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WASHINGTON, DC—In a House Appropriations Military Construction and Veterans Affairs subcommittee hearing today, Congresswoman Chellie Pingree (D-Maine) questioned Veterans Affairs (VA) Secretary Denis R. McDonough on how the Department is working to improve Military Sexual Trauma claims processing, as well as the VA’s efforts to improve communication with veterans who may have been exposed to per-and polyfluoroalkyl substances (PFAS) contamination at military installations. The hearing was convened to discuss the VA’s $139.1 billion budget request for the 2023 fiscal year, which represents a 18.7% increase over FY22 and 32% increase over FY21 enacted levels.

Citing a 2021 Office of Inspector General report that concluded the Veterans Benefits Administration “has not effectively or fully addressed previous OIG recommendations designed to improve MST claims processing,” Pingree pressed Secretary McDonough on the implementation status of the OIG’s four new recommendations. 

“We've adjudicated 10,179 MST cases … and we've granted in 78% of those cases,” Secretary McDonough said. “Now it could still be that we are not granting rightly in the 22% that are not getting the claim, whose claim is not being found in favor of, but the way we're trying to get better on that is we've consolidated MST claims into eight regional offices with specific teams with experience on these claims, and therefore have a better understanding of understanding how to resolve these claims. So, that's been since May 2021. Later this month, we're moving to a virtual regional office that handles all of these cases and just these cases and that will be run out of San Juan. So, I hope as we specialize in these cases, we get better on the error rate.” 

“We are constantly trying to get better,” he continued. “[…] And you are keeping the pressure on us. By maintaining the attention on, it helps us as well. We just gotta get this right.”

Pingree urged the Secretary to provide additional information about how the VA is working to improve communication and transparency with veterans who served at military installations with potentially hazardous levels of PFAS contamination, including the former Brunswick Naval Air Station.

“I know the DOD has identified hundreds of [installations] around the country that potentially has hazardous PFAS. And I just have concerns that we're not doing enough to address the exposure with the veteran population who have served, and in some cases lived with their families, at these installations,” Congresswoman Pingree said while questioning Secretary McDonough. “[…] Could you expand a little bit on what the VA's efforts are to improve outreach, and whether they will include outreach to PFAS exposed veterans?”

“This is a major priority for the president and he stood up for the first time in the interagency working group on PFAS. And you can imagine that obviously EPA is a key mover and shaker in that, but so is DOD and so is VA. And we're working very closely with the council of environmental quality and OSTP, as well as the DPC at the White House to make sure that as a government, we're looking at this holistically,” Secretary McDonough said. “So we share your concern about it. We're trying to get our hands around it as a government and an administration, holistically and via as a fundamental role to play in that as well.”

Click here to watch the complete exchange between Pingree and McDonough; a complete transcript is available below. Click here to watch the full hearing. 

 

Background

 

In August 2018, the VA OIG released a report which found that nearly half of denied MST claims over a six-month period in 2017 had not been properly processed.  Many claimants had not even been provided the opportunity for an exam and had been prematurely denied. The OIG made six recommendations intended to help VBA review and correct all prematurely denied MST claims since October 1, 2016, and to better process these claims in the future. VBA concurred with those recommendations and agreed to make the proposed improvements going forward.

 

However, in August 2021 a new OIG report was released which revealed that, despite some efforts at VBA to implement the 2018 OIG recommendations, VBA failed to adequately enforce and monitor the policy changes, and the same problems continue to persist.  In fact, the OIG evaluated denied MST claims over a three-month period in 2019, and found that approximately 57% of denied claims had been improperly processed, a clear increase over the 49% error rate in the 2018 report. Despite making efforts to improve the process, the percentage of improperly processed claims increased.

 

The OIG concluded that “VBA has not effectively or fully addressed previous OIG recommendations designed to improve MST claims processing. Veteran survivors of MST remain at risk of not receiving the VA benefits to which they are entitled.”  The updated report provides VBA with four recommendations for corrective action.  VBA concurred with all four.

 

Supporting men and women who were sexually assaulted during their service has been a top priority of Pingree’s. She recently reintroduced a bipartisan bill to improve access to resources and care for survivors of MST. The Servicemember and Veterans’ Empowerment and Support Act, which is adapted from their 2019 version of the bill, updates and expands the definition of MST to ensure servicemembers and veterans who experience online sexual harassment can access VA counseling and benefits. It also codifies the lower burden of proof established in VA policy nearly two decades ago and ensures that this relaxed evidentiary standard is appropriately extended to all mental health conditions resulting from sexual violence.    

 

As Maine and the nation face health threats due to PFAS contaminated land and water, Pingree has pushed for federal support and funding to support those affected. More than 600 military installations—including the Portsmouth Naval Shipyard, the former Brunswick Naval Air Station, the former Loring AFB, and the Bangor Airport, where the Air National Guard is stationed—have been identified by the Department of Defense as having potentially hazardous levels of PFAS contamination. Currently, the VA says that research on the health effects of PFAS exposure is inconclusive. 

 

Multiple bills have been introduced in Congress to improve VA and DOD tracking of PFAS exposure among servicemembers and veterans, as well as to provide health care coverage to exposed veterans who may experience negative impacts. Pingree and the House recently passed the Honoring Our PACT Act to comprehensively reform the way VA handles toxic exposures. The bill would require VA to establish a national registry for servicemembers and veterans experiencing health problems possibly due to PFAS exposure and would allow military personnel and veterans to receive updates on recent scientific developments on the effects of PFAS exposure, availability of possible treatment options, and information on what resources may be available to address their health concerns.

 

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Congresswoman Pingree

Let me jump into Military Sexual Trauma, because it's a long and complicated topic and I know we've discussed it before. I'll try to summarize quickly. 

 

We discussed the 2018 OIG report, which found that 49% of MST-related disability claims were inaccurately processed. And unfortunately, in August there was another report. Um, and to summarize, it said 57% are not processed correctly. So, the error rate is going up. I guess I want to know your reaction to that, what actions you're taking.

 

And let me just throw in a couple of other things. I have a bill, the Servicemembers and Veterans Empowerment and Support Act, which would improve the claims adjudication process. And it basically deals with this notion that currently only veterans with a PTSD diagnosis are eligible for relaxed evidentiary standard. But a different diagnosis, which is common with MST, like anxiety or depression, those aren't eligible. So, I've gotten some feedback from the VA on the bill, but I would really like to work with you to move this forward, you know, unless you have another plan for getting these numbers up. We just have to make sure that all the filing for compensation for mental health condition related to MST have access to the same relaxed evidentiary standard. I think that would help a lot. So, I'll let you talk.

 

Secretary Denis McDonough

Good. Well, thanks very much. And, and I appreciate the attention you pay to this issue because it gets to something else I think you saw at the Portland CBOC, which is we also have to make sure that our facilities and our programming and our decision making is reflective of hospitable to and welcoming of the fastest growing demographic, which is women veterans. 

 

Now it's not just women who are survivors of MST. It is women and men. But how we do on MST claims sends a really important signal to our women veterans who are survivors and to our men veterans who are survivors. So here's what we've done year to date. We've adjudicated 10,179 MST cases … and we've granted in 78% of those cases.

 

Now it could still be that we are not granting rightly in the 22% that are not getting the claim, whose claim is not being found in favor of, but the way we're trying to get better on that is we've consolidated MST claims into eight regional offices with specific teams with experience on these claims, and thereforegjk6m better understanding of understanding how to resolve these claims.

So, that's been since May 2021. Later this month, we're moving to a virtual regional office that handles all of these cases and just these cases and that will be run out of San Juan. So, I hope as we specialize in these cases, we get better on the error rate. 

 

The last point is we are constantly trying to get better. We're in the midst this month of a full training effort and updating effort of our claims providers. I think we're in touch with you. I know we're in touch with one of your colleagues on the authorizing side, miss Lu about coming to help us as we're thinking about this. But as you say, we also have to be constantly updating our clinical practice. I just saw a big story about the fact, by the way, standing to reason survivors of military sexual trauma are more likely to have hypertension. And so we ought to be factoring that new science and those new findings into our practice at VBA as well. 

 

So all of this is us trying to get better. All of us is all of this is us trying to incorporate more science and more understanding of the phenomenon into our practice. And you are keeping the pressure on us. By maintaining the attention on, it helps us as well. We just gotta get this right.

 

CP

Okay. I'm out of time. But when we get a chance, I want to, you know, push you a little bit on the evidentiary standard as well, because, and I greatly appreciate the training and the thought you're giving to this, but we'll, we'll get a chance to work on that and talk to you about that as well. So thank you. 

 

CP

One thing I really want get to is PFAS. It's, it's a major issue in Maine right now. We've got a lot of challenges going on in our agricultural sector because frankly we've been forward thinking about looking for PFAS and so we've seen a lot more than we wish we had. But we also know that happens on military installations and we have the Naval air station in my district. So, we're familiar with some of the issues that could happen regarding military installation.

 

I know the DOD has identified hundreds of these around the country that potentially has hazardous PFAS. And I just have concerns that we're not doing enough to address the exposure with the veteran population who have served installations. You touched on the idea of a VA new pilot model and your testimony for dealing with military environmental exposure. And it specifically mentioned that you're increasing your veteran outreach. But we hear a lot from veterans about the installation that they've served at, where they may have lived with their families and that the facilities have tested for higher levels of PFAS. So they're concerned about their own health, but could you expand a little bit on what the VA's efforts are to improve outreach, and whether they will include outreach to PFAS exposed veterans?

 

DM

Yeah, so … as it relates to toxic exposure, generally, we're trying to increase outreach and that's through all of our standard ways to include making sure that, for example, as I said, when somebody takes the step of filing for the burn pit registry, that they actually see some result therefrom. I think in too few cases that’s happened. 

 

So why don't I take, uh, for submission to you, kind of what our comms plan is with veterans around toxics and around PFAS.

 

That's one. Two, this is a major priority for the president and he stood up for the first time in the interagency working group on PFAS. And you can imagine that obviously EPA is a key mover and shaker in that, but so is DOD and so is VA. And we're working very closely with the council of environmental quality and OSTP, as well as the DPC at the White House to make sure that as a government, we're looking at this holistically. 

 

So we share your concern about it. We're trying to get our hands around it as a government and an administration, holistically and via as a fundamental role to play in that as well.

 

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