Remarks by Secretary Eric K. Shinseki
2011 Army Medical Command Training Symposium
San Antonio, Texas
June 28, 2011
General Schoomaker, many thanks for that kind introduction. But more importantly, thank you for your leadership of the Army's Medical Command (MEDCOM) and your enormous contributions as Surgeon General of the Army.
I am honored to join you this morning. A prolonged budget testimony schedule precluded my early commitment to being here; hence, the early start this morning. I appreciate having this opportunity to address the serious players in Army medicine and to salute your Surgeon General's significant leadership.
It's great to be back in the company of Soldiers—especially this group of Soldiers. Let me congratulate all of you on the upcoming 236th birthday of the Army Medical Department. Army medicine has my deepest respect for what it does for Soldiers and their families, and what it did for me and mine, personally. This is your lineage and heritage since 1775 when the Continental Army was organized as 10 companies of infantry—and one hospital.
The strong people who founded our Nation faced immense challenges. Today, our country, once again, faces daunting challenges. Those challenges require bold leadership, innovation, productive collaborations, and trust between all departments and agencies of our government, if we are to prevail over them.
President Obama, in his State of the Union Address, challenged all Americans to "win the future"—by out-innovating, out-educating, and out-building our competition. Everyone, and every institution, must do their part.
I know that the Army leads in these efforts. Last Friday night, I attended the awards banquet for eCYBERMISSION, the Army's web-based science, technology, engineering, and mathematics—STEM—national competition for 6th, 7th, 8th, and 9th graders. Nearly 3,200 three-to-four person teams—involving over 12,000 of our brightest middle school students, representing 54 states and territories—went head-to-head over the past year using the scientific method to propose and implement solutions to local problems confronting their communities.
Only 16 teams of 59 students made it to Washington, D.C. for the national finals, and one of those teams came from right here in San Antonio. Team "Dr. Med," comprised of Jocelyn Hernandez, Ricardo Rodriguez, Nathaly Salazar, Carlos Zapata, and team advisor, Sandra Geisbush, investigated the effects of improper disposal of pharmaceutical chemicals on Edwards Aquifer, a groundwater resource for the city of San Antonio. They concluded that pharmaceuticals impact the pH, alkalinity, hardness, nitrites, and nitrates in water sources, thereby impacting the ecology of Edwards Aquifer. It's a bit early in the day for hard science discussions, but I wanted to remind you about the Army's commitment to growing future scientists, to out-educating and out-innovating our competition, and to the quality of the response from our Nation's young people.
With the strong support of the President and Congress, VA is doing its part as well. The President's budget request for 2012, alone, is for $132.2 billion. Our discretionary budget request represents an increase of $5.9 billion, or 10.6% over the 2010 enacted budget.
Together, President Obama's 2010 and 2011 budgets, and the budget request for 2012, have meant a 30% increase for VA in the last three years—extraordinary, yet necessary to our goals of increasing Veterans' access to our services and benefits, eliminating the backlog in disability claims, and ending Veterans' homelessness by 2015.
Access: We have increased the number of enrolled Veterans by nearly 800,000 in the past two-and-a-half years. With the support of the President, we have also taken on longstanding issues from past wars—Agent Orange, Gulf War Illness, combat PTSD. Opening our doors, increasing access for Veterans suffering from these illnesses, has been a major step forward, even as we deal with increases in numbers and severity of injuries associated with the current conflicts.
Access also applies to education; we cannot out-educate and out-innovate the competition unless we make significant investments now. The Army knows that eCYBERMISSION is one representative example of its investments. VA knows that as well; and our investments in education will pay huge dividends in the future.
VA is the second-largest provider of educational benefits in government, and this year we'll spend more than $9 billion on our educational programs. Since the Post-9/11 GI Bill's implementation in 2009, over 518,000 Veterans and family members have enrolled in college; when you include all other VA college education programs, that number exceeds 813,000. And this year's budget request expands eligibility for Post-9/11 GI Bill benefits to include non-college degree programs—on-the-job training, flight training, and correspondence courses, to name a few. It also funds full automation of the payment process by the end of this calendar year, speeding tuition and housing payments to eligible Veterans.
Mental health. This budget request seeks nearly $51 billion for medical care, including $6.2 billion for critically-required mental health programs—$68 million directly to our suicide prevention initiatives alone. Our focus is on treatment for post-traumatic stress, Traumatic Brain Injury, and other psychological and cognitive health requirements as well as greater collaboration between the Departments of Defense and VA to seamlessly provide mental healthcare.
Claims backlog: In 2009, we produced 977,000 claims decisions, but took in one million claims in return. In 2010, for the first time, we produced a million claims decisions—but took in 1.2 million claims. We expect 1.45 million claims to be submitted this year and know that we will produce another record in claims decisions—but still fall short. This growth in claims is tied, in part, to the economic downturn. The numbers are so large that merely hiring more claims processors won't allow us to dominate the growth. We must automate, and quickly. The 2012 budget request for the Veterans Benefits Administration—VBA—is $2 billion, an increase of 19.5% over the 2010 budget.
These funds are needed to get us out of paper and into electronic processing, something that should have happened two decades ago. We have a host of promising options being piloted today, and expect them to begin paying off next year as we begin moving to fully automate the disability claims process.
Homelessness: President Obama strongly supports ending Veteran homelessness by 2015. Two years ago, there were approximately 131,000 homeless Veterans on any given night. Today, we estimate there are about 76,000 homeless Veterans. We intend to take this below 60,000 by June of next year, and end Veteran homelessness by 2015. The 2012 budget includes $939 million to prevent and reduce homelessness among Veterans, an increase of 17.5%, or $140 million, over 2011.
We are making progress in most areas, but we still have work to do; and we cannot do it effectively without partners and trust. So, the focus of your conference this year, "Army Medicine: Bringing Value, Inspiring Trust," and "Partnerships Built on Trust," underscores the criticality of trust and collaboration between DoD and VA for servicemembers, for Veterans, and for our Nation.
The quality of our partnership, the level of trust and collaboration, is evident to servicemembers and Veterans primarily when they transition from uniformed service. It can be especially difficult for those who have been severely wounded or injured.
So, DoD and VA have built a system for making that transition as simple as possible; it's called i-DES, the integrated Disability Evaluation System. I-DES intends to simplify the process through which wounded, ill, and injured servicemembers are returned to duty, medically retired, leave the service with a VA disability, or are simply released from active duty.
I-DES seeks to reduce the average processing time from 540 days to 295 days, and Secretary Gates and I are determined to drive this number down to 150 days—while still allowing servicemembers to exercise choice throughout the healing process. I-DES seeks to improve processing efficiency over the legacy DES system. Servicemembers who are being medically separated now have only one medical exam, with one proposed disability rating. I-DES seeks to eliminate inconsistencies that often existed in previous disability ratings between the services, and between the services and VA, eliminating the "pay gap" that had plagued the legacy system.
There are approximately 14,000 servicemembers currently in DES and 13,000 in i-DES. We appreciate the serious readiness problem this poses for the services, and we are committed in every way to help them bring this backlog down. Several weeks ago, we surged our medical teams in North Carolina to help the Marine Corps reduce its backlog in out-processing departing Marines; we completed 3,000 exams for Marines that week and are prepared to surge again, if needed.
We are implementing i-DES nationwide by the end of this fiscal year. Our teams have worked through the issues that plague the DES program and incorporated improvements into the i-DES process. Secretary Gates and I personally review and impose process improvements on i-DES so that the system is more transparent, more consistent, and more efficient in expeditiously out-processing those who have served our Nation.
We also strive for transparency, consistency, speed, and simplicity of use in our initiative to build and share medical information between the two departments.
Both Secretary Gates and I committed to a single, common electronic health record on 21 January 2009; that commitment was reinforced by the President in April of that year in his directive, to both departments, to get on with creating a virtual lifetime electronic record in which the electronic health record would be a key platform. After two years of hard work by teams from both departments, Secretary Gates and I met on 5 February, then, again, on 17 March, on 2 May, and finally, on 23 June to provide guidance and energy. Things happen when two secretaries have lunch together.
We have now formally committed our two departments to a single, common, joint platform for an electronic health record that is open in architecture and non-proprietary in design. We call this effort the integrated Electronic Health Record, or i-EHR. It's a complex goal, but it is achievable. We are much closer now. This isn't about VA or DoD. This is about what's best, in the years to come, for every servicemember who will, one day, become a Veteran—like most of you in this room.And it can be about what's good for our country; the i-EHR could become the national model for electronic health records, and maybe the model for the world.
I-EHR would enable the free flow of needed medical information between DoD and VA and other stakeholders and care providers who may urgently need the information—private health clinicians serving Veterans, servicemembers, benefits adjudicators, family members, care coordinators, and other caregivers. Again, once completed, the i-EHR can be a national model for capturing, storing, and sharing electronic health information.
A critical component of the i-EHR is the ability for all system users and health providers to be able to see health records of all types—a graphic user interface (GUI) through which to view medical records. We have a working model that was created in collaboration between Tripler Army Medical Center and the VA medical center co-located there. Secretary Gates and I have seen it demonstrated, and it has been utilized and tested by care providers from both departments. It is simple, functional, agile—and powerfully impressive. We will pilot it in Chicago, and Anchorage has volunteered to be the next site. Once we have gleaned what we need from the pilots, we will refine the GUI and field it, system-wide, in both departments.
Veterans' homelessness is another area in which DoD and VA can better partner—again, for the good of servicemembers and Veterans. This is a tough issue to confront, and harder to solve. As I said earlier, we are bringing the numbers down—the trend is in the right direction.
But we need to do better in our transition handoffs from uniformed service to civilian status. The tragedy of Veterans' homelessness may arise months, more likely years, after servicemembers take off the uniform; but, it is still, for many, part of a prolonged transition as they deal with the "baggage" they carry from their time in uniform.
Sadly, far too many Veterans enter a downward spiral that includes depression, substance abuse, and joblessness, which, too often, results in homelessness and, sometimes, in suicide. Add PTSD and TBI to this mix and we define a potent set of challenges that defy easy solution, try our imagination and our stamina, and test our willingness to subjugate individual approaches in order to work together to sort through issues none of us can solve individually.
The President has done everything he can to provide us the resources we know are needed to end Veterans' homelessness. But given the economic situation and recent announcements regarding troop drawdowns in Afghanistan, I cannot be sure how long budgets will remain stable for either of our departments. We must make progress now.
Let me touch on one last point that falls into the category of the undiscussable: prescribed medications, specifically, those powerful pain medications used to treat those who are in physical or mental pain. Are we courageous enough to ask whether we overmedicate some who are struggling with physical or psychological pain? Are we courageous enough to investigate whether we sometimes solve immediate problems in a manner that, ultimately, contributes to long-term problems—a downward spiral that, for some, results in homelessness and, for others, in other negative social consequences?
If substance abuse is one of the common issues of homelessness—and it is—are we contributing, in some way, to the problem with our medication policies? This is a question VA and DoD should address together. I am not a clinician and am able to ask the question without taking a side; however we come down on this, it will take courage.
A final reminder of why DoD and VA must position themselves for our responsibilities over the coming decade, was brought home to me recently in two inspiring articles in Army Times and USA Today, both about Army Ranger Sergeant First Class Joseph Kapacziewski.
Severely wounded in 2005, Sergeant Kapacziewski's right leg was shattered when an Iraqi insurgent's grenade landed inside the Stryker vehicle in which he was riding. Severely and painfully wounded, with extensive damage to the entire right side of his body, including a severed nerve and artery in his arm, Kapacziewski continued to press the fight against the enemy while simultaneously caring for other Rangers who had been wounded. Only after allowing himself to be medically evacuated did his thoughts turn to—"Is this going to ruin my chances of being a squad leader?"
Doctors feared he would never walk again, let alone ever rejoin the Ranger Regiment, which was his wish. Then, again, most of us don't fully appreciate the iron-willed determination it takes to be a Ranger; every day is living with pain in some form. In Sergeant Kapacziewski's own words, "I don't like people telling me I can't do something."
Kapacziewski had served with the Rangers since May 2002. He was wounded during his fifth combat deployment. After multiple surgeries, slowly overcoming the nerve damage, regaining the use of his right arm, and enduring unimaginable pain—he was one of the very few for whom morphine provides no relief—Sergeant Kapacziewski made another courageous call. He opted to have his right leg amputated below the knee, deciding that he would have greater mobility and better opportunity for recovery with a prosthetic leg.
In March of 2007, the leg was removed. Less than five months later, he was back to running, and after six months, he rejoined the Ranger Operations Company at Fort Benning. He kept pushing the physical envelope on excellence. Ten months after his amputation, Kapacziewski completed an Army PT test, a five-mile run, and a 12-mile road march with 40 pounds of gear strapped to his back. In March 2008, one year after his surgery, he returned to a line company as a Ranger squad leader, A Company A, 3-75 Infantry Regiment.
Sergeant Kapacziewski is the only amputee ever to assume combat duties in the Ranger Regiment. Since he rejoined the Rangers, he has deployed four more times. He has now been promoted to Platoon Sergeant in C Company, 3-75.
A year ago, 19 April 2010, Sergeant Kapacziewski ran down a road in eastern Afghanistan, on his prosthetic leg, through enemy fire, to reach a fellow Ranger who had been wounded in the stomach. Along with another Ranger, they dragged their comrade 75 yards to safety and administered first aid as insurgents with heavy machine guns tried to kill them—earning Kapacziewski an Army commendation for valor.
Your advancements in saving, healing, and rehabilitating the wounded, and the miracles of medicine, have returned more and more functionality to Soldiers like Sergeant Kapacziewski. Their determination is matched by your own courage and sacrifice under fire, and surpassed by your innovation, creativity, and equal dedication.
All who have been carried off battlefields on the backs of American Soldiers, know and trust what this medical department has provided to those who have felt the sting of battle. Your very real lifesaving capabilities allows us to place ourselves at risk. We go into harm's way because, down deep, we believe you'll come get us; that you'll know what to do when you get there; and that we're going to come out of it OK. Life may be different afterwards, but we will still have a lot of living left.
All of you follow in the footsteps of those who have carried us off battlefields, bound our wounds, comforted the dying—giving dignity to those last moments, and performing miraculous work for the rest of us. That is the tacit contract we have with you, and you have never let us down.
Ranger SFC Joseph Kapacziewski has returned to service; he's "leading the way" even as I speak. But, he will, one day, like many of the people in this room, need and depend on the critical healthcare services and benefits we provide when the uniform comes off. We must posture our departments for the future, a future we can already see today. We must "lead the way" for those who have gone into harm's way on our behalf. That's our responsibility, and that's our privilege. Young Americans, like SFC Kapacziewski, have earned our unwavering support, our consistent care, and our deep devotion—all of that, and more, through the sacrifice and service they have delivered, and continue to deliver, each and every day, on behalf of the Nation.
God bless our men and women in uniform; God bless our Veterans; and God bless our great Nation.