The trial, known as the Psilocybin Intervention for Veterans Overcoming Treatment-Resistant Depression,” or PIVOT, study aims to include at least 240 veterans, all of whom have difficult-to-treat major depressive disorder and some who also have PTSD.

The study will take place at five VA medical centers through June 2031 and will assess patients’ levels of depression before and after treatment, side effects and overall response among participants.

“Far too many veterans are living with mental health conditions that don’t respond to available treatments,” VA Secretary Doug Collins said in a statement. “Under President [Donald] Trump, VA is pursuing all avenues to evaluate new treatments and offer meaningful relief for those who have worn the uniform. This clinical trial reflects another step toward this goal.”

Last month, researchers with Ohio State University’s Center for Psychedelic Drug Research and Education published the findings of a small, 12-person study on the safety of using psilocybin to treat severe PTSD in veterans.

After receiving eight hours of psychotherapy and two doses of synthetic psilocybin and integrative therapy, nine participants, or 75%, no longer met the clinical criteria for having PTSD.

According to the research, published July 30 in Communications Medicine, participants showed no serious adverse effects, including suicidal ideation or behavior. Non-serious side effects included headache, anxiety and dizziness.

“For a population with severe treatment-resistant PTSD, these results are striking,” said Stacey Armstrong, associate director and senior researcher at the center.

The PIVOT study will involve veterans with major depressive disorder who have not responded to current treatments, including those with or without a diagnosis of PTSD. In the double-blind, randomized trial, veterans will receive one dose of psilocybin or a placebo, along with therapeutic support. They will receive a second dose one month later, also with support, and will be evaluated two to four weeks following each session.

They also will receive follow-up six months after their participation.

VA officials said for the study, they will use pharmaceutical-grade drugs and treat veterans in a “safe, controlled, clinical setting.”

The five VA facilities that are slated to host the research include: the Birmingham VA Health Care System and Tuscaloosa VA Medical Center, Alabama; the VA Portland Health Care System, Oregon; Cpl. Michael Crescenz VA Medical Center, Philadelphia; and VA Puget Sound Health Care System, Seattle.

Trump signed an executive order in April directing the Food and Drug Administration to accelerate the review of some psychedelic therapies to treat mental health conditions. The order also required the FDA, the Department of Health and Human Services and the VA to collaborate on psychedelic research.

As a result of the order, HHS and the VA signed an agreement last month to increase coordination on research, including increasing clinical trial participation, training therapists, nurses and doctors to administer psychedelic medications if they are approved and collecting data and evidence to support patients, physicians and federal regulators.

According to the VA, its staff is involved in 20 current clinical trials focused on psychedelic treatments for mental health conditions, including MDMA and LSD.

Studies sponsored by the Multidisciplinary Association of Psychedelic Studies have shown that 87% of veteran participants in a study on the use of MDMA — the chemical compound known recreationally as Ecstasy or Molly — had significant improvement in PTSD symptoms four months after receiving treatments, and 71% no longer met the diagnostic criteria for PTSD at the end of the studies.

The advancement of MDMA as a treatment met a setback in 2024, however, when the Food and Drug Administration rejected an application to approve it as a PTSD treatment, requesting more research on its safety and efficacy.

VA officials said in a release on the PIVOT study Wednesday that they strongly discourage self-medication, and veterans should not “replace other mental health treatment options with psychedelics or any other unprescribed substances.”

“Proven, evidence-based treatments are currently available at VA facilities to treat Veterans with mental health conditions,” they wrote.

Sen. Ruben Gallego, D-Ariz., has proposed barring the VA from collecting voluntary or involuntary separation pay from veterans who are approved to receive disability compensation.

The bill also would allow veterans who later qualify for military retirement pay to remit the net amount they received instead of the gross amount so they don’t end up paying more than they actually received after taxes.

Gallego, a former Marine and Iraq War veteran, and Rep. Gus Bilirakis, R-Fla, introduced a similar bill in the House when Gallego served in that chamber, but the legislation never made it out of committee.

The senator said the legislation is needed because the money is paid out for separate reasons: disability payments are akin to workman’s compensation and separation pay reflects “time served” — an incentive tool used by the Defense Department to manage force strength and design.

“It is ridiculous to claw back money from a veteran who has put life and limb on the line, just because later in life they qualify for disability benefits,” Gallego said in a statement to Military Times.

From 2013 to 2023, the VA recouped $2.44 billion in separation pay and bonuses from 112,834 veterans under a law that the department cites as prohibiting it from paying disability compensation to those who received the pay unless the money is paid back.

The VA has been required to recover the money since the 1940s, and the Defense Department is required to inform transitioning service members of the potential for recoupment. Sometimes, however, veterans are surprised when letters announcing the recoupment arrive, sometimes decades after they left military service.

In one case, an Air Force officer received $30,000 in separation pay in 1990 and received a letter in 2024 telling him his entire disability compensation check would be withheld until the money was recouped.

The situation placed the veteran at risk for losing his living quarters and vehicle, he told Military.com at the time.

“I fail to comprehend how or why they intend to cut me off for several months without even negotiating a lesser but [survivable] monthly contribution. I also fail to understand why it took 34 years for VA to come up with this [scheme]. Why now?” retired Air Force Maj. Raymond Thomas, 75, told the publication.

By law, veterans’ monthly disability compensation can be withheld if they received readjustment pay, non-disability severance pay, disability severance pay, special separation benefits or involuntary or voluntary separation pay.

According to the VA, the recoupment effort hit a peak in 2018 with 17,066 veterans paying more than $396 million.

The Restore Veterans Compensation Act would also change the recoupment rate for retired military veterans who are required to make payments to 25% of their paychecks rather than the current 40% — an alteration that would lessen the financial impact of the recoupment.

When Gallego and Bilirakis introduced their bill in 2022, it drew the support of Disabled American Veterans who said the practice of withholding VA disability compensation because a service member received a separation benefit “must end.”

Sen. James Risch, R-Id. introduced a separate bill Wednesday that would limit the amount that veterans paid each month to the VA for recoupment.

Risch’s Veterans Earned Benefits Access Act would allow the VA to collect the separation pay but limit it to no more than 25% of their monthly disability compensation checks. Currently, the VA can withhold the entire amount of checks until the veteran pays back the government.

“My [bill] ensures that veterans can receive the disability benefits they need while repaying their separation pay,” Risch said in a release.

In a review of 9.9 million veterans in the VA medical system from 2000 to 2024, researchers from the Harvard T.H. Chan School of Public Health, the Department of Veterans Affairs and elsewhere found that 14,419 patients had received an ALS diagnosis.

In the group with ALS, 46% were Army veterans – nearly the same percentage of soldiers in the entire patient cohort.

Using the rate of ALS diagnoses among Army veterans as the baseline and adjusting for sex, race, and ethnicity, researchers found that Air Force veterans had a 29% higher rate, former Coast Guard members had a 26% higher rate and Navy veterans had a 15% higher rate. Marines had the lowest rate, at 22% below that of Army veterans.

Overall, officers had a 64% higher rate than enlisted personnel, while women officers had a 72% higher rate. Differences among branches were more apparent in men ages 61 and younger and less evident among men older than 75.

“Our study looked at the rates of ALS among people in different branches of the U.S. military and found ALS rates varied considerably by branch and rank, with larger differences among younger veterans,” said study author Marc Weisskopf at the Harvard T.H. Chan School of Public Health in a release.

ALS is a rare disease diagnosed in roughly 5,000 Americans each year, according to the Centers for Disease Control and Prevention. A fatal illness most famously associated with baseball legend Lou Gehrig and British astrophysicist Stephen Hawking, it is a progressive disease that affects the motor neurons, causing them to lose connectivity and die off.

There are two types of ALS: sporadic, meaning occurring without a known cause in the general population, and familial, likely the result of an inherited genetic mutation, according to the ALS Association.

While military personnel are diagnosed with ALS at nearly twice the rate of civilians, the cause has not been scientifically proven. The VA presumes the condition to be service-connected given the heightened occurrence in the veteran population.

Researchers have theorized that exposure to hazardous environments and substances, including burn pits, jet fuel, exhaust, heavy metals, dioxins and other toxic materials, may contribute, but no direct connection has been proven.

“Our findings suggest that officers and those serving in the Air Force, Navy or Coast Guard may have been exposed to military environments that increase risk of ALS,” said Weisskopf. “Future research should aim to identify these exposures.”

In the civilian population, some occupations such as airline pilots, truck drivers, metal workers and those who work with pesticides and other toxic substances are associated with increased ALS risk, according to a 2022 Columbia University study.

The authors noted that the likelihood of developing ALS is low, even in the U.S. military. Of the 9.9 million veteran records reviewed, less than 0.2% of patients were diagnosed with ALS, according to the study.

“It is … important to note that ALS is rare and the overall risk remains small, so even statistically significant increases associated with branch and rank represent only modest increases in risk among military personnel,” Weisskopf said.

VA staff evacuated an unknown number of patients to local hospitals and are caring for 27 patients at area shelters, according to the facility’s Facebook page. The medical center, which lies less than a third of a mile from the fire perimeter as of Monday, will remain closed, “with future operations to be determined.”

More than 60,000 people have been evacuated from the area as a result of three fires collectively known as the Spokane Complex Fire. More than 8,000 acres had burned as of Monday, with 0% containment, according to the Washington State Department of Natural Resources.

Mann-Grandstaff is closest to the Old Trails Fire, which began Saturday and was fueled by high winds.

“We are grateful for the support received. Spokane VA extends our sincere condolences to all victims, including local VA staff members who, like so many, have lost so much,” VA officials wrote on the hospital’s Facebook page.

According to the post, Spokane-area VA outpatient clinics and business operation centers are also closed. The hospital provides administration and services for local VA clinics, including records, pharmacy management and specialty care.

Mann-Grandstaff is a 46-bed facility with more than 1,400 full-time positions, including its clinics.

This is a developing story. It will be updated as more information becomes available.

Researchers at the VA Palo Alto Health Care System and Stanford University School of Medicine in California looked at VA disability benefits and Social Security Disability payments to veterans across 14 years.

They found that the average yearly payment rose from $17,286 in 2010 to $24,057 in 2024, while the percentage of U.S. veterans receiving compensation rose from 9% in 2010 to 22% in 2024.

The increases are likely attributable to a number of causes, the authors said. They noted the high rate of deployments and increased possibility of serious service-connected illness and injury for post 9/11 veterans, improved medical care that resulted in increased survivorship of combat injuries in Iraq and Afghanistan and VA policies that have made more veterans eligible and made it easier to receive benefits.

Over the same time period, meanwhile, annual Social Security Disability Insurance payments to veterans remained steady, averaging around $19,550. Veterans may be eligible for SSDI payments if they have a condition that affects their ability to work.

According to the study published Thursday in JAMA Network Open, college educated, married and younger veterans were more likely to receive VA compensation while older veterans with non-service-connected disabilities were more likely to receive SSDI.

The authors theorized that the challenges associated with filing VA claims — “administrative hurdles,” as they described them — and the draw of VA education benefits may favor those who can navigate the system.

The increase in the percentage of veterans receiving VA disability benefits as well as the rise in amounts paid comes at a time when the population of U.S. veterans is declining: In 2010, the country had 22 million veterans; by 2024, that figure had declined to 15.8 million.

The researchers described their study as “descriptive” and drew few conclusions.

“These findings can inform policy discussions about optimal fiscal payments and program structures needed to achieve and streamline federal programmatic goals, while underscoring the need to reduce growing disability burden among veterans and to ensure ease of benefits navigation,” they wrote.

The authors did not respond to a request for an interview by publication.

Suicidal thoughts among U.S. veterans have risen nearly 50% in the past five years, but the frequency of suicide planning and attempts remained relatively stable, according to a new study based on a survey of 2,636 veterans.

Researchers from the Department of Veterans Affairs’ National Center for PTSD and the Yale School of Medicine analyzed data from the 2025-26 National Health and Resilience in Veterans Study and found that 13.4% of veterans reported suicidal thoughts in the previous two weeks, compared with 9% in the 2019-2020 survey.

The analysis found that rates of suicide planning and attempts remained unchanged in the same time frame, but for certain groups — particularly younger veterans and women — rates were higher for thoughts, planning and attempts over the five years.

Ian Fischer, the study’s lead author and a clinical psychologist at the VA Connecticut Healthcare System, said the research was needed to understand the changing veteran population and potential shifts in suicidal thoughts and behaviors that can drive suicide prevention efforts.

“The veteran population has become younger, and there have been increases in the proportion of women veterans and shifts in its racial and ethnic composition over the past five years, making it essential to monitor changes in suicidal thoughts and behaviors and identify the veterans who may benefit most from prevention and early intervention,” Fischer said Tuesday in a Yale press release.

More than 6,000 veterans have died each year by suicide since 2001. In 2024 — the most recent year for accurate nationwide data, 6,398 veterans died by suicide. Veterans ages 18 to 34 and those experiencing homelessness or health issues were at higher risk.

According to the VA, the suicide rates among veterans are 60% higher than the national average, with suicide the second leading cause of death among veterans under age 45.

The VA has invested millions in suicide prevention and teamed with community partners, providing grants and support to address suicide among former service members. It recently has focused on encouraging veterans to enroll in VA medical services, citing evidence that patients who receive health care at the VA have lower rates of suicide and suicide attempts.

The study, published July 20 in JAMA Network Open, showed that veterans who use the VA for primary health care were twice as likely to have received mental health treatment at some point in their lives. More than half of those who said they used VA health care services were actively enrolled in mental health care.

The survey also found that fewer than 37% of veterans who reported having suicidal thoughts in the previous two weeks were receiving mental health care.

“These findings suggest that the VA is playing an important role in connecting veterans at elevated suicide risk with mental healthcare,” said Brandon Nichter, a visiting scholar in Yale’s Department of Psychiatry and study coauthor, in a release.

“At the same time, many veterans with recent suicidal thoughts are still not engaged in treatment. Expanding outreach and reducing barriers to care across both VA and community health systems will be essential to reaching these individuals,” Nichter said.

According to the study, younger veterans remain at higher risk for suicide, possibly because post 9/11 veterans experienced of “elevated trauma exposure” during the wars in Iraq and Afghanistan.

Researchers noted that service-era comparisons are complicated by generational differences and “survivorship bias,” meaning older veterans may appear less likely to experience suicide behavior because younger veterans at highest risk are less likely to survive into old age.

According to the survey, woman veterans had higher odds of suicide planning and attempts, while VA national data shows that male veterans die by suicide at higher rates.

Risk factors for suicide attempts include major depression, alcohol use and adverse childhood experiences that preceded military service, according to the study, and risk factors for suicidal thoughts and planning included PTSD, major depressive disorder and adverse childhood experiences.

The authors cautioned that the study relied on self-reported data, and veterans may have been reluctant to disclose suicidal thoughts or attempts. Those surveyed also were a recruited group and did not include incarcerated or institutionalized veterans or other unique veteran subsets, meaning the sample was not fully representative of the U.S. veteran population.

Based on the survey results, researchers estimated that between 2.3 million and 2.4 million of the nation’s roughly 16 million veterans experienced suicidal thoughts within the study’s measured time frame. They also estimated that about 1.4 million veterans had planned suicide at some point and around 830,000 had attempted during their lifetimes.

The researchers said they hoped information contained in the study will be used for improving prevention efforts, intervention and treatment.

“Targeting key risk factors in vulnerable sub-populations may help mitigate suicide risk,” they wrote.

In a report released Tuesday, Government Accountability Office analysts said that although the VA outlays for the Community Care Program have risen from $9.5 billion in 2020 to $25 billion in 2025, the amount of improper payments have been reduced each year, from 78% of the total in 2020 to 2.4% in 2025.

The GAO said improper payments occur when the VA reimburses contractors that manage community care for outdated claims, incorrect reimbursement rates or payment amounts or bills that exceed authorized care.

Sometimes, the improper payments may be related to fraud, the GAO added, noting that as recently as February 2026, a home health care company submitted fraudulent claims for community care for $100,000 in services that were never provided. In another case, a provider agreed to pay $3.7 million to resolve charges that it fraudulently billed the VA for services that were not medically necessary.

The VA has worked to reduce improper payments and fraud risks, the GAO noted, by developing and implementing processes for identifying problems and assessing the root causes of improper payments.

The department developed and implemented corrective actions to address the issues, the analysts said.

The VA has not, however, conducted a fraud-risk assessment that identifies inherent risks, assesses the likelihood of fraud and determines its risk tolerance. GAO auditors recommended the VA create a fraud-risk framework and implement it.

“While VA has taken steps to identify and assess fraud risks, these efforts do not meet the key elements of a fraud risk assessment and have not resulted in a comprehensive fraud risk assessment for the program, leaving it vulnerable to fraud,” the report stated.

VA officials told the GAO that they were able to reduce improper payments in Community Care because they addressed the “broader system and policy issues,” such as payment processing errors and eligibility problems that followed the development of the nationwide program established in 2018 by the Mission Act.

VA officials said they would further address any issues that may contribute to improper payments in the next round of contracts for Community Care, which are expected to be awarded this year.

VA officials concurred with the GAO’s recommendation to create a fraud-risk framework, saying the department would establish oversight during its ongoing reorganization of the Veterans Health Administration, with the effort to be completed by March 2028.

The GAO also looked at improper payments by the Centers for Medicare and Medicaid Services to companies that manage Medicare Advantage plans. Analysts found that in 2025, CMS paid roughly $23.7 billion in improper payments, up from $16.3 billion in 2020.

Hegseth and Chairman of the Joint Chiefs of Staff Gen. John Caine testified before the Senate Appropriations Committee to seek $67.1 billion in supplemental money for the war and other DoD expenses, such as munitions, drones and the Army and National Guard deployments to the southern U.S. border and Washington, D.C.

Given that the department has $75 billion in its coffers from the $156 billion it received last year in reconciliation funding in the One Big Beautiful Bill, senators voiced skepticism over the emergency request.

Sen. Patty Murray of Washington, the committee’s top Democrat, said the committee would not “rubber stamp a request to bankroll this war,” given that the DoD received more than $1 trillion in funding last year and has requested $1.3 trillion this year.

“The president’s request is not even a primarily a request to cover the costs of the Iran war. This request is chock full of asks to fund unrelated DoD priorities, which should be considered through our annual appropriations process, not in an emergency supplemental,” the senator said.

Similarly, Sen. Kristin Gillibrand, D-N.Y., asked how to convey the DoD’s needs when constituents have seen gas prices, food and other household expenses rise.

“You’re asking for $1.5 trillion, unlimited money for bombs, but insufficient money for the American people for their healthcare, their food, their housing,” Gillibrand said.

Hegseth said the new funding is needed to support operations because the $75 billion in reconciliation funds are slated to be used to restore a military that was “ignored” under the Biden administration. The new request is an “urgent, necessary injection of resources to address” immediate needs, he said.

“The military requires a generational investment to deliver on peace through strength,” Hegseth said, later adding that he didn’t know what his predecessor, former Defense Secretary Lloyd Austin, “did for four years.”

“The amount of neglect, the amount of stale thinking and bureaucracy was staggering when we took over,” Hegseth said.

He added that the supplemental was “a new request based on new realities of a world we face.”

“[We’re] stepping up to meet the moment,” Hegseth said.

In May, Hegseth estimated that the cost of war at the time was $29 billion.

Roughly half of the supplemental request, $32.7 billion, is slated to fund the ongoing operation directly. The remainder is for national security priorities not related to the war.

The request includes $21 billion for munitions, $17.3 billion for operations, $12.1 billion for classified programs, $5.1 billion for cybersecurity, $2.4 billion for drones, $1.7 billion for readiness, $1.5 billion for fuel and $2 billion for “administration priorities” and National Guard support.

The request comes as the war, which began Feb. 28, has escalated in the past two weeks. The U.S. has conducted air strikes consecutively for the last 10 days, and four U.S. service members have been killed in the last four days, bringing the total number of U.S. casualties to 18.

At least 14 merchant mariners also have died as a result of attacks in the Strait of Hormuz, according to the International Maritime Organization, and transits have decreased dramatically as Iran has reasserted its control over the strategic waterway.

Caine told senators he sat before them asking for the funding “while the window of opportunity — while time — is still on our side.”

“Our adversaries are aligning in their interests, creating simultaneous challenges across multiple domains. They are sharing intelligence, combat capabilities and technology. Technology. That is accelerating the speed of war, isn’t it?” Caine said in opening remarks.

Of concern to Sen. John Kennedy, R-La., and several other senators, was the administration’s approach to the Russia-Ukraine war and funding promised to support Ukraine that has not been allocated. Kennedy wanted assurances that the DoD had chosen a clear side in the conflict, asking Caine who “we” wanted to win.

“Sir, I want Ukraine to win,” Caine said.

“Is Russia America’s friend?” Kennedy asked.

“I think that depends on your definition of friend. I think it’s a complicated relationship,” Caine replied. After a brief pause, he added, “But no, I don’t think they’re our friends.”

Kennedy also asked what the administration thinks will happen regarding the Strait of Hormuz and what Iran’s intentions are in developing a nuclear weapon — the initial reason President Donald Trump gave for attacking Iran.

“We need straight answers!” Kennedy told Hegseth.

Republican Sen. Lisa Murkowski of Alaska sought assurances that should the supplemental request be approved, the Trump administration would not perceive passage as a measure for restarting the 60-day clock on a War Powers Resolution, which the Senate passed 50-48 in June.

Citing precedent by President Bill Clinton in sending U.S. troops to Kosovo, Murkowski asked if the administration felt it had adequate authorization to continue the conflict in Iran.

“We certainly, as department, take the position of the White House that we have all the authorities necessary at this moment,” Hegseth said.

Two lawmakers, Sen. Tammy Baldwin, D-Wisc., and Sen. Shelley Moore Capito, R-W. Va., asked Hegseth to answer for the record, to concerns that service members injured in the current conflict did not receive proper medical care from the U.S. military or screenings for traumatic brain injury.

As of Tuesday, more than 440 troops have been injured in the conflict.

“Every effort was made to provide every level of medical care possible,” Hegseth said.

A Pentagon official said Thursday that the Defense Department has “welcomed back more than 230 warfighters,” and the Departments of the Army, Navy and Air Force continue to work with more than 600 service members who have expressed interest.

The official did not provide a breakdown of the returnees by service.

According to the Defense Department’s web site on COVID-19 reinstatement, more than 8,700 service members were involuntarily separated for refusing the immunization after they were ordered in 2021 to get the vaccine.

Data compiled by the services in December 2022 — days before the mandate was lifted by law — showed the figure was closer to 8,400 and included 3,717 Marines, 2,041 Navy sailors, 1,841 Army soldiers and 834 Air Force and Space Force members.

Eligible service members have been allowed to rejoin the service since 2023. In January 2025, President Donald Trump signed an executive order allowing them to come back with “full back pay and benefits.”

Under Pentagon policy, those eligible receive back pay, allowances and any bonuses they would have earned had they stayed in the military, minus income, VA benefits and separation payments they received in the interim.

Hegseth ordered the services in December to review all the discharge cases to determine whether members were entitled for upgrades of their discharge characterizations from General (Under Honorable Conditions) to Honorable.

In March, the department extended the deadline to those interested in rejoining the service by a year, until April 1, 2027, and it cut the active-duty return to service obligation from four years to two.

“Maybe, for some, four years felt like too much given what had been done to them. We hope two entices warriors of conscience to come back,” Hegseth said in a video posted on the social media platform X.

The Defense Department announced Wednesday that it planned to convene a panel to study the decision to require the COVID-19 vaccine and will declassify and release materials related to the mandate.

The National Academy of Public Administration, a nonprofit, nonpartisan organization that studies management and organization, is conducting an after-action review at the request of the Pentagon, with a report expected by the end of the year.

No surveys have been conducted of the personnel who were involuntarily separated regarding why they have not returned to service. Officials told the Associated Press last year that many troops “have moved on with their lives.”

In a surprising moment that followed more than an hour of heated debate over the Take Care of America’s Veterans Act on the House floor, Rep. Chris DeLuzio, D-Pa., offered a motion to return the bill to the House Veterans Affairs Committee for review.

The vote on DeLuzio’s proposal was to precede a final vote on the legislation, which has divided veterans groups, and the chamber rejected the effort in a 210-211 vote, with one of four Republicans who initially supported it, Rep. Victoria Spartz, R-Ind., changing her vote at the last minute.

But instead of proceeding with the final vote as planned, House leadership pulled the bill, with Johnson saying a decision on the measure now will be delayed for several weeks.

Punchbowl News reported that Johnson blamed “misinformation” over the bill for his reasons to hold the vote.

“Our Veterans Affairs Committee has done a great job engaging with veterans … There still remains, though, a lot of misinformation out there, so instead of putting the bill on the floor this afternoon, we’re gonna delay it just a bit. We’re gonna have several more weeks ahead of us before we get back here in September would be my guess when we process all this again,” Johnson told reporters.

The Take Care of America’s Veterans Act, H.R. 9237, encompasses more than 60 pieces of legislation, many of which have widespread support among veterans and advocates, such as the Major Richard Star Act, which would give retired, combat-injured veterans their full Veterans Affairs disability compensation and military retirement, and the Love Lives On Act, which would continue benefits for surviving spouses of the fallen if they remarry before age 55.

But the proposal for covering the cost — enacting a planned rule that would change the requirements for disability compensation for two conditions that commonly affect veterans, sleep apnea and tinnitus, has split the veterans community and lawmakers.

Supporters say the payment proposal is vital to getting the legislation made into law while critics argue that future benefits for veterans should not be used to pay for current needs.

At least 22 veterans organizations support the bill. During a press conference Tuesday, Mario Marquez, the executive director of government affairs for the American Legion, said the proposal represents the best way forward for getting top priorities accomplished.

“Leadership is about carefully evaluating the facts making difficult decisions and accepting responsibility for those actions and those decisions,” Marquez said. “Progress only happens when leaders are willing to tackle difficult issues and keep veterans at the center of the conversation.”

But other groups vociferously oppose it, with the VFW and Disabled American Veterans leading the charge. Their representatives joined Democrat lawmakers in a press conference Wednesday to push lawmakers to vote against the bill.

Past VFW National Legislative Service Director Pat Murray said as an amputee who lost his leg in Iraq and medically retired, he would receive increased compensation as a result of the bill. But, he added, he didn’t want to “get those benefits at the expense of others.”

“We support the provisions of the Major Richard Star Act and we want the full act passed because that is what veterans deserve,” Murray said.

Prior to the planned vote Thursday, lawmakers engaged in heated debate that pitted the chairman and ranking member of the House Veterans Affairs Committee against one another. Chairman Rep. Mike Bost, R-Ill., said he had taken a lot of heat over the proposal but believed the bill helps “the greatest number of veterans.”

“This bill includes long-standing priorities for veterans, and importantly, it does so in a way that is paid for and capable of actually moving from here to the Senate and to the President’s desk,” Bost said. “At some point, we have to decide whether we’re going to keep talking about these promises or actually move a package that can become law.”

Rep. Mark Takano, D-Calif., the committee’s ranking member, has proposed pulling apart the legislation and voting separately on the provisions. Takano said that while he supports many of the legislation’s provisions, he disagrees with a proposal to raise VA home loan fees, several GI Bill initiatives, some health proposals and the payment structure.

“Let’s be crystal clear about what this bill does. It says to troops downrange right now who are in harm’s way that they have to have worse benefits than veterans have today to pay for benefits and care that other veterans have earned. That’s ridiculous,” Takano said.

VA officials confirmed to Military Times that they intend to follow through on the audiology portion of the proposed rule, which would mean that tinnitus, which currently receives a 10% disability rating, would be treated as a symptom of another condition, such as hearing loss or a traumatic brain injury, and would no longer get a standalone rating.

The officials did not address the sleep apnea portion of the rule, but a Politico reporter posted a message on X saying administration officials told her the VA has “made no move to withdraw the proposed sleep apnea rule and will be moving forward with the rule change that appeared on the regulatory agenda.”

Under the proposed rule, veterans with asymptomatic sleep apnea or a mild case controlled by treatment could receive a 0% disability rating.

Bost said that if the VA moves ahead with the 2022 proposed rule, without his legislation, the savings would return to the Treasury Department and not be allocated specifically to veterans.

The estimated savings of enacting the rule could be $57 billion over 10 years.