Graeme Sloan/Sipa USA via AP Images
Secretary of Veterans Affairs Denis McDonough testifies during a Senate Veterans’ Affairs Committee hearing at the Capitol on timely access to health care, September 21, 2022.
Over the past 75 years, the Department of Veterans Affairs (VA) has developed one of the most sophisticated and powerful research enterprises in the United States. Conducting research that benefits veterans is, in fact, one of the four missions of the VA. In fulfilling this mission, three VA researchers have won the Nobel Prize, and thousands of others have investigated issues like effective treatments for PTSD or prosthetics that enhance mobility for amputees. VA research is key to the world-class care it delivers to its nine million patients, which studies show is often superior to the private sector.
VA research doesn’t just help veterans. VA researchers developed the first implantable cardiac pacemaker, the first shingles vaccine, and the nicotine patch. Among the thousands of active VA research projects are ones investigating the efficacy of treatments for COVID-19 and exploring how the virus spreads in hospitals.
This research is conducted in partnership with the nation’s medical schools. The vast majority of the schools have academic affiliations with the VA, and clinical staff at these institutions have joint appointments in the VA.
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Much of this research is in immediate jeopardy because of a Department of Justice (DOJ) legal guidance that few members of the veteran community, veteran service organizations, or legislators on Capitol Hill are aware of. Unless this misguided policy is reversed, the VA stands to lose hundreds of researchers, disrupting hundreds of millions of dollars of lifesaving research projects that benefit the health of veterans and the nation.
Fortunately, there is a fix: passage of the VA Infrastructure Powers Exceptional Research (VIPER) Act of 2021 (H.R. 5721). Among other improvements, it would ensure VA researchers can be paid by academic affiliates for joint research initiatives. Alarmingly, however, the legislation is completely stuck in the Senate Committee on Veterans’ Affairs.
What launched this troubling chain of events was a 2021 DOJ reinterpretation of the law that applies to payment by nongovernment sources for work done by VA employees. DOJ indicated that “an employee may not be paid by anyone but the Government for performance of her official duties.”
Following the DOJ’s guidance, the VA decreed in January 2022 that auxiliary funding of VA research projects could no longer be provided. The revision rescinds what had been common practice in the VA for decades (and remains standard practice outside the VA). Since shortly after World War II, VA researchers who work for the department can receive additional income if they devote extra time to research projects benefiting veterans. That’s how the VA can match market-rate salaries and successfully recruit top-tier researchers. Many of these researchers also provide much-needed clinical care to veterans, and train other VA staff.
In a deeply illogical move, the VA decided that complementary income streams could continue unhindered for funds administered through a publicly funded state university like the University of California, San Francisco or UCLA. As one longtime VA observer commented, “This double standard makes no sense. If it’s a conflict of interest for a researcher to be connected to Stanford University, why isn’t it a conflict for them to receive funds through the University of California system? In fact, it’s not a conflict of interest, it’s a separate function.”
Unless this misguided policy is reversed, the VA stands to lose hundreds of researchers, disrupting hundreds of millions of dollars of lifesaving research projects.
In January, the VA sent out a memo to research chiefs of staff and administrative officers, advising that they would have to review their programs. Anyone receiving funding from a private university would have to “decline the additional salary support and restructure the budget.” In August, the VA requested updated progress on this review, and research programs were told that they would have to immediately curtail additional salary support. If the new policy is not corrected, affected VA researchers across the country will be forced to either discontinue their line of research, switch to studying non-veterans, take a sizable pay cut, or leave the VA entirely to continue their projects. According to one knowledgeable source, 86 Houston-area VA researchers who work with Baylor University are impacted. Another source told the Prospect that two researchers have already left the Vermont VA for Dartmouth.
One renowned researcher stated, “These changes are beginning to demoralize the VA research workforce, with a real risk of flight to the universities and a destabilization of basic science and rehabilitation research. It’s the potential loss of clinical trials in cancer, cardiology, and mental health that poses the greatest risk for the veteran population.”
If there’s an exodus of VA researchers, these projects would be nearly impossible to replicate in the private sector. Even if there were available sources of funding (a very big if), they would lack the VA’s great research advantage: a large and stable population of patients who can provide a reliable source of “big data” because they remain in the VA health care system from discharge to grave.
Another VA researcher told the Prospect, “We’re some of the only ones who have answered critical and vexing questions about things like drug side effects. Why? Because we not only know what drugs have been prescribed to our patients but what drugs they took, because we provide them in our pharmacy. And then we can track patients’ experience while taking the drug. This is almost impossible to do outside the VA.”
The consequences of the decimation of this research capacity has alarmed the many academic medical schools that have worked with the VA for decades. In May, the Association of American Medical Colleges (AAMC) submitted written testimony to the House Committee on Appropriations, stating, “The combination of education, research, patient care, and community collaboration that occurs because of the close relationships between VA institutions and academic medical centers cultivates a culture of curiosity and innovation.” The AAMC urged the continuation of these collaborations and that Congress swiftly pass the VIPER Act.
VIPER was introduced last year by Rep. Mark Takano (D-CA), chair of the House Committee on Veterans’ Affairs, and ranking member Mike Bost (R-IL). The language that would ensure VA researchers can be paid by academic affiliates for joint research initiatives had no objections from the House or Senate Committees on Veterans’ Affairs, and was folded into a larger Senate end-of-year omnibus package, which seemed headed for easy passage.
But the omnibus package, including the VIPER Act, stalled. It remains frozen, while time is running out.
In an unprecedented action signaling how dangerously close the VA is to losing many more irreplaceable faculty, the deans of 20 prominent medical schools, like Harvard, Dartmouth, Brown, and the University of Pennsylvania, sent a letter last week to the chairs and ranking members of the Senate and House Committees on Veterans’ Affairs. The letter highlighted the innovations produced through the long-standing partnerships between the VA and the nation’s medical centers. “These very productive affiliations between VA medical centers and medical schools,” the letter cautioned, “are built around joint faculty appointments, in which faculty based at the VA often derive part of their salary from the academic institution, often through research grants from the National Institutes of Health or other sponsors.” The deans also urged the committees to “work quickly to pass a bipartisan veterans’ legislative package that includes the relevant provisions of HR 5721 that will allow VA employees to receive outside compensation related to their clinical and research activities at VA medical centers.”
Immediate passage of VIPER is crucial, says Kenneth W. Kizer, who served as perhaps the most prominent and impactful VA undersecretary for health. As Kizer reminds us, “VA research benefits not just veterans but all Americans, and anything that hinders this important work should be remedied immediately.”
