Warhorses. This is just over 50 minutes. Thank you all for being here and i met tj years ago and i came back and said something that journalism thing is like the and am so proud and happy to be here happy to have you all here. Its a crazy year for you. And we just stopped talking about the phillies and we ask questions and they never answered even for good news stories and draft press conferences for parents to get back to us and you keep coming back so i was wondering if you could talk about that. And thrilled to be chatting with you again and have admiration for you and the cover of. I think the topic for today is right, how we Cover National Security and thats how i entered the equation. The bottom line just believe we have 9 million enrollees so mom position missus we want to reach them and the reason is to make sure we can reach that and i admire what you are doing and transparency is a good way to run the other day the outcome youre looking for is for Veterans Trust the va and enough to come in and file a claim with us because we want all 19 million one way or another. That goes into my second question of it going out across the nation information about the pack act, the military press for a shrinking and im wondering if it makes it more difficult and trying to get the word out but get prepared. Let me say first so its going, i think we think that there are roughly a little over 6. 2 million veterans we believe qualify for the pack act. Theres a lot in the for whom we dont have great deployment records for so thats what youre starting with, that record numbers 5. 3 million veterans. Today we had about 450,000 file a claim under the impact act so you can see for 50000 is a big number especially working with the denominator and veterans in our care have the toxic exposure screen in the conversation with their primary care provider what youve experienced and repeated about 2. 3 million. Mileage it topic number and 40 of those veterans tell us about exposure that we were not aware of. These are veterans in our care and we are learning and this allows us to forward on that very is a sense. Why is that for 50000, why isnt it safer . Each of them as to the question youre asking, for lack of trust, its not everybody in the numbers are Getting Better later this year first time applying the trust survey and second a lot of us are unaware so its going to be us fighting aggressively but also the conversation with veterans which i know we all have on a plane, these are just the last weeks. Interests if they dont qualify for think they should qualify, as a reservist woman deployed in a combat zone, six different deployments, she didnt qualify. Incidentally they are more likely to be in category two or three unaware think they dont qualify and then we have a group of warriors more i choose not is that i can tell you. The way to prosecute when you file your claim, the claim we can use automation to understand but also helps us tell a better story about veterans in your unit, veterans in the unit close to so your filing doesnt and you have to understand the Bigger Picture to make benefits efficient. Our ability to make categories one, two and three make sure people are aware and no they personally are aware and it depends on getting the very interested in your talking a lot about this is the most important thing and its something we dealt with at the white house and something we deal with now and going back to your first question is so important for us. Trust is hard to earn and what is gone, its hard to get back. We can make progress. We talk a lot about how many people are her claim for benefits years and creates for men and women and those numbers are tiny. Ive got asthma, whats next . Hopefully we can get you in so theres of the and hopefully we continue into treatment. Is the immediate, before the benefits. You start getting it, we have a window here early in the pack act so the initial fiveyear window deployed veterans is now open so you come in, we can get you in. Sometimes at least for me, you dont know. We know qualifies and weve been working with our actuary we know about toxic, would we particularly need to hire them if are you, get smart about what people need and i knew that was right is a work of the guy who signed it so i knew that. So we did that assessment and heres what we know. What we overwhelmingly need is our Mental Health because what we know about what we have experienced as a country is that you may come into get treated for asthma first victory issues but you must i find is a great trick back there might be a reason to. Thats why i am really excited about the fact act. They patched is that experience for the renewal of the conversation, women who have actually not believed the have something and hopefully we can. So the audience, thank you because i dont think they would be here if it happened on the. The law think about hiring in the narrative that was difficult and look at the contract again and we start from scratch. This is modernization so for 20 years the public record, our clinicians are very proud that the architect and managers of the Electronic Health record its a really cool thing, the agility and thoughtfulness but that was a revolutionary vehicle and now a lot of time but its also specialized by va medical center, a truly comprehensive. Veterans when you retire, to have a full record in your Service Available so we can understand in terms of claims. In 2018 or 19, the contract to deploy and update Electronic Health record, the tenure contract into employees in oregon, we had. Thats a word . Yes the tenure contract and vision, we are in the middle of the. I believe strongly we need a contract with greater accountability and stability to have legit heavyweight experience working with our legit heavyweight Healthcare Professionals to make the Health Record work. We are trying to make sure we do it here. You play well with others on this . We have a big priority here in chicago and we have a jointly deployed va and you facility, that is an example thats really important dod we commit to them but i think dod is a good contract and it is important draw approval with dod but make. The va is a customer in and of itself so i think secretary also understand make sure we have everything in the contract. His right now and making sure we get it but without it appears that. The Affordable Care act for the insurers to get the get records on board and thinking about the skin in the game for this one im not sure what the rest of the skin in the game is. Its interesting and one thing you said is satisfaction the technology we are trying but as an agency weve been insistent that cant be the only major. It is an important one but at the end of the day we have risk sounding like management but ill give it a shot anyway. We have to remember the why and i think we lost that so the why is Better Health outcomes for veterans. Disputes about that we need better Electronic Health records to ensure Better Outcomes from. Thats the lifeblood of the va, the whole purpose of this multibilliondollar investment and we have to stay focused on the. The system itself contributing to the satisfaction of our profession very important and lucite in the game which is our commitment that you will have Better Health outcomes. We got decades of experience that suggests Electronic Health records so we got to get through this. Now we are trained, better deployed and we need a better contract and then look at Better Outcomes. Thats the whole reason. Everything else is what it means for a veteran. So getting back to the fact act. Seems like its taking a long time but its actually really fast. Vietnam veterans and any other generation of veterans getting out of his and this one is going pretty quickly. Can you talk about why . It wasnt all stuart even thoug i think the reason it went through his have said this in Public Session before reporting like yours that very much crystallizes the issue in a concrete way for members of congress mostly for the public so understanding of the issue which is more profound in this instance because this period of war going back to go for one has been so front and center in American Life that we focus on this. That wasnt the case for example in vietnam, artist of the country was divided then, to wanted to close that chapter how they go by but one is general awareness. Two is veterans, a member this, not somebody who wants to make words even when you try so veterans taken on themselves. Consequently the president very badly wanted this to happen and i think the is experience and it was careful wanting not to have his personal belief that developed as a result. Those interested in was focused is no doubt United States challenged congress to do something, its a powerful tool. The book, but we talked the first time i asked you why you would take this job . [laughter] am still not sure. [laughter] it feels like you have major job more difficult. Which is good in a way for us my question is you in the background have been pushing presumptive through, how . Long it takes to get those in presumptive through. What is it youre doing in the background to move things up . Looks really interesting. I think dans remarks touched on this. Among the things i am is the fact the law has codified a process we run internally to establish new presumptives. The highly sensitive at their heart weathers is their data, is there science to show its connected . One of the reasons we have to be as transparent that i believe we should be more transparent is because we have to get people to trust us more. Just had a conversation who doesnt believe her transparent about anything . We believe our strategy to delight. And in that context people just think not only are we not legit looking at anything, we are actually ignoring it. So weve set up a process works with every member of the federal government that has access to data that can help inform a decision about whether some set of toxic exposures and some conditions are connected. So much for a long time and we still do we work directly with the National Academies of science that really good theyre very smart are scientists its great. But there is no reason we should limit ourselves to that sole source of intelligence. We should get National Institutes of health. Ansell National Institute of cancer, osha. Dod data we should get firefighters data. She every bit of data that there is income that informed decisions about new presumptive connections. In the background thats overdoing fairly asked for more money from congress to grow out our center of excellence based on east orange new jersey. She look at more in science and get access to more science for to inform new decisions. But the fact at the end of theyg science for more sources, we are investing in more researchers to be able to prosecute more science. Making this connection is not easy. Its just standard beakers pipettes and all that stuff. You need a lot of that, you need time, need to dig into it, you need to prove it. So we are going to execute as the presumptively party established, there were nine of them plus 20v. And then well keep adding as we can get more and more. We sought recently appears to be a connection exposures to pilots and ground crews. Relating to cancer. It is a classic thing we have to now take an prosecute and try to make some connections to our establish process confirm the pact act allows us to do that. How quickly can we get that done . That is the milliondollar question. Not as fast as i want to stoop. But i keep checking. This raises an interesting question, right . We set off keep calling knees and say have you made that presumptive connection yet . And at what time i think jamie going cia to say you find out weapons of mass destruction must keep asking the question you are eroding their independence and their integrity, right . I want to not do that. But at the same token i went to not just let this it got be on the express. Effective veterans battling. Plexus taken years to get anything. So to understand a little. He said that was the milliondollar question. I think the other big question is as taxpayer talking about the budget the cost of these exposures is going to be a lot. If i were a taxpayer, and i am i would be pissed. Not only because he got so many people to the armys own regulations that you cannot burn trash in an open pit because of the truth but what we talk about these things any ideas about what we could be doing to prevent these types of conversations in the future . This is why i think of the three factors that led to the passage of the pact act we have to make sure we are continuing those to first principles. Which is the partner is scratching and digging into this, not relenting on it. Active duty and veterans continue to advocate when they see something to say something. And there is a certain degree when you go to war you go to work. You are actually very focused on that moment. And im obviously sympathetic to that as you because you did. This is why i thought the reporting earlier this week was unfair. In as much as we have to be honest with yourself with the full cost of war go to work. As President Biden calls at our sacred obligation to those who have fought our wars we have a lot of obligations but only one and that is to our vets. We have to start seeing that as a cost of war and factoring combat in but not expressing surprise all the time that this is happened. So how we budget for things, how we divvy up the federal budget actually hides in some ways the cost of war. Think us being candid about it and underscoring the white we are doing it the Silver Bullet here i guarantee this going to be another challenge you next time when we look back it seems so clearly as we continue to be honest with ourselves about what we are doing and the need for reporting about who is paying the price meant namely our troopers in fact all this is like extra credit exposed to toxins in iraq. I could optional exercise we get your back at work we get when you come home. That is our job to keep that promise could we make it as a country. We keep the promise for the idea is discretionary question support somehow that is a discretionary expense i think is wrong. Looks okay come think were supposed open for q a now. Its only easy questions i heard. There is someone i do not know whos going to call the questioners. So they go to early. [laughter] i am one of the Management Consultants by the way. Quick saturday sound constructed a sound good . [laughter] very clean. During your tenure many of the veterans regarding your with the healthcare initiative, burn pit earned about about getting veterans to their Health Appointments with uber. What are some initiatives you are most excited about during your time as secretary of defense . Really, really excited about coming down the pike and sharing with us. Thanks so much. One thing im really excited about his marine veteran on the west side. For some its really exciting place hope manner. There are big grantees that is helping us the veteran homelessness. And grantees like volatiles of america illinois and then our staff working together is what we are approaching functioning zero Homeless Veterans in chicago. Which is really exciting. But, this is a veteran make this marine veteran is recall. Support specialists. Really innovative cool program and the va. But in many ways is not at all innovative especially for those of us who are familiar with aa, alcoholics anonymous. Support specialists are 1200 of them across the country. All veterans in recovery who are trained and paid by va to help other veterans trying to get into recovery. What do we know about Substance Abuse disorder . We note trusting mentor mentee relationship is really important to making sure your daily work on fighting up Substance Abuse disorder sticks. What else do we know . We note vets helping events is very powerful force. You see this when it is active duty units helping one another. The most powerful force on the place of the planet in history. That same bond makes it that powerful is in these cases of 1200 individually trained. Support specialist bringing the same concept, unit cohesion watching out for each other not leaving you behind. I was getting her back. One of the real challenges we face as a country which is Substance Abuse disorder. That is powerful. It is all cheeky to call that innovation. Not even hours its alcoholics anonymous. But when you operate at the scale you do with the resources to the credit of republicans and democrats and generous appropriations for us we can take Something Like that and really scale it and im excited about that thanks for the question. Looks good morning. Thank you both for being here. My name is megan i am a Program Analyst with the ba. I support vision 17 which is most of texas. You know. And i have had the opportunity to work with primary care providers giving the data, the information they need, specifically for the toxic exposure screening. Some need back i have gotten is a general concerns time management and things of that nature introducing the toxic exposure screening. Particularly an hour more Rural Communities as you know primary care providers tend to be quite high patient loads and things of that nature. I think it really highlights a bigger issue within the ba. And that is just primary care. What does the va intend to do to ensure there is enough providers for our veterans . What are some solutions that might be implemented . Whether its partnering with the community, hiring initiatives, just to make sure those key primary care providers have the support they need to take care of our veterans. Right question. Thanks for your partnership, megan. I would see a couple of things. One, i hear the frustration. And on one level i want to say i hear you, we will work with you and im going to come back to what were going to work with people on. Another level i want to say we did in twopoint to million of these and 40 of cases are primary care providers are finding out about an exposure to these toxins through just heard dans speech about what this means. Who are learning about that for the first time. That is a clinically analytically important events. Veteran may be suffering from something we do not yet know. Based on that exposure. His were asking we ask our providers to give the toxic exposure screening for were not just asking them to check the reflexes. We are asking them to have a conversation with the veteran about something we know now to be profoundly impactful on their overall wellness. Oh to now be more understanding of the frustration for the primary care providers who are the best in the country, we do need more doctors, we need more nurses. We need more frontline workers. We need more psychologists. We are on the verge. Now every friday, three other friday we have a packed act dashboard. How we are doing on performance on the packed active straight watch out for that very thing the next one is due a week from tomorrow, not tomorrow. Just meant to be another transparency and confidence building mechanism. We are about to launch a workforce dashboard for the same purpose. We will track nine or 12 specific job categories and how we are doing. We will publish the data to show we have goals for this year but will show we are meeting and performing against our ultimate goal. I can tell you this, since its april we are now halfway through the fiscal year. Youre well on your way to our targets let me tell you about nurses. We have just had the best two quarters for the hiring of nurses that we have had in 25 years. Those are nurses three levels. Registered nurses, licensed practical nurses last july was the first month and a couple of fiscal years that we added more nurses than we lost. The last couple of years for a va similar to the lien of other healthcare systems. We are actually losing nurses from our healthcare rules for the going elsewhere change in the six or eight months. Why did it change . Congress passed two important laws mosey packed act as love authorities in there including pay authorities. And something called the raise act just expressly directed at nurses salaries. So we are using those authorities now. One thing we have to do better job of is a biltmore capability country. Rather than moving nurses of round the Healthcare Providers lets get more nurses. Im really proud of bas capabilities there, just in portland on tuesday or maybe it was wednesday. I am not sure. I do not even know it today is. Thursday. It wasnt yesterday tuesday. Ar increasing the nurse Assistance Program where nursing students to all of their clinical work in the portland ba. So what we find is when we do that those nurses are sticky and stay with va. We also know, which is a good thing, but we also know that if they are not Clinical Training opportunities for our diverse students we will get nurses. This is a win win effect we increasing the number of nurses in the market. We are also making them more likely to choose us when they get a job. An example of what were doing and we have to do much, much more of it. 70 of doctors get at least some of their training at ba. It is a remarkable figure. There is no reason that shouldnt grow. A question for virtual audience. They asked what more is being done or can be done for dependents that have lost a veteran to toxic exposure . Looks excellent question. We have a specific and concerted effort to make sure that survivors lost their veteran to toxic exposure have a clear understanding of the benefits available to them. That survivors specifically should contact 1800 might be a 411 or go to va. Gov packed. Survivor make sure they can file a claim as a survivor. The Survivor Benefits now as a result he packed act include ability over time of course and other benefits. I really encourage the question or two please contact us and we will get you filing your claim. Next secretary thank you very much for your candor, great admiration for the work youre doing. I have the pleasure of serving as ceo of eight nonprofits. Bottom line up front my question has little context but what can the va do to help with unique Mental Health challenges for folks that get care by virtual presumption question with the connection is to the warhorse for the worst published a piece with the presumption of guilt in january. I am a marine corps veteran is one of the few able to get through the system before the pact active through the jaws you something ive been dealing with since my service. One of things i realize or something unique when your care is not as clear as other injuries pretty step your stampede see you naked and care for get care for toxic exposure have some sense of what the bank is that leads to personally a decade plus of just wondering am i actually eligible for this . Is it something i should be seeking . Theres some really challenges when the warhorse for a while i thought this might be something relatively unique to me. The number of people that reached out just to say me too there are so many people that built this unique area really dealing with the mental toll of getting care, Getting Compensation for something that has more and more exposure. I wonder if theres a connection for the va great work recently about hispanic Mental Health services which quite literally helps in the life of a close friend a few weeks ago for a great admiration for that initiative. But thing about the primary care screening and the Mental Health support for folks going through this presumptive process. I think i would say three things to this. First remember why va started in the first instance. Started to two things primary care and Mental Health care. Nothing we been perfect on it but those are kind of the formative offerings for va. Going back to the day. Second, i really hope that any veteran were ever they are in the process rolled for example, if you are in crisis you can reach us doubt 988 press one we are make sure you are seen that day, right . Is that your question but i want to underscore this again. You do not be enrolled in the va to call the Veterans Crisis line. And under a new piece of law you also do not have to worry about how going to get paid for. I will make sure we take care of the copays and everything. So call 988 press one if you are in crisis. Third is the other thing you can do is walk into any of the three and 15 vet centers we have around the country which are Counseling Centers set up in retail settings. Overwhelmingly staffed by a veteran test counselors including count that veteran slaves themselves the va without the hassle their bench a vietnam vet synonymous with the big va they called it state established the vet centers. Great vet center here in chicago a couple of them in facts. Thats the third thing you can come see us there. You are establishing a relationship with your primary care provider in decisions about what care you get once you have established that conversation is derivative of your relationship with your provider. So its not like in the old days your Service Connected for your knee you can come in. Simba yes my elbow hurts and you say im sorry it got to go somewhere else. Thats not the way we work. We made a decision in the 90s to say we care about the whole vet. Mental health is your health. Lets call that the front door. The front door, Mental Health offering have that conversation. There are other doors in two. We were talking today you may enter a door with the Illinois Department of Veterans Affairs is not your job to know you went into the state to building when he shouldve got in the federal building. It is our job to connect you once you are in, right . Always raise with your provider what is on your mind and will take care of it. I think where it wrapping it up, one more question or a quick type is grandma when the students here in one of the big things we focus on was accountability. This question is for both of you we know this is not going to be the last one of these there are some journalists working on and there plenty of other issues. What do both of you think about the root cause here . So we can make sure we are making a decision again what toxic exposure now and billing the dollars later but how can we ensure we are finding out where the decisions were made to not use incinerators or any of these kinds of things so we can save a lot of lives Veterans Affairs inherently retrospective. How do we make that decision better upstream we hold accountable upstream . Alexis this is something at the really passionate about. I think the warhorse does as well but voters are not paying attention, none of this matters and voters cannot Pay Attention until they have what they need to understand. It used to be people look at their newspaper in the morning they see a flurry of headlines they would at least know what was going on. And now we choose our own streams of what we are interested in veterans and Veterans Issues and Service Members fall to the wayside. It is not front of the mind anymore. Think anytime we go to war if we are voting, it is our duty to Pay Attention think about this it makes me really angry. I think more reporting, or pushing it up congress but mark thinking about the money thats going to be spent. Just like getting it out there and drooling it hard i dont with this another way to do it you have to make voters care. I think thats right i think its one important doing today. Its really important that warhorse does what it does and you do what you do for warhorse. This is why we feel very strongly. Most important person in my life is my wife and i could never talk to her about the job. I dont work in a place like that any more there is no secret. Our business is your business. In fact your business is our business. Our job is to come up with her hands up on this. Lets make sure we are accounting for all of this. In our National Dialogue and in our national budget. When we do that will get upstream. Thank you so much for quick thanks for having me. Thanks everybody. [applause] make up on cspan2 will hear from the 80 new house members of the 118 congress as they talk about their upbringing, careers and political philosophy. Groups represented farmers testify on Crop Insurance and other federal safety net programs. Later into the secretary of state entity blinken global press freedom. Rex Early Saturday Morning coronation of king charles the third will take place. He became the king of the United Kingdom from the death of his mother Queen Elizabeth ii the longest reigning monarch we see coverage in its entirety at 4 0. From the rural procession to Westminster Abbey to the official chronic of the new king. 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