    [House Hearing, 112 Congress]
    [From the U.S. Government Publishing Office]

                             [H.A.S.C. No. 112-145]
    =======================================================================

                       BACK FROM THE BATTLEFIELD: DOD AND

     VA COLLABORATION TO ASSIST SERVICE MEMBERS RETURNING TO CIVILIAN LIFE

                                   __________

                                 JOINT HEARING

                                   before the

                          COMMITTEE ON ARMED SERVICES

                              meeting jointly with

                         COMMITTEE ON VETERANS' AFFAIRS

                              [Serial No. 112-71]

                            HOUSE OF REPRESENTATIVES

                          ONE HUNDRED TWELFTH CONGRESS

                                 SECOND SESSION

                                   __________

                                  HEARING HELD

                                 JULY 25, 2012

    [GRAPHIC] [TIFF OMITTED]

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                       HOUSE COMMITTEE ON ARMED SERVICES

                          One Hundred Twelfth Congress

                HOWARD P. ``BUCK'' McKEON, California, Chairman
    ROSCOE G. BARTLETT, Maryland         ADAM SMITH, Washington
    MAC THORNBERRY, Texas                SILVESTRE REYES, Texas
    WALTER B. JONES, North Carolina      LORETTA SANCHEZ, California
    W. TODD AKIN, Missouri               MIKE McINTYRE, North Carolina
    J. RANDY FORBES, Virginia            ROBERT A. BRADY, Pennsylvania
    JEFF MILLER, Florida                 ROBERT ANDREWS, New Jersey
    JOE WILSON, South Carolina           SUSAN A. DAVIS, California
    FRANK A. LoBIONDO, New Jersey        JAMES R. LANGEVIN, Rhode Island
    MICHAEL TURNER, Ohio                 RICK LARSEN, Washington
    JOHN KLINE, Minnesota                JIM COOPER, Tennessee
    MIKE ROGERS, Alabama                 MADELEINE Z. BORDALLO, Guam
    TRENT FRANKS, Arizona                JOE COURTNEY, Connecticut
    BILL SHUSTER, Pennsylvania           DAVE LOEBSACK, Iowa
    K. MICHAEL CONAWAY, Texas            NIKI TSONGAS, Massachusetts
    DOUG LAMBORN, Colorado               CHELLIE PINGREE, Maine
    ROB WITTMAN, Virginia                LARRY KISSELL, North Carolina
    DUNCAN HUNTER, California            MARTIN HEINRICH, New Mexico
    JOHN C. FLEMING, M.D., Louisiana     BILL OWENS, New York
    MIKE COFFMAN, Colorado               JOHN R. GARAMENDI, California
    TOM ROONEY, Florida                  MARK S. CRITZ, Pennsylvania
    TODD RUSSELL PLATTS, Pennsylvania    TIM RYAN, Ohio
    SCOTT RIGELL, Virginia               C.A. DUTCH RUPPERSBERGER, Maryland
    CHRIS GIBSON, New York               HANK JOHNSON, Georgia
    VICKY HARTZLER, Missouri             BETTY SUTTON, Ohio
    JOE HECK, Nevada                     COLLEEN HANABUSA, Hawaii
    BOBBY SCHILLING, Illinois            KATHLEEN C. HOCHUL, New York
    JON RUNYAN, New Jersey               JACKIE SPEIER, California
    AUSTIN SCOTT, Georgia                RON BARBER, Arizona
    TIM GRIFFIN, Arkansas
    STEVEN PALAZZO, Mississippi
    ALLEN B. WEST, Florida
    MARTHA ROBY, Alabama
    MO BROOKS, Alabama
    TODD YOUNG, Indiana
                      Robert L. Simmons II, Staff Director
                   Jeanette James, Professional Staff Member
                     Debra Wada, Professional Staff Member
                          James Weiss, Staff Assistant

                                     ------

                         COMMITTEE ON VETERANS' AFFAIRS

                         JEFF MILLER, Florida, Chairman
    CLIFF STEARNS, Florida               BOB FILNER, California, Ranking
    DOUG LAMBORN, Colorado               CORRINE BROWN, Florida
    GUS M. BILIRAKIS, Florida            SILVESTRE REYES, Texas
    DAVID P. ROE, Tennessee              MICHAEL H. MICHAUD, Maine
    MARLIN A. STUTZMAN, Indiana          LINDA T. SANCHEZ, California
    BILL FLORES, Texas                   BRUCE L. BRALEY, Iowa
    BILL JOHNSON, Ohio                   JERRY McNERNEY, California
    JEFF DENHAM, California              JOE DONNELLY, Indiana
    JON RUNYAN, New Jersey               TIMOTHY J. WALZ, Minnesota
    DAN BENISHEK, Michigan               JOHN BARROW, Georgia
    ANN MARIE BUERKLE, New York          RUSS CARNAHAN, Missouri
    TIM HUELSKAMP, Kansas
    MARK E. AMODEI, Nevada
    ROBERT L. TURNER, New York
                Helen W. Tolar, Staff Director and Chief Counsel

                                      (II)

                                C O N T E N T S

                                  ----------

                         CHRONOLOGICAL LIST OF HEARINGS
                                      2012

                                                                       Page

    Hearing:

    Wednesday, July 25, 2012, Back from the Battlefield: DOD and VA
      Collaboration to Assist Service Members Returning to Civilian
      Life...........................................................     1

    Appendix:

    Wednesday, July 25, 2012.........................................    43
                                  ----------

                            WEDNESDAY, JULY 25, 2012
     BACK FROM THE BATTLEFIELD: DOD AND VA COLLABORATION TO ASSIST SERVICE
                       MEMBERS RETURNING TO CIVILIAN LIFE
                  STATEMENTS PRESENTED BY MEMBERS OF CONGRESS

    Filner, Hon. Bob, a Representative from California, Ranking
      Member, Committee on Veterans' Affairs.........................     5
    McKeon, Hon. Howard P. ``Buck,'' a Representative from
      California, Chairman, Committee on Armed Services..............     1
    Miller, Hon. Jeff, a Representative from Florida, Chairman,
      Committee on Veterans' Affairs.................................     3
    Smith, Hon. Adam, a Representative from Washington, Ranking
      Member, Committee on Armed Services............................     4

                                   WITNESSES

    Panetta, Hon. Leon E., Secretary of Defense, U.S. Department of
      Defense........................................................     7
    Shinseki, Hon. Eric K., Secretary of Veterans Affairs, U.S.
      Department of Veterans Affairs.................................    12

                                    APPENDIX

    Prepared Statements:
        Buerkle, Hon. Ann Marie......................................    54
        McKeon, Hon. Howard P. ``Buck''..............................    47
        Miller, Hon. Jeff............................................    49
        Panetta, Hon. Leon E.........................................    56
        Shinseki, Hon. Eric K........................................    64
        Smith, Hon. Adam.............................................    51

    Documents Submitted for the Record:

        [There were no Documents submitted.]

    Witness Responses to Questions Asked During the Hearing:

        Mr. McKeon...................................................    84
        Mr. McKeon and Mr. Miller....................................    83

    Questions Submitted by Members Post Hearing:

        Mr. Barber...................................................    98
        Ms. Bordallo.................................................    92
        Mr. Cooper...................................................    88
        Mr. Franks...................................................    93
        Mr. Garamendi................................................    97
        Mr. Kissell..................................................    96
        Mr. Langevin.................................................    87
        Mr. Loebsack.................................................    94
        Mr. Schilling................................................    97
     BACK FROM THE BATTLEFIELD: DOD AND VA COLLABORATION TO ASSIST SERVICE
                       MEMBERS RETURNING TO CIVILIAN LIFE

                                  ----------

            House of Representatives, Committee on Armed
                Services, Meeting Jointly with Committee on
                Veterans' Affairs, Washington, DC, Wednesday,
                July 25, 2012.

        The committees met, pursuant to call, at 10:00 a.m., in
    room 2118, Rayburn House Office Building, Hon. Howard P.
    ``Buck'' McKeon (chairman of the Committee on Armed Services)
    presiding.

        OPENING STATEMENT OF HON. HOWARD P. ``BUCK'' MCKEON, A
     REPRESENTATIVE FROM CALIFORNIA, CHAIRMAN, COMMITTEE ON ARMED
                                SERVICES

        The Chairman. Good morning. The committee will come to
    order. Good morning, I welcome everyone for this special joint
    hearing with the Committee on Veterans' Affairs. Our focus is
    the collaboration between the Department of Defense [DOD] and
    the Department of Veterans Affairs [VA] to assist service
    members transitioning to civilian life. We have two of
    America's leaders with us, Secretary Panetta and Secretary
    Shinseki, to discuss how we as a Nation can best serve those
    who have served us in uniform.
        I also welcome Chairman Jeff Miller and Ranking Member Bob
    Filner and of course Ranking Member Adam Smith from our
    committee. I thank them all for their significant efforts to
    address a range of transition issues.
        It is no secret that I oppose plans to reduce the size of
    our military, especially when contingency operations are still
    ongoing in Afghanistan. I find it strange that at a time when
    we are still at war, the Department of Defense has announced it
    will actually reduce the size of the Army and Marine Corps.
    Such cuts put strain on our service members and their families.
        Moreover, I have been very vocal regarding the threat
    sequestration poses to the strength and integrity of our
    military. Reductions in end strengths represent additional
    service members that will be asked to leave the military on top
    of the over 175,000 service members that separate every year. I
    will continue to voice my staunch opposition to further cuts to
    the Defense budget which, if they take effect, will not only
    increase the damage to our national security, but also put
    significant strains on the transition system that is already
    working too slowly.
        Today's hearing demonstrates our joint longstanding
    commitment that there be no gap in services and support
    provided to our service members and their families as they
    transition from the Department of Defense to the Department of
    Veterans Affairs.
        The transition that service members experience from active
    service into civilian life must be improved. Veterans of Iraq
    and Afghanistan know that the hardships don't end when they
    leave the war zone. We in Congress are painfully aware that at
    this very moment 26,000 service members are in the midst of the
    disability evaluation process and are forced to wait over 400
    days on average before they can return home to their
    communities.
        To further assist this transition the Congress mandated
    over a decade ago that the DOD and the VA create a joint
    integrated Electronic Health Record [iEHR] to facilitate the
    transfer of service members' personal health information
    between the DOD and the VA health facilities. Unfortunately,
    after continuing delays we are now told that it isn't expected
    to be completed until 2017.
        And finally we hear about the veteran unemployment numbers;
    23.3 percent of veterans between the ages of 18 and 24 are
    unemployed. This highlights the difficulty our younger veterans
    are having to find employment. The idea that our service
    members can go from the front lines to the unemployment lines
    is unacceptable. These men and women whom I have called the
    next greatest generation, and who with their families have
    sacrificed so much for this country, deserve better than to
    have to face the uncertainty of leaving the military in these
    very hard economic times. We must never stop working on their
    behalf, and there is much work still to be done.
        During my meeting with Secretary Shinseki I came away
    impressed by his commitment to improving the transition. He met
    multiple times with Secretary Gates where a joint commitment to
    action was born. That commitment has continued with Secretary
    Panetta. I would like to hear from both of you today on the
    progress that you have made and also what you believe to be the
    critical next steps, and I would like to compliment both of you
    for working so hard together to make these things happen.
        Specifically, I want both of your views on the Transition
    Assistance Program, TAP, which facilitates the transition from
    Active Duty. With regard to objectives, do you both agree on
    TAP's objectives? For example, is TAP designed to prepare
    service members for entry into the job market or is the purpose
    to actually get a service member a job? How do you measure
    whether TAP is achieving its objectives?
        Service members transitioning deserve a government-wide
    approach that includes support from the Departments of Defense,
    Veterans Affairs, Labor, Education, Small Business
    Administration, among others. How is TAP providing such an
    approach?
        The unfortunate consequence of over a decade of war is that
    service members return with serious life-changing injuries.
    Even as the numbers of service members being deployed to combat
    zones goes down, projections are that the numbers of service
    members and veterans needing support will grow substantially
    for the foreseeable future. What are both Departments doing to
    help service members transition as quickly as possible while
    providing this generation of veterans the treatment they need
    to return to their families and live fulfilling, independent
    and productive lives?
        Given the significant evolution of medical science, service
    members now survive horrific injuries that would have been
    fatal even during the first Gulf War. Many of these wounded
    veterans will need long-term, comprehensive services and
    support that can only be provided by the military and by the
    VA. How are the Departments resourced for this long-term
    effort? What are the plans to maintain an equitable joint
    venture in light of the fact the Department of Defense is
    facing another half trillion dollar reduction due to
    sequestration? But the Department of Veterans Affairs is
    exempt.
        I now recognize Chairman Jeff Miller for his opening
    remarks to be followed by Ranking Member Adam Smith and Ranking
    Member Bob Filner for their opening remarks.
        [The prepared statement of Mr. McKeon can be found in the
    Appendix on page 47.]

     STATEMENT OF HON. JEFF MILLER, A REPRESENTATIVE FROM FLORIDA,
                CHAIRMAN, COMMITTEE ON VETERANS' AFFAIRS

        Mr. Miller. Thank you very much, Mr. Chairman, and to our
    ranking members for helping set up this really truly historic
    meeting today. According to a quick search, it appears that we
    never had these two Secretaries simultaneously appearing before
    our two committees. And I would suggest that we don't wait so
    long before we do it again. And if we are going to ask the VA
    and DOD to work together, I think our committees should be
    doing exactly the same. Secretary Panetta, Secretary Shinseki,
    it is a pleasure to have you both with us here today, and your
    presence I think underscores the goal that we all share that
    our separating service members have a seamless transition from
    their military life to the civilian life.
        Our committee, the Veterans' Affairs Committee, and the
    Subcommittee on Oversight and Investigation have held at least
    13 oversight hearings on transaction related issues. These
    topics include improving the joint disability evaluation system
    that your Departments administer, ensuring that the highest
    quality of health care for the severely wounded who can no
    longer continue on Active Duty and ensuring that our service
    members leaving the military are equipped successfully to enter
    today's workforce.
        We have also focused on the tools that your Departments
    must use effectively to deliver these 21st century services
    such as the electronic health records and other IT [information
    technology] solutions. The testimony that we have received so
    far on matters that we talked about has been somewhat mixed.
    Although we have heard a number of initiative plans and
    processes and improvements from your testimony today, I see
    that it echoes much of those improvements, but I think what we
    all want to see is clear bottom-line results. Several examples
    would include notwithstanding the resources that Congress has
    provided over the last several years to improve Iraq and
    Afghanistan veterans' access to mental health care, many, many
    concerns remain.
        A VA psychologist testified that, ``VA clinicians are
    overrun with veterans in need. Mental health service lines are
    pushing as many veterans into clinicians' schedules as possible
    to meet their performance measures but those veterans are not
    getting effective treatment.''
        Secondly, 5 years ago Secretary Shalala and Senator Dole
    called for the establishment of an effective Federal recovery
    coordinator program for the seriously wounded and their
    families. But rather than a single point of contact they called
    for, VA and DOD created two separate programs. The GAO
    [Government Accountability Office] testified that
    ``proliferation of these programs has resulted not only in
    inefficiencies but also confusion for those being served. So
    consequently the intended purpose, which is to better manage
    and facilitate care and service, may actually have had the
    opposite effect.''
        Five years ago Senator Barack Obama said, ``All of us are
    in agreement that we need to make the DOD disability review
    process less complex and better coordinated with the VA
    process.'' However, that process remains slow and continues to
    be complex. GAO has reported that case processing times have
    increased over time and measures of service member satisfaction
    have shown shortcomings.
        Finally, despite repeated assertions about the need for VA
    and DOD to share medical and other information electronically,
    it seems the goalpost continues to move over and over again on
    when this is finally going to take place. GAO says VA and DOD
    still don't fully agree on key planning and operational
    elements that would ensure future success.
        So it is my hope that raising these important issues to
    both of you here today will serve as a benchmark going forward
    by which all of us can hold you or your successors accountable.
    I know that both of you and I sincerely believe that both of
    you are committed to solving these problems. However, if what
    we have been doing isn't working or isn't showing the
    measurable results that we need, then let's work together to
    get things back on track.
        I look forward to your testimony and yield back my time.
        [The prepared statement of Mr. Miller can be found in the
    Appendix on page 49.]
        The Chairman. Thank you. Mr. Smith.

    STATEMENT OF HON. ADAM SMITH, A REPRESENTATIVE FROM WASHINGTON,
              RANKING MEMBER, COMMITTEE ON ARMED SERVICES

        Mr. Smith. Thank you, Mr Chairman. I thank both of our
    chairmen for holding this hearing. The service member
    transition is one of the most important issues that we face I
    believe as a country. We are going to have a large number of
    men and women who have served in the military transitioning
    out. How we take care of them is going to be I think one of the
    ultimate measures of how strong a society we are. I want to
    thank Secretary Panetta and Secretary Shinseki for being here
    today and also for your leadership. Having met with both of
    you, I know how committed you are to this issue and I see it
    with your DOD and Veterans Affairs personnel. They are
    absolutely committed to tackling the problem and making changes
    and making it better. And I think progress has been made in
    terms of health care and in terms of finding jobs we've seen a
    slight down-tick in the unemployment rate of service members.
    But we all know that much more needs to be done. I won't repeat
    everything that the two chairmen said except to say that I
    agree with them on the challenges in this area and how much
    more we need to do and how much better we need to get at
    coordinating that service.
        I think one of the things that really struck me about this
    issue is how so many people in this country want to help.
    Certainly it is true with your two Departments, it is true in
    Congress, but business leaders, community leaders, and we have
    so many people out there coming up with creative ideas every
    day for how to help our service members and their families as
    they transition out of the military. I think one of the great
    challenges is how do you bring those resources together and
    come up with the best practices approach? What works best and
    how can you then use all of that enthusiasm for helping the
    people who have served in the military make the most out of
    those resources and best coordinate it. I think that is a
    challenge you will have. There are folks outside of the
    government who are anxious to help, we need to work them in as
    well. But I agree with both of the chairmen and the challenges
    that they have outlined. I look forward to your testimony and
    the questions and answers about how we can best step up to this
    critically important challenge for our Nation. And with that, I
    yield back.
        [The prepared statement of Mr. Smith can be found in the
    Appendix on page 51.]
        The Chairman. Thank you. Mr. Filner.

    STATEMENT OF HON. BOB FILNER, A REPRESENTATIVE FROM CALIFORNIA,
             RANKING MEMBER, COMMITTEE ON VETERANS' AFFAIRS

        Mr. Filner. Thank you, Mr. Chairman, and thank you for
    holding this hearing. I mean the picture of our two Secretaries
    sitting there together says it all. I will tell you, Mr.
    Chairman, when I was chairman of the Veterans' Committee I was
    trying to work with our party to have such a joint session and
    we never could accomplish it. So thank you for getting it done.
    We appreciate that. Thank you, Mr. Secretaries. We are going to
    use the word ``transition'' a lot here. I just want to thank--
    can I say Leon here? When I first came to Congress the
    Secretary was very helpful in me transitioning from local
    government to the Congress. And I will never forget your
    kindness in mentoring, so thank you, Leon, for all of your work
    over the years with so many people. You have a legacy here of
    course that we will never forget.
        The issues that we have, we have been talking as a Congress
    and with the executive branch for many, many years, decades in
    fact, and we've got to break down the bureaucratic stuff that
    keeps us from having a common, for example, health record
    system. I mean it just, people die because that system is not
    integrated closely enough. And it seems that this is not beyond
    our capacity as a people to get those systems integrated.
        I want to say one word, we want to thank the President for
    announcing this reverse boot camp. I think it is a good start,
    the recognition of that. But I think it is just a start. And I
    have been talking for at least a decade about a deboot camp. I
    don't think, Mr. Secretaries, that you ought to build it on the
    TAP program. If any of you have attended those programs--what
    shall I say kindly--they are a waste of time for most people.
    The only people more bored than the service members actually
    sitting there--they are just thinking about getting out, they
    are not taking into account anything at these lectures--the
    only thing more bored than them is the people giving the
    lectures. It is not a very exciting time and to expand it to 5
    days doesn't seem to get at the heart. I think you've got to
    seriously look at--and I know there is cost factor and your
    predecessors would not look at it seriously--a real deboot
    camp. When we send our young men and women to military, they go
    through 10, 12 weeks to get the military ethos; you need almost
    as much time to transition.
        And first and foremost, which the President's program I
    don't think has, is adequate medical evaluation. You know we
    have thousands, tens of thousands, probably hundreds of
    thousands of young people leaving the military without adequate
    diagnosis of either their mental health or their physical
    health. We know PTSD [post-traumatic stress disorder] and TBI
    [traumatic brain injury] could be undiagnosed, they are
    unrecognized, people are in self-denial. And so they will
    transition and then have enormous problems, as you know,
    suicide, homelessness, whatever. We can stop that with an
    adequate diagnosis.
        If you did it in a setting where there was a transitional
    setting on a campus or, I don't know, some base somewhere with
    their families, with their company of soldiers, they get the
    support they need, that they lack when they do a sudden
    transition. Their families are with them, that is important.
    You can do their medical stuff, you do the job counseling, you
    do the educational counseling but in a relaxed atmosphere where
    everybody is paying attention. It would be part of Active Duty,
    8, 10, 12 weeks, whatever you think you can afford. But I tell
    you 5 days is a start, it is not going to do it. As you know,
    you know better than all of us, the rate of suicides, the
    homelessness, the convictions for crimes of recent veterans are
    symptoms of an incredible problem. It is an epidemic and we are
    not focusing on--we really don't want to know about it, it
    seems to me.
        And yet if you look at a reverse or deboot camp, and take
    it seriously, and deal with the medical and psychological and
    economic and educational issues over a period of time, I think
    you can greatly reduce this blot on our record after these
    young men and women serve so professionally in Iraq and
    Afghanistan or wherever they happen to serve and then come home
    and have domestic violence, and suicide, and homelessness, and
    joblessness.
        We are not doing our country a service. And I think you
    have the leadership skills, you have the ability, you work well
    together that we can get this blot off of our country's record
    and really do something seriously.
        So thank you all for being here. We thank you for your
    personal cooperation, your personal leadership. You can really
    change the two biggest bureaucracies we have in the Nation. You
    two can change them and we look forward to working with you to
    do it. Thank you.
        The Chairman. Thank you. Given the interest in the hearing
    today and it is a joint and that fact that it is a joint
    hearing and, after consultation with Mr. Smith, Mr. Miller, and
    Mr. Filner, I ask unanimous consent that each member shall have
    not more than 2 minutes to question the panel of witnesses,
    starting with me. Hearing no objection, so ordered.
        In addition, we will follow our committee rules and
    recognize members who arrived before the gavel in the order of
    seniority, alternating between Armed Services Committee
    majority and minority members followed by Veterans' Affairs
    majority and minority members.
        Lastly, I want to give special recognition to one of our
    committee staff, John Johnson, better known as JJ, who is
    responsible for artfully configuring this hearing room that
    normally holds 64 members, but today had been expanded to
    comfortably seat 82. You have my personal thanks, JJ.
        Now, Mr. Secretary, Secretary Panetta, if you would please
    begin.

     STATEMENT OF HON. LEON E. PANETTA, SECRETARY OF DEFENSE, U.S.
                         DEPARTMENT OF DEFENSE

        Secretary Panetta. Thank you, Mr. Chairman. I would ask
    that my full statement be made part of the record, and I will
    try to summarize it if I could.
        The Chairman. Both of your statements will be fully entered
    into the record. Hearing no objection, so ordered.
        Secretary Panetta. Thank you very much, Chairman McKeon,
    Chairman Miller, Ranking Member Smith, and Ranking Member
    Filner, dear former colleagues of mine, and I appreciate the
    opportunity to be here, and I also want to pay my respects to
    the members of both committees. This is a unique event, it is
    an important event. And first and foremost I want to thank all
    of the members of both the Armed Services and Veterans'
    Committee for the support that you provide the Department of
    Defense, our men and women in uniform and our veterans. We
    could simply not do the work that needs to be done in
    protecting this country and in serving those that are warriors
    and their families. We just could not do it without the
    partnership that we have with all of you. And for that reason
    let me just express my personal appreciation to all of you for
    your dedication and for your commitment to those areas.
        I also want to thank you for the opportunity to appear this
    morning alongside Secretary Shinseki. He is a great friend, a
    great public servant, a great military leader and a great
    friend to me and to our Nation's veterans. I appreciate the
    opportunity to appear alongside of him.
        I am pleased to have this chance to discuss the ways that
    the Department of Defense and the Department of Veterans
    Affairs are working together to try to meet the needs of our
    service members, our veterans, and their families. This hearing
    comes at a very important time for our Nation and for
    collaboration between our two Departments. DOD and VA are in
    the process of building an integrated military and veterans
    support system. It is something that should have been done a
    long time ago, but we are in the process of trying to make that
    happen, and develop a support system that is fundamentally
    different and a lot more robust than it has been in the past.
        Today, after a decade of war, a new generation of service
    members, of veterans is coming home, our Nation has made a
    lifetime commitment to them for their service and for their
    sacrifice, for their willingness to put their lives on the line
    for this country. These men and women have shouldered a very
    heavy burden. They have been deployed, as you know, time and
    time and time again. They fought battles in Iraq; they fought
    battles in Afghanistan; they have been targeted by terrorists
    and by IEDs [improvised explosive devices]; they have been
    deployed from Kuwait to South Korea, from the Pacific to the
    Middle East. Many are dealing with serious wounds, as well as
    with complex and difficult problems, both seen and unseen. They
    have fought and many have died to protect this country and we
    need to fight to protect them. We owe it to those returning
    service members and to the veterans to provide them with a
    seamless support system so that they can put their lives back
    together, so that they can pursue their goals, so that they can
    not only go back to their communities but be able to give back
    to their communities and to help strengthen our Nation in many
    ways.
        None of this, none of this is easy. It takes tremendous
    commitment on the part of all Americans, those in government,
    those in the military, it takes tremendous commitment on the
    part of those in the private sector, our business leaders and,
    frankly, all citizens across our country.
        There is no doubt that DOD and VA are working more closely
    together than we have before, but frankly we have much more to
    do to try to reach a level of cooperation to better meet the
    needs of those who have served our Nation in uniform,
    especially our Wounded Warriors.
        Since I became Secretary a little over a year ago,
    Secretary Shinseki and I have met on a regular basis in order
    to personally guide efforts to share resources and expand
    cooperation between our Departments. Partnership between our
    Departments extends to all levels led by a joint committee
    cochaired by the Under Secretary of Defense for Personnel and
    Readiness and the Deputy Secretary of Veterans Affairs. Senior
    military leaders have been deeply committed to this effort.
    This is about the care of their troops, but it is also about
    recruiting and retaining the very best military force in the
    world. When it comes down to it, caring for those who have
    served and their families is not only a moral imperative, it is
    a national security imperative as well.
        For those who have fought for their Nation we need to
    protect their care and their benefits, but we also need to
    protect their integrity and their honor. It is for that reason
    that before I discuss the specifics about DOD and VA
    collaboration I want to announce an important step that my
    Department is taking in order to help maintain the integrity of
    the awards and honors that are earned by our service members
    and their veterans. You are all aware of the Supreme Court
    decision that determined that free speech allows someone to lie
    about military awards and honors. Free speech is one thing, but
    dishonoring those who have been honored on the battlefield is
    something else. For that reason, today we are posting a new
    page on the Defense Department's Web site that will list those
    service members and veterans who have earned our Nation's
    highest military awards for valor. Initially the Web site will
    list the names of those who have earned the Medal of Honor
    since 9/11. But in the near term it will include the recipients
    of the services Crosses and the Silver Star since 9/11. We will
    look at expanding that information available on the Web site
    over time. This effort will help raise public awareness about
    our Nation's heroes and help deter those who might falsely
    claim military honors, which I know has been a source of great
    concern for many veterans and members of these committees and
    Members of the Congress. I want to thank you for your concerns
    and for your leadership on this issue, and our hope is that
    this will help protect the honor of those who serve the United
    States in battle.
        Now let me discuss the five priority areas that DOD and VA
    are trying to work on to enhance collaboration. The first is
    this transition program, Transition GPS program. At the
    Department of Defense our goal is to provide a comprehensive
    Transition Assistance Program that prepares those who are
    leaving the service for the next step, whether that is pursuing
    additional education, whether it is trying to find a job in the
    public sector or the private sector, or whether it is starting
    their own business.
        On Monday the President announced the new Transition GPS
    program that will extend transition preparation through the
    entire span of each service member's military career. The
    program will ensure that every service member develops their
    own individual transition plan, meets new career readiness
    standards, and is prepared to apply their valuable military
    experience however and wherever they choose.
        Second area that we focused on is trying to integrate the
    disability evaluation system. We have overhauled the legacy
    disability evaluation system and trying to make improvements
    with regards to developing a new system. In the past, as you
    know, service members with medical conditions preventing them
    from doing their military jobs had to navigate separate
    disability evaluation systems at both DOD and VA. We have
    replaced that legacy system with a single Integrated Disability
    Evaluation System [IDES] that enables our Departments to work
    in tandem. Under the new system currently in use, service
    members and veterans have to deal with fewer layers of
    bureaucracy, and they are able to receive VA disability
    compensation sooner after separating from the military.
        But let's understand as we try to do this, this is a tough
    challenge to try to make this work in a way that can respond to
    our veterans effectively. After all, veterans have rights, they
    have the right to ensure that their claims are carefully
    adjudicated, but at the same time we need to expedite the
    process and to ensure that as we do that we protect their
    benefits, and that is what we are trying do with this system.
        The third area is to try to integrate, as was pointed out,
    a new electronic health record system. We are working on a
    major initiative to try to do that. For too long efforts to
    achieve a seamless transition between our health care systems
    have been hamstrung by separate legacy health record systems.
    In response to challenge that was issued by the President and
    frankly Presidents in the past who have tried to address this
    issue, DOD and VA is finally working steadily to build an
    integrated Electronic Health Record system. When operational
    that system will be the single source for service members and
    veterans to access their medical history and for clinicians to
    use that history at any DOD and VA facility. Again, this is not
    easy, and so the way we are approaching it is to try to see if
    we can complete this process at two places, San Antonio and
    Hampton Roads, and then try to expand it to every other
    hospital. It is tough, but if we can achieve this, it would be
    a very significant achievement that I think could be a model
    not only for the hospitals that we run, but for hospitals in
    the private sector as well.
        Fourthly, we need greater collaboration on mental and
    behavioral health. Beyond these specific initiatives that I
    mentioned, we are trying to focus on enhancing collaboration in
    areas that involve some of the toughest challenges we face now
    related to mental and behavioral health. Post-traumatic stress
    has emerged as a signature unseen wound of this last decade of
    war. Its impact will be felt for decades to come and both the
    DOD and VA must therefore improve our ability to identify and
    treat this condition, as well as all mental and behavioral
    health conditions, and to better equip our system to deal with
    the unique challenges these conditions can present. For
    example, I have been very concerned about reports of problems
    with modifying diagnosis for post-traumatic stress in the
    military disability evaluation system. Many of these issues
    were brought to my attention by Members of Congress, and I
    appreciate their doing that, particularly the Senate Veterans'
    Affairs Committee chairman, Patty Murray, who addressed this
    issue because it happened in her own State in a particular way.
    To address these concerns I have directed a review across all
    of the uniformed services. This review led by the Under
    Secretary of Defense for Personnel and Readiness Erin Conaton
    will help ensure that we are delivering on our commitment to
    care for our service members. The review will be analytically
    sound, it will be action oriented, and it will provide
    hopefully the least disruptive impact to behavioral health
    services for service members. The effort here is to determine
    where those diagnoses take place, why they were downgraded
    downward, what took place so that we know exactly what has
    happened. I hope that the entire review will be completed
    within approximately 18 months.
        The last area is an area that has really concerned me,
    which is the area of trying to prevent military suicides. We
    have strongly focused on doing what we can to try to deal with
    this issue, which I have said is one of the most frustrating
    problems that I have come across as Secretary of Defense.
    Despite increased efforts and attention by both DOD and VA, the
    suicide trends among service members and veterans continues to
    move in a very troubling and tragic direction. And part of it
    is reflected in larger society. The fact is numbers are
    increasing now within the military. In close cooperation with
    the VA, DOD is taking aggressive steps to try to address this
    issue, including promoting a culture to try to get people to
    seek help, seek the kind of help that they need to improve
    access to mental and behavioral health care, to emphasize
    mental fitness and to work to better understand the issue of
    suicide with the help of other agencies, including the VA. One
    of the things I am trying to stress is that we have got to
    improve the ability of leadership within the military to see
    these issues, to see them coming and to do something to try to
    prevent it from happening.
        Our efforts to deliver the best possible services depend on
    the dedication of our DOD and VA professionals who work
    extremely hard every day on behalf of those who have served in
    uniform, and I extend my thanks to all who help support our men
    and women in uniform today, to our veterans and to our
    families.
        Let me just say we are one family, we have to be one family
    at the Department of Defense and the Department of Veterans
    Affairs, a family that supports one another and all those who
    have answered the call to defend our country. Together we will
    do everything possible to ensure that the bond between our two
    Departments and between our country and those who have defended
    it only grows stronger in the future.
        Let me also say this. As a former Congressman, now as
    Secretary of Defense and someone who has spent over 40 years
    involved in government in some capacity or another, I am well
    aware that too often the very best intentions, very best
    intentions for caring for our veterans can get trapped in
    bureaucratic infighting, it gets trapped by conflicting rules
    and regulations, it gets trapped by frustrating levels of
    responsibility. This cannot be an excuse for not dealing with
    these issues. It should be a challenge for both the VA and DOD,
    for the Congress and for the administration to try to meet that
    challenge together. Our warriors are trained not to fail on the
    battlefield. We must be committed not to fail them on the home
    front. I realize that there have been a lot of good words and a
    lot of good will and a lot of good intentions, but I can assure
    you that my interest is in results, not words. I am grateful
    for the support of the Congress, particularly these two
    committees, and I thank you and look forward to your questions.
        [The prepared statement of Secretary Panetta can be found
    in the Appendix on page 56.]
        The Chairman. Thank you, Mr. Secretary. You know there have
    been comments made about how unique this is to have this joint
    hearing between these two committees. It resulted from Chairman
    Miller coming to me with the idea and I want to thank him for
    that, and I think it also happened because we have two such
    outstanding Secretaries, both of whom are veterans, both of
    whom have devoted their life to service of this country.
    Secretary Panetta, many years in Congress, was here when I
    first came here and a couple of others of us that are still
    here, Mr. Barton and Mr. Filner. We are the old, old people on
    this committee now. But you were taken from our midst over to
    serve the President as Director of OMB [Office of Management
    and Budget] and then as his Chief of Staff, and then later was
    Director of Central Intelligence Agency and now as Secretary of
    Defense. I think that is a lifetime to be commended.
        And Secretary Shinseki, starting with entrance into the
    United States Military Academy, lifetime of service in the
    Army, culminating as Chief of Staff of the Army. No one could
    have a better career, leading troops in battle and leading the
    entire Army in the start of this war against terrorism. Thank
    you both for your service.
        Mr. Secretary.

       STATEMENT OF HON. ERIC K. SHINSEKI, SECRETARY OF VETERANS
              AFFAIRS, U.S. DEPARTMENT OF VETERANS AFFAIRS

        Secretary Shinseki. Thank you, Mr. Chairman. Chairman
    McKeon, Chairman Miller, Ranking Member Smith, Ranking Member
    Filner, other distinguished members of both committees, the
    House Armed Services and House Veterans' Affairs Committees,
    thank you for your steadfast support of service members and
    veterans and for this opportunity to testify before you.
        I am honored to be here with my friend as well, Secretary
    Leon Panetta. His leadership and close partnership on behalf of
    those who wear and have worn the uniforms of our Nation has
    been monumental.
        I would also like to acknowledge I believe we have here and
    other places veterans service organizations [VSOs] and veterans
    who are here today. I acknowledge them because with the VSOs,
    their insights have been helpful in developing, resourcing, and
    improving the programs that we overwatch in the Department of
    Veterans Affairs.
        I have said it often enough and I will say it one more
    time, little of what we do in VA originates in VA. Much of what
    we work on originates in DOD. And so what this means is that we
    in VA must be aware, must be agile and then must be fully
    capable of caring for those who have, in Lincoln's words, borne
    the battle. As a footnote, we still today in VA care for two
    children of Civil War veterans. The promises of President
    Abraham Lincoln are being delivered today by President Barack
    Obama, this Congress, and the VA. And 100 years from now we
    will still be fulfilling our commitment to the current
    generation of veterans, their families, and our survivors.
        History also shows, and this is VA's piece of history, also
    shows that our requirements in VA continue to grow for about a
    decade and maybe sometimes a little more after the last
    combatant comes back from operation. And so in this case about
    a decade or more after the last combatant leaves Afghanistan,
    VA's requirements will continue to grow; the operation will be
    over and budget will begin to reflect that, but at VA our
    requirements will still be growing.
        So for us it is important that we spend the time now to
    better anticipate their needs for care, for benefits and for a
    successful transition to civilian life for this current
    generation, without losing sight of the needs of previous
    generations that we also care for.
        Collaboration and cooperation between VA and DOD have never
    been more important and I think for the next two decades it
    will be entirely important because this will be in large
    measure the work of the Nation and focusing on how we care for
    the less than 1 percent of Americans who serve in uniform today
    and provide for us this way of life.
        Most significantly, we are looking initially here at four
    areas. Three of those areas will match up with what Secretary
    Panetta just provided. That doesn't mean that in his five and
    my four we are disconnected, but we describe them just a little
    bit differently.
        The integrated Electronic Health Record, the iEHR, which
    you have remarked has been in the process of discussion for 10
    years now, I think both Secretary Panetta and I have agreed on
    what that will be and we are moving towards a solution.
        The second point, more comprehensive sharing of data
    through a virtual lifetime electronic record, of which
    integrated Electronic Health Record is a key component.
        The third area of focus, the Integrated Disability
    Evaluation System, which is primarily a DOD enterprise with
    significant VA support to ensure an efficient process.
        And the fourth of our VA's areas of focus, the President's
    initiative to redesign the transition process and the
    implementation of the VOW [Veterans Opportunity to Work] to
    Hire Heroes Act.
        My testimony submitted to the committee expands on each of
    these areas in some detail, and I thank the chairman for
    accepting that written testimony into the record and I won't go
    into them in detail at this time.
        Well, let me briefly emphasize that it is especially
    important that we assure the greatest collaboration between VA
    and DOD in that critical phase before service members leave the
    military. We simply must transition them better. And I speak as
    one who has watched that process from a different vantage point
    over time. We do this best with warm handoffs between the
    Departments. That is key to assuring the success of
    transitioning service members back to their communities in
    productive ways. But it is also key in preventing the downward
    spiral that some face in being challenged. Transitioning
    doesn't work quite as well for them and in some cases
    homelessness and sometimes suicide are what we have to deal
    with.
        So I echo Secretary Panetta's comments. While we are
    pleased with the progress made to date on critical issues
    common to both VA and DOD, we know we have a responsibility to
    better harmonize our two large Departments in ways to better
    serve service members, families, veterans, and our survivors.
    Their well-being is the strongest justification of why we
    should be working together more closely and more
    collaboratively and we are today. There is more important work
    to be done, and I am proud to move forward with Secretary
    Panetta to make the most progress possible in our time on
    behalf of those who wear and have worn the uniforms of our
    Nation.
        And with that, Mr. Chairman, thank you and to the members
    of this committee for your unwavering support of our efforts,
    and I look forward to your questions.
        [The prepared statement of Secretary Shinseki can be found
    in the Appendix on page 64.]
        The Chairman. Thank you very much. I ask unanimous consent
    to include the record of all member statements into the record.
    Without objection, so ordered. We have already agreed that we
    will have about 2-minute questions, so I would encourage
    members to make their questions short so that we can have the
    answers complete, and we will start with me.
        As I have already said, we know that there is high
    unemployment among our veterans, our young veterans. And we
    know with the $487.0 billion cut in defense we will have
    100,000 leaving the military. We will have another 100,000 if
    the sequestration takes effect.
        What plans do we have to ensure that these service members
    will not go from the front lines to the unemployment lines? And
    how do you see potential reduction in the defense workforce
    resulting from the sequestration? What effect will that have on
    what will you be able to do to try to move them into some
    meaningful employment, Mr. Secretary?
        Secretary Panetta. Well, I sure as hell hope that
    sequestration doesn't happen.
        The Chairman. I am with you.
        Secretary Panetta. It would be, as I have said time and
    time again, a disaster in terms of the Defense Department as
    far as our budget is concerned and as far as our ability to
    respond to the threats that are out there and it would have a
    huge impact. It doubles the cuts in the military. It would
    obviously add another 100,000 that would have to be reduced,
    and the impact of that on top of the reductions that are
    currently going to take place would place a huge burden on the
    systems to be able to respond to that. I think it would be near
    impossible to try to do the kind of work that we are trying to
    do and make it work effectively.
        I think we can handle what we have proposed in our budget
    and the drawdown numbers that are coming now. We have tried to
    do this pursuant to a rational strategy over these next 5
    years. And I think the systems we are working on and what we
    are trying to put in place I am confident can respond to that.
    But if sequester should happen and if an additional burden is
    suddenly put on top of it, I think it could really strain the
    system.
        The Chairman. Mr. Secretary, could you please give us that
    input for the record?
        Secretary Panetta. Absolutely.
        [The information referred to can be found in the Appendix
    on page 84.]
        The Chairman. In keeping with it. My time has expired. Mr.
    Miller.
        Mr. Miller. Both Secretaries, in 1961 John F. Kennedy said
    we would put a man on the Moon, 8 years later America was
    there. We are talking about an integrated Electronic Health
    Record by 2017. Why could we put a man on the Moon in 8 years
    and we are not starting from ground zero with electronic health
    record. Why is it taking so long? Because it so vital
    especially, Secretary Shinseki, to solving the backlog issue
    that exists out there today in regards to disability claims.
        Secretary Shinseki. Mr. Chairman, I can't account for the
    previous 10 years. I do know there is a history here. But let
    me just suggest that two large Departments, each having their
    own electronic health record, which happened to be two very
    good, maybe the two best, electronic health records in the
    country, and trying to bring that culture together to say we
    are going to have one, and it is entirely possible. And I agree
    with you it is not technology, it is leadership here. And
    between Secretary Panetta and I, we have in the last year met
    four times. We are going to meet again in September. We are
    here today testifying together. I think this is a great signal
    to both of our Departments. Prior to that I recall meeting with
    Secretary Gates four or five times. So in 17 months, with two
    Secretaries of these two large Departments have sat side by
    side in direct communication on issues like this, with the
    integrated Electronic Health Record being the primary topic of
    discussion. It has taken us 17 months to get to an agreement
    that both Secretary Panetta and I signed that describes the way
    forward. And the way forward for us is a single joint common
    integrated Electronic Health Record. Each of those words means
    something. But key here is an agreement that it will be open in
    architecture, nonproprietary in design. That is a significant
    change from previous discussions which were wrapped around
    which proprietary contractor were we going to be interested in
    in establishing an arrangement with. I believe that was part of
    the challenge. The fact that we have agreed on a concept I
    think is groundbreaking here, and both Secretary Panetta and I
    have agreed to move forward on this.
        The Chairman. Thank you very much. The gentleman's time has
    expired. Again if you could complete the record on those
    questions that would be good.
        Mr. Smith.
        [The information referred to can be found in the Appendix
    on page 83.]
        Mr. Smith. Thank you, Mr Chairman. I have a question about
    the TAP program, following up on some of the comments Mr.
    Filner made. Exit interviews are notoriously difficult to get
    people interested in and I think the problem is service members
    are out, they are moving on. I met with some of your folks from
    both your offices that showed me how they had refined the
    program; they used to have a book this big, now they have a
    book this big.
        The bottom line is what are your thoughts on what you can
    do to get the service members to pay attention to the two or
    three most important things in that transition. It strikes me
    like we are overwhelming them with information, eyes just glaze
    over. If you had to explain it to them in 15 minutes, what are
    the critical pieces of information that you want to give them?
    How can we make that work better?
        Secretary Panetta. I will yield to Secretary Shinseki as
    well on this. You know, I remember when I got out of the
    service I couldn't wait to get the hell out of there and I
    didn't really want to spend a lot of time having people tell me
    what I was or was not going to do. In this instance I think the
    best way to try to bring these opportunities to attention of
    members is the counselors. We are assigning individual
    counselors as part of the transition program. They are going to
    sit down individually with them. I think that is the best way
    to get their attention and try to get them moving with regards
    to the potential benefits that are available to them.
        Secretary Shinseki. Just very quickly, I would echo
    Secretary Panetta here. I know that when I got ready to get out
    of the military I couldn't wait to get the hell out of there
    either. I would just say if we look at this as a transition
    assistance program, and the focus is on assistance, I think we
    come at it with a different attitude. If we look at this as an
    education responsibility of preparing folks for at least the
    next phase of their lives to make the right decisions, whether
    it is education, whether it is a work choice and certainly from
    the VA's point of view we are entirely interested in getting as
    many departing service members enrolled with us. Whether or not
    they have a requirement for health care today, having them
    enrolled 5 or 10 years down the road when issues crop up we
    have the evidence necessary to be able to deal with it. So we
    need to look at this as more than just assistance, but this is
    really preparing them, making them career-ready for the next
    phase of their lives.
        Mr. Smith. Thank you very much, Mr. Chairman.
        The Chairman. Thank you.
        Mr. Filner.
        Mr. Filner. You know, in a democracy where you need
    obviously the support and vote of people to go to war, the cost
    of war is a pretty important item to understand. And treating
    our veterans is obviously a part of the cost of war or should
    be considered that. I have tried on several occasions to add an
    amendment to any war appropriations, I don't know 15 to 20
    percent surcharge, because that is the difference in your
    budgets for veterans. And of course since we have been
    borrowing money for war and nobody wants to borrow the money
    for veterans. So it is not looked on kindly.
        But part of the cost of war, you know, we have the
    statistics, so about 6,000 killed in action--I am sorry, 5,000
    killed in action since 9/11, and almost 50,000 wounded. And
    yet, those who have showed up at the VA for help, and I know
    there are different definitions and different circumstances, I
    think it is close to, or could be over a million. Why is there
    such a disparity between--and it is important for the public to
    understand, what is the cost of war? How do you account for 1
    million veterans seeking help for problems in war, and only
    50,000 considered casualties?
        Mr. Panetta, I will go to you first. Since you know how to
    manipulate the 2 minutes, you are looking to him, I know, so
    you don't have to answer.
        Secretary Panetta. No. I mean, it clearly is the impact of
    war over the last 10 years and how it has affected those who
    have served. And when they do return, when they come back, the
    reality is that, you know, that not all of them, not all of
    them are getting the kind of care and benefits that they should
    get. And it is our responsibility to try to respond to those
    needs as they return.
        Look, this system is going to be overwhelmed. I mean, you
    know, let's not kid anybody. We are looking at a system that is
    already overwhelmed. The likelihood is as we draw down further
    troops and, you know, over these next 5 years, assuming
    sequester doesn't happen, we are still going to--you know, we
    are going to be adding another 100,000 per year. And the
    ability to be able to respond to that in a way that effectively
    deals with the health care issues, with the benefits issues,
    with all of the other challenges, that is not going to be an
    easy challenge. And you talk about the cost of war, this is
    inherently part of the cost of war. It is not just dealing with
    the fighting, it is also dealing with the veterans who return.
    And that is going to be a big ticket item if we are going to do
    this right.
        Mr. Filner. I just hope you look at that boot camp idea as
    a way to really get at that issue.
        The Chairman. Thank you. Mr. Bartlett.
        Mr. Bartlett. Thank you. By almost every account, we are
    failing our veterans. More of them are killing themselves than
    are killed by the enemy in Afghanistan, and the suicide rate is
    increasing. Homelessness is approaching the percentage of
    Vietnam veterans, and that is increasing. Unemployment is more
    than twice the unemployment percentage of the general
    population. The in-service disability evaluation delays are
    unacceptable. And after they are out, it may take more than a
    year. They are unemployable because of a disability, it may
    take more than a year for them to get that disability.
        Secretary Panetta, you mentioned that you hope that an 18-
    month review could be completed on time. I would suggest, sir,
    that that does not reflect the sense of urgency that this
    challenge requires. What do we need to do in the Congress to
    address this problem?
        Secretary Panetta. You know, I think that the one thing I
    have seen is that all of us share the same concern with regards
    to our ability to respond to these issues. The challenge is
    that as we try to make these systems work, there is a lot of
    built in resistance to adapting and changing the way we do
    things. And to the extent that we can work together, to try to
    make sure that we push for these changes to take place, and do
    it in a way that effectively responds to the challenges, that
    is something I think both the Congress as well as the
    administration have to push.
        We cannot accept the old way of doing things. Things are
    going to have to change. Things are going to have to be
    modified. People are going to have to respond differently. If
    we expect the same old responses to the problems we are having,
    then we are going to have the same old problems. We have got to
    change the way people respond to these issues.
        The Chairman. Thank you. Mr. Reyes.
        Mr. Reyes. Thank you, Mr. Chairman. And thank you,
    Secretaries, for being here. First of all, I wanted to thank
    both of you because you have put your personal leadership in
    areas that have never been done before. The issue of women have
    been very important to both of you in the military, both in
    terms of sexual harassment and attacks and those kinds of
    things.
        Secretary Panetta, you have been a stalwart there. And
    Secretary Shinseki, your leadership in prioritizing
    homelessness among veterans, especially among women veterans,
    is very much appreciated. I can tell you because veterans very
    much appreciate those priorities and your personal leadership
    in that. So I know both of you face immense challenges. But
    reflecting on what Chairman Miller said, I hope we continue to
    do these kinds of joint hearings because this truly is an
    important--I think one of the most important things that both
    of these committees can focus on. Just echoing what my
    chairman, Chairman Bartlett said, can each of you comment
    briefly on where we can be most helpful in terms as a Congress,
    especially from these two committees?
        Secretary Shinseki. I can speak on the VA piece of this.
    Actually, the Congress has already provided some significant
    assistance to VA. I would recall in 2008 and 2009, our budgets
    were enhanced by Congress. Since then, you have provided us
    advanced appropriations. Now, not all agree that it was a good
    move, but for VA, it provided us an opportunity to have a 2-
    year look at our budgets. And what it assured is that for the
    health care piece of our budget, every year on 1 October,
    whether or not there is a continuing resolution, we are able to
    fund our health care requirements so that veterans--there isn't
    a gap in care for veterans. In those ways, meaningful support
    has been provided.
        I would also say that we are dealing with issues that grow
    over time, and some of them very quickly, mental health, PTSD.
    The budgeting process is based on knowing requirements well
    out, and methodically reacting to growth in trend. When you
    have large growth in a short period of time, the budget process
    is not quite as agile, and it is a bit reactive. And so our
    efforts to try to harmonize, the reason that we are here is so
    that VA has some good ideas on what to expect and be able to
    put that into our budgeting process.
        The Chairman. Thank you. Mr. Bilirakis.
        Mr. Bilirakis. Thank you, Mr. Chairman. I appreciate it
    very much. Thank you, Secretary Panetta and Secretary Shinseki.
    You both mentioned in your testimony the prevalence of PTSD and
    TBI. And I believe we certainly need more research to establish
    better diagnostic tools and treatments. Through what channels
    are the DOD, VA, and the private sector sharing the research
    findings and collaborating on the direction of future research?
        Secretary Shinseki. I would just offer in 2009, the DOD and
    VA held its first mental health summit, a joint effort to bring
    our mental health programs to the same table and have a
    discussion. Twenty-eight strategic findings that came out of
    that, those findings we continue to execute today. While it was
    a broad look, inside that discussion were issues on PTSD, TBI.
    We spent about $30 million in the VA budget on research for
    PTSD. We learned a lot from DOD because they have extensive
    experience in this area in terms of diagnosis and dealing with
    PTSD, with formations, with people in formations, in combat,
    going back to combat.
        So there is much that we learn from our collaboration with
    DOD, through our research. More to be done, to be sure.
        Secretary Panetta. Let me add, what we try to do is to do
    mental health assessments both before and after deployments, so
    that we can identify and try to treat somebody who might have a
    problem, specifically with a PTSD. We have done about 600,000
    of these assessments. Our greatest limitation, our greatest
    limitation is the number of care providers is simply not
    sufficient for the demand. And we are competing with VA and
    with private health care systems to hire these people. But that
    is a real--that is an area of tremendous need in order to
    address the amount of problems we are facing.
        The Chairman. Thank you. Mr. Michaud.
        Mr. Michaud. Thank you very much. I want to thank you both
    for your service and for your both being here this morning. A
    quick question, and I want to read from a veterans service
    organization letter that they actually sent to Senator Webb
    just last week, and just part of it that says: ``The only
    branch of the military to show a marked improvement decreasing
    the number of persons taking their own lives is the United
    States Marines. They should also be praised for their active
    leadership from the very top in addressing the problem and
    implementing the solutions. The remaining services have yet to
    be motivated to take any substantive action.''
        Secretary Panetta, I have been to Iraq and Afghanistan
    several times, and I looked the generals in the eye and I asked
    them what are they doing personally to help destigmatize TBI,
    PTSD. And the second question is do they need any help? I get
    the same answer over there as I do here in DC, everything is
    okay. We have all the resources we need, we don't need any
    help. But the interesting thing is someone of much lesser rank
    came up to me after I asked the general that question outside
    and said we need a lot more help. And he suggested I talk to
    the clergy to find out what they are seeing happening.
        And I did, that trip, and every trip since then. And I am
    finding that our service members are not getting the help that
    they need. And my questions, particularly after looking at this
    letter that was sent to Senator Webb, it appears the Marines
    are doing a good job. So why is it so different between the
    Marines, the Army, and other branches? And can you address
    that?
        Secretary Panetta. You know, obviously there is no silver
    bullet here, I wish there were, to try to deal with suicide
    prevention. We have a new Suicide Prevention Office that is
    trying to look at programs to try to address this terrible
    epidemic. I mean, we are looking just--if you look at the
    numbers, recent totals are, we have got about 104 confirmed,
    and 102 pending investigations in 2012. The total is as high as
    206, almost one a day that we are seeing. That is an epidemic.
    Something is wrong.
        I think one of the areas--I mean, look, part of this is
    people are inhibited because they don't want to get the care
    that they probably need. So that is part of the problem is
    trying to get the help that is necessary. Two, to give them
    access to the kind of care that they need. But three, and
    again, I stress this because I see this in a number of other
    areas dealing with good discipline and good order and trying to
    make sure that our troops are responding to the challenges, it
    is the leadership in the field, it is the platoon commander, it
    is the platoon sergeant, it is the company commander, it is the
    company sergeant. The ability to look at their people to see
    these problems, to get ahead of it, and to be able to ensure
    that when you spot the problems, you are moving that individual
    to the kind of assistance that they need in order to prevent
    it. The Marines stay in close touch with their people. That is
    probably one of the reasons that, you know, the Marines are
    doing a good job. But what we are stressing in the other
    services is to try to develop that training of the command so
    that they, too, are able to respond to these kinds of
    challenges.
        The Chairman. Thank you. Mr. Thornberry.
        Mr. Thornberry. Secretary Panetta, there was a cover story
    on military suicides in Time Magazine within the past couple
    weeks. And some statistics really jumped out at me. One fact
    they said is that 33 percent of military suicides had never
    deployed overseas at all, and 43 percent had been deployed
    once. That is 76 percent, if you add it together. I am
    wondering, number one, are those statistics accurate? And
    number two, what does that tell us about the problem if a third
    of all the suicides--we are focused so much on the PTSD and so
    forth, if they have never deployed at all and a third of the
    suicides, maybe we are not looking at all the factors.
        Secretary Panetta. Those numbers are accurate as far as we
    know. And I think what you are seeing is that it reflects the
    larger problem in the society. Because the fact is that
    suicides are on the increase in the rest of society as well.
    So, problems with drinking, problems with finances, problems
    within the family, problems, you know, of trying to deal with
    conflicts that they are confronting, problems of dealing with
    just the general pressures that we are seeing in a society that
    is dealing, obviously, with economic pressures, at the same
    time is dealing with social pressures.
        All of that is impacting on families. And that is true in
    the military as well. And that is why we are seeing this occur
    not just from those that are deployed to the battlefield, but
    we are seeing it with regards to families that are here.
        Mr. Thornberry. It just seems to me that puts a little
    different perspective on the scope of the issues that both you
    gentlemen have to deal with if it is not just combat, but the
    entire gamut of those problems. Thank you, I yield back.
        The Chairman. Thank you. Mr. Secretary, do you know if
    there is any correlation between this age group in the military
    committing suicide and those not in the military, but of the
    same age group committing suicide?
        Secretary Shinseki. Mr. Chairman, an important question.
    The CDC [Centers for Disease Control] publishes every year the
    top 10 leading causes of death amongst Americans. And as I
    recall, the last report--and it is a continuous track in the
    age group 15 to 24, suicides is the third leading cause of
    death in the top 10 of Americans. In the age group 25 to 34, it
    is the second leading cause of death.
        So suicides, it is a national discussion here. And when you
    recruit out of that population and put youngsters through the
    stresses we all are familiar with in combat, very small
    percentage serve in uniform, yes, suicides become a matter of
    great focus, interest, and importance to both Secretaries. I
    guess the follow-on question is how do we try to decide who are
    best suited to serve in the recruiting effort? But I no longer
    have those responsibilities. I used to at one time.
        The Chairman. Thank you. Ms. Sanchez.
        Ms. Loretta Sanchez. Thank you, Mr. Chairman. And thank
    you, gentlemen, again, for being before us today. In preparing
    for this hearing, I asked my staff back in Orange County to go
    through the casework we have with respect to veterans in
    transition. And although we have a great relationship with our
    VA Hospital in Long Beach, and we have two clinics, one in
    Santa Ana and one in Anaheim in our district, the reality is
    that the most troublesome area with respect to these cases
    involve the quality and the lack of health care for our service
    members who are transitioning from active, or having been
    called up and are now out into the veterans world, if you will.
    And in fact, I have a lot of veterans who come to my office and
    they express real concern about not receiving treatment or
    having a long time to wait for a specialty doctor, for example.
        In Long Beach, it would be oncology, where we must be
    short-staffed or something of the sort. And the other really
    big concern for them is the issue of being prepped up for a
    surgery and then somebody on the surgery team doesn't show up
    out of whatever, and the surgery is then postponed. And it
    isn't until these people come to my office and we call in
    directly that we are able to get that rescheduled.
        So my question is, how are you addressing these types of
    concerns with respect to health care? And why, if a surgery is
    scheduled, why aren't people showing up to be on that surgery
    team? And more importantly, why does it take a congressional
    office to call to ask that it be rescheduled?
        Secretary Shinseki. All fair questions, Congresswoman. If
    you would give me the details, I am more than happy to research
    both your frustration and mine. We owe veterans better. And I
    agree with you.
        Ms. Loretta Sanchez. My second question is with respect to
    homelessness. We have a lot of great organizations helping us
    with that, but they are low on funds. Is there any grant
    program coming up for something like that for local 501(c)(3)s
    to help?
        Secretary Shinseki. We have provided grants for the past 2
    years. Two years ago, about $60 million worth of grants were
    provided under the Supportive Services to Veterans' Families
    Fund. Just recently announced this year's investment of $100
    million. And in the 2013 budget we have a request for an
    increase to that investment as well.
        Ms. Loretta Sanchez. Thank you so much, Mr. Secretary.
        Mr. Thornberry [presiding]. Mr. Stutzman.
        Mr. Stutzman. Thank you, Mr. Chairman. Thank you to both
    you gentlemen for being here today. The President has announced
    a new model of the TAP program. As we understand it, everyone
    will be required to attend a 1-day DOD pre-separation class,
    followed by a 3-day employment workshop, and a 1-day VA
    benefits briefing.
        Other training in non-job seeking, such as determining
    readiness for postsecondary education and entrepreneurship,
    will be offered as voluntary, and not subject to the mandatory
    provisions of law. This is hardly a tailored approach that
    would meet the needs of those whose post-discharge intentions
    are to attend school or to start a business. Offering
    nonemployment-related instruction as voluntary ignores the fact
    that it is difficult enough to get supervisors to allow service
    members to attend the current 3\1/2\-day course, much less 7 or
    8 days away from the unit, especially if that unit is preparing
    to deploy. Will you make all 8 days of TAP, including the
    voluntary nonemployment, mandatory?
        Secretary Panetta. I think we have got to move in that
    direction. You know, we are doing nine pilots that are
    basically going to test this out. And we are hoping to complete
    those pilots by November and learn, you know, just exactly what
    we have to require, how do we have to mandate it, how do we
    have to revise it. But, you know, my sense is the only way it
    works is if you make it mandatory.
        Mr. Stutzman. The model that the Marine Corps is using in
    giving the options to those who are about to discharge, is that
    a model that is worth looking at as well?
        Secretary Panetta. I would think so.
        Mr. Stutzman. It seems like that would give a lot of
    flexibility, because not every service member is going to be
    coming out planning on just going into the workforce.
        Secretary Panetta. That is right. Some will want to stay.
        Mr. Stutzman. Absolutely. Yes. Thank you. I yield back.
        Mr. Thornberry. Mr. Walz.
        Mr. Walz. Thank you, Mr. Chairman. I would like to thank
    both chairmen and the ranking members for making this happen. I
    have talked seamless transition for most of my adult life, and
    it appears like it is happening. So I thank you. And to both of
    you, you have my deepest gratitude, and the people of the First
    District, for the defense of this Nation and the care of our
    veterans. I have got kind of a tough one here, it is a
    troubling one, I know it troubles both of you. The issue that
    came out in the GAO report of the 26,000 soldiers discharged
    under personality disorders. My question is, and it is brought
    to the fact by the Vietnam Veterans Commission to study at Yale
    Law School about what are we doing about that? And my question
    to you, probably to you, Secretary Panetta, is what are we
    doing to review and correct the records of those veterans who
    may have been improperly discharged with a personality disorder
    diagnosis?
        Secretary Panetta. We are conducting a complete review of
    those areas. We have responded to the situation that took place
    up in Washington. That was the focus of the GAO report. And
    that is what concerned us a great deal. And as a result of
    that, we are not only running a review there, we are running a
    review elsewhere to make sure that the same kind of problems
    have not occurred elsewhere. You know, it is important that we
    determine why someone would get this diagnosis and then it
    would be downgraded. I mean, there may be some legitimate
    reasons for it. But in this instance, it happened to too many
    people. And that raised tremendous concerns.
        Mr. Walz. I appreciate that sentiment. Because my concern,
    I am sure like yours and now Secretary Shinseki's, is that one
    of the biggest problems here is it is not benefits
    compensation, it is the inability to get care for existing, and
    that could have been whether it was existing or exacerbated by
    their combat experiences, their time in the military, they are
    not getting that care through our wonderful folks at the VA,
    and how do we fix that? I would add, too, that as these have
    decreased, personality order discharges, adjustment disorder
    have increased. And so I thank you both for paying close
    attention to this. I yield back.
        Mr. Miller [presiding]. Mr. Jones.
        Mr. Jones. Thank you, Mr. Chairman. Mr. Secretary Panetta,
    2 years ago in the NDAA [National Defense Authorization Act]
    bill, the House had a provision that said if you have served
    this country at war and you come back home and you are in the
    process of a medical review of your condition, but in that
    period of time, you self-medicate and get yourself in trouble,
    so therefore you have been given less than an honorable
    discharge before the Medical Review Board finalized their
    decision, the House position basically said to that individual,
    if you are given less than an honorable discharge, you can go
    back to the Department of Defense and ask the Department of
    Defense to review your medical records and maybe change your
    discharge.
        And I would like to know how you all are handling this
    issue, how you are contacting those who maybe were given less
    than an honorable discharge?
        Secretary Panetta. Congressman, let me respond to you
    directly through the Department. Because this is the first time
    I am familiar with the issues you just presented. And I want to
    give you an accurate answer. And let me give you that answer
    through the Department, if I could.
        [The information referred to was not available at the time
    of printing.]
        Mr. Jones. Thank you, Mr. Secretary. That would be very
    satisfactory. And thank you very much. I yield back.
        Mr. Miller. Ms. Davis.
        Mrs. Davis. Thank you, Mr. Chairman. And thank you both for
    your really unparalleled leadership in trying to work and
    coordinate these programs. I wanted to ask you about
    coordination, about resolving the misalignment between the two
    care coordination programs between the DOD and the VA. You
    talked about traps and trying to get over those. What is it
    that is causing these problems? I know one of my colleagues
    mentioned earlier that it seems to be creating more confusion
    than anything else.
        Secretary Panetta. You know, the biggest problem here is
    these things have developed on separate tracks. And as a
    result, you know, you got two bureaucracies that basically
    developed their own approach to dealing with these systems. And
    they get familiar with them, that is what they use, they resist
    change, they resist coordination, they resist trying to work
    together. And that is the fundamental problem we have.
        Mrs. Davis. Have we tried to switch off occasionally? I
    think one of the other issues I really wanted to ask about was
    counseling, because the coordination programs as well as the
    Transition GPS program that the President has proposed and we
    are moving forward on, call for counselors. And we know the
    problems in mental health, but how are we planning for the kind
    of counselors that are going to be needed for this? Because
    clearly, they are going to have to be cross-trained in many
    ways, understanding both systems as well as small business, et
    cetera. How are we planning for the immersion of these kinds of
    folks who are really going to be critical to this, yet we
    really don't have them in any great number?
        Secretary Panetta. That, I think, is the fundamental key to
    making this transition work, is to have counselors that are
    familiar both with veterans and defense areas. What are the
    benefits? What are the opportunities that are available? And be
    able to present that. So it is going to take some training of
    the people that are going to be part of this effort so that
    they provide good counseling to those that are involved.
        Mrs. Davis. Is there a cost factor involved in that as well
    that we need to address?
        Secretary Panetta. There is going to be a cost factor
    involved here. And, you know, we will have to discuss it.
        Mrs. Davis. May I just suggest as well that there may be
    some great models around the country? We think we have one in
    San Diego. And if we could look at some of those models, that
    would be helpful. Thank you. Thank you, both.
        Mr. Miller. Mr. Flores.
        Mr. Flores. Thank you, Mr. Chairman. Thank you, Secretary
    Panetta and Secretary Shinseki for being here today. Also
    Secretary Panetta, thank you for protecting valor for those
    that have earned it. My question is a little bit more
    theoretical. And what prompts this is the claims processing
    time at the Waco Claims Regional Center in Texas, which is the
    worst in the country when it comes to adjudicating disability
    claims. What can we do if the IDES doesn't work? I mean, what
    are you thinking about in terms of a new paradigm to fix this
    issue? And both of you can answer, either one of you. It seems
    to me like we have got cultural issues that cannot be fixed by
    having new systems. So how do you make--I mean, you are doing
    your best to get the systems right, but what are we doing to
    fix the culture so that we do what we promised our military men
    and women, our veterans that we would do in terms of providing
    benefits to them for their service?
        It just seems to me like, you know, we have spent all our
    time on systems, we are not spending any time on culture. So
    can you help me with that? And let me interrupt before you
    answer. One other thing. Are you thinking about a pilot program
    so that if IDES doesn't work, what are you going to do? Where
    is the clean sheet of paper? Where is the whiteboard that has
    the big ideas to fix this?
        Secretary Shinseki. Congressman, I just want to be sure I
    am answering the right question here. Waco and claims would
    sound to me like disability claims that we normally handle.
    IDES is a joint program that DOD and VA. So it is the IDES
    question that you have here. We have piloted IDES. We started
    off with 27 sites. These are a DOD initiative with VA in
    support. We are at 139 sites now, fully operational across the
    Nation. And I think we both have put in place controls that
    will drive this to the target, which is 295 days for
    processing. Now, that sounds like a lot of time. On the one
    hand, when we did our systems independently, sequentially, DOD
    first and then VA, it was like 540 days. Right now, with an
    Integrated Disability Evaluation System, that is down below 400
    days, and we are targeted on 295.
        When we get to 295, which is going to be a bit of work, and
    it sounds like a long time, but involved in the 295 days is
    care and surgical procedures that veterans who have been
    injured are still going through. And there is leave associated
    with that. Whenever a surgery occurs, an individual is provided
    X amount of days for recuperation leave, so to speak. All of
    that is factored into this 295. So when the 295, while it
    sounds large, it is a treatment and transition program. I think
    we have a right model here. What is incumbent on us is to get
    to the targets we have described. In the 295, VA's piece of
    that is about 100 days. Right now we are at 145 days. We have
    been as low as 103, and then we get a surge from our friends in
    DOD and we adjust. But we know we can get to 100 days. And we
    are proceeding.
        Mr. Miller. Mr. Forbes.
        Mr. Forbes. Thank you, Mr. Chairman. Secretary Shinseki, we
    know right now that VA topped out in May at about 904,000
    claims. And as you just mentioned, we have got about 65 percent
    of them are over 125 days, and 1.25 million is projected for
    2013. My question is, can the current system handle the
    expected reductions in end strength projected in the
    President's budget and under sequestration? And if you could
    give me a yes or no answer on that, and then elaborate any way
    you want to to clarify it?
        Secretary Shinseki. Your number is a little higher than
    mine, but I will accept it. It is a big number, nearly 900,000
    by my count. Let me explain why the inventory, that is the
    total number of claims in processing, and the backlog portion
    of that, 65 percent or so, 550,000 of those are backlogged, why
    these numbers result. In the last 3 years, the VA has made
    three significant decisions. We awarded Agent Orange service
    connection for Vietnam veterans, three new diseases; we awarded
    Gulf War illness, nine new diseases for veterans who had been
    waiting in the case of Gulf War veterans 20 years since the
    conclusion of that conflict; for Vietnam veterans, 50 years.
        We also granted, the third decision was combat verifiable
    PTSD service connection for anyone who served in combat and has
    been diagnosed with verifiable PTSD.
        Mr. Forbes. Mr. Secretary, my time is running out. How will
    sequestration and these end strength reductions impact these
    claims going forward?
        Secretary Shinseki. Well, I would say that in the case of
    VA, we have been informed that VA is exempt from sequestration
    except for administrative costs. I don't have a definition of
    administrative costs right now. But what I would, Congressman,
    say, that I am with Secretary Panetta, the reason you have the
    two of us here, whatever impacts him is going to have some
    effect here, even though I have been exempted. And it has my
    attention.
        Mr. Forbes. Thank you, Mr. Chairman.
        Mr. Miller. Mr. Secretary, you just said that possibly
    administrative costs would be affected by sequestration. The
    President the other day at the VFW [Veterans of Foreign Wars]
    said no veteran issues would be touched by sequestration. Could
    you explain to this committee? Because there is still some
    conflicting information that is out there from the acting OMB
    [Office of Budget and Management] director letter that I got
    back in June. How much is VA going to be affected by
    sequestration?
        Secretary Shinseki. I will go back to I believe what you
    received in that letter, is that VA is exempt from
    sequestration. And I don't have the letter in front of me, Mr.
    Chairman. I think administrative costs were listed in that.
        Mr. Miller. So it is your understanding no benefit,
    function, program, account would be subject to, only
    administrative costs? And again, if you would like to take it
    for the record because of time.
        Secretary Shinseki. I think this would be one that I best
    provide to you a response for the record.
        [The information referred to was not available at the time
    of printing.]
        Mr. Miller. Thank you, Mr. Secretary. Ms. Bordallo.
        Ms. Bordallo. Thank you, Mr. Chairman. Secretary Panetta
    and Secretary Shinseki, thank you very much for being with us
    this morning.
        Secretary Shinseki, we talked about suicides quite a bit.
    But can you provide us with an update on your efforts to end
    veterans' homelessness? Can you give an estimated number? Is it
    as serious as suicides? And what programs do you have in place?
        Secretary Shinseki. Congresswoman, I think you may be
    familiar with the fact that we in the Department of Veterans
    Affairs have established 2015 as the point in time where we
    intend to end veterans' homelessness. And when I say end
    veterans' homelessness, there are two pieces to veterans'
    homelessness: One is the rescue. That is getting everyone on
    the street off the street, into housing, into programs that get
    them treatment for substance abuse or depression, training for
    employment, and moving on with their lives.
        What won't end in 2015 is prevention. Prevention will be
    ongoing. What do I mean by ``prevention''? Right now we have
    about 900,000 veterans in the GI Bill programs. And that is
    colleges, universities, community colleges, tech trade schools.
    Any youngster who fails out of that program right now in this
    economy is at high risk of homelessness. And so our prevention
    effort here is to make sure youngsters get into school, stay in
    a school, graduate, and have an opportunity to go on and work.
        Our housing mortgage program, last year about 90,000
    veteran mortgage holders who had defaulted on their home loans,
    we were able to defer roughly 75 percent of them from being
    evicted from their homes. And that is with VA's financial
    counselors getting in there, helping them get control of their
    finances, lowering the monthly payments, extending the payment
    period. The return to us is that we are able to then share
    stability. We will deal with these veterans as homeless
    veterans otherwise. And our records indicate that a homeless
    veteran's health care costs is about 3\1/2\ times what the
    health care costs are for veterans who are not homeless. So
    there is a--it is an important aspect of this. And while I say
    we were able to save 75 percent, there is still 25 percent we
    did not save. And we have got to just do better at it.
        Ms. Bordallo. Thank you. Thank you, Mr. Secretary.
        Mr. Miller. Mr. Johnson.
        Mr. Johnson of Ohio. Thank you, Mr. Chairman. And both of
    you, General Shinseki and Secretary Panetta, I have come to
    respect greatly both of your commitments and your heart for our
    veterans. I will tell you, though, that I am not convinced that
    all the members of your organizations, your Departments share
    that commitment and will follow through with the commitments
    that you two are making. I understand that you can't account
    for the last 10 years, Mr. Secretary. And I understand that
    you've got two bureaucracies that don't necessarily like to be
    told what to do and get along all the time. But I will submit
    to you that another 5 years is unacceptable. It is unacceptable
    to me, and gentlemen, it ought to be unacceptable to you. This
    is not a matter of can do or should do. This is a matter of
    want to and will do. This is 2012. And one of the underlying
    issues, Mr. Secretary, quite honestly, is the VA's lack of an
    overall information technology architecture.
        You and I have talked about this before. And it still
    doesn't exist today, as far as I know. I have pointed that out.
    My committee has pointed that out. Organizations outside that
    have looked at the VA's IT department have pointed that out.
    You know, I am just not convinced that 5 years from now, given
    that I don't know where you two will be, but my fear is that we
    are going to be sitting right here talking about this same
    issue again because we are not going about it with the
    discipline that is needed.
        I come from an information technology career of over 30
    years. I worked at U.S. Special Operations Command as the
    director of the CIO [Chief Information Officer] staff. I know
    what it takes to get this stuff done. And 5 years, gentlemen,
    is totally unacceptable. And I don't really have a question for
    you. I just want you to fix this, for crying out loud.
        Secretary Shinseki. May I respond? Congressman, you and I,
    but more primarily Roger Baker and you have had this
    discussion. I will work with you. And we believe we have a good
    mark on an architecture. Obviously, we haven't satisfied you.
    We will come back and work it again.
        Mr. Miller. Mr. Turner.
        Mr. Turner of Ohio. Thank you, Mr. Chairman. To both of our
    Secretaries, thank you for being here. I appreciate your
    leadership. And Secretary Panetta, I want to particularly thank
    you also for your work on sexual assault, which I know that you
    are working on in coordination with the Secretary of the VA,
    and your efforts to try to change the culture throughout DOD to
    both prevent sexual assault and to assist the victims. And
    thank you for your leadership there.
        Many of the questions that you have received from members
    have been about service members and their families
    transitioning out of the military. Secretary Panetta, one of
    the most important things for the service members in
    transitioning with their family is obviously to keep their
    family together. And that raises the issue of custody. I want
    to thank Chairman Miller, Chairman McKeon, Subcommittee
    Chairman Wilson, and also I want to acknowledge Chairman
    Skelton, former Chairman Skelton, and of course, Erin Conaton
    and her work on the issue of custody in this committee.
        The House, as you are aware, has passed eight times
    legislation that would protect the custody rights of service
    members, the VA Committee twice, HASC six times. Secretary
    Gates had endorsed the provisions that the committee had
    passed. You had sent a letter suggesting a compromise that
    Senator Boozman is going to be drafting in the Senate. I just
    want to ask for your support for that, and also, to tell you
    that we are going to need your additional assistance.
        The Uniform Laws Commission just brought out a draft
    uniform bill that would change the State laws, actually
    reversing all the progress that we have made actually in favor
    of taking service members' custody rights away. We hope to have
    your support for Senator Boozman's legislation. Secretary.
        Secretary Panetta. I appreciate that. As I indicated to you
    in my letter, I support the efforts that you have made. You
    have provided tremendous leadership on this issue. And I will
    do the same with regards to the amendments on the Senate side.
        Mr. Miller. Ms. Tsongas.
        Ms. Tsongas. Thank you, Mr. Chairman. And thank you both
    for being here today. Like others before me, Congressman
    Turner, I want to thank you, Secretary Panetta. I appreciate
    very much your efforts that you have made over the last several
    months to improve the treatment of survivors of military sexual
    assault. And Secretary Shinseki, I was so heartened to learn of
    your recent interest in the documentary film, ``The Invisible
    War.'' As you say, that which starts during military service
    ends up in the VA. And that movie so painfully highlights the
    multiple bureaucratic hurdles survivors of such assaults, which
    are all too frequent across all the services, must endure to
    prove that their physical or their psychiatric symptoms are
    connected to an incident of military sexual trauma.
        And it shows that too often, victims are unsuccessful in
    pursuing their claims for assistance. To address one aspect of
    this problem, the fiscal year 2012 Defense Authorization Act
    included language that required the Secretary of Defense, in
    consultation with the Secretary of Veterans Affairs, to develop
    a comprehensive policy for the Department of Defense on the
    retention of and access to evidence and records relating to
    sexual assaults involving members of the armed services.
        This policy is to be in place by October 1, 2012. Can you
    both comment on the status of this policy? I would also welcome
    any further thoughts you may have on how these claims can be
    processed faster and more accurately.
        Secretary Panetta. Well, it is a very important issue for
    me. I am not going to wait for the legislation in trying to put
    that policy in place, because I think it ought to take place in
    providing that kind of guidance and assistance to those that
    have been the victims of sexual assault so that they get the
    kind of support that they need in order to not only get the
    care they need, but if they want to continue in their career,
    to get the support system that would allow them to continue
    their career. And I think it is fair to say that Secretary
    Shinseki and I are going to work together on this issue to make
    sure that we can deal with this on both sides, not only the
    Defense side, but on the Veterans side for those that
    ultimately move in that direction.
        Ms. Tsongas. Thank you both. I look forward to seeing that
    policy in effect. Thanks.
        Mr. Miller. Mr. Denham.
        Mr. Denham. Thank you, Mr. Chair. Mr. Panetta, Mr.
    Shinseki, great to see you both here. Mr. Panetta, I have been
    working on these veterans issues for quite some time with you
    in our area of central California. By the way, thank you for
    support on the Veterans Skills to Jobs Act that was signed this
    week into law. A good bipartisan effort that Mr. Walz and I
    worked on after our Afghanistan trip. Another issue that came
    up during that same trip was working with our veterans on
    Active Duty that were transitioning back that had disabilities.
    And further conversations with General Bostick afterwards. You
    know, he had said that this is the number one issue, the
    evaluation process of those disabled before they get
    discharged, making sure that not a day goes by that they are
    having to wait for disability, or the issue of 20,000
    nondeployable men and women that are disabled on Active Duty.
        So he said it was the number one issue dealing with--
    legislative issue that needs to be fixed back from 1940. The
    question I would have for you, is what can we get done? What
    would be your recommendation? What is the legislative fix that
    you need us to pass that would help with this overall
    disability evaluation system?
        Secretary Panetta. My view is that one of the most
    important things we can do is address the needs of our Wounded
    Warriors and the ability of those individuals. If they want to
    stay in the service, we ought to do everything we can to help
    them stay in the service. If they want to move on, then it
    becomes something where we have got--we and the VA have to work
    together to make sure that that transition is as smooth as
    possible. We have a tremendous amount of focus on this. I guess
    probably the one key is, again, helping us in terms of funding
    to make sure that we have the funds necessary to complete these
    evaluations and give them the assistance they are going to need
    once they move on. That is a key area for me.
        Mr. Denham. Outside of funding, is there a legislative fix
    that you are looking for?
        Secretary Panetta. At this point, I have to tell you, I
    mean, I think we have the pieces we need. I mean, we have got
    large numbers that we have to deal with. But the programs are
    in place. The assistance is in place. We have just got to make
    sure that we provide the resources necessary so that we can do
    what we have to do to help them. That is the key.
        Mr. Denham. Thank you.
        Mr. Miller. Mr. Wittman.
        Mr. Wittman. Thank you, Mr. Chairman. Secretary Panetta,
    Secretary Shinseki, thank you so much for joining us. Secretary
    Panetta, I want to ask you about how we can better align
    military to civilian jobs in transition, especially as it
    relates to licenses and certifications. Give you a great
    example. You take a highly trained combat medic, comes back
    home, wants to go into the civilian side, wants to become an
    emergency medical technician. Unfortunately, as you know,
    certifications there prevent him or her from doing that. Has to
    go through lengthy schooling, take on lots of debt. Many times,
    they could probably be teaching the class. How can we better
    align the skills that are obtained in the military to parallel
    what they could be pursuing in jobs on the civilian side? That
    is one of many categories that I know that you are aware of.
    And it is really a matter of taking that military job
    description and figuring out how do we align that, or how do we
    get some paralleling with what they are doing in the military
    versus outside?
        Secretary Panetta. Well, it is a great point. It is
    something actually the First Lady has dedicated a lot of time
    to. We have got to push States to try to develop some common
    standards here with regards to accreditation in these various
    jobs. These guys come out and they have got great skills, they
    have worked in these areas, they have done tremendous work in
    their particular skill area. And to come out and then have to
    drag them through a whole process in order to be able to take
    those skills and make them applicable, that is something that--
    there are a number of States that are willing to basically take
    these individuals and take the accreditation that we provide
    and incorporate that at the State level. We have got to get all
    of the States to recognize that kind of credentialing.
        Mr. Wittman. Mr. Secretary, is it something we could do
    within DOD so as these individuals come out, if they become a
    trained medic, they would also, at the same time, that they get
    that certification would get something within the military to
    say by the way, now you have a credential that is an EMT
    [emergency medical technician] within that particular State,
    say where they are based or they have some kind of way that
    there is an equivalency there? Because they are obtaining the
    same skills there as they would outside.
        Secretary Panetta. I think that is a good point. One of the
    things I am looking at is can we develop some kind of
    certification within the military that would then be
    transferable in terms of their getting a job within the State.
        Mr. Wittman. It seems like if you just align things that
    align with outside, there could be some reciprocity.
        Secretary Panetta. That is right. Good point.
        Mr. Wittman. Thank you. Thank you, Mr. Chairman. I yield
    back.
        Mr. Miller. Mr. Courtney.
        Mr. Courtney. Thank you, Mr. Chairman, and thank both
    witnesses for your attendance here today. Secretary Shinseki,
    you know, I am wondering if you could talk for a minute about
    an initiative that I think falls under today's hearing, which I
    think is a very exciting example of the work the VA has been
    doing with health IT, which is the Blue Button program, which,
    again, is something that again, I think you have surpassed even
    the private sector in terms of really trying to give patients
    control over their own medical situation, as well as make a
    smarter system in our health care delivery.
        Secretary Shinseki. I will just say it is one of several IT
    initiatives, but Blue Button is the one that has received a lot
    of attention. And there are civilian health care systems now
    that are adopting the concept. And that is with a single stroke
    of a mouse on the Internet, you are able to access your data,
    personal data regarding health care. And you can download your
    records, you can take those records and use them as you would
    with your own private physician. It has tremendously grown in
    size, into the millions. And we think this is also helpful for
    the private sector in having that kind of concept capability.
        Mr. Courtney. And the nice thing about it is it gives the
    patient control in terms of being able to move, go from one
    provider to another. And again, just congratulations to you and
    your team for really leading the way for the whole health care
    sector really in terms of that initiative. And I know comments
    have come up, and I am running out of time, the issue of
    regionalizing claims is emerging as an issue in Connecticut as
    well. And again, I look forward to working with your Department
    in terms of trying to solve that problem.
        Secretary Shinseki. We will do that.
        Mr. Miller. Ms. Buerkle.
        Ms. Buerkle. Thank you, Mr. Chairman. And thank you both
    for being here this morning and for your service to our Nation.
    It is an honor to have you both here. My question has to do
    with, and you have heard some references to it, the Dole-
    Shalala Commission, and the fact that now 5 years later, after
    they issued this urgent call to streamline, to make sure we
    have a single point of reference for the care and the services
    and the benefits of our military, we have two very distinct
    entities. We have had multiple hearings trying to get assurance
    from DOD and from the VA as to how you are going to get this
    together so that we can make sure our veterans get the services
    without being overwhelmed by an extremely complex system.
        So I would ask both of you today, please, how specifically,
    what are the goals, what is the plan to get these two entities
    under one roof so that you are complying with the Dole-Shalala
    Commission and their recommendations for our veterans? I thank
    you both.
        Secretary Shinseki. The program, the Federal Recovery
    Coordination Program, in existence since 2007. And I think as
    Secretary Panetta indicated earlier, two good Departments
    launched and essentially developed good programs that don't
    quite harmonize. We have a task force with the specific
    direction to study and bring harmony to these programs. Where
    are we being--duplicating one another? Where are we not doing
    things that we should be doing? So it is going to get a good
    look here, and I say in the next couple of months. And I would
    be happy, and I think Secretary Panetta would be as well, to
    make our people available to provide the results of that.
        Secretary Panetta. You know, look, Secretary Shinseki and I
    share the same frustration. I mean, we have been working on
    this, and, frankly, we have been pushing to try to say why
    can't we get faster results? Why can't we get this done on a
    faster track? And, you know, bottom line is, frankly, we just
    have got to kick ass and try to make it happen. And that is
    what we are going to do.
        Ms. Buerkle. I would suggest in your opening statement, Mr.
    Panetta, you mentioned commitment, and that we look to our
    military as an example, their commitment to our country. We
    should be that committed to them to make sure we get this job
    done. I thank you both very much.
        Mr. Miller. Dr. Heck.
        Dr. Heck. Thank you, Mr. Chairman, and thank both of you
    for being here today. Likewise for your long and distinguished
    service to our country. Secretary Panetta, I am happy to hear
    about your initiative on the Stolen Valor Web site, realizing
    that any Web site will probably have limitations. As you may
    know, myself and Senator Brown have introduced legislation to
    reinstitute the Stolen Valor that will meet constitutional
    scrutiny. So hopefully, we will be able to gain your support on
    that. We have heard a lot about the Integrated Disability
    Evaluation System, something that after spending over 20 years
    in the Army Medical Department I think was far too long in
    coming. And I am encouraged by the pilot results. In fact, I
    have two down-trace units that are getting set to mobilize in
    October to support those efforts, CONUS [continental United
    States]. But we have seen over time the processing times start
    to creep back up.
        And even though there has been--customer service has
    increased over the legacy system, that was really a low bar to
    overcome. And we are hearing a lot of the fact that the program
    is somewhat complicated and convoluted. Other than volume
    driving the creep in processing times going back up, what other
    issues are there that are causing that processing time to
    increase, and what can we do to help you decrease those times?
        Secretary Shinseki. Well, I think I indicated earlier that
    we have a target of 295 days. Within, I would say, the DOD's
    portion of that is the medical care of seriously wounded and
    injured individuals who still have their care to be completed,
    and also recuperation leave as part of that. So it is a little
    bit--individuals have some control here. And also, I think
    Secretary Panetta alluded to this, these youngsters know the
    military health care system. They know it very well. They are
    very comfortable with it. It is world class. They know VA's
    health care system less. And there is a point in time where a
    decision has to be made to make that psychological commitment
    you are going to leave the military.
        We in VA can do a lot to help educate folks to make them
    comfortable about being able to let go of--you know, like wing
    walking, one hand hold before taking the next one. And I think
    that will help streamline the process. But as I say, we have
    both agreed to this 295-day target, and we are moving to that
    point.
        Mr. Miller. Mr. Johnson.
        Mr. Johnson of Georgia. Thank you, Mr. Chairman. Thank you,
    gentlemen, for being here. Secretary Panetta knows how much I
    appreciate his service to the Nation over the years. And I
    certainly thank you again, sir, in public. And General
    Shinseki, I have not had the opportunity to spread my love for
    you publicly, but you are a true gentleman.
        You served admirably in the United States Army, became a
    four-star general, became the Secretary of the Army--or
    chairman of the Army. Army Chief of Staff. That is what it was.
    And in that capacity, you put in place strategies, very
    innovative, that have held us in good stead up to this point.
        You are a forward-thinking leader. And you are also a
    courageous and honest leader. I would be remiss not to point
    out the fact that during the run-up to the war in Iraq, you
    took a public bashing from high-level members of the previous
    administration for your assessment as to the number of troops
    we would need to effectively occupy Iraq in the aftermath of
    the war going in. And you paid the price for that in being it
    said that you were perhaps forced to resign early. But
    nevertheless, the underdog is now on top.
        And you bring the same innovative, strategic thinking to
    your new post that you had in the old post. And it is
    definitely needed. And I think it is going to pay off. And I am
    glad that your Department and the Department of Defense have
    both become more integrated in how we address the needs of our
    service men and women as they make the transition from military
    force--has my time expired already? Okay. I keep hearing a--you
    want me to move on from what I am saying, or what?
        Mr. Miller. Your time has expired, Mr. Johnson.
        Mr. Johnson of Georgia. Has my time already expired?
        Mr. Miller. A minute ago.
        Mr. Johnson of Georgia. Oh, 2 minutes. I am sorry. All
    right. But thank you, sir, for your service. And I yield back.
        Secretary Shinseki. Mr. Chairman, may I just a small point
    here. I thank the Congressman for his compliments. I would just
    say there are more than this one individual who held that
    opinion. And I was not forced to resign. I served a full and
    complete tour as the Army Chief, and I was very proud do that.
    Thank you.
        Mr. Johnson of Georgia. Thank you. I stand corrected.
        Mr. Miller. Mr. Johnson, I am trying to save you from
    yourself because the next person up is Mr. Runyan.
        Mr. Johnson of Georgia. Oh, I don't think I need to be
    saved from myself.
        Mr. Miller. You haven't seen Mr. Runyan.
        Mr. Runyan. Thank you, Mr. Chairman, and, gentlemen, thank
    you for being here. I want to touch on the IDES process. I know
    in Secretary Panetta's opening statement the last sentence of
    that particular paragraph or the end of the IDES statement says
    you are going to have a senior level working group in
    coordination with the VA and provide recommendations on how to
    move forward. I know Secretary Shinseki knows that I happen to
    chair the DAMA [Disability Assistance and Memorial Affairs]
    Subcommittee in the House VA Committee. We just had a hearing
    on this back in March, and I asked the DOD to acknowledge the
    specific roles the VA has in the process and distinguish the
    roles that the VA and DOD carry out. And I have also been
    briefed by the GAO that they have great concern of the
    overlapping responsibilities in the two.
        There is a couple of issues and time running out that I
    just want to bring to both of your attention you can have here,
    specifically dealing too with the medical evaluation narrative
    summaries, is that clear, and they lack clear and complete
    diagnosis of the service member which a lot of times renders an
    unfair decision. And the arbitrary time date of 7 days to
    challenge that, refuting that decision. I sometimes think to
    get the complete medical evaluation you need I don't think that
    is possible. Dealing with the PEBLOs [Physical Evaluation Board
    Liaison Officers] and their ability or lack of--I don't know--I
    know quality control has been used a couple of times by some
    VSOs [veteran service organizations] but not so much they are
    not reaching out to the veteran. And I know some of the VSOs
    brought up instances where JAGs [Judge Advocate Generals] have
    been involved and the process went a lot smoother because they
    understand the process a lot better. There are some points I
    wanted to bring to both of your attention that I hope would
    come up in those discussions and I yield back.
        Mr. Miller. Mr. Scott.
        Mr. Scott. Thank you. Thank you, Mr. Chairman. Secretary
    Panetta, you mentioned earlier one the problems was the
    limitation of the number of health care providers. I have got
    some information I would like to share with you. I represent
    Georgia, which has a tremendous number of veterans, a proud
    military history. And one of the medical providers gave me this
    list and it is actually a list of reimbursements versus
    Medicare reimbursements. And I will just give you a couple of
    examples. For the exact same code, Medicare reimburses about
    $2,000 and TRICARE reimbursement is somewhere in the $630
    range. That is one of the reasons that many of the private
    sector providers out there are having to limit the number of
    our veterans that they are seeing; they are covered under
    TRICARE. So I will just share this with you, and it is not that
    they don't want to see them, it is that if they are the only
    person that is signed up in that area, then it becomes a huge
    portion of their practice. And quite honestly the practices
    have to be revenue positive. But I will leave this for you and
    we will go from there.
        Mr. Shinseki, if I had a second copy I would give it to you
    and I can get copy for you as well. We kind of beat around this
    a little bit. I trust both of you as great leaders. We beat
    around this issue of having two bureaucracies that resist
    change. And so my question, open-ended to either one of you
    that wants to take it, is would the men and women that are
    serving this country be better served if the health care
    benefits were handled under either one of the agencies instead
    of both of the agencies in having to make that transition?
        Secretary Panetta. Well, you know, I thought about that a
    lot. But I think the reality is we have got these systems in
    place. The veterans are very tied to their health care system
    and, you know, the benefits that they receive there, and
    obviously DOD is very tied to our system. But the key--I don't
    think that ought to inhibit our ability to bring these two
    systems together, let me put it that way. I don't think we have
    to create another monster. I think all we have to do is be able
    to get both of these two systems to work together and get it
    done.
        Secretary Shinseki. Mr. Chairman, might I add a little bit
    here. Two huge Departments, we are already collaborating, both
    bringing together in a number of locations joint and integrated
    activities; North Chicago, a Federal health care center, the
    director is a VA person, the second in command is a Navy
    captain. And we are learning a lot from that and we look for
    other areas where we can do this and there are several other
    examples of that. We look at bundling acquisition, large
    acquisition decisions. We are working on right now trying to
    see whether there is a benefit to bringing our pharmacy
    programs together.
        So I think there is great opportunity from efficiencies and
    a business standpoint. I would be cautious about saying we are
    going to create one system here. He has a to-go-to-war
    requirement and the go-to-war requirement has with it a whole
    list of preparations that you have to have competent leadership
    who have been trained how to do this in combat from the top of
    the organization all the way down to the youngest medic in that
    formation. That is an enormous responsibility, and that is a
    culture we don't want to change. We have the best go-to-war
    medical capability anywhere, and that has got to be a primary
    function here.
        Mr. Miller. Ms. Hanabusa.
        Ms. Hanabusa. Thank you, Mr. Chairman. Thank you both for
    being here. A special aloha to General Shinseki. My questions
    are for you, General. On page 7 of your testimony you talked
    about of course the VOW to Hire Heroes Act of 2011 which
    Congress and the President signed into law. Do you have any
    statistics or any report you can give us as to how that is
    coming along? And in that same light also on page 7 you talked
    about removing the impediments to credentialing with of course
    the DOD and I would like to know where we are in that as well.
    Thank you.
        Secretary Shinseki. On the VOW to Hire Heroes Act
    implementation, there are various pieces of that. I would say
    one piece, VRAP [Veterans Retraining Assistance Program], is up
    and running. We have veterans who are signing--this is between
    veterans between the age of 35 and 60 who have exhausted their
    unemployment benefits, have a capability for 1 year of training
    in a high priority work area. That is up and running, in the
    tens of thousands people have signed up. In the transition
    arena both Secretary Panetta and I are working this very hard.
    We think we have a good plan being put together, but in our
    case we are still looking at the details of that.
        I am not sure I have addressed all of your questions,
    Congresswoman, but--was there something I missed.
        Ms. Hanabusa. No, I will follow up with any specific
    questions that I may have for the record. Thank you very much.
    I yield back.
        Mr. Miller. Dr. Roe.
        Mr. Roe. Thank both of you all for being here today and
    your service to our Nation. Yesterday we had a hearing, just a
    briefing with Dr. David Rudd on the suicide problem and I would
    like to share with you, both of you all, I won't do it today
    because of time, with his data which was very impressive about
    multiple deployments and how that affected soldiers.
        Number two, I know I have been to Great Lakes twice and it
    is clear when you are a freshman Congressman as I was two terms
    ago when your CODEL [congressional delegation] is to Great
    Lakes in January when it was 4 below zero. So I have been there
    and the question is how is that interconnect interactivity
    between DOD and VA doing now, General Shinseki? Is that working
    better? I was there about a year ago. I know it is up and
    running but how is that working?
        Secretary Shinseki. It just gets better over time,
    Congressman. New concept, bringing two good teams together,
    integrating them. I would say that the area of challenge is the
    single electronic health record. And for the most part there
    are great workarounds but when you get to some places like
    pharmacy, because of the sensitivity to the safety aspects of
    that there are a lot of checks and rechecks. I don't think we
    have solved all of those issues and won't until we get this
    integrated Electronic Health Record. So one team, veteran or an
    active service family member walks in a front door, they go
    wherever. So in terms of the provision of care and access to
    care I think it is first rate. It is the business aspects of
    this that still require more work and the integrated Electronic
    Health Record will go a long way to solving that.
        Mr. Roe. Mr. Chairman, I had a Wounded Warrior in my office
    yesterday lost a leg above the knee, and I personally cannot do
    enough for these Wounded Warriors. I know that you all feel
    exactly the same way, and I certainly appreciate your service.
    Mr. Secretary, I will ask you any further questions at the
    Harris Teeter. I see you there shopping from time to time.
        Mr. Miller. Mr. Coffman.
        Mr. Coffman. Thank you, both of you, for your long and
    distinguished service to our country. Secretary Panetta, I just
    want to commend you and the Secretary and the Department of
    Defense for your work in dealing with combat stress. I have
    served in the Marine Corps in the first Gulf War, in the Iraq
    War. I remember the out-briefings I received in 1991 before I
    left the theater and they were excellent, 2006 they were
    excellent as well. I tracked the improvements in the Department
    of Defense in terms of on the Active Duty side in working with
    our military personnel and those new programs and I think we
    are doing the best we can.
        And you see, the Department of Defense sees post-traumatic
    stress disorder as a wound. However, Secretary Shinseki, the VA
    sees it as a disability. And the signature wound of this war is
    post-traumatic stress disorder and it seems that we have a
    disability-centric approach and not a treatment-centric
    approach in the Veterans Administration. And wouldn't it be
    wise if we invested dollars in treatment and reform the current
    system that was both compassionate, more compassionate I think
    to those who served our country and fair to the taxpayers and
    saving money in the long run by again investing in treatment in
    the short run and being able to allow veterans to see mental
    health practitioners within their private ones, within their
    own communities and not be relying upon the VA. And I would
    love it if you could respond to me now but also respond to me
    on the record because of our limited time.
        Secretary Shinseki. I would be happy to provide a more
    detailed response for the record.
        [The information referred to was not available at the time
    of printing.]
        Secretary Shinseki. Congressman, let me just say I am not
    sure when the decision to treat this as a wound occurred, but I
    think we have all used PTSD disorder as the descriptor for
    many, many years. We are closely linked with DOD on all things,
    we will go back and look at this. So on the one hand I don't
    disagree with what you are suggesting, but I would offer that
    we treat PTSD, we screen every veteran who comes to VA for
    PTSD, TBI, substance abuse, sexual assaults. And so we have a
    pretty comprehensive record of who to treat and then we set
    about treating them.
        Mr. Coffman. There is no requirement for treatment once
    that disability determination is made and I think we need to
    really rethink that and take a look at that again. All the
    mental health professionals that I talk to feel that it is
    treatable down to a level to where it is no longer
    debilitating. And so we need to rethink and potentially reform
    this again to be more compassionate for those who have served
    our country in repairing their lives, and also I think in the
    long run certainly being fair to the taxpayers of this country.
        Secretary Shinseki. I don't disagree. But I do say we
    treat, it is not just a disability.
        Mr. Coffman. Thank you, Mr. Chairman. I yield back.
        Mr. Miller. Ms. Speier.
        Ms. Speier. Thank you, Mr. Chairman. To each of you, we are
    in awe of the extraordinary contributions you have made to this
    country. Thank you for being here today.
        I am going to try to cram three questions into my two
    minutes so I am going to move fairly quickly. On Schedule II
    drugs there is an addiction that often occurs while members are
    still in the military that also continues once they are in the
    VA system. What are we doing to try and deal with this
    addiction problem?
        The for-profit colleges that many of our GIs are accessing,
    there are some bad actors. I want to know if you are sharing
    the bad actors with each other, both from the Department of
    Defense and the VA.
        And finally, I want to tell you about a 24-year-old Iraqi
    veteran who started community college, is starting community
    college next month, he wants to go to law school. His present
    worry is that his foot operation will make it difficult for him
    to get to class in this hilly community college campus. He and
    other injured veterans in my district all would like more time
    to complete their studies under the post-9/11 GI bill. I would
    argue that a 1-year extension would be in order for veterans
    with service-connected disabilities.
        I would like your opinions, both of your opinions on that.
        Secretary Shinseki. Let me just very quick try to take all
    three of them on. On addiction, I myself have asked our people
    whether or not we have medication policies that lead to
    addiction, and we are looking at it; I know that both DOD and
    VA look at this. I was speaking publicly at one point and I
    asked the question are we courageous enough to ask the question
    of whether or not our medication policies create other
    problems. It got a response out of the audience and so I think
    there is something here and we are looking at it.
        On the for-profits, we do share that information. In our
    case we found three bad actors and we have cut them off, and we
    will continue to look at that. But I would just say there are
    bad actors. It is just not for-profits, there are others that
    we need to be sensitive to.
        More time for individuals who are severely injured, you
    indicated. VA has a program for rehabilitating seriously
    injured folks that is a little more liberal and very capable.
    And I would like to ensure that the individuals you are talking
    to are aware of the voc rehab, we call it, vocational
    rehabilitation.
        Ms. Speier. I think you misunderstood my question, Mr.
    Secretary. Whether or not we can extend the GI bill for
    severely disabled veterans so that it does not elapse in the 4
    or 5 years that it is presently the time limit in which they
    have to access those benefits.
        Secretary Shinseki. I would say on the voc rehab--let me
    come back to you on the record to see the amount of time on voc
    rehab is enough. For the GI bill, it is stipulated in law how
    much time is available.
        [The information referred to was not available at the time
    of printing.]
        Secretary Panetta. I think it should be modified because it
    would give us that additional time in the event that they are
    dealing with the kind of serious wounds that your veteran is
    dealing with.
        Ms. Speier. Thank you.
        Mr. Miller. Mr. Gibson.
        Mr. Gibson. Thanks, Mr. Chairman. I thank the gentlemen for
    being here, for their distinguished careers and their
    leadership. And what they are doing is so important right now
    in terms of bringing us better transition.
        I would like to make a couple comments here just based on
    my experience initially as a private in the New York Army
    National Guard and over the course of 24 years rising to the
    rank of colonel, including brigade command where I had troopers
    that made the transition from Active Duty back home and now in
    the vantage point of serving in these responsibilities, that I
    think over time the Department of Defense has really done
    incredible work before service men and women, before they
    separate in terms of education and training, understanding what
    is out there. And now all these efforts to integrate the DOD
    and the VA, but what I think is missing is that back home, just
    when we think we are making a difference we learn of a new
    case, somebody in a village or a town that I was not even aware
    was struggling and they are spiraling down and we are looking
    to make a difference and get them into a community of caring,
    including the VA, VFW, American Legion.
        So Peter Welch and I, my colleague from Vermont, we have
    been working on a program that is actually doing very well for
    the National Guard, the Yellow Ribbon Program, and seeing if
    are there ways we can learn from that that we can provide
    better situational awareness to State officials that are
    actually working this issue. In New York, for example, we have
    it to the county level. And many times they just don't have the
    information knowing a veteran is coming home. Sometimes they
    get it a year of that after they get home but they don't have
    it before they get home; that is to say, the service man or
    woman is coming home and then when they get home. So we are
    very enthused about what you are doing. We don't want to
    duplicate what you are doing. What we are looking to do is to
    sort of evaluate it and see if there aren't ways that we can
    have in the framework, DOD, VA, and then the transition in the
    framework to the State apparatus. So I wanted to mention that
    and just make you aware. I know we have been working with your
    offices and they are doing great work on this.
        And then finally thank you for your work on Agent Orange. I
    will tell you we are not done, we still have Navy veterans from
    Vietnam that don't have the presumed coverage and we are
    working on that effort as well.
        Thank you, gentlemen.
        Mr. Miller. Mr. Larsen.
        Mr. Larsen. Thank you, Mr. Chairman. General, continue to
    support HUD-VASH [Department of Housing and Urban Development
    Veterans Affairs Supportive Housing]. HUD-VASH program is well
    used in Washington State, especially in my district, the
    housing authorities are partnering very well with others to
    make that happen.
        Second, we started a program in my office to assist some of
    our community and technical colleges to translate the skills
    and abilities that veterans bring into the private sector
    language of what they need, especially as it applies to
    aerospace manufacturing and aerospace skills needed. What we
    found is that some of our community and technical colleges did
    not even know there actually was a translator available online.
    It is sad enough we have to translate that language from
    military to private sector, but we do. So there is a fellow in
    my office we hired who is a 30-year chief, retired after 30
    years out of the Navy as a command master chief. And so his job
    now is doing some outreach to community colleges all over the
    State because they come to this one research or aerospace
    training center and let them know how this works. You might
    want to use that with the DOL [Department of Labor] and the
    Department of Education.
        But finally, where does this one kid fit? He comes home, he
    is discharged from the military, he goes home to a rural town,
    he is not enrolled in VA, has trouble adjusting, commits
    suicide, an actual story in my district. So he doesn't fit the
    military, he doesn't fit the VA. I am not asking you to solve
    that problem from 3 years ago, but I am asking you what is
    being done to reduce the likelihood of that kind of thing
    happening again?
        Secretary Shinseki. This is part of the reason you have two
    Secretaries sitting here, and our efforts are to create a warm
    handoff by and large across the board anyone departing the
    military, but especially for those that have indicated while
    they are serving in uniform that they have some mental health
    challenges. We need not to discover that the hard way. This
    handoff would give us the opportunity to bring to bear VA's
    significant mental health treatment capability so that there is
    a smooth transition for this.
        Secretary Panetta. I would agree with that. In these
    situations you have got to ring the bell, you have got to say
    there is a problem here, and the key right now is to be able to
    pick up that there are those problems, to make sure that that
    individual gets into the health care system and then to alert
    the VA so that they pick it up when we try to make this
    handoff, but that is one the keys we are focusing on.
        Secretary Shinseki. Mr. Chairman, just for one second, the
    translator that you were talking about, Congressman, we in VA
    have created one called VA for Vets. I am pretty sure your
    master chief is familiar with it, but there are about five
    others that touch on various aspects of translating skills.
        Mr. Miller. Mr. Stearns.
        Mr. Stearns. Thank you, Mr. Chairman, and let me compliment
    you for bringing these two committees together. I think this is
    fabulous. I have served on the Veterans Committee for 24 years,
    so I think this is a first and I just think it is a very good
    idea.
        Mr. Panetta and Mr. Shinseki, welcome. I am going to ask
    you sort of a basic question that the GAO has reported that
    basically it takes 200 days with a 68 percent accuracy to
    address the current backlog. And we are hoping that--I mean
    think the timeline is in 2015 to get to 100 days with 98
    percent accuracy. But the question would become how could you
    do this if roughly almost 700,000 new service members are
    coming in? I mean, come on now. How are you going to do this
    with 700,000 new members, new veterans coming in? How are you
    going to cut the backlog in half and increase the accuracy by
    almost 30, 40 percent?
        I will start with you Mr. Veteran Secretary.
        Secretary Shinseki. We are in the process of piloting now,
    you are familiar with VBMS, it is Veterans Benefit Management
    System, first automation tool we have had in VA. We are still
    paperbound today all these many years later.
        Mr. Stearns. I just don't want to interrupt you but Steve
    Buyer was chairman of the committee, he had a bill that was
    going to solve that problem, and this is many moons ago. So
    when you indicate you had this for the first time--I am just
    saying I thought that was implemented some time ago, but you
    are saying it wasn't.
        Secretary Shinseki. I would have to go back and refresh
    myself on what Chairman Buyer's initiative was. But clearly in
    the testimony I presented before the committee there was no
    automation tool ever discussed in the last 3\1/2\ years. In
    fact, the testimony was that we were building this and it was
    going to require close collaboration with DOD. We get paper
    from DOD, we are a paperbound process. And so in order to go
    paperless in VA, it is going to take coordination between both
    Departments and we are piloting that automation tool today and
    we intend to have 16 regional offices automation on VBMS by the
    end of this year. And by the end of 2013, VBMS on all of our 56
    regional offices, 14 and 15 to take down the backlog.
        Now Mr. Stearns, we created the backlog in large measure.
    We made an Agent Orange decision that added a quarter of a
    million claims to the existing inventory. We made a decision on
    combat PTSD that added half a million claims to that inventory.
    Some would say, why would you do that. It was the right
    decision to do for veterans had been waiting for many, many
    years. We are going to work the backlog now. Automation is the
    key piece here we are after.
        Secretary Panetta. Congressman, what you pointed out is a
    hell of a challenge. I mean, we are not kidding anybody. What
    you pointed out is exactly the concern because we are going to
    be adding more and more to that list. I think the key for us is
    if we can develop the systems to deal with what we are dealing
    with now and make those work, it is going to make it much
    easier as additional individuals come on board. If we don't get
    through this, if we don't deal with it and make it more
    efficient now, then it will become an even worse problem in the
    future.
        Mr. Stearns. Thank you, Mr. Chairman.
        Mr. Miller. Our final questioner today will be Dr.
    Benishek. You are recognized for 2 minutes.
        Mr. Benishek. Thank you, Mr. Chairman. I have a question as
    to the nature of the collaboration between the Department of
    Defense and the VA on reducing the backlog. Can you tell me
    more about that? How much--are you working together for this or
    can you just comment on that?
        Secretary Panetta. That is one of the fundamental
    challenges that we have taken on in both Departments is to
    address that backlog and try to make sure that both of us are
    trying to work in a way that reduces those numbers. I think the
    Secretary has done a great job at the Veterans side to try to
    reduce the number of days there. We are working to try to
    reduce the number of days on our side and to be able to try to
    provide this kind of seamless relationship so that overall we
    can deal with this huge backlog. It is a problem, we have
    recognized it as a problem, and I can tell you we are doing
    everything possible to try to see if we can confront it.
        Mr. Benishek. Are your staff talking every day then?
        Secretary Shinseki. Yes, they are. They are. When we say
    backlog here, there are about two or three transition programs
    from DOD to VA. We have IDES that most of us are familiar with,
    which is primarily a transitioning of seriously wounded and
    injured folks out of uniform and then to veteran status with
    us. That is only about 7 percent of the people leaving the
    military. We have two other programs called Benefits Delivery
    at Discharge and Quick Start, again transitioning individuals
    out of the military to us. Together those two programs account
    for maybe 6 percent of the number of folks leaving the
    military. So the vast majority is this large discussion of
    backlog that I was responding to Mr. Stearns on. And part of
    that backlog is created by decisions we have made and that we
    have testified to. Agent Orange, combat PTSD, Gulf War illness,
    all the right decisions. But understand that that creates a
    volume of claims. We are going to be better able to deal with
    it as we get automation in place. So that is an important step.
    We need to get that program funded and hold onto IT funding
    dollars that we have testified to.
        The second piece of this is this collaboration of DOD and
    VA sitting side by side making sure we have warm handoffs. It
    is one thing to know that there are 100,000 people coming out
    next year, but if they all come out on 1 October that is a
    different problem than this being scheduled out over 12 months
    or if they all come out at one location that is different than
    being spread across the country. We will match up, VA will
    match up with whatever the plan is in DOD and that is why this
    collaboration is important.
        Mr. Benishek. Thank you, gentlemen. I see my time is up.
        Mr. Miller. Thank you very much, gentlemen. Thank you for
    being here today, spending 2\1/2\ hours with our two
    committees. We appreciate you being so generous with your time
    to answer some very important questions. I would ask unanimous
    consent that all members would have 5 legislative days to
    revise and extend their remarks. Without objection, so ordered.
        With that, the committee is adjourned.
        [Whereupon, at 12:35 p.m., the committees were adjourned.]

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                                A P P E N D I X

                                 July 25, 2012

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                                 July 25, 2012

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                  WITNESS RESPONSES TO QUESTIONS ASKED DURING

                                  THE HEARING

                                 July 25, 2012

    ===============================================================

          RESPONSE TO QUESTION SUBMITTED BY MR. MCKEON AND MR. MILLER

        Secretary Panetta. DOD and VA currently share more clinical data
    than any other two healthcare organizations in the world. However,
    healthcare operations between the Departments are not integrated. The
    DOD and VA have multiple healthcare legacy systems and data stores,
    developed over decades, that must be modernized to enable the
    sustainability, flexibility and interoperability required to improve
    continuity of care. The integrated Electronic Health Record (iEHR) will
    employ a joint platform and service-oriented architecture that is
    standards-based; this will give the Departments the ability to
    integrate healthcare capabilities for streamlined care and benefits
    delivery and an architecture that supports rapid delivery and
    enhancement of new capabilities as needed. The agreements between the
    Departments associated with iEHR have been widely publicized. The
    Departments must balance the need to conduct proper planning for the
    overall effort with a strong desire to field new systems and
    applications as rapidly as possible.
        Effective governance has been established and put in place to
    assist the DOD/VA Interagency Program Office (IPO) in navigating
    Department-specific processes for acquiring IT solutions to ensure iEHR
    does not incur unnecessary delays. Given the need to merge two
    acquisition life cycles, the Departments have acknowledged the need to
    optimally align their processes to ensure agile and cost efficient
    delivery of capabilities to the clinical community. The iEHR is subject
    to the programmatic requirements of both the DOD Business Capability
    Lifecycle (BCL) and the VA Program Management Accountability System
    (PMAS). The IPO, DOD, and VA identified areas where process differences
    may exist, and are collaboratively engaging in efforts to ensure that
    any impediment that may arise is resolved in an efficient manner. The
    IPO leveraged BCL and PMAS to create a Capability Development Life
    Cycle Framework which captures the required documentation and milestone
    decisions for each phase, to include funding and investment decisions.
        The IPO has appropriately placed its initial focus on putting
    critical iEHR infrastructure and services in place. The iEHR requires
    significant work to create a technical framework in which clinical
    capabilities can be incrementally incorporated. Key steps have been
    taken toward achieving the infrastructure upon which the iEHR will be
    built and a master schedule is in place to guide iEHR progress: A
    Service Oriented Architecture (SOA) and Enterprise Service Bus (ESB)
    contract that has been let and those programs are meeting their
    milestones. Use of SOA reduces dependence on proprietary technologies
    and enables the Departments to avoid being ``locked-in'' to a specific
    vendor for a long term, which would hamper ongoing competition and
    stifle innovation.
        Ultimately, the iEHR will unify the two Departments' EHR systems
    into a common system that will ensure that DOD and VA health facilities
    have Service members' and Veterans' health information available
    throughout their lifetime. We anticipate joint use of the iEHR will
    help contain healthcare costs and provide higher value based healthcare
    delivery systems. By implementing a single, common health record for
    DOD and VA medical facilities, the iEHR will ensure that information
    about injuries and illnesses incurred during military service remain
    available for health and benefits purposes throughout a person's
    lifetime, supporting patient safety and continuity of care and
    facilitating access to and delivery of benefits. Seamless information
    sharing is expected to support the expeditious processing of disability
    claims in the future. Further, the iEHR will support the objectives of
    the HIPAA Privacy and Security Rules to ensure that when protected
    health information (PHI) is collected, maintained, used, disclosed or
    transmitted, reasonable and appropriate administrative, physical and
    technical safeguards have been implemented to ensure integrity,
    availability and confidentiality.
        The initial iEHR capabilities, laboratory and immunizations, will
    be delivered to two sites (San Antonio, Texas and Hampton Roads,
    Virginia) by the end of 2014. The capabilities of the iEHR will be
    increased incrementally through the end of 2017. [See page 15.]
                                     ______

                  RESPONSE TO QUESTION SUBMITTED BY MR. MCKEON
        Secretary Panetta. The President's budget makes the necessary
    budget constrictions to avoid devastating the Department through
    sequestration. If sequestration becomes an inevitability, the
    Department will evaluate all options available to comply with the law.
    [See page 14.]
    ?

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                  QUESTIONS SUBMITTED BY MEMBERS POST HEARING

                                 July 25, 2012

    =======================================================================

                      QUESTIONS SUBMITTED BY MR. LANGEVIN

        Mr. Langevin. Both DOD and the VA receive funding for spinal cord
    injury treatment, research, and education--the VA through the Office of
    Research and Development, and the DOD specifically through the
    Congressionally Directed Medical Research Program.
        While the programs share a common goal, there are important
    differences. To what extent are spinal cord injury research efforts
    coordinated and shared across Departments?
        Secretary Panetta. Spinal cord injury (SCI) research efforts are
    coordinated and shared across the Departments of Defense and Veterans
    Affairs at several levels. First, DOD and VA jointly sponsor research
    portfolio reviews and analyses (R&A) of major research efforts in
    Traumatic Brain Injury and Psychological Health; Clinical,
    Rehabilitative, and Regenerative Medicine; Combat Casualty Care;
    Military Operational Medicine; Military Infectious Diseases; and Health
    Information Technology and Medical Training. SCI research is covered in
    the Traumatic Brain Injury and Psychological Health, and Clinical,
    Rehabilitative, and Regenerative Medicine R&As. Through this review,
    research gaps are identified for future research investment and
    collaborative DOD/VA research opportunities.
        Second, VA participates in the CDMRP research planning efforts.
    Specifically, VA has co-chaired the SCI Research Program Integration
    Panel for the past two years. Other Panel members are from the VA the
    military Services (Army, Navy, and Air Force), the National Institutes
    of Health (NIH), and academic institutions, the Department of
    Education's National Institute on Disability and Rehabilitation
    Research, and consumer advocacy organizations (Paralyzed Veterans
    Association, United Spinal Association). The SCI panel provides
    strategic direction, screens pre-proposals, recommends proposals for
    funding, identifies research gaps and sets the vision for the coming
    year.
        Mr. Langevin. Secretary Panetta, in today's tepid economy, the DOD
    cannot downsize our forces without ensuring we provide mechanisms and
    programs for the service members to utilize before, during and after
    their transition from the military. In your words, what is the single
    most important role the DOD can play to assist these warriors in
    transition?
        Secretary Panetta. The Department's most important role is to
    prepare our Service members to become successful civilian citizens in
    their communities. We do this through a re-designed transition
    assistance program that focuses on providing all Service members with
    the appropriate tools needed to succeed. These tools include a
    crosswalk between military service and civilian experience; financial
    planning seminar; information about Department of Veterans Affairs (VA)
    benefits, and the Department of Labor employment workshop. The
    transition assistance program provides a transitioning Service member
    with a tangible product such as a budget, resume, listing of civilian
    careers that match military service experience and the practical
    application of how to apply for education benefits, home loans,
    disability (benefits, as appropriate) and experience in interviewing
    and searching for jobs. Using these tools along with the support from
    our interagency partners will result in the smooth transition from
    Service member to civilian.
        Mr. Langevin. Both DOD and the VA receive funding for spinal cord
    injury treatment, research, and education--the VA through the Office of
    Research and Development, and the DOD specifically through the
    Congressionally Directed Medical Research Program.
        While the programs share a common goal, there are important
    differences. To what extent are spinal cord injury research efforts
    coordinated and shared across Departments?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Langevin. The suicide rate for both service members and
    veterans is rising at an alarming rate, what is the VA doing to address
    this tragic rise today and what are your plans to address this trend in
    the future?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
                                     ______

                       QUESTIONS SUBMITTED BY MR. COOPER
        Mr. Cooper. Has VA measured how effective the VA National PTSD
    Center's numerous webinars and training sessions are for promoting
    among providers safer drug treatments for veterans experience PTSD? How
    many providers use those webinars and training sessions? Is this a
    number of providers that is satisfactory to VA and DOD? Has VA and DOD
    seen a change yet in PTSD treatment plans following these webinars and
    trainings? Are DOD and VA prepared to measure how effective the
    sessions are?
        Secretary Panetta. The Under Secretary for Health of the Department
    of Veterans Affairs and the Assistant Secretary of Defense for Health
    Affairs signed a formal Memorandum of Understanding (MOU) in March 2012
    to facilitate collaboration, coordination, and evaluation of training
    courses and programs in both Departments. DOD encourages providers to
    utilize all government resources when meeting continuing education
    requirements for medical professionals.
        Although DOD has not specified a target number of providers to
    participate in VA webinars, the new MOU can be used to further develop
    methods to increase DOD and VA webinar participation as well as efforts
    to develop a formalized method to assess the impact on provider
    practice.
        DOD has also partnered with VA via the Integrated Mental Health
    Strategy (IMHS) to improve collaboration related to provider training
    and webinars. In addition, DOD has begun to develop processes to
    measure effectiveness and changes in PH treatment outcomes after best
    practice implementation across the Military Health System.
        Mr. Cooper. A July 13, 2012, IOM study noted that PTSD screening,
    treatment, and rehabilitation services should be done ``in different
    populations of active-duty personnel and veterans.'' Does VA and DOD
    know of PTSD studies performed on active-duty service men and women,
    and/or military veterans? How numerous and how comprehensive have those
    studies been? That recent IOM study goes on to recommend that ``the DOD
    and the VA should coordinate, evaluate, and review these [active-duty
    personnel and veteran study] efforts continually and routinely and
    should disseminate the findings widely.'' How is the VA and DOD
    disseminating treatment findings now? How can they disseminate best
    practice treatment findings now? Would the EHR or drug formulary be
    helpful in doing this? Is there any incentive in place for VA and DOD
    providers to share, consult with, and use best practices found in other
    VA facilities?
        Secretary Panetta. There have been over 1,500 studies related to
    Active Duty military with PTSD, and 3,000 studies related to veterans
    with PTSD, completed since 1980. DOD has allocated significant
    resources dedicated to fund ongoing comprehensive PTSD research focused
    on the effectiveness of prevention, screening, treatment, and
    rehabilitation programs for Service members. PTSD research is also in
    progress through multiple military research institutions, to include
    the Armed Forces Health Surveillance Center, the Army Medical and
    Materiel Research Command, the Walter Reed Army Institute of Medicine,
    the Deployment Health Clinical Center, the Center for the Study of
    Traumatic Stress, and the Naval Health Research Center. These entities
    share their findings through annual reports posted on websites,
    publications in scientific journals, presentations at professional
    conferences, and various public forums. The VA/DOD Integrated Mental
    Health Strategy (IMHS) has specific task groups working to develop
    processes to rapidly translate research and move innovative programs
    into practice.
        DOD findings are translated into clinical practice via formal and
    informal PTSD training programs as well as clinical practice
    guidelines, recommendations, and support tools. For example, the Center
    for Deployment Psychology (CDP) is a DOD resource that trains mental
    health providers in evidence-based psychotherapies for PTSD. To date,
    CDP has trained approximately 6,700 mental health providers to deliver
    evidence-based psychotherapies for PTSD. There are also provider on-
    line training courses that are hosted through DOD, such as the Military
    Health System Learning Portal and the Center for Deployment Psychology.
    The Army Medical Command's Office of Quality Management provides tools
    to assist providers to follow the VA DOD Clinical Practice Guideline
    for Management of Post-traumatic Stress.
        DOD's National Center for Telehealth and Technology (T2), a
    Component Center of the Defense Center of Excellence for Psychological
    Health and Traumatic Brain Injury (DCoE), has developed products to
    inform providers, Service members, and their families about evidence-
    based practices for the treatment of PTSD, to include smart phone
    applications that assist patients and providers to follow evidence-
    based practices. T2 also designed innovative, state-of-the-art virtual
    delivery systems to increase the availability of evidence-based PTSD
    treatment. Further, DOD has multiple postgraduate education,
    internship, and fellowship behavioral health training programs for new
    accessions that require students to be trained in evidence-based
    Psychological Health (PH) practices.
        The electronic health record (EHR) will continue to be an important
    dissemination tool for PH treatment best practices, and DOD is
    positioned to further leverage the EHR to develop and implement
    standard PH practice guidelines, to include PTSD guidelines. For
    example, DOD currently uses an application in the EHR to inform primary
    care providers about medication best practices related to PTSD; the
    application has been used to treat over 30,000 patients. DOD recognizes
    that pharmacists in the Military Health System can help further improve
    psychiatric medication standard of care, and created a policy
    memorandum from February 22, 2012 entitled ``Guidance for Providers
    Prescribing Atypical Antipsychotic Medication.'' This memorandum
    suggests that Military Treatment Commanders work with their Pharmacy
    and Therapeutics Committee to monitor providers and their compliance
    with best practices related to use of medication for PTSD treatment.
        DOD ensures evidence-based and best practice treatment skills are
    integrated into care as part of the health care appraisal system,
    including a peer review process to ensure the highest standard of care
    is met. In addition, hospitals are motivated to use best practices that
    decrease care costs and maximize treatment outcomes through various
    means.
        Mr. Cooper. Do DOD and VA plan to create ``an evidence base to
    guide the integration of treatment for comorbidities with treatment for
    PTSD?'' How do you plan to encourage that kind of research?
        Secretary Panetta. DOD has already provided an evidence-based guide
    that helps providers manage co-occurring conditions, the ``Co-occurring
    Conditions Toolkit: Mild Traumatic Brain Injury and Psychological
    Health.'' This toolkit, based on scientific evidence, was developed to
    help primary care providers better assess and manage patients with
    psychological health and TBI conditions. In formulating these guides,
    knowledge gaps were identified to inform future research. In addition,
    DOD has funded over 30 studies related to treatment of PTSD and
    comorbid diagnoses (TBI, sleep disorders, alcohol and substance use
    disorders, anxiety, depression, and suicide). The results from these
    studies will further our knowledge in improving diagnosis and treatment
    of these conditions.
        In addition, DOD partners with other research institutes. For
    example, STRONG STAR (The South Texas Research Organizational Network
    Guiding Trauma and Resilience) is a multidisciplinary, multi-
    institutional research consortium funded by the DOD's Psychological
    Health and TBI Research Program. Their research includes the
    investigation of PTSD treatment with co-occurring disorders that
    include chronic pain, alcohol use, and insomnia.
        DOD creates research opportunities annually in the areas of
    traumatic brain injury and psychological health through the release of
    Program Announcements that describe the program of interest and the
    research need, the purpose and objectives, submission information,
    application review procedures, award administrative information, agency
    contacts, and time lines for submission and reviews. Program
    Announcements are posted on grants.gov for open and fair competition
    and submissions are received electronically.
        Mr. Cooper. Have DOD and VA identified PTSD treatment practices
    that are usually ineffective in active-duty service men and women and
    veterans?
        Secretary Panetta. DOD and VA published the VA DOD Clinical
    Practice Guideline for the Management of Post-Traumatic Stress in 2010.
    This guideline is based on thorough reviews of scientifically published
    evidence of Posttraumatic Stress Disorder treatments, including
    psychotherapy, medication, and complementary and alternative medicine
    interventions. This guideline includes an extensive discussion about
    treatments that have been found to be effective, found to be
    ineffective, have yet to be established as either effective or
    ineffective, or have found to be potentially harmful. A copy of the
    guideline is available at:
        http://www.healthquality.va.gov/
    Post_Traumatic_Stress_Disorder_PTSD.asp
        Mr. Cooper. Approximately what percentage of the experts who put
    together the VA/DOD Clinical Practice Guideline for Management of Post-
    Traumatic Stress have first-hand experience with treating veterans or
    active-duty personnel with prescription drugs? How much are those
    guidelines based on studies done in active-duty personnel and veterans?
        Secretary Panetta. Twenty one of the thirty-two DOD and VHA members
    of the Working Group for the 2010 revision of the VA/DOD Clinical
    Practice Guideline for the Management of Post-Traumatic have first-hand
    experience as prescribers. All of the members have experience treating
    veterans and active-duty personnel. A full list of members of this
    working group is found on page 10 of the Guideline (see below footnote
    for link).
        The Guidelines were based on literature and empirical findings
    specific to--and most relevant to--treatment of active duty Service
    members and veterans. The Introduction section of the Guideline
    provides an excellent overview of the criteria and standards used in
    the review of literature.
        Mr. Cooper. A July 13, 2012, Institute of Medicine study
    recommended that ``to study the efficacy of treatment and to move
    toward measurement-based PTSD care in the DOD and the VA, assessment
    data should be collected before, during, and after treatment and should
    be entered into patients' medical records. This information should be
    made accessible to researchers with appropriate safeguards to ensure
    patient confidentiality.'' How quickly can the VA and DOD put this
    recommendation into practice? What are the barriers to beginning to do
    this and how substantial are those barriers if they exist?
        Secretary Panetta. Assessment data is already collected before,
    during, and after treatment and entered into patients' medical records.
    The administration of standardized and validated PTSD clinical
    screening tools that are often used in research (e.g., the PTSD
    Checklist) is endorsed by the DOD for use when a Service member might
    benefit from further clinical evaluation or in monitoring treatment
    response. No standardized screening or assessment tool is available
    that can replace a comprehensive clinical interview that assesses the
    full spectrum of both PTSD and non-PTSD symptoms within broader social
    and occupational contexts. The DOD standard of care is that all data,
    inclusive of clinical assessment measures, becomes a part of the
    Service member's healthcare record.
        There are no inherent barriers to access of these records for
    research. Access to the use of TRICARE Management Activity (TMA) owned
    or managed data is subject to patient protections, privacy safeguards,
    and other research protocols mandated by law and implemented by
    institutional review boards and obtained through a formal agreement
    with TMA for sharing and use of data elements. The TMA Privacy and
    Civil Liberties Office (TMA Privacy Office) manages the data sharing
    agreement program and research protection program.
        The Department of Defense (DOD), Office of the Assistant Secretary
    of Defense (Health Affairs) (OASD[HA]) and the TRICARE Management
    Activity (TMA) support and encourage research, including human subject
    research. The Department of Defense (DOD) invests in Psychological
    Health (PH) research and the largest portion of the PH portfolio is
    directed toward PTSD. Out of the 225 current research projects in the
    PH portfolio, 162 focus on PTSD including studies specific to examining
    efficacy of treatment for PTSD and studies that focus on evidence-based
    long-term recovery protocols to decrease recurrence of PTSD symptoms.
        Recently, the Department in collaboration with the VA announced the
    creation of two research consortia one of which is focused on PTSD. The
    Consortium to Alleviate PTSD (CAP) Award will consist of a Coordinating
    Center and multiple Study Sites, and will be supported through this
    DOD/VA collaborative research effort. The primary purpose of the
    collaborative DOD/VA Consortium will be to improve the health and well-
    being of Service Members (Active Duty, National Guard, and Reservist)
    and Veterans, with the most effective diagnostics, prognostics, novel
    treatments, and rehabilitative strategies to treat acute PTSD and to
    prevent chronic PTSD. Key priorities of this Consortium are elucidation
    of factors that influence the different trajectories (onset/
    progression/duration) of PTSD and associated chronic mental and
    physical sequelae (including depression, anger/aggression, and
    substance use/abuse, etc.) and identification of measures for
    determining who is likely to go on to develop chronic PTSD. The
    Consortium will therefore work to improve prognostics, advance
    treatments, and mitigate negative long-term consequences associated
    with traumatic exposure.
        Mr. Cooper. In general, how does VA and DOD get evidence based
    medical information out to be used systematically throughout the
    systems? Is there a good example of a best practice being widely
    disseminated and used?
        Secretary Panetta. There are many points for wide dissemination of
    evidence-based medical information. A few are listed below:
          The DOD has central website for wellness resources for
    the military community at http://www.afterdeployment.org/. An adjunct
    program to this website has just been opened as a centralized
    information mart for providers at http://www.afterdeployment.org/
    providers/home. It includes continuing education materials, mobile
    applications, patient educational resources, libraries, briefings and
    quick links to the DOD/VA Clinical Practice guidelines.
          The DOD/VA Clinical Practice Guidelines are available at
    http://www.
    healthquality.va.gov/index.asp.
          PDHealth.mil at http://www.pdhealth.mil/main.asp provides
    a gateway to information on deployment health and healthcare for
    healthcare providers, service members, veterans, and families. It was
    designed to assist clinicians in the delivery of post-deployment
    healthcare by fostering a partnership between service members,
    veterans, families, and healthcare providers.
          Up-to-date and current information pertaining to research
    and best practices is available through the Combat & Operational Stress
    Research Quarterly published by the Navy (www.nccosc.navy.mil or direct
    link @ http://bit.ly/wnadBm) and the Deployment Health Clinical Center
    newsletter dispatched daily by email.
          The Department of Defense also disseminates evidence
    based information pertaining to practice, responsibilities, and
    requirements through the publication of Directives, Instructions and
    Guidance Memorandums.
        The clinical practice guideline titled ``Management of Post-
    Traumatic Stress Disorder and Acute Stress Reaction (2010)'' posted on
    the DOD/VA Clinical Practice Guidelines home page is an excellent
    example of a best practice that is widely disseminated and used.
        Mr. Cooper. Has evidence based psychotherapy been evaluated in
    active-duty service men and women with PTSD?
        Secretary Panetta. There are many points for wide dissemination of
    evidence-based medical information. A few are listed below:
          The DOD has central website for wellness resources for
    the military community at http://www.afterdeployment.org/. An adjunct
    program to this website has just been opened as a centralized
    information mart for providers at http://www.afterdeployment.org/
    providers/home. It includes continuing education materials, mobile
    applications, patient educational resources, libraries, briefings and
    quick links to the DOD/VA Clinical Practice guidelines.
          The DOD/VA Clinical Practice Guidelines are available at
    http://www.
    healthquality.va.gov/index.asp.
          PDHealth.mil at http://www.pdhealth.mil/main.asp provides
    a gateway to information on deployment health and healthcare for
    healthcare providers, service members, veterans, and families. It was
    designed to assist clinicians in the delivery of post-deployment
    healthcare by fostering a partnership between service members,
    veterans, families, and healthcare providers.
          Up-to-date and current information pertaining to research
    and best practices is available through the Combat & Operational Stress
    Research Quarterly published by the Navy (www.nccosc.navy.mil or direct
    link @ http://bit.ly/wnadBm) and the Deployment Health Clinical Center
    newsletter dispatched daily by email.
          The Department of Defense also disseminates evidence
    based information pertaining to practice, responsibilities, and
    requirements through the publication of Directives, Instructions and
    Guidance Memorandums.
        The clinical practice guideline titled ``Management of Post-
    Traumatic Stress Disorder and Acute Stress Reaction (2010)'' posted on
    the DOD/VA Clinical Practice Guidelines home page is an excellent
    example of a best practice that is widely disseminated and used.
        Mr. Cooper. Has VA measured how effective the VA National PTSD
    Center's numerous webinars and training sessions are for promoting
    safer drug treatments for veterans experience PTSD? How many providers
    use those webinars and training sessions? Is this a number of providers
    that is satisfactory to VA and DOD? Has VA and DOD seen yet a change in
    treatments following these webinars and trainings? Are they prepared to
    measure how effective the sessions are?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Cooper. A July 13, 2012, IOM study noted that PTSD screening,
    treatment, and rehabilitation services should be done ``in different
    populations of active-duty personnel and veterans.'' Does VA and DOD
    know of PTSD studies performed on active-duty service men and women,
    and/or military veterans? How numerous and how comprehensive have those
    studies been? That recent IOM study goes on to recommend that ``the DOD
    and the VA should coordinate, evaluate, and review these [active-duty
    personnel and veteran study] efforts continually and routinely and
    should disseminate the findings widely.'' How is the VA and DOD
    disseminating treatment findings now? How can they disseminate best
    practice treatment findings now? Would the EHR or drug formulary be
    helpful in doing this? Is there any incentive in place for VA and DOD
    providers to share, consult with, and use best practices found in other
    VA facilities?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Cooper. Do DOD and VA plan to create ``an evidence base to
    guide the integration of treatment for comorbidities with treatment for
    PTSD?'' How do you plan to encourage that kind of research?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Cooper. Have DOD and VA identified PTSD treatment practices
    that are usually ineffective in active-duty service men and women and
    veterans?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Cooper. Approximately what percentage of the experts who put
    together the VA/DOD Clinical Practice Guideline for Management of Post-
    Traumatic Stress have first-hand experience with treating veterans or
    active-duty personnel with prescription drugs? How much are those
    guidelines based on studies done in active-duty personnel and veterans?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Cooper. As Secretary Shinseki mentioned, the VA has ``a pretty
    comprehensive record of who to treat [for PTSD, TBI, substance abuse,
    sexual assaults] and then [the VA] sets about treating them.'' If this
    is the case, is how these veterans are treated for PTSD, tracked at
    all? Does the VA know for a fact which treatments are given most
    frequently to veterans with PTSD and in what combination? Do these
    treatments match up with what evidence there is for the most effective
    way to treat these veterans? Has either the VA or DOD studied patterns
    in treatment of PTSD in active-duty personnel and veterans?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Cooper. A July 13, 2012, Institute of Medicine study
    recommended that ``to study the efficacy of treatment and to move
    toward measurement-based PTSD care in the DOD and the VA, assessment
    data should be collected before, during, and after treatment and should
    be entered into patients' medical records. This information should be
    made accessible to researchers with appropriate safeguards to ensure
    patient confidentiality.'' How quickly can the VA and DOD put this
    recommendation into practice? What are the barriers to beginning to do
    this and how substantial are those barriers if they exist?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Cooper. In general, how does VA and DOD get evidence based
    medical information out to be used systematically throughout the
    systems? Is there a good example of a best practice being widely
    disseminated and used?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
                                     ______

                      QUESTIONS SUBMITTED BY MS. BORDALLO
        Ms. Bordallo. If we are to create a joint medical electronic
    records system, where all services including the VA will be using it at
    the same time, what will be different about this system that will
    prevent the system from running slow during peak hours or crashing in
    the middle of a heavy patient appointment schedule?
        Secretary Panetta. Systems Engineering and Testing will be
    conducted throughout the development and deployment of the integrated
    Electronic Health Record (iEHR) to ensure the system is stable and
    reliable in production environments. Network capacity planning will be
    performed and performance measures will be validated. The Development
    and Test Center/Environment (DTC/DTE), which consists of a set of
    systems, software, network, and test tools will be utilized throughout
    the system life cycle for continuous test and evaluation of system
    performance.
        Ms. Bordallo. Aside from the efficiencies a joint electronic
    medical record system will create, could you share some of the other
    benefits this system will produce as a byproduct?
        Secretary Panetta. The ultimate benefit the integrated Electronic
    Health Record (iEHR) will be improved quality of healthcare for our
    Service members and Veterans. The iEHR's close coupling with the VLER
    Health information exchange initiatives will accelerate the ability for
    DOD and VA healthcare providers to exchange information with other
    federal and private industry partners about patients they collectively
    care for.
          Patient-Centered Care: Patients will have a comprehensive
    and transportable medical profile that will support seamless transition
    of care between DOD and VA treatment facilities--as well as private
    providers. The iEHR will promote and facilitate an empowered patient,
    healthcare staff, and patient-centric approach, that will support
    healthcare information technology (HIT) systems that foster the
    delivery of effective, efficient, safe, and quality patient care.
          Precision of Care: Enhanced Clinical Decision Support
    (CDS) tools enabled by the iEHR will increase the precision of care
    delivered/received by providing access to comprehensive patient data
    and increased information exchange capabilities among providers that
    would otherwise not be available.
          More Time with Patients: Healthcare providers will be
    able to spend more time with their patients instead of searching for
    their data and signing on to multiple systems.
          Personal Health Records: Promoting partnership between
    healthcare team members and patients through an empowered patient care
    model for delivery of high quality medical care that engages patients
    in the healthcare process.
          Improve Quality of Care per Dollar Spent: Improving
    clinical outcomes while creating cost efficiencies in both workforce
    and IT life cycle costs.
          Population Health: Access to quality population health
    data and analytic tools will result in cost efficiencies and improved
    preventative healthcare. For example, insight into the number of
    diabetics who have not had their H1Cs done could inform a patient
    outreach program that have been shown to result in a reduction in
    amputations.
          Innovation: Promote innovations in technology and product
    research that support the delivery of quality healthcare and improved
    patient outcomes.
          Maturity of International HIT Standards: As the largest
    healthcare network in the world encouraging open solutions, the iEHR
    will be a driving force in the maturation of HIT standards improving
    the quality and landscape of HIT solutions available in the market.
          Interagency Collaboration Center of Excellence: The scale
    and scope of this effort provides the opportunity set the standard and
    influence policy for large scale interagency collaboration activities
    moving forward.
        Ms. Bordallo. What efforts are underway to improve the electronic
    delivery of information from DOD to VA and vice versa to improve
    benefits and health care delivery to service members and veterans?
    Additionally, can either witness discuss what is being done to develop
    a joint electronic medical records system. It's my understanding that
    each service including the VA currently operates a separate system and
    there is very little cross service functionality between any of the
    systems so how will you achieve cross-functionality and how do we
    improve the slow processing of the systems currently in place?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Ms. Bordallo. If we are to create a joint medical electronic
    records system, where all services including the VA will be using it at
    the same time, what will be different about this system that will
    prevent the system from running slow during peak hours or crashing in
    the middle of a heavy patient appointment schedule?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Ms. Bordallo. Aside from the efficiencies a joint electronic
    medical record system will create, could you share some of the other
    benefits this system will produce as a byproduct?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
                                     ______

                       QUESTIONS SUBMITTED BY MR. FRANKS
        Mr. Franks. Reports show that suicide rates among veterans,
    especially combat veterans, have increased over the past several years.
    Furthermore, studies have shown a correlation between people of faith
    and lower rates of suicide. Therefore, I'm concerned by reports
    indicating that the military is censoring religious references and
    symbols beyond Constitutional requirements. How is religion being
    incorporated into suicide prevention, and does the military's extra-
    Constitutional censorship of religion support your departments' suicide
    prevention efforts?
        Secretary Panetta. Suicide and the prevention thereof is one of the
    most vexing and important challenges the Department faces and we are
    committed to using every means available to assist our Service members
    and their families. Progress on this crucial issue will require a
    multi-functional and multi-faceted approach and our Chaplains fulfill a
    vital role in lending assistance to commanders, troops, and families in
    need. The Chaplaincies of the Military Departments are established to
    advise and assist commanders, troops, and families in the free exercise
    of religion in the context of military service as guaranteed by the
    Constitution. Our Chaplains serve a religiously diverse population and
    provide comprehensive religious support to all who seek it.
        The Department does not censure religious support. Indeed, all of
    the Military Departments have, over the course of the last several
    years, placed increased emphasis upon holistic efforts aimed at
    improving every aspect of fitness. This emphasis with a view toward the
    total comprehensive fitness of the force recognizes the vital component
    faith serves in the lives of many of our military families.
        Mr. Franks. Reports show that suicide rates among veterans,
    especially combat veterans, have increased over the past several years.
    Furthermore, studies have shown a correlation between people of faith
    and lower rates of suicide. Therefore, I'm concerned by reports
    indicating that the military is censoring religious references and
    symbols beyond Constitutional requirements. How is religion being
    incorporated into suicide prevention, and does the military's extra-
    Constitutional censorship of religion support your departments' suicide
    prevention efforts?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
                                     ______

                      QUESTIONS SUBMITTED BY MR. LOEBSACK
        Mr. Loebsack. What specific steps are the Department of Defense and
    the Department of Veterans Affairs taking to coordinate transition
    assistance and benefits for members of the National Guard and Reserve
    transitioning from Active Duty service back to civilian jobs and
    civilian life? How are the Departments coordinating to ensure members
    of the Reserve Component are aware of the DOD and VA benefits available
    to them?
        Secretary Panetta. In order to coordinate transition assistance and
    benefits for members of National Guard and Reserve transitioning from
    active duty to civilian life, DOD has worked with thje Department of
    Veterans Affairs, Department of Homeland Security, Department of
    Education and Office of Personnel Management over the last year to
    redesign the Transition Assistance Program (includes eligible National
    Guard and Reserve Service members).
        All eligible National Guard and Reserve Service members will
    receive transition assistance, which includes Pre-separation Counseling
    and VA Benefits Briefing. They will also be afforded the opportunity to
    register for their eBenefits account as well as the opportunity to
    either sign up for VA benefits to which they may be entitled and/or
    schedule a one-on-one appointment with a VA representative to submit
    applications for benefits.
        In addition, the VOW to Hire Heroes Act requires all eligible
    National Guard and Reserve members to participate in the re-designed
    Department of Labor Employment Workshop (except those with exemptions).
        Finally, the Transition GPS (Goals, Plans, Success) includes a CORE
    Curriculum which consists of the following modules and topics:
    Transition Overview, Considerations for Families, Special Issue, Value
    of a Mentor, Military Occupational Code (MOC) Crosswalk, and a
    Financial Management Seminar. The Transition GPS also includes three
    tracks (Education, Career Technical Training, and Entrepreneurship)
    which are in addition to the CORE curriculum. The track they select is
    based on their personal needs and goals.
        Furthermore, the DOD's Yellow Ribbon Reintegration Program (YRRP)
    provides National Guard and Reserve Service members and their families
    with critical support throughout the entire deployment cycle (pre-
    during and post-), easing transitions as Service members move between
    their military and civilian roles. Post-deployment activities are
    specially focused on reintegration into the family, community and
    workforce, providing information and resources through local and state
    agencies, military transition assistance, and other military-related
    non-profit organizations. On-site assistance with enrollment and other
    benefits is included in all YRRP activities, with follow-up
    capabilities offered for those Service members with more long-term
    needs.
        Mr. Loebsack. What specific steps are the Department of Defense and
    the Department of Veterans Affairs taking to identify service members
    transitioning to civilian life who require Post Traumatic Stress,
    Traumatic Brain Injury, or mental health care? How are the Departments
    ensuring that these service members do not fall through the cracks as
    they transition between the DOD and VA health systems? What steps are
    being taken to ensure that transitioning service members and their
    families are aware of the suicide prevention resources available to
    them?
        Secretary Panetta. For those Service members transitioning to
    civilian life who require Post Traumatic Stress Disorder (PTSD),
    Traumatic Brain Injury (TBI), or mental health care for other
    identified mental health conditions, the DOD ensures proper treatment
    and successful transition to civilian life through care coordination
    and transition assistance services through the following policies and
    practices:
          The Military Departments have engineered clinical case
    management services and practices for aspects of care within the
    Military Health System (MHS), particularly as it relates to the care of
    the wounded, ill or injured (WII) Service members. Directive-Type
    Memorandum (DTM) 08-033, ``Interim Guidance for Clinical Case
    Management for the Wounded, Ill, and Injured Service Member in the
    Military Health System'' was initially published in 2009 and updated in
    2012. This guidance delineates the requirements for the implementation
    of clinical case management in the MHS and established MHS medical and
    clinical policies and procedures for WII care.
          In 2011, DOD published policy, ``Continuity of Behavioral
    Health Care for Transferring and Transitioning Service Members,'' which
    prescribes guidelines that ensure continuity of care for Service
    members transferring to a new duty station or transitioning out of the
    Service. This policy directs the Military Services to develop policies
    for transfer of behavioral health care from military to civilian
    providers, including VA providers. When a separating Service member
    provides consent for sharing information with a follow-on behavioral
    health provider, DOD shares all relevant clinical information. This
    includes diagnoses, medications, treatment history including suicide
    risk, test results, treatment plans and prognosis. Service members'
    treatment record information is available to VA providers via the
    Bidirectional Health Information Exchange.
          DOD's inTransition program provides a telephonic coach
    for transitioning Service members with behavioral health issues,
    whether that is in the VA health care system, the Military Health
    System, TRICARE, or the community. The inTransition program has opened
    thousands of coaching cases since its inception in February 2010. The
    acceptance rate for service members referred to the program since
    inception exceeds 95%.
          The VA Liaison for Healthcare, a social worker or nurse
    strategically placed at an MTF with recovering service members
    returning from Afghanistan, is another asset. 33 Liaisons for
    Healthcare are stationed at 18 MTFs, helping transition ill and injured
    Service members from DOD to the VA system of care. Thousands of health
    care transitions have been coordinated.
        For individuals who have suffered a traumatic brain injury:
          The Defense Veterans Brain Injury Center (DVBIC) Regional
    Care Coordinator (RCC) program provides a nationwide care coordination
    network for Service members with TBI. This program facilitates
    transition from the DOD to VA care by working with VA case management
    teams.
          For Service members with more severe brain injuries, a
    DOD-VA Polytrauma Telehealth Network connects the current DOD treating
    team with the accepting treating team in the VA. This facilitates
    transfer planning, affords families an opportunity to meet care teams
    and ensures that medical records are transferred between facilities.
          DOD and VA work together on a Congressionally-mandated
    five year pilot program which assesses the effectiveness of providing
    assisted living services to Service members and Veterans with TBI who
    require ongoing care in the community. VA collaborated with the DVBIC
    on a family caregiver panel to develop a uniform training curriculum
    for family members in providing care and assistance.
        TRICARE Regional Offices have VA Liaisons who serve as
    intermediaries between VA facilities and the TRICARE regional
    contractors. VA Liaisons actively assist with authorizations and
    claims, and TRICARE contractors hold monthly calls with the VA's
    Medical Sharing Office to review the cases of active duty Service
    members who are receiving joint VA/DOD care.
        At each point of contact in these chain of transition events and
    post-active duty follow-on (e.g., the periodic health assessments,
    post-deployment screening, and yellow ribbon events), assessment for
    the potential for suicide occurs and information regarding suicide
    prevention and other helping resources are made available. In addition,
    Service and VA Mental Health and suicide prevention coordinators,
    suicide hotlines (VA and DOD), we have Military OneSource are available
    resources.
        The DOD-VA Integrated Mental Health Strategy includes actions
    specifically focused on transition and continuity of behavioral health
    care. DOD will continue to work with VA in implementation of our
    policies regarding transition and continuity of behavioral health and
    TBI care. We will ensure our providers address transition of behavioral
    health care for wounded warriors to VA and other civilian providers,
    and will continue to manage the important issues of suicide risk,
    occupational impairment, and PTSD.
        Mr. Loebsack. I have held multiple veterans forums across my
    District and have heard time and again from Iowa veterans that they are
    deeply frustrated by the time it takes to process their disability
    claims. The Integrated Disability System was meant to integrate the DOD
    and VA disability evaluation processes. What steps are being taken to
    improve IDES? Do additional steps need to be taken to standardize and
    streamline the disability evaluation process and improve DOD and VA
    collaboration?
        Secretary Panetta. The Departments collaborate closely on efforts
    to jointly refine and improve the IDES. In FY 2012, major efforts in
    this area included:
          The Military Departments significantly increased IDES
    staff levels in FY2012. DOD added authorizations for over 1,500 case
    managers, administrative assistants, and lawyers over the next four
    fiscal years to improve case processing timeliness and customer
    service. Additionally, each of the Services is increasing efforts to
    hire and retain physicians, particularly behavioral or mental health
    professionals. We expect to see process improvements during FY2013.
          In April 2012, the Secretary of Defense and Secretary of
    Veterans Affairs directed their Departments to implement a paperless,
    searchable claims file for the Integrated Disability Evaluation System
    (IDES). The Departments created an electronic case file transfer
    capability for IDES cases as an interim step towards that objective.
    The Departments initiated a pilot test of that capability at 11
    locations in September 2012. The Departments will decide whether to
    field the electronic case file transfer capability in January 2013.
          In June 2012, VA released version 2.0 of the Veterans
    Tracking Application (VTA). This version incorporated operational
    reports that improved IDES case oversight capabilities. Additionally,
    DOD developed and fielded case tracking tools that enable installation-
    level visibility of case duration and data errors.
          A DOD IDES Task Force, comprised of senior leaders from
    the Department, conducted an end-to-end business process review of the
    IDES and, as of October 2012, is preparing recommendations for
    additional improvements for the Secretary of Defense.
        Mr. Loebsack. What specific steps are the Department of Defense and
    the Department of Veterans Affairs taking to coordinate transition
    assistance and benefits for members of the National Guard and Reserve
    transitioning from Active Duty service back to civilian jobs and
    civilian life? How are the Departments coordinating to ensure members
    of the Reserve Component are aware of the DOD and VA benefits available
    to them?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Loebsack. What specific steps are the Department of Defense and
    the Department of Veterans Affairs taking to identify service members
    transitioning to civilian life who require Post Traumatic Stress,
    Traumatic Brain Injury, or mental health care? How are the Departments
    ensuring that these service members do not fall through the cracks as
    they transition between the DOD and VA health systems? What steps are
    being taken to ensure that transitioning service members and their
    families are aware of the suicide prevention resources available to
    them?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Loebsack. I have held multiple veterans forums across my
    District and have heard time and again from Iowa veterans that they are
    deeply frustrated by the time it takes to process their disability
    claims. The Integrated Disability System was meant to integrate the DOD
    and VA disability evaluation processes. What steps are being taken to
    improve IDES? Do additional steps need to be taken to standardize and
    streamline the disability evaluation process and improve DOD and VA
    collaboration?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
                                     ______

                       QUESTIONS SUBMITTED BY MR. KISSELL
        Mr. Kissell. What is the possibility of getting VA and DOD medical
    records electronically available for civilian medical venues? How and
    when might this be implemented?
        Secretary Panetta. One important goal of the integrated electronic
    health record (iEHR) is to maximize the information exchanged among DOD
    and VA health providers and private providers via bilateral
    communications and health information sharing. Specifically, the IPO is
    continuing to develop the Virtual Lifetime Electronic Record (VLER)
    Health program that enables the exchange of electronic medical data
    with the private sector. For example, under VLER Health, a private
    sector provider or hospital can request electronic health data from the
    DOD or VA, and the Departments can securely provide that information
    back to the requesting party. This exchange is governed by the Data Use
    and Reciprocal Support Agreement (DURSA) developed by the Office of the
    National Coordinator (ONC) at Health and Human Services (HHS). ONC is
    also responsible for the development of the infrastructure that
    supports this exchange. This infrastructure is called the Nation-wide
    Health Information Network (NwHIN), and the DOD and VA have been
    actively engaged in its development. Through the DOD's and VA's
    participation in the NwHIN, the departments will be able to exchange
    electronic health data in a secure and trusted way with private
    healthcare entities.
        VLER Health capability has been demonstrated at 4 joint DOD/VA
    sites, and at 11 other VA sites as part of the VLER Health
    demonstrations. Recently, the Joint Executive Committee (JEC) has
    approved the further deployment of VLER Health at sites that meet
    criteria that ensures its effective implementation: where there are
    large numbers of beneficiaries using private sector care, where the
    state Health Information Exchanges (HIEs) are mature, where the private
    sector has electronic medical records, and where the beneficiaries have
    ``opted-in'' to the program. These exchanges will continue to grow over
    the life of the iEHR.
        Mr. Kissell. What is the possibility of getting VA and DOD medical
    records electronically available for civilian medical venues? How and
    when might this be implemented?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
                                     ______

                      QUESTIONS SUBMITTED BY MR. GARAMENDI
        Mr. Garamendi. Please advise of the contractor that developed and
    currently maintain DOD's electronic health records system and the
    contractor that developed and currently maintain the VA's electronic
    health records system. Are either of these contractors developing the
    Joint Electronic Health Record, iEHR? If not, has this attributed to
    the delay of iEHR? What steps are being taken to ensure a seamless
    transition between current contractors and new contractor?
        Secretary Panetta. VistA was developed by the VA clinical
    community, rather than contractors. The Composite Health Care System
    (CHCS), DOD's predecessor system, was developed using the Veteran
    Administration's Decentralized Hospital Computer Program (DHCP) as the
    foundation and modifying modules when possible to meet the requirements
    established by DOD. Additionally, CHCS has a long history and does not
    have one specific contractor that can be singled out as responsible for
    its development.
        The current contractor support to iEHR was not involved in the
    support provided to DOD and VA legacy electronic health record (EHR)
    systems; however, this has not resulted in a delay. The DOD/VA IPO's
    government staff has extensive technical knowledge of respective legacy
    systems and/or reach back to the Departments for expertise as needed.
        Mr. Garamendi. In your testimony, you stated that the iEHR is
    expected to be fully operational no later than 2017. Considering the
    immediate need for this system, will additional funding enable you to
    provide the system sooner? If not, what steps can be taken to improve
    your current schedule?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
                                     ______

                      QUESTIONS SUBMITTED BY MR. SCHILLING
        Mr. Schilling. From casework, I've heard that veterans who have
    been treated for PTSD have been overwhelmed by doctors and that they
    have not made things better, but worse. In fact in one case a patient,
    who later committed suicide, was over-medicated by multiple doctors who
    did not check with each other, per his father. Is it common practice to
    have multiple doctors for one patient with PTSD? Can this be fixed by
    this new system?
        Secretary Panetta. It is not common practice for one patient to be
    treated for the sole condition of PTSD at the same time by multiple
    doctors. However, conditions that lead to or co-occur with PTSD (e.g.
    poly-trauma) may involve multiple providers and teams of care. The
    current system implemented by the DOD has many safeguards and risk
    mitigation strategies in place to prevent this type of incident from
    occurring--especially in regard to the prescription of pharmaceuticals.
    For example:
          The Tricare Policy Manual mandates that coordination
    between various medication providers must be evidenced in the treatment
    plan.
          Poly-pharmacy in the use of opiate medications has been
    reduced in Warrior Transition Units, and other clinical settings owing
    to leadership and case management interventions.
          The Army has implemented the Sole Provider Program to
    help identify patients who exhibit drug-seeking behavior by conducting
    periodic reviews of all prescriptions for controlled substances,
    identifying suspicious drug usage patterns.
          Clinic procedures limit the number of pills dispensed to
    potentially high-risk patients.
          Warning flags appear in electronic drug dispensing menus
    which require physician attention.
          Military Treatment Facilities (MTFs) have prescription
    restriction programs, and real-time monitoring and reconciliation of
    prescriptions dispensed through MTFs, mail-order, and network
    pharmacies.
          The Department of Defense (DOD) PharmacoEconomic Center
    (PEC) provides a single, comprehensive patient drug profile for DOD
    beneficiaries across the Military Health System, allowing monitoring
    and surveillance of drug contraindications or usage patterns of
    concern.
          When a prescription is filled within the U.S. Military
    Health System, an online system, the Pharmacy Data Transaction System,
    automatically checks the prescription against the patient's medication
    history before the drug is dispensed. This process includes retail,
    mail and military treatment facility pharmacies and has helped avoid
    more than 171,000 potentially life-threatening drug interactions.
          Pharmacists throughout the Military Health System provide
    consumers with a medication information sheet on each new and renewed
    prescription. DOD evaluates for drug-drug interactions on every
    prescription prescribed by mail order, a retail pharmacy or MTF,
    ensuring our patients receive medication that is safe and medically
    indicated.
        Mr. Schilling. From casework, I've heard that veterans who have
    been treated for PTSD have been overwhelmed by doctors and that they
    have not made things better, but worse. In fact in one case a patient,
    who later committed suicide, was over-medicated by multiple doctors who
    did not check with each other, per his father. Is it common practice to
    have multiple doctors for one patient with PTSD? Can this be fixed by
    this new system?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
                                     ______

                       QUESTIONS SUBMITTED BY MR. BARBER
        Mr. Barber. Our armed service members are some of the best trained,
    most disciplined, and most ambitious men and women in our country. How
    can the Department of Defense work with our other agencies, including
    the Department of Labor, to better educate employers and departing
    service members about how military skill sets translate to civilian
    skill sets? How Congress can be more helpful in conveying the skills
    and attribute of our veterans?
        Secretary Panetta. The Department very much appreciates Congress'
    actions to improve the employability of our Veterans. Sections 558 and
    551 of the National Defense Authorization Act for Fiscal Year 2012 are
    assisting us in identifying critical training gaps and in beginning
    skills training in sufficient time to facilitate a smooth transition to
    civilian life. Authorities in the recently enacted Veterans Skills to
    Jobs Act, Public Law 112-147 (H.R. 4155) will help with several aspects
    of credentialing and licensing of Service members. These recent
    Congressional initiatives are essential in the transition of our
    Service members from Active Duty to civilian life.
        The Department is working very closely with our federal partners to
    better educate employers about translating military to civilian skills.
    In May, we established the DOD Credentialing and Licensing Task Force
    led by the Deputy Assistant Secretary of Defense for Readiness to
    oversee all credentialing and licensing initiatives within the
    Department. Our Federal partners from the Departments of Labor,
    Veterans Affairs, Education and Transportation are represented on the
    Task Force and are working with us to address the unique challenges
    faced by Service members as they transition to civilian life. The
    Department is also working with the National Council of State
    Legislators, the American Legion, and several state governments to
    facilitate civilian recognition of military skills.
        Education and outreach by DOD and other Federal agencies are
    critical to helping employers better understand military skills.
    Meeting with employers on a regular, ongoing basis to address specific
    issues, such as promoting the quality and transferability of military
    education, training and experience, is important and may include
    translation of military technical and leadership skills using a
    nationally recognized badging system. Also, educating employers about
    Service members unique needs in regard to domicile/residency
    requirements, recognizing national certifications or other national
    exams, and deployment experiences and why these are not detriments to
    hiring Veterans would also be helpful.
        Civilian companies can become more involved in the hiring process
    by being encouraged to participate in job fairs where military members
    can interview with their resumes and military records in hand.
        DOD and other Federal agencies can also help business leaders
    better understand how well military members perform using recently
    added title 10 authorities that deal with apprenticeship and transition
    training opportunities for separating Service members. This may involve
    pilots with industry to hire military members at mid to senior levels
    on a trial basis and not merely focusing on the unemployed or
    sponsoring them at entry levels.
        Mr. Barber. As service members return from deployment and
    reintegrate, they experience a period of readjustment. Growing up in a
    military family, I know that their families, too, go through an often
    difficult transition. What are some of the efforts that DOD is working
    on to engage military families in the transition process and encourage
    spouses to take advantage of transition services?
        Secretary Panetta. The Department of Defense provides a number of
    services that support the transition of Service members and their
    families throughout the military life cycle. The return of a Service
    member from deployment is understandably an adjustment for the military
    family and calls for targeted efforts.
        Each Service branch sponsors information and support programs for
    Service members and their families and begin with pre-deployment
    preparation, like family care plans, and include deployed family events
    that take place during the Service member's deployment. Current
    programs also consist of reintegration briefings sponsored by the
    installation Family Support, Community Support or Readiness center.
    These reintegration briefings include family members and cover topics
    like preparing for a reunion, updating administrative, legal,
    financial, and employment affairs, and adjustments to be experienced by
    a Service member, spouse, and children. For Guard and Reserve
    personnel, Yellow Ribbon Reintegration events and the Joint Family
    Support Assistance Program are integral to family support.
        These centers also provide resources in the form of DVDs, books and
    activities for children of Service members to assist with dealing with
    the absence and return of the deployed family member.
        The Family Support Centers and Chapels of most military
    installations also offer Military Family Life Counselors (MFLCs),
    marriage counseling and communication classes, free childcare and or
    discounted activities for families.
        Of course, the military lifecycle includes the transition into
    civilian life. The re-designed Transition Assistance Program (TAP),
    known as Goals, Plans, Success (GPS), prepares separating Service
    members and their families by building career readiness skills and
    self-confidence necessary to assist in successful reentry into the
    civilian work force or student life. Spouses are encouraged to
    participate in transition planning and curriculum to the maximum extent
    possible alongside their spouses or attend on their own.
        The TAP GPS core curriculum provides information and training on
    financial management, teaches Service members how to translate their
    individual military skills into civilian skills, provides a detailed
    overview of potential veteran's benefits, and employment tools and
    resources to aid in finding a career. The TAP GPS Career Track modules
    are provided based on an individual's career choices and needs be those
    higher education, technical training, or entrepreneurial aspirations.
    Transition preparation cannot be a one size fits all approach and, just
    as our military families don't fit one mold, the new TAP GPS can be
    customized to meet their family needs.
        Service members must also create an Individual Transition Plan
    (ITP), a holistic tool that leads Service members through thoughtful
    consideration of family issues like impact of the career change upon
    children, elderly parents, and spouses. The changing financial
    situation, due to separation from military careers, is specifically
    highlighted and planned. Social support networks must be considered.
    The ITP is competed in private during TAP GPS modules so that family
    members can participate in its development at home and in classes.
        Utilization of Transition GPS will improve the Service members'
    effectiveness and their ability to be ``career ready.'' By creating an
    ITP that starts early and considers the spouse, children and family
    needs, the family can also be better prepared.
        Mr. Barber. Post Traumatic Stress Disorder and Traumatic Brain
    Injury have been called the signature injuries of the current wars
    abroad, but they can be silent injuries that often go undiagnosed or
    come with a stigma that cause them to go unreported. What steps is the
    Department of Defense taking to identify these service members and
    ensure their complete and successful transition into civilian life?
        Secretary Panetta. The Department of Defense (DOD) has pre- and
    post-deployment screening for symptoms of TBI, mental health issues and
    substance use and abuse (which can signal unidentified problems). The
    post-deployment screening occurs immediately following a deployment and
    is repeated at 3, 6 and 12 month intervals thereafter. All deployment
    health assessments incorporate both self-report questions for Service
    members and specific questions that guide healthcare providers in
    conducting mental health assessments for suicide risk, TBI, PTSD,
    depression, and alcohol use.
        National Guard and Reserve units partner with VA to conduct Yellow
    Ribbon events 90 days post-deployment, increasing awareness of VA
    benefits, programs and services. Military Services' demobilization
    events provide a setting for post-deployment National Guard and
    Reservist members to meet with VA staff to complete enrollment forms.
    As well, referral recommendations for VA behavioral health care are
    generated for National Guard and Reserve members during the 3-month
    post deployment assessment.
        For those who are injured and/or transitioning out of active duty
    status, the DOD ensures proper treatment and successful transition to
    civilian life through care coordination and transition assistance
    services. This continuum of evaluation, assessment, treatment, and
    coordination and transition services is carried out throughout the
    lifecycle of a Service member's tenure.
        In 2011, DOD published ``Continuity of Behavioral Health Care for
    Transferring and Transitioning Service Members,'' which prescribes
    guidelines that ensure continuity of care for Service members
    transferring to a new duty station or transitioning out of the Service.
    This policy directs the Military Services to develop policies for
    transfer of behavioral health care from military to civilian providers,
    including VA providers. When a separating Service member provides
    consent for sharing information with a follow-on behavioral health
    provider, DOD shares all relevant clinical information. This includes
    diagnoses, medications, treatment history including suicide risk, test
    results, treatment plans and prognosis. Service members' treatment
    record information is available to VA providers via the Bidirectional
    Health Information Exchange. DOD's inTransition program provides a
    telephonic coach for transitioning Service members with behavioral
    health issues, whether that is in the VA health care system, a Military
    Treatment Facility, TRICARE, or the community. The inTransition program
    has opened thousands of coaching cases since its inception in February
    2010. The acceptance rate for service members referred to the program
    since inception exceeds 95%.
        For those who have suffered a traumatic brain injury, The Defense
    Veterans Brain Injury Center (DVBIC) Regional Care Coordinator (RCC)
    program provides a nationwide care coordination network to support
    Service members with TBI. This program facilitates transition from the
    DOD to VA care by working with VA case management teams. For Service
    members with more severe brain injuries, a DOD-VA Polytrauma Telehealth
    Network connects the current treating team with the accepting treating
    team in the VA. This facilitates transfer planning, affords families an
    opportunity to meet receiving care teams and ensures that medical
    records are transferred between facilities. DOD and VA are working
    together on a Congressionally-mandated five year pilot program which
    assesses the effectiveness of providing assisted living services to
    Service members and Veterans with TBI who require ongoing care in the
    community. VA collaborated with the DVBIC on a family caregiver panel
    to develop a uniform training curriculum for family members in
    providing care and assistance.
        TRICARE Regional Offices have VA Liaisons who serve as
    intermediaries between VA facilities and the TRICARE regional
    contractors. VA Liaisons actively assist with authorizations and
    claims, and TRICARE contractors hold monthly calls with the VA's
    Medical Sharing Office to review the cases of active duty Service
    members who are receiving joint VA/DOD care.
        The VA Liaison for Healthcare, a social worker or nurse
    strategically placed at an MTF with recovering service members
    returning from Afghanistan, is another asset. 33 Liaisons for
    Healthcare are stationed at 18 MTFs, helping transition ill and injured
    Service members from DOD to the VA system of care. Thousands of health
    care transitions have been coordinated.
        The DOD-VA Integrated Mental Health Strategy includes actions
    specifically focused on transition and continuity of behavioral health
    care. Data are being shared between the Departments on rates of follow-
    up in at VA Medical Centers and Vet Centers for Service members
    referred to VA for a behavioral health issue identified during the
    PDHRA or the Post Deployment Health Assessment (PDHA). These data show
    that among Service members whose behavioral health follow-up is
    recommended during the PDHRA, 43% have a behavioral health encounter at
    a VA facility within 90 days.
        DOD will continue to work with VA in implementation of our policies
    regarding transition and continuity of behavioral health and TBI care.
    We will ensure our providers address transition of behavioral health
    care for wounded warriors to VA and other civilian providers, and will
    continue to manage the important issues of suicide risk and
    occupational impairment and suffering from PTSD.
        Mr. Barber. What is the Department of Defense doing to ensure close
    access to health care services for service members who are stationed in
    rural areas? Does DOD contract with exiting, private sector behavioral
    health professionals and agencies to provide health care services close
    to where service members are stationed?
        Secretary Panetta. Active duty members, including activated
    National Guard/Reserve members, who are stationed more than 50 miles or
    more than one hours drive from a military treatment facility are
    enrolled in TRICARE Prime Remote (TPR) to ensure most care is provided
    in their local area. Members may select a primary care manager (PCM)
    from the TRICARE network, or if one is not available, can select any
    TRICARE-authorized, non-network provider as their PCM. The PCM refers
    members to TRICARE network specialists in the local area if available
    (or TRICARE-authorized, non-network specialists), and coordinates with
    the regional contractor for authorizations and claims.
        Mr. Barber. My district in Southern Arizona is home to more than
    10,000 veterans. I appreciate the attention that VA and DOD are giving
    to this issue of transition assistance--an issue of critical importance
    to the service men and women I represent and their families. I hear
    from service members frequently about the long lag time between the
    time they file their VA claims at time of discharge, and the time the
    claim is adjudicated. They frequently wait 6 months or more before they
    receive compensation from the VA. For a service member transitioning
    from Active Duty and looking for a job, that VA check could be their
    only resource for buying food and paying rent. In addition to providing
    additional transitional assistance to our service members, what more
    can be done to fast track basic transition services and reduce the wait
    time?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Barber. Unemployment among our veterans has reached historic
    proportions. Nearly 780,000 veterans are unemployed, and as the numbers
    of troops in the Middle East are reduced, about 100,000 more vets will
    be looking for jobs. According to the Bureau of Labor Statistics the
    average unemployment rate in the U.S. in 2011 was 8.9 percent, but the
    rate of unemployment among anyone who was a member of the U.S. Armed
    Services since September 2001 was 12.1 percent. As part of the new
    Veterans Employment Initiative Task Force, what specifically will be
    done to eliminate this disparity in current unemployment levels between
    veterans and the general population? How will the Department of
    Veterans Affairs work to accomplish that goal?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Barber. Post Traumatic Stress Disorder and Traumatic Brain
    Injury have been called the signature injuries of the current wars
    abroad, but they can be silent injuries that often go undiagnosed or
    come with a stigma that cause them to go unreported. What steps is the
    Department of Veterans Affairs taking to identify these service members
    and ensure their complete and successful transition into civilian life?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]
        Mr. Barber. What is the Department of Veterans Affairs doing to
    ensure close access to health care services for veterans who live in
    rural areas far away from VA centers and clinics? Is the VA authorizing
    VA centers to contract with exiting, private sector behavioral health
    professionals and agencies to provide services close to where veterans
    live?
        Secretary Shinseki. [The information referred to was not available
    at the time of printing.]