Rachel Ramoni, DMD, ScD, VA Chief Research and Development Officer
WASHINGTON, DC — VA’s research portfolio has slowly but steadily grown larger year after year. Nearly every major piece of legislation impacting VA includes provisions requiring the department to conduct research, whether it be on toxic exposure, mental health, suicide or other high-profile issues affecting veterans’ health. Now some advocates are wondering whether that breadth of research requires more congressionally mandated focus.
“It’s time for Congress to step in and give [VA’s Office of Research and Development] clear legislative purposes and realign its granting process to improve veterans’ health outcomes,” declared Matthew Kuntz, executive director of the National Alliance on Mental Illness Montana at a VA Senate Committee hearing last month. “VA ORD’s current purposes are muddled by a variety of missions, objectives and priorities. Lack of focus makes it difficult to determine which outcomes VA, ORD or its congressional funders are looking for.”
Kuntz serves on the Secretary of Veterans Affairs National Research Advisory Council and was a member of the COVER Commission, which was tasked with examining models used by VA to treat veterans’ mental health. During his COVER Commission work, he and his fellow commissioners found “glaring gaps in VA’s research and application of research,” Kuntz said.
The department should focus its efforts on large-scale research and healthcare commercialization areas that have the potential to impact the most veterans, he told the committee. Those areas include toxic exposure, spinal cord injuries, prosthetics, substance-use disorders and geriatrics.
“[VA needs to fund more] large-scale studies like the Million Veterans Program,” Kuntz said. “This is what VA does best. We need to double down on these programs.”
The department should also invest in matching grants to help commercial manufacturers bring VA-researched products through the FDA process, as well as implementation and quality-improvement grants, he said. “ORD has taken clear steps to move to become an outcome-oriented organization, but it needs Congress to clarify its purpose and strategic funding methodologies.”
Testifying for VA was Rachel Ramoni, DMD, ScD, VA’s chief research and development officer. Since 2017, Ramoni has led VA’s efforts to consolidate its research portfolio under ORD after decades of scattered medical center-driven efforts. VA is requesting $938 million for research in the FY2024 budget request—a 2.4% increase over 2023. That modest but sustained growth is key to VA’s continued research success, Ramoni told the legislators.
“Research flourishes in the context of steady funding, rather than fluctuations of increasing and decreasing investment,” she explained. “Our research is conducted by highly specialized teams that can take years for a medical center to assemble. … Most of the staff who conduct this research are hired on term or temporary basis. When funding contracts, those teams must be disbanded, and their expertise is lost to the system.”
As for Kuntz’s call for more focused efforts in translating research to healthcare results, Ramoni said that VA is already doing it.
“[VA has an] infrastructure that promotes implementation,” she said. “The prototype is our Precision Oncology Program. We have 100 sites across the country. … We’re interacting with medical centers so we can more proactively implement [and] not just publish and hope people implement. We work closely with them to make sure they implement.”
Legislators pointed out that one area where VA research is struggling is in recruiting rural veterans to studies—a deficiency that Ramoni admitted to.
“Our ability to do research in rural areas, particularly clinical trials, is limited by the absence of academic affiliates there,” she explained.
Nearly all VA researchers hold dual appointments with universities, she said, making it difficult for them to work in areas lacking large academic institutions.
“But we are working on decentralized approaches, including the regulatory changes necessary to facilitate outreach to those areas in addition to leveraging tele-clinical trials,” Ramoni said.
Sen. Angus King (I-ME) noted that the pathology of suicide and other mental health issues may differ when it comes to rural veterans. “So, if you’re not doing these studies in rural areas, you may be missing some important information, because that’s where a lot of veterans are.”