's part of the value I would say which is unique to VA, is that our Dean organization has both research, academics, innovation, and partnerships all together into one group. And my intention is to utilize those in a synergistic way to build the future. Okay.

Ms. Pryor, am I saying your name right? Pryor, ma'am. Pryor. Thank you so much. Okay, so you're in charge of human capital management, correct?

Yes. Does this include the union employees? Yes, it does. And how many union employees are there in the VA now? I would have to take that back for the record, ma'am.

Okay, let's get that for the record. I would like to know— I also want to know how many full-time or full-time equivalents are actually showing up to work and working in person 5 days a week. One of the biggest complaints that we get in our offices— and I've got 6 offices in Tennessee— is the fact that VA caseworkers are very slow to get back to the veterans. And I know that the Secretary has done an amazing job working that backlog down. It was about a million case backlog when Secretary Collins came in, and I think they're under 200,000 in the backlog now.

But the employees, the rudeness, uh, the lack of caring, the being focused on themselves and not on the veteran— this is something that as a team We need to work on and we need to correct that. The VA is about the veteran first and foremost, and those employees are there to serve the veterans. So if we could get that information and if we can be helpful in making certain that we have a service-oriented approach to our veterans, I would be ever so gratefully appreciative and Thank you all for being here and for your work to serve our veterans. Yes, ma'am. Happy to take that back for the record and respond to you.

Senator Blackburn, thank you. Senator King.

Chairman, I apologize for being late. Perhaps we could apply AI to figure out how senators don't have to have 3 hearings scheduled at the same time. As you know, I'm very sympathetic because I should have been where you were. That would be a challenge.

I guess my first question is, it appears that this year's proposed budget is over a $40 million cut in various research lines. Is that accurate? Thank you, Senator King. Actually, respectfully, I think the number is about 2%, which is $23 million for the FY26 presidential budget. And that's largely reflecting the multi-year nature of medical research and is about contracts and personnel attrition, not program cuts.

So there's— you would argue that, well, a, a 2% cut in a 3.5% inflation world is really about a 5.5% cut in resources. Am I wrong?

Thank you, Senator King. Have less real dollars to spend next year on research than you did on last, last year. You know, I think it doesn't change the, the mission of the Office of Research and Development, which is to support veteran-focused research as best as we get that. But it's a diminution of resources, is it not? It's 2% below last year, and it's largely affecting contracts and attrition.

And in 3.5% inflation, it's 5.5% below last year in real dollars. What's the status of personnel? How many FTEs were engaged in research a year ago, and how many— or let's say, how many FTEs were engaged in research in January of 2025, and how many today? Thank you, Senator King. So at FY25, ORD funded 3,531 researchers out of roughly 7,000 VA researchers total.

If you want the actual numbers to your specific question, I'd have to take that for the record and get back to you with the actual numbers. Appreciate it if you would. And I differ somewhat with Senator Blackburn. I know people that are doing research. They don't necessarily have to be in an office in a VA facility to do research.

In fact, in some cases, that is not where they want to be or where they should be. So I, I, I want to I want to note that. What's the relationship of VA research to NIH?

Thank you, Senator King. I think we work with NIH and our VA researchers get funded by NIH, and I think we have a very collaborative nature with them through both the macro level, through large initiatives, to just the individual researcher who can get funded both intramurally through VA funds, through our research budget, or through outside, extramurally, through things like the NIH. I know that this administration has gone to some lengths to end what it calls DEI programs. Would a VA research program regarding women's health, menopause in women veterans, would that be considered a DEI project? Thank you, Senator King.

Um, I, I can say that, uh, our women's health research continues to be a very important part of our portfolio. Our budget proposed for next year is unchanged. We serve all veterans, so the goal is to focus on taking care of veterans, including our women veterans. Does that also include Black veterans, if there are special health needs that they might high blood pressure, for example, is— would that be a DEI project? Thank you, Senator King.

Um, we serve all veterans. In fact, actually, one of the big kind of accomplishments for VA research in our first 100 years is some of the work that, uh, was fundamental to figuring out that high blood pressure could be treated to save, uh, and improve people's, uh, risk of getting strokes and heart disease came from VA. So no VA projects have been canceled because of their perceived relationship to DEI. Is that correct? Is that what you're saying?

I'd have to take that for the record and get back to you. I'd appreciate it if, if you would. And to what extent— you, you wanted to take for the record the number of FTEs, but I presume that over the past year— well, first question, is the hiring freeze still in effect? Uh, thank you, Senator. The answer is no, but I'm going to pass it off to my colleague Miss Preer Please, Dr.

Zhang is correct, Senator. There is not a hiring freeze in VA. There was, correct? There was. And when was that terminated?

When we— when were people allowed to start rehiring? I would have to take that back. The hiring freeze started with the executive order. I don't have the exact date when it was lifted. And do you know how many people, uh, were— how many vacancies were created by the hiring freeze, and also how many took the fork in the road letter?

I can take that back for the record. I can share that our attrition rate for fiscal year 2025 was at 11%, and that is significantly higher than most years. Right now we're at 5.9%. But 11% attrition when there's a hiring freeze is a real loss of people, right? Yes, Senator.

Thank you, Mr. Chairman.

Thank you very much to our panel. We have votes at 5:30, and so I'm going to move to the second panel. So again, we're grateful for the time you spent with us.

I welcome our second panel to the witness table.

That panel consists of Ms. Gina Carrithers, President and CEO of the Prostate Cancer Foundation, Dr. Glenn Graham, Founding President of the Association of VA Neurology Services and former VA Executive Director of Neurology Clinical Programs.

Dr. Graham, thank you. Uh, who did the witnesses that were just here? Why aren't you staying to listen? Oh, there's one. No, they're here.

There she is. Good. Okay. All right. Always, uh, the detective.

Uh, thank you much, very much for being here, both of you. Uh, Dr. Graham, you're now recognized for your testimony. Thank you very much, Senator, and thanks to the committee members. I appreciate the opportunity to comment on the future of VA research. After 35 years of federal service, I retired from the VA on September 30, 2025, as the executive director of the National Neurology Clinical programs.

My testimony expresses my own opinions, informed by my years of VA service, my experience as a VA researcher, research supervisor, and mentor, and as current president of the nonprofit Association of VA Neurology Services. Research provides the hope that our children and their descendants will lead longer, healthier, more productive lives in the future. VA investigators, as has already been mentioned, have done great things. They developed the radioimmunoassay, they established liver transplantation, and anti-rejection treatment that contributed to the implantable cardiac pacemaker and developed the nicotine patch. VA-led research has particularly focused on advancing rehabilitation, functional electrical stimulation, powered prosthetic limbs, and advanced prosthetic arms.

VA-funded basic research established the scientific foundation for the first mechanistically new therapy for pain in over 20 years. VA is a recognized national and international leader in implementation science research. These accomplishments and many others have clearly benefited veterans and us all. However, recent changes within VHA have the potential to adversely affect the future of VA research and other VA services that benefit from the VA research enterprise. The approximately 2% proposed average cut across FY 2027 in the research budget is unfortunate.

While it may seem modest on the surface, the impacts are likely greater than the magnitude suggests. The NIH projects an approximately 2.7% rate of biomedical research inflation, so the loss of research purchasing power is closer to 5% than 2%. At a time when other traditional funders of research such as NIH are undergoing major changes, the VA research budget takes on even greater importance. Even including VERA offset support, research expenditures represent only about 1% of the total VHA budget. This small investment in the future of veterans' healthcare clearly has yielded enormous returns.

Funding and protected time for research in VA, as well as access to the wealth of clinical and genetic data available within the VA integrated healthcare system, has been a reliable incentive to attract and retain highly skilled researchers, including physician scientists in difficult-to-recruit specialties such as neurology, who otherwise would be unlikely to consider a VA career. These physicians also deliver care to veterans that is often only available after lengthy wait times in the local community, if it is available at all. Without them, specialist wait times will lengthen and access will decline. VA remains essential to training the next generation of healthcare practitioners. Fellowships that train subspecialist physicians include both clinical and research work.

The research component requires an active research portfolio and experienced intramural mentors supported by VA research funding and protected time. Without this, VA will not be competitive in attracting fellowship trainees. Also, certain programs like CDAs provide critical early career bridge enabling young investigators to propose research and launch their VA research and clinical careers. Another concern is the current work environment and culture within VA. Given the perception of changes within the VA system, recruiting clinicians of all sorts is becoming increasingly difficult.

Well, current policies and staffing models prioritize clinical care of veterans appropriately, but often to the detriment of the other congressionally mandated missions, including research. Clinicians interested in incorporating research or teaching in their practice will look elsewhere if such careers are no longer tenable in VA, especially given the lengthy, lengthy hiring process and less competitive salaries. Additionally, cuts and hiring restrictions are adversely impacting essential research. Staff. The current way of counting VA physician staff puts VA medical centers that employ research-engaged physicians who divide their time between VA and an academic affiliated institution at a disadvantage.

The current push to move a larger proportion of veteran care to the community also works against human-centered research in VA. Veterans referred to multiple community practices do not learn about relevant VA research, denying them the opportunity to participate. Their data are lost to the VA system. Decreased participation deprives veterans with serious medical conditions of treatment options and delays progress in VA clinical research. In summary, veterans, the institution of VHA, and the public have benefited greatly through VA's robust research program over the years. Congress wisely established the four missions of VHA: clinical care, education and training, research, and emergency preparedness.

These vital missions are mutually supportive and to a considerable extent inseparable. I respectfully request that the VA research mission continue to receive robust funding and policy support, both for its own sake and to allow the other VA missions to succeed. I've submitted some additional testimony as written materials only. Thank you for your attention.

Uh, thank you, Doctor, for your appearance before us today, and Uh, now Ms. Carruthers.

Thank you, Chairman Moran, and to the other members of the committee. My name is Gina Carruthers. I am the president and CEO of the Prostate Cancer Foundation. We represent the largest private research philanthropy in prostate cancer, having been founded in 1993 when in fact there was one drug that treated prostate cancer. Androgen Deprivation Therapy.

We've raised more than $1 billion since 1993 that has gone directly to research for therapies that will extend the lives of men impacted by this disease. That has generated today, under our seed funds, at least 16 FDA-approved therapies. Give you a bit on the prostate cancer's impact on our veterans. Prostate cancer is the most common cancer in our U.S. veterans. There are about 200,000 veterans who are living with this disease.

About 15,000 are diagnosed each year and treated within the VA system. And I'd like to emphasize that prostate cancer is not screened for in the VA. Um, in the U.S., it's largely not screened for at this time, but it's important to note that the program that we talk about today, Pro— ProPCAP, is actually targeted for advanced disease. That's disease that has left the prostate because it's not been diagnosed in its early stage.

The ProPCAP program has been developed specifically to address the men whose disease has moved beyond the prostate. And this is where men are at great risk for death from this disease. The way this program works is that we take genes from the patient, their DNA, and we also, when we have biopsy tissue, take the biopsy tissue and look at somatic mutations, those specific to the cancer itself. This allows for targeted treatments, treatments specific to either the man's DNA or, in fact, to the cancer's DNA to then be targeted to treat and extend the life of that patient. I'll give you a background on POPCap.

To fill the gap in 2016, the Prostate Cancer Foundation pledged $50 million to pioneer a large private-public partnership within the VA. And that's where POPCap came from. The result was a network of centers of excellence and that's been addressed a little bit. They're invested in both clinical and research teams that work on genetic testing and counseling of the men with offering FDA-approved drugs that target prostate cancer mutations and a chance for the veterans to enroll in clinical trials specific to the new treatments for these prostate cancer treatments. We've seen that across this— era that we've generated 27 clinical trials that have yielded more than 850 peer-reviewed publications. PopCap's success is tangible.

In one study, veterans treated at a PCF VA Center of Excellence were 50%— 57% more likely to receive precision testing and care than veterans treated outside the VA. 3 times more likely to receive testing compared to before PopCap started. As one example, here's a story of a West Point graduate and an Army veteran with advanced prostate cancer. When he did not respond to standard treatment, his center of excellence doctor ordered the precision testing. A drug was identified that would work in his specific cancer, and up over 5 years later, This veteran is alive, enjoying his family and his 2-year-old granddaughter. That's the impact of finding treatments that work on genetic mutations.

Since PopCap's finding, PCF's commitment to this program has risen to $65 million, driven entirely by private philanthropy. The PopCap Authorization Act of 2026 would deepen this to a permanent establishment that within the VA requiring at least one center of excellence in each region that the VA serves. The act will also require every center to employ a full prostate cancer clinical team and dedicated research staff, enabling more veterans to access precision testing, targeted treatments, and clinical trials no matter where they live. Each of our veterans dedicated his life for the safety and freedom of our country. They should be the first, not the last, to benefit from our medical breakthroughs and modern precision cancer care.

The PopCap Act of 2026 will drive this care, advance clinical trials, and benefit men, the women in their lives, and their families nationwide. It will amplify the impact of private philanthropy, helping protect the PopCap program And the Centers of Excellence now will offer this for our future generations. Thank you for your attention. Ms. Gruthers, thank you to you and to your foundation for the important and valuable work, life-saving work that it does. Thank you for the support of the POPCAW 26 Act.

Let me ask you about the How do you— let me ask it this way. What was the vision of the Prostate Cancer Foundation when it created the partnership with the VA, and is the VA fulfilling that dream of the foundation? So thank you, Senator Moran. That's a great question. I think the Prostate Cancer Foundation had the vision of bringing into our veterans the leading-edge cancer research and the defensive treatments that they— men could be offered who are— have prostate cancer in the VA. And that vision has been sustained, and we look at it as wanting to be continued to be sustained because men and their families have definitely benefited from— once you're diagnosed with this disease, to then understand your genetic profile and then to understand what treatments may work when standard treatments don't work.

And so from our perspective, it should be a sustainable program. And so, yes, our vision is being realized. We're continuing to work with our VA clinical trial organizations across this country, and we're continuing to support their efforts and support their efforts in terms of publications. Communication dissemination of their great research. The VA has also been a terrific partner in this.

They've been able to establish the clinical trial researchers in these programs, and they've been able to help them develop careers within the VA that are essential to the treatment for men with prostate cancer. You mentioned screening, but I'm not sure what the point was. We don't screen at the VA, we don't screen in the United States,— was there a point to be made to us in that regard? I really appreciate you asking that, Senator Moran. Today, in, in 2012, in the United States, the US Preventive Task Force Services made a decision to stop screening for prostate cancer in this country.

At that time, roughly 1% of our men in the United States were diagnosed with metastatic disease. That's disease that's left the prostate and is now in the bones and the lymphatic tissue, perhaps of the patient. Today we're roughly diagnosing 22 to 25% of our men in this country with advanced metastatic disease. Disease that leaves the prostate is far more challenging to treat and typically requires lifetime treating. Screening— early detection is a simple blood test.

And so when we move away from a simple blood test to screen men to see if they have elevated PSA over time, We lose the opportunity to have an early intervention, and hence we're chasing advanced disease. We focus on making drugs for this part of the disease. However, if we could bring back screening and we could implement screening in the prostate cancer population for men and the veterans as we've done with lung cancer, screening is essential. Early diagnosis leads to effective outcomes. In prostate cancer, 99% of our patients are cured when they're diagnosed early.

And today we're seeing 25, 22% of our men with advanced disease. In my own annual physical, uh, not to get personal, but, uh, there seems to be confusion. I'm often given the option, uh, rather than the doctor telling me what I should have transpire. Uh, and so I, I hope that there is the correct standard. Apparently there's disagreement or uncertainty about what you just said.

Is that true? So thank you, Senator Moran. It's an interesting situation. In 2018, the guidance came back for U.S. Preventive Task Force services to call for, um, shared decision-making. And shared decision-making leaves the patient responsible when in fact there's time in the primary care office for the conversation to ensue.

But in many cases, if we have men who have cardiovascular disease and other health challenges, the restriction of time inside your physician's office may not lead for that time to talk about what screening could be. Okay, uh, thank you. Uh, I just have a couple seconds left, uh, Dr. Graham, but let me ask you two, two quick questions. Um, less competitive salaries you mentioned. How less competitive are the salaries or were the salaries in your time at the VA?

Thank you for the question, Senator. You know, one of the challenges— this is certainly— there's a lot less— salaries are lower than income in private practice. Academic salaries, depending on the specialty and the institution, vary greatly.

I think, you know, one factor that we often face is particularly among junior physicians. Junior physicians often leave training with a large amount of debt. Some of the advantages of a VA career, not only in the terms of work, but in terms of, of long-term benefits, are things that come with a lifetime career. But often our junior physicians are focused on getting their families started, buying a home, paying off their educational loans. So often the problem particularly is when there's even a small amount of money early on when young physicians are facing a lot of debt is a big deterrent to hiring.

That makes sense to me. Senator Blumenthal.

Thanks, Mr. Chairman. Uh, thank you to the witnesses who are here now and to those who testified on the first panel. I apologize that, uh, I had a conflicting obligation, and I'm going to ask, uh, that my opening statement be put in the record. Without objection. Thank you.

As I say in my opening statement, I'm concerned about the effects of staffing cuts, shortages in funds for research, various actions taken by this administration that may inhibit or impede the kind of research that is done by the VA in the past. The VA has been a pathbreaker, an innovative force in American medicine. It has been a source of basic science progress and health systems research, um, really a bright star in the constellation of resources in our healthcare system in the United States.

Uh, Dr. Graham, I'd like to ask you, uh, you've had a long history in the VA, distinguished, and thank you. Before you left the department, how would you characterize morale among your VA colleagues, including those conducting research? Sure. Well, thank you for that question, Senator Blumenthal. I would have to say that, uh, staff in general were under a great deal of stress.

Particularly our researchers were concerned that with hiring delays, with loss, with attrition of staff, particularly support staff, which could be laboratory staff or clinical support or research office staff, as well as increased demands on the physicians to devote themselves just to the clinical mission of the VA and not get time for research, there was a lot of concern. More broadly, among other staff, there was, I'd say, more specific anxiety and fear. There was fear of reductions in force. There was fear of job loss. And I know this fear, particularly when there was opportunities to take early retirement.

There were folks, good folks that we lost in the organization because they were afraid that if they didn't take that option and they were riffed, they would have nothing. Uh, you know, I think in general it was difficult because I think people in the VA by large, at least those that I work with, were dedicated civil servants. They felt that federal service was an honor and a privilege and a duty to veterans. But yet somehow the federal civil servants, even including in the VA, were treated somehow as a public enemy. And that created a hostile work environment that I did not understand.

I can say that I had staff people that reported to me that were more upset and distraught and anxious than I have ever seen in my professional career. And clearly, in a healthcare organization, Senator, it's very important that you have psychological safety, that you be a high-reliability organization, that staff— and here I'm talking not just of research staff, but clinical staff, nurses, doctors, whatever— are safe to report errors, to point out potential areas where inefficiencies occur or harm could occur. But in a context where people are more afraid of losing their job or reprimanded or scapegoated, that doesn't foster a culture of safety, and that's bad in healthcare. Thank you. As I mentioned in my opening statement, as you're well aware, I'm sure, the department in its 2027 budget request cuts funding by $42 million for research.

Can you think of any justification for that kind of cut? No, in fact, Senator, I can't, particularly given the accomplishments of VA. I think this comes at a very bad time. It's already been alluded that other federal sources of funding, including NIH, are facing great uncertainties now. VA research being a constant, you know, Reliable source of support for research helping veterans certainly would be, would be very welcome.

And I think the VA return on investment has been very good. Recall that the VA, if we look at VHA budget, only 1% goes to research. That's not a big investment considering the yield, in my opinion, Senator. Ms. Carruthers, if I may ask you, will that kind of cut in research impact the precision oncology program for cancer of the prostate, um, in your view? If the cut is taken across— excuse me, Senator Blumenthal— if the cut is taken across the board, absolutely.

Um, prostate cancer, the precision oncology advancements in prostate cancer are phenomenal, and they benefit our veterans, and they benefit, frankly, all men in our society. Because you not only get a treatment that works against your cancer, it extends your life and the quality of your life. And so for that, we would see that those cuts would have a detrimental impact on our prostate cancer precision oncology research. Thank you. My time has expired, but I thank you both for your testimony.

And, and to the chairman, thank you for having this hearing. Very important. Thanks, Senator. Senator King. Thank you, Mr. Chairman.

I'm— this is a basic question, not about research, but it provoked by your comments. Do veterans as a— veterans who are enrolled in VA healthcare have routine annual physicals at the VA? Is that part of the VA medical structure? Do you know?

Senator King, if you're asking me, I do not know if that's a part. Of the normal structure. Anybody here that knows the answer to that? Well, I can comment that based on my time in VA, generally we have a system where every veteran, with few exceptions, should have a primary care provider and panel, and they should get annual reviews. But I'm just wondering if that's just a routine, sort of a routine physical.

Is that— who can tell me? Several people nodded. Is that a policy of the VA health system or not? Nobody knows. We'll find out.

Take it for the record.

I'm astounded that they don't do PSA tests. I mean, it just— that makes no sense. I understand there's a problem of false positives, but there are ways to deal with that of doing them over time, and you can do a biopsy.

Because I love the work that your foundation has done, But the best intervention is the one that happens early as opposed to later when it's much more high risk and more expensive. Shouldn't we be doing PSA— veterans PSA tests routinely? Senator King, thank you for the question. I think it's an extremely important component of basic healthcare for all of our men in this society and anywhere. There's— when you look at data for screening, you can make an argument, does it benefit overall survival, which is the metric.

The challenge is, if we're diagnosing men in their 50s, it clearly is yes. Because if you get metastatic prostate cancer, your cert— time for survival with aggressive disease is 7 to 10 years maximum with the best drugs today. If in fact you have a mutation in your disease that goes undetected, then your death can happen within the first 24 to 36 months. So the answer is yes. Clearly, if we had early detection, we're saving lives of our younger men in our society.

Does it work? Do we get that same benefit for men in their 70s? Well, the argument has been that they don't get aggressive disease. The challenge is the men that we're looking at, a man diagnosed last year at 72 years of age, a veteran, had a CDK12 mutation, which is a very aggressive mutation for prostate cancer. He also had a KRAS mutation, which is rare for prostate cancer.

His cancer was already outside the prostate. In fact, the treatments and his overall survival time now, will probably be 75 years of age. But if he had been screened at 55 or 60 or 65 whenever this, this problem arose in the first place, it would have been much more treatable, would it not? That's absolutely true. Whenever we diagnose prostate cancer in the early stage before it leaves the prostate, we have two very common treatment methods.

One is radiation therapy, one is surgery, and they both have very similar outcomes. And in fact, you know, this is the simplest, and for those men we see from the American Cancer Society's publication on statistics, you have 97 to 99% cure at 5 years. The prostate cancers that will recur are those that are high-risk disease. Then you have the option to find it and treat it again. So that's a smaller proportion of our men.

Thank you. Uh, Dr. Graham, I, I must say I I found your testimony disturbing about the effect of what's been going on, on the morale and recruitment retention within the VA health system. Our veterans deserve the best care possible, and that means the best providers possible. And if good providers are leaving or are not joining, that's a long-term problem that should be addressed. I hope the administration will take steps to rectify that, what has been a morale killer over the past year.

Sure, Senator King, I absolutely agree. I was, even at the time when I was still at VA, I was struck by the fact that people who had gone through the entire recruitment process up to basically signing on would sometimes decline jobs. I tried to get a specific percentage of that, it's hard to know. Although one media source said that early in the first part of 2025, there were about 40% of jobs offered to physicians in the VA were declined. So I think this is a real concern.

Thank you. Thank you, Mr. Chairman. Thank you for having this hearing. Thanks to members for participating in today's hearing. I'm sorry we have our schedules that exist as they do.

And thank you both for your testimony. Ms. Crothers, I think you, uh, with 3 members of the committee that are still here, 3 males in an age that, uh, uh, are as important for us to hear what you had to say. Yeah. Uh, let me ask either of you if you have anything you'd like to add to your testimony or anything you'd like to tell us that we haven't asked you about. You comfortable with where you are?

Just one or two points, Senator, if you can indulge me. Uh, we talk about this budgetary cut, 2%. VA brings in approximately half a billion dollars in non-VA research funds from NIH, Department of Defense, private foundations, even the private sector. I worry if our research enterprise in VA is deprecated. In other words, if people leave, if startup times are slow, if research support staff and clinician scientists are not there.

We will lose more money to the VA in these other sources of funding by far than the 2% that's being cut. So I worry about that, you know, because I think research has, has done wonderful things. I also worry about veterans losing the opportunity to participate in particularly clinical research who may be sent to the community scatter all over the place and never hear about research conducted at the VA of whatever sort to which they might participate and benefit. I think that's contained in my written statement, and I'll leave it there. You said that earlier, Doctor, and I made a note of it, and it's— in my mind, it means community care is a portion, a part of the VA system today.

How do we rectify the challenge that might be added to a veteran who is generally cared for in the community. That's often people that come from my state in rural areas. How do we make sure they have the information and awareness that the VA has trial programs and can participate in research? And so I made a note, and maybe you can help us with the answer to that. No, I agree.

I think for this to occur, it's going to take a concerted effort, a much greater effort to outreach to veterans getting all or most of their care in the community, that they can still participate in VA research research of various sorts, and I don't think that exists yet. Okay, uh, Senator Blumenthal. Thanks, Mr. Chairman, and, uh, again, my apologies for my late arrival. Um, I, I just want to put on the record that I am continuing to work for a bicameral and bipartisan agreement to advance our shared priorities, and I emphasize shared priorities, In the Take Care of America Veterans Act, particularly the Major Richard Starr Act, which both the chairman and I support, I will ask again at a time when we agree it is possible for passage by the Senate of a modified version of the Take Care of America Veterans Act My proposal will replace the Major Richard Starr Act language in that bill with my legislation to fully repeal the wounded veterans tax. It uses unobligated DOD funds from H.R.

1 To offset the cost of the bill, striking the controversial offset to cut more than $56 billion in future benefits for disabled veterans who suffer from sleep apnea or tinnitus.

Yesterday, in his testimony before the Appropriations Committee, Secretary Hegseth said there are about $75 billion in unobligated funds from HR1, and he said that not all of it could be obligated by the end of the year, which supports my view that we should utilize a portion of that appropriated, already appropriated, DOD funding in H.R. 1, Which is the best and bipartisan alternative to the current offset in the Take Care of America's Veterans Act. So I'm hopeful that we can move forward on that substitute version. And again, I look forward to working with my colleagues on both sides of the aisle in an effort to, to pass it through the Senate as quickly as possible. Thanks, Mr. Chairman.

Senator Blumenthal, thank you. I too share a view of finding a path forward on the Richard Starr Act and an opportunity to address a number of issues, 60-some pieces of legislation that are included in bipartisan pieces of legislation. One of them was mentioned by Senator Murray today as a priority of hers in regard to menopause and women. That's a bill that's included in the Take Care of America Act, Veterans Act. And I look forward to finding that path that not only takes care of the Richard Starr Act, but this broad array of widely supported by VSO and by veterans across the country, pieces of legislation.

The challenge we've had— we have had 6 years of people sponsoring the Richard Starr Act, 6 years in which people have said we're for the act, but it has failed to pass year after year after year. And in part, that is because there is not an offset to pay for, which is required by law, those provisions, not only in the Richard Starr Act, but in the other provisions in the legislation that's now included in this package. And we ask again today the Congressional Budget Office if the pay-for that you are suggesting is something that counts as a pay-for under the PAYGO Act passed by Congress years ago, and the answer was no. And so I worry that we're on this same path of having a conversation, let's, let's do this and get it done, and we end up in the same position that we've been in. For a long time.

And again, I look forward to you and I having another conversation. We haven't talked one-on-one much about this since the act was introduced. We've continued to work to see if there's a way that satisfies the needs of the law but results in an outcome as compared to words that say we're for something, but again ends up with no result. So again, I want an outcome and working to achieve that. I think we share that view, Mr. Chairman, that we want an outcome.

And I just make clear that the only change that I am making in the Take Care of America's Veterans Act is in that pay-for, so as not to deprive disabled veterans of funds they need and deserve for a veterans pro— for a Department of Defense obligation. We should not be making veterans pay for a Department of Defense obligation. And I think that we have the authority to take that money from H.R. 1 And use it in a way that serves the interests of our veterans and approve all of the Take Care of American Veterans Act programs. They are worthwhile and important.

We agree on that point, and I look forward to continuing our conversation. We will, and just for a slight moment longer right now, um, that I, I am so interested in getting the Richard Starr Act and these other pieces of legislation completed, passed by Congress, signed by the president. This is not jurisdiction. This, this issue of the Richard Starr Act is not jurisdiction of the Veterans Committee. Senator Blumenthal is looking for a defense pay-for.

It belongs— the issue, uh, by jurisdiction arises in the Armed Services Committee, of which he is a member.

Uh, and we'd be glad to have you accomplish this, and I know Senator Blumenthal tried in a markup just a few weeks ago to get this done, unsuccessfully. But because it is such an important opportunity for us to meet the needs of veterans, I'm looking for a way that has a result and that we can accomplish. Again, we agree on that. Free annual physicals for VA. I'm glad you have a suggestion, Senator King, and we're happy to consider, but My only point is that this is such an important issue that we need to find ways to reach a conclusion when we've been unable to do so for so long.

And my mom was a— what's the word— baby notch. And she accused me, her congressman, of just delaying until she was no longer alive. And I tried to convince my mom that that was not the case, but that legislation took took years to, to come to fruition. She was dead. And I want to make sure that the veterans who would benefit from all that legislation, but particularly from the Richard Starr Act, are still living by the time that Congress is able to act.

And just for the record, Mr. Chairman, as, uh, Senator King knows because he was in the markup, I was denied a vote. We never had a vote in the Armed Services I would call that, Senator Blumenthal, not a result. So we'll keep watching legislation. Our witnesses may be less interested in this topic than Senator Blumenthal and I and Senator King are. I know that people in the audience care about this greatly, and we're really engaged in trying to solve a problem that has existed for a long time.

No other questions? I want to once again thank our witnesses. It was very useful testimony. Thank you. Thank you.

Thank you. Each member has 5 legislative days in which to submit statements or questions for the record. We heard that a number of those were going to be submitted, so we'll be asking you to respond to what you said you would respond and maybe other things. Any senator who would like to submit such a question for the record, please do so in a timely manner. And I ask our witnesses to respond for the record, uh, questions they've received, and also in a timely manner.

And with that, our hearing is adjourned. Very good. Nice to meet you.