 We're going to get started here. Thank you. I want to welcome you, everyone, to DV's Service and Legislative Seminar. I'm Jim Marzak, DV's National Service Director, and I'm joined by Julie Elam, DV's National Legislative Director, your co-host for today's seminar. As we have done in the past several years, we will be having a candid conversation with senior leaders at the Department of Veterans Affairs about some of the most critical challenges and policies affecting veterans, burn pits, toxic exposures, VA health care, and benefits. But before we begin, we want to introduce each of our special guests and allow them a few minutes to make any opening remarks. For now, I'll turn it over to Joy. Thanks, Jim. I'm pleased to introduce VA Chief of Staff Dr. Rion Sa. Dr. Sa was appointed as the Department of Veterans Affairs, Veterans Health Administration Chief of Staff on June 4, 2023, previously serving as Senior Advisor to the Under Secretary for Health. Dr. Sa brings three decades of executive management and organizational leadership experience and expertise at the nexus of clinical care, business strategy and operations, and healthcare management and policy. Dr. Sa was commissioned through the U.S. Military Academy at West Point and completed his medical, public policy and business management studies at Georgetown University, and his public health studies were at the F. Edward Hebert School of Medicine at the Uniform Services University. He is a board certified in occupational medicine and is a fellow of the American College of Preventative Medicine and a fellow of the American College of Occupational and Environmental Medicine. Colonel Sa served as an Infantry and Medical Corps Officer for 26 years in the United States Army with a diverse set of operational, special operations and military health system responsibilities. He is a combat veteran who served as a task force surgeon during operation and during freedom in Afghanistan where he was awarded the Bronze Star Medal. He has had multiple overseas deployments throughout his Army career and his military qualifications include airborne, ranger, jump master and flight surgeon. Dr. Sa is a service connected disabled veteran who received care and support from the VA upon his military retirement. I'm also pleased to note that he is a lifetime member of DAV and hails from the great state of Texas. Please join me in welcoming VHA's Chief of Staff, Dr. Riyang Sa. Dr. Sa. Yep, go ahead. Well, good afternoon, everybody. It's great to be here today. As Joy mentioned, I was in the Army. I was in the Army for 26 years and as a life member of DAV, it's great to be with my veteran brothers and sisters today. It's also great to be back in Jersey. I grew up in North Jersey and spent my summers down here in the Jersey Shore. So, you know, it makes me feel very nostalgic to, you know, think back on my misspent youth. You know, I'm happy to give you an update on our progress, on our efforts to provide more care and more benefits to more veterans than ever before. I think Joy mentioned this, but I am relatively new to the role. I started a role in June. So, my knowledge of all of the facts and figures are not as deep as perhaps Mike's might be around some of his programs. So, I do plan on referring to my briefing book throughout the discussion. So, you know, I think it kind of brings me back to my roots where I remember, you know, going to middle school and high school in Jersey and cheat sheets were definitely very prevalent back then. So, you know, I did want to share my thanks to Mike for joining me on the panel and for answering all the hard questions. I want to thank Randy for inviting Dr. Elnahal and for allowing me as a older, fatter, slower replacement, allowing me to slip in at the last minute. I'd like to thank Joy and Jim for moderating the panel. And probably most importantly, I'd like to thank all the veterans out there and all of you, everyone in the room, who supports and remain dedicated to veterans and veterans issues. Veteran service organizations are key partners in our mission to provide veterans with the care they've earned and deserve. You play a critical role in providing the feedback to us to help us improve on how we serve veterans. You've also played a major role in the rollout of the largest expansion of veteran benefits in generations and helping to spread the word about our benefits and helping veterans file claims under the PACT Act. This landmark piece of legislation is one that DAV and VSOs in general have been fighting for and advocating for for many years. And your direct support is essential in helping veterans and filling out their claims. You know, if it's okay, I would like to share a personal story to start it. And, you know, most of my 26 years in the Army, I was in highly deployable units. And, you know, I spent a great deal of time in the field. And I think during the latter half of my career, when, you know, kind of my door kicking days were done and my new body habit was starting to emerge. You know, I spent my time caring for soldiers and providing healthcare services for soldiers and their families. And when I transitioned into civilian life and began to kind of feel the wear and tear on my own body, it was actually the DAV chapter, the DAV office in Virginia that helped me fill out my CMP application and get the disability benefits that I earned later. So, I was so grateful to the DAV that I think as soon as that experience ended, I signed up as a life member of DAV. So, I feel like it's kind of a complete circle to come back here and to have an opportunity to speak at the DAV National Convention in my new role as the VHA Chief of Staff. So, the work you do is very, very important. And we thank you again for the commitment you've shown to improving the lives of veterans. I look forward to the discussion. Thank you. Jim, back to you. Thank you, Joy. We are pleased to have with us Mr. Michael Frew, the Principal Deputy Undersecretary for Benefits who has more than two decades of experience working at VBA. Mike is responsible for administrating benefit programs for veterans, including education, home loan guarantee, insurance, disability compensation, pension, fiduciary, transition assistance, and veteran readiness and employment. He has also held several other important positions in VBA, including Assistant Deputy Undersecretary for Field Operations for the Benefits Assistance Service, VBA Chief of Staff, and Executive Director for VBA's Loan Guarantee Service. Mike is a graduate from Pepperdine University in Malibu, California, with an MBA from George Washington University in Washington, DC, and has also worked in the private sector for Pricewater, HouseCoopers, Bankers Trust, and Anderson Consulting. Please join me in extending a warm welcome to VBA's Principal Deputy Undersecretary, Mike Frew. Thank you, Jim. And thank you, Joy. And Dr. Suth, it's really nice to be able to share the stage with you, and I sure hope I can take some tough questions for you. But I appreciate you by my side. And I want to start with what Dr. Suth finished with, which is thanks to you. This is your 100-first convention. And we talk about delivering more care and more benefits to more veterans more quickly and more equitably than ever before, and we cannot do it ourselves. Even though I have 30,000 people working along with me at VBA and another 450,000 or so in Dr. Suth's world, trying to deliver care and benefits that veterans earned, it's hard for us to reach them. And the way that I've developed my relationship in the last 20 years with DAV and with VSOs is we can provide a lot of resources. I have money that we're delivering about $3 billion a week just in compensation benefits to veterans. And that's every single week, $150 billion last year, probably $175 or so billion this year. So it's going to quickly go to about $3.5 billion a week, plus education benefits and home loan guarantee benefits. So I can provide those resources. I can provide access to systems, but it's very hard for us to reach that last mile, make that connection with veterans around the country. And just like you met Riyan, where he needed to be met and help him access his benefits, that's what we've seen and that's what we rely on throughout the future for the 19.1 or so million veterans that are in the country today, that served their country today that earn benefits and maybe 10 million of them don't access their benefits. So there's a lot more that we want to reach out to and we rely on you and county and state servicing officers to help us. So thank you and thank all of you for that. So in the 101st anniversary of, maybe it's the 100th anniversary of your first convention, there's a lot of other anniversaries recently. When I came to VA, I came from International Mortgage Finance and I came to help out in the home loan program, which I love. So the GI Bill turned 79 this year. GI Bill's education, GI Bill's home loan, GI Bill is vocational rehabilitation, but home loan is the one that I loved. And the very first person that used to home loan was Captain Miles Meyer in DC, who bought a house for the hefty price tag of $5,000 in 1944. So his army captain, first one to use it, the SAH program, just turned 75 this last month. And the first person that used the SAH program bought a house in 1948, I guess, 49 for $9,500. And the SAH program paid for all of it. Of course, it's not enough to pay for all of it now, but it's adapted a lot over the year. We had an anniversary just the other week. I went to a 75th anniversary of SAH in Chicago at a disabled veteran's home called Ken Laurent. Ken Laurent is notable because he was a paraplegic who wrote Frank Lloyd Wright and said, I love the work that you do. I would love you to build a house for me, or design a house for me. So Frank Lloyd Wright wrote back and said, I can't promise you, you can afford me, but I would love to work with you and build you a house. And he built a house with disabilities 50 years before the ADA came out. The American with Disabilities Act that has most of the things that the ADA covers. And that special adapted housing veterans for 50 years, 75 years now, since then, have relied on to get into their house, to get into their kitchen, to use their house in the manner that they need to to conduct their activities of daily living. So that's another anniversary that we've gone through recently. And of course, we've got the Anniversary of the PACT Act, which we talk about as one of the most expansive, the biggest expansion of benefits in history, probably since the GI Bill, which is 79 years. I hope that I am not still talking 79 years from now about the PACT Act, but it has been a really, really big deal at VA. We've spent a lot of time planning for it. We spent a lot of time implementing it this year, relying a lot on you, DAV, and all of your servicing officers around the country to implement it. And we'll talk more about it throughout this panel. But I really look forward to talking to you and sharing what we've done this past year. Thank you, Mike. Great. Well, I'm gonna go ahead and get started with the questions. Nectrisa, the first one will be for you, but we'll try to take it easy. We'll give you a little bit of slack with two months there. But anyway, one of DAV's key legislative goals is to expand VA's healthcare capacity. We want to ensure that service disabled veterans who need and want to use the VA for their care have access to timely, high-quality services. And however, over the past year, VA has routinely had to offer veterans care or care in the community because of timeliness standards can't be met. We know that healthcare staffing shortages are prevalent throughout the United States and at VA, and competition for hiring healthcare providers is fierce. Could you just tell us what VA's plans are to fill the thousands of existing clinical vacancies and maybe talk a little bit about the specific challenges the department faces in regard to recruiting and retaining and hiring quality doctors, nurses, and other clinical staff? Yes, absolutely. If you look at the backdrop to what's going on in the healthcare labor market itself, there is a healthcare worker shortage that is impacting every healthcare system out there. Part of it may be due to the pandemic. I think there is a new phenomenon of what's known as provider burnout and staff burnout generally, where a lot of people are leaving the workforce itself. And so what we end up seeing is that almost every occupational series, almost every labor category that is out there is impacted by the labor shortages. So as an example, home health aids, I think we have a shortage of 446,000 is the projection of the deficit in home health aids. I think we have a 95,000 shortage when it comes to nursing assistants. We have a 29,000 shortage of nurse practitioners. So this is a really kind of a broad-based problem itself. However, in terms of what the VHA has done, the VHA started this year with three very ambitious goals. Number one, we decided that we wanted to target 52,000 hires for this year. 52,000 hires is the largest number of hires that VHA has hired in its 75-year history. We also set a goal of achieving a 3% growth rate. And then we wanted to also hire 30,000 employees in what we call the big seven occupations. These are the occupations where we have some very critical needs and these are very hard to hire occupations. So they include things like physicians, nurses, housekeeping aids, medical support assistants, nursing assistants, licensed practical nurses, and food service workers. So with these three goals in mind, we're about three quarters into the year, the fiscal year. And we are doing really well, actually, against our goals, or against our hiring and growth goals. So so far, as of June 2023, we have hired 43,784 employees. That's the most the VHA has ever hired in the first nine months of any given year. It is also over 10,000 employees more than the same point in time this past year. We've also achieved a 4.9% growth rate and our workforce has grown by almost 19,000 employees overall. Our end strength now stands at almost 400,000 employees and we've had our biggest growth rate in over 15 years. We've also hired 24,600 employees in our big seven occupations. So I think the other things that we're working on, we're working to make the VA and the VHA, in particular, a better place to work. And the state of VHA's workforce is maybe healthier than it's ever been. For the second year in a row, the VA has been selected as one of the top five best places to work. We've made significant progress also in implementing the Secretary's Human Infrastructure Plan. We've raised the federal worker minimum wage to $15 an hour. We've worked with Congress to pass the RAISE Act, which has helped us raise wages for 10,000 VA nurses. We've worked with Congress to pass the PACT Act, obviously, which provides greater flexibility to offer higher salaries, bonuses, awards, and to increase the amount of additional supports in student assistance, things of that nature. We're also working closely with Congress on the VA Careers Act, which would give us an unprecedented ability to compete for top healthcare talent. In a labor market that is facing significant labor market shortages, one of the restrictions that the VHA has traditionally had is that we have an upper cap on how much we can offer our healthcare workers. And sometimes the disparities between market-based prices and what our upper cap is are pretty significant. And so I think we're trying to address that more proactively. We are also, I was trying to keep up with... I was trying to keep up with Mike because he rattled off all these statistics off the top of his head. So I was trying to impress you as well, but I do have a lot of detail. What I will say is, despite a lot of the things and a lot of the progress that we've made across hiring and our workforce strategies in general, we still have some existing challenges. Our time to hire is relatively long. So the process of identifying talent, getting them through the onboarding system is much longer than we want it to be. So we have concerted efforts to try to improve upon that onboarding process. We have teams that are working very, very hard to make sure that we have more efficiency in that onboarding process. We're also taking the necessary steps to try to implement some incentives that we know will make a difference. So we're waiting for passage by OMB of critical pay positions. These are some of our positions that are the most important, but that we have the hardest time hiring for. So we're waiting to implement that. We're very close to implementing some critical skills incentives as well. So we're working on things that they're not quite there yet, but we're almost there. I think the one last thing that I would add is we have a new program called the Integrated Critical Staffing Program. And that is an effort to ensure that if we have a vacancy and it takes us, you know, let's say seven, eight, nine months to fill that vacancy, that we have a centralized process for filling that vacancy while that hiring process is going on. So it's a new innovative program that we will be launching in September. So we're very optimistic about it. And I think the final comment, sorry for being so long, Mike, but I think the final thing that I would say is as I was taking a look at some of the many things that we're doing, it reminded me of, you know, one of my favorite philosophers, not to get too nerdy, but one of my favorite philosophers is a guy named Epictetus. And Epictetus would often say in Latin, he would say ta fem and ta uca fem, all right? And that translates to what is up to us, what is not up to us. And when I look at the panoply of different initiatives that the VA is working on to improve upon hiring and improve upon the workforce, I think everything that is up to us, we are doing everything possible to try to make progress across these fronts. The things that are not up to us, the labor marketplace, the economy in general, legislative restrictions, things of that nature, that makes it hard for us to address those things effectively. But I think, again, we're making tremendous progress and we're very proud of the efforts that we've accomplished so far. Well, thank you for such a thorough overview. I think that's really overall a good news story. And even though in progress, definitely a good news story because we know how much that contributes to you being able to provide timely appointments and we understand the challenges that are out there. Jim? Thank you, Joy. Packed that, you know, we've heard about it. Yeah, we've heard about it this morning from the secretary. I will say that for the audience that we do have DAV service officers upstairs, as soon as you get up the escalator, it's the first room on our left here, service officers up there that can help you file your claim while you're here. So please take advantage of that. And since the secretary spoke this morning, it's been 32 people that we've already taken care of upstairs. So, and again, I think getting the word out is critical. And you mentioned it in your opening remarks, there's millions of veterans out there that don't know they may be entitled to benefits. So looking broadly over the past year, how would you grade VA on its implementation of the PACT Act? What do you think the most important things were that you did and what are some areas you think we all could do better in? Well, it's interesting you talk about grading because my son's applying for colleges now and we were at an information session and the college admissions said, some schools rate kids on a zero to 5.5%, some do a zero to four, some do smiley faces and frowny faces instead of grades. And I would give us a smiley face, probably a B plus or so in implementation of the PACT Act because we knew this was coming a year before the PACT Act was signed into law. We didn't know whether it was gonna be the House PACT Act or the Senate, was it called the Cost of War Act? And one was geared more around benefits, one was geared more around healthcare. So thankful to, you're probably thankful it was the benefits side that went out when this came out. But we've been planning for a year. So over a year before the PACT Act started, VBA Toxic Exposure Work Group was meeting with the VHA Toxic Exposure Group called VA Home with our new group and they were looking at, how can we decide an eligible disease for disability for a presumptive rather than using the traditional National Academy of Science, Engineering, Medicine or NASEM studies? And they really opened the doors. They said, we can look at IFFF, the International Firefighters Foundation, what are they looking at as diseases from toxic exposures or burn pit-like things that firemen suffer? Look at other bodies of evidence outside of NASEMs, published scientific documents, as well as look at VBA claims data as evidence supporting the potential for something to be a presumptive. So they kind of opened the aperture. And if you remember that resulted in three new presumptives, the asthma sinusitis and rhinitis about a year before the Toxic Exposure Act or PACDAC came out. And then we started hiring for it, saying we know there's gonna be a lot of appetite for this in the public. So we hired 2,000 people a year before PAC came out or during the course of that year. That was a tremendous year for us. Just as Riyang mentioned that they set records in hiring this past year, we did the year before PAC came out. And then as PAC came out and we said, oh my gosh, there's 23 presumptives, which covers about 300 different diagnosis or diseases that fortunately includes rhinitis, sinusitis, and asthma. So that's three we don't have to worry about. We've already done them. But 20 more that we had to worry about, we have taken, I guess we put our foot on the accelerator as far as we could for hiring. So this past year we hired over 10,000 people and we were only 30,000 strong now, which is the most we've ever been. We're not 10,000 stronger than before. We're only about 5,000 stronger than we were at the beginning of the year because for almost every hire that we make, it takes two or three hires to fill because people move up in their careers. So to hire a raider, we usually hire a developer. So our VSR comes from the VSR pool. VSR pool comes from maybe a phone technician in the National Call Center and then we get a new person at the back of the run. So all of our hiring actions, we're hiring faster, we're training faster, we're getting people up to speed faster. We can see that in our end strength. I would say that we are producing claims a whole lot faster than ever before. Three years ago we set a record in claims production with about one and a half million claims. Two years ago we beat that record by about 12%. This year we're 16% ahead of where we were last year, which was another record. So this will be four years in a row of record claims production. Again, three years ago we used to produce about 6,000 claims a day in a big day, like a very good day we could hang our head on. Last year we were producing 7,000 claims a day regularly. This year we hit 8,000 claims a day, 83 days so far this year. We had 9,000 claims a day twice, both in the last month, and we're 16% ahead of production last year. So that's good, that's where I'd say we get an A for doing things to get better. We did that by hiring, we did that by a lot of automation that your former national commander, Rob Reynolds is in charge of in the department, and we'll talk about that a little bit later, but those are the good things. The other part that's equally good that causes a little bit of trouble for us is our outreach has been tremendous. Secretary says get in line and file a claim, and people are getting in line and filing a claim. We've done a lot of paid advertising, more than we've ever done before. We're leveraging every type of media possible to tell veterans, the veterans that we know of, the 9 million or so that we have a relationship with today, but more so trying to reach the 9 or 10 million that we don't have any relationship with about these benefits, because PAC benefits predate the Vietnam War, and they go all the way up to today. So there's veterans that might not have been eligible for a benefit before, today they are. And we're trying to get the word out, there's a secretary said by next Wednesday, because that's the one year anniversary of the PAC Act. And if a veteran has a disability that manifested before the PAC Act was signed, and if they can apply or file an intent to file by next Wednesday, then they could get backdated benefits all the way to last year. So the outreach is a good and a bad thing. And here's where it gets problematic, is we have gotten more claims in this year than any other year before. I said we're 16% ahead in production, which is great. I will pat everyone on the back here that's helping us to do claims, and all of our people in the audience are in the field offices that are helping decide claims, but it's the 36% higher incoming that is causing us to say, how else can we do work better? We are not gonna stop hiring anytime soon because we've so far gotten 1.6 million claims in this year, about a month and a half faster than we got it in last year. So even though we're doing work faster, we have more people doing the work. It's more equitable, it's more efficient to get to the end decision. We are getting so much more work in the door, and that's just on the claim side because every new eligible service-connected veteran is now potentially eligible for VRE, or a funding fee-free mortgage, or other benefits, certainly healthcare in VHA, and that's just adding to the workload across VA. So I would say B plus B, definitely a happy face for implementing the PACT Act, and we hear so many stories about veterans and especially survivors make me happiest when they were not eligible for anything for years, and now all of a sudden the loved one that passed away is determined to be passed away for something that would have been eligible for PACT Act benefits, and now they can access the care that they should have had before. Well, I'll tell you that the collaboration, and I would agree, certainly a smiley face, in our opinion as well, the collaboration, I think, has been terrific. The PACT Act offsite meetings were accredited to VSOs or invited to participate in those. The outreach you're doing in the communities, they're inviting our local VSOs to participate in those as well. So we're creating more work for you as well, as we're out there doing the same thing. We did 390 information seminars last year, and it was really geared towards PACT Act, making sure people were aware and getting in the father claims. Going forward, what do you need help with? What can we help you with, whether it's funding, any type of legislation? We know you're hiring a lot of people, but anything that we can help you with in particular, as a lot of our members meet with their state legislators, so it'd be good for them to know if there's anything they should be pushing for for us. I think that, one, thank you for the offer. I absolutely appreciate that, and as I said at the beginning, we definitely don't exist alone in this ecosystem. We all need each other. There's a lot more collaboration among NCA, VHA, VBA than I've seen in years, certainly with DAV and the other VSOs, and I think that the fact we're getting more claims is a great problem to have. We need to get more awareness. I would say when my father got out of the Vietnam Wars, when he got out of the Army, he joined the Army National Guard, but he didn't access any benefits from BA because he lived in literally nowhere in Missouri in a town called Doolittle, Missouri. Any Army people lived in Fort Leonardwood. This is the town right next to Fort Leonardwood, which is not called Fort Lost in the Wood so there are no other, there are no VSOs in town. There were no people talking about benefits. And then when he passed away, my stepmom didn't know about DIC because even though I worked at VA, I hadn't heard of DIC because I'm a lone guy and you want to know about a mortgage, I could tell you about a mortgage. So she learned about that later. I want to find people like my dad and my stepmom and make sure they do know about what their benefits are before. So if my dad would have filed for benefits when he was alive, DIC would have been a whole lot easier for her. So one, I need awareness. Two, and we'll definitely want to talk about this later, there's a whole new cottage industry of people trying to help veterans access benefits and they don't do it for free. And I think the right price to pay to access the benefits you earn is free. We do it for them every day. You do it for them every day. And we'll talk more about it later, but I think we need to start identifying and holding those people to account because they are not doing veterans any service, even though some of them might have a good heart, they should not take money out of veterans' pockets that they've earned. Couldn't agree more and looking forward to continuing partnerships and doing more outreach together. So thank you. Joy. Dr. Sa, similar to Jim's question to Mr. Furu, the successful implementation of the PACT Act required that toxic exposed veterans were made aware of their new healthcare eligibility, as well as making sure that they can be screened and preparing to make sure that they know about that eligibility and getting the screening and providing the healthcare. Do you see any issues or can you at least let us know what you're facing on the healthcare side of things? Sure. You know, I think we're making great progress. Back on July 26th, Mr. Jacobs and Dr. Elnohal was in a PACT Act implementation hearing where they were able to update Congress on our progress to date. And they were very pleased with our progress to date. They really encouraged us to continue what we're doing to expand outreach and ensure that we get more veterans, more benefits and more healthcare. Dr. Elnohal this week actually spent a week visiting facilities around PACT Act events. He was actually up in East Orange at the VAMC up there. I was very disappointed that he didn't invite me to go with him on that one because I actually grew up on the border of East Orange right on the West Orange side in this very poor Irish-Italian neighborhood. And you know, again I was very nostalgic because I remember we used to have like our street, we used to have another street and then we used to meet in the middle in this Lily Marlene's parking lot and have rumbles. But our communities were so poor that all of the kids couldn't afford weapons so we used to steal cafeteria knives and have like fights in the Lily Marlene parking lot. So anyway, so the point of that, let me tell you about East Orange. The point of that is that, you know, we're very actively out there talking about the PACT Act. So he's up at East Orange, we had representatives from the White House, we had representatives from Congress, so we're making a lot of progress there. And I think the recurring theme that we see is that in order for PACT Act to be fully successful, we rely on both internal and external partnerships, including VSOs, DAV, et cetera. They're a critical part of our way to success on the PACT Act. To share a few, I think, interesting facts about this, so we've had 1.8 million PACT Act direct mail letters that were sent, so we should have 1.8 million veterans with those letters in hand that basically encourage veterans to enroll in healthcare and enroll in benefits. We've trained more than 88,000 providers from all different disciplines to perform the toxic screen exposures. We have screened 4.1 million veterans so far in this year. We have, and of those that we've screened, 1.8 million or roughly 44 percent have required follow-on visits for further evaluation. 1.7 million, 42 percent of veterans reported that they believed that they were exposed to at least one of the exposures from the exposure category list. So, again, we're making important impacts and really getting out there. 4.1 million veterans screened in one year. That is a phenomenal accomplishment from my perspective. And as we welcome new veterans and provide more care to those already in our system, we're really focused on building the capacity that's necessary to provide more care for more veterans. So, we're really focused on hiring. We're focused on improving our access standards. We're focused on infrastructure. As an example, we just signed Memoranda of Agreement with two academic affiliates at Stanford and University of Pennsylvania to expand our clinical spaces there. Throughout the course of the summer, we've had 130 PAKDAC events. We call it the Summer Vet Fest, where, again, we're encouraging veterans to sign up, learn more about this and really get the benefits that they deserve. I did want to take the opportunity to mention a few dates that are important. We are focused on this kind of 11th hour push to get veterans and survivors to apply for PAKDAC benefits. Applying before August 9th or filing an intent to file by August 9th is actually very important because if the benefits are granted, those benefits will be backdated to August 10th of last year. So August 9th is actually a really important date because August 10th being the date that President Biden signed this into law, it allows you to get kind of retroactive benefits that extend a year back. I think the other date that I would put out there is that post-9-11 combat veterans who served have healthcare enrollment periods that go through September 30th of this year as well. So two important dates to keep in mind. Thank you, Jim. Thank you, Joy. Toxic exposure risk activity, Terra, one of our favorite subjects to talk about. As you know, VA has a duty to assist veterans in supporting their claims for conditions related to Terra, which includes exposure to Agent Orange, radiation, mustard gas, burn pits, or water at Camp Lejeune, even if the veteran does not specifically claim it that way. That includes obtaining exams and medical opinions for those veterans. And we receive inquiries. We've had lots of discussion on this at the PAKDAC off-sites. Can you talk about why Terra requirement is so important for veterans and how it's impacting the claims process, particularly the additional workload for exams and medical opinions since the enactment of the PAKDAC? Yeah, I think that when Riyun was just talking about the toxic exposure screenings, that 44% of the 4.1 million veterans that you've screened, screened positive for some type of toxic exposure. It turns out as we look at service members and veterans, former service members, service serving in the military presents a lot of opportunities for exposure to toxins, whether it's through burn pits, through Agent Orange herbicide exposure, through the things listed in the PAKDAC, or it's garrison exposures where there's a fuel spill. You know, just anywhere, you're getting gas in your car and there's a fuel spill, that's a potential toxic exposure that a veteran could look at and say, I was exposed to something. And that happened more often than not. So almost 50% of the veterans that do a toxic exposure screening screen positive. Toxic exposure risk activity is defined in the PAKDAC is concerning to us for a couple things. And not just from the workload for VA or the exams that will go out, but it's for the potential raised false hope maybe for veterans that say, hey, I've got this toxic exposure risk activity, then next thing I should have is a rated disease from VA. Even if it's not a presumptive, I was exposed to toxins and there's a very good chance I can be rated for this disease. And a typical duty to assist transaction for a claim, we are required to order an exam when we have insufficient information to make a decision, whether it's positive, grant for the veteran or negative, which is a deny. Under TERRA, we're required to not only look through every single element of the veteran's experience, military personnel file, anything they give us for a potential of a toxic exposure, which we'll assume is going to be there for most veterans, but we have to look for it, whether they claim it or not. If we don't have enough evidence to grant a claim, we have to order an exam. So the old burden is if you can't make a decision, grant or deny you order an exam. Now if we can't grant, we have to order an exam. And order an exam will add another 20 to 30 days to a claim. It will add scheduling and hassle to a veteran. And what we've seen so far is it's not adding a large percentage to the granting category for claims. So when we were predicting workload or projecting workload, TERRA on top of PAC claims is adding a whole another half, 30 days or so, say a month to the process for potentially two plus million claims a year that we're getting in. So it's definitely going to impact veterans, whether they have a toxic exposure risk activity or not, because it's taking so long for us to tell whether they do. And everyone in the inventory, which there's 950,000 claims and veterans waiting for a decision on a claim today, it's only going to make that wait longer. And so we're very focused on that to say, what are ways we can do to help your servicing officers, help our VSRs and our VSRs get through the thought process of examining whether TERRA exists, taking the right action, ordering an exam as quickly as we can, and we've provided some job aids and tools to help people go through that. We're looking at automation to help us go through that. And we're also talking with VSOs like you, with Congress to say, is there any other way we can think about the toxic exposures of veterans that won't cause such a potentially long-term impact for them to wait for decisions that aren't necessarily going to be favorable for them? Well, I think that's a great point. You talked about false hope and kind of setting them up that they're not sure what the decision's going to be and they might have some potential benefits. The PACT added over 20 new categories of presumptive diseases that really consist of probably over 300 different potential diseases. Does VA intend on presenting a list so people do know exactly what they may be entitled to? Well, you know, it's kind of funny because Congress decided that head cancer is a presumptive, but I'm not a doctor. I don't think head cancer is a thing. I think you get carcinoma, the face, or you get something in some body part, brain cancer or other things. So we have to go through head cancer and neck cancer and other aspects that they wrote and define what it is. So va.gov has a list of what we have today. I would say it's probably not exhaustive as science changes and we add and subtract different things to the list, but definitely on va.gov, we've got hundreds of listed disabilities that could help your servicing officers as they're looking to help veterans file for claims. But at the end of the day, I would say, if you don't feel good and you think what you don't feel good about was caused by your service or exacerbated, have a veteran file a claim because presumptive or not, we're gonna look for a way to attach that to their service. Excellent, thank you very much. Thanks. So we'll switch topics here and talk hopefully a little bit about IT modernization and electronic health record initiative. Modernization of these electronic health record system is integral to the delivery of quality patient care and it's central to the future of the VA healthcare system. However, the rollout of the Oracle-Serner EHR system has been put on another pause due to problems documented by GAO and other, the Office of the Inspector General. What has VA done to address those issues identified and what efforts are underway to ensure that, regardless of how things move forward, that patient safety remains the number one priority during this IT transition period. Sure. I think what we know is that we know that a new federal electronic health record will be beneficial to veterans overall. We know that it'll help improve health outcomes. We know that it will lead to better care coordination. We know that it will add coherence to the largest healthcare system in the country. So we know that we must remain committed to successfully implementing a federal electronic health record. What we also know is that the current effort has not met our expectations and it hasn't met the expectations of our patients. It hasn't met the expectations of our providers. And we want to hold ourselves and we wanna hold Oracle-Serner accountable to make sure that we're doing it properly. So after considerable feedback from veterans, our frontline staff, from our partners at OIG and GAO, we've halted all work on future deployments of the electronic health record. And what we plan to do is we're focused really on three things. Number one, we do have one future deployment at the James LaValle Federal Health Center that is scheduled for March of 2024. So part of the work that we're doing is to ensure that that launch is done successfully and that we've learned from any lessons from our prior experiences. I think the second thing that we're focused on is we have five current sites. Those five current sites, we're doing a very thorough review of what are the things that we've learned during the initial implementation? What are the things that we can improve to ensure that those five sites are operating properly? And then number three, we're really developing the plan for future deployments. Because we recognize that this is an investment that is absolutely necessary for the VHA, we want to do it properly and we're learning from the experience the first time around. I think the other thing that is important to recognize is that electronic health record implementation in any healthcare system is always challenging. So I come from the commercial health space and I don't know of any EHR implementation that has gone smoothly the first time around. And so I think when you add the fact that we're dealing with 171 facilities, 1300, excuse me, 171 VA medical centers or hospitals, 1300 facilities, that we're gonna encounter some challenges but we're very focused on it and I think we have a good plan to relaunch after the program reset. Great, I think that's really important. This is something that as long as I've been around at least for the last 25 plus years, attempts have been made time and time again to do this and I know the secretaries made a commitment and Dr. Al Nahal that this has got to happen. It's got to bring VA into the, modernize the system that's very complicated to apparently replace with Vista but we hope that that's going to be successful and we always pray for you when you have to go before Congress and tell them about what's happening. I know they not have always been kind at some times but it does get frustrating. We really wanna see this and if there's anything we can do to help, we're certainly monitoring the situation. We're having meetings with you and we appreciate the updates and the routine and all the efforts. Absolutely and I have a great deal of confidence in the talents of our leadership and of our staff to implement this correctly. As many of you may know, the Veterans Health Administration was the leader in the launch of electronic health records. We were the leaders in the quality movement. You guys may remember when Dr. Kaiser was like transforming the VHA, the entire commercial health system looked to the VA and said we have a lot to learn from the Veterans Health Administration. We know that we're capable of doing that and I think the effort so far on the federal EHR, it has been challenging but we also know that we have the right orientation we're very mission focused folks and we know how to kind of get to a better way forward on this. Great, thank you, Jim. Thanks, Joy. The backlog of claims, as anticipated, over 700,000 claims filed as a result of PACT Act. The backlog, the actual number of claims pending is just under a million and that the backlog is nearing 300,000. Can you talk about VBA's plans to lower and ultimately eliminate the backlog? When do you think you would see some progress in regards to eliminating the backlog? We, well, backlog, just so everyone understands is a claim in inventory. We have almost a million claims in inventory. Backlog claims are those claims that are more than 125 days old, so say four months and the number was arbitrary and it was picked for us so we're not necessarily, I wouldn't agree that every claim could be decided in less than four months. For example, radiation claims from the 50s and 40s and 60s take a lot of research and a lot of time, so four months is not realistic for them, but we absolutely want to give veterans a decision as quickly as we can. The receipts, monoclames we're getting in is terrific lately. It's through the roof. We got 14,000 claims early this week, this past Monday or Tuesday, which I thought was tremendous and then we got 17,000 claims in two days later. So we're getting more claims in on any day than I've ever seen before. In fact, this July is our third highest receipts ever. And the second highest receipts is two months ago, so May. And the first highest is back when Neamer came into place and on one day we had 180,000 claims established. So we throw that out, that's 12 years ago, 10 years ago. Right now we're getting more claims each month than any month before and if that continues the backlog is gonna grow, the inventory's gonna grow. But we're doing a couple things to make sure that veterans get timely decisions. One, we're trying to hire and train staff as fast as we can and we've hired 22% more people in the last year and a half since fiscal year 22 than at any other time in our history. We're bigger than ever. We're trying to find ways to train people more quickly and we can tell that it works because our people are producing faster. They're doing more decisions more close to their hiring date than we expected and we model all of this out. We have very smart quantitative people that say you hire 100 people off the street, you put them in training that takes some of your people that know what they're doing to train and then you have to mentor that takes other trained people out of production. So it actually slows production when we hire because we're taking trained people out to get the new people up to speed but it's an investment that will have a long-term gain because we'll be stronger at the end of the way. We are training people faster, they are productive faster and then what I mentioned earlier, your former national commander, Rob Reynolds and the front row here, we made one of the best decisions ever about two and a half years ago when we said we wanna create a deputy undersecretary position for automation and we picked Rob because Rob had done a ton of stuff over the years before in loan guarantee and stakeholder enterprise portal created e-benefits if any of you used e-benefits which basically poured it over to va.gov, he has a group of people that are creating processes that make everything faster for us. I mentioned earlier that years ago a really good production day was 6,000. Last year it was 7,000, this year it's 8,000. I fully expect we'll be at nine or 10,000 in the next couple of years because we have more people can do more and because of what we're doing in automation. So when I talk about a deputy undersecretary for automation, I wanna be clear what that is because it's a couple of things. You know, one, it's automating repetitive tasks so that people don't have to do boring things. So we have excellent electronic health records in va. It's not a single system that we want in the future but we still have excellent electronic health records. Our VSRs have to gather evidence. We have a duty to assist veterans. When they file a claim, they go into our corporate database and they pull records over into the E-Folder in VBMS. That might take 10 minutes or 15 minutes per veteran but we're getting record number of claims. So if we get two and a half million claims this year and we can save 10 or 15 minutes per claim, that's about 650,000 hours of time that's saved or to put in the eyes of personnel, it's about 330 people that work for a year to do just pulling claims information over from health records. And for the veteran's perspective, that's probably 110 to 120,000 claims that we can do just for saving 10 minutes per claim or 15 minutes per claim. So that's one type of automation. Another type of automation is taking advantage of something that started ages ago where we started digitizing every piece of paper that VBA has. We went to all of our regional offices that were somewhere actually, the floors were sagging under the weight of the files that we had and John Stewart had a field day talking about that. But we started scanning. We sent trucks of people to take files, compile them, say which files are where, put them in boxes, seal them, put them in a truck, escort them to an offsite scanning facility and then store them forever and not in our ARRA. We've scanned billions of pages of documents that we now have advances in artificial intelligence and machine learning that allow us to let a computer look through thousands, tens of thousands, even millions of pages and each veteran's record and say how much of this record relates to a particular diagnostic code or a particular disease. And it will present that as evidence to a radar. And if we can use electronic AI and machine learning to look at a record as soon as you file. If you were to file a claim today, it would go to an automatic scanning center that would load it into our system. It would scour it and say are you claiming something that we already know a lot about that we can automatically look for keywords for medicines that you've taken, diagnoses in your past or any type of analysis that would say yes, this is likely to affect you. If we don't have enough evidence, the automation can automatically order an exam before a human even sees it. That's all on day one. If it does have enough information to make a decision, on day one it could go to a radar and the radar could be ready to look at that and say on day one, no one's looked at your claim but I will now have a cheat sheet like a cliff notes version of your evidence that I can examine and say, does this look like it's sufficient to rate a claim? Those are the types of tools that we're giving to our raiders and that your people should start to see as well. And the e-file that will help people see what does this veteran have that can help us get to a decision faster. It's a massive amount of change management because you're asking people, trust what something else is looking for. But in the old days, people would put on those little rubber finger things and they would page through hundreds of pages, thousands of pages and look for evidence. Now we're saying, let someone do it. And I would say it reminds me when I first used Google, I can remember the day I was at a client site when I was at Pricewaterhouse and this lady said, this is the most amazing thing. It's a white page with a box that says, I'm feeling lucky. And you type in something and you say, I'm feeling lucky and it tells you a result. Now, 15 years later, we don't even question it. It searches it, we trust it. Like if it says, the score of the Nats game is this, I'm not gonna look somewhere else and see if it's right, I know it's right. And that's what we need our people to get used to in the automation in our world. Well, the automation has been terrific and we've worked closely with Rob and his team. And I remember, I visited a scanning facility and Jamesville got to see how big of a production that is and how accurate it is. So it's very impressive. But I think automation, I think a lot of people were on the impression that, well, if someone's out of, they're automatically, a computer's deciding my claim and that's not accurate. There's still a person making a decision on the claim. It's a decision support tool. It's supporting that person making the decision and helping them gather all the evidence. So I appreciate you clarifying that, that was very helpful. When I love that term, decision support tool. It is definitely a human being that's making the final adjudication. Yep, I appreciate you saying that. Julie. Thanks, Jim. Dr. Sa, the number of women and minority veterans using VA healthcare system continues to rise and we know that it's expected to further increase over the next decades. What is VA doing to ensure women and minority veterans, including racial, ethnic and LGBTQ plus veterans have equitable access to VA programs and specialized services? I think when it comes to our efforts around health equity or promoting health equity, I'd say we have three primary levers. I think the first lever is around making sure that we have good data and analysis so that we understand where the health disparities may be. So, for example, one of the initiatives we have is if we have incomplete data on race, ethnicity, sex, gender, those types of things, we know that the gold standard for identification of those things ends up being self-reporting. So we are opening up the va.gov portal for veterans to be able to come in and correct their records directly. I think it's an easy way or an easy fix to ensure that the data itself is more accurate than we might currently have. We also have a lot of analytical dashboards and metrics. So we have things like the National Veterans Health Equity Report and the LGBTQ Plus Patient-Centered Care Tool. And it really allows us to conduct operational analyses to again, determine where are the best ways that we can start to develop strategies for reducing health disparities. I think the third is actually around outcomes and outcomes are actually very, very difficult typically to analyze. But we have something called Primary Care Equity Dashboard and that's population-based data and we can actually look at how are we doing on, for example, blood pressure control or how are we doing on diabetes control? So outcomes level data and then be able to go ahead and take a look at all of our demographic factors to determine is there a health disparity that we're seeing within one of our subpopulations inside the VHA. So these are very powerful tools that not a lot of, frankly, a lot of other communities are able to do, but because we have such a large closed, used to be a closed healthcare system, it allows us to conduct this analysis at a level of granularity that you don't commonly see. I think the second lever that we see is around the quality improvement. So what good is it to know that there are health disparities? What can we do to act upon those and improve upon those? So we have an equity-based quality improvement portfolio that is really focused on what are we doing around when we identify a health inequality or a health equity issue, how are we improving the situation? So we have a, the Office of Health Equity has a number of clinical themes that they focus on. So we have quality improvement projects underway that are focused on reducing disparities on the use of newer diabetes medications, on the use of statin medication use and adherence to medications. We're advancing the health of native Hawaiian and other Pacific Islander populations where we've seen a lot of disparities. And really all of these types of projects focus on eliminating health disparities as we find them. I'd say the third lever is really around education and training, types of tools and opportunities. So we have a lot of programs that are really focused on developing and disseminating tools around minority veterans, women veterans, a lot of other veterans that are priority populations for us. You know, Secretary McDonough has said to us many times and reaffirmed his commitment to making sure that VA's are harassment-free environment, including, you know, gender-based harassment and sexual assault across the department. And I know that was an important thing to him right from the beginning when he came in. Could you provide our members an update on the VA's white ribbon campaign and the derive prints efforts on this important initiative? Sure, it is a priority for the VA more broadly, definitely within the VHA as well, where we want to promote awareness as an effort to prevent and end harassment and sexual assault through this white ribbon VA campaign. So it's a national call to action and as a way to promote positive change within your organization. It's a opportunity where all regardless of gender can participate. It was inspired by the white ribbon organization, which is the world's largest movement to end violence against women and girls. More than 300,000 VA employees, veterans and partners have taken the white ribbon VA pledge to date. We have a white ribbon VA champion at every VA medical facility. We ensure that every new employee has the opportunity to take the white ribbon pledge throughout our entire staff and all of our SES swearing in ceremonies always end with a white ribbon VA pledge ceremony. DAV has been a key partner in promoting the white ribbon VA pledge as well. You've helped us get commitments from veterans who are part of the DAV through your outreach and your programming. And again, we just continue to promote and we remain committed to the white ribbon campaign. Great, well that's such so important and our leadership has been 100% behind that and making sure that we can help to do our part. We wanna just make sure that every veteran who needs to use the VA healthcare system can go and not have any poor experience with regard to any type of harassment and VA provides such unique and specialized services and it's critical that every veteran get the opportunity to use that and not wanna be dissuaded from going because of a poor experience. So I know our members that's important to them as well and wanna help do their part and watch out for everybody while we're there and make sure we report something if we see it. Thank you, Jim. Thank you, Joy. We filed nearly 175,000 claims to over half million issues last year and 97% of those were done electronically. And we really depend on VBA's core systems to allow us to do that whether it's VBMS, SCP. And the whole point behind that is that we're getting the information from there making sure that the claim is filed correctly and come into VBA appropriately which helps you process it quicker. You guys have any thoughts about sun setting any of the systems or VBMS as an example has been around, now it's been 12 years I think, so. I will never forget VBMS. So just curious on what your thoughts are on that. We know the stakeholder enterprise portal is likely going away at some point. Yes. And it's a wonderful tool for VSOs. So I'm hopeful we can get something in place before that sunset but I know that's a big ask as well. I would say, well one, we can't do any of our work without systems now. They're so, everything is so complex. The world is so interrelated that we need to gather far more information than ever before to accomplish just about anything. We rely on our systems. We rely on you who rely on our systems as well. So given that and knowing that we're always trying to make our systems better there's no system that's rolled out since even when I worked in the private sector that you're just happy with it when it's done. You're constantly adding features, adding enhancements, getting it to keep up with the days, technology, the days needs, the ability to do things more quickly or to handle more data. But got a funny story. When I worked in investment banking no one ever thought that numbers would have a billion in them. Like a dollar value of a billion. So they made all of the dollar values in this huge multinational investment bank to stop at 999,999,999,999 dollars and we first started to get billion dollar transactions. None of the systems worked. So clearly that needed to change and we're in the same place with most of our systems. We have a backbone of payment system that's under a comprehensive top to bottom fix in our office of finance, our CIO, CFO's office. And that's been underway for a decade and really, really hard the last couple of years. It's called FNBT for any that work with us. But for any payment that goes out of VA that's gonna be the new backbone. In education we have an old system that's based on COBOL that's been around forever that we're trying to get rid of called Benefits Delivery Network. Most of our systems were attached to that over the years. Most have been unattached and built in new ways now but education services still really, really comprehensively linked to that. So fortunately VBMS is not linked to BDN. VBMS is relatively fresh even if it's 10 years old or a decade old and I remembered it because they evicted us in loan guarantee and took our office space when they started designing VBMS. So I'll never forget VBMS. But it's also the backbone for most of what we do. And if we make changes to it we have regular cadence of meetings with you and the other big VSOs to say what works for you? What helps you? So one, there's no immediate changes in the future of VBMS other than iterative development. Two, SEP is old and I know it's old because Rob built it and Rob built it a long time ago. So SEP has to grow and it has to evolve. I don't know what the future is gonna be but I wanna make sure that you have the functionality that you need. You know I talked to Marty Carraways who are a VSO liaison. I can't see well because it's so bright but somewhere out here that if you need something and you don't think we're hearing, talk to him. If you feel like he's not listening, talk to me or Josh because we know that we can't deliver benefits without you. So if you need something to help us deliver benefits it's in our interest and it's in your interest to make sure you have it. All right, thank you, appreciate that. Dr. Sa, VA's number one clinical priority is to prevent veteran suicide. And there have been a number of new VA initiatives to ensure veterans have access to timely mental health services and especially Ducis veterans who are in acute mental health crisis. Last year, the 988 Suicide Crisis Lifeline was launched as part of the national effort to reduce suicide including veterans. Can you talk about VA's perspective, how the rollout went and how more broadly give us an update on VA's comprehensive mental health and suicide prevention strategies and plans for the future? Sure, absolutely suicide prevention remains our number one clinical priority. So since the launch of the dial 988 Press One campaign, the veteran crisis line, staff have fielded nearly a million contacts. This includes more than 800,000 calls, over 65,000 text messages and greater than 100,000 chats. This translates to roughly a 12% increase in calls, a 45% increase in texts and a 9% increase in chat messages over the preceding year. So despite this growth, our average speed to respond on the veteran crisis line is 9.3 seconds, which is below our 10 second standards. And the abandonment rate is 1.5%. So we're trying to keep that below 5%. So we're doing okay on that. But in order to prepare for and to continue to support the growing demand, the veteran crisis line has bolstered our workforce by over 900 new employees. This includes responders, supervisors, peer support specialists and other support staff. So as of July 16th of this year, the veteran crisis line has 1,806 full-time equivalents, of which 1096 employees are crisis responders. Speaking more generally about our suicide prevention and mental health strategies, we remain committed to mental health integration into our primary care and other specialty experiences. So we have worked hard to ensure that we have mental health professionals and behavioral health specialists available where veterans need it most, where they receive their care. So we've integrated mental health professionals into primary care, into our oncology clinics, into our pain clinics, and we continue to look for other areas where it makes a lot of sense for us to integrate mental health professionals. I think the suicide prevention strategies, since the creation of the VA Suicide Prevention Program in 2007, VA has onboarded more than 400 suicide prevention coordinators who provide the care coordination training and outreach to at-risk veterans. We also have a program called ReachVet, which was developed with the VA and the National Institutes of Mental Health, which is designed to conduct a predictive analysis model to identify the veterans who are at highest risk of suicide. And so through the ReachVet program, we've identified more than 6,000 veterans who are at increased risk for suicide. Our attempted outreach percentages are at 99%. So we identify a high-risk veteran. We've been able to make an attempt at greater than 99%. And our rate of successful outreach has reached 88%. So we still have room for improvement, but I think it's progress in helping us identify our veterans who are at greatest risk, but obviously it's not enough. I think some of the other things that are important that I would share is the Compact Act. The Compact Act for those who may not be familiar is if any veteran enrolled or non-enrolled inside the VHA, you can go to any VA or community care, community health care facility for emergency treatment with no out-of-pocket costs, right? So this includes your transportation, related prescriptions, inpatient, and crisis residential care for up to 30 days and other crisis related outpatient care for up to 90 days. So this really is a remarkable opportunity for veterans who are not even enrolled in our system to receive the care that they need. So the current estimates are roughly about nine million veterans who are not enrolled in the VA would be eligible to receive care under the Compact Act. I guess the last statement I would say is that the Office of Mental Health and Suicide Prevention's mission is to promote, protect, and restore veterans' mental health and overall well-being to empower and equip them to achieve their life goals and to provide quality-stated health care in a timely manner. And this is something that the entire VHA and the VA is committed to. Thank you. Jim? Thanks, Joy. Mike, in an effort to improve accuracy and consistent claims for PTSD, claims based upon military sexual trauma, VBA consolidated all the military sexual trauma related claims under the control of Puerto Rico VA Regional Office. Can you talk about whether this has improved either the accuracy of the claims or led to improved timeliness? That's a process that's still underway. So the MST, or military sexual trauma claims, are a subset of claims that has obviously been very important to us in VA. And it's gotten a lot of consideration in the last several years for how do we best handle not just the claims, but the claimants? What is the best way for us to help a veteran who has experienced a traumatic event during service, a sexually charged event during service, and try to touch them in a way that's compassionate, that's trauma-informed, that will allow them to hopefully not relive their experience, but get to a point where we can get them the care and the benefits that they need, especially the mental health care, so that they can start to move on with their lives and to recover. So we've gone through a lot of different evolutions in how we handle MST. We did create, right now, I would call it a virtual regional office, so it's under the charge of the director of the San Juan Regional Office, but it's not a San Juan function. It's a nationwide function. There are hundreds of employees, VSRs and RVSRs around the country, who all they do is focus on MST claims. That's been under consolidation for the last several months, I would say six months or so, as we went from several centers to this virtual regional office. We have more MST claims than ever, and I wouldn't say it's because processing time's down. Processing time is going fairly well. I think outreach and information and awareness of the fact that VA's here to help. We've got more people that are more aware of signs in veterans, and in fact, I had a former deputy undersecretary that called me and said, Mike, I was on a cruise of all places, and I met a veteran who wouldn't talk about our service, and I think it's because of an MST. I couldn't get her to talk to me. Her husband said that she's never talked to him about it. Can we get someone to talk to her? So I actually reached out to VHA, and we got someone from VHA to talk to her in a way that allowed her to feel safe and secure and to relate her experience so we could then determine a claim and get her connected to help. That's one veteran, and there's right now 30,000 or so veterans who have experienced an MST who are in a system. We want them all to get connected to care as soon as possible because they deserve the care. One, they've earned it. Two, they should have never had to go through that in the first place. We want to get them to the care that they need. So the timeliness is still a little bit more. We want it to be done in less than 125 days is our goal. Timeliness is about 146 days right now for MST claims. I would say that they are complex because what we get from claimants is sometimes relatively small and we have to infer a lot from evidence because we're not trying to cause these people to relive the experience that caused them to need to file a claim in the first place. So we're getting better at our trauma-informed communication, at eliciting the only information we need from veterans. We're getting better at looking at buddy statements and I forget the word that we use, but looking for signs in a veteran's experience if they had a perfect behavior record and then all of a sudden everything looked bad, if their attendance looked bad, if they're in subordination, all of a sudden started on a date, then we could use those as markers and say, hey, we don't have to know everything but we can see consequences of what could be found. So the claims themselves are a little bit more complex but as we get better, as we get our people more experience in it, I think we're gonna have to consider in the future what's the long-term impact on VSRs and RVSRs when the only type of claim that they're seeing day in and day out is military sexual trauma because it's gonna take a certain amount of compassion on their part and I'm very worried about what the long-term impact for them will be but we're going through this journey with a lot of people and I would say it's definitely faster for veterans filing out, it's definitely more equitable for veterans because we're better at winnowing out the information that we need from their service to determine whether this experience happened. Thank you, I appreciate that. Julie. Well, Jim, I see that we're just about out of time and I know that we wanted to give you both an opportunity to make any closing remarks or comments about maybe an issue we haven't covered here today or to expand on something more that you thought about so Dr. Soil, I'll let you start. But I have more notes. Yeah. Yeah, I'm not sure that I have an issue that I would particularly highlight I'm actually reminded of a TED talk that I watched. It's a woman named Emily S. Fahani Smith and she was talking about, she had done a lot of many years of research to determine what are the sources of meaning in one's life and she identified the four main pillars of meaning in one's life. It's mission, belonging, storytelling and transcendence. So the meaning behind it was that all of us need to have some kind of meaningful purpose that we kind of fix our lives around. Second, we need to have a sense of belonging to a broader community. Third, we need some kind of narrative arc to our life story and fourth, we need to feel like that our lives are greater than ourselves, right? And so when I think about that and I think about our own mission within the VHA, I think about that mission, right? First and foremost. So what the VA does, what the VHA does, it always reminds me that this is why it is so meaningful for all of us. When I come to something like a DAV National Convention, I'm reminded of the second pillar, right? Which is that sense of belonging. And again, I feel it's a great honor, it's a tremendous privilege to be able to spend time with this community that we all feel like we belong to. So for me, it's been a very powerful experience to be here. This is actually my very first VSO presentation. It's the first one I've been invited to. Actually, I wasn't invited, but the first one I was last minute injected into, but it's been a pleasure to spend some time with you. Great, well we've had, it's been a pleasure having you and we were so appreciative that you could fill in. I know Dr. Alnohal wanted to be here, but I think this is such an important opportunity for you to meet face to face with some of our members and them to see you. And we know how dedicated everyone is up there at VHA and within VBA and how hard you work to make sure things are really working for our veterans. So Jim, I'll turn it back to you for Mr. Frews. Thanks, Joy. Mike, I do have one more question. You're not getting off that easy. It's a softball. You promised that. It's a softball, but you mentioned claim sharks, these unaccredited claims companies, and I really wanted everyone here to understand what this is all about. You see a lot of advertisements out there, a lot of information coming out, telling veterans that they'll help you prepare your claim. These folks are not accredited and they charge absorbent fees, whether it's six times the monthly increase that you get. By law, no one is allowed to charge anybody to help you file an initial claim. Nobody can charge us fees for that. And it is happening all over the place right now. They're taking advantage of veterans and survivors and they sign these contracts and then they're held to them. Now they're a Congress trying to fight for a lot of get changed to allow them that a process to charge to file initial claims. So they're breaking the law right now and everybody knows it. Congress knows it. We see it happening all the time. They're not being punished for it and now they're trying to get into the system legally. It's very frustrating and I've met with VA, I've met with Congress. Veterans have sacrificed enough and paid for their benefits through their service. There's no reason why they should have to pay fees to file an initial claim. It's a non-adversarial process when you file your original claim or any claim before the VA for that matter. So there are accredited representatives, DAV, a bunch of other VSOs out there available to you that don't charge fees and will not charge fees. So make sure you're passing that word but I wanted to ask Mike, if VA is doing anything that could help protect veterans from these folks that we can refer to as unaccredited claims folks or claims sharks, whatever you want to call them. Well you're using very nice language. I am. I'm a mixed company so I didn't want to. Yeah, but they're all ours. I would say that I don't get upset about much and people that know me for a long time know that I'm pretty even keeled and pretty even tempered but I am getting infuriated by the proliferation of people who claim to be on veteran side who show up at TAP at the end of transition and say, sign up with me, it won't cost you a thing. I will take some of what you don't have already and I will help you get a claim. And I see ads that say, if you're not getting 80%, you're not getting 90%, you're not getting 100%, you are getting screwed. Come to us, come to our doctors. Our doctors will write the DBQ that will help you get 100% disability from VA and we will follow your paperwork. Give us your VA.gov sign in, give us your e-benefits if that's still alive Rob, sign in, we will pretend to be you and we will put in your paperwork and all you have to do is cash your check. And they are there every single month asking these veterans, I see that you've been rated, we want our money, we're here for you. So they're there to bill, they're there to catch the money. And I mentioned at the, see, he agrees. I mentioned at the beginning, that we deliver $3 billion a week to veterans. That's a lot of money and opportunity that there is no way that bad people are not interested in getting their hands on it. I'm not saying everyone's bad, but for the most of these people, I am furious that they're even allowed to go home at night and pretend that they care about veterans because what they'll do and what we've seen already is they will attach their name to a claim, they will take the next five or six months worth of payment increase. They will not be there to make the claim right if they did something wrong. They have no incentive to get effective date right, which is our number one error on a claim. Effective date could mean years of back pay to a veteran. How much more does it make to a company that has agreed to take five or six months of payment? They don't care. They will take the next five months. They don't need the last five months. They just need their five months. If you get the effective date wrong, who's gonna be left to fix it later? It will be your VSOs, it will be us, it will be more appeals probably in the process and I don't think they're helping the veteran a bit. You use the word that I like a lot. It's a non-adversarial relationship. In fact, Congress gave us the duty to assist to help find information for veterans, gather everything they don't send us that infuriated me and my step-mom when we were trying to apply for DIC and we already gave them everything and they said we're gonna go get more stuff. Like there's nothing else to get. We have that responsibility to make it easier for veterans and no one should profit off that and it drives me nuts and I want to stop it and we are gonna do everything we can. We've got general counsel, right cease and desist letters to some of these companies we're reaching out to DOJ for some of the more egregious ones that are absolutely violating the law but rest assured we know they are, if they file, if they charge a veteran money to file a claim, they are all breaking the law and we want to stop them. Yep, thank you, I appreciate it. So everyone please share that information, absolutely. Now's your opportunity to make any final comments. I was actually gonna end with Tara because I wanted to bring it up anyway but Dr. Suss said someday at the beginning that said I'm really happy to be back in New Jersey and I've never heard that phrase before. But now that I'm here, I would say this has been a wonderful day. I hope that you guys have an excellent convention and spend a lot of time with each other. When we're back in DC, we will continue to work on claim sharks, predatory actors, jackasses I would say in the system and make sure that we can stop them and everything else we can help veterans access their benefits. So thank you again. Well thank you. On behalf of Joy, myself and DAV, we really appreciate both of you taking time under your busy schedules to be here on a Saturday no less. So thank you for making the trip. And again, we wish you all the best and we look forward to continue working with both of you. Everyone please give them a big round. Thank you very much.