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Health Chairwoman Miller-Meeks Delivers Opening Remarks at Hearing on Substance Abuse Treatment for Veterans

Today, Rep. Mariannette Miller-Meeks, M.D. (R-Iowa), the Chairwoman of the House Committee on Veterans’ Affairs Subcommittee on Health, delivered the following opening remarks, as prepared, at the start of the subcommittee’s oversight hearing to discuss providing veterans with access to life-saving substance abuse disorder treatment as substance abuse and overdose deaths continue to be at an all-time high in the United States:

Good morning again. This oversight hearing for the Subcommittee on Health will now come to order.

Our country has been experiencing a substance abuse and overdose epidemic, we are seeing historic highs, and our nation’s veterans are not immune. One death from substance use disorder is too many, and it is a somber reality that many lives are taken by this treatable mental disorder.

165 million people, in the United States alone, struggle with drug and alcohol abuse. And over 106,000 Americans died from drug overdose in 2021.

As a 24-year veteran, I have seen the unique challenges that many of my fellow servicemembers and veterans face. Among the veteran population, we have sadly seen a 53% increase in drug overdose mortality rates from 2010 to 2019. Four in 10 veterans struggle with illicit drug use, seven in 10 struggle with alcohol use, and one out of eight struggles with both.

This is an enormous obstacle that we need to address.

Had VA sent us their testimony in a more timely manner, I would have liked to address the initiatives they are talking about today. In spite of that, I would like to acknowledge the VA Mental Health Residential Rehabilitation Treatment Programs, also called MH RRTP, provides rehabilitative and clinical care to veterans that need intensive specialty treatment for mental health and substance use disorders.

The MH RRTP continuum includes more than 70 programs for the treatment of substance use disorders (SUD) and more than 40 programs for the treatment of posttraumatic stress disorder (PTSD) with the expectation that all programs provide integrated, concurrent treatment for co-occurring SUD and mental health treatment needs.

That being said, veterans, through the MISSION Act, should be eligible to receive in-and out-patient substance abuse treatment in the community, when that is the appropriate course of action. I am very concerned about how VA has interpreted and differentiated between institutional and in-institutional extended care. It is becoming increasingly clear that once again bureaucracy has overcome intent.

VA continually repeats that there is “no wrong door” for veterans seeking substance abuse care, however, as we will hear from our witnesses on the second panel that there is inaccuracy and bureaucratic hyperbole with that statement.

I would like to point out three instances where the VA has not embodied their “no wrong door” declaration.

First, we have heard from a specific veteran who struggles with PTSD and alcohol abuse. After many attempts and three months of trying to receive care, this veteran was not able to get the help that they needed. This was essentially a “locked door”. This veteran spoke with multiple congressional offices and with VA central office. They were eventually referred to community care, however, it was rescinded, as VA ensured that this veteran could receive the care that they need. This veteran still struggles with their sobriety today.

Next, is an example of VA presenting “no door” to a veteran. As we will hear during our second panel, there is another instance where a veteran sought care in the community. However, VA noted that they could not refer this veteran in the community if a VA bed was available within 30 days. Veterans can and should not have to wait 30 days to receive the care that they desperately need. The program attempting to assist this veteran was told that veterans must first go to a domiciliary, then a grant per diem program, such as a VA homeless shelter, and then to the Salvation Army. Then, after all of these options have been exhausted, they could be referred into the community. That is a disgrace.

Finally, we have heard from a veteran that has struggled with PTSD, substance use disorder, and has a history of TBI. This specific veteran was searching for a residential program for substance use disorder at the VA. However, this veteran was denied because they did not have a history of seeking help through the VA. Because this veteran had not been to the VA since 2017, their record was “closed,” and they were never contacted about receiving care. This appears to be a case where a veteran experienced a “missing door.” Luckily, a VSO paid for a treatment program for this veteran.

There is no excuse for any of the neglectful and harmful care that these veterans are experiencing, and we need to hold VA to a much higher standard.

These three stories may seem just anecdotal, but, as we’ll also hear in OIG’s testimony today, these are not isolated instances, and they are too much of a norm.

I am saddened and frustrated that this is how VA has been managing care for those who have selflessly served our country.

Thank you all for being here and I look forward to our discussion on both panels to best identify ways to improve access.

With that, I yield to Ranking Member Brownley for her opening statement.
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