Hearing of the House Committee on Veterans Affairs - the State of the U.S. Department of Veterans Affairs
HEARING OF THE HOUSE COMMITTEE ON VETERANS AFFAIRS
SUBJECT: THE STATE OF THE U.S. DEPARTMENT OF VETERANS AFFAIRS
CHAIRED BY: REP. BOB FILNER (D-CA)
WITNESS: SECRETARY OF VETERANS AFFAIRS ERIC SHINSEKI
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REP. FILNER: We have had some vacancies on the Republican side and ratify their actions, so that we can officially proceed with our committee business. And Mr. Buyer, I will yield to you to discuss the couple of resolutions before us today.
REP. STEVE BUYER (R-IN): Thank you, Mr. Chairman. We have additions to the committee -- is Dr. Phil Roe of 1st District of Tennessee, and then Mr. Lamborn, who had served on the committee in the last Congress, then by virtue of his appointment was removed from the committee and is back officially on the committee. So what I have are two resolutions.
REP. FILNER: We want to welcome Mr. Lamborn back. He was very active a member, so thank you for joining us again.
REP. BUYER: The resolution before us would approve Mr. Lamborn as ranking member of the Disability Assistance and Memorial Affairs Subcommittee, Mr. Henry Brown of South Carolina as the ranking member of Subcommittee on Health and Dr. Roe as the ranking member on the Subcommittee on Oversight and Investigations. Dr. Boozman was previously approved by the committee as the ranking member of the Subcommittee on Economic Opportunity.
REP. FILNER: That is a motion to approve the ranking members from the Republican Caucus. All those in favor, say aye. (Chorus of ayes.) Opposed? (Silence.) That carries unanimously.
Any other -- there's no other business, is there?
REP./MR. : Yeah, there's --
REP. FILNER: Hold on.
REP./MS. : Subcommittee --
REP. FILNER: I think we have to officially approve the -- your list of subcommittee members.
REP. STEVE BUYER (R-IN): The resolution before us would finalize the subcommittee assignments for the Republican members of the committee by assigning Mr. Cliff Stearns to the Subcommittee on Oversight and Investigations. His experience on the subcommittee over the past years has been invaluable, and I'm pleased he's agreed to fill the final vacancy, and I move that members approve the resolution before the committee.
REP. FILNER: Thank you, Mr. Buyer. All those in favor, say aye. (Chorus of ayes.) Opposed? (Silence.)
That carries unanimously, and I thank you.
REP. BUYER: Thank you.
REP. FILNER: (Striking gavel.) And that concludes the business meeting of the Veterans' Affairs, and we are pleased to open up our hearing to hear from our new secretary, General Shinseki.
Mr. Secretary, we -- I think you're one of the first Cabinet members on the Hill, and we feel honored to be here. Your reputation precedes you. We know you're a man of courage and intellectual honesty. You've been called a soldier's soldier, which is one of the highest accolades, I think, that your troops can give to you. And we look to you to -- caring for the veterans now under your command, as it were, in the same way.
So we've seen some of your previous testimony in your confirmation hearings. We've had some conversations with you. We're so glad that you're here.
We have a great job to do, important job, a historic job, not only with our young men and women coming back from Iraq and Afghanistan, but of course we cannot forget the older veterans who made this country what it is today.
And you have a big job before you. We intend to support you in that. We intend to make sure you have the resources to carry out your job, and give you the backing that you need.
I think you're very familiar with many of the issues already, and you talked in your confirmation hearing about a transformation into a 21st-century Department of Veterans Affairs. So we look forward to making sure that that occurs and that every one of our brave young men and women, whether -- I'm sorry -- and brave older men and women get all the care and attention and love and dignity and honor that this nation can give. And I know that you will lead us to do that.
Mr. Buyer, I yield to you for a few comments, and then we'll hear from the secretary.
REP. BUYER: Thank you.
Thank you, Mr. Secretary, for being here, and we look forward to seeing you again as you present your present your department's budget.
I know, from my tenure on the Armed Services Committee, that you're a man of principle and you're a man that reflects Army values. And I think that's extremely important.
I also want to compliment you on the selection of your predecessor, years ago, to lead the health affairs department within the Army. And now you replace him as secretary. And I only regret that we didn't have more time to have worked with him.
He was a man of great experience. He brought a lot of talents and made a real difference in a short period of time. And I'm quite certain he'll be a valuable counsel to you. And don't hesitate to lean on him, as you've done throughout the years.
Even in the short time that I turned to him, when there were challenges, and I think some of the VSOs would compliment his leadership. And boy, there's no moss on that man's stone. He's always moving.
I was pleased to see the performance goals that you outlined. I think that's extremely important whenever you take over a great challenge. So those are enduring themes that, I believe, will be essential for you as you navigate at one of the most critical moments in the department's history.
I just want to touch on a few things -- there are some obvious -- in front of us. One is the disability claims backlog. You know, Congress asked for a disability commission. These are individuals that put their eyes on this with a lot of effort. And it seems to be collecting dust. And it's very bothersome to me.
You had the Dole-Shalala commission or presidential task force. And so there are a lot of people that have placed their eyes on these challenges. Yet, you know, what we have is an absence of leadership. Richard Burr and I, we stepped forward and we made an introduction of a bill. And it's interesting in this town.
You know, any time there's any form of leadership, the critic who lurks in the shadows always very quick to attack. And, but this is one that requires an enjoined solution, whether from you, whether it's from us, whether it's with the VSOs. But at some point, it's one that requires real leadership. So I submit that to you.
The other is building on the synergies of excellence between DOD and the VA. This is one that requires constant maintenance, and it will also one -- an issue that will take up many of your issues -- excuse me -- much of your time, whether it's the VA-DOD sharing of facilities, electronic medical records, or the benefits delivery at discharge.
The other is, we have the issue on collaboration with regard to how we construct VA facilities. Denver, Las Vegas, Charleston, Orlando, New Orleans -- there are opportunities here, and we need to break into a new paradigm on how we deliver the -- our health services.
The other is IT consolidation. I am quite certain that the gargoyles that defend bureaucracies and the old way of doing business will be very eager to take advantage of your new leadership to try to convince you as to why we should return to the days of old in a decentralized model on IT. I would ask of you to keep your eyes wide open as you step into this new position, and seek the best of counsel here as to why this committee, on a unanimous basis, has endorsed the centralized IT. And I just ask of you to keep your eyes on that.
We also recognize that when we created legislation, we probably came in a little too strong with regard to our identifying of -- we really wanted to know what you were spending at the VA on the IT budget. And I think we probably came in, Mr. Chairman, with a little too specificity (sic). And we'd be more than willing to work with you on how to build that transparency in a manner where your down-line leaders are able to do their jobs. Okay, so, Mr. Chairman, I and the committee will work with you to do that. We just recognize that there are some failed major IT projects out there.
On the third-party collections, you are -- you will accept -- be accepting leadership exerted by your predecessor in the buildout of the CPACs on revenue-cycle management. This is extremely important. The chairman and I and others of the committee have placed our eyes on this over the last seven years, and it is the very best way that we can continue to increase our revenues.
So please -- you know, it is within your discretion right now with regard to the priority on how you want to do the CPAC. I know that the last conversation I had with your predecessor, they had the West going last. If in -- you might want to re-look at that, because that would probably be the greatest amount of revenue. So you might want to look at redoing the order with regard to that buildout.
The other is, please off the heels and on your toes with regard to the energy initiatives. I was really pleased that he stepped forward and committed about $49 million on the 16 solar projects, and I'm really anxious to see the order in which you are proceeding, not only on solar, wind and alternative fuel, but also the construction of these mega-solar supernova systems with regard to the heating of water and how that can be utilized at the health systems. The implementation of the GI Bill, procurement reform.
The last thing I want to touch on is the dental issue. And I want to to thank the chairman. He's been very helpful, along with Chairman Ike Skelton, to give me great latitude to jump really on the Army Dental Corps. It was when the commander of the Army Dental Corps told me that it was not their mission to take care of the National Guard as they returned from theater.
What was happening was the Army was just turning them over to the VA. And that was wrong. To me, Army green is Army green. And if we're going to build a model that takes care of our equipment but we don't take care of our people, that was wrong. And that general really should be fortunate that I wasn't chief of staff of the Army, because I would have sent him to pasture.
Fortunately, what has happened, I'd like for you to know that the Army is leaning forward. The brigades that have been returning from October 1st on now are taking care of those Class 3s, and about 90 percent of those who are coming back in. So, finally they've gotten the message. But the Army has used the VA as a bill payer. And so I want to let you know about these kinds of things. They're leaning too much our way. And that's really sort of a budget issue and leadership issue. But I look forward to working with specificity on a lot of these projects.
With that, I yield back.
REP. FILNER: Thank you, Mr. Buyer. Mr. Secretary, I don't have to tell you about a lot of hope is -- the whole nation is looking with a lot of hope to the Obama administration. And certainly our 25 million veterans and their families are looking to you with that hope. We're confident -- I know the president's confident, but we're also confident that you're going to fulfill those hopes.
We look forward from hearing you today. Your written statement will made a part of the record. And you have the floor.
SEC. SHINSEKI: Mr. Chairman, Ranking Member Buyer, distinguished members of this Committee on Veterans' Affairs, I'm very honored to be here today. Thank you for this opportunity to appear before you this morning and -- so early in the cycle.
I'm also most honored to be entrusted by President Obama with the responsibility of leading great professionals at the Department of Veterans Affairs and serving the men and women whom we and, in fact, all of us in this country owe so much, generations of Americans who have done their duty, some of whom have seen this country through some of its darkest hours.
And so both to those veterans -- both there on the dais and those sitting back here in the audience and even some who may be watching these proceedings from remote locations in this country, thank you for your service and thank you for your sacrifice. I am honored to be serving as your secretary.
And for me the privilege of leading the Department of Veterans Affairs is a -- is a noble calling. I willingly took this assignment. I see it as one that offers an opportunity for me to give back to those who have served in uniform, those who served with and for me and those on whose shoulders all of us stood as we were growing up in the profession of arms.
I'd like to acknowledge the presence of some of our key veterans' service organizations this morning. They're here representing many other veterans' organizations who could not be here. Together we share the mission of fulfilling Lincoln's charge of caring for "him who shall have borne the battle, and for his widow, and his orphan."
Their advice and support on how to do this better will always be advice that's welcome.
I am committed to fulfilling President Obama's vision for transforming the Department of Veterans Affairs into a 21st-century organization worthy of those who, by their service and sacrifice, have kept this nation free. This is a time of great change, even greater challenge. But it's also a time of opportunity. At least, I see it that way: a time to reset the VA's vectors for the 21st century. And those vectors will be based on three fundamental principles, as far as I'm concerned. We'll be veteran-centric; we'll be results-driven; and we'll be forward looking. Our operating standards must embrace these fundamentals as the department delivers on its obligation: obligation to provide veterans the highest-quality care and services in a timely, consistent and fair manner.
First, veterans are the focus of all of our efforts. As our clients, they are the sole reason for our existence, and our number- one priority, bar none. At the end of the day, the only true gauge of our success is the excellence of our programs and the timeliness of the services and benefits we provide. We will be measured by our accomplishments, not by our promises.
Second, VA must be results-oriented. We must put veterans first by first putting in place the management tools we need to achieve positive, well-thought-through initiatives and outcomes. I am convinced that if we are to achieve our goals, we must set clear objectives, create even clearer metrics and then follow up relentlessly. Success in this broad foundational area is and will be a function of leadership, and it begins with me.
Third, we must be forward looking. We must continually seek to challenge ourselves to accomplish our mission more effectively, more efficiently, more innovatively, always rigorously mindful of husbanding our resources and using taxpayer dollars responsibly. VA will put a premium on working smart: leveraging best practices, cutting-edge technologies and strong and determined leadership to better serve our veterans.
To the members of this committee, the Department of Veterans Affairs has an opportunity to renew and strengthen the long-standing covenant between America and her veterans. We have a committed workforce whose professionals can and will undertake the kind of change that will restore this department to preeminence in government. With their support and assistance, I am privileged to undertake this mission. And with your support, I'm confident we'll succeed.
Thank you, Mr. Chairman. I look forward to your questions.
REP. FILNER: Thank you, Mr. Secretary. And we appreciate the time to deal with some of our members' concerns.
We'll start with Ms. Brown from Florida.
REP. CORRINE BROWN (D-FL): Thank you. Thank you, Mr. Chairman, for holding this hearing today.
And I want to welcome the secretary. Mr. Secretary, thank you for coming here today. And I'm pleased with your testimony, where you said you have much yet to learn about veterans affairs. I am pleased that you admit that you don't have all of the answers. And let me just tell you, us up here don't have all of the answers either. But we're willing to work together to make things better.
And I always like to quote the first president of the United States, who said -- George Washington -- "the willingness with which our young people are likely to serve in any war, no matter how justifiable, shall be directly proportionate as to how they perceive the veterans of those earlier wars are treated and appreciated by their country." And I'm looking forward, along with our colleagues in our committee, which I'm very proud of -- it's always been bipartisan -- when a person goes to war who serves their country, it doesn't matter whether they're a Democrat or a Republican, they're serving our country, and we as members of the Veterans Affairs -- and I've been on this committee for 17 years -- have always worked to that end. And I'm looking forward to working with you.
And I personally want to extend an invitation to you to come to Florida. You haven't been to Florida since basic training, and we know how many years ago that was. So things have changed in Florida, and we're looking forward to you coming and meeting with our veterans. First invitation before anyone else.
Thank you. (Laughter.) I yield back the balance of my time.
REP. FILNER: I hope you brought your travel consultant with you, Mr. Secretary. I think you'll be receiving many invitations.
REP. CLIFF STEARNS (R-FL): Thank you, Mr. Chairman.
At this point, then, we can ask our questions.
General, thank you very much for serving. We are honored to have your leadership and your background in this position. And there's been great leaders before you, but I know you'll be serving in a high capacity, and we look forward to it.
The ranking member, Mr. Buyer, talked a little bit about IT, and I just want to follow a little bit along this line. The goals of VA FLITE are to implement a one-VA information technology framework that enables the consolidation of IT solutions and the creation of cross- cutting common services to support the integration of information across business lines and provide secure, consistent, reliable and accurate information to all interested parties; improve the overall governance and performance of VA by applying sound business principles, ensuring accountability, employing resources effectively through enhanced capital asset management, acquisition practices and strategy (sourcing ?), and linking strategy planing to budgeting and performance.
My question is, given the new administration's focus on IT -- President Obama's talked about (cross-reliance ?) in health care to create a more efficient government -- how will the VA leverage IT to modernize and drive more standardization, which increase productivity and efficiency? For example, how will you use It to have better access to data to make quicker, more informed decisions? And do you see IT as being critical to improving the mission of the VA to provide better health care and benefits to our veterans?
SEC. SHINSEKI: Thank you, Congressman. In answering your question, I'll try to touch on what the ranking member also raised.
Let me just give you a picture of what the disability claims process looks like. If you were to walk into one of our rooms where adjudication or decisions are being made about disability for veterans, you would see individuals sitting at a desk with stacks of paper that go up halfway to the ceiling. And as they finish one pile, another pile comes in. There are 11,100 people doing this today for the Veterans Affairs Department -- good people, hired to do this rather challenging job in which they are trying to apply judgment to situations that occurred years ago, and in some cases situations that they don't have a full appreciation for the -- (off mike) -- of combat.
Eleven thousand, one hundred people equates to the 82nd Airborne Division. Now that's sort of my reference point here. If we don't take this and create a paperless process, I'll report a year from now that we hired more people to do this. In the last two years we've hired 4,000 additional adjudicators. This year we're hiring another 1,100 to address the backlog problem.
In my opinion, this is a brute force solution, and we need to very quickly take this into an IT format that allows us to do timely, accurate, consistent decision-making on behalf of our veterans. And this is part of what the backlog is about.
And I will also tell you, in the other part of the Veterans Administration, we have an electronic medical record that is probably well-respected and complimented by others in the medical profession. And so someplace between these two applications of information technology, we've got to bring goodness to what we live with day to day in the VA.
REP. STEARNS: General, let me just follow up. You mentioned the idea of a paperless electronic system, certainly with a benefits claim system. Part of your whole answer obviously includes training. And do you have -- I know it's too early, but do you have any idea -- are you going to try and put benchmark in place when we're going to have a paperless electronic benefits claim system?
SEC. SHINSEKI: Well, I'll share with you the benchmark that has been shared with me in the first two weeks of my arrival. It's 2012.
REP. STEARNS: Okay.
SEC. SHINSEKI: I don't know whether that's a good date or not. I just haven't, you know, gotten into what it will take us to get there. But my intent is to get to a paperless solution here as soon as possible. And that will take investment of course, in information technology, significant.
I have also drafted, and it's in final staffing, a policy letter to the department that says, I support and will continue the centralization of IT within the department. So that should be signed out here in about a week.
REP. FILNER: Thank you, Mr. Stearns.
REPRESENTATIVE VIC SNYDER (D-AR): Thank you.
Mr. Secretary, I appreciate you being here. And I'm going to be very brief and let somebody else ask questions also. But following up on this conversation, you referred to the stack of files sitting on the desk. So obviously you've done some tours already and visited some facilities. But have you had occasion to go into the file room? I would encourage you, on your next visit to an area, or any time you go to visit there, have them take you into the file room.
It's almost dangerous as the -- some of these file rooms are overwhelmed by individual files that will literally be three and four and five volumes. And I'm told that a lot it is that there will be something on the Internet that will be applicable, to a specific illness or injury. It will get printed out. The veteran will request that it be added to the file. And the files just keep growing and growing and growing.
But it's -- ironically I think that the information technology has in some ways contributed to the thickness of the files, because there's so much information out there. But we've got to get a handle on that whole thing of how you store this stuff and what you're going to do with it. But I would encourage you to visit the file rooms also.
I just want to make three quick points. I think that our chairman and ranking member may have mentioned them.
The G.I. Bill is so important to every American but certainly every member of this committee. And I think once again the G.I. Bill has the potential of transforming America at this very important time. And you're going to be the key person seeing that that happens. And I know this committee is interested in working along with you.
Medical research; as you know, from your past experience, there's not many good things about wars. But one of them is that we learn about things medically.
And there are opportunities now, if we apply money appropriately and in adequate amounts, to really do some good for a lot of people and families in terms of finding new ways of deal with -- dealing with things like PTSD and traumatic brain injury, but other things also. And I hope that you'll be an advocate for medical research within the VA system.
And finally, you have inherited America's problems. We want you to provide perfect health care in all areas, whether it's for PTSD or amputees or whatever it is, when, in fact, we as a country have not solved that problem. And I think you should feel free to lay it back on the Congress, which is, you know, "It would be easier for us if we actually had a network of mental-health services throughout America, including rural America, including underserved areas," and let us know when our American health-care system is part of a problem that you've inherited.
And I think it's going to be hard for you to have the level of care you want for every veteran until we as a country come to terms with what I think President Obama wants to do is, and address the health-care issues that we have.
But thank you for your service once again. We certainly look forward to working with you.
REP. FILNER: (Clears throat.) Excuse me. Mr. Miller?
REP. JEFF MILLER (R-FL): Thank you, Mr. Chairman.
Mr. Secretary, it was a pleasure visiting with you. And we do look forward to hosting you in Florida when you have the opportunity to come down.
Following on to Dr. Snyder's comments in regards to medical research, there are some -- even some exciting things going on down in the panhandle right now, with hyperbaric oxygen therapy for TBI folks. And we're real excited. There's some of the cutting-edge stuff going on down there with some of the things that were talked about in October in the consensus conference up here in Washington.
Mr. Stearns was talking about IT and the issues of medical records. And I think we all agree that that is an extremely important thing and certainly should lend a great chance of solving some of the backlog too. But we know that it's not going to be implemented quickly. But we do know that it's very important. And I think we all are committed to helping you meet that goal, if not by the date, prior to.
But what are the other areas that you may see? Or even -- pick one stumbling block that's out there between the -- for the transition for military personnel from DOD to VA. What would you see as one or a couple?
SEC. SHINSEKI: Well, I would say that -- I'll begin with leadership.
If this is going to happen faster and at a higher quality than is happening now -- and by the way, we've made tremendous progress in the last year to 18 months, thanks to the leadership of Secretary Peake and others.
But this is not a technical issue, in my opinion. And so if it's going to be solved any faster, it's going to take leadership.
Last Friday, I requested and had a personal meeting with the secretary of Defense. And we both agreed that in this interim when he and I are both sort of without deputies -- and the two deputies chair the senior oversight committee that's looking specifically at how to transition active-duty personnel into the ranks of the VA -- he and I agreed that we would chair the next meeting, which will occur some time this month, and maybe the next two meetings, personally, to provide the leadership, establish the priorities and keep the momentum on finding solutions for what seems difficult right now.
A single electronic medical record is something I would be interested in working on with him.
An individual enters the ranks as a youngster and stays for several years or stays for 20 and comes to us as a veteran. Those records ought to be transferable and ought to be accurate and complete, not just medical records but personnel records as well, because the personnel records are also part of the disability adjudication process. If we can get to this agreement on what an electronic medical record looks like, we will solve the challenges we're wrestling with today where we have two different records.
And I would add that I've asked about the relative qualities of both, and I'm told that the medical record that's used in the Veterans Administration is very highly regarded, both in Veterans Affairs but also in the military departments. And so I went and sampled with a couple of doctors here locally at -- the military doctors at Walter Reed -- a small sample of three. Everyone said VistA is the way to go -- VistA happens to be the VA's version.
And so I think if you put the issue before medical professionals, they can come to an agreement what a requirement for a medical record is. Once we get that, we can put then the smart people with the technical skills to be able to deliver what we think works. When we do that, we will be able to make this seamless transfer of information.
But to get to that point of having this single electronic medical record, single personnel record, well, it's going to take leadership. And I think that's where Secretary Gates and I can do a lot to leverage better and faster outcomes than we're currently facing.
REP. MILLER: Thank you, Mr. Secretary.
Also, I'd like to ask unanimous consent to enter my statement into the record as well.
REP. FILNER: Without objection, then, all members' statements will be entered into the record.
Mr. Michaud, who chairs our Health Subcommittee.
REP. MICHAEL H. MICHAUD (D-ME): Thank you very much, Mr. Chairman, Mr. Ranking Member, for having this hearing.
I want to thank you as well, Mr. Secretary, for coming here. And congratulations, and look forward to working with you over the next couple of years.
I have a couple of questions. There's been a lot of talk about the stimulus package and the economy. And my first question is, that deals with priority eight veterans, if you look at what's happening out in the real world, if you have a factory that shuts down, you have a lot of workers who are veterans who do not utilize the VA system because they don't need to because they have good health care at the place where they work. My question is, is once they get laid off and they need health care, unfortunately they have to go to the VA system. And when they look at the application that they made during the previous year's wages, they get denied. Then they appeal it, then they get accepted.
My question is, is there a way so that they can get accepted the first time around because of their economic status has changed? That's my first question.
My second question is, we've done a lot over the years with rural health care issues and access to health care. One of the biggest complaints of a lot of us here is of veteran(s) in rural areas being able to get that access to health care when they need it. Under the 2004 CARES process, they brought forward, you know, access points and new hospital facilities.
My second question is, do you think we ought to revisit the CARES process to make sure that it's still valid? And if so, is there a way that we can speed up that process -- i.e., if there's an access point in a rural area and you have a rural hospital or a federally qualified health care clinic in that rural area, wouldn't it make more sense to work collaboratively with them to get access in that particular rural area?
And my last and final question is, now that the campaign's over -- and you heard the chairman talk about hope and everyone's really optimistic with the new administration moving forward -- a lot of, you know, campaign promises are made during an election cycle. One of the issues that I heard the president talk about is taking care of our veterans, whether it's, you know, on the funding -- (audio break) --
SEC. SHINSEKI: (In progress following audio break) -- both rural health and our concerns about not understanding our mental health challenges as well has caused the VA to put a lot of energy into coming up with what I think are fairly creative solutions in not just hospitals but health centers and outpatient clinics and vet centers and mobile vans, 50 of them, that provide both primary care in a limited way but also health care.
And these opportunities allow us to address some of the rural challenges.
Contracting is an opportunity as well with local primary care providers. My only concern here would be that we meet -- we maintain the standards that a veteran would find at any VA facility. And if we can do that, we'll try to address those concerns as well.
I forgot the third issue that he --
REP. MICHAUD: Advance funding.
SEC. SHINSEKI: I would say just up front my preference would be for a timely budget. And I'll assure you I'll do my part to get a mature request from the VA and to the president in time. And I've been assured that he will support funding for VA medical.
And in a prior life, I lived with continuing resolutions, and I know full well the impact that they bring. And so timely budgets would be my preference. If that's not possible, I'm sure there will be a discussion about other options.
REP. FILNER: Thank you, Mr. Michaud.
We welcome Mr. Roe to our committee and you have the floor for any comments you might make.
REP. DAVID "PHIL" ROE (R-TN): General, congratulations. I remember when I was in the service. I served as a medical officer in the 2nd Infantry Division. And this was your medical record. You carried it around.
We have some experience, locally, you are correct, that the VA record system is a terrific system. And look forward to working with you.
I have had the privilege of going through -- the pain, I should say, of going through and converting our office to an electronic medical record. But it is an advantage and you can handle data much better. In our local community in my previous life I was a mayor of our city and we converted all of our police to electronic, so there was no paper at all. It's been a tremendous success.
I really look forward -- we have a huge VA campus in my district, and I'm going to make the third invitation here to invite you to Tennessee to visit.
There's no higher calling, in my mind, than to take care of our veterans who protect our nation. And I -- it's a privilege to be on this committee and to work with a person of your caliber. And I look forward to doing that.
I also will point out that already in our local VA you have -- it's completely heated and cooled by renewable energy. We use a landfill and treat the methane, and the entire campus is heated and cooled by renewables.
So this is something I'd like to work with -- in other VA facilities with you, and look forward to working with you.
I think we have something to offer, as far as my background as a physician, to work with some of these issues. And there are a lot of issues out there. There's no question about it.
One in particular, there are people who don't meet the income threshold in our area, who make a little bit too much money, but don't work in a job that has health insurance. And I really believe we need to address those veterans. It's a tremendous problem, and maybe more a national problem, as pointed out, also. But we have a sheriff in a local county that I represent who -- the county doesn't provide health insurance, and he can't get in the VA. He's an Army-discharged veteran, four years in the military in the Army, and cannot get in. That's wrong. And I'd like to see that corrected.
So just a few comments. Thank you very much. I think we certainly have a great secretary to work with.
REP. FILNER: Thank you, Mr. Roe.
The chair of our Economic Opportunity Subcommittee, Ms. Herseth Sandlin.
REP. STEPHANIE HERSETH SANDLIN (D-SD): Thank you, Mr. Chairman.
Thank you, Mr. Secretary, for your testimony today. Congratulations again on your recent appointment, and thank you for your many years of military service. It was a pleasure to meet with you last week. And as others have done, I extend the invitation to you once again, as I did last week, to South Dakota -- understanding that the summer months would be preferable than the dead of winter in South Dakota.
But I want to reiterate just a couple of items that we discussed, and bring two others to your attention. We did talk about the post- G.I. Bill -- post-9/11 G.I. Bill, and the August 2009 deadline. And as we work to achieve that goal, as you know, next week -- or, excuse me, the week of February 26th, the Economic Opportunity Subcommittee will be having a hearing to evaluate both the short-term and long-term goals, and where those time tables are and the strategies for implementing the new veterans education benefits.
And we also discussed the VA facility leasing initiative; community-based outreach clinics, as you know and Mr. Michaud pointed out, are so important to highly rural areas, advanced funding; as well as the Women Veterans Health Care Improvement Act. And I appreciated your comments and thoughts on a variety of issues, including the PTSC conversation that we had last week as well.
Two other issues that I wanted to bring to your attention are long-term care, and the polytrauma rehabilitation centers within the VA health system. The number of veterans 85 or older is projected to increase 110 percent between 2000 and 2020. Estimates indicate that this number will peak in 2012. And I believe meeting the long-term health care needs of our nation's veterans is one of the most important and difficult challenges facing the VA today. And I hope that you and your staff will work with this committee as we develop a comprehensive strategic plan for long-term care.
The other issue, as you know, with the polytrauma rehabilitation centers and the important work that they have been doing, particularly in working with our wounded warriors, from the wars in Iraq and Afghanistan that have produced thousands of severely wounded active- duty servicemembers and veterans; many of the veterans receive treatment at one of these four centers. And for the most part, these centers are providing extraordinary care.
The VA however, I think, needs to develop guidelines that ensure that the polytrauma centers aren't prematurely moving patients, out of the centers and into long-term care, before they reach optimal function, given that individual's potential through rehabilitation.
And my opinion stems from an experience that one of my constituents had. He received a traumatic brain injury from an IED in December of 2005 in Iraq. And he was informed that he would be transferred, out of the Minneapolis Polytrauma Center and into a long- term care facility, before his family believed he had received the level of rehabilitative care that he deserved.
And I agreed with him and at the time, based on my conversations with the family, their terrible experience with the caseworker that was assigned to them at the time. And my concern is that this was another perhaps budget issue, because the Department of Defense wasn't paying, because he was still active-duty.
And the polytrauma center basically said, if he hasn't achieved a certain level, after 90 days, we're moving him. And we were able to intervene with the Army and worked with the VA as well and got him into a private rehabilitation center.
And this constituent made dramatic improvements, in a matter of weeks, that he hadn't been making in the polytrauma center in Minneapolis. And he has now been able to return home and improves his functioning every week and every month.
And so I just wanted to bring this issue to your attention, in terms of the importance of those guidelines, so that we're not giving up, on many of these vulnerable young men and women, and prematurely moving them into long-term care, based on some fairly arbitrary standards that I think this particular family that I represent was dealing with at the time.
Thank, Mr. Chairman.
REP. FILNER: Thank you, Madame Chair.
REP. BRIAN BILBRAY (R-CA): Thank you, Mr. Chairman.
Secretary, I appreciate the time we were able to spend together. I think, Mr. Chairman, I've had the pleasure of having a very frank and open discussion with the secretary, and I have to say that I know a lot of members are very concerned about rural services, whatever, and I'd just like to share with the rest of the committee that anybody who's grown up in one of the out islands in Hawaii knows the challenges of being provided all the essential services and the logistical challenges there. And I think the secretary brings a personal experience with the challenges, as -- growing up in one of the out islands, that I think all of you will appreciate if a major concern is rural services.
So, Mr. Chairman, I yield back.
REP. FILNER: Thank you, Mr. Bilbray.
And the chair of our Oversight Subcommittee, Mr. Mitchell.
REP. HARRY MITCHELL (D-AZ): Thank you, Mr. Chairman.
And I want to welcome Secretary Shinseki and thank him for appearing before our committee. Mr. Secretary, given your long and dedicated service to the U.S. Army, I know that veterans will be well- served by your leadership.
The Subcommittee on Oversight and Investigations, which I am honored to chair, has focused on a number of issues, including VA outreach, record-sharing with the Department of Defense and implementation of effective information technology. At a time when less than 8 million of our nation's 25 million veterans are enrolled in the VA, we have pressed the VA to do more through outreach to the remaining 17 million. We asked the VA to find ways to bring the VA to these veterans, and the VA has since begun using modern media tools to do so. And I believe this is a great step in the right direction.
And turning to the records-sharing, the VA and the Department of Defense have been working on shared electronic medical records for the last 20 years, and much progress has been made in the last two. A commitment from both departments will be required to finish this job.
And finally let me say that I believe, when the VA and its dedicated workforce of private servants are doing their best, they can provide excellent health care and timely benefits. However, the VA needs strong leadership to solve significant management problems.
The department's financial and inventory management systems are completely inadequate, and its outside auditors found material control weaknesses for three years in a row.
With enhanced information technology systems, the VA's management will need to implement a high standard to achieve, and help employees to reach it.
And beyond these three issues, there are many challenges which face us, including the implementation, (as has been ?) mentioned before, of the GI bill, sorting through miles of disability claims. And we all have our work cut out for us.
But Mr. Chairman, with your leadership and with the leadership of Secretary Shinseki and the VA, I believe that we can make great progress.
And I yield back.
REP. FILNER: Thank you, Mr. Chairman.
REP. HENRY BROWN (R-SC): Thank you, Mr. Chairman. Thank you, Secretary, for being here today.
This is my ninth year on the Veterans Committee, and I served as -- in it now as the ranking member on health care, and so health care of our veterans is pretty important for Charleston, South Carolina, in my district down along the coast, and I guess as far as the whole nation as a whole, we certainly want to keep in mind those veterans that have paid the price for our freedom. And we certainly want to be there for them when their needs are there.
And I -- one of the things that we're working with down in Charleston and which we hope would be a model for the country is to try to collaborate as much on health-care delivery as possible. We recognize the sophistication now of the health-care delivery for those veterans (that are ?) coming back under much more extreme conditions than they were in previous conflicts. And so we want to be as flexible and as creative as possible. And so one of the projects we've been working on is to try to bring more collaboration between the VA community and the other health-care deliveries around the country.
And more specific, we've been working with the Medical University of South Carolina to try to draw the strength from both of those health-care delivery systems to better benefit the health-care delivery of our veterans. And so we've been going through the process of establishing some of the reasons that we can combine -- you know, some of the resources.
And we even -- as we speak, the Medical University is in the process of actually replacing all of their current campus. And what we were hoping to do is include the VA hospital into that development plan. In fact, we were able to get a $36.8 million -- in the reauthorization bill, and so that we hope that somehow that we can continue to move that forward, because of the timeliness of the development of the Medical University.
So we hope that you would be supportive of that effort, and any information we might be able to bring you up to date on, we'd be happy to do so.
Thank you for your service.
REP. FILNER: Thank you, Mr. Brown.
SEC. SHINSEKI: Mr. Chairman, may I make just a comment?
REP. FILNER: Please, Mr. Secretary.
SEC. SHINSEKI: I think most members know we have 153 VA hospitals across the country, and well in excess of a hundred of them are affiliated with medical schools. And I'm told that 50 percent of the physicians in this country have come through a VA experience. I think it's important -- I mentioned providing leadership in the area of regaining our, you know, position as well respected in this country in the health care business. I think that affiliation is an important part of it, and we'll continue to do that.
And to Mr. Buyer's comment, we ought to also look for where it makes sense in affiliation with DOD activities and see if we can harness talent, creativity and perhaps save on funding for some of these initiatives. And I know there -- you know, there is legislation that sort of dictates how we might be able to do this, but I think willing minds would be able to help us get more energy out of this.
I know when I came through the VA as a youngster out in Hawaii, and dealing with this issue of -- as an amputee, dealing with a surgical procedure, I must tell you -- and this was in a medical -- military medical center -- I must tell you that I've watched what the VA has done in terms of research and creative solutions. The Seattle Foot, that allows amputees to run, was designed, I'm told, in the VA.
And I think if we can continue to have these kinds of successes, it will benefit the nation at large, and certainly benefit the military, where we see a lot of youngsters now being able to stay in the military because they choose to and because they've been given functionality back -- not just form, but functionality.
REP. BROWN: Well, thank you very much for that support. And look forward to working with you. And I know we also have a DOD/VA joint outpatient clinic in Charleston, South Carolina, and so we're looking forward to seeing how that's going to actually operate, too.
So thank you very much, sir.
REP. FILNER: Thank you, Mr. Brown.
Chairman of our Disability Subcommittee, Mr. Hall.
REPRESENTATIVE JOHN HALL (D-NY): Thank you, Mr. Chairman and thank you, Mr. Secretary for your service and now for your willingness to serve again in this most important time.
We had the opportunity to speak before and I had the opportunity and will again extend the congratulations of the West Point community and of their -- they and the 70,000 or so veterans of the 19th District of New York. And all the vets of New York state, I think, are looking forward to your taking on the challenges that you've described and that you've heard us talking about.
There are a couple of things I wanted to mention in particular. One just came from a conversation I had this morning at the Military Association of New York breakfast with some Guard officers who are working on 30-day, 60-day, 90-day interviews with returning National Guard troops and their families who are coming back from Iraq and Afghanistan and having counselors interview the families separately in one room and the soldiers in another and -- to try to assess problems of readjustment, in particular PTSD.
One of the priorities that I hope we will succeed in the subcommittee's work this term in addressing is to provide the presumptive service connection for PTSD, for those who have the diagnosis but -- a doctor or a psychiatrist diagnoses a veteran as suffering from PTSD and they served in a war zone, as defined by the secretary, or in a(n) area of hostilities that they don't have to jump through any hurdles or over, you know, through hoops to prove that that was the cause. And I would look forward and I do look forward to working with you on fine-tuning -- and with members of the committee and the subcommittee -- on fine-tuning that legislation.
But they're finding, as I was told this morning, that the Guardsmen that they're working with are reluctant to talk to the brass. They're reluctant to talk to officers. They'll talk to other soldiers. They'll talk to counselors. They'll, you know, the families will first open up to a counselor. But once they do open up, I would like it to be -- if the diagnosis is there, the treatment should be automatic and as quick as possible.
The second thing that was mentioned by a couple people, I think, was the CARES process, and whether there's any adjustment that needs to be made there. And in particular, in my district we have the Castle Point and Montrose VA hospitals -- (inaudible) -- and Middletown, New York, and Orange County.
But Montrose is a big and beautiful site on the east bank of the Hudson River which is being looked at right now for highest and best use conversion, which I think should be mean highest and best use for veterans.
And what I'm concerned about is that in the name of a short-term revenue hit, that some of this or -- some or all of the site may be converted to condos, marinas, retail space for profit and for private developers. And we have severe need for transitional housing for homeless veterans, for independent living, assisted living and nursing care for our more elderly veterans and for rehabilitation housing where vets can live with their families while they're being rehabilitated from injuries, as they are in Silver Spring at the Homefront Village that some of us visited last year.
So with all those things, those needs and the veterans returning from Iraq and Afghanistan, I think it might be premature to close or knock down empty buildings at the Montrose facility. And in the course of inviting you to the Hudson Valley and to West Point again, your alma mater, I would ask you to visit Montrose with me and have a look at that, and look forward to working with you very much.
REP. FILNER: Mr. Walz.
REP. TIMOTHY WALZ (D-MN): Well, thank you, Mr. Chairman and Ranking Member, and thank you, Mr. Secretary. It's a real honor to be here with you. And of course having served at a time when you were serving also, to serve under you was a great honor.
And I'd like to especially thank your wife. As you all know, no warrior deploys alone or takes a mission alone, so your wife is giving up those -- (off mike) -- well-deserved retirement years that you worked so hard for in this nation. So to step back is -- thank her for all of us. It's a service to the nation again.
It's a great scene that I have here in seeing you. Sitting behind you are the men and women that literally represent millions of our veterans. They are the voice for those veterans. And I know you already know many of them on a first-name basis. They are here every day. They are speaking, and they've been doing it for decades. And they are your strongest supporters, sitting behind you; they are the strongest supporters of the VA.
And because of that, they've -- they will also be your toughest critics. They are there to make sure that that organization succeeds. They're there to make sure that you have the tools to make it succeed for our veterans. And they will point out shortcomings. And I think it's a very healthy dynamic. I see them as what makes the VA work, and they're the people that can help you greatly.
A couple things you said, General, make --
SEC. SHINSEKI: Sort of --
REP. WALZ: Please go ahead.
SEC. SHINSEKI: Sort of like leading soldiers.
REP. WALZ: Absolutely.
SEC. SHINSEKI: Same dynamic.
REP. WALZ: Well, to see you leading from the front is a real pleasure. And later on, when I invite you to Minnesota, being a sergeant major and inviting a general, you must come in the winter, coming from Hawaii, so -- (laughter) -- you're not going to miss -- Ms. Herseth Sandlin's much kinder than I am.
But I heard some great things here, and my colleagues were hitting on this -- I'm very proud of this -- one of the -- I think one of the greatest honors of my life is to serve on this committee and know the work that we're doing. And this is a committee that at times -- we may differ on the means; we never differ on the end of care for our veterans. And it's a very, again, healthy dynamic. These are great leaders up here, and I'm proud to be here and proud that you're going to lead the organization.
A couple things you said that I think are getting exactly at the heart of what we can do, at systemic things that we can fix, whether it's claims backlogs or how our veterans are cared for, are cultural. And I think you've already started to hit on that. And it's the issue of seamless transition. Everyone here and everyone out there is so sick of hearing about this for decades, but the reason they keep bringing it up is that group out there understands this is the key.
And I applaud Ranking Member Buyer. His work on the dental issue is exactly right. In the long run, not only will we care for our veterans better, we will save money, in my belief, as -- the way that the ranking member's talking about it. And our readiness will be increased. I know that my biggest fear, every time we went to a mobilization station, was I lost my soldiers on dental issues. And we need to have that readiness up, plus the care they get. So I think that's a huge issue, getting in on the seamless transition.
And talking about the single medical record -- and we heard Dr. Roe talk about it -- I represent the city of Rochester and the Mayo Clinic, and they too will echo your assessment that VistA is one of the best things out there. We know there are differences in the needs of some of these records, in being downrange -- and some of my colleagues, when we went to Afghanistan and Iraq with the specific purpose of watching how this worked -- we've got a system now that makes a position downrange have three computers and seven databases open to assess things for a soldier that's wounded. We can do better than that. And we can centralize that and get it moving through.
But what it does, in my opinion -- the DOD does a very good job of what they're tasked for. And their job is to fight wars and protect this nation. And the VA does a very good job of what they do -- is to care for our veterans. The problem lies in when we have that handoff, that seamless transition.
So I think the goal in you meeting with Secretary Gates, who is a great advocates of this and a great leader, and very proud to have him there, is to try and make sure -- because I think the systemic problem with the claims backlog is not getting these people in, is not getting them (transferred ?) over. And then we see, as I said, the DOD hands off most of these veterans at a point where things like diabetes haven't shown up yet and these -- some of these problems.
If we can get them early, if we can treat them, we're going to do what's right by the veteran, save money and, as one of my colleagues said, keep faith with the next generation.
So I'd like to hear just your feelings. And I've heard you say it, I heard you say it in your confirmation: this idea of seamless transition. And how do we finally crack that -- those silos that are set up between DOD and VA?
SEC. SHINSEKI: Just very quickly, one of the other things that I broached with Secretary Gates, besides our agreeing to chair the process to keep the initiatives going -- single, medical electronic record, but also mandatory enrollment in the VA. Not left to out- processing whims; mandatory enrollment in the VA, and have that as a requirement.
That alone will force the two institutions to begin to move together on what records need to be handed off at that point. And there's no excuse for not having that hand-off. But it will force us to do other things to achieve mandatory enrollment in VA.
Even for those who may not have a disability claim at that point, 10 years down the road, who knows? Twenty years down the road -- we don't want to be doing what we're doing now, which is chasing details and records that are, you know, hidden away some place. We will have that hand-off. It'll be controlled, and there'll be an opportunity even years down -- later, to make adjudications based on complete records.
REP. WALZ: Well, I can't say enough how much that pleases me. And I think there's probably a lot in the back of the room that are nodding, also, that this is one that we've been trying to get at.
And again, congratulations to you, and to our veterans. To have your leadership there is very comforting.
I yield back.
REP. FILNER: Thank you.
REP. CIRO RODRIGUEZ (D-TX): Thank you.
Mr. Secretary, welcome, and good seeing you once again. I sat on the Armed Services Committee for a while. I've been in this committee now, I guess, with a little -- I was out for a little bit -- but 11 years. And one of our frustrations has been trying to create that seamless transition and trying to get people to -- and I think Secretary Peake was a tremendous secretary, also, although he didn't participate long enough there to make a difference.
But we really need to see, and would ask you to come forth, you know, and let us know if there's areas that we need to do in terms of additional legislation that allows you the flexibility to do those things that need to occur and/or where there's resources that are needed, or whatever.
I know one of the areas was in terms of the new technology. And some of us felt frustrated, you know, when we compromised all those names of those veterans, you know, with that information, that their identity, you know, could be stolen, where we really needed maybe an external task force or whatever. I would hope that you are open to those ideas and see what you can make happen from a bureaucracy that has a lot of good people working in it but it also has some driftwood that shouldn't be there and that need to open up to some of that.
I also just want to follow up on the veterans' organizations. I would hope that you really kind of look as to how we can utilize them.
You just mentioned a beautiful comment about making it mandatory for everybody to be part of the VA.
The beauty of it is to go back, to those Vietnam veterans and all the others, to see. And the veterans organizations are the ideal ones that can help with that outreach.
When I -- I'm a social worker by profession. When -- I had served in the Texas House and other political subdivisions. And when I came up here, you know, I was astonished on the amount of casework that we do for the VA. And if I talk to any of these members of Congress, a great load of their casework, as members of Congress, is veterans.
So we're doing a lot of the casework that the VA ought to be doing. There's a real need for to look at maybe a case management system that allows an opportunity to help those veterans fill out those forms that we have to do, because it's so burdensome and so bureaucratic.
I was listening to your comments on the backlog. I'm pleased on them. I also want to stress rural America. I represent San Antonio to El Paso, 650 miles-700 miles to the border. And I also want to welcome you to come over.
We have some beautiful facilities out there and beautiful services. But we have some huge gaps in El Paso. We have an opportunity there to work with the Department of Defense there facility, as well as the VA. And we have some real problems that need to be worked out.
We have facilities that need a great deal of construction work and bring them up to par. And so we're looking forward to working with you and also dealing with these issues.
I wanted to stress and see what you might be able to do with those veterans from previous eras, not only those veterans that are coming back home now, but the suicide rates.
You know, that's not acceptable. We need to see what we can do in that area, in the area of mental health. And our veterans organizations can also play a role there.
I know that there's other programs in terms of job training, for our veterans, and other things that could be important and that we could also be playing a role in.
So as we move forward, I look forward to working with you on these issues. And I've been in this committee 11 years. And it's been frustrating. But I feel really optimistic in the last few years with the resources that we put there.
But you know, but I know that it's going to be tough getting the bureaucracy to move. And, but I think the majority of us, on both sides, are willing to see what we can do.
And I'm referring to previous secretaries -- Democrats and Republicans -- that we've had difficulty with, you know, because, you know, in 11 years I've served also under other Democrats, and the key is to -- we're all in this together, and one of our responsibilities is to making sure we service our veterans and whatever we can do to make that happen. So I wanted to personally thank you.
And if you can just make any comments as it deals with the rural services. I know we did some legislation for some pilot programs in that area for other facilities, because in spite of the fact that I represent those areas, I have no facilities in my area. You know, the VA facility is in somebody else's district, both in El Paso and in San Antonio, though they service my area. And I have 700 miles with not a single clinic or anything. And so I wanted to get your feedback on what might be some of the plans.
SEC. SHINSEKI: Well, sir, having driven I-10 several times from Dallas to El Paso, I know the terrain you describe. I will tell you that I grew up in Vietnam, and in many ways I'm now watching all of our efforts to understand PTSD, TBI, substance abuse amongst veterans. And I have a better appreciation for what we put my comrades through when we came back, and none of these programs were available. In fact, these were not terms that were in vogue then. And we still don't understand enough in this area. We're still learning.
One of the things we've started doing at the Veterans -- at VA is we screen all Iraq and Afghanistan veterans who register with us, and we've been doing this since April of 2007. And just through a four- question screen that asks them if they were ever associated with an event, like an IED event or similar, we've screened about 235,000 veterans; 43,000 of them who were never being tracked as potential TBI cases met our requirements, hit our radar screen as -- for follow-up.
And out of those numbers, about 12,500 have been confirmed as mild TBI. We've been able rule out 10,000 of those veterans, with about another 5,000 still left to be evaluated. So we're learning here and making this effort to screen as many Iraq and Afghanistan veterans as we can.
We're doing similar things with PTSD. And I would say that the numbers I'm given -- that in 1999 we were providing disability payments to about 120,000 veterans in the category of PTSD. Today, as of September, this past September, that number of veterans is up to 340,000. So we're making the effort here to identify PTSD patients as well.
We know, if we identify it, we have a good chance of treating it and -- precluding some downstream problems for these veterans.
Regarding suicide, we're part of a national hot line since July of '07, which we are collaborating with HHS on. We got 67,000 calls in 2008, and already this year -- this fiscal year we're up to about 25,000 suicide calls on this hot line, some of them involving active- duty personnel as well, not just veterans.
I think the key factor here is, I'm told that in over 1,700 cases we intervened and prevented an act of suicide in 2008; already this year over 700 interventions where we've been able to marshal forces with local authorities, find the individual who has called in, and intervene.
So we're doing more, not enough. We're learning as we go. I assure you that my recollection of what my friends went through as a result of Vietnam, I'll keep --
REP. RODRIGUEZ: Mr. Secretary, thank you very much. And I know we have high expectations for you, short of walking on water. We're going to be there with you also, because your success is our veterans' success also. So we'll be there right with you. Thank you.
REP. FILNER: Thank you, Mr. Rodriguez.
Mr. Secretary, if I could just follow up on that previous statement, on the examinations or the assessments, I think, when you meet with Secretary Gates, on another matter, you might mention this one.
I mean, there has to be a mandatory evaluation for both TBI and PTSD. Right now it may be a self-questionnaire, you know, as you referred to. Everybody knows, if they want to go home, they don't answer certain questions positively.
There's a whole dynamic, you know, against both -- it is a dynamic of denial, both self-denial and in the military. And I don't mean just by, you know, some clerk coming in with a questionnaire. I mean, you know, medical personnel giving an evaluation before they leave the service.
As you know, you can order that to happen. And it's not happening. And you pointed to the statistics. I think the statistics are even worse, I mean, are even higher. And even, you know, the screening when these young men and women come into the VA, a lot of it is done by self-questionnaires.
They just -- we just have to move away from that. It's -- the numbers are too high. The denial is too great. And the problems are overwhelming us in the civilian world.
You know, your comrades from Vietnam; the statistics show that more veterans have died from suicide than in the original war. That was over 58,000. That means we have not done this right. And you point to some things that are moving in the right direction. But I think we have a long way to go.
The statistics just boggle your mind, because these are our children. And we can't let it happen. And we're looking to you to move that in the right direction.
SEC. SHINSEKI: Yeah. Mr. Chairman, the numbers I gave you was just to demonstrate that it has not -- we haven't missed the importance of this area. We don't have the solutions. We're learning as we go.
One of the things we've done at the VA is, we've taken the mental health from being in a separate part of the complex and moved it into the primary care area, to reduce the stigma of someone having to go to that part of the hospital.
So we've integrated mental health with primary care. We've also trained primary care medical personnel on what to look for.
And it's through this process that we're beginning to get some response. There's more to be done.
REP. FILNER: I would also, I guess, suggest, as we go forward, that everywhere, when you start traveling around the nation, as I have done as chair, in every community of this nation people want to help. They want to help the new young men and women, the new veterans; they want to help the older veterans. And too often, the Veterans Administration comes -- appears as a bureaucracy that says, "No, we don't need your help."
The resources are in our nation. They are there. We have to tap them in a new way and reach out; not just say, oh, we're going to do it, if we can't, we'll just pretend we can.
Everybody wants to help. I mean, and you know, in a democracy, in a war, people understand that it's part of everybody's struggle, not just the few, the percent who will volunteer. And we need to tap them. And I look forward to working with you to make sure that occurs, also.
I'm sorry, Ms. Halvorson, we look forward to your participation on our committee, and you have the floor.
REP. DEBORAH HALVORSON (D-IL): Thank you, Mr. Chairman.
And thank you so much, Mr. Secretary, for being here. Before I get into the question I have, I want to follow up with what the chairman has just said. Unfortunately, last August my husband and I spent a lot of time at Walter Reed last year, because our son was injured in Afghanistan. He's a Special Forces captain. And I can attest to exactly that.
People came in every day, asking him questions. And the first few days, I don't think he was capable of answering any of these questions. On top of the fact that these are strong, tough guys who don't want to admit that there's anything wrong with them. And especially with him: He's a captain in Green Beret, Special Forces, working very hard.
And I think that -- and they came in every day, he got great help. However, every time they came in to ask him, if he knew what he was saying, he was fine, and he didn't have any problems.
And I think maybe we need to follow up and do something with that.
However, one of my major concerns -- and having spent so much time last August at Walter Reed myself, not only in my district but at Walter Reed, the concern was a lot about the women coming home. And I'm sure you're aware that women coming home, veterans, will double -- more than double in the next five years. And I think that that culturally as well as historically will present problems for the VA -- or not necessarily problems, but challenges.
And do you think that maybe you could help us identify -- or what challenges do you see, going forward, with -- whether it's health- related, cultural-related, what -- how we're going to be dealing with the women veterans that will be entering our system?
SEC. SHINSEKI: Thanks for the service of your son.
REP. HALVORSON: Thank you.
SEC. SHINSEKI: I -- just on this issue of woman veterans, we anticipate that by 2020, 15 percent of our veterans will be women. And having come through the experience of women joining the ranks of the Army in large numbers very quickly, we played catch-up there. And we're probably, in the VA, also playing a little catch-up here, from what was primarily a male population.
But timing is right for us to put in place the kinds of things that'll anticipate a 15 percent population. At every one of our 153 hospitals, there's a women's program coordinator. There is a women's advisory group that works with me on being able to anticipate what other things we -- initiatives we should be pursuing. And now's a good time to take this on. So I look forward to doing that.
As I say, we're aware of it -- of this change in trends. We're playing catch-up. But we'll do --
REP. HALVORSON: Great. I look forward to working with you on that and anything else I can help with. And as everybody else, I look forward to you coming to Illinois to be with us.
SEC. SHINSEKI: Okay. Thank you.
REP. FILNER: Mr. Secretary, I guess I want to give you the benefit of some experience here with the -- (chuckles) -- with the information you sometimes get and how -- you know, you've talked about your being out on the front lines. And let me just give an example where -- you mentioned there is a coordinator for women's health. There's also a suicide coordinator.
And there's some other coordinators. You ought to find out when you get to a hospital, who is that and what are they doing -- that is, it may be somebody who's, you know, who's doing it for a few percent of their job.
It is not really as widespread as sometimes the information you get. And I don't have to tell you, you know, with a big bureaucracy you got to be careful. But I have seen these statistics over time. Everybody has a coordinator and you go in to the hospital and it's -- there's some clerk who's correcting statistics. That's their coordination. They're not acting as, you know, health coordinators, as bringing all the resources together to make sure or tapping new resources. I'm sure the same thing is true in women's health.
I just -- I have a hunch that -- I -- you know, and again, you're experienced in these kinds of things. But we get this kind of information a lot and when you go back to see what it means, it is not as good as it sounds. And, you know, just a fair warning, I guess -- (laughs) -- as you try to develop this stuff.
SEC. SHINSEKI: I haven't been on the terrain yet, but I will be.
REP. FILNER: I just -- when I -- you know, when you said the -- you know, I'm sure you had information about that, right? I mean, there's 153 coordinators. I -- well, I'd just bet that's not the reality. I just -- I'll have to bet on that.
Mr. Perriello, thank you for serving on our committee. And we look forward to your participation.
REP. TOM PERRIELLO (D-VA): Thank you, Mr. Chairman, thank you, Ranking Member for allowing me to be part of this committee.
And thank you to you, Mr. Secretary, for your service to this country in the past and in the present.
This is a tremendous moment for us as a country. It's a gut- check moment not only on the battlefield, but on the economic front lines back home.
I want to just ask you about a couple of quick things related to my district and I think more broadly in the country. I represent an area of central and southern Virginia, one where I think you spent a little bit of time. And I would love for you to come back. I'm closer than a lot of these other districts, just a few hours away. So I hope you'll be able to join us.
When -- (inaudible) -- of Virginia did a report on access to veterans facilities, southern Virginia was the furthest behind in terms of access. And I think that's true in a lot of our rural communities. I want to make sure that as we think about access for our veterans, that our rural areas are not left out.
Second, I think it continues to be a great blight on this nation that 25 percent of those who are homeless in this country are veterans, and what strategies you think we need to be employing to address that issue.
And then finally is, of course, the issue of the economy. We're losing 16,500 jobs every day in this country. Several of the towns in my district have now topped 15 percent unemployment. This is something that reaches well beyond the issues of veterans in general, but obviously, economic opportunities -- finding economic opportunities for our veterans, that's so crucial, becomes all the more difficult in a job environment where we are doing everything we can just to cling to the jobs that we have.
Among the veterans that I meet with often in my new district, the two things that come up most often are access to health and access to jobs. What are things -- what are strategies that we can pursue in these very difficult economic times to make sure veterans are coming back? And I do see a dangerous trend given the uptick in PTSD both -- particularly for those returning from Iraq and Afghanistan, that some employers who in the past have taken great pride in trying to hire veterans, I sense a skepticism there, and what can we do to make sure that we're addressing economic opportunities for our returning men and women in uniform?
SEC. SHINSEKI: Well, Congressman, I don't have good answers for you today, but I would tell you that these are areas that I intend to spend time in. Besides visiting Secretary of Defense Gates, I intend to go and pay my calls at Labor, at Education, at HUD, Small Business Administration, because I think in many ways our veteran population is a microcosm of what's going on in the country, and if we can harness their talent, their capabilities and partner with them, we may come up with solutions that may be models for others.
But I do intend to pursue these areas -- jobs, HHS, both linking our primary care -- health care initiatives, but also in things of mental health, substance abuse amongst veterans, and then education for those who wish to pursue education, and then small business opportunities.
So there's going to be a series of meetings here. And I hope to be educated in that and hope to be able to work, with my counterparts, in addressing some of these issues.
REP. PERRIELLO: Thank you. We have a lot of confidence and look forward to working together to tackle those problems.
REP. FILNER: Thank you.
REP. BUYER: Thank you very much.
General, I'm hopeful that the two of us can meet next week. Then we'll go into some greater issues with greater details. Let me just touch on several issues that have been brought up here, by other members, and try to fill in some blanks. As you make your tour of other departments, I invite you to also place on your list the Department of Interior.
Now, the reason I ask you to do this is that we have the national shrine program with regard to the VA. So this is one of these moments where we can take a step back and say, you can tell a lot about an individual or a country by whom is honored and whom they associate with.
And most of the discussion today is really covered on the health care aspects and disability and other things. But there are two areas that have not been discussed. One deals with our cemeteries and our cemeteries administration. And unfortunately we kind of have three standards with regard to our national cemeteries.
We have that of the Battle Monuments Commission. And you've toured these facilities, I'm quite certain, as you go abroad. And so you can see the standard with which the Battle Monuments Commission take care for our fallen heroes.
Then we have the VA national cemeteries and the national shrine program and how the work, the good work that is done. But we want to increase that quality. And then you can go to the Department of Interior, to our national cemeteries.
So of the 14 national cemeteries within the Department of Interior, 12 of them are closed. Two of them are still operational. And when you go visit them, so go to Andersonville in Georgia. And you'll walk around and you'll -- it's quick to see that there are three different standards.
And I invite you to put your eyes on this one. And I'll work with you and your new undersecretary for cemeteries on what we can do to bring the Department of Interior and their standards up, to be very bold. They need to be brought up. And so I'd invite you to have that conversation and that charge to your counterpart.
The other comment would be, in your opening of your statement, you recited the words that are on the front of building which you occupy, in -- of Lincoln's second Inaugural Address, and that is referring to the widow. And I think it's time for us to modernize the DIC. When you look at the other systems that we have on how we care for someone that has been hurt in the line of work as a federal civilian employee, they get treated better than the military widow. I think that's wrong. I believe that's wrong.
And this is one where I want to engage with you. I don't know, because we've not had this personal sit-down, what your desire is and what type of imprint you seek to make on our country and taking care of our veterans. But if you want to move boldly, and you want to make that big imprint and to make a difference, you can do so by increasing the quality and standards, so not only with regard to our National Shrine Program and making sure that these other national cemeteries are brought up; we can make sure that our widows in fact are taken care of and increase their DIC baseline to reflect how other widows within other federal systems are done. I think that's a very important thing. So it's about quality, and it's about how we take care of people.
The other point I want to make with regard to clarification, so I can be very specific, when the sergeant major brought up the comments with regard to dental and the National Guard issue, it's sensitive to a few of us, sensitive because it took three years to get this to happen within the Army, and it should not have taken that long. You know what it's like to move systems. It shouldn't take long, but it does. And we tried to get his brigade taken care of, and some funny business took place with regard to how that study was conducted.
But I do want to extend some compliments. I want to extend some compliments to the former vice of the Army, General Cody. You know him well. He's a no-nonsense person. And that's who really put his eyes on it and began to move it forward.
There was another lady, by the name of Brigadier General Rhonda Cornum, who's very, very sharp and also a no-nonsense doctor. And there's another gentleman, Colonel Steven Eichenberg (sp), Six Sigma kind of guy, and -- within the Dental Corps, very, very sharp.
And the other is the DENCOM commander, Ted Wong. So they actually made all this happen.
The other point I would like to make with regard to the -- if I may, Mr. Chairman?
REP. FILNER: Please.
REP. BUYER: With regard to the stimulus package itself: Now, what specific veteran provisions and associated funding levels does the administration support within the stimulus package that's going through Congress?
So here we gave you a number; we have no idea what you intend to do with that number, and whether you anticipate, in this negotiation, whether that will change, increase, decrease. I'll leave that open to you.
SEC. SHINSEKI: I'm not sure that I have a number here. I just know that if we're going to maintain the momentum that the Congress provided to the VA in the last couple of years, that the higher of the two marks obviously would be of interest. But I understand that there's a process here, and I'll await the outcomes of that process.
REP. BUYER: The last point I'd like to make -- and maybe you could do this when we get together, you could provide me updates -- the chairman and I have worked hand in hand to increase the revenue- enhancement process. And this whole concern with regard to the eights -- the category eights -- has been, is the system been prepared to receive?
It's not -- it's a capacity issue. And that's what you're going to find when you get into this. And I was pleased that DAV and VFW have also now publicly raised capacity issues. Because they're absolutely right. And one of the pieces of this is revenue-cycle management. And that's the CPAC and the buildout of these CPACs to make this happen. Have you received your brief with regard to the CPAC and the buildout yet?
SEC. SHINSEKI: Probably not to the quality or the detail you're referring to, but I do know that we have a third-party collections process. And we're doing better at it, but --
REP. BUYER: If you could have your -- have somebody give you a brief before we get the chance to meet next week, that'd be really very productive.
With that, I yield back. Thank you.
SEC. SHINSEKI: I'll do that.
REP. FILNER: Thank you, Mr. Buyer.
Thank you, Mr. Secretary, for joining with us today. I just can't avoid, I guess -- (chuckles) -- following your last comment where you have a third-party process, again -- and I hope you'll work with us, because many of us have years and years and years of experience here, and when you get -- I mean, we don't have a real third-party process that meets its potential.
I mean, we do -- I mean, they say that, but it's -- every year they say, oh, we haven't collected a billion or two that we should have. And in fact -- and both Mr. Buyer and I have been acquainted with this -- there are systems that are available to you -- you as the VA -- that don't cost you anything, and yet will double or triple or quadruple your third-party collections, because they tell you exactly what kind of coverage a person coming into you care will have -- if I have summarized that correctly.
So again, your information is you have one. You do, but it's not anywhere near meeting the potential that it could.
REP. BUYER: Will the gentleman yield?
If your comments to us was that, in your opening statement, you wanted to leverage best practices, that's what this CPAC build-out is doing with stock camp and so that -- and there are some other systems to be able to do that, as you build out that envelope. And that's what the chairman is referring to.
REP. FILNER: Let me just say a couple of comments in conclusion, and give you a chance for any last statement you may want to make, Mr. Secretary.
You're the secretary of the Veterans Administration, and we have thrown at you, I mean, tons and tons of stuff. And you can focus on that, you know, until your end of days, and not make it perfect. But even with all that job, you're going to be sitting in a Cabinet meeting, I assume, and there are other issues that come up.
And we have a chance, I think, as a VA system, to contribute to other areas that are coming up. And you can't get so tunnel- visioned. I'll just give you a couple of examples that came up today. I think it was -- I think Mr. Michaud mentioned, if somebody becomes unemployed and they lose their health coverage, and they are a veteran, and their eligibility is based on a previous year's income, we could help there, right? If someone becomes unemployed, I think you should offer the president a veterans -- you know, that we will cover them. I mean, it just -- it could help that out.
In addition, although it didn't get the same publicity as the other half, as you know, we did a GI Bill for the 21st Century. And those educational benefits are incredible, and you're focused on making sure that they'll be available on August 1st. We did later a piece of that GI Bill that did not get the same attention, but has great relevance for today. And we have to publicize it more.
That is, a big part of the first GI Bill, of 1944, was the housing loan program.
I know many of us are here because of that. When my dad came back from World War II, he was able, with very little money, to buy us a house for the first time in our family's history. And we became part of the middle class, as 8 million other veterans' families did. So I'm here today.
We changed very fundamentally that program because it was not relevant to the existing markets. We raised the level of loan, you know, that they could make loans on a house. More importantly, we raised -- we got rid of the limits on refinancing and lowered those fees. We made the VA relevant to this crisis, that a lot of people don't know about.
And I think you and the president ought to publicize that a bit more, because with all the subprime stuff and all the stuff that got us into this trouble, the VA became irrelevant to veterans. It is now relevant again. And we have to show that -- I mean, you have a perfect opportunity to show that your department can aid people who are in trouble. I think they just don't know it.
And in addition, when she joins the Cabinet -- and I hope she will -- the secretary of Labor-designate, Ms. Solis, the first thing she said to me when I congratulated her on her nomination was, "We got to do something with veterans and their jobs." I mean, she understands and we've been working together for a decade on it. So I hope you'll make sure that Ms. Solis -- or I hope Secretary Solis -- and you will work on our ability to open up jobs for veterans.
I want to make one more comment. Then I think Mr. Buyer had some --
REP. : (Off mike.)
REP. FILNER: Oh, I'm sorry. I didn't -- did you just come back?
REP. : Yes.
REP. FILNER: Oh, I'm sorry. Mr. Buchanan, you may take a few minutes if you would like.
REP. : (Off mike.)
REP. FILNER: Okay. Thank you, sir.
Mr. Secretary, you have a great opportunity here. And I know you are up to the task. We have, as you know, more than a quarter-million people working in the VA. Most of them are so -- are dedicated, and they went to work for the VA because they wanted to help veterans. But as you know, in a big bureaucracy, sometimes your bureaucratic dynamic takes over and people forget their mission or, as in the case of the VA, we gave them less and less over a period of time and asked them to do more and more and morale suffers.
The bureaucratic takes over. Someone's going to get promoted because they save money. Then they're reluctant to recommend, for example, that the so-called fee basis -- that is, to get care in one's own community -- they deny because it's the bureaucratic dynamic, not the welfare of the veteran, that is paramount. And we see -- you know, you've heard them, the horror stories that occurred, whether in the claims process that may take years and years and years, or the kid that shows up at a hospital and says, "I'm thinking of killing myself," and some intake person says, "Come back in five weeks when we have time for you," and they go home and kill themselves.
We've heard, you know, of the shredding of documents, whether because there was some quota imposed and they felt they had to meet it, and so short-cutted the whole system. The statistics on suicide were not met in a very open way. As I said earlier, community participation is closed out.
This is what I think is a paramount job. I mean, you can hire the people to -- (inaudible) -- most of it, but the morale of the 280,000 or so of your employees and the morale of the veterans -- many of whom think VA means "veteran's adversary" whether than "veteran's advocate. They've had too many problems with the bureaucracy. So your visible -- your visible presence that you've talked about in every arena which I have seen you in is absolutely necessary at this time. I mean, they need to see you. They need to see your passion. They need to see your hands-on, because a lot of confidence has been lost. And I think we have to rebuild on that, rebuild that.
You have a reputation of doing that. You have a reputation of honesty and integrity and talking truth to power. You have a reputation, as I said earlier, of being the soldier's soldier. So now you're the veteran's veteran. And we think -- we have absolute confidence that you're going to be able to do this. But it's a culture that has to be changed. And I think you've recognized it already with your statement.
And everybody here has said we're looking forward to work with you, and it's absolutely true. On both sides of the aisle, whatever term people are in, it's true.
We are excited that you are there. We are excited that we are going to look to a transformation. And we will be there.
And you need to be honest with us, whether -- nobody ever asks us for resources, sitting in that chair, by the way. They -- you know, because you have to go by the president's budget and stuff.
But we need to know what's going on, so we can help you. That's what we want to do. We have an oversight function which we will exercise. But we have a supportive function, to make sure that you have the resources.
And thank you for spending the morning with us. You get the last word, for as detailed or as general as you want to be. And again thank you so much for being here.
SEC. SHINSEKI: Well, just very quickly, thank you again, Mr. Chairman, Ranking Member and the other members of the committee.
I appreciate this opportunity. And I don't think you'll ever hear anyone sitting here saying he enjoyed it. But I enjoyed being here this morning, getting to hear your issues and understanding, a little bit more than the orientation briefs I've taken, what the requirements that I have and what I need to do to begin to turn things in the direction that all of us would be positive about.
I'll make you two promises. I'll be a forceful advocate for veterans. That's why I decided to accept this position. And I'll be forthright and direct with you on what it takes to keep them at the focal point of our activities. And putting veterans first is, as I indicated in my opening statement, what we are all about. And I'll give you those two assurances.