Norb [Admiral Norbert Ryan]—thank you for that kind introduction, and thanks to you and Larry Farrell [General Lawrence Farrell] for this MOAA-NDIA–led dialogue on warrior-family issues. I am honored to be here today. Let me also acknowledge:
I think most here know that I didn't grow up in VA. Neither am I a clinician inside this large healthcare system. The learning curve was steep.
Shortly after becoming secretary, three and a half years ago, I encountered a statement that Veterans suffer disproportionately from homelessness, depression, substance abuse, and suicides—and they rank right up there in joblessness, as well. And as troubling as this statement was, equally stark was the absence of any clear understanding for why this was so or any discussion about what was being done to fix it.
It was the kind of matter-of-fact expression you sometimes encounter when a problem is so large or so complex that the focus is on just data management, rather than solving the problem—or when no one cares enough to fix it
Indeed, VA is a large healthcare provider—the largest integrated healthcare system in this country: 152 medical centers, 817 community-based outpatient clinics, 300 Vet centers, and outreach and mobile clinics that deliver healthcare to the most remote areas where Veterans choose to live. And through an extensive and growing telehealth network, which links these more than 1300 points of care, Veterans are able to access VA's benefits and services, including critical medical specialists at distant locations. But here's what's also true about VA:
These capabilities describe a robust system of care intended to serve the men and women who have safeguarded us and our way of life.
Given these capabilities, how do we explain a homeless population of over 100,000 Veterans in 2009? I took the statement about Veterans' homelessness, depression, substance abuse, and joblessness as a clear and troubling signal that Veterans, albeit in smaller numbers, were slipping through the seams in our comprehensive system of care, benefits, and services. Our homeless Veterans population suggested that there were issues with transitioning military members from uniformed service to productive employment and independent living.
The President said, "[We won't] be satisfied until every Veteran who has fought for America has a home in America." So in 2010, VA committed to ending Veterans homelessness in 2015. Nothing rivets your attention like an ambitious target on a short timeline with names attached to deliverables.
To end homelessness, you must commit to playing both offense and defense: offense—rescuing those, who are on the street homelessness today; and defense—preventing those, who are high risk for homelessness, from entering that downward spiral that ends up there. Homeless Veterans are the visible proof that the system has gaps in it.
To end homelessness, you must have tools, resources, and partners—no one of us can do this alone. And you must play offense and defense, not platooning like the Washington Redskins, but both offense and defense at the same time. This is full court press by the entire team, full time. There are no time outs, and no one takes a knee.
And after three and a half years of attacking this problem, people tell me that the primary cause of homelessness is substance abuse. Three and a half years ago, they told me it was mental health. This is an important insight. If substance abuse is the primary cause of Veterans' homelessness, we can now try to understand how Veterans end up as substance abusers and focus resources there—again to rescue, but more importantly to prevent.
I've asked whether our prescription habits—our policies and practice—contribute somehow to the addictions we are dealing with both in the services and at VA. I don't know the answer to this, but I've asked the question and am prepared to go wherever the answers lead us.
The commitment to end Veterans homelessness in five years was not just focused on rescuing homeless Veterans off of the streets of the Nation. It was also focused on strengthening our overall performance as an organization. In order to end Veteran homelessness, we would have to be better at the things we do day-to-day to prevent Veterans from falling into that downward spiral which can happen quickly, and once started there is an acceleration factor that's hard to brake. In the process, we would have to learn how to become an excellent organization—and advocacy would have to be our drumbeat—in thought, word, and deed—as some of us promise every week.
We have been at war for more than a decade, and the repeated deployments of Servicemembers have created issues that don't show up right away. More are surviving catastrophic injuries, but higher survival rates also mean more complex casualties—the compounding effects of post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and multiple amputations—five quadruple amputees from this war—with added complications of blindness, deafness, and genito-urinary injuries.
In 2009, of over 23 million living Veterans, only 7.4 million were enrolled in VA healthcare and only 3 million were receiving compensation and pension benefits. Why was our "market penetration" only 30 percent? In what would become the toughest economy since the great depression, the metrics were all wrong. We were going to have to adjust our stance and gain some agility quickly. We had an outreach problem—many Veterans didn't know about VA. We had an access problem—even if they knew about us, there was difficulty getting needed services. And even then, a backlog in compensation claims was a decades-long tradition.
Some numbers to provide some clarity about the claims backlog and some context for why it exists: Over the past three and a half years, VA has adjudicated 2.9 million Veterans' claims—900,000 claims in 2009; 2010, 1 million claims, unprecedented; 2011, another 1 million claims for a second year in a row—and we will likely break a million claims again this year. So the 570,000+ backlogged claims today were not the ones that were here three years ago, not even two years ago, not even a year ago. Now, there will always be some cases that linger because of specific complexities, but it's a dynamic process with claims coming and going. Anything over 125 days is considered backlogged. No one is standing at parade rest. Pushing 2.9 million claims out the door as 3.5 million claims came in? What explains this big number exchange?
Three and a half years ago, we had some unresolved issues from previous wars—issues we had carried over for decades, and some Veterans were dying without benefits. We decided to take them on:
These three decisions alone have dramatically expanded access to VA for nearly a million Veterans—that's step one. Step two is dealing with the nearly one million additional compensation claims that were going to follow, something we predicted as we made those decisions.
These were the right calls to make for Vietnam Veterans, for Gulf War Veterans, and for combat Veterans of all wars. We're not backing away from these decisions or the responsibility to deal with the additional claims.
VA has spent the past two years developing a new automation tool called VBMS—a paperless Veterans Benefits Management System being piloted at four regional offices today. We'll have VBMS up and running at 16 regional offices by the end of this year, and at all 56 regional offices by the end of 2013.
VBMS is key to VA's automating the massive numbers in what is today a paper-based process. VBMS is here and about to be fielded. In 2014, we expect DoD to begin providing all transition documents in electrons. That's how we intend to control the large number of compensation claims, while improving accuracy and fairness in the process.
Very little of what we do in VA originates in VA; most of what we do originates in DoD. So, seamlessly transitioning departing Servicemembers is crucial to our increasing access to VA's benefits and services, to our eliminating the backlog in compensation claims, and to our ending the blight of Veterans homelessness. Warm handoffs of transitioning Servicemembers require the synergy of both departments.
Secretaries of Defense Bob Gates and Leon Panetta and I have personally met ten times in the last 19 months on these issues—most recently on 10 September. Among our accomplishments, we have underwritten joint VA-DoD medical facilities where they make sense, begun reviewing how to harmonize our acquisition programs, and committed both our departments to a single, joint, integrated electronic health record (IEHR)—one that is open in architecture and non-proprietary in design. We expect initial operating capability in 2014 and full operating capability in 2017.
DoD-VA collaboration was an important priority—priority two was fixing VA's budget process. Creating change requires stable and predictable budgets. Thanks to the President and the support of Congress, we have received strong and stable budgetary support. I know you had Chairman Miller speak to you earlier, and his support was appreciated.
In 2009, VA's congressionally enhanced budget was $99.8 billion—a good budget. The President's 2013 budget request, currently before the Congress, is for $140.3 billion—a 40 percent increase. With that kind of funding, we have funded the following priorities:
First, to increase access, we have added 57 new community-based outpatient clinics, 20 more mobile health clinics, and a fifth polytrauma center in San Antonio, Texas. Three new hospitals are under construction—Denver, Orlando, and New Orleans—and we just opened a state-of-the-art VA medical center in Las Vegas last month—the first new VA hospital in 17 years.
We have also invested heavily in new telehealth initiatives to overcome the tyranny of distance. Enhanced IT technologies make it easier for Veterans to make appointments, access medical specialists, retrieve their medical records, and find out about available benefits and services—all without having to drive long distances.
I opened this morning discussing Veterans homelessness. The estimated number of homeless Veterans in 2009 was 107,000. By 2011, in spite of the extended economic downturn, that estimate was down to 67,500. We expect that the 2012 estimate, soon to be announced by the Department of Housing and Urban Development will keep us on track to ending the "rescue phase" of Veterans' homelessness in 2015. Education is critical to preventing Veterans homelessness. Since its inception in 2009, VA has issued approximately $21 billion in post-9/11 GI bill payments covering nearly 800,000 Veterans, Servicemembers, and eligible family members enrolled in everything from universities to community colleges to trade schools.
Last year, roughly 86,000 of our 1.3 million Veteran mortgage-holders defaulted on their home loans. VA intervened, working to lower mortgage payments and extending payment periods. 73,000 of those Veterans and their families were protected from foreclosure. While we celebrate that achievement, the question is, "What about the 13,000 or so who were in too deep for us to help?" How are we going to help them, and more importantly, how do we keep Veterans from falling into this situation in the future?
Mental health: In 2005, at the height of operations in Iraq, we had 13,000 mental health professionals handling the healthcare needs of our Veterans. Today, that number is greater than 20,000, and we are hiring 1,600 more clinical staff to address the growth in mental health requirements resulting from a decade of tough, high-risk, high-stress, repetitive, combat deployments.
We know that when we diagnose and treat, people get better. Among the roughly 8.6 million Veterans enrolled in VA healthcare, mental health treatment is up. At the same time, for Veterans receiving VA treatment, our suicide rates are down—treatment works.
However, too many Veterans still leave the military with mental health issues we never find out about. Most Veterans who commit suicide were never enrolled in VA. So, as good as we think our programs are, we can't help those we don't treat—another reason for our initiatives to increase access and develop a seamless transition between DoD and VA. These young people have done their duty, and we will not let them down.
One of our most successful outreach efforts is our Veterans' crisis line. DoD knows it as the military crisis line—same number, same trained VA mental health professionals answering the phone. Since 2007, over 640,000 people have called in, including over 8,000 active-duty service members. 99,000 were referred for care, and over 23,000 rescued from potential suicide. In 2009 we added on-line chat, and in 2011, a texting service. We will always find ways to reach out to Veterans in need.
Good jobs are essential for Veterans, and we are proud to have partnered with the First Lady's "Joining Forces" initiative and the U.S. Chamber of Commerce's "Hiring Our Heroes" campaign. The President challenged private companies to hire or train 100,000 Veterans and military spouses by the end of 2013. 2,100 companies responded, and 125,000 Veterans and spouses have already been hired, achieving the President's challenge more than a year early.
We have re-doubled our efforts to care for and assist Wounded Warriors and the strong families who care for them. In military and VA hospitals and in homes across this country, family members and caregivers are part of the recovery and rehabilitation program, providing extraordinary care and comfort each and every day.
Let me again acknowledge and thank our Wounded Warriors, who are with us today, for your dedicated service to our Nation. No one appreciates your service and your sacrifice more than President Obama. I witness this first hand. It is genuine; it runs deep; and it is unwavering—as reflected in his budget requests. We are pleased to have the resources we need to match your own resilience and determination. We are all astounded by the fight in you.
To our families—VA exists to support you. Wounded Warriors and their families know the inherent risks and harsh realities of military service. Your stories move and inspire us to be better at our missions. Today, VA still cares for the child of a Civil War Veteran. One other surviving child of a Civil War Veteran passed away just last month. The promises of President Abraham Lincoln are being delivered by President Barrack Obama. And the same will be true a century from now. The promises of this President and this Congress will be delivered by a president yet unborn. And VA will be here to fulfill those promises of presidents and the obligations of the American people. So, we must get this right for you.
We cannot do this alone—we will need the insights, instincts, collaboration, partnership, and alliance of everyone in this room and elsewhere: government agencies, NGOs, academia, non-profits, private sector, and those individual advocates who have enormous experience in this area—force multipliers like:
As of last month, more than 5,900 caregivers have enrolled in VA's caregiver support program, which provides an array of programs focused on knowledge and wellness. VA is committed to family-centric care—in family-friendly environments to support Wounded Warrior families—counseling, support groups, respite care, parenting toolkits, specialized training, social events, and other innovative initiatives.
Marriage counseling figures prominently. We are fielding programs like integrative behavioral couples therapy and couples therapy for substance abuse disorders. Plans for the coming year include a greater emphasis on parenting—couples-based treatment for PTSD—and refining our telehealth approaches to working with families.
We will continue to develop and field a continuum of needed quality-of-life services as our dialogue matures our understanding of your needs.
This has been a short summary of the state of your VA. By your next warrior-family symposium, I expect VA's report on the state of the department to reflect that between our 2009-2013 budgets:
We have not fixed everything—we know that. But you have had our very best efforts. I am proud of the 315,000 people who come to work at VA—over 100,000 of them Veterans. And you will continue to have our very best efforts. It's been an honor to be here with you today.
God bless those who serve and have served the Nation in uniform. God bless our President. And may God continue to bless this wonderful country of ours.