tv House Appropriations Subcommittee Holds Hearing on Veterans Health CSPAN April 20, 2021 5:40pm-7:13pm EDT
go to c-span.org/coronavirus for the federal response to the coronavirus pandemic. if you miss our live coverage, it's easy to quickly find the latest briefings and the biden administration's response. use the interactive gallery of maps to follow the cases in the u.s. and worldwide. go to c-span.org/coronavirus. next, a look at issues facing the veterans health administration including mental health, suicide, women's health and homelessness. the house appropriations subcommittee hearing is about an hour and a half.
>> i'd like to call the meeting of the military construction, veterans affairs and related subcommittee to order. thank you for participating in this hearing. before we begin, as this hearing is fully virtual, we must address a few housekeeping matters. for today's meeting the chair or staff may mute participants' microphones when they are not under recognition for the purposes of eliminating background noise. members are responsible for muting and unmuting themselves. if i notice you have not unmuted yourself i'll ask you if you'd like the staff to unmute you. if you indicate approval by nodding, staff will unmute your microphone. the five-minute clock still applies. if there's a technology issue, we'll move to the next member until the issue is resolved and you'll retain the balance of your time. you'll notice the clock on your screen that will show how much time is remaining. at one minute remaining the clock will turn to yellow. when your time has expired the
clock will turn red and i'll begin to recognize the next member. in terms of speaking order we'll follow the order set forth beginning with the chair and ranking member. then members present at the time the hearing is called to order will be recognizedlterning betw majority and minority. we have set up an email address to which members can send anything they wish to submit in writing at any of our hear,s or mark-ups. that email has been provided in advance to your staff. today we welcome back to the subcommittee, dr. cameron matthews, from the veterans health administration. she's accompanied by dr. david carroll, executive director of the office of mental health and suicide prevention at the veterans health administration. dr. patriciania hayes, chief officer of women's health and ms. laura duke, chief financial officer at the veterans health administration. today's hearing will cover some of the areas of care at va that
are essential to veterans' overall well-being. women's health, mental health and suicide prevention, whole health and homelessness are some of the areas this committee has emphasized improving and expanding. we're all proud of the work we've done to achieve that. this hearing will give us a chance to receive an update on how the efforts are going and what we should be looking to pursue in the coming fiscal year. once the president's budget is released we'll have the opportunity to dive further into the questions of future funding with the new secretary when he comes before our committee. in addition to investing the resources to help these programs succeed, this committee is also focused on oversight in each of these areas and such oversight simply cannot wait. there is too much work to be done to ensure that our veterans are receiving the services they need. these programs all come together to help va provide care and services in the comprehensive way that is required. all programs received increases
over the prior year in fy-2021 appropriations act. for example, the appropriations act enacted in december provided nearly $661 million for gender specific care for women. an historic high that reflects the need to support the fastest growing group of veterans at the va. in fact, women's health at va should not be considered in my view specialty care or a nice bonus in some facilities. it should be built into the system at a fundamental level and put into practice consistently across the va health care system. if we want to encourage veteran women to get their health care at va facilities we need them staffed with women specific providers and health care teams and offer visible programs that address health care issues facing women. they need access to va health care services and programs but they also have unique needs and benefit from tailored programs. areas like maternity care, gynecological care and gender specific conditions and diseases have benefited from an increased
focus at va. we want to keep making progress and move forward. likewise, we need to make greater product with the va mental health and suicide prevention programs. the rate of veterans dying by suicide is still deeply troubling as it continues to remain stagnant when it should be decreasing. what also concerns me is that data used in va's annual study is actually two years old. we aren't even getting a full picture of the current state of veterans dying by suicide. i know the va has been applying several proactive approaches to try and reduce these numbers such as keep -- seeking to keep them -- i look forward to hearing more about these efforts to prevent suicide as well as to make sure that every veteran who seeks out mental health care is getting it. no one should be turned away from care. we need to also make sure that care is of the highest quality. we are committed to ensuring that resources are available to
strengthen mental health programs and reach every veteran in need. in fy-21 we provided more than 10 bills for mental health programs and specifically for funds toward suicide prevention. this will help expand what's working and target gaps in current efforts. this is why i'm also so excited about the whole health program which supports a model of care that goes beyond treating the physical symptoms of diseases and works to personalize health care plans for veterans that consider the physical, mental, emotional, spiritual and environmental needs of veterans. i'm optimistic this model can help with a wide variety of veteran health care challenges like mental health, and i'm glad va has also seen the potential in this program. and finally, one of the most persistent challenges facing the va is that of veteran homelessness. va has made notable progress with the veterans experiencing homelessness declining by nearly half since 2010. but there is still more work to do, especially in light of the pandemic and its related
challenges. the c.a.r.e.s. act enabled va to direct $971 million to help homeless veterans impacted by the pandemic and provide nude -- provided new opportunities. the american rescue plan that passed earlier this week and is now law thanks to president biden's signature yesterday, includes funding to ensure that va has the resources to continue these efforts moving forward. pandemic or not -- pandemic or not, we must continue to work to reduce veteran homelessness and prevent veterans from sliding back into homelessness. all of these programs are at critical junctures. they'll continue to be our top priorities in this subcommittee for ensuring veterans health. i look forward to hearing from our witnesses about the work being done in these areas and what lies ahead. i'm now pleased to yield to our ranking member, judge carter, for his opening statement.
judge? >> thank you, madam chairman for this hearing today. the va's programs are very important to our veterans. this allows us to dig into some issues that we may not be able to do in a regular budget hearing. i think we all appreciate the opportunity to conduct oversight on veteran health care issues. oversight is missing in many instances, and we, i think, do a good job. i congratulate you for it. the testimony va presents today rightly highlights its notable acknowledgments in areas such as whole health care for women veterans. va even made progress especially in telehealth over the past year while engulfed in the pandemic.
of course, there's always more to be done and improvements to be made. before we get into those, let me express my appreciation to dr. matthews, as well as the other witnesses today, and all the va doctors, nurses and staff for the hard work and dedication to veterans. on a daily basis, you show this nation values that consider their sacrifice and service. before i go, i want to let you know, i just received a note. i never know for sure whether everybody sees my impact representatives when they come to town, but roger has become over the last 20 years a very good friend of mine. he always visits me. roger passed away yesterday. and his funeral is next week.
it's going on right now as we're holding this hearing. roger was a guy that can take serious issues and convince you of them, but he also had this fantastic humor that would always brighten your day. so if anybody knows him, if you have ever visited you, we lost a really good man to leukemia. thank you madam chairman for allowing me to do that. and i yield back. >> it it's my tradition and from mr. rogers, may his memory rest in peace. we are appreciative of his commitment and support for the state of israel and the u.s. israel relationship. okay, i don't believe either chairwoman the lower ranking member are here, so dr. matthews, you'll be the only
one that has actually is going to be completing the testimony. your full written testimony will now be in the record and you are now recognized for five minutes to summarize. >> good morning madam chair, ranking member carter and distinguished members of the subcommittee, my colleagues and i appreciate the opportunity to discuss how the uk provides a unified approach by leveraging all of our capabilities including homelessness, mental health and women self. a company today by my financial officer, dr. protegees, she fosters women's health and dr. david carroll, executive director of our office for suicide prevention. our commitment at va is to promote, protect and restore veterans health and well-being to empower and equip them to achieve their life goal and to provide state-of-the-art treatments needed. va provide a continuum of forward-looking -- residential an inpatient services across the country. services are integrated in order to ensure that the
veteran is at the center of their care, and then she or he receives those services when and where they are needed. both physical and mental health issues including opioid and other substance abuse disorders require overlapping, of integrated and -- as well as those services that stellar trans there associated social needs in order to prevent poor outcome. with your guidance and support, va has worked diligently to touch on the moon of most pressing needs amongst homelessness unlike veterans. the fund programs to help our veterans experiencing homelessness were housing insecurity. receives 760 million to provide emergency housing and homelessness prevention assistance, to mitigate the expected wave of evictions and potential homelessness that would've resulted from extensive unemployment during the pandemic. the emergency housing assistance included over 24,000 to hotel or motel placements that occurred since april of last year through january of 2021, reducing the risk of
covid-19 exposure for those vulnerable veterans. although it doesn't end there, va conducted a covid-19 testing with over 7000 veterans entering a residential program and has now vaccinated over 19,000 homeless veterans overall. the program received 170 million to support per gm increases to support -- and also a reduce risk of exposure in congregate settings. and finally, va you uses -- over 28,000 smartphones for homeless veterans to facilitate virtual access to providers, employers and landlords. sticking together, va's efforts have not addressed only helping the needs but their broader social, physical and mental health. va is leading the nation in the transformation from a system designed around episodic points of claire focused on lead management to one that is based on a partnership between the veterans and the va shape across time, focus on lifelong health well-being and resilience of veterans.
the whole health outcome of our evaluation other national electric facility, which were mandated -- demonstrated more rapid decrease in opioid me realization and improve quality of life, as well as an increased sense of meeting and purpose in life. among those veterans using the whole health approach. based on this effort, and building on the experience at the 18th -- rollout of whole health is well underway with an emphasis on integration of the whole health approach into all primary care and mental health clinical setting. it's the ultimate goal being seamless corporation into all va services. the current phase of the rollout includes 37 additional -- that are initially focused on a evaluation of specific dimensions of the whole health system. more women are choosing va for their health care more than before. with women accounting for more than 30% of veterans enrolled in the past five years. the number of women veterans using va take care has more than tripled since 2001. to dress the growing number of women veterans, we're who are
eligible for health care, va strategically and had services an axis for women veterans by investing 75 million and hiring and equipment initiative in 2021. via provides many services for women veterans including women specific areas of gynecology, paternity care and fertility services and mental health services in order to assist with military trauma. to provide the highest quality of care, va offers women veterans assignments to train and experience designated women's -- the providers offered general primary care and generally specific rhetoric or in -- national va satisfaction and quality data indicate that women who are assigned to women's health pcp have higher satisfaction and higher quality of gender specific care than those assigned by the provider. importantly, we also find out women also needs these -- twice as likely to choose to stay in va care overtime. va's goal is to meet all veterans where they all in life and walk with them to ensure
that they can achieve their goals by teaching, connecting them to resources and providing them with the care that they need along the way. our job david to give her a natives veterans the top quality experience they have earned and deserved and integrated in a seamless manner. this concludes my statement. we are very eager to take your questions, thank you. >> thank you so much, madam secretary, i appreciate your work and look forward to talking with you and your colleagues. you know, when we're all working from home here, we have to be staffed in unique and different ways, i was just death by my youngest daughter who brought me a pen. so forgive me for the interruption. i assume that miss hayes will likely need to answer at least my initial questions or get assistance from her, but, i understand there's been a
reorganization within vhs that elevated the women's health office, which i was thrilled to hear, to report directly for the secretary of health. can you talk a little bit about the impact of that change, but has it -- when did it happen, when did it enable us to do more effectively and frankly, that's a huge move from when i became ranking member on the chair of the subcommittee because it really felt like the women's health program was a stepchild of the va, and this is really a significant move. >> doctor hayes, i'd like you take that directly. >> whoever. >> good morning and thank you very much for having us and for allowing me to be part of this hearing. it is very important that va was able, through modernization and through the encouragement from congress to elevate the office of women's health from further down in patient care services were centrally, i had
three supervisors above me before i saw the undersecretary to a direct report to the office of the academic secretary for health. that obviously gives me direct lines of communication to be able to discuss the important means and impacts and gaps in services for women veterans, so i do have direct access to undersecretary, has my supervisor, but also in terms of regular -- very regular meetings, emails and conversations. we've been able to move, and i should note as you are asked, that happened in january of 2020, and was formally made really effective when we caught our complete budget at the beginning of this fiscal year with all of the their pieces in hr were transferred over with this sort of march seamlessly at the beginning of this fiscal year. that allows me to make direct recommendations through him to the network directors and really to have a constant kind of performance evaluation of
how we are doing on filling the gaps for willie -- women veterans. >> have you been able to see the impacts of that change just yet? what enables you to do this morph actively? >> pardon me. i think we were able to rollout the initiative which will be discussing in terms of millions we've put into hiring and equipment this year. we were able to start that by getting his approval and helping to get funds on october 1st. so i think those kinds of things that normally would have had to go through more change and more signatures have been expedited. >> fantastic. back in 2015, the va published a study that looked at barriers to accessing va care for women and how these barriers were experienced by women veterans, and i know that that study has informed a lot of these planning for your gender specific health care. has the study been updated since or are there plans to update it and how are you ensuring that you are keeping your finger on the pulse of white women veterans want to see at va, especially given that they are the fastest
growing population in the u.s.? >> the study is set to be updated for a number of reasons, but particularly because of the isakson wrote 2020 improvement act that requires us to redo the study. so we're in the process of doing that. but there are a number of ways that we can pay attention to the feedback women veterans, regular focus groups at every facility, at least cordially are underway. also, what we call the signals, which is out to 150,000 veterans on a regular basis. we're able to look at that by gender and location and drill down to veterans concerns and feedback, positive and negative at a local level, we regularly do that with the women veteran program managers. >> that's great. before my time runs out, we have a hearing, you're probably aware earlier this week about the access to -- for our veterans. you know that veterans are -- the va is currently tied to a department of defense
regulation on ivf, which is nearly a decade ago. it shuts out veterans who need donated sperm or eggs, so that treats out same sex couples and unmarried couples among others. how would decoupling the va from the d.o.d. policy allow you to provide ivf to more veterans who service connected disabilities continue to -- prevent them from conceiving? >> thank, you that such a critical issue for us. the current policy, as you've outlined, has some restrictions in there which are antiquated and gusting simply unfair. we want to be able to work with you so that va can, through legislation, establish va's own policies to open up the eligibility for veterans who would like to build families. i personally have talked over the last year for probably 60 veterans, for whom the ivf current regulations close them out and most heart wrenching and distressing conversation because of the ways that the regulations have been formulated. i want to work very closely
with you and are their members of congress so that we can fix this and invite veterans into full ivf and other fertility care. >> thank you so much, miss hayes, we want to work with you as well and we appreciate the incredible work you've done. secretary matthew's, you as well, thank you so much. my time has expired, and i will yield to judge carter for his five minutes of questions. ■>> thank you madam. doctor matthews, back when we are in texas, a lot of concern about burn pits and other top secret exposures. can you tell us about the clinical symptoms of a veteran who's been exposed to an open pit or other types of chemicals? what are the kinds of symptoms and why treatments are there? >> sure. thank you for the question. sir, this is definitely an area
i know of great concern for many veterans because unfortunately, there is a great range of symptoms. sometimes being quite subjective, meaning they just feel they can't exercise as well, they can't get the aaron. all the way up to coughing, wheezing, shortness of breath, which actually is a lot like asthma, so there's even a lot of confusion there. treatments very, a lot of them are very much symptomatic, if indeed it is looking, at least protesting that it looks a lot like asthma, we do have of course, very difficult courses there. but unfortunately for those more subjective symptoms that they have, we don't have a lot currently that the evidence shows. when we doesn't mean that we would necessarily attempt other options that may help the veterans feel more comfortable. but there is a great deal of research coming out of the
center in new jersey to look at exactly this. this is equally as concerning for us. >> according to calculations, there are trying to stop this burn pit issue because it is a hot topic right now. >> so they are trained and ex expected to definitely question a wide range of symptoms with those symptoms, they then make referrals over to our environmental health teams. every facility has a clinician and it's a program coordinator that is actually responsible for doing the full registry exam. once the veterans on the registry, there's regular even annual involvement. we even created an app called the exposure happy to help even if the primary care, before the referral has questions, to walk
through the veteran -- community providers can use it as well and we definitely promote that through our network. so while the formal training is three rather long modules online, that's usually taken by our environmental health doctor doing the more formal exams, the information is available and again, we do have the act available to simplify the process. >> thank you very much. do you have the -- >> of course, we perform a proportion of those exams through the exam work that we assist of ebi with, we will go good dogs directly making decisions about it. percentage, connection in which they actually declared, we assist with a physical exams and then handed information over to vp. >> think you. have a little bit more time, let me ask you, over the past
couple of years, using artificial intelligence to predict and prevent suicide, to have support income -- included reportings on the issue. how is the va using these technologies? >> doctor caroline, do you have information on that? >> good morning and thanks for the opportunity to participate in this hearing today, and we appreciate your support. so the thing that i would talk about first, ranking member, is our reach that program. it uses predictive analytics to look at veterans who are enrolled in va jay care to identify those who, from a statistical point of view maybe at the highest rate of predicted suicide risk and then our teams share that information with the providers at a local facilities, moving the review the records and reach out to veterans and ask what more can we be doing.
this gives a signal to the provider to make sure that they are examining. the care that's provided and to step up that care in any way that's important for the veterans. we have seen increase engagement in tariff, following these kinds of contacts and there's been a reduction in all cause mortality for those who have we engaged in this process. >> are you working with the v evo? the organizations and technology companies to get very important data? >> yes. we work with the vsop's on many fronts to make sure that there is messaging going out about the resources that are available to va and we are working with partners across the federal government and the private sector on advancing all of our work in social media and other forms of communication
and technology platforms. >> it seems, at least, in this modern day, suicide is becoming almost epidemic, not just among the old veterans, although it is there, but also across the board. and i'm not sure whether -- i was not ever sure whether we got better reporting, somebody knows more about, it ten in the past, or if it's an epidemic. but so it seems to be. and in the army, there's a whole department that just looks at that. i thank you for what you do. this stuff is very, i think, complicated area to work with people who would consider suicide. but it seems to be right now, epidemic across the board, even in our schools. so, you are very important to
this country. thank you for what you do. i yield back. >> thank you. >> thank you judge, i'd like to call upon congressman case for his five minutes of questions. >> thank you madam chair. doctor matthews, or whoever you want to refer this to. i talked with you a little bit about veterans homelessness. yes, there have been great strides made, still way too many veterans homeless and as i you know better than me, disproportionate veteran populations are impacted by homelessness, particularly true in my home state of, hawaii, where it's at very difficult issue to try to solve all the way around. ethnic disparities on many fronts. and i guess the question is, we have had this discussion when
the time comes, so are we comfortable with whether we're kind of going backward -- i would assume that there are great pressures on the homeless population and to maintain this momentum in the middle of covid-19. to -- what are we doing to try to stay on top of it and to maintain this progress? i know that in the cares act, we flew the agreed to live woody to their homeless programs for exactly this purpose. whether it be allocated to emergency homeless programs where to keep people who were housed out of homelessness. can you just update and kind of the covid-19 world on where you think the progress of going after veterans homelessness is? >> like you for the question, sir. you are right, i think without the pit count, it definitely is a risk there, a set of unknowns. but i'm very proud of the work that we've done during the
pandemic. i think we approached it holistically as possible. there was obviously the need to truly focus on remerges the housing. and so, more than 24,000 again, on hotel and motel placements to really make sure that we were decreasing risk of exposure, i mean this is not just about getting veterans off the street, was also about making sure that they were getting out of congregate settings. so there are media spacing, which is quite critical. we even established, of course, increase the rates through the grand, pregame program. we provided additional funding through access of the f. in order to assure that we had navigators for the grantees. they can fun navigators to make sure the veterans were connected back to the va, we're connected to health services. again, quite critical that we're looking at more than just their housing means. a lot of the outreach that we did, unfortunately had to be
restricted because we didn't have a recent pit count, like you highlighted, but it was focused on targeting the homelessness, that we at least have some record of and then of course, assuring homelessness prevention assistance where possible. again through our grantees, our community partners, our facilities, reaching out to those veterans, making sure that if there were any concerns regarding family members, regarding employment, of course test to loosen, iraqi require testing in any enrollment with new housing services,. and then of course, the smartphone program, distributing more than 28,000 so that we can stay connected with him, so that their providers, their landlords even their employers could be in touch with them and more importantly, vice, first or so that they can reach out when indeed, there was a need. so we really did want the full
gamut of expanding services of really reacting, i think, quite appropriately to the increase risk over the last year. and it won't stop there. the goal of course is to get them into permanent housing, to get them employed, to prevent homelessness in the long term so that they have a sustainable path and again, that's what's that new navigator program is, that's why we are really pushing, of course, our vouchers. it's one of the more complicated programs that i've had the fortune to work with. but that complication is a necessary piece to respond to the many factors then are fortunately cause homelessness, so thank you for the question, it's such an important point. >> yeah, and my time is it just about up. so quickly, -- no, i'm glad you are talking, not me. what are the gaps still? how do you know right now what's a veteran has gone into
a homeless situation where he didn't have any private or history, it was covid related, maybe wasn't, maybe was recent. but how are you trying to reach those veterans that are off the grid and there is no way to find them right now? >> unfortunately, that is a huge gap that we will continue to work with our partners over at hud, we will work with public housing authorities, local government, even our grandkids who are receiving funding from us. they may have connection to veterans that we may not necessarily be connecting within the facilities. i think this is more than anything, not a problem that va alone can solve. so will continue to partner, and of course, push as soon as possible for the next boot tell you we could really get an assessment of what numbers are out there. >> thank you very much. >> thank you mister case. mr. case yields back. mr. validate will, you are recognized for your five
minutes of questions. >> madam chair, thank you doctor matthews, and dr. carroll for testifying today. i want to take a quick moment before i start my questions to talk about they heard the veterans affair, support of housing. which you noted in your testimony are key to preventing veterans homelessness, and it's important that -- several weeks ago, a constituent of mine who is a disabled army veteran contacted my office for help. after months of frustration, he had applied for the program for housing veterans in july of 2020. after he had informed -- this was after he was informed by his landlord that his home was going to be sold and he needed to move out. nearly three months later, the veteran was issued a housing voucher. but the va did not sign -- a sign a housing specialist to help him find a landlord who would accept a voucher. these vouchers were only valid for eight weeks but the veteran was not called by housing specialists for five weeks. during those five weeks without
health, the veteran says he called and emailed the va and repeatedly with no response. finally, when the housing specialist who called him, she was shocked to learn that he's had about traverse along. the housing specialist tried to find him a place to live, and the remaining three weeks but was unsuccessful in the voucher expired. if ed immediately asked to reapply for the new veteran was told that his application would be fast-tracked, but the holiday season seemed to have caused more delays. the veteran contacted office in desperation on january 19th of this year. after a judge ruled to evict, so the property sale can be finalized. we worked for this case manager to fast-tracked his application for a second voucher which was issued a couple of days later on january 21st. six months after the initial application. the next day, the veteran met with the va housing specialist who said, he would spend the weekend looking for housing and would meet with the veteran on monday to show him his options. but the housing specialist did not contact him on monday.
facing eviction and homelessness, the veteran depleted his savings to purchase a travel trailer and moved into an rv park with his wife. a big ball was dropped in october when the va did not assigned a housing specialist to the veteran until five weeks into his voucher. that mistake has had serious consequences and, the most serious of which is the eviction of a veteran's record going forward. in june -- july 2020, va provided over 600 vacancies. it also reported a significant number of vouchers, allowed to the central valley communities who are going on you simply because the va did not have enough resources to distribute them. to help, the isaac row veteran bill, signed into law earlier this year, requires the va to contract out with vacant casework services to local qualified community housing providers. why is the va struggle to hire
and retain case managers and what can be done to solve this problem? >> thank you so much for those questions. that is definitely a very concerning and disappointing story and i would certainly like to assist, if you were willing to pass on the remaining information. if that is still happening. i think our issue with hiring is one that's quite complicated, that we indeed are working with our facility to address. these, as social work conditions in some locations are quite difficult to fill. particularly, it's a range of issues particularly, whether it's salary or whether it's location and expectation of travel, as well. that is not an excuse, it's just that we are indeed working with the field to feel these
empty positions and to recognize, really the importance of case management, the voucher alone is of course, not sufficient. i think it's also worth highlighting, that even with case managers and some of our markets unfortunately, there are other factors that prevent housing, and as you even said, when a specialist, although delayed and unacceptable, i realize that one has -- looking for housing ouch options in that area, they still were not available. we have some severe market factors that are addressing the ability for veterans to use these vouchers. so we're working with our partners and even working directly with landlords and communities to address that as of as well. >> i'm sorry, because i'm almost out of time. how are you identifying these local community housing providers to assist the va with that programming and how would you notify these local -- to distribute housing vouchers to homeless veterans?
>> our homeless program office at the individual facilities work with their public housing authorities for viable, either future or current landlords. and that's how the information is distributed. it's to local partnership. >> all right, my time is expired but i would like to spend more time on this issue at another time. so thank you. >> thank you. he yields back. miss, you are recognized for your five minutes of question. >> thank you madam chair, thank you for holding this important hearing and doctor to all the doctors and your team's for the important work you do for our veterans, we really do appreciate it. i know my colleagues have already brought out some of the concerns that i share, i appreciate hearing about the investment that you're making in women's health, as you mentioned the beginning of humans health relations shouldn't be a special health, women are critical part of our forces and our veterans, and i'm glad to see there is more focus on that.
and certainly, the concerns people have been bringing up, ranking members and about, suicide within our veterans is really tragic and meets all the focus we can possibly give it and unfortunately in maine, we have the highest suicide rate with our veterans. between that and mental health concerns, where appreciative of the work you do and know how important it is. i might get a chance to talk more about those, but i want to bring up a topic that we are not covering right now, but it's a concern of mine and that's related to the healthy diet and food is medicine. we have a lot of evidence available to us now that access to healthy foods and diet and eating habits really impact our health and is particularly true with many of our veterans. i work some language into the 2021 report that encourages the va to create a pilot program to provide for respect corruption
store veterans, in partnership with community organizations, something guzman successfully done with a lot of our medical providers as well as in many insurance settings. can you just tell me which office is responsible for this activity and whether any steps have been taken around that language? >> sure, yes. we actually do have a nutrition services office that reports up through me. and they are actually quite excited about the wanted me to express their gratitude. >> great, we'll be following that and it's clearly appreciate that you are already taking it on. i think a career of great of service health to a lot of people. so back to suicide. just about safety, which i know can be a challenging topic but, we have a huge coalition in maine that are interested in this, last year the main bureau of veteran services created a main, safer homes task force to prevent firearm and medication safety and an effort to prevent suicide in maine.
they're taking off a public health approach to combat our suicide rate, and includes a broad coalition that gonna shoot groups, the vsop's, our cdc and the va system. the report on the milcon va bill includes a provision, encouraging the va to collaborate with states and gun safety and gun storage, as we are doing in maine. is there any office within the v ha that is taking a coordinated approach to the cooperations and share best practices? >> thank you madam chair, i'll take the question. as members of the community have already said, suicide prevention is a national public health problem, it is not something that va can tackle alone and it requires a public health approach, and it's everyone's business to, to your point. those are some of the core tenants of our suicide prevention program. and we are working, i'm very
pleased to hear about the effort in maine that is exactly the kind of program that we are trying to foster through our regional programs, working with visions and regions in the country to advance. suicide prevention and social connection for veterans and their communities. by veterans, for veterans. it's part of our governors and mayors challenge programs to enable those groups to look at their own state or local data so they can inform their approaches, and as part of that, we have developed a tool kit, a program of fuel, suicide prevention is everyone's business, i toolkit for safe firearms storage in your community. and it is about safety, it's about -- so happy to do it that way. hope so, as you said before, working with tso groups and other private groups, you know,
to advance safety in this area. >> create. thank you for that, again, we appreciate the work you are doing and i like the slogan that it's everyone's business, because it's certainly something that we all have to acknowledge. just quickly with the time i have available, i had a meeting recently with one of our veterans groups and they expressed some frustration that mental health activities have only being provided via teller health, and not available in person. i know we've had for so many covid restrictions and frankly, many people suggest to me that having health available for mental health services has been beneficial. but i was just curious about, are those restrictions changing, is it a requirement of the va right now or just where are we with that? i don't have much time so just quickly, if you can? >> very quickly. there is no prohibition against in person care, i want to make that clear. we have seen a rapid shift to the use of virtual care, tele-mental health over the past year and we've been
successful at doing that. both making veterans comfortable with that, as well as our providers. but we have always maintained the ability, based upon the individual's need for what they need. in some cases, and maybe they need to come into a facility because that's the only way we can provide care such as a complete -- but the driving factor in all of this is safety, and looking at the infection rate in the local community and powering local leaders to make decisions that are going to make sense for the facilities. >> great, thank you. appreciate that you have that flexibility and i yield back even though i have no time feel that, thank you madam chair. >> thank you very much. mr. rutherford, you are recognized for five minutes to ask your questions. >> thank you madam chair. i think are presenters today for some great things that are
obviously going on with nda. i've looked at these reports and i'm very encouraged by some of these numbers. and when you look at, you know, has my colleague, mr. case was talking earlier about the homelessness, i know one of the driving for two of the driving factors in a lot of homeless cases his severe addiction, severe mental health issues. and i see some drop in the opioid, and i think it's a direct result of the complimentary integrated health system and so -- pardon me. >> sorry mr. rutherford. chad carter, you may want to hit mute. and i hope you are okay.
>> sorry about that. >> i was just getting concerned about you. >> thank you madam chair. so my question is this. when we look at the 18 flagship locations for the whole health initiative and would i didn't see who was the mental health games, which means the drop in mental health or the suicide occurrences, how much of that reduction is -- and those 18 flagship locations forces the rest of the country. i didn't see that, and i'm curious whether that whole health, because i believe in that. i know that whole health approach is responsible for
that reduction we see an opioid addiction, and then sort of the reduction of suicide in those cases where they've sought care with a va in the last two years. do you have any anecdotal information on that, miss matthews? >> definitely. actually, it's more than anecdotal. the 18 sites, actually shows a threefold production in opioid utilization. when they actually compare the veterans who are using the old health approach versus ones who weren't. so we know this is a direct rick relationship and were very excited about that. and then there's even broader decrease that we see, again when using whole health as in even more by 38%, compared to
those who didn't use it. so we're actually quite ecstatically focused on this as a solution, we obviously need to take care of the whole veteran a, dress their concerns, address their pain, make sure that they, as well as our partners are looking at their whole being. have unfortunately is data on suicide prevention yet, but i assume that is coming . we need to look at that data a little i think we need to look at the data for a little bit longer to make a conclusion. >> okay, and to follow up on the suicide piece a little bit, another study just came out as you may know -- dogs to veterans with -- who are diagnosed ptsd or dbi.
-- from what i understand, the report is now complete. we and the findings are encouraging. in fact it does reduce suicide among these veterans who are suffering. and can you tell me when they expect to find a final report to roll out. i heard something that they're not quite ready to say let's start getting dogs out. >> well are you speaking to the actual study report? >> sure doctor matthews -- >> he went on mute. >> thank you and thank you for the question. we are working for our colleagues in with our
colleagues in the research and development to make sure the findings of the report get distributed. and i think there are multiple issues here, and one is we want to provide the support that veterans need in the manner that is appropriate for them, which may include for many service you know service dogs taking care of the animal, but ensuring that veterans have access to a comprehensive program of treatment across the board. and that is it is integrated with everything else. the long term consequences such as you mentioned in your question around suicide prevention, i think we need to study that more. we need to see what the long term consequences are. i think certainly we are eager to go forward in expanding support in this area. >> good thank you. >> madam chair i see that my time is up, so since i had a
couple of major interruptions here could i just make a statement? >> no go ahead go right ahead. >> thank you thank you. >> i just wanted to respond to something that was said earlier. about the d.o.d. policy being antiquated. on the fertilization services. i just want to make the point that there are many who would tell you that that is not antiquated. that is a common sense and morally correct approach, so we're talking about public dollars. i just want to make sure that that you understand there is another point of view on that thank you. >> i yield back. >> thank you mister rutherford, we can move to have that for the conversation another day. i'm quite sure we will. mr. rutherford yields back, and mr. -- you're recognized for your five minutes. >> okay thank you madam chair. this has been great information,
we really appreciate it, and doctor matthew's great work on the whole health program. it sounds promising let's go back to what the congresswoman was talking about a little while ago about suicide. 17 that's a day are dying, every single day. six of those vets in access to va health care, and in the previous two years which means 11 had never access any health care with the va. and if we don't change something we're going to keep losing these majority of these folks every single day ongoing. so what i'd like to know is, what is needed to reach out to the vets who are in crisis sooner, and are there differentiators between the ones who reach out, and the six that we talked to every single day, or the 11 that never sought help from the va and
could you see any patterns? age, geography, race, income levels, to give us some additional idea of how to help these folks. >> before i allow -- to speak to some of those data questions, and those are so critical to make sure we're paying attention to very particular groups of veterans, i think it is worth highlighting worth highlighting that yes those the 11 that have not access va services. and those are focused on both clinical interventions as well as health care interventions, and we need the broader community we need those partnerships with the states and the mayors and to truly reach out and to make sure we are reaching those veterans, regardless of whether they are coming to the va or not. this is so much bigger than us. but do you have some information on the data that the congressman was asking about? >> thank you doctor matthews, i appreciate your question congressman, and i would be
happy to sit down and do a deep dive with you or with members of the committee at any time on this suicide data, and in your limited time i will try to make some brief remarks. i think to the point that dr. matthews was making, we need the clinical interventions within our health care system as well as community based interventions to understand those 11. and actually as we have looked at the data, while one point is we probably know that about two of those 11 every day have had previous contact with the va but. perhaps they have not had any va health care over the last two or three years or longer, but part of our program is to look at things that we can do right now, and one of the planks in that program is to look at prior v eight users and
you also stratified. to go back to the point earlier about artificial intelligence, to stratified within that group those who we think might be at greatest rate risk and to reach out to them. and perhaps get them engaged in care. but we know there are veterans who will choose not to receive health care from the va. so our community partnership programs are working with states, and mayors and others and other community groups and veteran groups and we have many public faces, resources that provide training for community providers and we have a consultation program for suicide risk management and for post traumatic stress disorder that are available to community providers and not just v a ha providers and they make use of that which is the good news so i think we are trying to both support the work that we are doing within the va, as well as
supporting the work that is going on outside of the va. both in the health care system as well as the community's world. >> just quickly to follow up with the community, and i agree with you completely, we've only worked hard on expanding the community based behavioural health centers, and it's a pilot project we've added more states that we drew we drove more funding into it especially with covid, and i think it's critical to a lot of that to don't live near a to loop was to a va hospital, to be able to go to a community health center. and some of them don't have time to schedule so they can go there quickly. but how do you collaborate with the certified community and the health centers? >> so i think we are interested in collaborating with any community provider, and i think
the way that we touch them most readily is through the public facing materials that we have. and working certainly through our community tier programs, to make sure that providers in those programs have access to the same training materials. i think we work you know we are talking today about specialized areas within the h. a, within suicide prevention, homelessness, women's health, and the reality that is on a day-to-day basis we work collaboratively. and my point here is we work collaboratively with our homeless program providers, and our workers atone nationally who are in the community, who have this touch points. community paste care management. and we have our community and practice calls focused on working broadly in the community with other communities of practice. >> i know my time is expired,
but i would suggest really blowing up the amount of certified community behavioural health centers all across the country, and i was working with the senator on this at i think that's an area that is changing quickly, and you should work it on proactively and reach out and connect so we could better help our vets in these areas. thank you. >> thank you sir. >> thank you mister congressman. >> mr. gonzales you are recognized for five minutes. >> thank you madam chair, we have provided 19 billion to the va, which as of last month, ten point billion remains available. this week with the passage of the american -- an additional 17 billion was appropriated and of that 13.5 billion was specifically for suicide prevention. it was also for women's health, homeless programs and there is an ample amount of resources available.
women make up approximately 10% of all of the united states veteran population. last year, the appropriations bill was passed and it was around 90 billion dollars. of that 660 million were for women specifically. that is less than 1%. we have over 10% of the population women, but less than 1% is spent on women. i understand that some of that same excesses of care's go to both men and women, but is there anything in particular that we can work on, that can help specifically for women? >> and dr. hayes, anyone can answer that. >> i will jump in before dr. hayes answers, i do want to clarify one thing, that the funding that is spent on gender
specific activities of course are the services that only women can seek out. mammograms, gynecology, infertility, maternity care. this in no way means that there are other funding spent for the other multitude of services that women need. so i do you know i would like to say that it is not necessarily just that portion of funding that has been on women, it spent on those services that are needed. and it may not necessarily equate to that same proportion of effort. but doctor hayes, do you have anything to add there? >> certainly, as congress has generally provided that proportion of budget for women. but in addition in 2021, we were allocated special purpose funds because we had gone to the leadership in va, and we've developed a plan in october we sent out 40 million specifically for hiring the
equipment for women. because we had done a deep dive on what was missing. and that was buying us about 400 providers right now. in addition congress, in the last appropriation they did give a 35 million additional targeted funds for women. we are frankly scrambling a bit right now to make sure we have another rfp, and that will go out next week to help fill any additional gaps. we also expect, that we will be able to put out special purpose funds at about that magnitude, so we're talking 75 to 85 million in the next couple of years because what the field has let us know is that these positions that they are hiring right now, they need to be able to have those positions in place over the next several years. that is our commitment, from the va che, and we will speak to that if needed. >> thank you thank you for that. so the va received 971 million
from the va homeless program. with the cares act. with the american rescue plan, they thereabouts received five billion. apple amount of resources there. so how much money remains in that program, from the cares act? >> some so, this is laura, and just to clarify sir, you are asking what remains from care, that identifies for the homeless program? >> that is right, of the 971 that was appropriated. >> i'm pulling that up for you right now. but just to clarify sir, with the american rescue plan, there is significant funding for veterans health, provided to include these services but also in addition to the service and general care being provided. so >> i'm essentially i want to highlight that there is ample
resources available and it is not really the resources, it is what is needed right now and what is needed is the actions and the programs and the successful programs that are working on that note. i am almost out of time. only three states, so we have a lot of work to do here, my question and it could go for record, where is texas on this benchmark? >> sir, just to answer, we've obligated 828 million of the 971 million and cares for homelessness. >> that you queue for that. , perfect. >> all deaf we get back to you in texas, i'm not checking currently, but i will get you that answer. >> thank you, the gentleman yields back. i do just want to clarify though, mr. gonzales, and i know that this was prior to your service, but the 13 and a
half billion that you mentioned for the cares act included those areas that you mentioned, but we're not limited to them. so i mean, that funding that we provided was much broader for all the v8 medical care. and it includes the ability for the va to utilize those funds for those purposes. and then, there was not a 971 million dollar appropriation for homelessness, specifically in carers, that's what va chose to allocate towards it from the total amount they received. so i just wanted to make sure that you were clear and also confirm with them that that was the plan. okay great. thank you. miss ali, you are recognized for your five minutes of questions. >> all right, thank you madam chair. and i really appreciate having this important hearing today. and i thank all the witnesses for all you the work that you do with veterans and for being here. i -- we've talked a lot today about
veteran suicide and those who died by suicide, and you know, the 5.8 per 100,000 is definitely too high. we know that one veteran suicide a day is way too much. and so, acknowledging our goal must be to bring that number to zero. i wanted to talk about my bill, the leave no veteran behind act that was signed as part of the veteran compact act. this bill requires the va to see contact to cover veterans to encourage them to receive comprehensive physical and mental health exams. and this really pays off of what congressman was discussing with you, and i wanted to ask dr. carroll, it's been over 90 days since the compact act was signed into law. and can you give us an update on how the implementation is going specifically about
outreach? >> i'd be happy to and i appreciate the question and appreciate the act that was passed and we share the mission. and the imperative that you laid out for us. so i think, the bottom line is, we are still in the planning for it, this is going to impact potentially care and veterans in multiple good ways, but i think the complexity here has to do with the proper messaging to veterans, in terms of the opportunities that are available to them, that are there. they may vary from individual to individual in terms of what is actually appropriate or necessary or in their best interest and the opportunity for us to work with each
individual veteran and to set up a process so that we can do that. and then also in terms of thinking about the emergent care provisions in the act and making sure that the expectations for our staff are clarified because there are multiple touch points, whether it's through the veterans crisis line, whether it's through va's facility emergency department or some other role, you know, what exactly is the role of each individual in that part. and in regarding the prison -- provisions where va would be expected to pay for care that is provided outside a va to someone who is not currently enrolled in va, there are multiple -- and what we are trying -- we have workgroups assigned to the different provisions in the act, and we're moving forward with the planning. now, i'll also defer to doctor
matthews if she wants to add anything to that. >> i agree with you, just to add in, i think a great deal of that concern of how we can best track but we are doing, we're doing a great deal of outreach right now to veterans across the country. for vaccine administration. so those touch points are equally as critical and a lot of this outreach, even in some by some of our whole health staff and our facility that we're hearing about, is to ask them if they are receiving mental health care. so why while we may not necessarily have the structure to measure and be able to report out quite yet, that's what a lot of the planning is around. we know for a fact and unfortunately, more anecdotally, that within the vaccine outreach that we are doing, that we are touching a great number of veteran, including
those, we've actually seen increase and roll mint as veterans are seeking out va to receive the vaccine. so even a better conversation, do you have primary care? one was the last time you talk to someone about your mental health? are you interested in whole health? you know, we're having the broader conversation, so we thank you for that bill because it really does marry exactly where we want to go. >> thank you. and i would just had that coordinating during the transition, because as we know, transitioning veterans have an increased risk of suicide, so i'd love to see a little more put on coordination with the department of defense and i know that it's a little tricky. but my time is up so i yield back and thank you both. >> thank you miss ali, she yields back and mr. chris, you are recognized for your five minutes of questions.
sir, you need to un-mute. >> thank you madam chair, i appreciate the prompt. so i wanted to ask to dr. hayes, in my house in florida, we are blessed to have a very robust women's bedroom community and i have witnessed firsthand some of the challenges being faced there, especially a lack of women doctors and medical professionals. so i guess my question to you would be, what are your plans to recruit, incentivize and retain more women providers? please. >> thank you so much for that question. we have not noted that in some areas of the country, we do have recruitment difficulties as one of the problems, but we have set up essentially a tiger team with a va workforce management and recruiting office to do a number of things, including outreach to
physicians in the community, working with medical school graduates, etc. we have a full flannel on that. we also, part of what i spoke about a moment ago about making sure that the field, the va facilities are fully staffed, as they should be, is that right now, they can seek monies from us, we're giving them the funding to be able to hire. so one of the barriers has been that facilities were kind of juggling this, and if they didn't think they had enough women to support another full position, maybe they weren't going for it. but right now, we're telling them higher up, ask for the money, get the position in place and because we, know that by the time the position is in place, we're certainly going to have enough women for that provider to see. so it's a combination of an issue of not paint looking for the providers, and right now encouraging the field to hire and also working on these recruitment issues. and we do have a full recruitment staff, station essentially headhunters at the national level, but one of
facility says we can't seem to hire the women providers that we need, that they can turn to them for that support and i'll go out and actually look for providers, incentivize it, we have the ability to help people relocate, we have hiring incentives and we are trying to end educate the fields about all the incentives we have to get to be able to get people in place. >> thank you for much. so beyond the issue of providers, what are your biggest needs for women's health, and especially military sexual trauma? >> i think the challenge is in the field have been that we've been slow to respond to the fact that we have so many women coming in, and from leadership on down, we've had to make sure that people recognize we need a full program of outreach, as we were talking about just a moment ago. how do we reach all these folks? we've been calling women through the women veteran center, we've called over 1.6 million women, encouraging them to be part of their va benefits. military sexual trauma is an
experience of about 25% of our women veterans in the country. and so, a concerning amount of the outreach that we're doing is to make sure that we let women and men know that we have the right services for them at the va. you'll see a lot coming out, april is sexual assault awareness month, will you will be seeing that particular effort and in addition, we have a new women's health transition program, where we are working with service members, women service members, there is a special course in the program. so that they are directed to the kinds of services that va has and that they recognize that we welcome them for dealing with the issues of surviving military sexual trauma. >> great, thank you very much. i can see how much time i have, left but i only have one more question. my dad was a physician and my sister is a physician but i can remember going on house calls
with my dad as a kid, reading the va's full health initiative, seeing it's consistent with that personalized type of approach, which i think is incredible and not just what we see in health care outside the va, so it can you please provide an update on how this is being implemented? >> all right, thank you so much for that question. we are expanding beyond our 18 flagship site, that has gone successfully as we discussed earlier, improvement of sense of meaning, have sense of purpose. and we are very excited about this. so we've moved on the rollout to the additional 37 sites. however, i'll caviar, that's more of the formal program, but we have sites across the nation that are eager for this, that are making those really purposeful decisions to have resources for veterans so that there addressing their well-being, they're referring
for additional resources and the program that perhaps on necessarily officially started at their site, so i don't even want to give you that 37 number and make you think that that is the only expansion that the program has got. but those 37 are part of the formal evaluation, that's why we describe it. but i think even more, so i mean the last year has taught us a great amount about how we have an integrated system, needing to address care intel health and address larger public health concern, so even through whole health, we've expanded a great deal of really self opportunities, through our websites, through our blog, through our modules on the phone. it is perfectly primed to kind of shift to telemedicine to also expand hole health resources and we've had a great deal update with 30,000 something views of different websites over the last year, so whole health is really broader than just what physically is
being provided, what services are being provided in the facility. and the pandemic, the silver lining really helps to push those resources out. >> that's great, we'll listen, thank you so much, i appreciate that answer and madam chair, i yield back, thank you. >> thank you so much. the gentleman yields back. that concludes our first round. i have a couple of quick followups and i don't know if anybody on the committee, who just proceed through the order of the remaining members and after him finished, and then we can wrap up. >> my follow-up question is on military sexual trauma, i don't want to see if dr. carroll could answer that question as well from the mental health side. because obviously dealing with military sexual trauma crosses both physical health care and mental health care. >> thank you madam chairwoman and yes, it does.
and it is an experience that affects a whole person, both mental health and physical health and as doctor he says, this is a prague bloom that affects both men and women and i think we just why we have a strong foundation and fee age he's provided integrated care. we screen from military sexual trauma, that's part of our standard screening across primary care and our mental health clinics. and then, we refer to that person into care, appropriate gender sensitive care, that's evidence inform, we also work very closely with their partners because we know that sometimes veterans, or in some cases active duty service members may be seeking services for military sexual trauma but may not be coming to a v ha facility and so i think the training resources that we have for providers to make sure to
provide this level of care, you know, apply both within the va facilities as well as our that center partners. >> thank you very much. the other question i had is really about some of the revelation some of the revelations that came with what's happening on the u.s. capital. we've been seeing a lot of reports saying how many of the attackers were veterans, there's been a growing recognition that the military has to do more to act to address extremism in its ranks. once they are no longer active duty they become veterans, and in your care. is this an issue that va mental health programs have been looking at as well? is there anything to look out for an address extremist tendencies among them? >> dr. carroll?
>> yes if i may, and i think this is an emerging area and i think we share that, and i think we are trying to understand more. the process though that we do have in place and actually that we were able to push out after you know in early january, it has to do with the fact that mental health providers costs are every day in a situation where they have to talk about difficult issues. whether it is family violence whether it is difficulty in behaviors or extreme views. they have to talk with veterans, and they provide a safe and welcoming space for veterans to work through those issues. and the provider and the veteran may have different opinions. and i think that we try to support our providers to make sure that they feel comfortable having difficult conversations
with veterans, when there may be a difference of opinion. as well as to help veterans think about the whole life that they have and not just thinking about a particular issue but as doctor matthews had said several times a whole person a whole health perspective which means how are you living in your various communities and what's your experience in those communities and how can we help you improve your relationships within those communities. >> i think that is a bit too generalized of an answer and i was focused more on extremism and whether your mental health programs got started to look at that more specifically so if that is more than you're able to answer here. i >> would be happy to get back to you and it's with that lens but it's with that lens that we are going down that path, but i would be happy to get pat to get back with you with more focused on extremism. >> thank god appreciate that.
>> so that concludes my questions and dr. carter do you have any additional questions? >> on a more fundamental component and i think the strategy is that everyone from the federal agency to the community organizations to families have a role to play. how does the va deal with outreach and boots on the ground capacity deal with -- and also the american legion's buddy check program. is va a partner to the american legion effort? do they coordinate with suicide prevention? nonprofit organizations? and other service organizations? and how does this coronation work? >> yes sir and the short answer is yes we coordinate and
communicate all the time with american legion and other veteran service organizations. particularly in the area of suicide prevention and mental health care. the va is also a member of the national action alliance, working with other federal partners and private partners in the space and the folks from the veterans service organizations help inform and guide our outreach campaigns and it is mutual and i've worked collaboratively with them on the outreach that they are doing and they pass along our training resources, on how to talk to someone. if you are concerned maybe that they are suicidal, and how to get them into care. our training resources are something that we provide and help them incorporate those into the work that they are doing. as >> when i was a judge, we
had a treatment center in our county, and it was actually very successful and one of the things i think we learned or experienced was that those people, there in the fall back position, that they need somewhere they can go to after treatment, and that is most likely to be successful. they went back to all the where they hell had been, without anyone checking on them. as they did some of them fall back and that situations. so the american legion they check program it look like a great idea. marines are there, you know and it's the world they fought in. and i encourage you to work
with those people. thank you. i yield back. >> thank you judge, and the judge yields back. are there additional questions? >> i see you there? and i'm not sure if that's a picture of you, or are you actually frozen? okay. since he is not responding, mr. rutherford, or mr. -- do you have any additional questions? >> no i do not thank you madam chair for hosting this. i think today was it informative one, and i will have some more questions for the record later. >> yes thank you so much and mr. rutherford? >> thank you madam chair, i would like to go back to the the issue of the ms tees and one of the interesting numbers
that i see here is there is concern that the va policies are not properly you know where these cases are not being properly adjudicated by according to the va policy now when and i understand when it gets to the epa ethic as a disability claim one of the things that just jumped out at me is the issue denial reason being not incurred or caused by service which means there is no corroborating evidence, including markers to be claimed in service or ms de stressor so i do understand that there is some training going on to try and capture these stressors and
miss matthews can you tell me more about the success that we are having in training on capturing you know if we don't collect the evidence, we are never going to prosecute the plan. we are never going to be able to provide the service for ptsd as a result of this. >> excellent question. training around -- . >> i think this is dr. hayes, i think what he is referring to actually is an advanced training of the va training specialist. which would have additional information back from the be a. on the va side we do support through our mental health folks and the individual to be able to get to the point of filing a claim and going through what could be a stressful claims
process within the technical aspects that are represented. and that belongs to the v be a side. >> yes and i just want to make sure that we are implicating the vba i want those elements are that you guys need on your side. because that's why we're saying if they are not collecting the evidence up front, then it is never going to get to you in a form where we can actually provide assistance for these folks. >> i think you're right sir, and i think you also see emerging very soon so information about new activities at the department of defense, to go forward on this issue and to make sure how the reporting is done, and all of the things that you are raising about what happens when somebody is on active duty and they have military sexual trauma. i see your point here sir. >> thank you. >> and i will be trying to
follow that in the future. i think that is the core of the problem. or part of the problem here. but i think it's a big piece of it. so thank you. with that madam chair, i will yield. >> thank you so much the gentleman yields back. so mr. drone, i'm not sure if you can hear me do you have any additional questions? okay i did see him move, so i assume he's there but he doesn't have any questions. so that concludes i don't believe there are any other members who are still with us, who have any questions. so that concludes this morning's hearing, which is now has now lead into the afternoon. i want to thank our witnesses for participating in today's hearing, and discussing on these issues on an ongoing basis. we do expect and i do expect that we will have another