Now were going toint dues our head table. Please hold your applause until everyone has been introduced. The head table is usually reserved for members of the club , our guests, and guesses of our headlineser speaker. Going from my far left, mike ith, c. E. O. Of green smith p. R. Nabbling press clubHeadliners Team member. Jim noon, vietnam navy veteran and commander of the American Legion nabbling press clubheadliners pl press club, which is founded by general pershing. Myron, my predecessor National PressClub President , 107th president of vet , a vietnam veteran as well. The honorable john elliott, who i have been chasing around capitol hill and all kinds of places for almost 20, 25 years. Way too many years. John is the assistant secretary for public and Intergovernmental Affairs at the United States department of Veterans Affairs. Katelyn kenny, producer at cbs radios connecting vets dotcom. Thomas murfirks acting undersecretary for benefits at the u. S. Department of Veterans Affairs. Evan katelyn kenny, womensing, more luncheons than i care to count. Captain, u. S. Navy retired. National press clubheadliners member who coordinated todays luncheon. Our speaker for a moment. Joseph morton, Washington Bureau chief for the omaha world harold and former member of the National Press club board of governors. Thanks for coming. Vivica wright simpson, chief of staff at the United States department of Veterans Affairs. Moment. Joseph morton, Washington Bureau chief luke, Lieutenant Colonel u. S. Army retired and global war on terrorism terror veteran. Longtime member, john sergeant, United States marine corps, vietnam veatveth ran, president of the blinded American Veterans foundation. You have been with us member for over 30 years, havent you, john . Too long. Communications manager at the stable sports u. S. A. [applause] like to acknowledge additional members of the Headliners Team for organizing todays event, betsy and lisa our cochairs. Jamie, heather, lisa, kevin, april, and of course our press club staff. Specifically lindsay, laura, and our executive director, william. Four or television and radio audiences please be aware that in the audience today are members of the general public. So any applause or reaction you may hear is not necessarily from the working press. Dr. Shulkin was nominated by President Donald Trump to serve as the ninth Veterans Affairs or v. A. Secretary, commonly called, and confirmed by the United States senate in february. Prior to his role as secretary, he served as the v. A. s undersecretary for health 18 months, leading the nations largest integrated Health Care System with more than 1700 sites of care serving nine million veterans. Before he began his service with the v. A. , he held numerous chief executive roles at the morris town medical center, and atlantic Health Care System, Accountable Care organization, served as president and chief executive officer of the Beth Israel Medical Center in new york. He has held numerous physician leadership roles, including chief medical officer at the university of pennsylvania health. Hes a fellow pennsylvanian. A lot of you know that im a pennsylvanian. Always acknowledge that. Temple university hospital, Medical College of pennsylvania hospital. Hes also held academic ositions including chairman of medicine, Drexel University school of medicine. Internist, he is a fellow of the American College of physicians. And has been named one of the 50 most influential physician executives of the country. And among the 100 most influential people in American Health care by modern health care. We look forward to our dialogue today on v. A. s efforts to care for millions of americas veterans internist, he is a and improve the effectiveness of the v. A. Health carecies tefment so Health Care System. Please give a warm National Press club welcome to secretary david shulkin. [applause] secretary shulkin good afternoon, everybody. Its great to be here. And i couldnt think of a better time to spend with you than five days before veterans day. Saturday i hope all of you have that marked down and are planning on doing something meaningful on saturday. We have been celebrating veterans day really for 98 years. First as Armistice Day when world war sr. Ended, and 54 years ago changed it to officially to veterans day. Some of you may have seen last week right before the president left for his trip to asia, that he signed a proclamation declaring the entire month of november, veterans and military families month. Which really, i think, is indicative of his real passion and respect for this countrys veterans. And so each day of this month we have Something Special that is going to be announced or an activity that will happen. Today were here with you. That counts. Youll see things like for the i. D. Card a national for veterans being rolled out. Youll see the president S White House hotline, the 24 7 hotline answered by veterans and military families. That will be rolled out in the month of november. And expansion of a new national cementtary in los angeles. Tomorrow well be ringing the bell on wall street in honor of veterans for the close. A Public Service announcement that is going out across the country this month, narrated by tom happings on redution veteran suicide. So the month is filled with loot of recognitions and important events, but it really is a symbol, i think, of the progress hat were making and the transformation and modernization of the department. And as you know, in this during this year we have seen some pretty important transformation and changes happen at the v. A. We have had five major bills go through congress. Im particularly proud everything were doing through congress is being done in a bipartisan way with real clear alignment between where congress, department, and president wants to take the department of Veterans Affairs. We have had for the first time a new bill with authorities for accountability. We have seen an expansion of the g. I. Bill called the forever g. I. Bill. We have seen two bills not only expanding options for care in the community, but also investments in the v. A. With 28 new leases. And we have seen appeals modernization, which hasnt happened since the 1930s. A lot of activity. Were also seeing progress on the five priorities that i have stated are most important to me as secretary. Giving veterans more choice about how and where they get their care and benefits. And that creates a system that really allows us to be more responsible and accountable to veterans as customers. We have seen progress in our timeliness of services, in our wait times that now are publicly posted for everybody to see how long it takes to get appointments. We still are the only Health System in the country that times. Y posts its wait we now postdatea showing that v. A. Actually does better than the private sector in wait times. Maybe thats why they dont post their wait times. Were improving performance in disability timeliness. With the new appeals modernization, well be making progress on the timeliness of appeals. Were modernizing the v. A. I have announced a new Electronic Medical record. The same one the department of defense uses. I also announced were going to be disposing of 1,100 vacant and underutilized facilities. Fourth priority is were going to focus more on those things that matter most to veterans. What we call foundsal services. Foundational services. Conditions veterans are impacted on in their connection to service like spinal cord injury, blind rehabilitate shin. Posttraumatic stress. Traumatic brain injury. Polytrauma. Things that matter most. Youll see v. A. Investing more of those services and not as much in service that is can be accessed easily in the private sector. Last and the only clinical priority of the five i talk about is suicide prevention. 20 veterans a day taking their life unacceptable that that is still happening. So were focusing all of our efforts working in also of ways that we havent focused on before to try to get that number down. And down significantly. So those are the areas that ere working on. Because im here at the National Press club, i wanted to challenge myself and in the spirit of veterans day, aim going to talk about something much time t spend as as maybe i should talking about that, that is our area of benefits. I think that this is an area that i believe we can do much t as maybe i should talking about that, that is better in. We have a system that, my opinion, is far too complex. Filled with too much bureaucracy. I know that we just can improve this as well. So every speech should tart with a disclaimer. Conflict should start with a disclaimer. Conflict of interest. Im going to start by saying i am far from an expert in the issue of benefits. I really consider myself a Health Care Expert and still as a practicing physician. About health care. Not as much about benefits. I have learned a lot as secretary, im trying to learn every day more. I want to thank tom murphy for being patient with me and also teaching me. But i have learned a lot since i became secretary. That the want to say way whenever i approach an issue that i dont know a lot about, i have to go back and understand how we got to where we got to. I have to go back and really understand the people before me. Why they made decisions like and a little bit about the history. So today what im and a little t the history. So today what im going to do is give you a lesson in history about benefits just because i myself. O this for this will lead towards after understanding the history my thoughts about where we go from here and what those future opportunities are. So when i started learning about benefits for veterans, i actually went all the way back time of the romans. And this is the earliest i could trace when roman soldiers would finish a war, they would actually get rewarded by being given land for their service. But the first time i could find the American History on supporting veterans was in 1636. Thats when the pilgrims of Plymouth Colony were with the indians war with the indians antipilgrims passed a lat at that time that stated disabled soldiers would be supported by the kohl nifment virginia was the first colony colony. Virginia was the first colony that followed with that law in 1644, and maryland followed in 1661. Next its 1776, the continental congress, they actually provided pensions to disabled soldiers. But at that time paper money was worthless, so the soldiers really went destitute. They had worthless paper. In 1778, this time the officers were offered half of their pay for life during peacetime, but begin the treasury didnt have any money and so it just issued i. O. U. s. In 1818, president james monroe introduced the First Pension benefit. 0 a month for life for officers. And 8 for enlisted soldiers. Congress calculated, this must have been the goy, officers. And c. B. O. , that the total cost of the 500,000 expecting very few people would actually apply, but the cost turned out to be much, much higher. Six times as many veterans applied for the benefit than they had expected. So in 1820, two years later, congress had to amend the pension law to include only those that were indigent. In 1829, president jackson tried increase the pension to veterans, but congress defeated it. Said they werent going to go along with it. But due to the previous pension and the concern for escalating costs, in 1834 Congress Held a hearing, formed a committee. You can see we still hold some of these traditions. And found that there were 32,900 men who were still receiving pension from the revolutionary war. That was 50 years earlier. So they concluded that the andem was filled with fraud abuse in thecies tefment in the system. That didnt stop congress. A few years later in 1836, they expanded the pension, this time for widows of soldiers. The first home for veterans in the United States was the naval asylum. This is the first time the government went out and started building places where veterans could go. In 1834 it began to accept its first retired navy sailors. And that building still standards today in philadelphia. All thole though a new naval building was built in gulfport, mississippi, where soldiers are able to go during after retirement. On march 3, 1865, president lincoln, a month before the end signed a law r, establishing a National Soldiers and sailors asylum. The next day on the signed a la inaugural address, thats where lincoln committed the nation motto, till hold as our to care for him who shall have born the battle and his widow and or fann. Thats something and orphan. Thats something today we talk a lot about. In the decade after the civil war, pensions were increased 10 times. Consecutively. So about the time of lincoln, you were offered 75 for a lost leg. 50 for a lost arm. Or if you decided not to take the payment, if you would forgo t. You would be given an artificial limb from the government every three years. They would replace it for you for life. That 6, this was the year organizations were formed. With this the sole purpose, maybe like today, to Lobby Congress for more help for veterans and to build more soldiers homes. The largest Veterans Service organization at the time was the grand army of the republic. And youll still find those g. A. R. , on a lot of the tombstones g. A. R. , on a lot of e tombstones in our national cementtaries today. Right around 1866, thats when morphine was developed. As was the hypodermic needle. You began to start seeing a huge rise of drug abuse among veterans. It was estimated that in 1866 that there were more than 45,000 veterans who were addicted to morphine. At that time veterans with drug and alcohol abuse or even mental as th issues werent viewed being related to conflict of war, but they were seen as criminals or as weak and were completely shunned by society and often their families. Treasury secretary estimated that claims for veterans had reached estimated r veterans had reached 150 million. Resident rutherford haste hayes, at that time expanded benefits by signing the arrears act which extended disability claims beyond five years. Up to that point you hayes, at that time had a fiveyear limitation. 1878, there had been 25,904 claims for pensions filed. But after the arrears act, by 1980, it had gone from 25,000 to 138,000 claims filed a fivefold increase. In 1885, president grove cleveland took office and pensions for soldiers at that time were the single largest item in the federal budget. Yet cleveland signed 1,453 additional veteran bills to add benefits. So he was the most prolific in terms of expanding benefits. In 1887, so just two years later, cleveland actually vetoed the dependent pension bill to grant benefits to disabled veterans regardless of whether they were Service Connected or not. So he vetoed it. And this was thought to be the major reason he was defeated for reelection the next year. Even though he had signed 1,400 bills, his unwillingness to support that one bill was thought to be his end of his political career. Hen penning anyone Harrison Benjamin harrison was president in 1890, Congress Passed that bill, the dependent pension act. Any veteran who served 90 days or more was eligible for a pension. In 1907, and again in 1912, congress graduated the payments by age and length of service. So continued to increase them. Were now at world war sr. , 1917. Congress established a new disability system of compensation and vocational rehabilitation for disabled veterans. World war sr. More than 300,000 veterans were wounded but only 47,000 claims were approved. It was a pretty steep curve to get approved even at the end of world war sr. The first consolidation of all these veterans programs, which had been disbursed throughout the government, occurred in 1921 when congress combined everything to create the Veterans Bureau. The budget of the Veterans Bureau at that time was 477 million. Colonel Charles Forbes was put in charge of the bureau in 1922. He started to set out construction of v. A. Hospitals across the country because the world war sr. Vets were coming back with tuberculosis and psychiatric issues were quite significant. I dont know how many of you know about Charles Forbes, but things didnt end too well with him. He ended up being arrested and going to jail for having stolen a lot of the money that was supposed to go to constructing v. A. Hospitals. The second time that the v. A. Veterans programs got consolidated, was on july 21, 1930, when president hoover elkate vathed the Veterans Bureau to elevated the Veterans Bureau to the veterans administration, what we call it today. Vetoed president hoover the world war just and compensation act, which had would have allowed veterans to borrow up to 50 of their Life Insurance value. Congress the world war just and compensation act, which had president hoover, and so more than three million veterans took advantage of borrowing on their Life Insurance. ,000 e summer of 1932, 17 veterans of world war sr. Marched on washington, d. C. , to demand payment of a bonus that was promised on them. It was never paid. They called themselves the Bonus Expeditionary force and dubbed the bonus army by the media. The marchers protested all throughout washington, outside white house, white house, capi federal buildings until president hoover had to send troops to clear the campsite where they were all living along the river. The troops included infantry, cavalierry, and six light tanks commanded by major george patton. And army chief of staff Douglas Macarthur had the command and his aid at that time was dwight eisenhower. The three of them. And the bonus marchers and their wives and children were driven out by the soldiers and their shelt earns belongings were burned. Two veterans were shot and killed by police for resisting that type of eviction. The bonus army turned out to be a political disaster for hoover and was one of the main reasons why they thought that he lost his 18932 election to f. D. R. In 1935, we were in the great depression, president Franklin Roosevelt vetoed a bonus bill to give an additional 2. 5 million to veterans. But again congress overturned that veto. The disabled veterans act of 1943 was passed for veterans with Service Connected disabilities. More than 60,000 veterans of world war ii benefit interested that. The g. I. Bill was signed june 22, 1944, and represented a major advancement in Veterans Benefits. Over 7. 8 million world war ii veterans took advantage of the ducation benefits at a cost of 14. 5 billion. The g. I. Bill also created the v. A. Home loan program which helped build 1 5 of all single residences in the United States between 1944 and 1993. Part of the motivation of why the g. I. Bill residences passed that fear of what happened with the bonus army after world war sr. They didnt want to see that repeated in world war ii. The g. I. Bill and the veterans readd judgment assistance asket 1952 were put in place to help those that were newly discharged, particularly coming home from the war. All you may have heard of general omar bradley. Hes the only secretary whose picture hangs in my office to this day. He was the v. A. Administrator from 1945 to 1947. But they brought him back in 1956. So nine years after he left being the head of the v. A. , to chair a committee. The president s commission on veterans pensions. What he said was, at that time, was our present structure of veterans programs is not a system. Based ecreation of laws largely on precedents built up over 150 years of piecemeal development. So the commission he chaired said, the practice of assisting the veteran in the immediate readjustment to civil life would be most effective. A veteran should receive help when he needs it the most. He was advocating a different approach towards looking at benefits. Instead of it being piecemeal a system to help people in their transition to civil life. At that time in 1956 veterans were 45 of the u. S. Population. Fast forward 50 years, 2007. The doleshalala commission, they found that there was no clear National Policy of Veterans Benefits and recommended to congress a complete restructuring of the disability and compensation systems to achieve the following objectives. To clarify the d. O. D. And v. A. Disability systems. To create a single comprehensive medical exam. To provide lifetime tricare benefits for combat injured soldiers. To restructure the v. A. Disability system. To determine the appropriate length and amounts of transition payments. To update the disability ratings schedules. And to develop flexibility rehab and educational programs. So looking back over these 150 years, at least 150 rehab and el programs. Years, i come to the following conclusions. After sort of immerses myself in this history. That the congresstry, our country, is never really fully prepared for the impact of returning veterans. There always seem to be surprised that these people come back and they have all sorts of issues that need our help. That the changes in benefits that we have seen over these 150 years are always politically contentious and they are related to the Economic Conditions of the country. Whether we expand them or essentially have to renege on our commitments to our veterans. And they tend to have no real rationale for why they happen. Its more opportunistic rather than thinking about this with the systems approach. Some of our disability payments look like they really require the veteran to remain disabled. And they create disincentives to recovery. While other of our benefits are enablers, help people restore their function and independence. Me putsem it appears to v. A. In an adversarial relationship with veterans. Where they have to come to us and ask rather than we are trying to help them, at least some our benefits. And lastly, i would say the cost projections always fall short. The actual costs of these programs always tend to be more than whats initially thought. We also have a very complex system of benefits when we look where were now. Its filled with red tape. Its filled with uncertainty. And difficulty in navigating. The compensation and the c. M. P. Exams as we call them are examinations that to doctors use equipment that we never heard of. Are based in rules and systems that clearly are equipment that we never outdate. We have a system of ratings and reratings where you constantly need to go back and ask for adjustments. It is difficult often to distinguish Service Related disabilities from age related disabilities. And we have built in systems to maximize getting more disabled. There are some parts that if youre not above 50 Service Connected you will not be able to access other benefits. Before 2004, military veterans couldnt concurrently receive d. O. D. Retirement benefits and v. A. Disability compensation. But in fiscal year 2013, just to give you a sense, we had 59,000 d. O. D. Retirees now receiving concurrent payments of d. O. D. Retirement v. A. Disability compensation. Social security, disability insurance, and just for those 59,000 that totaled more than 3. 5 billion. In the past 20 years we have seen a dramatic increase in the average degree of disability. How severe the disabilities are. Flat for 30d almost for the previous 45 years. At about 30 disability. That would be the average that it stayed flat. Up until about 1995. Since then its increased by 2 3 from 30 flat for 30 in 1995 to this year. So the average degree of disability. We see veterans coming back for more and more rating decisions and filing disability claims. 81 of veterans who file supplemental claims are receiving already monetary compensation from veterans benefit administration. Claims eterans filing are already rated 50 or higher. 10 of those who file claims areclaims already at 100 disability rating and their filing. In 1999, just to give are already at you a of what was happening with the disability system. 10 of veterans had disability for ten nigh tiss, of what was the oors. Tenitis, ringing in the years. From 1999 through 2016, the rate of ptsd had doubled across the country, and now over 50 of new claims filed for tinitis. It was 10 now its above 50 . Ptsd accounts for 24 of all disability payouts, about 15 billion a year. We have nearly 900,000 veterans receiving payments for ptsd, 17,000 a year. The next most common or costly disability is sleep abneya at 3 billion. Then Heart Disease followed by depression, hearing loss, and diabetes. Mandatory benefits have really been growing in recent years. In 1980 it was 13. 7 billion. Its 95. 3 billion. Huge increase. We biggest its causes in 2005 had the presumptions for agent orange exposure for diabetes and several Court Decisions called the nemer decision we adjusted payments. In 2011 three new presum tiffs for agent orange. We had an average degree of disability increase that we talked about up to above 50 now. And we have seen a large number of new veterans filing because they are dissatisfied with their current rating system. P. B. A. s administrative cost vs. Increased dramatically from 1 billion in 2000 to nearly 5 billion now. In administrative claims. Our contract medical exams, the c. M. P. Exams are about 20 of the investigationary budget. When you think about our benefits program, the most successful programs, i believe, are those that are enabling veterans to have meaningful lives and to have independence and security. When you think about those that have been the most successful, i think of the g. I. Bill, the home loan program, vocational rehab program, our support for those that are severely disabled, our group Life Insurance programs. So what should our benefit programs do . I would in my opinion suggest that they should be providing Financial Security for those who are severely disabled. They should be providing mental and physical wellbeing to our veterans. Helping them with Economic Opportunities and pursuing their professional and career development. And reintegration into civilian into the civilian community as was suggested by omar bradley and then again by the dole shalala commission. With those four aims in mind, here are some things we should consider in making futurepolicy. We have to maim simpler benefits determinations. Frankly were spending too much on administrative costs. We have to let veterans know what they can expect. They shouldnt have to constantly be refiling claims to get what they deserve. We have to emphasize Service Connection for disabilities so we arent compensating veterans for age related issues. We have to focus benefits on enabling independence so veterans can succeed on their own. Thats what leads towards feeling a sense of wellbeing. We need for there to be continued support for those who are truly dependent. Those veterans of Service Connected disabilities making it impossible to get by without assistance. Thats a commitment that our country has to always uphold. So what would some of these new benefit Solutions Look Like when we think about benefits designed. You are already beginning to seat v. A. Providing some of those solutions. Under tom murphys leadership were introducing this month day of discharge determinations. When you leave service, getting a decision on the day of discharge. Were working towards the day welfare reform we could do instant adjudications, just like you can get a credit score on your phone or on your computer whether you are approved for a new credit card, instant adjudications where people get decisions. I think we need more incentives for achieving wellness and independence. This should be a system that focuses on veterans abilities not on their disabilities. And i believe v. A. Needs to transform into an organization where were veterans advocates and we facilitate them getting benefits not being the gatekeeper of benefits decisions. So today here at the National Press club i call a new way of thinking about benefits. I want to see an ongoing dialogue with stakeholders about rationalizing Veterans Benefits. A veterans benefit Advisory Board that can bring clarity to what were trying to do for veterans and whats best and how we can do that in the best way. I think as history has shown me policymakers just havent thought strategicically about Veterans Benefits over these past 150 years. They just kept on piling on benefits without any clear objective other than patriotic gratitude and political exspeedens. Sometimes more of the latter than former. The original g. I. Bill might be the exception. It started with the veteran Service Organizations who were looking ahead to the end of the war. With clear but limited aims of getting returning veterans back life. Vilian thats the kind of thinking we need to do again. I look forward to having that discussion with our new veterans benefit Advisory Board. Let me be clear, though, this is not about taking away benefits from veterans. This is about making veterans making benefits work bert for veterans and transforming the department of Veterans Affairs to do better for years and for generations for future veterans. I think they deserve no less than that. Thank you very much. [applause] host now the questions are starting to fly forward. There are a lot of different questions that have come up during the luncheon. Were going to start with headlines, actually. As we well know were barely 24 at after a mass shooting the First Baptist church in texas. The shooter was a veteran. The shooter also was discovered in his history to have a bad conduct discharge with ties to domestic abuse, and somehow he got his hands on a gun and committed this awful tragedy. And we had the governor 6 texas of texas and the president of the United States issue from the hip proclamations this is a Mental Health matter. As a medical professional, is that a sound thing to do to come from government when we really dont know what was going on, especially somehow n. O. W. Since the shooters diseased . Second, does this cause to you ok at the notion of what away ts should go depending on what kind of a a veteran receives . Not just here but in the bergdahl case his attorney argued for him to not have a disHonorable Discharge because at would take away the benefits he would need benefits he would need to get care because of what happened to him during captivity. Could you just address texas and bergdahl on benefits since were talking about benefits . Secretary shulkin well, i think it should go without saying this is a very sood situation and tragedy not only for the families in the town of texas but for the country. But in my opinion, i do not him a veteran. That would give him much more respect than he deserves. He is a criminal. And i think that he was were a disHonorable Discharge. Does not deserve to have the same tight as the men and women who served this country and honorably been discharged. There is a distinction between those that have received an other than Honorable Discharge and those that have received a disHonorable Discharge. Bad conduct. We have distinguished between those two. Honorable other than discharges we do believe are in need of our assistance and help, particularly with mental illness. And i have as secretary authorized the provision of emergency Mental Health services for those that are other honora discharges we than honorable, because we know they are a higher rate of suicide and homelessness. Hose with bad conduct or such ge, bad discharges as this gentleman, have violated the law, have violated our rals and ethics and do i not h believe deserve the and i do not believe deserve the types of services and benefits and v. A. Will not be providing those benefits. This is not a person who has ever been treated in the v. A. System and would not be eligible for those benefits. Believe deserve its sad. I dont think we know enough about his state of mind to give him a diagnosis. Unfortunately in this world there are people that are evil and there are people that are criminal. And you dont always know the reason why. But i certainly believe that he was an evil person. Host what about in the case of former sergeant now former private bergdahl and his plea to get benefits because of what captivity . Him in thats a unique circumstance. Secretary shulkin again, hes a person that has received a bad conduct captivity . Thats a unique circumstance. D not recognize him as having the ability to receive benefits at v. A. I dont believe that he honors those that have served and have worn the uniform proudly. And it doesnt mean that as a and as a compassionate person that i do not i certainly want him to get the help that he needs and believe he should have access to treatment, and as but it would in the system thats supported by the department of Veterans Affairs. Host the system shouldnt change in your view . Secretary shulkin i think our system does need to change. We need to change in recognizing that many of those that have other than Honorable Discharges, not bad conduct discharges, but other than Honorable Discharges are there because of a need for Mental Health services and behavioral issues. I do believe our system needs to change to begin to start providing those services to them. I believe there is a very small segment, two individuals that were talking about today, that and violated basic legal moral and ethical behaviors. That we do not owe those same rights to. Now, they have other systems that i believe that they could get the help that they need. Whether they are prison systems or other communitybased systems, but not the department of Veterans Affairs. Host question on you talked about weightless. Recently others have unearthed an unauthorized wait list in omaha and other place where is concealed. They were unauthorized. A number of veterans were basically are you aware and confident that these issues are w resolved in terms of we heard a lot of talk about trying to reduce the backlog, trying to reduce the wait list. And now they are popping up in someplaces. Are you confident that this effort to drill down at that is resolved or do you have a long way to go . Secretary shulkin well, we have come a long way since the wait time crisis in 2014. It looked like there was systemic problems in the way we scheduled patients. We were not thinking about wait think about way we them today, which is through a clinical lens, which is which veterans need care the most urgently now, which is the thin them today, which is through a we do it. We have come a tremendous way. Lets put this situation in omaha into context. We have over 350,000 employees in the department of Veterans Affairs. Were the largest system in the entire country. Were talking about two employees. Two employees that scheduled and did not follow our proper procedures. To label the entire department of Veterans Affairs as having a systemic issue when you are lking two out of 350,000 employees would be irresponsible. Those two employees no longer work for the department of Veterans Affairs. Those two employees were discovered and actually found by the omaha v. A. Facility. They did exactly what youd want them to do. They were monitoring their own policies and procedures. Identified two employees that were not following the pleaduresle. Procedures. Took appropriate actions and retrained all their staff to make sure they were following procedures. Am i going to say that we dont have a constant issue with retraining . We have 30,000 people who schedule appointments in the v. A. They are often gs4 and 5 employees. Of course we have to always be vigilant in monitoring our systems and retraining and improving. But this does not necessarily represent that the v. A. Has fallen back to the problems that we this in 2014. Far from that. Were making progress. We still have a ways to go. Well stick at this until we get this better and bert. Each day i think were getting better. Host one aspect of that is the notion of whistleblowers. Theres still a lot of my colleagues have reported that whistleblowers still feel retaliation is an issue. Which would go back to dealing with issues like secret wait list and things of that nature. Not just that issue but a whole range of other issues. What reforms are you instituting to make sure whistleblowers are protected to make sure the system comes better . Secretary shulkin one of the very First Executive orders that President Trump signed and that i had asked him to support was to allow me to establish the office of whistleblower protection and accountability. Reporting directly to mee. Trade we stood that up. We actually have working in that office whistleblowers themselves like brandon coleman, who was at the center of exposing the problems in 2014 at phoenix. So we are taking seriously whistleblower protection. The accountability law gives protections to whistleblowers. And were not only taking those seriously, but making sure that we protections to whistleblowers. And were re258ation does not o. I should say one of the issues were dealing with is way too many people are claiming that the whistleblowers when thats not an appropriate definition. It is not acceptable to be a whistleblower when it is your job to do that job and youre falling short. Rather than be held accountable you declare yourself a whistleblower. Were going through a very course on an accelerated course on how you change a culture in v. A. That is to course on allow peop really are identifying issues and declaring themselves whistleblowers appropriately to get that information to us so we can act on it. But also to hold people and managers accountable for what their jobs are and not be able to just claim whistleblower status when its not appropriate. Finding this balance and adjustment in such a Large Organization thats run the way it has for decades and decades without true accountability is going to be a learning curve. Were going to have some ups and downs as we go through this process. Thats why this Office Reports directly to me and its part of my job as secretary to define is and culture transform this organization. Host going through your extended history of benefits, you touched on drug abuse. Opioids is a massive problem in he country and in particular since you specified the history among veterans. What specific declaration has been made by the president , what are the next steps that your office is doing to get those recommendations up and running . And to try to get at reducing the Opioid Crisis as it relates to the nations veterans . Secretary shulkin like many of the problems in American Health v. A. System who sees and recognizes these issues first. Issues the Public Health identified and been out in front of. Hepatitis c. The issue of suicide im talking about. Which is an issue among veterans but for all americans this is a Public Health cry sifments the Opioid Crisis was no different. N front of. Hepatitis c. V. A. Recognized this as a Major National problem in 2010. When nobody else was talking about the opioid addiction. We initiated then the Opioid Safety Initiative and since then we have brought opioid use down among veterans by 36 across the country. I was at a facility last week, coatesville, pennsylvania, where the use rate on opioid was 4 . The National Average in v. A. Is around 12 . We have sites that are like coatesville and also cleveland, ohio, where our rates are down at really very, very low levels. We have done this through a multifaceted program. We have an acronym as everything in v. A. Does, this one is called stop pain, it goes through so we can show others in American Health care how to effectively begin to address this. Its on our website. I wont go through it for you now. But we not only will continue to work on what we know works, hich are best practices in health care, but having participated in the opioid reduction committee, the president s committee chaired very aptly by governor chrisive ew jersey, that has really allowed me to refocus the organizations efforts to double down on whats working, to go out there and to talk about this more and to really destigmatize allowed me to the issue of Substance Abuse and Mental Health. To be able to help start allowing people to talk about it and family members to ask for help among veterans in need. I believe what the president has focusing his efforts on this. You know he shared about his own Family History of addiction. This has allowed us to accelerate our progress and keep focused on this very important issue. Host there have been several questions received on the subject of agent orange. And benefits from the v. A. Ecently you talked about you launched a review to find out if agent orange if the v. A. Should expand the list of presumptive disabilities, bladder cancer, you name it. Where does that review stand . Are you ready to make an analmt today on whether or not a pol an announcement today on whether or not a policy has been revised in terms allowing more ailments to expand the list of what qualifies for which ties the benefits again for v. A. Covering ailments related to agent orange . Secretary shulkin im glad to clarify the situation since i think it may be a little bit murky. V. A. Has undergone extensive study of the issue of agent orange and relationships to a number of comorbidities. I reviewed in benefits talk today the first time that we acknowledged that was 2005. We added more presum tiffs in 2011. We have been studying additional conditions. Handed to handed to v. A. Back in early 2016. And v. A. Was required to give a report on that within 60 days of the data coming back in. This is an example where v. A. Is not performing at an acceptable level. That decision has been delayed and delayed and delayed. I made a commitment i would not delay that any further as secretary. I would make a decision by november 1 of 2017. Which was last week. I can assure you, i spent a great deal of time personally looking at all the data on the presumptives and i have made a decision. And people who know me understand im not usually a gray person. I make decisions and i believe thats my job as secretary to make those decisions. I have made a decision. I have passed that on in the process that we follow in the federal government so that that can go to the appropriate parties who have to take that decision that i have made and put a financial figure to it, go through the legal ramifications of that decision, and then that will be put into rule making processes. That is exactly whats happening. Im not announcing what the decisions i have made are other than i have made those decisions and i have passed them on alonth process. It should be in a short few months before the regulation and rule making processes will begin. Thats part of not allowing things to sit in v. A. Host are you sure youre at the National Press club . You can announce your decision right here. Secretary shulkin my intention is to do whats right for veterans. And if i were to not honor the process thats used, my fear is i would hurt the ultimate getting veterans the benefits they deserve. A responsibility that i take very seriously. I am protecting the sanctity of the process that has been used by previous secretaries and administrations. And thats the reason. Its not because i dont know what i believe the right answer is, its because i want to get to the right outcome for veterans. Host thats a few months. Two months . Three . Secretary shulkin listen. I love targets. I usually announce the dates exactly when were going to be announcing things at v. A. I wish hi a date. Since i dont control that process i dont have a specific date for you. I have asked for one and hopefully will get one soon. I think its a matter of a few months not anything longer than that. Host watch this space. Secretary shulkin yes. Host you talked about financial management. And how benefits have ballooned in terms of the budget. Has financial fiscal management improved in your view in the number of arenas in terms of Veterans Affairs . Secretary shulkin no. We have great difficulty in doing financial projections so that we can understand our needs and also how we can provide services. And we have a great deal of problems on delivering projects on time. And on budget. Many of this i do not want to deflect the responsibility and accountability that we have in this. We clearly own a lot of those issues. But much of this, when i look at this from my private sector background where this is, as chief executive, i have to be able for Financial Decisions and projections, much of the difficulty has to do with the omplexity of the laws that were given by congress. Example. E you an we have been very challenged, multiple times, in projecting our choice funding. Which is our care in the community funding. Well, if you had to run a seven different seven different silos, Checking Accounts, and you had to use the following rules, you cant record your checks in your Checking Account when you spend the money. You have to guess at the time that you are thinking about a decision what its going to cost. So we have to record our obligations at the time that we send a veteran out for care, but we have to guess r they going to see the doctor one time . 10 times . 15 times . Will they be in the hospital . Will they require surgery . Home care . Doing financial projections when you are asked to be looking through a crystal ball is something i never experienced in the private sector, nor would i ever recommend it to anybody who wanted to run a fiscally sound organization. Were working now with congress, with both our committees in the senate and house, to come up with financial rules that will serve the American Public and veterans better that are predictable, easier to ue, easier to manage, and then let us be accountable for a rational system rather than what we have now which is a system thats completely irrational. Host before we get to the last question, couple of coming attractions. Before we have to actually give you what we give to all of our headliners. The traditional National Press club mug . Secretary shulkin is it worth less than 25 . Host yes. No gift rule violation. A couple of things i want to go over in templets upcoming calendars and attractions. This week well have Chris Matthews coming through to talk about his new book on bobby kennedy, a raging spirit. On wednesday. The president of the world bank on november 20. We also have donna brazil, her her. C. Chair with book on december 12. Were both pennsylvania guys. How far are your eagles going to go this year . Guy. Steelers secretary shulkin yeah. I think its eagles all the way. [applause] host please remain in your seats while the secretary departs. You want information on this and other activities here at the National Press club, go to www. Press. Org. [captions Copyright National cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] fairly short recess and recess until 4 30 eastern time debate several bills. On the agenda today, dealing with veterans, home if modifications with debate sever bills. On veterans who are disabled. And gray stones for family members. 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