Minister Blaney, thank you for that kind introduction, and for hosting us to Ottawa for this timely and important conference;
I am honored to have this opportunity to describe for you the U.S. Department of Veterans Affairs; its support programs for Veterans of all generations; its requirements for nurturing and rehabilitating our newest generation of Veterans, who serve in Iraq and Afghanistan today; and the challenges of transition as they depart the military.
First, though it wasn't always this way, today the U.S. military is an all-volunteer force. The U.S. Department of Veterans Affairs ("VA" for short) traces its lineage back to our Civil War of the 1860's, the most devastating war in our history—nearly 215,000 killed, more than 280,000 seriously injured, and roughly 314,000 died of rampant disease. Our mission comes from President Abraham Lincoln's 2nd Inaugural Address, March 4, 1865: ". . . to care for him who shall have borne the battle, and for his widow and his orphan." These words adorn most of our buildings to this day.
Following the Civil War, 11 soldiers' homes were established, which became the first of our VA hospitals. Five of them remain in operation today and are historical landmarks. Of equal historical significance, there are two children of Civil War Veterans still on our beneficiary rolls today—the promises of President Abraham Lincoln are being delivered by President Barack Obama 146 years later. It is an important perspective. Nowhere else in my government is there quite this sense of historical obligation throughout the ages from one administration through each succeeding administration. And the same will be true 100 years from now—the promises of this President will be delivered by a president and a secretary of VA, yet unborn, but the promises will be delivered. Such is the mission and the history of VA.
Today, we have a little over 22 million living Veterans—not all of them are combat Veterans. To qualify as a Veteran, one must have served honorably on active duty in our military forces and been discharged under conditions other than dishonorable—1.7 million Veterans who served during World War II are still alive; 2.2 million from Korea; 7.3 million from Vietnam; there are 5 million Veterans from the current conflicts in Iraq and Afghanistan; and half a million served during the Persian Gulf War. Others served in Somalia and a handful of smaller operations.
Only 8.4 million Veterans are enrolled to receive VA healthcare—about a third of our total Veteran population of 22 million. To care for them, VA operates a large healthcare system. Those 11 soldiers' homes from our Civil War era evolved into 152 major, high-quality medical centers, which are academically affiliated with 107 of the top medical schools in our country. These relationships provide tremendous synergies in healthcare delivery, research, and education through shared staff, co-used assets, and collaborative studies. Fully two thirds of all—not just VA—physicians and many of the nurses in the U.S. have undergone some level of medical training with VA.
Each medical center also serves as a flagship to a cluster of anywhere from three to nine VA Community-Based Outpatient Clinics (CBOCs), which are located out in communities where Veterans have chosen to live. Together, our 152 medical centers and their 804 CBOCs; along with about 280 Vet Centers—storefront readjustment/counseling centers from our Vietnam War days—and some 50 mobile clinics for reaching out into remote and inaccessible areas, comprise a healthcare delivery network that is outpatient-centric for 90 percent of day-to-day needs and inpatient-capable for the 10 percent of time when requirements turn acute or critical.
This constellation of care points is further knitted together by a high-quality electronic health record called "VISTA" and telehealth IT links that mitigate the tyranny of distance between where Veterans get their day-to-day primary care and where medical specialists reside elsewhere in the system. Additionally, there are roughly 40,000 chronically ill Veterans whose homes are medically wired and linked to monitoring centers where their vital signs are monitored by nurses around the clock, so that we are able to anticipate and react to changes in their conditions, often even before they start to feel ill and have to drive to the emergency room. We see information technology as potentially the next major breakthrough in healthcare delivery in the U.S. and are investing heavily in it.
In addition to our healthcare enterprise:
While we are primarily focused on serving Veterans, there are several programs that provide services and benefits to Veterans' family members:
Since 2009, we have been working to fix three longstanding critical priorities: increasing Veterans' access to VA benefits and services; eliminating a backlog in disability claims that has built up over many years; and ending Veterans' homelessness.
Access: Where access is concerned, we have increased the number of Veterans enrolled in our healthcare system by nearly 800,000 in the last two-and-a-half years—a 10 percent improvement. To serve them better, we have built more than 30 new Community-Based Outpatient Clinics since 2008, and we are in the process of building five new hospitals. As I also indicated, we are investing heavily in telehealth technologies that will extend our reach into the most remote rural areas.
Claims backlog: In 2009, we completed 977,000 disability claims but took one million claims in return. In 2010, we completed over one million claims for the first time ever but then took in another 1.2 million claims. We expect to receive 1.45 million claims this year—more than double the claims we received in 2000. This is a big numbers game, and merely hiring more claims handlers will not allow us to dominate this inventory in disability claims.
I have committed to ending the claims backlog in 2015, by putting in place a system that processes all claims within 125 days at a 98 percent accuracy level. We have a host of promising options being piloted today, and expect them to begin paying off in 2012, as we begin fully automating the disability claims process.
Homelessness: No Veteran should be homeless, and VA has put all our capabilities into ending Veterans homelessness—primary medical and dental care, mental health, substance abuse treatment, education, case management, housing, and jobs counseling. Since 2008, VA has permanently housed over 29,000 homeless Veterans, and another 30,000 have been assisted through our homeless call center.
What we have learned over the past two-and-a-half years is that we cannot end Veterans homelessness through street rescues alone. We must develop robust prevention initiatives that address an "at risk" population that is difficult to see and may be several times larger than the street population.
But we know this "at risk" population exists, and we also know that the healthcare costs for homeless Veteran is about 3.5 times the cost for a Veteran who is not homeless. We intend to reduce the number of homeless Veterans to below 60,000 by next June 2012, with the goal of ending it in 2015.
A number of Veterans returning from service in Iraq and Afghanistan bear the signature wounds of this current conflict—TBI (traumatic brain injury) and PTSD (post-traumatic stress disorder). In Korea and Vietnam, our ratio of combat deaths to surviving wounded was 1:3. In the first two years in Iraq, it was 1:13. Clearly, more of our wounded are surviving. The stark reality—more injured Veterans, who survive combat, are permanently disabled from devastating injuries requiring a lifetime of care.
VA has long been a leader in the development of prosthetic technology. We are now also investing heavily in the treatment of today's signature wounds.
For TBI, we've made enormous advances in treating our most serious head injuries—those arriving at our polytrauma centers comatose, with injuries that only a few years ago were thought to be irreversible and hopeless.
Through innovative care at our four "emerging consciousness" centers, nearly 70 percent of these comatose patients have been brought back to consciousness—a rate that far exceeds the national norm.
PTSD has plagued every generation of warfighters. Last year, we simplified claims processing for combat Veterans suffering from verifiable PTSD to end decades of forcing Veterans to document a stressor event that caused their disorders.
We have nearly tripled spending on mental health programs since 2005, and since 2008, we have hired more than 3,500 mental health professionals. Our mental health staff now totals almost 21,000.
One of our most successful initiatives is our Veterans Crisis Line, connecting callers with a trained VA professional, who can deal confidentially with an immediate crisis. Over 450,000 people have called the crisis line, including over 6,000 active-duty servicemembers. We have made over 64,000 referrals for care, and close to 17,000 actively suicidal Veterans have been rescued.
In 2009, we added an on-line chat service for people who might feel uncomfortable talking to someone in person. To date, we've made contact with almost 20,000 people through on-line chat. Many of them have been referred to the hotline for immediate personal care.
In today's tough economy, a major challenge for Veterans returning to civilian life is finding a job. We provide preferential hiring for Veterans in the federal and many state governments. VA maintains a Veterans First policy for Veteran small business owners, who have the required qualifications, in competing for our contracts. We recently conducted a training and exposition conference for Veteran small business owners focusing on how to launch a business, how to survive the first several crucial years, how to network, how to compete for federal contracts, and how to grow the business responsibly. Earlier this month, President Obama announced several new initiatives to increase Veterans employment:
One of our more promising outreach initiatives was establishment of a Veteran Call Center to provide information on VA services and benefits. Since 2008, the call center has received 700,000 calls and has contacted over 504,000 Veterans. We have also recently begun a major push to outreach to Veterans through social media such as Facebook and Twitter, as well as our own webpage dedicated to Veterans of Iraq and Afghanistan.
Some day our missions in Iraq and Afghanistan will end, but VA's mission will continue to grow long after the last American combatant returns home. We must be sure to care for those who have "borne the battle," which is where I opened these remarks.
My thanks, once again, to Minister Blaney and our Canadian hosts for bringing us together. These talks will prove most helpful, and I look forward to hearing the remaining presentations.