00:00Thank you, Madam Chair, and I too want to thank all of you for your service to our nation's veterans.
00:05We appreciate it very, very much.
00:08Dr. Hunter, I appreciate that in your testimony you highlighted the importance of military cultural competency and training.
00:16Can you expand on why VA providers are so uniquely positioned to care for veterans
00:23and what it means for your members that their providers understand their unique needs?
00:30Thank you so much.
00:32VA providers are required to undergo extensive training on military cultural competency.
00:37This includes things like multiple compound exposures, whether it is toxins, the interaction between mental and physical health care,
00:46as well as emerging research on some of our technologies.
00:50Additionally, VA providers, some of which are actually cleared to be able to access classified medical records,
00:59and so they can understand environmental exposures that were there.
01:02For myself, this was life-saving.
01:05At a regular routine optometry appointment that I had where I was experiencing vision changes,
01:10and I thought it was because maybe I was just over the age of 40,
01:13my VA optometrist was able to connect symptoms I was experiencing to exposures from my service time
01:22and get me screened for ocular melanoma.
01:25Turned out I had it.
01:27We caught it super early at this case, but in every single community care optometry appointment I had,
01:34not once had I been asked about my time in military service, where might I have been,
01:39the type of exposures that I would have seen.
01:41And if we look at the post-9-11 generation, and we look at what was found in the PACT Act,
01:47the ideas of presumptive connections for things like toxic exposures,
01:52but we're seeing more and more aviation equipment, the time around fueling,
01:56as well as the compound traumas with military sexual trauma and PTSD,
02:02it is essential that our veterans are seen by providers who understand that.
02:06And in the community, while the Mission Act says they should have training,
02:11we actually have no idea what sort of training they're getting.
02:14We don't have oversight on that in a real and meaningful way,
02:18the way we do have oversight on the types of training that VA providers have.
02:22Thank you for that.
02:23And I think in reading Dr. Mobb's testimony, she cited a RAND article,
02:29excuse me, a RAND article, stating that, at least making the assertion that VA providers aren't trained.
02:39I know that you've previously worked at RAND.
02:43Are you familiar with this article at all?
02:45Yes, I was one of the contributing authors to that study.
02:48Are you, so can you, is that true, what the conclusion of that article said?
02:53No, the article said that we are aware of the training that VA providers received.
02:58We do not have oversight on the training that community care providers receive.
03:03Thank you for that.
03:04And another thing I appreciate about your testimony was that you included extensive citations throughout
03:12to articles in academic journals, to studies from nonpartisan entities like RAND, GAO, and the CBO.
03:20One thing that worries me about the way legislation sometimes comes together
03:26is that it is informed by anecdotes and the experiences of perhaps vocal minority voice
03:34rather than by the true evidence.
03:38So what does the evidence say about where veterans prefer to receive their care
03:43and where the quality and outcomes are better?
03:46The preponderance of the evidence shows that veterans prefer VA care.
03:53And when we look at some of the very, very tragic stories that we see
03:57and the anecdotes that we hear, we need to take every single one of them seriously
04:00and look into what has happened.
04:02And the VA does have significant measures to actually address providers
04:06that provide subpar care.
04:08But we also need to be reminded, as I was often in my doctoral studies,
04:12that the plural of antidote isn't data.
04:14And if we look at the preponderance of the data,
04:17the data lead us to VA care providing better care.
04:20And in surveys of our own members, only 14% express any confidence in community care
04:26being able to address and coordinate their complex medical needs.
04:31Thanks for that.
04:32Do you have any suggestions on really how we help veterans, the public for that matter,
04:42to better understand the evidence and overcome this perception
04:47that the VA care isn't as good as community care?
04:51I think it is very incumbent upon VSOs to take an educating role on what the VA is
04:56and also incumbent on members of Congress to continue to engage with VA providers
05:00to ensure that we have appropriate oversight and engagement
05:04to understand the quality of care that exists.
05:08Thank you for that.
05:08I yield back.
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