Chaired By: Rep. Chet Edwards
Witnesses: Eric Shinseki, Secretary Of Veterans Affairs
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REP. EDWARDS: (In progress) -- committee to order and want to welcome Secretary Shinseki and your leadership team to our subcommittee. It's good to have all of you here and thank you for the work you do on behalf of America's veterans.
Members, the purpose of today's hearing is to hear the administration's budget for Fiscal Year 2010. We've seen broad numbers on that, and look forward to hearing some of the specific details behind those budget numbers.
I'll make a very brief opening comment before recognizing Mr. Wamp and Mr. Lewis for any opening comments they would care to make.
Let me begin by saying it's the responsibility of this subcommittee to ensure that we are not only saying thanks to our heroes, but providing for their earned needs as well. I'm proud of the work this subcommittee has done on a bipartisan basis since January of 2007.
I want to thank Mr. Wamp for his close partnership at every step of the way. With this we've been able to increase health care and benefits funding for veterans over the past two years by $17.7 billion, $9.9 billion more than requested by the administration.
These funding increases will mean a number of things; improved access to needed health care services at our VA medical facilities. It will mean all Operation Iraqi Freedom and Operation Enduring Freedom veterans will be screened for posttraumatic stress disorder and traumatic brain injury.
The increase will mean that the Department of Veterans Affairs will be able to address a significant backlog in facilities maintenance to ensure that our veterans are cared for in a safe and healthy environment. It will mean that fewer veterans will be homeless.
And I know we all long for the day where there's not one homeless veteran on any street of any city in America. Our increases over the past few years will mean our veterans will receive the benefits they've earned much sooner than otherwise.
And it will mean that this generation of veterans will receive a greater education benefit than at any time in our history. Yet despite all of that work together we know that much work remains to be done.
We'd like to again thank all of the members of this subcommittee on both sides of the aisle for our work over the past two years, and look forward to continuing that work together, as we craft in the weeks ahead the Fiscal Year 2010 budget for the Department of Veterans Affairs.
The administration's budget request for Fiscal Year 2010 totals on the discretionary side $53 billion and an additional $55.8 billion in mandatory spending. On the discretionary side of the ledger, the amount requested represents an increase of $5.4 billion over the Fiscal Year 2009 appropriation, an increase of over 11 percent.
And again, we look forward to hearing more of the details and the rationale behind those budget proposals. At this time it's my privilege to represent our partner, Mr. Wamp, our ranking member for any comments he'd care to make.
REP. ZACH WAMP (R-TN): Well, thank you, Mr. Chairman, for your leadership and for that partnership.
And Mr. Secretary, I always like it when you come because we get to come to the big room here, as opposed to the smaller room over in the Capitol, as much as we enjoy that. And I want to first applaud President Obama for your selection, which I think was a very wise one and an early one.
And of course, you have a long and storied history before the Military Construction and Veterans Affairs Subcommittee here in all aspects of your life and for your whole team. We're grateful for your service to our country.
I also want to say that I thought that Secretary Peake did a very good job. Both of you have unique skill-sets, and experience, and knowledge, and understanding that is very, very helpful to all of our veterans.
And I think frankly this is somewhat of a seamless transition, even though change is underway. I also want to say what I said to a group of realtors that were just in my office when they asked me about this privilege I have to be the ranking member on this subcommittee, that I'm grateful that in a bipartisan way we can say that we're doing more and more for our veterans in terms of funding, creating efficiencies, and more accountability in the VA.
And in a bipartisan way we have met at the water's edge so to speak, on this issue, and continue to do so. And I applaud our chairman, and the leadership of the Congress, and the executive branch over the last three years particularly as we have -- as is manifested in this budget request, making a greater commitment to our nation's veterans at a time where it says all the right things, and it actually does all the right things.
And there're many fears out there that our country is not honoring our veterans. And I can actually look people in the eye today and say that is changing rapidly. And I really believe that, and that's a good thing.
Now, in your testimony, Mr. Secretary, you mentioned 28 times in some form of the word "transformation." So I want to ask you a little later about that, because I do think that sweeping changes are still in order, and I do like that spirit that you're coming in that you want to change things and transform the VA.
I am a little puzzled still about what this administration's position is on advanced appropriations. We as appropriators think that there's a lot of value in this annual process of scrutinizing budget requests, and that frankly that's how you bring accountability.
And without it, the executive branch could just run the country without any oversight from the people which was guaranteed under the Constitution. And I'd like for you to clarify that as we go through today.
And then maybe even speak to some of the new positions that you have proposed and created in the VA. The VA is a very necessary, very necessary agency, but it is a large bureaucracy.
And one thing I'd like to see is that it doesn't get any larger when we have so many new and efficient ways to deliver health care, particularly to our nation's veterans.
Growing programs might not necessarily be the way, but having said all of that, I just can't thank you enough for your service to our country for so many years in so many different very valuable ways. And I do stand united with the leadership of this Congress committed to every man and woman that you represent as you sit here and testify today. And I yield back.
REP. EDWARDS: Thank you, Mr. Wamp for your comments and for your workday and day out on behalf of America's veterans. It's certainly a privilege when we have the opportunity to have the Ranking Member of the Full Committee, Mr. Lewis, here.
He is no stranger to anyone who has ever worn our nation's uniform because he has spent so many years of his life in Congress fighting for our servicemen and women, their families, our veterans and their families. He is now the ranking member of the full committee, having served as chairman of the full committee, chairman of the Defense Appropriations Subcommittee.
And Mr. Lewis, we're honored to have you here and I'd like to recognize you for any opening comments you'd care to make.
REP. JERRY LEWIS (R-CA): Thank you very much, Mr. Chairman. I don't intend to make an extended statement except to say that unfortunately I'm going to have to go to the Rules Committee in a while, they'll -- the supplemental appropriations bill on the floor tomorrow.
But I did want to come to recognize the great people who are beginning to lead this agency in a new direction. I think my colleagues will be interested to know the first time I met Eric Shinseki was when he -- the day he was being sworn in as chief of the Army. And he and his wife Patty, and Arlene, and I have become friends over these many years.
I really do believe he has the experience and the capability of giving an entirely new direction to the agency which I think really does need that new direction. So it's a pleasure to be with you. I may have a chance to ask a couple of questions in a moment. Thank you.
REP. EDWARDS: Thank you, Mr. Lewis.
General Shinseki is no stranger to this subcommittee, or any of us on the committee, but this is his first time here as Secretary Shinseki. So for the record, let me briefly introduce him in saying that he is the seventh secretary of Veterans Affairs sworn in on January 21, 2009.
As Mr. Lewis referenced, he served as chief of staff in the United States Army from June 21, 1999 until June 11, 2003 and retired from active duty on August 1, 2003 after 38 years of service.
And thank you and Patty both for those many years of service to our Army. His previous assignments as a leader in the Army included commanding general U.S. Army Europe and Seventh Army, commanding general NATO Land Forces Central Europe, commander of the NATO-led Stabilization Force in Bosnia-Herzegovina.
He served two distinguished tours of the service in Vietnam and has a degree from West Point 1965, and a master's degree from Duke University.
And as Mr. Lewis referenced his wife Patty, I think, that their family commitment to our troops and their families is indicated by her leadership in creating the Military Child Education Coalition which has been a very, very important and effective voice on behalf of the children of our servicemen and women who make so many sacrifices every day, even as we speak.
Mr. Secretary, your full printed testimony will be submitted without objection into the record. I'd like to recognize you now. Thank you for bringing your leadership team with you. I'd like to recognize you now for any opening comments you'd care to make.
SEC. SHINSEKI: Thank you very much, Mr. Chairman. And thank you Ranking Member Wamp, and the other members, distinguished members of this committee for holding this hearing, allowing us to be here.
And Mr. Wamp, thank you for those kind remarks for Jim Peake. He is an old friend. And I picked him to be the Army surgeon general while I was still serving, never regretted that choice. And he went on to do great things here.
I'm honored to be following him and continuing many of the good things he started. I'm pleased to also to be joined today by VA's senior leadership, Mr. Chairman, and members of the committee. If you don't mind, I'd like to take a moment to introduce them.
I'll begin on my far left, Undersecretary Pat Dunne from Benefits Administration, next to me Dr. Gerald Cross, acting undersecretary for Health, acting undersecretary for -- Acting Assistant Secretary for Management Rita Reed, Acting Undersecretary Steve Muro from the National Cemetery Administration, and Acting Assistant Secretary Steph Warren from the Office of Information Technology.
And I thought having all us here would be able to sort of address many of the questions that may come up today. I'd also like to acknowledge the leaders of our veteran service organizations who are also part of the audience and partners and advocates for nation's veterans.
We thank you for this opportunity to present the president's 2010 budget for the Department of Veterans Affairs. Let me also thank you for your unwavering support, as chairman indicated, on this committee for our veterans through previous generous appropriations to our budget, and for the stimulus funds you authorized for the department.
VA has begun to lay down the groundwork to implement President Obama's charge to us to transform VA into a 21st century organization. VA's 2010 budget request increases VA's resources to nearly $113 billion, up 15 percent from our 2009 resource level, the largest percentage increase for VA requested by a president in over 30 years.
With this budget, VA's transformation begins by increasing our investment in information technology by undertaking organizational reforms, by ramping up the training and leader development of our workforce, and by other initiatives which are intended to improve the ways in which we serve veterans.
These are essential if we're going to improve client services and enhance responsiveness to veterans' needs. Information technology is vital to achieving the president's vision for 21st century VA. IT enables almost everything we do at Veterans Affairs.
More than $3.3 billion in funding is needed to support our IT requirements and will allow VA to invest in new and emerging technologies to create an informational backbone which will enable efficient, effective, and client-focused services.
The 2010 budget provides resources to establish a new office for the assistant secretary for Acquisition, Logistics, and Construction, the importance of which is underscored not only by the budget's $1.9 billion in capital funding to resource it, but by the more than $13 billion in product services and VA contracts that are handled each year. And we need this office to bring all of that together in a smart way.
There are few higher priorities before us than to ensure a seamless transition from active military service to civilian life. VA will continue to collaborate with the Department of Defense on transition initiatives, including development and implementation of a joint virtual lifetime electronic record, a presidential priority.
This budget requests funds -- this budget request funds health care for a new and changing veteran demographic. Women veterans for example, are increasingly relying on VA and the budget provides $183 million to meet their specific health care needs.
The budget includes $440 million to improve access to care for veterans in rural and highly rural areas, and $5.9 billion for both institutional and non-institutional long-term care services.
This budget makes important commitments to newly qualified Priority 8 Group -- Priority Group 8 veterans and to the expanding numbers of combat veterans from ongoing operations. We are requesting $2.1 billion to meet the health care needs of veterans who served in Iraq and Afghanistan.
And thanks to the leadership shown by Congress and the commitment expressed by President Obama, we will implement an expansion of eligibility to health care for Priority Group 8 veterans beginning in this summer through the next four years implemented over time.
Our 2010 budget requests nearly $4.6 billion for expanded outreach and enhanced services for mental health and traumatic brain injuries. This budget also provides $47.4 billion in total resources for VA medical care, an 11 percent increase over the 2009 resource level.
And importantly, it increases VA's investments in research, patient-centered health care, and technology to support our commitment to client-focused health care services.
The president is committed to expanding proven programs which include joint initiatives with other cabinet agencies and non-profit organizations to combat homelessness and requests $3.2 billion to address the estimated 154,000 veterans who sleep on our streets every night. The $1.8 billion provided to the Veterans Benefits Administration is 25 percent higher than in 2009.
Our primary focus is to strengthen our investments in a paperless infrastructure, to leverage ways to decrease waiting times for veterans' claims processing. VA provides continuity of care until veterans are laid to rest.
To properly honor them, the president's budget request includes $242 million in operations and maintenance funding for the National Cemetery Administration. Veterans are VA's sole reason for existence.
In today's challenging fiscal and economic environment, we must be diligent stewards of every dollar if we are to deliver timely high quality benefits and services to the men and women we serve.
While we recognize that the growth and funding requested for 2010 is significant, we also acknowledge that our responsibility for being accountable and showing measurable returns on this investment, and Mr. Chairman, and members of the committee, I assure you I will do everything possible to ensure that the funds Congress appropriates will be used to improve the quality of life for veterans and the efficiency of our operations. Thank you and I look forward to your questions.
REP. EDWARDS: Mr. Secretary, thank you very much. We will begin questioning under the five-minute rule.
Mr. Lewis, I know you have responsibilities at the Rules Committee. I don't know how tight that schedule is but I'd be happy to recognize you if you'd like to begin the questions which would free you up to --
REP. LEWIS: No, let this go to the ranking member. Regular order is fine.
REP. EDWARDS: Are you sure? Are you sure? All right. Well, if you'll let me know. I'll begin with Mr. Wamp.
Go ahead, Mr. Wamp.
REP. WAMP: Well, I just want to jump right in what I said, Mr. Secretary, on the transformation and exactly how you see that playing out? You know, my history here goes back to having high expectations with CARES and what it might lead to and had hoped that maybe by perception at least some of the more antiquated facilities in places like the northeast, where veterans still live, but more used to live, and then they moved to places like where I live where land is cheap, and water is abundant, and the climate is good and I'm -- little chamber of commerce promotion there.
But we are growing in our veteran population in the southeast, in the mountains and lakes of East Tennessee, and we don't have the facilities that they do in other parts of the country. And as I said to you in my office when you honored me and came last week, we had hoped that CARES might lead to more facilities.
I know that the CBOC approach is very helpful, very good; super CBOCs moving more and more programs and benefits into the super CBOCs for the veterans. But how does the transformation, you know, from CARES to what your plans are now going forward, how does it play out?
What are the big initiatives? How does it shape the infrastructure in the face of the VA for the veteran in terms of what they will see and the benefits that they will actually derive?
SEC. SHINSEKI: I would say transformation is a journey. It's hard to describe it as a destination, and I'll tell you where we are starting.
We start by looking at everything we do, every line of operation, make sure we understand what the relationship is to the mission we have which is care of veterans. And we know we have some hiccups here.
We don't process claims quickly enough, an extended inordinate amount of waiting time for veterans. We know that at least in our house IT is sort of the elephant.
So much of what we do is tied to IT, whether it's electronic health record, which has been a tremendous shot in the arm for not just VA's medical services but from -- for folks who also borrowed that electronic health record, it's been very helpful.
But there are so many other aspects of what we do in VA that's still paperbound and sort of caught up in processes. And so we don't know how to get beyond that until we put IT backbone that fully links what we do and what we say we should be doing.
Part of looking internally is also looking at ourselves and ensuring that -- and I wouldn't call it efficiencies, but it is that what we do day-to-day counts towards the execution of that mission. I can tell you that in the three months here since our arrival, challenge -- conduct of some conferences and meetings that didn't quite meet that definition.
And so we've begun to strip away some of those probably good ideas at one time and maybe, good ideas some time in the future, but for right now, for where we are, and what we expect out of our own organization, we're challenging all the assumptions about what we do, how we spend money, and what the payoff for the mission is.
Internal to that look is looking at how we develop our people. The VA is not unlike some of our service departments, where people come in at an entry level and stay for, you know, a career, 20, 30 years.
I met a lady who is -- in the elevator the other day that's been there 50 years. A challenge to us is to understand that we have a development process, a training program, an education effort that takes people who are going to be with us for that extended period of time and grow them, leader development skills, and prepare them for upward mobility in the organization so that we're gaining from their experience of serving with us.
Nothing magical here, good organizations do this. They invest in their human resource element, they grow their talent, and they benefit over time from those investments. I think that's the start point.
We've asked questions about why 40 years after Vietnam we're still adjudicating Agent Orange? Why 20 years after the Gulf War we're still wrestling with Gulf War illness?
My sense is that these answers are best arrived -- at least we think that -- historically we felt that they are best arrived through the scientific method which is collecting a lot of data, writing papers, having discussions, and at some point agreeing that this is probably service connected. Unfortunately, that invests a lot of time. Veterans, on the other hand, don't have all that time.
About three years into their first reunion after combat operation -- Agent Orange was stopped being used in Vietnam in 1970 -- my sense is the veterans who sat around the table and compared personal notes realized they had afflictions that were similar, probably came to a conclusion much faster that something was wrong. It's just taken us much longer to come to the same conclusion.
And over that 40 years we've acknowledged that soft tissue sarcoma, respiratory cancers on, and on, and on, are yeah, tied to Agent Orange. So part of challenging our assumptions is going to be, is this the way we want to continue to do this?
Because we know where history has brought us, still adjudicating Parkinson's disease today as a connection to Agent Orange. If it is the way we continue to choose to continue to do this, then 20 and 40 years from now the injuries from this war will be being adjudicated.
And I think we owe veterans a better response, a quicker response. And this is part of this effort to transform. It's the challenge, the assumptions we've been operating with for 40 years.
REP. WAMP: I'll follow-up later.
REP. EDWARDS: Okay. Thank you, Mr. Wamp.
REP. SAM FARR (D-CA): Thank you very much, Mr. Chairman, and I want to follow up on Mr. Wamp's questioning. We're really going to miss him when he leaves this committee. So I -- he really I think senses the sort of -- where the rubber meets the road.
The -- I just want to think here the big picture; you cannot be in your files in the Veterans Department unless you've been in the files of the Department of Defense, right? I mean, it's a assumption that there's a starting point in the Department of Defense.
And after you get out of the Department of Defense you get into the Department of Veterans Affairs. So a lot of the initial data is really there. And it seems to me, you know, that's the area that we are very much aware of but we in Congress need to know more how we can push to make that data interoperable.
Interoperability is a big word around here. It's obviously -- you coined it and done it many years ago in the military; got into the civilian side through law enforcement essentially through -- just so that you could have communication networks between law enforcement and fire and other kind of first responders.
I think it's also now carried to next phase of whether you're really going to be interoperable in anything you do, you've got to cross-train. And it seems to me that we have not yet made the Department of Defense's information interoperable with the Department of Veterans Affairs.
And you told us that in the fact that the medical files can't even -- we're going to -- you are the world leader in setting up electronic medical data. And yet the Department of Defense -- you're going to get all the information from them and their files won't move over.
I'm really interested, because as I see Operation Enduring Freedom and Operation Iraqi Freedom, as these soldiers come back and they are going to go back to these communities all over the United States and in our territories, are you assessing what that impact is going to be on the ground and how do you do that? And for example, if you decide to build the CBOC clinic that Mr. Wamp was talking about, how long does it take to get that clinic on line?
What can we do to make sure this process can be improved? How does the VA handle the excesses in demands in the meantime? And if indeed, we were going to provide services to Priority 6, 7, and 8 veterans in FY10, would there be sufficient funding for the CBOCs to handle the increased demand? And how long would it take the VA to meet that demand?
MR. : I'm going to take the question about CBOCs. The amount of time, you know, I think is a function of -- it depends on the size of the facility and the demand. It can be as quickly as a couple of years start to finish in the process where patients are being seen.
I think two years, there's a fast track method for doing this. But otherwise if it's a normal routine decision standup of CBOC, and that fits into a pattern, it will go into the queue and you know could be a little longer than that.
REP. FARR: Yes. Is -- will every veteran you receive, say for medical purposes have with them the military medical record?
SEC. SHINSEKI: First of all, Mr. Farr, not every member of the military leaving the service necessarily comes to enroll as a veteran, and hence this is part of the effort. To answer your question, they do have, you know, my recollection of my own time we carried around our own paper set of records as a backup.
We both, DOD and VA has electronic health records, but they're not totally integrated. You can take information out of one, but they're not totally useful in terms of passing records.
Having said that, however, Secretary Gates and I have personally been working on this issue. We've met four, maybe five times, and have set into motion the process by which our agreement to create something called, "uniform registration," where a member joining one of the military services today is automatically registered --
REP. FARR: That's cool.
SEC. SHINSEKI: -- in the VA.
REP. FARR: That's smart.
SEC. SHINSEKI: That decision, that agreement between us is really a forcing function for both departments to put their assets and their brainpower together to come up with that single joint virtual electronic record that President Obama publicly announced here a couple of weeks ago with both Secretary Gates and I present.
The intent is to have exactly what's being described here and this is the seamless transition. Problem has been that seamlessness between midnight of the day the uniform comes off and 8:00 the next morning doesn't exist.
And so we're attacking it over time. When that youngster puts on the uniform -- some have asked why is the VA reaching so early to create this joint record -- well, when that youngster puts on the uniform, servicemen's group life insurance that is mandatory for every member in uniform administered by the VA, if that youngster chooses to take out a college loan and get education on their own administered by the VA, guaranteed home loans administered by VA, so a perception that you suddenly become a veteran with entitlements to benefits and services when the uniform comes off is a little misleading.
Those entitlements are there well before that, which argues that we ought to have this sharing of information. As we do this we will begin to solve some of the issues that you're -- (cross talk.)
REP. FARR: And then to bring those CBOC online, how long does that take?
MR. : There are several types of CBOC. If we're doing what we call an outreach clinic, which is really run by the VISN, the regional command, so to speak, they can do that fairly quickly, perhaps even in less than a year, and have a small part-time clinic in a leased facility located in that area.
But typically as the secretary said a couple of years in the planning process, the budgeting process, hiring, setting up the clinic, getting the outreach to our veteran population to let them know where it's going to be situated and so forth. And may I say, sir, I'm a patient at the VA, you talk about the interoperability.
Progress has been made. And on my last visit they pulled up my military record and my lab test from when I was in Georgia as a soldier, and compared it to my current test, and that was very valuable.
REP. EDWARDS: Thank you, Mr. Farr.
REP. LEWIS: Thank you very much, Mr. Chairman. Some years ago, Mr. Chairman, I had the privilege of essentially chairing a piece of this committee when I was responsible for VA.
And during those days, I probably didn't have the best relationships with the VSOs as I might have wanted, in no small part because it was my view that while we had very fine bipartisan support here within the Congress to get funding for veterans efforts, servicing our veterans, we had great difficulty following the money down to where the veterans lived, to the hospitals, et cetera and the VSOs did a great job here with us.
But the need for following to the community and insisting that there be real change has taken a long time. I'm pleased to say there has been progress there. It took us a long time, for example, within our committee also to get the Navy and Marine Corps to be able to communicate with each other.
We've made progress there, but we're far from perfect. So the effort you're talking about, communicating with those who are serving the soldier in uniform and the veteran who overnight changes his position, is a very worthwhile effort, but a very, very big challenge.
I must say that in your testimony and in the chairman's comments of concern about the homeless, there is demonstration there of an area where we might make great, great progress. The -- in California, we made a big change because we used to solve people's mental problems by throwing them in hospitals.
We decided that we would make it tougher to put people in hospitals with the promise that there would be clinics in the communities where they could get their medication and thereby begin to rebuild their lives.
We made it tough to enter the hospitals, we never built the clinics. This is a place where in terms of the homeless your administration would have a huge, huge affect. If we take our basic hospital system and make clinics more readily available with a design to deal with those soldiers who long served, who now are in a desperate circumstance, we might get a very significant percentage of those homeless off the street.
So I'd be interested in your reaction to that. And I think you know it's my intention to have us work very closely together.
SEC. SHINSEKI: Mr. Lewis, thank you for that question. The homeless issue is particularly vexing one. I mean, I can tell you that 154,000 veterans that are homeless tonight -- today, men and women, and veterans from every generation including the ones who are currently on operation in Afghanistan and Iraq, so that's how devastating this area is.
Our effort is to prevent the first step of homelessness. And so it isn't just about, you know, going and finding the ones that are on the street today. It is what are we doing with VVA's home loans to prevent foreclosures, and working with veterans who are in a financial tough time, sometimes not of their making, just the economic conditions, giving them every option to stay in their habitations. If we can do that, we've prevented that first step.
But once we are dealing with folks who are homeless, they fall in the category of joblessness, homelessness, depression, substance abuse, potential suicide. Veterans lead the country in those statistics.
And in the past several years we've been successful in reducing the homeless number, and this is an estimate, I will grant you that, 240,000 down to 154,000 today. So well, we've made progress and we think we have some good ideas on how to break the cycle of homelessness.
Eighty percent of them after the first year are still living -- after they finish our two-year program are still living successfully independently. So we think we have opportunities here. And we do intend to go after that.
We are putting $3.2 billion against this area in the 2010 budget. But we know we can't do it alone. This is one of those issues that sitting in an office in Washington with a 1000-mile screwdriver to fine-tune does not work.
We have to reach out and create partnerships with people in the communities that deal with these issues, every community in this country as part and parcel of this larger issue. $26 million we are going to use to partner with Housing and Urban Development, with Labor, with Education, Health and Human Services, Small Business Administration to put together a package of tools in which we get folks off the street, we wean them off whatever substance may be there, and then we begin the process of bettering this 80 percent record a year later.
REP. LEWIS: I believe that the veteran's base of personnel could be a fabulous place for us to make breakthroughs, a relative medical research providing better service to all Americans, but particularly to veterans. Like you, veterans often come out of service and their papers -- all of their background stuff is in paper in a folder.
Well, it wasn't so long ago in my own veteran's hospital that our staff found that veterans are walking around the hospitals with those same folders, and there was no real information they say. They didn't get service because the records weren't straight and nobody could ever find them.
That's changed. It is very significant that we've seen that change. Well, I would have hope that we recognize that dollars do not reflect all of our solutions, and if we can better coordinate as you suggest with the NIH, with the research hospitals, as the Pettis Memorial Hospital does with Loma Linda.
SEC. SHINSEKI: Right.
REP. LEWIS: The work they're doing in terms of breakthroughs for prostate cancer and breast cancer treatment, for example, is pretty phenomenal, and it's because of the exercising the work between the veterans being served and research hospitals. So with that the thrust of your testimony is very pleasing to me, and I'd hope you'd exercise those pathways.
SEC. SHINSEKI: Thank you, sir.
REP. EDWARDS: Thank you, Mr. Lewis.
REP. STEVE ISRAEL (D-NY): Thank you, Mr. Chairman. Mr. Chairman, I would like to follow-up with Mr. Lewis' eloquent words about homeless veterans.
And Mr. Secretary, I want to thank you for visiting my office two weeks ago. I enjoyed the visit immensely. You know, when we talk about 154,000 homeless veterans, I think it's important to put a face on that because it doesn't really resonate. People can't appreciate the scope of the problem unless they understand what a homeless veteran is all about.
And I told you the story, Mr. Secretary, of Joe Soukup, who came to my office on Long Island. He had fought in Vietnam, had PTSD, lived in a truck. Received medals from his service in combat in Vietnam, ended up living in a truck, and on Valentine's Day, on a snowy night, decided to kill himself.
And whether it was divine intervention or maybe something else, he decided to drive to the Northport VA. And he went into the Northport VA and he said, I was thinking of killing myself tonight. And a caseworker there said, Joe, we're going to help you.
And to this day he would say that's the first time somebody from government said we're going to help you. And they put him on a trajectory to get help. And we got him his retroactive payments.
And Joe Soukup is actually now, Mr. Chairman, organizing clinics for veterans on Long Island who have PTSD. So that is a story of failure turned to success, but that's only one out of 154,000.
I commend you, Mr. Secretary, and the administration for putting this critical focus into homeless veterans. One of the concerns I have is that $3.2 billion, is it enough?
Of the ($)3.2 billion, ($)2.7 (billion) is going to health care and ($)500 million will go to support of services.
In a climate of tight budgets and fiscal responsibility, I understand the pressure is to make sure that we're safeguarding every dollar.
But it seems to me that homeless veterans ought to be an absolute priority. And are there other things that we could be doing in your view, are there innovations that we should be looking at?
Could you do more if this committee or subcommittee were to increase the level of resources that you have to make sure that all of the Joe Soukups are being treated, identified, and put on the trajectory that he found.
MR. : Sir, I appreciate those remarks. There's always more that can be done. Our view is that no veteran should be homeless, no veteran needs to be homeless. We have the programs that if we can bring them to bear for the veteran, we can do something about that.
The core issues, of course, are mental health and substance abuse, and those are what we have to address. That's why the -- that's the typical reason why they're homeless.
Two broad categories of things that we're doing relate to Grant and Per Diem, and the work that we're doing there, but particularly I wanted to note that in transitional housing we're moving from -- we now have 11,000 beds and are expanding over the next several years to 15,000 beds and in the HUD-VASH program, our plans are right now --
REP. ISRAEL: I'm sorry, the HUD?
MR. : HUD-VASH, V-A-S-H.
REP. ISRAEL: Okay.
MR. : Expanding from about 10,000 to about 20,000 very -- in the near term. I think that will make a difference. And as the secretary said, I think we've already made some progress over the past couple of years.
As we measure it -- and it's hard to measure, but this is something that we're committed to and that every one of us, I think, on the staff feel that no veteran should be on the street.
MR. : Mr. Israel, if I could follow-up. The -- I think the reason that the allocation of funds goes the way described here is so much of it -- what appears to be medical services, it is because that's sort of the first step in beginning the process of recovery.
If we can't get through the substance abuse and some of the other mental health issues that may be present, it's hard to get to the education, and job counseling, and the rest of this. And so it essentially begins as a sort of a medical services issue.
REP. ISRAEL: Well, I appreciate that, Mr. Secretary. I know this is front-end investment. And I'm sure that most, if not all of my colleagues, are interested in continuing to work very closely with you so that we can grow our focus on homeless veterans from here on. And I thank you very much for your leadership.
REP. EDWARDS: Thank you, Mr. Israel.
REP. ANDER CRENSHAW (R-FL): Thank you, Mr. Chairman.
And Mr. Secretary, I thank you for being here today. I know that you've got a tremendous background of dedication in taking care of men and women in uniform, and I know you're going to take that same dedication and commitment to this job, so thank you for all of that.
And it's really good to hear you talk about transformation. You know, there is an old saying that change is inevitable, but growth is optional.
And I think you recognize that in the sense that, you know, change is going to come and that's what you do, what kind of change that you bring, and I think the growth part is the transformational part. And I think as you pointed out, when you've got a big bureaucracy like you've got, you've got to start looking at yourself and looking from within.
And one of the things I saw that you're going to have is a new office of the assistant secretary for Acquisition, Construction, and Logistics. And I know we've spent a lot of money -- we appropriate a lot of money in terms of military construction and things like that.
And so I wanted to ask you maybe just in terms of this transformation, this new office, this new department, can you tell us kind of what your I guess, view of the role that that's going to be?
May be tell us what some of the functions are that may be being taken care of by the existing departments, and obviously some are going to be brand-new? And then maybe talk about how -- you know, what kind of control you'll have within that to make sure that it's conducting the kind of oversight, if you could do that, sir?
SEC. SHINSEKI: This is to formalize a new office that was stood up here recently where Acquisition, Logistics, and Construction co- located as a subject area. We contract in a variety of places.
We do acquisition in different formats in different places. And we need a single point where we can see what our priorities are, how the money is being invested, and what the returns are. Right now, that's a little difficult to see.
And I'm used to a structured acquisition process in which there are objectives to be met prior to a decision to acquire something and then there are deliverables over time. When you don't have that kind of a process, you go 3 or 4, 10 years, and you find out something doesn't work.
And there has been just one too many example of that in the history of our experience, and we need not to do that anymore, and we need to put together a disciplined acquisition process where all of this comes together. You have to make your case for why this is important, and what it's going to cost, and then deliver.
But it is to discipline our processes. We're looking at 16 people for this -- to be added to this office to create this new office for the assistant secretary. And we've provided some budget resources for them to begin to standup the office.
But it is to discipline our process that covers 153 hospitals, 755 outpatient clinics, 230 vet centers, and 50 mobile vans, and 57 regional offices. We need to discipline the way we see our priorities and also how we spend money on acquisition.
REP. CRENSHAW: So it'd be fair to say right now some of those -- some of that happens, but it's kind of piecemeal, and this is trying to bring things together, have one office kind of specifically review and analyze all those projects and bring about a better result. Well, thank you, sir, and I think that's a great program.
Thank you, Mr. Chairman.
REP. EDWARDS: Thank you, Mr. Crenshaw.
REP. JOHN T. SALAZAR (D-CO): Thank you, Mr. Chairman.
And thank you, Mr. Secretary, for being here. And appreciate all your hard work over the last several years, and your dedication to this country. And always -- I want to tell you that I appreciate your promptness when we call you for a meeting or a phone call as well as Undersecretary Muro.
Let me just ask you or thank you, first of all, for the Fitzsimons Army Hospital. I guess we'll be breaking ground on that shortly or you have already broken ground. And can you tell me where we are on the FY10 budget for that facility?
MR. : This is the Denver hospital?
REP. SALAZAR: Fitzsimons, yes, sir.
MR. : Sir, we have for funding for 2010 $119 million in the budget. Our future funding will be ($)493 million and that's the information.
REP. SALAZAR: Okay. I do appreciate that. And one other thing, I know that my work through the Veterans' Affairs Committee over the several -- last several years we have encountered some problems in VA with identity theft or with identity compromise, where we had lost those computers or they -- by one of the members. With your push on IT, what are we doing as far as cyber security? Could one of you address that?
MR. : We're working closely, sir, with our IT colleagues to make sure that security among our physician staff and our nurses were -- that hasn't always been the foremost concern that they've focused on does become something that they think about, that we make it a part of our culture.
And I think that's the key for us. We're making a difference in terms of the people who use the IT in terms of their culture, making this something that I think about as routine part of their practice everyday. And that has been a bit painful at times, but we're working through that, and I think we've made some progress.
REP. SALAZAR: So are you committing certain resources to the security portion of the IT?
MR. : Yes.
MR. : Yes, sir, to give you a laydown on how we're approaching information -- how we're dealing with cyber security and information protection at the department, there's approximately $120 million in the FY10 request to fund those programs, not just at the technical level of putting systems and controls in place, but also training for the staff, so having annual security awareness training and privacy training for all employees at the department, so they understand that obligation to be a steward of the veterans' data.
The approach that we've taken is fixing the liabilities that we're aware of, the things that have been identified as a result of IG investigations of GAO audits, monitoring our systems to understand if we're in a insecure condition and what we need to do to protect it.
So active monitoring, we have a Network and Security Operations Center that monitors 24/7 what's happening at our perimeter, are folks doing bad things, and then responding to that.
We're standardizing our desktop computers and our systems to make sure that when things get out of balance, when you have all these different unique systems, it's hard to protect them. So standardizing those, so we can put the controls in place to make sure we're able to secure them and secure them at a reasonable cost.
We're controlling the use of sensitive data in terms of tracking where it is and putting policies and procedures in place to make sure that the employees understand if you're sending something that has personally identifiable information in it, we need to encrypt it when you send it. And you do not send it off to somebody who's not an employee or is not authorized to access it.
Again, I spoke to enhancing, training, and awareness, a very active engagement with the staff, national training programs, videos, and trying to be creative in reaching out to a VA employee, so they understand it is very, very important to husband that information and to protect it.
Now, we're also making sure that as we develop new systems that we are building security into them that they're not an afterthought. Hopefully, that gives you a sense of how we're taking on information protection at the department, sir.
REP. SALAZAR: So how have you changed it from or has is it been changed from, you know, two years ago?
MR. : The way we've taken on -- your question of what's changed; when the incidents took place, there was a dearth of policy in terms of how you should approach it, it was very fragmented. So some areas it was understood how you need to deal with it.
In those areas, there may have been policy, but no procedure, or even folks not doing what they needed to do. So a tremendous effort went into making sure policies were put in place to explain the folks' obligations, and then procedures to change how we do things, and then down to the level of at the sites making the changes and fixing the system.
I have a dashboard on my desk that tracks all the open findings and progress made location by location, where are they, so I have a constant update, what's happening. And if I see things going out of kilter, being able to reach in and say, you're missing your focus here, you need to get into that.
MR. : Mr. Chairman, I'd just add a comment here to Mr. Salazar's questions -- two things. We begin our day 8:00 every morning with an update on exactly these kinds of issues. It is a daily brief on where we stand, what do we have to do the rest of the day, to assure information security and our links are working.
If I might, let me go back to the question you initially asked about Denver. I'd just give you a little more information; ($)119 million this year, but in the near future in order to stay on our timelines to deliver that hospital by summer of 2013, we'll have to work project funding for another ($)493 million in order to complete the project.
Site acquisition is complete. They'll begin moving dirt shortly, if they haven't already started. Vertical construction begins FY10.
REP. SALAZAR: Okay, thank you, sir.
REP. EDWARDS: Thank you, Mr. Salazar.
REP. JOHN R. CARTER (R-TX): Thank you, Mr. Chairman.
Mr. Secretary, it was great talking to you in the office the other day. When we were talking, we spoke about the possibility of adjusting the rural clinic eligibility circles, bringing the VA health services to more underserved communities like Stephenville, Texas.
We also spoke about the possibility of use of part-time or mobile outpatient clinics. I see the budget includes a request of ($)440 million to continue improving access to medical care of veterans in rural areas.
Can you talk about how that money will be spent towards the goal of bringing services to rural veterans without having them to drive 100 miles or more? Is there plan to utilize some of that funding to reanalyze the VHA strategic planning process through which the community-based outpatient clinics locations are selected?
MR. : I can't answer specifically for that location, but I'll have a better answer for you --
REP. CARTER: Well, we're not just looking at rural veterans. In general, what plans do you have for those folks who are outside the circle?
MR. : Yeah, I just would like to tell you that the budget includes $440 million to improve access to medical care for veterans in rural and highly rural areas, including the use of health resource centers that maybe available out there, or mobile clinics, rural health consultants, and outreach clinics.
And the whole intent here is to ensure that we're not medical center bound. And that's been the migration over the last decade. Great medical centers, but then how do we get that moved out to where veterans live.
And there are three definitions that in the VA governs the geography of this country; there is urban, there is rural, and there is highly rural. So two-thirds of our definitions acknowledge the fact that we're dealing with unusual circumstance, smaller numbers, but we still owe them the services we provide in the urban centers.
And this is part of our attempt here to close that gap.
REP. CARTER: Well, I know we have an interest in this area because of what we talked about Stevensville, but on the Transportation Subcommittee that -- of which I'm a member, we discussed the services of rural areas where the transportation network quite frankly upon the East Coast and the New England area, and it's really -- a whole lot of it is designed to get veterans places because they're scattered out in small counties around everywhere.
And they use a bus system, but I sat down with a map of Texas, and in reality there would be no profitable buses that they could go pickup one veteran in one county unless you're part of our state. And so we've got to be, I think, aware of there's a lot of veterans in West Texas, but they're scattered out over a wide -- a wide area.
And so I have an interest in that, and that's why I brought that up. And I thank you for what you can do, and we discussed it at length in my office. Because if we don't take care of the veterans -- these guys like to buy land and get away from things, a lot of them do, but they still ought to be -- we still have to -- are responsible for their health care. So I know you'll keep that on the front- burner, I appreciate it.
Thank you, Mr. Chairman.
REP. EDWARDS: Thank you, Judge Carter.
I believe we have time for Mr. Dicks to finish his questions before we need to recess for three votes.
REP. NORMAN D. DICKS (D-WA): Mr. Secretary, we have great confidence in you. And I appreciated our chance to talk the other day. And I also appreciate the fact that we put in a clinic in Port Angeles, Washington. It's not a full-fledged clinic, but it's a partial clinic. And have one in Bremerton too.
And a lot of people -- lot of veterans though have to get up at like 2:00 in the morning up at Clallam Bay and drive all the way to Port Angeles all the way down to cross the Hood Canal Bridge into Seattle. It takes about eight hours -- not eight hours, about five or six hours. And they have -- and all they have is a volunteer so -- to drive the truck.
So I don't know if we can do any better than that. I think we put -- I think the administration has put money in here to keep working on this rural issue. I think it's -- I think -- and then people really appreciated the clinic.
We didn't have one in Port Angeles. So for a lot of those people, being able to go there was a big step forward. And we also -- I think there's also a clinic in another small area, Yelva (ph), an Indian reservation that is putting a new health care clinic and we're using that as well.
You and I talked about backlog. And I know there's been a tremendous effort to get the backlog under control. What is the backlog on people who are trying to get in to the hospitals that -- and how long do they have to wait?
I'm sure it's different by district, by VISN area, and I think we are VISN-21. Do you have any idea what those numbers are?
MR. : Yes sir, we do. Well, we measure it nationwide, we measure it by VISN, and by locality. And I can certainly have my staff -- or I can go over with your staff anytime and give you the very specific numbers that we have.
What our standards are for mental health that a new patient is to be evaluated within 24 hours, and that may be done by phone or it may be done in person. And that's seven days a week, and that is our standard.
Our second standard is that once that is done, they are to have a comprehensive mental health evaluation by a mental health clinician within 14 days. We're measuring that right now and across the board including your area; 95 percent of the time, we're meeting that standard of 14 days.
Now for primary care and specialty care, across the board right now, its running 97 percent, 98 percent -- primary care 98 percent, specialty about 97, meeting our 30-day standard.
REP. DICKS: Well, that's good. I know you're working on that and trying to keep that at a high level which we appreciate. You know, we just built a new -- or revitalized a facility at Retsil, Washington. And I know they have -- now have a capability to handle some homeless.
Do you do that a lot with the states? I mean, when they're building their veterans home, state veterans home, to have an -- to make it accessible to homeless veterans, or should we be doing it?
MR. : Well, we have a couple of programs. We have the Per Diem program where we work with local community to provide transitional housing. And then we work with the HUD-VASH program to provide vouchers for what we want to be long-term solutions.
REP. DICKS: Okay, this is the state veterans?
MR. : State veteran nursing home is based on medical conditions and those situations more so than in homeless.
REP. DICKS: Well, in this one they must have worked out some way to do it, because they do have homeless there as well. Which I think is, you know, I mean, using the existing facilities, if you can, seems to make sense to me. Especially, this was, I mean, this was a $35 million upgrade of this facility. It's a very nice facility.
MR. : We use a number of venues. Using excess capacity and dedicating it to a homeless population is one. Another is we partner with some of the nonprofits out there. Catholic Charities Chicago, we've got a terrific partnership working, and it just so happens that that homeless shelter is next door to one of our outpatient clinics.
So the health care -- availability of health care --
REP. DICKS: Sure.
MR. : -- for those homeless veterans, a good fit. Then on the second floor, we have a vet Center, which is run by vets and so they have this camaraderie, you know, effect. And inside the vet Center there's a bank of computers for job searchers in which there's a counselor helping folks with that part of it.
So dealing with the homeless issue has many hats to it, and we find great success when we can bring -- to include folks in the community together to help us. We get a better return on the investment.
REP. DICKS: Thank you, Mr. Chairman.
REP. EDWARDS: Thank you, Mr. Dicks. Members, we've got about six minutes, but not many members have voted yet. So we've got time to get over. We'll stand in recess until after the end of the third vote, if we could try to get back as soon as possible for those that can come back, we'd appreciate that. Thank you.
REP. EDWARDS: I'd like to call the committee back to order.
Mr. Secretary, thank you. And all of you for the inconvenience of having us go vote. I have often said this job would be a good job if it weren't for having a vote. But we appreciate your staying here.
I'd like to begin my first round of questioning by addressing the issue of forward funding for the VA. A decision has not been made as to whether in the FY 2010 budget we will also include forward funding to FY11. But the administration supported that and the budget resolution allows that.
Mr. Wamp's raised a question that I'd like to address.
I think it's a legitimate and important question to ask and that is what would be the impact of congressional oversight VA budgeting process if we went to forward funding like that?
I'd like to ask you if we are going to do this, we obviously would need input -- detailed input from the administration over the next few weeks as to what we would propose for Fiscal Year 2011. Could you say for the record where the VA is in that process of looking at a budget submission for Fiscal Year 2011?
SEC. SHINSEKI: Mr. Chairman, I just reinforce with you that both the president and I feel very strongly that funding for Veterans Affairs and the impact that has on our veterans who come to us for health care shouldn't be hindered.
And you know, timely budgets are a great thing, but if we look at our history they're aware of that. And continued resolution has created a host of other issues for us, and for that reason he and I have agreed that advanced appropriations is a reasonable way to look at this.
I think you know that within the VA we have a modeling process that looks forward. It's based on the Milliman (ph) model. We contracted with them. This model looks out 20 years.
And I would say year one is great; year 20 is probably not worth much. But we have gone and looked back at the second year of that process, went back and looked at how the second year modeling, compared to what was enacted and executed, very favorable.
So we think we have the basic tools to be able to look beyond the first year. Timing and implementation, I mean, this would be significant. When we did take the step, we would hope that all the details have been worked out.
And what I would like to do is come back and work with you in the committee, and your staff, and -- on exactly what that implementation timeline would be, so that it would be a good fit the first time we do it. But in terms of modeling the information is the there.
For 84 percent of you know, what we do in VHA, modeling is there. And then --
REP. EDWARDS: Okay.
SEC. SHINSEKI: -- the other 16 percent we have to do other efforts.
REP. EDWARDS: Okay. I'd welcome that, and the sooner you could do it, the better. Once you have the data you need, because if we are to implement this for Fiscal Year 2010 and 2011, we'd have to see those numbers pretty quickly.
In fact, you know, taking a look at those numbers might allow us to determine which way we want to go. If we feel good about the numbers, and believe we could continue oversight of the VA despite a two-year budget, then we might move ahead.
If we feel the numbers are rushed and not well put together then it might cause us to second guess, and Mr. Wamp might want to have some follow-up comments on that.
I would like to read one thing into the record that usually we don't talk about.
Mr. Muro, with Memorial Affairs, and your representation of that important part of the VA, I'm very proud and I hope everyone that works in Memorial Affairs at the VA is proud of the fact that according to the records I have, the VA's National Cemetery System has received the highest rating in customer satisfaction for any federal agency or private sector corporation ever surveyed as part of the American Customer Satisfaction Index, a 95 out of a possible 100 points.
Is that a correct statement of the facts and when did that rating occur if it is?
SEC. SHINSEKI: I'd just like to affirm that that's accurate, but let me let the individual who is responsible for much of that provide some detail.
MR. MURO: Thank you, thank you chairman. Yes, it is accurate and we actually accomplished it two times, in '05 and in '07.
REP. EDWARDS: And I want to compliment you and please pass on this subcommittee's compliments to everyone who had a hand in earning that level of respect from -- I'm sure the vast majority of those in the customer satisfaction survey were family members of veterans. And what a great show of respect of our servicemen and women.
In a town where you only make the front page of the Washington Post if you've done something wrong, how refreshing it is to be able to at least speak publicly in this committee hearing about that the VA having done something that no other federal agency or private sector corporation has done.
Thank you and I salute you and the VA and its employees for that. My final -- I'll tell you what, my final question will be asked in the next round of -- I'm going to try to follow the five minute rule.
I'd like to recognize Mr. Wamp for any questions he might have.
REP. WAMP: Well, thank you, Mr. Chairman. I have basically three lines of short questions. But I want to first read into the record quotes from the GAO study, April 29, 2009 about advanced appropriations, just so the committee and the secretary can absorb what an independent analysis of this request might entail.
It says the provision of advanced appropriations would quote "use up" end quote discretionary budget authority for the next year and so limit Congress' flexibility to respond to changing priorities and needs.
While providing funds for two years in a single appropriations act provides certainty about some funds, the longer projection period increases the uncertainty of the data and projections used. If VA is expected to submit its budget proposal for health care for two years, then lead time for the second year would be 30 months.
This additional lead time increases the uncertainty of the estimates and could worsen the challenges VA already faces when formulating its health care budget.
It says providing advanced appropriations will not mitigate or solve the problems we have reported on regarding data, calculations, or assumptions in developing VA's health care budget, nor will it address any link between cost growth and program design. Congressional oversight will continue to be critical.
So you make a great point, but just because the Congress has not done its job, funding programs in a timely manner, it doesn't mean you have to go and change the constitutional process I think of annual oversight appropriations from the legislative branch.
I think we need to be real careful here. But also I think we need to use this as a incentive with the leadership to remind them with relative to these most important Americans, the men and women who put themselves in harm's way on our behalf and stand between the threat and our civilian population, the most important Americans, cannot have their needs met unless we do our work on time.
And this chairman has done that. And this leadership right now has done that. But it has to continue, or this becomes a real wedge issue between the executive branch and the legislative branch. And I know when we were in the majority I was more inclined obviously to try to support the administration all their requests, and now you have that burden, Mr. Chairman.
But I hope that you will remember always the importance of this legislative prerogative and it's not just a prerogative, it is a requirement. So that's all I'll say about advance appropriation.
Let me go back briefly to the transformation piece that you were talking about, because when you were answering my first question, I got a lot of process response on the transformation. And I'm really looking more for the bigger piece like contracting.
I want to know where that fits in to any transformation you have.
And I used to think of contracting, of adding options to veterans' toolbox for their benefits, and I'm not talking about a voucher, because I know that's like taboo.
But I know that my veterans will say this in Chattanooga, Tennessee, man, we love our outpatient clinic, and it's better than ever. And they're so needed, and we get great benefits, and you're expanding it. And thank you, and we love it, and we need it, and don't take that away.
And they say a hospital at Murphy's Burrow is necessary. And they do just about everything. And you got long-term care, and mental health services, and you talked about one of your employees. There is a person in the long-term care wing of Murphy's Burrow that's been there over 60 years. A person has been in that hospital for over 60 years.
So it's an amazing benefit. So I'm not talking about in anyway eroding the VA delivery system, because that should be guaranteed for our veterans that they have this. But there are cases where contracting makes a whole lot more sense than driving two hours to get inpatient care, and it's a huge burden on the family to have to drive two hours to see their loved one, who is the inpatient receiving the treatment.
And if we're not going to build new facilities because we can't, think of a new model is take the health care system to the veterans through CBOCs and the new facilities, okay, I understand that. But what about those other cases where contracting services are creating an additional option for the veteran makes more sense, is that part of your transformation?
MR. : A couple of comments.
MR. : All about cleanup here.
MR. : A couple of comments related to that. The transformational model that will have an impact on this is the HCC, the Health Care Center, an example of that being in Oregon, Texas. And the idea is that we shouldn't have to drive five hours to get to -- to get a colonoscopy.
MR. : Right.
MR. : And by the way, if you have to go through the preparation for that and then drive five miles, that's not a good day.
So if you are having a heart attack or something like that, in this HCC concept, you would get it taken care of locally, because that's a time related element. If you have something like a knee replacement, or something that can be scheduled that's scheduled long in advance, you make all of the arrangements, well, certainly, we will want to centralize that regional -- on a regional basis and take care of that for the veteran.
But it's a combination of those factors. Working with local community, we're still preserving the veteran system, health care system, in its regional basis, providing primary care locally as well. So as primary care locally, time-sensitive things go to local community in that HCC concept. Other things that are planned long in advance can be regionalized.
REP. WAMP: Are you keeping a healthy inventory of specialists in the VA, from radiologists to other people that you need? How is that going?
MR. : Well, thanks to the Congress and the physician and dentist pay bill we've been very successful, and had the best years in hiring for the past couple of years that we've ever had as far as I know.
And I think last year we hired at least for part-time over -- probably about 1,500 physicians and over 4,000 nurses.
REP. WAMP: Wow.
MR. : Mr. Wamp, if I could just add to that. If we were to go up 50,000 feet and look down on our health care delivery system, I hope that what you would see, you know, a collection of population of veterans, and then within that a medical center, first-grade medical center, someplace in the midst, and then health care center that's a step below that.
And the difference being all the same services are provided, just no inpatient care.
REP. WAMP: Right.
MR. : And then below that the large outpatient clinics, and then the community-based veterans -- vet centers, and then the mobile vans. All of that intending to address the problem you are talking about, which is access.
And for the last decade plus, the effort has been to reach out. In those communities where patients would have trouble making the drive, be it in the winter time, or be it any time just because of the long distances to get to the medical center where specialized and inpatient care is available, there is an opportunity to provide on a fee basis arrangement, contracting in the community where a quality hospital may also provide inpatient services.
And so that arrangement is there. I guess the only hitch here is that we would try to provide VA services because we know what our standard is and we are pretty meticulous about it. But where that standard is also available in the community, and it's to the benefit of the veteran not to have to make that drive, I mean, that option is there.
And we do do that. There are some communities in rural areas where they don't have that capability. And so we try to put a larger facility in that area, or ultimately you know, we have to ask them to make that long drive for just the inpatient care.
Ninety five percent of what veterans would need on a day-to-day basis, shots, lab work, medication, X-rays is handled by any of these other than medical center facility. So the attempt is to address those needs and those concerns.
REP. EDWARDS: Mr. Farr, before I recognize you, I'd like to follow-up on something Mr. Wamp said, couple of points I think that are very important. One, on advanced funding.
I think that is an important to decision to make and -- we -- I would reiterate we have not made that decision, and I think we need to sit down with our respective staffs and go through that. Once we see some numbers on what Fiscal Year 2011 would like, and then talk about the question, do we delete our oversight authority?
And on the second point, that I think is a good point, when you say there is a natural tendency as the democratic chairman of this subcommittee to want to work with the administration. I think I'd use the analogy of a spring scrimmage for football, a collage football team.
They're all on the same team, but to make themselves better, they play against each other, and challenge each other in spring scrimmage. And so while I've the greatest respect for everyone at this table, and I've known the General Shinseki -- Secretary Shinseki since he was at 1st Cavalry Division at Ford Hood, while we're maybe 90 percent of the time we're absolutely partners on the same team on the same side of the line, I do take it seriously as I think we all should the relative balance, checks and balances our founding fathers intended in the constitution.
So I think we ought to be very vigorous on a bipartisan basis, in not necessarily attacking, but in challenging the administration to show the fact, show the data.
And one area that you brought up I think would be a prefect example is -- was some of the proposals the innovations to bring about the transformation you do propose several new offices.
And I would hope at the end of the first year there would be some metrics by which we could judge did we just cerate new bureaucratic positions, or do they actually meet metrics of saving taxpayers dollars? And I'm glad the ranking member brought up these points. I think they're both very important points.
I look forward to working with you on that.
SEC. SHINSEKI: Mr. Chairman, may I just add?
REP. EDWARDS: Please, Mr. Secretary.
SEC. SHINSEKI: I'd just offer to you, I -- and you know, to Mr. Wamp's point. There is great value in the competitive arena where people with initiatives want to compete for funding need to come and present their case. You know, I couldn't -- I'm a firm believer in that based on previous jobs I've had.
But I do think that you would expect me not to take the attitude that if advance appropriations were to be enacted that there is a buy in the second year. You would expect, and you could count on me to provide the arguments for what validates what is being asked for in that second year, you'll have a chance to look at that. It is a competitive process.
I would also offer that as good as we might put together this implementation plan, the second year is always challenged with the unknowns. You know, whether it's an H1N1 virus, or whether it's a Katrina. And so I would look for an opportunity to find a way to create a mechanism for the second year that could be adjusting for those unknowns -- unanticipated, or may be even boneheaded cost. But that -- what we want to do is get it right for our veterans.
REP. EDWARDS: Okay, thank you, Mr. Secretary.
REP. FARR: Thank you. I've -- all my life in politics, I've been trying to get a two-year budget for county, state, federal government. It runs into all kinds of difficulties, because we just don't operate our lives on a two-year cycle. It's almost on a daily cycle. And this would be interesting. I'm open to that.
What I wanted to address and I'm very pleased to see that Admiral Dunne is here. Admiral Dunne was -- when I was in -- (inaudible) -- he was the superintendent, the commander of the Naval Postgraduate School at Monterey before his retirement. And what I wanted -- yeah, you wouldn't know that, would you? It's probably mentioned in every hearing.
But well, we beat BRAC on it, so we did some well. What we have at Fort Ord which is -- we didn't beat BRAC on, they closed it. But out on Fort Ord is the manpower -- the Manpower Defense -- Defense Manpower Data Center.
And I don't know if anybody in VA knows about it, but it is essentially the Department of Defense's one-stop for every kind of information you need on any personnel in the Defense Department, and the families of those soldiers and the defense contractors who are -- may be overseas.
And it seems to me that that IT is something that may be the veterans department would -- could work on. I'm really keen on jointness, because essentially, and I'm working on how we can work with you on this. I mean, the Defense Department has the luxury of essentially -- you operate out of bases. So all the personnel are assigned to a base, operate out of a base.
But when they get out of the Defense Department and go to the veterans department, they are all -- they're scattered all over the world. And you have to deal with essentially your line of support isn't on campus, on base, your line of support is in the community.
And I think that's the thing that Mr. Wamp and I are really keen on is how can we integrate more of what is good in the community and the sort of in the civilian sector under the community support systems and specialists that are there, and things like that, so that veterans, when they do need some help, we don't have to go hundreds of miles in order to get that help.
We could find that there are resources in our own community. And along those lines what I'd just like to have you comment, because I'm very keen because of the -- we still have about 6,000 uniformed personnel on the Monterey Peninsula, either at the Defense Language Institute, or at the Naval Postgraduate School, or at the Navy Lab, or at the Fleet Numerical.
I mean, it adds up. We have seven different military footprints on the Monterey Peninsula. And a lot of -- we have just finished all the housing on the RCI housing, and we are now trying to do these joint clinic which really makes sense.
And now the VA is leading the effort here. And I'd just like to have you tell us the importance of how it is to meet this critical unmet health care need for both the local veterans population, and the active-duty dependent beneficiaries through using your new health care center facilities act, the private sector funding?
I mean, I know you've mentioned that. But what I see is we can't get -- we couldn't get this facility built without using that modality, because the line to be in the fit up would take is way out there, like 2015 or something. And we're going to incur a lot of cost, unnecessary costs, and with this critical ability to get it privately funded, it just seems to me a win-win.
And I wondered if you had any -- it might not work in every community, but where you do have significantly Defense Department presence and a significant veterans community living there, we ought to have that jointness. They used to have the jointness when they go on the base to use the -- to use the privileges of the PX, or use the privileges of the gas station. But they don't have that privileges to go into to a joint medical facility.
SEC. SHINSEKI: Well, I'll let Dr. Cross talk about the Fort Ord health care situation. But I would just lead into this by saying we have a history of DOD-VA joint facilities.
We do it in New Mexico with Air Force, Alaska with the Air Force; Leavenworth, Kansas, El Paso, Texas with the Army, Key West, Florida. So there are a number of these that suggest we have a history of doing this and doing this well.
And in the case of Chicago, Great Lakes Naval and Northern Chicago VA Medical Center, we have integrated it to the point where a VA director and a serving -- an active serving naval captain are working together.
One is the director, the other is the vice director, if you will. Fully integrated, and we hope that that partnership is going to you know, go forward this fall.
With that as a background, we have some history here. We have some experience on how to do this right. Let me ask Dr. Cross to talk about the potential here.
MR. CROSS: The key to this is you have a new methodology of having private sector funding for the facility --
REP. FARR: Right.
MR. CROSS: -- which is essentially what we did with RCI housing.
REP. FARR: Right, right.
MR. : Mr. Farr, there is a good news here. And although this project did not go forward as a JIF project for a joint clinic between DOD and VA, we're moving forward with this as a lease project in the VA 2010 budget. And this is to make it a new health care center just as I was describing it for the Texas venture.
In this project, we've constructed a new health care center to provide primary care, specialty care, mental health, expanded diagnostics in ambulatory surgery and that division is expected by -- probably by the end of fiscal year 2012.
REP. FARR: Admiral Dunne, it's nice to have you back on the team.
MR. DUNNE: It's great to be here, sir. And I'd like to take the opportunity to thank you for all your efforts to make sure that the Postgraduate School could celebrate its 100 years this year.
REP. FARR: And Admiral, let me assure you, doesn't pass up an opportunity to emphasize the assets that --
MR. DUNNE: Invited to the celebration.
REP. EDWARDS: Thank you, Mr. Farr.
REP. CARTER: Thank you, Mr. Chairman.
REP. EDWARDS: Judge Carter?
REP. CARTER: Actually, I believe that's the first words out of his mouth every time he opens it. Secretary sent out 220,000 questionnaires in my district, off to my constituents. And I -- there's a last line in that questionnaire that says, "If you are unable to communicate some of your concerns, you're welcome to call a congressman."
And last night, I spent my time talking to these constituents, and one of these constituents was a veteran. In fact, it's -- there are usually are quite a few veterans that actually take advantage of calling me, or me calling them actually.
And I promised him if I ran into you all I was going to you about this. So I will, and it's just luck that it must be today. He is concerned, he worked first -- he served in the military for 20 years or 30 years, I'm not sure which, and they went to work for the Texas Veterans' Commission which helps veterans work through the system.
And now, he is working with processing the system for himself. And he says, this is a perception he believes it to be a reality that the people who process claims, adjudicate claims -- initial people who adjudicate claims are working on a piecework quota system that they have to do so many claims to get promoted to the next promotion level.
And they have to meet a quota every week. And he is convinced that when they get behind in the quota, that sometimes they just deny a claim just to get the number of cases dealt with that week that they're supposed to deal with, which throws into the appeal system which can -- which the -- then he says, which the VA can then stretch out for a year or two. And then in his case, it was almost two years in which then it was -- he had 60 days within which to reply.
And he thinks that something should be done about the fact that there is this quota that are set on these caseworkers which would cause them rightfully or wrongfully to think. Well, a couple of them, I just let them slide by, and let me think the appellate process, but I'll be able to get promoted.
I'd like a comment, maybe of your, or the other people about whether that system -- his perception that system has any reality. He claims his issue was arthritis. And the way he's -- the reason he thinking -- he questions this whole process is that he -- when he first went in for arthritis, they said traumatic arthritis. He appealed it's not -- never had a trauma.
And they did a restudy and came back and agreed with him, and they awarded him arthritis in both his elbows and then later in his neck for -- it was a congenital arthritis. And then it moved into his shoulders. On this request, when he made this request, once again he got traumatic arthritis, and thrown into the appellate -- the appeal system.
And he said that it was so easy to see, if they'd just taken the time to read the records that he'd been through this whole process, and on his neck and his both elbows and -- but he felt like they just did it because they were in a hurry, and not because they were trying to deny him his claim for any other purpose, but they were just in a hurry. So I promised him about raising this issue. I know it's individual to one soldier, but it's important to him and I gave him my word.
MR. : Sir, even if one soldier feels that way, we've got more work to do. There is what's called a performance standard for the rating representatives that work in the regional offices. But there is also a quality standard and part of that quality standard is that the cases that they work are reviewed periodically on a random basis. And if they were to deny a claim, that was otherwise should have been awarded, they would be held accountable for that.
And so that information would be back to their supervisor and factored in as well as the -- simply the amount of cases that they do. So from a supervisory level, simply volume itself is not enough to achieve success. And we want to make sure that every veteran who comes to us to get their claim adjudicated, that we do it accurately, and that we do it right the first time, and that there is no need for our veterans to appeal because they feel that they didn't get a right -- a properly adjudicated claim.
REP. CARTER: I will call him tonight and tell him that.
MR. : Thank you, sir.
REP. CARTER: Yeah.
REP. EDWARDS: Thank you, Judge Carter.
REP. PATRICK J. KENNEDY (D-RI): Thank you, Mr. Chairman. And welcome all of you, Mr. Secretary, welcome, thank you.
Secretary Shinseki, as you know with Monday's tragic events at Camp Liberty underscoring the critical epidemic of mental illness amongst number of our military and veterans too. Climbing suicide rates and shortage of mental health professionals and broken families seem to be common themes that are always appearing in our newspapers for our veterans and their families. And the stories are constantly that we cannot afford to wait any longer to staff up and reach out to those who are in need.
Could you tell us, you know, how with the integration with the DOD, we are going to make sure that every single soldier that is going to have the face to face interview coming out of the Department of Defense, and every Guard and Reservists and the like to get a face to face interview, so that when they're coming into the VA, we have a full assessment of their needs, and are able to hopefully prevent any onset of PTSD from ever happening.
SEC. SHINSEKI: Key point for us is, first of all, to make sure that we have the people, the expertise in place to take care of these veterans. And that's why over the past several years, we've added almost 5,000 new mental health professionals. We've also expanded our Vet Centers
But regarding the interview, that's -- I think that's very key. And what we were finding was when they first come back from overseas, that if we talk to them right then, didn't get much of a response. They were focused on one thing and one thing only; that was going home.
REP. KENNEDY: Right.
SEC. SHINSEKI: So DOD actually took the initiative to do, 90 to 180 days, later the post-deployment health reappraisal. That was actually a very successful initiative. We wanted to buy into them. So I've taken our local VA staff and our Vet Center staff, but mostly our Vet Center staff, to be physically there to be face to face with the individuals when the units go through the PDHRA. We've done boatloads of those now.
They often end up making referrals right then. And getting them arranged -- arrangements must be made to get them into a care after that. They are much more sensitive at that point. You have a much better conservation, and it really didn't make a difference.
MR. : Mr. Kennedy, may I just add to that.
REP. KENNEDY: Yeah.
MR. : One of our efforts in establishing this relationship with DOD for the single joint electronic record --
REP. KENNEDY: Yes.
MR. : -- is first of all, have a registration for every serving member in the military.
REP. KENNEDY: Right.
MR. : As you know, right now, not all who leave the service come to enroll with the VA. But this would be automatic.
So we now have a population that we can identify and deal with. And then between DOD and the VA, this face to face interview that you talk about is what we intend to do.
Some of this may be done prior to the uniform coming off, but certainly, for those that have been to Iraq and Afghanistan, that's our priority, is to talk to them face to face and to get this identification, and begin the tracking process. Even if at that time there was no, you know, definite determination that PTSD was a factor; if it crops up six months later, at least we've got a point of reference to look back at.
Veterans' service-connected PTSD has increased from 120,000 in '99 to today we are carrying on our roads 344,000 folks, not all of them Iraq, Afghan veterans. These are our PTSD cases that have occurred over time. The Vietnam veterans are probably the hardest hit. What this factor, just didn't know enough, and they weren't being screened, and many of them are still carrying those burdens.
Out of that number, as of February, about 53,000 Iraq and Afghanistan veterans are being validated for service-connected PTSD. So where we are able to get to that face to face, there are assets in our health care system to be able to make those determinations and begin the treatment process.
What we do know is if diagnosed, we can treat, and if we treat, things generally get better. If we don't diagnose or treat, they don't; invariably they get worse.
REP. KENNEDY: And you know, obviously, we are in the midst of health care reform. I am told that the best treatment for PTSD is prevention. And that it's really, simply a matter of making sure that they don't get PTSD. And you can -- there are real known protocols to take to keep people from falling into getting PTSD.
And rather than waiting for them to get it, and then come in and get treated, we ought to be preempting them from getting it by having a "welcome home" strategy for them. A plan of action, where we say a, b, c, d, this is the -- these are the things that we know work to make sure you get yourself back on the ground and rolling.
And you get yourself surrounded by loved ones, and friends, and community, and family, and welcomed back home properly. And when you follow this protocol, your incidence of PTSD will just drop, you know, precipitously. And we just know that through the study of PTSD, but if you don't have those support systems in place, you know, your incidence, your -- the possibility of your suffering from PTSD is just going to skyrocket.
Now, why we would wait? You know, one way or another to -- for a soldier or veteran to fall into one of those categories where they are lucky enough either to have a support of family, or not so lucky enough to end up without a job, without a support of community, and without -- when we, the VA, and our country can like kind of set it up, to me and as beyond me, especially when it's going to be -- cost us a fortune; you know, just financially let alone. You know, morally, we shouldn't be allowing it to get as far as that.
We should have the setup in advance where we connect them right away to whatever they need in terms of -- and plus we take the stigma right away from it. We just say, here is the, you know, here is the rolodex; here is the one, two, three, four. And then it's not about PTSD, it's about connecting these are the things that were told that make you like you have the best chance ever of, like, getting your feet on the ground, you know.
So that brings me -- my next question is why don't we have best practices for mental health in our health care system in the VA? We have best practices for every other health disease group in the VA health system, but mental illnesses.
MR. : We do.
REP. KENNEDY: No, you don't. I've been to two dozen of your health clinics --
MR. : Let me --
REP. KENNEDY: -- and you do not have metrics base for substance abuse, PTSD, anything. You have -- you practice different types of treatment for substance abuse, for everything else. You don't have a one-size-fits-all for -- in terms of programs that you know work, that you take to scale like you would for MRSA, for cancer, for cardiovascular disease. The same does not hold true for mental health system-wide in your mental and --
MR. : I certainly agree with you, Mr. Kennedy, that one size doesn't fit all. That's why we do have different types of programs. We are leading the way. We work with the Academy of Sciences to decide what is the very best type of treatment for PTSD. We worked -- we're the leader in that.
REP. KENNEDY: And its prevention. Am I right?
MR. : For treatment, it's exposure therapy.
REP. KENNEDY: Yeah, no, but it's prevention to surround people. People are the best solution to PTSD, loved ones, community, and we are doing nothing to prevent PTSD. You've got wonderful little clinics with 24 people in them.
How are you going to -- you can treat people when they have acute PTSD, but we've got to prevent them from getting PTSD to begin with?
MR. : I certainly agree with that. And I think actually prevention occurs before deployment.
REP. KENNEDY: Okay, so -- all right. Well, how is the aversion therapy going?
MR. : We trained 1,600 of our providers in this based on what the IOM recommended. And we're going to expand from there. We are going to be into the thousands.
REP. KENNEDY: Okay, well, if you could submit to the committee how that's going and whether you feel like you are going to keep pace with the need, that will be great.
MR. : I'd be very pleased to do that.
REP. KENNEDY: And Mr. Chairman, if I could indulge just one more question?
REP. EDWARDS: Okay.
REP. KENNEDY: Are you co-locating your TBI clinics with your other centers of excellence in epilepsy and the like, neuroscience clinics?
MR. : We're working on some new centers of excellence for epilepsy. I think if the plan that we have at the moment, I'm not sure if it's a final plan, at least one or two of them will be co- located with the polytrauma level one centers. Some other ones would probably be elsewhere.
REP. KENNEDY: The only concern we have is, obviously, make them most of the dollars we're spending by co-locating the same neuroscientists.
MR. : I think it's a good point. I appreciate it.
REP. KENNEDY: Thank you, Mr. Chairman.
REP. EDWARDS: Thank you, Mr. Kennedy, certainly an important area to explore.
Mr. Secretary, could I ask where are we on the implementation of the new GI bill; are we on time and schedule? Will veterans that have qualified for the GI benefits start receiving those on time this fall, and will they know soon enough to be able to make their plans for colleges and universities this fall?
SEC. SHINSEKI: I'm going to let Admiral Dunne provide the detail, but Mr. Chairman, upfront answering your question, a very, very tight timeline.
REP. EDWARDS: Right.
SEC. SHINSEKI: And I won't say lots of risks, but there is some risk in the process, and we learn something that every time we put up, you know, a new tool out there. But I'm -- I've been to the training center. I can tell you that training is going well.
Highly motivated people, I asked them if they could do it. There was standing, rousing applause. So on our end, between leadership and providing the information technology that will enable us to do this first time as a manual process assisted by computers; we are in a good line. The issue is we have to keep that line going.
REP. EDWARDS: Okay.
MR. DUNNE: Mr. Chairman, we are definitely, there was never any doubt that we had the right people to execute this program. And they've been working very, very hard since last summer. We brought onboard 530 new people on schedule, and we trained them on schedule in order to be able to process claims.
We were able to start processing claims on the 1st of May. We already have received over 20,000 claims that are coming in at the rate of about 3,000 claims per day. And so we're very pleased with the response that we're getting from the veterans.
We are doing everything possible, we think, to communicate with them and make sure that they know. It's better to submit your application early. The sooner we get it, the sooner we can act on it. And we're moving along with the testing of the other IT systems that we need, and perhaps Mr. Warren could add more on the IT side.
But our folks are performing very well at this point, and we are pleased with the response from the veterans.
MR. WARREN: So the bottom-line is there should be no veteran who is qualified for the benefits who would have a problem getting approval of the funding for the class that start in fall unless there is some bumps along the way between now and the fall.
MR. : We expect that we've got many challenges between now and the 1st of August. But we're on it every single day, and if a veteran gets his application, we're going to make sure that they get into class.
REP. EDWARDS: Okay. Could I also ask you -- or have your time to address how many people you've hired in the claims processing system since, say in the last two years? I know we've got enough fund, and I think to provide as many as -- if you count the stimulus bills, as many as 6,000 to 7,000 new claims processes.
How many have you hired and how many yet to go. And my -- also on that, are you out looking, or are you exercising any outreach to look for combat veterans as potential employees; particularly wounded combat veterans to serve as employees in the VA benefit system?
MR. : Absolutely sir. The first increment of personnel, as you know, was 3,100, and we started that in January of 2007 and we completed that phase. For 2009, we're authorized another 1,100 and we are in the process of hiring those. Now we're about halfway through that hiring.
In addition, as you mentioned with the stimulus package, there was authorization for 1,500 temporary employees. We are in the process now of hiring those. We've got 44 who are already onboard at the regional offices, another 86 who have report dates within the next two weeks. And the remainder of the jobs, we're in the process of announcing and interviewing potential personnel.
We are very anxious to -- at any opportunity to hire a veteran into the VA because we know what good employees they are.
REP. EDWARDS: Right.
MR. : And we -- when we have an announcement that one of our ROs, the first place they go is right to the VR&E Office and see if there is any veterans who have completed their training and are perhaps interested in working in the RO.
I can tell you for, as an example, I went to one of the RPOs after we hired the 530 folks with the GI bill, and I asked how many in the room were veterans. And almost everybody in the room raised their hand. And I asked about the three that didn't, and they said, well, they're either relatives or dependents of veterans.
So I think we can always do better, Sir. We always need to make sure we keep that focus on that we're looking for veterans, but I think we're doing pretty well.
REP. EDWARDS: That's good to hear. And my final question in this round, Secretary Shinseki, would be as a follow-up to Mr. Kennedy's questions about the mental health care issues and care. Obviously, suicide is a great concern to all of us. Could you update us on the status of the VA Suicide Hotline and how that is working?
SEC. SHINSEKI: Sir, it's one of our most successful ventures, quite frankly. We received 120,000 phone calls since it's opened in 2007.
REP. EDWARDS: Right.
SEC. SHINSEKI: Over half of those phone calls, however, were not veterans. We still help them. Now the key thing is --
REP. EDWARDS: How did they find out the number? How did they get it?
SEC. SHINSEKI: The number -- we tied them, we decided not to go along with this. We tied them with Health and Human Services into an existing phone system. And so when you call up the number 273-TALK --
REP. EDWARDS: How do you get that number? I'm having a problem. I'm literally thinking about committing suicide. How do I get that 273-TALK number?
SEC. SHINSEKI: We put it on the Internet, we put it on the buses, we put it on the metro, we took -- put it out to the PSOs; we put it on public service announcements. We got Gary Sinise from "Forest Gump" doing public service announcements --
REP. EDWARDS: Right.
SEC. SHINSEKI: -- Deborah Norville; on and on and on. Everyway that we can, we're giving that number out, and it must be working because a 120,000 people have called.
REP. EDWARDS: Okay.
SEC. SHINSEKI: So they call the main number and then it says, "If you're calling about a veteran, or you are a veteran, press 1 now." So 120,000 people pressed 1.
REP. EDWARDS: Right.
SEC. SHINSEKI: Then out of that, the key number I would like you to remember; we've done 3,000 -- over 3,000 rescues. What that means is while the veteran was on the phone, while the caller was on the phone, we sent ambulance or police to the location where they were at that very moment. And I've just -- if you would bear with me for a moment --
REP. EDWARDS: Take whatever time you need on that.
SEC. SHINSEKI: Most spectacular thing happened about two weeks ago. We got a call from a mother and she was talking to her son through her computer using, I think, a program called Skype. And she was very upset because her son told her on the computer he is going to commit suicide. He had a gun in his hand.
And she called the hotline, the VA hotline in Canandaigua, New York, and they called the Pentagon. Pentagon worked with the local Red Cross and their contacts, and -- I think it's about roughly about 23 minutes later, she watched and -- or heard, well, a person arrived, talked to her son, took the gun out of his hand. The soldier, in this case, was in a wreck.
REP. EDWARDS: Oh, my God. That -- what an incredible story. Thank you. Thank you for that. And I'm so glad to know that the hotline is being used in literally saving lives.
Thank you for that.
MR. : Just call 911, you get the same response?
SEC. SHINSEKI: Well, they would get the police. But many of these cases that call the hotline are not calling because they are immediately suicidal. Some of them just want to talk. And then we put them in contact with our suicide prevention coordinators that we have now located at every one of our medical centers, and sometimes several of them.
I think our hotline is the best because we -- instead of using volunteers, we use psychologists, social workers, nurses who have mental health experience. These are people who are very experienced. The second reason why we're the best, I think, a bit of my -- my pride in this.
If it's one of our patients, we can pull up their record electronically while they're on the phone. And that has actually helped us save lives at times because sometimes they didn't want to tell us exactly where there were at and what their situation was.
REP. EDWARDS: Right.
SEC. SHINSEKI: And with a little detective work, we will be tracing that man.
REP. EDWARDS: Well, thank you for that. And I hope those kinds of positive stories of saving America's veterans, and in this case, an active duty service man; and those kind of stories need to be told.
REP. WAMP: Thank you, Mr. Chairman. My final question of the day is on the cemetery front, and Mr. Muro, the chairman rightly gave you a hot compliment however based on customer satisfaction.
And it is such a well-stewarded recognition of these national cemeteries across the country of the sacrifices that have been made. They're solemn places; I'll be there in two weeks to keynote the commemoration at Chattanooga National Cemetery for Memorial Day.
And I'm there often several times a year. But our cemetery which has civil war soldiers, and many, many storied interments there, is set to close on your schedule in 2019, which I used to think 2019 was a long time from now. But I used to think 2009 was a long time from now and it got here really fast.
So that's a short period of time. Now, they have done studies of ways they could change things around and extend that somewhat, but there is also 15 acres that could be available next to it and it can only grow in one direction because of the streets and right-of-ways.
And so I don't know if you specifically know about this. But I'm interested overall in what the posture is of the VA. This is something that at a time of war, people are really keen into are we going to guarantee this ultimate resting place.
And I don't mean in the next state over. I mean, in the area. I know you have like a 100 mile, 120-mile circumference of each of -- excuse me
MR. : It's 75 miles.
REP. WAMP: Seventy miles. Okay, 75-miles circumference of where these could be, but this is obviously a National Cemetery at Chattanooga that you said that you would want to keep open and preserve. So can you give me an update about where we are with the study?
Assistant Secretary Tuerk was very, very helpful when the last administration came in physically toward the side, and the city is willing to cooperate in any and every way to take the lead on assembling any land, but I've almost seen a posture around the countries; I've studied this that you wait until you are five years away from closure to begin to act.
And obviously, that's not the way to do business in terms of long-term planning; it's much more beneficial to begin the process much in advance of closure so that you can take the necessary steps to actually secure the available land, plus if there is available land, you want to secure it while it's still available before somebody goes and builds a new building on top of it. But anyway, do you know anything about that?
MR. : Yes, sir. Right now we actually have -- because of our new burial policy and practice of pre-placed cribs. We actually have enough land to last an additional 25 years above 2019, before we have to worry about looking for other land in the area. So we are good; 2019 plus 25, and we're already going to start planning the process to install the cribs there so we don't run out.
We tried to stay -- we've changed our policy. We're trying to stay two to three years ahead of closure or -- so that we expand, so we don't close the cemetery. And if we are going to close because there is no further land to use, then we are looking for land, and last year there was appropriation for funds for that. So we are trying to stay ahead of it.
REP. WAMP: Well, I appreciate that. I would say with the VSOs in the room that I hope you communicate effectively with the VSOs so that their membership will understand what you are doing because usually they don't find out except after they make enough noise and their member of Congress then engages as to what any policy maybe that you are in the middle of enacting.
And I can assure you that the veteran community that lives there, they don't really believe this extra 25 years within the fence because your stated closure date was 2019, and then all of a sudden, kind of miraculously, well, they can start pulling rocks out of the ground and make room for more.
And you know, that's just -- they don't believe it. And so help us, if you will, convince the veteran population that you are going to stand behind keeping the cemetery open at all costs because that's basically all they care about. And if you can assure them of that, and then if there is any way going forward to secure that land or even allow the city to hold the land until which time you need it, that would be wise if there is any possible way within your budget constraints to do so. We appreciate your cooperation on that, and I yield back, Mr. Chairman.
REP. EDWARDS: Thank you, Mr. Wamp.
REP. FARR: Thank you, Mr. Chairman. I am amazed, and Mr. Wamp and I've -- I think he has always the questions ahead of me, but they're same questions all day. But I want to talk about the veteran cemeteries. I want to also thank you for your career in this field and for your public service.
REP. WAMP: You're welcome. Thank you.
REP. FARR: I really encourage you, Mr. Secretary, and his staff to look at this 75-mile policy, it's been in concrete for so long, and it's a dum-dum policy. It -- the population of California lives along the coasts. So in this wisdom of developing a 70-mile of a radius, and because of congressional earmarks, you're building your veteran cemeteries in the middle of San Joaquin Valley.
There is no history of military in the San Joaquin Valley; you're building three of them. One of them is already there. It's in Santa Nella which is a truck stop. No hotels, no people, no town, no mayor, nothing. And we are within 75 miles of that. The Monterey Peninsula, the oldest piece of military real estate in the United States started with Spanish occupation. The Presidio of Monterey, and Fort Ord, the land was acquired for the military in 1919. It still has military presence there and a huge veterans presence and that's why you're going to build the clinic there.
But we can't build a cemetery. You have to go the state of California, state of California says, "We don't do state cemeteries." So we are going to the third process, is we're going to get -- trying to get a private developer to put up money, and we'll give them some of the cemetery land put enough money in the pot so the state can file for a state application.
Now, I want to just think outside the box a little bit because I understand that and I'm sort of interested in this, does the 128 cemeteries that you maintain in 39 states and Puerto Rico, as well as 33 lots and monument sites, it's Department of Army that maintains two of the cemeteries, Arlington National Cemetery in Virginia and the U.S. Soldiers and Airmen's Home National Cemetery in Washington DC.
There are also a number of state cemeteries. And the Department of Interior maintains 14 veterans' cemeteries. If I knew, I could go to the Department of Interior and the Department of Army and maybe got them to build the cemetery, I would have done that. But I don't know why it is one, that all of these cemeteries are under just one, you know, under one -- under your department, maybe administratively they are, but why they're being maintained by these -- by the Department of the Army and the Department of the Interior.
And why can't we think outside the box to figure out I've got the land there -- and the title is in the Department of Defense. The feasibility study for it is there; it's going to take us forever to find a third party to put up enough money to build the cemetery.
At the Presidio of Monterey, the Naval Post Graduate School, we could have -- it's the destination tourist area. People want to be there. There are a lot of people that are carrying ashes in their home waiting for the cemetery to be built. And I'd like to just see if there is a way we could find, rather than just reimbursement, which is, you know that's reimbursed for costs incurred. So we have to spend the money. Look, we got to find that money, we got to spend it, and then we can get it reimbursed.
And I mean, this is where California history began. It began with military history, and it's still there. And I would like to try to see if we could work someway to work in a cemetery by your department or whether you'll have to go to the Department of Interior.
MR. : Okay. Let me try to answer some of your questions, Congressman. First of all, San Joaquin Valley, when that cemetery was build, the National Cemetery System could only build on property that was either donated or transferred from DOD. We didn't have the funds at that time to purchase land. So San Joaquin Valley, San Joaquin National Cemetery was a donated piece of property and --
REP. FARR: The Bureau of Reclamation.
MR. : Correct. So that -- hopefully, that answers that one. In reference --
REP. FARR: When President Kennedy, his uncle was the president.
MR. : Oh, you are right.
REP. FARR: It had nothing to do with anything functional for a cemetery; it's just federal land in the middle of nowhere.
MR. : Right, and it was donated. The other question in reference to the Ford Ord cemetery, and the state project that we worked with the state to build the other one which is up in Redding, California; we are working closely with the state and they do have an application right now for that. So they are working with that organization to try to get it.
REP. FARR: For which?
MR. : For Fort Ord.
REP. FARR: They have an application to you?
MR. : Yeah, they have the pre-application in right now, and we are waiting on state legislation to pass it, and then we --
REP. FARR: No, wait a minute. The state legislation passed it saying that they have to put the money up into an account with the state before they will exercise it. And the Shasta Veterans' Department, that was a state senator; he insisted that they couldn't pass the state budget unless they made that state -- his cemetery in -- up in little old Shasta County. In a weak moment, the legislation, the governor signed the bill, and then they hired him as the secretary for Veterans Affairs in California.
So it was a real sweetheart deal, and the state said they'd never do it again. And Schwarzenegger says they won't do state cemeteries, so unless in this case, the money is put up by the private sector.
MR. : And the other question was in reference to how VA received the cemeteries we have. In 1973, Congress passed law and transferred certain cemeteries over to VA. It's where we started and kept -- Army kept DOD and the soldiers.
REP. FARR: The Interior Department doesn't run any cemeteries?
MR. : They run -- yes, they have 14 total cemeteries. Two are open for interments, the rest are closed -- at Park Service.
REP. FARR: We'll work on some, okay.
MR. : Okay.
REP. EDWARDS: Thank you Mr. Farr. Mr. Kennedy.
REP. KENNEDY: Thank you, Mr. Chairman.
We could go back, Mr. Chairman, your question about mental health extended services. The concern I have is the Guard and Reserve. You know because their benefits really aren't as great as obviously the standing military. When they come out, they often don't have the access to the TRICARE benefits, they may go back to their job and so forth. They don't have access to the same benefits. And of course their dependents, their family don't have any access to benefits.
And so the real question is, lot of those families in Guard and Reservists are getting their services through states, through their community mental health centers and the like. What I'm interested in is what we are going to do as a committee, given the fact that states are shedding all of their mental health services because they are all in a free fall economically.
What are we going to do, as a committee, to respond to the need at these community mental health centers of those veterans, to go into those community mental health centers looking for services, because there are no services for them at the VA, because they are quote, unquote, "Weakened Warriors," but they aren't.
They are now part of our total force, but because of the nature of them being Guard and Reservists, they don't enjoy the same package of benefits that the, you know, regular service does. So can you all, kind of answer for me, what are we going to do about this whole new group of veterans that, you know, may not have all quote "service- connected injuries," and the like that are going to allow them to get access to the VA, and how are we going to manage to make sure they get the necessary health care that they need?
MR. : Yeah, I strongly agree with you that, yes, that's a real concern of ours that the Reserve and National Guard come back, they don't go to a military post.
REP. KENNEDY: Yeah.
MR. : They stay with their actual duty colleagues, or they go out into the small communities across the nation and the cities. And that's where they live in trying to return to their previous lives. Congress, working with the VA, just fairly, recently, created a new benefit, and that was that returning from a combat employment automatically create a five years of eligibility.
REP. KENNEDY: Right.
MR. : That was a tremendous hope, and we really appreciate that. They did several things, they also expanded the dental capability, the timeframe as well, from 90 to 180 days. That made a difference because it gives time now for if that new veteran wants to try and obtain eligibility through the CMP process, they've got plenty of time. They're still covered for the health care; they can still be seen and taken care of, as long as there is anything that's even quasi-related to their service in their overseas.
And I want to thank you for that.
REP. KENNEDY: Is -- are we going to have, like I know Secretary Shinseki was talking about, back in the Vietnam War there was always a challenge to Agent Orange because there was a question, was this the real thing or not? With this war, with you know, the combination of TBI and posttraumatic stress disorder being the signature wound, are we going to have a bureaucratic process of challenging veterans when they come in and saying, you know, "prove it."
Or are we going to have an assumption that, if they've been to three tours of duty, they've been out in their combat, they've been out and they're driving outside the Green Zone everyday, you know, which we know would take any normal person knowing that they are taking their lives in their hands everyday when they drive outside that Green Zone, that that's going to put any normal person in a position where they could suffer from posttraumatic stress, and say that they're going to be eligible for veterans benefits, access to the health care system.
MR. : Thanks. For the health care component, we're happy to see them. It's not a matter of trying to prove that they need to be seen. If they say they need to be seen, they need to be seen, and during that five-year period they have the eligibility to do so.
REP. KENNEDY: Okay.
MR. : And I think as I mentioned earlier, that gave some time to engage with my colleagues of VBA as well to -- (off mike.) Admiral Dunne.
MR. DUNNE: From the benefit side, we're of course, charged with evaluating the need for compensation based on the medical evaluation that's provided.
REP. KENNEDY: Right.
MR. DUNNE: And we are looking very carefully right now at the process that we go through to -- when a veteran claims PTSD, the evidentiary requirements that are in place, we're evaluating those to make sure that they are sufficient to ensure that during the time period when they have straight access to VHA, that we're able to complete the medical evaluation that's required, so that if necessary, we can ensure that they get their compensation benefits in a timely manner.
REP. KENNEDY: One of the concerns I hear about homeless vets is that while we're increasing the number of permanent vouchers -- and thank God, finally we have permanent vouchers, and so these temporary vouchers for these endemically homeless vets. We need more support services for these vouchers. In other words, we need administrative personnel, like, I hear there are a lot of vouchers in a lot of these different places because there aren't enough staff on hand in various places to administer these vouchers and get the support services wrapped around these veterans who need these vouchers.
One case in point, my cousin Bobby Shriver, who is on the council out in Santa Monica says that there is a number of excess vouchers. I had a hard time believing it knowing the number of homeless veterans out there. And he says it's because there is not enough veterans, you know, staff to help administer those vouchers. So maybe you could take a look at that.
MR. : Let me take a look at that and then come back to you, sir, answer on --
REP. KENNEDY: And if you could --
MR. : I was not aware of excess vouchers.
REP. KENNEDY: Okay. If you could also look at what percentage of our VA medical centers, what the timeline it is for folks to get help from mental health services, and what the shortage is for mental health professionals in all these outpatient clinics and mental health centers.
You know we have this -- there was a big study from -- McClaskey (ph) did a couple of years about how long it took for someone to get served in a VA clinic. And in some places, it took x number of days; other places it took just, you know, few days. And it'd be nice to know kind of how that's gotten evened out now that we've plussed up the accounts.
MR. : Sure, thanks.
REP. EDWARDS: Thank you, Mr. Kennedy.
Members, I think we are getting close to the series of votes. And I only have two other quick points. One, I would like to ask Secretary Shinseki -- either you or Secretary Warren, whoever is appropriate to address the question of, is you're trying to develop DOD in VA medical records that can communicate with each other and be passed seamlessly back and forth.
How does that work in with the country trying to set up some sort of national standard for private, profit, and non-profit hospitals? I assume we won't have VA and DOD accepting one standard and the rest of the country going in another way, because we need records to deal with the transfer from a VA hospital or DOD hospital to a private hospital, and is the development of the national health care reform bill in a standard -- does that slowdown the DOD-VA process in coming up with medical records, electronic record systems?
MR. : This is an important question, Mr. Chairman. The agreement that Secretary Gates and I have made in which the president publicly announced that there would be one standard; now begins the hard work of exactly what is an electronic record, what is the electronic health piece of it, and what is the electronic administrative and personal piece of it. What does it look like, and make that come together.
There is great interest in doing this quickly. And part of the interest is to be able to come to an agreement on exactly that requirement and be able to share, perhaps, with HHS. Here is, you know, those of us who've been at this for a while, here is a good start point for you, so that there'd be some synchronization, some linkage between the opportunities that they will have to decide for the rest of the country.
And the work that VA and DOD has already done for a couple of decades; lot of hard lessons learned, some disappointing ones, but we've come long ways here. And so as we create a single, joint, virtual electronic record, I think it's important for us to link in with secretary at HHS and just offer up a model to consider.
REP. EDWARDS: Okay. And my final point and/or question would be this. We don't do earmarks in the VA, and we're anyway very fortunate of that. But what happens as a result is that some of us, perhaps, because we serve on the subcommittee, have private entities, entrepreneurs come to us and say, "Here is a great idea that can help the VA provide better medical care at a less cost to taxpayers."
We don't really have the ability to evaluate whether those makes sense. And maybe nine out of ten of those proposals wouldn't make any sense, but one out of ten might be the one that could save the VA millions of dollars and help save lives and provide better care.
Does the VA have a system for evaluating good ideas and separating those from bad ideas in terms of health care innovation? And secondly, on that same point, is there a system by which you can fund innovative ideas that might help the whole country without taking that money out of the hide of the OAM budget of the local VA hospital, or the VISN.
Because if you don't have that separate funding source, I could see I'm VISN director, and I don't want to take money out of my VISN or out of my hospital to fund what could be a national pilot program that could help the entire VA health care system. Do we -- I haven't found a care -- thorough process. Maybe I've heard at some point the secretary for Health has -- in the VA has some kind of a discretionary fund.
But is there any kind of a formalized process, review, good ideas. We have the same problem in Homeland Security. We've all had people come in with ideas there. Well, any thoughts on that? Yes.
MR. : Comparative effective research.
MR. : Should have it in our CMS.
REP. EDWARDS: You have a system of comparative effective research in VA.
REP. : Actually, I'm interested in what the acting secretary for Health is -- undersecretary for Health is going to say the -- answer this question.
REP. EDWARDS: Dr. Cross.
MR. SHINSEKI: But it is just to --
REP. EDWARDS: Right.
MR. SHINSEKI: -- lead into this. It is part of the reason why I am hoping that we'll get your support in setting up an office for the assistant secretary for acquisition, so that we'll have a single place where good ideas can come and be vetted and, you know, a void being dissipated or being --
REP. EDWARDS: Right.
MR. SHINSEKI: -- discouraged or frustrated by where it gets a professional vetting, because right now these things do go on, but they go on in multiple places in the VA.
REP. EDWARDS: Right, and is that, Mr. Secretary, where these ideas would be placed in the future when you create that office?
MR. SHINSEKI: In the future, if we were able to stand up this office, this is where this kind of innovative thinking, creative thinking, would have an opportunity to be aired, evaluated, and then shared.
REP. EDWARDS: Okay.
MR. SHINSEKI: Let me let Dr. Cross answer what we do today.
REP. EDWARDS: Okay.
MR. CROSS: I'm looking forward to hearing what I'm going to say as well.
Now seriously, sir, there is some formal process. And let me -- it's a little bit different from what you might expect. We do a lot of innovation in terms of pharmaceuticals, new drug treatments, new surgical treatments, vaccines -- the herpes zoster vaccine, the shingles vaccine worked with civilian medical schools and the VA to make that a reality, and it's now FDA-approved and out there, and used everyday.
And we work with DARPA, and you may have seen "60 Minutes," our TV show recently, where they talked about the DARPA arm, that the VA is working with them. Our new prosthetic far more advanced than anything that we've seen before, and ability to manipulate objects. So in terms of research, we do a great deal to -- but particularly on the health side, it's really pharmaceuticals, new treatments, new devices, and sometimes --
REP. EDWARDS: What office evaluates those under the present system without the new acquisitions office in place? Is that the undersecretary's office, do you have particular staff to do that, or did you subcontract that out to various parts of the country within the VA system? How do you evaluate the -- ?
MR. CROSS: The kind of things I'm talking about go through research protocols.
REP. EDWARDS: Right.
MR. CROSS: And our research office handles the --
REP. EDWARDS: If it's not a new drug, it's -- you know, it's somebody coming in, or the system for telephoning veterans to be sure they take their drugs this morning, and if they don't call back -- and that was the one that came into my office, for example. I have no idea whether it made sense or not. But -- and you know, if the veteran didn't call back, then it keeps calling him until they call back and say, yes, I took my prescription drug this morning. I mean, how about that kind of devise or other projects that are, you know, that can -- that you mentioned.
MR. CROSS: I think I know that project by the way. Two ways that happens. Number one is, they go to the local facility, local VISN and say, listen, I'd like to try this out locally, would you be interested. And number two, they come to the central office and talk to someone of my staff and say, listen, I've got this great idea, this great product, can I get a briefing. We do accept those briefings, and we do accept some of these proposals after the staff would look down and see if it makes sense.
REP. EDWARDS: Okay. And in the future, will that go through the Office of Acquisitions? If in the future somebody like this calls our offices, who should we refer them to?
MR. : That would be my preference for all of those to come into one location and then from there they'd be shared with the experts also on the --
REP. EDWARDS: Okay.
MR. : A discipline process for evaluating the goodness. They're all good, they're well-intended. But where is the fit?
REP. EDWARDS: Okay. I thank you for that answer.
Mr. Wamp, do you have any additional questions?
REP. WAMP: Yeah, Mr. Chairman. Really a cutting edge piece of high-tech and that is dogs. We talked about this, Mr. Chairman and Mr. Secretary, these dogs that help our veterans particularly, not only the guide dogs for those who are physically impaired, but also those who are suffering from PTSD.
They take them out, so they have to go out for a walk, and help them calm their nerves when they are feeling an anxiety attack and the like. They can be trained in the prisons by prisoners. What's your feeling about us expanding the use of these kinds of animal -- use of animals to help out those many, many veterans that you've identified as, you know, having issues, anxiety issues and PTSD issues?
MR. : The answer I'm going to give you is a little bit mixed in terms of how we're responding to this. And so I want to be frank that this is how we're approaching it right now. I don't want to paint a picture that's different from reality in any way. Guide dogs have been part of our program for a long time. Everybody knows they're well-accepted and often supported by us. So now we are talking about a different category of dogs called service dogs.
Service dogs are -- we support them in a limited fashion for physically and hearing-disabled veterans under a case-by-case basis. We work with an organization, and I believe, it's called the Assistance Dogs International. And we have a draft -- we have an information letter that we've drafted to inform the field that only these accredited dogs organizations who do not charge for the dogs or their training should be utilized.
VA then, in that circumstance, will pay the veterinary bills and any hardware the dog may require while performing the designated task. I don't know how many that we're supporting at this time; I don't think it's a large number Mr. Kennedy, certainly not compared to guide dogs. But I'd be happy to have our staff talk to you about this.
REP. KENNEDY: That would be great. I'd love to get a briefing on that. Thank you.
REP. EDWARDS: Well, with that let me thank you all for being here.
Secretary Shinseki, I look forward to working with you. And each of you; Admiral Dunne, Dr. Cross, Secretary Reed, Secretary Merrill, Secretary Warren, thanks to each of you for your dedication to our veterans.
And we may have finished our formal questioning, but one of our colleagues who has done so much on behalf of veterans, Mr. Buyer, Indiana, who is the ranking member and former chairman in the VA authorizing committee. We can't do anything. We can't write -- (inaudible) -- we can't write checks in this subcommittee if he didn't authorize it in his.
It's good to see Mr. Buyer here. And I even saw on the Washington Post, I believe, today about new legislation you've introduced, Mr. Buyer, to help widows of those who served in combat and given a lot for our country. We're glad to have you here, and welcome you to this subcommittee anytime you're here. Please.
MR. BUYER: (Off mike.)
REP. EDWARDS: Oh, that is great.
MR. BUYER: (Off mike.)
REP. EDWARDS: Well, Mr. Buyer, thank you. And welcome to all of you. My only disappointment of today is I didn't bring my 11-year-old son here to meet you, sir. Thank you for coming and what you do to support our service men and women, particularly, the members of the Guard. Thank you; we are honored to have you all here. With that we will stand adjourned.
Thank you, Mr. Secretary.