Testimony
Testimony
Here's a look at documents involving congressional testimony and member statements
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Disabled American Veterans Deputy National Legislative Director Retzer Testifies Before House Veterans' Affairs Subcommittee
WASHINGTON, March 27 -- The House Veterans' Affairs Subcommittee on Health released the following testimony by Jon Retzer, deputy national legislative director for health at the Disabled American Veterans, from a March 11, 2025, on legislation affecting VA programs and services:* * *
Chairwoman Miller-Meeks, Ranking Member Brownley and Members of the Subcommittee:
Thank you for inviting DAV (Disabled American Veterans) to testify at today's legislative hearing of the Subcommittee on Health. DAV is a Congressionally chartered non-profit veterans service organization composed of nearly one million ... Show Full Article WASHINGTON, March 27 -- The House Veterans' Affairs Subcommittee on Health released the following testimony by Jon Retzer, deputy national legislative director for health at the Disabled American Veterans, from a March 11, 2025, on legislation affecting VA programs and services: * * * Chairwoman Miller-Meeks, Ranking Member Brownley and Members of the Subcommittee: Thank you for inviting DAV (Disabled American Veterans) to testify at today's legislative hearing of the Subcommittee on Health. DAV is a Congressionally chartered non-profit veterans service organization composed of nearly one millionwartime service-disabled veterans. Our single purpose is to empower veterans to lead high-quality lives with respect and dignity.
It is crucial to provide timely, coordinated, and comprehensive health care tailored to meet the diverse needs of veterans. DAV is pleased to offer our views on the bills under consideration today by the Subcommittee. These bills address the necessity for timely access to medical services, infrastructure improvements, the removal of financial barriers, better understanding of health outcomes, the incorporation of adaptive sports prosthetics, hyperbaric oxygen therapy, secure firearm storage programs and effective care coordination.
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H.R. 217, the Communities Helping Invest through Property and Improvements Needed or CHIP IN for Veterans Act
The CHIP IN for Veterans Act includes provisions that would make permanent a pilot program that authorized the Department of Veterans Affairs (VA) to accept donated facilities or donations to make facility infrastructure improvements. This legislation would eliminate the cap on the number of projects allowed in the pilot program and enhance the quality and availability of veteran services without additional federal costs. For example, in Omaha, Nebraska, there was a project/donation for construction of an ambulatory care center and in Tulsa, Oklahoma a project/donation to construct an inpatient facility and parking garage to support the Muskogee Veterans Affairs Medical Center (VAMC). In 2021, VA received $120 million for a capital contribution to execute the Muskogee plan. These collaborations lead to improved access to care and services for veterans, while fostering community support and involvement.
We support the CHIP IN for Veterans Act in accordance with DAV Resolution No. 193, urging necessary infrastructure funding and exploring new funding models.
H.R. 658, to establish qualifications for the appointment of a person as a marriage and family therapist, qualified to provide clinical supervision, in the Veterans Health Administration
H.R. 658 seeks to establish qualifications for marriage and family therapists (MFTs) providing clinical supervision within the Veterans Health Administration (VHA). The bill aims to enhance mental health services for veterans and maintain consistent care across VHA facilities by ensuring that MFTs are highly qualified and recognized by reputable organizations like the American Association for Marriage and Family Therapy.
Veterans face numerous mental health challenges, including post-traumatic stress disorder (PTSD), depression, anxiety, substance use disorders, and traumatic brain injuries (TBI). Qualified MFTs can significantly improve mental health outcomes by providing effective supervision and promoting better therapeutic practices, potentially reducing the incidence of suicide among veterans. Including family and relationships in mental health treatment is crucial for the holistic well-being of veterans. Many veterans have found that involving their loved ones in therapy sessions helps create a better support system, and fosters improved understanding and communication. This approach can lead to more effective treatment, as the support from family members can reinforce coping strategies and provide a sense of belonging and stability.
We support this bill in accordance with DAV Resolution No. 224, which calls for program improvements, sufficient staffing, and enhanced resources for VA mental health services.
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H.R.1107, the Protecting Veteran Access to Telemedicine Services Act of 2025
The Protecting Veteran Access to Telemedicine Services Act is a crucial step toward ensuring that veterans receive the high-quality, accessible health care they earned. Many veterans face challenges in accessing timely and consistent medical care, particularly in rural and underserved areas. This legislation addresses these challenges by leveraging the power of telemedicine to provide controlled medications to veterans without the need for in-person medical visits.
Telemedicine bridges the gap for veterans living in remote locations, allowing them to receive necessary medications and consultations from home. This convenience is particularly beneficial for those with mobility issues or limited transportation options. Additionally, the flexibility of telemedicine allows veterans to schedule appointments that fit their busy lives, leading to better adherence to treatment plans and improved health outcomes. The bill would ensure that health care providers can maintain regular contact with patients, providing continuous care and preventing interruptions in treatment, which is vital for managing chronic conditions. Telemedicine is also a game-changer for mental health services, helping to reduce the stigma and barriers often associated with seeking help by providing therapy and support remotely. Finally, the bill includes robust guidelines and processes to ensure that the delivery and dispensing of controlled substances via telemedicine is safe and legal, maintains integrity of the health care system and patient safety while expanding access to care for veteran patients.
We support this bill in accordance with DAV Resolution No. 342, which urges the VA to enhance its national pain management program using patient-centered, interdisciplinary, and holistic approaches, ensuring timely medication delivery and humane alternatives to controlled substances. It also encourages the VA to regularly update its clinical guidance and policies to comply with federal law and best practices for prescribing and dispensing controlled substances. By harnessing the power of telemedicine, we can provide veterans with the accessible, efficient, and high-quality care they deserve.
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H.R. 1336, the Veterans National Traumatic Brain Injury Treatment Act
The Veterans National Traumatic Brain Injury Treatment Act would require the VA to establish a pilot program to provide hyperbaric oxygen therapy (HBOT) to veterans suffering from TBI or PTSD.
Veterans with TBI and PTSD face significant challenges, and traditional treatments have proven ineffective for some. Studies have shown that HBOT, which involves breathing pure oxygen in a pressurized chamber, can enhance the body's natural healing processes. This therapy, traditionally used for treating severe wounds that won't heal, has been found to promote the growth of new blood vessels, reduce inflammation, and improve oxygen delivery to injured tissues. One small clinical trial, published in the Journal of Clinical Psychiatry (JCP) in 2024, has also demonstrated improvements in PTSD symptoms and brain function among veterans undergoing HBOT.
However, despite these promising findings, more comprehensive research is necessary to fully understand the efficacy and safety of HBOT for patients with TBI and PTSD. According to the VA, the scientific evidence is currently mixed, and rigorous, larger-scale studies are recommended to validate the initial positive outcomes noted in the 2024 JCP study and to address any potential risks. A 2018 report by the VA's Evidence Synthesis Program found that large treatment benefits demonstrated in uncontrolled case series have not been easily replicated in well-controlled randomized controlled trials (RCTs). The report suggests that the potential benefits of HBOT may be subtle and require larger RCTs to demonstrate significant effects.
Currently, the VA offers HBOT as a treatment option for a small number of veterans with persistent PTSD symptoms that are resistant to standard treatments. This treatment is provided through partnerships with HBOT providers at select VA health care systems and medical centers. The VA is also conducting a multisite research study to examine the use of HBOT for patients diagnosed with PTSD.
While HBOT shows promise, we must remain committed to a comprehensive and evidence-based approach. By supporting further research and careful evaluation, we can better ensure that our veterans receive the best possible and most effective care for TBI and PTSD. We therefore recommend the Subcommittee include provisions in this bill to prioritize rigorous research alongside providing veterans access to HBOT. It is important to thoroughly validate and understand the efficacy and risks of this therapy as an alternative treatment option for PTSD and TBI before it is more broadly implemented.
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H.R. 1644, the Copay Fairness for Veterans Act
The Copay Fairness for Veterans Act aims to eliminate copayments for medications and preventive health services provided by the VA. It would enhance access to these services by removing financial barriers that can discourage veterans from seeking essential care. Preventive services are critical for early detection and management of certain health issues, leading to improved health outcomes. The bill also includes provisions for women veterans to ensure they receive preventative care services, screenings and contraceptives as outlined in the Health Resources and Services Administration Preventative Services Guidelines.
By removing financial barriers, the bill encourages routine check-ups, vaccinations and critical screenings, leading to better overall health management and fewer emergency medical situations. Many veterans, especially those on fixed incomes, struggle with copayments for health services and medication. By removing required copayments, the bill provides much-needed financial relief, ensuring that veterans can access the care they need without worrying about additional costs. Moreover, promoting preventive care can lead to long-term cost savings for both veterans and the health care system by reducing the need for more expensive treatments and hospitalizations. Preventive services with an "A" or "B" rating from the United States Preventive Services Task Force and immunizations recommended by the Advisory Committee on Immunization Practices are essential components of this approach.
We support this bill in accordance with DAV Resolution No. 246, which calls for legislation to eliminate or reduce VA and DOD health care out of-pocket costs for service-connected disabled veterans to improve health care access, provide financial relief, enhance health equity and encourage routine care. This bill reflects our nation's commitment to supporting our veterans and ensuring they receive the care they earned.
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H.R. 1823, to direct the VA Secretary and the Comptroller General of the United States to report on certain funding shortfalls in the VA
This bill seeks to address funding shortfalls in the VA by directing the VA Secretary and the Comptroller General of the United States to conduct thorough reviews and report on funding shortfalls.
The bill specifically mandates a review by the Comptroller General to investigate the circumstances and causes of funding shortfalls in the Veterans Benefits Administration (VBA) for fiscal year 2024 and the VHA for fiscal year 2025. The review must include a comparison of monthly obligations and expenditures against the spending plan, an analysis of any transfers between accounts, an evaluation of reasons for significant diversions from the spending plan, an assessment of the accuracy of projections and estimates, and recommendations for remedial actions to improve accuracy and prevent future shortfalls. The Comptroller General would be required to submit a report to the VA Secretary, who will then submit the report to the specified congressional committees.
By identifying and addressing funding shortfalls, the bill aims to improve the financial management of the VBA and VHA and establish more efficient use of resources and better allocation of funds to critical services. The goal of the bill is to improve financial management, enhance accountability, establish preventive measures, and ensure more timely reporting of projected budget shortfalls. The bill also requires thorough reviews and reports aimed at increasing accountability within the VA and promoting more transparent and responsible budget management practices. The identification of remedial actions may help prevent future funding shortfalls, ensuring uninterrupted services for veterans.
We support this bill in accordance with DAV Resolutions Nos. 23 and 403, advocating for consistent VA funding, full implementation of existing laws, and protection of veterans' services and health care from budget caps.
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H.R. 1860, the Women Veterans Cancer Care Coordination Act
The Women Veterans Cancer Care Coordination Act seeks to revolutionize cancer care for women veterans by establishing a comprehensive support system. The bill mandates the designation of Regional Breast and Gynecologic Cancer Care Coordinators within each Veteran Integrated Services Network (VISN). These coordinators would be tasked with ensuring seamless communication and coordination between VA clinicians and community cancer care providers.
Eligibility for care coordination would be extended to veterans diagnosed with breast or gynecologic cancer or those identified with precancerous conditions, provided they qualify for health care through the Veterans Community Care Program (VCCP). Additionally, the bill would require the establishment of regions for care coordination, to determine the specific needs of veterans in different areas, including rural communities. This regional approach aims to provide tailored support, ensuring that veterans receive timely and appropriate care regardless of their location.
The prescribed duties of the Regional Breast and Gynecologic Cancer Care Coordinators are multifaceted. They would facilitate the coordination of care between VA clinicians and community care providers, ensuring that veterans receive consistent and comprehensive treatment. They would be responsible for monitoring the services provided, tracking health outcomes, and maintaining data on cancer care. This data driven approach will help identify trends, measure effectiveness, and guide future improvements in care delivery.
A significant component of the bill is the requirement for the VA Secretary to submit a detailed report to Congress within three years of enactment. This report would compare health outcomes between veterans treated at VA facilities and those treated by community providers. It would assess the timeliness, safety, and quality of care, and identify any necessary changes or additional resources needed to enhance cancer care for women veterans. By establishing dedicated coordinators, focusing on data-driven care, and providing essential information and support, the bill strives to improve health outcomes and quality of life for these veterans and to ensure they receive coordinated, comprehensive, and compassionate care.
The bill would also help to ensure that male veterans who suffer from breast cancer due to toxic exposures receive the same specialized care as their female counterparts. The Honoring our PACT Act, signed into law in August 2022 (P.L. 117-168), expands and extends eligibility for VA health care for veterans with toxic exposures. This includes male veterans who have been diagnosed with breast cancer.
The VA has recognized the need to address the health effects of toxic exposures and has included male breast cancer in the list of conditions presumed to be caused by military service. Male veterans who have been exposed to toxic substances during their service and have developed breast cancer are eligible for the same benefits and specialized care as female veterans.
We support this bill in accordance with DAV Resolution 39, which calls for ensuring that the VA provides health care services and specialized programs, including gender-specific services, to eligible women veterans at the same degree and extent as services provided to male veterans. It also emphasizes improving women's health programs and finding innovative methods to address care barriers, ensuring women veterans receive quality treatment and specialized services.
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Draft Bill, the Saving Our Veterans Lives Act of 2025
The Saving Our Veterans Lives Act of 2025 aims to prevent veteran suicide by providing eligible veterans with secure firearm storage items upon request. The alarming rate of veteran suicide is a stark reminder of the urgent need for comprehensive measures to protect those who have sacrificed so much for our country. According to the VA 2024 National Veteran Suicide Prevention Annual Report, there were 6,407 suicides among veterans in 2022, with firearms being involved in 72% of these cases. Firearms are the primary method of suicide among veterans, and by providing secure storage options for firearms--such as a lockbox or safe, this Act aims to reduce access to lethal means during moments of crisis, potentially saving countless lives.
Creating time and space is a critical component of this Act's strategy to reduce veteran suicides. Providing veterans with secure firearm storage can create a critical time delay, allowing them to reconsider their actions and seek help during moments of crisis. This additional time can be a lifesaving interval, as it provides a window of opportunity for the veteran to reach out for support, contact the crisis hotline, or have a moment of reflection. The VA's 2024 suicide prevention report highlighted a reduction in suicide rates among veterans with VHA mental health diagnoses, underscoring the effectiveness of targeted suicide prevention efforts. By delaying access to firearms during a crisis period, the Act empowers veterans to make safer choices and access the help they need.
The Act includes an educational component that would help inform veterans about the benefits of secure firearm lock box storage with a goal of more responsible firearm handling and storage practices. The development of informational videos would help ensure that veterans receive the necessary guidance on secure storage as a suicide prevention strategy. Proper firearm storage not only protects veterans but also their families, reducing the risk of accidental discharges and unauthorized access by children or other household members. This program aims to promote a culture of safety within the veteran's community, fostering a secure environment for all.
We support this bill in accordance with DAV Resolution No. 224, which calls for mental health and suicide prevention program improvements to include suicide rate data collection and reporting, improved outreach for stigma reduction, sufficient mental health staffing, and enhanced resources for VA mental health programs.
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Draft Bill, the No Wrong Door for Veterans Act
The No Wrong Door for Veterans Act would reauthorize and extend the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program through September 30, 2028, ensuring that community-based suicide prevention initiatives and mental health services will continue to be available to veterans.
By adjusting the grant amount and clarifying the criteria for eligible entities, the bill promotes equitable distribution of funds and aims to ensure that qualified organizations can provide high-quality mental health services to veterans. Moreover, the bill's emphasis on improved coordination and communication between grantees and VA medical centers is a significant enhancement. Quarterly briefings for local VA medical center personnel will help facilitate better collaboration and information sharing, hopefully leading to more efficient and effective delivery of mental health services. This improved coordination is crucial for creating a seamless support network for veterans in crisis.
Another critical provision in the legislation is the bill's requirement that grantees notify eligible individuals about emergent suicide care options and report requests for such care to the VA. Increased awareness and utilization of suicide prevention resources can lead to more timely intervention and potentially save lives. By requiring the use of screening protocols selected by the Secretary, the bill also ensures that veterans receive consistent and standardized care, further enhancing the quality of mental health services.
While the intent of extending the Fox Suicide Prevention Grant Program is commendable, DAV recommends strengthening the proposed legislation to ensure it meets its primary objective--reducing risk of suicide in this population. We recommend the bill reiterate the standard of baseline mental health screening that all grantees must provide or coordinate the provision of a baseline mental health screening to all eligible individuals they serve at the time those services begin. This mental health screening must be provided using a validated screening tool that assesses suicide risk and mental and behavioral health conditions. Applicants or partner organizations must measure the effectiveness of suicide prevention services provided to eligible individuals and their families using pre- and post-evaluations that employ validated measures of suicide risk and mood-related symptoms.
Additionally, funding criteria in the bill is associated with the number of participants served rather than prioritizing demonstrated improvements in veterans' well-being (i.e., reduction in suicide risk factors). We want to ensure that resources are directed to programs that achieve measurable outcomes. Finally, we suggest the payment structure be more clearly defined to prevent overcompensation for minimal services.
Given that the funding renewal for this initiative was supposed to be based on demonstrated improvements in veterans evaluation measures, we recommend a cautious, annual renewal process until comprehensive data confirms the program's overall efficacy and specifically, which services are most effective in reducing suicide risk in the veteran population. These changes are essential to maximize the program's potential and truly support at-risk veterans.
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Draft Bill, the Providing Veterans Essential Medications Act
The Providing Veterans Essential Medications Act would amend title 38, United States Code, to ensure that veterans receiving nursing home care in state homes have access to necessary, yet costly, medications.
Under this bill, the VA Secretary is directed to either reimburse state homes for these high-cost medications or furnish them directly, at the election of the state home. The bill defines "costly medication" as any drug or medicine whose average wholesale price for a one-month supply, plus a transaction fee, exceeds 8.5% of the payment made by the Secretary for the veteran's care. This amendment seeks to alleviate the financial burden on state homes and ensure that veterans continue to receive appropriate and comprehensive care without the added stress of high medication costs.
The cost of high-cost medications, such as revolutionary cancer drugs, can often exceed $1,000 a day. This bill will ensure that state homes are not financially strained by these costs. VA providing these types of medications also incentivizes more state homes to provide care for severely disabled veterans and increases the availability of high-quality long-term care services across the country. The PACT Act has led to an increase in veterans adjudicated as severely disabled due to toxic exposure. This rise will more likely than not necessitate State Veterans Homes to provide high-cost medications to more veterans. As the number of veterans requiring specialized and expensive medications grows, State Veterans Homes will face increased financial strain. It is essential to ensure that these homes receive adequate funding and support to meet the rising demand for care. This bill will help address the growing demand for high-cost medications in state homes and ensure that all veterans receive the health care they earned.
We support this bill in accordance with DAV Resolution No. 227, which calls on Congress and the VA to provide sufficient funding to support State Veterans Homes, including adequate per diem payments for skilled nursing care, domiciliary care and adult day health care, which properly support different levels of care within each program.
Draft Bill, to establish the period during which the referral of a veteran, made by a health care provider of the Department of Veterans Affairs, to a non-Department provider, for care under the VA Community Care Program, remains valid.
This bill seeks to streamline the referral process for community services, reduce administrative barriers, and improve access to care. The bill's primary objective is to establish the period during which a referral of a veteran, made by a health care provider of the VA, to a non-Department provider remains valid under the VCCP. The bill specifies that this period begins on the day the covered veteran has their first appointment with the non-Department provider. This provision would ensure veterans referred to non-Department providers have a clear referral validity period, facilitating smoother transitions.
We support this bill in accordance to DAV Resolution No. 18, which supports legislation that establishes clearly defined VA health care services for enrolled veterans.
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Draft Bill, the Veterans Supporting Prosthetics Opportunities and Recreational Therapy or SPORT Act
The DAV has long recognized the importance of adaptive sports in the rehabilitation and well-being of veterans through our involvement with events like the National Disabled Veterans Winter Sports Clinic, and the National Disabled Veterans Golf Clinic. These recreational therapy programs help veterans improve their physical and mental health through sports and activities tailored to their abilities, while connecting them with other veterans and a community to help overcome limitations and challenge their perceived disabilities.
The Veterans SPORT Act seeks to include adaptive prostheses and terminal devices, for participation in sports and other recreational activities, in the medical services provided by VA to eligible veterans. Including adaptive sports devices is congruent with VA's holistic approach to veteran care, which includes the physical, psychological and social aspects of rehabilitation. This legislation aims to enhance the quality of life for our nation's ill and injured veterans by providing them with the necessary adaptive devices to participate in various sports and recreational activities, which plays a vital role in their overall physical and mental well-being. These devices enable service-disabled veterans to engage in a wide range of activities, including Paralympic sports like track and field, swimming, and wheelchair basketball; archery with adaptive equipment; cycling with hand cycles and adaptive bicycles; skiing with adaptive equipment; hunting with specialized devices; rock climbing with modified safety equipment; skydiving with adaptive gear; golf with adaptive golf equipment; and various water sports like paddle boarding, kayaking, pedal boating, and canoeing.
We support this bill in accordance with DAV Resolution No. 429, which urges the VA to keep centralized funding for Prosthetics and Sensory Aids Service to provide high-quality prosthetic items and train veterans on their use and care. By supporting this bill, we honor the sacrifices of our most severely disabled veterans and promote their overall well-being by providing them with the necessary adaptive devices to once again engage in sports and recreational activities.
In closing, the proposed bills under consideration by the Subcommittee today represent a comprehensive and multifaceted approach to addressing the urgent needs of our veterans. By prioritizing timely access to care, effective care coordination, and comprehensive, individualized health care options, these bills aim to enhance the quality of life for our veterans, who have bravely served our nation.
This concludes my testimony on behalf of DAV. I am pleased to answer questions you or members of the Subcommittee may have.
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Original text here: https://docs.house.gov/meetings/VR/VR03/20250311/117987/HHRG-119-VR03-Wstate-RetzerJ-20250311.pdf
American Enterprise Institute Senior Fellow Peter Testifies Before House Veterans' Affairs Subcommittee
WASHINGTON, March 27 -- The House Veterans' Affairs Subcommittee on Economic Opportunity released the following testimony by Tobias Peter, co-director of the Housing Center and senior fellow at the American Enterprise Institute, from a March 11, 2025, hearing on veteran care and benefits related legislation:* * *
Chairman Van Orden and Ranking Member Pappas, and distinguished Members of the Subcommittee, thank you for the opportunity to testify today.
The VA Loan Program: Managing Mortgage Risk and Policy Considerations The VA loan program has consistently outperformed other government-backed ... Show Full Article WASHINGTON, March 27 -- The House Veterans' Affairs Subcommittee on Economic Opportunity released the following testimony by Tobias Peter, co-director of the Housing Center and senior fellow at the American Enterprise Institute, from a March 11, 2025, hearing on veteran care and benefits related legislation: * * * Chairman Van Orden and Ranking Member Pappas, and distinguished Members of the Subcommittee, thank you for the opportunity to testify today. The VA Loan Program: Managing Mortgage Risk and Policy Considerations The VA loan program has consistently outperformed other government-backedmortgage programs--including FHA, Fannie Mae, and Freddie Mac--in managing mortgage risk.
During the aftermath of the Great Financial Crisis, VA loans recorded default rates:
* Nearly 50% lower than FHA loans, despite serving borrowers with comparable risk profiles.
* Nearly 45% lower than Fannie Mae and Freddie Mac's loans when adjusted for differences in risk profiles.
Even in recent years, under less stressful market conditions, the VA's serious delinquency rates have remained about half the level of those of FHA, despite serving borrowers with comparable risk profiles. (See Appendix 1 for more details.) While the precise reasons for this disparity are complex, several factors likely contribute:
* More prudent underwriting standards, particularly the VA's residual income requirement, which ensure borrowers have sufficient income after expenses.
* The VA's appraisal process, including its Tidewater Initiative, is veteran-focused and promotes more accurate appraisals, while reducing the risk of inflated valuations.
* The military background of VA borrowers, which may correlate with greater financial discipline and stability.
* Unlike the FHA, which insures 100% of the loan amount, the VA guaranty has a stop loss of 25% of the loan amount. This aligns the private servicer's loss mitigation interests with those of the VA and the veteran.
VA Loan Servicing at a Crossroads Despite these strengths, VA loan servicing faces significant challenges. While no one wants to see foreclosures, especially among veterans, it is essential to recognize that a housing finance system without the possibility of foreclosure is inherently unsustainable--much like "religion without hell."
Without accountability, the system risks morphing into an entitlement program, distorting market incentives and ultimately undermining long-term stability for both veterans and taxpayers.
Moreover, history has shown that government programs often begin with a limited scope, only to expand beyond recognition and sustainability due to constant program expansion--the federal student loan program being a prime example.
Expanded loss mitigation programs carry significant risks:
* Short-term reductions in delinquency and default rates may be illusory, as borrowers may continue struggling even after intervention.
* Encourages riskier lending practices, with some already advocating for more generous loan terms despite high default risks.
This is particularly concerning, given that 54% of VA first-time borrowers have less than one months' of reserves (assets remaining after deducting closing costs, gifts, and down payments), leaving them financially vulnerable in the event of unexpected hardships.
* Increases housing demand without addressing supply constraints, further inflating home prices.
* Places taxpayers at greater risk, as federal backing means losses are ultimately borne by the public.
Recent Biden administration initiatives reflect a trend toward socializing mortgage finance. I commend this committee's leadership for seeking to reverse some of these concerning developments.
Concerns with the VA Servicing Purchase (VASP) Program The VASP program could set a negative precedent for direct lending by the VA, potentially reshaping the entire veteran housing finance system--at the expense of veterans, taxpayers, and private servicers.
The VA is apparently using its statutory authority to adopt a more interventionist approach to foreclosure prevention. As my AEI colleague Philip Wallach recently testified, this approach amounts to an "extraordinarily generous form of relief," potentially tempting borrowers holding mortgages with 7-8% interest rates to undertake strategic default. The program's protections against such default, however, appear insufficient, creating moral hazard.
This represents a philosophical shift from the VA's traditional role of guaranteeing private loans in Ginnie Mae securities to directly managing veteran mortgages--a step toward socialized lending with potentially unintended consequences, including:
* Potentially disrupting the current alignment among private servicers, the VA, and veterans in managing loss mitigation efforts. If this were to happen, default rates within the VA program--particularly under financial stress--could begin to mirror those of FHA, Fannie Mae, and Freddie Mac, undermining the program's historically stronger performance.
* Increased taxpayer exposure in the event of widespread defaults, as the VASP program merely defers financial risk rather than addressing its root causes. By kicking the can down the road, VASP could amplify long-term losses, creating a greater financial burden on taxpayers in the future.
* Higher taxpayer costs, as lowering the interest rate to 2.5% on a VASP loan can be extremely expensive. To my knowledge, the VA has not disclosed the per-loan cost of this rate reduction, making the total financial impact unclear.
* Looser lending standards, increasing overall mortgage risk and the likelihood of defaults.
* Increased risk of political interference, leading to expanding benefits and growing financial liabilities over time.
* Servicers potentially exiting the market due to diminished roles and crowding out of traditional lenders, which could reduce competition and limit financing options for veterans, ultimately leaving them with fewer choices and less flexibility in the mortgage market.
* Potentially disadvantaging veterans over time as the VA assumes the role of direct lender and servicer, despite lacking the expertise required for large-scale loan management.
The parallels between VASP and the federal student loan program are clear:
* The 2010 Student Aid and Fiscal Responsibility Act made the government the sole student loan lender through the Direct Loan Program, thereby eliminating private underwriting.
* Unrestricted borrowing fueled tuition inflation and rising defaults.
* Income-driven repayment shifted costs to taxpayers, with forgiveness after 10-25 years.
* Moral hazard increased as borrowers expected partial or full loan forgiveness.
Just as the student loan program evolved into an unsustainable entitlement, VASP marks the first step down a similar path, eroding private-sector discipline in favor of costly, taxpayer-funded federal intervention.
Given that the VA intends this program to serve "more than 40,000 Veterans" and that it likely is already well underway, I commend the committee's leadership for its efforts to limit its scope by:
* Capping VA loan purchases at 250 per fiscal year, and
* Mandating the VA to study within 180 days the sale of acquired VASP loans to the private sector, where they can be managed more efficiently.
Furthermore, it is likely a vast overstatement to claim that all borrowers currently seriously delinquent on their VA loans will inevitably lose their homes to foreclosure if the VASP program is curtailed.
Today, loan workouts are still available but much harder to achieve given today's higher mortgage rates. Yet there's a simpler, common-sense option for many struggling borrowers: selling the home. My analysis of servicer data shows that out of approximately 80,000 seriously delinquent VA loans, about 84% of borrowers would hold positive equity after selling their homes -- even after accounting for arrearages and transaction costs (see table)./1
This reflects the fact that most veterans purchased their homes years ago and have benefited significantly from rapid home price appreciation during the pandemic, along with steady principal paydown through amortization. Among those with positive equity, the average amount is $128,000, with a median of $97,000. But instead of encouraging sales that would preserve veterans' dignity -- as was traditionally the case -- the VASP program fosters government dependency while shifting the risk and losses onto taxpayers.
To be clear, 16% of seriously delinquent borrowers -- roughly 13,000 veterans -- would still face negative equity if forced to sell, with an average shortfall of $19,000 and a median of $14,000. But this is primarily due to transaction costs -- costs that are part of the risk and responsibility that come with homeownership, willingly accepted at the time of purchase. They are also far less behind on their payments and they also have the most to gain from the VASP's 2.5% mortgage rate as their rates are on average over 6%.
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1 The current equity position is calculated as the difference between the estimated current home value and the unpaid principal balance. We estimate the current home value by adjusting the original loan amount and loan-to-value (LTV) ratio using ZIP-level changes from the FHFA Home Price Index. From this, we subtract all missed interest payments -- inferred from the loan term, note rate, loan age, and original loan amount -- as well as assumed transaction costs equal to 7% of the current home value. The data exclude any equity that a borrower may have extracted previously through a home equity loan or a HELOC.
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Table: Estimated equity distribution of VA seriously delinquent borrowers if they sold their homes
Note: Data are for purchase and refinance loans and are as of Dec. 2024. The current equity position is calculated as the difference between the estimated current home value and the unpaid principal balance. We estimate the current home value by adjusting the original loan amount and loan-to-value (LTV) ratio using ZIP-level changes from the FHFA Home Price Index. From this, we subtract all missed interest payments -- inferred from the loan term, note rate, loan age, and original loan amount -- as well as assumed transaction costs equal to 7% of the current home value.
Source: ICE McDash and AEI Housing Center.
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My analysis also compares the loan characteristics of the roughly 80,000 currently seriously delinquent VA borrowers to the broader VA loan portfolio. The data show a clear pattern: Seriously delinquent borrowers had significantly lower credit scores at origination -- about 51 points lower on average, with an average score of 673 --than those of borrowers who remain current, who have an average score of 723./2
The problem of borrowers with lower credit scores becoming seriously delinquent seems to have become significantly worse since 2020 (see chart)./3
This points to a deeper problem -- not simply borrower hardship, but a failure of too loose government underwriting standards that should be addressed at the front end, rather than through costly government programs after the fact. (See Appendix 1 for more details, which provides periodic tables of actual defaults under severe stress for various combinations of credit score, LTV, and DTI buckets at loan origination. For reference, the loans that are serious delinquent and were originated in 2022-2024 have an expected default rate of 22.5% under severe stress, while the ones that are not seriously delinquent have an expected default rate of 9.3% -- or about 2.5 times lower.)
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2 The analysis controls for loan purpose and year of origination. The seriously delinquent borrowers also have about 2.4 ppts higher debt-to-income (DTI) ratios at origination than those that are not seriously delinquent, but DTIs are only reported in about 20% of loans.
3 Some of this effect may also be due to selection bias as seriously delinquent borrowers may have exited the VA loan book through foreclosure or home sale over the years. But the point remains that lower credit scores are a significant contributor to serious delinquency.
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Evaluating the VA Home Loan Program Reform Act The proposed loss mitigation options offer a more structured and balanced approach compared to the VASP program, but they come with significant drawbacks:
* Establishes a waterfall for servicers, with partial claims as last resort.
* However, it could create incentives for servicers to bypass traditional loss mitigation tools (e.g., servicer forbearance, repayment plans, loan modifications) and move directly to partial claims since they bear no financial risk leaving taxpayers on the hook.
* It also front-loads partial claims against the 25% stop loss, potentially disadvantaging veterans in the long run. If a veteran exhausts their entitlement early, they could have fewer loss mitigation options available 5, 10, or 15 years down the road, leaving them more vulnerable in future financial hardships.
* It is crucial to remember that the VA's 25% stop-loss provision has historically protected the program under financial stress, ensuring long-term sustainability.
* The inclusion of a sunset provision for the Partial Claim option in September 2027 is a notable strength, as it effectively limits taxpayer exposure when compared to the VASP program. The one-claim-per-loan limit further curbs long-term liability.
* However, there is no overall cap on the Partial Claim program, which could lead to moral hazard, encouraging some borrowers to take advantage of 0% loans and live payment-free for extended periods (especially if they restart payments within three years).
* Requiring reporting to Congress is a positive step toward oversight and evaluation.
* However, reporting should be ongoing, publicly accessible, and include all costs, in order to allow policymakers, researchers, and taxpayers to assess the program's effectiveness in time.
While VA Home Loan Program Reform Act is a clear improvement over the VASP program, it should not be considered as a long-term solution. Ultimately, a well-designed loss mitigation strategy should balance borrower relief with fiscal responsibility, preventing unnecessary taxpayer exposure. Proponents argue that forbearance and partial claim programs were successful during the pandemic, but the pandemic was not a true stress test because:
* Double-digit home price appreciation (HPA) artificially protected borrowers from foreclosure risk, which allowed borrowers to easily sell their homes.
* Historically low unemployment rates minimized delinquency rates.
* Pre-pandemic trends (2017-2019) saw an average of 15,000 completed VA loan foreclosures per year. Despite all loss mitigation efforts, 2023 still saw 10,000 completed foreclosures, proving that some defaults are inevitable and that expanded loss mitigation cannot eliminate risk.
* * *
A Better Path Forward: Sustainable Homeownership
The ultimate goal should be to provide every veteran a fair opportunity to succeed at homeownership without relying on government bailouts.
My research, analyzing 200,000 VA loans and 1,600,000 GSE loans originated in 2006-07 (just before the Global Financial Crisis, a true stress event), identifies several key factors that significantly reduce default risk:
Shorter Loan Terms:
* Loans with terms of 15-20 years reduced serious default rates by over 50%, particularly among borrowers with credit scores below 660.
Multiple Borrowers:
* Loans with two borrowers instead of one saw a 20-30% reduction in serious defaults, likely due to greater income stability and diversification within the household.
* Stable Housing Markets:
* In areas where lending practices were more prudent, home prices remained stable and did not experience significant declines, default rates were about 50% lower for the typical VA borrower.
* Adequate Liquid Reserves:
* Borrowers with sufficient liquid reserves demonstrated greater staying power, reducing defaults by several percentage points. Importantly, these findings are consistent with more recent loan data from 2013-2015, suggesting that these factors remain relevant predictors of loan performance across different market cycles.
The details of this analysis can be found in Appendix 1.
* * *
Conclusion:
Balancing Sustainability with Accessibility As this committee considers next steps, the choice is clear:
* Market-based solutions that promote sustainable homeownership, or
* A socialized housing finance system, with the long-term risks that entails.
While homeownership brings many societal and personal benefits, it must be sustainable--not forced. By focusing on responsible underwriting, prudent loan characteristics at origination, and borrower resilience, we can protect both veterans and taxpayers while ensuring a stable housing finance system for years to come.
In Appendix 2, I also offer brief comments on the Fair Access to Coops for Veterans Act of 2025, which may not represent a significant expansion of housing supply accessible to most veterans.
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Original text here: https://docs.house.gov/meetings/VR/VR10/20250311/117985/HHRG-119-VR10-Wstate-PeterT-20250311.pdf
University of Iowa Health Care Clinical Assistant Professor Kozminski Testifies Before House Veterans' Affairs Subcommittee
WASHINGTON, March 27 -- The House Veterans' Affairs Subcommittee on Health released the following testimony by Andrew Kozminski, clinical assistant professor of emergency medicine and anesthesia at the University of Iowa Health Care, from a March 11, 2025, hearing on the Veterans National Traumatic Brain Injury Treatment Act (H.R. 1336):* * *
Good afternoon, Chairwoman Dr. Miller-Meeks, Ranking Member Brownley, and Members of the Subcommittee. Thank you for inviting me to participate in this hearing to discuss H.R. 1336, The Veterans National Traumatic Brain Injury Treatment Act.
This piece ... Show Full Article WASHINGTON, March 27 -- The House Veterans' Affairs Subcommittee on Health released the following testimony by Andrew Kozminski, clinical assistant professor of emergency medicine and anesthesia at the University of Iowa Health Care, from a March 11, 2025, hearing on the Veterans National Traumatic Brain Injury Treatment Act (H.R. 1336): * * * Good afternoon, Chairwoman Dr. Miller-Meeks, Ranking Member Brownley, and Members of the Subcommittee. Thank you for inviting me to participate in this hearing to discuss H.R. 1336, The Veterans National Traumatic Brain Injury Treatment Act. This pieceof legislation aims to improve the health of our veterans. Establishing a pilot program for the use of hyperbaric oxygen (HBO) therapy for veterans with traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD) could help improve these patients' quality of life. Besides the potential clinical improvement, a VA pilot program would enable veterans to receive HBO in a safe environment. Furthermore, using this pilot program as a means to conduct more research for these indications could help to improve the delivery of care for not just veterans but for all civilians.
Over the course of a lifetime, an average of 7% of veterans experience PTSD with the highest incidence at 29% for veterans deployed in Operations Iraqi Freedom and Enduring Freedom. As an emergency medicine physician, I have cared for numerous veterans suffering from TBIs and PTSD. With my experience in hyperbaric medicine, I think the implementation of HBO for these ailments would be uncomplicated. Veterans already use this therapy through their VA insurance for currently approved HBO indications. Thus, HBO has proven its safety after many decades of use by the medical community. For these reasons, this legislation has potential to help improve the lives of our friends, families, and neighbors.
I am Dr. Andrew Kozminski, an emergency medicine physician with a specialization in undersea & hyperbaric medicine. I am the current medical director for hyperbaric medicine at University of Iowa Health Care (UIHC) and medical director for the UIHC Wound Center.
One main function as the director of a hyperbaric medicine service is providing safe treatments for patients. The usual population for a hyperbaric medicine service includes patients with complicated chronic wounds, radiation injuries, and cases of acute soft tissue ischemia. Most patients receiving HBO across the country are in ambulatory, non-critical condition. However, many large healthcare systems are treating patients for emergency indications (i.e. decompression sickness, arterial gas embolism, central retinal artery occlusion, carbon monoxide poisoning, acute blood loss anemia) and patients who come from intensive care settings with life or limb-threatening conditions like necrotizing fasciitis, crush injuries, or impending compartment syndrome. At the University of Iowa, my team has treated the full spectrum of indications and for patients who are merely days-old to greater than 100 years of age. This range of patient demographics and conditions highlights HBO's relative safety when administered by trained hyperbaric medicine professionals at accredited healthcare facilities.
Since 2018, University of Iowa Health Care has participated and has been a top enrolling site in a phase II adaptive, multi-center, randomized clinical trial called Hyperbaric Oxygen Brain Injury Treatment Trial (HOBIT). This trial aims to determine
the optimal dose and frequency of hyperbaric oxygen that is most likely to improve outcomes for acute severe traumatic brain injury patients. As expected for those who incur a severe TBI, the mechanism of injury can damage any and all organ systems, which can make treating these cases riskier than an average HBO patient. However, despite these critical circumstances, skilled healthcare providers knowledgeable in the specific potential complications within a hyperbaric environment have been able to maintain a robust safety profile throughout the course of this trial. In comparison to treating these patients, caring for ambulatory, non-critically ill patients with chronic TBI or PTSD should be well within the capabilities of any accredited hospital system across the country with HBO capabilities.
The 14th Edition of the Undersea & Hyperbaric Medical Society's Indications Manual contains a summary of 34 publications, a mixture of case reports, retrospective reviews, prospective and randomized clinical trials from 1985 to 2018, that aimed to examine TBI and the potential role for HBO as a treatment. Adverse events, if reported, are listed in this summary. Neurologic oxygen toxicity and claustrophobia are two such adverse events that might be more prevalent in this sub-population compared to the general HBO patient population.
Oxygen toxicity seizures for the general population are a potential but rare complication of hyperbaric oxygen and is something I educate all of my patients on prior to beginning their treatment course. The Epilepsy Foundation reports 1 in 50 TBI cases result in post-traumatic epilepsy. This does not mean veterans with a TBI and concurrent epilepsy will be unable to receive HBO treatments. It is appropriate, however, to adjust treatment profiles to account for lower seizure thresholds in patients with known epilepsy or patients that experience an oxygen toxicity seizure during their treatment course. In any case, an oxygen toxicity seizure is a complication that trained hyperbaric medicine professionals are well-versed in how to manage and should be able to ensure continued patient safety throughout a treatment course.
I have also treated many patients with claustrophobia or hesitancy about receiving treatment in a confined space. Anecdotally, some patients find wearing an oxygen mask or hood to be bothersome. Within a patient population suffering from traumatic combat experiences, there will be some qualifying patients who refuse treatment because of the confined environment. Anxiolytic medications can be administered safely by trained professionals to help these patients receive HBO. In a worst-case scenario, a patient would need to be removed from a hyperbaric chamber mid-treatment. Aborting a treatment does not pose any increased risk of physical harm to a patient and would not keep them from continuing with other forms of therapy for their condition.
It is important to comment on the possibility of complications during an HBO treatment not only to provide a complete picture of the risks and benefits but to highlight the importance of trained hyperbaric medicine professionals being the ones to administer this care for our veterans. As TBI and PTSD are not currently covered indications by insurance companies in the United States, there are desperate patients who seek HBO treatments at health clinics or "health spas" --businesses that claim to offer life-altering HBO treatments at low prices for off-label indications. In my experience, these "health spas" do not adhere to the same level of safety as hyperbaric services within a hospital system, nor might they even provide correct HBO doses or treatment profiles. Just this past January, a 5-year-old child was killed in Troy, Michigan at one of these businesses from an explosion. Reportedly, the mishap is still under investigation, but it was likely a result of insufficient training and/or lax safety measures. I do not want our veterans, or any person, to seek treatment for TBI or PTSD in health clinics that place patients in danger. Establishing a pilot program for veterans will enable them to get treatment at fully accredited institutions where they can be cared for by true medical professionals.
Unfortunately, current treatment options for TBI and PTSD leave a range of 15-50% of patients with persistent symptoms after standard intervention. The medical community strives to improve this outcome through more research and clinical trials. This legislation will help progress and add to this effort.
My participation in the ongoing HOBIT trial--testing the effect of HBO on acute, severe TBI--encompasses the extent of my personal experience in treating TBI or PTSD with HBO. As mentioned, these conditions are currently off-label and thus classified as experimental. I look to the lead investigators in my field and the research they have completed to derive my opinion on whether HBO has potential for providing relief for patients with chronic TBI and PTSD.
It is believed that HBO holds promise as a treatment for these conditions as it elevates oxygen tension in the blood and damaged tissues which helps promote neuroplasticity in the acute setting of injury. For chronic TBI cases, it has been found that HBO can improve cellular metabolism, reduce cell death and oxidative stress, and enhance mitochondrial function. These mechanisms aim to promote neuronal repair and regeneration. The Brain Injury and Mechanism of Action (BIMA) trial, published in 2016, demonstrated improved post-concussive symptoms, PTSD, cognitive processing speed, sleep quality and balance function by 13 weeks after 40, 60-minute HBO sessions at 1.5 ATA. Unfortunately, these improvements did not persist beyond 6 months. More studies have also shown clinical improvement in their HBO intervention groups while others have mixed results and would likely provide clearer answers with more patient recruitment and better long-term follow-up.
Most recently, Dr. Lindell Weaver, a leader in my field, and his team published their most recent study last month (February 2025), "A double-blind randomized trial of hyperbaric oxygen for persistent symptoms after brain injury." This study included both TBI and non-TBI brain injuries, making the findings more generalizable across patient populations. Participants were divided either into an HBO treatment group or a sham group for the first phase of the trial. The treatment group received 40 HBO sessions at 1.5 ATA within 12 weeks. 13-week follow-up showed improvements in cognitive test scores, similar to what was seen in the BIMA trial, for both sham and HBO groups. These improvements were maintained at 6-months only for the HBO group. The second phase of the trial offered another 40 HBO sessions to all trial participants. At final follow-up, 3 months after the last treatments were given, patients who received 80 HBO treatments had greater neuropsychiatric improvement compared to their results after 40 sessions. The initial sham group, patients who received a maximum of 40 treatments, showed neuropsychiatric improvements similar to the treatment group in the first phase of the trial.
I find the outcomes of these trials to be promising. More work needs to be performed to better understand the potential long-term efficacy of HBO for TBI and PTSD. HBO dose and treatment frequency could also be further investigated, though 1.5 ATA is more neuroprotective in a population with higher incidence of seizures. For TBI and PTSD, HBO should still be performed in conjunction with frequent, specialized brain injury rehabilitation.
In conclusion, this piece of legislation aims to improve the health of our veterans. Establishing a pilot program for the VA to offer HBO therapy for veterans with TBIs and PTSD could help improve these patients' quality of life, provide access to safe health care environments in which to receive these treatments, and continue to build insight on how best to construct and administer treatment courses in the future.
* * *
References:
* Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder; Board on the Health of Select Populations; Institute of Medicine. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment. Washington (DC): National Academies Press (US); 2014 Jun 17. 2, Diagnosis, Course, and Prevalence of PTSD. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224874/ Elaine Kiriakopoulos MD, et al. "Traumatic Brain Injury and Epilepsy." Epilepsy Foundation, www.epilepsy.com/causes/structural/traumatic-brain-injury-and-epilepsy. Accessed Mar. 2025.
* Fann JR, Hart T, Schomer KG. Treatment for depression after traumatic brain injury: a systematic review. J Neurotrauma. 2009 Dec;26(12):2383-402. doi: 10.1089/neu.2009.1091. PMID: 19698070; PMCID: PMC2864457.
* Skipper LD, Churchill S, Wilson SH, Deru K, Labutta RJ, Hart BB. Hyperbaric oxygen for persistent post-concussive symptoms: long-term follow-up. Undersea Hyperb Med. 2016 Aug-Sept;43(5):601-613. PMID: 28768076.
* "Va.Gov: Veterans Affairs." How Common Is PTSD in Adults?, 13 Sept. 2018, www.ptsd.va.gov/understand/common/common_adults.asp#:~:text=About%205%20out%20of%20every,some%20point%20in%20their%20life.
* "Va.Gov: Veterans Affairs." How Common Is PTSD in Veterans?, 24 July 2018, www.ptsd.va.gov/understand/common/common_veterans.asp.
* Weaver LK, Chhoeu A, Lindblad AS, Churchill S, Deru K, Wilson SH. Executive summary: The Brain Injury and Mechanism of Action of Hyperbaric Oxygen for Persistent Post-Concussive Symptoms after Mild Traumatic Brain Injury (mTBI) (BIMA) Study. Undersea Hyperb Med. 2016 Aug-Sept;43(5):485-489. PMID: 28768068.
* Weaver, L.K., Ziemnik, R., Deru, K. et al. A double-blind randomized trial of hyperbaric oxygen for persistent symptoms after brain injury. Sci Rep 15, 6885 (2025). https://doi.org/10.1038/s41598-025-86631-6
* Weaver LK, Wilson SH, Lindblad AS, Churchill S, Deru K, Price RC, Williams CS, Orrison WW, Walker JM, Meehan A, Mirow S. Hyperbaric oxygen for post-concussive symptoms in United States military service members: a randomized clinical trial. Undersea Hyperb Med. 2018 Mar-Apr;45(2):129-156. PMID: 29734566.
* Weaver, Lindell. "Hyperbaric Oxygen for Symptoms Following Mild Traumatic Brain Injury." UHMS Hyperbaric Medicine Indications Manual, 14th ed., Best Publishing, 2019, pp. 379-389.
Summary:
Good afternoon, Chairwoman Dr. Miller-Meeks, Ranking Member Brownley, and Members of the Subcommittee. Thank you for inviting me to participate in this hearing to discuss H.R. 1336, The Veterans National Traumatic Brain Injury Treatment Act.
I am Dr. Andrew Kozminski, an emergency medicine physician with a specialization in undersea & hyperbaric medicine. I am the current medical director for hyperbaric medicine at University of Iowa Health Care (UIHC) and medical director for the UIHC Wound Center.
This legislation aims to improve the health of our veterans. Establishing a pilot program for the implementation of hyperbaric oxygen (HBO) therapy for veterans with traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD).
As an emergency medicine physician, I have cared for numerous veterans suffering from TBIs and PTSD. With my experience in hyperbaric medicine, I think the implementation of HBO for these ailments would be uncomplicated. Veterans already use this therapy through their VA insurance for currently approved HBO indications. Consequently, HBO has proven its safety after many decades of use by the medical community. For these reasons, this legislation has potential to help improve the lives of our friends, families, and neighbors.
I want to comment on the potential for an increased likelihood of oxygen toxicity seizures in this patient population as 1 in 50 TBI patients develop post-traumatic epilepsy. However, an oxygen toxicity seizure is a complication that trained hyperbaric medicine professionals are well-versed in how to manage and should be able to ensure continued patient safety throughout a treatment course. Clinical trials I will mention even utilize a protective pressure of 1.5 ATA, which should reduce the likelihood of this complication. However, this is an important reason to create a pilot program through the VA health system as this would provide a safe option for patients seeking treatment for what is currently an off-label indication. Without this program, desperate patients may find themselves at the mercy of popular "health spas"--businesses that might not have adequately trained staff, may use incorrect treatment profiles, and at times pose serious risk to their clients.
The research that investigators in my field have completed on the utility of HBO for TBI and PTSD shows promise for improving health outcomes in these patient populations. For chronic TBI cases, HBO has been found to improve cellular metabolism, reduce cell death and oxidative stress, and enhance mitochondrial function. These mechanisms aim to promote neuronal repair and regeneration. The Brain Injury and Mechanism of Action (BIMA) trial, published in 2016, demonstrated improved post-concussive symptoms, PTSD, cognitive processing speed, sleep quality and balance function by 13 weeks after 40, 60-minute HBO sessions at 1.5 ATA. Unfortunately, these improvements did not persist beyond the 6-month follow-up.
In February 2025, Dr. Lindell Weaver, a leader in my field, and his team published their most recent study, "A double-blind randomized trial of hyperbaric oxygen for persistent symptoms after brain injury." This study showed similar results to what was observed in the BIMA trial for both sham and HBO groups at 13 weeks, with the HBO treatment group maintaining the neuropsychiatric benefits at 6 months. A second phase within the trial offered another 40 HBO sessions to all participants. At final follow-up, 3 months after the last of the second round of HBO treatments were given, patients who received 80 HBO treatments had greater neuropsychiatric improvement compared to their results after 40 sessions. The patients who received a maximum of 40 treatments also showed neuropsychiatric improvements compared to their baseline scores but less improvement than their counterparts who received 80 treatments.
In conclusion, I find the outcomes of these clinical trials to be promising. Establishing a pilot program for the VA to offer HBO therapy for veterans with TBIs and PTSD could help improve these patients' quality of life, provide access to safe health care environments in which to receive these treatments, and continue to build insight on how best to construct and administer treatment courses in the future.
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Original text here: https://docs.house.gov/meetings/VR/VR03/20250311/117987/HHRG-119-VR03-Wstate-KozminskiA-20250311.pdf
Edison Electric Institute Senior VP Aaronson Testifies Before House Homeland Security Subcommittee
WASHINGTON, March 26 -- The House Homeland Security Subcommittee on Cybersecurity and Infrastructure Protection released the following testimony by Scott Aaronson, senior vice president for energy security and industry operations at the Edison Electric Institute, from a March 11, 2025, hearing entitled "Regulatory Harm or Harmonization? Examining the Opportunity to Improve the Cyber Regulatory Regime":* * *
Chairman Garbarino, Ranking Member Swalwell, and members of the Subcommittee, thank you for the opportunity to testify. My name is Scott Aaronson, and I am Senior Vice President for Energy ... Show Full Article WASHINGTON, March 26 -- The House Homeland Security Subcommittee on Cybersecurity and Infrastructure Protection released the following testimony by Scott Aaronson, senior vice president for energy security and industry operations at the Edison Electric Institute, from a March 11, 2025, hearing entitled "Regulatory Harm or Harmonization? Examining the Opportunity to Improve the Cyber Regulatory Regime": * * * Chairman Garbarino, Ranking Member Swalwell, and members of the Subcommittee, thank you for the opportunity to testify. My name is Scott Aaronson, and I am Senior Vice President for EnergySecurity & Industry Operations at the Edison Electric Institute (EEI). EEI is the association that represents all U.S. investor-owned electric companies, which together are projected to invest more than $200 billion this year to make the energy grid stronger, smarter, cleaner, more dynamic, and more secure against all hazards. That includes cyber threats. EEI's member companies provide electricity for nearly 250 million Americans and operate in all 50 states and the District of Columbia. The electric power industry supports more than seven million jobs in communities across the United States. I appreciate your invitation to discuss this important topic on their behalf.
We rely on safe, reliable, affordable, and resilient energy to power our daily lives, run our nation's economy, and support national security. Today, demand for electricity is growing at the fastest pace in decades, creating challenges for our nation, as well as opportunities to ensure America is home to the industries, technologies, and jobs of tomorrow. America's investorowned electric companies are uniquely positioned to meet growing demand and to address evolving risks, while working to keep customer bills as low as possible.
* * *
EEI's Comments on Cyber Regulatory Harmonization
The electricity subsector is a part of the energy sector that is designated by National Security Memorandum/NSM-22 as one of the 16 critical infrastructure sectors whose assets, systems, and networks are considered so vital to the United States that their incapacitation or destruction would have a debilitating effect on national security, economic security, or public health and safety. The reliance of virtually all industries on electric power means that all critical infrastructure sectors have some dependence on the energy sector.
The electric subsector employs a risk-based, defense-in-depth approach to cybersecurity, including employing a variety of tools and strategies that support existing voluntary and mandatory cybersecurity standards and regulations, both of which are valuable tools in ensuring the cybersecurity of critical infrastructure.
Throughout the country, investor-owned electric companies are meeting and exceeding existing cybersecurity regulations and standards. As the federal government, states, and private sector work together to reduce risk holistically and continue to enhance cybersecurity protections of critical infrastructure, it is important that new cybersecurity requirements are not duplicative, conflicting, overlapping, or inefficient. Regulations that include flexibility and support for resilience, response, and recovery can help electric companies protect the electric grid. We also need to have strong partnerships in place across key sectors and with government in order to maintain the robust cybersecurity posture needed to face the realities of potential cyber warfare.
In November 2023, EEI submitted comments on the Office of the National Cyber Director's (ONCD) Request for Information on Cybersecurity Regulatory Harmonization./1
In summary, EEI's comments recognized that cybersecurity regulations must keep pace with the evolving threat landscape. Because industry owns, operates, and secures the majority of the energy grid, the federal government should incorporate industry's subject matter expertise in developing and implementing new regulations and streamline processes from which new regulations may emerge. EEI's comments also provided examples of cybersecurity regulatory conflicts, inconsistencies, redundancies, challenges, and opportunities. Some of the key points that EEI made include:
* Effective communication between government and industry is paramount to reconciling existing and future cybersecurity regulations;
* Harmonization is needed to address the high costs and inefficiencies caused by existing regulations or standards, or both;
* Harmonization efforts also must address third-party business partners;
* In addition to federal regulations, EEI members also are subject to (and must comply with) many state, local, tribal, and territorial cybersecurity requirements and standards; and,
* * *
1 Comment from Edison Electric Institute, REGULATIONS.GOV, https://www.regulations.gov/comment/ONCD-20230001-0039 (November 1, 2023).
* * *
* Additional matters to help harmonize cybersecurity regulations, such as:
* Voluntary information sharing and protection;
* Privacy laws and regulations;
* Information handling;
* Cloud security;
* Contract terms; and,
* Government coordination.
* * *
EEI's Engagement on CIRCIA
While the Cyber Incident Reporting for Critical Infrastructure Act of 2022 (CIRCIA) is the first federal cybersecurity reporting requirement focused specifically on reporting across all 16 critical infrastructure sectors, electric companies have been subject to similar federal reporting for years pursuant to mandates imposed by the Federal Energy Regulatory Commission (FERC), the North American Electric Reliability Corporation (NERC), the Transportation Security Administration (TSA), and the Department of Energy (DOE). These existing reporting requirements should be considered by the Cybersecurity and Infrastructure Security Agency (CISA) as it determines how to implement its own cybersecurity and incident reporting regulations.
In May 2024, EEI had the opportunity to testify during this subcommittee's hearing entitled, "Surveying CIRCIA: Sector Perspectives on the Notice of Proposed Rulemaking."/2
EEI testified that one of our member electric companies estimated they could file roughly 65,000 reports through 2033 under the proposed rule -- vastly exceeding CISA's estimate of more than 200,000 total reports during that period. In addition, our testimony highlighted that the Department of Homeland Security's (DHS) Cyber Incident Reporting Council (CIRC) report on harmonization identified that there currently are 45 different federal cyber incident reporting requirements administered by 22 federal agencies./3
We recommended that CISA thoroughly explore opportunities to limit duplicative reporting through the "substantially similar" exception of CIRCIA, and through the establishment of CIRCIA Agreements with federal counterparts. EEI's testimony also identified several areas for enhancement of the proposed rule, including:
* Scope of substantial cyber incident definition;
* * *
2 Statement of Scott Aaronson, CONGRESS.GOV, https://www.congress.gov/118/meeting/house/117105/witnesses/HHRG-118-HM08-Wstate-AaronsonS20240501.pdf (May 1, 2024).
* * *
* Volume of information requested;
* Workforce burden;
* Data preservation requirements; and
* Protection of information.
Following the hearing last May, EEI has continued to engage with CISA on CIRCIA. In July 2024, EEI submitted three sets of comments on the proposed rule. The first set of comments was sent on behalf of EEI's member electric companies and included feedback that was discussed in the May hearing, including:
* CISA's proposed definition of "substantial cyber incident" is too broad and therefore must be narrowed in scope;
* The amount of information required under the proposed rule is excessive, significantly increasing a covered entity's reporting burden while often contributing little analytical value;
* CISA must do all it can to protect reported information from threat actors and recognize its own limitations;
* The proposed rule's data-preservation requirements are unduly onerous;
* The proposed rule includes contrasting interpretations of the term "promptly" as it relates to the timeframe within which covered entities must submit supplemental reports;
* CISA's proposed marking requirements need clarifying; and
* Harmonizing existing and proposed cybersecurity requirements is vital./4
* * *
3 Harmonization of Cyber Incident Reporting to the Federal Government, DHS.GOV, https://www.dhs.gov/sites/default/files/2023-09/Harmonization%20of%20Cyber%20Incident%20Reporting%20to%20the%20Federal%20Government.pdf (September 19, 2023).
4 Comment Submitted by Edison Electric Institute, REGULATIONS.GOV, https://www.regulations.gov/comment/CISA2022-0010-0452 (July 5, 2024).
* * *
The second set of comments was sent on behalf of the communications sector, electricity subsector, and financial services sector, encouraging CISA to limit the scope and raise the threshold for incident reporting by amending the definition of a substantial cyber incident in the final rule./5
Cosigners of these comments included some of the most sophisticated critical infrastructure owners and operators across the United States, including the American Bankers Association, American Public Power Association, Bank Policy Institute, EEI, National Rural Electric Cooperative Association, NTCA--The Rural Broadband Association, Securities Industry and Financial Markets Association, and USTelecom--The Broadband Association.
The third set of comments was sent on behalf of more than 50 organizations seeking clarification on whether trade associations would be considered "covered entities" that are required to report cyber incidents to CISA under the proposed rule./6
The uncertainty around the inclusion of associations, which serve members within critical infrastructure sectors--but which do not own or operate critical infrastructure--in the definition of a covered entity is just one example of the ways in which CISA's proposed rule is out of scope. These comments were intended to ensure CISA appropriately tailors reporting requirements to provide only the most relevant information necessary to protect homeland security.
Also in July 2024, subcommittee Chairman Andrew Garbarino,/7 subcommittee Ranking Member Eric Swalwell, full committee Ranking Member Bennie Thompson, Rep. Yvette Clarke,/8 as well as then-Senate Homeland Security and Government Affairs Committee Chairman Gary Peters,/9 submitted comments on the proposed rule. The feedback provided by Congress suggested that CISA mischaracterized or failed to meet the congressional intent of CIRCIA. Universally, congressional leaders have encouraged CISA to refine the scope of definitions and to meaningfully incorporate industry feedback in the final rule.
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5 Comment Submitted by ABA, APPA, BPI, EEI, NRECA, NTCA, SIFMA, USTelecom, REGULATIONS.GOV, https://www.regulations.gov/comment/CISA-2022-0010-0254 (June 28, 2024).
6 Comment Submitted by National Association of Manufacturers and 50 other trade associations, REGULATIONS.GOV, https://www.regulations.gov/comment/CISA-2022-0010-0320 (July 3, 2024).
7 Comment Submitted by Congressman Andrew R. Garbarino, REGULATIONS.GOV, https://www.regulations.gov/comment/CISA-2022-0010-0464 (July 9, 2024).
8 Comment Submitted by CHS - Ranking Member Bennie G. Thompson, Ranking Member Eric Swalwell, Rep. Yvette Clarke, REGULATIONS.GOV, https://www.regulations.gov/comment/CISA-2022-0010-0463 (July 9, 2024).
9 Comment Submitted by Homeland Security and Government Affairs Committee, REGULATIONS.GOV, https://www.regulations.gov/comment/CISA-2022-0010-0424 (July 3, 2024).
* * *
Finally, in October 2024, EEI, along with more than 20 organizations, sent a letter to CISA regarding the status of CIRCIA implementation, specifically requesting the establishment of an ex parte process to enhance stakeholder engagement and facilitate ongoing dialogue for its implementation./10
The letter urged CISA to:
* Adopt an ex parte process for ongoing stakeholder engagement;
* Narrow the scope of CIRCIA to enable a positive cycle of information sharing and actionable insights;
* Proactively harmonize CIRCIA implementation with existing regulatory requirements to optimize operational response; and,
* Strengthen safeguards for information and protections against liability to support cyberattack victims and foster candor in reporting.
To date, CISA has not established an ex parte process and the status of the remaining recommendations remains unknown.
* * *
Opportunities for CIRCIA and Recommendations for Congress
Nearly a year after this subcommittee's hearing and EEI's testimony on CIRCIA, we are in a period of transition with a new Administration and a new Congress. Change brings opportunity--and I urge this subcommittee to leverage this opportunity to help CISA improve implementation of CIRCIA.
As we stated in our comments on the proposed rule, EEI and its members wholly endorse the policy objectives underpinning CIRCIA. CIRCIA is an important law with an important goal of identifying and mitigating cyber risks across all sectors of the economy, and I appreciate this committee's leadership in shepherding this effort forward these last several years. When CIRCIA was enacted, Congress emphasized that the legislation sought to strike a balance between enabling CISA to receive information quickly and allowing the impacted entity to respond to an attack without imposing burdensome requirements. Details matter when it comes to how CIRCIA, or how any mandatory cyber incident reporting regime, is implemented. We need our most skilled cyber experts to be spending the majority of their time protecting America's critical infrastructure, not filling out paperwork.
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10 Cross-sector Letter on CIRCIA Implementation, CYBERSCOOP.COM, https://cyberscoop.com/wpcontent/uploads/sites/3/2024/10/10.29.24-Cross-sector-Letter-on-CIRCIA-Implementation68.pdf (October 29, 2024).
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When evaluating how best to proceed, I encourage Congress to consider that:
* A final CIRCIA rule could help mitigate attacks and the disruptions they cause to American individuals and businesses. Therefore, improving the existing proposal and finalizing the rule by the fall 2025 deadline, as mandated by statute, may be preferable to issuing a new proposed rule. A new proposal may cause confusion and unnecessary delays, as well as increase costly paperwork for both covered entities and the federal government.
* CISA faces several challenges in improving the existing proposal to better align with congressional intent. These include difficulties in collaborating with industry stemming from the lack of an established ex parte process, as well as issues related to natural attrition and staff turnover following the change in Administration. Additionally, uncertainty around congressional appropriations may impact CISA's ability to effectively intake incident reports by the end of 2025.
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Recommendations for Congress:
1. Conduct oversight regarding the current status of CIRCIA, including staffing levels, resource needs, the projected timeline for final rule completion, and anticipated future engagement with industry stakeholders.
2. Facilitate coordination amongst congressional committees of jurisdiction to:
a. Ensure alignment between CISA, Sector Risk Management Agencies, and other regulators, confirming that CIRCIA Agreements are developed in compliance with the law's substantially similar reporting exception; and
b. Review concerns with existing federal reporting requirements, including the national security concerns associated with the public disclosure of incidents required by the U.S. Securities and Exchange Commission.
3. Further clarify CISA's role in cybersecurity regulatory harmonization in relation to other federal entities, such as DHS and ONCD; and assess the next steps for the CIRC at DHS, as well as the legislative proposals recommended by CIRC in its harmonization report.
4. Reauthorize the Cybersecurity Information Sharing Act of 2015 (CISA 2015), a pivotal law that encourages and protects cyber threat information sharing between the government and the private sector. While CISA 2015 is more about information sharing than incident reporting, both are essential to strengthening our collective cyber defenses to meet the evolving threat landscape.
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Conclusion
Thank you again to this Committee for holding today's hearing and for your ongoing efforts to strengthen America's energy security. EEI's member companies are committed to working with federal partners and stakeholders across all sectors to achieve cyber regulatory harmonization that prioritizes and enhances U.S. critical infrastructure security. We appreciate the bipartisan support of this committee in ensuring we get CIRCIA right and we look forward to continuing our collaboration to protect the safety, security, and well-being of all Americans.
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Original text here: https://homeland.house.gov/wp-content/uploads/2025/03/2025-03-11-CIP-HRG-Testimony.pdf
American Federation for Children Spokesman Blanks Testifies Before House Education & Workforce Subcommittee
WASHINGTON, March 26 -- The House Education and Workforce Subcommittee on Early Childhood, Elementary, and Secondary Education released the following testimony by American Federation for Children spokesman Walter Blanks Jr. from a March 11, 2025, hearing entitled "Education Without Limits: Exploring the Benefits of School Choice":* * *
Mr. Chairman and distinguished Members of the U.S. House Committee on Education and Workforce. My name is Walter Blanks Jr., I am a spokesperson for the American Federation for Children, and I am here today because school choice changed my life.
I grew up in ... Show Full Article WASHINGTON, March 26 -- The House Education and Workforce Subcommittee on Early Childhood, Elementary, and Secondary Education released the following testimony by American Federation for Children spokesman Walter Blanks Jr. from a March 11, 2025, hearing entitled "Education Without Limits: Exploring the Benefits of School Choice": * * * Mr. Chairman and distinguished Members of the U.S. House Committee on Education and Workforce. My name is Walter Blanks Jr., I am a spokesperson for the American Federation for Children, and I am here today because school choice changed my life. I grew up inOhio, where my local public school was failing me. Every day, I walked into a classroom where I felt unseen, unheard, and unchallenged. I struggled academically, and my parents knew that if something didn't change, I would never reach my full potential. But like so many families, we could not afford private school tuition on our own.
My parents had reached their breaking point when I found myself sitting in the principal's office after being attacked by a group of other students. Instead of addressing the immediate issue, the principal turned to my mother and said, "If you give us five years, we'll have the middle school and high school turned around, and Walter will be able to thrive." Without hesitation, my mother looked him in the eye and said, "In five years, Walter will either be in jail or in a body bag--and we don't have time for either." She took my hand, we left, and from that moment on, I never stepped foot in that school again.
Thankfully, my parents applied for, and I received a school choice scholarship through the state of Ohio's Edchoice Scholarship Program, which gave me the opportunity to attend a private school that completely transformed my life. For the first time, I was in an environment that nurtured my potential. I went from a student who struggled to one who thrived. That opportunity set me on a path that led me here today, advocating for students who are just like I was.
My journey has taken me places I never could have imagined--including the White House, where I met President Trump. I'll never forget looking him in the eye and telling him that I wanted his job someday. That moment wasn't just about ambition--it was about recognizing that when students are given the right opportunities, there are no limits to what they can achieve. My life is living proof.
Unfortunately, too many students across the country are still waiting for their chance. That's why I also support the Educational Choice for Children Act (ECCA). The ECCA would give students in every state access to scholarships, opening doors to schools that best meet their needs. For some, it's the difference between struggling and succeeding. For others, it's quite literally a lifesaver. I appreciate the Members of the Committee who have supported this important bill and urge every representative to support this life-changing opportunity.
Every child deserves the same opportunity I had--the chance to succeed, to dream big, and to write their own future. I have had great success because of my school choice journey and firmly believe more students should have that chance. Thank you.
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Original text here: https://edworkforce.house.gov/uploadedfiles/blanks_jr_congressional_testimony-_final.pdf