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Today, Rep. Mariannette Miller-Meeks (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 the effects of traumatic brain injury (TBI) on active-duty servicemembers and then as they become veterans and the steps the Department of Veterans Affairs (VA) is taking to ensure veterans who are living with TBI’s get the care and treatment they need, that meets their individual needs, after their time in uniform.

Good morning.

This oversight hearing of the Subcommittee on Health will now come to order.

Without objection, the Chair may declare a recess at any time.

Before we begin, please join us in keeping the servicemembers deployed to the Middle East and in harms way in our thoughts, as well as the families of the courageous servicemembers who recently gave their lives in our prayers.

I would like to welcome all the members and witnesses to today’s hearing.

March is brain injury awareness month.

That’s why I am proud to be leading this hearing on how VA can continue to lead the way in care for traumatic brain injury, or TBI.

In a budget briefing last summer, VA shared that TBI is the top clinical, legislative, and agency priority. I look forward to hearing how VA has prioritized TBI so far and what we can expect for the rest of this year.

I am confident VA has all the data, legal authority, and funding it needs to effectively treat TBI. Right now, I believe VA’s main objective should be to build on the quality of data and quality of care for the veteran.

Here is what VA does best: specialized treatment, rehabilitation, and research.

After enrollment in VA healthcare, veterans are assigned to a primary care team. These primary care staff are trained on issues unique to post-deployed veterans. That includes TBI.

I am pleased that TBI and other issues unique to veterans are a part of the primary care experience at VA, not a specialty that requires extra steps.

VA polytrauma centers are a key resource for veterans with TBI. At these centers, VA is not just treating but leading in outpatient and inpatient care for veterans with TBI. The centers in Richmond, Tampa, Minneapolis, Palo Alto, and San Antonio are knowledge hubs for other facilities treating polytrauma nationwide.

This is important infrastructure to treat veterans diagnosed with complex multi-trauma injuries, including TBI.

VA’s research enterprise is also unmatched. One longitudinal research program, “LIMBIC,” examines the effects of and treatment for service-connected TBI, with a focus on the long-term effects of mild TBI.

The LIMBIC goals are to: (1) learn more about how concussion affects the brain, (2) find out the effects of concussion later in life, such as risk for dementia, (3) see if some service members and veterans are more likely to be affected, and (4) identify the best treatments for concussion.

VA researchers at this center have documented links between combat concussions and dementia, Parkinson’s disease, chronic pain, opioid usage, and suicide risk.

They have also developed specialized diagnostic tests using questionnaires, physical exams, brain imaging, fluid biomarkers, and electrophysiology to probe how the brain recovers from injury.

With these systems in place, and as a physician, I believe VA can evaluate veterans with TBI and can help.

I have heard many veterans share their positive experiences with VA.

Indeed, a report by the VA Office of Inspector General about TBI treatment at one facility revealed that the facility was providing needed care for veterans with TBI.

Unfortunately, I have also heard many veterans share their negative experiences with VA.

Here is where I have seen VA needs improvement: consistent quality in patient care and data.

In January, the VA OIG released a report about a patient who died by suicide after receiving mental health care at a VA facility.

Among the reviewed concerns, the VA OIG found that the VA facility did not provide adequate follow up for the patient’s TBI.

This veteran was a middle-aged male with a history of mental illness, migraines, chronic pain, and gait disturbances with documented falls. In other words, his was the classic clinical picture of an individual with TBI.

Yet somehow, the patient did not receive follow-up specific to the TBI, and his mental health only declined until the end.

Fortunately, the facility in question now requires annual training on TBI screening and care consultations. I wish this had been the case sooner.

At another facility, the VA OIG found that a veteran who screened positive for TBI and died by suicide, failed to receive adequate care at VA. Among many other issues, facility staff did not submit a consultation for a TBI evaluation following the veteran’s positive TBI screen, even though a consult is required.

This is unacceptable. These veterans earned TBI care at VA. Their service demands better.

Their service demands consistency in quality care. They deserve to know that VA has got their back.

While quality in patient care is the most urgent need, quality in data is also necessary.

In the past, annual congressional reports have reflected outdated information about the number of inpatient beds dedicated to TBI. Reports have also omitted key spending information and the number of veterans with TBI treated annually.

Some might say, “what’s the big deal?” Well, these numbers show VA’s capacity to provide care. The numbers should reveal the needs of the patient population and how a medical center is able to meet those needs.

Congress needs this information to know what resources to allocate for TBI care. VA also needs these numbers to determine the resources a hospital should get.

I know VA has the capability to report this kind of data. Like I said, VA has all the data it needs. It must capture that data consistently and then be able to translate that information into clinical practice. Otherwise, wrong data takes resources away from areas of need. I look forward to hearing from VA about what they are doing to put this into practice.

Under my leadership, veterans’ health will always be this subcommittee’s priority. We must eliminate preventable errors.

As a practitioner and 24-year Army veteran, I know excellence is possible. And it is imperative. The one who bears the cost of shortfalls is always—always—the veteran.

This also means positioning VA to support the veteran of contemporary and future warfare.

This is where I see opportunities for VA.

We may not know the landscape of tomorrow’s battlefield. But with the right systems and people in place, VA can navigate whatever lies ahead.

Finally, while we may not discuss it extensively today, I want to recognize the veterans who use residential rehabilitation for TBI.

This population is small, but it is far from invisible. I appreciate efforts by VA’s geriatrics and extended care program to address the needs of these veterans.

I will take every opportunity I can to ensure these veterans get the care they deserve from VA.

Under the leadership of Chairman Bost, President Trump, and Secretary Collins, I am confident in VA’s role as a premium care provider for veterans with TBI.

When VA is on-mission, it is the best in the business for veterans with chronic and sometimes catastrophic injuries—visible and hidden.

I now yield to Ranking Member Brownley for any opening remarks she may have.