 Good morning. I'm Jim Marslack, DAV National Service Director. I'm pleased to be here this morning with Joy Elam, DAV's National Legislative Director for a very special service and legislative seminar. This year our format will be a little different than in prior years. Rather than having seven or eight VA officials and congressional staff, we have just two guests. But we could not find two more important leaders for America's veterans to talk about the future of the VA, veterans' health care and benefit programs. On my left is the Honorable Robert A. MacDonald, who was nominated last summer by President Obama to serve as the 8th Secretary of Veterans Affairs and quickly confirmed unanimously by the United States Senate. Prior to joining VA, Secretary MacDonald worked for more than 30 years at the Procter and Gamble Company, one of the largest consumer product companies in the world, rising all the way to become chairman, president, and CEO before retiring in 2013. Mr. MacDonald is a 1975 graduate of the United States Military Academy at West Point and later earned his MBA from the University of Utah in 1978. He is an Army veteran who served with the famed 82nd Airborne Division and was awarded the Meritorious Service Medal. In recognition of his outstanding leadership from the moment he was sworn in as Secretary last year and has demonstrated personal commitment to ensuring that all veterans receive the services and benefits they have earned, DAV presented him with our very first Outstanding Federal Executive of the Year Award. Please join me in welcoming Secretary Bob MacDonald. Is my mic good? Okay. And on my right is Representative Jeff Miller, who serves as chairman of the House Committee on Veterans Affairs, where he is responsible for the authorization and oversight of the Department of Veterans Affairs, Veterans Health Care, and Benefits Programs. Congressman Miller was first elected to Congress in November 2000 and re-elected every two years since to represent Florida's first congressional district, which runs along the Pay and Handle and includes Pensacola and Fort Walton Beach. Chairman Miller also serves as a senior member of the House Armed Services and Intelligence Committees. A 1984 graduate of the University of Florida, Mr. Miller worked as a real estate broker and a deputy sheriff before being elected in 1997 to serve two terms in the Florida House of Representatives. In recognition of his commitment and leadership to pass legislation to provide advanced appropriations for veterans benefits, one of our highest legislative priorities last year, DAV presented him with our very first Outstanding House Legislator of the Year. Please join me with a warm welcome for Chairman Jeff Miller. We'll get started. As we previously discussed, gentlemen, we'll start by giving you each of you a chance to share your vision about the future of the VA and its health care and benefits programs. Chairman Miller, the floor is yours. I'm here in Denver with my good friend. This is amazing. This room is packed this morning. I know there's standing room out there. People kind of thought this was going to be a Donald Trump rumble between the two of us. You're going to find out that we are very, very good friends. As we were just talking about the future of the VA, it can be boiled down very simply to keeping the promise and doing what's right for those of you who have worn the uniform of this country. My dad was a World War II vet. Both grandfathers won in World War II, won in World War I. Actually, my grandfather was in World War I, was a stable sergeant for General Pershing's mules. So it goes to show you how far I guess we have come since then. But we both want the same thing. I think sometimes we have a little different tact in how we get there, but that's the way this process is really supposed to work. I'm part of the legislative body. The secretary is part of the executive branch. We have the oversight responsibility of making sure that the VA is doing what they tell us that they're going to be doing. But I will tell you this, standing on this stage today, knowing that Bob McDonald is the secretary of the Department of Veterans Affairs, I could not have a better feeling for where the department is going in the future. We talk a lot about the past, and Bob says, let's just keep focusing on the future. And of course, I think we need to look at the past in order to see where we've been and why we're in certain instances. But I know that this individual wants to do the right thing by you, as do all the members of our Veterans Affairs Committee. We are a bipartisan group. We usually pass everything out of our committee in a bipartisan fashion. Unfortunately, we had our first real partisan vote, if you will, the other day, and it was on what I think is a very simple piece of legislation that basically would give the secretary another tool in his quiver to be able to hold people accountable. And basically that is if somebody can't or won't do their job, I think the secretary needs to have the ability to fire that individual. Now, last year in the Choice Act, we gave the secretary the ability to do that with the top executives, about 435 individuals, but we did not touch the line folks. And that's not to say that the line folks are all bad because they're not. We know that there are hundreds of thousands of VA employees that go to work every single day that want to do the right thing because of the people that they're serving. But there are people that are there, and even people within the VA will tell you that there are people that are there that know that they're protected and they can't be pushed out of the job that they're in. And that is just something that I think that the American people think is not right. This doesn't say that the secretary has to fire people, it says that he can. Now, unfortunately, the unions came out in broad opposition to the bill and put a lot of misinformation out there and basically this bill does not take away the evidentiary requirements that are currently required now to fire somebody. It doesn't take anybody's appeal rights away. They still have the same appeal rights. So we're trying to work through this process, including the unions at the table in a dialogue to see what we can do to make this a little bit better piece of legislation so that it can pass the Senate and so that the president can sign it because the president said he would veto it if it came to his desk as it is written today. There is no perfect piece of legislation. Anything is subject to change and I'm more than happy to discuss where we can make those changes. But I think, you know, as the chairman of our committee, the two things that I talk about the most that the VA are transparency and accountability. And the secretary has gone a long way in becoming more transparent in making sure that his folks know that they should be upfront and honest in the very beginning and not try to hide things like the waiting time debacle that we saw in Phoenix last year, that we all need to work in a cooperative way and not push and pull all the time against each other. We are obviously going to have different thoughts through this process. But when you have a gentleman that agrees to come out of retirement, basically to take the helm of a rudderless ship that was in desperate need of leadership at the very top level, you can't do anything but salute the person that takes this role. And the press is real good about always picking out the quotes that I make that are disparaging towards the secretary or the department. But I want you to know that I support what the secretary is trying to do. I support what the people that are inside the department are trying to do. I just want those that don't want to get on the team to find another team to play on. So we're going to have a chance to talk this morning about issues like the Aurora facility and some of the budget issues that have come up within the department. I don't want to spend a lot of time up here other than to say I am deeply honored to be able to chair what I think is the most important committee that we have in the entire House of Representatives. And that is not only to provide the authorization for the benefits that you've earned, but also to provide the oversight to make sure that the dollars that we appropriate to the department are being spent wisely and help suggest ways that we think that they can be spent in a little bit better fashion. But to be able to work with friends across the aisle, my Democrat colleague Kareem Brown and I are in the same delegation in Florida, we disagree on a lot of things politically, but on one thing, we agree that we're going to do everything we can to keep the promise that was made to each and every one of you that made the choice. Some of you made a choice, I understand with a letter that may have came in your mailbox. But to keep the promise to those of you that were the uniform of this nation. For that I can say thank you so much. It's an honor to represent the people from the first district of Florida, which by the way a lot of people say where are you from? I say LA, they say LA. I didn't know you're from California. I said no, lower Alabama. I'm from the panhandle of Florida and it's a great place if you've never been there. We invite you all to come down. It's a pleasure to be here. Looking forward to talking with you. Great to be with you again. Many thanks again to Ron Hope for his tremendous leadership of DAV. Mark Burgess, of course, and Gary Augustine for everything they're doing to continue this public dialogue on what veterans need. Also special thanks to Chairman Jeff Miller. As Jeff said in his remarks, there really is tremendous unanimity within the Congress, within the committee, between VA and the committee. And we really appreciate the effort that Chairman Miller placed on getting the funding, the additional funding that we needed for care in the community before the end of this fiscal year. And obviously we could not have done that without Chairman and his leadership in the committee. Chairman Miller in his comments talked a lot about accountability, so I want to just come back to that accountability subject. We talked this a little bit on Saturday when we were together. I'm concerned about some of the legislation that the House has worked on and that would pass that tends to differentiate VA from other departments of government and could potentially harm our ability to attract top performers or people within government or even outside government to come into VA. The House version of the budget bill that was passed in May would prohibit performance awards and bonuses for many key employees. And HR 1994 passed in July would impose on VA several seemingly unreasonable requirements, mandated rotation of senior executives, arbitrary restrictions on performance ratings, and no right to appeal in some cases. I'm all for holding people accountable for their actions. I mean, you can imagine running one of the largest global companies in the world. You hold people accountable for their actions. But you can't motivate good people to do a good job by punishing them for the things that others have done. And you can't tie my hands on personal management and expect me to turn around the department. A key principle of my management philosophy is what I call sustainable accountability, which means several things. Making sure your people understand your organization's mission, values, and strategy. And as I talked Saturday, the first thing we did was we had every employee recommit themselves to our mission and our values. And we just redid that. We're going to do that every single year. Second, setting realistic performance goals and providing them the resources to meet them. Third, listening to their complaints and helping them solve problems. That's why in the 200 visits I've done to different VA facilities, I always hold a town hall meeting, talk to union leaders, listen to employees, listen to veteran stakeholders. Many of them DAV members are rewarding employees for good work and when all else fails, calling them to account for their misdeeds. Now I will tell you, a VA has not operated that way in the past. It's been managing to a budget instead of managing to requirements. And that's put many people in positions of having to do more with less. Some responded by doing things that they shouldn't have done. And we're dealing with that. We've proposed disciplinary action against 187 employees for access related misdeeds. And if you're familiar with the situation in Augusta, Georgia, there's a former VA employee by the name of Cathedral Henderson who has been investigated by the Department of Justice, charged by the FBI, indicted, and now faces punishment that could be five years in jail and $250,000 for every of 50 charges that he's under. I would call that accountability. What would you call it? Now we don't know the result of the 186 other investigations that will come out. But as those results come out, you will see the actions affecting the people who may have done misdeeds and access to scheduling. We've also proposed, as the chairman suggested, the removal of six senior executives. Four have been removed, fired, and two chose to retire before we took action on their firing. We've terminated 1,755 employees since my confirmation. That's compared to just 1,100 in all of 2014. Now some of those were on a probationary period of employment, but that's, of course, why you have a probationary period of employment is in order to separate those who can succeed from those who can't. And we brought new leadership in whenever it's needed. Of my top team, the people who report to me, there are 18 of them, 11 are new since I was nominated secretary. In all of our medical centers around the country, 91% have either new directors or new leadership teams. Nobody in VHA and the Veterans Hospital Administration in 2014 is getting a bonus. Nobody is getting a performance bonus for 2014. Now as you can imagine, our leaders were not happy about that, and I took the heat for it. But my point of view is how could anybody get a bonus when your secretary was forced to resign? Secondly, nobody in VHA in 2014 of the senior executives has been rated outstanding. Nobody. Again, I took heat for that. But again, I ask, how can you rate someone, anyone, outstanding when the team loses and the secretary resigns? None of the people, if you think about the Denver project and Chairman Miller mentioned that, none of the people who were involved in the construction of Denver as it went off the rails between 2010-2011 are now employed by the VA with one exception. Everybody's gone. The secretary, deputy secretary, head of acquisition logistics and construction, director of CFM, CFM director of operations, project executive, CFM contracting officer, all gone. Only the former project executive is still with the VA and he's assigned elsewhere to a non-supervisory role in a downgraded, lower grade position. So we've taken action and we are trying to make a difference. We've met the access crisis with more of everything available, more hours, more space, more people, more productivity, more accountability, more transparency, and more choice. I detailed those results on Saturday. 97% of appointments are within 30 days of the desired date. 7 million more appointments this year versus the previous year, 4.5 million outside in community care, 2.5 million within the VA. For those who don't think we like the Choice Act, 4.5 million appointments outside in community care. The new electronic, the electronic wait list is down 47%. VA healthcare providers have increased physician productivity by 8%. That's 8% on top of a 2.8% increase in budget. So we're working both harder and smarter to provide more care for more veterans. VA does face some serious challenges. In the past 15 years, as the very large Vietnam-era cohort of veterans has aged, the number of claims, the number of medical issues per claim, the number of medical issues in total, the average degree of veterans' disability compensation all have risen at a dramatic rate. So while the number of veterans is actually declining, the number of veterans seeking care and benefits is increasing. And that's what's caused last year's crisis. Veterans' demand for services and benefits exceeded VA's capacity to meet it. It's important that Congress and the American people understand that. More veterans are still coming to VA for healthcare. This fiscal year, the number of veterans enrolled for healthcare has gone up by about 4,000 a month on average, 4,000 a month. The number of enrolled veterans actually coming to us for treatment has also gone up about 100,000 so far in 2015. And as we continue to work to improve the care we provide and provide access to that care, more and more veterans are going to come in. Why? Three reasons. Veterans are aging and therefore needing more care. Two, VA is providing more access to high-quality care and often better than available elsewhere in the community. Three, financial incentives make VA the choice, the smart choice. Let me give you an example. VA provides the best hearing aid technology anywhere. Medicare doesn't cover hearing aids. And most insurance plans have very limited coverage for hearing aids. So choosing VA for hearing aids saves veterans about $4,200. Most veterans have other choices. 81% have either Medicare, Medicaid, tri-care, or some private insurance. But more veterans are turning to VA for more of the care. Not for all of their care, though. On average, enrolled veterans rely on VA for only 34% of their care. But if that percentage rises just one percentage point, only one percentage point from 34 to 35%, the cost increase of a VA, the need for an increase in budget, is $1.4 billion. The more veterans come to us for care, the harder it is for us to solve the access problems, to balance supply and demand without additional resources. That's the fundamental problem, and it's only made worse by our aging infrastructure. 900 VA facilities are over 90 years old, and 1,300 are over 70 years old. And if we didn't close the facilities gap now, we could be facing another access crisis in 20 to 30 years. I can't spend healthcare funds on healthcare in some cases. I can't even spend care in the community funds on care in the community in some cases. So we believe in giving veterans a choice, and we're committed to doing that, but we need the budget flexibility to move money from one account to another in order to care for veterans. A month ago, VA was faced with a critical shortfall in funding for care in the community, and I already thanked Chairman Miller again here publicly for his help in solving that. We are running out of money, and we're running out because we've provided so much more care in the community in the past year. Authorizations for care in the community are up 44%. The new miracle drugs, the Cure Hepatitis C, compounded the problem. These new drugs are extraordinarily expensive, and the cost of curing veterans of Hepatitis C plus all the extra care in the community all but exhausted our care in community funds. Without additional funding, I would have been forced to either defer all remaining non-choice care in the community authorizations until October to begin shutting down hospitals and clinics all over the country. All of us agreed that was unacceptable. So I appealed to Chairman Miller and his congressional colleagues, and they responded greatly and as needed. And giving me the budgetary flexibility used choice program funds for care in the community. These were funds set aside for care in the community. We needed to use them for a care in the community, but they were in different pockets. But that agreement was given to me for only this fiscal year, meaning it ends September 30th. So next fiscal year, October 1st, I'll be back in the same bind of not having the flexibility to allocate funds to pay for the care veterans are actually choosing. We believe in giving veterans a choice and we're committed to making a choice program work. Authorizations on the choice program have gone up steadily over the past six months. Choice now pays for about half of the care in the community and it's about up 50% versus what it was. But choice doesn't cover everything. It's just one of seven programs that we have for care in the community. And one of the things I've committed to Chairman Miller to do is we need to find a way to take these seven programs that are so complex and put them into one. It's better for veterans, it's better for veterans and it's also better for VA employees. Imagine being the VA employee faced with seven different programs they have to understand. As I review those programs with different members of Congress, they're also surprised. And they're surprised at how differentiated the programs are, how confusing and how complex it is. But the point is our resources are still inadequate to meet our requirements and only Congress has the power to correct this situation. We need Congress to give us permanent flexibility to move money from one pocket to the other to care. And we need Congress to fully fund the President's 2016 budget. The House has already voted to cut the President's budget request or not give the President the entire request by $1.4 billion. If we applied that across the board, that would mean healthcare for 70,000 veterans for a year. Also in that budget that was passed by the House, our construction budget was cut by 50%. At a time where over half of our facilities are over 60 years old, that really doesn't make much sense. Now, we've made great progress in the last year. We've tackled the access problem. We've begun a dramatic transformation of VA's organization structure and business processes called MyVA. We talked about that on Saturday. MyVA will improve care for veterans for years to come. But we need to work with Congress in order to get this done. Congress defines the benefits that veterans get. Congress appropriates the budget for paying for those benefits. We are the ones in the middle trying to execute that. Obviously, the benefits and the budget have to match. And I look forward to working with Chairman Miller on that. Thank you very much for your attention. Chairman Miller, Secretary McDonald, thank you both for your remarks. I'll begin with some questions about healthcare. Secretary McDonald, you're up first. It's been just over a year since you were sworn in as Secretary and also one year since the Veterans Access Choice and Accountability Act was signed into law. And I know you said you fully support choice and you're trying to improve the numbers of people being able to access that program. But can you talk about the challenges you faced while implementing the law and the steps you've taken and are taking to eliminate the confusion among veterans and VA employees that occurred right off the bat? Joy, as I said, I think the ultimate answer is the Chairman and I and Chairman Isakson from the Senate need to work together on combining these seven programs that we have for outside care into one. It's very confusing. And frankly, not only is it confusing but members of Congress unfortunately get confused also because their constituencies want different things. For example, I went to Montana with Senator John Tester and he called a meeting of providers, meaning medical people from that area. And they all told me how much they love the ARCH program and they didn't want the choice program. In fact, they wanted to opt out of the choice program. We've had trouble getting them into the choice program and they wanted a program called ARCH. Well, it didn't take me long to figure out why. The reimbursement rates for ARCH are higher than the reimbursement rates for choice. But there's only certain services that are available in ARCH and there are only certain services available in choice. Similarly, I'm headed this afternoon to Alaska. The members of Congress of Alaska have asked for an exclusion from choice. They don't want to be part of choice. Well, we have worked out prior to choice, we worked out an arrangement in Alaska using the Native Alaskan Health Services. And it's a great arrangement. It's provided great care for veterans in Alaska. But again, the reimbursement rates are higher for this program than for choice. And also, the services offerings are different. So, what we're going to work together on is get to one set of reimbursement rates, one program, one set of services, and that will make this system much, much easier. In the meantime, before that legislation is passed, we are working with our third party administrative partners, making sure every veteran understands what's available with choice, how they can get into choice. We're making individual phone calls. We're trying to get more providers into the choice network and we're working with Dave McIntyre, who I see here in the audience, and other leaders of our third party administrators to do that. We want to make the choice program successful. Thank you. Chairman Miller, I know you've expressed frustration early on with the choice program and that it just, it was very difficult, some rough, rough start. Would you care to comment? Like any program like choice, as large as it is, it's going to have bumps in its rollout. There's no question. I mean, we asked the third party administrators to do what they did in a 30-day period, which is an extremely short window for them to do what we asked of them. The thing that concerns me, and the secretary is working really day and night, I think, to solve this problem, but some of the communication from the top getting down to the line employees was lacking. And so you would have people that would call, they would be told they didn't qualify for choice or that it wasn't available in that particular area. And those are changing. I think they're becoming more, not the norm, the anomaly, if you will, in the program. The thing that concerns me, when we develop choice, and I think the idea of making choice permanent, that is to allow the veteran to choose where they go and when they go, I think it's critical. Part of the negotiation process, and if you wanted to see a real negotiation, Bernie Sanders and Jeff Miller in a room together doing this, but we got something. That's what's supposed to happen. I mean, that's what compromise is all about. One of the compromise points was that choice would be a sunset in three years or when the choice dollars ran out, which we appropriated $10 billion. And so part of my concern with filling the budget hole that the secretary brought to our attention, the only place that we could go was to the choice program. Well, unfortunately, we now have taken about 30% of that money and we've got to look at a way of replenishing that money so that the program itself does not die before it actually gets up and running. I think everybody out there wants the choice of staying in the system, should they choose to do that, or being able, especially in the rural areas. You talk about Montana in places, even where I come from in the Panhandle of Florida in the northern part of my district. You know, it's a long way for folks to get to a VA facility, but there are primary care physicians, specialists come to that area in particular times of the week and they could be able, because they are outside the 40 mile area. I think though that as we move forward in this process and I wholeheartedly agree that combining the seven individual fee basis or six fee basis programs and the one choice program together is the right thing because it does confuse not only the veteran, but certainly those that are administering the program. We're obviously very much in favor of continuing choice as is the chairman. And one of the things, one of the implications for that that I think is very, very important to talk about is that puts a responsibility on the VA to train the American medical industry in what it means to care for a veteran. And one of the things I've been doing is working with Secretary Sylvia Burwell, Health and Human Services, to get doctors who are in the community who are not VA doctors to know to ask the question, have you ever served in the military? Because it's going to be, it's going to take a while to train every single doctor in this country on traumatic brain injury, post-traumatic stress, how you deal with the infection in a limb with a prosthetic. That's going to be a difficult thing to do. And what I want to make sure is that the doctors in the community are trained to know how to care for veterans and that we have a seamless handoff between VA and the community. Our electronic health record is a great way to do that and we need to get more of the doctors in the community to use our electronic health record. It would make the transition much easier. And if I can add, you know, one of the greatest things I think that has been going on over the years is a collaborative effort with not only the VA and DOD, but with the VA and medical schools and being able, there are a vast number of physicians that come through the VA that actually get a lot of their residency training. Right here in Denver, the original VA hospital was going to be a bed tower that was associated with a medical school in an attempt to be able to give a better training platform for the physicians that were coming out of this medical school. And we need to look at ways to do more of that to leverage not only what the private sector or the educational sector may have and what the VA is trying to do. I agree. There are certain things that VA and only VA can do. But there are a lot. You should not have to go to a VA clinic for a flu shot. You should not have to go to a VA clinic for some of the very normal primary care issues that are out there. That lets that clinic and those people that are in there servicing other veterans have the time to be able to make those appointments in a timely fashion. I think what hurt VA the most in April of last year when it was finally uncovered was that there were some unrealistic goals that were put in place 14 days for people to be able to get in to see a physician. The private sector has a hard time doing that. The same thing on disability ratings of 125 days in the backlog. We need to make the goals obviously that are attainable so that people don't go by human nature which as some did to try to fudge the numbers especially in the appointment wait time because that harms potentially a veteran who is waiting to get in to have a colonoscopy film read or something else like that as we saw in Columbia and in Augusta. Hopefully under the secretary's leadership those are things of the past. There still are going to be things that bump up but I think the choice program as it's designed and it will be continually modified is to try to supplement what the VA does not to take away the VA itself but to help the VA do what it does better. I think the chairman raises a great question. I think the question for all of us as veterans myself included is the choice. Do we want to have multiple doctors in multiple places we go for care or would we prefer to keep one doctor, one primary care doctor for care and I think the fact that we give the veterans choice they can decide that. Secondly I couldn't agree with the chairman more the system that Omar Bradley set up in 1946-47 of aligning VA institutions with medical schools is one of the great things about the VA system for vets. They get the very best doctors in the country who are teaching what they have to practice every single day and as we talked on Saturday 70% of the doctors in this country are trained by the VA or within the VA. Third point and last point which is the whole point on 30 days or the fact that the 14-day requirement that we got VA in the trouble last year which it did is we've got to have a different discussion with Congress. Our discussion with Congress has to be less about a budget. What we need to start with are what are the requirements that we want to agree on. So the chairman and I need to agree that that 30-day standard is the standard and if that's the requirement, that's the standard then we can easily say well here's what the budget should be but without agreement on that requirement which is what you do in business. This is what you do in business. You look at the consumer demand and then you decide what the finances should be. You don't decide the finances and then try to reach an outcome that is unreachable and I would argue that's what happened. VA works to a budget not to a requirement not to a consumer demand requirement and so what we need to do is understand that maybe 30 days isn't the right number because 30 days has this cost associated with it and that's the discussion I want to have and I have had with the chairman and the committee. You guys can probably leave the stage because Bob and I are going to go back and forth about this. Welcome to our meetings. You know, we got a lot of flies on the wall. Oh, I know. Hey flies, where are you? Here's the issue. The law today says that the VA must work to the budget. That's what the law says. I understand what the secretary is talking about as far as, you know, to the requirement. The problem that we have to confront is being able to determine if in fact physicians are seeing the number of patients that they need to see. Is it because, you know, this is the anecdotal evidence that I know. VA docs see 8 to 10 patients a day. Do they see more? Actually, that's the number that we get is 8 to 10 patients a day. There may be more that don't. But, hang on, hang on. The chairman said it was anecdotal information. Please cut him some slack. Yeah, it's anecdotal information. The VA cannot tell us, the committee that authorized in budgets for them, how much it costs for a physician to see a veteran. They can tell you what the doc cost is, but not the fiscal plant cost. Those are all things that you have to know in the private sector in order to do what they do. When a physician in the private sector sees patients, they will see patients in the 20 to 30 range. The unfortunate thing is, when you go in to see a physician, they sit there and look at a computer screen almost the entire time that they're talking to you because they have to do a lot of things that a scribe could do and the physician could go on to see more folks. Another thing that Bob talks about is the way that the rooms are set up for physicians to see the patients are not like they are now where you can rotate through and improve the efficiency of physicians. So there are a lot of things that we all need to come to agreement on. I understand meeting the requirements that are out there, but even in the veteran world, budget dollars are finite, and we have to make sure that the dollars that are being spent are exactly the way that you would want them to be spent. Thank you both for those comments. Just to touch on the single extended care network, everyone seems to agree that that would be the best idea to make that less complex for both the people administrating, the VA employees administrating those programs, and for veterans. So let me ask you, I know you just passed legislation that was included in the flexibility with giving VA the flexibility to use the funds, but there was a November 1st deadline about coming up with a plan just for you, Secretary McDonald, is three months enough time to develop that plan? Do you think you have some ideas internally how you're going to do that, or is that a reasonable amount? No, the work is underway. I mean, before the legislation was passed that required us to do that plan, we'd been working on that before. The chairman and I had discussed that, I don't know how many months ago, but we've been talking about this for some time. What became more poignant to me that I didn't realize was how this complexity is getting in the way of VA employees doing good work. As I look back at what happened over 2014, as I said in my prepared remarks, we had a lot of individuals thinking that they were doing the right thing, reacting to the wrong measures. And in reality, we put them in a system that was designed to fail. And what we need to do is sort that system out and help it succeed. I have no doubt that we will come up with a plan before November 1, and that what we are going to have to do is there are going to be a lot of vested interests in this plan because this is business for people. And those vested interests are obviously going to come to members of Congress to lobby. And obviously, they're not going to lobby for lower rates. And I've not had a member of Congress write me yet asking to take away something. So we're going to have to put together a plan that makes a lot of sense, and I think we will. Do you think that the rural, the situation with rural community, veterans living in rural communities is going to be, it's going to be more difficult in those locations rather than in your more urban centers where you have access to health net or tri-west or one of those? The devil will be in the detail, and the chairman and I will work through that detail. But let me help dimensionalize this. I have said previously that VA is the canary in the coal mine for American medicine. The American people cannot do without the VA because of all the innovations we've come up with. But also, we tend to see what's going on in American medicine. We're not producing enough primary care doctors in this country. Florida is short 17,000. California is short 22,000. So knowing that when a senator or congressman says to me, well, you need to get a doctor in the rural area of ex-geography, I've got to take responsibility for increasing the throughput of the medical school. In some places, like in Nevada, we're working with members of Congress to create a new medical school. There are no medical schools in Nevada. There are no in Montana. So we've got to look at the total system, see where the constraint is, and then work on eliminating that constraint. So getting into the one network system I think will be relatively easy, but understanding where that constraint is and working on the constraint together will be the hard work. Chairman Miller, there are a number of proposals being floated to reform the VA healthcare system. And some have suggested that VA should be smaller or maybe turned into centers of excellence that provide only the specialized care for service-connected disabled veterans and their injuries and illnesses. One plan that's being promoted by concerned veterans of America calls to privatize or downsize and could even put VA's long-term existence at risk. Would you care to share your thoughts on these proposals? Well, first of all, you need to invite CVA to come defend their own plan because I'm not going to defend that nor would I defend anybody else's plan. You know, what I want to see is a VA that works. I think that's the same thing that the Secretary wants. And if the VA needs help supplementing and that's why when I started my comments, you know, the VA does some things very, very well unlike any other medical facility in the country. And yes, there have been so many innovative ideas that have come out of the VA because of the specialized patient population that they deal with on a daily basis. But there are many, many things that can be done in the private sector that the VA shouldn't have to do. Putting VA clinics everywhere all over the country is a very complex way to manage the healthcare in the 21st century when you do have private care facilities. And one of the things that we did and the Secretary is very, very right when he talks about the docs that are going to be leaving the system, they're going to be the population is aging out of the medical profession. We have added through the Choice Act, yes, additional slots for graduate medical students. There are medical schools that are being started all over the country. And I know that the Secretary, I've been with him at medical schools where he was together at the University of Central Florida where he has been recruiting folks to come to work at the VA. We want the VA to be known as the preeminent place for folks to come to work. If you want to be able to come to work on issues that nobody else gets to deal with, geriatric care, for instance, come to the VA because the population that we have while they are very special people and have done things that others in this country have not done, you will have an opportunity to use your medical license and profession differently. So we've tried to expand and we understood the same thing in the nursing population. I know in Florida we are having a shortage of nurses coming into the system as well. And so we have to be prepared not only for VA, but be prepared for it nationally within the medical world. May I make a comment? I agree with the chairman on all his points and he and I have talked this as before. You know, I said previously that the VA is necessary for the American public, not just for veterans, not just for American medicine. Many of those innovations, those three Nobel Prizes, those seven Lasker awards, doing the first implantable pacemaker, doing the first liver transplant, inventing the shingles vaccine, those are all things that benefit the American public. They're not unique to veterans. And the question is in a system where you don't have a VA, where you might not have the research, the $1.8 billion that is funded in research, what for-profit system is going to do that research? I mean, as somebody who came from the private sector, I do believe there's a role for government. And you can debate what size that role is, but who's going to do that if the VA doesn't? And in the case of training 70% of the doctors in this country are being the largest employee of nurses, who's going to do that if the VA doesn't? And as a result of that system, which Omar Bradley established, our veterans get great care because they're getting care from, for example, our chief of staff in Palo Alto, teaches at Stanford Medical School and does clinical work in the VA. So it's a great system. We need to strengthen it. We need to supplement it with private care, community care, but there's no question that we are not in favor of privatization or doing anything that would atrophy the VA system to a point where it couldn't adequately care for veterans. I appreciate those comments. I think from DAV's point of view, we've been very concerned about some of the proposals that are out there. And while we want veterans to have that choice, we also want them to have the choice, especially our membership, who really is our high users of the VA healthcare system. They've received very comprehensive care within VA. That ability to continue to do that without having to drive farther or wait longer for that care of VA, you know, starts to be downsized into these more sense. As you know, Joy, and Chairman and I worked together on this. We redefined that 40-mile limit to be driving distance versus geodesic disc difference. And that was, I think, a big thing. And also, the chairman worked very hard in the last proposal to give me more flexibility in deciding what was the geographic barrier or burden to the veteran. And that will allow us to do more as well. You know, when you run a business, you run a business based on principles, not rules. And by definition, when you pass a law, a law has to be very rule-based. But if we can get to the point where trust is there and I know we have to rebuild trust, I think we're after the same thing. And hopefully we can provide greater flexibility, trusting that we use that flexibility in the right way to work together to care for veterans. And that's what I think we really want to see is both the Congress and the administration working together to really do what's best for veterans and make sure that they're part of the discussion as this moves forward with all the changes and a new vision for VA in the future. I think we'll switch gears now and move to a few benefits questions. So I'll turn it over to Jim. Thank you, Joy. Mr. Secretary, one of the challenges you had inherited was a long-standing backlog of claims and some ambitious goals for 2015 that all claims would be completed within 125 days at a 98% accuracy standard. Can you update us on VA's progress on reaching both of these goals, whether they would have met this year and what you see as appropriate future goals? Well, the 125 days on disability claims, the disability claims peaked at 611,000 in about the middle of 2013. Today, before I came here, I discovered we are less than 110,000. So we've gone from 611,000 to less than 110,000. I don't know what that is. That's about 80%, something like that, reducing them. What we've done to do that, and it's been some tremendous work. I really have not seen another transformation in government, maybe even in business, that has been this stark, is we digitized the process. This would not have happened without DAV because you can't digitize the process without fully developed claims and the work that you've done and other veterans service organizations have done to give us fully developed claims has been outstanding and enabling of this. So by digitizing the process, I hope you're clapping for yourselves. To digitize the process allows us to do a number of things. One, you can deal with a claim a lot more quickly. Two, it's easier for us to train people in dealing with the claim. Three, we can move the claim anywhere in the country as if we had different hubs of manufacturing and whoever has the bandwidth to do more, we can move the claim there. Four, we've gotten rid of tons and tons of paper. And now if you go into our offices, you'll find we have a lot of vacant space, which we're trying to work with our committees to eliminate because it costs a taxpayer money. So we've been able to do that. But sadly, we've done it by people working mandatory overtime for over four years or around four years. And we've been working with the chairman and our other committees to try to get more people that we can put in this process so we can get off a mandatory overtime. Unfortunately, given the focus that's been on access, as the choice care was passed, the part about the extra people we need for Veterans Benefits Administration was stripped out. So we didn't get that money. We didn't get that headcount. We put it in the 2016 budget, but as I said, some of that's already been reduced. So we've got to get those extra people. What we've tried to do to overcome that is we have now trained more people and enabled them to work from home. So we pick up two hours in the commute in order to have them work on claims. We'll get to the goal. Whatever virtual zero is by December, we'll get there. The issue I'm now working and we are working is the appeals backlog. Because first of all, I don't want you to think that getting rid of the disability claim backlog has increased the appeals backlog. It doesn't work that way. But because we've had more and more claims, typically about 10 to 11% of Veterans appeal the decision and that 10 or 11% has stayed constant over a long period of time. But because it's 10 or 11% of a larger number, that number goes up. So what we're doing right now and working with DAV, again, I have to credit DAV, I have to credit Gary Augustine for developing something we call the fully developed appeal which is like an accelerator lane for the appeal. We want to get that passed in the law. We're working to do that. Gary and his leadership and all of us have worked hard to get all the Veterans Service Organizations involved in that. And we need to do to appeals what we've done to claims. And that's our big job right now. Thank you. And Chair Miller, thank you for sponsoring HR 800 which includes fully developed appeals that the Secretary was just talking about. Can you talk about the committee's plans to advance that legislation? Well, obviously we, as we return from the August work period and there are members that are traveling the world right now. It is, the press would have you believe everybody is home on vacation. We are out meeting with constituents, going to events just like this. And when we return, we will do everything that we can to push the legislation forward. The problem that we run into is that we're into a time crunch as the clock begins to tick on the first half of the 114th Congress. We have a lot of heavy lifting that the entire Congress has to do that affects all of the United States, debt ceiling increase, other budgetary issues that we have to deal with. But it's my intention to try to move it forward as quickly as possible. The question is, you know, can the Senate, you know, move something and get it to the President's desk? You know, unfortunately many of the good things that we have been able to pass in a bipartisan fashion in the House bogged down over on the Senate side. And Chairman Isakson is working very diligently with his ranking member, Dick Blumenthal, to try to move things forward. But they move a little slower over on the Senate side. They have different rules of engagement over there. And so we, with your help, will try to move it forward and get it on to the President's desk. I will say, and this is not a gotcha moment. I just want to know in here because I hear again, anecdotally, around the country that people are still waiting long periods of time for their claims to be adjudicated. And I'd like to know how many of you in here, if you can, raise your hand, are waiting on a claim right now to be adjudicated? Okay. Well, I can't do anything about the over 15 years. But let's see, was I on a diapers then? But what I would suggest is if you are waiting, you think of an extraordinary length of time, please email me or call me, bob.mcdonald.va.gov. And you have my phone number. I gave it to you Saturday. And we will look at your particular case. The average claim today that comes in today is dealt with in less than 125 days. But we will do our best to get after every single one of your claims, even the backlog claims. Look, what I'm trying to do is there have been a lot of issues that have been standing in VA for a long period of time. And I'm trying to knock them off with Chairman's Help every single day. There was a four-year-old lawsuit in L.A. that was getting in the way of us housing homeless veterans. There was a lawsuit in the state of Florida that I got rid of. There was a question about C-123 Agent Orange, which we have figured out and solved. There was Camp Lejeune, which we have figured out and solved. So give us some time. Give us some time. Give us the resources. We've done this before. We'll get it fixed. Give us, but please have some patience. 15 years is too long. And the Secretary is right. I mean, that length of time, you know, there needs to be an answer at some point. What I was going to say in addition to in the appeals world is that we are trying to work legislation through now that will give the Board of Appeals additional personnel to be able to handle the additional appeals that are coming through. We're trying to put together the possibility of letting even them do assembly of the appeals process or the case itself because they are experts in what they do. I have talked to the judges about the need to bring some additional, we've gone from seven, I think to nine right now, but in a temporary basis. So again, trying to help the Secretary accomplish his goals, you know, this is not a partisan issue. This is not just start under President Obama. It was under President Bush. It was back under President Clinton. You know that because you have all been fighting some of these fights for a long period of time. This is about the veteran population. This is about doing what's right. This is what's trying. We're about getting the efficiencies that Bob is accustomed to in the private sector brought to government. And that's tough because government is not used to working efficiently. They're used to having. So with with leaders like Bob McDonald and the team that he's brought, I tell you, the people that are coming into my office now that he has brought onto his team are superstars. They really, really are. Now, these are the top folks. But hopefully that will reinstill in many of the employees at the Department of Veterans Affairs is they are an agency that matters not just to you, but to all of America. Because as I said to start with, we have to keep the promise that was made before Iraq and Afghanistan or our current conflicts all the way back into World War II. We should be doing what we said we were going to do and do it in a timely fashion. And that ain't easy sometimes. And that's what the Secretary is trying to accomplish. I just I just want to if I can jump on what the chairman said because I think he and I have talked to so many times. This time in the life of the VA reminds me a little bit of 1946-47. I mean, when Omar Bradley came back after World War II, he felt like veterans just weren't getting the care they deserved. And that's why he set up the system that we have today that serves veterans well when we can get them into the system and keep that system robust. I think we have a unique moment in time. We have unusual consensus within the country that something needs to be done for veterans. We have the unusual unanimity within Congress, within the executive branch. We have two leaders and I would include our other leaders in the Congress who know what needs to be done. And now it's just a matter of us working together and pledging to all of you that we will get this done. We will get this done. And I'm committing to you that I and the organization of VA will get it done. I mean, the transformation we've put in place, my VA, please go on our website. I've got over 55 pages there. As the chairman said, I brought in people from the private sector. The best people you could find. A guy who actually ran a hospital system. A guy who worked for McKinsey to change businesses. A guy who had worked at McDonald's who knows what customer service is about. A deputy secretary who's committed to this. He's my West Point classmate. We have a unique moment in time. Let's work together to take advantage of it as we're going to try to do to create a system that will be there for the veterans of Afghanistan or Iraq or the next war 20, 30, 40 years from now. Let's not let happen what happened in 2014 as all of us veterans aged. Mr. Secretary, you just discussed my VA a little bit. And I know there's six bulletin boards out front of the convention hall that a lot of our members have been taking a look at. Thanks for putting them there. Absolutely. Can you elaborate on how you feel these changes will help strengthen VA's healthcare and benefit programs? Sure. When I got to the VA, we put together this 90-day plan called the Road to Veterans Day. There were three simple strategies. Strategy one was to rebuild trust, not just with the veterans, but with members of Congress and the American people. Strategy two was to improve all our metrics, access to care, disability claim backlog, homelessness. Strategy three was to do what's right for the long term. And I have to tell you, I had a lot of people say to me, why do you want to do that? You're only going to be there for a year, year and a half. You know, you're not going to be there that long. Why work on the long term? It's going to be hard work. But you know what? We couldn't live with ourselves if we didn't do that. Five strategies, very simple. Improve the veteran experience. Our veteran experience is not where it needs to be. It's uneven by veteran encounter. So what we did was we hired a chief veteran experience officer, Tom Allen, over 20 years experience at McDonald's. He took McDonald's to Europe and to France, adapting it for the needs of the French consumer. We're learning from Starbucks. We're learning from Ritz Carlton. We're learning from Disney. And these folks are helping train us, helping us train our people on what good customer service looks like. We're creating community boards that involve all parts of VA as well as people from in the community, like DAV members, so that decisions can be made at a local level, resources can be allocated, and needs can be met. You can't solve customer needs from Washington. You have to have that local sensing. At the same time, we created an external advisory committee that includes some of the very best leaders in the country. Joe Robles, the CEO, past CEO of U.S.A.A., is our chair. Great guy. U.S.A.A. has great customer service. Fred Lee, who wrote a book, if Disney ran your hospital. So he's helping us as well. Toby Cosgrove, who is the CEO, longtime CEO, good friend of Cleveland Clinic. So we're bringing together the very best minds. Second, we got to improve the employee experience. If you check, there's a definite correlation between companies that provide great customer experiences and companies that are good to work for. We don't have that. In fact, people at the VA are scared. They're scared. We have trouble keeping people on that we want to keep on because of all the criticism, all the new laws that are being passed to differentiate VA from the rest of government. So we got to improve the employee experience. So we brought on a guy named Noel Tishi. He is a professor at the University of Michigan. He was Jack Welch's mentor at GE. He set up Crotonville, which is the training location at GE. We're putting in place a lot of new employee policies, training, development. We raise the salary of our doctors 20%. We're not to raise the salary. We raise the salary bands so that we could raise the salary because we weren't competitive. So we're doing the things the private sector does. Third, we have to improve our internal support services. Our IT systems are awful. The scheduling system from Phoenix dates to 1985. It's virtually green screen MS thoughts. It's way outdated. We have to fix that. The financial management system which helped create the controversy between the chairman and I at the last hearing on why didn't we know this problem earlier, this financial problem earlier, is written in COBOL, a language I wrote in 1973 at West Point. That's got to be changed. Now, having said that, the VAs tried to change it twice in the past and failed. So when I'm telling the chairman, is this a unique moment in time? Give me the money to change that. And I will change it forever for VA. Fourth, we need to create a culture of continuous improvement. Of the roughly 200 visits I've made to VA facilities, I hold town hall meetings like this. If you're a VA employee, you would tell me you feel like you're the prisoner of a system you can't control. And I would say, no, you're not. You're in a new system. You can control it. I'm expecting you to change it and improve it for the veteran. And I'm going to train you to do that. So we're going to train people in a technology business learn 20 years ago called Lean Six Sigma, which helps people get engaged, energized, and I have to tell you, the union leadership is behind this. They're with us. They want this to happen. Number five, last but not least, is strategic partnerships. We can't do this job by ourselves. We're in favor of choice. We're in favor of partnering with people in the community. One of my very first trips was to Boston. There, there's an organization called Homebase. Homebase is funded by the Boston Red Sox Foundation. We also met with a wonderful gentleman who owns the New York Mets, who wanted to help veterans. And in the past, VA had pushed these people away because they saw them as competition. VA is no longer doing that. We're embracing them. We want them to come in and we want to work with Homebase because Homebase does good things for veterans. And additionally, there's an ethical issue. Homebase can treat the 15% of veterans who have less than honorable discharges that we in the VA cannot treat by law. So we brought in a guy again from the private sector. His name is Matt Collier. He's in charge of strategic partnerships, made great progress, and we're going to continue to push along that way. Those are the five strategies. I would love to have my next house hearing on my VA, and we bring in all the people working on this and we lay out for the members of the committee how they can help us. Can I talk a little bit about some of the things that the secretary mentioned, number one, and he mentioned it in his open remarks, that the bill that I sponsored in 1994 differentiates VA from the rest of the federal government. We did the exact same thing last year in the Choice Act. We differentiated all of the SES employees and gave the secretary the ability to fire. At that point, the unions were not against the bill, but when we began to deal with the people that are part of their membership, that's when they came out with both barrels blazing. And I think that what's important is people in the outside world, outside of the federal government want to make sure that folks are held accountable, which is what Bob McDonald wants to do. My bill doesn't say he must fire them. It says that he can fire them. And look, if it works at the VA, let's spread it throughout the entire federal government so that people are not in sconce. Now, here's the other thing. The software that the department deals with, as Bob has already said, is so antiquated. Many of the programs that they deal with are old. It's not because they haven't had the money appropriated either. There have been hundreds of millions of dollars in the past given to the VA to try to solve these problems. We appropriated a billion dollars to DOD and to VA to try to make a seamless electronic medical record so that upon your induction, until your death, that medical record follows you through. DOD basically did this and said, we can't do it. We're going to go our own way. That's not the way we should work collaboratively. For the first time ever, we held a joint hearing before Bob's arrival with the Secretary of Defense and the Secretary of the VA to talk about it, to try to find out why they had not done this. The other thing is, it doesn't have to be designed by the VA. It can be found outside and talking about the programs and the software. It can be found off the shelf out there with the software and programmers that can do the necessary code writing to make it applicable to the VA. What happens in the federal government, everybody, this is not critical of VA. This is VA-wide, federal government-wide. Everybody thinks they have to be the one to write the program. Look, there are some young people in Redmond, Washington that I guarantee you, if you said, we're going to put $10 million out there and we're going to ask you to try to come up with whatever Bob needs, they'll do it. And they'll do it for $10 million versus going out and spending $300 or $400 million to try to develop internally. And again, this is not a criticism about the direction that Bob is trying to take, but it shows you how hard it has been to work even, you know, one of the interesting things I found when I became a member of the U.S. House of Representatives and this was in Pensacola, Florida. We had a naval hospital that was way underutilized and we had no VA hospital in our area and we tried and tried to get the VA to do a collaborative effort with that VA or that naval hospital. Ultimately, it did not happen. The naval hospital now has atrophied down to the point they have no ICU, their emergency room is closed. They send people into the private sector now, into the local community. We do have a huge joint ambulatory care clinic that is there but the synergy was supposed to be there between DOD and VA and they keep getting this pushback and it's frustrating to me that at the point you become a veteran and get that DD 214, it's almost as if DOD says we're done. Jeff covered a lot of ground, so let me talk about where we agree, where we disagree and then he can add. He's right and I said it in my comments. We had appropriated money for a new financial management system. It's called FMS Financial Management. This is the COBOL program and we failed twice. That's true. One of the new leaders we brought into the VA is Laverne Council. She's the new head of IT, Assistant Secretary of Office of Information Technology. She was the CIO for Johnson & Johnson. She was the CIO for Dell. I'm telling you folks, we got a unique moment in time. We got a unique moment in time where we've taken some of the very best leaders from the private sector and from the government sector and put them together in the VA. Let's not lose that moment in time and I commit to you, Mr. Chairman, give me the money. I will put in a system that will work and it will work for many years and he knows that. Second, we disagree on the HR bill just to be clear and I just don't want VA to be called out differently. I'm trying to hire people and it's hard for me to hire them at a time when they feel like they're going to be called out separately from other members of government. We'll leave that as it is. Jeff and I know where we stand. Third, on the DOD medical record, we have been working very, very hard to create interoperability between the VA record and the DOD record and we've made tremendous progress. Now in the end, I'm an engineer and a computer science geek but in the end, this is all about ones and zeros and I would love it and maybe at the winter meeting, Gary or if we could do this, I would love to bring in our team and show you the interoperability between the DOD record and the VA record because it's remarkable progress and the last point is the partnership with DOD and I would like to work with the chairman on what's going on in Pensacola. I have a soft spot in my heart for Pensacola. I got eight stitches over my right eye in the Pensacola Naval Air Station after a rugby game and in rugby in those days, you weren't allowed to substitute. You had to get stitched up and go back in the game and those naval doctors and nurses were taking a lot of time to stitch me up and they were using very big thread. In fact, the nurse came up to me and grabbed my hand and she said, what do you want, a silver bullet to bite on big guy? Anyway, I also spent several weeks of my life in the swamps around in Jeff's district in Ranger School and Jeff, I really love your swamps. They're great. And you know the Rangers are in it right now and they have the first two females going through the program. Absolutely. Listen, if you want to go to Ranger School and you want to pass Ranger School, I don't care if you're a man, a woman, a frog, an alligator, have it. Only 37% of people pass the first time so it's a difficult course. Good on for those women. But anyway, we are partnering with DOD and we need to do more of it. In San Antonio, if you go into the San Antonio Hospital there, you cannot tell which are the VA doctors and which is San Antonio doctors. If you go to Fort Benning, Georgia, I was just at Fort Benning a few weeks ago, Martin Army Hospital has 135 beds. They can't fill them. Their doctors can't stay current as doctors because they're only treating young soldiers who are 18 to 22 years old who don't get sick. They love our patients. So we've been able to work with Martin Army Hospital to have the 18 specialties that we need done in Martin Army Hospital. They gave us one of their buildings that we're turning into a woman's clinic because we've got to get space for women. So, Nellis Air Force Base, the flight surgeons love our veteran patients. White Patterson Air Force Base, the flight surgeons love our patients. We want to work more and more with DOD. There's no reason the American public should pay for two redundant systems. So we're on with you. Well, you've covered a lot of ground in the last few minutes. I want to go back to my VA initiative and something our members have asked me a couple of times as we've been here is, when can they start to see some of these improvements in the services that they receive? Well, some of them have already seen them. For example, I mean, I get about 150 phone calls or text messages a day on my cell phone. And originally, all of those were complaints. And now I would say 30% to 40% are positive reactions to a difference we've made in people's lives. So we are making those differences. For example, now you don't need to see a primary care physician in order to see an optometrist. So that's a change we've made. And there are many more. We've hired over 1,100 new doctors. We've hired over 2,400 new nurses. We've put in over a million new square feet of clinical space because as the chairman rightly pointed out, you've got to do space and suppliers and providers at the same time. But there's still things that bug me. I got a call last night. This one veteran was away from his home VA and he couldn't get care without reapplying in that new location. That is simply unacceptable. I mean, how come I have a prescription at Walgreens in Cincinnati, Ohio, and I moved to Washington, DC because I like to chairman so much. And I can get my prescription there. Well, I'll tell you the problem. The problem is the computer-based system. So this is why we got Laverne in. We're going to work with the chairman. We're going to need money. But we're going to fix that system once and for all so you can go wherever you want. Why do we have over 500? I think it's more like 800 even. 1,800 numbers. Why do we have multiple websites? What we're going to do by the end of this year, this is Tom Allen's job, head of veteran experience, is we're going to have 1,800 number. We're going to have one website. And you're going to be able to figure out the name of that website. I think we must pay people to figure out strange names of websites, e-benefits, e-healthy benefits, blue button. I mean, we want something that is easily recognizable by the veteran. Basically, it's simple. We've got to start looking at everything we do from the lens of the veteran. Over a third of us are veterans. So you're going to see these changes over time. We'd like you to be part of it. We will publicize them so you know what to look for. And Secretary McDonald, I'd like to mention every year DAB goes to convention. And as you know, so many of our members have health issues that, you know, but they come to convention. They're traveling and they start to have a problem. And VA has always made sure that they provide a medical room. The nurses and doctors in a medical room, wherever we are around the country, wherever we go. And we appreciate that so much. They're very good to our members. Thank you, Joy. That's our job. We should do that. That's great. Glad to hear that. In your opening, in the Secretary's opening remarks, he discussed his concerns about the accountability bill and how they hurt recruitment efforts. Can you discuss a little bit about his concerns? Well, I start by saying I don't know anybody that wants to work at an agency where ineffective people are protected and rewarded, have been rewarded in the past because, and the Secretary has done this, and this is where we're getting to this trust level. Bob and I have talked about it. Almost everybody at the VA got a bonus, everybody. The person that was in charge of the Aurora Hospital got tens of thousands of dollars in bonuses and was able to retire with his full retirement benefits. Now, I know what the courts say about it being a, your benefits are a tangible right. I get that. But what we're also trying to do is to change the paradigm that if somebody does something illegally, but I'm not saying that anybody did anything illegal, I'm not going that direction, that you should be able to claw back part of that benefit. I think, and I, at the, we've, there been, I miss that, all of Congress. You know, you know what's interesting about Congress, especially the House of Representatives, that we stand for recall every two years. Every two years we stand for election before the people that send us to Washington, D.C. People in my congressional district want to know why people like, just take Charlie Rangel for it. Just, we're, Charlie's my friend. Charlie is a Korean War veteran, but we are as diametrically opposed on political opposites on issues. But if I went to Charlie's district and tried to run, I would get killed. And if Charlie came to my district, he would not be elected in my district. And so we are a microcosm of the way the country is and the arguments that we have back and forth on political basis are very different. But the House stands every two years before the electorate. Obviously, the Senate goes every six years, and our president stands every four years. So, I mean, that's about as accountable as you can get. That's what the founding fathers established. Little did they know that our economy and the budget of this government would be in the trillions of dollars when this country was first founded and that we would be charged with doing as many things as we are and that the Constitution would be interpreted to allow the federal government to do as many things as we do today. So, you know, I get it. There are, people want to know why is Congress in single digits? Well, part of that is because when you take Congress as a whole, if you're a Republican, you don't like what the Democrats are doing. If you're a Democrat, you don't like what the Republicans are doing, so we'll throw them all out. But if you go to your own congressional district, I would say that most folks, most folks are pretty happy with the person that they've elected. And if not, there's a process that we go through, again, every two years in order to change the election. Let me give you another example. People think members of Congress stay around for a long, long time. Some do, some do. When I was elected, I was elected right after September 11th, October 16th of 2001. I was number 435. I'm now number 115, which means that 320 people, senior to me, have left in a 15-year period, 14 at this point, 15-year period. And that doesn't take into account the number of people that were junior to me in seniority that have gone on. The average length of time that a member of Congress stays is six years, three terms, three terms. So it's not quite what it may look like. Certainly there are a lot of people that stay a long, long time. You know, John Dingle, great friend of mine, bless his heart. I mean, 50-plus years in Congress. You won't see me there 50 years. I just to drill down a little bit on some of the chairman's comments. The bonuses I think that he's talking about are bonuses that were paid for prior years' activities, not 2014 activities. Because as I said in my prepared remarks, all performance bonuses for VHA, for Veterans Health Administration in 2014, none of the senior leaders are getting those. Nobody was rated outstanding. I think the other part that he may be talking about in terms of bonuses is there are financial flexibility, compensation flexibility within the VA rules that allowed the VA to provide incentives for people to move the rule locations and do other things like that. I would say they were misused. We've talked this and we're clamping down on those, making sure we only use them appropriately. One of the things, the chairman was very concerned about this as to how the senior leaders of VA were being held accountable. I went over and sat down with him and took him through the relative ratings I did for all of the top 400 executives. And as I told you, nobody in VHA was rated outstanding. And I showed a distribution of those ratings that was starkedly different versus what it had been in previous years. In previous years, everyone had been rated outstanding or excellent. And basically what we did was we spread it. So you had people rated poor. You had people rated mediocre. And we had the performance rating match the performance, match what the person did. I would argue it's the best distribution of ratings in the federal government and it's equal to the private sector. How do I know that? Because I ran one of the companies that's the best in the development of leaders in the private sector. So I think we're making progress. What I'm worried about in the new law, potential law, is many of the other things that are in it that are certain requirements requiring me to do certain things. If I measure that versus the way I could run things in the private sector, it would simply handcuff me to an extent that I couldn't lead the organization. It's like the budget, 70 plus line items of budget. You can't move one from the other, one from the other. I have to go back to the committee every time we need money. If we're going to run VA like a business and we're going to allow a choice, which I'm very much in favor of, you got to give the flexibility of the leadership to be able to move the money to where the veteran decides the choice is. It makes no sense. I'm spending more time dealing with hearings in Congress. All that time I could spend, I could spend going to VA sites and working with veterans. So I just want to make sure we have a system that allows us to spend that time with veterans, not with members of Congress. I love Congress. Wait, I don't want there to be any mistake here. We do get along and we are working together. I do like them. It's nothing about the chairman. Secretary McDonnell, this one's for you. Because we're here in Denver, we have a question about the unfinished VA Medical Center, you project that you inherited. You've been quite candid in talking about the mistakes that were made at VA over the past decade regarding the project. But you've also talked about the importance of completing the Medical Center without taking funding away from other hospital construction projects or services for veterans. What needs to happen for VA in Congress to reach a long-term agreement to complete the Denver VA? Well, I was there yesterday. I did a thorough project review yesterday. We have to complete the Medical Center in Aurora. First of all, I know there's been a lot talked about publicly. This is not a hospital. If you're thinking of a hospital, forget it. This is not a hospital. This is over a dozen buildings that's going to provide regional medical care, everything from spinal cord injuries, the highest level of medical care for the region of Colorado and other states that this represents. People are going to come from afar to come to this Medical Center. It's multiple buildings, highest-rated there, right next to the University of Colorado, which is our medical school affiliate here. The mistakes that occurred in the construction of this building were terrible mistakes. We all own it. We apologize for it. And there's no excuse. They shouldn't have happened. All you have to do is walk up to the complex and I'm an engineer, by the way. My undergraduate degree is engineering. I have my engineering training certificate from the state of Pennsylvania. So I looked and I said, oh, my goodness, the architects went nuts. There were no engineers on this project. The design is over the top. But nevertheless, that is the design. And we're now value engineering it as we go to make sure we're trying to save as much money for the American people. The other thing that we've done is we've changed the process of doing this. We now involve the Corps of Engineers and we agree that the Corps of Engineers should be involved in the big construction projects of VA. Those over $250 million. We now are saying we will not go to Congress. We will not ask for money until the design is 35% completed. This design was constantly floating and you can't build a structure that way. We now have integrated project management, which we didn't have. We have a review committee before we even start production that includes engineers and architects, not just architects. And more importantly than that, I want to drive to a construction system for the VA that I would describe as the best in the private sector. If you go into a Walmart, for example, in California, that Walmart looks pretty similar to the Walmart in Alabama and Florida. If you go to a Costco, same thing. We need to get to a standardized construction platform or footprint, not only so we lower the cost of construction because the cost of construction is largely in the design. Once it's been designed and once you start building, there's not much you can do to pull back. But more importantly than that, it will help the operations of the VA. I can show you lower operating costs if I move a doctor from Orlando to Chicago and the building is standardized because they'll know exactly where to go and how to get it done. I mean, it would be analogous to giving everybody a different M16 or M14 to use on a firing range. That just doesn't make sense. So we're moving in the right direction, but we do need to finish this project. You know, this part of Colorado has had a 31% increase of the veterans entering the medical system. We can't wait too long. Our building here is too old, too antiquated. We can't wait too long to get into this. The operating rooms that we're building in this new building are 50% larger than our current operating rooms. Today in our current operating rooms, we have trouble getting in the scanner equipment, the x-rays, the digital technology we need to do modern surgery. That's why I'm so concerned about the construction budget of the VA and the fact that 50% of our buildings are over 60 years old. We simply have to update that infrastructure. And again, I think now is a unique moment in time where jointly we can do that. Chairman Miller, would you care to respond? First of all, I support allowing the Corps of Engineers to do major construction and the threshold that I talk about is $100 million. People say, well, the Corps of Engineers bills dams. They build hospitals. They build hospitals for DOD. They build them on budget and they build them on time. And again, there really is no need to be all things to all people when there's somebody else within the federal government, whether it be the GSA, whether it be the Corps of Engineers that can do this. One of the things that has concerned me besides the cost overrun, which I know was very difficult when Sloan Gibson called me on the phone the day that the number was finally arrived at, because he had been over here and digging and digging and digging into the numbers. And he knew, it was very apparent that they were not going to be able to. You remember, you know, the original hospital, when it went from a bed tower to a hospital, it was $600 million, then it went to $800 million and Congress put a cap on it at that point. They said, you cannot spend more than $800 million. And of course, when I were talking about one point, the number I was given was 1.73. They're trying to draw that number down. I think they probably will. For this complex that's out here, but even back the end of last year when the contractor won the lawsuit and the court said they could walk off the job and buy a lot as they did and to get them back onto the job. An additional $250 million was infused back into it very quickly which brought labor back to the project, but there still wasn't a thorough plan in my mind at that point and we still are working through that process. Yes, the hospital is at the point now where most everybody is thinking that it has to be completed. The concern is the number that is still out there, we have now appropriated enough money or allowed the secretary to move enough money around that gives us till basically October 1st. There's another 600 million that's gonna have to be given to the VA in order to finish this project. Originally, the first place that was looked at was in the $5 billion portion of the choice that was for construction of facilities. That's a logical place to go to. The outcry from other members of Congress was deafening because money was being taken away from their project to finish this project. And that basically is not fair to those other members who have waited in line. And so finding that money, and that's why I ask, I believe if the administration wanted to, without making it come from within the VA budget, they could find the money scraping it from other nooks and crannies around. I mean, the secretary has been very thorough in trying to sweep as much money that is remaining in accounts as he could in order to put this project together. But I believe that if we went outside of the VA budget, this is a crisis. It is a crisis at a facility that needs to be resolved. It doesn't need to be done piecemeal as we have unfortunately been forced to do to hand out 50 million, 100 million, 150, whatever the number is from time to time. We need to give the last number to the secretary to allow the facility to be complete. Where that's going to come from is where the debate is going to happen. And that's one of the things, Jim, that is on Congress's plate for the Colorado veteran community that's out there. But again, never again should this be allowed to happen. And I firmly believe that if the controls are put in place by the secretary today, whoever the next secretary is, he or she, when they come in, regardless of whether it's a year and a half or five years from now, they will be able to know how it should be done so that we don't ever have to go through this process again. Yeah, as the chairman talked, we're trying to build a clock, not tell time. So we're trying to put in place the changes in process, the new policies so that this never happens again. Chairman's also right that this is all of these things are going to be need to dealt with in a short period of time. And so you need to make sure, please, that you let your voice be heard as to how you want it handled. Remember the context here. We need to find, as the chairman said, another $600 million or so to complete this hospital. In the context of a 2016 budget, which starts October 1st, and remember the budget that was passed by the House reduced the request from the president and the VA by 50% in construction. That would eliminate four new sites that we had planned and six new cemeteries. So not only are we having a problem just trying to keep the business going with that budget, but we're going to have a problem paying for the hospital too. So these are issues that you need to make sure you get your voice heard on. The president's budget breaks sequestration. The budget that was passed by the House is in favor of sequestration. So it depends whether or not you're in favor of sequestration and whether or not you think that should be done at the expense of veterans. I have a point of view. I think we should fund the president's budget. We should finish the hospital. But as the chairman said, the well is not forever. Well, and I think, you know, nobody is a fan of sequester. Even those of us that voted for the deal that brought sequester to bear understanding that a vast majority of VA is protected from sequester, but not everything. And we have tried to go through so that should sequester ever be and it still is an issue today, but should it ever come up 20 or 30 years from now that VA is protected, there is a conflict in the role. And interestingly enough, one of the things that the secretary has been really fighting hard to do is build more community-based outpatient clinics. The CBOX are so important to the rural communities again, especially, and VA had found a very unique way and it's a way that I support. You know, usually what's done is somebody comes in, they will contract with VA to build this clinic and lease it for 20 years to the secretary. That takes the burden off of VA from coming up with the entire nut in the very beginning to build these facilities. And Congressional Budget Office is now caught on and they said, oh, we get what you're doing. You're obligating the taxpayers over a 20-year period with an operating lease when you really should be counting it as a capital improvement number. And so they started scoring all of these clinics together. We approved 27 clinics in the Choice Act last year. The intent was that we would immediately be able to start the process. VA would be able to go out, start digging the dirt. Now they're saying not because of them, but because of the way this is being scored. It would be 2017. We already had a backlog to start with. And so this construction process has been allowed to fester and everybody understands the need. We can't for some reason get the CBO to break from what they're doing. They are a bipartisan group and organization and so we're going to find a way because, you know, again, these clinics are needed. Your members of Congress have been fighting for them in many instances for years and then to be told, you know, most of this was last year to be told that, hey, it's going to be three more years before, you know, your clinic will be up and running. That's tough. I mean, we have medical schools in places like Texas Tech that have offered a unique opportunity for folks in Lubbock to be able to be a part of their medical facility where their med school is that's on a bus route and it's in a great location. They want to be a part of the VA experience and process, but it's being held up now because of the inability to count these as operating leases as they had in the past. It's billions of additional dollars to do it the way CBO wants it to be done. Yeah, we agree with the chairman obviously and community based outpatient clinics are really the way to go in the future. The idea of building these monolithic hospitals even in the private sector, you don't see that as much anymore. Oftentimes because by the time you get the thing built the demography has changed so much that it's outdated. Nevertheless, we're working through all the issues the chairman talked about and we will continue working. Thank you. I think that's very important for not only DAV membership but all veterans. You've talked so much about the aging infrastructure. DAV as part of the independent budget has talked about that and a real concern about the future of the infrastructure needs within VA and how they're going to be handled and what is the best way to proceed. You know, the other thing that Bob is confronted with is not only does he have the aging infrastructure but he has historic infrastructure. Historic infrastructure. Some of these places, I was in South Dakota last year. A beautiful facility, an absolute gorgeous VA facility. Then you go to Milwaukee to Dayton to Togus to see some of these facilities are out there and you have to maintain, you can't just let them crumble but obviously in certain instances you can't utilize them anymore because they don't meet the needs and the specifications of healthcare as it's delivered today and as Bob has already said, you know, the equipment is so different today than it was even during the Vietnam War when hospitals like Milwaukee were being built with, you know, hundreds and hundreds and hundreds of beds. You just don't have that anymore. And so trying to find that happy medium to be able to serve the population while the demographics are changing drastically every day except in Florida where everybody seems to want to come for a little bit of time. You're not against that. No, come on, come on. But, you know, and when you see Phoenix in places like Arizona and Denver, you know, where the population is growing, it's hard for VA to stay ahead of that curve because I guess it's a difficult forecast, you know, where folks are going to want to live because veterans are going to want to live where they want to live. Well, plus, of course, we have the aging veteran population. We talked about that. Two million veterans over the age of 65. The year I graduated from West Point, 1975. 10 million veterans over the age of 65 in 2017. But then we've also got 250,000 service members leaving the service every year, which adds to that. And if we don't get ahead of this infrastructure issue, we're going to have another crisis. I, you know, working, the chairman is absolutely right that a lot of these buildings are historic. What we've got to do is we've got to better communicate with members of Congress who obviously want to protect the facility in their geography. We've got to work better with members of the DAV and other veteran service organizations. You obviously want to protect your facility, but we've got to be able to build a trust that says we're going to care for you. Here are the requirements, 30 days for primary care, you know, at least or at worst. And we've got to build that trust so that you know that if, you know, the reason we don't want to keep that facility going is it's unsafe for you. You know, if that operating room is unsafe for you, then we should close it. We should try to lease or build a new one. And we're going to really have to communicate as we go through this. The other thing I've said to the folks in VA is we need to work through a map and look at all the DOD assets, look at all the Indian Health Service assets, look at our medical school affiliate assets. And we've got to say, where are the places we need to invest in the infrastructure, and where are the places where we can share the infrastructure from something that already exists. We're not going to get to where we need to be if we try to build everything new from a green field. And so we're working on that. It's a lot of work. It's a lot of work. But it's the best thing to do for veterans. And I think we're all hoping that the administration and Congress will really work together on that and put together a plan as you move forward to make sure those needs are met. You mentioned this question would be for Chairman Miller. We've been discussing a little bit about the budget coming up. And DAV and our independent budget partners have recommended more funding for VA medical care and VA construction over the past decade than either VA has requested or Congress appropriated. And the next year, but next year, you know, the IB again estimates that VA's funding will be about 1.5 billion less than VA will need based on the discussions that have been ongoing with the secretary. Are you confident about the funding that's been currently approved for next year? Do you think it will be enough? Well, first of all, there's been nothing approved for next year. There's been a house budget that's been passed. We wait on the Senate. And of course, then the budget is a blueprint. That is not the actual appropriation. That's where the dollars actually begin to flow. So VA Milcon on the house side military construction VA bill is where the dollars actually come forward. So and and the appropriators can can change those numbers around it as they choose to do it. The unfortunate thing is it has been so difficult to be able to work with the Senate for a number of years under both parties control. And right now the appropriation process is pretty much shut down. What concerns me is that we may be coming to a CR continuing resolution point again, which for federal spending is a good thing because it keeps federal spending at whatever the last appropriated number was. What's bad for VA is it doesn't allow the growth to take place that's necessary because of the increasing population. So I'm not a fan of CRs. I'm not a fan of Omnibus or Cromnibus bills either where everything is just thrown into a bucket basically in past. We have appropriation committees out there. I think there's 12 or 13 of them. They need to go through regular order, debate all of this information, be able to get it done. Unfortunately, I do not hold a whole lot of hope for us to make progress before the fiscal year ends for this year. And that puts VA in a tough spot because of the growth that's needed in there again, like I said, for the increasing population that's coming in. The chairman said it better than I could say it. With the continuing resolution process, you are allowed a few exceptions. Do you have a term for that? I recall the term. So for example, exceptions. Okay. I don't remember the term. Let's say it's exceptions. So I didn't want anybody in the audience who's wondering what's going to happen with the Denver medical complex to think that we can't deal with it. We can, but what we will have to do is create it as an exception to the continuing resolution so we can get that done. And we will work to, you know, we are, as I said, there's tremendous unanimity that, you know, Jeff and I both care deeply about veterans. And as you can tell from this discussion, most of everything we've said, we agree on. And what we need to do is push forward and get the right exceptions there if we are forced to go to a continuing resolution so that we can continue business and in the end care for veterans. I mean, to me it's, you know, when I joined the military, when you all joined the military, you joined based upon a commitment. You committed to put your life in danger for this country knowing that the country committed back certain things. And one of the things the country committed back was VA care. So let's forget about the shenanigans that go month to month and week to week and all the transactions, but let's get back to if we're going to commit our military to battle, let's make sure that we care for them when they come home. And we're both committed to that. And I know this goes without saying for this group, but the war is not over. We had a seventh special forces group soldier from my district that was killed in Kabul. And, you know, our men and women are still in harm's way and because of the rise of the Islamic State, it is going to be worse as they try to stretch their caliphate across parts of the Middle East. We have men and women in harm's way. They may not be in combat, but even as many of you in this room know, even in a train mode with the Afghan army or whoever it may be, there are those that want to do harm to the Afghan national army. And if they get an American while they're at it, they get a bonus at that point. We had two special Air Force operators that died in a freefall exercise earlier this week at Herbert Field. Even when you're not in combat, you can be killed or injured. And some of you have been injured even in the training portion of your role in the military. And so America should never forget that even though we are at a point now where we say that our troops are not in a combat role, they are still in very dangerous places every day and every night. And just to build on the Chairman's comment because I couldn't agree more is this is a dynamic situation. A few weeks ago, we published some research that proved that those of you, whoever, those who had a catastrophic instance while they were in the service and may have had the beginnings of post-traumatic stress, if that post-traumatic stress didn't evidence itself, it still could evidence itself as you age. In other words, you could think you don't have post-traumatic stress, but when you get to be 55, 60, whatever, that post-traumatic stress could come out. So we also have to remember that a lot of folks who came back may not demonstrate the illnesses that they have, particularly those unseen illnesses. And we've got to be ever vigilant that we can care for them, identify them and care for them in the future because as we age, our body deteriorates and that allows symptoms to come out that may not have come out earlier. And as a final comment, I mean, a final question for both of you. I think you both know DAV's been really trying to promote women veterans issues, making sure Congress is aware of all the issues for women veterans. And I know VA is fully aware that the population of women coming to the VA has nearly doubled, or more than doubled in just the past five years and is expected to continue to grow. DAV does a special report, Women Veterans Along Journey Home, and you held a hearing as your chairman about women veterans. Would you like to make a few comments just about what you plan to do to make sure that you can care for our women veterans as well that are serving in combat deployments and coming home and have unique barriers that they're facing and challenges? Well, I want to thank the DAV for the study you did. I thought it was an outstanding study and it demonstrated something that the American public would not automatically think about, you know, for example, the effect of a prosthetic, or the effect of a pregnancy on a prosthetic. I want to thank the chairman for playing a role in that. I took down, one of the first things I did when I took over this hallowed office that I have, which people tell me was the office of Omar Bradley when he started the VA, was to take down one of the paintings from the wall and to put up a poster that says women in the military has pictures of women in each one of the services. And I did that because I think in retrospect, a decade from now, people are going to look back at this moment in time and say, did the VA make the transition it needed to make to care for the 20% of veterans who are women? And that's the number it will be. Right now, it's about 11, 12%. It changes every day. Eventually it will be 20% and probably even higher. How do you do that with an infrastructure where 50% of your buildings or more are over 50 years old? We've inherited some buildings from DOD. We're scratching and clawing to do that. At Fort McPherson, we got a wonderful building that we've turned into a woman's clinic. At Martin Army Hospital, they gave us a building up on the hill that they didn't need with the new hospital that we're turning into a woman's clinic. So again, this is something that we're ever mindful of. We've got women's healthcare specialists in our facilities. We're hiring more women primary care doctors. But this is a big, big issue for VA and I think one that we will be judged on in the future. We've got to get ahead of it and we've got to set ourselves up for success in the future. And it's going to be hard work. And I concur with what the Secretary, I mean the population is changing for those that were in the service in Vietnam and Korea and World War II, you probably couldn't have imagined the population changing the way it is and the number of females that the VA now is having to treat. I think in October, I'm going to introduce the first female amputee from Iraq or Afghanistan at an event in Pensacola. And I'm sure she's a member of this organization but it is a changing demographic. And I think VA and I think the veteran population as a whole gets it because these are individuals that have earned their healthcare as well. Some of them would prefer separate entrances to come in. The VA is working to try to do that. They can't do it everywhere but they're trying to do that to make that experience of the female veteran when they come in. One that will encourage them to come back and be a part of the process. There are so many things now that VA has to think about that they didn't in years past and we want to be supportive in that role. And VA has made a lot of progress. There's still ways to go with regard to women veterans but I'm very pleased as well. We have a very special guest this afternoon, two o'clock today at our women's seminar. Ms. Julie Herrera Di Stefano right here in the front row. She is a film producer that's done a wonderful film, Journey to Normal, Women of War Come Home. In collaboration, she collaborated with DAV with regard to our report. And we're so pleased to have her. She's going to do a short screening of her film today. Again, really recognizing the challenges of women veterans and their journey home as they come back and what their needs, their special unique nights are. So again, we appreciate both of your support in that regard. And it looks like we're coming up on closing time almost the end of the time that we have here but we did promise each of you a few minutes to make some closing comments and just sort of wrap up based on the discussion that we've had here today. So Chairman Miller, I'll let you go ahead and go first. Well, I think the first thing I want, I hope you'll take away is that there is a true friendship and respect between the Secretary and myself. We both want to serve the veteran population in the very best way we can. We will differ from time to time as we differ with DAV from time to time on the way that we can accomplish some of these issues. But this is a great opportunity for us to have a free flowing conversation to talk to you. This is a wonderful opportunity to do a town hall with some of the veterans that are the most impacted by some of the things Congress does, rightly or wrongly, that you may support or you may oppose. But certainly what the Secretary is trying to do is he changes the way the VA moves. Again, doing it the same way over and over again, expecting a different outcome, does not work. And so the Secretary is trying to shake things up, understanding that this is the second largest agency in the federal government, things don't happen fast. And we will support him in any way that we can. We certainly support DAV. And I thank you, number one, for the service, for those of you who wore the uniform, but then also for the family members that are here as well because you served as well when your family member was off doing whatever they were called to do as a member of the Uniform Services. And with that I say thank you for allowing me to come spend some time with you today. I want to underscore this sense of partnership, friendship. We know we have a big job to do, but I hope as you saw over the last couple hours, we're united on virtually everything and the other things that we have differences on, we can sort out. The important thing to me is I think we have a unique moment in time. It's a moment in time that probably will never come again. The unique moment in time is the American public is very supportive of the American veteran. Those of us who served during the era of Vietnam can remember it was very different then. We have a unique moment in time now. We have a chairman and a secretary who work well together. We have a Congress that's united behind veterans. We have an aging infrastructure. We have a lack of medical providers. We need to hire more providers. We need to update the infrastructure. We need to do the right things to build a system, a system of both inside VA care and in the community care that will care for all of you for years to come and importantly care for those veterans who are going to be aging that are coming back from Iraq and Afghanistan. If we don't do those right things today, we're going to be back into the crisis we had in 2014 in another 10, 15, 20 years. So let's get after it today. We've got a great leadership team at the VA as I said, 11 of 18, our new all or world class kind of leaders. So let's use this unique moment in time to get it done now. I want to thank you for your support and I will say this on behalf of Chairman Miller and myself. May God bless all the veterans of this country. May God bless the DAV and may God bless the United States of America which we all love. Thank you. Before we close, Mr. Chairman, I understand you have a special presentation you'd like to make. Absolutely. If I could get Joe Vialante to come forward. Joe, bear with me just for a minute. One of the things that we get to do as members of Congress is introduce certain things into the congressional record for folks that have done things above and beyond basically the call of duty. I've been in the Congress now 14 years. I've known Joe ever since I came there. We've been on the same side on some issues and we've been on the other side but we've never let that affect our ability to be friends and if I can just real quickly read this, it won't take long but this is from the proceedings and debates of the 114th Congress, the first session in Washington on Thursday, July 9th. So we've had this ready to go for a while. Recognizing the dedicated service of Joe Vialante to our great nation and her warriors. On July 31st, our nation's veterans will lose one of our strongest advocates when Joe Vialante retires as National Legislative Director for the Disabled American Veterans at DAV's National Service and Legislative Headquarters in Washington, D.C. A New Jersey native, Mr. Vialante joined the Marine Corps in 1969 serving with the 2nd Battalion, 4th Marines and Battalion Landing Team 2-4 in Southeast Asia where he was injured. After being discharged in 1972 with the rank of Sergeant, Mr. Vialante received a bachelor's degree in history and political science from the University of New Mexico and eventually earned his law degree from San Fernando Valley College of Law in California. Following private practice in California, Mr. Vialante began working as a VA staff attorney at the Board of Veterans Appeals in 1985 but Joe felt he could better serve veterans by working for an organization that advocates for veterans. So leaving the VA, Mr. Vialante joined DAV's professional staff as Staff Counsel, Judicial Appeals Representative at the Court of Appeals for Veterans Claims in 1990. And following his time at the Board, Mr. Vialante was appointed Legislative Counsel for DAV in 1992 and was later promoted to Deputy National Legislative Director in 96 and Legislative Director in 97. In addition to his work at DAV, Mr. Vialante has served on numerous boards and committees. Mr. Vialante served as a member of the Board of National Foundation for Women Legislators from 2001 and 2009 and a member of the Board of Governors of the Federal Circuit Bar Association from 2001 to 04. Additionally, Mr. Vialante co-hosted Veterans Forum, a local cable television program dedicated to veteran issues from 1991 to 94. He chaired the Veterans Appeals Committee and Legislative Committee of the Federal Circuit Bar Association from 92 to 96 in 97 to 01, was Vice-Chair of the American Bar Association Coordinator Committee on Veteran Benefits and Services from 91 to 94, and at-large member of the Board of Governors of the Veterans Law Committee of the Federal Bar Association from 92 to 93. Mr. Speaker, it would be a challenge to find someone who has done more as an advocate for veterans than Mr. Joe Vialante. So in the long-standing tradition of the Navy and Marine Corps, I wish Joe and his family fair winds and following seas. Bravo, Zulu Marine.