Transcripts For CSPAN Veterans Affairs Fiscal Year 2016 Budget Request 20150215

After the mehta that sis, not going at the root cause. I would like to hear a definition of defeat, definitive one, and then i would like to hear what your root cause is of why there is an isis, why there was an al qaeda, and ive got one other question after that, ambassador, if you would go first. It is a good point and it is the major flaw of this draft. The draft doesnt tell you give this back to the president and it doesnt authorize the president to do anything more than using armed forces against isil. It doesnt say defeat, though thats one of the things he says is his goal, working to defeat in the there is no goal. One reason we have all been debating about how long this thing should be or what kind of troops or what enduring means is there is no goal. My goal is to defeat isis, to destroy its hold on terrain in iraq and syria. Thats what should be in this thing. That is a military mission. We can do it if possible with our allies. Potentially we will have to use our own forces. If thats a vital mission, thats what the president should be tasked to do by you. I think you are absolutely right. And if we dont define what isil is as a radical islamic jihadist group, you cant defeat it. It is like lets build a house and i give you a bunch of 2 by 4s and the material and youre like, whats the plan . I dont know. Just build a house. Thats what i see here. Thats a simple analogy or bad analogy. But i see us wanting to commit but not really wanting to commit. It is like youre not playing to win. Youre playing not to lose. And it is just if were not going to go in there with a very specific strategy, this is a bad idea. Dr. Brennan, what is your opinion . I agree with that. I think what you need to do, to defeat iraq and syria, or isis is to understand were putting at some level an artificial distinction with at the border between iraq and syria. We have to look at the entire organization. I agree iraq first, but we need to be thinking about how do we attack this entire organization and make certain that no longer controls territory. And the ambassadors exactly right. Thats a military objective. But it means we have to be able to move into syria also. Which is attacking a sovereign state, may be a failed state but were attacking that. That opens up a whole other can of worms. I would disagree with my colleagues in a sense that i think disagree . I disagree in a sense that i think there is a strategy, again, preliminary evidence that it is working. This is what the military advisers to the president are recommending as a way to defeat the enemy. So this combination of limited u. S. Force with air strikes paired with the Coalition Partners on the ground has killed 7,000 isis fighters out of an organization that is how many have grown out of that though. Every time you kill one, you get 10 or 20 more to join the cause. So are we winning . And it has helped the iraqi forces, the partners and kurds Iraqi Security forces retake key strategic areas. In five months, i think there is limbed and preliminary but significant evidence that this combination of limited u. S. Force and partners is working. I appreciate your time. I appreciate your time. Im out of time. Thank you, mr. Chairman. I thank the member from florida. Well, we appreciate the time of all of our witnesses here today. This was a start of a very important we thank you again. We will be adding some additional questions to our panel. We stand adjourned. That has been some congressional resistance to the president s call for military. In a statement i have supported u. S. Airstrikes and against isis on the hill, a mental found that two thirds of americans want the u. S. To put some boots on the ground to fight the islam escape. The majority was the congress to support president obamas call for military action. 30 2 are opposed to it. While Congress Considers that off rosacea come another issue is funding or the Homeland Security department. The house passed a ill they blocked president obamas executive order on immigration. John boehner was asked about that in an interview today on fox news sunday. Senator mcconnell has done a great job as the new majority leader. He has allowed over 20 mm to the Keystone Pipeline bill. The Senate Democrats are blocking the ability to even did take the bill. Senator mcconnell has offered them an opportunity to offer amendments. Its there term. That is the way the system works. That is the way the constitution spells it out. If the senate doesnt like it, they will have to produce something i understand there are two sides to the argument. But here is the bottom line. The deadline is then two weeks from now. The fact is that you and congress will be out our recess for the next week. Can you promised the American Eagle with the Terror Threat only growing that you are not going to allow an a for the department of Homeland Security to run out. The house as acted. We had done our job. Senate democrats are the ones putting us in this curious position. It is up to senate cast to get their act together. All i can ask chris, one more time. The house has done is job under the constitution its time for the senate to do its job very Senate Democrats are the ones standing in the way. They are the ones jeopardizing funding and offer their ideas and lets see what the senate can do. What if the Homeland Security Department Funding runs out . Then Senate Democrats are the ones to blame. And you are willing to let that happen . Absolutely. Lawmakers return february 23 with funding expected on the agenda. A funding for the department is set to run out that same week, february 27. The Political Landscape has changed. Not only are there for a theory new republican and working new democrats in the house and 12 new republicans in the house there are eight women in congress, including the first africanamerican republican the house and a woman veteran. The congressional chronicle plates has a lot of information, and when a result of these session of congress. President obama 2016 by jerry west cause for spending, nearly 8 from 25th teen. The House Veterans Affairs Committee Held a hearing on the proposal. This is 2. 5 hours. The hearing will come to order. We are here to discuss the president s fiscal year 2016 budget requests. Mr. Secretary, welcome to the committee. I would say that it is a welcome change. So too are the openness you have had with me with the members of this committee and with hours and uroplasty change culture at the a. As your testimony illustrates, you have been active in visiting the eight facilities. Talking with employees, veterans groups and your sector colleagues with one aim in mind, being everyones focus squarely on the needs of veterans. Thank you for your willingness to take the job of secretary and putting everything that you have to that job. Turning to the illness of examining the ba budget request i see boston of things but there are some areas where we will have considerable question marks. The committees task assailant to learn as much as possible to inform our use and in and estimates letter that is due next friday. On the positive side, you have boldly tackled a very sensitive issue of v. A. s scheduling posture addressing the closure of runs safe vacant, or underutilized this these begins an important conversation about the future alignment of das infrastructure. I have long argued that we needed a strategic reassessment of the v. A. Instruction program. That is in part what the independent assessment and the Veterans Health care assessment this covert and last summers choice act just choice act. I have several areas of concern that i hope you and our second panel and address. First and i am going to be frank because i have in the past with you on this particular issue the proposal to reallocate any portion of the 10 billion appropriated for the Veterans Choice Program is a nonstarter. I understand there is a great degree of uncertainty in the programs utilization. In a probe reading the money the congress had to work with the best estimates we had at the time to stretch those dollars including limiting eligibility and criteria for veterans. So is there is going to be any reality, it will be to further improve and in the program is elf and not address other unspecified needs. Second, the written press is an additional 1. 3 billion for v. A. Medical care on top of the appropriation for fiscal year 2016, bringing the total proposed increase to 7. 4 send. At a threshold level, you do not understand how it interacts with the 15 billion that congress provided last summer or nonv. A. Care. It would appear that there are considerable unknown variables in this area, such as with the Choice Program the 2d standards that the v. A. Should expect. And the ability to hire professionals. I hope to expand on this during questioning. Principally to hire additionals. Mr. Secretary, there are several of us on this committee. We know the disability claim staffing has doubled in the last two years. We have invested over half 1 billion in the bms in this and more other systems. We have clues to enable a quicker decision. All of these investments were made with the promise that productivity would improve and shift away from the usual trend of an memorable workforce and overtime to deal with the workload. Again, this is another harry a i hope to addressing questioning. Veterans are better served with constant and aggressive oversight. Mr. Brown and i have asked for a larger Committee Budget towards that end. One thing you and i have talked about is the office of Inspector General and ive only larger than the 13 percent increase in the budget. Its not even enough to cover inflationary costs and let alone the increased oversight we all rely on so heavily. Again, mr. Secretary, i look forward to what youre doing. I look forward to hearing from the veterans organizations on the second panel. The v. A. System is for them and what they represent. So their input on budgetary mass on budgetary matters is critical. Welcome, mr. Secretary. Want to say that you are very that i am very happy that you are here this morning. The president has proposed a large increase for v. A. By 2016, the president has for word s has opposed in nearly 8 increase in health care, or chanel, construction, research and claims assessing. Given this large request, i am looking forward to a discussion today and how it will assist our work as committee to make sure this proposed budget give you the dollars that you need but also assure us how, in congress, every dollar you receive will be spent wisely. And certainly wish that the department of Veterans Affairs department of reform act was the law of the land. It is important to assist us in matching resources suit the needs of our veterans and ensure we are planning the dont let our veterans down. Mr. Secretary, the first question i will ask is that your proposed budget is you all of the dollars you need to fix the problems you face. Meet the goals and initiatives the department have laid out. Keeping in mind that funding provided by short had her that are not face delays in getting access getting access to health care. I always hear from veterans how they care when it is available i hope you are going to Work Together to make sure that health care is available to them when they need it. This is the first year that the a benefits program will be fully funded on advanced appropriations. They will have to worry about what we are doing in congress and it wont affect how we are rate. Finally, i want to hear about your form and reorganization efforts and how this is a west will support these f. I also want to hear about how youre making progress in nine effort to reform and reach and energize and reinvigorate the v. A. Too often, always hear about is the problems the v. A. Is having. I would like to consider what we can do to ask those problems and support what v. A. Is getting right. I am pleased with this budget requests. I hope these dollars can fix what is wrong and strengthen what is right with the v. A. I yield back the balance of our time. Works i welcome our response to our table this morning. Thank you for being here. Please proceed with your statement. Thank you. Thanks for the opportunity to discuss the a discusss budget. Last week for a round a groundbreaking town hall meeting. We appreciate the president s and hours of support for veterans, their families and survivors as well as the advocacy for veteran organizations. Air nation is emerging from the longest war in a serious reap good the a is emerging from one of the most high seas he did armand has ever experienced. We now have before us the greatest opportunity we have to improve care for veterans and build a more efficient and more effective system. With your support, the v. A. Intends to take full advantage of this remarkable timely rigidity. Timely opportunity. We share a goal is to make the v. A. A model agency with regards to customer experience. With efficient and effective operations, we looked a bit part role to death to become part to be comparable. The cause of fulfilling those obligations our veterans grows and we expect it will continue to grow within the foreseeable future. We know that services and benefits are veterans do not peek until roughly four decades after he and. This chart demonstrates the number of veterans receiving serviceconnect did disability benefits from world war i and peak in 1988. For world war ii it takes a 1985 for korea it peaked in 1993. And for vietnam veterans, it was just last year, in 2014 my when it is worth remembering that today, almost 100 years after the civil war ground to a halt, the a is still providing benefits to the child of a civil war veteran. We still have troops in both iraq and afghanistan. In the last decade, we have already seen dramatic increases in the demand for benefits and care. This chart shows how, for 40 years, 19 xt 2000, the percentage of veterans receiving company station from the a was stable at about 8. 5 but in the last 14 years, since 2001, the percentage has dramatically increased to nine to 19 , more than double. Simultaneously, the number of lanes and the number, the number of claims and number of medical issues and related claims that v. A. Has completed his sword. As this chart shows, they completed almost 980,000 claimed. Claims. We project that we will complete over 1. 4 million claims in the next fiscal year. But there has been even more dramatic growth in the number of medical issues and claims. 2. 7 million in 2009. A 115 increase over eight years. These increases were accompanied by the traumatic rise in disability compensation granted to veterans. Veterans from 1950 to 1995 the average degree of disability held steady at 30 3 . Since the year 2000 average degree of disability has risen to 47. 7 , as this chart shows. While it is true that the total number of veterans is declining the number of those seeking care and benefits from v. A. Is increasing. Fueled by a decade of war injury claims, a claims appeal process, increased medical claim issues, far greater survival rate among those wounded, more sophisticated methods for identifying and treating veterans issues, demographic shifts, demands for services and benefits have exceeded the capacity of the a to meet it. It is important that congress and the American People understand why this is happening. The most important consideration is that American Veterans are aging. As with any population, health care requirements and the demand for benefits both increase as age and exit the workforce. This chart reveals an astounding shift. In 1975, the year that i graduated from west point, just 40 years ago only 2. 2 million American Veterans were 65 or older. 7. 5 of our veteran population. Here on the far left we expect 9. 8 million will be 65 or older. That is 75 to 46 . An astounding increase. Today we serve a population that is older, with more chronic conditions and less able to afford private sector care. We predict that Veterans Benefits for recent conflicts will peak around 2055 if we assume that afghanistan and the rack are winding down this year. It is fair to imagine that members of congress, the president , and the secretary of Veterans Affairs in 2175 will be debating resources that will impart health care for the family members in iraq and afghanistan. Currently 11 million of the veterans in this country are registered enrolled, or use at least one v. A. Benefit or service. Veterans are demanding more services than at before. The number of veterans seeking medical care is steadily growing. The requirement for female veterans, Mental Health, they have increased radically. Over 630 635 million email veterans are enrolled. 400,000 actively use it, double the number from the year 2000. We see annual increases of about 9 , with the trend continuing and probably even going higher. The female veteran call center connects with over 100,000 female veterans per year. 1. 4 million veterans with a Mental Health diagnosis are enrolled. An increase of 64 from the year 2015. There were approximately 19. 6 million outpatient encounters in 2014. Since its inception in 2007 through 2014 the Veterans Crisis line has answered over 1. 6 million calls and assisted in over 45,000 rescues. Over one million veterans received services through the primary care Mental Health Integration Program begun in 2007 through november of 2014. The annual number of encounters has grown from about 182 thousand in fiscal year 2008 to over one million in 2014. As veterans witness the results of the positive changes that the v. A. Is making and regain trust in the v. A. , as the military simultaneously downsizes, the number of veterans choosing v. A. Services will continue to arise. It should, and the veterans have earned it. We are listening listening hard to what employees, bsos and others are telling us. What we hear drives us when historic, unprecedented departmentwide transformation changing the culture of the v. A. And making the veteran the center of everything that we do. Reach we call that transformation my v. A. That is the way we want the veterans to think about it. Theres, personalized, customize. This entails organizational reforms to better unify efforts. It focuses on five objectives that i have shown here on the bottom. The first is improving the veteran experience so that every veteran has a seamless integrated, and Responsive Customer Service experience every single time. Second improving the employer experience of of the employees can better serve veterans. We have no hope of taking care of veterans of we dont take care of the employees of the v. A. Third, improving the internal support system services. Four, establishing a culture of Continuous Improvement so that local levels can correct problems more immediately and then replicate Proven Solutions across our entire network. Fifth, enhancing Strategic Partnerships. My v. A. Revolutionizes the culture and the Department Around the needs of veterans measuring success by outcomes as opposed to some kind of internal metrics. We intend every veteran to have a seamless, integrated, and Responsive Customer Service experience every single time. Recognizing the department geographically is the first substantial and important step in achieving this goal. In the past, v. A. Had nine disjointed geographic organizational structures. One for each line of business. Imagine a business with nine different subs notices having different organizational structures and different middlemanagement. Our new unified organizational framework has won National Structure as shown in this chart. It has just five regions. Aligning their disparate organizational boundaries and was single framework. This facilitates internal coordination and collaboration along business lines and creates opportunities for integration at a lower level and promotes Effective Customer service. Veterans will see one v. A. Rather than individual, disconnected organizations. Last, it is also about ensuring that the v. A. Is a sound word of taxpayer dollars. We want six sigma efficiencies over the operations to be sure that we develop Veterans Services with operational efficiency. But we need the help of congress. The a cannot be a sound steward of taxpayer resources with the portfolio we are currently carrying. No business would carry such a portfolio. Veterans deserve much better. It is time to close their substandard and underutilized infrastructure. Nine facilities im sorry 900 facilities are over 90 years old. More than 1300 are over 70 years old. Currently we have 336 buildings that are vacant or less than 50 occupied. That 10. 5 million square feet of excess that cost us an estimated 24 million per year to maintain. These funds could be used to hire registered nurses for one year, or pay for 144 primary care nursing home care veterans. We need to do the harder right rather than the easier wrong. These reforms will take time. Over the longterm it will enable us to better provide veterans with the services and benefits that they have earned and that the nation promises them. The 2016 budget allows the continuing of this transformation to meet the intent. The 2016 budget for the v. A. Requests 168. 8 million, 78. 5 million in discretionary funds with mandatory funds for benefit programs. It is an increase over the 2015 active level and provides the resources necessary for those who have selflessly served the nation. The budget will increase action to medical care, including for veterans. It will address infrastructure challenges including major and minor renovations. It will end the backlog of claims and homelessness by the end of 2015 and fund medical and Prosthetics Research addressing the infrastructure and modernization. We know that this is a large request but it is not sufficient for meeting the requirements of 2016 or 2017. Therefore the president will transmit a legislative proposal to allow flexibility is necessary to reallocate if needed a portion of funds to improve operations with a fiscally responsible budget neutral approach to best care for veterans. As this chart demonstrates, the proposal is largely driven by the uncertainty of the resources that we need to fund the program. It is difficult to predict the use of the program or the interaction with the medical care base budget because it is all new. We have no longterm data to draw up on yet. Current estimates range from a low of 4 billion to a high of about 13 billion over the course of the program. We want and need the flexibility to move resources if veterans decide to stay inside v. A. Rather than move outside. This is about assuring that every veteran receives the care that they have earned and deserve regardless of where they choose to get it from. Embers of the committee we meet today at an historically important time for v. A. And the nation. March will mark the 150th anniversary of president lincoln solemn promise to those who have fought in the most devastating war in our countrys history. He promised that we care for those in the battle and their families and their survivors. That is vas primary mission. Its our only mission. As the noblest mission supporting the gray assist of any agency in the country and we count on your support to uphold that sacred commitment. Thank you again for your unwavering support for veterans, for working with us on these budget request and for making things better for all of our great nations veterans. We look forward to your questions. Thank you very much mr. Secretary for your testimony and as we approach president lincolns birthday tomorrow we are ever mindful of his commitment to the veterans of this nation and our responsibility as a congress and as an administration. Can you tell me a little bit about how the 15 billion that was appropriated last year in addition to the budget, how that is accounted for in this budget . Well sir as you know that money is obligated only when veterans use the program. So, so far in terms of Veterans Choice Program we have had nearly a half a million calls from veterans and providers about the program. So far we have roughly 24,000 veterans make appointments on the program and go outside so we obligate that money as it is. Also, we are in the process of leasing 27 new facilities and that work is already underway. We are using the money to hire more doctors. We have more medical professionals. We have a netnet increase of over 8000 medical professionals. That is in the last nine months. November was our biggest month of hiring. We hired over 2000 more medical professionals than we lost. Our turnover rate is about 8 , 8. 9 . The turnover rate in the industry is about 18 so we are trying everything we can do to maintain the medical professionals. We did have a shift of over 500 million but we think the costs will shift to the Choice Program. Could you explain that a little bit further . I know there was a telephone conference with staff to talk about the shift. Understanding the program is still very new, we thought some of the costs we normally see in the fee program would be picked up by the Choice Program. Right now though our actual results where we are seeing much more demand for the fee program on the va side of the budget. I would say that is a critical component to knowing whether this request is adequate or not. That is why the hesitance to do anything mr. Secretary with the choice piece. Again we arrived at the criteria because we wanted to have zero. In a veteran out there had a choice. That number came back from cbo at about 50 billion. We couldnt do that so that is where the 40 came from. There has to be some savings i would suspect that are derived by alleviating some of the pressure within the system by those that are going outside because of the Choice Program. We are going to be looking at that very carefully. What we also dont understand is what level we have from veterans who did want services who werent using these services because of the long wait Times Distance and there is still a lot to understand about choice. Mr. Chairman i dont know that now is the time to make a move of any funds. What im trying to do is subsidize the committee to the fact that there is a lot of uncertainty and in our budget we have roughly 70 line items were we have inflexibility. We cant move money from one might add him to another and what im asking is that we Work Together to have flexibility so no matter where veteran goes we can move the appropriate money they are and make sure that veteran receives care. We will commit to helping you have flexibility mr. Secretary almost anywhere within your agency except within that choice piece. Because of the uncertainty that is there. That is what is interesting about this budget request. You talk about all the uncertainty thats out there yet we are asking for an increase in stds and asking for increases in dollar amounts. Let me get back real quick, have i have one other question that i need to get to ms. Brown. One of the things that i think a lot of us have asked and by no of positions on the committee have asked over and over again and ive never gotten an answer. Is twofold. Number one how much does it cost for a veteran to be seen within the va versus the private sector and the private sector mrs. Secretary you know could answer that right away. You have a hard time answering that within the department and the other issue is what we know whether the clinical workforce is operating at its Maximum Capacity and efficiency based on the workload that is out there . There has been a lot of anecdotal evidence presented to this committee that say it is not and physicians are seen as few as two patients a day which is absolutely unheard of. Let me ask dr. Clancy to comment on that but before she does let me say as you know my first trip was to phoenix and when i arrived in phoenix i discovered we were short 1000 people in each primary care doctor had one clinical room and in the private sector today a primary care doctor has three clinical rooms. We have an issue of stopping which the committee helped with the choice act but we also have an issue on infrastructure. Its an old infrastructure. We have Women Veterans and we dont have currently the situation today. In boston i visited an operating room. Our operating rooms are 35 smaller than they need to be. If you have an operating room which is 90 years old they dont use robots or computers in operating rooms 90 years ago. We need that equipment today to provide her veterans with the best operating surgery can possibly conduct. Is on a productivity issue which i think is incredibly important, we have a tool and we have discussed this with representative wenstrup where facilities can look at productivity of different types of clinics understanding what the clinician is doing in this space issues the secretary Mott Mcdonald just mentioned and also the efficiency and capabilities of the people around them who are supporting them. That tool has been deployed systemwide. We are right now examining some of the data quality issues and very importantly having that externally reviewed. We would be happy to come back and brief you in more depth. We think its a good tool and at this point its more diagnostic than it is in a place where we can give people grades for example but we also want to make sure that some of the best and brightest minds have taken a look at it and kicked the tires and so forth so we are confident as we measure productivity. I just want to reinforce what the secretary said a minute ago. Some of our clinics, some of the better clinics would bring tears to your eyes in terms of how well they are doing but they are really landlocked. It almost feels like a gift much less a two or three would see in the private sector. Ms. Brown. Thank you mr. Chairman. Before i begin my questioning mr. Secretary understand you were in our land of last week on wednesday meeting with the nurses association. Can you give us an update of how that went in also he made an announcement about the opening of a hospital in orlando. Can you give us an update on that also . Yes maam. I was in orlando and i spoke to the American Nurses association and i was there to tell them about how exciting it would be to work in the va today and just like you and the chairman went with me to a the medical schools in florida to recruit, we were recruiting. We picked up quite a few people who were registered in coming to work for the va. The va is the largest employer of nurses in the country and its important our nurses are very important to us and they do a great job so that is why i was there. Separately i did visit the orlando hospital atlanta medical center. There are now patients being seen. We are in the process of moving in. We expect to have a commemoration ceremony of sorts for memorial day but between now and then there will be new clinics being set up every single week there. Its a fantastic facility and i think the citizens of orlando and the area of florida will really enjoy going there. Thank you. Dr. Clancy is there a discussion on this committee about you know we have doctors on this committee and they talk about this responsibility. Its a little different working with the va because what we expect that of the va physicians is a little more comprehensive. When a person goes and, lets say im going into a podiatrist. They cant just go in and deal with a podiatrist that is comprehensive. Its a whole different case work. Can you explain that to us . With that leave that primary care and care for the whole thank you. Dr. Clancy is there a discussion on this committee about you know we have doctors on this committee and they talk about this responsibility. Its a little different working with the va because what we expect that of the va physicians is a little more comprehensive. When a person goes and, lets say im going into a podiatrist. They cant just go in and deal with a podiatrist that is comprehensive. Its a whole different case work. Can you explain that to us . With that leave that primary care and care for the whole veteran if you will is the foundation of the system so for the most part we dont have people just coming in for podiatry or a hearing aid, for example of very popular use of our facilities, without also checking some of their other risks to their health and so forth. We are taking a very hard look because there are two overarching goals for this year, getting access right whether its within our facilities, whether its virtually by telehealth or Something Like that or with the Choice Program but all of that is seamless and are equally high second goal is exceptional veteran experience. We recognize some veterans actually might choose to simply commend for podiatry and skip the rest so we are going to be looking at different options for doing that by way of maximizing efficiency and frankly making the veteran experience very satisfactory. In general we have an Incredible Opportunity because of the entirety of the department to have an impact on health that no other Health Care System house. A lot of things affect health besides medical care. Its its income comments education whether you have a place to live and so forth in the department has tools through vba and so forth to actually address all of those needs that we take that very seriously. The last question i have what are we doing working with the department as veterans transition to make it seamless and the bumps in the road. I met a veteran who has been out two years and 10 disability but the point is he cant get his paperwork from dod. What are we doing . We have asked this question for years. Its a great question. I have to say secretary hagel and i are totally aligned that we want to have a seamless handoff from the department of defense to the va. Thats why we have instituted programs like cap while the person is on active duty and allison can talk about that. Congressman brown some good news to report on this front though it didnt obviously help that particular veteran two years ago, we are engaged now in the mandatory program for all of our servicemembers including National Guard and reserve for which there are now nearly a million who qualify for benefits that did not previously. Another thing that is starting literally right now is the mandatory separation health assessment. The choice to the veteran told a session is if you are going to make a claim to be a for anything that va will do a complete separation top to bottom before you leave service so we capture everything serviceconnected on the spot. The next thing i will tell you is we have moved substantially forward with dod on the system where they give complete Service Treatment and all the parts and pieces we have talked about before that we used to call the gold standard. For while the numbers were really high but they have come down to now about 21 of them are overdue so they are Getting Better and we are giving them faster and to build while the i. T. Connections now such that we simply note in vbms that we have a claim, the system tells the dod system we are asking for the records in the records come back automatically into vbms and are instantly loaded up into our vbms system. That is helps us tantawi. The last thing i will share with you that we have also done is we have reduced substantially those folks waiting in the process are getting much better in our process and i can tell you the benefits district program, the backlog has been reduced by a significant amount. There are only five or 10 of those two are now over 125 days. Thank you. Thank you very much and i yield back the balance of my time. Mr. Secretary and want to read a text i got from a friend of mine. I had a reason to deal with the v. In jacksonville this morning on a home we finished for a veteran, a guy named max handled my request. I left the conversation warming complete. Very good experience. Never had that before. Thank you. May i get the names i can send a note of recognition . I am serious. It was unsolicited and it came in while i was sitting here. As you know i have given him my cell phone out nationally and i get 120 contacts today. Right now i would say 35 are positive. Thats not enough. All of us sitting here at this table wants 100 of those to be positive and we are working on it. You betcha and i will be glad to provide you his name. Mr. Chairman you did say jacksonville . Yeah i did. [laughter] maybe thats why they never had a good experience. [laughter] mr. Lamborn. Thank you mr. Chairman and thank you for being here secretary mcdonald. Im pleased to see you have focused a portion of your budget on construction efforts. Can you tell me the status of the southern Colorado National cemetery project family you anticipate they will begin accepting early burials . Im very concerned that this project stays on track. We are as well. We are in the design phase right now and we think that design phase will take about a year or year and a half. Ron would elect to provide more detailed . Congressman lamborn as you know we have made progress, significant progress on establishing the cemetery in southern colorado. We acquired the 374 acres at Rolling Hills branch in el paso county. We do have sufficient funds in the budget right now to complete the design. Completed through construction documents, the final phase of design. Once that is completed we will begin the solicitation phase for construction of phase one. Assuming Construction Funds are provided in the next budget cycle and that is yet to be determined we would expect the first burials to occur sometime in calendar year 2018. Im disappointed that the timeline seems to be slipping. I will do everything i can to make sure that those funds are in the budget and i will work with other folks to try to achieve that but it sounds like there has been slipping to the right and that is disappointing. We are going through a complete review right now our Construction Management process does you no. Sloan gibbs and the deputy secretary is leading that and we have the corps of engineers help. We have got to find a way to shorten these timelines that we face. We will be looking up at an obviously any work we can do to accelerate it we would like to do. And i will work with you if any amendments are necessary or legislative action to give you the authority to make faster progress in the future on the further projects. Changing subject secretary mcdonald imagined they were five proposed regions as opposed to 21 visits. I guess that is more efficient. His menu will have fewer personnel doing the same job is before which to me is the hallmark, result of more efficiency. As i said in my remarks this organization is focused on productivity improvement. I dont feel we can come to you and ask for more money unless we are demonstrating we are saving money at the same time. That is why we have identified the buildings that are empty that cost us money every year. We have nine different geographic maps, each one for different line of business whether its insurance. I have one other question. It goes to five regions and we havent yet determined how many we will have but they have to fit those five regions and we have a team of directors looking at that now. Everybody is trying to fit into that structure. The point is there will be more efficiency at the middle management level. I hope that means fewer people doing the same job which means less budget dollars. We are trying to put every budget dollar weakened against the veteran experience making the veteran experience better. And lastly a new attempt on this but the transition between dod and va and i have 100,000 veterans in my district and mom is that many dependents and family members and the military compensation and moderate Retirement Modernization Committee has come up with recommendations that there needs to be better transition. You have mentioned some things who are working on and thats good to hear but what can be done in the future . What could be improved to make that transition better . When we met with the committee throughout the work i think they have done excellent work. Some of the ideas of allison mentioned are brandnew and before that committee wrote its report, in fact when they gave us the report we mentioned some of these things and they missed the report. The report was already imprinting but this idea of the medical exam before the servicemember leaves the service thats the biggest idea and the problems we have had in the past will be able to resolve with that and also with the way we strengthen the tap program. I think we are Getting Better but we will continue to look and see if theyre of the things we can do. Thank you so much. Thank you mr. Secretary. Its nice to see you again and we appreciate you being here. Before i asked my general question im going to bring up what i always bring up and that is the reno office. We have been without a permanent director for about two years. We are on our second interim. I understand they have asserted to recruit yet but if you move it would be a lot easier to recruit a person to come and take that position. That is my first one. Second the hospital built in las vegas was too small by the time was completed because they didnt anticipate the increased usage. We heard deputy secretary sablan say they were going to move some resources to help with the hospital from denver i believe it is, aurora. I want to be sure you are not moving resources from a las vegas hospital to fix the problem in aurora so we can follow up with that. And my general question, for the last couple of years we have focused on the backlog fixing that problem and also problems with their hospitals. I would like to see us as we move into the next few years look at other areas of benefits and make to be a more relevant to our 21st century veterans. I appreciate the things you mentioned in your testimony. One is women, the second is a lgbt veterans in the third is the issue of medical marijuana. These are all big issues during these times are you talked about how many more Women Veterans we expect to have but really what we dont know is what we dont know and Women Veterans task force. Can get it better handle on performance and the demographics and Research Analyst who i would like to note the va is making those two positions a priority and if we have your commitment that those would be positions that would be funded and utilized . Second i would ask you mr. Secretary if you would commit to whether you think the law needs to be change that prevents the va from giving the lgbt veterans the same benefits that other veterans get. They earned them and they deserve them and they just happen to live in the wrong state. I dont think thats fair and third with medical marijuana as more and more states are legalizing medical marijuana va doctors arent able to make any kind of recommendations concerning that. I wonder how that be a policy might be moving to address that issue. Thank you for the questions. First on women, i took down the painting in my office that it probably been on the wall since omar bradley was the administrator via an ipod posters. Has a picture of a woman in service and each branch of the military. Did that on purpose because this is going to be a defining issue for those of us leading the va right now. You already heard that our buildings are old. We need space to be able to create the womens clinics. We just opened a womens clinic in washington d. C. I would encourage you to go see it. Its a beautiful clinic but its different than where the men would want to go and of course the care is different because we have other kinds of care. This is a very important issue for us and we are working hard to identify where we can put womens clinics with womens care. We just got a building from dod in Fort Mcpherson in georgia where we set up a womens clinic. This is a very big issue for us. We are going to stay after. Relative to the lgbt we are following the law. If a couple is married in a given state we will give them benefits. We need a new interpretation in the law. There is an exception to that great in the National Cemetery if we are able because of the Legal Authority i have two be able to bury partners together when they so choose and in every case we have done that we have looked at the relationship and we have granted that. If i may interject i appreciate that but in state cemeteries it still remains a problem as i understand it. Yes maam, i dont control those. But they get funding from the va. Some of them. On the medical marijuana and let me ask dr. Clancy to comment. A fair number of our clinicians have veterans who use marijuana medically in boats. They live in areas where this is legally possible. Very early days for us to have medical policies but their active discussions going on now and we are trying to learn from what we know about treating differing conditions which by the way are not necessarily identical with those conditions for which veterans believe they are helpful. I think there is an Incredible Opportunity for us to learn from some of those experiences that we have to be careful given the variation in legal issues but we would be happy to provide more detail for the record. Thank you mr. Chairman. I yield to ms. Brown for 30 seconds. In the area of medical marijuana we have passed the bill saying that the va doctors cannot administer even at this stage says its legal and they could be charged with so it passed last year on the floor. I didnt vote for it and it was an issue for congress. I think maybe you should introduce a bill but as we speak it is illegal for a va doctor to administer marijuana. That his crew recs representative brown and i was not clear enough on that point. That said again trying to be responsive to veterans experiences and what theyre telling us, we are trying to learn from that and understand and anticipate what a different future might look like. Absolutely. Theyre all kinds of additional kinds of therapy but as you see now it is illegal for a physician to administer it. Am i correct . Last year we passed a bill on the floor saying it was illegal for a va physician and i yield back. Thank you. Mr. Bilirakis. Thank you. First of all i want to thank you mr. Secretary for taking the position and being so accessible to us and more importantly to our veterans. Again you have made a great deal of progress and we want to help you make more progress of thank you for your corporation we are here for you. First of all i want to talk about, have some questions with regard to police authorizations. First of all i want to thank you for working with me to ensure me to ensure veterans and Committee Stakeholders in my area in the pasco county lease consolidation located in central florida. To ensure the success of its utilization is important that their opinions on potential locations and what Specialty Services should be offered were considered. I know you agree. Im pleased to hear there will be a potential site visit. Can you give me an idea when that might be . Our staffs that this morning actually so i dont know the outcome of that meeting but i think it should be imminent tomorrow or the next day. Thank you and again is this something we can work with you want to expedite these leases in general, the leases in general . Im not talking about the 27 leases from last year. As i said sloan gibson or deputy secretary is going to the process to understand how can we speed up our ability to design reconstruct and as we go through that if it looks like theres an opportunity for legislation we will come back to you and ask you for your help. Right now we are not ready for that but we are taking a close look at it. My next question has to do with the future please authorizations. I understand there is a relationship between va and gsa with goocher lease authorizations, not the 27 authorized last year. Can you discuss what offers are being considered and that there is enough request in the budget and should the full extent of the least they required . I will start and maybe allen can help. At one time over a year ago now we had a blanket lease authorization which would allow us to enter into from gsa which would allow us to enter into leases easily with their authority. That has been revoked and it requires us to go to gsa for them to study our leases. In some cases at the cost of the least exceeds i think its 2. 85 million than they actually have to take it to a committee which takes even more time. We have been working with them to speed up the process but we are trying to see if there is a totally different way beacon do it. We are applying technology to see if theres a way we can improve the process even more. Gsa has been working cooperatively with us. We are working on getting those processes right and making sure we all are working under the same standards for scoring, so i think that is progressing well right now. A couple of things in followup, and followup, and then ill be working with the chair. But one is we want to stay in very close touch with your team is in touch with the rest of our facility, particularly addressing homelessness in west la and then were suggested to have a followup hearing you come back. So we can stay closely engaged. This is a team sport. I want to start by commending you on the efforts of your team in west los angeles. We had a hearing yesterday in the oversight and Investigation Committee and we had a discussion about the steps that will take. A couple of things in followup and then ill be working with the chair. But one is we want to stay in very close touch with your team is in touch with the rest of our facility, particularly addressing homelessness in west la and then were suggested to have a followup hearing you come back. So we can stay closely engaged. This is a team sport. We all need to play together on the same team. Veterans being homeless. The largest Homeless Population in the country. Next not evident frustrations. We got the land in 1888. I want to go to the opposite of the country tonight talked briefly about the Veterans Choice Program. Make sure that the Veterans Choice Program, whatever happens elsewhere, will continue in the state. This is critical for us because we have got folks. They dont they dont travel the distance is that my colleague, such particularly of late. Can i ask about how the veterans choice act is working in those states . You mentioned briefly about hiring new physicians and medical personnel. I want to make sure that the believes the system of the future of the at work the va an outside care. In the last year we do a 550 million appointments and outside care. This was about a year ago. We are believers in that because that is the way our veterans will you serve the best. It was misinformation. There was there was never his intent to get the Choice Program were somehow. It was simply asking for recognition that we have seven new line owns a budget , imagine your household, Checking Account for gasoline, a Checking Account for groceries. The price of gasoline goes down by half. Your hungry but you cant move the money from the gasoline account of the 3rd account. I cant work with veterans and have the flexibility to do that. Very hard to achieve Customer Satisfaction when you have all these restrictions on how you can take care of customers. That was the only. I was making. Its early day. Ive had nearly 500,000 calls and about 24,000 appointments. Will let you know. We invited over. Congressman brown, congresswoman miller they went through our daily were something we call a daily standup. Secretary deputy secretary gibson leads it and i will let you to come over and watch us to the. I would argue that it like if you confidence in the data and you can see the tram lines. Thank you. Mr. Secretary, in the budget submission for the office of general counsel congress the conference, defending against complex litigation such as the Construction Projects in orlando and denver the lost the case on every single. For the hospital in my district. The only way the construction could continue was the contractor demanded that the va Construction Management personnel be kicked off the project. Project. They come in and take over the project. And so i i think this is characteristic of the glossing over the extraordinary problems confronted by your department. Mired in bureaucratic incompetence and corruption. Theres know substance. There substance. There is no substance. Am highly offended by your comment. I fundamentally believe as unfortunate as it is then at the end of the day at the end of this president s term that you we will not have made a difference in changing the culture of this organization by virtue of the fact that you continue to gloss over his problems. Am offended by your comment. Been hear six months. You been hear longer than i have. I find it ironic that when i went to la i went to la to solve a lawsuit your busy calling for hearing him him him advise you as to how to the extraordinary problems. What you need to do is focus on providing the Health Care Benefits and get out of that Construction Management business. Each Major Construction project is hundreds of millions of dollars over budget and years behind schedule. Thats a problem. We work very closely with the corps of engineers. A good friend and has been helpful. He is told told us he does not want to responsibility. Were doing it in denver and we appreciate your help. I hope you can make a difference. Maybe if you want ill give you my cell phone tonight you can answer some of the calls or go on the websites and see what the veterans are saying. I run a large company, sir. This organization to reflect the value am not sure what. I need your help. Mr. Secretary, let me begin by thanking you for your service. Of only been in congress a little over two years i really feel that you personally have said a bar for in fact facing the future future so that we bill the better va and do better for the veterans we serve. Case in. A few days after so meeting with. A meeting with the incredible staff that work under mr. Danzig we ensure that we had in there to begin with. And ensure that we had someone theyre to be transformational. So want to thank you. I also want to thank you for your willingness to work with us to do better. No need to focus on the past 1 billion. We cant do that anymore. We have partners like texas tech, the Public Hospital Toll Brothers providers, all of whom are desperate to work with us. I would like your commitment that were going to do with the short time that we no that you have with this administration put together a plant so that it is unstoppable. Can i have that commitment from you . As we talked for their and went to the texas tech site but we want to do in el paso is exactly what we did in los angeles, got everyone together will Work Together to get this done. I look forward to working with Texas Tech Department of the army. Currently our facilities connected the beaumont. Thank you. I also want to thank you for the presentation you made at the outset. He placed her current problems in context. Not all of them, some of the them originate the va the commitment in afghanistan and iraq and he in terms to those veterans and 2025. 10,000 servicemembers there expect more us casualties. In a state of perpetual war. Funding the assets. The cost the cost to care for them and their family and their children. I hope are all keeping that in mind. A much larger cost. The component to ss va healthcare process. An independent assessment. Let us find implementing the findings and assessments. No know when thats supposed to conclude. Thank you, representative. Required a number of assessments which thankfully we think im incredible gift. Last week and i spoke to Blue Ribbon Panel they have assembled will take a look across all of the assessment working very hard to make sure that that happens in a looking at all aspects of the operation. Dollars in the budget to implement the recommendations . We expect that this will be a core part of management. For the recommendations is actionable and relevant. Were very much looking forward to those. Thank you. If a man going to go back to something that was touched on briefly last time thats what we actually spend. Thats what i asked him not knowing the of how many rvus per year that the va generates is a common term used both in private sector and in the va. And then with the total cost. But total cost the domain just what the dr. Is getting paid. Administration, physical plant. It sound like mr. Gibson several long way from coming up with that number. How much do we spend on everything to do with healthcare that was generated . Im curious why we cant come up with a number is a wonder sometimes, we really determining committees and more costeffective to refer out rather than bill that . Thats a system we have to develop. Where in the process of doing that. The department has had a history of working to a budget that that has not worked to a demand or customer focus. Congress will provide a budget and thats the department we worked for. Were actually making some relatively large changes your to get that data. You can tell but the process of doing that, that was a big undertaking. If we know what the budget is rather Health Administrators and cost, cant that give us something to start with. As the project out im looking down the road. Im here for the same reason you are. We have to come up with those numbers. Effectively especially when it comes to dollars. Thats part of the independent assessment. One of the wild currency of the country are quite familiar with cost per private sector. Fixed cost versus variable costs. Thats the. That was in the overall opening statement. If. Well be looking at that very hard. As secretary mcdonald said what we provided as well as will we send out to Community Partners through nonv. A. Or fee care, or Something Like it possibly with a different name. I look forward to seeing those types and numbers. That has to be our guide. Everyplace is going to have a little bit different demand. I would forward working with you. I was here for three terms starting with the 110th congress. This is an enormous challenge, as you pointed out in your opening remarks. A lot more services required. Id like this to give a brief update on the backlog. Focus on some of the california r. O. s. Please be brief. Absolutely. The backlog is down nationally. We have been producing now the claims perspective we started 47 more than we did before starting this transformation effort. Quality we have not traded for. Its up 8 Percentage Points and the medical level is now up at 96 percent. We have not put off nonreading. When we need firsttime claims that opens the door to more followon nonreading opportunity. 1. 32 million claims last year and as you saw on the chart the disability level is now on average of 47. 7 percent. You have a wider opportunity for many more veterans. Since since we last saw you your here their backlog is down 67. 3 percent. There doing much better than they were. They have also done much better on the mail issues. We think this whole committee moving let us down. Thirtytwo days down to eight days. Thats a phenomenal saving. President reagan had a saying, trust but verify. Thank you. Following up, the challenges , you said almost a quote that the va is not ready for legislative help on this issue. I would like to see if you think publicprivate partnerships will be beneficial. As i said in my remarks, on my v. A. , Strategic Partnerships is one of the five points. Historically va has not had as many Strategic Partnerships. One of the 1st things i found we had people willing to offer help that we did not accept. So they came from the private sector. Secondly, relative to construction a lot of changes have been made. Probably since the last time you were on the community. Number one, a lot of times the design was done by architects. Engineers have been added to the Design Committee. The whole Design Committee reviews it. Many of the structures i would not have built because there architect dreams are very expensive. Secondly elected that entire process where were training, doing a better job training project managers a number of steps are being taken. As the congressman said we are now working with the corps of engineers and then asked them to do a complete review from a to z, as well as what part of the process they could help us with. On the parochial issue have been temporary structures put up. Some of the basic requirements such as disability accessible bathrooms have not been met. Can i get your commitment to take strong action to make sure those basic requirements are met soon . The vha investment supports our commitment to achieve interoperability with the department of defense. Including those who participated in the new Veterans Choice Program. With 136 increase in vhrs and vista funding from 2014 to 22016 to 2016, can we now expect to see thirdparty administrators and nonv. A. Providers get access to these systems . Let me talk on the high level, then i will talk about specifics. I believe the Electronic Medical record that will win in the future is a record that is open source, free, to everyone, as well as crowd sourced in terms of innovation. Crowd sourced innovation occurs at a much more rapid pace than any company can protect your own innovation rate. Our record is opensource. It is crowd sourced in terms of innovation. I was at the ama convention talking about the importance of private sector providers using a record so that we can do a really warm handoff under the Choice Program. Is that working pretty good . Its early days. We have more work to do to make sure the veterans record is there when they get there, and that we get the annotations back from the doctor, and thats part of the work were doing. Here to for some of the providers were giving the Veterans Health records that the entire record where the provider only needed the last discharge summary. It would have taken 2 to 3 hours to get through that stack. We need something more seamless and efficient. We need the interoperability back, and forward. If i could submit for the record four charts. We have 31 partners, uc davis, medical systems. There also is a way of sending the email to that 3rd party provider. We would send the full medical records, were taking the va record and the dod record together. Modify it so that we can provide that to the thirdparty providers. When we send the veteran out for thirdparty care, they are able to send the url. Do you have a timeline . Six months, 12 months . These documents are what is happening now. It will give you the record in terms of using the existing systems. We are about a year away. When have a choice issue with respect to veterans opting in. Sharing that information to somebody outside of the system. The technology piece, we are using the viewer that we deployed last year to add in the capability. My 2nd question, going back to the efficiency even with that is there a measurement for a provider on a daily basis that we can access or you can access and get us . Chairman miller said its not anywhere close to being acceptable. As a physician i know what one exam room can see. Iron understand the complications patients i understand the publications patients have. The answer is yes. As you get to see last week and the secretary invited anyone who wants to come. We go over this data every morning. It is much more visible. Some of our providers are also teaching or doing research. If got to be as transparent about all aspects of this as possible. This entire exercise gives us close to realtime information and we post this every two weeks. Are we doing anything with the information . If that physician or that provider is not push himself a little bit he is pushing a little bit more . I think the word would be motivating. Given the issues on access is not a problem. Everyone is looking at this data locally and regionally and nationally. Thank you, mr. Chairman. Thank you for the opportunity to be back on this committee. Its really is one of the greatest honors ive experienced in my life. Im glad to know you are there. This room is filled with some of the most honorable, patriotic and professional people that i know. And i have to say it certainly somewhat subjective, but over the last year we have had Difficult Conversations. They were they were difficult because all of us understood the implications of our actions impacted veterans. But trying to find solutions and i can say from my experience, and i think its the one youre hearing here, the professionalism and a a willingness to fix this team has been greatly gratifying. Its not that were ever going to stop having accountability. I accept that and believe your challenge is right. Were in this together. We bring up these parochial issues. Those are the things our constituents are talking about. I do believe this is a unique opportunity for transformational change. This window we will close. The nature of politics. We need to seize on it. I can tell you from the folks that work out there, i just came from a meeting a meeting with the group. The fantastic v. A. Nurses. They want to get this right. If we tell them the v. A. Is not working, they know thats not true. When we hear from them, i hear this feedback, from the groups. I just want to go on. I think there is new ideas out there, this new model. I want to tie it all together. The 1st thing i worked on was vhas pain management, and this comes back again and again mainly because it ties in on so many levels. I think its timely that yesterday we signed in the clay hunt bill, one step. I recognize the incredible work that is already being done, but it might be an knew way of looking at this, new approach that ties in with why we bring these solutions, these are all connected. I agree with you, ive been here eight years. So what i ask is when we provided move forward on something, if we figure out a new model and before we wait for it to run its course we correct and self correct. I know because i for one have bought into your vision of transformation. I want to be that partner and want to make sure i didnt pass a piece of legislation that added more your plate and did not improve the care of veterans. We are very much in favor. We partner with everybody who wants to do it. I have the opportunity with the writer of american sniper, the leader and team rubicon and i talked about the fact that we are the canary in the coal mine for american medicine. We see things because of the battlefields are veterans go on way before for the american public. Mental health is a big issue any isue. Issue. Any veteran committing suicide is disastrous. The work that you have done gives us more residencies, the ability to pay back student loans. The average medical School Student is graduating with about 185,000 in debt. Im working hard to try to get more residencies for Mental Health and to get greater throughput. But you know of the 22 veterans who we estimate commit suicide today, 17 of them are committed. Arent connected to the v. A. So one of the things im working on what we do have treatments for posttraumatic stress, we do know how to alleviate it. We just need to get those people connected. Thank you for working as partners. There are Difficult Conversations because our veterans are counting on us to have those conversations. Thank you, mr. Chairman. Mr. Secretary, i want to thank you for the opportunity to have breakfast and share with you the concerns of some of our veterans who because of our geographic and economic isolation dont share in all the benefits they are entitled to. Our veterans who make up 10 percent of our entire population have issues that are basic and comparatively small. Generally taken for granted. In a nutshell they need a cemetery. We have no flights. We need access to Better Health care. The local hospital has no cat scan, no cancer specialist. Our veterans must always seek care off island. Obama care, most of our veterans do not understand, always out of merchandise. Theres always complaining as to why it is we dont get merchandise and services provided. Our veterans have difficulty getting their medical records to apply for benefits. What i would like to ask you is the va budget submission has identified an expected increase in claims receipts for fy 2015 at 1. 3 million and fy 2016 at 1. 4 million. These figures represent an increase of 17 and 20 percent respectively over the 1. 14 million claims received in fy 2014. Can you please explain what factors and information you considered in determining the anticipated volumes of claims receipts for these two years . Absolutely. Let me tell you that the large portion of that is not going to be the brandnew veteran who is now leaving Service Transition to us but the fact that we have done so many veterans claims and every veteran is entitled to come back which is about 67 percent of our workload. The majority of our workload not the original claim. So as a result you can come back and get another. That growth largely attributed to the increased expectation for supplemental claims. And so that is where the majority of it is. Thank you. If we can i would like to bring our over and sit down with our leadership over there and sit down and see if we can help and fix it or it we care very much about every veteran, and we care about those in samoa. That would be great. Thank you, mr. Chairman. Mr. Secretary, i want to thank you for your extraordinary lead leadership over the last six months and i feel very confident that the rudder of the va is being repaired. We certainly believe that we are on a good trajectory for really riding the ship. I want to thank you for todays presentation. I do think it absolutely demonstrates what the challenges are within the va, both in the short and longterm and the fact that all of the challenges that we all must collectively tackle for our veterans. I appreciate the meeting we had in our office last week. I was very excited to go home this weekend and talk to my veterans in Ventura County and to let them know that an important milestone has occurred here including a new clinic in oxnard for veterans. It was clear to me there are veterans were underserved when i was first sworn into congress. I think this clinic will indeed right a wrong, and our veterans will be better served. So i just wanted you to speak to that. I wanted my veterans in Ventura County to hear from you directly , your agreement for the need of this clinic and what the time estimates will be to acquire the lease and build out the facility. If you could comment on that i would appreciate if. First of all, i apologize to you for not visiting Ventura County when i was in los angeles. That was a relatively a quick trip and i was there for one reason, to get a settlement with the community to get Homeless Veterans off the streets of skidrow. I will come to Ventura County and get together with you. Perhaps this will be a good topic. As deputy sec. Gibson goes through and looks at our construction im hoping that the kind of time we have seen in the past to be able to get Something Like oxnard going will be shortened. We will Work Together. Right now i i dont have any estimates, but we will get together with you and work on that. We want to meet the needs of the veterans in Ventura County. Very good. Could you just described briefly what the process will be in terms of our stakeholders, veterans being included in this process. Absolutely. I always bring together all the stakeholders, members of congress, veteran service organizations, mayors. This is a team sport particularly in the case of homelessness as an example, we cant do the right thing unless if theres not a landlord in the city of los angeles willing to rent at that voucher rate, we will still have Homeless Veterans. What we did in los angeles is going to be a prototype of what i hope to do everywhere else in the country, which is v. A. Can be the lightning rod to call the Community Together with the local mayor, and work to improve the situation. In this case, we will work with you on the oxnard facility. Thank you very much. I think we are making progress on the vha side. There is more progress to be done on the benefits side. This year is 2015. They set an ambitious goal. Your predecessor set an ambitious goal in terms of the backlog. Just your comments in terms of meeting that goal. We think that goal is doable. We are not changing the goal. One thing that is really clear is we do need more people, even though the productivity is up the inflow is so great command great, the inflow has grown so much. And the repetitive appeals has created a workload issue we had to work mandatory overtime, a prescription for disaster. I do have some experience leading large organizations. As a result of that we have got to get more people, or find even further productivity improvements which were working on. Going into the entire digital record has been a big big improvement. One of the nice things about it is we dont have need any more space. We can hire additional people. People working on digital files. In fact, congresswoman, i want to thank the entire community. For increasing the budget. We would not have been able to accomplish this without the support of this committee and every person on it. You saw the the growth of the requirement from 2,000. Thank you chairman and Ranking Member for being here long enough to see us through the growth. I want to tell you that there is a savings application to this. Working through the agreements with d. O. D. On what we do with half a million cubic feet of paper we no longer touch. That is 5000 tons, and equal to 10 Mount Everests and two empire state buildings. We dont touch that anymore. 95 of everything we doing now is in a paperless environment. We are working with d. O. D. On a solution to get that out of the buildings. When we do, we have some potential savings in the tune of 30 million that we can bring back to you and say this is what the benefit is buy or not needing to house all those cabinets and all those things anymore. Were already realizing the 2. 4 million savings and simply shipping costs. Take you, i yield back. Thank you i yield back. Thank you, mr. Chairman. Appreciate the opportunity. I would like to ask a few questions and then discuss the Choice Program which is important to me. My district includes 63 counties. Distance is the main problem. I just had an email contact from a veteran who drives 340 miles one way for cardiology. If the va Choice Program cant provide something closer for him than we need to relook at how we are implementing that. There is concern with providers for veterans are looking into taking advantage of that is the fact that its only temporary. Are you and the administration committed to making this a permanent option . As you know, we have had an external program. An external program is necessary as we look toward a future where the network is both va care and outside. Were also going through an analysis. I dont want to assume that is going to continue. We are talking about how we can do a better job marketing it and also if we should look at that 40 miles and change the interpretation of it, gets edo to score something differently so we can make sure the program is robust. And your thoughts . Im all for it. Im all for whatever it takes to satisfy veterans. I appreciate the 40 mile discussion. If you were in a place that a c bock was implemented in the last 20 years, that keeps you out of a Choice Program. Even if the services are provided with c bock, that restricts that access. The gentleman that is asked to drive to kansas city, 340 miles one way only because of the c bock they are never going to provide the Cardiology Services we need. If that something youre willing to look at, or you going to require us to pass some changes along . You would have flexibility to make that determination. It is straightforward in the law. That is what we have heard from cbo and others. Each option will have a different estimated price. We will come back to you and let you know what those options are. I agree with your point of view. Distance from a place you cant get the service seems like a weak measure. That is what has resulted in the current appropriations. Weve got to work with cbo to rescore all those opportunities and decide together. As the crow flies versus as a real person drives, and think that is an interpretation that can be changed. Even with the 40 miles in the Choice Program theres nothing that would prohibit you from using a feeforservice approach , which has created many of these problems. Correct. Weve got to get the word out that that is possible. The word needs to go with folks answering the phone at the v. A. Regional medical center. That is not what they are told, you can get your cardiologist services and drive 100 miles you can go to wichita, which is only 157 miles. You could probably have got those in his own hometown. The answer should be, yes we can, we are going to look at a way. When im in a rural area, i have 70 Community Hospitals coming to my office, tim, we would like to serve these veterans and we are not able to. If the Choice Program, if we can make that permanent, i think we will serve veterans, servant better and give them access to the care they deserve. I appreciate your commitment to make these programs permanent. I think they are critical. Thank you. Ms. Rice . Thank you, mr. Chairman. As everyone here has thank you, i thank you for spending time with me yesterday. Its incredibly informative trade all the brave men and women who work so hard to protect our freedoms deserve the help right now. What they dont deserve is a kneejerk try to bandaid on a gaping wound fix. I appreciate the thoughtful way you are approaching his reforms. Theyre going to serve the men and women who protect us in the long run. I have a couple of quick questions. You mentioned the 22 veterans who commit suicide everyday. Seventeen of them had not accessed any service. We spoke about this. How are you going to reach out . There are number of things we have to do. We have got to eliminate the stigma in this country around Mental Health care. This is a fortuitous mountain fortuitous moment in time. Because american sniper is the largest selling war movie and is starting to do that. Thats why i went on the charlie rose show last night to talk about this. We were together in el paso and looking at a private sector hospital. There was a neon sign at the top of this one building to the said Mental Health clinic and there wasnt a car in the parking lot. I turned to him and said, of course. Of course theres not a car in the parking lot. What we do is take our veterans through the primary care physician into the Mental Health treatment and as a result of that the stigma doesnt exist and they may not even know there talking to a psychiatrist. We have to get rid of the stigma. We have to reach all the veterans. We have the ability to put on tv a Public Service campaign that the council worked with us pro bono to get people signed up. I dont feel yet that we are ready for that. Our capacity is so strained if we were to get more people into the system we might have issues. We have to train the american public. If you see somebody you think has an issue we have an acronym. S is seeing and recognizing the individual may have an issue, we have a hot line you can we go immediately into action. Call and we go immediately into action. The medical exam is also a big help, but we have got to get our arms around the 17 veterans and care for the. Them. I know that there was discussion in terms of the facilities in california that are vulnerable to earthquakes. The va is just outside my district, but i still claim that as my own. On behalf of the veterans who live in my district and have to travel out there Superstorm Sandy hit my Congressional District harder than any other place in new york state. I was wondering if part of your construction plan included i understand the focus on earthquakes in places like california, but in similarly fragile and vulnerable areas like long island, is there a plan to have Emergency Preparedness to prevent any obstruction just destruction and Services Disruption in services . Safety is number one. We consider seismic and other natural disasters as safety. In the case of sandy, for example, we have a facility near the battery, near battery park in lower manhattan. The entire first floor was water. We are now building a wall that can help us keep out higher levels of water should another storm occur. Safety is number one. I dont have the specific facts on the facility in long island. We can get together and go through that. Thank you so much, mr. Secretary. Thank you, mr. Chairman. Thank you, secretary ville zach vilsack